Att Public Health Service Act

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TITLE III—GENERAL POWERS AND DUTIES OF PUBLIC
HEALTH SERVICE
PART A—RESEARCH

AND INVESTIGATION

IN GENERAL

SEC. 301. ø241¿ (a) The Secretary shall conduct in the Service,
and encourage, cooperate with, and render assistance to other appropriate public authorities, scientific institutions, and scientists in
the conduct of, and promote the coordination of, research, investigations, experiments, demonstrations, and studies relating to the
causes, diagnosis, treatment, control, and prevention of physical
and mental diseases and impairments of man, including water purification, sewage treatment, and pollution of lakes and streams. In
carrying out the foregoing the Secretary is authorized to—
(1) collect and make available through publications and
other appropriate means, information as to, and the practical
application of, such research and other activities;
(2) make available research facilities of the Service to appropriate public authorities, and to health officials and scientists engaged in special study;
(3) make grants-in-aid to universities, hospitals, laboratories, and other public or private institutions, and to individuals for such research projects as are recommended by the advisory council to the entity of the Department supporting such
projects and make, upon recommendation of the advisory council to the appropriate entity of the Department, grants-in-aid
to public or nonprofit universities, hospitals, laboratories, and
other institutions for the general support of their research;
(4) secure from time to time and for such periods as he
deems advisable, the assistance and advice of experts, scholars,
and consultants from the United States or abroad;
(5) for purposes of study, admit and treat at institutions,
hospitals, and stations of the Service, persons not otherwise eligible for such treatment;
(6) make available, to health officials, scientists, and appropriate public and other nonprofit institutions and organizations, technical advice and assistance on the application of statistical methods to experiments, studies, and surveys in health
and medical fields;
(7) enter into contracts, including contracts for research in
accordance with and subject to the provisions of law applicable
to contracts entered into by the military departments under
title 10, United States Code, sections 2353 and 2354, except
that determination, approval, and certification required thereby shall be by the Secretary of Health, Education, and Welfare;
and
1
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(8) adopt, upon recommendations of the advisory councils
to the appropriate entities of the Department or, with respect
to mental health, the National Advisory Mental Health Council, such additional means as the Secretary considers necessary
or appropriate to carry out the purposes of this section.
The Secretary may make available to individuals and entities, for
biomedical and behavioral research, substances and living organisms. Such substances and organisms shall be made available
under such terms and conditions (including payment for them) as
the Secretary determines appropriate.
(b)(1) The Secretary shall conduct and may support through
grants and contracts studies and testing of substances for carcinogenicity, teratogenicity, mutagenicity, and other harmful biological
effects. In carrying out this paragraph, the Secretary shall consult
with entities of the Federal Government, outside of the Department
of Health, Education, and Welfare, engaged in comparable activities. The Secretary, upon request of such an entity and under appropriate arrangements for the payment of expenses, may conduct
for such entity studies and testing of substances for carcinogenicity,
teratogenicity, mutagenicity, and other harmful biological effects.
(2)(A) The Secretary shall establish a comprehensive program
of research into the biological effects of low-level ionizing radiation
under which program the Secretary shall conduct such research
and may support such research by others through grants and contracts.
(B) The Secretary shall conduct a comprehensive review of
Federal programs of research on the biological effects of ionizing
radiation.
(3) The Secretary shall conduct and may support through
grants and contracts research and studies on human nutrition,
with particular emphasis on the role of nutrition in the prevention
and treatment of disease and on the maintenance and promotion
of health, and programs for the dissemination of information respecting human nutrition to health professionals and the public. In
carrying out activities under this paragraph, the Secretary shall
provide for the coordination of such of these activities as are performed by the different divisions within the Department of Health,
Education, and Welfare and shall consult with entities of the Federal Government, outside of the Department of Health, Education,
and Welfare, engaged in comparable activities. The Secretary, upon
request of such an entity and under appropriate arrangements for
the payment of expenses, may conduct and support such activities
for such entity.
(4) The Secretary shall publish a biennial report which contains—
(A) a list of all substances (i) which either are known to
be carcinogens or may reasonably be anticipated to be carcinogens and (ii) to which a significant number of persons residing
in the United States are exposed;
(B) information concerning the nature of such exposure
and the estimated number of persons exposed to such substances;
(C) a statement identifying (i) each substance contained in
the list under subparagraph (A) for which no effluent, ambient,
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or exposure standard has been established by a Federal agency, and (ii) for each effluent, ambient, or exposure standard established by a Federal agency with respect to a substance contained in the list under subparagraph (A), the extent to which,
on the basis of available medical, scientific, or other data, such
standard, and the implementation of such standard by the
agency, decreases the risk to public health from exposure to
the substance; and
(D) a description of (i) each request received during the
year involved—
(I) from a Federal agency outside the Department of
Health, Education, and Welfare for the Secretary, or
(II) from an entity within the Department of Health,
Education, and Welfare to any other entity within the Department,
to conduct research into, or testing for, the carcinogenicity of
substances or to provide information described in clause (ii) of
subparagraph (C), and (ii) how the Secretary and each such
other entity, respectively, have responded to each such request.
(5) The authority of the Secretary to enter into any contract for
the conduct of any study, testing, program, research, or review, or
assessment under this subsection shall be effective for any fiscal
year only to such extent or in such amounts as are provided in advance in Appropriation Acts.
(c) The Secretary may conduct biomedical research, directly or
through grants or contracts, for the identification, control, treatment, and prevention of diseases (including tropical diseases)
which do not occur to a significant extent in the United States.
(d) The Secretary may authorize persons engaged in biomedical, behavioral, clinical, or other research (including research
on mental health, including research on the use and effect of alcohol and other psychoactive drugs) to protect the privacy of individuals who are the subject of such research by withholding from all
persons not connected with the conduct of such research the names
or other identifying characteristics of such individuals. Persons so
authorized to protect the privacy of such individuals may not be
compelled in any Federal, State, or local civil, criminal, administrative, legislative, or other proceedings to identify such individuals.
(e) The Secretary, acting through the Director of the Centers
for Disease Control and Prevention, shall expand, intensify, and coordinate the activities of the Centers for Disease Control and Prevention with respect to preterm labor and delivery and infant mortality.
NARCOTICS

SEC. 302. ø242¿ (a) In carrying out the purposes of section 301
with respect to drugs the use or misuse of which might result in
drug abuse or dependency, the studies and investigations authorized therein shall include the use and misuse of narcotic drugs and
other drugs. Such studies and investigations shall further include
the quantities of crude opium, coca leaves, and their salts, derivatives, and preparations, and other drugs subject to control under
the Controlled Substances Act and Controlled Substances Import
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and Export Act, together with reserves thereof, necessary to supply
the normal and emergency medicinal and scientific requirements of
the United States. The results of studies and investigations of the
quantities of narcotic drugs or other drugs subject to control under
such Acts, together with reserves of such drugs, that are necessary
to supply the normal and emergency medicinal and scientific requirements of the United States, shall be reported not later than
the first day of April of each year to the Attorney General, to be
used at his discretion in determining manufacturing quotas or importation requirements under such Acts.
(b) The Surgeon General shall cooperate with States for the
purpose of aiding them to solve their narcotic drug problems and
shall give authorized representatives of the States the benefit of his
experience in the care, treatment, and rehabilitation of narcotic addicts to the end that each State may be encouraged to provide adequate facilities and methods for the care and treatment of its narcotic addicts.
GENERAL AUTHORITY RESPECTING RESEARCH, EVALUATIONS, AND
DEMONSTRATIONS IN HEALTH STATISTICS, HEALTH SERVICES, AND
HEALTH CARE TECHNOLOGY ASSESSMENT

SEC. 304. 1 ø242b¿ (a) The Secretary may, through the Agency
for Health Care Policy and Research or the National Center for
Health Statistics or using National Research Service Awards or
other appropriate authorities, undertake and support training programs to provide for an expanded and continuing supply of individuals qualified to perform the research, evaluation, and demonstration projects set forth in section 306 and in title IX.
(b) To implement subsection (a) and section 306, the Secretary
may, in addition to any other authority which under other provisions of this Act or any other law may be used by him to implement such subsection, do the following:
(1) Utilize personnel and equipment, facilities, and other
physical resources of the Department of Health and Human
Services, permit appropriate (as determined by the Secretary)
entities and individuals to utilize the physical resources of
such Department, provide technical assistance and advice,
make grants to public and nonprofit private entities and individuals, and, when appropriate, enter into contracts with public and private entities and individuals.
(2) Admit and treat at hospitals and other facilities of the
Service persons not otherwise eligible for admission and treatment at such facilities.
(3) Secure, from time to time and for such periods as the
Secretary deems advisable but in accordance with section 3109
of title 5, United States Code, the assistance and advice of consultants from the United States or abroad. The Secretary may
for the purpose of carrying out the functions set forth in sections 305, 2 306, and 309, obtain (in accordance with section
3109 of title 5 of the United States Code, but without regard
1 Former section 303 was repealed by section 3201(b)(1) of Public Law 106–310 (114 Stat.
1190).
2 See footnote for section 306.

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to the limitation in such section on the number of days or the
period of service) for each of the centers the services of not
more than fifteen experts who have appropriate scientific or
professional qualifications.
(4) Acquire, construct, improve, repair, operate, and maintain laboratory, research, and other necessary facilities and
equipment, and such other real or personal property (including
patents) as the Secretary deems necessary; and acquire, without regard to the Act of March 3, 1877 (40 U.S.C. 34), by lease
or otherwise, through the Administrator of General Services,
buildings or parts of buildings in the District of Columbia or
communities located adjacent to the District of Columbia.
(c)(1) The Secretary shall coordinate all health services research, evaluations, and demonstrations, all health statistical and
epidemiological activities, and all research, evaluations, and demonstrations respecting the assessment of health care technology undertaken and supported through units of the Department of Health
and Human Services. To the maximum extent feasible such coordination shall be carried out through the Agency for Health Care Policy and Research and the National Center for Health Statistics.
(2) The Secretary shall coordinate the health services research,
evaluations, and demonstrations, the health statistical and (where
appropriate) epidemiological activities, and the research, evaluations, and demonstrations respecting the assessment of health care
technology authorized by this Act through the Agency for Health
Care Policy and Research and the National Center for Health Statistics.
NATIONAL CENTER FOR HEALTH STATISTICS

SEC. 306. 1 ø242k¿ (a) There is established in the Department
of Health and Human Services the National Center for Health Statistics (hereinafter in this section referred to as the ‘‘Center’’) which
shall be under the direction of a Director who shall be appointed
by the Secretary. The Secretary, acting through the Center, shall
conduct and support statistical and epidemiological activities for
the purpose of improving the effectiveness, efficiency, and quality
of health services in the United States.
(b) In carrying out subsection (a), the Secretary, acting through
the Center—
(1) shall collect statistics on—
(A) the extent and nature of illness and disability of
the population of the United States (or of any groupings of
the people included in the population), including life expectancy, the incidence of various acute and chronic illnesses, and infant and maternal morbidity and mortality,
(B) the impact of illness and disability of the population on the economy of the United States and on other
aspects of the well-being of its population (or of such
groupings),
(C) environmental, social, and other health hazards,
(D) determinants of health,
1 Former section 305 was repealed by section 6103(d)(1)(A) of Public Law 101–239 (103 Stat.
2205). Title IX now applies to the matter with which former section 305 was concerned.

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(E) health resources, including physicians, dentists,
nurses, and other health professionals by specialty and
type of practice and the supply of services by hospitals, extended care facilities, home health agencies, and other
health institutions,
(F) utilization of health care, including utilization of (i)
ambulatory health services by specialties and types of
practice of the health professionals providing such services, and (ii) services of hospitals, extended care facilities,
home health agencies, and other institutions,
(G) health care costs and financing, including the
trends in health care prices and cost, the sources of payments for health care services, and Federal, State, and
local governmental expenditures for health care services,
and
(H) family formation, growth, and dissolution;
(2) shall undertake and support (by grant or contract) research, demonstrations, and evaluations respecting new or improved methods for obtaining current data on the matters referred to in paragraph (1);
(3) may undertake and support (by grant or contract) epidemiological research, demonstrations, and evaluations on the
matters referred to in paragraph (1); and
(4) may collect, furnish, tabulate, and analyze statistics,
and prepare studies, on matters referred to in paragraph (1)
upon request of public and nonprofit private entities under arrangements under which the entities will pay the cost of the
service provided.
Amounts appropriated to the Secretary from payments made under
arrangements made under paragraph (4) shall be available to the
Secretary for obligation until expended.
(c) The Center shall furnish such special statistical and epidemiological compilations and surveys as the Committee on Labor
and Human Resources and the Committee on Appropriations of the
Senate and the Committee on Energy and Commerce and the Committee on Appropriations of the House of Representatives may request. Such statistical and epidemiological compilations and surveys shall not be made subject to the payment of the actual or estimated cost of the preparation of such compilations and surveys.
(d) To insure comparability and reliability of health statistics,
the Secretary shall, through the Center, provide adequate technical
assistance to assist State and local jurisdictions in the development
of model laws dealing with issues of confidentiality and comparability of data.
(e) For the purpose of producing comparable and uniform
health information and statistics, there is established the Cooperative Health Statistics System. The Secretary, acting through the
Center, shall—
(1) coordinate the activities of Federal agencies involved in
the design and implementation of the System;
(2) undertake and support (by grant or contract) research,
development, demonstrations, and evaluations respecting the
System;
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(3) make grants to and enter into contracts with State and
local health agencies to assist them in meeting the costs of
data collection and other activities carried out under the System; and
(4) review the statistical activities of the Department of
Health and Human Services to assure that they are consistent
with the System.
States participating in the System shall designate a State agency
to administer or be responsible for the administration of the statistical activities within the State under the System. The Secretary,
acting through the Center, shall prescribe guidelines to assure that
statistical activities within States participating in the system 1
produce uniform and timely data and assure appropriate access to
such data.
(f) To assist in carrying out this section, the Secretary, acting
through the Center, shall cooperate and consult with the Departments of Commerce and Labor and any other interested Federal
departments or agencies and with State and local health departments and agencies. For such purpose he shall utilize insofar as
possible the services or facilities of any agency of the Federal Government and, without regard to section 3709 of the Revised Statutes (41 U.S.C. 5), of any appropriate State or other public agency,
and may, without regard to such section, utilize the services or facilities of any private agency, organization, group, or individual, in
accordance with written agreements between the head of such
agency, organization, or group and the Secretary or between such
individual and the Secretary. Payment, if any, for such services or
facilities shall be made in such amounts as may be provided in
such agreement.
(g) To secure uniformity in the registration and collection of
mortality, morbidity, and other health data, the Secretary shall
prepare and distribute suitable and necessary forms for the collection and compilation of such data.
(h)(1) There shall be an annual collection of data from the
records of births, deaths, marriages, and divorces in registration
areas. The data shall be obtained only from and restricted to such
records of the States and municipalities which the Secretary, in his
discretion, determines possess records affording satisfactory data in
necessary detail and form. The Secretary shall encourage States
and registration areas to obtain detailed data on ethnic and racial
populations, including subpopulations of Hispanics, Asian Americans, and Pacific Islanders with significant representation in the
State or registration area. Each State or registration area shall be
paid by the Secretary the Federal share of its reasonable costs (as
determined by the Secretary) for collecting and transcribing (at the
request of the Secretary and by whatever method authorized by
him) its records for such data.
(2) There shall be an annual collection of data from a statistically valid sample concerning the general health, illness, and disability status of the civilian noninstitutionalized population. Specific topics to be addressed under this paragraph, on an annual or
periodic basis, shall include the incidence of illness and accidental
1 So

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injuries, prevalence of chronic diseases and impairments, disability,
physician visits, hospitalizations, and the relationship between demographic and socioeconomic characteristics and health characteristics.
(i) The Center may provide to public and nonprofit private entities technical assistance in the effective use in such activities of
statistics collected or compiled by the Center.
(j) In carrying out the requirements of section 304(c) and paragraph (1) of subsection (e) of this section, the Secretary shall coordinate health statistical and epidemiological activities of the Department of Health and Human Services by—
(1) establishing standardized means for the collection of
health information and statistics under laws administered by
the Secretary;
(2) developing, in consultation with the National Committee on Vital and Health Statistics, and maintaining the
minimum sets of data needed on a continuing basis to fulfill
the collection requirements of subsection (b)(1);
(3) after consultation with the National Committee on
Vital and Health Statistics, establishing standards to assure
the quality of health statistical and epidemiological data collection, processing, and analysis;
(4) in the case of proposed health data collections of the
Department which are required to be reviewed by the Director
of the Office of Management and Budget under section 3509 of
title 44, United States Code, reviewing such proposed collections to determine whether they conform with the minimum
sets of data and the standards promulgated pursuant to paragraphs (2) and (3), and if any such proposed collection is found
not to be in conformance, by taking such action as may be necessary to assure that it will conform to such sets of data and
standards, and
(5) periodically reviewing ongoing health data collections of
the Department, subject to review under such section 3509, to
determine if the collections are being conducted in accordance
with the minimum sets of data and the standards promulgated
pursuant to paragraphs (2) and (3) and, if any such collection
is found not to be in conformance, by taking such action as
may be necessary to assure that the collection will conform to
such sets of data and standards not later than the nineteenth
day after the date of the completion of the review of the collection.
(k)(1) There is established in the Office of the Secretary a committee to be known as the National Committee on Vital and Health
Statistics (hereinafter in this subsection, referred to as the ‘‘Committee’’) which shall consist of 18 members.
(2) The members of the Committee shall be appointed from
among persons who have distinguished themselves in the fields of
health statistics, electronic interchange of health care information,
privacy and security of electronic information, population-based
public health, purchasing or financing health care services, integrated computerized health information systems, health services
research, consumer interests in health information, health data
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standards, epidemiology, and the provision of health services.
Members of the Committee shall be appointed for terms of 4 years.
(3) Of the members of the Committee—
(A) 1 shall be appointed, not later than 60 days after the
date of the enactment of the Health Insurance Portability and
Accountability Act of 1996, by the Speaker of the House of
Representatives after consultation with the Minority Leader of
the House of Representatives;
(B) 1 shall be appointed, not later than 60 days after the
date of the enactment of the Health Insurance Portability and
Accountability Act of 1996, by the President pro tempore of the
Senate after consultation with the Minority Leader of the Senate; and
(C) 16 shall be appointed by the Secretary.
(4) Members of the Committee shall be compensated in accordance with section 208(c).
(5) The Committee—
(A) shall assist and advise the Secretary—
(i) to delineate statistical problems bearing on health
and health services which are of national or international
interest;
(ii) to stimulate studies of such problems by other organizations and agencies whenever possible or to make investigations of such problems through subcommittees;
(iii) to determine, approve, and revise the terms, definitions, classifications, and guidelines for assessing health
status and health services, their distribution and costs, for
use (I) within the Department of Health and Human Services, (II) by all programs administered or funded by the
Secretary, including the Federal-State-local cooperative
health statistics system referred to in subsection (e), and
(III) to the extent possible as determined by the head of
the agency involved, by the Department of Veterans Affairs, the Department of Defense, and other Federal agencies concerned with health and health services;
(iv) with respect to the design of and approval of
health statistical and health information systems concerned with the collection, processing, and tabulation of
health statistics within the Department of Health and
Human Services, with respect to the Cooperative Health
Statistics System established under subsection (e), and
with respect to the standardized means for the collection
of health information and statistics to be established by
the Secretary under subsection (j)(1);
(v) to review and comment on findings and proposals
developed by other organizations and agencies and to
make recommendations for their adoption or implementation by local, State, national, or international agencies;
(vi) to cooperate with national committees of other
countries and with the World Health Organization and
other national agencies in the studies of problems of mutual interest;
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tions, and to make proposals for improvement of the Nation’s health statistics and health information systems;
and
(viii) in complying with the requirements imposed on
the Secretary under part C of title XI of the Social Security Act;
(B) shall study the issues related to the adoption of uniform data standards for patient medical record information
and the electronic exchange of such information;
(C) shall report to the Secretary not later than 4 years
after the date of the enactment of the Health Insurance Portability and Accountability Act of 1996 recommendations and
legislative proposals for such standards and electronic exchange; and
(D) shall be responsible generally for advising the Secretary and the Congress on the status of the implementation
of part C of title XI of the Social Security Act.
(6) In carrying out health statistical activities under this part,
the Secretary shall consult with, and seek the advice of, the Committee and other appropriate professional advisory groups.
(7) Not later than 1 year after the date of the enactment of the
Health Insurance Portability and Accountability Act of 1996, and
annually thereafter, the Committee shall submit to the Congress,
and make public, a report regarding the implementation of part C
of title XI of the Social Security Act. Such report shall address the
following subjects, to the extent that the Committee determines appropriate:
(A) The extent to which persons required to comply with
part C of title XI of the Social Security Act are cooperating in
implementing the standards adopted under such part.
(B) The extent to which such entities are meeting the security standards adopted under such part and the types of penalties assessed for noncompliance with such standards.
(C) Whether the Federal and State Governments are receiving information of sufficient quality to meet their responsibilities under such part.
(D) Any problems that exist with respect to implementation of such part.
(E) The extent to which timetables under such part are
being met.
(l) In carrying out this section, the Secretary, acting through
the Center, shall collect and analyze adequate health data that is
specific to particular ethnic and racial populations, including data
collected under national health surveys. Activities carried out
under this subsection shall be in addition to any activities carried
out under subsection (m).
(m)(1) The Secretary, acting through the Center, may make
grants to public and nonprofit private entities for—
(A) the conduct of special surveys or studies on the health
of ethnic and racial populations or subpopulations;
(B) analysis of data on ethnic and racial populations and
subpopulations; and
(C) research on improving methods for developing statistics on ethnic and racial populations and subpopulations.
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(2) The Secretary, acting through the Center, may provide
technical assistance, standards, and methodologies to grantees supported by this subsection in order to maximize the data quality and
comparability with other studies.
(3) Provisions of section 308(d) do not apply to surveys or studies conducted by grantees under this subsection unless the Secretary, in accordance with regulations the Secretary may issue, determines that such provisions are necessary for the conduct of the
survey or study and receives adequate assurance that the grantee
will enforce such provisions.
(4)(A) Subject to subparagraph (B), the Secretary, acting
through the Center, shall collect data on Hispanics and major Hispanic subpopulation groups and American Indians, and for developing special area population studies on major Asian American and
Pacific Islander populations.
(B) The provisions of subparagraph (A) shall be effective with
respect to a fiscal year only to the extent that funds are appropriated pursuant to paragraph (3) of subsection (n), and only if the
amounts appropriated for such fiscal year pursuant to each of paragraphs (1) and (2) of subsection (n) equal or exceed the amounts
so appropriated for fiscal year 1997.
(n)(1) For health statistical and epidemiological activities undertaken or supported under subsections (a) through (l), there are
authorized to be appropriated such sums as may be necessary for
each of the fiscal years 1991 through 2003.
(2) For activities authorized in paragraphs (1) through (3) of
subsection (m), there are authorized to be appropriated such sums
as may be necessary for each of the fiscal years 1999 through 2003.
Of such amounts, the Secretary shall use not more than 10 percent
for administration and for activities described in subsection (m)(2).
(3) For activities authorized in subsection (m)(4), there are authorized to be appropriated $1,000,000 for fiscal year 1998, and
such sums as may be necessary for each of the fiscal years 1999
through 2002.
INTERNATIONAL COOPERATION

SEC. 307. ø242l¿ (a) The Secretary may participate with other
countries in cooperative endeavors in—
(1) biomedical research, health care technology, and the
health services research and statistical analysis authorized
under section 306 and title IX; and
(2) biomedical research, health care services, health care
research, or other related activities in furtherance of the activities, objectives or goals authorized under the Tom Lantos and
Henry J. Hyde United States Global Leadership Against HIV/
AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008.
(b) In connection with the cooperative endeavors authorized by
subsection (a), the Secretary may—
(1) make such use of resources offered by participating foreign countries as he may find necessary and appropriate;
(2) establish and maintain fellowships in the United States
and in participating foreign countries;
(3) make grants to public institutions or agencies and to
nonprofit private institutions or agencies in the United States
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and in participating foreign countries for the purpose of establishing and maintaining the fellowships authorized by paragraph (2);
(4) make grants or loans of equipment and materials, for
use by public or nonprofit private institutions or agencies, or
by individuals, in participating foreign countries;
(5) participate and otherwise cooperate in any international meetings, conferences, or other activities concerned
with biomedical research, health services research, health statistics, or health care technology;
(6) facilitate the interchange between the United States
and participating foreign countries, and among participating
foreign countries, of research scientists and experts who are
engaged in experiments or programs of biomedical research,
health services research, health statistical activities, or health
care technology activities, and in carrying out such purpose
may pay per diem compensation, subsistence, and travel for
such scientists and experts when away from their places of residence at rates not to exceed those provided in section 5703(b)
of title 5, United States Code, for persons in the Government
service employed intermittently;
(7) procure, in accordance with section 3109 of title 5,
United States Code, the temporary or intermittent services of
experts or consultants;
(8) enter into contracts with individuals for the provision
of services (as defined in section 104 of part 37 of title 48, Code
of Federal Regulations (48 CFR 37.104)) in participating foreign countries, which individuals may not be deemed employees of the United States for the purpose of any law administered by the Office of Personnel Management;
(9) provide such funds by advance or reimbursement to the
Secretary of State, as may be necessary, to pay the costs of acquisition, lease, construction, alteration, equipping, furnishing
or management of facilities outside of the United States; and
(10) in consultation with the Secretary of State, through
grant or cooperative agreement, make funds available to public
or nonprofit private institutions or agencies in foreign countries in which the Secretary is participating in activities described under subsection (a) to acquire, lease, construct, alter,
or renovate facilities in those countries.
(c) The Secretary may provide to personnel appointed or assigned by the Secretary to serve abroad, allowances and benefits
similar to those provided under chapter 9 of title I of the Foreign
Service Act of 1980 (22 U.S.C. 4081 et seq.). Leaves of absence for
personnel under this subsection shall be on the same basis as that
provided under subchapter I of chapter 63 of title 5, United States
Code or section 903 of the Foreign Service Act of 1980 (22 U.S.C.
4083), to individuals serving in the Foreign Service.
(d) In carrying out immunization programs and other programs
in developing countries for the prevention, treatment, and control
of infectious diseases, including HIV/AIDS, tuberculosis, and malaria, the Director of the Centers for Disease Control and Prevention, in coordination with the Coordinator of United States Government Activities to Combat HIV/AIDS Globally, the National InstiMarch 13, 2013

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tutes of Health, national and local government, and other organizations, such as the World Health Organization and the United Nations Children’s Fund, shall develop and implement effective strategies to improve injection safety, including eliminating unnecessary
injections, promoting sterile injection practices and technologies,
strengthening the procedures for proper needle and syringe disposal, and improving the education and information provided to the
public and to health professionals.
GENERAL PROVISIONS RESPECTING EFFECTIVENESS, EFFICIENCY, AND
QUALITY OF HEALTH SERVICES

SEC. 308. ø242m¿ (a)(1) Not later than March 15 of each year,
the Secretary shall submit to the President and Congress the following reports:
(A) A report on health care costs and financing. Such report shall include a description and analysis of the statistics
collected under section 306(b)(1)(G).
(B) A report on health resources. Such report shall include
a description and analysis, by geographical area, of the statistics collected under section 306(b)(1)(E).
(C) A report on the utilization of health resources. Such report shall include a description and analysis, by age, sex, income, and geographic area, of the statistics collected under section 306(b)(1)(F).
(D) A report on the health of the Nation’s people. Such report shall include a description and analysis, by age, sex, income, and geographic area, of the statistics collected under section 306(b)(1)(A).
(2) The reports required in paragraph (1) shall be prepared
through the National Center for Health Statistics.
(3) The Office of Management and Budget may review any report required by paragraph (1) of this subsection before its submission to Congress, but the Office may not revise any such report or
delay its submission beyond the date prescribed for its submission,
and may submit to Congress its comments respecting any such report.
(b)(1) No grant or contract may be made under section 304,
306, or 307 unless an application therefor has been submitted to
the Secretary in such form and manner, and containing such information, as the Secretary may by regulation prescribe and unless a
peer review group referred to in paragraph (2) has recommended
the application for approval.
(2)(A) Each application submitted for a grant or contract under
section 306 in an amount exceeding $50,000 of direct costs and for
a health services research, evaluation, or demonstration project, or
for a grant under section 306(m), shall be submitted to a peer review group for an evaluation of the technical and scientific merits
of the proposals made in each such application. The Director of the
National Center for Health Statistics shall establish such peer review groups as may be necessary to provide for such an evaluation
of each such application.
(B) A peer review group to which an application is submitted
pursuant to subparagraph (A) shall report its finding and recMarch 13, 2013

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ommendations respecting the application to the Secretary, acting
through the Director of the National Center for Health Statistics,
in such form and manner as the Secretary shall by regulation prescribe. The Secretary may not approve an application described in
such subparagraph unless a peer review group has recommended
the application for approval.
(C) The Secretary, acting through the Director of the National
Center for Health Statistics, shall make appointments to the peer
review groups required in subparagraph (A) from among persons
who are not officers or employees of the United States and who
possess appropriate technical and scientific qualifications, except
that peer review groups regarding grants under section 306(m)
may include appropriately qualified such officers and employees.
(c) The Secretary shall take such action as may be necessary
to assure that statistics developed under sections 304 and 306 are
of high quality, timely, comprehensive as well as specific, standardized, and adequately analyzed and indexed, and shall publish,
make available, and disseminate such statistics on as wide a basis
as is practicable.
(d) No information, if an establishment or person supplying the
information or described in it is identifiable, obtained in the course
of activities undertaken or supported under section 304, 306, or 307
may be used for any purpose other than the purpose for which it
was supplied unless such establishment or person has consented
(as determined under regulations of the Secretary) to its use for
such other purpose and in the case of information obtained in the
course of health statistical or epidemiological activities under section 304 or 306, such information may not be published or released
in other form if the particular establishment or person supplying
the information or described in it is identifiable unless such establishment or person has consented (as determined under regulations
of the Secretary) to its publication or release in other form.
(e)(1) Payments of any grant or under any contract under section 304, 306, or 307 may be made in advance or by way of reimbursement, and in such installments and on such conditions, as the
Secretary deems necessary to carry out the purposes of such section.
(2) The amounts otherwise payable to any person under a
grant or contract made under section 304, 306, or 307 shall be reduced by—
(A) amounts equal to the fair market value of any equipment or supplies furnished to such person by the Secretary for
the purpose of carrying out the project with respect to which
such grant or contract is made, and
(B) amounts equal to the pay, allowances, traveling expenses, and related personnel expenses attributable to the performance of services by an officer or employee of the Government in connection with such project, if such officer or employee was assigned or detailed by the Secretary to perform
such services,
but only if such person requested the Secretary to furnish such
equipment or supplies, or such services, as the case may be.
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(f) Contracts may be entered into under section 304 or 306
without regard to section 3324 of title 31, United States Code, and
section 3709 of the Revised Statutes (41 U.S.C. 5).
HEALTH CONFERENCES AND HEALTH EDUCATION INFORMATION

SEC. 310. 1 ø242o¿ (a) A conference of the health authorities in
and among the several States shall be called annually by the Secretary. Whenever in his opinion the interests of the public health
would be promoted by a conference, the Secretary may invite as
many of such health authorities and officials of other State or local
public or private agencies, institutions, or organizations to confer
as he deems necessary or proper. Upon the application of health
authorities of five or more States it shall be the duty of the Secretary to call a conference of all State health authorities joining in
the request. Each State represented at any conference shall be entitled to a single vote. Whenever at any such conference matters relating to mental health are to be discussed, the mental health authorities of the respective States shall be invited to attend.
(b) From time to time the Secretary shall issue information related to public health, in the form of publications or otherwise, for
the use of the public, and shall publish weekly reports of health
conditions in the United States and other countries and other pertinent health information for the use of persons and institutions concerned with health services.
SEC. 310A. ø242s¿ CENTERS FOR DISEASE CONTROL AND PREVENTION
OFFICE OF WOMEN’S HEALTH.
(a) ESTABLISHMENT.—There is established within the Office of

the Director of the Centers for Disease Control and Prevention, an
office to be known as the Office of Women’s Health (referred to in
this section as the ‘‘Office’’). The Office shall be headed by a director who shall be appointed by the Director of such Centers.
(b) PURPOSE.—The Director of the Office shall—
(1) report to the Director of the Centers for Disease Control and Prevention on the current level of the Centers’ activity
regarding women’s health conditions across, where appropriate, age, biological, and sociocultural contexts, in all aspects
of the Centers’ work, including prevention programs, public
and professional education, services, and treatment;
(2) establish short-range and long-range goals and objectives within the Centers for women’s health and, as relevant
and appropriate, coordinate with other appropriate offices on
activities within the Centers that relate to prevention, research, education and training, service delivery, and policy development, for issues of particular concern to women;
(3) identify projects in women’s health that should be conducted or supported by the Centers;
(4) consult with health professionals, nongovernmental organizations, consumer organizations, women’s health professionals, and other individuals and groups, as appropriate, on
the policy of the Centers with regard to women; and
1 Former section 309 was repealed by section 6103(d)(1)(B) of Public Law 101–239 (103 Stat.
2205).

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(5) serve as a member of the Department of Health and
Human Services Coordinating Committee on Women’s Health
(established under section 229(b)(4)).
(c) DEFINITION.—As used in this section, the term ‘‘women’s
health conditions’’, with respect to women of all age, ethnic, and racial groups, means diseases, disorders, and conditions—
(1) unique to, significantly more serious for, or significantly more prevalent in women; and
(2) for which the factors of medical risk or type of medical
intervention are different for women, or for which there is reasonable evidence that indicates that such factors or types may
be different for women.
(d) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of
carrying out this section, there are authorized to be appropriated
such sums as may be necessary for each of the fiscal years 2010
through 2014.
PART B—FEDERAL-STATE COOPERATION
IN GENERAL

SEC. 311. ø243¿ (a) The Secretary is authorized to accept from
State and local authorities any assistance in the enforcement of
quarantine regulations made pursuant to this Act which such authorities may be able and willing to provide. The Secretary shall
also assist States and their political subdivisions in the prevention
and suppression of communicable diseases and with respect to
other public health matters, shall cooperate with and aid State and
local authorities in the enforcement of their quarantine and other
health regulations, and shall advise the several States on matters
relating to the preservation and improvement of the public health.
(b) The Secretary shall encourage cooperative activities between the States with respect to comprehensive and continuing
planning as to their current and future health needs, the establishment and maintenance of adequate public health services, and otherwise carrying out the public health activities. The Secretary is
also authorized to train personnel for State and local health work.
The Secretary may charge only private entities reasonable fees for
the training of their personnel under the preceding sentence.
(c)(1) The Secretary is authorized to develop (and may take
such action as may be necessary to implement) a plan under which
personnel, equipment, medical supplies, and other resources of the
Service and other agencies under the jurisdiction of the Secretary
may be effectively used to control epidemics of any disease or condition and to meet other health emergencies or problems. The Secretary may enter into agreements providing for the cooperative
planning between the Service and public and private community
health programs and agencies to cope with health problems (including epidemics and health emergencies).
(2) The Secretary may, at the request of the appropriate State
or local authority, extend temporary (not in excess of six months)
assistance to States or localities in meeting health emergencies of
such a nature as to warrant Federal assistance. The Secretary may
require such reimbursement of the United States for assistance
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Sec. 312

able under the circumstances. Any reimbursement so paid shall be
credited to the applicable appropriation for the Service for the year
in which such reimbursement is received.
SEC. 312. ø244¿ PUBLIC ACCESS DEFIBRILLATION PROGRAMS.
(a) IN GENERAL.—The Secretary shall award grants to

States,
political subdivisions of States, Indian tribes, and tribal organizations to develop and implement public access defibrillation programs—
(1) by training and equipping local emergency medical
services personnel, including firefighters, police officers, paramedics, emergency medical technicians, and other first responders,
to
administer
immediate
care,
including
cardiopulmonary resuscitation and automated external
defibrillation, to cardiac arrest victims;
(2) by purchasing automated external defibrillators, placing the defibrillators in public places where cardiac arrests are
likely to occur, and training personnel in such places to administer cardiopulmonary resuscitation and automated external
defibrillation to cardiac arrest victims;
(3) by setting procedures for proper maintenance and testing of such devices, according to the guidelines of the manufacturers of the devices;
(4) by providing training to members of the public in
cardiopulmonary resuscitation and automated external
defibrillation;
(5) by integrating the emergency medical services system
with the public access defibrillation programs so that emergency medical services personnel, including dispatchers, are informed about the location of automated external defibrillators
in their community; and
(6) by encouraging private companies, including small
businesses, to purchase automated external defibrillators and
provide training for their employees to administer
cardiopulmonary resuscitation and external automated
defibrillation to cardiac arrest victims in their community.
(b) PREFERENCE.—In awarding grants under subsection (a), the
Secretary shall give a preference to a State, political subdivision of
a State, Indian tribe, or tribal organization that—
(1) has a particularly low local survival rate for cardiac arrests, or a particularly low local response rate for cardiac arrest victims; or
(2) demonstrates in its application the greatest commitment to establishing and maintaining a public access
defibrillation program.
(c) USE OF FUNDS.—A State, political subdivision of a State, Indian tribe, or tribal organization that receives a grant under subsection (a) may use funds received through such grant to—
(1) purchase automated external defibrillators that have
been approved, or cleared for marketing, by the Food and Drug
Administration;
(2) provide automated external defibrillation and basic life
support training in automated external defibrillator usage
through nationally recognized courses;
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(3) provide information to community members about the
public access defibrillation program to be funded with the
grant;
(4) provide information to the local emergency medical
services system regarding the placement of automated external
defibrillators in public places;
(5) produce materials to encourage private companies, including small businesses, to purchase automated external
defibrillators;
(6) establish an information clearinghouse, that shall be
administered by an organization that has substantial expertise
in
pediatric
education,
pediatric
medicine,
and
electrophysiology and sudden death, that provides information
to increase public access to defibrillation in schools; and
(7) further develop strategies to improve access to automated external defibrillators in public places.
(d) APPLICATION.—
(1) IN GENERAL.—To be eligible to receive a grant under
subsection (a), a State, political subdivision of a State, Indian
tribe, or tribal organization shall prepare and submit an application to the Secretary at such time, in such manner, and containing such information as the Secretary may reasonably require.
(2) CONTENTS.—An application submitted under paragraph
(1) shall—
(A) describe the comprehensive public access
defibrillation program to be funded with the grant and
demonstrate how such program would make automated external defibrillation accessible and available to cardiac arrest victims in the community;
(B) contain procedures for implementing appropriate
nationally recognized training courses in performing
cardiopulmonary resuscitation and the use of automated
external defibrillators;
(C) contain procedures for ensuring direct involvement
of a licensed medical professional and coordination with
the local emergency medical services system in the oversight of training and notification of incidents of the use of
the automated external defibrillators;
(D) contain procedures for proper maintenance and
testing of the automated external defibrillators, according
to the labeling of the manufacturer;
(E) contain procedures for ensuring notification of local
emergency medical services system personnel, including
dispatchers, of the location and type of devices used in the
public access defibrillation program; and
(F) provide for the collection of data regarding the effectiveness of the public access defibrillation program to be
funded with the grant in affecting the out-of-hospital cardiac arrest survival rate.
(e) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of
carrying out this section, there are authorized to be appropriated
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PUBLIC HEALTH SERVICE ACT

Sec. 313

$25,000,000 for for 1 each of fiscal years 2003 through 2014. Not
more than 10 percent of amounts received under a grant awarded
under this section may be used for administrative expenses.
SEC. 313. ø245¿ PUBLIC ACCESS DEFIBRILLATION DEMONSTRATION
PROJECTS.
(a) IN GENERAL.—The Secretary shall award grants to political

subdivisions of States, Indian tribes, and tribal organizations to develop and implement innovative, comprehensive, community-based
public access defibrillation demonstration projects that—
(1) provide cardiopulmonary resuscitation and automated
external defibrillation to cardiac arrest victims in unique settings;
(2) provide training to community members in
cardiopulmonary resuscitation and automated external
defibrillation; and
(3) maximize community access to automated external
defibrillators.
(b) USE OF FUNDS.—A recipient of a grant under subsection (a)
shall use the funds provided through the grant to—
(1) purchase automated external defibrillators that have
been approved, or cleared for marketing, by the Food and Drug
Administration;
(2) provide basic life training in automated external
defibrillator usage through nationally recognized courses;
(3) provide information to community members about the
public access defibrillation demonstration project to be funded
with the grant;
(4) provide information to the local emergency medical
services system regarding the placement of automated external
defibrillators in the unique settings; and
(5) further develop strategies to improve access to automated external defibrillators in public places.
(c) APPLICATION.—
(1) IN GENERAL.—To be eligible to receive a grant under
subsection (a), a political subdivision of a State, Indian tribe,
or tribal organization shall prepare and submit an application
to the Secretary at such time, in such manner, and containing
such information as the Secretary may reasonably require.
(2) CONTENTS.—An application submitted under paragraph
(1) may—
(A) describe the innovative, comprehensive, community-based public access defibrillation demonstration
project to be funded with the grant;
(B) explain how such public access defibrillation demonstration project represents innovation in providing public access to automated external defibrillation; and
(C) provide for the collection of data regarding the effectiveness of the demonstration project to be funded with
the grant in—
(i) providing emergency cardiopulmonary resuscitation and automated external defibrillation to car1 The

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words ‘‘for for’’ so in law.

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diac arrest victims in the setting served by the demonstration project; and
(ii) affecting the cardiac arrest survival rate in the
setting served by the demonstration project.
(d) AUTHORIZATION OF APPROPRIATIONS.—There is authorized
to be appropriated to carry out this section $5,000,000 for each of
fiscal years 2002 through 2006. Not more than 10 percent of
amounts received under a grant awarded under this section may
be used for administrative expenses.
GRANTS FOR COMPREHENSIVE HEALTH PLANNING AND PUBLIC HEALTH
SERVICES

Grants to States for Comprehensive State Health Planning
SEC. 314. ø246¿ (a)(1) AUTHORIZATION.—In order to assist the
States in comprehensive and continuing planning for their current
and future health needs, the Secretary is authorized during the period beginning July 1, 1966, and ending June 30, 1973, to make
grants to States which have submitted, and had approved by the
Secretary, State plans for comprehensive State health planning.
For the purposes of carrying out this subsection, there are hereby
authorized to be appropriated $2,500,000 for the fiscal year ending
June 30, 1967, $7,000,000 for the fiscal year ending June 30, 1968,
$10,000,000 for the fiscal year ending June 30, 1969, $15,000,000
for the fiscal year ending June 30, 1970, $15,000,000 for the fiscal
year ending June 30, 1971, $17,000,000 for the fiscal year ending
June 30, 1972, $20,000,000 for the fiscal year ending June 30,
1973, and $10,000,000 for the fiscal year ending June 30, 1974.
(2) STATE PLANS FOR COMPREHENSIVE STATE HEALTH PLANNING.—In order to be approved for purposes of this subsection, a
State plan for comprehensive State health planning must—
(A) designate, or provide for the establishment of, a single
State agency, which may be an interdepartmental agency, as
the sole agency for administering or supervising the administration of the State’s health planning functions under the plan;
(B) provide for the establishment of a State health planning council, which shall include representatives of Federal,
State, and local agencies (including as an ex officio member, if
there is located in such State one or more hospitals or other
health care facilities of the Department of Veterans Affairs, the
individual whom the Secretary of Veterans Affairs shall have
designated to serve on such council as the representative of the
hospitals or other health care facilities of such Department
which are located in such State) and nongovernmental organizations and groups concerned with health (including representation of the regional medical program or programs included in
whole or in part within the State) and of consumers of health
services, to advise such State agency in carrying out its functions under the plan, and a majority of the membership of such
council shall consist of representatives of consumers of health
services;
(C) set forth policies and procedures for the expenditure of
funds under the plan, which, in the judgment of the Secretary,
are designed to provide for comprehensive State planning for
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health services (both public and private and including home
health care), including the facilities and persons required for
the provision of such services, to meet the health needs of the
people of the State and including environmental considerations
as they relate to public health;
(D) provide for encouraging cooperative efforts among governmental or nongovernmental agencies, organizations and
groups concerned with health services, facilities, or manpower,
and for cooperative efforts between such agencies, organizations, and groups and similar agencies, organizations, and
groups in the fields of education, welfare, and rehabilitation;
(E) contain or be supported by assurances satisfactory to
the Secretary that the funds paid under this subsection will be
used to supplement and, to the extent practicable, to increase
the level of funds that would otherwise be made available by
the State for the purpose of comprehensive health planning
and not to supplant such non-Federal funds;
(F) 1 provide such methods of administration (including
methods relating to the establishment and maintenance of personnel standards on a merit basis, except that the Secretary
shall exercise no authority with respect to the selection, tenure
of office, and compensation of any individual employed in accordance with such methods) as are found by the Secretary to
be necessary for the proper and efficient operation of the plan;
(G) provide that the State agency will make such reports,
in such form and containing such information, as the Secretary
may from time to time reasonably require, and will keep such
records and afford such access thereto as the Secretary finds
necessary to assure the correctness and verification of such reports;
(H) provide that the State agency will from time to time,
but not less often than annually, review its State plan approved under this subsection and submit to the Secretary appropriate modifications thereof;
(I) effective July 1, 1968, (i) provide for assisting each
health care facility in the State to develop a program for capital expenditures for replacement, modernization, and expansion which is consistent with an overall State plan developed
in accordance with criteria established by the Secretary after
consultation with the State which will meet the needs of the
State for health care facilities, equipment, and services without
duplication and otherwise in the most efficient and economical
manner, and (ii) provide that the State agency furnishing such
assistance will periodically review the program (developed pursuant to clause (i)) of each health care facility in the State and
recommended appropriate modification thereof;
(J) provide for such fiscal control and fund accounting procedures as may be necessary to assure proper disbursement of
1 Section 208(a)(3) of Public Law 91–648 (42 U.S.C. 4728) transferred to the United States
Civil Service Commission all functions, powers, and duties of the Secretary under any law applicable to a grant program which requires the establishment and maintenance of personnel standards on a merit basis with respect to the program. Reorganization Plan No. 2 of 1978 (42 U.S.C.
1101 note) transferred to the Office of Personnel Management all functions of the United States
Civil Service Commission.

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and accounting for funds paid to the State under this subsection; and
(K) contain such additional information and assurances as
the Secretary may find necessary to carry out the purposes of
this subsection.
(3)(A) STATE ALLOTMENTS.—From the sums appropriated for
such purpose for each fiscal year, the several States shall be entitled to allotments determined, in accordance with regulations, on
the basis of the population and the per capita income of the respective States; except that no such allotment to any State for any fiscal year shall be less than 1 per centum of the sum appropriated
for such fiscal year pursuant to paragraph (1). Any such allotment
to a State for a fiscal year shall remain available for obligation by
the State, in accordance with the provisions of this subsection and
the State’s plan approved thereunder, until the close of the succeeding fiscal year.
(B) The amount of any allotment to a State under subparagraph (A) for any fiscal year which the Secretary determines will
not be required by the State, during the period for which it is available, for the purposes for which allotted shall be available for reallotment by the Secretary from time to time, on such date or dates
as he may fix, to other States with respect to which such a determination has not been made, in proportion to the original allotments to such States under subparagraph (A) for such fiscal year,
but with such proportionate amount for any of such other States
being reduced to the extent it exceeds the sum the Secretary estimates such State needs and will be able to use during such period;
and the total of such reductions shall be similarly reallotted among
the States whose proportionate amounts were not so reduced. Any
amount so reallotted to a State from funds appropriated pursuant
to this subsection for a fiscal year shall be deemed part of its allotment under subparagraph (A) for such fiscal year.
(4) PAYMENTS TO STATES.—From each State’s allotment for a
fiscal year under this subsection, the State shall from time to time
be paid the Federal share of the expenditures incurred during that
year or the succeeding year pursuant to its State plan approved
under this subsection. Such payments shall be made on the basis
of estimates by the Secretary of the sums the State will need in
order to perform the planning under its approved State plan under
this subsection, but with such adjustments as may be necessary to
take account of previously made underpayments or overpayments.
The ‘‘Federal share’’ for any State for purposes of this subsection
shall be all, or such part as the Secretary may determine, of the
cost of such planning, except that in the case of the allotments for
the fiscal year ending June 30, 1970, it shall not exceed 75 per centum, of such cost.
Project Grants for Areawide Health Planning
(b)(1)(A) The Secretary is authorized, during the period beginning July 1, 1966, and ending June 30, 1974, to make, with the approval of the State agency administering or supervising the administration of the State plan approved under subsection (a), project
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tion (but with appropriate representation of the interests of local
government where the recipient of the grant is not a local government or combination thereof or an agency of such government or
combination) to cover not to exceed 75 per centum of the costs of
projects for developing (and from time to time revising) comprehensive regional, metropolitan area, or other local area plans for coordination of existing and planned health services, including the facilities and persons required for provision of such services; and including the provision of such services through home health care;
except that in the case of project grants made in any State prior
to July 1, 1968, approval of such State agency shall be required
only if such State has such a State plan in effect at the time of
such grants. No grant may be made under this subsection after
June 30, 1970, to any agency or organization to develop or revise
health plans for an area unless the Secretary determines that such
agency or organization provides means for appropriate representation of the interests of the hospitals, other health care facilities,
and practicing physicians serving such area, and the general public. For the purposes of carrying out this subsection, there are hereby authorized to be appropriated $5,000,000 for the fiscal year ending June 30, 1967, $7,500,000 for the fiscal year ending June 30,
1968, $10,000,000 for the fiscal year ending June 30, 1969,
$15,000,000 for the fiscal year ending June 30, 1970, $20,000,000
for the fiscal year ending June 30, 1971, $30,000,000 for the fiscal
year ending June 30, 1972, $40,000,000 for the fiscal year ending
June 30, 1973, and $25,100,000 for the fiscal year ending June 30,
1974.
(B) Project grants may be made by the Secretary under subparagraph (A) to the State agency administering or supervising the
administration of the State plan approved under subsection (a)
with respect to a particular region or area, but only if (i) no application for such a grant with respect to such region or area has been
filed by any other agency or organization qualified to receive such
a grant, and (ii) such State agency certifies, and the Secretary
finds, that ample opportunity has been afforded to qualified agencies and organizations to file application for such a grant with respect to such region or area and that it is improbable that, in the
foresee-able future, any agency or organization which is qualified
for such a grant will file application therefor.
(2)(A) In order to be approved under this subsection, an application for a grant under this subsection must contain or be supported by reasonable assurances that there has been or will be established, in or for the area with respect to which such grant is
sought, an areawide health planning council. The membership of
such council shall include representatives of public, voluntary, and
non-profit private agencies, institutions, and organizations concerned with health (including representatives of the interests of
local government of the regional medical program for such area,
and of consumers of health services). A majority of the members of
such council shall consist of representatives of consumers of health
services.
(B) In addition, an application for a grant under this subsection must contain or be supported by reasonable assurances that
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ing health care facilities in its area to develop a program for capital
expenditures for replacement, modernization, and expansion, which
is consistent with an overall State plan which will meet the needs
of the State and the area for health care facilities, equipment, and
services without duplication and otherwise in the most efficient
and economical manner.
Project Grants for Training, Studies, and Demonstrations
(c) The Secretary is also authorized, during the period beginning July 1, 1966, and ending June 30, 1974, to make grants to any
public or nonprofit private agency, institution, or other organization to cover all or any part of the cost of projects for training,
studies, or demonstrations looking toward the development of improved or more effective comprehensive health planning throughout
the Nation. For the purposes of carrying out this subsection, there
are hereby authorized to be appropriated $1,500,000 for the fiscal
year ending June 30, 1967, $2,500,000 for the fiscal year ending
June 30, 1968, $5,000,000 for the fiscal year ending June 30, 1969,
$7,500,000 for the fiscal year ending June 30, 1970, $8,000,000 for
the fiscal year ending June 30, 1971, $10,000,000 for the fiscal year
ending June 30, 1972, $12,000,000 for the fiscal year ending June
30, 1973, and $4,700,000 for the fiscal year ending June 30, 1974.
FAMILY SUPPORT GROUPS FOR ALZHEIMER’S DISEASE PATIENTS

SEC. 316. 1 ø247a¿ (a) Subject to available appropriations, the
Secretary, acting through the National Institute of Mental Health,
the National Institutes of Health, and the Administration on
Aging, shall promote the establishment of family support groups to
provide, without charge, educational, emotional, and practical support to assist individuals with Alzheimer’s disease or a related
memory disorder and members of the families of such individuals.
In promoting the establishment of such groups, the Secretary shall
give priority to—
(1) university medical centers and other appropriate health
care facilities which receive Federal funds from the Secretary
and which conduct research on Alzheimer’s disease or provide
services to individuals with such disease; and
(2) community-based programs which receive funds from
the Secretary, acting through the Administration on Aging.
(b) The Secretary shall promote the establishment of a national
network to coordinate the family support groups described in subsection (a).
PROJECT GRANTS FOR PREVENTIVE HEALTH SERVICES

SEC. 317. ø247b¿ (a) The Secretary may make grants to States,
and in consultation with State health authorities, to political subdivisions of States and to other public entities to assist them in
meeting the costs of establishing and maintaining preventive
health service programs.
1 With respect to section 315, subsection (d) of such section provided as follows: ‘‘This section
shall cease to exist on March 31, 1989.’’. See section 1 of Public Law 100–471 (102 Stat. 2284).

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(b) No grant may be made under subsection (a) unless an application therefor has been submitted to, and approved by, the Secretary. Such an application shall be in such form and be submitted
in such manner as the Secretary shall by regulation prescribe and
shall provide—
(1) a complete description of the type and extent of the
program for which the applicant is seeking a grant under subsection (a);
(2) with respect to each such program (A) the amount of
Federal, State, and other funds obligated by the applicant in
its latest annual accounting period for the provision of such
program, (B) a description of the services provided by the applicant in such program in such period, (C) the amount of Federal funds needed by the applicant to continue providing such
services in such program, and (D) if the applicant proposes
changes in the provision of the services in such program, the
priorities of such proposed changes, reasons for such changes,
and the amount of Federal funds needed by the applicant to
make such changes;
(3) assurances satisfactory to the Secretary that the program which will be provided with funds under a grant under
subsection (a) will be provided in a manner consistent with the
State health plan in effect under section 1524(c) and in those
cases where the applicant is a State, that such program will
be provided, where appropriate, in a manner consistent with
any plans in effect under an application approved under section 315;
(4) assurances satisfactory to the Secretary that the applicant will provide for such fiscal control and fund accounting
procedures as the Secretary by regulation prescribes to assure
the proper disbursement of and accounting for funds received
under grants under subsection (a);
(5) assurances satisfactory to the Secretary that the applicant will provide for periodic evaluation of its program or programs;
(6) assurances satisfactory to the Secretary that the applicant will make such reports (in such form and containing such
information as the Secretary may by regulation prescribe) as
the Secretary may reasonably require and keep such records
and afford such access thereto as the Secretary may find necessary to assure the correctness of, and to verify, such reports;
(7) assurances satisfactory to the Secretary that the applicant will comply with any other conditions imposed by this section with respect to grants; and
(8) such other information as the Secretary may by regulation prescribe.
(c)(1) The Secretary shall not approve an application submitted
under subsection (b) for a grant for a program for which a grant
was previously made under subsection (a) unless the Secretary determines—
(A) the program for which the application was submitted
is operating effectively to achieve its stated purpose,
(B) the applicant complied with the assurances provided
the Secretary when applying for such previous grant, and
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(C) the applicant will comply with the assurances provided
with the application.
(2) The Secretary shall review annually the activities undertaken by each recipient of a grant under subsection (a) to determine if the program assisted by such grant is operating effectively
to achieve its stated purposes and if the recipient is in compliance
with the assurances provided the Secretary when applying for such
grant.
(d) The amount of a grant under subsection (a) shall be determined by the Secretary. Payments under such grants may be made
in advance on the basis of estimates or by the way of reimbursement, with necessary adjustments on account of underpayments or
overpayments, and in such installments and on such terms and
conditions as the Secretary finds necessary to carry out the purposes of such grants.
(e) The Secretary, at the request of a recipient of a grant under
subsection (a), may reduce the amount of such grant by—
(1) the fair market value of any supplies (including vaccines and other preventive agents) or equipment furnished the
grant recipient, and
(2) the amount of the pay, allowances, and travel expenses
of any officer or employee of the Government when detailed to
the grant recipient and the amount of any other costs incurred
in connection with the detail of such officer or employee.
When the furnishing of such supplies or equipment or the detail of
such an officer or employee is for the convenience of and at the request of such grant recipient and for the purpose of carrying out
a program with respect to which the grant under subsection (a) is
made. The amount by which any such grant is so reduced shall be
available for payment by the Secretary of the costs incurred in furnishing the supplies or equipment, or in detailing the personnel, on
which the reduction of such grant is based, and such amount shall
be deemed as part of the grant and shall be deemed to have been
paid to the grant recipient.
(f)(1) Each recipient of a grant under subsection (a) shall keep
such records as the Secretary shall by regulation prescribe, including records which fully disclose the amount and disposition by such
recipient of the proceeds of such grant, the total cost of the undertaking in connection with which such grant was made, and the
amount of that portion of the cost of the undertaking supplied by
other sources, and such other records as will facilitate an effective
audit.
(2) The Secretary and the Comptroller General of the United
States, or any of their duly authorized representatives, shall have
access for the purpose of audit and examination to any books, documents, papers, and records of the recipient of grants under subsection (a) that are pertinent to such grants.
(g)(1) Nothing in this section shall limit or otherwise restrict
the use of funds which are granted to a State or to an agency or
a political subdivision of a State under provisions of Federal law
(other than this section) and which are available for the conduct of
preventive health service programs from being used on connection
with programs assisted through grants under subsection (a).
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(2) Nothing in this section shall be construed to require any
State or any agency or political subdivision of a State to have a
preventive health service program which would require any person,
who objects to any treatment provided under such a program, to be
treated or to have any child or ward treated under such program.
(h) The Secretary shall include, as part of the report required
by section 1705, a report on the extent of the problems presented
by the diseases and conditions referred to in subsection (j) on the
amount of funds obligated under grants under subsection (a) in the
preceding fiscal year for each of the programs listed in subsection
(j); and on the effectiveness of the activities assisted under grants
under subsection (a) in controlling such diseases and conditions.
(i) The Secretary may provide technical assistance to States,
State health authorities, and other public entities in connection
with the operation of their preventive health service programs.
(j)(1) Except for grants for immunization programs the authorization of appropriations for which are established in paragraph
(2), for grants under subsections (a) and (k)(1) for preventive health
service programs to immunize without charge children, adolescents,
and adults against vaccine-preventable diseases, there are authorized to be appropriated such sums as may be necessary. Not more
than 10 percent ot the total amount appropriated under the preceding sentence for any fiscal year shall be available for grants
under subsection (k)(1) for such fiscal year.
(2) For grants under subsection (a) for preventive health service programs for the provision without charge of immunizations
with vaccines approved for use, and recommended for routine use,
there are authorized to be appropriated such sums as may be necessary.
(k)(1) The Secretary may make grants to States, political subdivisions of States, and other public and nonprofit private entities
for—
(A) research into the prevention and control of diseases
that may be prevented through vaccination;
(B) demonstration projects for the prevention and control
of such diseases;
(C) public information and education programs for the prevention and control of such diseases; and
(D) education, training, and clinical skills improvement activities in the prevention and control of such diseases for
health professionals (including allied health personnel).
(2) The Secretary may make grants to States, political subdivisions of States, and other public and nonprofit private entities for—
(A) research into the prevention and control of diseases
and conditions;
(B) demonstration projects for the prevention and control
of such diseases and conditions;
(C) public information and education programs for the prevention and control of such diseases and conditions; and
(D) education, training, and clinical skills improvement activities in the prevention and control of such diseases and conditions for health professionals (including allied health personnel).
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(3) No grant may be made under this subsection unless an application therefor is submitted to the Secretary in such form, at
such time, and containing such information as the Secretary may
by regulation prescribe.
(4) Subsections (d), (e), and (f) shall apply to grants under this
subsection in the same manner as such subsections apply to grants
under subsection (a).
(l) AUTHORITY TO PURCHASE RECOMMENDED VACCINES FOR
ADULTS.—
(1) IN GENERAL.—The Secretary may negotiate and enter
into contracts with manufacturers of vaccines for the purchase
and delivery of vaccines for adults as provided for under subsection (e).
(2) STATE PURCHASE.—A State may obtain additional quantities of such adult vaccines (subject to amounts specified to
the Secretary by the State in advance of negotiations) through
the purchase of vaccines from manufacturers at the applicable
price negotiated by the Secretary under this subsection.
(m) DEMONSTRATION PROGRAM TO IMPROVE IMMUNIZATION
COVERAGE.—
(1) IN GENERAL.—The Secretary, acting through the Director of the Centers for Disease Control and Prevention, shall establish a demonstration program to award grants to States to
improve the provision of recommended immunizations for children, adolescents, and adults through the use of evidencebased, population-based interventions for high-risk populations.
(2) STATE PLAN.—To be eligible for a grant under paragraph (1), a State shall submit to the Secretary an application
at such time, in such manner, and containing such information
as the Secretary may require, including a State plan that describes the interventions to be implemented under the grant
and how such interventions match with local needs and capabilities, as determined through consultation with local authorities.
(3) USE OF FUNDS.—Funds received under a grant under
this subsection shall be used to implement interventions that
are recommended by the Task Force on Community Preventive
Services (as established by the Secretary, acting through the
Director of the Centers for Disease Control and Prevention) or
other evidence-based interventions, including—
(A) providing immunization reminders or recalls for
target populations of clients, patients, and consumers;
(B) educating targeted populations and health care
providers concerning immunizations in combination with
one or more other interventions;
(C) reducing out-of-pocket costs for families for vaccines and their administration;
(D) carrying out immunization-promoting strategies
for participants or clients of public programs, including assessments of immunization status, referrals to health care
providers, education, provision of on-site immunizations, or
incentives for immunization;
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(E) providing for home visits that promote immunization through education, assessments of need, referrals, provision of immunizations, or other services;
(F) providing reminders or recalls for immunization
providers;
(G) conducting assessments of, and providing feedback
to, immunization providers;
(H) any combination of one or more interventions described in this paragraph; or
(I) immunization information systems to allow all
States to have electronic databases for immunization
records.
(4) CONSIDERATION.—In awarding grants under this subsection, the Secretary shall consider any reviews or recommendations of the Task Force on Community Preventive
Services.
(5) EVALUATION.—Not later than 3 years after the date on
which a State receives a grant under this subsection, the State
shall submit to the Secretary an evaluation of progress made
toward improving immunization coverage rates among highrisk populations within the State.
(6) REPORT TO CONGRESS.—Not later than 4 years after the
date of enactment of the Affordable Health Choices Act, the
Secretary shall submit to Congress a report concerning the effectiveness of the demonstration program established under
this subsection together with recommendations on whether to
continue and expand such program.
(7) AUTHORIZATION OF APPROPRIATIONS.—There is authorized to be appropriated to carry out this subsection, such sums
as may be necessary for each of fiscal years 2010 through 2014.
SCREENINGS, REFERRALS, AND EDUCATION REGARDING LEAD
POISONING

SEC. 317A. ø247b–1¿ (a) AUTHORITY FOR GRANTS.—
(1) IN GENERAL.—Subject to paragraph (2), the Secretary,
acting through the Director of the Centers for Disease Control
and Prevention, may make grants to States and political subdivisions of States for the initiation and expansion of community programs designed—
(A) to provide, for infants and children—
(i) screening for elevated blood lead levels;
(ii) referral for treatment of such levels; and
(iii) referral for environmental intervention associated with such levels; and
(B) to provide education about childhood lead poisoning.
(2) AUTHORITY REGARDING CERTAIN ENTITIES.—With respect to a geographic area with a need for activities authorized
in paragraph (1), in any case in which neither the State nor
the political subdivision in which such area is located has applied for a grant under paragraph (1), the Secretary may make
a grant under such paragraph to any grantee under section
329, 330, or 340A for carrying out such activities in the area.
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(3) PROVISION OF ALL SERVICES AND ACTIVITIES THROUGH
EACH GRANTEE.—In making grants under paragraph (1), the
Secretary shall ensure that each of the activities described in
such paragraph is provided through each grantee under such
paragraph. The Secretary may authorize such a grantee to provide the services and activities directly, or through arrangements with other providers.
(b) STATUS AS MEDICAID PROVIDER.—
(1) IN GENERAL.—Subject to paragraph (2), the Secretary
may not make a grant under subsection (a) unless, in the case
of any service described in such subsection that is made available pursuant to the State plan approved under title XIX of the
Social Security Act for the State involved—
(A) the applicant for the grant will provide the service
directly, and the applicant has entered into a participation
agreement under the State plan and is qualified to receive
payments under such plan; or
(B) the applicant will enter into an agreement with a
provider under which the provider will provide the service,
and the provider has entered into such a participation
agreement and is qualified to receive such payments.
(2) WAIVER REGARDING CERTAIN SECONDARY AGREEMENTS.—
(A) In the case of a provider making an agreement
pursuant to paragraph (1)(B) regarding the provision of
services, the requirement established in such paragraph
regarding a participation agreement shall be waived by the
Secretary if the provider does not, in providing health care
services, impose a charge or accept reimbursement available from any third-party payor, including reimbursement
under any insurance policy or under any Federal or State
health benefits plan.
(B) A determination by the Secretary of whether a provider referred to in subparagraph (A) meets the criteria for
a waiver under such subparagraph shall be made without
regard to whether the provider accepts voluntary donations regarding the provision of services to the public.
(c) PRIORITY IN MAKING GRANTS.—In making grants under subsection (a), the Secretary shall give priority to applications for programs that will serve areas with a high incidence of elevated blood
lead levels in infants and children.
(d) GRANT APPLICATION.—No grant may be made under subsection (a), unless an application therefor has been submitted to,
and approved by, the Secretary. Such an application shall be in
such form and shall be submitted in such manner as the Secretary
shall prescribe and shall include each of the following:
(1) A complete description of the program which is to be
provided by or through the applicant.
(2) Assurances satisfactory to the Secretary that the program to be provided under the grant applied for will include
educational programs designed to—
(A) communicate to parents, educators, and local
health officials the significance and prevalence of lead poisoning in infants and children (including the sources of
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lead exposure, the importance of screening young children
for lead, and the preventive steps that parents can take in
reducing the risk of lead poisoning) which the program is
designed to detect and prevent; and
(B) communicate to health professionals and paraprofessionals updated knowledge concerning lead poisoning
and research (including the health consequences, if any, of
low-level lead burden; the prevalence of lead poisoning
among all socioeconomic groupings; the benefits of expanded lead screening; and the therapeutic and other
interventions available to prevent and combat lead poisoning in affected children and families).
(3) Assurances satisfactory to the Secretary that the applicant will report on a quarterly basis the number of infants and
children screened for elevated blood lead levels, the number of
infants and children who were found to have elevated blood
lead levels, the number and type of medical referrals made for
such infants and children, the outcome of such referrals, and
other information to measure program effectiveness.
(4) Assurances satisfactory to the Secretary that the applicant will make such reports respecting the program involved as
the Secretary may require.
(5) Assurances satisfactory to the Secretary that the applicant will coordinate the activities carried out pursuant to subsection (a) with related activities and services carried out in
the State by grantees under title V or XIX of the Social Security Act.
(6) Assurances satisfactory to the Secretary that Federal
funds made available under such a grant for any period will
be so used as to supplement and, to the extent practical, increase the level of State, local, and other non-Federal funds
that would, in the absence of such Federal funds, be made
available for the program for which the grant is to be made
and will in no event supplant such State, local, and other nonFederal funds.
(7) Assurances satisfactory to the Secretary that the applicant will ensure complete and consistent reporting of all blood
lead test results from laboratories and health care providers to
State and local health departments in accordance with guidelines of the Centers for Disease Control and Prevention for
standardized reporting as described in subsection (m).
(8) Such other information as the Secretary may prescribe.
(e) RELATIONSHIP TO SERVICES AND ACTIVITIES UNDER OTHER
PROGRAMS.—
(1) IN GENERAL.—A recipient of a grant under subsection
(a) may not make payments from the grant for any service or
activity to the extent that payment has been made, or can reasonably be expected to be made, with respect to such service
or activity—
(A) under any State compensation program, under an
insurance policy, or under any Federal or State health
benefits program; or
(B) by an entity that provides health services on a prepaid basis.
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(2) APPLICABILITY TO CERTAIN SECONDARY AGREEMENTS
FOR PROVISION OF SERVICES.—Paragraph (1) shall not apply in
the case of a provider through which a grantee under subsection (a) provides services under such subsection if the Secretary has provided a waiver under subsection (b)(2) regarding
the provider.
(f) METHOD AND AMOUNT OF PAYMENT.—The Secretary shall
determine the amount of a grant made under subsection (a). Payments under such grants may be made in advance on the basis of
estimates or by way of reimbursement, with necessary adjustments
on account of underpayments or overpayments, and in such installments and on such terms and conditions as the Secretary finds necessary to carry out the purposes of such grants. Not more than 10
percent of any grant may be obligated for administrative costs.
(g) SUPPLIES, EQUIPMENT, AND EMPLOYEE DETAIL.—The Secretary, at the request of a recipient of a grant under subsection (a),
may reduce the amount of such grant by—
(1) the fair market value of any supplies or equipment furnished the grant recipient; and
(2) the amount of the pay, allowances, and travel expenses
of any officer or employee of the Government when detailed to
the grant recipient and the amount of any other costs incurred
in connection with the detail of such officer or employee;
when the furnishing of such supplies or equipment or the detail of
such an officer or employee is for the convenience of and at the request of such grant recipient and for the purpose of carrying out
a program with respect to which the grant under subsection (a) is
made. The amount by which any such grant is so reduced shall be
available for payment by the Secretary of the costs incurred in furnishing the supplies or equipment, or in detailing the personnel, on
which the reduction of such grant is based, and such amount shall
be deemed as part of the grant and shall be deemed to have been
paid to the grant recipient.
(h) RECORDS.—Each recipient of a grant under subsection (a)
shall keep such records as the Secretary shall prescribe, including
records which fully disclose the amount and disposition by such recipient of the proceeds of such grant, the total cost of the undertaking in connection with which such grant was made, and the
amount of that portion of the cost of the undertaking supplied by
other sources, and such other records as will facilitate an effective
audit.
(i) AUDIT AND EXAMINATION OF RECORDS.—The Secretary and
the Comptroller General of the United States, or any of their duly
authorized representatives, shall have access for the purpose of
audit and examination to any books, documents, papers, and
records of the recipient of a grant under subsection (a), that are
pertinent to such grant.
(j) ANNUAL REPORT.—
(1) IN GENERAL.—Not later than May 1 of each year, the
Secretary shall submit to the Congress a report on the effectiveness during the preceding fiscal year of programs carried
out with grants under subsection (a) and of any programs that
are carried out by the Secretary pursuant to subsection (l)(2).
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(2) CERTAIN REQUIREMENTS.—Each report under paragraph (1) shall include, in addition to any other information
that the Secretary may require, the following information:
(A) The number of infants and children screened.
(B) Demographic information on the population of infants and children screened, including the age and racial
or ethnic status of such population.
(C) The number of screening sites.
(D) A description of the severity of the extent of the
blood lead levels of the infants and children screened, expressed in categories of severity.
(E) The sources of payment for the screenings.
(F) The number of grantees that have established systems to ensure mandatory reporting of all blood lead tests
from laboratories and health care providers to State and
local health departments.
(G) A comparison of the data provided pursuant to
subparagraphs (A) through (F) with the equivalent data, if
any, provided in the report under paragraph (1) preceding
the report involved.
(k) INDIAN TRIBES.—For purposes of this section, the term ‘‘political subdivision’’ includes Indian tribes.
(l) FUNDING.—
(1) AUTHORIZATION OF APPROPRIATIONS.—For the purpose
of carrying out this section, there are authorized to be appropriated $40,000,000 for fiscal year 1993, and such sums as may
be necessary for each of the fiscal years 1994 through 2005.
(2) ALLOCATION FOR OTHER PROGRAMS.—Of the amounts
appropriated under paragraph (1) for any fiscal year, the Secretary may reserve not more than 20 percent for carrying out
programs regarding the activities described in subsection (a) in
addition to the program of grants established in such subsection.
(m) GUIDELINES FOR STANDARDIZED REPORTING.—The Secretary, acting through the Director of the Centers for Disease Control and Prevention, shall develop national guidelines for the uniform reporting of all blood lead test results to State and local
health departments.
EDUCATION, TECHNOLOGY ASSESSMENT, AND EPIDEMIOLOGY
REGARDING LEAD POISONING

SEC. 317B. ø247b–3¿ (a) PREVENTION.—
(1) PUBLIC EDUCATION.—The Secretary, acting through the
Director of the Centers for Disease Control and Prevention,
shall carry out a program to educate health professionals and
paraprofessionals and the general public on the prevention of
lead poisoning in infants and children. In carrying out the program, the Secretary shall make available information concerning the health effects of low-level lead toxicity, the causes
of lead poisoning, and the primary and secondary preventive
measures that may be taken to prevent such poisoning.
(2) INTERAGENCY TASK FORCE.—
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(A) Not later than 6 months after the date of the enactment of the Preventive Health Amendments of 1992 1,
the Secretary shall establish a council to be known as the
Interagency Task Force on the Prevention of Lead Poisoning (in this paragraph referred to as the ‘‘Task Force’’).
The Task Force shall coordinate the efforts of Federal
agencies to prevent lead poisoning.
(B) The Task Force shall be composed of—
(i) the Secretary, who shall serve as the chair of
the Task Force;
(ii) the Secretary of Housing and Urban Development;
(iii) the Administrator of the Environmental Protection Agency; and
(iv) senior staff of each of the officials specified in
clauses (i) through (iii), as selected by the officials respectively.
(C) The Task Force shall—
(i) review, evaluate, and coordinate current strategies and plans formulated by the officials serving as
members of the Task Force, including—
(I) the plan of the Secretary of Health and
Human Services entitled ‘‘Strategic Plan for the
Elimination of Lead Poisoning’’, dated February
21, 1991;
(II) the plan of the Secretary of Housing and
Urban Development entitled ‘‘Comprehensive and
Workable Plan for the Abatement of Lead-Based
Paint in Privately Owned Housing’’, dated December 7, 1990; and
(III) the strategy of the Administrator of the
Environmental Protection Agency entitled ‘‘Strategy for Reducing Lead Exposures’’, dated February 21, 1991;
(ii) develop a unified implementation plan for programs that receive Federal financial assistance for activities related to the prevention of lead poisoning;
(iii) establish a mechanism for sharing and disseminating information among the agencies represented on the Task Force;
(iv) identify the most promising areas of research
and education concerning lead poisoning;
(v) identify the practical and technological constraints to expanding lead poisoning prevention;
(vi) annually carry out a comprehensive review of
Federal programs providing assistance to prevent lead
poisoning, and not later than May 1 of each year, submit to the Committee on Labor and Human Resources
of the Senate and the Committee on the Environment
and Public Works of the Senate, and to the Committee
on Energy and Commerce of the House of Representatives, a report that summarizes the findings made as
1 Enacted

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a result of such review and that contains the recommendations of the Task Force on the programs and
policies with respect to which the Task Force is established, including related budgetary recommendations;
and
(vii) annually review and coordinate departmental
and agency budgetary requests with respect to all lead
poisoning prevention activities of the Federal Government.
(b) TECHNOLOGY ASSESSMENT AND EPIDEMIOLOGY.—The Secretary, acting through the Director of the Centers for Disease Control and Prevention, shall, directly or through grants or contracts—
(1) provide for the development of improved, more cost-effective testing measures for detecting lead toxicity in children;
(2) provide for the development of improved methods of assessing the prevalence of lead poisoning, including such methods as may be necessary to conduct individual assessments for
each State;
(3) provide for the collection of data on the incidence and
prevalence of lead poisoning of infants and children, on the demographic characteristics of infants and children with such
poisoning (including racial and ethnic status), and on the
source of payment for treatment for such poisoning (including
the extent to which insurance has paid for such treatment);
and
(4) provide for any applied research necessary to improve
the effectiveness of programs for the prevention of lead poisoning in infants and children.
NATIONAL CENTER ON BIRTH DEFECTS AND DEVELOPMENTAL
DISABILITIES

SEC. 317C. ø247b–4¿ (a) IN GENERAL.—
(1) NATIONAL CENTER.—There is established within the
Centers for Disease Control and Prevention a center to be
known as the National Center on Birth Defects and Developmental Disabilities (referred to in this section as the ‘‘Center’’),
which shall be headed by a director appointed by the Director
of the Centers for Disease Control and Prevention.
(2) GENERAL DUTIES.—The Secretary shall carry out programs—
(A) to collect, analyze, and make available data on
birth defects, developmental disabilities, and disabilities
and health (in a manner that facilitates compliance with
subsection (c)(2)), including data on the causes of such defects and disabilities and on the incidence and prevalence
of such defects and disabilities;
(B) to operate regional centers for the conduct of applied epidemiological research on the prevention of such
defects and disabilities;
(C) to provide information and education to the public
on the prevention of such defects and disabilities;
(D) to conduct research on and to promote the prevention of such defects and disabilities, and secondary health
conditions among individuals with disabilities; and
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(E) to support a National Spina Bifida Program to prevent and reduce suffering from the Nation’s most common
permanently disabling birth defect.
(3) FOLIC ACID.—The Secretary shall carry out section
317J through the Center.
(4) CERTAIN PROGRAMS.—
(A) TRANSFERS.—All programs and functions described
in subparagraph (B) are transferred to the Center, effective upon the expiration of the 180-day period beginning
on the date of the enactment of the Children’s Health Act
of 2000 1.
(B) RELEVANT PROGRAMS.—The programs and functions described in this subparagraph are all programs and
functions that—
(i) relate to birth defects; folic acid; cerebral palsy;
intellectual disabilities; child development; newborn
screening; autism; fragile X syndrome; fetal alcohol
syndrome; pediatric genetic disorders; disability prevention; or other relevant diseases, disorders, or conditions as determined the Secretary; and
(ii) were carried out through the National Center
for Environmental Health as of the day before the
date of the enactment of the Act referred to in subparagraph (A).
(C) RELATED TRANSFERS.—Personnel employed in connection with the programs and functions specified in subparagraph (B), and amounts available for carrying out the
programs and functions, are transferred to the Center, effective upon the expiration of the 180-day period beginning
on the date of the enactment of the Act referred to in subparagraph (A). Such transfer of amounts does not affect
the period of availability of the amounts, or the availability of the amounts with respect to the purposes for
which the amounts may be expended.
(b) GRANTS AND CONTRACTS.—
(1) IN GENERAL.—In carrying out subsection (a), the Secretary may make grants to and enter into contracts with public
and nonprofit private entities.
(2) SUPPLIES AND SERVICES IN LIEU OF AWARD FUNDS.—
(A) Upon the request of a recipient of an award of a
grant or contract under paragraph (1), the Secretary may,
subject to subparagraph (B), provide supplies, equipment,
and services for the purpose of aiding the recipient in carrying out the purposes for which the award is made and,
for such purposes, may detail to the recipient any officer
or employee of the Department of Health and Human
Services.
(B) With respect to a request described in subparagraph (A), the Secretary shall reduce the amount of payments under the award involved by an amount equal to
the costs of detailing personnel and the fair market value
of any supplies, equipment, or services provided by the
1 Public

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Law 106–310, enacted October 17, 2000.

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Secretary. The Secretary shall, for the payment of expenses incurred in complying with such request, expend
the amounts withheld.
(3) APPLICATION FOR AWARD.—The Secretary may make an
award of a grant or contract under paragraph (1) only if an application for the award is submitted to the Secretary and the
application is in such form, is made in such manner, and contains such agreements, assurances, and information as the Secretary determines to be necessary to carry out the purposes for
which the award is to be made.
(c) BIENNIAL REPORT.—Not later than February 1 of fiscal year
1999 and of every second such year thereafter, the Secretary shall
submit to the Committee on Commerce of the House of Representatives, and the Committee on Labor and Human Resources of the
Senate, a report that, with respect to the preceding 2 fiscal years—
(1) contains information regarding the incidence and prevalence of birth defects, developmental disabilities, and the
health status of individuals with disabilities and the extent to
which these conditions have contributed to the incidence and
prevalence of infant mortality and affected quality of life;
(2) contains information under paragraph (1) that is specific to various racial and ethnic groups (including Hispanics,
non-Hispanic whites, Blacks, Native Americans, and Asian
Americans);
(3) contains an assessment of the extent to which various
approaches of preventing birth defects, developmental disabilities, and secondary health conditions among individuals with
disabilities have been effective;
(4) describes the activities carried out under this section;
(5) contains information on the incidence and prevalence of
individuals living with birth defects and disabilities or developmental disabilities, information on the health status of individuals with disabilities, information on any health disparities experienced by such individuals, and recommendations for improving the health and wellness and quality of life of such individuals;
(6) contains a summary of recommendations from all birth
defects research conferences sponsored by the Centers for Disease Control and Prevention, including conferences related to
spina bifida; and
(7) contains any recommendations of the Secretary regarding this section.
(d) APPLICABILITY OF PRIVACY LAWS.—The provisions of this
section shall be subject to the requirements of section 552a of title
5, United States Code. All Federal laws relating to the privacy of
information shall apply to the data and information that is collected under this section.
(e) ADVISORY COMMITTEE.—Notwithstanding any other provision of law, the members of the advisory committee appointed by
the Director of the National Center for Environmental Health that
have expertise in birth defects, developmental disabilities, and disabilities and health shall be transferred to and shall advise the National Center on Birth Defects and Developmental Disabilities efMarch 13, 2013

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38

fective on the date of enactment of the Birth Defects and Developmental Disabilities Prevention Act of 2003.
(f) 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 2003
through 2007.
PREVENTIVE HEALTH MEASURES WITH RESPECT TO PROSTATE CANCER

SEC. 317D. ø247b–5¿ (a) IN GENERAL.—The Secretary, acting
through the Director of the Centers for Disease Control and Prevention, may make grants to States and local health departments
for the purpose of enabling such States and departments to carry
out programs that may include the following:
(1) To identify factors that influence the attitudes or levels
of awareness of men and health care practitioners regarding
screening for prostate cancer.
(2) To evaluate, in consultation with the Agency for Health
Care Policy and Research and the National Institutes of
Health, the effectiveness of screening strategies for prostate
cancer.
(3) To identify, in consultation with the Agency for Health
Care Policy and Research, issues related to the quality of life
for men after prostrate cancer screening and followup.
(4) To develop and disseminate public information and
education programs for prostate cancer, including appropriate
messages about the risks and benefits of prostate cancer
screening for the general public, health care providers, policy
makers and other appropriate individuals.
(5) To improve surveillance for prostate cancer.
(6) To address the needs of underserved and minority populations regarding prostate cancer.
(7) Upon a determination by the Secretary, who shall take
into consideration recommendations by the United States Preventive Services Task Force and shall seek input, where appropriate, from professional societies and other private and public
entities, that there is sufficient consensus on the effectiveness
of prostate cancer screening—
(A) to screen men for prostate cancer as a preventive
health measure;
(B) to provide appropriate referrals for the medical
treatment of men who have been screened under subparagraph (A) and to ensure, to the extent practicable, the provision of appropriate followup services and support services such as case management;
(C) to establish mechanisms through which State and
local health departments can monitor the quality of
screening procedures for prostate cancer, including the interpretation of such procedures; and
(D) to improve, in consultation with the Health Resources and Services Administration, the education, training, and skills of health practitioners (including appropriate allied health professionals) in the detection and control of prostate cancer.
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(8) To evaluate activities conducted under paragraphs (1)
through (7) through appropriate surveillance or program monitoring activities.
(b) REQUIREMENT OF MATCHING FUNDS.—
(1) IN GENERAL.—The Secretary may not make a grant
under subsection (a) unless the applicant involved agrees, with
respect to the costs to be incurred by the applicant in carrying
out the purpose described in such section, to make available
non-Federal contributions (in cash or in kind under paragraph
(2)) toward such costs in an amount equal to not less than $1
for each $3 of Federal funds provided in the grant. Such contributions may be made directly or through donations from
public or private entities.
(2) DETERMINATION OF AMOUNT OF NON-FEDERAL CONTRIBUTION.—
(A) Non-Federal contributions required in paragraph
(1) may be in cash or in kind, fairly evaluated, including
equipment or services (and excluding indirect or overhead
costs). Amounts provided by the Federal Government, or
services assisted or subsidized to any significant extent by
the Federal Government, may not be included in determining the amount of such non-Federal contributions.
(B) In making a determination of the amount of nonFederal contributions for purposes of paragraph (1), the
Secretary may include only non-Federal contributions in
excess of the average amount of non-Federal contributions
made by the applicant involved toward the purpose described in subsection (a) for the 2-year period preceding
the fiscal year for which the applicant involved is applying
to receive a grant under such subsection.
(C) In making a determination of the amount of nonFederal contributions for purposes of paragraph (1), the
Secretary shall, subject to subparagraphs (A) and (B) of
this paragraph, include any non-Federal amounts expended pursuant to title XIX of the Social Security Act by
the applicant involved toward the purpose described in
paragraphs (1) and (2) of subsection (a).
(c) EDUCATION ON SIGNIFICANCE OF EARLY DETECTION.—The
Secretary may not make a grant under subsection (a) unless the
applicant involved agrees that, in carrying out subsection (a)(3),
the applicant will carry out education programs to communicate to
men, and to local health officials, the significance of the early detection of prostate cancer.
(d) REQUIREMENT OF PROVISION OF ALL SERVICES BY DATE
CERTAIN.—The Secretary may not make a grant under subsection
(a) unless the applicant involved agrees—
(1) to ensure that, initially and throughout the period during which amounts are received pursuant to the grant, not less
than 60 percent of the grant is expended to provide each of the
services or activities described in paragraphs (1) and (2) of
such subsection;
(2) to ensure that, by the end of any second fiscal year of
payments pursuant to the grant, each of the services or activities described in such subsection is provided; and
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40

(3) to ensure that not more than 40 percent of the grant
is expended to provide the services or activities described in
paragraphs (3) through (6) of such section 1.
(e) ADDITIONAL REQUIRED AGREEMENTS.—
(1) PRIORITY FOR LOW-INCOME MEN.—The Secretary may
not make a grant under subsection (a) unless the applicant involved agrees that low-income men, and men at risk of prostate cancer, will be given priority in the provision of services
and activities pursuant to paragraphs (1) and (2) of such subsection.
(2) LIMITATION ON IMPOSITION OF FEES FOR SERVICES.—The
Secretary may not make a grant under subsection (a) unless
the applicant involved agrees that, if a charge is imposed for
the provision of services or activities under the grant, such
charge—
(A) will be made according to a schedule of charges
that is made available to the public;
(B) will be adjusted to reflect the income of the man
involved; and
(C) will not be imposed on any man with an income
of less than 100 percent of the official poverty line, as established by the Director of the Office of Management and
Budget and revised by the Secretary in accordance with
section 673(2) of the Omnibus Budget Reconciliation Act of
1981.
(3) RELATIONSHIP TO ITEMS AND SERVICES UNDER OTHER
PROGRAMS.—The Secretary may not make a grant under subsection (a) unless the applicant involved agrees that the grant
will not be expended to make payment for any item or service
to the extent that payment has been made, or can reasonably
be expected to be made, with respect to such item or service—
(A) under any State compensation program, under an
insurance policy, or under any Federal or State health
benefits program; or
(B) by an entity that provides health services on a prepaid basis.
(4) COORDINATION WITH OTHER PROSTATE CANCER PROGRAMS.—The Secretary may not make a grant under subsection (a) unless the applicant involved agrees that the services and activities funded through the grant will be coordinated
with other Federal, State, and local prostate cancer programs.
(5) LIMITATION ON ADMINISTRATIVE EXPENSES.—The Secretary may not make a grant under subsection (a) unless the
applicant involved agrees that not more than 10 percent of the
grant will be expended for administrative expenses with respect to the grant.
(6) RESTRICTIONS ON USE OF GRANT.—The Secretary may
not make a grant under subsection (a) unless the applicant involved agrees that the grant will not be expended to provide
inpatient hospital services for any individual.
1 So

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in law. Probably should be ‘‘subsection’’.

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(7) RECORDS AND AUDITS.—The Secretary may not make a
grant under subsection (a) unless the applicant involved agrees
that—
(A) the applicant will establish such fiscal control and
fund accounting procedures as may be necessary to ensure
the proper disbursal of, and accounting for, amounts received by the applicant under such section; and
(B) upon request, the applicant will provide records
maintained pursuant to paragraph (1) to the Secretary or
the Comptroller of the United States for purposes of auditing the expenditures by the applicant of the grant.
(f) REPORTS TO SECRETARY.—The Secretary may not make a
grant under subsection (a) unless the applicant involved agrees to
submit to the Secretary such reports as the Secretary may require
with respect to the grant.
(g) DESCRIPTION OF INTENDED USES OF GRANT.—The Secretary
may not make a grant under subsection (a) unless—
(1) the applicant involved submits to the Secretary a description of the purposes for which the applicant intends to expend the grant;
(2) the description identifies the populations, areas, and localities in the applicant 1 with a need for the services or activities described in subsection (a);
(3) the description provides information relating to the
services and activities to be provided, including a description
of the manner in which the services and activities will be coordinated with any similar services or activities of public or
nonprivate entities; and
(4) the description provides assurances that the grant
funds will be used in the most cost-effective manner.
(h) REQUIREMENT OF SUBMISSION OF APPLICATION.—The Secretary may not make a grant under subsection (a) unless an application for the grant is submitted to the Secretary, the application
contains the description of intended uses required in subsection (g),
and the application is in such form, is made in such manner, and
contains such agreements, assurances, and information as the Secretary determines to be necessary to carry out this section.
(i) METHOD AND AMOUNT OF PAYMENT.—The Secretary shall
determine the amount of a grant made under subsection (a). Payments under such grants may be made in advance on the basis of
estimates or by way of reimbursement, with necessary adjustments
on account of the underpayments or overpayments, and in such installments and on such terms and conditions as the Secretary finds
necessary to carry out the purposes of such grants.
(j) TECHNICAL ASSISTANCE AND PROVISION OF SUPPLIES AND
SERVICES IN LIEU OF GRANT FUNDS.—
(1) TECHNICAL ASSISTANCE.—The Secretary may provide
training and technical assistance with respect to the planning,
development, and operation of any program or service carried
out pursuant to subsection (a). The Secretary may provide such
technical assistance directly or through grants to, or contracts
with, public and private entities.
1 So

March 13, 2013

in law.

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42

(2) PROVISION OF SUPPLIES AND SERVICES IN LIEU OF GRANT
FUNDS.—
(A) Upon the request of an applicant receiving a grant
under subsection (a), the Secretary may, subject to subparagraph (B), provide supplies, equipment, and services
for the purpose of aiding the applicant in carrying out such
section and, for such purpose, may detail to the applicant
any officer or employee of the Department of Health and
Human Services.
(B) With respect to a request described in subparagraph (A), the Secretary shall reduce the amount of payments under the grant under subsection (a) to the applicant involved by an amount equal to the costs of detailing
personnel (including pay, allowances, and travel expenses)
and the fair market value of any supplies, equipment, or
services provided by the Secretary. The Secretary shall, for
the payment of expenses incurred in complying with such
request, expend the amounts withheld.
(k) DEFINITION.—For purposes of this section, the term ‘‘units
of local government’’ includes Indian tribes.
(l) AUTHORIZATION OF APPROPRIATIONS.—
(1) IN GENERAL.—For the purpose of carrying out this section, there are authorized to be appropriated $20,000,000 for
fiscal year 1993, and such sums as may be necessary for each
of the fiscal years 1994 through 2004.
(2) ALLOCATION FOR TECHNICAL ASSISTANCE.—Of the
amounts appropriated under paragraph (1) for a fiscal year,
the Secretary shall reserve not more than 20 percent for carrying out subsection (j)(1).
NATIONAL STRATEGY FOR COMBATING AND ELIMINATING
TUBERCULOSIS

SEC. 317E. ø247b–6¿ (a) IN GENERAL.—The Secretary, acting
through the Director of the Centers for Disease Control and Prevention, may make grants to States, political subdivisions, and
other public entities for preventive health service programs for the
prevention, control, and elimination of tuberculosis.
(b) RESEARCH AND DEVELOPMENT; DEMONSTRATION PROJECTS;
EDUCATION AND TRAINING.—With respect to the prevention, treatment, control, and elimination of tuberculosis, the Secretary may,
directly or through grants to public or nonprofit private entities,
carry out the following:
(1) Research, with priority given to research and development concerning latent tuberculosis infection, strains of tuberculosis resistant to drugs, and research concerning cases of tuberculosis that affect certain populations at risk for tuberculosis.
(2) Research and development and related activities to develop new tools for the elimination of tuberculosis, including
drugs, diagnostics, vaccines, and public health interventions,
such as directly observed therapy and non-pharmaceutical
intervention, and methods to enhance detection and response
to outbreaks of tuberculosis, including multidrug resistant tuberculosis. The Secretary is encouraged to give priority to proMarch 13, 2013

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Sec. 317E

grammatically relevant research so that new tools can be utilized in public health practice.
(3) Demonstration projects for—
(A) the development of regional capabilities to prevent,
control, and eliminate tuberculosis and prevent multidrug
resistant and extensively drug resistant strains of tuberculosis;
(B) the intensification of efforts to reduce health disparities in the incidence of tuberculosis;
(C) the intensification of efforts to control tuberculosis
along the United States-Mexico border and among United
States-Mexico binational populations, including through
expansion of the scope and number of programs that—
(i) detect and treat binational cases of tuberculosis; and
(ii) treat high-risk cases of tuberculosis referred
from Mexican health departments;
(D) the intensification of efforts to prevent, detect, and
treat tuberculosis among foreign-born persons who are in
the United States;
(E) the intensification of efforts to prevent, detect, and
treat tuberculosis among populations and settings documented as having a high risk for tuberculosis; and
(F) tuberculosis detection, control, and prevention.
(4) Public information and education activities.
(5) Education, training, clinical skills improvement activities, and workplace exposure prevention for health professionals, including allied health personnel and emergency response employees.
(6) Support of Centers to carry out activities under paragraphs (1) through (4).
(7) Collaboration with international organizations and foreign countries in carrying out such activities.
(8) Develop, enhance, and expand information technologies
that support tuberculosis control including surveillance and
database management systems with cross-jurisdictional capabilities, which shall conform to the standards and implementation specifications for such information technologies as recommended by the Secretary.
(c) COOPERATION WITH PROVIDERS OF PRIMARY HEALTH SERVICES.—The Secretary may make a grant under subsection (a) or (b)
only if the applicant for the grant agrees that, in carrying out activities under the grant, the applicant will cooperate with public
and nonprofit private providers of primary health services or substance abuse services, including entities receiving assistance under
section 329, 330, or 340A or under title V or XIX.
(d) APPLICATION FOR GRANT.—
(1) IN GENERAL.—The Secretary may make a grant under
subsection (a) or (b) only if an application for the grant is submitted to the Secretary and the application, subject to paragraph (2), is in such form, is made in such manner, and contains such agreements, assurances, and information as the Secretary determines to be necessary to carry out the subsection
involved.
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44

(2) PLAN FOR PREVENTION, CONTROL, AND ELIMINATION.—
The Secretary may make a grant under subsection (a) only if
the application under paragraph (1) contains a plan regarding
the prevention, control, and elimination of tuberculosis in the
geographic area with respect to which the grant is sought.
(3) DETERMINATION OF AMOUNT OF NONFEDERAL CONTRIBUTIONS.—
(A) PRIORITY.—In awarding grants under subsection
(a) or (b), the Secretary shall give highest priority to an
applicant that provides assurances that the applicant will
contribute non-Federal funds to carry out activities under
this section, which may be provided directly or through donations from public or private entities and may be in cash
or in kind, including equipment or services.
(B) FEDERAL AMOUNTS NOT TO BE INCLUDED AS CONTRIBUTIONS.—Amounts provided by the Federal Government, or services assisted or subsidized to any significant
extent by the Federal Government, may not be included in
determining the amount of non-Federal contributions as
described in subparagraph (A).
(e) SUPPLIES AND SERVICES IN LIEU OF GRANT FUNDS.—
(1) IN GENERAL.—Upon the request of a grantee under subsection (a) or (b), the Secretary may, subject to paragraph (2),
provide supplies, equipment, and services for the purpose of
aiding the grantee in carrying out the subsection involved and,
for such purpose, may detail to the State any officer or employee of the Department of Health and Human Services.
(2) CORRESPONDING REDUCTION IN PAYMENTS.—With respect to a request described in paragraph (1), the Secretary
shall reduce the amount of payments under the grant involved
by an amount equal to the costs of detailing personnel and the
fair market value of any supplies, equipment, or services provided by the Secretary. The Secretary shall, for the payment
of expenses incurred in complying with such request, expend
the amounts withheld.
(f) ADVISORY COUNCIL.—
(1) IN GENERAL.—The Secretary shall establish an advisory
council to be known as the Advisory Council for the Elimination of Tuberculosis (in this subsection referred to as the
‘‘Council’’).
(2) DUTIES.—The Council shall provide advice and recommendations regarding the elimination of tuberculosis to the
Secretary. In addition, the Council shall, with respect to eliminating such disease, provide to the Secretary and other appropriate Federal officials advice on—
(A) coordinating the activities of the Department of
Health and Human Services and other Federal agencies
that relate to the disease, including activities under subsection (b);
(B) responding rapidly and effectively to emerging
issues in tuberculosis; and
(C) efficiently utilizing the Federal resources involved.
(3) COMPREHENSIVE PLAN.—
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(A) IN GENERAL.—In carrying out paragraph (2), the
Council shall make or update recommendations on the development, revision, and implementation of a comprehensive plan to eliminate tuberculosis in the United States.
(B) CONSULTATION.—In carrying out subparagraph
(A), the Council may consult with appropriate public and
private entities, which may, subject to the direction or discretion of the Secretary, include—
(i) individuals who are scientists, physicians,
laboratorians, and other health professionals, who are
not officers or employees of the Federal Government
and who represent the disciplines relevant to tuberculosis elimination;
(ii) members of public-private partnerships or private entities established to address the elimination of
tuberculosis;
(iii) members of national and international nongovernmental organizations whose purpose is to eliminate tuberculosis;
(iv) members from the general public who are
knowledgeable with respect to tuberculosis elimination
including individuals who have or have had tuberculosis; and
(v) scientists, physicians, laboratorians, and other
health professionals who reside in a foreign country
with a substantial incidence or prevalence of tuberculosis, and who represent the specialties and disciplines relevant to the research under consideration.
(C) CERTAIN COMPONENTS OF PLAN.—In carrying out
subparagraph (A), the Council shall, subject to the direction or discretion of the Secretary—
(i) consider recommendations for the involvement
of the United States in continuing global and crossborder tuberculosis control activities in countries
where a high incidence of tuberculosis directly affects
the United States; and
(ii) review the extent to which progress has been
made toward eliminating tuberculosis.
(4) BIENNIAL REPORT.—
(A) IN GENERAL.—The Council shall submit a biennial
report to the Secretary, as determined necessary by the
Secretary, on the activities carried under this section.
Each such report shall include the opinion of the Council
on the extent to which its recommendations regarding the
elimination of tuberculosis have been implemented, including with respect to—
(i) activities under subsection (b); and
(ii) the national plan referred to in paragraph (3).
(B) PUBLIC.—The Secretary shall make a report submitted under subparagraph (A) public.
(5) COMPOSITION.—The Council shall be composed of—
(A) ex officio representatives from the Centers for Disease Control and Prevention, the National Institutes of
Health, the United States Agency for International DevelMarch 13, 2013

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opment, the Agency for Healthcare Research and Quality,
the Health Resources and Services Administration, the
United States-Mexico Border Health Commission, and
other Federal departments and agencies that carry out significant activities related to tuberculosis;
(B) State and local tuberculosis control and public
health officials;
(C) individuals who are scientists, physicians,
laboratorians, and other health professionals who represent disciplines relevant to tuberculosis elimination; and
(D) members of national and international nongovernmental organizations established to address the elimination of tuberculosis.
(6) STAFF, INFORMATION, AND OTHER ASSISTANCE.—The
Secretary shall provide to the Council such staff, information,
and other assistance as may be necessary to carry out the duties of the Council.
(g) FEDERAL TUBERCULOSIS TASK FORCE.—
(1) DUTIES.—The Federal Tuberculosis Task Force (in this
subsection referred to as the ‘‘Task Force’’) shall provide to the
Secretary and other appropriate Federal officials advice on research into new tools under subsection (b)(2), including advice
regarding the efficient utilization of the Federal resources involved.
(2) COMPREHENSIVE PLAN FOR NEW TOOLS DEVELOPMENT.—
In carrying out paragraph (1), the Task Force shall make recommendations on the development of a comprehensive plan for
the creation of new tools for the elimination of tuberculosis, including drugs, diagnostics, and vaccines.
(3) CONSULTATION.—In developing the comprehensive plan
under paragraph (1), the Task Force shall consult with external parties including representatives from groups such as—
(A) scientists, physicians, laboratorians, and other
health professionals who represent the specialties and disciplines relevant to the research under consideration;
(B) members from public-private partnerships, private
entities, or foundations (or both) engaged in activities relevant to research under consideration;
(C) members of national and international nongovernmental organizations established to address tuberculosis
elimination;
(D) members from the general public who are knowledgeable with respect to tuberculosis including individuals
who have or have had tuberculosis; and
(E) scientists, physicians, laboratorians, and other
health professionals who reside in a foreign country with
a substantial incidence or prevalence of tuberculosis, and
who represent the specialties and disciplines relevant to
the research under consideration.
(h) AUTHORIZATION OF APPROPRIATIONS.—
(1) GENERAL PROGRAM.—
(A) IN GENERAL.—For the purpose of carrying out this
section, there are authorized to be appropriated
$200,000,000 for fiscal year 2009, $210,000,000 for fiscal
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Sec. 317F

year 2010, $220,500,000 for fiscal year 2011, $231,525,000
for fiscal year 2012, and $243,101,250 for fiscal year 2013.
(B) RESERVATION FOR EMERGENCY GRANTS.—Of the
amounts appropriated under subparagraph (A) for a fiscal
year, the Secretary may reserve not more than 25 percent
for emergency grants under subsection (a) for any geographic area, State, political subdivision of a State, or
other public entity in which there is, relative to other
areas, a substantial number of cases of tuberculosis,
multidrug resistant tuberculosis, or extensively drug resistant tuberculosis or a substantial rate of increase in
such cases.
(C) PRIORITY.—In allocating amounts appropriated
under subparagraph (A), the Secretary shall give priority
to allocating such amounts for grants under subsection (a).
(D) ALLOCATION OF FUNDS.—
(i) REQUIREMENT OF FORMULA.—Of the amounts
appropriated under subparagraph (A), not reserved
under subparagraph (B), and allocated by the Secretary for grants under subsection (a), the Secretary
shall distribute a portion of such amounts to grantees
under subsection (a) on the basis of a formula.
(ii) RELEVANT FACTORS.—The formula developed
by the Secretary under clause (i) shall take into account the level of tuberculosis morbidity and case complexity in the respective geographic area and may consider other factors relevant to tuberculosis in such
area.
(iii) NO CHANGE TO FORMULA REQUIRED.—This
subparagraph does not require the Secretary to modify
the formula that was used by the Secretary to distribute funds to grantees under subsection (a) for fiscal year 2009.
(2) LIMITATION.—The authorization of appropriations established in paragraph (1) for a fiscal year is effective only if
the amount appropriated under such paragraph for such year
equals or exceeds the amount appropriated to carry out this
section for fiscal year 2009.
LOAN REPAYMENT PROGRAM

SEC. 317F. ø247b–7¿ (a) IN GENERAL.—
(1) AUTHORITY.—Subject to paragraph (2), the Secretary
may carry out a program of entering into contracts with appropriately qualified health professionals under which such health
professionals agree to conduct prevention activities, as employees of the Centers for Disease Control and Prevention and the
Agency for Toxic Substances and Disease Registry, in consideration of the Federal Government agreeing to repay, for each
year of such service, not more than $35,000 of the principal
and interest of the educational loans of such health professionals.
(2) LIMITATION.—The Secretary may not enter into an
agreement with a health professional pursuant to paragraph
(1) unless such professional—
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48

(A) has a substantial amount of educational loans relative to income; and
(B) agrees to serve as an employee of the Centers for
Disease Control and Prevention or the Agency for Toxic
Substances and Disease Registry for purposes of paragraph (1) for a period of not less than 3 years.
(b) APPLICABILITY OF CERTAIN PROVISIONS.—With respect to
the National Health Service Corps Loan Repayment Program established in subpart III of part D of title III of this Act, the provisions of such subpart shall, except as inconsistent with subsection
(a), apply to the program established in this section in the same
manner and to the same extent as such provisions apply to the National Health Service Corps Loan Repayment Program.
(c) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of
carrying out this section, there are authorized to be appropriated
$500,000 for fiscal year 1994, and such sums as may be necessary
for each of the fiscal years 1995 through 2002.
(d) AVAILABILITY OF APPROPRIATIONS.—Amounts appropriated
for a fiscal year for contracts under subsection (a) shall remain
available until the expiration of the second fiscal year beginning
after the fiscal year for which the amounts were appropriated.
SEC. 317G. ø247b–8¿ FELLOWSHIP AND TRAINING PROGRAMS.

The Secretary, acting through the Director of the Centers for
Disease Control and Prevention, shall establish fellowship and
training programs to be conducted by such Centers to train individuals to develop skills in epidemiology, surveillance, laboratory analysis, and other disease detection and prevention methods. Such
programs shall be designed to enable health professionals and
health personnel trained under such programs to work, after receiving such training, in local, State, national, and international efforts toward the prevention and control of diseases, injuries, and
disabilities. Such fellowships and training may be administered
through the use of either appointment or nonappointment procedures.
DIABETES IN CHILDREN AND YOUTH

SEC. 317H. ø247b–9¿ (a) SURVEILLANCE ON
TES.—The Secretary, acting through the Director

JUVENILE DIABEof the Centers for
Disease Control and Prevention, shall develop a sentinel system to
collect data on juvenile diabetes, including with respect to incidence and prevalence, and shall establish a national database for
such data.
(b) TYPE 2 DIABETES IN YOUTH.—The Secretary shall implement a national public health effort to address type 2 diabetes in
youth, including—
(1) enhancing surveillance systems and expanding research to better assess the prevalence and incidence of type 2
diabetes in youth and determine the extent to which type 2 diabetes is incorrectly diagnosed as type 1 diabetes among children; and
(2) developing and improving laboratory methods to assist
in diagnosis, treatment, and prevention of diabetes including,
but not limited to, developing noninvasive ways to monitor
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blood glucose to prevent hypoglycemia and improving existing
glucometers that measure blood glucose.
(c) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of
carrying out this section, there are authorized to be appropriated
such sums as may be necessary for each of the fiscal years 2001
through 2005.
COMPILATION OF DATA ON ASTHMA

SEC. 317I. ø247b–10¿ (a) IN GENERAL.—The Secretary, acting
through the Director of the Centers for Disease Control and Prevention, shall—
(1) conduct local asthma surveillance activities to collect
data on the prevalence and severity of asthma and the quality
of asthma management;
(2) compile and annually publish data on the prevalence of
children suffering from asthma in each State; and
(3) to the extent practicable, compile and publish data on
the childhood mortality rate associated with asthma nationally.
(b) SURVEILLANCE ACTIVITIES.—The Director of the Centers for
Disease Control and Prevention, acting through the representative
of the Director on the National Asthma Education Prevention Program Coordinating Committee, shall, in carrying out subsection (a),
provide an update on surveillance activities at each Committee
meeting.
(c) COLLABORATIVE EFFORTS.—The activities described in subsection (a)(1) may be conducted in collaboration with eligible entities awarded a grant under section 399L.
(d) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of
carrying out this section, there are authorized to be appropriated
such sums as may be necessary for each of the fiscal years 2001
through 2005.
EFFECTS OF FOLIC ACID IN PREVENTION OF BIRTH DEFECTS

SEC. 317J. ø247b–11¿ (a) IN GENERAL.—The Secretary, acting
through the Director of the Centers for Disease Control and Prevention, shall expand and intensify programs (directly or through
grants or contracts) for the following purposes:
(1) To provide education and training for health professionals and the general public for purposes of explaining the
effects of folic acid in preventing birth defects and for purposes
of encouraging each woman of reproductive capacity (whether
or not planning a pregnancy) to consume on a daily basis a dietary supplement that provides an appropriate level of folic
acid.
(2) To conduct research with respect to such education and
training, including identifying effective strategies for increasing the rate of consumption of folic acid by women of reproductive capacity.
(3) To conduct research to increase the understanding of
the effects of folic acid in preventing birth defects, including
understanding with respect to cleft lip, cleft palate, and heart
defects.
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(4) To provide for appropriate epidemiological activities regarding folic acid and birth defects, including epidemiological
activities regarding neural tube defects.
(b) CONSULTATIONS WITH STATES AND PRIVATE ENTITIES.—In
carrying out subsection (a), the Secretary shall consult with the
States and with other appropriate public or private entities, including national nonprofit private organizations, health professionals,
and providers of health insurance and health plans.
(c) TECHNICAL ASSISTANCE.—The Secretary may (directly or
through grants or contracts) provide technical assistance to public
and nonprofit private entities in carrying out the activities described in subsection (a).
(d) EVALUATIONS.—The Secretary shall (directly or through
grants or contracts) provide for the evaluation of activities under
subsection (a) in order to determine the extent to which such activities have been effective in carrying out the purposes of the program
under such subsection, including the effects on various demographic populations. Methods of evaluation under the preceding
sentence may include surveys of knowledge and attitudes on the
consumption of folic acid and on blood folate levels. Such methods
may include complete and timely monitoring of infants who are
born with neural tube defects.
(e) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of
carrying out this section, there are authorized to be appropriated
such sums as may be necessary for each of the fiscal years 2001
through 2005.
SAFE MOTHERHOOD

SEC. 317K. ø247b–12¿ (a) SURVEILLANCE.—
(1) PURPOSE.—The purpose of this subsection is to develop
surveillance systems at the local, State, and national level to
better understand the burden of maternal complications and
mortality and to decrease the disparities among population at
risk of death and complications from pregnancy.
(2) ACTIVITIES.—For the purpose described in paragraph
(1), the Secretary, acting through the Director of the Centers
for Disease Control and Prevention, may carry out the following activities:
(A) The Secretary may establish and implement a national surveillance program to identify and promote the investigation of deaths and severe complications that occur
during pregnancy.
(B) The Secretary may expand the Pregnancy Risk Assessment Monitoring System to provide surveillance and
collect data in each State.
(C) The Secretary may expand the Maternal and Child
Health Epidemiology Program to provide technical support, financial assistance, or the time-limited assignment
of senior epidemiologists to maternal and child health programs in each State.
(b) PREVENTION RESEARCH.—
(1) PURPOSE.—The purpose of this subsection is to provide
the Secretary with the authority to further expand research
concerning risk factors, prevention strategies, and the roles of
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the family, health care providers and the community in safe
motherhood.
(2) RESEARCH.—The Secretary may carry out activities to
expand research relating to—
(A) encouraging preconception counseling, especially
for at risk populations such as diabetics;
(B) the identification of critical components of prenatal
delivery and postpartum care;
(C) the identification of outreach and support services,
such as folic acid education, that are available for pregnant women;
(D) the identification of women who are at high risk
for complications;
(E) preventing preterm delivery;
(F) preventing urinary tract infections;
(G) preventing unnecessary caesarean sections;
(H) an examination of the higher rates of maternal
mortality among African American women;
(I) an examination of the relationship between domestic violence and maternal complications and mortality;
(J) preventing and reducing adverse health consequences that may result from smoking, alcohol and illegal drug use before, during and after pregnancy;
(K) preventing infections that cause maternal and infant complications; and
(L) other areas determined appropriate by the Secretary.
(c) PREVENTION PROGRAMS.—
(1) 1 IN GENERAL.—The Secretary may carry out activities
to promote safe motherhood, including—
(A) public education campaigns on healthy pregnancies and the building of partnerships with outside organizations concerned about safe motherhood;
(B) education programs for physicians, nurses and
other health care providers; and
(C) activities to promote community support services
for pregnant women.
(d) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of
carrying out this section, there are authorized to be appropriated
such sums as may be necessary for each of the fiscal years 2001
through 2005.
PRENATAL AND POSTNATAL HEALTH

SEC. 317L. ø247b–13¿ (a) IN GENERAL.—The Secretary, acting
through the Director of the Centers for Disease Control and Prevention, shall carry out programs—
(1) to collect, analyze, and make available data on prenatal
smoking, alcohol and illegal drug use, including data on the
implications of such activities and on the incidence and prevalence of such activities and their implications;
1So in law. Subsection (c) does not contain a paragraph (2). See section 901 of Public Law
106–310 (114 Stat. 1126).

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(2) to conduct applied epidemiological research on the prevention of prenatal and postnatal smoking, alcohol and illegal
drug use;
(3) to support, conduct, and evaluate the effectiveness of
educational and cessation programs; and
(4) to provide information and education to the public on
the prevention and implications of prenatal and postnatal
smoking, alcohol and illegal drug use.
(b) GRANTS.—In carrying out subsection (a), the Secretary may
award grants to and enter into contracts with States, local governments, scientific and academic institutions, federally qualified
health centers, and other public and nonprofit entities, and may
provide technical and consultative assistance to such entities.
(c) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of
carrying out this section, there are authorized to be appropriated
such sums as may be necessary for each of the fiscal years 2001
through 2005.
ORAL HEALTH PROMOTION AND DISEASE PREVENTION
FOR

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SEC. 317M. ø247b–14¿ (a) GRANTS TO INCREASE RESOURCES
COMMUNITY WATER FLUORIDATION.—
(1) IN GENERAL.—The Secretary, acting through the Director of the Centers for Disease Control and Prevention, may
make grants to States and Indian tribes for the purpose of increasing the resources available for community water fluoridation.
(2) USE OF FUNDS.—A State shall use amounts provided
under a grant under paragraph (1)—
(A) to purchase fluoridation equipment;
(B) to train fluoridation engineers;
(C) to develop educational materials on the benefits of
fluoridation; or
(D) to support the infrastructure necessary to monitor
and maintain the quality of water fluoridation.
(b) COMMUNITY WATER FLUORIDATION.—
(1) IN GENERAL.—The Secretary, acting through the Director of the Centers for Disease Control and Prevention and in
collaboration with the Director of the Indian Health Service,
shall establish a demonstration project that is designed to assist rural water systems in successfully implementing the
water fluoridation guidelines of the Centers for Disease Control
and Prevention that are entitled ‘‘Engineering and Administrative Recommendations for Water Fluoridation, 1995’’ (referred
to in this subsection as the ‘‘EARWF’’).
(2) REQUIREMENTS.—
(A) COLLABORATION.—In collaborating under paragraph (1), the Directors referred to in such paragraph shall
ensure that technical assistance and training are provided
to tribal programs located in each of the 12 areas of the
Indian Health Service. The Director of the Indian Health
Service shall provide coordination and administrative support to tribes under this section.
(B) GENERAL USE OF FUNDS.—Amounts made available
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systems in improving the effectiveness of water fluoridation and to meet the recommendations of the EARWF.
(C) FLUORIDATION SPECIALISTS.—
(i) IN GENERAL.—In carrying out this subsection,
the Secretary shall provide for the establishment of
fluoridation specialist engineering positions in each of
the Dental Clinical and Preventive Support Centers
through which technical assistance and training will
be provided to tribal water operators, tribal utility operators and other Indian Health Service personnel
working directly with fluoridation projects.
(ii) LIAISON.—A fluoridation specialist shall serve
as the principal technical liaison between the Indian
Health Service and the Centers for Disease Control
and Prevention with respect to engineering and fluoridation issues.
(iii) CDC.—The Director of the Centers for Disease Control and Prevention shall appoint individuals
to serve as the fluoridation specialists.
(D) IMPLEMENTATION.—The project established under
this subsection shall be planned, implemented and evaluated over the 5-year period beginning on the date on which
funds are appropriated under this section and shall be designed to serve as a model for improving the effectiveness
of water fluoridation systems of small rural communities.
(3) EVALUATION.—In conducting the ongoing evaluation as
provided for in paragraph (2)(D), the Secretary shall ensure
that such evaluation includes—
(A) the measurement of changes in water fluoridation
compliance levels resulting from assistance provided under
this section;
(B) the identification of the administrative, technical
and operational challenges that are unique to the fluoridation of small water systems;
(C) the development of a practical model that may be
easily utilized by other tribal, State, county or local governments in improving the quality of water fluoridation
with emphasis on small water systems; and
(D) the measurement of any increased percentage of
Native Americans or Alaskan Natives who receive the benefits of optimally fluoridated water.
(c) SCHOOL-BASED DENTAL SEALANT PROGRAM.—
(1) IN GENERAL.—The Secretary, acting through the Director of the Centers for Disease Control and Prevention and in
collaboration with the Administrator of the Health Resources
and Services Administration, shall award a grant to each of
the 50 States and territories and to Indians, Indian tribes, tribal organizations and urban Indian organizations (as such
terms are defined in section 4 of the Indian Health Care Improvement Act) to provide for the development of school-based
dental sealant programs to improve the access of children to
sealants.
(2) USE OF FUNDS.—A State shall use amounts received
under a grant under paragraph (1) to provide funds to eligible
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school-based entities or to public elementary or secondary
schools to enable such entities or schools to provide children
with access to dental care and dental sealant services. Such
services shall be provided by licensed dental health professionals in accordance with State practice licensing laws.
(3) ELIGIBILITY.—To be eligible to receive funds under
paragraph (1), an entity shall—
(A) prepare and submit to the State an application at
such time, in such manner and containing such information as the State may require; and
(B) be a public elementary or secondary school—
(i) that is located in an urban area in which and
more than 50 percent of the student population is participating in Federal or State free or reduced meal programs; or
(ii) that is located in a rural area and, with respect to the school district in which the school is located, the district involved has a median income that
is at or below 235 percent of the poverty line, as defined in section 673(2) of the Community Services
Block Grant Act (42 U.S.C. 9902(2)).
(d) ORAL HEALTH INFRASTRUCTURE.—
(1) COOPERATIVE AGREEMENTS.—The Secretary, acting
through the Director of the Centers for Disease Control and
Prevention, shall enter into cooperative agreements with State,
territorial, and Indian tribes or tribal organizations (as those
terms are defined in section 4 of the Indian Health Care Improvement Act) to establish oral health leadership and program guidance, oral health data collection and interpretation,
(including determinants of poor oral health among vulnerable
populations), a multi-dimensional delivery system for oral
health, and to implement science-based programs (including
dental sealants and community water fluoridation) to improve
oral health.
(2) AUTHORIZATION OF APPROPRIATIONS.—There is authorized to be appropriated such sums as necessary to carry out
this subsection for fiscal years 2010 through 2014.
(e) DEFINITIONS.—For purposes of this section, the term ‘‘Indian tribe’’ means an Indian tribe or tribal organization as defined
in section 4(b) and section 4(c) of the Indian Self-Determination
and Education Assistance Act.
(f) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of
carrying out this section, there are authorized to be appropriated
such sums as may be necessary for each of the fiscal years 2001
through 2005.
SURVEILLANCE AND EDUCATION REGARDING HEPATITIS C VIRUS

SEC. 317N. ø247b–15¿ (a) IN GENERAL.—The Secretary, acting
through the Director of the Centers for Disease Control and Prevention, may (directly and through grants to public and nonprofit
private entities) provide for programs to carry out the following:
(1) To cooperate with the States in implementing a national system to determine the incidence of hepatitis C virus
infection (in this section referred to as ‘‘HCV infection’’) and to
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assist the States in determining the prevalence of such infection, including the reporting of chronic HCV cases.
(2) To identify, counsel, and offer testing to individuals
who are at risk of HCV infection as a result of receiving blood
transfusions prior to July 1992, or as a result of other risk factors.
(3) To provide appropriate referrals for counseling, testing,
and medical treatment of individuals identified under paragraph (2) and to ensure, to the extent practicable, the provision
of appropriate follow-up services.
(4) To develop and disseminate public information and
education programs for the detection and control of HCV infection, with priority given to high risk populations as determined
by the Secretary.
(5) To improve the education, training, and skills of health
professionals in the detection and control of HCV infection,
with priority given to pediatricians and other primary care
physicians, and obstetricians and gynecologists.
(b) LABORATORY PROCEDURES.—The Secretary may (directly
and through grants to public and nonprofit private entities) carry
out programs to provide for improvements in the quality of clinicallaboratory procedures regarding hepatitis C, including reducing
variability in laboratory results on hepatitis C antibody and PCR
testing.
(c) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of
carrying out this section, there are authorized to be appropriated
such sums as may be necessary for each of the fiscal years 2001
through 2005.
GRANTS FOR LEAD POISONING RELATED ACTIVITIES

SEC. 317O. ø247b–16¿ (a) AUTHORITY TO MAKE GRANTS.—
(1) IN GENERAL.—The Secretary shall make grants to
States to support public health activities in States and localities where data suggests that at least 5 percent of preschoolage children have an elevated blood lead level through—
(A) effective, ongoing outreach and community education targeted to families most likely to be at risk for lead
poisoning;
(B) individual family education activities that are designed to reduce ongoing exposures to lead for children
with elevated blood lead levels, including through home
visits and coordination with other programs designed to
identify and treat children at risk for lead poisoning; and
(C) the development, coordination and implementation
of community-based approaches for comprehensive lead
poisoning prevention from surveillance to lead hazard control.
(2) STATE MATCH.—A State is not eligible for a grant under
this section unless the State agrees to expend (through State
or local funds) $1 for every $2 provided under the grant to
carry out the activities described in paragraph (1).
(3) APPLICATION.—To be eligible to receive a grant under
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retary in such form and manner and containing such information as the Secretary may require.
(b) COORDINATION WITH OTHER CHILDREN’S PROGRAMS.—A
State shall identify in the application for a grant under this section
how the State will coordinate operations and activities under the
grant with—
(1) other programs operated in the State that serve children with elevated blood lead levels, including any such programs operated under title V, XIX, or XXI of the Social Security Act; and
(2) one or more of the following—
(A) the child welfare and foster care and adoption assistance programs under parts B and E of title IV of such
Act;
(B) the head start program established under the
Head Start Act (42 U.S.C. 9831 et seq.);
(C) the program of assistance under the special supplemental nutrition program for women, infants and children (WIC) under section 17 of the Child Nutrition Act of
1966 (42 U.S.C. 1786);
(D) local public and private elementary or secondary
schools; or
(E) public housing agencies, as defined in section 3 of
the United States Housing Act of 1937 (42 U.S.C. 1437a).
(c) PERFORMANCE MEASURES.—The Secretary shall establish
needs indicators and performance measures to evaluate the activities carried out under grants awarded under this section. Such indicators shall be commensurate with national measures of maternal and child health programs and shall be developed in consultation with the Director of the Centers for Disease Control and Prevention.
(d) AUTHORIZATION OF APPROPRIATIONS.—There are authorized
to be appropriated to carry out this section such sums as may be
necessary for each of the fiscal years 2001 through 2005.
HUMAN PAPILLOMAVIRUS

(johanna’s law) 1

SEC. 317P. ø247b–17¿ (a) SURVEILLANCE .—
(1) IN GENERAL.—The Secretary, acting through the Centers for Disease Control and Prevention, shall—
(A) enter into cooperative agreements with States and
other entities to conduct sentinel surveillance or other special studies that would determine the prevalence in various age groups and populations of specific types of human
papillomavirus (referred to in this section as ‘‘HPV’’) in different sites in various regions of the United States,
through collection of special specimens for HPV using a variety of laboratory-based testing and diagnostic tools; and
(B) develop and analyze data from the HPV sentinel
surveillance system described in subparagraph (A).
1 The typeface of the parenthetical matter in the section heading probably should appear in
light face and all small caps.

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(2) REPORT.—The Secretary shall make a progress report
to the Congress with respect to paragraph (1) no later than 1
year after the effective date of this section.
(b) PREVENTION ACTIVITIES; EDUCATION PROGRAM.—
(1) IN GENERAL.—The Secretary, acting through the Centers for Disease Control and Prevention, shall conduct prevention research on HPV, including—
(A) behavioral and other research on the impact of
HPV-related diagnosis on individuals;
(B) formative research to assist with the development
of educational messages and information for the public, for
patients, and for their partners about HPV;
(C) surveys of physician and public knowledge, attitudes, and practices about genital HPV infection; and
(D) upon the completion of and based on the findings
under subparagraphs (A) through (C), develop and disseminate educational materials for the public and health
care providers regarding HPV and its impact and prevention.
(2) REPORT; FINAL PROPOSAL.—The Secretary shall make a
progress report to the Congress with respect to paragraph (1)
not later than 1 year after the effective date of this section,
and shall develop a final report not later than 3 years after
such effective date, including a detailed summary of the significant findings and problems and the best strategies to prevent
future infections, based on available science.
(c) HPV EDUCATION AND PREVENTION.—
(1) IN GENERAL.—The Secretary shall prepare and distribute educational materials for health care providers and the
public that include information on HPV. Such materials shall
address—
(A) modes of transmission;
(B) consequences of infection, including the link between HPV and cervical cancer;
(C) the available scientific evidence on the effectiveness or lack of effectiveness of condoms in preventing infection with HPV; and
(D) the importance of regular Pap smears, and other
diagnostics for early intervention and prevention of cervical cancer purposes in preventing cervical cancer.
(2) MEDICALLY ACCURATE INFORMATION.—Educational material under paragraph (1), and all other relevant educational
and prevention materials prepared and printed from this date
forward for the public and health care providers by the Secretary (including materials prepared through the Food and
Drug Administration, the Centers for Disease Control and Prevention, and the Health Resources and Services Administration), or by contractors, grantees, or subgrantees thereof, that
are specifically designed to address STDs including HPV shall
contain medically accurate information regarding the effectiveness or lack of effectiveness of condoms in preventing the STD
the materials are designed to address. Such requirement only
applies to materials mass produced for the public and health
care providers, and not to routine communications.
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(d) JOHANNA’S LAW.—
(1) NATIONAL PUBLIC AWARENESS CAMPAIGN.—
(A) IN GENERAL.—The Secretary shall carry out a national campaign to increase the awareness and knowledge
of health care providers and women with respect to
gynecologic cancers.
(B) WRITTEN MATERIALS.—Activities under the national campaign under subparagraph (A) shall include—
(i) maintaining a supply of written materials that
provide information to the public on gynecologic cancers; and
(ii) distributing the materials to members of the
public upon request.
(C) PUBLIC SERVICE ANNOUNCEMENTS.—Activities
under the national campaign under subparagraph (A)
shall, in accordance with applicable law and regulations,
include developing and placing, in telecommunications
media, public service announcements intended to encourage women to discuss with their physicians their risks of
gynecologic cancers. Such announcements shall inform the
public on the manner in which the written materials referred to in subparagraph (B) can be obtained upon request, and shall call attention to early warning signs and
risk factors based on the best available medical information.
(2) REPORT AND STRATEGY.—
(A) REPORT.—Not later than 6 months after the date
of the enactment of this subsection, the Secretary shall
submit to the Congress a report including the following:
(i) A description of the past and present activities
of the Department of Health and Human Services to
increase awareness and knowledge of the public with
respect to different types of cancer, including
gynecologic cancers.
(ii) A description of the past and present activities
of the Department of Health and Human Services to
increase awareness and knowledge of health care providers with respect to different types of cancer, including gynecologic cancers.
(iii) For each activity described pursuant to clause
(i) or (ii), a description of the following:
(I) The funding for such activity for fiscal year
2006 and the cumulative funding for such activity
for previous fiscal years.
(II) The background and history of such activity, including—
(aa) the goals of such activity;
(bb) the communications objectives of
such activity;
(cc) the identity of each agency within the
Department of Health and Human Services
responsible for any aspect of the activity; and
(dd) how such activity is or was expected
to result in change.
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(III) How long the activity lasted or is expected to last.
(IV) The outcomes observed and the evaluation methods, if any, that have been, are being, or
will be used with respect to such activity.
(V) For each such outcome or evaluation
method, a description of the associated results,
analyses, and conclusions.
(B) STRATEGY.—
(i) DEVELOPMENT; SUBMISSION TO CONGRESS.—Not
later than 3 months after submitting the report required by subparagraph (A), the Secretary shall develop and submit to the Congress a strategy for improving efforts to increase awareness and knowledge
of the public and health care providers with respect to
different types of cancer, including gynecological cancers.
(ii) CONSULTATION.—In developing the strategy
under clause (i), the Secretary should consult with
qualified private sector groups, including nonprofit organizations.
(3) FULL COMPLIANCE.—
(A) IN GENERAL.—Not later than March 1, 2008, the
Secretary shall ensure that all provisions of this section,
including activities directed to be carried out by the Centers for Disease Control and Prevention and the Food and
Drug Administration, are fully implemented and being
complied with. Not later than April 30, 2008, the Secretary
shall submit to Congress a report that certifies compliance
with the preceding sentence and that contains a description of all activities undertaken to achieve such compliance.
(B) If the Secretary fails to submit the certification as
provided for under subparagraph (A), the Secretary shall,
not later than 3 months after the date on which the report
is to be submitted under subparagraph (A), and every 3
months thereafter, submit to Congress an explanation as
to why the Secretary has not yet complied with the first
sentence of subparagraph (A), a detailed description of all
actions undertaken within the month for which the report
is being submitted to bring the Secretary into compliance
with such sentence, and the anticipated date the Secretary
expects to be in full compliance with such sentence.
(4) CONSULTATION WITH NONPROFIT GYNECOLOGIC CANCER
ORGANIZATIONS.—In carrying out the national campaign under
this subsection, the Secretary shall consult with nonprofit
gynecologic cancer organizations, with a mission both to conquer ovarian or other gynecologic cancer and to provide outreach to State and local governments and communities, for the
purpose of determining the best practices for providing
gynecologic cancer information and outreach services to varied
populations.
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(6) 1 AUTHORIZATION OF APPROPRIATIONS.—For the purpose
of carrying out this subsection, there is authorized to be appropriated $16,500,000 for the period of fiscal years 2007 through
2009 and $18,000,000 for the period of fiscal years 2012
through 2014.
SEC. 317Q. ø247b–18¿ SURVEILLANCE AND RESEARCH REGARDING
MUSCULAR DYSTROPHY.
(a) IN GENERAL.—The Secretary, acting through the Director of

the Centers for Disease Control and Prevention, may award grants
and cooperative agreements to public or nonprofit private entities
(including health departments of States and political subdivisions
of States, and including universities and other educational entities)
for the collection, analysis, and reporting of data on Duchenne and
other forms of muscular dystrophy. In making such awards, the
Secretary may provide direct technical assistance in lieu of cash.
(b) NATIONAL MUSCULAR DYSTROPHY EPIDEMIOLOGY PROGRAM.—The Secretary, acting through the Director of the Centers
for Disease Control and Prevention, may award grants to public or
nonprofit private entities (including health departments of States
and political subdivisions of States, and including universities and
other educational entities) for the purpose of carrying out epidemiological activities regarding Duchenne and other forms of muscular
dystrophies, including collecting and analyzing information on the
number, incidence, correlates, and symptoms of cases. In carrying
out the preceding sentence, the Secretary shall provide for a national surveillance program. In making awards under this subsection, the Secretary may provide direct technical assistance in
lieu of cash.
(c) COORDINATION WITH CENTERS OF EXCELLENCE.—The Secretary shall ensure that epidemiological information under subsections (a) and (b) is made available to centers of excellence supported under section 404E(b) by the Director of the National Institutes of Health.
(d) DATA.—In carrying out this section, the Secretary may ensure that any data on patients that is collected as part of the Muscular Dystrophy STARnet (under a grant under this section) is regularly updated to reflect changes in patient condition over time.
(e) REPORTS AND STUDY.—
(1) ANNUAL REPORT.—Not later than 18 months after the
date of the enactment of the Paul D. Wellstone Muscular Dystrophy Community Assistance, Research, and Education
Amendments of 2008, and annually thereafter, the Director of
the Centers for Disease Control and Prevention shall submit to
the appropriate committees of the Congress a report—
(A) concerning the activities carried out by MD
STARnet site 1 funded under this section during the year
for which the report is prepared;
(B) containing the data collected and findings derived
from the MD STARnet sites each fiscal year (as funded
under a grant under this section during fiscal years 2008
through 2012); and
1 So
1 So

March 13, 2013

in law. There is no paragraph (5).
in law. The term ‘‘site’’ probably should be ‘‘sites’’.

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(C) that every 2 years outlines prospective data collection objectives and strategies.
(2) TRACKING HEALTH OUTCOMES.—The Secretary may provide health outcome data on the health and survival of people
with muscular dystrophy.
(f) AUTHORIZATION OF APPROPRIATIONS.—There are authorized
to be appropriated such sums as may be necessary to carry out this
section.
SEC. 317R. ø247b–20¿ FOOD SAFETY GRANTS.
(a) IN GENERAL.—The Secretary may

award grants to States
and Indian tribes (as defined in section 4(e) of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450b(e))) to
expand participation in networks to enhance Federal, State, and
local food safety efforts, including meeting the costs of establishing
and maintaining the food safety surveillance, technical, and laboratory capacity needed for such participation.
(b) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of
carrying out this section, there are authorized to be appropriated
$19,500,000 for fiscal year 2010, and such sums as may be necessary for each of the fiscal years 2011 through 2015.
SEC. 317S. ø247b–21¿ MOSQUITO-BORNE DISEASES; COORDINATION
GRANTS TO STATES; ASSESSMENT AND CONTROL GRANTS
TO POLITICAL SUBDIVISIONS.
(a) COORDINATION GRANTS TO STATES; ASSESSMENT GRANTS TO
POLITICAL SUBDIVISIONS.—
(1) IN GENERAL.—With respect to mosquito control pro-

grams to prevent and control mosquito-borne diseases (referred
to in this section as ‘‘control programs’’), the Secretary, acting
through the Director of the Centers for Disease Control and
Prevention, may make grants to States for the purpose of—
(A) coordinating control programs in the State involved; and
(B) assisting such State in making grants to political
subdivisions of the State to conduct assessments to determine the immediate needs in such subdivisions for control
programs, and to develop, on the basis of such assessments, plans for carrying out control programs in the subdivisions.
(2) PREFERENCE IN MAKING GRANTS.—In making grants
under paragraph (1), the Secretary shall give preference to
States that have one or more political subdivisions with an incidence, prevalence, or high risk of mosquito-borne disease, or
a population of infected mosquitoes, that is substantial relative
to political subdivisions in other States.
(3) CERTAIN REQUIREMENTS.—A grant may be made under
paragraph (1) only if—
(A) the State involved has developed, or agrees to develop, a plan for coordinating control programs in the
State, and the plan takes into account any assessments or
plans described in subsection (b)(3) that have been conducted or developed, respectively, by political subdivisions
in the State;
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(B) in developing such plan, the State consulted or will
consult (as the case may be under subparagraph (A)) with
political subdivisions in the State that are carrying out or
planning to carry out control programs;
(C) the State agrees to monitor control programs in
the State in order to ensure that the programs are carried
out in accordance with such plan, with priority given to coordination of control programs in political subdivisions described in paragraph (2) that are contiguous;
(D) the State agrees that the State will make grants
to political subdivisions as described in paragraph (1)(B),
and that such a grant will not exceed $10,000; and
(E) the State agrees that the grant will be used to supplement, and not supplant, State and local funds available
for the purpose described in paragraph (1).
(4) REPORTS TO SECRETARY.—A grant may be made under
paragraph (1) only if the State involved agrees that, promptly
after the end of the fiscal year for which the grant is made, the
State will submit to the Secretary a report that—
(A) describes the activities of the State under the
grant; and
(B) contains an evaluation of whether the control programs of political subdivisions in the State were effectively
coordinated with each other, which evaluation takes into
account any reports that the State received under subsection (b)(5) from such subdivisions.
(5) NUMBER OF GRANTS.—A State may not receive more
than one grant under paragraph (1).
(b) PREVENTION AND CONTROL GRANTS TO POLITICAL SUBDIVISIONS.—
(1) IN GENERAL.—The Secretary, acting through the Director of the Centers for Disease Control and Prevention, may
make grants to political subdivisions of States or consortia of
political subdivisions of States, for the operation of control programs.
(2) PREFERENCE IN MAKING GRANTS.—In making grants
under paragraph (1), the Secretary shall give preference to a
political subdivision or consortium of political subdivisions
that—
(A) has—
(i) a history of elevated incidence or prevalence of
mosquito-borne disease;
(ii) a population of infected mosquitoes; or
(iii) met criteria determined by the Secretary to
suggest an increased risk of elevated incidence or
prevalence of mosquito-borne disease in the pending
fiscal year;
(B) demonstrates to the Secretary that such political
subdivision or consortium of political subdivisions will, if
appropriate to the mosquito circumstances involved, effectively coordinate the activities of the control programs
with contiguous political subdivisions;
(C) demonstrates to the Secretary (directly or through
State officials) that the State in which such a political subMarch 13, 2013

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division or consortium of political subdivisions is located
has identified or will identify geographic areas in such
State that have a significant need for control programs
and will effectively coordinate such programs in such
areas; and
(D) is located in a State that has received a grant
under subsection (a).
(3) REQUIREMENT OF ASSESSMENT AND PLAN.—A grant may
be made under paragraph (1) only if the political subdivision
or consortium of political subdivisions involved—
(A) has conducted an assessment to determine the immediate needs in such subdivision or consortium for a control program, including an entomological survey of potential mosquito breeding areas; and
(B) has, on the basis of such assessment, developed a
plan for carrying out such a program.
(4) REQUIREMENT OF MATCHING FUNDS.—
(A) IN GENERAL.—With respect to the costs of a control
program to be carried out under paragraph (1) by a political subdivision or consortium of political subdivisions, a
grant under such paragraph may be made only if the subdivision or consortium agrees to make available (directly
or through donations from public or private entities) nonFederal contributions toward such costs in an amount that
is not less than 1⁄3 of such costs ($1 for each $2 of Federal
funds provided in the grant).
(B) DETERMINATION OF AMOUNT CONTRIBUTED.—NonFederal contributions required in subparagraph (A) may be
in cash or in kind, fairly evaluated, including plant, equipment, or services. Amounts provided by the Federal Government, or services assisted or subsidized to any significant extent by the Federal Government, may not be included in determining the amount of such non-Federal contributions.
(C) WAIVER.—The Secretary may waive the requirement established in subparagraph (A) if the Secretary determines that extraordinary economic conditions in the political subdivision or consortium of political subdivisions
involved justify the waiver.
(5) REPORTS TO SECRETARY.—A grant may be made under
paragraph (1) only if the political subdivision or consortium of
political subdivisions involved agrees that, promptly after the
end of the fiscal year for which the grant is made, the subdivision or consortium will submit to the Secretary, and to the
State within which the subdivision or consortium is located, a
report that describes the control program and contains an evaluation of whether the program was effective.
(6) AMOUNT OF GRANT; NUMBER OF GRANTS.—
(A) AMOUNT OF GRANT.—
(i) SINGLE POLITICAL SUBDIVISION.—A grant under
paragraph (1) awarded to a political subdivision for a
fiscal year may not exceed $100,000.
(ii) CONSORTIUM.—A grant under paragraph (1)
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sions may not exceed $110,000 for each political subdivision. A consortium is not required to provide
matching funds under paragraph (4) for any amounts
received by such consortium in excess of amounts each
political subdivision would have received separately.
(iii) WAIVER OF REQUIREMENT.—A grant may exceed the maximum amount in clause (i) or (ii) if the
Secretary determines that the geographical area covered by a political subdivision or consortium awarded
a grant under paragraph (1) has an extreme need due
to the size or density of—
(I) the human population in such geographical
area; or
(II) the mosquito population in such geographical area.
(B) NUMBER OF GRANTS.—A political subdivision or a
consortium of political subdivisions may not receive more
than one grant under paragraph (1).
(c) APPLICATIONS FOR GRANTS.—A grant may be made under
subsection (a) or (b) only if an application for the grant is submitted to the Secretary and the application is in such form, is
made in such manner, and contains such agreements, assurances,
and information as the Secretary determines to be necessary to
carry out this section.
(d) TECHNICAL ASSISTANCE.—Amounts appropriated under subsection (f) may be used by the Secretary to provide training and
technical assistance with respect to the planning, development, and
operation of assessments and plans under subsection (a) and control programs under subsection (b). The Secretary may provide
such technical assistance directly or through awards of grants or
contracts to public and private entities.
(e) DEFINITION OF POLITICAL SUBDIVISION.—In this section, the
term ‘‘political subdivision’’ means the local political jurisdiction
immediately below the level of State government, including counties, parishes, and boroughs. If State law recognizes an entity of
general government that functions in lieu of, and is not within, a
county, parish, or borough, the Secretary may recognize an area
under the jurisdiction of such other entities of general government
as a political subdivision for purposes of this section.
(f) AUTHORIZATION OF APPROPRIATIONS.—
(1) IN GENERAL.—For the purpose of carrying out this section, there are authorized to be appropriated $100,000,000 for
fiscal year 2003, and such sums as may be necessary for each
of fiscal years 2004 through 2007.
(2) PUBLIC HEALTH EMERGENCIES.—In the case of control
programs carried out in response to a mosquito-borne disease
that constitutes a public health emergency, the authorization
of appropriations under paragraph (1) is in addition to applicable authorizations of appropriations under the Public Health
Security and Bioterrorism Preparedness and Response Act of
2002.
(3) FISCAL YEAR 2004 APPROPRIATIONS.—For fiscal year
2004, 50 percent or more of the funds appropriated under paraMarch 13, 2013

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graph (1) shall be used to award grants to political subdivisions or consortia of political subdivisions under subsection (b).
SEC. 317T. ø247b–22¿ MICROBICIDE RESEARCH.
(a) IN GENERAL.—The Director of the Centers

for Disease Control and Prevention is strongly encouraged to fully implement the
Centers’ microbicide agenda to support research and development
of microbicides for use to prevent the transmission of the human
immunodeficiency virus.
(b) AUTHORIZATION OF APPROPRIATIONS.—There are authorized
to be appropriated such sums as may be necessary for each of fiscal
years 2009 through 2013 to carry out this section.
PROJECTS AND PROGRAMS FOR THE PREVENTION AND CONTROL OF
SEXUALLY TRANSMITTED DISEASES 1

SEC. 318. ø247c¿ (a) The Secretary may provide technical assistance to appropriate public and non-profit private entities and to
scientific institutions for their research in, and training and public
health programs for the prevention and control of sexually transmitted diseases.
(b) The Secretary may make grants to States, political subdivisions of States, and any other public and nonprofit private entity
for—
(1) research into the prevention and control of sexually
transmitted diseases;
(2) demonstration projects for the prevention and control of
sexually transmitted diseases;
(3) public information and education programs for the prevention and control of such diseases; and
(4) education, training, and clinical skills improvement activities in the prevention and control of such diseases for
health professionals (including allied health personnel).
(c) The Secretary is also authorized to make project grants to
States and, in consultation with the State health authority, to political subdivisions of States, for—
(1) sexually transmitted diseases surveillance activities, including the reporting, screening, and followup of diagnostic
tests for, and diagnosed cases of, sexually transmitted diseases;
(2) casefinding and case followup activities respecting sexually transmitted diseases, including contact tracing of infectious cases of sexually transmitted diseases and routine testing, including laboratory tests and followup systems;
(3) interstate epidemiologic referral and followup activities
respecting sexually transmitted diseases; and
1 Title II of Public Law 103–333, an appropriations Act, provides (under the heading relating
to the Centers for Disease Control and Prevention; see 108 Stat. 2550) in part as follows: ‘‘That
funds appropriated under this heading for fiscal year 1995 and subsequent fiscal years shall be
available for payment of the costs of medical care, related expenses, and burial expenses hereafter incurred by or on behalf of any person who had participated in the study of untreated
syphilis initiated in Tuskegee, Alabama, in 1932, in such amounts and subject to such terms
and conditions as prescribed by the Secretary of Health and Human Services and for payment,
in such amounts and subject to such terms and conditions, of such costs and expenses hereafter
incurred by or on behalf of such person’s wife or offspring determined by the Secretary to have
suffered injury or disease from syphilis contracted from such person’’.

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(4) such special studies or demonstrations to evaluate or
test sexually transmitted diseases prevention and control strategies and activities as may be prescribed by the Secretary.
(d) The Secretary may make grants to States and political subdivisions of States for the development, implementation, and evaluation of innovative, interdisciplinary approaches to the prevention
and control of sexually transmitted diseases.
(e)(1) For the purpose of making grants under subsections (b)
through (d), there are authorized to be appropriated $85,000,000
for fiscal year 1994, and such sums as may be necessary for each
of the fiscal years 1995 through 1998.
(2) Each recipient of a grant under this section shall keep such
records as the Secretary shall prescribe including records which
fully disclose the amount and disposition by such recipient of the
proceeds of such grant, the total cost of the project or undertaking
in connection with which such grant was given or used and the
amount of that portion of the cost of the project or undertaking
supplied by other sources, and such other records as will facilitate
an effective audit.
(3) The Secretary and the Comptroller General of the United
States, or any of their duly authorized representatives, shall have
access for the purpose of audit and examination to any books, documents, papers, and records of the recipients of grants under this
section that are pertinent to such grants.
(4) The Secretary, at the request of a recipient of a grant under
this section, may reduce such grant by the fair market value of any
supplies or equipment furnished to such recipient and by the
amount of pay, allowances, travel expenses, and any other costs in
connection with the detail of an officer or employee of the United
States to the recipient when the furnishing of such supplies or
equipment or the detail of such an officer or employee is for the
convenience of and at the request of such recipient and for the purpose of carrying out the program with respect to which the grant
under this section is made. The amount by which any such grant
is so reduced shall be available for payment by the Secretary of the
costs incurred in furnishing the supplies, equipment, or personal
services on which the reduction of such grant is based.
(5) All information obtained in connection with the examination, care, or treatment of any individual under any program which
is being carried out with a grant made under this section shall not,
without such individual’s consent, be disclosed except as may be
necessary to provide service to him or as may be required by a law
of a State or political subdivision of a State. Information derived
from any such program may be disclosed—
(A) in summary, statistical, or other form; or
(B) for clinical or research purposes;
but only if the identity of the individuals diagnosed or provided
care or treatment under such program is not disclosed.
(f) Nothing in this section shall be construed to require any
State or any political subdivision of a State to have a sexually
transmitted diseases program which would require any person,
who objects to any treatment provided under such a program, to be
treated under such a program.
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INFERTILITY AND SEXUALLY TRANSMITTED DISEASES

SEC. 318A. ø247c–1¿ (a) IN GENERAL.—The Secretary, acting
through the Director of the Centers for Disease Control and Prevention, may make grants to States, political subdivisions of
States, and other public or nonprofit private entities for the purpose of carrying out the activities described in subsection (c) regarding any treatable sexually transmitted disease that can cause
infertility in women if treatment is not received for the disease.
(b) AUTHORITY REGARDING INDIVIDUAL DISEASES.—With respect to diseases described in subsection (a), the Secretary shall, in
making a grant under such subsection, specify the particular disease or diseases with respect to which the grant is to be made. The
Secretary may not make the grant unless the applicant involved
agrees to carry out this section only with respect to the disease or
diseases so specified.
(c) AUTHORIZED ACTIVITIES.—With respect to any sexually
transmitted disease described in subsection (a), the activities referred to in such subsection are—
(1) screening women for the disease and for secondary conditions resulting from the disease, subject to compliance with
criteria issued under subsection (f);
(2) providing treatment to women for the disease;
(3) providing counseling to women on the prevention and
control of the disease (including, in the case of a woman with
the disease, counseling on the benefits of locating and providing such counseling to any individual from whom the
woman may have contracted the disease and any individual
whom the woman may have exposed to the disease);
(4) providing follow-up services;
(5) referrals for necessary medical services for women
screened pursuant to paragraph (1), including referrals for
evaluation and treatment with respect to acquired immune deficiency syndrome and other sexually transmitted diseases;
(6) in the case of any woman receiving services pursuant
to any of paragraphs (1) through (5), providing to the partner
of the woman the services described in such paragraphs, as appropriate;
(7) providing outreach services to inform women of the
availability of the services described in paragraphs (1) through
(6);
(8) providing to the public information and education on
the prevention and control of the disease, including disseminating such information; and
(9) providing training to health care providers in carrying
out the screenings and counseling described in paragraphs (1)
and (3).
(d) REQUIREMENT OF AVAILABILITY OF ALL SERVICES THROUGH
EACH GRANTEE.—The Secretary may make a grant under subsection (a) only if the applicant involved agrees that each activity
authorized in subsection (c) will be available through the applicant.
With respect to compliance with such agreement, the applicant
may expend the grant to carry out any of the activities directly,
and may expend the grant to enter into agreements with other
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public or nonprofit private entities under which the entities carry
out the activities.
(e) REQUIRED PROVIDERS REGARDING CERTAIN SERVICES.—The
Secretary may make a grant under subsection (a) only if the applicant involved agrees that, in expending the grant to carry out activities authorized in subsection (c), the services described in paragraphs (1) through (7) of such subsection will be provided only
through entities that are State or local health departments, grantees under section 329, 330, 340A, or 1001, or are other public or
nonprofit private entities that provide health services to a significant number of low-income women.
(f) QUALITY ASSURANCE REGARDING SCREENING FOR DISEASES.—For purposes of this section, the Secretary shall establish
criteria for ensuring the quality of screening procedures for diseases described in subsection (a).
(g) CONFIDENTIALITY.—The Secretary may make a grant under
subsection (a) only if the applicant involved agrees, subject to applicable law, to maintain the confidentiality of information on individuals with respect to activities carried out under subsection (c).
(h) LIMITATION ON IMPOSITION OF FEES FOR SERVICES.—The
Secretary may make a grant under subsection (a) only if the applicant involved agrees that, if a charge is imposed for the provision
of services or activities under the grant, such charge—
(1) will be made according to a schedule of charges that is
made available to the public;
(2) will be adjusted to reflect the income of the individual
involved; and
(3) will not be imposed on any individual with an income
of less than 150 percent of the official poverty line, as established by the Director of the Office of Management and Budget
and revised by the Secretary in accordance with section 673(2)
of the Omnibus Budget Reconciliation Act of 1981.
(i) LIMITATIONS ON CERTAIN EXPENDITURES.—The Secretary
may make a grant under subsection (a) only if the applicant involved agrees that not less than 80 percent of the grant will be expended for the purpose of carrying out paragraphs (1) through (7)
of subsection (c).
(j) REPORTS TO SECRETARY.—
(1) COLLECTION OF DATA.—The Secretary may make a
grant under subsection (a) only if the applicant involved
agrees, with respect to any disease selected under subsection
(b) for the applicant, to submit to the Secretary, for each fiscal
year for which the applicant receives such a grant, a report
providing—
(A) the incidence of the disease among the population
of individuals served by the applicant;
(B) the number and demographic characteristics of individuals in such population;
(C) the types of interventions and treatments provided
by the applicant, and the health conditions with respect to
which referrals have been made pursuant to subsection
(c)(5);
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(D) an assessment of the extent to which the activities
carried pursuant to subsection (a) have reduced the incidence of infertility in the geographic area involved; and
(E) such other information as the Secretary may require with respect to the project carried out with the
grant.
(2) UTILITY AND COMPARABILITY OF DATA.—The Secretary
shall carry out activities for the purpose of ensuring the utility
and comparability of data collected pursuant to paragraph (1).
(k) MAINTENANCE OF EFFORT.—With respect to activities for
which a grant under subsection (a) is authorized to be expended,
the Secretary may make such a grant only if the applicant involved
agrees to maintain expenditures of non-Federal amounts for such
activities at a level that is not less than the average level of such
expenditures maintained by the applicant for the 2-year period preceding the fiscal year for which the applicant is applying to receive
such a grant.
(l) REQUIREMENT OF APPLICATION.—
(1) IN GENERAL.—The Secretary may make a grant under
subsection (a) only if an application for the grant is submitted
to the Secretary, the application contains the plan required in
paragraph (2), and the application is in such form, is made in
such manner, and contains such agreements, assurances, and
information as the Secretary determines to be necessary to
carry out this section.
(2) SUBMISSION OF PLAN FOR PROGRAM OF GRANTEE.—
(A) IN GENERAL.—The Secretary may make a grant
under subsection (a) only if the applicant involved submits
to the Secretary a plan describing the manner in which the
applicant will comply with the agreements required as a
condition of receiving such a grant, including a specification of the entities through which activities authorized in
subsection (c) will be provided.
(B) PARTICIPATION OF CERTAIN ENTITIES.—The Secretary may make a grant under subsection (a) only if the
applicant provides assurances satisfactory to the Secretary
that the plan submitted under subparagraph (A) has been
prepared in consultation with an appropriate number and
variety of—
(i) representatives of entities in the geographic
area involved that provide services for the prevention
and control of sexually transmitted diseases, including
programs to provide to the public information and education regarding such diseases; and
(ii) representatives of entities in such area that
provide family planning services.
(m) DURATION OF GRANT.—The period during which payments
are made to an entity from a grant under subsection (a) may not
exceed 3 years. The provision of such payments shall be subject to
annual approval by the Secretary of the payments and subject to
the availability of appropriations for the fiscal year involved to
make the payments in such year. The preceding sentence may not
be construed to establish a limitation on the number of grants
under such subsection that may be made to an entity.
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(n) TECHNICAL ASSISTANCE, AND SUPPLIES AND SERVICES IN
LIEU OF GRANT FUNDS.—
(1) TECHNICAL ASSISTANCE.—The Secretary may provide
training and technical assistance to grantees under subsection
(a) with respect to the planning, development, and operation of
any program or service carried out under such subsection. The
Secretary may provide such technical assistance directly or
through grants or contracts.
(2) SUPPLIES, EQUIPMENT, AND EMPLOYEE DETAIL.—The
Secretary, at the request of a recipient of a grant under subsection (a), may reduce the amount of such grant by—
(A) the fair market value of any supplies or equipment
furnished the grant recipient; and
(B) the amount of the pay, allowances, and travel expenses of any officer or employee of the Government when
detailed to the grant recipient and the amount of any
other costs incurred in connection with the detail of such
officer or employee;
when the furnishing of such supplies or equipment or the detail of such an officer or employee is for the convenience of and
at the request of such grant recipient and for the purpose of
carrying out a program with respect to which the grant under
subsection (a) is made. The amount by which any such grant
is so reduced shall be available for payment by the Secretary
of the costs incurred in furnishing the supplies or equipment,
or in detailing the personnel, on which the reduction of such
grant is based, and such amount shall be deemed as part of the
grant and shall be deemed to have been paid to the grant recipient.
(o) EVALUATIONS AND REPORTS BY SECRETARY.—
(1) EVALUATIONS.—The Secretary shall, directly or through
contracts with public or private entities, provide for annual
evaluations of programs carried out pursuant to subsection (a)
in order to determine the quality and effectiveness of the programs.
(2) REPORT TO CONGRESS.—Not later than 1 year after the
date on which amounts are first appropriated pursuant to subsection (q), and biennially thereafter, the Secretary shall submit to the Committee on Energy and Commerce of the House
of Representatives, and to the Committee on Labor and
Human Resources of the Senate, a report—
(A) summarizing the information provided to the Secretary in reports made pursuant to subsection (j)(1), including information on the incidence of sexually transmitted diseases described in subsection (a); and
(B) summarizing evaluations carried out pursuant to
paragraph (1) during the preceding fiscal year.
(p) COORDINATION OF FEDERAL PROGRAMS.—The Secretary
shall coordinate the program carried out under this section with
any similar programs administered by the Secretary (including coordination between the Director of the Centers for Disease Control
and Prevention and the Director of the National Institutes of
Health).
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(q) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of
carrying out this section, other than subsections (o) and (r), there
are authorized to be appropriated $25,000,000 for fiscal year 1993,
and such sums as may be necessary for each of the fiscal years
1994 through 1998.
(r) SEPARATE GRANTS FOR RESEARCH ON DELIVERY OF SERVICES.—
(1) IN GENERAL.—The Secretary may make grants for the
purpose of conducting research on the manner in which the delivery of services under subsection (a) may be improved. The
Secretary may make such grants only to grantees under such
subsection and to public and nonprofit private entities that are
carrying out programs substantially similar to programs carried out under such subsection.
(2) AUTHORIZATION OF APPROPRIATIONS.—For the purpose
of carrying out paragraph (1), there are authorized to be appropriated such sums as may be necessary for each of the fiscal
years 1993 through 1998.
DATA COLLECTION REGARDING PROGRAMS UNDER TITLE XXVI

SEC. 318B. ø247c–2¿ For the purpose of collecting and providing data for program planning and evaluation activities under
title XXVI, there are authorized to be appropriated to the Secretary
(acting through the Director of the Centers for Disease Control and
Prevention) such sums as may be necessary for each of the fiscal
years 2001 through 2005. Such authorization of appropriations is
in addition to other authorizations of appropriations that are available for such purpose.
SEC. 319. ø247d¿ PUBLIC HEALTH EMERGENCIES.
(a) EMERGENCIES.—If the Secretary determines,

after consultation with such public health officials as may be necessary, that—
(1) a disease or disorder presents a public health emergency; or
(2) a public health emergency, including significant outbreaks of infectious diseases or bioterrorist attacks, otherwise
exists,
the Secretary may take such action as may be appropriate to respond to the public health emergency, including making grants,
providing awards for expenses, and entering into contracts and conducting and supporting investigations into the cause, treatment, or
prevention of a disease or disorder as described in paragraphs (1)
and (2). Any such determination of a public health emergency terminates upon the Secretary declaring that the emergency no longer
exists, or upon the expiration of the 90-day period beginning on the
date on which the determination is made by the Secretary, whichever occurs first. Determinations that terminate under the preceding sentence may be renewed by the Secretary (on the basis of
the same or additional facts), and the preceding sentence applies
to each such renewal. Not later than 48 hours after making a determination under this subsection of a public health emergency (including a renewal), the Secretary shall submit to the Congress
written notification of the determination.
(b) PUBLIC HEALTH EMERGENCY FUND.—
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(1) IN GENERAL.—There is established in the Treasury a
fund to be designated as the ‘‘Public Health Emergency Fund’’
to be made available to the Secretary without fiscal year limitation to carry out subsection (a) only if a public health emergency has been declared by the Secretary under such subsection. There is authorized to be appropriated to the Fund
such sums as may be necessary.
(2) REPORT.—Not later than 90 days after the end of each
fiscal year, the Secretary shall prepare and submit to the Committee on Health, Education, Labor, and Pensions and the
Committee on Appropriations of the Senate and the Committee
on Commerce and the Committee on Appropriations of the
House of Representatives a report describing—
(A) the expenditures made from the Public Health
Emergency Fund in such fiscal year; and
(B) each public health emergency for which the expenditures were made and the activities undertaken with
respect to each emergency which was conducted or supported by expenditures from the Fund.
(c) SUPPLEMENT NOT SUPPLANT.—Funds appropriated under
this section shall be used to supplement and not supplant other
Federal, State, and local public funds provided for activities under
this section.
(d) DATA SUBMITTAL AND REPORTING DEADLINES.—In any case
in which the Secretary determines that, wholly or partially as a result of a public health emergency that has been determined pursuant to subsection (a), individuals or public or private entities are
unable to comply with deadlines for the submission to the Secretary of data or reports required under any law administered by
the Secretary, the Secretary may, notwithstanding any other provision of law, grant such extensions of such deadlines as the circumstances reasonably require, and may waive, wholly or partially,
any sanctions otherwise applicable to such failure to comply. Before
or promptly after granting such an extension or waiver, the Secretary shall notify the Congress of such action and publish in the
Federal Register a notice of the extension or waiver.
SEC. 319A. ø247d–1¿ VACCINE TRACKING AND DISTRIBUTION.
(a) TRACKING.—The Secretary, together with relevant

manufacturers, wholesalers, and distributors as may agree to cooperate,
may track the initial distribution of federally purchased influenza
vaccine in an influenza pandemic. Such tracking information shall
be used to inform Federal, State, local, and tribal decision makers
during an influenza pandemic.
(b) DISTRIBUTION.—The Secretary shall promote communication between State, local, and tribal public health officials and such
manufacturers, wholesalers, and distributors as agree to participate, regarding the effective distribution of seasonal influenza vaccine. Such communication shall include estimates of high priority
populations, as determined by the Secretary, in State, local, and
tribal jurisdictions in order to inform Federal, State, local, and tribal decision makers during vaccine shortages and supply disruptions.
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(c) CONFIDENTIALITY.—The information submitted to the Secretary or its contractors, if any, under this section or under any
other section of this Act related to vaccine distribution information
shall remain confidential in accordance with the exception from the
public disclosure of trade secrets, commercial or financial information, and information obtained from an individual that is privileged
and confidential, as provided for in section 552(b)(4) of title 5,
United States Code, and subject to the penalties and exceptions
under sections 1832 and 1833 of title 18, United States Code, relating to the protection and theft of trade secrets, and subject to privacy protections that are consistent with the regulations promulgated under section 264(c) of the Health Insurance Portability and
Accountability Act of 1996. None of such information provided by
a manufacturer, wholesaler, or distributor shall be disclosed without its consent to another manufacturer, wholesaler, or distributor,
or shall be used in any manner to give a manufacturer, wholesaler,
or distributor a proprietary advantage.
(d) GUIDELINES.—The Secretary, in order to maintain the confidentiality of relevant information and ensure that none of the information contained in the systems involved may be used to provide proprietary advantage within the vaccine market, while allowing State, local, and tribal health officials access to such information to maximize the delivery and availability of vaccines to high
priority populations, during times of influenza pandemics, vaccine
shortages, and supply disruptions, in consultation with manufacturers, distributors, wholesalers and State, local, and tribal health
departments, shall develop guidelines for subsections (a) and (b).
(e) AUTHORIZATION OF APPROPRIATIONS.—There are authorized
to be appropriated to carry out this section, such sums for each of
fiscal years 2007 through 2011.
(f) REPORT TO CONGRESS.—As part of the National Health Security Strategy described in section 2802, the Secretary shall provide an update on the implementation of subsections (a) through
(d).
SEC. 319C–1. ø247d–3a¿ IMPROVING STATE AND LOCAL PUBLIC HEALTH
SECURITY. 1
(a) IN GENERAL.—To enhance the security of the United States

with respect to public health emergencies, the Secretary shall
award cooperative agreements to eligible entities to enable such entities to conduct the activities described in subsection (d).
(b) ELIGIBLE ENTITIES.—To be eligible to receive an award
under subsection (a), an entity shall—
(1)(A) be a State;
(B) be a political subdivision determined by the Secretary
to be eligible for an award under this section (based on criteria
described in subsection (i)(4)); or
(C) be a consortium of entities described in subparagraph
(A); and
(2) prepare and submit to the Secretary an application at
such time, and in such manner, and containing such information as the Secretary may require, including—
1 Former sections 319B and 319C were repealed by section 204(b)(1) of Public Law 109–417
(120 Stat. 2951).

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(A) an All-Hazards Public Health Emergency Preparedness and Response Plan which shall include—
(i) a description of the activities such entity will
carry out under the agreement to meet the goals identified under section 2802;
(ii) a pandemic influenza plan consistent with the
requirements of paragraphs (2) and (5) of subsection
(g);
(iii) preparedness and response strategies and capabilities that take into account the medical and public health needs of at-risk individuals in the event of
a public health emergency;
(iv) a description of the mechanism the entity will
implement to utilize the Emergency Management Assistance Compact or other mutual aid agreements for
medical and public health mutual aid; and
(v) a description of how the entity will include the
State Unit on Aging in public health emergency preparedness;
(B) an assurance that the entity will report to the Secretary on an annual basis (or more frequently as determined by the Secretary) on the evidence-based benchmarks and objective standards established by the Secretary to evaluate the preparedness and response capabilities of such entity under subsection (g);
(C) an assurance that the entity will conduct, on at
least an annual basis, an exercise or drill that meets any
criteria established by the Secretary to test the preparedness and response capabilities of such entity, and that the
entity will report back to the Secretary within the application of the following year on the strengths and weaknesses
identified through such exercise or drill, and corrective actions taken to address material weaknesses;
(D) an assurance that the entity will provide to the
Secretary the data described under section 319D(d)(3) as
determined feasible by the Secretary;
(E) an assurance that the entity will conduct activities
to inform and educate the hospitals within the jurisdiction
of such entity on the role of such hospitals in the plan required under subparagraph (A);
(F) an assurance that the entity, with respect to the
plan described under subparagraph (A), has developed and
will implement an accountability system to ensure that
such entity make satisfactory annual improvement and describe such system in the plan under subparagraph (A);
(G) a description of the means by which to obtain public comment and input on the plan described in subparagraph (A) and on the implementation of such plan, that
shall include an advisory committee or other similar mechanism for obtaining comment from the public and from
other State, local, and tribal stakeholders; and
(H) as relevant, a description of the process used by
the entity to consult with local departments of public
health to reach consensus, approval, or concurrence on the
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relative distribution of amounts received under this section.
(c) LIMITATION.—Beginning in fiscal year 2009, the Secretary
may not award a cooperative agreement to a State unless such
State is a participant in the Emergency System for Advance Registration of Volunteer Health Professionals described in section
319I.
(d) USE OF FUNDS.—
(1) IN GENERAL.—An award under subsection (a) shall be
expended for activities to achieve the preparedness goals described under paragraphs (1), (2), (4), (5), and (6) of section
2802(b).
(2) EFFECT OF SECTION.—Nothing in this subsection may
be construed as establishing new regulatory authority or as
modifying any existing regulatory authority.
(e) COORDINATION WITH LOCAL RESPONSE CAPABILITIES.—An
entity shall, to the extent practicable, ensure that activities carried
out under an award under subsection (a) are coordinated with activities of relevant Metropolitan Medical Response Systems, local
public health departments, the Cities Readiness Initiative, and
local emergency plans.
(f) CONSULTATION WITH HOMELAND SECURITY.—In making
awards under subsection (a), the Secretary shall consult with the
Secretary of Homeland Security to—
(1) ensure maximum coordination of public health and
medical preparedness and response activities with the Metropolitan Medical Response System, and other relevant activities;
(2) minimize duplicative funding of programs and activities;
(3) analyze activities, including exercises and drills, conducted under this section to develop recommendations and
guidance on best practices for such activities; and
(4) disseminate such recommendations and guidance, including through expanding existing lessons learned information systems to create a single Internet-based point of access
for sharing and distributing medical and public health best
practices and lessons learned from drills, exercises, disasters,
and other emergencies.
(g) ACHIEVEMENT OF MEASURABLE EVIDENCE-BASED BENCHMARKS AND OBJECTIVE STANDARDS.—
(1) IN GENERAL.—Not later than 180 days after the date of
enactment of the Pandemic and All-Hazards Preparedness Act,
the Secretary shall develop or where appropriate adopt, and require the application of, measurable evidence-based benchmarks and objective standards that measure levels of preparedness with respect to the activities described in this section and with respect to activities described in section 319C–
2. In developing such benchmarks and standards, the Secretary shall consult with and seek comments from State, local,
and tribal officials and private entities, as appropriate. Where
appropriate, the Secretary shall incorporate existing objective
standards. Such benchmarks and standards shall—
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(A) include outcome goals representing operational
achievement of the National Preparedness Goals developed
under section 2802(b); and
(B) at a minimum, require entities to—
(i) measure progress toward achieving the outcome goals; and
(ii) at least annually, test, exercise, and rigorously
evaluate the public health and medical emergency preparedness and response capabilities of the entity, and
report to the Secretary on such measured and tested
capabilities and measured and tested progress toward
achieving outcome goals, based on criteria established
by the Secretary.
(2) CRITERIA FOR PANDEMIC INFLUENZA PLANS.—
(A) IN GENERAL.—Not later than 180 days after the
date of enactment of the Pandemic and All-Hazards Preparedness Act, the Secretary shall develop and disseminate to the chief executive officer of each State criteria for
an effective State plan for responding to pandemic influenza.
(B) RULE OF CONSTRUCTION.—Nothing in this section
shall be construed to require the duplication of Federal efforts with respect to the development of criteria or standards, without regard to whether such efforts were carried
out prior to or after the date of enactment of this section.
(3) TECHNICAL ASSISTANCE.—The Secretary shall, as determined appropriate by the Secretary, provide to a State, upon
request, technical assistance in meeting the requirements of
this section, including the provision of advice by experts in the
development of high-quality assessments, the setting of State
objectives and assessment methods, the development of measures of satisfactory annual improvement that are valid and reliable, and other relevant areas.
(4) NOTIFICATION OF FAILURES.—The Secretary shall develop and implement a process to notify entities that are determined by the Secretary to have failed to meet the requirements
of paragraph (1) or (2). Such process shall provide such entities
with the opportunity to correct such noncompliance. An entity
that fails to correct such noncompliance shall be subject to
paragraph (5).
(5) WITHHOLDING OF AMOUNTS FROM ENTITIES THAT FAIL
TO ACHIEVE BENCHMARKS OR SUBMIT INFLUENZA PLAN.—Beginning with fiscal year 2009, and in each succeeding fiscal year,
the Secretary shall—
(A) withhold from each entity that has failed substantially to meet the benchmarks and performance measures
described in paragraph (1) for the immediately preceding
fiscal year (beginning with fiscal year 2008), pursuant to
the process developed under paragraph (4), the amount described in paragraph (6); and
(B) withhold from each entity that has failed to submit
to the Secretary a plan for responding to pandemic influenza that meets the criteria developed under paragraph
(2), the amount described in paragraph (6).
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(6) AMOUNTS DESCRIBED.—
(A) IN GENERAL.—The amounts described in this paragraph are the following amounts that are payable to an entity for activities described in section 319C–1 or 319C–2:
(i) For the fiscal year immediately following a fiscal year in which an entity experienced a failure described in subparagraph (A) or (B) of paragraph (5) by
the entity, an amount equal to 10 percent of the
amount the entity was eligible to receive for such fiscal year.
(ii) For the fiscal year immediately following two
consecutive fiscal years in which an entity experienced
such a failure, an amount equal to 15 percent of the
amount the entity was eligible to receive for such fiscal year, taking into account the withholding of funds
for the immediately preceding fiscal year under clause
(i).
(iii) For the fiscal year immediately following
three consecutive fiscal years in which an entity experienced such a failure, an amount equal to 20 percent
of the amount the entity was eligible to receive for
such fiscal year, taking into account the withholding of
funds for the immediately preceding fiscal years under
clauses (i) and (ii).
(iv) For the fiscal year immediately following four
consecutive fiscal years in which an entity experienced
such a failure, an amount equal to 25 percent of the
amount the entity was eligible to receive for such a fiscal year, taking into account the withholding of funds
for the immediately preceding fiscal years under
clauses (i), (ii), and (iii).
(B) SEPARATE ACCOUNTING.—Each failure described in
subparagraph (A) or (B) of paragraph (5) shall be treated
as a separate failure for purposes of calculating amounts
withheld under subparagraph (A).
(7) REALLOCATION OF AMOUNTS WITHHELD.—
(A) IN GENERAL.—The Secretary shall make amounts
withheld under paragraph (6) available for making awards
under section 319C–2 to entities described in subsection
(b)(1) of such section.
(B) PREFERENCE IN REALLOCATION.—In making awards
under section 319C–2 with amounts described in subparagraph (A), the Secretary shall give preference to eligible
entities (as described in section 319C–2(b)(1)) that are located in whole or in part in States from which amounts
have been withheld under paragraph (6).
(8) WAIVE OR REDUCE WITHHOLDING.—The Secretary may
waive or reduce the withholding described in paragraph (6), for
a single entity or for all entities in a fiscal year, if the Secretary determines that mitigating conditions exist that justify
the waiver or reduction.
(h) GRANTS FOR REAL-TIME DISEASE DETECTION IMPROVEMENT.—
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(1) IN GENERAL.—The Secretary may award grants to eligible entities to carry out projects described under paragraph (4).
(2) ELIGIBLE ENTITY.—For purposes of this section, the
term ‘‘eligible entity’’ means an entity that is—
(A)(i) a hospital, clinical laboratory, university; or
(ii) a poison control center or professional organization
in the field of poison control; and
(B) a participant in the network established under
subsection 319D(d).
(3) APPLICATION.—Each eligible entity desiring a grant
under this subsection shall submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require.
(4) USE OF FUNDS.—
(A) IN GENERAL.—An eligible entity described in paragraph (2)(A)(i) that receives a grant under this subsection
shall use the funds awarded pursuant to such grant to
carry out a pilot demonstration project to purchase and implement the use of advanced diagnostic medical equipment
to analyze real-time clinical specimens for pathogens of
public health or bioterrorism significance and report any
results from such project to State, local, and tribal public
health entities and the network established under section
319D(d).
(B) OTHER ENTITIES.—An eligible entity described in
paragraph (2)(A)(ii) that receives a grant under this section shall use the funds awarded pursuant to such grant
to—
(i) improve the early detection, surveillance, and
investigative capabilities of poison control centers for
chemical, biological, radiological, and nuclear events
by training poison information personnel to improve
the accuracy of surveillance data, improving the definitions used by the poison control centers for surveillance, and enhancing timely and efficient investigation
of data anomalies;
(ii) improve the capabilities of poison control centers to provide information to health care providers
and the public with regard to chemical, biological, radiological, or nuclear threats or exposures, in consultation with the appropriate State, local, and tribal public
health entities; or
(iii) provide surge capacity in the event of a chemical, biological, radiological, or nuclear event through
the establishment of alternative poison control center
worksites and the training of nontraditional personnel.
(i) FUNDING.—
(1) AUTHORIZATION OF APPROPRIATIONS.—
(A) IN GENERAL.—For the purpose of carrying out this
section, there is authorized to be appropriated
$824,000,000 for fiscal year 2007, of which $35,000,000
shall be used to carry out subsection (h), for awards pursuant to paragraph (3) (subject to the authority of the Secretary to make awards pursuant to paragraphs (4) and
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(5)), and such sums as may be necessary for each of fiscal
years 2008 through 2011.
(B) COORDINATION.—There are authorized to be appropriated, $10,000,000 for fiscal year 2007 to carry out subsection (f)(4) of this section and section 2814.
(C) REQUIREMENT FOR STATE MATCHING FUNDS.—Beginning in fiscal year 2009, in the case of any State or consortium of two or more States, the Secretary may not
award a cooperative agreement under this section unless
the State or consortium of States agree that, with respect
to the amount of the cooperative agreement awarded by
the Secretary, the State or consortium of States will make
available (directly or through donations from public or private entities) non-Federal contributions in an amount
equal to—
(i) for the first fiscal year of the cooperative agreement, not less than 5 percent of such costs ($1 for each
$20 of Federal funds provided in the cooperative
agreement); and
(ii) for any second fiscal year of the cooperative
agreement, and for any subsequent fiscal year of such
cooperative agreement, not less than 10 percent of
such costs ($1 for each $10 of Federal funds provided
in the cooperative agreement).
(D) DETERMINATION OF AMOUNT OF NON-FEDERAL CONTRIBUTIONS.—As determined by the Secretary, non-Federal
contributions required in subparagraph (C) may be provided directly or through donations from public or private
entities and may be in cash or in kind, fairly evaluated, including plant, equipment or services. Amounts provided by
the Federal government, or services assisted or subsidized
to any significant extent by the Federal government, may
not be included in determining the amount of such nonFederal contributions.
(2) MAINTAINING STATE FUNDING.—
(A) IN GENERAL.—An entity that receives an award
under this section shall maintain expenditures for public
health security at a level that is not less than the average
level of such expenditures maintained by the entity for the
preceding 2 year period.
(B) RULE OF CONSTRUCTION.—Nothing in this section
shall be construed to prohibit the use of awards under this
section to pay salary and related expenses of public health
and other professionals employed by State, local, or tribal
public health agencies who are carrying out activities supported by such awards (regardless of whether the primary
assignment of such personnel is to carry out such activities).
(3) DETERMINATION OF AMOUNT.—
(A) IN GENERAL.—The Secretary shall award cooperative agreements under subsection (a) to each State or consortium of 2 or more States that submits to the Secretary
an application that meets the criteria of the Secretary for
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mentation conditions established by the Secretary for such
awards
(B) BASE AMOUNT.—In determining the amount of an
award pursuant to subparagraph (A) for a State, the Secretary shall first determine an amount the Secretary considers appropriate for the State (referred to in this paragraph as the ‘‘base amount’’), except that such amount
may not be greater than the minimum amount determined
under subparagraph (D).
(C) INCREASE ON BASIS OF POPULATION.—After determining the base amount for a State under subparagraph
(B), the Secretary shall increase the base amount by an
amount equal to the product of—
(i) the amount appropriated under paragraph
(1)(A)(i)(I) for the fiscal year, less an amount equal to
the sum of all base amounts determined for the States
under subparagraph (B), and less the amount, if any,
reserved by the Secretary under paragraphs (4) and
(5); and
(ii) subject to paragraph (4)(C), the percentage
constituted by the ratio of an amount equal to the population of the State over an amount equal to the total
population of the States (as indicated by the most recent data collected by the Bureau of the Census).
(D) MINIMUM AMOUNT.—Subject to the amount appropriated under paragraph (1)(A)(i)(I), an award pursuant to
subparagraph (A) for a State shall be the greater of the
base amount as increased under subparagraph (C), or the
minimum amount under this subparagraph. The minimum
amount under this subparagraph is—
(i) in the case of each of the several States, the
District of Columbia, and the Commonwealth of Puerto Rico, an amount equal to the lesser of—
(I) $5,000,000; or
(II) if the amount appropriated under paragraph (1)(A)(i)(I) is less than $667,000,000, an
amount equal to 0.75 percent of the amount appropriated under such paragraph, less the
amount, if any, reserved by the Secretary under
paragraphs (4) and (5); or
(ii) in the case of each of American Samoa, Guam,
the Commonwealth of the Northern Mariana Islands,
and the Virgin Islands, an amount determined by the
Secretary to be appropriate, except that such amount
may not exceed the amount determined under clause
(i).
(4) CERTAIN POLITICAL SUBDIVISIONS.—
(A) IN GENERAL.—For fiscal year 2007, the Secretary
may, before making awards pursuant to paragraph (3) for
such year, reserve from the amount appropriated under
paragraph (1) for the year an amount determined necessary by the Secretary to make awards under subsection
(a) to political subdivisions that have a substantial number
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sponding to public health emergencies, and face a high degree of risk from bioterrorist attacks or other public health
emergencies. Not more than three political subdivisions
may receive awards pursuant to this subparagraph.
(B) COORDINATION WITH STATEWIDE PLANS.—An award
pursuant to subparagraph (A) may not be made unless the
application of the political subdivision involved is in coordination with, and consistent with, applicable Statewide
plans described in subsection (c).
(C) RELATIONSHIP TO FORMULA GRANTS.—In the case of
a State that will receive an award pursuant to paragraph
(3), and in which there is located a political subdivision
that will receive an award pursuant to subparagraph (A),
the Secretary shall, in determining the amount under
paragraph (3)(C) for the State, subtract from the population of the State an amount equal to the population of
such political subdivision.
(D) CONTINUITY OF FUNDING.—In determining whether
to make an award pursuant to subparagraph (A) to a political subdivision, the Secretary may consider, as a factor indicating that the award should be made, that the political
subdivision received public health funding from the Secretary for fiscal year 2006.
(5) SIGNIFICANT UNMET NEEDS; DEGREE OF RISK.—
(A) IN GENERAL.—For fiscal year 2007, the Secretary
may, before making awards pursuant to paragraph (3) for
such year, reserve from the amount appropriated under
paragraph (1) for the year an amount determined necessary by the Secretary to make awards under subsection
(a) to eligible entities that—
(i) have a significant need for funds to build capacity to identify, detect, monitor, and respond to a
bioterrorist or other threat to the public health, which
need will not be met by awards pursuant to paragraph
(3); and
(ii) face a particularly high degree of risk of such
a threat.
(B) RECIPIENTS OF GRANTS.—Awards pursuant to subparagraph (A) may be supplemental awards to States that
receive awards pursuant to paragraph (3), or may be
awards to eligible entities described in subsection (b)(1)(B)
within such States.
(C) FINDING WITH RESPECT TO DISTRICT OF COLUMBIA.—The Secretary shall consider the District of Columbia
to have a significant unmet need for purposes of subparagraph (A), and to face a particularly high degree of risk for
such purposes, on the basis of the concentration of entities
of national significance located within the District.
(6) FUNDING OF LOCAL ENTITIES.—The Secretary shall, in
making awards under this section, ensure that with respect to
the cooperative agreement awarded, the entity make available
appropriate portions of such award to political subdivisions
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volving the consensus, approval or concurrence with such local
entities.
(j) ADMINISTRATIVE AND FISCAL RESPONSIBILITY.—
(1) ANNUAL REPORTING REQUIREMENTS.—Each entity shall
prepare and submit to the Secretary annual reports on its activities under this section and section 319C–2. Each such report shall be prepared by, or in consultation with, the health
department. In order to properly evaluate and compare the
performance of different entities assisted under this section
and section 319C–2 and to assure the proper expenditure of
funds under this section and section 319C–2, such reports shall
be in such standardized form and contain such information as
the Secretary determines and describes within 180 days of the
date of enactment of the Pandemic and All-Hazards Preparedness Act (after consultation with the States) to be necessary
to—
(A) secure an accurate description of those activities;
(B) secure a complete record of the purposes for which
funds were spent, and of the recipients of such funds;
(C) describe the extent to which the entity has met the
goals and objectives it set forth under this section or section 319C–2;
(D) determine the extent to which funds were expended consistent with the entity’s application transmitted
under this section or section 319C–2; and
(E) publish such information on a Federal Internet
website consistent with subsection (k).
(2) AUDITS; IMPLEMENTATION.—
(A) IN GENERAL.—Each entity receiving funds under
this section or section 319C–2 shall, not less often than
once every 2 years, audit its expenditures from amounts
received under this section or section 319C–2. Such audits
shall be conducted by an entity independent of the agency
administering a program funded under this section or section 319C–2 in accordance with the Comptroller General’s
standards for auditing governmental organizations, programs, activities, and functions and generally accepted auditing standards. Within 30 days following the completion
of each audit report, the entity shall submit a copy of that
audit report to the Secretary.
(B) REPAYMENT.—Each entity shall repay to the
United States amounts found by the Secretary, after notice
and opportunity for a hearing to the entity, not to have
been expended in accordance with this section or section
319C–2 and, if such repayment is not made, the Secretary
may offset such amounts against the amount of any allotment to which the entity is or may become entitled under
this section or section 319C–2 or may otherwise recover
such amounts.
(C) WITHHOLDING OF PAYMENT.—The Secretary may,
after notice and opportunity for a hearing, withhold payment of funds to any entity which is not using its allotment under this section or section 319C–2 in accordance
with such section. The Secretary may withhold such funds
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until the Secretary finds that the reason for the withholding has been removed and there is reasonable assurance that it will not recur.
(3) MAXIMUM CARRYOVER AMOUNT.—
(A) IN GENERAL.—For each fiscal year, the Secretary,
in consultation with the States and political subdivisions,
shall determine the maximum percentage amount of an
award under this section that an entity may carryover to
the succeeding fiscal year.
(B) AMOUNT EXCEEDED.—For each fiscal year, if the
percentage amount of an award under this section unexpended by an entity exceeds the maximum percentage permitted by the Secretary under subparagraph (A), the entity shall return to the Secretary the portion of the unexpended amount that exceeds the maximum amount permitted to be carried over by the Secretary.
(C) ACTION BY SECRETARY.—The Secretary shall make
amounts returned to the Secretary under subparagraph
(B) available for awards under section 319C–2(b)(1). In
making awards under section 319C–2(b)(1) with amounts
collected under this paragraph the Secretary shall give
preference to entities that are located in whole or in part
in States from which amounts have been returned under
subparagraph (B).
(D) WAIVER.—An entity may apply to the Secretary for
a waiver of the maximum percentage amount under subparagraph (A). Such an application for a waiver shall include an explanation why such requirement should not
apply to the entity and the steps taken by such entity to
ensure that all funds under an award under this section
will be expended appropriately.
(E) WAIVE OR REDUCE WITHHOLDING.—The Secretary
may waive the application of subparagraph (B), or reduce
the amount determined under such subparagraph, for a
single entity pursuant to subparagraph (D) or for all entities in a fiscal year, if the Secretary determines that mitigating conditions exist that justify the waiver or reduction.
(k) COMPILATION AND AVAILABILITY OF DATA.—The Secretary
shall compile the data submitted under this section and make such
data available in a timely manner on an appropriate Internet
website in a format that is useful to the public and to other entities
and that provides information on what activities are best contributing to the achievement of the outcome goals described in subsection (g).
SEC. 319C–2. ø247d–3b¿ PARTNERSHIPS FOR STATE AND REGIONAL
HOSPITAL PREPAREDNESS TO IMPROVE SURGE CAPACITY.
(a) IN GENERAL.—The Secretary shall award competitive

grants or cooperative agreements to eligible entities to enable such
entities to improve surge capacity and enhance community and
hospital preparedness for public health emergencies.
(b) ELIGIBILITY.—To be eligible for an award under subsection
(a), an entity shall—
(1)(A) be a partnership consisting of—
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(i) one or more hospitals, at least one of which shall
be a designated trauma center, consistent with section
1213(c);
(ii) one or more other local health care facilities, including clinics, health centers, primary care facilities, mental health centers, mobile medical assets, or nursing
homes; and
(iii)(I) one or more political subdivisions;
(II) one or more States; or
(III) one or more States and one or more political subdivisions; and
(B) prepare, in consultation with the Chief Executive Officer and the lead health officials of the State, District, or territory in which the hospital and health care facilities described
in subparagraph (A) are located, and submit to the Secretary,
an application at such time, in such manner, and containing
such information as the Secretary may require; or
(2)(A) be an entity described in section 319C–1(b)(1); and
(B) submit an application at such time, in such manner,
and containing such information as the Secretary may require,
including the information or assurances required under section
319C–1(b)(2) and an assurance that the State will adhere to
any applicable guidelines established by the Secretary.
(c) USE OF FUNDS.—An award under subsection (a) shall be expended for activities to achieve the preparedness goals described
under paragraphs (1), (3), (4), (5), and (6) of section 2802(b).
(d) PREFERENCES.—
(1) REGIONAL COORDINATION.—In making awards under
subsection (a), the Secretary shall give preference to eligible
entities that submit applications that, in the determination of
the Secretary—
(A) will enhance coordination—
(i) among the entities described in subsection
(b)(1)(A)(i); and
(ii) between such entities and the entities described in subsection (b)(1)(A)(ii); and
(B) include, in the partnership described in subsection
(b)(1)(A), a significant percentage of the hospitals and
health care facilities within the geographic area served by
such partnership.
(2) OTHER PREFERENCES.—In making awards under subsection (a), the Secretary shall give preference to eligible entities that, in the determination of the Secretary—
(A) include one or more hospitals that are participants
in the National Disaster Medical System;
(B) are located in a geographic area that faces a high
degree of risk, as determined by the Secretary in consultation with the Secretary of Homeland Security; or
(C) have a significant need for funds to achieve the
medical preparedness goals described in section 2802(b)(3).
(e) CONSISTENCY OF PLANNED ACTIVITIES.—The Secretary may
not award a cooperative agreement to an eligible entity described
in subsection (b)(1) unless the application submitted by the entity
is coordinated and consistent with an applicable State All-Hazards
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Public Health Emergency Preparedness and Response Plan and relevant local plans, as determined by the Secretary in consultation
with relevant State health officials.
(f) LIMITATION ON AWARDS.—A political subdivision shall not
participate in more than one partnership described in subsection
(b)(1).
(g) COORDINATION WITH LOCAL RESPONSE CAPABILITIES.—An
eligible entity shall, to the extent practicable, ensure that activities
carried out under an award under subsection (a) are coordinated
with activities of relevant local Metropolitan Medical Response Systems, local Medical Reserve Corps, the Cities Readiness Initiative,
and local emergency plans.
(h) MAINTENANCE OF FUNDING.—
(1) IN GENERAL.—An entity that receives an award under
this section shall maintain expenditures for health care preparedness at a level that is not less than the average level of
such expenditures maintained by the entity for the preceding
2 year period.
(2) RULE OF CONSTRUCTION.—Nothing in this section shall
be construed to prohibit the use of awards under this section
to pay salary and related expenses of public health and other
professionals employed by State, local, or tribal agencies who
are carrying out activities supported by such awards (regardless of whether the primary assignment of such personnel is to
carry out such activities).
(i) PERFORMANCE AND ACCOUNTABILITY.—The requirements of
section 319C–1(g), (j), and (k) shall apply to entities receiving
awards under this section (regardless of whether such entities are
described under subsection (b)(1)(A) or (b)(2)(A)) in the same manner as such requirements apply to entities under section 319C–1.
An entity described in subsection (b)(1)(A) shall make such reports
available to the lead health official of the State in which such partnership is located.
(j) AUTHORIZATION OF APPROPRIATIONS.—
(1) IN GENERAL.—For the purpose of carrying out this section, there is authorized to be appropriated $474,000,000 for
fiscal year 2007, and such sums as may be necessary for each
of fiscal years 2008 through 2011.
(2) RESERVATION OF AMOUNTS FOR PARTNERSHIPS.—Prior to
making awards described in paragraph (3), the Secretary may
reserve from the amount appropriated under paragraph (1) for
a fiscal year, an amount determined appropriate by the Secretary for making awards to entities described in subsection
(b)(1)(A).
(3) AWARDS TO STATES AND POLITICAL SUBDIVISIONS.—
(A) IN GENERAL.—From amounts appropriated for a
fiscal year under paragraph (1) and not reserved under
paragraph (2), the Secretary shall make awards to entities
described in subsection (b)(2)(A) that have completed an
application as described in subsection (b)(2)(B).
(B) AMOUNT.—The Secretary shall determine the
amount of an award to each entity described in subparagraph (A) in the same manner as such amounts are determined under section 319C–1(i).
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SEC. 319D. ø247d–4¿ REVITALIZING THE CENTERS FOR DISEASE CONTROL AND PREVENTION.
(a) FACILITIES; CAPACITIES.—
(1) FINDINGS.—Congress finds that the Centers for Disease

Control and Prevention has an essential role in defending
against and combatting public health threats domestically and
abroad and requires secure and modern facilities, and expanded and improved capabilities related to bioterrorism and
other public health emergencies, sufficient to enable such Centers to conduct this important mission.
(2) FACILITIES.—
(A) IN GENERAL.—The Director of the Centers for Disease Control and Prevention may design, construct, and
equip new facilities, renovate existing facilities (including
laboratories, laboratory support buildings, scientific communication facilities, transshipment complexes, secured
and isolated parking structures, office buildings, and other
facilities and infrastructure), and upgrade security of such
facilities, in order to better conduct the capacities described in section 319A, and for supporting public health
activities.
(B) MULTIYEAR CONTRACTING AUTHORITY.—For any
project of designing, constructing, equipping, or renovating
any facility under subparagraph (A), the Director of the
Centers for Disease Control and Prevention may enter into
a single contract or related contracts that collectively include the full scope of the project, and the solicitation and
contract shall contain the clause ‘‘availability of funds’’
found at section 52.232–18 of title 48, Code of Federal Regulations.
(3) IMPROVING THE CAPACITIES OF THE CENTERS FOR DISEASE CONTROL AND PREVENTION.—The Secretary shall expand,
enhance, and improve the capabilities of the Centers for Disease Control and Prevention relating to preparedness for and
responding effectively to bioterrorism and other public health
emergencies. Activities that may be carried out under the preceding sentence include—
(A) expanding or enhancing the training of personnel;
(B) improving communications facilities and networks,
including delivery of necessary information to rural areas;
(C) improving capabilities for public health surveillance and reporting activities, taking into account the integrated system or systems of public health alert communications and surveillance networks under subsection (b);
and
(D) improving laboratory facilities related to bioterrorism and other public health emergencies, including increasing the security of such facilities.
(b) NATIONAL COMMUNICATIONS AND SURVEILLANCE NETWORKS.—
(1) IN GENERAL.—The Secretary, directly or through
awards of grants, contracts, or cooperative agreements, shall
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tems of public health alert communications and surveillance
networks between and among—
(A) Federal, State, and local public health officials;
(B) public and private health-related laboratories, hospitals, and other health care facilities; and
(C) any other entities determined appropriate by the
Secretary.
(2) REQUIREMENTS.—The Secretary shall ensure that networks under paragraph (1) allow for the timely sharing and
discussion, in a secure manner, of essential information concerning bioterrorism or another public health emergency, or
recommended methods for responding to such an attack or
emergency.
(3) STANDARDS.—Not later than one year after the date of
the enactment of the Public Health Security and Bioterrorism
Preparedness and Response Act of 2002, the Secretary, in cooperation with health care providers and State and local public
health officials, shall establish any additional technical and reporting standards (including standards for interoperability) for
networks under paragraph (1).
(c) AUTHORIZATION OF APPROPRIATIONS.—
(1) FACILITIES; CAPACITIES.—
(A) FACILITIES.—For the purpose of carrying out subsection (a)(2), there are authorized to be appropriated
$300,000,000 for each of the fiscal years 2002 and 2003,
and such sums as may be necessary for each of the fiscal
years 2004 through 2006.
(B) MISSION; IMPROVING CAPACITIES.—For the purposes of achieving the mission of the Centers for Disease
Control and Prevention described in subsection (a)(1), for
carrying out subsection (a)(3), for better conducting the capacities described in section 319A, and for supporting public health activities, there are authorized to be appropriated such sums as may be necessary for each of the fiscal years 2002 through 2006.
(2) NATIONAL COMMUNICATIONS AND SURVEILLANCE NETWORKS.—For the purpose of carrying out subsection (b), there
are authorized to be appropriated such sums as may be necessary for each of the fiscal years 2002 through 2006.
(d) PUBLIC HEALTH SITUATIONAL AWARENESS.—
(1) IN GENERAL.—Not later than 2 years after the date of
enactment of the Pandemic and All-Hazards Preparedness Act,
the Secretary, in collaboration with State, local, and tribal public health officials, shall establish a near real-time electronic
nationwide public health situational awareness capability
through an interoperable network of systems to share data and
information to enhance early detection of rapid response to,
and management of, potentially catastrophic infectious disease
outbreaks and other public health emergencies that originate
domestically or abroad. Such network shall be built on existing
State situational awareness systems or enhanced systems that
enable such connectivity.
(2) STRATEGIC PLAN.—Not later than 180 days after the
date of enactment the Pandemic and All-Hazards Preparedness
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Act, the Secretary shall submit to the appropriate committees
of Congress, a strategic plan that demonstrates the steps the
Secretary will undertake to develop, implement, and evaluate
the network described in paragraph (1), utilizing the elements
described in paragraph (3).
(3) ELEMENTS.—The network described in paragraph (1)
shall include data and information transmitted in a standardized format from—
(A) State, local, and tribal public health entities, including public health laboratories;
(B) Federal health agencies;
(C) zoonotic disease monitoring systems;
(D) public and private sector health care entities, hospitals, pharmacies, poison control centers or professional
organizations in the field of poison control, and clinical laboratories, to the extent practicable and provided that such
data are voluntarily provided simultaneously to the Secretary and appropriate State, local, and tribal public
health agencies; and
(E) such other sources as the Secretary may deem appropriate.
(4) RULE OF CONSTRUCTION.—Paragraph (3) shall not be
construed as requiring separate reporting of data and information from each source listed.
(5) REQUIRED ACTIVITIES.—In establishing and operating
the network described in paragraph (1), the Secretary shall—
(A) utilize applicable interoperability standards as determined by the Secretary through a joint public and private sector process;
(B) define minimal data elements for such network;
(C) in collaboration with State, local, and tribal public
health officials, integrate and build upon existing State,
local, and tribal capabilities, ensuring simultaneous sharing of data, information, and analyses from the network
described in paragraph (1) with State, local, and tribal
public health agencies; and
(D) in collaboration with State, local, and tribal public
health officials, develop procedures and standards for the
collection, analysis, and interpretation of data that States,
regions, or other entities collect and report to the network
described in paragraph (1).
(e) STATE AND REGIONAL SYSTEMS TO ENHANCE SITUATIONAL
AWARENESS IN PUBLIC HEALTH EMERGENCIES.—
(1) IN GENERAL.—To implement the network described in
subsection (d), the Secretary may award grants to States or
consortia of States to enhance the ability of such States or consortia of States to establish or operate a coordinated public
health situational awareness system for regional or Statewide
early detection of, rapid response to, and management of potentially catastrophic infectious disease outbreaks and public
health emergencies, in collaboration with appropriate public
health agencies, sentinel hospitals, clinical laboratories, pharmacies, poison control centers, other health care organizations,
and animal health organizations within such States.
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(2) ELIGIBILITY.—To be eligible to receive a grant under
paragraph (1), the State or consortium of States shall submit
to the Secretary an application at such time, in such manner,
and containing such information as the Secretary may require,
including an assurance that the State or consortium of States
will submit to the Secretary—
(A) reports of such data, information, and metrics as
the Secretary may require;
(B) a report on the effectiveness of the systems funded
under the grant; and
(C) a description of the manner in which grant funds
will be used to enhance the timelines and comprehensiveness of efforts to detect, respond to, and manage potentially catastrophic infectious disease outbreaks and public
health emergencies.
(3) USE OF FUNDS.—A State or consortium of States that
receives an award under this subsection—
(A) shall establish, enhance, or operate a coordinated
public health situational awareness system for regional or
Statewide early detection of, rapid response to, and management of potentially catastrophic infectious disease outbreaks and public health emergencies;
(B) may award grants or contracts to entities described in paragraph (1) within or serving such State to assist such entities in improving the operation of information
technology systems, facilitating the secure exchange of
data and information, and training personnel to enhance
the operation of the system described in subparagraph (A);
and
(C) may conduct a pilot program for the development
of multi-State telehealth network test beds that build on,
enhance, and securely link existing State and local telehealth programs to prepare for, monitor, respond to, and
manage the events of public health emergencies, facilitate
coordination and communication among medical, public
health, and emergency response agencies, and provide
medical services through telehealth initiatives within the
States that are involved in such a multi-State telehealth
network test bed.
(4) LIMITATION.—Information technology systems acquired
or implemented using grants awarded under this section must
be compliant with—
(A) interoperability and other technological standards,
as determined by the Secretary; and
(B) data collection and reporting requirements for the
network described in subsection (d).
(5) INDEPENDENT EVALUATION.—Not later than 4 years
after the date of enactment of the Pandemic and All-Hazards
Preparedness Act, the Government Accountability Office shall
conduct an independent evaluation, and submit to the Secretary and the appropriate committees of Congress a report
concerning the activities conducted under this subsection and
subsection (d).
(f) TELEHEALTH ENHANCEMENTS FOR EMERGENCY RESPONSE.—
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(1) EVALUATION.—The Secretary, in consultation with the
Federal Communications Commission and other relevant Federal agencies, shall—
(A) conduct an inventory of telehealth initiatives in existence on the date of enactment of the Pandemic and AllHazards Preparedness Act, including—
(i) the specific location of network components;
(ii) the medical, technological, and communications capabilities of such components;
(iii) the functionality of such components; and
(iv) the capacity and ability of such components to
handle increased volume during the response to a public health emergency;
(B) identify methods to expand and interconnect the
regional health information networks funded by the Secretary, the State and regional broadband networks funded
through the rural health care support mechanism pilot
program funded by the Federal Communications Commission, and other telehealth networks;
(C) evaluate ways to prepare for, monitor, respond
rapidly to, or manage the events of, a public health emergency through the enhanced use of telehealth technologies,
including mechanisms for payment or reimbursement for
use of such technologies and personnel during public
health emergencies;
(D) identify methods for reducing legal barriers that
deter health care professionals from providing telemedicine
services, such as by utilizing State emergency health care
professional credentialing verification systems, encouraging States to establish and implement mechanisms to
improve interstate medical licensure cooperation, facilitating the exchange of information among States regarding
investigations and adverse actions, and encouraging States
to waive the application of licensing requirements during
a public health emergency;
(E) evaluate ways to integrate the practice of telemedicine within the National Disaster Medical System; and
(F) promote greater coordination among existing Federal interagency telemedicine and health information technology initiatives.
(2) REPORT.—Not later than 12 months after the date of
enactment of the Pandemic and All-Hazards Preparedness Act,
the Secretary shall prepare and submit a report to the Committee on Health, Education, Labor, and Pensions of the Senate and the Committee on Energy and Commerce of the House
of Representatives regarding the findings and recommendations pursuant to subparagraphs (A) through (F) of paragraph
(1).
(g) AUTHORIZATION OF APPROPRIATIONS.—There are authorized
to be appropriated to carry out this section, such sums as may be
necessary in each of fiscal years 2007 through 2011.
SEC. 319E. ø247d–5¿ COMBATING ANTIMICROBIAL RESISTANCE.
(a) TASK FORCE.—
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(1) IN GENERAL.—The Secretary shall establish an Antimicrobial Resistance Task Force to provide advice and recommendations to the Secretary and coordinate Federal programs relating to antimicrobial resistance. The Secretary may
appoint or select a committee, or other organization in existence as of the date of the enactment of this section, to serve
as such a task force, if such committee, or other organization
meets the requirements of this section.
(2) MEMBERS OF TASK FORCE.—The task force described in
paragraph (1) shall be composed of representatives from such
Federal agencies, and shall seek input from public health constituencies, manufacturers, veterinary and medical professional
societies and others, as determined to be necessary by the Secretary, to develop and implement a comprehensive plan to address the public health threat of antimicrobial resistance.
(3) AGENDA.—
(A) IN GENERAL.—The task force described in paragraph (1) shall consider factors the Secretary considers appropriate, including—
(i) public health factors contributing to increasing
antimicrobial resistance;
(ii) public health needs to detect and monitor antimicrobial resistance;
(iii) detection, prevention, and control strategies
for resistant pathogens;
(iv) the need for improved information and data
collection;
(v) the assessment of the risk imposed by pathogens presenting a threat to the public health; and
(vi) any other issues which the Secretary determines are relevant to antimicrobial resistance.
(B) DETECTION AND CONTROL.—The Secretary, in consultation with the task force described in paragraph (1)
and State and local public health officials, shall—
(i) develop, improve, coordinate or enhance participation in a surveillance plan to detect and monitor
emerging antimicrobial resistance; and
(ii) develop, improve, coordinate or enhance participation in an integrated information system to assimilate, analyze, and exchange antimicrobial resistance data between public health departments.
(4) MEETINGS.—The task force described under paragraph
(1) shall convene not less than twice a year, or more frequently
as the Secretary determines to be appropriate.
(b) RESEARCH AND DEVELOPMENT OF NEW ANTIMICROBIAL
DRUGS AND DIAGNOSTICS.—The Secretary and the Director of Agricultural Research Services, consistent with the recommendations of
the task force established under subsection (a), shall directly or
through awards of grants or cooperative agreements to public or
private entities provide for the conduct of research, investigations,
experiments, demonstrations, and studies in the health sciences
that are related to—
(1) the development of new therapeutics, including vaccines and antimicrobials, against resistant pathogens;
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(2) the development or testing of medical diagnostics to detect pathogens resistant to antimicrobials;
(3) the epidemiology, mechanisms, and pathogenesis of
antimicrobial resistance;
(4) the sequencing of the genomes, or other DNA analysis,
or other comparative analysis, of priority pathogens (as determined by the Director of the National Institutes of Health in
consultation with the task force established under subsection
(a)), in collaboration and coordination with the activities of the
Department of Defense and the Joint Genome Institute of the
Department of Energy; and
(5) other relevant research areas.
(c) EDUCATION OF MEDICAL AND PUBLIC HEALTH PERSONNEL.—
The Secretary, after consultation with the Assistant Secretary for
Health, the Surgeon General, the Director of the Centers for Disease Control and Prevention, the Administrator of the Health Resources and Services Administration, the Director of the Agency for
Healthcare Research and Quality, members of the task force described in subsection (a), professional organizations and societies,
and such other public health officials as may be necessary, shall—
(1) develop and implement educational programs to increase the awareness of the general public with respect to the
public health threat of antimicrobial resistance and the appropriate use of antibiotics;
(2) develop and implement educational programs to instruct health care professionals in the prudent use of antibiotics; and
(3) develop and implement programs to train laboratory
personnel in the recognition or identification of resistance in
pathogens.
(d) GRANTS.—
(1) IN GENERAL.—The Secretary shall award competitive
grants to eligible entities to enable such entities to increase the
capacity to detect, monitor, and combat antimicrobial resistance.
(2) ELIGIBLE ENTITIES.—Eligible entities for grants under
paragraph (1) shall be State or local public health agencies, Indian tribes or tribal organizations, or other public or private
nonprofit entities.
(3) USE OF FUNDS.—An eligible entity receiving a grant
under paragraph (1) shall use funds from such grant for activities that are consistent with the factors identified by the task
force under subsection (a)(3), which may include activities
that—
(A) provide training to enable such entity to identify
patterns of resistance rapidly and accurately;
(B) develop, improve, coordinate or enhance participation in information systems by which data on resistant infections can be shared rapidly among relevant national,
State, and local health agencies and health care providers;
and
(C) develop and implement policies to control the
spread of antimicrobial resistance.
(e) GRANTS FOR DEMONSTRATION PROGRAMS.—
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(1) IN GENERAL.—The Secretary shall award competitive
grants to eligible entities to establish demonstration programs
to promote judicious use of antimicrobial drugs or control the
spread of antimicrobial-resistant pathogens.
(2) ELIGIBLE ENTITIES.—Eligible entities for grants under
paragraph (1) may include hospitals, clinics, institutions of
long-term care, professional medical societies, schools or programs that train medical laboratory personnel, or other public
or private nonprofit entities.
(3) TECHNICAL ASSISTANCE.—The Secretary shall provide
appropriate technical assistance to eligible entities that receive
grants under paragraph (1).
(f ) SUPPLEMENT NOT SUPPLANT.—Funds appropriated under
this section shall be used to supplement and not supplant other
Federal, State, and local public funds provided for activities under
this section.
(g) AUTHORIZATION OF APPROPRIATIONS.—There are authorized
to be appropriated to carry out this section, $40,000,000 for fiscal
year 2001, $25,000,000 for each of the fiscal years 2002 and 2003,
and such sums as may be necessary for each of the fiscal years
2004 through 2006.
SEC. 319F. ø247d–6¿ PUBLIC HEALTH COUNTERMEASURES TO A BIOTERRORIST ATTACK.
(a) ALL-HAZARDS PUBLIC HEALTH AND MEDICAL RESPONSE
CURRICULA AND TRAINING.—
(1) IN GENERAL.—The Secretary, in collaboration with the

Secretary of Defense, and in consultation with relevant public
and private entities, shall develop core health and medical response curricula and trainings by adapting applicable existing
curricula and training programs to improve responses to public
health emergencies.
(2) CURRICULUM.—The public health and medical response
training program may include course work related to—
(A) medical management of casualties, taking into account the needs of at-risk individuals;
(B) public health aspects of public health emergencies;
(C) mental health aspects of public health emergencies;
(D) national incident management, including coordination among Federal, State, local, tribal, international agencies, and other entities; and
(E) protecting health care workers and health care
first responders from workplace exposures during a public
health emergency.
(3) PEER REVIEW.—On a periodic basis, products prepared
as part of the program shall be rigorously tested and peer-reviewed by experts in the relevant fields.
(4) CREDIT.—The Secretary and the Secretary of Defense
shall—
(A) take into account continuing professional education
requirements of public health and healthcare professions;
and
(B) cooperate with State, local, and tribal accrediting
agencies and with professional associations in arranging
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for students enrolled in the program to obtain continuing
professional education credit for program courses.
(5) DISSEMINATION AND TRAINING.—
(A) IN GENERAL.—The Secretary may provide for the
dissemination and teaching of the materials described in
paragraphs (1) and (2) by appropriate means, as determined by the Secretary.
(B) CERTAIN ENTITIES.—The education and training activities described in subparagraph (A) may be carried out
by Federal public health or medical entities, appropriate
educational entities, professional organizations and societies, private accrediting organizations, and other nonprofit institutions or entities meeting criteria established
by the Secretary.
(C) GRANTS AND CONTRACTS.—In carrying out this subsection, the Secretary may carry out activities directly or
through the award of grants and contracts, and may enter
into interagency agreements with other Federal agencies.
(b) ADVICE TO THE FEDERAL GOVERNMENT.—
(1) REQUIRED ADVISORY COMMITTEES.—In coordination
with the working group under subsection (a), the Secretary
shall establish advisory committees in accordance with paragraphs (2) and (3) to provide expert recommendations to assist
such working groups in carrying out their respective responsibilities under subsections (a) and (b) 1.
(2) NATIONAL ADVISORY COMMITTEE ON CHILDREN AND TERRORISM 2.—
(A) IN GENERAL.—For purposes of paragraph (1), the
Secretary shall establish an advisory committee to be
known as the National Advisory Committee on At-Risk Individuals and Public Health Emergencies (referred to in
this paragraph as the ‘‘Advisory Committee’’).
(B) DUTIES.—The Advisory Committee shall provide
recommendations regarding—
(i) the preparedness of the health care (including
mental health care) system to respond to public health
emergencies as they relate to at-risk individuals;
(ii) needed changes to the health care and emergency medical service systems and emergency medical
services protocols to meet the special needs of at-risk
individuals; and
(iii) changes, if necessary, to the national stockpile
under section 121 of the Public Health Security and
Bioterrorism Preparedness and Response Act of 2002
to meet the emergency health security of at-risk individuals.
1 Probably should be ‘‘to assist such working group in carrying out its responsibilities under
subsection (a)’’. Formerly there were two working groups, one under subsection (a) and one
under subsection (b). Now there is only the working group under subsection (a). See the amendments made by sections 104(a) and 108 of Public Law 107–188 (116 Stat. 605, 609).
2 The heading for subsection (b)(2) probably should read ‘‘NATIONAL ADVISORY COMMITTEE ON
AT-RISK INDIVIDUALS AND PUBLIC HEALTH EMERGENCIES’’. The amendment made by section
301(d)(1) of Public Law 109–417 (120 Stat. 2854) to strike ‘‘CHILDREN AND TERRORISM’’ and insert ‘‘AT-RISK INDIVIDUALS AND PUBLIC HEALTH EMERGENCIES’’ could not be executed due to incorrect capitalization of the word ‘‘Children’’ in the matter to be struck. Also the letter ‘‘A’’ in the
word ‘‘At-risk’’ in the inserted text probably should be lowercase type.

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(C) COMPOSITION.—The Advisory Committee shall be
composed of such Federal officials as may be appropriate
to address the special needs of the diverse population
groups of at-risk populations.
(D) TERMINATION.—The Advisory Committee terminates six years after the date of the enactment of the Public Health Security and Bioterrorism Preparedness and Response Act of 2002.
(3) EMERGENCY PUBLIC INFORMATION AND COMMUNICATIONS ADVISORY COMMITTEE.—
(A) IN GENERAL.—For purposes of paragraph (1), the
Secretary shall establish an advisory committee to be
known as the Emergency Public Information and Communications Advisory Committee (referred to in this paragraph as the ‘‘EPIC Advisory Committee’’).
(B) DUTIES.—The EPIC Advisory Committee shall
make recommendations to the Secretary and report on appropriate ways to communicate public health information
regarding bioterrorism and other public health emergencies to the public.
(C) COMPOSITION.—The EPIC Advisory Committee
shall be composed of individuals representing a diverse
group of experts in public health, medicine, communications, behavioral psychology, and other areas determined
appropriate by the Secretary.
(D) DISSEMINATION.—The Secretary shall review the
recommendations of the EPIC Advisory Committee and ensure that appropriate information is disseminated to the
public.
(E) TERMINATION.—The EPIC Advisory Committee terminates one year after the date of the enactment of Public
Health Security and Bioterrorism Preparedness and Response Act of 2002.
(c) EXPANSION OF EPIDEMIC INTELLIGENCE SERVICE PROGRAM.—The Secretary may establish 20 officer positions in the Epidemic Intelligence Service Program, in addition to the number of
the officer positions offered under such Program in 2006, for individuals who agree to participate, for a period of not less than 2
years, in the Career Epidemiology Field Officer program in a State,
local, or tribal health department that serves a health professional
shortage area (as defined under section 332(a)), a medically underserved population (as defined under section 330(b)(3)), or a medically underserved area or area at high risk of a public health emergency as designated by the Secretary.
(d) CENTERS FOR PUBLIC HEALTH PREPAREDNESS; CORE CURRICULA AND TRAINING.—
(1) IN GENERAL.—The Secretary may establish at accredited schools of public health, Centers for Public Health Preparedness (hereafter referred to in this section as the ‘‘Centers’’).
(2) ELIGIBILITY.—To be eligible to receive an award under
this subsection to establish a Center, an accredited school of
public health shall agree to conduct activities consistent with
the requirements of this subsection.
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(3) CORE CURRICULA.—The Secretary, in collaboration with
the Centers and other public or private entities shall establish
core curricula based on established competencies leading to a
4-year bachelor’s degree, a graduate degree, a combined bachelor and master’s degree, or a certificate program, for use by
each Center. The Secretary shall disseminate such curricula to
other accredited schools of public health and other health professions schools determined appropriate by the Secretary, for
voluntary use by such schools.
(4) CORE COMPETENCY-BASED TRAINING PROGRAM.—The
Secretary, in collaboration with the Centers and other public
or private entities shall facilitate the development of a competency-based training program to train public health practitioners. The Centers shall use such training program to train
public health practitioners. The Secretary shall disseminate
such training program to other accredited schools of public
health, health professions schools, and other public or private
entities as determined by the Secretary, for voluntary use by
such entities.
(5) CONTENT OF CORE CURRICULA AND TRAINING PROGRAM.—The Secretary shall ensure that the core curricula and
training program established pursuant to this subsection respond to the needs of State, local, and tribal public health authorities and integrate and emphasize essential public health
security capabilities consistent with section 2802(b)(2).
(6) ACADEMIC-WORKFORCE COMMUNICATION.—As a condition of receiving funding from the Secretary under this subsection, a Center shall collaborate with a State, local, or tribal
public health department to—
(A) define the public health preparedness and response needs of the community involved;
(B) assess the extent to which such needs are fulfilled
by existing preparedness and response activities of such
school or health department, and how such activities may
be improved;
(C) prior to developing new materials or trainings,
evaluate and utilize relevant materials and trainings developed by others Centers; and
(D) evaluate community impact and the effectiveness
of any newly developed materials or trainings.
(7) PUBLIC HEALTH SYSTEMS RESEARCH.—In consultation
with relevant public and private entities, the Secretary shall
define the existing knowledge base for public health preparedness and response systems, and establish a research agenda
based on Federal, State, local, and tribal public health preparedness priorities. As a condition of receiving funding from
the Secretary under this subsection, a Center shall conduct
public health systems research that is consistent with the
agenda described under this paragraph.
(e) ACCELERATED RESEARCH AND DEVELOPMENT ON PRIORITY
PATHOGENS AND COUNTERMEASURES.—
(1) IN GENERAL.—With respect to pathogens of potential
use in a bioterrorist attack, and other agents that may cause
a public health emergency, the Secretary, taking into considerMarch 13, 2013

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ation any recommendations of the working group under subsection (a), shall conduct, and award grants, contracts, or cooperative agreements for, research, investigations, experiments,
demonstrations, and studies in the health sciences relating
to—
(A) the epidemiology and pathogenesis of such pathogens;
(B) the sequencing of the genomes, or other DNA analysis, or other comparative analysis, of priority pathogens
(as determined by the Director of the National Institutes
of Health in consultation with the working group established in subsection (a)), in collaboration and coordination
with the activities of the Department of Defense and the
Joint Genome Institute of the Department of Energy;
(C) the development of priority countermeasures; and
(D) other relevant areas of research;
with consideration given to the needs of children and other vulnerable populations.
(2) PRIORITY.—The Secretary shall give priority under this
section to the funding of research and other studies related to
priority countermeasures.
(3) ROLE OF DEPARTMENT OF VETERANS AFFAIRS.—In carrying out paragraph (1), the Secretary shall consider using the
biomedical research and development capabilities of the Department of Veterans Affairs, in conjunction with that Department’s affiliations with health-professions universities. When
advantageous to the Government in furtherance of the purposes of such paragraph, the Secretary may enter into cooperative agreements with the Secretary of Veterans Affairs to
achieve such purposes.
(4) PRIORITY COUNTERMEASURES.—For purposes of this section, the term ‘‘priority countermeasure’’ means a drug, biological product, device, vaccine, vaccine adjuvant, antiviral, or diagnostic test that the Secretary determines to be—
(A) a priority to treat, identify, or prevent infection by
a biological agent or toxin listed pursuant to section
351A(a)(1), or harm from any other agent that may cause
a public health emergency; or
(B) a priority to treat, identify, or prevent conditions
that may result in adverse health consequences or death
and may be caused by the administering of a drug, biological product, device, vaccine, vaccine adjuvant, antiviral, or
diagnostic test that is a priority under subparagraph (A).
(f) AUTHORIZATION OF APPROPRIATIONS.—
(1) FISCAL YEAR 2007.—There are authorized to be appropriated to carry out this section for fiscal year 2007—
(A) to carry out subsection (a)—
(i) $5,000,000 to carry out paragraphs (1) through
(4); and
(ii) $7,000,000 to carry out paragraph (5);
(B) to carry out subsection (c), $3,000,000; and
(C) to carry out subsection (d), $31,000,000, of which
$5,000,000 shall be used to carry out paragraphs (3)
through (5) of such subsection.
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(2) SUBSEQUENT FISCAL YEARS.—There are authorized to be
appropriated such sums as may be necessary to carry out this
section for fiscal year 2008 and each subsequent fiscal year.
SEC. 319F–1. ø247d–6a¿ AUTHORITY FOR USE OF CERTAIN PROCEDURES REGARDING QUALIFIED COUNTERMEASURE RESEARCH AND DEVELOPMENT ACTIVITIES. 2
(a) IN GENERAL.—
(1) AUTHORITY.—In conducting and supporting research

and development activities regarding countermeasures under
section 319F(h), the Secretary may conduct and support such
activities in accordance with this section and, in consultation
with the Director of the National Institutes of Health, as part
of the program under section 446, if the activities concern
qualified countermeasures.
(2) DEFINITIONS.—In this section:
(A) QUALIFIED COUNTERMEASURE.—The term ‘‘qualified countermeasure’’ means a drug (as that term is defined by section 201(g)(1) of the Federal Food, Drug, and
Cosmetic Act (21 U.S.C. 321(g)(1))), biological product (as
that term is defined by section 351(i) of this Act (42 U.S.C.
262(i))), or device (as that term is defined by section 201(h)
of the Federal Food, Drug, and Cosmetic Act (21 U.S.C.
321(h))), that the Secretary determines to be a priority
(consistent with sections 302(2) and 304(a) of the Homeland Security Act of 2002) to—
(i) diagnose, mitigate, prevent, or treat harm from
any biological agent (including organisms that cause
an infectious disease) or toxin, chemical, radiological,
or nuclear agent that may cause a public health emergency affecting national security; or
(ii) diagnose, mitigate, prevent, or treat harm
from a condition that may result in adverse health
consequences or death and may be caused by administering a drug, biological product, or device that is
used as described in this subparagraph.
(B) INFECTIOUS DISEASE.—The term ‘‘infectious disease’’ means a disease potentially caused by a pathogenic
organism (including a bacteria, virus, fungus, or parasite)
that is acquired by a person and that reproduces in that
person.
(3) INTERAGENCY COOPERATION.—
(A) IN GENERAL.—In carrying out activities under this
section, the Secretary is authorized, subject to subparagraph (B), to enter into interagency agreements and other
collaborative undertakings with other agencies of the
United States Government.
(B) LIMITATION.—An agreement or undertaking under
this paragraph shall not authorize another agency to exercise the authorities provided by this section.
(4) AVAILABILITY OF FACILITIES TO THE SECRETARY.—In any
grant, contract, or cooperative agreement entered into under
2 Section 5 of Public Law 108–276 (118 Stat. 860) requires various reports regarding section
319F–1 and related provisions of law. Section 5 is included in the appendix to this compilation.

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the authority provided in this section with respect to a biocontainment laboratory or other related or ancillary specialized
research facility that the Secretary determines necessary for
the purpose of performing, administering, or supporting qualified countermeasure research and development, the Secretary
may provide that the facility that is the object of such grant,
contract, or cooperative agreement shall be available as needed
to the Secretary to respond to public health emergencies affecting national security.
(5) TRANSFERS OF QUALIFIED COUNTERMEASURES.—Each
agreement for an award of a grant, contract, or cooperative
agreement under section 319F(h) for the development of a
qualified countermeasure shall provide that the recipient of the
award will comply with all applicable export-related controls
with respect to such countermeasure.
(b) EXPEDITED PROCUREMENT AUTHORITY.—
(1) INCREASED SIMPLIFIED ACQUISITION THRESHOLD FOR
QUALIFIED COUNTERMEASURE PROCUREMENTS.—
(A) IN GENERAL.—For any procurement by the Secretary of property or services for use (as determined by the
Secretary) in performing, administering, or supporting
qualified countermeasure research or development activities under this section that the Secretary determines necessary to respond to pressing research and development
needs under this section, the amount specified in section
4(11) of the Office of Federal Procurement Policy Act (41
U.S.C. 403(11)), as applicable pursuant to section 302A(a)
of the Federal Property and Administrative Services Act of
1949 (41 U.S.C. 252a(a)), shall be deemed to be
$25,000,000 in the administration, with respect to such
procurement, of—
(i) section 303(g)(1)(A) of the Federal Property and
Administrative Services Act of 1949 (41 U.S.C.
253(g)(1)(A)) and its implementing regulations; and
(ii) section 302A(b) of such Act (41 U.S.C. 252a(b))
and its implementing regulations.
(B) APPLICATION OF CERTAIN PROVISIONS.—Notwithstanding subparagraph (A) and the provision of law and
regulations referred to in such subparagraph, each of the
following provisions shall apply to procurements described
in this paragraph to the same extent that such provisions
would apply to such procurements in the absence of subparagraph (A):
(i) Chapter 37 of title 40, United States Code (relating to contract work hours and safety standards).
(ii) Subsections (a) and (b) of section 7 of the AntiKickback Act of 1986 (41 U.S.C. 57(a) and (b)).
(iii) Section 304C of the Federal Property and Administrative Services Act of 1949 (41 U.S.C. 254d) (relating to the examination of contractor records).
(iv) Section 3131 of title 40, United States Code
(relating to bonds of contractors of public buildings or
works).
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(v) Subsection (a) of section 304 of the Federal
Property and Administrative Services Act of 1949 (41
U.S.C. 254(a)) (relating to contingent fees to middlemen).
(vi) Section 6002 of the Solid Waste Disposal Act
(42 U.S.C. 6962).
(vii) Section 1354 of title 31, United States Code
(relating to the limitation on the use of appropriated
funds for contracts with entities not meeting veterans
employment reporting requirements).
(C) INTERNAL CONTROLS TO BE INSTITUTED.—The Secretary shall institute appropriate internal controls for procurements that are under this paragraph, including requirements with regard to documenting the justification
for use of the authority in this paragraph with respect to
the procurement involved.
(D) AUTHORITY TO LIMIT COMPETITION.—In conducting
a procurement under this paragraph, the Secretary may
not use the authority provided for under subparagraph (A)
to conduct a procurement on a basis other than full and
open competition unless the Secretary determines that the
mission of the BioShield Program under the Project BioShield Act of 2004 would be seriously impaired without
such a limitation.
(2) PROCEDURES OTHER THAN FULL AND OPEN COMPETITION.—
(A) IN GENERAL.—In using the authority provided in
section 303(c)(1) of title III of the Federal Property and Administrative Services Act of 1949 (41 U.S.C. 253(c)(1)) to
use procedures other than competitive procedures in the
case of a procurement described in paragraph (1) of this
subsection, the phrase ‘‘available from only one responsible
source’’ in such section 303(c)(1) shall be deemed to mean
‘‘available from only one responsible source or only from a
limited number of responsible sources’’.
(B) RELATION TO OTHER AUTHORITIES.—The authority
under subparagraph (A) is in addition to any other authority to use procedures other than competitive procedures.
(C) APPLICABLE GOVERNMENT-WIDE REGULATIONS.—
The Secretary shall implement this paragraph in accordance with government-wide regulations implementing such
section 303(c)(1) (including requirements that offers be solicited from as many potential sources as is practicable
under the circumstances, that required notices be published, and that submitted offers be considered), as such
regulations apply to procurements for which an agency has
authority to use procedures other than competitive procedures when the property or services needed by the agency
are available from only one responsible source or only from
a limited number of responsible sources and no other type
of property or services will satisfy the needs of the agency.
(3) INCREASED MICROPURCHASE THRESHOLD.—
(A) IN GENERAL.—For a procurement described by
paragraph (1), the amount specified in subsections (c), (d),
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and (f) of section 32 of the Office of Federal Procurement
Policy Act (41 U.S.C. 428) shall be deemed to be $15,000
in the administration of that section with respect to such
procurement.
(B) INTERNAL CONTROLS TO BE INSTITUTED.—The Secretary shall institute appropriate internal controls for purchases that are under this paragraph and that are greater
than $2,500.
(C) EXCEPTION TO PREFERENCE FOR PURCHASE CARD
MECHANISM.—No provision of law establishing a preference
for using a Government purchase card method for purchases shall apply to purchases that are under this paragraph and that are greater than $2,500.
(4) REVIEW.—
(A) REVIEW ALLOWED.—Notwithstanding subsection (f),
section 1491 of title 28, United States Code, and section
3556 of title 31 of such Code, review of a contracting agency decision relating to a procurement described in paragraph (1) may be had only by filing a protest—
(i) with a contracting agency; or
(ii) with the Comptroller General under subchapter V of chapter 35 of title 31, United States
Code.
(B) OVERRIDE OF STAY OF CONTRACT AWARD OR PERFORMANCE COMMITTED TO AGENCY DISCRETION.—Notwithstanding section 1491 of title 28, United States Code, and
section 3553 of title 31 of such Code, the following authorizations by the head of a procuring activity are committed
to agency discretion:
(i) An authorization under section 3553(c)(2) of
title 31, United States Code, to award a contract for
a procurement described in paragraph (1) of this subsection.
(ii) An authorization under section 3553(d)(3)(C) of
such title to perform a contract for a procurement described in paragraph (1) of this subsection.
(c) AUTHORITY TO EXPEDITE PEER REVIEW.—
(1) IN GENERAL.—The Secretary may, as the Secretary determines necessary to respond to pressing qualified countermeasure research and development needs under this section,
employ such expedited peer review procedures (including consultation with appropriate scientific experts) as the Secretary,
in consultation with the Director of NIH, deems appropriate to
obtain assessment of scientific and technical merit and likely
contribution to the field of qualified countermeasure research,
in place of the peer review and advisory council review procedures that would be required under sections 301(a)(3),
405(b)(1)(B), 405(b)(2), 406(a)(3)(A), 492, and 494, as applicable
to a grant, contract, or cooperative agreement—
(A) that is for performing, administering, or supporting qualified countermeasure research and development activities; and
(B) the amount of which is not greater than
$1,500,000.
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(2) SUBSEQUENT PHASES OF RESEARCH.—The Secretary’s
determination of whether to employ expedited peer review with
respect to any subsequent phases of a research grant, contract,
or cooperative agreement under this section shall be determined without regard to the peer review procedures used for
any prior peer review of that same grant, contract, or cooperative agreement. Nothing in the preceding sentence may be construed to impose any requirement with respect to peer review
not otherwise required under any other law or regulation.
(d) AUTHORITY FOR PERSONAL SERVICES CONTRACTS.—
(1) IN GENERAL.—For the purpose of performing, administering, or supporting qualified countermeasure research and
development activities, the Secretary may, as the Secretary determines necessary to respond to pressing qualified countermeasure research and development needs under this section,
obtain by contract (in accordance with section 3109 of title 5,
United States Code, but without regard to the limitations in
such section on the period of service and on pay) the personal
services of experts or consultants who have scientific or other
professional qualifications, except that in no case shall the
compensation provided to any such expert or consultant exceed
the daily equivalent of the annual rate of compensation for the
President.
(2) FEDERAL TORT CLAIMS ACT COVERAGE.—
(A) IN GENERAL.—A person carrying out a contract
under paragraph (1), and an officer, employee, or governing board member of such person, shall, subject to a determination by the Secretary, be deemed to be an employee of the Department of Health and Human Services
for purposes of claims under sections 1346(b) and 2672 of
title 28, United States Code, for money damages for personal injury, including death, resulting from performance
of functions under such contract.
(B) EXCLUSIVITY OF REMEDY.—The remedy provided by
subparagraph (A) shall be exclusive of any other civil action or proceeding by reason of the same subject matter
against the entity involved (person, officer, employee, or
governing board member) for any act or omission within
the scope of the Federal Tort Claims Act.
(C) RECOURSE IN CASE OF GROSS MISCONDUCT OR CONTRACT VIOLATION.—
(i) IN GENERAL.—Should payment be made by the
United States to any claimant bringing a claim under
this paragraph, either by way of administrative determination, settlement, or court judgment, the United
States shall have, notwithstanding any provision of
State law, the right to recover against any entity identified in subparagraph (B) for that portion of the damages so awarded or paid, as well as interest and any
costs of litigation, resulting from the failure of any
such entity to carry out any obligation or responsibility assumed by such entity under a contract with
the United States or from any grossly negligent or
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reckless conduct or intentional or willful misconduct
on the part of such entity.
(ii) VENUE.—The United States may maintain an
action under this subparagraph against such entity in
the district court of the United States in which such
entity resides or has its principal place of business.
(3) INTERNAL CONTROLS TO BE INSTITUTED.—
(A) IN GENERAL.—The Secretary shall institute appropriate internal controls for contracts under this subsection,
including procedures for the Secretary to make a determination of whether a person, or an officer, employee, or
governing board member of a person, is deemed to be an
employee of the Department of Health and Human Services pursuant to paragraph (2).
(B) DETERMINATION OF EMPLOYEE STATUS TO BE
FINAL.—A determination by the Secretary under subparagraph (A) that a person, or an officer, employee, or governing board member of a person, is or is not deemed to
be an employee of the Department of Health and Human
Services shall be final and binding on the Secretary and
the Attorney General and other parties to any civil action
or proceeding.
(4) NUMBER OF PERSONAL SERVICES CONTRACTS LIMITED.—
The number of experts and consultants whose personal services are obtained under paragraph (1) shall not exceed 30 at
any time.
(e) STREAMLINED PERSONNEL AUTHORITY.—
(1) IN GENERAL.—In addition to any other personnel authorities, the Secretary may, as the Secretary determines necessary to respond to pressing qualified countermeasure research and development needs under this section, without regard to those provisions of title 5, United States Code, governing appointments in the competitive service, and without
regard to the provisions of chapter 51 and subchapter III of
chapter 53 of such title relating to classification and General
Schedule pay rates, appoint professional and technical employees, not to exceed 30 such employees at any time, to positions
in the National Institutes of Health to perform, administer, or
support qualified countermeasure research and development
activities in carrying out this section.
(2) LIMITATIONS.—The authority provided for under paragraph (1) shall be exercised in a manner that—
(A) recruits and appoints individuals based solely on
their abilities, knowledge, and skills;
(B) does not discriminate for or against any applicant
for employment on any basis described in section
2302(b)(1) of title 5, United States Code;
(C) does not allow an official to appoint an individual
who is a relative (as defined in section 3110(a)(3) of such
title) of such official;
(D) does not discriminate for or against an individual
because of the exercise of any activity described in paragraph (9) or (10) of section 2302(b) of such title; and
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(E) accords a preference, among equally qualified persons, to persons who are preference eligibles (as defined in
section 2108(3) of such title).
(3) INTERNAL CONTROLS TO BE INSTITUTED.—The Secretary
shall institute appropriate internal controls for appointments
under this subsection.
(f) ACTIONS COMMITTED TO AGENCY DISCRETION.—Actions by
the Secretary under the authority of this section are committed to
agency discretion.
SEC. 319F–2. ø247d–6b¿ STRATEGIC NATIONAL STOCKPILE AND SECURITY COUNTERMEASURE PROCUREMENTS. 1
(a) STRATEGIC NATIONAL STOCKPILE.—
(1) IN GENERAL.—The Secretary, in collaboration with the

Director of the Centers for Disease Control and Prevention,
and in coordination with the Secretary of Homeland Security
(referred to in this section as the ‘‘Homeland Security Secretary’’), shall maintain a stockpile or stockpiles of drugs, vaccines and other biological products, medical devices, and other
supplies in such numbers, types, and amounts as are determined by the Secretary to be appropriate and practicable, taking into account other available sources, to provide for the
emergency health security of the United States, including the
emergency health security of children and other vulnerable
populations, in the event of a bioterrorist attack or other public
health emergency. The Secretary shall conduct an annual review (taking into account at-risk individuals) of the contents of
the stockpile, including non-pharmaceutical supplies, and
make necessary additions or modifications to the contents
based on such review.
(2) PROCEDURES.—The Secretary, in managing the stockpile under paragraph (1), shall—
(A) consult with the working group under section
319F(a);
(B) ensure that adequate procedures are followed with
respect to such stockpile for inventory management and
accounting, and for the physical security of the stockpile;
(C) in consultation with Federal, State, and local officials, take into consideration the timing and location of
special events;
(D) review and revise, as appropriate, the contents of
the stockpile on a regular basis to ensure that emerging
threats, advanced technologies, and new countermeasures
are adequately considered;
(E) devise plans for the effective and timely supplychain management of the stockpile, in consultation with
appropriate Federal, State and local agencies, and the public and private health care infrastructure;
(F) deploy the stockpile as required by the Secretary
of Homeland Security to respond to an actual or potential
emergency;
1 Section 5 of Public Law 108–276 (118 Stat. 860) requires various reports regarding section
319F–2 and related provisions of law. Section 5 is included in the appendix to this compilation.

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(G) deploy the stockpile at the discretion of the Secretary to respond to an actual or potential public health
emergency or other situation in which deployment is necessary to protect the public health or safety; and
(H) ensure the adequate physical security of the stockpile.
(b) SMALLPOX VACCINE DEVELOPMENT.—
(1) IN GENERAL.—The Secretary shall award contracts,
enter into cooperative agreements, or carry out such other activities as may reasonably be required in order to ensure that
the stockpile under subsection (a) includes an amount of vaccine against smallpox as determined by such Secretary to be
sufficient to meet the health security needs of the United
States.
(2) RULE OF CONSTRUCTION.—Nothing in this section shall
be construed to limit the private distribution, purchase, or sale
of vaccines from sources other than the stockpile described in
subsection (a).
(c) ADDITIONAL AUTHORITY REGARDING PROCUREMENT OF CERTAIN COUNTERMEASURES; AVAILABILITY OF SPECIAL RESERVE
FUND.—
(1) IN GENERAL.—
(A) USE OF FUND.—A security countermeasure may, in
accordance with this subsection, be procured with amounts
in the special reserve fund under paragraph (10).
(B) SECURITY COUNTERMEASURE.—For purposes of this
subsection, the term ‘‘security countermeasure’’ means a
drug (as that term is defined by section 201(g)(1) of the
Federal Food, Drug, and Cosmetic Act (21 U.S.C.
321(g)(1))), biological product (as that term is defined by
section 351(i) of this Act (42 U.S.C. 262(i))), or device (as
that term is defined by section 201(h) of the Federal Food,
Drug, and Cosmetic Act (21 U.S.C. 321(h))) that—
(i)(I) the Secretary determines to be a priority
(consistent with sections 302(2) and 304(a) of the
Homeland Security Act of 2002) to diagnose, mitigate,
prevent, or treat harm from any biological, chemical,
radiological, or nuclear agent identified as a material
threat under paragraph (2)(A)(ii), or to diagnose, mitigate, prevent, or treat harm from a condition that may
result in adverse health consequences or death and
may be caused by administering a drug, biological
product, or device against such an agent;
(II) the Secretary determines under paragraph
(2)(B)(ii) to be a necessary countermeasure; and
(III)(aa) is approved or cleared under chapter V of
the Federal Food, Drug, and Cosmetic Act or licensed
under section 351 of this Act; or
(bb) is a countermeasure for which the Secretary
determines that sufficient and satisfactory clinical experience or research data (including data, if available,
from pre-clinical and clinical trials) support a reasonable conclusion that the countermeasure will qualify
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for approval or licensing within eight years after the
date of a determination under paragraph (5); or
(ii) is authorized for emergency use under section
564 of the Federal Food, Drug, and Cosmetic Act.
(2) DETERMINATION OF MATERIAL THREATS.—
(A) MATERIAL THREAT.—The Homeland Security Secretary, in consultation with the Secretary and the heads of
other agencies as appropriate, shall on an ongoing basis—
(i) assess current and emerging threats of chemical, biological, radiological, and nuclear agents; and
(ii) determine which of such agents present a material threat against the United States population sufficient to affect national security.
(B) PUBLIC HEALTH IMPACT; NECESSARY COUNTERMEASURES.—The Secretary shall on an ongoing basis—
(i) assess the potential public health consequences
for the United States population of exposure to agents
identified under subparagraph (A)(ii); and
(ii) determine, on the basis of such assessment,
the agents identified under subparagraph (A)(ii) for
which countermeasures are necessary to protect the
public health.
(C) NOTICE TO CONGRESS.—The Secretary and the
Homeland Security Secretary shall promptly notify the
designated congressional committees (as defined in paragraph (10)) that a determination has been made pursuant
to subparagraph (A) or (B).
(D) ASSURING ACCESS TO THREAT INFORMATION.—In
making the assessment and determination required under
subparagraph (A), the Homeland Security Secretary shall
use all relevant information to which such Secretary is entitled under section 202 of the Homeland Security Act of
2002, including but not limited to information, regardless
of its level of classification, relating to current and emerging threats of chemical, biological, radiological, and nuclear agents.
(3) ASSESSMENT OF AVAILABILITY AND APPROPRIATENESS OF
COUNTERMEASURES.—
(A) IN GENERAL.—The Secretary, in consultation with
the Homeland Security Secretary, shall assess on an ongoing basis the availability and appropriateness of specific
countermeasures to address specific threats identified
under paragraph (2).
(B) INFORMATION.—The Secretary shall institute a
process for making publicly available the results of assessments under subparagraph (A) while withholding such information as—
(i) would, in the judgment of the Secretary, tend
to reveal public health vulnerabilities; or
(ii) would otherwise be exempt from disclosure
under section 552 of title 5, United States Code.
(4) CALL FOR DEVELOPMENT OF COUNTERMEASURES; COMMITMENT FOR RECOMMENDATION FOR PROCUREMENT.—
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(A) PROPOSAL TO THE PRESIDENT.—If, pursuant to an
assessment under paragraph (3), the Homeland Security
Secretary and the Secretary make a determination that a
countermeasure would be appropriate but is either
currently not developed or unavailable for procurement as
a security countermeasure or is approved, licensed, or
cleared only for alternative uses, such Secretaries may
jointly submit to the President a proposal to—
(i) issue a call for the development of such countermeasure; and
(ii) make a commitment that, upon the first development of such countermeasure that meets the conditions for procurement under paragraph (5), the Secretaries will, based in part on information obtained pursuant to such call, make a recommendation under
paragraph (6) that the special reserve fund under
paragraph (10) be made available for the procurement
of such countermeasure.
(B) COUNTERMEASURE SPECIFICATIONS.—The Homeland Security Secretary and the Secretary shall, to the extent practicable, include in the proposal under subparagraph (A)—
(i) estimated quantity of purchase (in the form of
number of doses or number of effective courses of
treatments regardless of dosage form);
(ii) necessary measures of minimum safety and effectiveness;
(iii) estimated price for each dose or effective
course of treatment regardless of dosage form; and
(iv) other information that may be necessary to
encourage and facilitate research, development, and
manufacture of the countermeasure or to provide specifications for the countermeasure.
(C) PRESIDENTIAL APPROVAL.—If the President approves a proposal under subparagraph (A), the Homeland
Security Secretary and the Secretary shall make known to
persons who may respond to a call for the countermeasure
involved—
(i) the call for the countermeasure;
(ii) specifications for the countermeasure under
subparagraph (B); and
(iii) the commitment described in subparagraph
(A)(ii).
(5) SECRETARY’S DETERMINATION OF COUNTERMEASURES APPROPRIATE FOR FUNDING FROM SPECIAL RESERVE FUND.—
(A) IN GENERAL.—The Secretary, in accordance with
the provisions of this paragraph, shall identify specific security countermeasures that the Secretary determines, in
consultation with the Homeland Security Secretary, to be
appropriate for inclusion in the stockpile under subsection
(a) pursuant to procurements made with amounts in the
special reserve fund under paragraph (10) (referred to in
this subsection individually as a ‘‘procurement under this
subsection’’).
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(B) REQUIREMENTS.—In making a determination under
subparagraph (A) with respect to a security countermeasure, the Secretary shall determine and consider the
following:
(i) The quantities of the product that will be needed to meet the stockpile needs.
(ii) The feasibility of production and delivery within eight years of sufficient quantities of the product.
(iii) Whether there is a lack of a significant commercial market for the product at the time of procurement, other than as a security countermeasure.
(6) RECOMMENDATION FOR PRESIDENT’S APPROVAL.—
(A) RECOMMENDATION FOR PROCUREMENT.—In the case
of a security countermeasure that the Secretary has, in accordance with paragraphs (3) and (5), determined to be appropriate for procurement under this subsection, the
Homeland Security Secretary and the Secretary shall jointly submit to the President, in coordination with the Director of the Office of Management and Budget, a recommendation that the special reserve fund under paragraph (10) be made available for the procurement of such
countermeasure.
(B) PRESIDENTIAL APPROVAL.—The special reserve fund
under paragraph (10) is available for a procurement of a
security countermeasure only if the President has approved a recommendation under subparagraph (A) regarding the countermeasure.
(C) NOTICE TO DESIGNATED CONGRESSIONAL COMMITTEES.—The Secretary and the Homeland Security Secretary shall notify the designated congressional committees of each decision of the President to approve a recommendation under subparagraph (A). Such notice shall
include an explanation of the decision to make available
the special reserve fund under paragraph (10) for procurement of such a countermeasure, including, where available, the number of, nature of, and other information concerning potential suppliers of such countermeasure, and
whether other potential suppliers of the same or similar
countermeasures were considered and rejected for procurement under this section and the reasons therefor.
(D) SUBSEQUENT SPECIFIC COUNTERMEASURES.—Procurement under this subsection of a security countermeasure for a particular purpose does not preclude the
subsequent procurement under this subsection of any
other security countermeasure for such purpose if the Secretary has determined under paragraph (5)(A) that such
countermeasure is appropriate for inclusion in the stockpile and if, as determined by the Secretary, such countermeasure provides improved safety or effectiveness, or for
other reasons enhances preparedness to respond to threats
of use of a biological, chemical, radiological, or nuclear
agent. Such a determination by the Secretary is committed
to agency discretion.
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(E) RULE OF CONSTRUCTION.—Recommendations and
approvals under this paragraph apply solely to determinations that the special reserve fund under paragraph (10)
will be made available for a procurement of a security
countermeasure, and not to the substance of contracts for
such procurement or other matters relating to awards of
such contracts.
(7) PROCUREMENT.—
(A) IN GENERAL.—For purposes of a procurement
under this subsection that is approved by the President
under paragraph (6), the Homeland Security Secretary and
the Secretary shall have responsibilities in accordance
with subparagraphs (B) and (C).
(B) INTERAGENCY AGREEMENT; COST.—The Homeland
Security Secretary shall enter into an agreement with the
Secretary for procurement of a security countermeasure in
accordance with the provisions of this paragraph. The special reserve fund under paragraph (10) shall be available
for payments made by the Secretary to a vendor for such
procurement.
(C) PROCUREMENT.—
(i) IN GENERAL.—The Secretary shall be responsible for—
(I) arranging for procurement of a security
countermeasure, including negotiating terms (including quantity, production schedule, and price)
of, and entering into, contracts and cooperative
agreements, and for carrying out such other activities as may reasonably be required, in accordance with the provisions of this subparagraph;
and
(II) promulgating such regulations as the Secretary determines necessary to implement the provisions of this subsection.
(ii) CONTRACT TERMS.—A contract for procurements under this subsection shall (or, as specified
below, may) include the following terms:
(I) PAYMENT CONDITIONED ON DELIVERY.—The
contract shall provide that no payment may be
made until delivery of a portion, acceptable to the
Secretary, of the total number of units contracted
for, except that, notwithstanding any other provision of law, the contract may provide that, if the
Secretary determines (in the Secretary’s discretion) that an advance payment, partial payment
for significant milestones, or payment to increase
manufacturing capacity is necessary to ensure
success of a project, the Secretary shall pay an
amount, not to exceed 10 percent of the contract
amount, in advance of delivery. The Secretary
shall, to the extent practicable, make the determination of advance payment at the same time as
the issuance of a solicitation. The contract shall
provide that such advance payment is required to
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be repaid if there is a failure to perform by the
vendor under the contract. The contract may also
provide for additional advance payments of 5 percent each for meeting the milestones specified in
such contract, except that such payments shall not
exceed 50 percent of the total contract amount. If
the specified milestones are reached, the advanced
payments of 5 percent shall not be required to be
repaid. Nothing in this subclause shall be construed as affecting the rights of vendors under
provisions of law or regulation (including the Federal Acquisition Regulation) relating to the termination of contracts for the convenience of the Government.
(II) DISCOUNTED PAYMENT.—The contract may
provide for a discounted price per unit of a product that is not licensed, cleared, or approved as
described in paragraph (1)(B)(i)(III)(aa) at the
time of delivery, and may provide for payment of
an additional amount per unit if the product becomes so licensed, cleared, or approved before the
expiration date of the contract (including an additional amount per unit of product delivered before
the effective date of such licensing, clearance, or
approval).
(III) CONTRACT DURATION.—The contract shall
be for a period not to exceed five years, except
that, in first awarding the contract, the Secretary
may provide for a longer duration, not exceeding
eight years, if the Secretary determines that complexities or other difficulties in performance under
the contract justify such a period. The contract
shall be renewable for additional periods, none of
which shall exceed five years.
(IV) STORAGE BY VENDOR.—The contract may
provide that the vendor will provide storage for
stocks of a product delivered to the ownership of
the Federal Government under the contract, for
such period and under such terms and conditions
as the Secretary may specify, and in such case
amounts from the special reserve fund under
paragraph (10) shall be available for costs of shipping, handling, storage, and related costs for such
product.
(V) PRODUCT APPROVAL.—The contract shall
provide that the vendor seek approval, clearance,
or licensing of the product from the Secretary; for
a timetable for the development of data and other
information to support such approval, clearance,
or licensing; and that the Secretary may waive
part or all of this contract term on request of the
vendor or on the initiative of the Secretary.
(VI) NON-STOCKPILE TRANSFERS OF SECURITY
COUNTERMEASURES.—The contract shall provide
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that the vendor will comply with all applicable export-related controls with respect to such countermeasure.
(VII) SALES EXCLUSIVITY.—The contract may
provide that the vendor is the exclusive supplier
of the product to the Federal Government for a
specified period of time, not to exceed the term of
the contract, on the condition that the vendor is
able to satisfy the needs of the Government. During the agreed period of sales exclusivity, the vendor shall not assign its rights of sales exclusivity
to another entity or entities without approval by
the Secretary. Such a sales exclusivity provision
in such a contract shall constitute a valid basis for
a sole source procurement under section 303(c)(1)
of the Federal Property and Administrative Services Act of 1949 (41 U.S.C. 253(c)(1)).
(VIII) WARM BASED SURGE CAPACITY.—The
contract may provide that the vendor establish domestic manufacturing capacity of the product to
ensure that additional production of the product is
available in the event that the Secretary determines that there is a need to quickly purchase additional quantities of the product. Such contract
may provide a fee to the vendor for establishing
and maintaining such capacity in excess of the initial requirement for the purchase of the product.
Additionally, the cost of maintaining the domestic
manufacturing capacity shall be an allowable and
allocable direct cost of the contract.
(IX) CONTRACT TERMS.—The Secretary, in any
contract for procurement under this section, may
specify—
(aa) the dosing and administration requirements for countermeasures to be developed and procured;
(bb) the amount of funding that will be
dedicated by the Secretary for development
and acquisition of the countermeasure; and
(cc) the specifications the countermeasure
must meet to qualify for procurement under a
contract under this section.
(iii) AVAILABILITY OF SIMPLIFIED ACQUISITION PROCEDURES.—
(I) IN GENERAL.—If the Secretary determines
that there is a pressing need for a procurement of
a specific countermeasure, the amount of the procurement under this subsection shall be deemed
to be below the threshold amount specified in section 4(11) of the Office of Federal Procurement
Policy Act (41 U.S.C. 403(11)), for purposes of application to such procurement, pursuant to section
302A(a) of the Federal Property and Administrative Services Act of 1949 (41 U.S.C. 252a(a)), of—
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(aa) section 303(g)(1)(A) of the Federal
Property and Administrative Services Act of
1949 (41 U.S.C. 253(g)(1)(A)) and its implementing regulations; and
(bb) section 302A(b) of such Act (41
U.S.C. 252a(b)) and its implementing regulations.
(II) APPLICATION OF CERTAIN PROVISIONS.—
Notwithstanding subclause (I) and the provision of
law and regulations referred to in such clause,
each of the following provisions shall apply to procurements described in this clause to the same extent that such provisions would apply to such procurements in the absence of subclause (I):
(aa) Chapter 37 of title 40, United States
Code (relating to contract work hours and
safety standards).
(bb) Subsections (a) and (b) of section 7 of
the Anti-Kickback Act of 1986 (41 U.S.C.
57(a) and (b)).
(cc) Section 304C of the Federal Property
and Administrative Services Act of 1949 (41
U.S.C. 254d) (relating to the examination of
contractor records).
(dd) Section 3131 of title 40, United
States Code (relating to bonds of contractors
of public buildings or works).
(ee) Subsection (a) of section 304 of the
Federal Property and Administrative Services
Act of 1949 (41 U.S.C. 254(a)) (relating to contingent fees to middlemen).
(ff) Section 6002 of the Solid Waste Disposal Act (42 U.S.C. 6962).
(gg) Section 1354 of title 31, United
States Code (relating to the limitation on the
use of appropriated funds for contracts with
entities not meeting veterans employment reporting requirements).
(III) INTERNAL CONTROLS TO BE ESTABLISHED.—The Secretary shall establish appropriate internal controls for procurements made
under this clause, including requirements with respect to documentation of the justification for the
use of the authority provided under this paragraph with respect to the procurement involved.
(IV) AUTHORITY TO LIMIT COMPETITION.—In
conducting a procurement under this subparagraph, the Secretary may not use the authority
provided for under subclause (I) to conduct a procurement on a basis other than full and open competition unless the Secretary determines that the
mission of the BioShield Program under the
Project BioShield Act of 2004 would be seriously
impaired without such a limitation.
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(iv) PROCEDURES OTHER THAN FULL AND OPEN
COMPETITION.—
(I) IN GENERAL.—In using the authority provided in section 303(c)(1) of title III of the Federal
Property and Administrative Services Act of 1949
(41 U.S.C. 253(c)(1)) to use procedures other than
competitive procedures in the case of a procurement under this subsection, the phrase ‘‘available
from only one responsible source’’ in such section
303(c)(1) shall be deemed to mean ‘‘available from
only one responsible source or only from a limited
number of responsible sources’’.
(II) RELATION TO OTHER AUTHORITIES.—The
authority under subclause (I) is in addition to any
other authority to use procedures other than competitive procedures.
(III) APPLICABLE GOVERNMENT-WIDE REGULATIONS.—The Secretary shall implement this clause
in accordance with government-wide regulations
implementing such section 303(c)(1) (including requirements that offers be solicited from as many
potential sources as is practicable under the circumstances, that required notices be published,
and that submitted offers be considered), as such
regulations apply to procurements for which an
agency has authority to use procedures other than
competitive procedures when the property or services needed by the agency are available from only
one responsible source or only from a limited
number of responsible sources and no other type
of property or services will satisfy the needs of the
agency.
(v) PREMIUM PROVISION IN MULTIPLE AWARD CONTRACTS.—
(I) IN GENERAL.—If, under this subsection, the
Secretary enters into contracts with more than
one vendor to procure a security countermeasure,
such Secretary may, notwithstanding any other
provision of law, include in each of such contracts
a provision that—
(aa) identifies an increment of the total
quantity of security countermeasure required,
whether by percentage or by numbers of
units; and
(bb) promises to pay one or more specified
premiums based on the priority of such vendors’ production and delivery of the increment
identified under item (aa), in accordance with
the terms and conditions of the contract.
(II) DETERMINATION OF GOVERNMENT’S REQUIREMENT NOT REVIEWABLE.—If the Secretary includes in each of a set of contracts a provision as
described in subclause (I), such Secretary’s determination of the total quantity of security counterMarch 13, 2013

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measure required, and any amendment of such
determination, is committed to agency discretion.
(vi) EXTENSION OF CLOSING DATE FOR RECEIPT OF
PROPOSALS NOT REVIEWABLE.—A decision by the Secretary to extend the closing date for receipt of proposals for a procurement under this subsection is committed to agency discretion.
(vii) LIMITING COMPETITION TO SOURCES RESPONDING TO REQUEST FOR INFORMATION.—In conducting a
procurement under this subsection, the Secretary may
exclude a source that has not responded to a request
for information under section 303A(a)(1)(B) of the Federal Property and Administrative Services Act of 1949
(41 U.S.C. 253a(a)(1)(B)) if such request has given notice that the Secretary may so exclude such a source.
(8) INTERAGENCY COOPERATION.—
(A) IN GENERAL.—In carrying out activities under this
section, the Homeland Security Secretary and the Secretary are authorized, subject to subparagraph (B), to
enter into interagency agreements and other collaborative
undertakings with other agencies of the United States
Government. Such agreements may allow other executive
agencies to order qualified and security countermeasures
under procurement contracts or other agreements established by the Secretary. Such ordering process (including
transfers of appropriated funds between an agency and the
Department of Health and Human Services as reimbursements for such orders for countermeasures) may be conducted under the authority of section 1535 of title 31,
United States Code, except that all such orders shall be
processed under the terms established under this subsection for the procurement of countermeasures.
(B) LIMITATION.—An agreement or undertaking under
this paragraph shall not authorize another agency to exercise the authorities provided by this section to the Homeland Security Secretary or to the Secretary.
(9) RESTRICTIONS ON USE OF FUNDS.—Amounts in the special reserve fund under paragraph (10) shall not be used to
pay—
(A) costs for the purchase of vaccines under procurement contracts entered into before the date of the enactment of the Project BioShield Act of 2004; or
(B) costs other than payments made by the Secretary
to a vendor for a procurement of a security countermeasure under paragraph (7).
(10) DEFINITIONS.—
(A) SPECIAL RESERVE FUND.—For purposes of this subsection, the term ‘‘special reserve fund’’ has the meaning
given such term in section 510 of the Homeland Security
Act of 2002 1.
1 Subsections (a) through (c) of such section provide as follows:
(a) AUTHORIZATION OF APPROPRIATIONS.—For the procurement of security countermeasures
under section 319F–2(c) of the Public Health Service Act (referred to in this section as the ‘‘security countermeasures program’’), there is authorized to be appropriated up to $5,593,000,000 for

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(B) DESIGNATED CONGRESSIONAL COMMITTEES.—For
purposes of this section, the term ‘‘designated congressional committees’’ means the following committees of the
Congress:
(i) In the House of Representatives: the Committee on Energy and Commerce, the Committee on
Appropriations, the Committee on Government Reform, and the Select Committee on Homeland Security
(or any successor to the Select Committee).
(ii) In the Senate: the appropriate committees.
(d) DISCLOSURES.—No Federal agency shall disclose under section 552 of title 5, United States Code, any information identifying
the location at which materials in the stockpile under subsection
(a) are stored.
(e) DEFINITION.—For purposes of subsection (a), the term
‘‘stockpile’’ includes—
(1) a physical accumulation (at one or more locations) of
the supplies described in subsection (a); or
(2) a contractual agreement between the Secretary and a
vendor or vendors under which such vendor or vendors agree
to provide to such Secretary supplies described in subsection
(a).
(f) AUTHORIZATION OF APPROPRIATIONS.—
(1) STRATEGIC NATIONAL STOCKPILE.—For the purpose of
carrying out subsection (a), there are authorized to be appropriated $640,000,000 for fiscal year 2002, and such sums as
may be necessary for each of fiscal years 2003 through 2006.
Such authorization is in addition to amounts in the special reserve fund referred to in subsection (c)(10)(A).
(2) SMALLPOX VACCINE DEVELOPMENT.—For the purpose of
carrying out subsection (b), there are authorized to be appropriated $509,000,000 for fiscal year 2002, and such sums as
may be necessary for each of fiscal years 2003 through 2006.
SEC. 319F–3. ø247d–6d¿ TARGETED LIABILITY PROTECTIONS FOR PANDEMIC AND EPIDEMIC PRODUCTS AND SECURITY COUNTERMEASURES.
(a) LIABILITY PROTECTIONS.—
(1) IN GENERAL.—Subject to the other provisions of this

section, a covered person shall be immune from suit and liability under Federal and State law with respect to all claims for
loss caused by, arising out of, relating to, or resulting from the
administration to or the use by an individual of a covered
countermeasure if a declaration under subsection (b) has been
issued with respect to such countermeasure.
(2) SCOPE OF CLAIMS FOR LOSS.—
the fiscal years 2004 through 2013. Of the amounts appropriated under the preceding sentence,
not to exceed $3,418,000,000 may be obligated during the fiscal years 2004 through 2008, of
which not to exceed $890,000,000 may be obligated during fiscal year 2004.
(b) SPECIAL RESERVE FUND.—For purposes of the security countermeasures program, the term
‘‘special reserve fund’’ means the ‘‘Biodefense Countermeasures’’ appropriations account or any
other appropriation made under subsection (a).
(c) AVAILABILITY.—Amounts appropriated under subsection (a) become available for a procurement under the security countermeasures program only upon the approval by the President of
such availability for the procurement in accordance with paragraph (6)(B) of such program.

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(A) LOSS.—For purposes of this section, the term ‘‘loss’’
means any type of loss, including—
(i) death;
(ii) physical, mental, or emotional injury, illness,
disability, or condition;
(iii) fear of physical, mental, or emotional injury,
illness, disability, or condition, including any need for
medical monitoring; and
(iv) loss of or damage to property, including business interruption loss.
Each of clauses (i) through (iv) applies without regard to
the date of the occurrence, presentation, or discovery of the
loss described in the clause.
(B) SCOPE.—The immunity under paragraph (1) applies to any claim for loss that has a causal relationship
with the administration to or use by an individual of a covered countermeasure, including a causal relationship with
the design, development, clinical testing or investigation,
manufacture, labeling, distribution, formulation, packaging, marketing, promotion, sale, purchase, donation, dispensing, prescribing, administration, licensing, or use of
such countermeasure.
(3) CERTAIN CONDITIONS.—Subject to the other provisions
of this section, immunity under paragraph (1) with respect to
a covered countermeasure applies only if—
(A) the countermeasure was administered or used during the effective period of the declaration that was issued
under subsection (b) with respect to the countermeasure;
(B) the countermeasure was administered or used for
the category or categories of diseases, health conditions, or
threats to health specified in the declaration; and
(C) in addition, in the case of a covered person who is
a program planner or qualified person with respect to the
administration or use of the countermeasure, the countermeasure was administered to or used by an individual
who—
(i) was in a population specified by the declaration; and
(ii) was at the time of administration physically
present in a geographic area specified by the declaration or had a connection to such area specified in the
declaration.
(4) APPLICABILITY OF CERTAIN CONDITIONS.—With respect
to immunity under paragraph (1) and subject to the other provisions of this section:
(A) In the case of a covered person who is a manufacturer or distributor of the covered countermeasure involved, the immunity applies without regard to whether
such countermeasure was administered to or used by an
individual in accordance with the conditions described in
paragraph (3)(C).
(B) In the case of a covered person who is a program
planner or qualified person with respect to the administration or use of the covered countermeasure, the scope of imMarch 13, 2013

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munity includes circumstances in which the countermeasure was administered to or used by an individual in
circumstances in which the covered person reasonably
could have believed that the countermeasure was administered or used in accordance with the conditions described
in paragraph (3)(C).
(5) EFFECT OF DISTRIBUTION METHOD.—The provisions of
this section apply to a covered countermeasure regardless of
whether such countermeasure is obtained by donation, commercial sale, or any other means of distribution, except to the
extent that, under paragraph (2)(E) of subsection (b), the declaration under such subsection provides that subsection (a) applies only to covered countermeasures obtained through a particular means of distribution.
(6) REBUTTABLE PRESUMPTION.—For purposes of paragraph
(1), there shall be a rebuttable presumption that any administration or use, during the effective period of the emergency declaration by the Secretary under subsection (b), of a covered
countermeasure shall have been for the category or categories
of diseases, health conditions, or threats to health with respect
to which such declaration was issued.
(b) DECLARATION BY SECRETARY.—
(1) AUTHORITY TO ISSUE DECLARATION.—Subject to paragraph (2), if the Secretary makes a determination that a disease or other health condition or other threat to health constitutes a public health emergency, or that there is a credible
risk that the disease, condition, or threat may in the future
constitute such an emergency, the Secretary may make a declaration, through publication in the Federal Register, recommending, under conditions as the Secretary may specify, the
manufacture, testing, development, distribution, administration, or use of one or more covered countermeasures, and stating that subsection (a) is in effect with respect to the activities
so recommended.
(2) CONTENTS.—In issuing a declaration under paragraph
(1), the Secretary shall identify, for each covered countermeasure specified in the declaration—
(A) the category or categories of diseases, health conditions, or threats to health for which the Secretary recommends the administration or use of the countermeasure;
(B) the period or periods during which, including as
modified by paragraph (3), subsection (a) is in effect, which
period or periods may be designated by dates, or by milestones or other description of events, including factors
specified in paragraph (6);
(C) the population or populations of individuals for
which subsection (a) is in effect with respect to the administration or use of the countermeasure (which may be a
specification that such subsection applies without geographic limitation to all individuals);
(D) the geographic area or areas for which subsection
(a) is in effect with respect to the administration or use of
the countermeasure (which may be a specification that
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cluding, with respect to individuals in the populations
identified under subparagraph (C), a specification, as determined appropriate by the Secretary, of whether the declaration applies only to individuals physically present in
such areas or whether in addition the declaration applies
to individuals who have a connection to such areas, which
connection is described in the declaration; and
(E) whether subsection (a) is effective only to a particular means of distribution as provided in subsection
(a)(5) for obtaining the countermeasure, and if so, the particular means to which such subsection is effective.
(3) EFFECTIVE PERIOD OF DECLARATION.—
(A) FLEXIBILITY OF PERIOD.—The Secretary may, in describing periods under paragraph (2)(B), have different periods for different covered persons to address different
logistical, practical or other differences in responsibilities.
(B) ADDITIONAL TIME TO BE SPECIFIED.—In each declaration under paragraph (1), the Secretary, after consulting, to the extent the Secretary deems appropriate,
with the manufacturer of the covered countermeasure,
shall also specify a date that is after the ending date specified under paragraph (2)(B) and that allows what the Secretary determines is—
(i) a reasonable period for the manufacturer to arrange for disposition of the covered countermeasure,
including the return of such product to the manufacturer; and
(ii) a reasonable period for covered persons to take
such other actions as may be appropriate to limit administration or use of the covered countermeasure.
(C) ADDITIONAL PERIOD FOR CERTAIN STRATEGIC NATIONAL STOCKPILE COUNTERMEASURES.—With respect to a
covered countermeasure that is in the stockpile under section 319F-2, if such countermeasure was the subject of a
declaration under paragraph (1) at the time that it was obtained for the stockpile, the effective period of such declaration shall include a period when the countermeasure is
administered or used pursuant to a distribution or release
from the stockpile.
(4) AMENDMENTS TO DECLARATION.—The Secretary may
through publication in the Federal Register amend any portion
of a declaration under paragraph (1). Such an amendment
shall not retroactively limit the applicability of subsection (a)
with respect to the administration or use of the covered countermeasure involved.
(5) CERTAIN DISCLOSURES.—In publishing a declaration
under paragraph (1) in the Federal Register, the Secretary is
not required to disclose any matter described in section 552(b)
of title 5, United States Code.
(6) FACTORS TO BE CONSIDERED.—In deciding whether and
under what circumstances or conditions to issue a declaration
under paragraph (1) with respect to a covered countermeasure,
the Secretary shall consider the desirability of encouraging the
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ture, labeling, distribution, formulation, packaging, marketing,
promotion, sale, purchase, donation, dispensing, prescribing,
administration, licensing, and use of such countermeasure.
(7) JUDICIAL REVIEW.—No court of the United States, or of
any State, shall have subject matter jurisdiction to review,
whether by mandamus or otherwise, any action by the Secretary under this subsection.
(8) PREEMPTION OF STATE LAW.—During the effective period of a declaration under subsection (b), or at any time with
respect to conduct undertaken in accordance with such declaration, no State or political subdivision of a State may establish,
enforce, or continue in effect with respect to a covered countermeasure any provision of law or legal requirement that—
(A) is different from, or is in conflict with, any requirement applicable under this section; and
(B) relates to the design, development, clinical testing
or investigation, formulation, manufacture, distribution,
sale, donation, purchase, marketing, promotion, packaging,
labeling, licensing, use, any other aspect of safety or efficacy, or the prescribing, dispensing, or administration by
qualified persons of the covered countermeasure, or to any
matter included in a requirement applicable to the covered
countermeasure under this section or any other provision
of this Act, or under the Federal Food, Drug, and Cosmetic
Act.
(9) REPORT TO CONGRESS.—Within 30 days after making a
declaration under paragraph (1), the Secretary shall submit to
the appropriate committees of the Congress a report that provides an explanation of the reasons for issuing the declaration
and the reasons underlying the determinations of the Secretary with respect to paragraph (2). Within 30 days after
making an amendment under paragraph (4), the Secretary
shall submit to such committees a report that provides the reasons underlying the determination of the Secretary to make
the amendment.
(c) DEFINITION OF WILLFUL MISCONDUCT.—
(1) DEFINITION.—
(A) IN GENERAL.—Except as the meaning of such term
is further restricted pursuant to paragraph (2), the term
‘‘willful misconduct’’ shall, for purposes of subsection (d),
denote an act or omission that is taken—
(i) intentionally to achieve a wrongful purpose;
(ii) knowingly without legal or factual justification; and
(iii) in disregard of a known or obvious risk that
is so great as to make it highly probable that the
harm will outweigh the benefit.
(B) RULE OF CONSTRUCTION.—The criterion stated in
subparagraph (A) shall be construed as establishing a
standard for liability that is more stringent than a standard of negligence in any form or recklessness.
(2) AUTHORITY TO PROMULGATE REGULATORY DEFINITION.—
(A) IN GENERAL.—The Secretary, in consultation with
the Attorney General, shall promulgate regulations, which
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may be promulgated through interim final rules, that further restrict the scope of actions or omissions by a covered
person that may qualify as ‘‘willful misconduct’’ for purposes of subsection (d).
(B) FACTORS TO BE CONSIDERED.—In promulgating the
regulations under this paragraph, the Secretary, in consultation with the Attorney General, shall consider the
need to define the scope of permissible civil actions under
subsection (d) in a way that will not adversely affect the
public health.
(C) TEMPORAL SCOPE OF REGULATIONS.—The regulations under this paragraph may specify the temporal effect
that they shall be given for purposes of subsection (d).
(D) INITIAL RULEMAKING.—Within 180 days after the
enactment of the Public Readiness and Emergency Preparedness Act, the Secretary, in consultation with the Attorney General, shall commence and complete an initial
rulemaking process under this paragraph.
(3) PROOF OF WILLFUL MISCONDUCT.—In an action under
subsection (d), the plaintiff shall have the burden of proving by
clear and convincing evidence willful misconduct by each covered person sued and that such willful misconduct caused
death or serious physical injury.
(4) DEFENSE FOR ACTS OR OMISSIONS TAKEN PURSUANT TO
SECRETARY’S DECLARATION.—Notwithstanding any other provision of law, a program planner or qualified person shall not
have engaged in ‘‘willful misconduct’’ as a matter of law where
such program planner or qualified person acted consistent with
applicable directions, guidelines, or recommendations by the
Secretary regarding the administration or use of a covered
countermeasure that is specified in the declaration under subsection (b), provided either the Secretary, or a State or local
health authority, was provided with notice of information regarding serious physical injury or death from the administration or use of a covered countermeasure that is material to the
plaintiff’s alleged loss within 7 days of the actual discovery of
such information by such program planner or qualified person.
(5) EXCLUSION FOR REGULATED ACTIVITY OF MANUFACTURER
OR DISTRIBUTOR.—
(A) IN GENERAL.—If an act or omission by a manufacturer or distributor with respect to a covered countermeasure, which act or omission is alleged under subsection
(e)(3)(A) to constitute willful misconduct, is subject to regulation by this Act or by the Federal Food, Drug, and Cosmetic Act, such act or omission shall not constitute ‘‘willful
misconduct’’ for purposes of subsection (d) if—
(i) neither the Secretary nor the Attorney General
has initiated an enforcement action with respect to
such act or omission; or
(ii) such an enforcement action has been initiated
and the action has been terminated or finally resolved
without a covered remedy.
Any action or proceeding under subsection (d) shall be
stayed during the pendency of such an enforcement action.
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(B) DEFINITIONS.—For purposes of this paragraph, the
following terms have the following meanings:
(i) ENFORCEMENT ACTION.—The term ‘‘enforcement
action’’ means a criminal prosecution, an action seeking an injunction, a seizure action, a civil monetary
proceeding based on willful misconduct, a mandatory
recall of a product because voluntary recall was refused, a proceeding to compel repair or replacement of
a product, a termination of an exemption under section 505(i) or 520(g) of the Federal Food, Drug, and
Cosmetic Act, a debarment proceeding, an investigator
disqualification proceeding where an investigator is an
employee or agent of the manufacturer, a revocation,
based on willful misconduct, of an authorization under
section 564 of such Act, or a suspension or withdrawal,
based on willful misconduct, of an approval or clearance under chapter V of such Act or of a licensure
under section 351 of this Act.
(ii) COVERED REMEDY.—The term ‘‘covered remedy’’ means an outcome—
(I) that is a criminal conviction, an injunction,
or a condemnation, a civil monetary payment, a
product recall, a repair or replacement of a product, a termination of an exemption under section
505(i) or 520(g) of the Federal Food, Drug, and
Cosmetic Act, a debarment, an investigator disqualification, a revocation of an authorization
under section 564 of such Act, or a suspension or
withdrawal of an approval or clearance under
chapter 5 of such Act or of a licensure under section 351 of this Act; and
(II) that results from a final determination by
a court or from a final agency action.
(iii) FINAL.—The terms ‘‘final’’ and ‘‘finally’’—
(I) with respect to a court determination, or to
a final resolution of an enforcement action that is
a court determination, mean a judgment from
which an appeal of right cannot be taken or a voluntary or stipulated dismissal; and
(II) with respect to an agency action, or to a
final resolution of an enforcement action that is
an agency action, mean an order that is not subject to further review within the agency and that
has not been reversed, vacated, enjoined, or otherwise nullified by a final court determination or a
voluntary or stipulated dismissal.
(C) RULES OF CONSTRUCTION.—
(i) IN GENERAL.—Nothing in this paragraph shall
be construed—
(I) to affect the interpretation of any provision
of the Federal Food, Drug, and Cosmetic Act, of
this Act, or of any other applicable statute or regulation; or
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(II) to impair, delay, alter, or affect the authority, including the enforcement discretion, of
the United States, of the Secretary, of the Attorney General, or of any other official with respect
to any administrative or court proceeding under
this Act, under the Federal Food, Drug, and Cosmetic Act, under title 18 of the United States
Code, or under any other applicable statute or
regulation.
(ii) MANDATORY RECALLS.—A mandatory recall
called for in the declaration is not a Food and Drug
Administration enforcement action.
(d) EXCEPTION TO IMMUNITY OF COVERED PERSONS.—
(1) IN GENERAL.—Subject to subsection (f), the sole exception to the immunity from suit and liability of covered persons
set forth in subsection (a) shall be for an exclusive Federal
cause of action against a covered person for death or serious
physical injury proximately caused by willful misconduct, as
defined pursuant to subsection (c), by such covered person. For
purposes of section 2679(b)(2)(B) of title 28, United States
Code, such a cause of action is not an action brought for violation of a statute of the United States under which an action
against an individual is otherwise authorized.
(2) PERSONS WHO CAN SUE.—An action under this subsection may be brought for wrongful death or serious physical
injury by any person who suffers such injury or by any representative of such a person.
(e) PROCEDURES FOR SUIT.—
(1) EXCLUSIVE FEDERAL JURISDICTION.—Any action under
subsection (d) shall be filed and maintained only in the United
States District Court for the District of Columbia.
(2) GOVERNING LAW.—The substantive law for decision in
an action under subsection (d) shall be derived from the law,
including choice of law principles, of the State in which the alleged willful misconduct occurred, unless such law is inconsistent with or preempted by Federal law, including provisions
of this section.
(3) PLEADING WITH PARTICULARITY.—In an action under
subsection (d), the complaint shall plead with particularity
each element of the plaintiff’s claim, including—
(A) each act or omission, by each covered person sued,
that is alleged to constitute willful misconduct relating to
the covered countermeasure administered to or used by
the person on whose behalf the complaint was filed;
(B) facts supporting the allegation that such alleged
willful misconduct proximately caused the injury claimed;
and
(C) facts supporting the allegation that the person on
whose behalf the complaint was filed suffered death or serious physical injury.
(4) VERIFICATION, CERTIFICATION, AND MEDICAL RECORDS.—
(A) IN GENERAL.—In an action under subsection (d),
the plaintiff shall verify the complaint in the manner stated in subparagraph (B) and shall file with the complaint
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the materials described in subparagraph (C). A complaint
that does not substantially comply with subparagraphs (B)
and (C) shall not be accepted for filing and shall not stop
the running of the statute of limitations.
(B) VERIFICATION REQUIREMENT.—
(i) IN GENERAL.—The complaint shall include a
verification, made by affidavit of the plaintiff under
oath, stating that the pleading is true to the knowledge of the deponent, except as to matters specifically
identified as being alleged on information and belief,
and that as to those matters the plaintiff believes it to
be true.
(ii) IDENTIFICATION OF MATTERS ALLEGED UPON INFORMATION AND BELIEF.—Any matter that is not specifically identified as being alleged upon the information and belief of the plaintiff, shall be regarded for all
purposes, including a criminal prosecution, as having
been made upon the knowledge of the plaintiff.
(C) MATERIALS REQUIRED.—In an action under subsection (d), the plaintiff shall file with the complaint—
(i) an affidavit, by a physician who did not treat
the person on whose behalf the complaint was filed,
certifying, and explaining the basis for such physician’s belief, that such person suffered the serious
physical injury or death alleged in the complaint and
that such injury or death was proximately caused by
the administration or use of a covered countermeasure; and
(ii) certified medical records documenting such injury or death and such proximate causal connection.
(5) THREE-JUDGE COURT.—Any action under subsection (d)
shall be assigned initially to a panel of three judges. Such
panel shall have jurisdiction over such action for purposes of
considering motions to dismiss, motions for summary judgment, and matters related thereto. If such panel has denied
such motions, or if the time for filing such motions has expired,
such panel shall refer the action to the chief judge for assignment for further proceedings, including any trial. Section 1253
of title 28, United States Code, and paragraph (3) of subsection
(b) of section 2284 of title 28, United States Code, shall not
apply to actions under subsection (d).
(6) CIVIL DISCOVERY.—
(A) TIMING.—In an action under subsection (d), no discovery shall be allowed—
(i) before each covered person sued has had a reasonable opportunity to file a motion to dismiss;
(ii) in the event such a motion is filed, before the
court has ruled on such motion; and
(iii) in the event a covered person files an interlocutory appeal from the denial of such a motion, before the court of appeals has ruled on such appeal.
(B) STANDARD.—Notwithstanding any other provision
of law, the court in an action under subsection (d) shall
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lated to material issues contested in such action, and the
court shall compel a response to a discovery request (including a request for admission, an interrogatory, a request for production of documents, or any other form of
discovery request) under Rule 37, Federal Rules of Civil
Procedure, only if the court finds that the requesting party
needs the information sought to prove or defend as to a
material issue contested in such action and that the likely
benefits of a response to such request equal or exceed the
burden or cost for the responding party of providing such
response.
(7) REDUCTION IN AWARD OF DAMAGES FOR COLLATERAL
SOURCE BENEFITS.—
(A) IN GENERAL.—In an action under subsection (d),
the amount of an award of damages that would otherwise
be made to a plaintiff shall be reduced by the amount of
collateral source benefits to such plaintiff.
(B) PROVIDER OF COLLATERAL SOURCE BENEFITS NOT
TO HAVE LIEN OR SUBROGATION.—No provider of collateral
source benefits shall recover any amount against the plaintiff or receive any lien or credit against the plaintiff’s recovery or be equitably or legally subrogated to the right of
the plaintiff in an action under subsection (d).
(C) COLLATERAL SOURCE BENEFIT DEFINED.—For purposes of this paragraph, the term ‘‘collateral source benefit’’ means any amount paid or to be paid in the future
to or on behalf of the plaintiff, or any service, product, or
other benefit provided or to be provided in the future to or
on behalf of the plaintiff, as a result of the injury or
wrongful death, pursuant to—
(i) any State or Federal health, sickness, incomedisability, accident, or workers’ compensation law;
(ii) any health, sickness, income-disability, or accident insurance that provides health benefits or income-disability coverage;
(iii) any contract or agreement of any group, organization, partnership, or corporation to provide, pay
for, or reimburse the cost of medical, hospital, dental,
or income disability benefits; or
(iv) any other publicly or privately funded program.
(8) NONECONOMIC DAMAGES.—In an action under subsection (d), any noneconomic damages may be awarded only in
an amount directly proportional to the percentage of responsibility of a defendant for the harm to the plaintiff. For purposes
of this paragraph, the term ‘‘noneconomic damages’’ means
damages for losses for physical and emotional pain, suffering,
inconvenience, physical impairment, mental anguish, disfigurement, loss of enjoyment of life, loss of society and companionship, loss of consortium, hedonic damages, injury to reputation,
and any other nonpecuniary losses.
(9) RULE 11 SANCTIONS.—Whenever a district court of the
United States determines that there has been a violation of
Rule 11 of the Federal Rules of Civil Procedure in an action
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under subsection (d), the court shall impose upon the attorney,
law firm, or parties that have violated Rule 11 or are responsible for the violation, an appropriate sanction, which may include an order to pay the other party or parties for the reasonable expenses incurred as a direct result of the filing of the
pleading, motion, or other paper that is the subject of the violation, including a reasonable attorney’s fee. Such sanction shall
be sufficient to deter repetition of such conduct or comparable
conduct by others similarly situated, and to compensate the
party or parties injured by such conduct.
(10) INTERLOCUTORY APPEAL.—The United States Court of
Appeals for the District of Columbia Circuit shall have jurisdiction of an interlocutory appeal by a covered person taken within 30 days of an order denying a motion to dismiss or a motion
for summary judgment based on an assertion of the immunity
from suit conferred by subsection (a) or based on an assertion
of the exclusion under subsection (c)(5).
(f) ACTIONS BY AND AGAINST THE UNITED STATES.—Nothing in
this section shall be construed to abrogate or limit any right, remedy, or authority that the United States or any agency thereof may
possess under any other provision of law or to waive sovereign immunity or to abrogate or limit any defense or protection available
to the United States or its agencies, instrumentalities, officers, or
employees under any other law, including any provision of chapter
171 of title 28, United States Code (relating to tort claims procedure).
(g) SEVERABILITY.—If any provision of this section, or the application of such provision to any person or circumstance, is held to
be unconstitutional, the remainder of this section and the application of such remainder to any person or circumstance shall not be
affected thereby.
(h) RULE OF CONSTRUCTION CONCERNING NATIONAL VACCINE
INJURY COMPENSATION PROGRAM.—Nothing in this section, or any
amendment made by the Public Readiness and Emergency Preparedness Act, shall be construed to affect the National Vaccine Injury Compensation Program under title XXI of this Act.
(i) DEFINITIONS.—In this section:
(1) COVERED COUNTERMEASURE.—The term ‘‘covered countermeasure’’ means—
(A) a qualified pandemic or epidemic product (as defined in paragraph (7));
(B) a security countermeasure (as defined in section
319F–2(c)(1)(B)); or
(C) a drug (as such term is defined in section 201(g)(1)
of the Federal Food, Drug, and Cosmetic Act (21 U.S.C.
321(g)(1)), biological product (as such term is defined by
section 351(i) of this Act), or device (as such term is defined by section 201(h) of the Federal Food, Drug and Cosmetic Act (21 U.S.C. 321(h)) that is authorized for emergency use in accordance with section 564 of the Federal
Food, Drug, and Cosmetic Act.
(2) COVERED PERSON.—The term ‘‘covered person’’, when
used with respect to the administration or use of a covered
countermeasure, means—
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(A) the United States; or
(B) a person or entity that is—
(i) a manufacturer of such countermeasure;
(ii) a distributor of such countermeasure;
(iii) a program planner of such countermeasure;
(iv) a qualified person who prescribed, administered, or dispensed such countermeasure; or
(v) an official, agent, or employee of a person or
entity described in clause (i), (ii), (iii), or (iv).
(3) DISTRIBUTOR.—The term ‘‘distributor’’ means a person
or entity engaged in the distribution of drugs, biologics, or devices, including but not limited to manufacturers; repackers;
common carriers; contract carriers; air carriers; own-label distributors; private-label distributors; jobbers; brokers; warehouses, and wholesale drug warehouses; independent wholesale drug traders; and retail pharmacies.
(4) MANUFACTURER.—The term ‘‘manufacturer’’ includes—
(A) a contractor or subcontractor of a manufacturer;
(B) a supplier or licenser of any product, intellectual
property, service, research tool, or component or other article used in the design, development, clinical testing, investigation, or manufacturing of a covered countermeasure;
and
(C) any or all of the parents, subsidiaries, affiliates,
successors, and assigns of a manufacturer.
(5) PERSON.—The term ‘‘person’’ includes an individual,
partnership, corporation, association, entity, or public or private corporation, including a Federal, State, or local government agency or department.
(6) PROGRAM PLANNER.—The term ‘‘program planner’’
means a State or local government, including an Indian tribe,
a person employed by the State or local government, or other
person who supervised or administered a program with respect
to the administration, dispensing, distribution, provision, or
use of a security countermeasure or a qualified pandemic or
epidemic product, including a person who has established requirements, provided policy guidance, or supplied technical or
scientific advice or assistance or provides a facility to administer or use a covered countermeasure in accordance with a
declaration under subsection (b).
(7) QUALIFIED PANDEMIC OR EPIDEMIC PRODUCT.—The term
‘‘qualified pandemic or epidemic product’’ means a drug (as
such term is defined in section 201(g)(1) of the Federal Food,
Drug, and Cosmetic Act (21 U.S.C. 321(g)(1)), biological product (as such term is defined by section 351(i) of this Act), or
device (as such term is defined by section 201(h) of the Federal
Food, Drug and Cosmetic Act (21 U.S.C. 321(h)) that is—
(A)(i) a product manufactured, used, designed, developed, modified, licensed, or procured—
(I) to diagnose, mitigate, prevent, treat, or cure a
pandemic or epidemic; or
(II) to limit the harm such pandemic or epidemic
might otherwise cause; or
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(ii) a product manufactured, used, designed, developed,
modified, licensed, or procured to diagnose, mitigate, prevent, treat, or cure a serious or life-threatening disease or
condition caused by a product described in clause (i); and
(B)(i) approved or cleared under chapter V of the Federal Food, Drug, and Cosmetic Act or licensed under section 351 of this Act;
(ii) the object of research for possible use as described
by subparagraph (A) and is the subject of an exemption
under section 505(i) or 520(g) of the Federal Food, Drug,
and Cosmetic Act; or
(iii) authorized for emergency use in accordance with
section 564 of the Federal Food, Drug, and Cosmetic Act.
(8) QUALIFIED PERSON.—The term ‘‘qualified person’’, when
used with respect to the administration or use of a covered
countermeasure, means—
(A) a licensed health professional or other individual
who is authorized to prescribe, administer, or dispense
such countermeasures under the law of the State in which
the countermeasure was prescribed, administered, or dispensed; or
(B) a person within a category of persons so identified
in a declaration by the Secretary under subsection (b).
(9) SECURITY COUNTERMEASURE.—The term ‘‘security countermeasure’’ has the meaning given such term in section 319F–
2(c)(1)(B).
(10) SERIOUS PHYSICAL INJURY.—The term ‘‘serious physical injury’’ means an injury that—
(A) is life threatening;
(B) results in permanent impairment of a body function or permanent damage to a body structure; or
(C) necessitates medical or surgical intervention to
preclude permanent impairment of a body function or permanent damage to a body structure.
SEC. 319F–4. ø247d–6e¿ COVERED COUNTERMEASURE PROCESS.
(a) ESTABLISHMENT OF FUND.—Upon the issuance by the

Secretary of a declaration under section 319F–3(b), there is hereby established in the Treasury an emergency fund designated as the
‘‘Covered Countermeasure Process Fund’’ for purposes of providing
timely, uniform, and adequate compensation to eligible individuals
for covered injuries directly caused by the administration or use of
a covered countermeasure pursuant to such declaration, which
Fund shall consist of such amounts designated as emergency appropriations under section 402 of H. Con. Res. 95 of the 109th Congress, this emergency designation shall remain in effect through
October 1, 2006.
(b) PAYMENT OF COMPENSATION.—
(1) IN GENERAL.—If the Secretary issues a declaration
under 319F–3(b), the Secretary shall, after amounts have by
law been provided for the Fund under subsection (a), provide
compensation to an eligible individual for a covered injury directly caused by the administration or use of a covered countermeasure pursuant to such declaration.
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(2) ELEMENTS OF COMPENSATION.—The compensation that
shall be provided pursuant to paragraph (1) shall have the
same elements, and be in the same amount, as is prescribed
by sections 264, 265, and 266 in the case of certain individuals
injured as a result of administration of certain countermeasures against smallpox, except that section 266(a)(2)(B)
shall not apply.
(3) RULE OF CONSTRUCTION.—Neither reasonable and necessary medical benefits nor lifetime total benefits for lost employment income due to permanent and total disability shall be
limited by section 266.
(4) DETERMINATION OF ELIGIBILITY AND COMPENSATION.—
Except as provided in this section, the procedures for determining, and for reviewing a determination of, whether an individual is an eligible individual, whether such individual has
sustained a covered injury, whether compensation may be
available under this section, and the amount of such compensation shall be those stated in section 262 (other than in
subsection (d)(2) of such section), in regulations issued pursuant to that section, and in such additional or alternate regulations as the Secretary may promulgate for purposes of this section. In making determinations under this section, other than
those described in paragraph (5)(A) as to the direct causation
of a covered injury, the Secretary may only make such determination based on compelling, reliable, valid, medical and scientific evidence.
(5) COVERED COUNTERMEASURE INJURY TABLE.—
(A) IN GENERAL.—The Secretary shall by regulation
establish a table identifying covered injuries that shall be
presumed to be directly caused by the administration or
use of a covered countermeasure and the time period in
which the first symptom or manifestation of onset of each
such adverse effect must manifest in order for such presumption to apply. The Secretary may only identify such
covered injuries, for purpose of inclusion on the table,
where the Secretary determines, based on compelling, reliable, valid, medical and scientific evidence that administration or use of the covered countermeasure directly
caused such covered injury.
(B) AMENDMENTS.—The provisions of section 263
(other than a provision of subsection (a)(2) of such section
that relates to accidental vaccinia inoculation) shall apply
to the table established under this section.
(C) JUDICIAL REVIEW.—No court of the United States,
or of any State, shall have subject matter jurisdiction to
review, whether by mandamus or otherwise, any action by
the Secretary under this paragraph.
(6) MEANINGS OF TERMS.—In applying sections 262, 263,
264, 265, and 266 for purposes of this section—
(A) the terms ‘‘vaccine’’ and ‘‘smallpox vaccine’’ shall
be deemed to mean a covered countermeasure;
(B) the terms ‘‘smallpox vaccine injury table’’ and
‘‘table established under section 263’’ shall be deemed to
refer to the table established under paragraph (4); and
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(C) other terms used in those sections shall have the
meanings given to such terms by this section.
(c) VOLUNTARY PROGRAM.—The Secretary shall ensure that a
State, local, or Department of Health and Human Services plan to
administer or use a covered countermeasure is consistent with any
declaration under 319F–3 and any applicable guidelines of the Centers for Disease Control and Prevention and that potential participants are educated with respect to contraindications, the voluntary
nature of the program, and the availability of potential benefits
and compensation under this part.
(d) EXHAUSTION; EXCLUSIVITY; ELECTION.—
(1) EXHAUSTION.—Subject to paragraph (5), a covered individual may not bring a civil action under section 319F–3(d)
against a covered person (as such term is defined in section
319F–3(i)(2)) unless such individual has exhausted such remedies as are available under subsection (a), except that if
amounts have not by law been provided for the Fund under
subsection (a), or if the Secretary fails to make a final determination on a request for benefits or compensation filed in accordance with the requirements of this section within 240 days
after such request was filed, the individual may seek any remedy that may be available under section 319F–3(d).
(2) TOLLING OF STATUTE OF LIMITATIONS.—The time limit
for filing a civil action under section 319F–3(d) for an injury
or death shall be tolled during the pendency of a claim for compensation under subsection (a).
(3) RULE OF CONSTRUCTION.—This section shall not be construed as superseding or otherwise affecting the application of
a requirement, under chapter 171 of title 28, United States
Code, to exhaust administrative remedies.
(4) EXCLUSIVITY.—The remedy provided by subsection (a)
shall be exclusive of any other civil action or proceeding for
any claim or suit this section encompasses, except for a proceeding under section 319F–3.
(5) ELECTION.—If under subsection (a) the Secretary determines that a covered individual qualifies for compensation, the
individual has an election to accept the compensation or to
bring an action under section 319F–3(d). If such individual
elects to accept the compensation, the individual may not bring
such an action.
(e) DEFINITIONS.—For purposes of this section, the following
terms shall have the following meanings:
(1) COVERED COUNTERMEASURE.—The term ‘‘covered countermeasure’’ has the meaning given such term in section 319F–
3.
(2) COVERED INDIVIDUAL.—The term ‘‘covered individual’’,
with respect to administration or use of a covered countermeasure pursuant to a declaration, means an individual—
(A) who is in a population specified in such declaration, and with respect to whom the administration or use
of the covered countermeasure satisfies the other specifications of such declaration; or
(B) who uses the covered countermeasure, or to whom
the covered countermeasure is administered, in a good
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faith belief that the individual is in the category described
by subparagraph (A).
(3) COVERED INJURY.—The term ‘‘covered injury’’ means serious physical injury or death.
(4) DECLARATION.—The term ‘‘declaration’’ means a declaration under section 319F–3(b).
(5) ELIGIBLE INDIVIDUAL.—The term ‘‘eligible individual’’
means an individual who is determined, in accordance with
subsection (b), to be a covered individual who sustains a covered injury.
SEC. 319G. ø247d–7¿ DEMONSTRATION PROGRAM TO ENHANCE BIOTERRORISM TRAINING, COORDINATION, AND READINESS.
(a) IN GENERAL.—The Secretary shall make grants to not more

than three eligible entities to carry out demonstration programs to
improve the detection of pathogens likely to be used in a bioterrorist attack, the development of plans and measures to respond to
bioterrorist attacks, and the training of personnel involved with the
various responsibilities and capabilities needed to respond to acts
of bioterrorism upon the civilian population. Such awards shall be
made on a competitive basis and pursuant to scientific and technical review.
(b) ELIGIBLE ENTITIES.—Eligible entities for grants under subsection (a) are States, political subdivisions of States, and public or
private non-profit organizations.
(c) SPECIFIC CRITERIA.—In making grants under subsection (a),
the Secretary shall take into account the following factors:
(1) Whether the eligible entity involved is proximate to,
and collaborates with, a major research university with expertise in scientific training, identification of biological agents,
medicine, and life sciences.
(2) Whether the entity is proximate to, and collaborates
with, a laboratory that has expertise in the identification of biological agents.
(3) Whether the entity demonstrates, in the application for
the program, support and participation of State and local governments and research institutions in the conduct of the program.
(4) Whether the entity is proximate to, and collaborates
with, or is, an academic medical center that has the capacity
to serve an uninsured or underserved population, and is
equipped to educate medical personnel.
(5) Such other factors as the Secretary determines to be
appropriate.
(d) DURATION OF AWARD.—The period during which payments
are made under a grant under subsection (a) may not exceed 5
years. The provision of such payments shall be subject to annual
approval by the Secretary of the payments and subject to the availability of appropriations for the fiscal year involved to make the
payments.
(e) SUPPLEMENT NOT SUPPLANT.—Grants under subsection (a)
shall be used to supplement, and not supplant, other Federal,
State, or local public funds provided for the activities described in
such subsection.
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(f ) GENERAL ACCOUNTING OFFICE REPORT 1.—Not later than
180 days after the conclusion of the demonstration programs carried out under subsection (a), the Comptroller General of the
United States shall submit to the Committee on Health, Education,
Labor, and Pensions and the Committee on Appropriations of the
Senate, and the Committee on Commerce and the Committee on
Appropriations of the House of Representatives, a report that describes the ability of grantees under such subsection to detect
pathogens likely to be used in a bioterrorist attack, develop plans
and measures for dealing with such threats, and train personnel
involved with the various responsibilities and capabilities needed to
deal with bioterrorist threats.
(g) AUTHORIZATION OF APPROPRIATIONS.—There is authorized
to be appropriated to carry out this section $6,000,000 for fiscal
year 2001, and such sums as may be necessary through fiscal year
2006.
SEC. 319H. ø247d–7a¿ GRANTS REGARDING TRAINING AND EDUCATION
OF CERTAIN HEALTH PROFESSIONALS.
(a) IN GENERAL.—The Secretary may make awards of grants

and cooperative agreements to appropriate public and nonprofit
private health or educational entities, including health professions
schools and programs as defined in section 799B, for the purpose
of providing low-interest loans, partial scholarships, partial fellowships, revolving loan funds, or other cost-sharing forms of assistance for the education and training of individuals in any category
of health professions for which there is a shortage that the Secretary determines should be alleviated in order to prepare for or respond effectively to bioterrorism and other public health emergencies.
(b) AUTHORITY REGARDING NON-FEDERAL CONTRIBUTIONS.—
The Secretary may require as a condition of an award under subsection (a) that a grantee under such subsection provide non-Federal contributions toward the purpose described in such subsection.
(c) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of
carrying out this section, there are authorized to be appropriated
such sums as may be necessary for each of the fiscal years 2002
through 2006.
SEC. 319I. ø247d–7b¿ EMERGENCY SYSTEM FOR ADVANCE REGISTRATION OF HEALTH PROFESSIONS VOLUNTEERS.
(a) IN GENERAL.—Not later than 12 months after the date of

enactment of the Pandemic and All-Hazards Preparedness Act, the
Secretary shall link existing State verification systems to maintain
a single national interoperable network of systems, each system
being maintained by a State or group of States, for the purpose of
verifying the credentials and licenses of health care professionals
who volunteer to provide health services during a public health
emergency.
(b) REQUIREMENTS.—The interoperable network of systems established under subsection (a) (referred to in this section as the
‘‘verification network’’) shall include—
1 Now the Government Accountability Office. See section 8 of Public Law 108–271 (118 Stat.
814).

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(1) with respect to each volunteer health professional included in the verification network—
(A) information necessary for the rapid identification
of, and communication with, such professionals; and
(B) the credentials, certifications, licenses, and relevant training of such individuals; and
(2) the name of each member of the Medical Reserve
Corps, the National Disaster Medical System, and any other
relevant federally-sponsored or administered programs determined necessary by the Secretary.
(c) OTHER ASSISTANCE.—The Secretary may make grants and
provide technical assistance to States and other public or nonprofit
private entities for activities relating to the verification network developed under subsection (a).
(d) ACCESSIBILITY.—The Secretary shall ensure that the
verification network is electronically accessible by State, local, and
tribal health departments and can be linked with the identification
cards under section 2813.
(e) CONFIDENTIALITY.—The Secretary shall establish and require the application of and compliance with measures to ensure
the effective security of, integrity of, and access to the data included in the verification network.
(f) COORDINATION.—The Secretary shall coordinate with the
Secretary of Veterans Affairs and the Secretary of Homeland Security to assess the feasibility of integrating the verification network
under this section with the VetPro system of the Department of
Veterans Affairs and the National Emergency Responder
Credentialing System of the Department of Homeland Security.
The Secretary shall, if feasible, integrate the verification network
under this section with such VetPro system and the National
Emergency Responder Credentialing System.
(g) UPDATING OF INFORMATION.—The States that are participants in the verification network shall, on at least a quarterly
basis, work with the Director to provide for the updating of the information contained in the verification network.
(h) CLARIFICATION.—Inclusion of a health professional in the
verification network shall not constitute appointment of such individual as a Federal employee for any purpose, either under section
2812(c) or otherwise. Such appointment may only be made under
section 2812 or 2813.
(i) HEALTH CARE PROVIDER LICENSES.—The Secretary shall encourage States to establish and implement mechanisms to waive
the application of licensing requirements applicable to health professionals, who are seeking to provide medical services (within
their scope of practice), during a national, State, local, or tribal
public health emergency upon verification that such health professionals are licensed and in good standing in another State and
have not been disciplined by any State health licensing or disciplinary board.
(j) RULE OF CONSTRUCTION.—This section may not be construed as authorizing the Secretary to issue requirements regarding the provision by the States of credentials, licenses, accreditations, or hospital privileges.
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(k) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of
carrying out this section, there are authorized to be appropriated
$2,000,000 for fiscal year 2002, and such sums as may be necessary
for each of the fiscal years 2003 through 2011.
SEC. 319J. ø247d–7c¿ SUPPLIES AND SERVICES IN LIEU OF AWARD
FUNDS.
(a) IN GENERAL.—Upon the request of a recipient of an award

under any of sections 319 through 319I or section 319K, the Secretary may, subject to subsection (b), provide supplies, equipment,
and services for the purpose of aiding the recipient in carrying out
the purposes for which the award is made and, for such purposes,
may detail to the recipient any officer or employee of the Department of Health and Human Services.
(b) CORRESPONDING REDUCTION IN PAYMENTS.—With respect to
a request described in subsection (a), the Secretary shall reduce the
amount of payments under the award involved by an amount equal
to the costs of detailing personnel and the fair market value of any
supplies, equipment, or services provided by the Secretary. The
Secretary shall, for the payment of expenses incurred in complying
with such request, expend the amounts withheld.
SEC. 319K. ø247d–7d¿ SECURITY FOR COUNTERMEASURE DEVELOPMENT AND PRODUCTION.
(a) IN GENERAL.—The Secretary, in consultation with the At-

torney General and the Secretary of Defense, may provide technical
or other assistance to provide security to persons or facilities that
conduct development, production, distribution, or storage of priority
countermeasures (as defined in section 319F(h)(4)).
(b) GUIDELINES.—The Secretary may develop guidelines to enable entities eligible to receive assistance under subsection (a) to
secure their facilities against potential terrorist attack.
SEC. 319L. ø247d–7e¿ BIOMEDICAL ADVANCED RESEARCH AND DEVELOPMENT AUTHORITY.
(a) DEFINITIONS.—In this section:

(1) BARDA.—The term ‘‘BARDA’’ means the Biomedical
Advanced Research and Development Authority.
(2) FUND.—The term ‘‘Fund’’ means the Biodefense Medical Countermeasure Development Fund established under
subsection (d).
(3) OTHER TRANSACTIONS.—The term ‘‘other transactions’’
means transactions, other than procurement contracts, grants,
and cooperative agreements, such as the Secretary of Defense
may enter into under section 2371 of title 10, United States
Code.
(4) QUALIFIED COUNTERMEASURE.—The term ‘‘qualified
countermeasure’’ has the meaning given such term in section
319F–1.
(5) QUALIFIED PANDEMIC OR EPIDEMIC PRODUCT.—The term
‘‘qualified pandemic or epidemic product’’ has the meaning
given the term in section 319F–3.
(6) ADVANCED RESEARCH AND DEVELOPMENT.—
(A) IN GENERAL.—The term ‘‘advanced research and
development’’ means, with respect to a product that is or
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may become a qualified countermeasure or a qualified pandemic or epidemic product, activities that predominantly—
(i) are conducted after basic research and preclinical development of the product; and
(ii) are related to manufacturing the product on a
commercial scale and in a form that satisfies the regulatory requirements under the Federal Food, Drug,
and Cosmetic Act or under section 351 of this Act.
(B) ACTIVITIES INCLUDED.—The term under subparagraph (A) includes—
(i) testing of the product to determine whether the
product may be approved, cleared, or licensed under
the Federal Food, Drug, and Cosmetic Act or under
section 351 of this Act for a use that is or may be the
basis for such product becoming a qualified countermeasure or qualified pandemic or epidemic product, or
to help obtain such approval, clearance, or license;
(ii) design and development of tests or models, including animal models, for such testing;
(iii) activities to facilitate manufacture of the
product on a commercial scale with consistently high
quality, as well as to improve and make available new
technologies to increase manufacturing surge capacity;
(iv) activities to improve the shelf-life of the product or technologies for administering the product; and
(v) such other activities as are part of the advanced stages of testing, refinement, improvement, or
preparation of the product for such use and as are
specified by the Secretary.
(7) SECURITY COUNTERMEASURE.—The term ‘‘security countermeasure’’ has the meaning given such term in section 319F–
2.
(8) RESEARCH TOOL.—The term ‘‘research tool’’ means a device, technology, biological material (including a cell line or an
antibody), reagent, animal model, computer system, computer
software, or analytical technique that is developed to assist in
the discovery, development, or manufacture of qualified countermeasures or qualified pandemic or epidemic products.
(9) PROGRAM MANAGER.—The term ‘‘program manager’’
means an individual appointed to carry out functions under
this section and authorized to provide project oversight and
management of strategic initiatives.
(10) PERSON.—The term ‘‘person’’ includes an individual,
partnership, corporation, association, entity, or public or private corporation, and a Federal, State, or local government
agency or department.
(b) STRATEGIC PLAN FOR COUNTERMEASURE RESEARCH, DEVELOPMENT, AND PROCUREMENT.—
(1) IN GENERAL.—Not later than 6 months after the date
of enactment of the Pandemic and All-Hazards Preparedness
Act, the Secretary shall develop and make public a strategic
plan to integrate biodefense and emerging infectious disease
requirements with the advanced research and development,
strategic initiatives for innovation, and the procurement of
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qualified countermeasures and qualified pandemic or epidemic
products. The Secretary shall carry out such activities as may
be practicable to disseminate the information contained in such
plan to persons who may have the capacity to substantially
contribute to the activities described in such strategic plan.
The Secretary shall update and incorporate such plan as part
of the National Health Security Strategy described in section
2802.
(2) CONTENT.—The strategic plan under paragraph (1)
shall guide—
(A) research and development, conducted or supported
by the Department of Health and Human Services, of
qualified countermeasures and qualified pandemic or epidemic products against possible biological, chemical, radiological, and nuclear agents and to emerging infectious diseases;
(B) innovation in technologies that may assist advanced research and development of qualified countermeasures and qualified pandemic or epidemic products
(such research and development referred to in this section
as ‘‘countermeasure and product advanced research and
development’’); and
(C) procurement of such qualified countermeasures
and qualified pandemic or epidemic products by such Department.
(c) BIOMEDICAL ADVANCED RESEARCH AND DEVELOPMENT AUTHORITY.—
(1) ESTABLISHMENT.—There is established within the Department of Health and Human Services the Biomedical Advanced Research and Development Authority.
(2) IN GENERAL.—Based upon the strategic plan described
in subsection (b), the Secretary shall coordinate the acceleration of countermeasure and product advanced research and development by—
(A) facilitating collaboration between the Department
of Health and Human Services and other Federal agencies,
relevant industries, academia, and other persons, with respect to such advanced research and development;
(B) promoting countermeasure and product advanced
research and development;
(C) facilitating contacts between interested persons
and the offices or employees authorized by the Secretary
to advise such persons regarding requirements under the
Federal Food, Drug, and Cosmetic Act and under section
351 of this Act; and
(D) promoting innovation to reduce the time and cost
of countermeasure and product advanced research and development.
(3) DIRECTOR.—The BARDA shall be headed by a Director
(referred to in this section as the ‘‘Director’’) who shall be appointed by the Secretary and to whom the Secretary shall delegate such functions and authorities as necessary to implement
this section.
(4) DUTIES.—
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(A) COLLABORATION.—To carry out the purpose described in paragraph (2)(A), the Secretary shall—
(i) facilitate and increase the expeditious and direct communication between the Department of
Health and Human Services and relevant persons
with respect to countermeasure and product advanced
research and development, including by—
(I) facilitating such communication regarding
the processes for procuring such advanced research and development with respect to qualified
countermeasures and qualified pandemic or epidemic products of interest; and
(II) soliciting information about and data from
research on potential qualified countermeasures
and qualified pandemic or epidemic products and
related technologies;
(ii) at least annually—
(I) convene meetings with representatives
from relevant industries, academia, other Federal
agencies, international agencies as appropriate,
and other interested persons;
(II) sponsor opportunities to demonstrate the
operation and effectiveness of relevant biodefense
countermeasure technologies; and
(III) convene such working groups on countermeasure and product advanced research and development as the Secretary may determine are
necessary to carry out this section; and
(iii) carry out the activities described in section
405 of the Pandemic and All-Hazards Preparedness
Act.
(B) SUPPORT ADVANCED RESEARCH AND DEVELOPMENT.—To carry out the purpose described in paragraph
(2)(B), the Secretary shall—
(i) conduct ongoing searches for, and support calls
for, potential qualified countermeasures and qualified
pandemic or epidemic products;
(ii) direct and coordinate the countermeasure and
product advanced research and development activities
of the Department of Health and Human Services;
(iii) establish strategic initiatives to accelerate
countermeasure and product advanced research and
development and innovation in such areas as the Secretary may identify as priority unmet need areas; and
(iv) award contracts, grants, cooperative agreements, and enter into other transactions, for countermeasure and product advanced research and development.
(C) FACILITATING ADVICE.—To carry out the purpose
described in paragraph (2)(C) the Secretary shall—
(i) connect interested persons with the offices or
employees authorized by the Secretary to advise such
persons regarding the regulatory requirements under
the Federal Food, Drug, and Cosmetic Act and under
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section 351 of this Act related to the approval, clearance, or licensure of qualified countermeasures or
qualified pandemic or epidemic products; and
(ii) with respect to persons performing countermeasure and product advanced research and development funded under this section, enable such offices or
employees to provide to the extent practicable such advice in a manner that is ongoing and that is otherwise
designed to facilitate expeditious development of qualified countermeasures and qualified pandemic or epidemic products that may achieve such approval, clearance, or licensure.
(D) SUPPORTING INNOVATION.—To carry out the purpose described in paragraph (2)(D), the Secretary may
award contracts, grants, and cooperative agreements, or
enter into other transactions, such as prize payments, to
promote—
(i) innovation in technologies that may assist
countermeasure and product advanced research and
development;
(ii) research on and development of research tools
and other devices and technologies; and
(iii) research to promote strategic initiatives, such
as rapid diagnostics, broad spectrum antimicrobials,
and vaccine manufacturing technologies.
(5) TRANSACTION AUTHORITIES.—
(A) OTHER TRANSACTIONS.—
(i) IN GENERAL.—The Secretary shall have the authority to enter into other transactions under this subsection in the same manner as the Secretary of Defense enters into such transactions under section 2371
of title 10, United States Code.
(ii) LIMITATIONS ON AUTHORITY.—
(I) IN GENERAL.—Subsections (b), (c), and (h)
of section 845 of the National Defense Authorization Act for Fiscal Year 1994 (10 U.S.C. 2371
note) shall apply to other transactions under this
subparagraph as if such transactions were for prototype projects described by subsection (a) of such
section 845.
(II) WRITTEN DETERMINATIONS REQUIRED.—
The authority of this subparagraph may be exercised for a project that is expected to cost the Department of Health and Human Services in excess
of $20,000,000 only upon a written determination
by the senior procurement executive for the Department (as designated for purpose of section
16(c) of the Office of Federal Procurement Policy
Act (41 U.S.C. 414(c))), that the use of such authority is essential to promoting the success of the
project. The authority of the senior procurement
executive under this subclause may not be delegated.
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(iii) GUIDELINES.—The Secretary shall establish
guidelines regarding the use of the authority under
clause (i). Such guidelines shall include auditing requirements.
(B) EXPEDITED AUTHORITIES.—
(i) IN GENERAL.—In awarding contracts, grants,
and cooperative agreements, and in entering into
other transactions under subparagraph (B) or (D) of
paragraph (4), the Secretary shall have the expedited
procurement authorities, the authority to expedite
peer review, and the authority for personal services
contracts, supplied by subsections (b), (c), and (d) of
section 319F–1.
(ii) APPLICATION OF PROVISIONS.—Provisions in
such section 319F–1 that apply to such authorities and
that require institution of internal controls, limit review, provide for Federal Tort Claims Act coverage of
personal services contractors, and commit decisions to
the discretion of the Secretary shall apply to the authorities as exercised pursuant to this paragraph.
(iii) AUTHORITY TO LIMIT COMPETITION.—For purposes of applying section 319F–1(b)(1)(D) to this paragraph, the phrase ‘‘BioShield Program under the
Project BioShield Act of 2004’’ shall be deemed to
mean the countermeasure and product advanced research and development program under this section.
(iv) AVAILABILITY OF DATA.—The Secretary shall
require that, as a condition of being awarded a contract, grant, cooperative agreement, or other transaction under subparagraph (B) or (D) of paragraph (4),
a person make available to the Secretary on an ongoing basis, and submit upon request to the Secretary,
all data related to or resulting from countermeasure
and product advanced research and development carried out pursuant to this section.
(C) ADVANCE PAYMENTS; ADVERTISING.—The Secretary
may waive the requirements of section 3324(a) of title 31,
United States Code, or section 3709 of the Revised Statutes of the United States (41 U.S.C. 5) upon the determination by the Secretary that such waiver is necessary to
obtain countermeasures or products under this section.
(D) MILESTONE-BASED PAYMENTS ALLOWED.—In awarding contracts, grants, and cooperative agreements, and in
entering into other transactions, under this section, the
Secretary may use milestone-based awards and payments.
(E) FOREIGN NATIONALS ELIGIBLE.—The Secretary may
under this section award contracts, grants, and cooperative
agreements to, and may enter into other transactions with,
highly qualified foreign national persons outside the
United States, alone or in collaboration with American
participants, when such transactions may inure to the benefit of the American people.
(F) ESTABLISHMENT OF RESEARCH CENTERS.—The Secretary may assess the feasibility and appropriateness of
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establishing, through contract, grant, cooperative agreement, or other transaction, an arrangement with an existing research center in order to achieve the goals of this
section. If such an agreement is not feasible and appropriate, the Secretary may establish one or more federallyfunded research and development centers, or university-affiliated research centers, in accordance with section
303(c)(3) of the Federal Property and Administrative Services Act of 1949 (41 U.S.C. 253(c)(3)).
(6) AT-RISK INDIVIDUALS.—In carrying out the functions
under this section, the Secretary may give priority to the advanced research and development of qualified countermeasures
and qualified pandemic or epidemic products that are likely to
be safe and effective with respect to children, pregnant women,
elderly, and other at-risk individuals.
(7) PERSONNEL AUTHORITIES.—
(A) SPECIALLY QUALIFIED SCIENTIFIC AND PROFESSIONAL PERSONNEL.—
(i) IN GENERAL.—In addition to any other personnel authorities, the Secretary may—
(I) without regard to those provisions of title
5, United States Code, governing appointments in
the competitive service, appoint highly qualified
individuals to scientific or professional positions in
BARDA, such as program managers, to carry out
this section; and
(II) compensate them in the same manner and
subject to the same terms and conditions in which
individuals appointed under section 9903 of such
title are compensated, without regard to the provisions of chapter 51 and subchapter III of chapter
53 of such title relating to classification and General Schedule pay rates.
(ii) MANNER OF EXERCISE OF AUTHORITY.—The authority provided for in this subparagraph shall be exercised subject to the same limitations described in
section 319F–1(e)(2).
(iii) TERM OF APPOINTMENT.—The term limitations
described in section 9903(c) of title 5, United States
Code, shall apply to appointments under this subparagraph, except that the references to the ‘‘Secretary’’
and to the ‘‘Department of Defense’s national security
missions’’ shall be deemed to be to the Secretary of
Health and Human Services and to the mission of the
Department of Health and Human Services under this
section.
(B) SPECIAL CONSULTANTS.—In carrying out this section, the Secretary may appoint special consultants pursuant to section 207(f).
(C) LIMITATION.—
(i) IN GENERAL.—The Secretary may hire up to
100 highly qualified individuals, or up to 50 percent of
the total number of employees, whichever is less,
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under the authorities provided for in subparagraphs
(A) and (B).
(ii) REPORT.—The Secretary shall report to Congress on a biennial basis on the implementation of this
subparagraph.
(d) FUND.—
(1) ESTABLISHMENT.—There is established the Biodefense
Medical Countermeasure Development Fund, which shall be
available to carry out this section in addition to such amounts
as are otherwise available for this purpose.
(2) FUNDING.—To carry out the purposes of this section,
there are authorized to be appropriated to the Fund—
(A) $1,070,000,000 for fiscal years 2006 through 2008,
the amounts to remain available until expended; and
(B) such sums as may be necessary for subsequent fiscal years, the amounts to remain available until expended.
(e) INAPPLICABILITY OF CERTAIN PROVISIONS.—
(1) DISCLOSURE.—
(A) IN GENERAL.—The Secretary shall withhold from
disclosure under section 552 of title 5, United States Code,
specific technical data or scientific information that is created or obtained during the countermeasure and product
advanced research and development carried out under subsection (c) that reveals significant and not otherwise publicly known vulnerabilities of existing medical or public
health defenses against biological, chemical, nuclear, or radiological threats. Such information shall be deemed to be
information described in section 552(b)(3) of title 5, United
States Code.
(B) REVIEW.—Information subject to nondisclosure
under subparagraph (A) shall be reviewed by the Secretary
every 5 years, or more frequently as determined necessary
by the Secretary, to determine the relevance or necessity
of continued nondisclosure.
(C) SUNSET.—This paragraph shall cease to have force
or effect on the date that is 7 years after the date of enactment of the Pandemic and All-Hazards Preparedness Act.
(2) REVIEW.—Notwithstanding section 14 of the Federal
Advisory Committee Act, a working group of BARDA under
this section and the National Biodefense Science Board under
section 319M shall each terminate on the date that is 5 years
after the date on which each such group or Board, as applicable, was established. Such 5-year period may be extended by
the Secretary for one or more additional 5-year periods if the
Secretary determines that any such extension is appropriate.
SEC. 319M. ø247d–f¿ NATIONAL BIODEFENSE SCIENCE BOARD AND
WORKING GROUPS.
(a) IN GENERAL.—
(1) ESTABLISHMENT AND FUNCTION.—The Secretary shall

establish the National Biodefense Science Board (referred to in
this section as the ‘‘Board’’) to provide expert advice and guidance to the Secretary on scientific, technical and other matters
of special interest to the Department of Health and Human
Services regarding current and future chemical, biological, nuMarch 13, 2013

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clear, and radiological agents, whether naturally occurring, accidental, or deliberate.
(2) MEMBERSHIP.—The membership of the Board shall be
comprised of individuals who represent the Nation’s preeminent scientific, public health, and medical experts, as follows—
(A) such Federal officials as the Secretary may determine are necessary to support the functions of the Board;
(B) four individuals representing the pharmaceutical,
biotechnology, and device industries;
(C) four individuals representing academia; and
(D) five other members as determined appropriate by
the Secretary, of whom—
(i) one such member shall be a practicing
healthcare professional; and
(ii) one such member shall be an individual from
an organization representing healthcare consumers.
(3) TERM OF APPOINTMENT.—A member of the Board described in subparagraph (B), (C), or (D) of paragraph (2) shall
serve for a term of 3 years, except that the Secretary may adjust the terms of the initial Board appointees in order to provide for a staggered term of appointment for all members.
(4) CONSECUTIVE APPOINTMENTS; MAXIMUM TERMS.—A
member may be appointed to serve not more than 3 terms on
the Board and may serve not more than 2 consecutive terms.
(5) DUTIES.—The Board shall—
(A) advise the Secretary on current and future trends,
challenges, and opportunities presented by advances in biological and life sciences, biotechnology, and genetic engineering with respect to threats posed by naturally occurring infectious diseases and chemical, biological, radiological, and nuclear agents;
(B) at the request of the Secretary, review and consider any information and findings received from the working groups established under subsection (b); and
(C) at the request of the Secretary, provide recommendations and findings for expanded, intensified, and
coordinated biodefense research and development activities.
(6) MEETINGS.—
(A) INITIAL MEETING.—Not later than one year after
the date of enactment of the Pandemic and All-Hazards
Preparedness Act, the Secretary shall hold the first meeting of the Board.
(B) SUBSEQUENT MEETINGS.—The Board shall meet at
the call of the Secretary, but in no case less than twice annually.
(7) VACANCIES.—Any vacancy in the Board shall not affect
its powers, but shall be filled in the same manner as the original appointment.
(8) CHAIRPERSON.—The Secretary shall appoint a chairperson from among the members of the Board.
(9) POWERS.—
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(A) HEARINGS.—The Board may hold such hearings,
sit and act at such times and places, take such testimony,
and receive such evidence as the Board considers advisable
to carry out this subsection.
(B) POSTAL SERVICES.—The Board may use the United
States mails in the same manner and under the same conditions as other departments and agencies of the Federal
Government.
(10) PERSONNEL.—
(A) EMPLOYEES OF THE FEDERAL GOVERNMENT.—A
member of the Board that is an employee of the Federal
Government may not receive additional pay, allowances, or
benefits by reason of the member’s service on the Board.
(B) OTHER MEMBERS.—A member of the Board that is
not an employee of the Federal Government may be compensated at a rate not to exceed the daily equivalent of the
annual rate of basic pay prescribed for level IV of the Executive Schedule under section 5315 of title 5, United
States Code, for each day (including travel time) during
which the member is engaged in the actual performance of
duties as a member of the Board.
(C) TRAVEL EXPENSES.—Each member of the Board
shall receive travel expenses, including per diem in lieu of
subsistence, in accordance with applicable provisions
under subchapter I of chapter 57 of title 5, United States
Code.
(D) DETAIL OF GOVERNMENT EMPLOYEES.—Any Federal
Government employee may be detailed to the Board with
the approval for the contributing agency without reimbursement, and such detail shall be without interruption
or loss of civil service status or privilege.
(b) OTHER WORKING GROUPS.—The Secretary may establish a
working group of experts, or may use an existing working group or
advisory committee, to—
(1) identify innovative research with the potential to be developed as a qualified countermeasure or a qualified pandemic
or epidemic product;
(2) identify accepted animal models for particular diseases
and conditions associated with any biological, chemical, radiological, or nuclear agent, any toxin, or any potential pandemic
infectious disease, and identify strategies to accelerate animal
model and research tool development and validation; and
(3) obtain advice regarding supporting and facilitating advanced research and development related to qualified countermeasures and qualified pandemic or epidemic products that
are likely to be safe and effective with respect to children,
pregnant women, and other vulnerable populations, and other
issues regarding activities under this section that affect such
populations.
(c) DEFINITIONS.—Any term that is defined in section 319L and
that is used in this section shall have the same meaning in this
section as such term is given in section 319L.
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(d) AUTHORIZATION OF APPROPRIATIONS.—There are authorized
to be appropriated $1,000,000 to carry out this section for fiscal
year 2007 and each fiscal year thereafter.
HANSEN’S DISEASE PROGRAM

SEC. 320. ø247e¿ (a)(1) At or through the National Hansen’s
Disease Programs Center (located in the State of Louisiana), the
Secretary shall without charge provide short-term care and treatment, including outpatient care, for Hansen’s disease and related
complications to any person determined by the Secretary to be in
need of such care and treatment. The Secretary may not at or
through such Center provide long-term care for any such disease
or complication.
(2) The Center referred to in paragraph (1) shall conduct training in the diagnosis and management of Hansen’s disease and related complications, and shall conduct and promote the coordination of research (including clinical research), investigations, demonstrations, and studies relating to the causes, diagnosis, treatment, control, and prevention of Hansen’s disease and other
mycobacterial diseases and complications related to such diseases.
(3) Paragraph (1) is subject to section 211 of the Department
of Health and Human Services Appropriations Act, 1998. 1
(b) In addition to the Center referred to in subsection (a), the
Secretary may establish sites regarding persons with Hansen’s disease. Each such site shall provide for the outpatient care and treatment for Hansen’s disease and related complications to any person
determined by the Secretary to be in need of such care and treatment.
(c) The Secretary shall carry out subsections (a) and (b) acting
through an agency of the Service. For purposes of the preceding
sentence, the agency designated by the Secretary shall carry out
both activities relating to the provision of health services and activities relating to the conduct of research.
(d) The Secretary shall make payments to the Board of Health
of the State of Hawaii for the care and treatment (including outpatient care) in its facilities of persons suffering from Hansen’s disease at a rate determined by the Secretary. The rate shall be approximately equal to the operating cost per patient of such facilities, except that the rate may not exceed the comparable costs per
patient with Hansen’s disease for care and treatment provided by
the Center referred to in subsection (a). Payments under this subsection are subject to the availability of appropriations for such
purpose.
COORDINATED PROGRAM TO IMPROVE PEDIATRIC ORAL HEALTH

SEC. 320A. 2 ø247d–8¿ (a) IN GENERAL.—The Secretary, acting
through the Administrator of the Health Resources and Services
Administration, shall establish a program to fund innovative oral
health activities that improve the oral health of children under 6
1 Title

II of Public Law 105–78. See 111 Stat. 1477, 1489.
placement of this section in title III was carried out to reflect the probable intent of
Congress. Section 1603 of Public Law 106–310 (114 Stat. 1151) provided for an amendment to
‘‘Part B of the Public Health Service Act’’, without specifying which title of this Act was the
subject of the amendment.
2 The

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years of age who are eligible for services provided under a Federal
health program, to increase the utilization of dental services by
such children, and to decrease the incidence of early childhood and
baby bottle tooth decay.
(b) GRANTS.—The Secretary shall award grants to or enter into
contracts with public or private nonprofit schools of dentistry or accredited dental training institutions or programs, community dental programs, and programs operated by the Indian Health Service
(including federally recognized Indian tribes that receive medical
services from the Indian Health Service, urban Indian health programs funded under title V of the Indian Health Care Improvement Act, and tribes that contract with the Indian Health Service
pursuant to the Indian Self-Determination and Education Assistance Act) to enable such schools, institutions, and programs to develop programs of oral health promotion, to increase training of
oral health services providers in accordance with State practice
laws, or to increase the utilization of dental services by eligible
children.
(c) DISTRIBUTION.—In awarding grants under this section, the
Secretary shall, to the extent practicable, ensure an equitable national geographic distribution of the grants, including areas of the
United States where the incidence of early childhood caries is highest.
(d) AUTHORIZATION OF APPROPRIATIONS.—There is authorized
to be appropriated to carry out this section $10,000,000 for each
the fiscal years 2001 through 2005.
PART C—HOSPITALS, MEDICAL EXAMINATIONS,

AND

MEDICAL CARE

HOSPITALS

SEC. 321. ø248¿ The Surgeon General, pursuant to regulations,
shall—
(a) Control, manage, and operate all institutions, hospitals,
and stations of the Service, including minor repairs and maintenance, and provide for the care, treatment, and hospitalization of patients, including the furnishing of prosthetic and orthopedic devices; and from time to time with the approval of
the President, select suitable sites for and establish such additional institutions, hospitals, and stations in the States and
possessions of the United States as in his judgment are necessary to enable the Service to discharge its functions and duties;
(b) Provide for the transfer of Public Health Service patients, in the care of attendants where necessary, between hospitals and stations operated by the Service or between such
hospitals and stations and other hospitals and stations in
which Public Health Service patients may be received, and the
payment of expenses of such transfer;
(c) Provide for the disposal of articles produced by patients
in the course of their curative treatment, either by allowing the
patient to retain such articles or by selling them and depositing the money received therefor to the credit of the appropriation from which the materials for making the articles were
purchased;
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(d) Provide for the disposal of money and effects, in the
custody of the hospitals or stations, of deceased patients; and
(e) Provide, to the extent the Surgeon General determines
that other public or private funds are not available therefor,
for the payment of expenses of preparing and transporting the
remains of, or the payment of reasonable burial expenses for,
any patient dying in a hospital or station.
CARE AND TREATMENT OF PERSONS UNDER QUARANTINE AND CERTAIN
OTHER PERSONS

SEC. 322. ø249¿ (a) Any person when detained in accordance
with quarantine laws, or, at the request of the Immigration and
Naturalization Service, any person detained by that Service, may
be treated and cared for by the Public Health Service.
(b) Persons not entitled to treatment and care at institutions,
hospitals, and stations of the Service may, in accordance with regulations of the Surgeon General, be admitted thereto for temporary
treatment and care in case of emergency.
(c) Persons whose care and treatment is authorized by subsection (a) may, in accordance with regulations, receive such care
and treatment at the expense of the Service from public or private
medical or hospital facilities other than those of the Service, when
authorized by the officer in charge of the station at which the application is made.
CARE AND TREATMENT OF FEDERAL PRISONERS 1

SEC. 323. ø250¿ The Service shall supervise and furnish medical treatment and other necessary medical, psychiatric, and related technical and scientific services, authorized by the Act of May
13, 1930, as amended (U.S.C., 1940 edition, title 18, secs. 751,
752), 2 in penal and correctional institutions of the United States.
EXAMINATION AND TREATMENT OF FEDERAL EMPLOYEES

SEC. 324. ø251¿ (a) The Surgeon General is authorized to provide at institutions, hospitals, and stations of the Service medical,
surgical, and hospital services and supplies for persons entitled to
treatment under the United States Employees’ Compensation Act 3
and extensions thereof. The Surgeon General may also provide for
making medical examinations of—
(1) employees of the Federal Government for retirement
purposes;
(2) employees in Federal classified service, and applicants
for appointment, as requested by the Civil Service Commission
for the purpose of promoting health and efficiency;
1 Title I of the Departments of Commerce, Justice, and State, the Judiciary, and Related Agencies Appropriations Act, 2005 (as contained in division B of Public Law 108–447) provided that
of the amounts appropriated for salaries and expenses regarding the Federal Prison System ‘‘the
Attorney General may transfer to the Health Resources and Services Administration such
amounts as may be necessary for direct expenditures by that Administration for medical relief
for inmates of Federal penal and correctional institutions’’. (See 118 Stat. 2860.) Similar provisions have appeared in the analogous appropriations Act of many prior years. See section 250a
of title 42, United States Code, and the notes following such section.
2 Now codified to section 4005 of title 18, United States Code.
3 Codified to chapter 81 of title 5, United States Code.

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(3) seamen for purposes of qualifying for certificates of
service; and
(4) employees eligible for benefits under the Longshoremen’s and Harbor Workers’ Compensation Act, as amended
(U.S.C. 1940 edition, title 33, chapter 18), 4 as requested by
any deputy commissioner thereunder.
(b) The Secretary is authorized to provide medical, surgical,
and dental treatment and hospitalization and optometric care for
Federal employees (as defined in section 8901(1) of title 5 of the
United States Code) and their dependents at remote medical facilities of the Public Health Service where such care and treatment
are not otherwise available. Such employees and their dependents
who are not entitled to this care and treatment under any other
provision of law shall be charged for it at rates established by the
Secretary to reflect the reasonable cost of providing the care and
treatment. Any payments pursuant to the preceding sentence shall
be credited to the applicable appropriation to the Public Health
Service for the year in which such payments are received.
EXAMINATION OF ALIENS

SEC. 325. ø252¿ The Surgeon General shall provide for making, at places within the United States or in other countries, such
physical and mental examinations of aliens as are required by the
immigration laws, subject to administrative regulations prescribed
by the Attorney General and medical regulations prescribed by the
Surgeon General with the approval of the Secretary.
SERVICES TO COAST GUARD, COAST AND GEODETIC SURVEY, AND
PUBLIC HEALTH SERVICE

SEC. 326. ø253¿ (a) Subject to regulations of the President—
(1) commissioned officers, chief warrant officers, warrant
officers, cadets, and enlisted personnel of the Regular Coast
Guard on active duty, including those on shore duty and those
on detached duty; and Regular and temporary members of the
United States Coast Guard Reserve when on active duty;
(2) commissioned officers, ships’ officers, and members of
the crews of vessels of the United States Coast and Geodetic
Survey on active duty including those on shore duty and those
on detached duty; and
(3) commissioned officers of the Regular or Reserve Corps
of the Public Health Service on active duty;
shall be entitled to medical, surgical, and dental treatment and
hospitalization by the Service. The Surgeon General may detail
commissioned officers for duty aboard vessels of the Coast Guard
or the Coast and Geodetic Survey.
(b)(1) The Secretary may provide health care for an officer of
the Regular or Reserve Corps involuntarily separated from the
Service, and for any dependent of such officer, if—
(A) the officer or dependent was receiving health care at
the expense of the Service at the time of the separation; and
4 Codification

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(B) the Secretary finds that the officer or dependent is unable to obtain appropriate insurance for the conditions for
which the officer or dependent was receiving health care.
(2) Health care may be provided under paragraph (1) for a period of not more than one year from the date of separation of the
officer from the Service.
(c) The Service shall provide all services referred to in subsection (a) required by the Coast Guard or Coast and Geodetic Survey and shall perform all duties prescribed by statute in connection
with the examinations to determine physical or mental condition
for purposes of appointment, enlistment, and reenlistment, promotion and retirement, and officers of the Service assigned to duty
on Coast Guard or Coast and Geodetic Survey vessels may extend
aid to the crews of American vessels engaged in deep-sea fishing.
INTERDEPARTMENTAL WORK

SEC. 327. ø254¿ Nothing contained in this part shall affect the
authority of the Service to furnish any materials, supplies, or
equipment, or perform any work or services, requested in accordance with section 7 of the Act of May 21, 1920, as amended (U.S.C.,
1940 edition, title 31, sec. 686), or the authority of any other executive department to furnish any materials, supplies, or equipment,
or perform any work or services, requested by the Department of
Health, Education, and Welfare for the Service in accordance with
that section.
SHARING OF MEDICAL CARE FACILITIES AND RESOURCES

SEC. 327A. ø254a¿ (a) For purposes of this section—
(1) the term ‘‘specialized health resources’’ means health
care resources (whether equipment, space, or personnel) which,
because of cost, limited availability, or unusual nature, are either unique in the health care community or are subject to
maximum utilization only through mutual use;
(2) the term ‘‘hospital’’, unless otherwise specified, includes
(in addition to other hospitals) any Federal hospital.
(b) For the purpose of maintaining or improving the quality of
care in Public Health Service facilities and to provide a professional
environment therein which will help to attract and retain highly
qualified and talented health personnel, to encourage mutually
beneficial relationships between Public Health Service facilities
and hospitals and other health facilities in the health care community, and to promote the full utilization of hospitals and other
health facilities and resources, the Secretary may—
(1) enter into agreements or arrangements with schools of
medicine, schools of osteopathic medicine, and with other
health professions schools, agencies, or institutions, for such
interchange or cooperative use of facilities and services on a reciprocal or reimbursable basis, as will be of benefit to the
training or research programs of the participating agencies;
and
(2) enter into agreement or arrangements with hospitals
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change of use of specialized health resources, and providing for
reciprocal reimbursement.
Any reimbursement pursuant to any such agreement or arrangement shall be based on charges covering the reasonable cost of such
utilization, including normal depreciation and amortization costs of
equipment. Any proceeds to the Government under this subsection
shall be credited to the applicable appropriation of the Public
Health Service for the year in which such proceeds are received.
PART D—PRIMARY HEALTH CARE
Subpart I—Health Centers
SEC. 330. ø254b¿ HEALTH CENTERS.
(a) DEFINITION OF HEALTH CENTER.—
(1) IN GENERAL.—For purposes of

this section, the term
‘‘health center’’ means an entity that serves a population that
is medically underserved, or a special medically underserved
population comprised of migratory and seasonal agricultural
workers, the homeless, and residents of public housing, by providing, either through the staff and supporting resources of the
center or through contracts or cooperative arrangements—
(A) required primary health services (as defined in
subsection (b)(1)); and
(B) as may be appropriate for particular centers, additional health services (as defined in subsection (b)(2)) necessary for the adequate support of the primary health
services required under subparagraph (A);
for all residents of the area served by the center (hereafter referred to in this section as the ‘‘catchment area’’).
(2) LIMITATION.—The requirement in paragraph (1) to provide services for all residents within a catchment area shall
not apply in the case of a health center receiving a grant only
under subsection (g), (h), or (i).
(b) DEFINITIONS.—For purposes of this section:
(1) REQUIRED PRIMARY HEALTH SERVICES.—
(A) IN GENERAL.—The term ‘‘required primary health
services’’ means—
(i) basic health services which, for purposes of this
section, shall consist of—
(I) health services related to family medicine,
internal medicine, pediatrics, obstetrics, or gynecology that are furnished by physicians and where
appropriate, physician assistants, nurse practitioners, and nurse midwives;
(II) diagnostic laboratory and radiologic services;
(III) preventive health services, including—
(aa) prenatal and perinatal services;
(bb) appropriate cancer screening;
(cc) well-child services;
(dd) immunizations against vaccine-preventable diseases;
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(ff) pediatric eye, ear, and dental
screenings to determine the need for vision
and hearing correction and dental care;
(gg) voluntary family planning services;
and
(hh) preventive dental services;
(IV) emergency medical services; and
(V) pharmaceutical services as may be appropriate for particular centers;
(ii) referrals to providers of medical services (including specialty referral when medically indicated)
and other health-related services (including substance
abuse and mental health services);
(iii) patient case management services (including
counseling, referral, and follow-up services) and other
services designed to assist health center patients in
establishing eligibility for and gaining access to Federal, State, and local programs that provide or financially support the provision of medical, social, housing,
educational, or other related services;
(iv) services that enable individuals to use the
services of the health center (including outreach and
transportation services and, if a substantial number of
the individuals in the population served by a center
are of limited English-speaking ability, the services of
appropriate personnel fluent in the language spoken
by a predominant number of such individuals); and
(v) education of patients and the general population served by the health center regarding the availability and proper use of health services.
(B) EXCEPTION.—With respect to a health center that
receives a grant only under subsection (g), the Secretary,
upon a showing of good cause, shall—
(i) waive the requirement that the center provide
all required primary health services under this paragraph; and
(ii) approve, as appropriate, the provision of certain required primary health services only during certain periods of the year.
(2) ADDITIONAL HEALTH SERVICES.—The term ‘‘additional
health services’’ means services that are not included as required primary health services and that are appropriate to
meet the health needs of the population served by the health
center involved. Such term may include—
(A) behavioral and mental health and substance abuse
services;
(B) recuperative care services;
(C) environmental health services, including—
(i) the detection and alleviation of unhealthful
conditions associated with—
(I) water supply;
(II) chemical and pesticide exposures;
(III) air quality; or
(IV) exposure to lead;
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(ii) sewage treatment;
(iii) solid waste disposal;
(iv) rodent and parasitic infestation;
(v) field sanitation;
(vi) housing; and
(vii) other environmental factors related to health;
and
(D) in the case of health centers receiving grants
under subsection (g), special occupation-related health
services for migratory and seasonal agricultural workers,
including—
(i) screening for and control of infectious diseases,
including parasitic diseases; and
(ii) injury prevention programs, including prevention of exposure to unsafe levels of agricultural chemicals including pesticides.
(3) MEDICALLY UNDERSERVED POPULATIONS.—
(A) IN GENERAL.—The term ‘‘medically underserved
population’’ means the population of an urban or rural
area designated by the Secretary as an area with a shortage of personal health services or a population group designated by the Secretary as having a shortage of such services.
(B) CRITERIA.—In carrying out subparagraph (A), the
Secretary shall prescribe criteria for determining the specific shortages of personal health services of an area or
population group. Such criteria shall—
(i) take into account comments received by the
Secretary from the chief executive officer of a State
and local officials in a State; and
(ii) include factors indicative of the health status
of a population group or residents of an area, the ability of the residents of an area or of a population group
to pay for health services and their accessibility to
them, and the availability of health professionals to
residents of an area or to a population group.
(C) LIMITATION.—The Secretary may not designate a
medically underserved population in a State or terminate
the designation of such a population unless, prior to such
designation or termination, the Secretary provides reasonable notice and opportunity for comment and consults
with—
(i) the chief executive officer of such State;
(ii) local officials in such State; and
(iii) the organization, if any, which represents a
majority of health centers in such State.
(D) PERMISSIBLE DESIGNATION.—The Secretary may
designate a medically underserved population that does
not meet the criteria established under subparagraph (B)
if the chief executive officer of the State in which such population is located and local officials of such State recommend the designation of such population based on unusual local conditions which are a barrier to access to or
the availability of personal health services.
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(c) PLANNING GRANTS.—
(1) IN GENERAL.—
(A) CENTERS.—The Secretary may make grants to
public and nonprofit private entities for projects to plan
and develop health centers which will serve medically underserved populations. A project for which a grant may be
made under this subsection may include the cost of the acquisition and lease of buildings and equipment (including
the costs of amortizing the principal of, and paying the interest on, loans) and shall include—
(i) an assessment of the need that the population
proposed to be served by the health center for which
the project is undertaken has for required primary
health services and additional health services;
(ii) the design of a health center program for such
population based on such assessment;
(iii) efforts to secure, within the proposed
catchment area of such center, financial and professional assistance and support for the project;
(iv) initiation and encouragement of continuing
community involvement in the development and operation of the project; and
(v) proposed linkages between the center and
other appropriate provider entities, such as health departments, local hospitals, and rural health clinics, to
provide better coordinated, higher quality, and more
cost-effective health care services.
(B) MANAGED CARE NETWORKS AND PLANS.—The Secretary may make grants to health centers that receive assistance under this section to enable the centers to plan
and develop a managed care network or plan. Such a grant
may only be made for such a center if—
(i) the center has received grants under subsection
(e)(1)(A) for at least 2 consecutive years preceding the
year of the grant under this subparagraph or has otherwise demonstrated, as required by the Secretary,
that such center has been providing primary care services for at least the 2 consecutive years immediately
preceding such year; and
(ii) the center provides assurances satisfactory to
the Secretary that the provision of such services on a
prepaid basis, or under another managed care arrangement, will not result in the diminution of the
level or quality of health services provided to the
medically underserved population served prior to the
grant under this subparagraph.
(C) PRACTICE MANAGEMENT NETWORKS.—The Secretary
may make grants to health centers that receive assistance
under this section to enable the centers to plan and develop practice management networks that will enable the
centers to—
(i) reduce costs associated with the provision of
health care services;
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(ii) improve access to, and availability of, health
care services provided to individuals served by the
centers;
(iii) enhance the quality and coordination of
health care services; or
(iv) improve the health status of communities.
(D) USE OF FUNDS.—The activities for which a grant
may be made under subparagraph (B) or (C) may include
the purchase or lease of equipment, which may include
data and information systems (including paying for the
costs of amortizing the principal of, and paying the interest on, loans for equipment), the provision of training and
technical assistance related to the provision of health care
services on a prepaid basis or under another managed care
arrangement, and other activities that promote the development of practice management or managed care networks
and plans.
(2) LIMITATION.—Not more than two grants may be made
under this subsection for the same project, except that upon a
showing of good cause, the Secretary may make additional
grant awards.
(3) RECOGNITION OF HIGH POVERTY.—
(A) IN GENERAL.—In making grants under this subsection, the Secretary may recognize the unique needs of
high poverty areas.
(B) HIGH POVERTY AREA DEFINED.—For purposes of
subparagraph (A), the term ‘‘high poverty area’’ means a
catchment area which is established in a manner that is
consistent with the factors in subsection (k)(3)(J), and the
poverty rate of which is greater than the national average
poverty rate as determined by the Bureau of the Census.
(d) LOAN GUARANTEE PROGRAM.—
(1) ESTABLISHMENT.—
(A) IN GENERAL.—The Secretary shall establish a program under which the Secretary may, in accordance with
this subsection and to the extent that appropriations are
provided in advance for such program, guarantee up to 90
percent of the principal and interest on loans made by
non-Federal lenders to health centers, funded under this
section, for the costs of developing and operating managed
care networks or plans described in subsection (c)(1)(B), or
practice management networks described in subsection
(c)(1)(C).
(B) USE OF FUNDS.—Loan funds guaranteed under this
subsection may be used—
(i) to establish reserves for the furnishing of services on a pre-paid basis;
(ii) for costs incurred by the center or centers, otherwise permitted under this section, as the Secretary
determines are necessary to enable a center or centers
to develop, operate, and own the network or plan; or
(iii) to refinance an existing loan (as of the date of
refinancing) to the center or centers, if the Secretary
determines—
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(I) that such refinancing will be beneficial to
the health center and the Federal Government; or
(II) that the center (or centers) can demonstrate an ability to repay the refinanced loan
equal to or greater than the ability of the center
(or centers) to repay the original loan on the date
the original loan was made.
(C) PUBLICATION OF GUIDANCE.—Prior to considering
an application submitted under this subsection, the Secretary shall publish guidelines to provide guidance on the
implementation of this section. The Secretary shall make
such guidelines available to the universe of parties affected
under this subsection, distribute such guidelines to such
parties upon the request of such parties, and provide a
copy of such guidelines to the appropriate committees of
Congress.
(D) PROVISION DIRECTLY TO NETWORKS OR PLANS.—At
the request of health centers receiving assistance under
this section, loan guarantees provided under this paragraph may be made directly to networks or plans that are
at least majority controlled and, as applicable, at least majority owned by those health centers.
(E) FEDERAL CREDIT REFORM.—The requirements of
the Federal Credit Reform Act of 1990 (2 U.S.C. 661 et
seq.) shall apply with respect to loans refinanced under
subparagraph (B)(iii).
(2) PROTECTION OF FINANCIAL INTERESTS.—
(A) IN GENERAL.—The Secretary may not approve a
loan guarantee for a project under this subsection unless
the Secretary determines that—
(i) the terms, conditions, security (if any), and
schedule and amount of repayments with respect to
the loan are sufficient to protect the financial interests
of the United States and are otherwise reasonable, including a determination that the rate of interest does
not exceed such percent per annum on the principal
obligation outstanding as the Secretary determines to
be reasonable, taking into account the range of interest rates prevailing in the private market for similar
loans and the risks assumed by the United States, except that the Secretary may not require as security
any center asset that is, or may be, needed by the center or centers involved to provide health services;
(ii) the loan would not be available on reasonable
terms and conditions without the guarantee under this
subsection; and
(iii) amounts appropriated for the program under
this subsection are sufficient to provide loan guarantees under this subsection.
(B) RECOVERY OF PAYMENTS.—
(i) IN GENERAL.—The United States shall be entitled to recover from the applicant for a loan guarantee
under this subsection the amount of any payment
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retary for good cause waives such right of recovery
(subject to appropriations remaining available to permit such a waiver) and, upon making any such payment, the United States shall be subrogated to all of
the rights of the recipient of the payments with respect to which the guarantee was made. Amounts recovered under this clause shall be credited as reimbursements to the financing account of the program.
(ii) MODIFICATION OF TERMS AND CONDITIONS.—To
the extent permitted by clause (iii) and subject to the
requirements of section 504(e) of the Credit Reform
Act of 1990 (2 U.S.C. 661c(e)), any terms and conditions applicable to a loan guarantee under this subsection (including terms and conditions imposed under
clause (iv)) may be modified or waived by the Secretary to the extent the Secretary determines it to be
consistent with the financial interest of the United
States.
(iii) INCONTESTABILITY.—Any loan guarantee made
by the Secretary under this subsection shall be incontestable—
(I) in the hands of an applicant on whose behalf such guarantee is made unless the applicant
engaged in fraud or misrepresentation in securing
such guarantee; and
(II) as to any person (or successor in interest)
who makes or contracts to make a loan to such
applicant in reliance thereon unless such person
(or successor in interest) engaged in fraud or misrepresentation in making or contracting to make
such loan.
(iv) FURTHER TERMS AND CONDITIONS.—Guarantees of loans under this subsection shall be subject to
such further terms and conditions as the Secretary determines to be necessary to assure that the purposes
of this section will be achieved.
(3) LOAN ORIGINATION FEES.—
(A) IN GENERAL.—The Secretary shall collect a loan
origination fee with respect to loans to be guaranteed
under this subsection, except as provided in subparagraph
(C).
(B) AMOUNT.—The amount of a loan origination fee
collected by the Secretary under subparagraph (A) shall be
equal to the estimated long term cost of the loan guarantees involved to the Federal Government (excluding administrative costs), calculated on a net present value basis,
after taking into account any appropriations that may be
made for the purpose of offsetting such costs, and in accordance with the criteria used to award loan guarantees
under this subsection.
(C) WAIVER.—The Secretary may waive the loan origination fee for a health center applicant who demonstrates
to the Secretary that the applicant will be unable to meet
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the conditions of the loan if the applicant incurs the additional cost of the fee.
(4) DEFAULTS.—
(A) IN GENERAL.—Subject to the requirements of the
Credit Reform Act of 1990 (2 U.S.C. 661 et seq.), the Secretary may take such action as may be necessary to prevent a default on a loan guaranteed under this subsection,
including the waiver of regulatory conditions, deferral of
loan payments, renegotiation of loans, and the expenditure
of funds for technical and consultative assistance, for the
temporary payment of the interest and principal on such
a loan, and for other purposes. Any such expenditure made
under the preceding sentence on behalf of a health center
or centers shall be made under such terms and conditions
as the Secretary shall prescribe, including the implementation of such organizational, operational, and financial reforms as the Secretary determines are appropriate and the
disclosure of such financial or other information as the
Secretary may require to determine the extent of the implementation of such reforms.
(B) FORECLOSURE.—The Secretary may take such action, consistent with State law respecting foreclosure procedures and, with respect to reserves required for furnishing services on a prepaid basis, subject to the consent
of the affected States, as the Secretary determines appropriate to protect the interest of the United States in the
event of a default on a loan guaranteed under this subsection, except that the Secretary may only foreclose on assets offered as security (if any) in accordance with paragraph (2)(A)(i).
(5) LIMITATION.—Not more than one loan guarantee may
be made under this subsection for the same network or plan,
except that upon a showing of good cause the Secretary may
make additional loan guarantees.
(6) AUTHORIZATION OF APPROPRIATIONS.—There are authorized to be appropriated to carry out this subsection such sums
as may be necessary.
(e) OPERATING GRANTS.—
(1) AUTHORITY.—
(A) IN GENERAL.—The Secretary may make grants for
the costs of the operation of public and nonprofit private
health centers that provide health services to medically
underserved populations.
(B) ENTITIES THAT FAIL TO MEET CERTAIN REQUIREMENTS.—The Secretary may make grants, for a period of
not to exceed 2 years, for the costs of the operation of public and nonprofit private entities which provide health
services to medically underserved populations but with respect to which the Secretary is unable to make each of the
determinations required by subsection (k)(3).
(C) OPERATION OF NETWORKS AND PLANS.—The Secretary may make grants to health centers that receive assistance under this section, or at the request of the health
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paragraphs (B) and (C) of subsection (c)(1)) that is at least
majority controlled and, as applicable, at least majority
owned by such health centers receiving assistance under
this section, for the costs associated with the operation of
such network or plan, including the purchase or lease of
equipment (including the costs of amortizing the principal
of, and paying the interest on, loans for equipment).
(2) USE OF FUNDS.—The costs for which a grant may be
made under subparagraph (A) or (B) of paragraph (1) may include the costs of acquiring and leasing buildings and equipment (including the costs of amortizing the principal of, and
paying interest on, loans), and the costs of providing training
related to the provision of required primary health services
and additional health services and to the management of
health center programs.
(3) CONSTRUCTION.—The Secretary may award grants
which may be used to pay the costs associated with expanding
and modernizing existing buildings or constructing new buildings (including the costs of amortizing the principal of, and
paying the interest on, loans) for projects approved prior to October 1, 1996.
(4) LIMITATION.—Not more than two grants may be made
under subparagraph (B) of paragraph (1) for the same entity.
(5) AMOUNT.—
(A) IN GENERAL.—The amount of any grant made in
any fiscal year under subparagraphs (A) and (B) of paragraph (1) to a health center shall be determined by the
Secretary, but may not exceed the amount by which the
costs of operation of the center in such fiscal year exceed
the total of—
(i) State, local, and other operational funding provided to the center; and
(ii) the fees, premiums, and third-party reimbursements, which the center may reasonably be expected
to receive for its operations in such fiscal year.
(B) NETWORKS AND PLANS.—The total amount of grant
funds made available for any fiscal year under paragraph
(1)(C) and subparagraphs (B) and (C) of subsection (c)(1) to
a health center or to a network or plan shall be determined by the Secretary, but may not exceed 2 percent of
the total amount appropriated under this section for such
fiscal year.
(C) PAYMENTS.—Payments under grants under subparagraph (A) or (B) of paragraph (1) shall be made in advance or by way of reimbursement and in such installments as the Secretary finds necessary and adjustments
may be made for overpayments or underpayments.
(D) USE OF NONGRANT FUNDS.—Nongrant funds described in clauses (i) and (ii) of subparagraph (A), including any such funds in excess of those originally expected,
shall be used as permitted under this section, and may be
used for such other purposes as are not specifically prohibited under this section if such use furthers the objectives
of the project.
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(f) INFANT MORTALITY GRANTS.—
(1) IN GENERAL.—The Secretary may make grants to
health centers for the purpose of assisting such centers in—
(A) providing comprehensive health care and support
services for the reduction of—
(i) the incidence of infant mortality; and
(ii) morbidity among children who are less than 3
years of age; and
(B) developing and coordinating service and referral
arrangements between health centers and other entities
for the health management of pregnant women and children described in subparagraph (A).
(2) PRIORITY.—In making grants under this subsection the
Secretary shall give priority to health centers providing services to any medically underserved population among which
there is a substantial incidence of infant mortality or among
which there is a significant increase in the incidence of infant
mortality.
(3) REQUIREMENTS.—The Secretary may make a grant
under this subsection only if the health center involved agrees
that—
(A) the center will coordinate the provision of services
under the grant to each of the recipients of the services;
(B) such services will be continuous for each such recipient;
(C) the center will provide follow-up services for individuals who are referred by the center for services described in paragraph (1);
(D) the grant will be expended to supplement, and not
supplant, the expenditures of the center for primary health
services (including prenatal care) with respect to the purpose described in this subsection; and
(E) the center will coordinate the provision of services
with other maternal and child health providers operating
in the catchment area.
(g) MIGRATORY AND SEASONAL AGRICULTURAL WORKERS.—
(1) IN GENERAL.—The Secretary may award grants for the
purposes described in subsections (c), (e), and (f) for the planning and delivery of services to a special medically underserved population comprised of—
(A) migratory agricultural workers, seasonal agricultural workers, and members of the families of such migratory and seasonal agricultural workers who are within a
designated catchment area; and
(B) individuals who have previously been migratory
agricultural workers but who no longer meet the requirements of subparagraph (A) of paragraph (3) because of age
or disability and members of the families of such individuals who are within such catchment area.
(2) ENVIRONMENTAL CONCERNS.—The Secretary may enter
into grants or contracts under this subsection with public and
private entities to—
(A) assist the States in the implementation and enforcement of acceptable environmental health standards,
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including enforcement of standards for sanitation in migratory agricultural worker and seasonal agricultural
worker labor camps, and applicable Federal and State pesticide control standards; and
(B) conduct projects and studies to assist the several
States and entities which have received grants or contracts
under this section in the assessment of problems related to
camp and field sanitation, exposure to unsafe levels of agricultural chemicals including pesticides, and other environmental health hazards to which migratory agricultural
workers and seasonal agricultural workers, and members
of their families, are exposed.
(3) DEFINITIONS.—For purposes of this subsection:
(A) MIGRATORY AGRICULTURAL WORKER.—The term
‘‘migratory agricultural worker’’ means an individual
whose principal employment is in agriculture, who has
been so employed within the last 24 months, and who establishes for the purposes of such employment a temporary
abode.
(B) SEASONAL AGRICULTURAL WORKER.—The term ‘‘seasonal agricultural worker’’ means an individual whose
principal employment is in agriculture on a seasonal basis
and who is not a migratory agricultural worker.
(C) AGRICULTURE.—The term ‘‘agriculture’’ means
farming in all its branches, including—
(i) cultivation and tillage of the soil;
(ii) the production, cultivation, growing, and harvesting of any commodity grown on, in, or as an adjunct to or part of a commodity grown in or on, the
land; and
(iii) any practice (including preparation and processing for market and delivery to storage or to market
or to carriers for transportation to market) performed
by a farmer or on a farm incident to or in conjunction
with an activity described in clause (ii).
(h) HOMELESS POPULATION.—
(1) IN GENERAL.—The Secretary may award grants for the
purposes described in subsections (c), (e), and (f) for the planning and delivery of services to a special medically underserved population comprised of homeless individuals, including
grants for innovative programs that provide outreach and comprehensive primary health services to homeless children and
youth and children and youth at risk of homelessness.
(2) REQUIRED SERVICES.—In addition to required primary
health services (as defined in subsection (b)(1)), an entity that
receives a grant under this subsection shall be required to provide substance abuse services as a condition of such grant.
(3) SUPPLEMENT NOT SUPPLANT REQUIREMENT.—A grant
awarded under this subsection shall be expended to supplement, and not supplant, the expenditures of the health center
and the value of in kind contributions for the delivery of services to the population described in paragraph (1).
(4) TEMPORARY CONTINUED PROVISION OF SERVICES TO CERTAIN FORMER HOMELESS INDIVIDUALS.—If any grantee under
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this subsection has provided services described in this section
under the grant to a homeless individual, such grantee may,
notwithstanding that the individual is no longer homeless as
a result of becoming a resident in permanent housing, expend
the grant to continue to provide such services to the individual
for not more than 12 months.
(5) DEFINITIONS.—For purposes of this section:
(A) HOMELESS INDIVIDUAL.—The term ‘‘homeless individual’’ means an individual who lacks housing (without
regard to whether the individual is a member of a family),
including an individual whose primary residence during
the night is a supervised public or private facility that provides temporary living accommodations and an individual
who is a resident in transitional housing.
(B) SUBSTANCE ABUSE.—The term ‘‘substance abuse’’
has the same meaning given such term in section 534(4).
(C) SUBSTANCE ABUSE SERVICES.—The term ‘‘substance
abuse services’’ includes detoxification, risk reduction, outpatient treatment, residential treatment, and rehabilitation for substance abuse provided in settings other than
hospitals.
(i) RESIDENTS OF PUBLIC HOUSING.—
(1) IN GENERAL.—The Secretary may award grants for the
purposes described in subsections (c), (e), and (f) for the planning and delivery of services to a special medically underserved population comprised of residents of public housing
(such term, for purposes of this subsection, shall have the same
meaning given such term in section 3(b)(1) of the United States
Housing Act of 1937) and individuals living in areas immediately accessible to such public housing.
(2) SUPPLEMENT NOT SUPPLANT.—A grant awarded under
this subsection shall be expended to supplement, and not supplant, the expenditures of the health center and the value of
in kind contributions for the delivery of services to the population described in paragraph (1).
(3) CONSULTATION WITH RESIDENTS.—The Secretary may
not make a grant under paragraph (1) unless, with respect to
the residents of the public housing involved, the applicant for
the grant—
(A) has consulted with the residents in the preparation of the application for the grant; and
(B) agrees to provide for ongoing consultation with the
residents regarding the planning and administration of the
program carried out with the grant.
(j) ACCESS GRANTS.—
(1) IN GENERAL.—The Secretary may award grants to eligible health centers with a substantial number of clients with
limited English speaking proficiency to provide translation, interpretation, and other such services for such clients with limited English speaking proficiency.
(2) ELIGIBLE HEALTH CENTER.—In this subsection, the term
‘‘eligible health center’’ means an entity that—
(A) is a health center as defined under subsection (a);
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(B) provides health care services for clients for whom
English is a second language; and
(C) has exceptional needs with respect to linguistic access or faces exceptional challenges with respect to linguistic access.
(3) GRANT AMOUNT.—The amount of a grant awarded to a
center under this subsection shall be determined by the Administrator. Such determination of such amount shall be based
on the number of clients for whom English is a second language that is served by such center, and larger grant amounts
shall be awarded to centers serving larger numbers of such clients.
(4) USE OF FUNDS.—An eligible health center that receives
a grant under this subsection may use funds received through
such grant to—
(A) provide translation, interpretation, and other such
services for clients for whom English is a second language,
including hiring professional translation and interpretation services; and
(B) compensate bilingual or multilingual staff for language assistance services provided by the staff for such clients.
(5) APPLICATION.—An eligible health center desiring a
grant under this subsection shall submit an application to the
Secretary at such time, in such manner, and containing such
information as the Secretary may reasonably require, including—
(A) an estimate of the number of clients that the center serves for whom English is a second language;
(B) the ratio of the number of clients for whom
English is a second language to the total number of clients
served by the center;
(C) a description of any language assistance services
that the center proposes to provide to aid clients for whom
English is a second language; and
(D) a description of the exceptional needs of such center with respect to linguistic access or a description of the
exceptional challenges faced by such center with respect to
linguistic access.
(6) AUTHORIZATION OF APPROPRIATIONS.—There are authorized to be appropriated to carry out this subsection, in addition
to any funds authorized to be appropriated or appropriated for
health centers under any other subsection of this section, such
sums as may be necessary for each of fiscal years 2002 through
2006.
(k) APPLICATIONS.—
(1) SUBMISSION.—No grant may be made under this section unless an application therefore is submitted to, and approved by, the Secretary. Such an application shall be submitted in such form and manner and shall contain such information as the Secretary shall prescribe.
(2) DESCRIPTION OF NEED.—An application for a grant
under subparagraph (A) or (B) of subsection (e)(1) for a health
center shall include—
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(A) a description of the need for health services in the
catchment area of the center;
(B) a demonstration by the applicant that the area or
the population group to be served by the applicant has a
shortage of personal health services; and
(C) a demonstration that the center will be located so
that it will provide services to the greatest number of individuals residing in the catchment area or included in such
population group.
Such a demonstration shall be made on the basis of the criteria
prescribed by the Secretary under subsection (b)(3) or on any
other criteria which the Secretary may prescribe to determine
if the area or population group to be served by the applicant
has a shortage of personal health services. In considering an
application for a grant under subparagraph (A) or (B) of subsection (e)(1), the Secretary may require as a condition to the
approval of such application an assurance that the applicant
will provide any health service defined under paragraphs (1)
and (2) of subsection (b) that the Secretary finds is needed to
meet specific health needs of the area to be served by the applicant. Such a finding shall be made in writing and a copy
shall be provided to the applicant.
(3) REQUIREMENTS.—Except as provided in subsection
(e)(1)(B), the Secretary may not approve an application for a
grant under subparagraph (A) or (B) of subsection (e)(1) unless
the Secretary determines that the entity for which the application is submitted is a health center (within the meaning of subsection (a)) and that—
(A) the required primary health services of the center
will be available and accessible in the catchment area of
the center promptly, as appropriate, and in a manner
which assures continuity;
(B) the center has made and will continue to make
every reasonable effort to establish and maintain collaborative relationships with other health care providers in the
catchment area of the center;
(C) the center will have an ongoing quality improvement system that includes clinical services and management, and that maintains the confidentiality of patient
records;
(D) the center will demonstrate its financial responsibility by the use of such accounting procedures and other
requirements as may be prescribed by the Secretary;
(E) the center—
(i)(I) has or will have a contractual or other arrangement with the agency of the State, in which it
provides services, which administers or supervises the
administration of a State plan approved under title
XIX of the Social Security Act for the payment of all
or a part of the center’s costs in providing health services to persons who are eligible for medical assistance
under such a State plan; and
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(II) 1 has or will have a contractual or other
arrangement with the State agency administering
the program under title XXI of such Act (42
U.S.C. 1397aa et seq.) with respect to individuals
who are State children’s health insurance program
beneficiaries; or
(ii) has made or will make every reasonable effort
to enter into arrangements described in subclauses (I)
and (II) of clause (i);
(F) the center has made or will make and will continue to make every reasonable effort to collect appropriate
reimbursement for its costs in providing health services to
persons who are entitled to insurance benefits under title
XVIII of the Social Security Act, to medical assistance
under a State plan approved under title XIX of such Act,
or to assistance for medical expenses under any other public assistance program or private health insurance program;
(G) the center—
(i) has prepared a schedule of fees or payments for
the provision of its services consistent with locally prevailing rates or charges and designed to cover its reasonable costs of operation and has prepared a corresponding schedule of discounts to be applied to the
payment of such fees or payments, which discounts
are adjusted on the basis of the patient’s ability to
pay;
(ii) has made and will continue to make every reasonable effort—
(I) to secure from patients payment for services in accordance with such schedules; and
(II) to collect reimbursement for health services to persons described in subparagraph (F) on
the basis of the full amount of fees and payments
for such services without application of any discount;
(iii)(I) will assure that no patient will be denied
health care services due to an individual’s inability to
pay for such services; and
(II) will assure that any fees or payments required
by the center for such services will be reduced or
waived to enable the center to fulfill the assurance described in subclause (I); and
(iv) has submitted to the Secretary such reports as
the Secretary may require to determine compliance
with this subparagraph;
(H) the center has established a governing board
which except in the case of an entity operated by an Indian tribe or tribal or Indian organization under the Indian Self-Determination Act or an urban Indian organization under the Indian Health Care Improvement Act (25
U.S.C. 1651 et seq.)—
1 Indentation

March 13, 2013

is so in law. See section 101(7)(A)(i)(III) of Public Law 107–251 (116 Stat. 225).

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(i) is composed of individuals, a majority of whom
are being served by the center and who, as a group,
represent the individuals being served by the center;
(ii) meets at least once a month, selects the services to be provided by the center, schedules the hours
during which such services will be provided, approves
the center’s annual budget, approves the selection of a
director for the center, and, except in the case of a
governing board of a public center (as defined in the
second sentence of this paragraph), establishes general
policies for the center; and
(iii) in the case of an application for a second or
subsequent grant for a public center, has approved the
application or if the governing body has not approved
the application, the failure of the governing body to
approve the application was unreasonable;
except that, upon a showing of good cause the Secretary
shall waive, for the length of the project period, all or part
of the requirements of this subparagraph in the case of a
health center that receives a grant pursuant to subsection
(g), (h), (i), or (p);
(I) the center has developed—
(i) an overall plan and budget that meets the requirements of the Secretary; and
(ii) an effective procedure for compiling and reporting to the Secretary such statistics and other information as the Secretary may require relating to—
(I) the costs of its operations;
(II) the patterns of use of its services;
(III) the availability, accessibility, and acceptability of its services; and
(IV) such other matters relating to operations
of the applicant as the Secretary may require;
(J) the center will review periodically its catchment
area to—
(i) ensure that the size of such area is such that
the services to be provided through the center (including any satellite) are available and accessible to the
residents of the area promptly and as appropriate;
(ii) ensure that the boundaries of such area conform, to the extent practicable, to relevant boundaries
of political subdivisions, school districts, and Federal
and State health and social service programs; and
(iii) ensure that the boundaries of such area eliminate, to the extent possible, barriers to access to the
services of the center, including barriers resulting
from the area’s physical characteristics, its residential
patterns, its economic and social grouping, and available transportation;
(K) in the case of a center which serves a population
including a substantial proportion of individuals of limited
English-speaking ability, the center has—
(i) developed a plan and made arrangements responsive to the needs of such population for providing
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services to the extent practicable in the language and
cultural context most appropriate to such individuals;
and
(ii) identified an individual on its staff who is fluent in both that language and in English and whose
responsibilities shall include providing guidance to
such individuals and to appropriate staff members
with respect to cultural sensitivities and bridging linguistic and cultural differences;
(L) the center, has developed an ongoing referral relationship with one or more hospitals; and
(M) the center encourages persons receiving or seeking
health services from the center to participate in any public
or private (including employer-offered) health programs or
plans for which the persons are eligible, so long as the center, in complying with this subparagraph, does not violate
the requirements of subparagraph (G)(iii)(I).
For purposes of subparagraph (H), the term ‘‘public center’’
means a health center funded (or to be funded) through a
grant under this section to a public agency.
(4) APPROVAL OF NEW OR EXPANDED SERVICE APPLICATIONS.—The Secretary shall approve applications for grants
under subparagraph (A) or (B) of subsection (e)(1) for health
centers which—
(A) have not received a previous grant under such subsection; or
(B) have applied for such a grant to expand their services;
in such a manner that the ratio of the medically underserved
populations in rural areas which may be expected to use the
services provided by such centers to the medically underserved
populations in urban areas which may be expected to use the
services provided by such centers is not less than two to three
or greater than three to two.
(l) TECHNICAL ASSISTANCE.—The Secretary shall establish a
program through which the Secretary shall provide (either through
the Department of Health and Human Services or by grant or contract) technical and other assistance to eligible entities to assist
such entities to meet the requirements of subsection (k)(3). Services
provided through the program may include necessary technical and
nonfinancial assistance, including fiscal and program management
assistance, training in fiscal and program management, operational
and administrative support, and the provision of information to the
entities of the variety of resources available under this title and
how those resources can be best used to meet the health needs of
the communities served by the entities.
(m) MEMORANDUM OF AGREEMENT.—In carrying out this section, the Secretary may enter into a memorandum of agreement
with a State. Such memorandum may include, where appropriate,
provisions permitting such State to—
(1) analyze the need for primary health services for medically underserved populations within such State;
(2) assist in the planning and development of new health
centers;
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(3) review and comment upon annual program plans and
budgets of health centers, including comments upon allocations
of health care resources in the State;
(4) assist health centers in the development of clinical
practices and fiscal and administrative systems through a technical assistance plan which is responsive to the requests of
health centers; and
(5) share information and data relevant to the operation of
new and existing health centers.
(n) RECORDS.—
(1) IN GENERAL.—Each entity which receives a grant under
subsection (e) shall establish and maintain such records as the
Secretary shall require.
(2) AVAILABILITY.—Each entity which is required to establish and maintain records under this subsection shall make
such books, documents, papers, and records available to the
Secretary or the Comptroller General of the United States, or
any of their duly authorized representatives, for examination,
copying or mechanical reproduction on or off the premises of
such entity upon a reasonable request therefore. The Secretary
and the Comptroller General of the United States, or any of
their duly authorized representatives, shall have the authority
to conduct such examination, copying, and reproduction.
(o) DELEGATION OF AUTHORITY.—The Secretary may delegate
the authority to administer the programs authorized by this section
to any office, except that the authority to enter into, modify, or
issue approvals with respect to grants or contracts may be delegated only within the central office of the Health Resources and
Services Administration.
(p) SPECIAL CONSIDERATION.—In making grants under this section, the Secretary shall give special consideration to the unique
needs of sparsely populated rural areas, including giving priority in
the awarding of grants for new health centers under subsections (c)
and (e), and the granting of waivers as appropriate and permitted
under subsections (b)(1)(B)(i) and (k)(3)(G).
(q) AUDITS.—
(1) IN GENERAL.—Each entity which receives a grant under
this section shall provide for an independent annual financial
audit of any books, accounts, financial records, files, and other
papers and property which relate to the disposition or use of
the funds received under such grant and such other funds received by or allocated to the project for which such grant was
made. For purposes of assuring accurate, current, and complete
disclosure of the disposition or use of the funds received, each
such audit shall be conducted in accordance with generally accepted accounting principles. Each audit shall evaluate—
(A) the entity’s implementation of the guidelines established by the Secretary respecting cost accounting,
(B) the processes used by the entity to meet the financial and program reporting requirements of the Secretary,
and
(C) the billing and collection procedures of the entity
and the relation of the procedures to its fee schedule and
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surance and public programs to pay for the health services
it provides.
A report of each such audit shall be filed with the Secretary
at such time and in such manner as the Secretary may require.
(2) RECORDS.—Each entity which receives a grant under
this section shall establish and maintain such records as the
Secretary shall by regulation require to facilitate the audit required by paragraph (1). The Secretary may specify by regulation the form and manner in which such records shall be established and maintained.
(3) AVAILABILITY OF RECORDS.—Each entity which is required to establish and maintain records or to provide for and
audit under this subsection shall make such books, documents,
papers, and records available to the Secretary or the Comptroller General of the United States, or any of their duly authorized representatives, for examination, copying or mechanical reproduction on or off the premises of such entity upon a
reasonable request therefore. The Secretary and the Comptroller General of the United States, or any of their duly authorized representatives, shall have the authority to conduct
such examination, copying, and reproduction.
(4) WAIVER.—The Secretary may, under appropriate circumstances, waive the application of all or part of the requirements of this subsection with respect to an entity.
(r) AUTHORIZATION OF APPROPRIATIONS.—
(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.
(2) SPECIAL PROVISIONS.—
(A) PUBLIC CENTERS.—The Secretary may not expend
in any fiscal year, for grants under this section to public
centers (as defined in the second sentence of subsection
(k)(3)) the governing boards of which (as described in subsection (k)(3)(H)) do not establish general policies for such
centers, an amount which exceeds 5 percent of the
amounts appropriated under this section for that fiscal
year. For purposes of applying the preceding sentence, the
term ‘‘public centers’’ shall not include health centers that
receive grants pursuant to subsection (h) or (i).
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(B) DISTRIBUTION OF GRANTS.—For fiscal year 2002
and each of the following fiscal years, the Secretary, in
awarding grants under this section, shall ensure that the
proportion of the amount made available under each of
subsections (g), (h), and (i), relative to the total amount appropriated to carry out this section for that fiscal year, is
equal to the proportion of the amount made available
under that subsection for fiscal year 2001, relative to the
total amount appropriated to carry out this section for fiscal year 2001.
(3) FUNDING REPORT.—The Secretary shall annually prepare and submit to the appropriate committees of Congress a
report concerning the distribution of funds under this section
that are provided to meet the health care needs of medically
underserved populations, including the homeless, residents of
public housing, and migratory and seasonal agricultural workers, and the appropriateness of the delivery systems involved
in responding to the needs of the particular populations. Such
report shall include an assessment of the relative health care
access needs of the targeted populations and the rationale for
any substantial changes in the distribution of funds.
(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 lowincome patients.
(s) DEMONSTRATION PROGRAM FOR INDIVIDUALIZED WELLNESS
PLANS.—
(1) IN GENERAL.—The Secretary shall establish a pilot program to test the impact of providing at-risk populations who
utilize community health centers funded under this section an
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tors for preventable conditions as identified by a comprehensive risk-factor assessment.
(2) AGREEMENTS.—The Secretary shall enter into agreements with not more than 10 community health centers funded
under this section to conduct activities under the pilot program
under paragraph (1).
(3) WELLNESS PLANS.—
(A) IN GENERAL.—An individualized wellness plan prepared under the pilot program under this subsection may
include one or more of the following as appropriate to the
individual’s identified risk factors:
(i) Nutritional counseling.
(ii) A physical activity plan.
(iii) Alcohol and smoking cessation counseling and
services.
(iv) Stress management.
(v) Dietary supplements that have health claims
approved by the Secretary.
(vi) Compliance assistance provided by a community health center employee.
(B) RISK FACTORS.—Wellness plan risk factors shall include—
(i) weight;
(ii) tobacco and alcohol use;
(iii) exercise rates;
(iv) nutritional status; and
(v) blood pressure.
(C) COMPARISONS.—Individualized wellness plans shall
make comparisons between the individual involved and a
control group of individuals with respect to the risk factors
described in subparagraph (B).
(4) AUTHORIZATION OF APPROPRIATIONS.—There is authorized to be appropriated to carry out this subsection, such sums
as may be necessary.
SEC. 330A. ø254c¿ RURAL HEALTH CARE SERVICES OUTREACH,
RURAL HEALTH NETWORK DEVELOPMENT, AND SMALL
HEALTH CARE PROVIDER QUALITY IMPROVEMENT
GRANT PROGRAMS.
(a) PURPOSE.—The purpose of this section is to provide grants

for expanded delivery of health care services in rural areas, for the
planning and implementation of integrated health care networks in
rural areas, and for the planning and implementation of small
health care provider quality improvement activities.
(b) DEFINITIONS.—
(1) DIRECTOR.—The term ‘‘Director’’ means the Director
specified in subsection (d).
(2) FEDERALLY QUALIFIED HEALTH CENTER; RURAL HEALTH
CLINIC.—The terms ‘‘Federally qualified health center’’ and
‘‘rural health clinic’’ have the meanings given the terms in section 1861(aa) of the Social Security Act (42 U.S.C. 1395x(aa)).
(3) HEALTH PROFESSIONAL SHORTAGE AREA.—The term
‘‘health professional shortage area’’ means a health professional shortage area designated under section 332.
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(4) MEDICALLY UNDERSERVED COMMUNITY.—The term
‘‘medically underserved community’’ has the meaning given the
term in section 799B(6).
(5) MEDICALLY UNDERSERVED POPULATION.—The term
‘‘medically underserved population’’ has the meaning given the
term in section 330(b)(3).
(c) PROGRAM.—The Secretary shall establish, under section
301, a small health care provider quality improvement grant program.
(d) ADMINISTRATION.—
(1) PROGRAMS.—The rural health care services outreach,
rural health network development, and small health care provider quality improvement grant programs established under
section 301 shall be administered by the Director of the Office
of Rural Health Policy of the Health Resources and Services
Administration, in consultation with State offices of rural
health or other appropriate State government entities.
(2) GRANTS.—
(A) IN GENERAL.—In carrying out the programs described in paragraph (1), the Director may award grants
under subsections (e), (f), and (g) to expand access to, coordinate, and improve the quality of essential health care
services, and enhance the delivery of health care, in rural
areas.
(B) TYPES OF GRANTS.—The Director may award the
grants—
(i) to promote expanded delivery of health care
services in rural areas under subsection (e);
(ii) to provide for the planning and implementation of integrated health care networks in rural areas
under subsection (f); and
(iii) to provide for the planning and implementation of small health care provider quality improvement
activities under subsection (g).
(e) RURAL HEALTH CARE SERVICES OUTREACH GRANTS.—
(1) GRANTS.—The Director may award grants to eligible
entities to promote rural health care services outreach by expanding the delivery of health care services to include new and
enhanced services in rural areas. The Director may award the
grants for periods of not more than 3 years.
(2) ELIGIBILITY.—To be eligible to receive a grant under
this subsection for a project, an entity—
(A) shall be a rural public or rural nonprofit private
entity;
(B) shall represent a consortium composed of members—
(i) that include 3 or more health care providers;
and
(ii) that may be nonprofit or for-profit entities;
and
(C) shall not previously have received a grant under
this subsection for the same or a similar project, unless the
entity is proposing to expand the scope of the project or
the area that will be served through the project.
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(3) APPLICATIONS.—To be eligible to receive a grant under
this subsection, an eligible entity, in consultation with the appropriate State office of rural health or another appropriate
State entity, shall prepare and submit to the Secretary an application, at such time, in such manner, and containing such
information as the Secretary may require, including—
(A) a description of the project that the eligible entity
will carry out using the funds provided under the grant;
(B) a description of the manner in which the project
funded under the grant will meet the health care needs of
rural underserved populations in the local community or
region to be served;
(C) a description of how the local community or region
to be served will be involved in the development and ongoing operations of the project;
(D) a plan for sustaining the project after Federal support for the project has ended;
(E) a description of how the project will be evaluated;
and
(F) other such information as the Secretary determines to be appropriate.
(f) RURAL HEALTH NETWORK DEVELOPMENT GRANTS.—
(1) GRANTS.—
(A) IN GENERAL.—The Director may award rural
health network development grants to eligible entities to
promote, through planning and implementation, the development of integrated health care networks that have combined the functions of the entities participating in the networks in order to—
(i) achieve efficiencies;
(ii) expand access to, coordinate, and improve the
quality of essential health care services; and
(iii) strengthen the rural health care system as a
whole.
(B) GRANT PERIODS.—The Director may award such a
rural health network development grant for implementation activities for a period of 3 years. The Director may
also award such a rural health network development grant
for planning activities for a period of 1 year, to assist in
the development of an integrated health care network, if
the proposed participants in the network do not have a
history of collaborative efforts and a 3-year grant would be
inappropriate.
(2) ELIGIBILITY.—To be eligible to receive a grant under
this subsection, an entity—
(A) shall be a rural public or rural nonprofit private
entity;
(B) shall represent a network composed of participants—
(i) that include 3 or more health care providers;
and
(ii) that may be nonprofit or for-profit entities;
and
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(C) shall not previously have received a grant under
this subsection (other than a grant for planning activities)
for the same or a similar project.
(3) APPLICATIONS.—To be eligible to receive a grant under
this subsection, an eligible entity, in consultation with the appropriate State office of rural health or another appropriate
State entity, shall prepare and submit to the Secretary an application, at such time, in such manner, and containing such
information as the Secretary may require, including—
(A) a description of the project that the eligible entity
will carry out using the funds provided under the grant;
(B) an explanation of the reasons why Federal assistance is required to carry out the project;
(C) a description of—
(i) the history of collaborative activities carried
out by the participants in the network;
(ii) the degree to which the participants are ready
to integrate their functions; and
(iii) how the local community or region to be
served will benefit from and be involved in the activities carried out by the network;
(D) a description of how the local community or region
to be served will experience increased access to quality
health care services across the continuum of care as a result of the integration activities carried out by the network;
(E) a plan for sustaining the project after Federal support for the project has ended;
(F) a description of how the project will be evaluated;
and
(G) other such information as the Secretary determines to be appropriate.
(g) SMALL HEALTH CARE PROVIDER QUALITY IMPROVEMENT
GRANTS.—
(1) GRANTS.—The Director may award grants to provide
for the planning and implementation of small health care provider quality improvement activities. The Director may award
the grants for periods of 1 to 3 years.
(2) ELIGIBILITY.—To be eligible for a grant under this subsection, an entity—
(A)(i) shall be a rural public or rural nonprofit private
health care provider or provider of health care services,
such as a critical access hospital or a rural health clinic;
or
(ii) shall be another rural provider or network of small
rural providers identified by the Secretary as a key source
of local care; and
(B) shall not previously have received a grant under
this subsection for the same or a similar project.
(3) APPLICATIONS.—To be eligible to receive a grant under
this subsection, an eligible entity, in consultation with the appropriate State office of rural health or another appropriate
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plication, at such time, in such manner, and containing such
information as the Secretary may require, including—
(A) a description of the project that the eligible entity
will carry out using the funds provided under the grant;
(B) an explanation of the reasons why Federal assistance is required to carry out the project;
(C) a description of the manner in which the project
funded under the grant will assure continuous quality improvement in the provision of services by the entity;
(D) a description of how the local community or region
to be served will experience increased access to quality
health care services across the continuum of care as a result of the activities carried out by the entity;
(E) a plan for sustaining the project after Federal support for the project has ended;
(F) a description of how the project will be evaluated;
and
(G) other such information as the Secretary determines to be appropriate.
(4) EXPENDITURES FOR SMALL HEALTH CARE PROVIDER
QUALITY IMPROVEMENT GRANTS.—In awarding a grant under
this subsection, the Director shall ensure that the funds made
available through the grant will be used to provide services to
residents of rural areas. The Director shall award not less than
50 percent of the funds made available under this subsection
to providers located in and serving rural areas.
(h) GENERAL REQUIREMENTS.—
(1) PROHIBITED USES OF FUNDS.—An entity that receives a
grant under this section may not use funds provided through
the grant—
(A) to build or acquire real property; or
(B) for construction.
(2) COORDINATION WITH OTHER AGENCIES.—The Secretary
shall coordinate activities carried out under grant programs
described in this section, to the extent practicable, with Federal and State agencies and nonprofit organizations that are
operating similar grant programs, to maximize the effect of
public dollars in funding meritorious proposals.
(3) PREFERENCE.—In awarding grants under this section,
the Secretary shall give preference to entities that—
(A) are located in health professional shortage areas or
medically underserved communities, or serve medically underserved populations; or
(B) propose to develop projects with a focus on primary
care, and wellness and prevention strategies.
(i) REPORT.—Not later than September 30, 2005, the Secretary
shall prepare and submit to the appropriate committees of Congress a report on the progress and accomplishments of the grant
programs described in subsections (e), (f), and (g).
(j) AUTHORIZATION OF APPROPRIATIONS.—There are authorized
to be appropriated to carry out this section $45,000,000 for each of
fiscal years 2008 through 2012.
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SEC. 330A–1. ø254c–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 ‘‘nursemanaged health clinic’’ means a nurse-practice arrangement,
managed by advanced practice nurses, that provides primary
care or wellness services to underserved or vulnerable populations and that is associated with a school, college, university
or department of nursing, federally qualified health center, or
independent nonprofit health or social services agency.
(b) AUTHORITY TO AWARD GRANTS.—The Secretary shall award
grants for the cost of the operation of nurse-managed health clinics
that meet the requirements of this section.
(c) APPLICATIONS.—To be eligible to receive a grant under this
section, an entity shall—
(1) be an NMHC; and
(2) submit to the Secretary an application at such time, in
such manner, and containing—
(A) assurances that nurses are the major providers of
services at the NMHC and that at least 1 advanced practice nurse holds an executive management position within
the organizational structure of the NMHC;
(B) an assurance that the NMHC will continue providing comprehensive primary health care services or
wellness services without regard to income or insurance
status of the patient for the duration of the grant period;
and
(C) an assurance that, not later than 90 days of receiving a grant under this section, the NMHC will establish a
community advisory committee, for which a majority of the
members shall be individuals who are served by the
NMHC.
(d) GRANT AMOUNT.—The amount of any grant made under
this section for any fiscal year shall be determined by the Secretary, taking into account—
(1) the financial need of the NMHC, considering State,
local, and other operational funding provided to the NMHC;
and
(2) other factors, as the Secretary determines appropriate.
(e) AUTHORIZATION OF APPROPRIATIONS.—For the purposes of
carrying out this section, there are authorized to be appropriated
$50,000,000 for the fiscal year 2010 and such sums as may be necessary for each of the fiscal years 2011 through 2014.

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SEC. 330B. ø254c–2¿ SPECIAL DIABETES PROGRAMS FOR TYPE I DIABETES. 1
(a) IN GENERAL.—The Secretary, directly or through grants,

shall provide for research into the prevention and cure of Type I
diabetes.
(b) FUNDING.—
(1) TRANSFERRED FUNDS.—Notwithstanding section 2104(a)
of the Social Security Act, from the amounts appropriated in
such section for each of fiscal years 1998 through 2002,
$30,000,000 is hereby transferred and made available in such
fiscal year for grants under this section.
(2) APPROPRIATIONS.—For the purpose of making grants
under this section, there is appropriated, out of any funds in
the Treasury not otherwise appropriated—
(A) $70,000,000 for each of fiscal years 2001 and 2002
(which shall be combined with amounts transferred under
paragraph (1) for each such fiscal years);
(B) $100,000,000 for fiscal year 2003; and
(C) $150,000,000 for each of fiscal years 2004 through
2014.
SEC. 330C. ø254c–3¿ SPECIAL DIABETES PROGRAMS FOR INDIANS. 1
(a) IN GENERAL.—The Secretary shall make grants for pro-

viding services for the prevention and treatment of diabetes in accordance with subsection (b).
(b) SERVICES THROUGH INDIAN HEALTH FACILITIES.—For purposes of subsection (a), services under such subsection are provided
in accordance with this subsection if the services are provided
through any of the following entities:
(1) The Indian Health Service.
(2) An Indian health program operated by an Indian tribe
or tribal organization pursuant to a contract, grant, cooperative
agreement, or compact with the Indian Health Service pursuant to the Indian Self-Determination Act.
(3) An urban Indian health program operated by an urban
Indian organization pursuant to a grant or contract with the
Indian Health Service pursuant to title V of the Indian Health
Care Improvement Act.
(c) FUNDING.—
(1) TRANSFERRED FUNDS.—Notwithstanding section 2104(a)
of the Social Security Act, from the amounts appropriated in
such section for each of fiscal years 1998 through 2002,
$30,000,000, to remain available until expended, is hereby
transferred and made available in such fiscal year for grants
under this section.
(2) APPROPRIATIONS.—For the purpose of making grants
under this section, there is appropriated, out of any money in
the Treasury not otherwise appropriated—
1 Section 4923 of Public Law 105–33 (111 Stat. 574, as amended by section 1(c) of Public Law
107–360 (116 Stat. 3019),) requires the Secretary of Health and Human Services to conduct
evaluations regarding programs under sections 330B and 330C. An interim report is required
to be submitted to the appropriate committees of Congress not later than January 1, 2000, and
a final report is required to be submitted not later than January 1, 2007.

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(A) $70,000,000 for each of fiscal years 2001 and 2002
(which shall be combined with amounts transferred under
paragraph (1) for each such fiscal years);
(B) $100,000,000 for fiscal year 2003; and
(C) $150,000,000 for each of fiscal years 2004 through
2014.
SEC. 330D. ø254c–4¿ CENTERS FOR STRATEGIES ON FACILITATING UTILIZATION OF PREVENTIVE HEALTH SERVICES AMONG
VARIOUS POPULATIONS.
(a) IN GENERAL.—The Secretary, acting through the appro-

priate agencies of the Public Health Service, shall make grants to
public or nonprofit private entities for the establishment and operation of regional centers whose purpose is to develop, evaluate, and
disseminate effective strategies, which utilize quality management
measures, to assist public and private health care programs and
providers in the appropriate utilization of preventive health care
services by specific populations.
(b) RESEARCH AND TRAINING.—The activities carried out by a
center under subsection (a) may include establishing programs of
research and training with respect to the purpose described in such
subsection, including the development of curricula for training individuals in implementing the strategies developed under such subsection.
(c) PRIORITY REGARDING INFANTS AND CHILDREN.—In carrying
out the purpose described in subsection (a), the Secretary shall give
priority to various populations of infants, young children, and their
mothers.
(d) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of
carrying out this section, there are authorized to be appropriated
such sums as may be necessary for each of the fiscal years 2000
through 2004.
SEC. 330E. ø254c–5¿ EPILEPSY; SEIZURE DISORDER.
(a) NATIONAL PUBLIC HEALTH CAMPAIGN.—
(1) IN GENERAL.—The Secretary shall develop

and implement public health surveillance, education, research, and intervention strategies to improve the lives of persons with epilepsy,
with a particular emphasis on children. Such projects may be
carried out by the Secretary directly and through awards of
grants or contracts to public or nonprofit private entities. The
Secretary may directly or through such awards provide technical assistance with respect to the planning, development, and
operation of such projects.
(2) CERTAIN ACTIVITIES.—Activities under paragraph (1)
shall include—
(A) expanding current surveillance activities through
existing monitoring systems and improving registries that
maintain data on individuals with epilepsy, including children;
(B) enhancing research activities on the diagnosis,
treatment, and management of epilepsy;
(C) implementing public and professional information
and education programs regarding epilepsy, including initiatives which promote effective management of the dis-

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ease through children’s programs which are targeted to
parents, schools, daycare providers, patients;
(D) undertaking educational efforts with the media,
providers of health care, schools and others regarding stigmas and secondary disabilities related to epilepsy and seizures, and its effects on youth;
(E) utilizing and expanding partnerships with organizations with experience addressing the health and related
needs of people with disabilities; and
(F) other activities the Secretary deems appropriate.
(3) COORDINATION OF ACTIVITIES.—The Secretary shall ensure that activities under this subsection are coordinated as
appropriate with other agencies of the Public Health Service
that carry out activities regarding epilepsy and seizure.
(b) SEIZURE DISORDER; DEMONSTRATION PROJECTS IN MEDICALLY UNDERSERVED AREAS.—
(1) IN GENERAL.—The Secretary, acting through the Administrator of the Health Resources and Services Administration, may make grants for the purpose of carrying out demonstration projects to improve access to health and other services regarding seizures to encourage early detection and treatment in children and others residing in medically underserved
areas.
(2) APPLICATION FOR GRANT.—A grant may not be awarded
under paragraph (1) unless an application therefore is submitted to the Secretary and the Secretary approves such application. Such application shall be submitted in such form and
manner and shall contain such information as the Secretary
may prescribe.
(c) DEFINITIONS.—For purposes of this section:
(1) The term ‘‘epilepsy’’ refers to a chronic and serious neurological condition characterized by excessive electrical discharges in the brain causing recurring seizures affecting all life
activities. The Secretary may revise the definition of such term
to the extent the Secretary determines necessary.
(2) The term ‘‘medically underserved’’ has the meaning applicable under section 799B(6).
(d) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of
carrying out this section, there are authorized to be appropriated
such sums as may be necessary for each of the fiscal years 2001
through 2005.
SEC. 330F. ø254c–6¿ CERTAIN SERVICES FOR PREGNANT WOMEN.
(a) INFANT ADOPTION AWARENESS.—
(1) IN GENERAL.—The Secretary shall make grants to

national, regional, or local adoption organizations for the purpose
of developing and implementing programs to train the designated staff of eligible health centers in providing adoption information and referrals to pregnant women on an equal basis
with all other courses of action included in nondirective counseling to pregnant women.
(2) BEST-PRACTICES GUIDELINES.—
(A) IN GENERAL.—A condition for the receipt of a grant
under paragraph (1) is that the adoption organization in-

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volved agree that, in providing training under such paragraph, the organization will follow the guidelines developed under subparagraph (B).
(B) PROCESS FOR DEVELOPMENT OF GUIDELINES.—
(i) IN GENERAL.—The Secretary shall establish
and supervise a process described in clause (ii) in
which the participants are—
(I) an appropriate number and variety of
adoption organizations that, as a group, have expertise in all models of adoption practice and that
represent all members of the adoption triad (birth
mother, infant, and adoptive parent); and
(II) affected public health entities.
(ii) DESCRIPTION OF PROCESS.—The process referred to in clause (i) is a process in which the participants described in such clause collaborate to develop
best-practices guidelines on the provision of adoption
information and referrals to pregnant women on an
equal basis with all other courses of action included in
nondirective counseling to pregnant women.
(iii) DATE CERTAIN FOR DEVELOPMENT.—The Secretary shall ensure that the guidelines described in
clause (ii) are developed not later than 180 days after
the date of the enactment of the Children’s Health Act
of 2000 1.
(C) RELATION TO AUTHORITY FOR GRANTS.—The Secretary may not make any grant under paragraph (1) before
the date on which the guidelines under subparagraph (B)
are developed.
(3) USE OF GRANT.—
(A) IN GENERAL.—With respect to a grant under paragraph (1)—
(i) an adoption organization may expend the grant
to carry out the programs directly or through grants
to or contracts with other adoption organizations;
(ii) the purposes for which the adoption organization expends the grant may include the development
of a training curriculum, consistent with the guidelines developed under paragraph (2)(B); and
(iii) a condition for the receipt of the grant is that
the adoption organization agree that, in providing
training for the designated staff of eligible health centers, such organization will make reasonable efforts to
ensure that the individuals who provide the training
are individuals who are knowledgeable in all elements
of the adoption process and are experienced in providing adoption information and referrals in the geographic areas in which the eligible health centers are
located, and that the designated staff receive the
training in such areas.
(B) RULE OF CONSTRUCTION REGARDING TRAINING OF
TRAINERS.—With respect to individuals who under a grant
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under paragraph (1) provide training for the designated
staff of eligible health centers (referred to in this subparagraph as ‘‘trainers’’), subparagraph (A)(iii) may not be construed as establishing any limitation regarding the geographic area in which the trainers receive instruction in
being such trainers. A trainer may receive such instruction
in a different geographic area than the area in which the
trainer trains (or will train) the designated staff of eligible
health centers.
(4) ADOPTION ORGANIZATIONS; ELIGIBLE HEALTH CENTERS;
OTHER DEFINITIONS.—For purposes of this section:
(A) The term ‘‘adoption organization’’ means a national, regional, or local organization—
(i) among whose primary purposes are adoption;
(ii) that is knowledgeable in all elements of the
adoption process and on providing adoption information and referrals to pregnant women; and
(iii) that is a nonprofit private entity.
(B) The term ‘‘designated staff’’, with respect to an eligible health center, means staff of the center who provide
pregnancy or adoption information and referrals (or will
provide such information and referrals after receiving
training under a grant under paragraph (1)).
(C) The term ‘‘eligible health centers’’ means public
and nonprofit private entities that provide health services
to pregnant women.
(5) TRAINING FOR CERTAIN ELIGIBLE HEALTH CENTERS.—A
condition for the receipt of a grant under paragraph (1) is that
the adoption organization involved agree to make reasonable
efforts to ensure that the eligible health centers with respect
to which training under the grant is provided include—
(A) eligible health centers that receive grants under
section 1001 (relating to voluntary family planning
projects);
(B) eligible health centers that receive grants under
section 330 (relating to community health centers, migrant
health centers, and centers regarding homeless individuals
and residents of public housing); and
(C) eligible health centers that receive grants under
this Act for the provision of services in schools.
(6) PARTICIPATION OF CERTAIN ELIGIBLE HEALTH CLINICS.—
In the case of eligible health centers that receive grants under
section 330 or 1001:
(A) Within a reasonable period after the Secretary begins making grants under paragraph (1), the Secretary
shall provide eligible health centers with complete information about the training available from organizations receiving grants under such paragraph. The Secretary shall
make reasonable efforts to encourage eligible health centers to arrange for designated staff to participate in such
training. Such efforts shall affirm Federal requirements, if
any, that the eligible health center provide nondirective
counseling to pregnant women.
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(B) All costs of such centers in obtaining the training
shall be reimbursed by the organization that provides the
training, using grants under paragraph (1).
(C) Not later than 1 year after the date of the enactment of the Children’s Health Act of 2000 1, the Secretary
shall submit to the appropriate committees of the Congress
a report evaluating the extent to which adoption information and referral, upon request, are provided by eligible
health centers. Within a reasonable time after training
under this section is initiated, the Secretary shall submit
to the appropriate committees of the Congress a report
evaluating the extent to which adoption information and
referral, upon request, are provided by eligible health centers in order to determine the effectiveness of such training and the extent to which such training complies with
subsection (a)(1). In preparing the reports required by this
subparagraph, the Secretary shall in no respect interpret
the provisions of this section to allow any interference in
the provider-patient relationship, any breach of patient
confidentiality, or any monitoring or auditing of the counseling process or patient records which breaches patient
confidentiality or reveals patient identity. The reports required by this subparagraph shall be conducted by the Secretary acting through the Administrator of the Health Resources and Services Administration and in collaboration
with the Director of the Agency for Healthcare Research
and Quality.
(b) APPLICATION FOR GRANT.—The Secretary may make a grant
under subsection (a) only if an application for the grant is submitted to the Secretary and the application is in such form, is
made in such manner, and contains such agreements, assurances,
and information as the Secretary determines to be necessary to
carry out this section.
(c) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of
carrying out this section, there are authorized to be appropriated
such sums as may be necessary for each of the fiscal years 2001
through 2005.
SEC. 330G. ø254c–7¿ SPECIAL NEEDS ADOPTION PROGRAMS; PUBLIC
AWARENESS CAMPAIGN AND OTHER ACTIVITIES.
(a) SPECIAL NEEDS ADOPTION AWARENESS CAMPAIGN.—
(1) IN GENERAL.—The Secretary shall, through making

grants to nonprofit private entities, provide for the planning,
development, and carrying out of a national campaign to provide information to the public regarding the adoption of children with special needs.
(2) INPUT ON PLANNING AND DEVELOPMENT.—In providing
for the planning and development of the national campaign
under paragraph (1), the Secretary shall provide for input from
a number and variety of adoption organizations throughout the
States in order that the full national diversity of interests
among adoption organizations is represented in the planning
and development of the campaign.
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(3) CERTAIN FEATURES.—With respect to the national campaign under paragraph (1):
(A) The campaign shall be directed at various populations, taking into account as appropriate differences
among geographic regions, and shall be carried out in the
language and cultural context that is most appropriate to
the population involved.
(B) The means through which the campaign may be
carried out include—
(i) placing public service announcements on television, radio, and billboards; and
(ii) providing information through means that the
Secretary determines will reach individuals who are
most likely to adopt children with special needs.
(C) The campaign shall provide information on the
subsidies and supports that are available to individuals regarding the adoption of children with special needs.
(D) The Secretary may provide that the placement of
public service announcements, and the dissemination of
brochures and other materials, is subject to review by the
Secretary.
(4) MATCHING REQUIREMENT.—
(A) IN GENERAL.—With respect to the costs of the activities to be carried out by an entity pursuant to paragraph (1), a condition for the receipt of a grant under such
paragraph is that the entity agree to make available (directly or through donations from public or private entities)
non-Federal contributions toward such costs in an amount
that is not less than 25 percent of such costs.
(B) DETERMINATION OF AMOUNT CONTRIBUTED.—NonFederal contributions under subparagraph (A) may be in
cash or in kind, fairly evaluated, including plant, equipment, or services. Amounts provided by the Federal Government, or services assisted or subsidized to any significant extent by the Federal Government, may not be included in determining the amount of such contributions.
(b) NATIONAL RESOURCES PROGRAM.—The Secretary shall (directly or through grant or contract) carry out a program that,
through toll-free telecommunications, makes available to the public
information regarding the adoption of children with special needs.
Such information shall include the following:
(1) A list of national, State, and regional organizations
that provide services regarding such adoptions, including exchanges and other information on communicating with the organizations. The list shall represent the full national diversity
of adoption organizations.
(2) Information beneficial to individuals who adopt such
children, including lists of support groups for adoptive parents
and other postadoptive services.
(c) OTHER PROGRAMS.—With respect to the adoption of children
with special needs, the Secretary shall make grants—
(1) to provide assistance to support groups for adoptive
parents, adopted children, and siblings of adopted children;
and
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(2) to carry out studies to identify—
(A) the barriers to completion of the adoption process;
and
(B) those components that lead to favorable long-term
outcomes for families that adopt children with special
needs.
(d) APPLICATION FOR GRANT.—The Secretary may make an
award of a grant or contract under this section only if an application for the award is submitted to the Secretary and the application is in such form, is made in such manner, and contains such
agreements, assurances, and information as the Secretary determines to be necessary to carry out this section.
(e) FUNDING.—For the purpose of carrying out this section,
there are authorized to be appropriated such sums as may be necessary for each of the fiscal years 2001 through 2005.
SEC. 330H. ø254c–8¿ HEALTHY START FOR INFANTS.
(a) IN GENERAL.—
(1) CONTINUATION AND EXPANSION OF PROGRAM.—The

Secretary, acting through the Administrator of the Health Resources and Services Administration, Maternal and Child
Health Bureau, shall under authority of this section continue
in effect the Healthy Start Initiative and may, during fiscal
year 2001 and subsequent years, carry out such program on a
national basis.
(2) DEFINITION.—For purposes of paragraph (1), the term
‘‘Healthy Start Initiative’’ is a reference to the program that,
as an initiative to reduce the rate of infant mortality and improve perinatal outcomes, makes grants for project areas with
high annual rates of infant mortality and that, prior to the effective date of this section, was a demonstration program carried out under section 301.
(b) CONSIDERATIONS IN MAKING GRANTS.—
(1) REQUIREMENTS.—In making grants under subsection
(a), the Secretary shall require that applicants (in addition to
meeting all eligibility criteria established by the Secretary) establish, for project areas under such subsection, communitybased consortia of individuals and organizations (including
agencies responsible for administering block grant programs
under title V of the Social Security Act, consumers of project
services, public health departments, hospitals, health centers
under section 330, and other significant sources of health care
services) that are appropriate for participation in projects
under subsection (a).
(2) OTHER CONSIDERATIONS.—In making grants under subsection (a), the Secretary shall take into consideration the following:
(A) Factors that contribute to infant mortality, such as
low birthweight.
(B) The extent to which applicants for such grants facilitate—
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(ii) a comprehensive approach to women’s health
care to improve perinatal outcomes.
(3) SPECIAL PROJECTS.—Nothing in paragraph (2) shall be
construed to prevent the Secretary from awarding grants
under subsection (a) for special projects that are intended to
address significant disparities in perinatal health indicators in
communities along the United States-Mexico border or in Alaska or Hawaii.
(c) COORDINATION.—Recipients of grants under subsection (a)
shall coordinate their services and activities with the State agency
or agencies that administer block grant programs under title V of
the Social Security Act in order to promote cooperation, integration,
and dissemination of information with Statewide systems and with
other community services funded under the Maternal and Child
Health Block Grant.
(d) RULE OF CONSTRUCTION.—Except to the extent inconsistent
with this section, this section may not be construed as affecting the
authority of the Secretary to make modifications in the program
carried out under subsection (a).
(e) FUNDING.—
(1) AUTHORIZATION OF APPROPRIATIONS.—For the purpose
of carrying out this section, there are authorized to be appropriated—
(A) $120,000,000 for fiscal year 2008; and
(B) for each of fiscal years 2009 through 2013, the
amount authorized for the preceding fiscal year increased
by the percentage increase in the Consumer Price Index
for all urban consumers for such year.
(2) ALLOCATION.—
(A) PROGRAM ADMINISTRATION.—Of the amounts appropriated under paragraph (1) for a fiscal year, the Secretary may reserve up to 5 percent for coordination, dissemination, technical assistance, and data activities that
are determined by the Secretary to be appropriate for carrying out the program under this section.
(B) EVALUATION.—Of the amounts appropriated under
paragraph (1) for a fiscal year, the Secretary may reserve
up to 1 percent for evaluations of projects carried out
under subsection (a). Each such evaluation shall include a
determination of whether such projects have been effective
in reducing the disparity in health status between the general population and individuals who are members of racial
or ethnic minority groups.
SEC. 330I. ø254c–14¿ TELEHEALTH NETWORK AND TELEHEALTH RESOURCE CENTERS GRANT PROGRAMS.
(a) DEFINITIONS.—In this section:
(1) DIRECTOR; OFFICE.—The terms ‘‘Director’’ and ‘‘Office’’

mean the Director and Office specified in subsection (c).
(2) FEDERALLY QUALIFIED HEALTH CENTER AND RURAL
HEALTH CLINIC.—The term ‘‘Federally qualified health center’’
and ‘‘rural health clinic’’ have the meanings given the terms in
section 1861(aa) of the Social Security Act (42 U.S.C.
1395x(aa)).
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(3) FRONTIER COMMUNITY.—The term ‘‘frontier community’’
shall have the meaning given the term in regulations issued
under subsection (r).
(4) MEDICALLY UNDERSERVED AREA.—The term ‘‘medically
underserved area’’ has the meaning given the term ‘‘medically
underserved community’’ in section 799B(6).
(5) MEDICALLY UNDERSERVED POPULATION.—The term
‘‘medically underserved population’’ has the meaning given the
term in section 330(b)(3).
(6) TELEHEALTH SERVICES.—The term ‘‘telehealth services’’
means services provided through telehealth technologies.
(7) TELEHEALTH TECHNOLOGIES.—The term ‘‘telehealth
technologies’’ means technologies relating to the use of electronic information, and telecommunications technologies, to
support and promote, at a distance, health care, patient and
professional health-related education, health administration,
and public health.
(b) PROGRAMS.—The Secretary shall establish, under section
301, telehealth network and telehealth resource centers grant programs.
(c) ADMINISTRATION.—
(1) ESTABLISHMENT.—There is established in the Health
Resources and Services Administration an Office for the Advancement of Telehealth. The Office shall be headed by a Director.
(2) DUTIES.—The telehealth network and telehealth resource centers grant programs established under section 301
shall be administered by the Director, in consultation with the
State offices of rural health, State offices concerning primary
care, or other appropriate State government entities.
(d) GRANTS.—
(1) TELEHEALTH NETWORK GRANTS.—The Director may, in
carrying out the telehealth network grant program referred to
in subsection (b), award grants to eligible entities for projects
to demonstrate how telehealth technologies can be used
through telehealth networks in rural areas, frontier communities, and medically underserved areas, and for medically underserved populations, to—
(A) expand access to, coordinate, and improve the
quality of health care services;
(B) improve and expand the training of health care
providers; and
(C) expand and improve the quality of health information available to health care providers, and patients and
their families, for decisionmaking.
(2) TELEHEALTH RESOURCE CENTERS GRANTS.—The Director
may, in carrying out the telehealth resource centers grant program referred to in subsection (b), award grants to eligible entities for projects to demonstrate how telehealth technologies
can be used in the areas and communities, and for the populations, described in paragraph (1), to establish telehealth resource centers.
(e) GRANT PERIODS.—The Director may award grants under
this section for periods of not more than 4 years.
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(f) ELIGIBLE ENTITIES.—
(1) TELEHEALTH NETWORK GRANTS.—
(A) GRANT RECIPIENT.—To be eligible to receive a
grant under subsection (d)(1), an entity shall be a nonprofit entity.
(B) TELEHEALTH NETWORKS.—
(i) IN GENERAL.—To be eligible to receive a grant
under subsection (d)(1), an entity shall demonstrate
that the entity will provide services through a telehealth network.
(ii) NATURE OF ENTITIES.—Each entity participating in the telehealth network may be a nonprofit or
for-profit entity.
(iii) COMPOSITION OF NETWORK.—The telehealth
network shall include at least 2 of the following entities (at least 1 of which shall be a community-based
health care provider):
(I) Community or migrant health centers or
other Federally qualified health centers.
(II) Health care providers, including pharmacists, in private practice.
(III) Entities operating clinics, including rural
health clinics.
(IV) Local health departments.
(V) Nonprofit hospitals, including community
access hospitals.
(VI) Other publicly funded health or social
service agencies.
(VII) Long-term care providers.
(VIII) Providers of health care services in the
home.
(IX) Providers of outpatient mental health
services and entities operating outpatient mental
health facilities.
(X) Local or regional emergency health care
providers.
(XI) Institutions of higher education.
(XII) Entities operating dental clinics.
(2) TELEHEALTH RESOURCE CENTERS GRANTS.—To be eligible to receive a grant under subsection (d)(2), an entity shall
be a nonprofit entity.
(g) APPLICATIONS.—To be eligible to receive a grant under subsection (d), an eligible entity, in consultation with the appropriate
State office of rural health or another appropriate State entity,
shall prepare and submit to the Secretary an application, at such
time, in such manner, and containing such information as the Secretary may require, including—
(1) a description of the project that the eligible entity will
carry out using the funds provided under the grant;
(2) a description of the manner in which the project funded
under the grant will meet the health care needs of rural or
other populations to be served through the project, or improve
the access to services of, and the quality of the services received by, those populations;
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(3) evidence of local support for the project, and a description of how the areas, communities, or populations to be served
will be involved in the development and ongoing operations of
the project;
(4) a plan for sustaining the project after Federal support
for the project has ended;
(5) information on the source and amount of non-Federal
funds that the entity will provide for the project;
(6) information demonstrating the long-term viability of
the project, and other evidence of institutional commitment of
the entity to the project;
(7) in the case of an application for a project involving a
telehealth network, information demonstrating how the project
will promote the integration of telehealth technologies into the
operations of health care providers, to avoid redundancy, and
improve access to and the quality of care; and
(8) other such information as the Secretary determines to
be appropriate.
(h) TERMS; CONDITIONS; MAXIMUM AMOUNT OF ASSISTANCE.—
The Secretary shall establish the terms and conditions of each
grant program described in subsection (b) and the maximum
amount of a grant to be awarded to an individual recipient for each
fiscal year under this section. The Secretary shall publish, in a
publication of the Health Resources and Services Administration,
notice of the application requirements for each grant program described in subsection (b) for each fiscal year.
(i) PREFERENCES.—
(1) TELEHEALTH NETWORKS.—In awarding grants under
subsection (d)(1) for projects involving telehealth networks, the
Secretary shall give preference to an eligible entity that meets
at least 1 of the following requirements:
(A) ORGANIZATION.—The eligible entity is a rural community-based organization or another community-based organization.
(B) SERVICES.—The eligible entity proposes to use Federal funds made available through such a grant to develop
plans for, or to establish, telehealth networks that provide
mental health, public health, long-term care, home care,
preventive, or case management services.
(C) COORDINATION.—The eligible entity demonstrates
how the project to be carried out under the grant will be
coordinated with other relevant federally funded projects
in the areas, communities, and populations to be served
through the grant.
(D) NETWORK.—The eligible entity demonstrates that
the project involves a telehealth network that includes an
entity that—
(i) provides clinical health care services, or educational services for health care providers and for patients or their families; and
(ii) is—
(I) a public library;
(II) an institution of higher education; or
(III) a local government entity.
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(E) CONNECTIVITY.—The eligible entity proposes a
project that promotes local connectivity within areas, communities, or populations to be served through the project.
(F) INTEGRATION.—The eligible entity demonstrates
that health care information has been integrated into the
project.
(2) TELEHEALTH RESOURCE CENTERS.—In awarding grants
under subsection (d)(2) for projects involving telehealth resource centers, the Secretary shall give preference to an eligible entity that meets at least 1 of the following requirements:
(A) PROVISION OF SERVICES.—The eligible entity has a
record of success in the provision of telehealth services to
medically underserved areas or medically underserved
populations.
(B) COLLABORATION AND SHARING OF EXPERTISE.—The
eligible entity has a demonstrated record of collaborating
and sharing expertise with providers of telehealth services
at the national, regional, State, and local levels.
(C) BROAD RANGE OF TELEHEALTH SERVICES.—The eligible entity has a record of providing a broad range of telehealth services, which may include—
(i) a variety of clinical specialty services;
(ii) patient or family education;
(iii) health care professional education; and
(iv) rural residency support programs.
(j) DISTRIBUTION OF FUNDS.—
(1) IN GENERAL.—In awarding grants under this section,
the Director shall ensure, to the greatest extent possible, that
such grants are equitably distributed among the geographical
regions of the United States.
(2) TELEHEALTH NETWORKS.—In awarding grants under
subsection (d)(1) for a fiscal year, the Director shall ensure
that—
(A) not less than 50 percent of the funds awarded
shall be awarded for projects in rural areas; and
(B) the total amount of funds awarded for such
projects for that fiscal year shall be not less than the total
amount of funds awarded for such projects for fiscal year
2001 under section 330A (as in effect on the day before the
date of enactment of the Health Care Safety Net Amendments of 2002).
(k) USE OF FUNDS.—
(1) TELEHEALTH NETWORK PROGRAM.—The recipient of a
grant under subsection (d)(1) may use funds received through
such grant for salaries, equipment, and operating or other
costs, including the cost of—
(A) developing and delivering clinical telehealth services that enhance access to community-based health care
services in rural areas, frontier communities, or medically
underserved areas, or for medically underserved populations;
(B) developing and acquiring, through lease or purchase, computer hardware and software, audio and video
equipment, computer network equipment, interactive
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equipment, data terminal equipment, and other equipment
that furthers the objectives of the telehealth network grant
program;
(C)(i) developing and providing distance education, in
a manner that enhances access to care in rural areas, frontier communities, or medically underserved areas, or for
medically underserved populations; or
(ii) mentoring, precepting, or supervising health care
providers and students seeking to become health care providers, in a manner that enhances access to care in the
areas and communities, or for the populations, described
in clause (i);
(D) developing and acquiring instructional programming;
(E)(i) providing for transmission of medical data, and
maintenance of equipment; and
(ii) providing for compensation (including travel expenses) of specialists, and referring health care providers,
who are providing telehealth services through the telehealth network, if no third party payment is available for
the telehealth services delivered through the telehealth
network;
(F) developing projects to use telehealth technology to
facilitate collaboration between health care providers;
(G) collecting and analyzing usage statistics and data
to document the cost-effectiveness of the telehealth services; and
(H) carrying out such other activities as are consistent
with achieving the objectives of this section, as determined
by the Secretary.
(2) TELEHEALTH RESOURCE CENTERS.—The recipient of a
grant under subsection (d)(2) may use funds received through
such grant for salaries, equipment, and operating or other
costs for—
(A) providing technical assistance, training, and support, and providing for travel expenses, for health care providers and a range of health care entities that provide or
will provide telehealth services;
(B) disseminating information and research findings
related to telehealth services;
(C) promoting effective collaboration among telehealth
resource centers and the Office;
(D) conducting evaluations to determine the best utilization of telehealth technologies to meet health care needs;
(E) promoting the integration of the technologies used
in clinical information systems with other telehealth technologies;
(F) fostering the use of telehealth technologies to provide health care information and education for health care
providers and consumers in a more effective manner; and
(G) implementing special projects or studies under the
direction of the Office.
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(l) PROHIBITED USES OF FUNDS.—An entity that receives a
grant under this section may not use funds made available through
the grant—
(1) to acquire real property;
(2) for expenditures to purchase or lease equipment, to the
extent that the expenditures would exceed 40 percent of the
total grant funds;
(3) in the case of a project involving a telehealth network,
to purchase or install transmission equipment (such as laying
cable or telephone lines, or purchasing or installing microwave
towers, satellite dishes, amplifiers, or digital switching equipment);
(4) to pay for any equipment or transmission costs not directly related to the purposes for which the grant is awarded;
(5) to purchase or install general purpose voice telephone
systems;
(6) for construction; or
(7) for expenditures for indirect costs (as determined by
the Secretary), to the extent that the expenditures would exceed 15 percent of the total grant funds.
(m) COLLABORATION.—In providing services under this section,
an eligible entity shall collaborate, if feasible, with entities that—
(1)(A) are private or public organizations, that receive Federal or State assistance; or
(B) are public or private entities that operate centers, or
carry out programs, that receive Federal or State assistance;
and
(2) provide telehealth services or related activities.
(n) COORDINATION WITH OTHER AGENCIES.—The Secretary
shall coordinate activities carried out under grant programs described in subsection (b), to the extent practicable, with Federal
and State agencies and nonprofit organizations that are operating
similar programs, to maximize the effect of public dollars in funding meritorious proposals.
(o) OUTREACH ACTIVITIES.—The Secretary shall establish and
implement procedures to carry out outreach activities to advise potential end users of telehealth services in rural areas, frontier communities, medically underserved areas, and medically underserved
populations in each State about the grant programs described in
subsection (b).
(p) TELEHEALTH.—It is the sense of Congress that, for purposes
of this section, States should develop reciprocity agreements so that
a provider of services under this section who is a licensed or otherwise authorized health care provider under the law of 1 or more
States, and who, through telehealth technology, consults with a licensed or otherwise authorized health care provider in another
State, is exempt, with respect to such consultation, from any State
law of the other State that prohibits such consultation on the basis
that the first health care provider is not a licensed or authorized
health care provider under the law of that State.
(q) REPORT.—Not later than September 30, 2005, the Secretary
shall prepare and submit to the appropriate committees of Congress a report on the progress and accomplishments of the grant
programs described in subsection (b).
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(r) REGULATIONS.—The Secretary shall issue regulations specifying, for purposes of this section, a definition of the term ‘‘frontier
area’’. The definition shall be based on factors that include population density, travel distance in miles to the nearest medical facility, travel time in minutes to the nearest medical facility, and such
other factors as the Secretary determines to be appropriate. The
Secretary shall develop the definition in consultation with the Director of the Bureau of the Census and the Administrator of the
Economic Research Service of the Department of Agriculture.
(s) AUTHORIZATION OF APPROPRIATIONS.—There are authorized
to be appropriated to carry out this section—
(1) for grants under subsection (d)(1), $40,000,000 for fiscal
year 2002, and such sums as may be necessary for each of fiscal years 2003 through 2006; and
(2) for grants under subsection (d)(2), $20,000,000 for fiscal
year 2002, and such sums as may be necessary for each of fiscal years 2003 through 2006.
SEC. 330J. ø254c–15¿ RURAL EMERGENCY MEDICAL SERVICE TRAINING AND EQUIPMENT ASSISTANCE PROGRAM.
(a) GRANTS.—The Secretary, acting through the Administrator

of the Health Resources and Services Administration (referred to in
this section as the ‘‘Secretary’’) shall award grants to eligible entities to enable such entities to provide for improved emergency medical services in rural areas.
(b) ELIGIBILITY.—To be eligible to receive a grant under this
section, an entity shall—
(1) be—
(A) a State emergency medical services office;
(B) a State emergency medical services association;
(C) a State office of rural health;
(D) a local government entity;
(E) a State or local ambulance provider; or
(F) any other entity determined appropriate by the
Secretary; and
(2) prepare and submit to the Secretary an application at
such time, in such manner, and containing such information as
the Secretary may require, that includes—
(A) a description of the activities to be carried out
under the grant; and
(B) an assurance that the eligible entity will comply
with the matching requirement of subsection (e).
(c) USE OF FUNDS.—An entity shall use amounts received
under a grant made under subsection (a), either directly or through
grants to emergency medical service squads that are located in, or
that serve residents of, a nonmetropolitan statistical area, an area
designated as a rural area by any law or regulation of a State, or
a rural census tract of a metropolitan statistical area (as determined under the most recent Goldsmith Modification, originally
published in a notice of availability of funds in the Federal Register
on February 27, 1992, 57 Fed. Reg. 6725), to—
(1) recruit emergency medical service personnel;
(2) recruit volunteer emergency medical service personnel;
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(3) train emergency medical service personnel in emergency response, injury prevention, safety awareness, and other
topics relevant to the delivery of emergency medical services;
(4) fund specific training to meet Federal or State certification requirements;
(5) develop new ways to educate emergency health care
providers through the use of technology-enhanced educational
methods (such as distance learning);
(6) acquire emergency medical services equipment, including cardiac defibrillators;
(7) acquire personal protective equipment for emergency
medical services personnel as required by the Occupational
Safety and Health Administration; and
(8) educate the public concerning cardiopulmonary resuscitation, first aid, injury prevention, safety awareness, illness
prevention, and other related emergency preparedness topics.
(d) PREFERENCE.—In awarding grants under this section the
Secretary shall give preference to—
(1) applications that reflect a collaborative effort by 2 or
more of the entities described in subparagraphs (A) through (F)
of subsection (b)(1); and
(2) applications submitted by entities that intend to use
amounts provided under the grant to fund activities described
in any of paragraphs (1) through (5) of subsection (c).
(e) MATCHING REQUIREMENT.—The Secretary may not award a
grant under this section to an entity unless the entity agrees that
the entity will make available (directly or through contributions
from other public or private entities) non-Federal contributions toward the activities to be carried out under the grant in an amount
equal to 25 percent of the amount received under the grant.
(f) EMERGENCY MEDICAL SERVICES.—In this section, the term
‘‘emergency medical services’’—
(1) means resources used by a qualified public or private
nonprofit entity, or by any other entity recognized as qualified
by the State involved, to deliver medical care outside of a medical facility under emergency conditions that occur—
(A) as a result of the condition of the patient; or
(B) as a result of a natural disaster or similar situation; and
(2) includes services delivered by an emergency medical
services provider (either compensated or volunteer) or other
provider recognized by the State involved that is licensed or
certified by the State as an emergency medical technician or
its equivalent (as determined by the State), a registered nurse,
a physician assistant, or a physician that provides services
similar to services provided by such an emergency medical
services provider.
(g) AUTHORIZATION OF APPROPRIATIONS.—
(1) IN GENERAL.—There are authorized to be appropriated
to carry out this section such sums as may be necessary for
each of fiscal years 2002 through 2006.
(2) ADMINISTRATIVE COSTS.—The Secretary may use not
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graph (1) for a fiscal year for the administrative expenses of
carrying out this section.
SEC. 330K. ø254c–16¿ MENTAL HEALTH SERVICES DELIVERED VIA
TELEHEALTH.
(a) DEFINITIONS.—In this section:
(1) ELIGIBLE ENTITY.—The term ‘‘eligible entity’’ means a

public or nonprofit private telehealth provider network that offers services that include mental health services provided by
qualified mental health providers.
(2) QUALIFIED MENTAL HEALTH PROFESSIONALS.—The term
‘‘qualified mental health professionals’’ refers to providers of
mental health services reimbursed under the medicare program carried out under title XVIII of the Social Security Act
(42 U.S.C. 1395 et seq.) who have additional training in the
treatment of mental illness in children and adolescents or who
have additional training in the treatment of mental illness in
the elderly.
(3) SPECIAL POPULATIONS.—The term ‘‘special populations’’
refers to the following 2 distinct groups:
(A) Children and adolescents in mental health underserved rural areas or in mental health underserved urban
areas.
(B) Elderly individuals located in long-term care facilities in mental health underserved rural or urban areas.
(4) TELEHEALTH.—The term ‘‘telehealth’’ means the use of
electronic information and telecommunications technologies to
support long distance clinical health care, patient and professional health-related education, public health, and health administration.
(b) PROGRAM AUTHORIZED.—
(1) IN GENERAL.—The Secretary, acting through the Director of the Office for the Advancement of Telehealth of the
Health Resources and Services Administration, shall award
grants to eligible entities to establish demonstration projects
for the provision of mental health services to special populations as delivered remotely by qualified mental health professionals using telehealth and for the provision of education regarding mental illness as delivered remotely by qualified mental health professionals using telehealth.
(2) POPULATIONS SERVED.—The Secretary shall award the
grants under paragraph (1) in a manner that distributes the
grants so as to serve equitably the populations described in
subparagraphs (A) and (B) of subsection (a)(3).
(c) USE OF FUNDS.—
(1) IN GENERAL.—An eligible entity that receives a grant
under this section shall use the grant funds—
(A) for the populations described in subsection
(a)(3)(A)—
(i) to provide mental health services, including diagnosis and treatment of mental illness, as delivered
remotely by qualified mental health professionals
using telehealth; and
(ii) to collaborate with local public health entities
to provide the mental health services; and
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(B) for the populations described in subsection
(a)(3)(B)—
(i) to provide mental health services, including diagnosis and treatment of mental illness, in long-term
care facilities as delivered remotely by qualified mental health professionals using telehealth; and
(ii) to collaborate with local public health entities
to provide the mental health services.
(2) OTHER USES.—An eligible entity that receives a grant
under this section may also use the grant funds to—
(A) pay telecommunications costs; and
(B) pay qualified mental health professionals on a reasonable cost basis as determined by the Secretary for services rendered.
(3) PROHIBITED USES.—An eligible entity that receives a
grant under this section shall not use the grant funds to—
(A) purchase or install transmission equipment (other
than such equipment used by qualified mental health professionals to deliver mental health services using telehealth under the project involved); or
(B) build upon or acquire real property.
(d) EQUITABLE DISTRIBUTION.—In awarding grants under this
section, the Secretary shall ensure, to the greatest extent possible,
that such grants are equitably distributed among geographical regions of the United States.
(e) APPLICATION.—An entity that desires 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
determines to be reasonable.
(f) REPORT.—Not later than 4 years after the date of enactment
of the Health Care Safety Net Amendments of 2002, the Secretary
shall prepare and submit to the appropriate committees of Congress a report that shall evaluate activities funded with grants
under this section.
(g) AUTHORIZATION OF APPROPRIATIONS.—There are authorized
to be appropriated to carry out this section, $20,000,000 for fiscal
year 2002 and such sums as may be necessary for fiscal years 2003
through 2006.
SEC. 330L. ø254c–18¿ TELEMEDICINE; INCENTIVE GRANTS REGARDING
COORDINATION AMONG STATES.
(a) IN GENERAL.—The Secretary may make grants to State pro-

fessional licensing boards to carry out programs under which such
licensing boards of various States cooperate to develop and implement State policies that will reduce statutory and regulatory barriers to telemedicine.
(b) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of
carrying out subsection (a), there are authorized to be appropriated
such sums as may be necessary for each of the fiscal years 2002
through 2006.

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Subpart II—National Health Service Corps Program
NATIONAL HEALTH SERVICE CORPS

SEC. 331. ø254d¿ (a)(1) For the purpose of eliminating health
manpower 1 shortages in health professional shortage areas, there
is established, within the Service, the National Health Service
Corps, which shall consist of—
(A) such officers of the Regular and Reserve Corps of the
Service as the Secretary may designate,
(B) such civilian employees of the United States as the
Secretary may appoint, and
(C) such other individuals who are not employees of the
United States.
(2) The Corps shall be utilized by the Secretary to provide primary health services in health professional shortage areas.
(3) For purposes of this subpart and subpart III:
(A) The term ‘‘Corps’’ means the National Health Service
Corps.
(B) The term ‘‘Corps member’’ means each of the officers,
employees, and individuals of which the Corps consists pursuant to paragraph (1).
(C) The term ‘‘health professional shortage area’’ has the
meaning given such term in section 332(a).
(D) The term ‘‘primary health services’’ means health services regarding family medicine, internal medicine, pediatrics,
obstetrics and gynecology, dentistry, or mental health, that are
provided by physicians or other health professionals.
(E)(i) The term ‘‘behavioral and mental health professionals’’ means health service psychologists, licensed clinical
social workers, licensed professional counselors, marriage and
family therapists, psychiatric nurse specialists, and psychiatrists.
(ii) The term ‘‘graduate program of behavioral and mental
health’’ means a program that trains behavioral and mental
health professionals.
(b)(1) The Secretary may conduct at schools of medicine, osteopathic medicine, dentistry, and, as appropriate, nursing and other
schools of the health professions, including schools at which graduate programs of behavioral and mental health are offered, and at
entities which train allied health personnel, recruiting programs
for the Corps, the Scholarship Program, and the Loan Repayment
Program. Such recruiting programs shall include efforts to recruit
individuals who will serve in the Corps other than pursuant to obligated service under the Scholarship or Loan Repayment Program.
(2) In the case of physicians, dentists, behavioral and mental
health professionals, certified nurse midwives, certified nurse practitioners, and physician assistants who have an interest and a commitment to providing primary health care, the Secretary may establish fellowship programs to enable such health professionals to
gain exposure to and expertise in the delivery of primary health
services in health professional shortage areas. To the maximum ex1 So in law. Probably should be ‘‘health professional shortages’’. See section 401 of Public Law
101–597 (104 Stat. 3035).

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tent practicable, the Secretary shall ensure that any such programs
are established in conjunction with accredited residency programs,
and other training programs, regarding such health professions.
(c)(1) The Secretary may reimburse an applicant for a position
in the Corps (including an individual considering entering into a
written agreement pursuant to section 338D) for the actual and
reasonable expenses incurred in traveling to and from the applicant’s place of residence to an eligible site to which the applicant
may be assigned under section 333 for the purpose of evaluating
such site with regard to being assigned at such site. The Secretary
may establish a maximum total amount that may be paid to an individual as reimbursement for such expenses.
(2) The Secretary may also reimburse the applicant for the actual and reasonable expenses incurred for the travel of 1 family
member to accompany the applicant to such site. The Secretary
may establish a maximum total amount that may be paid to an individual as reimbursement for such expenses.
(3) In the case of an individual who has entered into a contract
for obligated service under the Scholarship Program or under the
Loan Repayment Program, the Secretary may reimburse such individual for all or part of the actual and reasonable expenses incurred in transporting the individual, the individual’s family, and
the family’s possessions to the site of the individual’s assignment
under section 333. The Secretary may establish a maximum total
amount that may be paid to an individual as reimbursement for
such expenses.
(d)(1) The Secretary may, under regulations promulgated by
the Secretary, adjust the monthly pay of each member of the Corps
(other than a member described in subsection (a)(1)(C)) who is directly engaged in the delivery of health services in a health professional shortage area as follows:
(A) During the first 36 months in which such a member is
so engaged in the delivery of health services, his monthly pay
may be increased by an amount which when added to the
member’s monthly pay and allowances will provide a monthly
income competitive with the average monthly income from a
practice of an individual who is a member of the profession of
the Corps member, who has equivalent training, and who has
been in practice for a period equivalent to the period during
which the Corps member has been in practice.
(B) During the period beginning upon the expiration of the
36 months referred to in subparagraph (A) and ending with the
month in which the member’s monthly pay and allowances are
equal to or exceed the monthly income he received for the last
of such 36 months, the member may receive in addition to his
monthly pay and allowances an amount which when added to
such monthly pay and allowances equals the monthly income
he received for such last month.
(C) For each month in which a member is directly engaged
in the delivery of health services in a health professional shortage area in accordance with an agreement with the Secretary
entered into under section 741(f)(1)(C), under which the Secretary is obligated to make payments in accordance with section 741(f)(2), the amount of any monthly increase under subMarch 13, 2013

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paragraph (A) or (B) with respect to such member shall be decreased by an amount equal to one-twelfth of the amount
which the Secretary is obligated to pay upon the completion of
the year of practice in which such month occurs.
For purposes of subparagraphs (A) and (B), the term ‘‘monthly pay’’
includes special pay received under chapter 5 of title 37 of the
United States Code.
(2) In the case of a member of the Corps who is directly engaged in the delivery of health services in a health professional
shortage area in accordance with a service obligation incurred
under the Scholarship Program or the Loan Repayment Program,
the adjustment in pay authorized by paragraph (1) may be made
for such a member only upon satisfactory completion of such service obligation, and the first 36 months of such member’s being so
engaged in the delivery of health services shall, for purposes of
paragraph (1)(A), be deemed to begin upon such satisfactory completion.
(3) A member of the Corps described in subparagraph (C) of
subsection (a)(1) shall when assigned to an entity under section 333
be subject to the personnel system of such entity, except that such
member shall receive during the period of assignment the income
that the member would receive if the member was a member of the
Corps described in subparagraph (B) of such subsection.
(e) Corps members assigned under section 333 to provide
health services in health professional shortage areas shall not be
counted against any employment ceiling affecting the Department.
(f) Sections 214 and 216 shall not apply to members of the National Health Service Corps during their period of obligated service
under the Scholarship Program or the Loan Repayment Program,
except when such members are Commissioned Corps officers who
entered into a contract with Secretary under section 338A or 338B
after December 31, 2006 and when the Secretary determines that
exercising the authority provided under section 214 or 216 with respect to any such officer to would not cause unreasonable disruption to health care services provided in the community in which
such officer is providing health care services.
(g)(1) The Secretary shall, by rule, prescribe conversion provisions applicable to any individual who, within a year after completion of service as a member of the Corps described in subsection
(a)(1)(C), becomes a commissioned officer in the Regular or Reserve
Corps of the Service.
(2) The rules prescribed under paragraph (1) shall provide that
in applying the appropriate provisions of this Act which relate to
retirement, any individual who becomes such an officer shall be entitled to have credit for any period of service as a member of the
Corps described in subsection (a)(1)(C).
(h) The Secretary shall ensure that adequate staff is provided
to the Service with respect to effectively administering the program
for the Corps.
(i)(1) 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
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uals are authorized to satisfy the requirement of obligated service
through providing clinical practice that is half time.
(2) A waiver described in paragraph (1) may be provided by the
Secretary only if—
(A) the entity for which the service is to be performed—
(i) has been approved under section 333A for assignment of a Corps member; and
(ii) has requested in writing assignment of a health
professional who would serve half time;
(B) the Secretary has determined that assignment of a
health professional who would serve half time would be appropriate for the area where the entity is located;
(C) a Corps member who is required to perform obligated
service has agreed in writing to be assigned for half-time service to an entity described in subparagraph (A);
(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
(F) the Corps member agrees in writing that if the Corps
member begins providing half-time service but fails to begin or
complete the period of obligated service, the method stated in
338E(c) for determining the damages for breach of the individual’s written contract will be used after converting periods of
obligated service or of service performed into their full-time
equivalents.
(3) In evaluating waivers issued under paragraph (1), the Secretary shall examine the effect of multidisciplinary teams.
(j) For the purposes of this subpart and subpart III:
(1) The term ‘‘Department’’ means the Department of
Health and Human Services.
(2) The term ‘‘Loan Repayment Program’’ means the National Health Service Corps Loan Repayment Program established under section 338B.
(3) The term ‘‘Scholarship Program’’ means the National
Health Service Corps Scholarship Program established under
section 338A.
(4) The term ‘‘State’’ includes, in addition to the several
States, only the District of Columbia, the Commonwealth of
Puerto Rico, the Commonwealth of the Northern Mariana Islands, the Virgin Islands, Guam, American Samoa, and the
Trust Territory of the Pacific Islands.
(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.
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(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.
DESIGNATION OF HEALTH PROFESSIONAL SHORTAGE AREAS

SEC. 332. ø254e¿ (a)(1) For purposes of this subpart the term
‘‘health professional shortage area’’ means (A) an area in an urban
or rural area (which need not conform to the geographic boundaries
of a political subdivision and which is a rational area for the delivery of health services) which the Secretary determines has a health
manpower shortage, (B) a population group which the Secretary determines has such a shortage, or (C) a public or nonprofit private
medical facility or other public facility which the Secretary determines has such a shortage. All Federally qualified health centers
and rural health clinics, as defined in section 1861(aa) of the Social
Security Act (42 U.S.C. 1395x(aa)), that meet the requirements of
section 334 shall be automatically designated as having such a
shortage. The Secretary shall not remove an area from the areas
determined to be health professional shortage areas under subparagraph (A) of the preceding sentence until the Secretary has afforded interested persons and groups in such area an opportunity
to provide data and information in support of the designation as a
health professional shortage area or a population group described
in subparagraph (B) of such sentence or a facility described in subparagraph (C) of such sentence, and has made a determination on
the basis of the data and information submitted by such persons
and groups and other data and information available to the Secretary.
(2) For purposes of this subsection, the term ‘‘medical facility’’
means a facility for the delivery of health services and includes—
(A) a hospital, State mental hospital, public health center,
outpatient medical facility, rehabilitation facility, facility for
long-term care, community mental health center, migrant
health center, facility operated by a city or county health department, and community health center and which is not reasonably accessible to an adequately served area;
(B) such a facility of a State correctional institution or of
the Indian Health Service, and a health program or facility operated by a tribe or tribal organization under the Indian SelfDetermination Act;
(C) such a facility used in connection with the delivery of
health services under section 321 (relating to hospitals), 322
(relating to care and treatment of persons under quarantine
and others), 323 (relating to care and treatment of Federal
prisoners), 324 (relating to examination and treatment of certain Federal employees), 325 (relating to examination of
aliens), 326 (relating to services to certain Federal employees),
320 (relating to services for persons with Hansen’s disease), or
330(h) (relating to the provision of health services to homeless
individuals); and
(D) a Federal medical facility.
(3) Homeless individuals (as defined in section 330(h)(5)), seasonal agricultural workers (as defined in section 330(g)(3)) and miMarch 13, 2013

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gratory agricultural workers (as so defined)), and residents of public housing (as defined in section 3(b)(1) of the United States Housing Act of 1937 (42 U.S.C. 1437a(b)(1))) may be population groups
under paragraph (1).
(b) The Secretary shall establish by regulation criteria for the
designation of areas, population groups, medical facilities, and
other public facilities, in the States, as health professional shortage
areas. In establishing such criteria, the Secretary shall take into
consideration the following:
(1) The ratio of available health manpower to the number
of individuals in an area or population group, or served by a
medical facility or other public facility under consideration for
designation.
(2) Indicators of a need, notwithstanding the supply of
health manpower, for health services for the individuals in an
area or population group or served by a medical facility or
other public facility under consideration for designation.
(3) The percentage of physicians serving an area, population group, medical facility, or other public facility under consideration for designation who are employed by hospitals and
who are graduates of foreign medical schools.
(c) In determining whether to make a designation, the Secretary shall take into consideration the following:
(1) The recommendations of the Governor of each State in
which the area, population group, medical facility, or other
public facility under consideration for designation is in whole
or part located.
(2) The extent to which individuals who are (A) residents
of the area, members of the population group, or patients in
the medical facility or other public facility under consideration
for designation, and (B) entitled to have payment made for
medical services under title XVIII, XIX, or XXI of the Social
Security Act, cannot obtain such services because of suspension
of physicians from the programs under such titles.
(d)(1) In accordance with the criteria established under subsection (b) and the considerations listed in subsection (c), the Secretary shall designate health professional shortage areas in the
States, publish a descriptive list of the areas, population groups,
medical facilities, and other public facilities so designated, and at
least annually review and, as necessary, revise such designations.
(2) For purposes of paragraph (1), a complete descriptive list
shall be published in the Federal Register not later than July 1 of
1991 and each subsequent year.
(e)(1) Prior to the designation of a public facility, including a
Federal medical facility, as a health professional shortage area, the
Secretary shall give written notice of such proposed designation to
the chief administrative officer of such facility and request comments within 30 days with respect to such designation.
(2) Prior to the designation of a health professional shortage
area under this section, the Secretary shall, to the extent practicable, give written notice of the proposed designation of such area
to appropriate public or private nonprofit entities which are located
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ments from such entities with respect to the proposed designation
of such area.
(f) The Secretary shall give written notice of the designation of
a health professional shortage area, not later than 60 days from
the date of such designation, to—
(1) the Governor of each State in which the area, population group, medical facility, or other public facility so designated is in whole or part located; and
(2) appropriate public or nonprofit private entities which
are located or which have a demonstrated interest in the area
so designated.
(g) Any person may recommend to the Secretary the designation of an area, population group, medical facility, or other public
facility as a health professional shortage area.
(h) The Secretary may conduct such information programs in
areas, among population groups, and in medical facilities and other
public facilities designated under this section as health professional
shortage areas as may be necessary to inform public and nonprofit
private entities which are located or have a demonstrated interest
in such areas of the assistance available under this title by virtue
of the designation of such areas.
(i) DISSEMINATION.—The Administrator of the Health Resources and Services Administration shall disseminate information
concerning the designation criteria described in subsection (b) to—
(1) the Governor of each State;
(2) the representative of any area, population group, or facility selected by any such Governor to receive such information;
(3) the representative of any area, population group, or facility that requests such information; and
(4) the representative of any area, population group, or facility determined by the Administrator to be likely to meet the
criteria described in subsection (b).
(j)(1) The Secretary shall submit the report described in paragraph (2) if the Secretary, acting through the Administrator of the
Health Resources and Services Administration, issues—
(A) a regulation that revises the definition of a health professional shortage area for purposes of this section; or
(B) a regulation that revises the standards concerning priority of such an area under section 333A.
(2) On issuing a regulation described in paragraph (1), the Secretary shall prepare and submit to the Committee on Energy and
Commerce of the House of Representatives and the Committee on
Health, Education, Labor, and Pensions of the Senate a report that
describes the regulation.
(3) Each regulation described in paragraph (1) shall take effect
180 days after the committees described in paragraph (2) receive
a report referred to in such paragraph describing the regulation.
ASSIGNMENT OF CORPS PERSONNEL

SEC. 333. ø254f¿ (a)(1) The Secretary may assign members of
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retary, health services in or to a health professional shortage area
during the assignment period only if—
(A) a public or private entity, which is located or has a
demonstrated interest in such area, makes application to the
Secretary for such assignment;
(B) such application has been approved by the Secretary;
(C) the entity agrees to comply with the requirements of
section 334; and
(D) the Secretary has (i) conducted an evaluation of the
need and demand for health professional shortage area, the intended use of Corps members to be assigned to the area, community support for the assignment of Corps members to the
area, the area’s efforts to secure health professional shortage
area, and the fiscal management capability of the entity to
which Corps members would be assigned and (ii) on the basis
of such evaluation has determined that—
(I) there is a need and demand for health manpower
for the area;
(II) there has been appropriate and efficient use of any
Corps members previously assigned to the entity for the
area;
(III) there is general community support for the assignment of Corps members to the entity;
(IV) the area has made unsuccessful efforts to secure
health manpower for the area;
(V) there is a reasonable prospect of sound fiscal management, including efficient collection of fee-for-service,
third-party, and other appropriate funds, by the entity
with respect to Corps members assigned to such entity;
and
(VI) 1 the entity demonstrates willingness to
support or facilitate mentorship, professional development, and training opportunities for Corps
members.
An application for assignment of a Corps member to a health professional shortage area shall include a demonstration by the applicant that the area or population group to be served by the applicant has a shortage of personal health services and that the Corps
member will be located so that the member will provide services to
the greatest number of persons residing in such area or included
in such population group. Such a demonstration shall be made on
the basis of the criteria prescribed by the Secretary under section
332(b) and on additional criteria which the Secretary shall prescribe to determine if the area or population group to be served by
the applicant has a shortage of personal health services.
(2) Corps members may be assigned to a Federal health care
facility, but only upon the request of the head of the department
or agency of which such facility is a part.
(3) In approving applications for assignment of members of the
Corps the Secretary shall not discriminate against applications
from entities which are not receiving Federal financial assistance
under this Act. In approving such applications, the Secretary shall
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give preference to applications in which a nonprofit entity or public
entity shall provide a site to which Corps members may be assigned.
(b)(1) The Secretary may not approve an application for the assignment of a member of the Corps described in subparagraph (C)
of section 331(a)(1) to an entity unless the application of the entity
contains assurances satisfactory to the Secretary that the entity (A)
has sufficient financial resources to provide the member of the
Corps with an income of not less than the income to which the
member would be entitled if the member was a member described
in subparagraph (B) of section 331(a)(1), or (B) would have such financial resources if a grant was made to the entity under paragraph (2).
(2)(A) If in approving an application of an entity for the assignment of a member of the Corps described in subparagraph (C) of
section 331(a)(1) the Secretary determines that the entity does not
have sufficient financial resources to provide the member of the
Corps with an income of not less than the income to which the
member would be entitled if the member was a member described
in subparagraph (B) of section 331(a)(1), the Secretary may make
a grant to the entity to assure that the member of the Corps assigned to it will receive during the period of assignment to the entity such an income.
(B) The amount of any grant under subparagraph (A) shall be
determined by the Secretary. Payments under such a grant may be
made in advance or by way of reimbursement, and at such intervals and on such conditions, as the Secretary finds necessary. No
grant may be made unless an application therefor is submitted to
and approved by the Secretary. Such an application shall be in
such form, submitted in such manner, and contain such information, as the Secretary shall by regulation prescribe.
(c) The Secretary shall assign Corps members to entities in
health professional shortage areas without regard to the ability of
the individuals in such areas, population groups, medical facilities,
or other public facilities to pay for such services.
(d)(1) The Secretary may provide technical assistance to a public or private entity which is located in a health professional shortage area and which desires to make an application under this section for assignment of a Corps member to such area. Assistance
provided under this paragraph may include assistance to an entity
in (A) analyzing the potential use of health professions personnel
in defined health services delivery areas by the residents of such
areas, (B) determining the need for such personnel in such areas,
(C) determining the extent to which such areas will have a financial base to support the practice of such personnel and the extent
to which additional financial resources are needed to adequately
support the practice, (D) determining the types of inpatient and
other health services that should be provided by such personnel in
such areas, and (E) developing long-term plans for addressing
health professional shortages and improving access to health care.
The Secretary shall encourage entities that receive technical assistance under this paragraph to communicate with other communities, State Offices of Rural Health, State Primary Care AssociaMarch 13, 2013

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tions and Offices, and other entities concerned with site development and community needs assessment.
(2) The Secretary may provide, to public and private entities
which are located in a health professional shortage area to which
area a Corps member has been assigned, technical assistance to assist in the retention of such member in such area after the completion of such member’s assignment to the area.
(3) The Secretary may provide, to health professional shortage
areas to which no Corps member has been assigned, (A) technical
assistance to assist in the recruitment of health manpower for such
areas, and (B) current information on public and private programs
which provide assistance in the securing of health manpower.
(4)(A) The Secretary shall undertake to demonstrate the improvements that can be made in the assignment of members of the
Corps to health professional shortage areas and in the delivery of
health care by Corps members in such areas through coordination
with States, political subdivisions of States, agencies of States and
political subdivisions, and other public and private entities which
have expertise in the planning, development, and operation of centers for the delivery of primary health care. In carrying out this
subparagraph, the Secretary shall enter into agreements with
qualified entities which provide that if—
(i) the entity places in effect a program for the planning,
development, and operation of centers for the delivery of primary health care in health professional shortage areas which
reasonably addresses the need for such care in such areas, and
(ii) under the program the entity will perform the functions described in subparagraph (B),
the Secretary will assign under this section members of the Corps
in accordance with the program.
(B) For purposes of subparagraph (A), the term ‘‘qualified entity’’ means a State, political subdivision of a State, an agency of a
State or political subdivision, or other public or private entity operating solely within one State, which the Secretary determines is
able—
(i) to analyze the potential use of health professions personnel in defined health services delivery areas by the residents of such areas;
(ii) to determine the need for such personnel in such areas
and to recruit, select, and retain health professions personnel
(including members of the National Health Service Corps) to
meet such need;
(iii) to determine the extent to which such areas will have
a financial base to support the practice of such personnel and
the extent to which additional financial resources are needed
to adequately support the practice;
(iv) to determine the types of inpatient and other health
services that should be provided by such personnel in such
areas;
(v) to assist such personnel in the development of their
clinical practice and fee schedules and in the management of
their practice;
(vi) to assist in the planning and development of facilities
for the delivery of primary health care; and
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(vii) to assist in establishing the governing bodies of centers for the delivery of such care and to assist such bodies in
defining and carrying out their responsibilities.
(e) Notwithstanding any other law, any member of the Corps
licensed to practice medicine, osteopathic medicine, dentistry, or
any other health profession in any State shall, while serving in the
Corps, be allowed to practice such profession in any State.
SEC. 333A. ø254f–1¿ PRIORITIES IN ASSIGNMENT OF CORPS PERSONNEL.
(a) IN GENERAL.—In approving applications made under sec-

tion 333 for the assignment of Corps members, the Secretary
shall—
(1) give priority to any such application that—
(A) is made regarding the provision of primary health
services to a health professional shortage area with the
greatest such shortage; and
(B) is made by an entity that—
(i) serves a health professional shortage area described in subparagraph (A);
(ii) coordinates the delivery of primary health
services with related health and social services;
(iii) has a documented record of sound fiscal management; and
(iv) will experience a negative impact on its capacity to provide primary health services if a Corps member is not assigned to the entity;
(2) with respect to the geographic area in which the health
professional shortage area is located, take into consideration
the willingness of individuals in the geographic area, and of
the appropriate governmental agencies or health entities in the
area, to assist and cooperate with the Corps in providing effective primary health services; and
(3) take into consideration comments of medical, osteopathic, dental, or other health professional societies whose
members deliver services to the health professional shortage
area, or if no such societies exist, comments of physicians, dentists, or other health professionals delivering services to the
area.
(b) ESTABLISHMENT OF CRITERIA FOR DETERMINING PRIORITIES.—
(1) IN GENERAL.—The Secretary shall establish criteria
specifying the manner in which the Secretary makes a determination under subsection (a)(1)(A) of the health professional
shortage areas with the greatest such shortages.
(2) PUBLICATION OF CRITERIA.—The criteria required in
paragraph (1) shall be published in the Federal Register not
later than July 1, 1991. Any revisions made in the criteria by
the Secretary shall be effective upon publication in the Federal
Register.
(c) NOTIFICATIONS REGARDING PRIORITIES.—
(1) PROPOSED LIST.—The Secretary shall prepare and publish a proposed list of health professional shortage areas and
entities that would receive priority under subsection (a)(1) in
the assignment of Corps members. The list shall contain the
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information described in paragraph (2), and the relative scores
and relative priorities of the entities submitting applications
under section 333, in a proposed format. All such entities shall
have 30 days after the date of publication of the list to provide
additional data and information in support of inclusion on the
list or in support of a higher priority determination and the
Secretary shall reasonably consider such data and information
in preparing the final list under paragraph (2).
(2) PREPARATION OF LIST FOR APPLICABLE PERIOD.—For the
purpose of carrying out paragraph (3), the Secretary shall prepare and, as appropriate, update a list of health professional
shortage areas and entities that are receiving priority under
subsection (a)(1) in the assignment of Corps members. Such
list—
(A) shall include a specification, for each such health
professional shortage area, of the entities for which the
Secretary has provided an authorization to receive assignments of Corps members in the event that Corps members
are available for the assignments; and
(B) shall, of the entities for which an authorization described in subparagraph (A) has been provided, specify—
(i) the entities provided such an authorization for
the assignment of Corps members who are participating in the Scholarship Program;
(ii) the entities provided such an authorization for
the assignment of Corps members who are participating in the Loan Repayment Program; and
(iii) the entities provided such an authorization for
the assignment of Corps members who have become
Corps members other than pursuant to contractual obligations under the Scholarship or Loan Repayment
Programs.
The Secretary may set forth such specifications by medical
specialty.
(3) NOTIFICATION OF AFFECTED PARTIES.—
(A) ENTITIES.—Not later than 30 days after the Secretary has added to a list under paragraph (2) an entity
specified as described in subparagraph (A) of such paragraph, the Secretary shall notify such entity that the entity has been provided an authorization to receive assignments of Corps members in the event that Corps members
are available for the assignments.
(B) INDIVIDUALS.—In the case of an individual obligated to provide service under the Scholarship Program,
not later than 3 months before the date described in section 338C(b)(5), the Secretary shall provide to such individual the names of each of the entities specified as described in paragraph (2)(B)(i) that is appropriate for the
individual’s medical specialty and discipline.
(4) REVISIONS.—If the Secretary proposes to make a revision in the list under paragraph (2), and the revision would adversely alter the status of an entity with respect to the list, the
Secretary shall notify the entity of the revision. Any entity adversely affected by such a revision shall be notified in writing
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by the Secretary of the reasons for the revision and shall have
30 days from such notification to file a written appeal of the
determination involved which shall be reasonably considered
by the Secretary before the revision to the list becomes final.
The revision to the list shall be effective with respect to assignment of Corps members beginning on the date that the revision becomes final.
(d) LIMITATION ON NUMBER OF ENTITIES OFFERED AS ASSIGNMENT CHOICES IN SCHOLARSHIP PROGRAM.—
(1) DETERMINATION OF AVAILABLE CORPS MEMBERS.—By
April 1 of each calendar year, the Secretary shall determine
the number of participants in the Scholarship Program who
will be available for assignments under section 333 during the
program year beginning on July 1 of that calendar year.
(2) DETERMINATION OF NUMBER OF ENTITIES.—At all times
during a program year, the number of entities specified under
subsection (c)(2)(B)(i) shall be—
(A) not less than the number of participants determined with respect to that program year under paragraph
(1); and
(B) not greater than twice the number of participants
determined with respect to that program year under paragraph (1).
SEC. 334. ø254g¿ CHARGES FOR SERVICES BY ENTITIES USING CORPS
MEMBERS.
(a) AVAILABILITY OF SERVICES REGARDLESS OF ABILITY TO PAY
OR PAYMENT SOURCE.—An entity to which a Corps member is as-

signed shall not deny requested health care services, and shall not
discriminate in the provision of services to an individual—
(1) because the individual is unable to pay for the services;
or
(2) because payment for the services would be made
under—
(A) the medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.);
(B) the medicaid program under title XIX of such Act
(42 U.S.C. 1396 et seq.); or
(C) the State children’s health insurance program
under title XXI of such Act (42 U.S.C. 1397aa et seq.).
(b) CHARGES FOR SERVICES.—The following rules shall apply to
charges for health care services provided by an entity to which a
Corps member is assigned:
(1) IN GENERAL.—
(A) SCHEDULE OF FEES OR PAYMENTS.—Except as provided in paragraph (2), the entity shall prepare a schedule
of fees or payments for the entity’s services, consistent
with locally prevailing rates or charges and designed to
cover the entity’s reasonable cost of operation.
(B) SCHEDULE OF DISCOUNTS.—Except as provided in
paragraph (2), the entity shall prepare a corresponding
schedule of discounts (including, in appropriate cases,
waivers) to be applied to the payment of such fees or payments. In preparing the schedule, the entity shall adjust
the discounts on the basis of a patient’s ability to pay.
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(C) USE OF SCHEDULES.—The entity shall make every
reasonable effort to secure from patients fees and payments for services in accordance with such schedules, and
fees or payments shall be sufficiently discounted in accordance with the schedule described in subparagraph (B).
(2) SERVICES TO BENEFICIARIES OF FEDERAL AND FEDERALLY ASSISTED PROGRAMS.—In the case of health care services
furnished to an individual who is a beneficiary of a program
listed in subsection (a)(2), the entity—
(A) shall accept an assignment pursuant to section
1842(b)(3)(B)(ii) of the Social Security Act (42 U.S.C.
1395u(b)(3)(B)(ii)) with respect to an individual who is a
beneficiary under the medicare program; and
(B) shall enter into an appropriate agreement with—
(i) the State agency administering the program
under title XIX of such Act with respect to an individual who is a beneficiary under the medicaid program; and
(ii) the State agency administering the program
under title XXI of such Act with respect to an individual who is a beneficiary under the State children’s
health insurance program.
(3) COLLECTION OF PAYMENTS.—The entity shall take reasonable and appropriate steps to collect all payments due for
health care services provided by the entity, including payments
from any third party (including a Federal, State, or local government agency and any other third party) that is responsible
for part or all of the charge for such services.
PROVISION OF HEALTH SERVICES BY CORPS MEMBERS

SEC. 335. ø254h¿ (a) In providing health services in a health
professional shortage area, Corps members shall utilize the techniques, facilities, and organizational forms most appropriate for the
area, population group, medical facility, or other public facility, and
shall, to the maximum extent feasible, provide such services (1) to
all individuals in, or served by, such health professional shortage
area regardless of their ability to pay for the services, and (2) in
a manner which is cooperative with other health care providers
serving such health professional shortage area.
(b)(1) Notwithstanding any other provision of law, the Secretary may (A) to the maximum extent feasible make such arrangements as he determines necessary to enable Corps members to utilize the health facilities in or serving the health professional shortage area in providing health services; (B) make such arrangements
as he determines are necessary for the use of equipment and supplies of the Service and for the lease or acquisition of other equipment and supplies; and (C) secure the permanent or temporary
services of physicians, dentists, nurses, administrators, and other
health personnel. If there are no health facilities in or serving such
area, the Secretary may arrange to have Corps members provide
health services in the nearest health facilities of the Service or may
lease or otherwise provide facilities in or serving such area for the
provision of health services.
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(2) If the individuals in or served by a health professional
shortage area are being served (as determined under regulations of
the Secretary) by a hospital or other health care delivery facility
of the Service, the Secretary may, in addition to such other arrangements as he may make under paragraph (1), arrange for the
utilization of such hospital or facility by Corps members in providing health services, but only to the extent that such utilization
will not impair the delivery of health services and treatment
through such hospital or facility to individuals who are entitled to
health services and treatment through such hospital or facility.
(c) The Secretary may make one loan to any entity with an approved application under section 333 to assist such entity in meeting the costs of (1) establishing medical, dental, or other health
profession practices, including the development of medical practice
management systems; (2) acquiring equipment for use in providing
health services; and (3) renovating buildings to establish health facilities. No loan may be made under this subsection unless an application therefor is submitted to, and approved by, the Secretary.
The amount of any such loan shall be determined by the Secretary,
except that no such loan may exceed $50,000.
(d) Upon the expiration of the assignment of all Corps members to a health professional shortage area, the Secretary may (notwithstanding any other provision of law) sell, to any appropriate
local entity, equipment and other property of the United States utilized by such members in providing health services. Sales made
under this subsection shall be made at the fair market value (as
determined by the Secretary) of the equipment or such other property; except that the Secretary may make such sales for a lesser
value to an appropriate local entity, if he determines that the entity is financially unable to pay the full market value.
(e)(1)(A) It shall be unlawful for any hospital to deny an authorized Corps member admitting privileges when such Corps
member otherwise meets the professional qualifications established
by the hospital for granting such privileges and agrees to abide by
the published bylaws of the hospital and the published bylaws,
rules, and regulations of its medical staff.
(B) Any hospital which is found by the Secretary, after notice
and an opportunity for a hearing on the record, to have violated
this subsection shall upon such finding cease, for a period to be determined by the Secretary, to receive and to be eligible to receive
any Federal funds under this Act or under titles XVIII, XIX, or XXI
of the Social Security Act.
(2) For purposes of this subsection, the term ‘‘hospital’’ includes
a State or local public hospital, a private profit hospital, a private
nonprofit hospital, a general or special hospital, and any other type
of hospital (excluding a hospital owned or operated by an agency
of the Federal Government), and any related facilities.
SEC. 336. ø254h–1¿ FACILITATION OF EFFECTIVE PROVISION OF CORPS
SERVICES.
(a) CONSIDERATION OF INDIVIDUAL CHARACTERISTICS OF MEMBERS IN MAKING ASSIGNMENTS.—In making an assignment of a

Corps member to an entity that has had an application approved
under section 333, the Secretary shall, subject to making the assignment in accordance with section 333A, seek to assign to the enMarch 13, 2013

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tity a Corps member who has (and whose spouse, if any, has) characteristics that increase the probability that the member will remain in the health professional shortage area involved after the
completion of the period of service in the Corps.
(b) COUNSELING ON SERVICE IN CORPS.—
(1) IN GENERAL.—The Secretary shall, subject to paragraph
(3), offer appropriate counseling on service in the Corps to individuals during the period of membership in the Corps, particularly during the initial period of each assignment.
(2) CAREER ADVISOR REGARDING OBLIGATED SERVICE.—
(A) In the case of individuals who have entered into
contracts for obligated service under the Scholarship or
Loan Repayment Program, counseling under paragraph (1)
shall include appropriate counseling on matters particular
to such obligated service. The Secretary shall ensure that
career advisors for providing such counseling are available
to such individuals throughout the period of participation
in the Scholarship or Loan Repayment Program.
(B) With respect to the Scholarship Program, counseling under paragraph (1) shall include counseling individuals during the period in which the individuals are pursuing an educational degree in the health profession involved, including counseling to prepare the individual for
service in the Corps.
(3) EXTENT OF COUNSELING SERVICES.—With respect to individuals who have entered into contracts for obligated service
under the Scholarship or Loan Repayment Program, this subsection shall be carried out regarding such individuals
throughout the period of obligated service (and, additionally,
throughout the period specified in paragraph (2)(B), in the case
of the Scholarship Program). With respect to Corps members
generally, this subsection shall be carried out to the extent
practicable.
(c) GRANTS REGARDING PREPARATION OF STUDENTS FOR PRACTICE.—With respect to individuals who have entered into contracts
for obligated service under the Scholarship or Loan Repayment
Program, the Secretary may make grants to, and enter into contracts with, public and nonprofit private entities (including health
professions schools) for the conduct of programs designed to prepare such individuals for the effective provision of primary health
services in the health professional shortage areas to which the individuals are assigned.
(d) PROFESSIONAL DEVELOPMENT AND TRAINING.—
(1) IN GENERAL.—The Secretary shall assist Corps members in establishing and maintaining professional relationships
and development opportunities, including by—
(A) establishing appropriate professional relationships
between the Corps member involved and the health professions community of the geographic area with respect to
which the member is assigned;
(B) establishing professional development, training,
and mentorship linkages between the Corps member involved and the larger health professions community, including through distance learning, direct mentorship, and
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development and implementation of training modules designed to meet the educational needs of offsite Corps members;
(C) establishing professional networks among Corps
members; or
(D) engaging in other professional development,
mentorship, and training activities for Corps members, at
the discretion of the Secretary.
(2) ASSISTANCE IN ESTABLISHING PROFESSIONAL RELATIONSHIPS.—In providing such assistance under paragraph (1), the
Secretary shall focus on establishing relationships with hospitals, with academic medical centers and health professions
schools, with area health education centers under section 751,
with health education and training centers under section 752,
and with border health education and training centers under
such section 752. Such assistance shall include assistance in
obtaining faculty appointments at health professions schools.
(3) SUPPLEMENT NOT SUPPLANT.—Such efforts under this
subsection shall supplement, not supplant, non-government efforts by professional health provider societies to establish and
maintain professional relationships and development opportunities.
(e) TEMPORARY RELIEF FROM CORPS DUTIES.—
(1) IN GENERAL.—The Secretary shall, subject to paragraph
(4), provide assistance to Corps members in establishing arrangements through which Corps members may, as appropriate, be provided temporary relief from duties in the Corps
in order to pursue continuing education in the health professions, to participate in exchange programs with teaching centers, to attend professional conferences, or to pursue other interests, including vacations.
(2) ASSUMPTION OF DUTIES OF MEMBER.—
(A) Temporary relief under paragraph (1) may be provided only if the duties of the Corps member involved are
assumed by another health professional. With respect to
such temporary relief, the duties may be assumed by
Corps members or by health professionals who are not
Corps members, if the Secretary approves the professionals for such purpose. Any health professional so approved by the Secretary shall, during the period of providing such temporary relief, be deemed to be a Corps
member for purposes of section 224 (including for purposes
of the remedy described in such section), section 333(f) 1,
and section 335(e).
(B) In carrying out paragraph (1), the Secretary shall
provide for the formation and continued existence of a
group of health professionals to provide temporary relief
under such paragraph.
(3) RECRUITMENT FROM GENERAL HEALTH PROFESSIONS
COMMUNITY.—In carrying out paragraph (1), the Secretary
shall—
1 So in law. As a result of the amendments made by section 103(b) of Public Law 101–597
(104 Stat. 3015), there is no subsection (f) in section 333. (Subsection (e) of section 333, like
sections 224 and 335(e), establishes a right for Corps members.)

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(A) encourage health professionals who are not Corps
members to enter into arrangements under which the
health professionals temporarily assume the duties of
Corps members for purposes of paragraph (1); and
(B) with respect to the entities to which Corps members have been assigned under section 333, encourage the
entities to facilitate the development of arrangements described in subparagraph (A).
(4) LIMITATION.—In carrying out paragraph (1), the Secretary may not, except as provided in paragraph (5), obligate
any amounts (other than for incidental expenses) for the purpose of—
(A) compensating a health professional who is not a
Corps member for assuming the duties of a Corps member;
or
(B) paying the costs of a vacation, or other interests
that a Corps member may pursue during the period of
temporary relief under such paragraph.
(5) SOLE PROVIDERS OF HEALTH SERVICES.—In the case of
any Corps member who is the sole provider of health services
in the geographic area involved, the Secretary may, from
amounts appropriated under section 338, obligate on behalf of
the member such sums as the Secretary determines to be necessary for purposes of providing temporary relief under paragraph (1).
(f) DETERMINATIONS REGARDING EFFECTIVE SERVICE.—In carrying out subsection (a) and sections 338A(d) and 338B(d), the Secretary shall carry out activities to determine—
(1) the characteristics of physicians, dentists, and other
health professionals who are more likely to remain in practice
in health professional shortage areas after the completion of
the period of service in the Corps;
(2) the characteristics of health manpower shortage
areas 1, and of entities seeking assignments of Corps members,
that are more likely to retain Corps members after the members have completed the period of service in the Corps; and
(3) the appropriate conditions for the assignment and utilization in health manpower shortage areas 1 of certified nurse
practitioners, certified nurse midwives, and physician assistants.
ANNUAL REPORTS

SEC. 336A. ø254i¿ The Secretary shall submit an annual report
to Congress, and shall include in such report with respect to the
previous calendar year—
(1) the number, identity, and priority of all health professional shortage areas designated in such year and the number
of health professional shortage areas which the Secretary estimates will be designated in the subsequent year;
1 So in law. Probably should be ‘‘health professional shortage areas’’. See section 401 of Public
Law 101–597 (104 Stat. 3035).

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(2) the number of applications filed under section 333 in
such year for assignment of Corps members and the action
taken on each such application;
(3) the number and types of Corps members assigned in
such year to health professional shortage areas, the number
and types of additional Corps members which the Secretary estimates will be assigned to such areas in the subsequent year,
and the need for additional members for the Corps;
(4) the recruitment efforts engaged in for the Corps in such
year and the number of qualified individuals who applied for
service in the Corps in such year;
(5) the number of patients seen and the number of patient
visits recorded during such year with respect to each health
professional shortage area to which a Corps member was assigned during such year;
(6) the number of Corps members who elected, and the
number of Corps members who did not elect, to continue to
provide health services in health professional shortage areas
after termination of their service in the Corps and the reasons
(as reported to the Secretary) of members who did not elect for
not making such election;
(7) the results of evaluations and determinations made
under section 333(a)(1)(D) during such year; and
(8) the amount charged during such year for health services provided by Corps members, the amount which was collected in such year by entities in accordance with section 334,
and the amount which was paid to the Secretary in such year
under such agreements 1.
NATIONAL ADVISORY COUNCIL

SEC. 337. ø254j¿ (a) There is established a council to be known
as the National Advisory Council on the National Health Service
Corps (hereinafter in this section referred to as the ‘‘Council’’). The
Council shall be composed of fifteen members appointed by the Secretary. The Council shall consult with, advise, and make recommendations to, the Secretary with respect to his responsibilities
in carrying out this subpart (other than section 338G), and shall
review and comment upon regulations promulgated by the Secretary under this subpart.
(b)(1) Members of the Council shall be appointed for a term of
three years, except that any member appointed to fill a vacancy occurring prior to the expiration of the term for which the member’s
predecessor was appointed shall be appointed for the remainder of
such term. No member shall be removed, except for cause.
(2) Members of the Council (other than members who are officers or employees of the United States), while attending meetings
or conferences thereof or otherwise serving on the business of the
Council, shall be entitled to receive for each day (including traveltime) in which they are so serving compensation at a rate fixed by
the Secretary (but not to exceed the daily equivalent of the annual
1 There is no antecedent reference to ‘‘agreements’’. Formerly, paragraph (8) contained the
clause ‘‘, the amount which was collected in such year by entities in accordance with agreements
under section 334,’’. Section 307(b) of Public Law 107–251 (116 Stat. 1649) struck ‘‘agreements
under’’ in that clause.

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rate of basic pay in effect for grade GS–18 of the General Schedule); and while so serving away from their homes or regular places
of business all members may be allowed travel expenses, including
per diem in lieu of subsistence, as authorized by section 5703 of
title 5 of the United States Code for persons in the Government
service employed intermittently.
(c) Section 14 of the Federal Advisory Committee Act shall not
apply with respect to the Council.
AUTHORIZATION OF APPROPRIATION

SEC. 338. ø254k¿ (a) For the purpose of carrying out this subpart, there are authorized to be appropriated such sums as may be
necessary for each of the fiscal years 2008 through 2012.
(b) An appropriation under an authorization under subsection
(a) for any fiscal year may be made at any time before that fiscal
year and may be included in an Act making an appropriation under
an authorization under subsection (a) for another fiscal year; but
no funds may be made available from any appropriation under
such authorization for obligation under sections 331 through 335,
section 336A, and section 337 before the fiscal year for which such
appropriation is authorized.

Subpart III—Scholarship Program and Loan
Repayment Program
NATIONAL HEALTH SERVICE CORPS SCHOLARSHIP PROGRAM

SEC. 338A. ø254l¿ (a) The Secretary shall establish the National Health Service Corps Scholarship Program to assure, with
respect to the provision of primary health services pursuant to section 331(a)(2)—
(1) an adequate supply of physicians, dentists, behavioral
and mental health professionals, certified nurse midwives, certified nurse practitioners, and physician assistants; and
(2) if needed by the Corps, an adequate supply of other
health professionals.
(b) To be eligible to participate in the Scholarship Program, an
individual must—
(1) be accepted for enrollment, or be enrolled, as a full-time
student (A) in an accredited (as determined by the Secretary)
educational institution in a State and (B) in a course of study
or program, offered by such institution and approved by the
Secretary, leading to a degree in medicine, osteopathic medicine, dentistry, or other health profession, or an appropriate
degree from a graduate program of behavioral and mental
health;
(2) be eligible for, or hold, an appointment as a commissioned officer in the Regular or Reserve Corps of the Service
or be eligible for selection for civilian service in the Corps;
(3) submit an application to participate in the Scholarship
Program; and
(4) sign and submit to the Secretary, at the time of submittal of such application, a written contract (described in subsection (f)) to accept payment of a scholarship and to serve (in
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accordance with this subpart) for the applicable period of obligated service in a health professional shortage area.
(c)(1) In disseminating application forms and contract forms to
individuals desiring to participate in the Scholarship Program, the
Secretary shall include with such forms—
(A) a fair summary of the rights and liabilities of an individual whose application is approved (and whose contract is accepted) by the Secretary, including in the summary a clear explanation of the damages to which the United States is entitled
under section 338E in the case of the individual’s breach of the
contract; and
(B) information respecting meeting a service obligation
through private practice under an agreement under section
338D and such other information as may be necessary for the
individual to understand the individual’s prospective participation in the Scholarship Program and service in the Corps, including a statement of all factors considered in approving applications for participation in the Program and in making assignments for participants in the Program.
(2) The application form, contract form, and all other information furnished by the Secretary under this subpart shall be written
in a manner calculated to be understood by the average individual
applying to participate in the Scholarship Program. The Secretary
shall make such application forms, contract forms, and other information available to individuals desiring to participate in the Scholarship Program on a date sufficiently early to insure that such individuals have adequate time to carefully review and evaluate such
forms and information.
(3)(A) The Secretary shall distribute to health professions
schools materials providing information on the Scholarship Program and shall encourage the schools to disseminate the materials
to the students of the schools.
(B)(i) In the case of any health professional whose period of obligated service under the Scholarship Program is nearing completion, the Secretary shall encourage the individual to remain in a
health professional shortage area and to continue providing primary health services.
(ii) During the period in which a health professional is planning and making the transition to private practice from obligated
service under the Scholarship Program, the Secretary may provide
assistance to the professional regarding such transition if the professional is remaining in a health professional shortage area and
is continuing to provide primary health services.
(C) In the case of entities to which participants in the Scholarship Program are assigned under section 333, the Secretary shall
encourage the entities to provide options with respect to assisting
the participants in remaining in the health professional shortage
areas involved, and in continuing to provide primary health services, after the period of obligated service under the Scholarship
Program is completed. The options with respect to which the Secretary provides such encouragement may include options regarding
the sharing of a single employment position in the health professions by 2 or more health professionals, and options regarding the
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recruitment of couples where both of the individuals are health
professionals.
(d)(1) Subject to section 333A, in providing contracts under the
Scholarship Program—
(A) the Secretary shall consider the extent of the demonstrated interest of the applicants for the contracts in providing primary health services;
(B) the Secretary, in considering applications from individuals accepted for enrollment or enrolled in dental school, shall
consider applications from all individuals accepted for enrollment or enrolled in any accredited dental school in a State;
and
(C) may consider such other factors regarding the applicants as the Secretary determines to be relevant to selecting
qualified individuals to participate in such Program.
(2) In providing contracts under the Scholarship Program, the
Secretary shall give priority—
(A) first, to any application for such a contract submitted
by an individual who has previously received a scholarship
under this section or under section 758;
(B) second, to any application for such a contract submitted by an individual who has characteristics that increase
the probability that the individual will continue to serve in a
health professional shortage area after the period of obligated
service pursuant to subsection (f) is completed; and
(C) third, subject to subparagraph (B), to any application
for such a contract submitted by an individual who is from a
disadvantaged background.
(e)(1) An individual becomes a participant in the Scholarship
Program only upon the Secretary’s approval of the individual’s application submitted under subsection (b)(3) and the Secretary’s acceptance of the contract submitted by the individual under subsection (b)(4).
(2) The Secretary shall provide written notice to an individual
promptly upon the Secretary’s approving, under paragraph (1), of
the individual’s participation in the Scholarship Program.
(f) The written contract (referred to in this subpart) between
the Secretary and an individual shall contain—
(1) an agreement that—
(A) subject to paragraph (2), the Secretary agrees (i) to
provide the individual with a scholarship (described in
subsection (g)) in each such school year or years for a period of years (not to exceed four school years) determined
by the individual, during which period the individual is
pursuing a course of study described in subsection
(b)(1)(B), and (ii) to accept (subject to the availability of appropriated funds for carrying out sections 331 through 335
and section 337) the individual into the Corps (or for
equivalent service as otherwise provided in this subpart);
and
(B) subject to paragraph (2), the individual agrees—
(i) to accept provision of such a scholarship to the
individual;
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(ii) to maintain enrollment in a course of study described in subsection (b)(1)(B) until the individual
completes the course of study;
(iii) while enrolled in such course of study, to
maintain an acceptable level of academic standing (as
determined under regulations of the Secretary by the
educational institution offering such course of study);
(iv) if pursuing a degree from a school of medicine
or osteopathic medicine, to complete a residency in a
specialty that the Secretary determines is consistent
with the needs of the Corps; and
(v) to serve for a time period (hereinafter in the
subpart referred to as the ‘‘period of obligated service’’)
equal to—
(I) one year for each school year for which the
individual was provided a scholarship under the
Scholarship Program, or
(II) two years,
whichever is greater, as a provider of primary health
services in a health professional shortage area (designated under section 332) to which he is assigned by
the Secretary as a member of the Corps, or as otherwise provided in this subpart;
(2) a provision that any financial obligation of the United
States arising out of a contract entered into under this subpart
and any obligation of the individual which is conditioned thereon, is contingent upon funds being appropriated for scholarships under this subpart and to carry out the purposes of sections 331 through 335 and sections 337 and 338;
(3) a statement of the damages to which the United States
is entitled, under section 338E for the individual’s breach of
the contract; and
(4) such other statements of the rights and liabilities of the
Secretary and of the individual, not inconsistent with the provisions of this subpart.
(g)(1) A scholarship provided to a student for a school year
under a written contract under the Scholarship Program shall consist of—
(A) payment to, or (in accordance with paragraph (2)) on
behalf of, the student of the amount (except as provided in section 711) of—
(i) the tuition of the student in such school year; and
(ii) all other reasonable educational expenses, including fees, books, and laboratory expenses, incurred by the
student in such school year; and
(B) payment to the student of a stipend of $400 per month
(adjusted in accordance with paragraph (3)) for each of the 12
consecutive months beginning with the first month of such
school year.
(2) The Secretary may contract with an educational institution,
in which a participant in the Scholarship Program is enrolled, for
the payment to the educational institution of the amounts of tuition and other reasonable educational expenses described in paragraph (1)(A). Payment to such an educational institution may be
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made without regard to section 3648 of the Revised Statutes (31
U.S.C. 529).
(3) The amount of the monthly stipend, specified in paragraph
(1)(B) and as previously adjusted (if at all) in accordance with this
paragraph, shall be increased by the Secretary for each school year
ending in a fiscal year beginning after September 30, 1978, by an
amount (rounded to the next highest multiple of $1) equal to the
amount of such stipend multiplied by the overall percentage (under
section 5303 of title 5, United States Code) of the adjustment (if
such adjustment is an increase) in the rates of pay under the General Schedule made effective in the fiscal year in which such school
year ends.
(h) Notwithstanding any other provision of law, individuals
who have entered into written contracts with the Secretary under
this section, while undergoing academic training, shall not be
counted against any employment ceiling affecting the Department.
SEC. 338B. ø254l–1¿ NATIONAL HEALTH SERVICE CORPS LOAN REPAYMENT PROGRAM.
(a) ESTABLISHMENT.—The Secretary shall establish a program

to be known as the National Health Service Corps Loan Repayment
Program to assure, with respect to the provision of primary health
services pursuant to section 331(a)(2)—
(1) an adequate supply of physicians, dentists, behavioral
and mental health professionals, certified nurse midwives, certified nurse practitioners, and physician assistants; and
(2) if needed by the Corps, an adequate supply of other
health professionals.
(b) ELIGIBILITY.—To be eligible to participate in the Loan Repayment Program, an individual must—
(1)(A) have a degree in medicine, osteopathic medicine,
dentistry, or another health profession, or an appropriate degree from a graduate program of behavioral and mental health,
or be certified as a nurse midwife, nurse practitioner, or physician assistant;
(B) be enrolled in an approved graduate training program
in medicine, osteopathic medicine, dentistry, behavioral and
mental health, or other health profession; or
(C) be enrolled as a full-time student—
(i) in an accredited (as determined by the Secretary)
educational institution in a State; and
(ii) in the final year of a course of a study or program,
offered by such institution and approved by the Secretary,
leading to a degree in medicine, osteopathic medicine, dentistry, or other health profession;
(2) be eligible for, or hold, an appointment as a commissioned officer in the Regular or Reserve Corps of the Service
or be eligible for selection for civilian service in the Corps; and
(3) submit to the Secretary an application for a contract
described in subsection (f) (relating to the payment by the Secretary of the educational loans of the individual in consideration of the individual serving for a period of obligated service).
(c) APPLICATION, CONTRACT, AND INFORMATION REQUIREMENTS.—
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(1) SUMMARY AND INFORMATION.—In disseminating application forms and contract forms to individuals desiring to participate in the Loan Repayment Program, the Secretary shall
include with such forms—
(A) a fair summary of the rights and liabilities of an
individual whose application is approved (and whose contract is accepted) by the Secretary, including in the summary a clear explanation of the damages to which the
United States is entitled under section 338E in the case of
the individual’s breach of the contract; and
(B) information respecting meeting a service obligation
through private practice under an agreement under section
338D and such other information as may be necessary for
the individual to understand the individual’s prospective
participation in the Loan Repayment Program and service
in the Corps.
(2) UNDERSTANDABILITY.—The application form, contract
form, and all other information furnished by the Secretary
under this subpart shall be written in a manner calculated to
be understood by the average individual applying to participate
in the Loan Repayment Program.
(3) AVAILABILITY.—The Secretary shall make such application forms, contract forms, and other information available to
individuals desiring to participate in the Loan Repayment Program on a date sufficiently early to ensure that such individuals have adequate time to carefully review and evaluate such
forms and information.
(4) RECRUITMENT AND RETENTION.—
(A) The Secretary shall distribute to health professions
schools materials providing information on the Loan Repayment Program and shall encourage the schools to disseminate the materials to the students of the schools.
(B)(i) In the case of any health professional whose period of obligated service under the Loan Repayment Program is nearing completion, the Secretary shall encourage
the individual to remain in a health professional shortage
area and to continue providing primary health services.
(ii) During the period in which a health professional is
planning and making the transition to private practice
from obligated service under the Loan Repayment Program, the Secretary may provide assistance to the professional regarding such transition if the professional is remaining in a health professional shortage area and is
continuing to provide primary health services.
(C) In the case of entities to which participants in the
Loan Repayment Program are assigned under section 333,
the Secretary shall encourage the entities to provide options with respect to assisting the participants in remaining in the health professional shortage areas involved, and
in continuing to provide primary health services, after the
period of obligated service under the Loan Repayment Program is completed. The options with respect to which the
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tion in the health professions by 2 or more health professionals, and options regarding the recruitment of couples
where both of the individuals are health professionals.
(d)(1) Subject to section 333A, in providing contracts under the
Loan Repayment Program—
(A) the Secretary shall consider the extent of the demonstrated interest of the applicants for the contracts in providing primary health services; and
(B) may consider such other factors regarding the applicants as the Secretary determines to be relevant to selecting
qualified individuals to participate in such Program.
(2) In providing contracts under the Loan Repayment Program,
the Secretary shall give priority—
(A) to any application for such a contract submitted by an
individual whose training is in a health profession or specialty
determined by the Secretary to be needed by the Corps;
(B) to any application for such a contract submitted by an
individual who has (and whose spouse, if any, has) characteristics that increase the probability that the individual will continue to serve in a health professional shortage area after the
period of obligated service pursuant to subsection (f) is completed; and
(C) subject to subparagraph (B), to any application for such
a contract submitted by an individual who is from a disadvantaged background.
(e) APPROVAL REQUIRED FOR PARTICIPATION.—An individual becomes a participant in the Loan Repayment Program only upon the
Secretary and the individual entering into a written contract described in subsection (f).
(f) CONTENTS OF CONTRACTS.—The written contract (referred to
in this subpart) between the Secretary and an individual shall contain—
(1) an agreement that—
(A) subject to paragraph (3), the Secretary agrees—
(i) to pay on behalf of the individual loans in accordance with subsection (g); and
(ii) to accept (subject to the availability of appropriated funds for carrying out sections 331 through
335 and section 337) the individual into the Corps (or
for equivalent service as otherwise provided in this
subpart); and
(B) subject to paragraph (3), the individual agrees—
(i) to accept loan payments on behalf of the individual;
(ii) in the case of an individual described in subsection (b)(1)(C), to maintain enrollment in a course of
study or training described in such subsection until
the individual completes the course of study or training;
(iii) in the case of an individual described in subsection (b)(1)(C), while enrolled in such course of study
or training, to maintain an acceptable level of academic standing (as determined under regulations of
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the Secretary by the educational institution offering
such course of study or training); and
(iv) to serve for a time period (hereinafter in this
subpart referred to as the ‘‘period of obligated service’’)
equal to 2 years or such longer period as the individual may agree to, as a provider of primary health
services in a health professional shortage area (designated under section 332) to which such individual is
assigned by the Secretary as a member of the Corps
or released under section 338D;
(2) a provision permitting the Secretary to extend for such
longer additional periods, as the individual may agree to, the
period of obligated service agreed to by the individual under
paragraph (1)(B)(iv), including extensions resulting in an aggregate period of obligated service in excess of 4 years;
(3) a provision that any financial obligation of the United
States arising out of a contract entered into under this subpart
and any obligation of the individual that is conditioned thereon, is contingent on funds being appropriated for loan repayments under this subpart and to carry out the purposes of sections 331 through 335 and sections 337 and 338;
(4) a statement of the damages to which the United States
is entitled, under section 338E for the individual’s breach of
the contract; and
(5) such other statements of the rights and liabilities of the
Secretary and of the individual, not inconsistent with this subpart.
(g) PAYMENTS.—
(1) IN GENERAL.—A loan repayment provided for an individual under a written contract under the Loan Repayment
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—
(A) tuition expenses;
(B) all other reasonable educational expenses, including fees, books, and laboratory expenses, incurred by the
individual; or
(C) reasonable living expenses as determined by the
Secretary.
(2) PAYMENTS FOR YEARS SERVED.—
(A) IN GENERAL.—For each year of obligated service
that an individual contracts to serve under subsection (f)
the Secretary may pay up to $50,000, plus, beginning with
fiscal year 2012, an amount determined by the Secretary
on an annual basis to reflect inflation, on behalf of the individual for loans described in paragraph (1). In making a
determination of the amount to pay for a year of such service by an individual, the Secretary shall consider the extent to which each such determination—
(i) affects the ability of the Secretary to maximize
the number of contracts that can be provided under
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the Loan Repayment Program from the amounts appropriated for such contracts;
(ii) provides an incentive to serve in health professional shortage areas with the greatest such shortages; and
(iii) provides an incentive with respect to the
health professional involved remaining in a health
professional shortage area, and continuing to provide
primary health services, after the completion of the
period of obligated service under the Loan Repayment
Program.
(B) REPAYMENT SCHEDULE.—Any arrangement made
by the Secretary for the making of loan repayments in accordance with this subsection shall provide that any repayments for a year of obligated service shall be made no later
than the end of the fiscal year in which the individual
completes such year of service.
(3) TAX LIABILITY.—For the purpose of providing reimbursements for tax liability resulting from payments under
paragraph (2) on behalf of an individual—
(A) the Secretary shall, in addition to such payments,
make payments to the individual in an amount equal to 39
percent of the total amount of loan repayments made for
the taxable year involved; and
(B) may make such additional payments as the Secretary determines to be appropriate with respect to such
purpose.
(4) PAYMENT SCHEDULE.—The Secretary may enter into an
agreement with the holder of any loan for which payments are
made under the Loan Repayment Program to establish a
schedule for the making of such payments.
(h) EMPLOYMENT CEILING.—Notwithstanding any other provision of law, individuals who have entered into written contracts
with the Secretary under this section, while undergoing academic
or other training, shall not be counted against any employment
ceiling affecting the Department.
OBLIGATED SERVICE

SEC. 338C. ø254m¿ (a) SERVICE IN FULL-TIME CLINICAL PRACTICE.—Except as provided in section 338D, each individual who has
entered into a written contract with the Secretary under section
338A or 338B shall provide service in the full-time clinical practice
of such individual’s profession as a member of the Corps for the period of obligated service provided in such contract. The Secretary
may treat teaching as clinical practice for up to 20 percent of such
period of obligated service. 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.
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(b)(1) If an individual is required under subsection (a) to provide service as specified in section 338A(f)(1)(B)(v) or
338B(f)(1)(B)(iv) (hereinafter in this subsection referred to as ‘‘obligated service’’), the Secretary shall, not later than ninety days before the date described in paragraph (5), determine if the individual shall provide such service—
(A) as a member of the Corps who is a commissioned officer in the Regular or Reserve Corps of the Service or who is
a civilian employee of the United States, or
(B) as a member of the Corps who is not such an officer
or employee,
and shall notify such individual of such determination.
(2) If the Secretary determines that an individual shall provide
obligated service as a member of the Corps who is a commissioned
officer in the Service or a civilian employee of the United States,
the Secretary shall, not later than sixty days before the date described in paragraph (5), provide such individual with sufficient information regarding the advantages and disadvantages of service
as such a commissioned officer or civilian employee to enable the
individual to make a decision on an informed basis. To be eligible
to provide obligated service as a commissioned officer in the Service, an individual shall notify the Secretary, not later than thirty
days before the date described in paragraph (5), of the individual’s
desire to provide such service as such an officer. If an individual
qualifies for an appointment as such an officer, the Secretary shall,
as soon as possible after the date described in paragraph (5), appoint the individual as a commissioned officer of the Regular or Reserve Corps of the Service and shall designate the individual as a
member of the Corps.
(3) If an individual provided notice by the Secretary under
paragraph (2) does not qualify for appointment as a commissioned
officer in the Service, the Secretary shall, as soon as possible after
the date described in paragraph (5), appoint such individual as a
civilian employee of the United States and designate the individual
as a member of the Corps.
(4) If the Secretary determines that an individual shall provide
obligated service as a member of the Corps who is not an employee
of the United States, the Secretary shall, as soon as possible after
the date described in paragraph (5), designate such individual as
a member of the Corps to provide such service.
(5)(A) In the case of the Scholarship Program, the date referred
to in paragraphs (1) through (4) shall be the date on which the individual completes the training required for the degree for which
the individual receives the scholarship, except that—
(i) for an individual receiving such a degree after September 30, 2000, from a school of medicine or osteopathic medicine, such date shall be the date the individual completes a
residency in a specialty that the Secretary determines is consistent with the needs of the Corps; and
(ii) at the request of an individual, the Secretary may, consistent with the needs of the Corps, defer such date until the
end of a period of time required for the individual to complete
advanced training (including an internship or residency).
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(B) No period of internship, residency, or other advanced clinical training shall be counted toward satisfying a period of obligated service under this subpart.
(C) In the case of the Loan Repayment Program, if an individual is required to provide obligated service under such Program,
the date referred to in paragraphs (1) through (4)—
(i) shall be the date determined under subparagraph (A) in
the case of an individual who is enrolled in the final year of
a course of study;
(ii) shall, in the case of an individual who is enrolled in an
approved graduate training program in medicine, osteopathic
medicine, dentistry, or other health profession, be the date the
individual completes such training program; and
(iii) shall, in the case of an individual who has a degree
in medicine, osteopathic medicine, dentistry, or other health
profession and who has completed graduate training, be the
date the individual enters into an agreement with the Secretary under section 338B.
(c) An individual shall be considered to have begun serving a
period of obligated service—
(1) on the date such individual is appointed as an officer
in a Regular or Reserve Corps of the Service or is designated
as a member of the Corps under subsection (b)(3) or (b)(4), or
(2) in the case of an individual who has entered into an
agreement with the Secretary under section 338D, on the date
specified in such agreement,
whichever is earlier.
(d) The Secretary shall assign individuals performing obligated
service in accordance with a written contract under the Scholarship
Program to health professional shortage areas in accordance with
sections 331 through 335 and sections 337 and 338. If the Secretary determines that there is no need in a health professional
shortage area (designated under section 332) for a member of the
profession in which an individual is obligated to provide service
under a written contract and if such individual is an officer in the
Service or a civilian employee of the United States, the Secretary
may detail such individual to serve his period of obligated service
as a full-time member of such profession in such unit of the Department as the Secretary may determine.
PRIVATE PRACTICE

SEC. 338D. ø254n¿ (a) The Secretary shall, to the extent permitted by, and consistent with, the requirements of applicable
State law, release an individual from all or part of his service obligation under section 338C(a) or under section 225 (as in effect on
September 30, 1977) if the individual applies for such a release
under this section and enters into a written agreement with the
Secretary under which the individual agrees to engage for a period
equal to the remaining period of his service obligation in the fulltime private clinical practice (including service as a salaried employee in an entity directly providing health services) of his health
profession—
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(1) in the case of an individual who received a scholarship
under the Scholarship Program or a loan repayment under the
Loan Repayment Program and who is performing obligated
service as a member of the Corps in a health professional
shortage area on the date of his application for such a release,
in the health professional shortage area in which such individual is serving on such date or in the case of an individual
for whom a loan payment was made under the Loan Repayment Program and who is performing obligated service as a
member of the Corps in a health professional shortage area on
the date of the application of the individual for such a release,
in the health professional shortage area selected by the Secretary; or
(2) in the case of any other individual, in a health professional shortage area (designated under section 332) selected by
the Secretary.
(b)(1) The written agreement described in subsection (a)
shall—
(A) provide that, during the period of private practice by
an individual pursuant to the agreement, the individual shall
comply with the requirements of section 334 that apply to entities; and
(B) contain such additional provisions as the Secretary
may require to carry out the objectives of this section.
(2) The Secretary shall take such action as may be appropriate
to ensure that the conditions of the written agreement prescribed
by this subsection are adhered to.
(c) If an individual breaches the contract entered into under
section 338A or 338B by failing (for any reason) to begin his service
obligation in accordance with an agreement entered into under subsection (a) or to complete such service obligation, the Secretary
may permit such individual to perform such service obligation as
a member of the Corps.
(d) The Secretary may pay an individual who has entered into
an agreement with the Secretary under subsection (a) an amount
to cover all or part of the individual’s expenses reasonably incurred
in transporting himself, his family, and his possessions to the location of his private clinical practice.
(e) Upon the expiration of the written agreement under subsection (a), the Secretary may (notwithstanding any other provision
of law) sell to the individual who has entered into an agreement
with the Secretary under subsection (a), equipment and other property of the United States utilized by such individual in providing
health services. Sales made under this subsection shall be made at
the fair market value (as determined by the Secretary) of the
equipment or such other property, except that the Secretary may
make such sales for a lesser value to the individual if he determines that the individual is financially unable to pay the full market value.
(f) The Secretary may, out of appropriations authorized under
section 338, pay to individuals participating in private practice
under this section the cost of such individual’s malpractice insurance and the lesser of—
(1)(A) $10,000 in the first year of obligated service;
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(B) $7,500 in the second year of obligated service;
(C) $5,000 in the third year of obligated service; and
(D) $2,500 in the fourth year of obligated service; or
(2) an amount determined by subtracting such individual’s
net income before taxes from the income the individual would
have received as a member of the Corps for each such year of
obligated service.
(g) The Secretary shall, upon request, provide to each individual released from service obligation under this section technical
assistance to assist such individual in fulfilling his or her agreement under this section.
BREACH OF SCHOLARSHIP CONTRACT OR LOAN REPAYMENT CONTRACT

SEC. 338E. ø254o¿ (a)(1) An individual who has entered into a
written contract with the Secretary under section 338A and who—
(A) fails to maintain an acceptable level of academic standing in the educational institution in which he is enrolled (such
level determined by the educational institution under regulations of the Secretary);
(B) is dismissed from such educational institution for disciplinary reasons; or
(C) voluntarily terminates the training in such an educational institution for which he is provided a scholarship
under such contract, before the completion of such training,
in lieu of any service obligation arising under such contract, shall
be liable to the United States for the amount which has been paid
to him, or on his behalf, under the contract.
(2) An individual who has entered into a written contract with
the Secretary under section 338B and who—
(A) in the case of an individual who is enrolled in the final
year of a course of study, fails to maintain an acceptable level
of academic standing in the educational institution in which
such individual is enrolled (such level determined by the educational institution under regulations of the Secretary) or voluntarily terminates such enrollment or is dismissed from such
educational institution before completion of such course of
study; or
(B) in the case of an individual who is enrolled in a graduate training program, fails to complete such training program
and does not receive a waiver from the Secretary under section
338B(b)(1)(B)(ii),
in lieu of any service obligation arising under such contract shall
be liable to the United States for the amount that has been paid
on behalf of the individual under the contract.
(b)(1)(A) Except as provided in paragraph (2), if (for any reason
not specified in subsection (a) or section 338G(d)) an individual
breaches his written contract by failing to begin such individual’s
service obligation under section 338A in accordance with section
338C or 338D, to complete such service obligation, or to complete
a required residency as specified in section 338A(f)(1)(B)(iv), the
United States shall be entitled to recover from the individual an
amount determined in accordance with the formula
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A=3ϕ(t¥s/t)
in which ‘‘A’’ is the amount the United States is entitled to recover,
‘‘ϕ’’ is the sum of the amounts paid under this subpart to or on behalf of the individual and the interest on such amounts which
would be payable if at the time the amounts were paid they were
loans bearing interest at the maximum legal prevailing rate, as determined by the Treasurer of the United States; ‘‘t’’ is the total
number of months in the individual’s period of obligated service;
and ‘‘s’’ is the number of months of such period served by him in
accordance with section 338C or a written agreement under section
338D.
(B)(i) Any amount of damages that the United States is entitled to recover under this subsection or under subsection (c) shall,
within the 1-year period beginning on the date of the breach of the
written contract (or such longer period beginning on such date as
specified by the Secretary), be paid to the United States. Amounts
not paid within such period shall be subject to collection through
deductions in Medicare payments pursuant to section 1892 of the
Social Security Act.
(ii) If damages described in clause (i) are delinquent for 3
months, the Secretary shall, for the purpose of recovering such
damages—
(I) utilize collection agencies contracted with by the Administrator of the General Services Administration; or
(II) enter into contracts for the recovery of such damages
with collection agencies selected by the Secretary.
(iii) Each contract for recovering damages pursuant to this subsection shall provide that the contractor will, not less than once
each 6 months, submit to the Secretary a status report on the success of the contractor in collecting such damages. Section 3718 of
title 31, United States Code, shall apply to any such contract to the
extent not inconsistent with this subsection.
(iv) To the extent not otherwise prohibited by law, the Secretary shall disclose to all appropriate credit reporting agencies information relating to damages of more than $100 that are entitled
to be recovered by the United States under this subsection and that
are delinquent by more than 60 days or such longer period as is
determined by the Secretary.
(2) If an individual is released under section 753 from a service
obligation under section 225 (as in effect on September 30, 1977)
and if the individual does not meet the service obligation incurred
under section 753, subsection (f) of such section 225 shall apply to
such individual in lieu of paragraph (1) of this subsection.
(3) The Secretary may terminate a contract with an individual
under section 338A if, not later than 30 days before the end of the
school year to which the contract pertains, the individual—
(A) submits a written request for such termination; and
(B) repays all amounts paid to, or on behalf of, the individual under section 338A(g).
(c)(1) If (for any reason not specified in subsection (a) or section
338G(d)) an individual breaches the written contract of the individual under section 338B by failing either to begin such individual’s service obligation in accordance with section 338C or 338D or
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to complete such service obligation, the United States shall be entitled to recover from the individual an amount equal to the sum
of—
(A) the total of the amounts paid by the United States
under section 338B(g) on behalf of the individual for any period
of obligated service not served;
(B) an amount equal to the product of the number of
months of obligated service that were not completed by the individual, multiplied by $7,500; and
(C) the interest on the amounts described in subparagraphs (A) and (B), at the maximum legal prevailing rate, as
determined by the Treasurer of the United States, from the
date of the breach;
except that the amount the United States is entitled to recover
under this paragraph shall not be less than $31,000.
(2) The Secretary may terminate a contract with an individual
under section 338B if, not later than 45 days before the end of the
fiscal year in which the contract was entered into, the individual—
(A) submits a written request for such termination; and
(B) repays all amounts paid on behalf of the individual
under section 338B(g).
(3) Damages that the United States is entitled to recover shall
be paid in accordance with subsection (b)(1)(B).
(d)(1) Any obligation of an individual under the Scholarship
Program (or a contract thereunder) or the Loan Repayment Program (or a contract thereunder) for service or payment of damages
shall be canceled upon the death of the individual.
(2) The Secretary shall by regulation provide for the partial or
total waiver or suspension of any obligation of service or payment
by an individual under the Scholarship Program (or a contract
thereunder) or the Loan Repayment Program (or a contract thereunder) whenever compliance by the individual is impossible or
would involve extreme hardship to the individual and if enforcement of such obligation with respect to any individual would be unconscionable.
(3)(A) Any obligation of an individual under the Scholarship
Program (or a contract thereunder) or the Loan Repayment Program (or a contract thereunder) for payment of damages may be released by a discharge in bankruptcy under title 11 of the United
States Code only if such discharge is granted after the expiration
of the 7-year period beginning on the first date that payment of
such damages is required, and only if the bankruptcy court finds
that nondischarge of the obligation would be unconscionable.
(B)(i) Subparagraph (A) shall apply to any financial obligation
of an individual under the provision of law specified in clause (ii)
to the same extent and in the same manner as such subparagraph
applies to any obligation of an individual under the Scholarship or
Loan Repayment Program (or contract thereunder) for payment of
damages.
(ii) The provision of law referred to in clause (i) is subsection
(f) of section 225 of this Act, as in effect prior to the repeal of such
section by section 408(b)(1) of Public Law 94–484.
(e) Notwithstanding any other provision of Federal or State
law, there shall be no limitation on the period within which suit
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may be filed, a judgment may be enforced, or an action relating to
an offset or garnishment, or other action, may be initiated or taken
by the Secretary, the Attorney General, or the head of another Federal agency, as the case may be, for the repayment of the amount
due from an individual under this section.
(f) The amendment made by section 313(a)(4) of the Health
Care Safety Net Amendments of 2002 (Public Law 107–251) shall
apply to any obligation for which a discharge in bankruptcy has not
been granted before the date that is 31 days after the date of enactment of such Act.
SEC. 338F. ø254o–1¿ FUND REGARDING USE OF AMOUNTS RECOVERED
FOR CONTRACT BREACH TO REPLACE SERVICES LOST AS
RESULT OF BREACH.
(a) ESTABLISHMENT OF FUND.—There is established in the

Treasury of the United States a fund to be known as the National
Health Service Corps Member Replacement Fund (hereafter in this
section referred to as the ‘‘Fund’’). The Fund shall consist of such
amounts as may be appropriated under subsection (b) to the Fund.
Amounts appropriated for the Fund shall remain available until expended.
(b) AUTHORIZATION OF APPROPRIATIONS TO FUND.—For each
fiscal year, there is authorized to be appropriated to the Fund an
amount equal to the sum of—
(1) the amount collected during the preceding fiscal year
by the Federal Government pursuant to the liability of individuals under section 338E for the breach of contracts entered
into under section 338A or 338B;
(2) the amount by which grants under section 338I have,
for such preceding fiscal year, been reduced under subsection
(g)(2)(B) of such section; and
(3) the aggregate of the amount of interest accruing during
the preceding fiscal year on obligations held in the Fund pursuant to subsection (d) and the amount of proceeds from the
sale or redemption of such obligations during such fiscal year.
(c) USE OF FUND.—
(1) PAYMENTS TO CERTAIN HEALTH FACILITIES.—Amounts in
the Fund and available pursuant to appropriations Act may,
subject to paragraph (2), be expended by the Secretary to make
payments to any entity—
(A) to which a Corps member has been assigned under
section 333; and
(B) that has a need for a health professional to provide
primary health services as a result of the Corps member
having breached the contract entered into under section
338A or 338B by the individual.
(2) PURPOSE OF PAYMENTS.—An entity receiving payments
pursuant to paragraph (1) may expend the payments to recruit
and employ a health professional to provide primary health
services to patients of the entity, or to enter into a contract
with such a professional to provide the services to the patients.
(d) INVESTMENT.—
(1) IN GENERAL.—The Secretary of the Treasury shall invest such amounts of the Fund as such Secretary determines
are not required to meet current withdrawals from the Fund.
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Such investments may be made only in interest-bearing obligations of the United States. For such purpose, such obligations
may be acquired on original issue at the issue price, or by purchase of outstanding obligations at the market price.
(2) SALE OF OBLIGATIONS.—Any obligation acquired by the
Fund may be sold by the Secretary of the Treasury at the market price.
SPECIAL LOANS FOR FORMER CORPS MEMBERS TO ENTER PRIVATE
PRACTICE

SEC. 338G. ø254p¿ (a) The Secretary may, out of appropriations authorized under section 338, make one loan to a Corps member who has agreed in writing—
(1) to engage in the private full-time clinical practice of the
profession of the member in a health professional shortage
area (designated under section 332) for a period of not less
than 2 years which—
(A) in the case of a Corps member who is required to
complete a period of obligated service under this subpart,
begins not later than 1 year after the date on which such
individual completes such period of obligated service; and
(B) in the case of an individual who is not required to
complete a period of obligated service under this subpart,
begins at such time as the Secretary considers appropriate;
(2) to conduct such practice in accordance with section
338D(b)(1); and
(3) to such additional conditions as the Secretary may require to carry out this section.
Such a loan shall be used to assist such individual in meeting the
costs of beginning the practice of such individual’s profession in accordance with such agreement, including the costs of acquiring
equipment and renovating facilities for use in providing health
services, and of hiring nurses and other personnel to assist in providing health services. Such loan may not be used for the purchase
or construction of any building.
(b)(1) The amount of a loan under subsection (a) to an individual shall not exceed $25,000.
(2) The interest rate for any such loan shall not exceed an annual rate of 5 percent.
(c) The Secretary may not make a loan under this section unless an application therefor has been submitted to, and approved
by, the Secretary. The Secretary shall, by regulation, set interest
rates and repayment terms for loans under this section.
(d) If the Secretary determines that an individual has breached
a written agreement entered into under subsection (a), he shall, as
soon as practicable after making such determination notify the individual of such determination. If within 60 days after the date of
giving such notice, such individual is not practicing his profession
in accordance with the agreement under such subsection and has
not provided assurances satisfactory to the Secretary that he will
not knowingly violate such agreement again, the United States
shall be entitled to recover from such individual—
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(1) in the case of an individual who has received a grant
under this section (as in effect prior to October 1, 1984), an
amount determined under section 338E(b), except that in applying the formula contained in such section ‘‘ϕ’’ shall be the
sum of the amount of the grant made under subsection (a) to
such individual and the interest on such amount which would
be payable if at the time it was paid it was a loan bearing interest at the maximum legal prevailing rate, ‘‘t’’ shall be the
number of months that such individual agreed to practice his
profession under agreement, and ‘‘s’’ shall be the number of
months that such individual practices his profession in accordance with such agreement; and
(2) in the case of an individual who has received a loan
under this section, the full amount of the principal and interest
owed by such individual under this section.
SEC. 338H. ø254q¿ AUTHORIZATION OF APPROPRIATIONS.
(a) AUTHORIZATION OF APPROPRIATIONS.—For the

purpose of
carrying out this section 1, 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.
(b) SCHOLARSHIPS FOR NEW PARTICIPANTS.—Of the amounts
appropriated under subsection (a) for a fiscal year, the Secretary
shall obligate not less than 10 percent for the purpose of providing
contracts for—
(1) scholarships under this subpart to individuals who
have not previously received such scholarships; or
(2) scholarships or loan repayments under the Loan Repayment Program under section 338B to individuals from disadvantaged backgrounds.
(c) SCHOLARSHIPS AND LOAN REPAYMENTS.—With respect to
certification as a nurse practitioner, nurse midwife, or physician
assistant, the Secretary shall, from amounts appropriated under
subsection (a) for a fiscal year, obligate not less than a total of 10
percent for contracts for both scholarships under the Scholarship
1 The reference to ‘‘this section’’ in section 338H(a) probably should be a reference to ‘‘this subpart’’.

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Program under section 338A and loan repayments under the Loan
Repayment Program under section 338B to individuals who are entering the first year of a course of study or program described in
section 338A(b)(1)(B) that leads to such a certification or individuals who are eligible for the loan repayment program as specified
in section 338B(b) for a loan related to such certification.
SEC. 338I. ø254q–1¿ GRANTS TO STATES FOR LOAN REPAYMENT PROGRAMS.
(a) IN GENERAL.—
(1) AUTHORITY FOR GRANTS.—The Secretary, acting

through the Administrator of the Health Resources and Services Administration, may make grants to States for the purpose of assisting the States in operating programs described in
paragraph (2) in order to provide for the increased availability
of primary health care services in health professional shortage
areas. The National Advisory Council established under section
337 shall advise the Administrator regarding the program
under this section.
(2) LOAN REPAYMENT PROGRAMS.—The programs referred
to in paragraph (1) are, subject to subsection (c), programs of
entering into contracts under which the State involved agrees
to pay all or part of the principal, interest, and related expenses of the educational loans of health professionals in consideration of the professionals agreeing to provide primary
health services in health professional shortage areas.
(3) DIRECT ADMINISTRATION BY STATE AGENCY.—The Secretary may not make a grant under paragraph (1) unless the
State involved agrees that the program operated with the
grant will be administered directly by a State agency.
(b) REQUIREMENT OF MATCHING FUNDS.—
(1) IN GENERAL.—The Secretary may not make a grant
under subsection (a) unless the State agrees that, with respect
to the costs of making payments on behalf of individuals under
contracts made pursuant to paragraph (2) of such subsection,
the State will make available (directly or through donations
from public or private entities) non-Federal contributions in
cash toward such costs in an amount equal to not less than $1
for each $1 of Federal funds provided in the grant.
(2) DETERMINATION OF AMOUNT OF NON-FEDERAL CONTRIBUTION.—In determining the amount of non-Federal contributions in cash that a State has provided pursuant to paragraph (1), the Secretary may not include any amounts provided
to the State by the Federal Government.
(c) COORDINATION WITH FEDERAL PROGRAM.—
(1) ASSIGNMENTS FOR HEALTH PROFESSIONAL SHORTAGE
AREAS UNDER FEDERAL PROGRAM.—The Secretary may not
make a grant under subsection (a) unless the State involved
agrees that, in carrying out the program operated with the
grant, the State will assign health professionals participating
in the program only to public and nonprofit private entities located in and providing health services in health professional
shortage areas.
(2) REMEDIES FOR BREACH OF CONTRACTS.—The Secretary
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volved agrees that the contracts provided by the State pursuant to paragraph (2) of such subsection will provide remedies
for any breach of the contracts by the health professionals involved.
(3) LIMITATION REGARDING CONTRACT INDUCEMENTS.—
(A) Except as provided in subparagraph (B), the Secretary may not make a grant under subsection (a) unless
the State involved agrees that the contracts provided by
the State pursuant to paragraph (2) of such subsection will
not be provided on terms that are more favorable to health
professionals than the most favorable terms that the Secretary is authorized to provide for contracts under the
Loan Repayment Program under section 338B, including
terms regarding—
(i) the annual amount of payments provided on
behalf of the professionals regarding educational
loans; and
(ii) the availability of remedies for any breach of
the contracts by the health professionals involved.
(B) With respect to the limitation established in subparagraph (A) regarding the annual amount of payments
that may be provided to a health professional under a contract provided by a State pursuant to subsection (a)(2),
such limitation shall not apply with respect to a contract
if—
(i) the excess of such annual payments above the
maximum amount authorized in section 338B(g)(2)(A)
for annual payments regarding contracts is paid solely
from non-Federal contributions under subsection (b);
and
(ii) the contract provides that the health professional involved will satisfy the requirement of obligated service under the contract solely through the
provision of primary health services in a health professional shortage area that is receiving priority for purposes of section 333A(a)(1) and that is authorized to
receive assignments under section 333 of individuals
who are participating in the Scholarship Program
under section 338A.
(d) RESTRICTIONS ON USE OF FUNDS.—The Secretary may not
make a grant under subsection (a) unless the State involved agrees
that the grant will not be expended—
(1) to conduct activities for which Federal funds are expended—
(A) within the State to provide technical or other nonfinancial assistance under subsection (f) of section 330;
(B) under a memorandum of agreement entered into
with the State under subsection (h) of such section; or
(C) under a grant under section 338J; or
(2) for any purpose other than making payments on behalf
of health professionals under contracts entered into pursuant
to subsection (a)(2).
(e) REPORTS.—The Secretary may not make a grant under subsection (a) unless the State involved agrees—
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(1) to submit to the Secretary such reports regarding the
States loan repayment program, as are determined to be appropriate by the Secretary; and
(2) to submit such a report not later than January 10 of
each fiscal year immediately following any fiscal year for which
the State has received such a grant.
(f) REQUIREMENT OF APPLICATION.—The Secretary may not
make a grant under subsection (a) unless an application for the
grant is submitted to the Secretary and the application is in such
form, is made in such manner, and contains such agreements, assurances, and information as the Secretary determines to be necessary to carry out such subsection.
(g) NONCOMPLIANCE.—
(1) IN GENERAL.—The Secretary may not make payments
under subsection (a) to a State for any fiscal year subsequent
to the first fiscal year of such payments unless the Secretary
determines that, for the immediately preceding fiscal year, the
State has complied with each of the agreements made by the
State under this section.
(2) REDUCTION IN GRANT RELATIVE TO NUMBER OF
BREACHED CONTRACTS.—
(A) Before making a grant under subsection (a) to a
State for a fiscal year, the Secretary shall determine the
number of contracts provided by the State under paragraph (2) of such subsection with respect to which there
has been an initial breach by the health professionals involved during the fiscal year preceding the fiscal year for
which the State is applying to receive the grant.
(B) Subject to paragraph (3), in the case of a State
with 1 or more initial breaches for purposes of subparagraph (A), the Secretary shall reduce the amount of a
grant under subsection (a) to the State for the fiscal year
involved by an amount equal to the sum of the expenditures of Federal funds made regarding the contracts involved and an amount representing interest on the amount
of such expenditures, determined with respect to each contract on the basis of the maximum legal rate prevailing for
loans made during the time amounts were paid under the
contract, as determined by the Treasurer of the United
States.
(3) WAIVER REGARDING REDUCTION IN GRANT.—The Secretary may waive the requirement established in paragraph
(2)(B) with respect to the initial breach of a contract if the Secretary determines that such breach by the health professional
involved was attributable solely to the professional having a
serious illness.
(h) DEFINITIONS.—For purposes of this section, the term
‘‘State’’ means each of the 50 States, the District of Columbia, the
Commonwealth of Puerto Rico, the United States Virgin Islands,
Guam, American Samoa, Palau, the Marshall Islands, and the
Commonwealth of the Northern Mariana Islands.
(i) AUTHORIZATION OF APPROPRIATIONS.—
(1) IN GENERAL.—For the purpose of making grants under
subsection (a), there are authorized to be appropriated
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$12,000,000 for fiscal year 2008, and such sums as may be necessary for each of fiscal years 2009 through 2012.
(2) AVAILABILITY.—Amounts appropriated under paragraph
(1) shall remain available until expended.
(j) PUBLIC HEALTH LOAN REPAYMENT.—
(1) IN GENERAL.—The Secretary may award grants to
States for the purpose of assisting such States in operating
loan repayment programs under which such States enter into
contracts to repay all or part of the eligible loans borrowed by,
or on behalf of, individuals who agree to serve in State, local,
or tribal health departments that serve health professional
shortage areas or other areas at risk of a public health emergency, as designated by the Secretary.
(2) LOANS ELIGIBLE FOR REPAYMENT.—To be eligible for repayment under this subsection, a loan shall be a loan made,
insured, or guaranteed by the Federal Government that is borrowed by, or on behalf of, an individual to pay the cost of attendance for a program of education leading to a degree appropriate for serving in a State, local, or tribal health department
as determined by the Secretary and the chief executive officer
of the State in which the grant is administered, at an institution of higher education (as defined in section 102 of the Higher Education Act of 1965), including principal, interest, and related expenses on such loan.
(3) APPLICABILITY OF EXISTING REQUIREMENTS.—With respect to awards made under paragraph (1)—
(A) the requirements of subsections (b), (f), and (g)
shall apply to such awards; and
(B) the requirements of subsection (c) shall apply to
such awards except that with respect to paragraph (1) of
such subsection, the State involved may assign an individual only to public and nonprofit private entities that
serve health professional shortage areas or areas at risk of
a public health emergency, as determined by the Secretary.
(4) AUTHORIZATION OF APPROPRIATIONS.—There are authorized to be appropriated to carry out this subsection, such sums
as may be necessary for each of fiscal years 2007 through 2010.
SEC. 338J. ø254r¿ GRANTS TO STATES FOR OPERATION OF OFFICES
OF RURAL HEALTH.
(a) IN GENERAL.—The Secretary, action through the Director of

the Office of Rural Health Policy (established in section 711 of the
Social Security Act), may make grants to States for the purpose of
improving health care in rural areas through the operation of State
offices of rural health.
(b) REQUIREMENT OF MATCHING FUNDS.—
(1) IN GENERAL.—The Secretary may not make a grant
under subsection (a) unless the State involved agrees, with respect to the costs to be incurred by the State in carrying out
the purpose described in such subsection, to provide non-Federal contributions toward such costs in an amount equal to—
(A) for the first fiscal year of payments under the
grant, not less than $1 for each $3 of Federal funds provided in the grant;
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(B) for any second fiscal year of such payments, not
less than $1 for each $1 of Federal funds provided in the
grant; and
(C) for any third fiscal year of such payments, not less
than $3 for each $1 of Federal funds provided in the grant.
(2) DETERMINATION OF AMOUNT OF NON-FEDERAL CONTRIBUTION.—
(A) Subject to subparagraph (B), non-Federal contributions required in paragraph (1) may be in cash or in kind,
fairly evaluated, including plant, equipment, or services.
Amounts provided by the Federal Government, or services
assisted or subsidized to any significant extent by the Federal Government, may not be included in determining the
amount of such non-Federal contributions.
(B) The Secretary may not make a grant under subsection (a) unless the State involved agrees that—
(i) for the first fiscal year of payments under the
grant, 100 percent or less of the non-Federal contributions required in paragraph (1) will be provided in the
form of in-kind contributions;
(ii) for any second fiscal year of such payments,
not more than 50 percent of such non-Federal contributions will be provided in the form of in-kind contributions; and
(iii) for any third fiscal year of such payments,
such non-Federal contributions will be provided solely
in the form of cash.
(c) CERTAIN REQUIRED ACTIVITIES.—The Secretary may not
make a grant under subsection (a) unless the State involved agrees
that activities carried out by an office operated pursuant to such
subsection will include—
(1) establishing and maintaining within the State a clearinghouse for collecting and disseminating information on—
(A) rural health care issues;
(B) research findings relating to rural health care; and
(C) innovative approaches to the delivery of health
care in rural areas;
(2) coordinating the activities carried out in the State that
relate to rural health care, including providing coordination for
the purpose of avoiding redundancy in such activities; and
(3) identifying Federal and State programs regarding rural
health, and providing technical assistance to public and nonprofit private entities regarding participation in such programs.
(d) REQUIREMENT REGARDING ANNUAL BUDGET FOR OFFICE.—
The Secretary may not make a grant under subsection (a) unless
the State involved agrees that, for any fiscal year for which the
State receives such a grant, the office operated pursuant to subsection (a) will be provided with an annual budget of not less than
$50,000.
(e) CERTAIN USES OF FUNDS.—
(1) RESTRICTIONS.—The Secretary may not make a grant
under subsection (a) unless the State involved agrees that—
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(A) if research with respect to rural health is conducted pursuant to the grant, not more than 10 percent of
the grant will be expended for such research; and
(B) the grant will not be expended—
(i) to provide health care (including providing cash
payments regarding such care);
(ii) to conduct activities for which Federal funds
are expended—
(I) within the State to provide technical and
other nonfinancial assistance under subsection (f)
of section 330 1;
(II) under a memorandum of agreement entered into with the State under subsection (h) of
such section; 2 or
(III) under a grant under section 338I;
(iii) to purchase medical equipment, to purchase
ambulances, aircraft, or other vehicles, or to purchase
major communications equipment;
(iv) to purchase or improve real property; or
(v) to carry out any activity regarding a certificate
of need.
(2) AUTHORITIES.—Activities for which a State may expend
a grant under subsection (a) include—
(A) paying the costs of establishing an office of rural
health for purposes of subsection (a);
(B) subject to paragraph (1)(B)(ii)(III), paying the costs
of any activity carried out with respect to recruiting and
retaining health professionals to serve in rural areas of the
State; and
(C) providing grants and contracts to public and nonprofit private entities to carry out activities authorized in
this section.
(f) REPORTS.—The Secretary may not make a grant under subsection (a) unless the State involved agrees—
(1) to submit to the Secretary reports containing such information as the Secretary may require regarding activities
carried out under this section by the State; and
(2) to submit such a report not later than January 10 of
each fiscal year immediately following any fiscal year for which
the State has received such a grant.
(g) REQUIREMENT OF APPLICATION.—The Secretary may not
make a grant under subsection (a) unless an application for the
grant is submitted to the Secretary and the application is in such
form, is made in such manner, and contains such agreements, assurances, and information as the Secretary determines to be necessary to carry out such subsection.
(h) NONCOMPLIANCE.—The Secretary may not make payments
under subsection (a) to a State for any fiscal year subsequent to the
first fiscal year of such payments unless the Secretary determines
that, for the immediately preceding fiscal year, the State has com1 Probably should be ‘‘subsection (k)’’. See the amendment made by section 2 of Public Law
104–299 (110 Stat. 3626).
2 Probably should be ‘‘subsection (m)’’. See the amendment referred to in footnote 1.

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plied with each of the agreements made by the State under this
section.
(i) DEFINITIONS.—For purposes of this section, the term ‘‘State’’
means each of the several States.
(j) AUTHORIZATION OF APPROPRIATIONS.—
(1) IN GENERAL.—For the purpose of making grants under
subsection (a), there are authorized to be appropriated
$3,000,000 for fiscal year 1991, $4,000,000 for fiscal year 1992,
$3,000,000 for fiscal year 1993, and such sums as may be necessary for each of the fiscal years 1998 through 2002.
(2) AVAILABILITY.—Amounts appropriated under paragraph
(1) shall remain available until expended.
(k) TERMINATION OF PROGRAM.—No grant may be made under
this section after the aggregate amounts appropriated under subsection (j)(1) are equal to $36,000,000.
SEC. 338K. ø254s¿ NATIVE HAWAIIAN HEALTH SCHOLARSHIPS.

(a) Subject to the availability of funds appropriated under the
authority of subsection (d), the Secretary shall provide scholarship
assistance, pursuant to a contract with the Papa Ola Lokahi, to
students who—
(1) meet the requirements of section 338A(b), and
(2) are Native Hawaiians.
(b)(1) The scholarship assistance provided under subsection (a)
shall be provided under the same terms and subject to the same
conditions, regulations, and rules that apply to scholarship assistance provided under section 338A.
(2) The Native Hawaiian Health Scholarship program shall not
be administered by or through the Indian Health Service.
(c) For purposes of this section, the term ‘‘Native Hawaiian’’
means any individual who is—
(1) a citizen of the United States,
(2) a resident of the State of Hawaii, and
(3) a descendant of the aboriginal people, who prior to
1778, occupied and exercised sovereignty in the area that now
constitutes the State of Hawaii, as evidenced by—
(A) genealogical records,
(B) Kupuna (elders) or Kama’aina (long-term community residents) verification, or
(C) birth records of the State of Hawaii.
(d) There are authorized to be appropriated $1,800,000 for each
of the fiscal years 1990, 1991, and 1992 for the purpose of funding
the scholarship assistance provided under subsection (a).
SEC. 338L. ø254t¿ DEMONSTRATION PROJECT.
(a) PROGRAM AUTHORIZED.—The Secretary

shall establish a
demonstration project to provide for the participation of individuals
who are chiropractic doctors or pharmacists in the Loan Repayment Program described in section 338B.
(b) PROCEDURE.—An individual that receives assistance under
this section with regard to the program described in section 338B
shall comply with all rules and requirements described in such section (other than subparagraphs (A) and (B) of section 338B(b)(1))
in order to receive assistance under this section.
(c) LIMITATIONS.—
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(1) IN GENERAL.—The demonstration project described in
this section shall provide for the participation of individuals
who shall provide services in rural and urban areas.
(2) AVAILABILITY OF OTHER HEALTH PROFESSIONALS.—The
Secretary may not assign an individual receiving assistance
under this section to provide obligated service at a site unless—
(A) the Secretary has assigned a physician (as defined
in section 1861(r) of the Social Security Act) or other
health professional licensed to prescribe drugs to provide
obligated service at such site under section 338C or 338D;
and
(B) such physician or other health professional will
provide obligated service at such site concurrently with the
individual receiving assistance under this section.
(3) RULES OF CONSTRUCTION.—
(A) SUPERVISION OF INDIVIDUALS.—Nothing in this section shall be construed to require or imply that a physician
or other health professional licensed to prescribe drugs
must supervise an individual receiving assistance under
the demonstration project under this section, with respect
to such project.
(B) LICENSURE OF HEALTH PROFESSIONALS.—Nothing
in this section shall be construed to supersede State law
regarding licensure of health professionals.
(d) DESIGNATIONS.—The demonstration project described in
this section, and any providers who are selected to participate in
such project, shall not be considered by the Secretary in the designation of a health professional shortage area under section 332
during fiscal years 2002 through 2004.
(e) RULE OF CONSTRUCTION.—This section shall not be construed to require any State to participate in the project described
in this section.
(f) REPORT.—
(1) IN GENERAL.—The Secretary shall evaluate the participation of individuals in the demonstration projects under this
section and prepare and submit a report containing the information described in paragraph (2) to—
(A) the Committee on Health, Education, Labor, and
Pensions of the Senate;
(B) the Subcommittee on Labor, Health and Human
Services, and Education of the Committee on Appropriations of the Senate;
(C) the Committee on Energy and Commerce of the
House of Representatives; and
(D) the Subcommittee on Labor, Health and Human
Services, and Education of the Committee on Appropriations of the House of Representatives.
(2) CONTENT.—The report described in paragraph (1) shall
detail—
(A) the manner in which the demonstration project described in this section has affected access to primary care
services, patient satisfaction, quality of care, and health
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care services provided for traditionally underserved populations;
(B) how the participation of chiropractic doctors and
pharmacists in the Loan Repayment Program might affect
the designation of health professional shortage areas; and
(C) whether adding chiropractic doctors and pharmacists as permanent members of the National Health
Service Corps would be feasible and would enhance the effectiveness of the National Health Service Corps.
(g) AUTHORIZATION OF APPROPRIATIONS.—
(1) IN GENERAL.—There are authorized to be appropriated
to carry out this section, such sums as may be necessary for
fiscal years 2002 through 2004.
(2) FISCAL YEAR 2005.—If the Secretary determines and
certifies to Congress by not later than September 30, 2004,
that the number of individuals participating in the demonstration project established under this section is insufficient for
purposes of performing the evaluation described in subsection
(f)(1), the authorization of appropriations under paragraph (1)
shall be extended to include fiscal year 2005.
SEC. 338M. ø254u¿ PUBLIC HEALTH DEPARTMENTS.
(a) IN GENERAL.—To the extent that funds

are appropriated
under subsection (e), the Secretary shall establish a demonstration
project to provide for the participation of individuals who are eligible for the Loan Repayment Program described in section 338B and
who agree to complete their service obligation in a State health department that provides a significant amount of service to health
professional shortage areas or areas at risk of a public health emergency, as determined by the Secretary, or in a local or tribal health
department that serves a health professional shortage area or an
area at risk of a public health emergency.
(b) PROCEDURE.—To be eligible to receive assistance under subsection (a), with respect to the program described in section 338B,
an individual shall—
(1) comply with all rules and requirements described in
such section (other than section 338B(f)(1)(B)(iv)); and
(2) agree to serve for a time period equal to 2 years, or
such longer period as the individual may agree to, in a State,
local, or tribal health department, described in subsection (a).
(c) DESIGNATIONS.—The demonstration project described in
subsection (a), and any healthcare providers who are selected to
participate in such project, shall not be considered by the Secretary
in the designation of health professional shortage areas under section 332 during fiscal years 2007 through 2010.
(d) REPORT.—Not later than 3 years after the date of enactment of this section, the Secretary shall submit a report to the relevant committees of Congress that evaluates the participation of
individuals in the demonstration project under subsection (a), the
impact of such participation on State, local, and tribal health departments, and the benefit and feasibility of permanently allowing
such placements in the Loan Repayment Program.
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(e) 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 2007 through 2010.
Subpart IV—Home Health Services
HOME HEALTH SERVICES

SEC. 339. ø255¿ (a)(1) For the purpose of encouraging the establishment and initial operation of home health programs to provide home health services in areas in which such services are inadequate or not readily accessible, the Secretary may, in accordance
with the provisions of this section, make grants to public and nonprofit private entities and loans to proprietary entities to meet the
initial costs of establishing and operating such home health programs. Such grants and loans may include funds to provide training for paraprofessionals (including homemaker home health aides)
to provide home health services.
(2) In making grants and loans under this subsection, the Secretary shall—
(A) consider the relative needs of the several States for
home health services;
(B) give preference to areas in which a high percentage of
the population proposed to be served is composed of individuals
who are elderly, medically indigent, or disabled; and
(C) give special consideration to areas with inadequate
means of transportation to obtain necessary health services.
(3)(A) No loan may be made to a proprietary entity under this
section unless the application of such entity for such loan contains
assurances satisfactory to the Secretary that—
(i) at the time the application is made the entity is fiscally
sound;
(ii) the entity is unable to secure a loan for the project for
which the application is submitted from non-Federal lenders at
the rate of interest prevailing in the area in which the entity
is located; and
(iii) during the period of the loan, such entity will remain
fiscally sound.
(B) Loans under this section shall be made at an interest rate
comparable to the rate of interest prevailing on the date the loan
is made with respect to the marketable obligations of the United
States of comparable maturities, adjusted to provide for administrative costs.
(4) Applications for grants and loans under this subsection
shall be in such form and contain such information as the Secretary shall prescribe.
(5) There are authorized to be appropriated for grants and
loans under this subsection $5,000,000 for each of the fiscal years
ending on September 30, 1983, September 30, 1984, September 30,
1985, September 30, 1986, and September 30, 1987.
(b)(1) The Secretary may make grants to and enter into contracts with public and private entities to assist them in developing
appropriate training programs for paraprofessionals (including
homemaker home health aides) to provide home health services.
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(2) Any program established with a grant or contract under
this subsection to train homemaker home health aides shall—
(A) extend for at least forty hours, and consist of classroom
instruction and at least twenty hours (in the aggregate) of supervised clinical instruction directed toward preparing students to deliver home health services;
(B) be carried out under appropriate professional supervision and be designed to train students to maintain or enhance the personal care of an individual in his home in a manner which promotes the functional independence of the individual; and
(C) include training in—
(i) personal care services designed to assist an individual in the activities of daily living such as bathing, exercising, personal grooming, and getting in and out of bed;
and
(ii) household care services such as maintaining a safe
living environment, light housekeeping, and assisting in
providing good nutrition (by the purchasing and preparation of food).
(3) In making grants and entering into contracts under this
subsection, special consideration shall be given to entities which establish or will establish programs to provide training for persons
fifty years of age and older who wish to become paraprofessionals
(including homemaker home health aides) to provide home health
services.
(4) Applications for grants and contracts under this subsection
shall be in such form and contain such information as the Secretary shall prescribe.
(5) There are authorized to be appropriated for grants and contracts under this subsection $2,000,000 for each of the fiscal years
ending September 30, 1983, September 30, 1984, September 30,
1985, September 30, 1986, and September 30, 1987.
(c) The Secretary shall report to the Committee on Labor and
Human Resources of the Senate and the Committee on Energy and
Commerce of the House of Representatives on or before January 1,
1984, with respect to—
(1) the impact of grants made and contracts entered into
under subsections (a) and (b) (as such subsections were in effect prior to October 1, 1981);
(2) the need to continue grants and loans under subsections (a) and (b) (as such subsections are in effect on the
day after the date of enactment of the Orphan Drug Act); and
(3) the extent to which standards have been applied to the
training of personnel who provide home health services.
(d) For purposes of this section, the term ‘‘home health services’’ has the meaning prescribed for the term by section 1861(m)
of the Social Security Act.

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Subpart V—Healthy Communities Access Program
SEC. 340. ø256¿ GRANTS TO STRENGTHEN THE EFFECTIVENESS, EFFICIENCY, AND COORDINATION OF SERVICES FOR THE UNINSURED AND UNDERINSURED.
(a) IN GENERAL.—The Secretary may award grants to eligible

entities to assist in the development of integrated health care delivery systems to serve communities of individuals who are uninsured
and individuals who are underinsured—
(1) to improve the efficiency of, and coordination among,
the providers providing services through such systems;
(2) to assist communities in developing programs targeted
toward preventing and managing chronic diseases; and
(3) to expand and enhance the services provided through
such systems.
(b) ELIGIBLE ENTITIES.—To be eligible to receive a grant under
this section, an entity shall be an entity that—
(1) represents a consortium—
(A) whose principal purpose is to provide a broad
range of coordinated health care services for a community
defined in the entity’s grant application as described in
paragraph (2); and
(B) that includes at least one of each of the following
providers that serve the community (unless such provider
does not exist within the community, declines or refuses to
participate, or places unreasonable conditions on their participation)—
(i) a Federally qualified health center (as defined
in section 1861(aa) of the Social Security Act (42
U.S.C. 1395x(aa)));
(ii) a hospital with a low-income utilization rate
(as defined in section 1923(b)(3) of the Social Security
Act (42 U.S.C. 1396r–4(b)(3)), that is greater than 25
percent;
(iii) a public health department; and
(iv) an interested public or private sector health
care provider or an organization that has traditionally
served the medically uninsured and underserved; and
(2) submits to the Secretary an application, in such form
and manner as the Secretary shall prescribe, that—
(A) defines a community or geographic area of uninsured and underinsured individuals;
(B) identifies the providers who will participate in the
consortium’s program under the grant, and specifies each
provider’s contribution to the care of uninsured and underinsured individuals in the community, including the volume of care the provider provides to beneficiaries under
the medicare, medicaid, and State child health insurance
programs and to patients who pay privately for services;
(C) describes the activities that the applicant and the
consortium propose to perform under the grant to further
the objectives of this section;
(D) demonstrates the consortium’s ability to build on
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plication) for serving a community or geographic area of
uninsured and underinsured individuals by involving providers who have traditionally provided a significant volume of care for that community;
(E) demonstrates the consortium’s ability to develop
coordinated systems of care that either directly provide or
ensure the prompt provision of a broad range of high-quality, accessible services, including, as appropriate, primary,
secondary, and tertiary services, as well as substance
abuse treatment and mental health services in a manner
that assures continuity of care in the community or geographic area;
(F) provides evidence of community involvement in the
development, implementation, and direction of the program that the entity proposes to operate;
(G) demonstrates the consortium’s ability to ensure
that individuals participating in the program are enrolled
in public insurance programs for which the individuals are
eligible or know of private insurance programs where
available;
(H) presents a plan for leveraging other sources of revenue, which may include State and local sources and private grant funds, and integrating current and proposed
new funding sources in a way to assure long-term sustainability of the program;
(I) describes a plan for evaluation of the activities carried out under the grant, including measurement of
progress toward the goals and objectives of the program
and the use of evaluation findings to improve program performance;
(J) demonstrates fiscal responsibility through the use
of appropriate accounting procedures and appropriate
management systems;
(K) demonstrates the consortium’s commitment to
serve the community without regard to the ability of an individual or family to pay by arranging for or providing free
or reduced charge care for the poor; and
(L) includes such other information as the Secretary
may prescribe.
(c) LIMITATIONS.—
(1) NUMBER OF AWARDS.—
(A) IN GENERAL.—For each of fiscal years 2003, 2004,
2005, and 2006, the Secretary may not make more than 35
new awards under subsection (a) (excluding renewals of
such awards).
(B) RULE OF CONSTRUCTION.—This paragraph shall not
be construed to affect awards made before fiscal year 2003.
(2) IN GENERAL.—An eligible entity may not receive a
grant under this section (including with respect to any such
grant made before fiscal year 2003) for more than 3 consecutive fiscal years, except that such entity may receive such a
grant award for not more than 1 additional fiscal year if—
(A) the eligible entity submits to the Secretary a request for a grant for such an additional fiscal year;
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(B) the Secretary determines that extraordinary circumstances (as defined in paragraph (3)) justify the granting of such request; and
(C) the Secretary determines that granting such request is necessary to further the objectives described in
subsection (a).
(3) EXTRAORDINARY CIRCUMSTANCES.—
(A) IN GENERAL.—In paragraph (2), the term ‘‘extraordinary circumstances’’ means an event (or events) that is
outside of the control of the eligible entity that has prevented the eligible entity from fulfilling the objectives described by such entity in the application submitted under
subsection (b)(2).
(B) EXAMPLES.—Extraordinary circumstances include—
(i) natural disasters or other major disruptions to
the security or health of the community or geographic
area served by the eligible entity; or
(ii) a significant economic deterioration in the
community or geographic area served by such eligible
entity, that directly and adversely affects the entity
receiving an award under subsection (a).
(d) PRIORITIES.—In awarding grants under this section, the
Secretary—
(1) shall accord priority to applicants that demonstrate the
extent of unmet need in the community involved for a more coordinated system of care; and
(2) may accord priority to applicants that best promote the
objectives of this section, taking into consideration the extent
to which the application involved—
(A) identifies a community whose geographical area
has a high or increasing percentage of individuals who are
uninsured;
(B) demonstrates that the applicant has included in its
consortium providers, support systems, and programs that
have a tradition of serving uninsured individuals and
underinsured individuals in the community;
(C) shows evidence that the program would expand
utilization of preventive and primary care services for uninsured and underinsured individuals and families in the
community, including behavioral and mental health services, oral health services, or substance abuse services;
(D) proposes a program that would improve coordination between health care providers and appropriate social
service providers;
(E) demonstrates collaboration with State and local
governments;
(F) demonstrates that the applicant makes use of nonFederal contributions to the greatest extent possible; or
(G) demonstrates a likelihood that the proposed program will continue after support under this section ceases.
(e) USE OF FUNDS.—
(1) USE BY GRANTEES.—
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(A) IN GENERAL.—Except as provided in paragraphs
(2) and (3), a grantee may use amounts provided under
this section only for—
(i) direct expenses associated with achieving the
greater integration of a health care delivery system so
that the system either directly provides or ensures the
provision of a broad range of culturally competent
services, as appropriate, including primary, secondary,
and tertiary services, as well as substance abuse treatment and mental health services; and
(ii) direct patient care and service expansions to
fill identified or documented gaps within an integrated
delivery system.
(B) SPECIFIC USES.—The following are examples of
purposes for which a grantee may use grant funds under
this section, when such use meets the conditions stated in
subparagraph (A):
(i) Increases in outreach activities and closing
gaps in health care service.
(ii) Improvements to case management.
(iii) Improvements to coordination of transportation to health care facilities.
(iv) Development of provider networks and other
innovative models to engage physicians in voluntary
efforts to serve the medically underserved within a
community.
(v) Recruitment, training, and compensation of
necessary personnel.
(vi) Acquisition of technology for the purpose of coordinating care.
(vii) Improvements to provider communication, including implementation of shared information systems
or shared clinical systems.
(viii) Development of common processes for determining eligibility for the programs provided through
the system, including creating common identification
cards and single sliding scale discounts.
(ix) Development of specific prevention and disease management tools and processes.
(x) Translation services.
(xi) Carrying out other activities that may be appropriate to a community and that would increase access by the uninsured to health care, such as access
initiatives for which private entities provide non-Federal contributions to supplement the Federal funds
provided through the grants for the initiatives.
(2) DIRECT PATIENT CARE LIMITATION.—Not more than 15
percent of the funds provided under a grant awarded under
this section may be used for providing direct patient care and
services.
(3) RESERVATION OF FUNDS FOR NATIONAL PROGRAM PURPOSES.—The Secretary may use not more than 3 percent of
funds appropriated to carry out this section for providing technical assistance to grantees, obtaining assistance of experts
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and consultants, holding meetings, developing of tools, disseminating of information, evaluation, and carrying out activities
that will extend the benefits of programs funded under this
section to communities other than the community served by
the program funded.
(f) GRANTEE REQUIREMENTS.—
(1) EVALUATION OF EFFECTIVENESS.—A grantee under this
section shall—
(A) report to the Secretary annually regarding—
(i) progress in meeting the goals and measurable
objectives set forth in the grant application submitted
by the grantee under subsection (b); and
(ii) the extent to which activities conducted by
such grantee have—
(I) improved the effectiveness, efficiency, and
coordination of services for uninsured and underinsured individuals in the communities or geographic areas served by such grantee;
(II) resulted in the provision of better quality
health care for such individuals; and
(III) resulted in the provision of health care to
such individuals at lower cost than would have
been possible in the absence of the activities conducted by such grantee; and
(B) provide for an independent annual financial audit
of all records that relate to the disposition of funds received through the grant.
(2) PROGRESS.—The Secretary may not renew an annual
grant under this section for an entity for a fiscal year unless
the Secretary is satisfied that the consortium represented by
the entity has made reasonable and demonstrable progress in
meeting the goals and measurable objectives set forth in the
entity’s grant application for the preceding fiscal year.
(g) MAINTENANCE OF EFFORT.—With respect to activities for
which a grant under this section is authorized, the Secretary may
award such a grant only if the applicant for the grant, and each
of the participating providers, agree that the grantee and each such
provider will maintain its expenditures of non-Federal funds for
such activities at a level that is not less than the level of such expenditures during the fiscal year immediately preceding the fiscal
year for which the applicant is applying to receive such grant.
(h) TECHNICAL ASSISTANCE.—The Secretary may, either directly or by grant or contract, provide any entity that receives a
grant under this section with technical and other nonfinancial assistance necessary to meet the requirements of this section.
(i) EVALUATION OF PROGRAM.—Not later than September 30,
2005, the Secretary shall prepare and submit to the appropriate
committees of Congress a report that describes the extent to which
projects funded under this section have been successful in improving the effectiveness, efficiency, and coordination of services for uninsured and underinsured individuals in the communities or geographic areas served by such projects, including whether the
projects resulted in the provision of better quality health care for
such individuals, and whether such care was provided at lower
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costs, than would have been provided in the absence of such
projects.
(j) DEMONSTRATION AUTHORITY.—The Secretary may make
demonstration awards under this section to historically black
health professions schools for the purposes of—
(1) developing patient-based research infrastructure at historically black health professions schools, which have an affiliation, or affiliations, with any of the providers identified in
subsection (b)(1)(B);
(2) establishment of joint and collaborative programs of
medical research and data collection between historically black
health professions schools and such providers, whose goal is to
improve the health status of medically underserved populations; or
(3) supporting the research-related costs of patient care,
data collection, and academic training resulting from such affiliations.
(k) 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 2002 through 2006.
(l) DATE CERTAIN FOR TERMINATION OF PROGRAM.—Funds may
not be appropriated to carry out this section after September 30,
2006.
SEC. 340A. ø256a¿ PATIENT NAVIGATOR GRANTS.
(a) GRANTS.—The Secretary, acting through

the Administrator
of the Health Resources and Services Administration, may make
grants to eligible entities for the development and operation of
demonstration programs to provide patient navigator services to
improve health care outcomes. The Secretary shall coordinate with,
and ensure the participation of, the Indian Health Service, the National Cancer Institute, the Office of Rural Health Policy, and such
other offices and agencies as deemed appropriate by the Secretary,
regarding the design and evaluation of the demonstration programs.
(b) USE OF FUNDS.—The Secretary shall require each recipient
of a grant under this section to use the grant to recruit, assign,
train, and employ patient navigators who have direct knowledge of
the communities they serve to facilitate the care of individuals, including by performing each of the following duties:
(1) Acting as contacts, including by assisting in the coordination of health care services and provider referrals, for individuals who are seeking prevention or early detection services
for, or who following a screening or early detection service are
found to have a symptom, abnormal finding, or diagnosis of,
cancer or other chronic disease.
(2) Facilitating the involvement of community organizations in assisting individuals who are at risk for or who have
cancer or other chronic diseases to receive better access to
high-quality health care services (such as by creating partnerships with patient advocacy groups, charities, health care centers, community hospice centers, other health care providers,
or other organizations in the targeted community).

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(3) Notifying individuals of clinical trials and, on request,
facilitating enrollment of eligible individuals in these trials.
(4) Anticipating, identifying, and helping patients to overcome barriers within the health care system to ensure prompt
diagnostic and treatment resolution of an abnormal finding of
cancer or other chronic disease.
(5) Coordinating with the relevant health insurance ombudsman programs to provide information to individuals who
are at risk for or who have cancer or other chronic diseases
about health coverage, including private insurance, health care
savings accounts, and other publicly funded programs (such as
Medicare, Medicaid, health programs operated by the Department of Veterans Affairs or the Department of Defense, the
State children’s health insurance program, and any private or
governmental prescription assistance programs).
(6) Conducting ongoing outreach to health disparity populations, including the uninsured, rural populations, and other
medically underserved populations, in addition to assisting
other individuals who are at risk for or who have cancer or
other chronic diseases to seek preventative care.
(c) PROHIBITIONS.—
(1) REFERRAL FEES.—The Secretary shall require each recipient of a grant under this section to prohibit any patient
navigator providing services under the grant from accepting
any referral fee, kickback, or other thing of value in return for
referring an individual to a particular health care provider.
(2) LEGAL FEES AND COSTS.—The Secretary shall prohibit
the use of any grant funds received under this section to pay
any fees or costs resulting from any litigation, arbitration, mediation, or other proceeding to resolve a legal dispute.
(d) GRANT PERIOD.—
(1) IN GENERAL.—Subject to paragraphs (2) and (3), the
Secretary may award grants under this section for periods of
not more than 3 years.
(2) EXTENSIONS.—Subject to paragraph (3), the Secretary
may extend the period of a grant under this section. Each such
extension shall be for a period of not more than 1 year.
(3) LIMITATIONS ON GRANT PERIOD.—In carrying out this
section, the Secretary shall ensure that the total period of a
grant does not exceed 4 years.
(e) APPLICATION.—
(1) IN GENERAL.—To seek a grant under this section, an eligible entity shall submit an application to the Secretary in
such form, in such manner, and containing such information as
the Secretary may require.
(2) CONTENTS.—At a minimum, the Secretary shall require
each such application to outline how the eligible entity will establish baseline measures and benchmarks that meet the Secretary’s requirements to evaluate program outcomes.
(3) MINIMUM CORE PROFICIENCIES.—The Secretary shall
not award a grant to an entity under this section unless such
entity provides assurances that patient navigators recruited,
assigned, trained, or employed using grant funds meet minimum core proficiencies, as defined by the entity that submits
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the application, that are tailored for the main focus or intervention of the navigator involved.
(f) UNIFORM BASELINE MEASURES.—The Secretary shall establish uniform baseline measures in order to properly evaluate the
impact of the demonstration projects under this section.
(g) PREFERENCE.—In making grants under this section, the
Secretary shall give preference to eligible entities that demonstrate
in their applications plans to utilize patient navigator services to
overcome significant barriers in order to improve health care outcomes in their respective communities.
(h) DUPLICATION OF SERVICES.—An eligible entity that is receiving Federal funds for activities described in subsection (b) on
the date on which the entity submits an application under subsection (e) may not receive a grant under this section unless the
entity can demonstrate that amounts received under the grant will
be utilized to expand services or provide new services to individuals
who would not otherwise be served.
(i) COORDINATION WITH OTHER PROGRAMS.—The Secretary
shall ensure coordination of the demonstration grant program
under this section with existing authorized programs in order to facilitate access to high-quality health care services.
(j) STUDY; REPORTS.—
(1) FINAL REPORT BY SECRETARY.—Not later than 6 months
after the completion of the demonstration grant program under
this section, the Secretary shall conduct a study of the results
of the program and submit to the Congress a report on such
results that includes the following:
(A) An evaluation of the program outcomes, including—
(i) quantitative analysis of baseline and benchmark measures; and
(ii) aggregate information about the patients
served and program activities.
(B) Recommendations on whether patient navigator
programs could be used to improve patient outcomes in
other public health areas.
(2) INTERIM REPORTS BY SECRETARY.—The Secretary may
provide interim reports to the Congress on the demonstration
grant program under this section at such intervals as the Secretary determines to be appropriate.
(3) REPORTS BY GRANTEES.—The Secretary may require
grant recipients under this section to submit interim and final
reports on grant program outcomes.
(k) RULE OF CONSTRUCTION.—This section shall not be construed to authorize funding for the delivery of health care services
(other than the patient navigator duties listed in subsection (b)).
(l) DEFINITIONS.—In this section:
(1) The term ‘‘eligible entity’’ means a public or nonprofit
private health center (including a Federally qualified health
center (as that term is defined in section 1861(aa)(4) of the Social Security Act)), a health facility operated by or pursuant to
a contract with the Indian Health Service, a hospital, a cancer
center, a rural health clinic, an academic health center, or a
nonprofit entity that enters into a partnership or coordinates
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referrals with such a center, clinic, facility, or hospital to provide patient navigator services.
(2) The term ‘‘health disparity population’’ means a population that, as determined by the Secretary, has a significant
disparity in the overall rate of disease incidence, prevalence,
morbidity, mortality, or survival rates as compared to the
health status of the general population.
(3) The term ‘‘patient navigator’’ means an individual who
has completed a training program approved by the Secretary
to perform the duties listed in subsection (b).
(m) AUTHORIZATION OF APPROPRIATIONS.—
(1) IN GENERAL.—To carry out this section, there are authorized to be appropriated $2,000,000 for fiscal year 2006,
$5,000,000 for fiscal year 2007, $8,000,000 for fiscal year 2008,
$6,500,000 for fiscal year 2009, $3,500,000 for fiscal year 2010,
and such sums as may be necessary for each of fiscal years
2011 through 2015.
(2) AVAILABILITY.—The amounts appropriated pursuant to
paragraph (1) shall remain available for obligation through the
end of fiscal year 2015.
Subpart VII—Drug Pricing Agreements 1
LIMITATION ON PRICES OF DRUGS PURCHASED BY COVERED ENTITIES

SEC. 340B. ø256b¿ (a) REQUIREMENTS FOR AGREEMENT WITH
SECRETARY.—
(1) IN GENERAL.—The Secretary shall enter into an agreement with each manufacturer of covered outpatient drugs
under which the amount required to be paid (taking into account any rebate or discount, as provided by the Secretary) to
the manufacturer for covered outpatient drugs (other than
drugs described in paragraph (3)) purchased by a covered entity on or after the first day of the first month that begins after
the date of the enactment of this section, does not exceed an
amount equal to the average manufacturer price for the drug
under title XIX of the Social Security Act in the preceding calendar quarter, reduced by the rebate percentage described in
paragraph (2). Each such agreement shall require that the
manufacturer furnish the Secretary with reports, on a quarterly basis, of the price for each covered outpatient drug subject to the agreement that, according to the manufacturer, represents the maximum price that covered entities may permissibly be required to pay for the drug (referred to in this section
as the ‘‘ceiling price’’), and shall require that the manufacturer
offer each covered entity covered outpatient drugs for purchase
at or below the applicable ceiling price if such drug is made
available to any other purchaser at any price.
(2) REBATE PERCENTAGE DEFINED.—
(A) IN GENERAL.—For a covered outpatient drug purchased in a calendar quarter, the ‘‘rebate percentage’’ is
the amount (expressed as a percentage) equal to—
1 So in law. Former subpart VI was repealed by section 4(a)(3) of Public Law 104–299 (110
Stat. 3645).

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(i) the average total rebate required under section
1927(c) of the Social Security Act with respect to the
drug (for a unit of the dosage form and strength involved) during the preceding calendar quarter; divided
by
(ii) the average manufacturer price for such a unit
of the drug during such quarter.
(B) OVER THE COUNTER DRUGS.—
(i) IN GENERAL.—For purposes of subparagraph
(A), in the case of over the counter drugs, the ‘‘rebate
percentage’’ shall be determined as if the rebate required under section 1927(c) of the Social Security Act
is based on the applicable percentage provided under
section 1927(c)(3) of such Act.
(ii) DEFINITION.—The term ‘‘over the counter
drug’’ means a drug that may be sold without a prescription and which is prescribed by a physician (or
other persons authorized to prescribe such drug under
State law).
(3) DRUGS PROVIDED UNDER STATE MEDICAID PLANS.—
Drugs described in this paragraph are drugs purchased by the
entity for which payment is made by the State under the State
plan for medical assistance under title XIX of the Social Security Act.
(4) COVERED ENTITY DEFINED.—In this section, the term
‘‘covered entity’’ means an entity that meets the requirements
described in paragraph (5) and is one of the following:
(A) A Federally-qualified health center (as defined in
section 1905(l)(2)(B) of the Social Security Act).
(B) An entity receiving a grant under section 340A 1.
(C) A family planning project receiving a grant or contract under section 1001.
(D) An entity receiving a grant under subpart II of
part C of title XXVI (relating to categorical grants for outpatient early intervention services for HIV disease).
(E) A State-operated AIDS drug purchasing assistance
program receiving financial assistance under title XXVI.
(F) A black lung clinic receiving funds under section
427(a) of the Black Lung Benefits Act.
(G) A comprehensive hemophilia diagnostic treatment
center receiving a grant under section 501(a)(2) of the Social Security Act.
(H) A Native Hawaiian Health Center receiving funds
under the Native Hawaiian Health Care Act of 1988.
(I) An urban Indian organization receiving funds
under title V of the Indian Health Care Improvement Act.
(J) Any entity receiving assistance under title XXVI
(other than a State or unit of local government or an entity
described in subparagraph (D)), but only if the entity is
certified by the Secretary pursuant to paragraph (7).
(K) An entity receiving funds under section 318 (relating to treatment of sexually transmitted diseases) or sec1 See

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tion 317(j)(2) (relating to treatment of tuberculosis)
through a State or unit of local government, but only if the
entity is certified by the Secretary pursuant to paragraph
(7).
(L) A subsection (d) hospital (as defined in section
1886(d)(1)(B) of the Social Security Act) that—
(i) is owned or operated by a unit of State or local
government, is a public or private non-profit corporation which is formally granted governmental powers
by a unit of State or local government, or is a private
non-profit hospital which has a contract with a State
or local government to provide health care services to
low income individuals who are not entitled to benefits
under title XVIII of the Social Security Act or eligible
for assistance under the State plan under this title;
(ii) for the most recent cost reporting period that
ended before the calendar quarter involved, had a disproportionate share adjustment percentage (as determined under section 1886(d)(5)(F) of the Social Security Act) greater than 11.75 percent or was described
in section 1886(d)(5)(F)(i)(II) of such Act; and
(iii) does not obtain covered outpatient drugs
through a group purchasing organization or other
group purchasing arrangement.
(M) A children’s hospital excluded from the Medicare
prospective payment system pursuant to section
1886(d)(1)(B)(iii) of the Social Security Act, or a free-standing cancer hospital excluded from the Medicare prospective
payment system pursuant to section 1886(d)(1)(B)(v) of the
Social Security Act, that would meet the requirements of
subparagraph (L), including the disproportionate share adjustment percentage requirement under clause (ii) of such
subparagraph, if the hospital were a subsection (d) hospital as defined by section 1886(d)(1)(B) of the Social Security Act.
(N) An entity that is a critical access hospital (as determined under section 1820(c)(2) of the Social Security
Act), and that meets the requirements of subparagraph
(L)(i).
(O) An entity that is a rural referral center, as defined
by section 1886(d)(5)(C)(i) of the Social Security Act, or a
sole community hospital, as defined by section
1886(d)(5)(C)(iii) of such Act, and that both meets the requirements of subparagraph (L)(i) and has a disproportionate share adjustment percentage equal to or greater
than 8 percent.
(5) REQUIREMENTS FOR COVERED ENTITIES.—
(A) PROHIBITING DUPLICATE DISCOUNTS OR REBATES.—
(i) IN GENERAL.—A covered entity shall not request payment under title XIX of the Social Security
Act for medical assistance described in section
1905(a)(12) of such Act with respect to a drug that is
subject to an agreement under this section if the drug
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is subject to the payment of a rebate to the State
under section 1927 of such Act.
(ii) ESTABLISHMENT OF MECHANISM.—The Secretary shall establish a mechanism to ensure that covered entities comply with clause (i). If the Secretary
does not establish a mechanism within 12 months
under the previous sentence, the requirements of section 1927(a)(5)(C) of the Social Security Act shall
apply.
(B) PROHIBITING RESALE OF DRUGS.—With respect to
any covered outpatient drug that is subject to an agreement under this subsection, a covered entity shall not resell or otherwise transfer the drug to a person who is not
a patient of the entity.
(C) AUDITING.—A covered entity shall permit the Secretary and the manufacturer of a covered outpatient drug
that is subject to an agreement under this subsection with
the entity (acting in accordance with procedures established by the Secretary relating to the number, duration,
and scope of audits) to audit at the Secretary’s or the manufacturer’s expense the records of the entity that directly
pertain to the entity’s compliance with the requirements
described in subparagraphs (A) or (B) with respect to
drugs of the manufacturer.
(D) ADDITIONAL SANCTION FOR NONCOMPLIANCE.—If
the Secretary finds, after audit as described in subparagraph (C) and after notice and hearing, that a covered entity is in violation of a requirement described in subparagraphs 1 (A) or (B), the covered entity shall be liable to the
manufacturer of the covered outpatient drug that is the
subject of the violation in an amount equal to the reduction in the price of the drug (as described in subparagraph
(A)) provided under the agreement between the entity and
the manufacturer under this paragraph.
(6) TREATMENT OF DISTINCT UNITS OF HOSPITALS.—In the
case of a covered entity that is a distinct part of a hospital, the
hospital shall not be considered a covered entity under this
paragraph unless the hospital is otherwise a covered entity
under this subsection.
(7) CERTIFICATION OF CERTAIN COVERED ENTITIES.—
(A) DEVELOPMENT OF PROCESS.—Not later than 60
days after the date of enactment of this subsection, the
Secretary shall develop and implement a process for the
certification of entities described in subparagraphs (J) and
(K) of paragraph (4).
(B) INCLUSION OF PURCHASE INFORMATION.—The process developed under subparagraph (A) shall include a requirement that an entity applying for certification under
this paragraph submit information to the Secretary concerning the amount such entity expended for covered outpatient drugs in the preceding year so as to assist the Sec1 So in law. See section 602(a) of Public Law 102–585 (106 Stat. 4967). Probably should be
‘‘subparagraph’’.

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retary in evaluating the validity of the entity’s subsequent
purchases of covered outpatient drugs at discounted prices.
(C) CRITERIA.—The Secretary shall make available to
all manufacturers of covered outpatient drugs a description of the criteria for certification under this paragraph.
(D) LIST OF PURCHASERS AND DISPENSERS.—The certification process developed by the Secretary under subparagraph (A) shall include procedures under which each State
shall, not later than 30 days after the submission of the
descriptions under subparagraph (C), prepare and submit
a report to the Secretary that contains a list of entities described in subparagraphs (J) and (K) of paragraph (4) that
are located in the State.
(E) RECERTIFICATION.—The Secretary shall require the
recertification of entities certified pursuant to this paragraph on a not more frequent than annual basis, and shall
require that such entities submit information to the Secretary to permit the Secretary to evaluate the validity of
subsequent purchases by such entities in the same manner
as that required under subparagraph (B).
(8) DEVELOPMENT OF PRIME VENDOR PROGRAM.—The Secretary shall establish a prime vendor program under which
covered entities may enter into contracts with prime vendors
for the distribution of covered outpatient drugs. If a covered
entity obtains drugs directly from a manufacturer, the manufacturer shall be responsible for the costs of distribution.
(9) NOTICE TO MANUFACTURERS.—The Secretary shall notify manufacturers of covered outpatient drugs and single State
agencies under section 1902(a)(5) of the Social Security Act of
the identities of covered entities under this paragraph, and of
entities that no longer meet the requirements of paragraph (5)
or that are no longer certified pursuant to paragraph (7).
(10) NO PROHIBITION ON LARGER DISCOUNT.—Nothing in
this subsection shall prohibit a manufacturer from charging a
price for a drug that is lower than the maximum price that
may be charged under paragraph (1).
(b) OTHER DEFINITIONS 1.—
(1) IN GENERAL.—In this section, the terms ‘‘average manufacturer price’’, ‘‘covered outpatient drug’’, and ‘‘manufacturer’’ have the meaning given such terms in section 1927(k)
of the Social Security Act.
(2) 2 COVERED DRUG.—In this section, the term ‘‘covered
drug’’—
(A) means a covered outpatient drug (as defined in
section 1927(k)(2) of the Social Security Act); and
(B) includes, notwithstanding paragraph (3)(A) of section 1927(k) of such Act, a drug used in connection with
1 The

amendment made by section 7101(b)(2)(A) of Public Law 111–148 strikes ‘‘OTHER DEFIand all that follows through ‘‘In this section’’ and inserts ‘‘OTHER DEFINITIONS.—
(1) IN GENERAL.—In this section’’.

NITION’’

The heading of such amendment should have been to strike ‘‘OTHER DEFINITIONS’’. The
amendment made by such section has been carried out to reflect the probable intent of Congress.
2 There are no references to the term ‘‘covered drug’’ in this section.

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an inpatient or outpatient service provided by a hospital
described in subparagraph (L), (M), (N), or (O) of subsection (a)(4) that is enrolled to participate in the drug discount program under this section.
(d) 3 IMPROVEMENTS IN PROGRAM INTEGRITY.—
(1) MANUFACTURER COMPLIANCE.—
(A) IN GENERAL.—From amounts appropriated under
paragraph (4), the Secretary shall provide for improvements in compliance by manufacturers with the requirements of this section in order to prevent overcharges and
other violations of the discounted pricing requirements
specified in this section.
(B) IMPROVEMENTS.—The improvements described in
subparagraph (A) shall include the following:
(i) The development of a system to enable the Secretary to verify the accuracy of ceiling prices calculated by manufacturers under subsection (a)(1) and
charged to covered entities, which shall include the
following:
(I) Developing and publishing through an appropriate policy or regulatory issuance, precisely
defined standards and methodology for the calculation of ceiling prices under such subsection.
(II) Comparing regularly the ceiling prices calculated by the Secretary with the quarterly pricing data that is reported by manufacturers to the
Secretary.
(III) Performing spot checks of sales transactions by covered entities.
(IV) Inquiring into the cause of any pricing
discrepancies that may be identified and either
taking, or requiring manufacturers to take, such
corrective action as is appropriate in response to
such price discrepancies.
(ii) The establishment of procedures for manufacturers to issue refunds to covered entities in the event
that there is an overcharge by the manufacturers, including the following:
(I) Providing the Secretary with an explanation of why and how the overcharge occurred,
how the refunds will be calculated, and to whom
the refunds will be issued.
(II) Oversight by the Secretary to ensure that
the refunds are issued accurately and within a
reasonable period of time, both in routine instances of retroactive adjustment to relevant pric3 In law, there is no subsection (c) in section 340B of the Public Health Service Act. Subsection
(d) of section 340B of the Public Health Service, as in effect before the enactment of Public Law
111–148, was redesignated as subsection (c) by section 2501(f)(1)(C) of Public Law 111–148,
amended to read by section 7101(d) of Public Law 111–148, and stricken by section 2302(2) of
Public Law 111–152. Subsection (d) of section 340B of the Public Health Service, as currently
in effect, is shown according to the probable intent of the Congress. Section 7102(a) of Public
Law 111–148 does not execute because it amends to read a nonexistent subsection (d). Notably,
section 2302(3) of Public Law 111–152 assumes that section 7102(a) of Public Law 111–148 executed properly and makes amendments to subsection (d).

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ing data and exceptional circumstances such as
erroneous or intentional overcharging for covered
outpatient drugs.
(iii) The provision of access through the Internet
website of the Department of Health and Human
Services to the applicable ceiling prices for covered
outpatient drugs as calculated and verified by the Secretary in accordance with this section, in a manner
(such as through the use of password protection) that
limits such access to covered entities and adequately
assures security and protection of privileged pricing
data from unauthorized re-disclosure.
(iv) The development of a mechanism by which—
(I) rebates and other discounts provided by
manufacturers to other purchasers subsequent to
the sale of covered outpatient drugs to covered entities are reported to the Secretary; and
(II) appropriate credits and refunds are issued
to covered entities if such discounts or rebates
have the effect of lowering the applicable ceiling
price for the relevant quarter for the drugs involved.
(v) Selective auditing of manufacturers and wholesalers to ensure the integrity of the drug discount program under this section.
(vi) The imposition of sanctions in the form of civil
monetary penalties, which—
(I) shall be assessed according to standards
established in regulations to be promulgated by
the Secretary not later than 180 days after the
date of enactment of the Patient Protection and
Affordable Care Act;
(II) shall not exceed $5,000 for each instance
of overcharging a covered entity that may have occurred; and
(III) shall apply to any manufacturer with an
agreement under this section that knowingly and
intentionally charges a covered entity a price for
purchase of a drug that exceeds the maximum applicable price under subsection (a)(1).
(2) COVERED ENTITY COMPLIANCE.—
(A) IN GENERAL.—From amounts appropriated under
paragraph (4), the Secretary shall provide for improvements in compliance by covered entities with the requirements of this section in order to prevent diversion and violations of the duplicate discount provision and other requirements specified under subsection (a)(5).
(B) IMPROVEMENTS.—The improvements described in
subparagraph (A) shall include the following:
(i) The development of procedures to enable and
require covered entities to regularly update (at least
annually) the information on the Internet website of
the Department of Health and Human Services relating to this section.
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(ii) The development of a system for the Secretary
to verify the accuracy of information regarding covered
entities that is listed on the website described in
clause (i).
(iii) The development of more detailed guidance
describing methodologies and options available to covered entities for billing covered outpatient drugs to
State Medicaid agencies in a manner that avoids duplicate discounts pursuant to subsection (a)(5)(A).
(iv) The establishment of a single, universal, and
standardized identification system by which each covered entity site can be identified by manufacturers,
distributors, covered entities, and the Secretary for
purposes of facilitating the ordering, purchasing, and
delivery of covered outpatient drugs under this section, including the processing of chargebacks for such
drugs.
(v) The imposition of sanctions, in appropriate
cases as determined by the Secretary, additional to
those to which covered entities are subject under subsection (a)(5)(D), through one or more of the following
actions:
(I) Where a covered entity knowingly and intentionally violates subsection (a)(5)(B), the covered entity shall be required to pay a monetary
penalty to a manufacturer or manufacturers in
the form of interest on sums for which the covered
entity is found liable under subsection (a)(5)(D),
such interest to be compounded monthly and
equal to the current short term interest rate as
determined by the Federal Reserve for the time
period for which the covered entity is liable.
(II) Where the Secretary determines a violation of subsection (a)(5)(B) was systematic and
egregious as well as knowing and intentional, removing the covered entity from the drug discount
program under this section and disqualifying the
entity from re-entry into such program for a reasonable period of time to be determined by the
Secretary.
(III) Referring matters to appropriate Federal
authorities within the Food and Drug Administration, the Office of Inspector General of Department of Health and Human Services, or other
Federal agencies for consideration of appropriate
action under other Federal statutes, such as the
Prescription Drug Marketing Act (21 U.S.C. 353).
(3) ADMINISTRATIVE DISPUTE RESOLUTION PROCESS.—
(A) IN GENERAL.—Not later than 180 days after the
date of enactment of the Patient Protection and Affordable
Care Act, the Secretary shall promulgate regulations to establish and implement an administrative process for the
resolution of claims by covered entities that they have
been overcharged for drugs purchased under this section,
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and claims by manufacturers, after the conduct of audits
as authorized by subsection (a)(5)(C), of violations of subsections (a)(5)(A) or (a)(5)(B), including appropriate procedures for the provision of remedies and enforcement of determinations made pursuant to such process through
mechanisms and sanctions described in paragraphs (1)(B)
and (2)(B).
(B) DEADLINES AND PROCEDURES.—Regulations promulgated by the Secretary under subparagraph (A) shall—
(i) designate or establish a decision-making official
or decision-making body within the Department of
Health and Human Services to be responsible for reviewing and finally resolving claims by covered entities that they have been charged prices for covered
outpatient drugs in excess of the ceiling price described in subsection (a)(1), and claims by manufacturers that violations of subsection (a)(5)(A) or (a)(5)(B)
have occurred;
(ii) establish such deadlines and procedures as
may be necessary to ensure that claims shall be resolved fairly, efficiently, and expeditiously;
(iii) establish procedures by which a covered entity
may discover and obtain such information and documents from manufacturers and third parties as may
be relevant to demonstrate the merits of a claim that
charges for a manufacturer’s product have exceeded
the applicable ceiling price under this section, and
may submit such documents and information to the
administrative official or body responsible for adjudicating such claim;
(iv) require that a manufacturer conduct an audit
of a covered entity pursuant to subsection (a)(5)(C) as
a prerequisite to initiating administrative dispute resolution proceedings against a covered entity;
(v) permit the official or body designated under
clause (i), at the request of a manufacturer or manufacturers, to consolidate claims brought by more than
one manufacturer against the same covered entity
where, in the judgment of such official or body, consolidation is appropriate and consistent with the goals
of fairness and economy of resources; and
(vi) include provisions and procedures to permit
multiple covered entities to jointly assert claims of
overcharges by the same manufacturer for the same
drug or drugs in one administrative proceeding, and
permit such claims to be asserted on behalf of covered
entities by associations or organizations representing
the interests of such covered entities and of which the
covered entities are members.
(C) FINALITY OF ADMINISTRATIVE RESOLUTION.—The
administrative resolution of a claim or claims under the
regulations promulgated under subparagraph (A) shall be
a final agency decision and shall be binding upon the parMarch 13, 2013

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ties involved, unless invalidated by an order of a court of
competent jurisdiction.
(4) AUTHORIZATION OF APPROPRIATIONS.—There are authorized to be appropriated to carry out this subsection, such sums
as may be necessary for fiscal year 2010 and each succeeding
fiscal year.
(e) 1 EXCLUSION OF ORPHAN DRUGS FOR CERTAIN COVERED ENTITIES.—For covered entities described in subparagraph (M) (other
than a children’s hospital described in subparagraph (M)), (N), or
(O) of subsection (a)(4), the term ‘‘covered outpatient drug’’ shall
not include a drug designated by the Secretary under section 526
of the Federal Food, Drug, and Cosmetic Act for a rare disease or
condition.
Subpart VIII—Bulk Purchases of Vaccines for Certain Programs
BULK PURCHASES OF VACCINES FOR CERTAIN PROGRAMS

SEC. 340C. ø256c¿ (a) AGREEMENTS FOR PURCHASES.—
(1) IN GENERAL.—Not later than 180 days after the date of
the enactment of the Preventive Health Amendments of 1992 1,
the Secretary, acting through the Director of the Centers for
Disease Control and Prevention and in consultation with the
Administrator of the Health Resources and Services Administration, shall enter into negotiations with manufacturers of
vaccines for the purpose of establishing and maintaining agreements under which entities described in paragraph (2) may
purchase vaccines from the manufacturers at the prices specified in the agreements.
(2) RELEVANT ENTITIES.—The entities referred to in paragraph (1) are entities that provide immunizations against vaccine-preventable diseases with assistance provided under section 330.
(b) NEGOTIATION OF PRICES.—In carrying out subsection (a),
the Secretary shall, to the extent practicable, ensure that the prices
provided for in agreements under such subsection are comparable
to the prices provided for in agreements negotiated by the Secretary on behalf of grantees under section 317(j)(1).
(c) AUTHORITY OF SECRETARY.—In carrying out subsection (a),
the Secretary, in the discretion of the Secretary, may enter into the
agreements described in such subsection (and may decline to enter
into such agreements), may modify such agreements, may extend
such agreements, and may terminate such agreements.
(d) RULE OF CONSTRUCTION.—This section may not be construed as requiring any State to reduce or terminate the supply of
vaccines provided by the State to any of the entities described in
subsection (a)(2).
1 Subsection (e) is shown according to the probable intent of Congress. Section 2302(4) of Public Law 111–152 inserts subsection (e) ‘‘after subsection (d)’’. See note in section 340B(d) of the
Public Health Service Act regarding the inclusion of subsection (d) to reflect the probable intent
of Congress.

Section 204(a)(1) of Public Law 111–309 amends subsection (e) of section 340B (effective on
the enactment of such Public Law).
1 Enacted October 27, 1992.

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BREAST AND CERVICAL CANCER INFORMATION

SEC. 340D. ø256d¿ (a) IN GENERAL.—As a condition of receiving grants, cooperative agreements, or contracts under this Act,
each of the entities specified in subsection (c) shall, to the extent
determined to be appropriate by the Secretary, make available information concerning breast and cervical cancer.
(b) CERTAIN AUTHORITIES.—In carrying out subsection (a), an
entity specified in subsection (c)—
(1) may make the information involved available to such
individuals as the entity determines appropriate;
(2) may, as appropriate, provide information under subsection (a) on the need for self-examination of the breasts and
on the skills for such self-examinations;
(3) shall provide information under subsection (a) in the
language and cultural context most appropriate to the individuals to whom the information is provided; and
(4) shall refer such clients as the entities determine appropriate for breast and cervical cancer screening, treatment, or
other appropriate services.
(c) RELEVANT ENTITIES.—The entities specified in this subsection are the following:
(1) Entities receiving assistance under section 317F (relating to tuberculosis) 1.
(2) Entities receiving assistance under section 318 (relating to sexually transmitted diseases).
(3) Migrant health centers receiving assistance under section 329 2.
(4) Community health centers receiving assistance under
section 330 2.
(5) Entities receiving assistance under section 330(h) (relating to homeless individuals).
(6) Entities receiving assistance under section 340A 2 (relating to health services for residents of public housing).
(7) Entities providing services with assistance under title
V or title XIX.
(8) Entities receiving assistance under section 1001 (relating to family planning).
(9) Entities receiving assistance under title XXVI (relating
to services with respect to acquired immune deficiency syndrome).
(10) Non-Federal entities authorized under the Indian SelfDetermination Act.
Subpart IX—Support of Graduate Medical Education Programs in
Children’s Hospitals
SEC. 340E. ø256e¿ PROGRAM OF PAYMENTS TO CHILDREN’S HOSPITALS THAT OPERATE GRADUATE MEDICAL EDUCATION
PROGRAMS.
(a) PAYMENTS.—The Secretary shall make two payments under

this section to each children’s hospital for each of fiscal years 2000
1 The reference to section 317F is so in law. See section 2502(b) of Public Law 106–310 (114
Stat. 1163). Section 317E relates to tuberculosis, not section 317F.
2 See footnote for section 217(a).

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through 2005 and each of fiscal years 2007 through 2011, one for
the direct expenses and the other for indirect expenses associated
with operating approved graduate medical residency training programs. The Secretary shall promulgate regulations pursuant to the
rulemaking requirements of title 5, United States Code, which
shall govern payments made under this subpart.
(b) AMOUNT OF PAYMENTS.—
(1) IN GENERAL.—Subject to paragraphs (2) and (3), the
amounts payable under this section to a children’s hospital 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 operating approved graduate medical residency training programs.
(B) INDIRECT EXPENSE AMOUNT.—The amount determined under subsection (d) for indirect expenses associated with the treatment of more severely ill patients and
the additional costs relating to teaching residents in such
programs.
(2) CAPPED AMOUNT.—
(A) IN GENERAL.—The total of the payments made to
children’s hospitals under paragraph (1)(A) or paragraph
(1)(B) in a fiscal year shall not exceed the funds appropriated under paragraph (1) or (2), respectively, of subsection (f) for such payments for that fiscal year.
(B) PRO RATA REDUCTIONS OF PAYMENTS FOR DIRECT
EXPENSES.—If the Secretary determines that the amount of
funds appropriated under subsection (f)(1) for a fiscal year
is insufficient to provide the total amount of payments otherwise due for such periods under paragraph (1)(A), the
Secretary shall reduce the amounts so payable on a pro
rata basis to reflect such shortfall.
(3) ANNUAL REPORTING REQUIRED.—
(A) REDUCTION IN PAYMENT FOR FAILURE TO REPORT.—
(i) IN GENERAL.—The amount payable under this
section to a children’s hospital for a fiscal year (beginning with fiscal year 2008 and after taking into account paragraph (2)) shall be reduced by 25 percent if
the Secretary determines that—
(I) the hospital has failed to provide the Secretary, as an addendum to the hospital’s application under this section for such fiscal year, the report required under subparagraph (B) for the previous fiscal year; or
(II) such report fails to provide the information required under any clause of such subparagraph.
(ii) NOTICE AND OPPORTUNITY TO PROVIDE MISSING
INFORMATION.—Before imposing a reduction under
clause (i) on the basis of a hospital’s failure to provide
information described in clause (i)(II), the Secretary
shall provide notice to the hospital of such failure and
the Secretary’s intention to impose such reduction and
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shall provide the hospital with the opportunity to provide the required information within a period of 30
days beginning on the date of such notice. If the hospital provides such information within such period, no
reduction shall be made under clause (i) on the basis
of the previous failure to provide such information.
(B) ANNUAL REPORT.—The report required under this
subparagraph for a children’s hospital 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:
(i) The types of resident training programs that
the hospital provided for residents described in subparagraph (C), such as general pediatrics, internal
medicine/pediatrics, and pediatric subspecialties, including both medical subspecialties certified by the
American Board of Pediatrics (such as pediatric gastroenterology) and non-medical subspecialties approved by other medical certification boards (such as
pediatric surgery).
(ii) The number of training positions for residents
described in subparagraph (C), the number of such positions recruited to fill, and the number of such positions filled.
(iii) The types of training that the hospital provided for residents described in subparagraph (C) related to the health care needs of different populations,
such as children who are underserved for reasons of
family income or geographic location, including rural
and urban areas.
(iv) The changes in residency training for residents described in subparagraph (C) which the hospital has made during such residency academic year
(except that the first report submitted by the hospital
under this subparagraph shall be for such changes
since the first year in which the hospital received payment under this section), including—
(I) changes in curricula, training experiences,
and types of training programs, and benefits that
have resulted from such changes; and
(II) changes for purposes of training the residents in the measurement and improvement of
the quality and safety of patient care.
(v) The numbers of residents described in subparagraph (C) who completed their residency training
at the end of such residency academic year and care
for children within the borders of the service area of
the hospital or within the borders of the State in
which the hospital is located. Such numbers shall be
disaggregated with respect to residents who completed
residencies in general pediatrics or internal medicine/
pediatrics, subspecialty residencies, and dental
residencies.
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(C) RESIDENTS.—The residents described in this subparagraph are those who—
(i) are in full-time equivalent resident training positions in any training program sponsored by the hospital; or
(ii) are in a training program sponsored by an entity other than the hospital, but who spend more than
75 percent of their training time at the hospital.
(D) REPORT TO CONGRESS.—Not later than the end of
fiscal year 2011, the Secretary, acting through the Administrator of the Health Resources and Services Administration, shall submit a report to the Congress—
(i) summarizing the information submitted in reports to the Secretary under subparagraph (B);
(ii) describing the results of the program carried
out under this section; and
(iii) making recommendations for improvements to
the program.
(c) AMOUNT OF PAYMENT FOR DIRECT GRADUATE MEDICAL EDUCATION.—
(1) IN GENERAL.—The amount determined under this subsection for payments to a children’s hospital 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 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 hospital’s graduate approved medical residency training programs (as determined under section
1886(h)(4) of the Social Security Act during the fiscal year.
(2) UPDATED PER RESIDENT AMOUNT FOR DIRECT GRADUATE
MEDICAL EDUCATION.—The updated per resident amount for direct graduate medical education for a hospital for a fiscal year
is an amount determined as follows:
(A) DETERMINATION OF HOSPITAL SINGLE PER RESIDENT
AMOUNT.—The Secretary shall compute for each hospital
operating an approved graduate medical education program (regardless of whether or not it is a children’s hospital) a single per resident amount equal to the average
(weighted by number of full-time equivalent residents) of
the primary care per resident amount and the non-primary
care per resident amount computed under section
1886(h)(2) of the Social Security Act for cost reporting periods ending during fiscal year 1997.
(B) DETERMINATION OF WAGE AND NON-WAGE-RELATED
PROPORTION OF THE SINGLE PER RESIDENT AMOUNT.—The
Secretary shall estimate the average proportion of the single per resident amounts computed under subparagraph
(A) that is attributable to wages and wage-related costs.
(C) STANDARDIZING PER RESIDENT AMOUNTS.—The Secretary shall establish a standardized per resident amount
for each such hospital—
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(i) by dividing the single per resident amount computed under subparagraph (A) into a wage-related portion and a non-wage-related portion by applying the
proportion determined under subparagraph (B);
(ii) by dividing the wage-related portion by the
factor applied under section 1886(d)(3)(E) of the Social
Security Act for discharges occurring during fiscal
year 1999 for the hospital’s area; and
(iii) by adding the non-wage-related portion to the
amount computed under clause (ii).
(D) DETERMINATION OF NATIONAL AVERAGE.—The Secretary shall compute a national average per resident
amount equal to the average of the standardized per resident amounts computed under subparagraph (C) for such
hospitals, with the amount for each hospital weighted by
the average number of full-time equivalent residents at
such hospital.
(E) APPLICATION TO INDIVIDUAL HOSPITALS.—The Secretary shall compute for each such hospital that is a children’s hospital a per resident amount—
(i) by dividing the national average per resident
amount computed under subparagraph (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 for discharges occurring during the preceding fiscal year for the hospital’s area; and
(iii) by adding the non-wage-related portion to the
amount computed under clause (ii).
(F) UPDATING RATE.—The Secretary shall update such
per resident amount for each such children’s hospital by
the estimated percentage increase in the consumer price
index for all urban consumers during the period beginning
October 1997 and ending with the midpoint of the Federal
fiscal year for which payments are made.
(d) AMOUNT OF PAYMENT FOR INDIRECT MEDICAL EDUCATION.—
(1) IN GENERAL.—The amount determined under this subsection for payments to a children’s hospital for indirect expenses associated with the treatment of more severely ill patients and the additional costs associated with the teaching of
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) take into account variations in case mix among
children’s hospitals and the ratio of the number of fulltime equivalent residents in the hospitals’ approved graduate medical residency training programs to beds (but excluding beds or bassinets assigned to healthy newborn infants); and
(B) assure that the aggregate of the payments for indirect expenses associated with the treatment of more seMarch 13, 2013

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verely ill patients and the additional costs related to the
teaching of residents under this section in a fiscal year are
equal to the amount appropriated for such expenses for the
fiscal year involved under subsection (f)(2).
(e) MAKING OF PAYMENTS.—
(1) INTERIM PAYMENTS.—The Secretary shall determine,
before the beginning of each fiscal year involved for which payments may be made for a hospital under this section, the
amounts of the payments for direct graduate medical education
and indirect medical education for such fiscal year and shall
(subject to paragraph (2)) make the payments of such amounts
in 12 equal interim installments during such period. Such interim payments to each individual hospital shall be based on
the number of residents reported in the hospital’s most recently filed Medicare cost report prior to the application date
for the Federal fiscal year for which the interim payment
amounts are established. In the case of a hospital that does not
report residents on a Medicare cost report, such interim payments shall be based on the number of residents trained during the hospital’s most recently completed Medicare cost report
filing period.
(2) WITHHOLDING.—The Secretary shall withhold up to 25
percent from each interim installment for direct and indirect
graduate medical education paid under paragraph (1) as necessary to ensure a hospital will not be overpaid on an interim
basis.
(3) RECONCILIATION.—Prior to the end of each fiscal year,
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 and 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.
(f) AUTHORIZATION OF APPROPRIATIONS.—
(1) DIRECT GRADUATE MEDICAL EDUCATION.—
(A) IN GENERAL.—There are hereby authorized to be
appropriated, out of any money in the Treasury not otherwise appropriated, for payments under subsection
(b)(1)(A)—
(i) for fiscal year 2000, $90,000,000;
(ii) for fiscal year 2001, $95,000,000;
(iii) for each of the fiscal years 2002 through 2005,
such sums as may be necessary; and
(iv) for each of fiscal years 2007 through 2011,
$110,000,000.
(B) CARRYOVER OF EXCESS.—The amounts appropriated under subparagraph (A) for fiscal year 2000 shall
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remain available for obligation through the end of fiscal
year 2001.
(2) INDIRECT MEDICAL EDUCATION.—There are hereby authorized to be appropriated, out of any money in the Treasury
not otherwise appropriated, for payments under subsection
(b)(1)(B)—
(A) for fiscal year 2000, $190,000,000;
(B) for fiscal year 2001, $190,000,000;
(C) for each of the fiscal years 2002 through 2005,
such sums as may be necessary; and
(D) for each of fiscal years 2007 through 2011,
$220,000,000.
(g) DEFINITIONS.—In this section:
(1) APPROVED GRADUATE MEDICAL RESIDENCY TRAINING
PROGRAM.—The term ‘‘approved graduate medical residency
training program’’ has the meaning given the term ‘‘approved
medical residency training program’’ in section 1886(h)(5)(A) of
the Social Security Act.
(2) CHILDREN’S HOSPITAL.—The term ‘‘children’s hospital’’
means a hospital with a Medicare payment agreement and
which is excluded from the Medicare inpatient prospective payment system pursuant to section 1886(d)(1)(B)(iii) of the Social
Security Act and its accompanying regulations.
(3) DIRECT GRADUATE MEDICAL EDUCATION COSTS.—The
term ‘‘direct graduate medical education costs’’ has the meaning given such term in section 1886(h)(5)(C) of the Social Security Act.

Subpart X—Primary Dental Programs
SEC. 340F. ø256f¿ DESIGNATED
SHORTAGE AREA.

DENTAL

HEALTH

PROFESSIONAL

In this subpart, the term ‘‘designated dental health professional shortage area’’ means an area, population group, or facility
that is designated by the Secretary as a dental health professional
shortage area under section 332 or designated by the applicable
State as having a dental health professional shortage.
SEC. 340G. ø256g¿ GRANTS FOR INNOVATIVE PROGRAMS.
(a) GRANT PROGRAM AUTHORIZED.—The Secretary,

acting
through the Administrator of the Health Resources and Services
Administration, is authorized to award grants to States for the purpose of helping States develop and implement innovative programs
to address the dental workforce needs of designated dental health
professional shortage areas in a manner that is appropriate to the
States’ individual needs.
(b) STATE ACTIVITIES.—A State receiving a grant under subsection (a) may use funds received under the grant for—
(1) loan forgiveness and repayment programs for dentists
who—
(A) agree to practice in designated dental health professional shortage areas;

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(B) are dental school graduates who agree to serve as
public health dentists for the Federal, State, or local government; and
(C) agree to—
(i) provide services to patients regardless of such
patients’ ability to pay; and
(ii) use a sliding payment scale for patients who
are unable to pay the total cost of services;
(2) dental recruitment and retention efforts;
(3) grants and low-interest or no-interest loans to help
dentists who participate in the medicaid program under title
XIX of the Social Security Act (42 U.S.C. 1396 et seq.) to establish or expand practices in designated dental health professional shortage areas by equipping dental offices or sharing in
the overhead costs of such practices;
(4) the establishment or expansion of dental residency programs in coordination with accredited dental training institutions in States without dental schools;
(5) programs developed in consultation with State and
local dental societies to expand or establish oral health services
and facilities in designated dental health professional shortage
areas, including services and facilities for children with special
needs, such as—
(A) the expansion or establishment of a communitybased dental facility, free-standing dental clinic, consolidated health center dental facility, school-linked dental facility, or United States dental school-based facility;
(B) the establishment of a mobile or portable dental
clinic; and
(C) the establishment or expansion of private dental
services to enhance capacity through additional equipment
or additional hours of operation;
(6) placement and support of dental students, dental residents, and advanced dentistry trainees;
(7) continuing dental education, including distance-based
education;
(8) practice support through teledentistry conducted in accordance with State laws;
(9) community-based prevention services such as water
fluoridation and dental sealant programs;
(10) coordination with local educational agencies within
the State to foster programs that promote children going into
oral health or science professions;
(11) the establishment of faculty recruitment programs at
accredited dental training institutions whose mission includes
community outreach and service and that have a demonstrated
record of serving underserved States;
(12) the development of a State dental officer position or
the augmentation of a State dental office to coordinate oral
health and access issues in the State; and
(13) any other activities determined to be appropriate by
the Secretary.
(c) APPLICATION.—
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(1) IN GENERAL.—Each State desiring 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 reasonably require.
(2) ASSURANCES.—The application shall include assurances
that the State will meet the requirements of subsection (d) and
that the State possesses sufficient infrastructure to manage
the activities to be funded through the grant and to evaluate
and report on the outcomes resulting from such activities.
(d) MATCHING REQUIREMENT.—The Secretary may not make a
grant to a State under this section unless that State agrees that,
with respect to the costs to be incurred by the State in carrying out
the activities for which the grant was awarded, the State will provide non-Federal contributions in an amount equal to not less than
40 percent of Federal funds provided under the grant. The State
may provide the contributions in cash or in kind, fairly evaluated,
including plant, equipment, and services and may provide the contributions from State, local, or private sources.
(e) REPORT.—Not later than 5 years after the date of enactment of the Health Care Safety Net Amendments of 2002, the Secretary shall prepare and submit to the appropriate committees of
Congress a report containing data relating to whether grants provided under this section have increased access to dental services in
designated dental health professional shortage areas.
(f) AUTHORIZATION OF APPROPRIATIONS.—There is authorized to
be appropriated to carry out this section, $25,000,000 for the 5-fiscal year period beginning with fiscal year 2008.
SEC. 340G–1. ø256g–1¿ DEMONSTRATION PROGRAM.
(a) IN GENERAL.—
(1) AUTHORIZATION.—The Secretary is authorized

to award
grants to 15 eligible entities to enable such entities to establish
a demonstration program to establish training programs to
train, or to employ, alternative dental health care providers in
order to increase access to dental health care services in rural
and other underserved communities.
(2) DEFINITION.—The term ‘‘alternative dental health care
providers’’ includes community dental health coordinators, advance practice dental hygienists, independent dental hygienists, supervised dental hygienists, primary care physicians,
dental therapists, dental health aides, and any other health
professional that the Secretary determines appropriate.
(b) TIMEFRAME.—The demonstration projects funded under this
section shall begin not later than 2 years after the date of enactment of this section, and shall conclude not later than 7 years after
such date of enactment.
(c) ELIGIBLE ENTITIES.—To be eligible to receive a grant under
subsection (a), an entity shall—
(1) be—
(A) an institution of higher education, including a community college;
(B) a public-private partnership;
(C) a federally qualified health center;

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(D) an Indian Health Service facility or a tribe or tribal organization (as such terms are defined in section 4 of
the Indian Self-Determination and Education Assistance
Act);
(E) a State or county public health clinic, a health facility operated by an Indian tribe or tribal organization, or
urban Indian organization providing dental services; or
(F) a public hospital or health system;
(2) be within a program accredited by the Commission on
Dental Accreditation or within a dental education program in
an accredited institution; and
(3) shall submit an application to the Secretary at such
time, in such manner, and containing such information as the
Secretary may require.
(d) ADMINISTRATIVE PROVISIONS.—
(1) AMOUNT OF GRANT.—Each grant under this section
shall be in an amount that is not less than $4,000,000 for the
5-year period during which the demonstration project being
conducted.
(2) DISBURSEMENT OF FUNDS.—
(A) PRELIMINARY DISBURSEMENTS.—Beginning 1 year
after the enactment of this section, the Secretary may disperse to any entity receiving a grant under this section not
more than 20 percent of the total funding awarded to such
entity under such grant, for the purpose of enabling the
entity to plan the demonstration project to be conducted
under such grant.
(B) SUBSEQUENT DISBURSEMENTS.—The remaining
amount of grant funds not dispersed under subparagraph
(A) shall be dispersed such that not less than 15 percent
of such remaining amount is dispersed each subsequent
year.
(e) COMPLIANCE WITH STATE REQUIREMENTS.—Each entity receiving a grant under this section shall certify that it is in compliance with all applicable State licensing requirements.
(f) EVALUATION.—The Secretary shall contract with the Director of the Institute of Medicine to conduct a study of the demonstration programs conducted under this section that shall provide analysis, based upon quantitative and qualitative data, regarding access to dental health care in the United States.
(g) CLARIFICATION REGARDING DENTAL HEALTH AIDE PROGRAM.—Nothing in this section shall prohibit a dental health aide
training program approved by the Indian Health Service from
being eligible for a grant under this section.
(h) AUTHORIZATION OF APPROPRIATIONS.—There is authorized
to be appropriated such sums as may be necessary to carry out this
section.

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Subpart XI—Support of Graduate Medical
Education in Qualified Teaching Health Centers
SEC. 340H. ø256h¿ PROGRAM OF PAYMENTS TO TEACHING HEALTH
CENTERS THAT OPERATE GRADUATE MEDICAL EDUCATION PROGRAMS.
(a) PAYMENTS.—Subject to subsection (h)(2), the Secretary shall

make payments under this section for direct expenses and for indirect expenses to qualified teaching health centers that are listed as
sponsoring institutions by the relevant accrediting body for expansion of existing or establishment of new approved graduate medical
residency training programs.
(b) AMOUNT OF PAYMENTS.—
(1) IN GENERAL.—Subject to paragraph (2), the amounts
payable under this section to qualified teaching health centers
for an approved graduate medical residency training program
for a fiscal year are each of the following amounts:
(A) DIRECT EXPENSE AMOUNT.—The amount determined under subsection (c) for direct expenses associated
with sponsoring approved graduate medical residency
training programs.
(B) INDIRECT EXPENSE AMOUNT.—The amount determined under subsection (d) for indirect expenses associated with the additional costs relating to teaching residents in such programs.
(2) CAPPED AMOUNT.—
(A) IN GENERAL.—The total of the payments made to
qualified teaching health centers under paragraph (1)(A)
or paragraph (1)(B) in a fiscal year shall not exceed the
amount of funds appropriated under subsection (g) for
such payments for that fiscal year.
(B) LIMITATION.—The Secretary shall limit the funding
of full-time equivalent residents in order to ensure the direct and indirect payments as determined under subsection (c) and (d) do not exceed the total amount of funds
appropriated in a fiscal year under subsection (g).
(c) AMOUNT OF PAYMENT FOR DIRECT GRADUATE MEDICAL EDUCATION.—
(1) IN GENERAL.—The amount determined under this subsection for payments to qualified teaching health centers for direct graduate expenses relating to approved graduate medical
residency training programs for a fiscal year is equal to the
product of—
(A) the updated national per resident amount for direct graduate medical education, as determined under
paragraph (2); and
(B) the average number of full-time equivalent residents in the teaching health center’s graduate approved
medical residency training programs as determined under
section 1886(h)(4) of the Social Security Act (without regard to the limitation under subparagraph (F) of such section) during the fiscal year.
(2) UPDATED NATIONAL PER RESIDENT AMOUNT FOR DIRECT
GRADUATE MEDICAL EDUCATION.—The updated per resident
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amount for direct graduate medical education for a qualified
teaching health center for a fiscal year is an amount determined as follows:
(A) DETERMINATION OF QUALIFIED TEACHING HEALTH
CENTER PER RESIDENT AMOUNT.—The Secretary shall compute for each individual qualified teaching health center a
per resident amount—
(i) by dividing the national average per resident
amount computed under section 340E(c)(2)(D) into a
wage-related portion and a non-wage related portion
by applying the proportion determined under subparagraph (B);
(ii) by multiplying the wage-related portion by the
factor applied under section 1886(d)(3)(E) of the Social
Security Act (but without application of section 4410
of the Balanced Budget Act of 1997 (42 U.S.C. 1395ww
note)) during the preceding fiscal year for the teaching
health center’s area; and
(iii) by adding the non-wage-related portion to the
amount computed under clause (ii).
(B) UPDATING RATE.—The Secretary shall update such
per resident amount for each such qualified teaching
health center as determined appropriate by the Secretary.
(d) AMOUNT OF PAYMENT FOR INDIRECT MEDICAL EDUCATION.—
(1) IN GENERAL.—The amount determined under this subsection for payments to qualified teaching health centers for indirect expenses associated with the additional costs of teaching
residents for a fiscal year is equal to an amount determined
appropriate by the Secretary.
(2) FACTORS.—In determining the amount under paragraph (1), the Secretary shall—
(A) evaluate indirect training costs relative to supporting a primary care residency program in qualified
teaching health centers; and
(B) based on this evaluation, assure that the aggregate
of the payments for indirect expenses under this section
and the payments for direct graduate medical education as
determined under subsection (c) in a fiscal year do not exceed the amount appropriated for such expenses as determined in subsection (g).
(3) INTERIM PAYMENT.—Before the Secretary makes a payment under this subsection pursuant to a determination of indirect expenses under paragraph (1), the Secretary may provide to qualified teaching health centers a payment, in addition to any payment made under subsection (c), for expected
indirect expenses associated with the additional costs of teaching residents for a fiscal year, based on an estimate by the Secretary.
(e) CLARIFICATION REGARDING RELATIONSHIP TO OTHER PAYMENTS FOR GRADUATE MEDICAL EDUCATION.—Payments under this
section—
(1) shall be in addition to any payments—
(A) for the indirect costs of medical education under
section 1886(d)(5)(B) of the Social Security Act;
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(B) for direct graduate medical education costs under
section 1886(h) of such Act; and
(C) for direct costs of medical education under section
1886(k) of such Act;
(2) shall not be taken into account in applying the limitation on the number of total full-time equivalent residents
under subparagraphs (F) and (G) of section 1886(h)(4) of such
Act and clauses (v), (vi)(I), and (vi)(II) of section 1886(d)(5)(B)
of such Act for the portion of time that a resident rotates to
a hospital; and
(3) shall not include the time in which a resident is counted toward full-time equivalency by a hospital under paragraph
(2) or under section 1886(d)(5)(B)(iv) of the Social Security Act,
section 1886(h)(4)(E) of such Act, or section 340E of this Act.
(f) RECONCILIATION.—The Secretary shall determine any
changes to the number of residents reported by a hospital in the
application of the hospital for the current fiscal year to determine
the final amount payable to the hospital for the current fiscal year
for both direct expense and indirect expense amounts. Based on
such determination, the Secretary shall recoup any overpayments
made to pay any balance due to the extent possible. The final
amount so determined shall be considered a final intermediary determination for the purposes of section 1878 of the Social Security
Act and shall be subject to administrative and judicial review
under that section in the same manner as the amount of payment
under section 1186(d) of such Act is subject to review under such
section.
(g) FUNDING.—To carry out this section, there are appropriated
such sums as may be necessary, not to exceed $230,000,000, for the
period of fiscal years 2011 through 2015.
(h) ANNUAL REPORTING REQUIRED.—
(1) ANNUAL REPORT.—The report required under this paragraph for a qualified teaching health center for a fiscal year is
a report that includes (in a form and manner specified by the
Secretary) the following information for the residency academic
year completed immediately prior to such fiscal year:
(A) The types of primary care resident approved training programs that the qualified teaching health center provided for residents.
(B) The number of approved training positions for residents described in paragraph (4).
(C) The number of residents described in paragraph
(4) who completed their residency training at the end of
such residency academic year and care for vulnerable populations living in underserved areas.
(D) Other information as deemed appropriate by the
Secretary.
(2) AUDIT AUTHORITY; LIMITATION ON PAYMENT.—
(A) AUDIT AUTHORITY.—The Secretary may audit a
qualified teaching health center to ensure the accuracy
and completeness of the information submitted in a report
under paragraph (1).
(B) LIMITATION ON PAYMENT.—A teaching health center may only receive payment in a cost reporting period for
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a number of such resident positions that is greater than
the base level of primary care resident positions, as determined by the Secretary. For purposes of this subparagraph, the ‘‘base level of primary care residents’’ for a
teaching health center is the level of such residents as of
a base period.
(3) REDUCTION IN PAYMENT FOR FAILURE TO REPORT.—
(A) IN GENERAL.—The amount payable under this section to a qualified teaching health center for a fiscal year
shall be reduced by at least 25 percent if the Secretary determines that—
(i) the qualified teaching health center has failed
to provide the Secretary, as an addendum to the qualified teaching health center’s application under this
section for such fiscal year, the report required under
paragraph (1) for the previous fiscal year; or
(ii) such report fails to provide complete and accurate information required under any subparagraph of
such paragraph.
(B) NOTICE AND OPPORTUNITY TO PROVIDE ACCURATE
AND MISSING INFORMATION.—Before imposing a reduction
under subparagraph (A) on the basis of a qualified teaching health center’s failure to provide complete and accurate information described in subparagraph (A)(ii), the
Secretary shall provide notice to the teaching health center
of such failure and the Secretary’s intention to impose
such reduction and shall provide the teaching health center with the opportunity to provide the required information within the period of 30 days beginning on the date of
such notice. If the teaching health center provides such information within such period, no reduction shall be made
under subparagraph (A) on the basis of the previous failure to provide such information.
(4) RESIDENTS.—The residents described in this paragraph
are those who are in part-time or full-time equivalent resident
training positions at a qualified teaching health center in any
approved graduate medical residency training program.
(i) REGULATIONS.—The Secretary shall promulgate regulations
to carry out this section.
(j) DEFINITIONS.—In this section:
(1) APPROVED GRADUATE MEDICAL RESIDENCY TRAINING
PROGRAM.—The term ‘‘approved graduate medical residency
training program’’ means a residency or other postgraduate
medical training program—
(A) participation in which may be counted toward certification in a specialty or subspecialty and includes formal
postgraduate training programs in geriatric medicine approved by the Secretary; and
(B) that meets criteria for accreditation (as established
by the Accreditation Council for Graduate Medical Education, the American Osteopathic Association, or the American Dental Association).
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(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.

Subpart XI—Community-Based Collaborative Care
Network Program
SEC. 340H. ø256i¿ COMMUNITY-BASED COLLABORATIVE CARE NETWORK PROGRAM. 1
(a) IN GENERAL.—The Secretary may award grants to eligible

entities to support community-based collaborative care networks
that meet the requirements of subsection (b).
(b) COMMUNITY-BASED COLLABORATIVE CARE NETWORKS.—
(1) DESCRIPTION.—A community-based collaborative care
network (referred to in this section as a ‘‘network’’) shall be a
consortium of health care providers with a joint governance
structure (including providers within a single entity) that provides comprehensive coordinated and integrated health care
services (as defined by the Secretary) for low-income populations.
(2) REQUIRED INCLUSION.—A network shall include the following providers (unless such provider does not exist within
the community, declines or refuses to participate, or places unreasonable conditions on their participation):
(A) A hospital that meets the criteria in section
1923(b)(1) of the Social Security Act; and
(B) All Federally qualified health centers (as defined
in section 1861(aa) of the Social Security Act located in the
community.
(3) PRIORITY.—In awarding grants, the Secretary shall give
priority to networks that include—
(A) the capability to provide the broadest range of
services to low-income individuals;
(B) the broadest range of providers that currently
serve a high volume of low-income individuals; and
(C) a county or municipal department of health.
(c) APPLICATION.—
(1) APPLICATION.—A network described in subsection (b)
shall submit an application to the Secretary.
(2) RENEWAL.—In subsequent years, based on the performance of grantees, the Secretary may provide renewal grants to
prior year grant recipients.
(d) USE OF FUNDS.—
(1) USE BY GRANTEES.—Grant funds may be used for the
following activities:
(A) Assist low-income individuals to—
(i) access and appropriately use health services;
(ii) enroll in health coverage programs; and
1 So in law. Sections 5508(c) and 10333 of Public Law 111–148 added a subpart XI including
adding two sections designated as section 340H).

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(iii) obtain a regular primary care provider or a
medical home.
(B) Provide case management and care management.
(C) Perform health outreach using neighborhood
health workers or through other means.
(D) Provide transportation.
(E) Expand capacity, including through telehealth,
after-hours services or urgent care.
(F) Provide direct patient care services.
(2) GRANT FUNDS TO HRSA GRANTEES.—The Secretary may
limit the percent of grant funding that may be spent on direct
care services provided by grantees of programs administered
by the Health Resources and Services Administration or impose other requirements on such grantees deemed necessary.
(e) 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 2011 through 2015.
PART E—NARCOTIC ADDICTS

AND

OTHER DRUG ABUSERS 1

CARE AND TREATMENT

SEC. 341. ø257¿ (a) The Surgeon General is authorized to provide for the confinement, care, protection, treatment, and discipline
of persons addicted to the use of habit-forming narcotic drugs who
are civilly committed to treatment under the Narcotic Addict Rehabilitation Act of 1966, addicts and other persons with drug abuse
and drug dependence problems who voluntarily submit themselves
for treatment, and addicts convicted of offenses against the United
States, including persons convicted by general courts-martial and
consular courts. Such care and treatment shall be provided at hospitals of the Service especially equipped for the accommodation of
such patients or elsewhere where authorized under other provisions of law, and shall be designed to rehabilitate such persons, to
restore them to health, and, where necessary, to train them to be
self-supporting and self-reliant; but nothing in this section or in
this part shall be construed to limit the authority of the Surgeon
General under other provisions of law to provide for the conditional
release of patients and for aftercare under supervision. In carrying
out this subsection, the Secretary shall establish in each hospital
and other appropriate medical facility of the Service a treatment
and rehabilitation program for drug addicts and other persons with
drug abuse and drug dependence problems who are in the area
served by such hospital or other facility; except that the requirement of this sentence shall not apply in the case of any such hospital or other facility with respect to which the Secretary determines that there is not sufficient need for such a program in such
hospital or other facility.
(b) Upon the admittance to, and departure from, a hospital of
the Service of a person who voluntarily submitted himself for treat1 The probable intent of the Congress is that part E be repealed. Section 3405(a) of Public
Law 106–310 (114 Stat. 1221) provides as follows: ‘‘Part E of title III (42 U.S.C. 257 et seq.)
is repealed.’’ No Act is identified as the subject of the amendment, but the citation given to the
United States Code, section 257 of title 42, is the Code section that codifies section 341 of this
Act (the first section in part E).

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ment pursuant to the provisions of this section, and who at the
time of his admittance to such hospital was a resident of the District of Columbia, the Surgeon General shall furnish to the Commissioners of the District of Columbia or their designated agent,
the name, address, and such other pertinent information as may be
useful in the rehabilitation to society of such person.
(c) The Secretary may enter into agreements with the Secretary of Veterans Affairs, the Secretary of Defense, and the head
of any other department or agency of the Government under which
agreements hospitals and other appropriate medical facilities of the
Service may be used in treatment and rehabilitation programs provided by such department or agency for drug addicts and other persons with drug abuse and other drug dependence problems who are
in areas served by such hospitals or other facilities.
EMPLOYMENT OF ADDICTS OR OTHER PERSONS WITH DRUG ABUSE AND
DRUG DEPENDENCE PROBLEMS

SEC. 342. ø258¿ Narcotic addicts or other persons with drug
abuse and drug dependence problems in hospitals of the Service
designated for their care shall be employed in such manner and
under such conditions as the Surgeon General may direct. In such
hospitals the Surgeon General may, in his discretion, establish industries, plants, factories, or shops for the production and manufacture of articles, commodities, and supplies for the United States
Government. The Secretary of the Treasury may require any Government department, establishment, or other institution, for whom
appropriations are made directly or indirectly by the Congress of
the United States, to purchase at current market prices, as determined by him or his authorized representative, such of the articles,
commodities, or supplies so produced or manufactured as meet
their specifications; and the Surgeon General shall provide for payment to the inmates or their dependents of such pecuniary earnings as he may deem proper. The Secretary shall establish a working-capital fund for such industries, plants, factories, and shops out
of any funds appropriated for Public Health Service hospitals at
which addicts or other persons with drug abuse and drug dependence problems are treated and cared for; and such fund shall be
available for the purchase, repair, or replacement of machinery or
equipment, for the purchase of raw materials and supplies, for the
purchase of uniforms and other distinctive wearing apparel of employees in the performance of their official duties, and for the employment of necessary civilian officers and employees. The Surgeon
General may provide for the disposal of products of the industrial
activities conducted pursuant to this section, and the proceeds of
any sales thereof shall be covered into the Treasury of the United
States to the credit of the working-capital fund.
CONVICTS

SEC. 343. ø259¿ (a) The authority vested with the power to
designate the place of confinement of a prisoner shall transfer to
hospitals of the Service especially equipped for the accommodation
of addicts or other persons with drug abuse and drug dependence
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sons with drug abuse and drug dependence problems who have
been or are hereafter sentenced to confinement, or who are now or
shall hereafter be confined, in any penal, correctional, disciplinary,
or reformatory institution of the United States, including those addicts or other persons with drug abuse and drug dependence problems convicted of offenses against the United States who are confined in State and Territorial prisons, penitentiaries, and reformatories, except that no addict or other person with a drug abuse or
other drug dependence problem shall be transferred to a hospital
of the Service who, in the opinion of the officer authorized to direct
the transfer, is not a proper subject for confinement in such an institution either because of the nature of the crime he has committed or because of his apparent incorrigibility. The authority
vested with the power to designate the place of confinement of a
prisoner shall transfer from a hospital of the Service to the institution from which he was received, or to such other institution as
may be designated by the proper authority, any addict or other person with a drug abuse or other drug dependence problem whose
presence at a hospital of the Service is detrimental to the wellbeing of the hospital or who does not continue to be a narcotic addict or other person with a drug abuse or other drug dependence
problem. All transfers of such prisoners to or from a hospital of the
Service shall be accompanied by necessary attendants as directed
by the officer in charge of such hospital and the actual and necessary expenses incident to such transfers shall be paid from the
appropriation for the maintenance of such Service hospital except
to the extent that other Federal agencies are authorized or required by law to pay expenses incident to such transfers. When
sentence is pronounced against any person whom the prosecuting
officer believes to be an addict or other person with a drug abuse
or other drug dependence problem such officer shall report to the
authority vested with the power to designate the place of confinement, the name of such person, the reasons for his belief, all pertinent facts bearing on such addiction, drug abuse, or drug dependence and the nature of the offense committed. Whenever an alien
addict or other person with a drug abuse or other drug dependence
problem transferred to a Service hospital pursuant to this subsection is entitled to his discharge but is subject to deportation, in
lieu of being returned to the penal institution from which he came
he shall be deported by the authority vested by law with power
over deportation.
(b) [Repealed.]
(c) Not later than one month prior to the expiration of the sentence of any addict or other person with a drug abuse or other drug
dependence problem confined in a Service hospital, he shall be examined by the Surgeon General or his authorized representative.
If the Surgeon General believes the person to be discharged is still
an addict or other person with a drug abuse or other drug dependence problem and that he may by further treatment in a Service
hospital be cured of his addiction, drug abuse, or drug dependence
the addict or other person with a drug abuse or other drug dependence problem shall be informed, in accordance with regulations, of
the advisability of his submitting himself to further treatment. The
addict or other person with a drug abuse or other drug dependence
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problem may then apply in writing to the Surgeon General for further treatment in a Service hospital for a period not exceeding the
maximum length of time considered necessary by the Surgeon General. Upon approval of the application by the Surgeon General or
his authorized agent, the addict or other person with a drug abuse
or other drug dependence problem may be given such further treatment as is necessary to cure him of his addiction, drug abuse, or
drug dependence.
(d) Every person convicted of an offense against the United
States, upon discharge, or upon release on parole or supervised release from a hospital of the Service, shall be furnished with the
gratuities and transportation authorized by law to be furnished to
prisoners upon release from a penal, correctional, disciplinary, or
reformatory institution.
(e) Any court of the United States having the power to suspend
the imposition or execution of sentence and to place a defendant on
probation under any existing laws may impose as one of the conditions of such probation that the defendant, if an addict, or other
person with a drug abuse or other drug dependence problem shall
submit himself for treatment at a hospital of the Service especially
equipped for the accommodation of addicts or other persons with
drug abuse and drug dependence problems until discharged therefrom as cured and that he shall be admitted thereto for such purpose. Upon the discharge of any such probationer from a hospital
of the Service, he shall be furnished with the gratuities and transportation authorized by law to be furnished to prisoners upon release from a penal, correctional, disciplinary, or reformatory institution. The actual and necessary expense incident to transporting
such probationer to such hospital and to furnishing such transportation and gratuities shall be paid from the appropriation for the
maintenance of such hospital except to the extent that other Federal agencies are authorized or required by law to pay the cost of
such transportation: Provided, That where existing law vests a discretion in any officer as to the place to which transportation shall
be furnished or as to the amount of clothing and gratuities to be
furnished, such discretion shall be exercised by the Surgeon General with respect to addicts or other persons with drug abuse and
drug dependence problems discharged from hospitals of the Service.
VOLUNTARY PATIENTS

SEC. 344. ø260¿ (a) Any addict, or other person with a drug
abuse or other drug dependence problem whether or not he shall
have been convicted of an offense against the United States, may
apply to the Surgeon General for admission to a hospital of the
Service especially equipped for the accommodation of addicts or
other persons with drug abuse and drug dependence problems.
(b) Any applicant shall be examined by the Surgeon General
who shall determine whether the applicant is an addict, or other
person with a drug abuse or other drug dependence problem
whether by treatment in a hospital of the Service he may probably
be cured of his addiction, drug abuse, or drug dependence and the
estimated length of time necessary to effect his cure. The Surgeon
General may, in his discretion, admit the applicant to a Service
hospital. No such addict or other person with drug abuse or other
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drug dependence problem shall be admitted unless he agrees to
submit to treatment for the maximum amount of time estimated by
the Surgeon General to be necessary to effect a cure, and unless
suitable accommodations are available after all eligible addicts or
other persons with drug abuse and drug dependence problems convicted of offenses against the United States have been admitted.
Any such addict or other person with a drug abuse or other drug
dependence problem may be required to pay for his subsistence,
care, and treatment at rates fixed by the Surgeon General and
amounts so paid shall be covered into the Treasury of the United
States to the credit of the appropriation from which the expenditure for his subsistence, care, and treatment was made. Appropriations available for the care and treatment of addicts or other persons with drug abuse and drug dependence problems admitted to
a hospital of the Service under this section shall be available, subject to regulations, for paying the cost of transportation to any
place within the continental United States, including subsistence
allowance while traveling, for any indigent addict or other person
with a drug abuse or other drug dependence problem who is discharged as cured.
(c) Any addict or other person with a drug abuse or other drug
dependence problem admitted for treatment under this section, including any addict, or other person with a drug abuse or other drug
dependence problem not convicted of an offense, who voluntarily
submits himself for treatment, may be confined in a hospital of the
Service for a period not exceeding the maximum amount of time estimated by the Surgeon General as necessary to effect a cure of the
addiction, drug abuse, or drug dependence or until such time as he
ceases to be an addict or other person with a drug abuse or other
drug dependence problem.
(d) Any addict or other person with a drug abuse or other drug
dependence problem admitted for treatment under this section
shall not thereby forfeit or abridge any of his rights as a citizen of
the United States; nor shall such admission or treatment be used
against him in any proceeding in any court; and the record of his
voluntary commitment shall, except as otherwise provided by this
Act, be confidential and shall not be divulged.
PERSONS COMMITTED FROM DISTRICT OF COLUMBIA

SEC. 345. ø260a¿ (a) The Surgeon General is authorized to
admit for care and treatment in any hospital of the Service suitably
equipped therefor, and thereafter to transfer between hospitals of
the Service in accordance with section 321(b), any addict who is
committed, under the provisions of the Act of June 24, 1953 (Public
Law 76, Eighty-third Congress) 1, to the Service or to a hospital
thereof for care and treatment and who the Surgeon General determines is a proper subject for care and treatment. No such addict
shall be admitted unless (1) committed prior to July 1, 1958; and
(2) at the time of commitment, the number of persons in hospitals
of the Service who have been admitted pursuant to this subsection
is less than 100; and (3) suitable accommodations are available
1 67

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after all eligible addicts convicted of offenses against the United
States have been admitted.
(b) Any person admitted to a hospital of the Service pursuant
to subsection (a) shall be discharged therefrom (1) upon order of
the Superior Court of the District of Columbia, or (2) when he is
found by the Surgeon General to be cured and rehabilitated. When
any such person is so discharged, the Surgeon General shall give
notice thereof to the Superior Court of the District of Columbia and
shall deliver such person to such court for such further action as
such court may deem necessary and proper under the provisions of
the Act of June 24, 1953 (Public Law 76, Eighty-third Congress). 1
(c) With respect to the detention, transfer, parole, or discharge
of any person committed to a hospital of the Service in accordance
with subsection (a), the Surgeon General and the officer in charge
of the hospital, in addition to authority otherwise vested in them,
shall have such authority as may be conferred upon them, respectively, by the order of the committing court.
(d) The cost of providing care and treatment for persons admitted to a hospital of the Service pursuant to subsection (a) shall be
a charge upon the District of Columbia and shall be paid by the
District of Columbia to the Public Health Service, either in advance
or otherwise, as may be determined by the Surgeon General. Such
cost may be determined for each addict or on the basis of rates established for all or particular classes of patients, and shall include
the cost of transportation to and from facilities of the Public Health
Service. Moneys so paid to the Public Health Service shall be covered into the Treasury of the United States as miscellaneous receipts. Appropriations available for the care and treatment of addicts admitted to a hospital of the Service under this section shall
be available, subject to regulations, for paying the cost of transportation to the District of Columbia, including subsistence allowance
while traveling, for any such addict who is discharged.
PENALTIES

SEC. 346. ø261¿ (a) Any person not authorized by law or by the
Surgeon General who introduces or attempts to introduce into or
upon the grounds of any hospital of the Service at which addicts
or other persons with drug abuse and drug dependence problems
are treated and cared for, any habit-forming narcotic drug, or substance controlled under the Controlled Substances Act, weapon, or
any other contraband article or thing, or any contraband letter or
message intended to be received by an inmate thereof, shall be
guilty of a felony and, upon conviction thereof, shall be punished
by imprisonment for not more than ten years.
(b) It shall be unlawful for any person properly committed
thereto to escape or attempt to escape from a hospital of the Service at which addicts or other persons with drug abuse and drug dependence problems are treated and cared for, and any such person
upon apprehension and conviction in a United States court shall be
punished by imprisonment for not more than five years, such sentence to begin upon the expiration of the sentence for which such
person was originally confined.
(c) Any person who procures the escape of any person admitted
to a hospital of the Service at which addicts or other persons with
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drug abuse and drug dependence problems are treated and cared
for, or who advises, connives at, aids, or assists in such escape, or
who conceals any such inmate after such escape, shall be punished
upon conviction in a United States court by imprisonment in the
penitentiary for not more than three years.
RELEASE OF PATIENTS

SEC. 347. ø261a¿ For purposes of this Act, an individual shall
be deemed cured of his addiction, drug abuse, or drug dependence,
and rehabilitated if the Surgeon General determines that he has
received the maximum benefits of treatment and care by the Service for his addiction, drug abuse, or drug dependence, or if the Surgeon General determines that his further treatment and care for
such purpose would be detrimental to the interests of the Service.
PART F—LICENSING—BIOLOGICAL PRODUCTS
LABORATORIES 1

AND

CLINICAL

Subpart 1—Biological Products
REGULATION OF BIOLOGICAL PRODUCTS 2

SEC. 351. ø262¿ (a)(1) No person shall introduce or deliver for
introduction into interstate commerce any biological product unless—
(A) a biologics license under this subsection or subsection
(k) is in effect for the biological product; and
(B) each package of the biological product is plainly
marked with—
(i) the proper name of the biological product contained
in the package;
(ii) the name, address, and applicable license number
of the manufacturer of the biological product; and
(iii) the expiration date of the biological product.
(2)(A) The Secretary shall establish, by regulation, requirements for the approval, suspension, and revocation of biologics licenses.
(B) PEDIATRIC STUDIES.—A person that submits an application for a license under this paragraph shall submit
to the Secretary as part of the application any assessments
required under section 505B of the Federal Food, Drug,
and Cosmetic Act.
(C) The Secretary shall approve a biologics license application—
(i) on the basis of a demonstration that—
(I) the biological product that is the subject of the application is safe, pure, and potent; and
1 Section 511(d) of Public Law 104–132 (110 Stat. 1284) relates to the regulatory control of
biological agents and includes a requirement that the Secretary ‘‘establish and maintain a list
of each biological agent that has the potential to pose a severe threat to public health and safety’’.
2 Section 123(f) of Public Law 105–115 (111 Stat. 2324) provides as follows:
‘‘(f) SPECIAL RULE.—The Secretary of Health and Human Services shall take measures to minimize differences in the review and approval of products required to have approved biologics license applications under section 351 of the Public Health Service Act (42 U.S.C. 262) and products required to have approved new drug applications under section 505(b)(1) of the Federal
Food, Drug, and Cosmetic Act (21 U.S.C. 355(b)(1)).’’.

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(II) the facility in which the biological product is manufactured, processed, packed, or held meets standards designed to assure that the biological product continues to be
safe, pure, and potent; and
(ii) if the applicant (or other appropriate person) consents
to the inspection of the facility that is the subject of the application, in accordance with subsection (c).
(D) POSTMARKET STUDIES AND CLINICAL TRIALS; LABELING;
RISK EVALUATION AND MITIGATION STRATEGY.—A person that submits an application for a license under this paragraph is subject to
sections 505(o), 505(p), and 505–1 of the Federal Food, Drug, and
Cosmetic Act.
(3) The Secretary shall prescribe requirements under which a
biological product undergoing investigation shall be exempt from
the requirements of paragraph (1).
(b) No person shall falsely label or mark any package or container of any biological product or alter any label or mark on the
package or container of the biological product so as to falsify the
label or mark.
(c) Any officer, agent, or employee of the Department of Health
and Human Services, authorized by the Secretary for the purpose,
may during all reasonable hours enter and inspect any establishment for the propagation or manufacture and preparation of any
biological product.
(d)(1) Upon a determination that a batch, lot, or other quantity
of a product licensed under this section presents an imminent or
substantial hazard to the public health, the Secretary shall issue
an order immediately ordering the recall of such batch, lot, or other
quantity of such product. An order under this paragraph shall be
issued in accordance with section 554 of title 5, United States
Code.
(2) Any violation of paragraph (1) shall subject the violator to
a civil penalty of up to $100,000 per day of violation. The amount
of a civil penalty under this paragraph shall, effective December 1
of each year beginning 1 year after the effective date of this paragraph, be increased by the percent change in the Consumer Price
Index for the base quarter of such year over the Consumer Price
Index for the base quarter of the preceding year, adjusted to the
nearest 1⁄10 of 1 percent. For purposes of this paragraph, the term
‘‘base quarter’’, as used with respect to a year, means the calendar
quarter ending on September 30 of such year and the price index
for a base quarter is the arithmetical mean of such index for the
3 months comprising such quarter.
(e) No person shall interfere with any officer, agent, or employee of the Service in the performance of any duty imposed upon
him by this section or by regulations made by authority thereof.
(f) Any person who shall violate, or aid or abet in violating, any
of the provisions of this section shall be punished upon conviction
by a fine not exceeding $500 or by imprisonment not exceeding one
year, or by both such fine and imprisonment, in the discretion of
the court.
(g) Nothing contained in this Act shall be construed as in any
way affecting, modifying, repealing, or superseding the provisions
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of the Federal Food, Drug, and Cosmetic Act (U.S.C., 1940 edition,
title 21, ch. 9). 1
(h) 2 A partially processed biological product which—
(1) is not in a form applicable to the prevention, treatment,
or cure of diseases or injuries of man;
(2) is not intended for sale in the United States; and
(3) is intended for further manufacture into final dosage
form outside the United States,
shall be subject to no restriction on the export of the product under
this Act or the Federal Food, Drug, and Cosmetic Act (21 U.S.C.
321 et. seq.) if the product is manufactured, processed, packaged,
and held in conformity with current good manufacturing practice
requirements or meets international manufacturing standards as
certified by an international standards organization recognized by
the Secretary and meets the requirements of section 801(e)(1) of
the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 381(e)).
(i) In this section:
(1) The term ‘‘biological product’’ means a virus, therapeutic serum, toxin, antitoxin, vaccine, blood, blood component
or derivative, allergenic product, protein (except any chemically
synthesized polypeptide), or analogous product, or arsphenamine or derivative of arsphenamine (or any other trivalent organic arsenic compound), applicable to the prevention, treatment, or cure of a disease or condition of human beings.
(2) The term ‘‘biosimilar’’ or ‘‘biosimilarity’’, in reference to
a biological product that is the subject of an application under
subsection (k), means—
(A) that the biological product is highly similar to the
reference product notwithstanding minor differences in
clinically inactive components; and
(B) there are no clinically meaningful differences between the biological product and the reference product in
terms of the safety, purity, and potency of the product.
(3) The term ‘‘interchangeable’’ or ‘‘interchangeability’’, in
reference to a biological product that is shown to meet the
standards described in subsection (k)(4), means that the biological product may be substituted for the reference product
without the intervention of the health care provider who prescribed the reference product.
(4) The term ‘‘reference product’’ means the single biological product licensed under subsection (a) against which a biological product is evaluated in an application submitted under
subsection (k).
(j) The Federal Food, Drug, and Cosmetic Act, including the requirements under sections 505(o), 505(p), and 505–1 of such Act,
applies to a biological product subject to regulation under this section, except that a product for which a license has been approved
under subsection (a) shall not be required to have an approved application under section 505 of such Act.
1 Codification

remains chapter 9 of title 21, United States Code (§301 et seq.).
2 Section 2102(d)(2) of title II of Public Law 104–134 (110 Stat. 1321-319) amended certain
provisions in subsection (h). Subsequently, section 2104 of such Public Law (110 Stat. 1321-320)
amended subsection (h) in its entirety. The above reflects only the latter amendment.

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(k) LICENSURE OF BIOLOGICAL PRODUCTS AS BIOSIMILAR OR
INTERCHANGEABLE.—
(1) IN GENERAL.—Any person may submit an application
for licensure of a biological product under this subsection.
(2) CONTENT.—
(A) IN GENERAL.—
(i) REQUIRED INFORMATION.—An application submitted under this subsection shall include information
demonstrating that—
(I) the biological product is biosimilar to a reference product based upon data derived from—
(aa) analytical studies that demonstrate
that the biological product is highly similar to
the reference product notwithstanding minor
differences in clinically inactive components;
(bb) animal studies (including the assessment of toxicity); and
(cc) a clinical study or studies (including
the assessment of immunogenicity and pharmacokinetics or pharmacodynamics) that are
sufficient to demonstrate safety, purity, and
potency in 1 or more appropriate conditions of
use for which the reference product is licensed
and intended to be used and for which licensure is sought for the biological product;
(II) the biological product and reference product utilize the same mechanism or mechanisms of
action for the condition or conditions of use prescribed, recommended, or suggested in the proposed labeling, but only to the extent the mechanism or mechanisms of action are known for the
reference product;
(III) the condition or conditions of use prescribed, recommended, or suggested in the labeling proposed for the biological product have been
previously approved for the reference product;
(IV) the route of administration, the dosage
form, and the strength of the biological product
are the same as those of the reference product;
and
(V) the facility in which the biological product
is manufactured, processed, packed, or held meets
standards designed to assure that the biological
product continues to be safe, pure, and potent.
(ii) DETERMINATION BY SECRETARY.—The Secretary may determine, in the Secretary’s discretion,
that an element described in clause (i)(I) is unnecessary in an application submitted under this subsection.
(iii) ADDITIONAL INFORMATION.—An application
submitted under this subsection—
(I) shall include publicly-available information
regarding the Secretary’s previous determination
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that the reference product is safe, pure, and potent; and
(II) may include any additional information in
support of the application, including publiclyavailable information with respect to the reference
product or another biological product.
(B) INTERCHANGEABILITY.—An application (or a supplement to an application) submitted under this subsection
may include information demonstrating that the biological
product meets the standards described in paragraph (4).
(3) EVALUATION BY SECRETARY.—Upon review of an application (or a supplement to an application) submitted under this
subsection, the Secretary shall license the biological product
under this subsection if—
(A) the Secretary determines that the information submitted in the application (or the supplement) is sufficient
to show that the biological product—
(i) is biosimilar to the reference product; or
(ii) meets the standards described in paragraph
(4), and therefore is interchangeable with the reference product; and
(B) the applicant (or other appropriate person) consents to the inspection of the facility that is the subject of
the application, in accordance with subsection (c).
(4) SAFETY STANDARDS FOR DETERMINING INTERCHANGEABILITY.—Upon review of an application submitted under this
subsection or any supplement to such application, the Secretary shall determine the biological product to be interchangeable with the reference product if the Secretary determines
that the information submitted in the application (or a supplement to such application) is sufficient to show that—
(A) the biological product—
(i) is biosimilar to the reference product; and
(ii) can be expected to produce the same clinical
result as the reference product in any given patient;
and
(B) for a biological product that is administered more
than once to an individual, the risk in terms of safety or
diminished efficacy of alternating or switching between
use of the biological product and the reference product is
not greater than the risk of using the reference product
without such alternation or switch.
(5) GENERAL RULES.—
(A) ONE REFERENCE PRODUCT PER APPLICATION.—A biological product, in an application submitted under this
subsection, may not be evaluated against more than 1 reference product.
(B) REVIEW.—An application submitted under this
subsection shall be reviewed by the division within the
Food and Drug Administration that is responsible for the
review and approval of the application under which the
reference product is licensed.
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tion and mitigation strategies under the Federal Food,
Drug, and Cosmetic Act shall apply to biological products
licensed under this subsection in the same manner as such
authority applies to biological products licensed under subsection (a).
(6) EXCLUSIVITY FOR FIRST INTERCHANGEABLE BIOLOGICAL
PRODUCT.—Upon review of an application submitted under this
subsection relying on the same reference product for which a
prior biological product has received a determination of interchangeability for any condition of use, the Secretary shall not
make a determination under paragraph (4) that the second or
subsequent biological product is interchangeable for any condition of use until the earlier of—
(A) 1 year after the first commercial marketing of the
first interchangeable biosimilar biological product to be approved as interchangeable for that reference product;
(B) 18 months after—
(i) a final court decision on all patents in suit in
an action instituted under subsection (l)(6) against the
applicant that submitted the application for the first
approved interchangeable biosimilar biological product; or
(ii) the dismissal with or without prejudice of an
action instituted under subsection (l)(6) against the
applicant that submitted the application for the first
approved interchangeable biosimilar biological product; or
(C)(i) 42 months after approval of the first interchangeable biosimilar biological product if the applicant
that submitted such application has been sued under subsection (l)(6) and such litigation is still ongoing within
such 42-month period; or
(ii) 18 months after approval of the first interchangeable biosimilar biological product if the applicant that submitted such application has not been sued under subsection (l)(6).
For purposes of this paragraph, the term ‘‘final court decision’’
means a final decision of a court from which no appeal (other
than a petition to the United States Supreme Court for a writ
of certiorari) has been or can be taken.
(7) EXCLUSIVITY FOR REFERENCE PRODUCT.—
(A) EFFECTIVE DATE OF BIOSIMILAR APPLICATION APPROVAL.—Approval of an application under this subsection
may not be made effective by the Secretary until the date
that is 12 years after the date on which the reference product was first licensed under subsection (a).
(B) FILING PERIOD.—An application under this subsection may not be submitted to the Secretary until the
date that is 4 years after the date on which the reference
product was first licensed under subsection (a).
(C) FIRST LICENSURE.—Subparagraphs (A) and (B)
shall not apply to a license for or approval of—
(i) a supplement for the biological product that is
the reference product; or
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(ii) a subsequent application filed by the same
sponsor or manufacturer of the biological product that
is the reference product (or a licensor, predecessor in
interest, or other related entity) for—
(I) a change (not including a modification to
the structure of the biological product) that results
in a new indication, route of administration, dosing schedule, dosage form, delivery system, delivery device, or strength; or
(II) a modification to the structure of the biological product that does not result in a change in
safety, purity, or potency.
(8) GUIDANCE DOCUMENTS.—
(A) IN GENERAL.—The Secretary may, after opportunity for public comment, issue guidance in accordance,
except as provided in subparagraph (B)(i), with section
701(h) of the Federal Food, Drug, and Cosmetic Act with
respect to the licensure of a biological product under this
subsection. Any such guidance may be general or specific.
(B) PUBLIC COMMENT.—
(i) IN GENERAL.—The Secretary shall provide the
public an opportunity to comment on any proposed
guidance issued under subparagraph (A) before
issuing final guidance.
(ii) INPUT REGARDING MOST VALUABLE GUIDANCE.—
The Secretary shall establish a process through which
the public may provide the Secretary with input regarding priorities for issuing guidance.
(C) NO REQUIREMENT FOR APPLICATION CONSIDERATION.—The issuance (or non-issuance) of guidance under
subparagraph (A) shall not preclude the review of, or action on, an application submitted under this subsection.
(D) REQUIREMENT FOR PRODUCT CLASS-SPECIFIC GUIDANCE.—If the Secretary issues product class-specific guidance under subparagraph (A), such guidance shall include
a description of—
(i) the criteria that the Secretary will use to determine whether a biological product is highly similar to
a reference product in such product class; and
(ii) the criteria, if available, that the Secretary
will use to determine whether a biological product
meets the standards described in paragraph (4).
(E) CERTAIN PRODUCT CLASSES.—
(i) GUIDANCE.—The Secretary may indicate in a
guidance document that the science and experience, as
of the date of such guidance, with respect to a product
or product class (not including any recombinant protein) does not allow approval of an application for a license as provided under this subsection for such product or product class.
(ii) MODIFICATION OR REVERSAL.—The Secretary
may issue a subsequent guidance document under
subparagraph (A) to modify or reverse a guidance document under clause (i).
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(iii) NO EFFECT ON ABILITY TO DENY LICENSE.—
Clause (i) shall not be construed to require the Secretary to approve a product with respect to which the
Secretary has not indicated in a guidance document
that the science and experience, as described in clause
(i), does not allow approval of such an application.
(l) PATENTS.—
(1) CONFIDENTIAL ACCESS TO SUBSECTION (k) APPLICATION.—
(A) APPLICATION OF PARAGRAPH.—Unless otherwise
agreed to by a person that submits an application under
subsection (k) (referred to in this subsection as the ‘‘subsection (k) applicant’’) and the sponsor of the application
for the reference product (referred to in this subsection as
the ‘‘reference product sponsor’’), the provisions of this
paragraph shall apply to the exchange of information described in this subsection.
(B) IN GENERAL.—
(i) PROVISION OF CONFIDENTIAL INFORMATION.—
When a subsection (k) applicant submits an application under subsection (k), such applicant shall provide
to the persons described in clause (ii), subject to the
terms of this paragraph, confidential access to the information required to be produced pursuant to paragraph (2) and any other information that the subsection (k) applicant determines, in its sole discretion,
to be appropriate (referred to in this subsection as the
‘‘confidential information’’).
(ii) RECIPIENTS OF INFORMATION.—The persons described in this clause are the following:
(I) OUTSIDE COUNSEL.—One or more attorneys
designated by the reference product sponsor who
are employees of an entity other than the reference product sponsor (referred to in this paragraph as the ‘‘outside counsel’’), provided that
such attorneys do not engage, formally or informally, in patent prosecution relevant or related to
the reference product.
(II) IN-HOUSE COUNSEL.—One attorney that
represents the reference product sponsor who is
an employee of the reference product sponsor, provided that such attorney does not engage, formally
or informally, in patent prosecution relevant or related to the reference product.
(iii) PATENT OWNER ACCESS.—A representative of
the owner of a patent exclusively licensed to a reference product sponsor with respect to the reference
product and who has retained a right to assert the
patent or participate in litigation concerning the patent may be provided the confidential information, provided that the representative informs the reference
product sponsor and the subsection (k) applicant of his
or her agreement to be subject to the confidentiality
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provisions set forth in this paragraph, including those
under clause (ii).
(C) LIMITATION ON DISCLOSURE.—No person that receives confidential information pursuant to subparagraph
(B) shall disclose any confidential information to any other
person or entity, including the reference product sponsor
employees, outside scientific consultants, or other outside
counsel retained by the reference product sponsor, without
the prior written consent of the subsection (k) applicant,
which shall not be unreasonably withheld.
(D) USE OF CONFIDENTIAL INFORMATION.—Confidential
information shall be used for the sole and exclusive purpose of determining, with respect to each patent assigned
to or exclusively licensed by the reference product sponsor,
whether a claim of patent infringement could reasonably
be asserted if the subsection (k) applicant engaged in the
manufacture, use, offering for sale, sale, or importation
into the United States of the biological product that is the
subject of the application under subsection (k).
(E) OWNERSHIP OF CONFIDENTIAL INFORMATION.—The
confidential information disclosed under this paragraph is,
and shall remain, the property of the subsection (k) applicant. By providing the confidential information pursuant
to this paragraph, the subsection (k) applicant does not
provide the reference product sponsor or the outside counsel any interest in or license to use the confidential information, for purposes other than those specified in subparagraph (D).
(F) EFFECT OF INFRINGEMENT ACTION.—In the event
that the reference product sponsor files a patent infringement suit, the use of confidential information shall continue to be governed by the terms of this paragraph until
such time as a court enters a protective order regarding
the information. Upon entry of such order, the subsection
(k) applicant may redesignate confidential information in
accordance with the terms of that order. No confidential
information shall be included in any publicly-available
complaint or other pleading. In the event that the reference product sponsor does not file an infringement action
by the date specified in paragraph (6), the reference product sponsor shall return or destroy all confidential information received under this paragraph, provided that if the
reference product sponsor opts to destroy such information,
it will confirm destruction in writing to the subsection (k)
applicant.
(G) RULE OF CONSTRUCTION.—Nothing in this paragraph shall be construed—
(i) as an admission by the subsection (k) applicant
regarding the validity, enforceability, or infringement
of any patent; or
(ii) as an agreement or admission by the subsection (k) applicant with respect to the competency,
relevance, or materiality of any confidential information.
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(H) EFFECT OF VIOLATION.—The disclosure of any confidential information in violation of this paragraph shall be
deemed to cause the subsection (k) applicant to suffer irreparable harm for which there is no adequate legal remedy and the court shall consider immediate injunctive relief to be an appropriate and necessary remedy for any violation or threatened violation of this paragraph.
(2) SUBSECTION (k) APPLICATION INFORMATION.—Not later
than 20 days after the Secretary notifies the subsection (k) applicant that the application has been accepted for review, the
subsection (k) applicant—
(A) shall provide to the reference product sponsor a
copy of the application submitted to the Secretary under
subsection (k), and such other information that describes
the process or processes used to manufacture the biological
product that is the subject of such application; and
(B) may provide to the reference product sponsor additional information requested by or on behalf of the reference product sponsor.
(3) LIST AND DESCRIPTION OF PATENTS.—
(A) LIST BY REFERENCE PRODUCT SPONSOR.—Not later
than 60 days after the receipt of the application and information under paragraph (2), the reference product sponsor
shall provide to the subsection (k) applicant—
(i) a list of patents for which the reference product
sponsor believes a claim of patent infringement could
reasonably be asserted by the reference product sponsor, or by a patent owner that has granted an exclusive license to the reference product sponsor with respect to the reference product, if a person not licensed
by the reference product sponsor engaged in the making, using, offering to sell, selling, or importing into
the United States of the biological product that is the
subject of the subsection (k) application; and
(ii) an identification of the patents on such list
that the reference product sponsor would be prepared
to license to the subsection (k) applicant.
(B) LIST AND DESCRIPTION BY SUBSECTION (k) APPLICANT.—Not later than 60 days after receipt of the list
under subparagraph (A), the subsection (k) applicant—
(i) may provide to the reference product sponsor a
list of patents to which the subsection (k) applicant believes a claim of patent infringement could reasonably
be asserted by the reference product sponsor if a person not licensed by the reference product sponsor engaged in the making, using, offering to sell, selling, or
importing into the United States of the biological product that is the subject of the subsection (k) application;
(ii) shall provide to the reference product sponsor,
with respect to each patent listed by the reference
product sponsor under subparagraph (A) or listed by
the subsection (k) applicant under clause (i)—
(I) a detailed statement that describes, on a
claim by claim basis, the factual and legal basis of
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the opinion of the subsection (k) applicant that
such patent is invalid, unenforceable, or will not
be infringed by the commercial marketing of the
biological product that is the subject of the subsection (k) application; or
(II) a statement that the subsection (k) applicant does not intend to begin commercial marketing of the biological product before the date
that such patent expires; and
(iii) shall provide to the reference product sponsor
a response regarding each patent identified by the reference product sponsor under subparagraph (A)(ii).
(C) DESCRIPTION BY REFERENCE PRODUCT SPONSOR.—
Not later than 60 days after receipt of the list and statement under subparagraph (B), the reference product sponsor shall provide to the subsection (k) applicant a detailed
statement that describes, with respect to each patent described in subparagraph (B)(ii)(I), on a claim by claim
basis, the factual and legal basis of the opinion of the reference product sponsor that such patent will be infringed
by the commercial marketing of the biological product that
is the subject of the subsection (k) application and a response to the statement concerning validity and enforceability provided under subparagraph (B)(ii)(I).
(4) PATENT RESOLUTION NEGOTIATIONS.—
(A) IN GENERAL.—After receipt by the subsection (k)
applicant of the statement under paragraph (3)(C), the reference product sponsor and the subsection (k) applicant
shall engage in good faith negotiations to agree on which,
if any, patents listed under paragraph (3) by the subsection (k) applicant or the reference product sponsor shall
be the subject of an action for patent infringement under
paragraph (6).
(B) FAILURE TO REACH AGREEMENT.—If, within 15 days
of beginning negotiations under subparagraph (A), the subsection (k) applicant and the reference product sponsor fail
to agree on a final and complete list of which, if any, patents listed under paragraph (3) by the subsection (k) applicant or the reference product sponsor shall be the subject
of an action for patent infringement under paragraph (6),
the provisions of paragraph (5) shall apply to the parties.
(5) PATENT RESOLUTION IF NO AGREEMENT.—
(A) NUMBER OF PATENTS.—The subsection (k) applicant shall notify the reference product sponsor of the number of patents that such applicant will provide to the reference product sponsor under subparagraph (B)(i)(I).
(B) EXCHANGE OF PATENT LISTS.—
(i) IN GENERAL.—On a date agreed to by the subsection (k) applicant and the reference product sponsor, but in no case later than 5 days after the subsection (k) applicant notifies the reference product
sponsor under subparagraph (A), the subsection (k)
applicant and the reference product sponsor shall simultaneously exchange—
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(I) the list of patents that the subsection (k)
applicant believes should be the subject of an action for patent infringement under paragraph (6);
and
(II) the list of patents, in accordance with
clause (ii), that the reference product sponsor believes should be the subject of an action for patent
infringement under paragraph (6).
(ii) NUMBER OF PATENTS LISTED BY REFERENCE
PRODUCT SPONSOR.—
(I) IN GENERAL.—Subject to subclause (II), the
number of patents listed by the reference product
sponsor under clause (i)(II) may not exceed the
number of patents listed by the subsection (k) applicant under clause (i)(I).
(II) EXCEPTION.—If a subsection (k) applicant
does not list any patent under clause (i)(I), the reference product sponsor may list 1 patent under
clause (i)(II).
(6) IMMEDIATE PATENT INFRINGEMENT ACTION.—
(A) ACTION IF AGREEMENT ON PATENT LIST.—If the
subsection (k) applicant and the reference product sponsor
agree on patents as described in paragraph (4), not later
than 30 days after such agreement, the reference product
sponsor shall bring an action for patent infringement with
respect to each such patent.
(B) ACTION IF NO AGREEMENT ON PATENT LIST.—If the
provisions of paragraph (5) apply to the parties as described in paragraph (4)(B), not later than 30 days after
the exchange of lists under paragraph (5)(B), the reference
product sponsor shall bring an action for patent infringement with respect to each patent that is included on such
lists.
(C) NOTIFICATION AND PUBLICATION OF COMPLAINT.—
(i) NOTIFICATION TO SECRETARY.—Not later than
30 days after a complaint is served to a subsection (k)
applicant in an action for patent infringement described under this paragraph, the subsection (k) applicant shall provide the Secretary with notice and a
copy of such complaint.
(ii) PUBLICATION BY SECRETARY.—The Secretary
shall publish in the Federal Register notice of a complaint received under clause (i).
(7) NEWLY ISSUED OR LICENSED PATENTS.—In the case of a
patent that—
(A) is issued to, or exclusively licensed by, the reference product sponsor after the date that the reference
product sponsor provided the list to the subsection (k) applicant under paragraph (3)(A); and
(B) the reference product sponsor reasonably believes
that, due to the issuance of such patent, a claim of patent
infringement could reasonably be asserted by the reference
product sponsor if a person not licensed by the reference
product sponsor engaged in the making, using, offering to
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sell, selling, or importing into the United States of the biological product that is the subject of the subsection (k) application,
not later than 30 days after such issuance or licensing, the reference product sponsor shall provide to the subsection (k) applicant a supplement to the list provided by the reference product sponsor under paragraph (3)(A) that includes such patent,
not later than 30 days after such supplement is provided, the
subsection (k) applicant shall provide a statement to the reference product sponsor in accordance with paragraph (3)(B),
and such patent shall be subject to paragraph (8).
(8) NOTICE OF COMMERCIAL MARKETING AND PRELIMINARY
INJUNCTION.—
(A) NOTICE OF COMMERCIAL MARKETING.—The subsection (k) applicant shall provide notice to the reference
product sponsor not later than 180 days before the date of
the first commercial marketing of the biological product licensed under subsection (k).
(B) PRELIMINARY INJUNCTION.—After receiving the notice under subparagraph (A) and before such date of the
first commercial marketing of such biological product, the
reference product sponsor may seek a preliminary injunction prohibiting the subsection (k) applicant from engaging
in the commercial manufacture or sale of such biological
product until the court decides the issue of patent validity,
enforcement, and infringement with respect to any patent
that is—
(i) included in the list provided by the reference
product sponsor under paragraph (3)(A) or in the list
provided by the subsection (k) applicant under paragraph (3)(B); and
(ii) not included, as applicable, on—
(I) the list of patents described in paragraph
(4); or
(II) the lists of patents described in paragraph
(5)(B).
(C) REASONABLE COOPERATION.—If the reference product sponsor has sought a preliminary injunction under
subparagraph (B), the reference product sponsor and the
subsection (k) applicant shall reasonably cooperate to expedite such further discovery as is needed in connection with
the preliminary injunction motion.
(9) LIMITATION ON DECLARATORY JUDGMENT ACTION.—
(A) SUBSECTION (k) APPLICATION PROVIDED.—If a subsection (k) applicant provides the application and information required under paragraph (2)(A), neither the reference
product sponsor nor the subsection (k) applicant may, prior
to the date notice is received under paragraph (8)(A), bring
any action under section 2201 of title 28, United States
Code, for a declaration of infringement, validity, or enforceability of any patent that is described in clauses (i)
and (ii) of paragraph (8)(B).
(B) SUBSEQUENT FAILURE TO ACT BY SUBSECTION (k)
APPLICANT.—If a subsection (k) applicant fails to complete
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an action required of the subsection (k) applicant under
paragraph (3)(B)(ii), paragraph (5), paragraph (6)(C)(i),
paragraph (7), or paragraph (8)(A), the reference product
sponsor, but not the subsection (k) applicant, may bring an
action under section 2201 of title 28, United States Code,
for a declaration of infringement, validity, or enforceability
of any patent included in the list described in paragraph
(3)(A), including as provided under paragraph (7).
(C) SUBSECTION (k) APPLICATION NOT PROVIDED.—If a
subsection (k) applicant fails to provide the application and
information required under paragraph (2)(A), the reference
product sponsor, but not the subsection (k) applicant, may
bring an action under section 2201 of title 28, United
States Code, for a declaration of infringement, validity, or
enforceability of any patent that claims the biological product or a use of the biological product.
(m) PEDIATRIC STUDIES.—
(1) APPLICATION OF CERTAIN PROVISIONS.—The provisions
of subsections (a), (d), (e), (f), (h), (i), (j), (k), (l), (n), and (p) of
section 505A of the Federal Food, Drug, and Cosmetic Act shall
apply with respect to the extension of a period under paragraphs (2) and (3) to the same extent and in the same manner
as such provisions apply with respect to the extension of a period under subsection (b) or (c) of section 505A of the Federal
Food, Drug, and Cosmetic Act.
(2) MARKET EXCLUSIVITY FOR NEW BIOLOGICAL PRODUCTS.—
If, prior to approval of an application that is submitted under
subsection (a), the Secretary determines that information relating to the use of a new biological product in the pediatric population may produce health benefits in that population, the Secretary makes a written request for pediatric studies (which
shall include a timeframe for completing such studies), the applicant agrees to the request, such studies are completed using
appropriate formulations for each age group for which the
study is requested within any such timeframe, and the reports
thereof are submitted and accepted in accordance with section
505A(d)(3) of the Federal Food, Drug, and Cosmetic Act—
(A) the periods for such biological product referred to
in subsection (k)(7) are deemed to be 4 years and 6 months
rather than 4 years and 12 years and 6 months rather
than 12 years; and
(B) if the biological product is designated under section 526 for a rare disease or condition, the period for such
biological product referred to in section 527(a) is deemed
to be 7 years and 6 months rather than 7 years.
(3) MARKET EXCLUSIVITY FOR ALREADY-MARKETED BIOLOGICAL PRODUCTS.—If the Secretary determines that information
relating to the use of a licensed biological product in the pediatric population may produce health benefits in that population and makes a written request to the holder of an approved application under subsection (a) for pediatric studies
(which shall include a timeframe for completing such studies),
the holder agrees to the request, such studies are completed
using appropriate formulations for each age group for which
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the study is requested within any such timeframe, and the reports thereof are submitted and accepted in accordance with
section 505A(d)(3) of the Federal Food, Drug, and Cosmetic
Act—
(A) the periods for such biological product referred to
in subsection (k)(7) are deemed to be 4 years and 6 months
rather than 4 years and 12 years and 6 months rather
than 12 years; and
(B) if the biological product is designated under section 526 for a rare disease or condition, the period for such
biological product referred to in section 527(a) is deemed
to be 7 years and 6 months rather than 7 years.
(4) EXCEPTION.—The Secretary shall not extend a period
referred to in paragraph (2)(A), (2)(B), (3)(A), or (3)(B) if the
determination under section 505A(d)(3) is made later than 9
months prior to the expiration of such period.
SEC. 351A. ø262a¿ ENHANCED CONTROL OF DANGEROUS BIOLOGICAL
AGENTS AND TOXINS. 3
(a) REGULATORY CONTROL OF CERTAIN BIOLOGICAL AGENTS
AND TOXINS.—
(1) LIST OF BIOLOGICAL AGENTS AND TOXINS.—
(A) IN GENERAL.—The Secretary shall by regulation

establish and maintain a list of each biological agent and
each toxin that has the potential to pose a severe threat
to public health and safety.
(B) CRITERIA.—In determining whether to include an
agent or toxin on the list under subparagraph (A), the Secretary shall—
(i) consider—
(I) the effect on human health of exposure to
the agent or toxin;
(II) the degree of contagiousness of the agent
or toxin and the methods by which the agent or
toxin is transferred to humans;
(III) the availability and effectiveness of
pharmacotherapies and immunizations to treat
and prevent any illness resulting from infection by
the agent or toxin; and
(IV) any other criteria, including the needs of
children and other vulnerable populations, that
the Secretary considers appropriate; and
(ii) consult with appropriate Federal departments
and agencies and with scientific experts representing
appropriate professional groups, including groups with
pediatric expertise.
(2) BIENNIAL REVIEW.—The Secretary shall review and republish the list under paragraph (1) biennially, or more often
3 A program is carried out by the Secretary of Agriculture with respect to each biological agent
and each toxin that the Secretary determines has the potential to pose a severe threat to animal
or plant health, or to animal or plant products. Such program has requirements and authorities
similar to those established in section 351A above. See subtitle B of title II of Public Law 107–
188 (section 211 et seq.; 116 Stat. 647). Subtitle C of such title (section 221 et seq.; 116 Stat.
657) relates to interagency coordination of the two programs.

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as needed, and shall by regulation revise the list as necessary
in accordance with such paragraph.
(b) REGULATION OF TRANSFERS OF LISTED AGENTS AND TOXINS.—The Secretary shall by regulation provide for—
(1) the establishment and enforcement of safety procedures
for the transfer of listed agents and toxins, including measures
to ensure—
(A) proper training and appropriate skills to handle
such agents and toxins; and
(B) proper laboratory facilities to contain and dispose
of such agents and toxins;
(2) the establishment and enforcement of safeguard and
security measures to prevent access to such agents and toxins
for use in domestic or international terrorism or for any other
criminal purpose;
(3) the establishment of procedures to protect the public
safety in the event of a transfer or potential transfer of such
an agent or toxin in violation of the safety procedures established under paragraph (1) or the safeguard and security measures established under paragraph (2); and
(4) appropriate availability of biological agents and toxins
for research, education, and other legitimate purposes.
(c) POSSESSION AND USE OF LISTED AGENTS AND TOXINS.—The
Secretary shall by regulation provide for the establishment and enforcement of standards and procedures governing the possession
and use of listed agents and toxins, including the provisions described in paragraphs (1) through (4) of subsection (b), in order to
protect the public health and safety.
(d) REGISTRATION; IDENTIFICATION; DATABASE.—
(1) REGISTRATION.—Regulations under subsections (b) and
(c) shall require registration with the Secretary of the possession, use, and transfer of listed agents and toxins, and shall include provisions to ensure that persons seeking to register
under such regulations have a lawful purpose to possess, use,
or transfer such agents and toxins, including provisions in accordance with subsection (e)(6).
(2) IDENTIFICATION; DATABASE.—Regulations under subsections (b) and (c) shall require that registration include (if
available to the person registering) information regarding the
characterization of listed agents and toxins to facilitate their
identification, including their source. The Secretary shall maintain a national database that includes the names and locations
of registered persons, the listed agents and toxins such persons
are possessing, using, or transferring, and information regarding the characterization of such agents and toxins.
(e) SAFEGUARD AND SECURITY REQUIREMENTS FOR REGISTERED
PERSONS.—
(1) IN GENERAL.—Regulations under subsections (b) and (c)
shall include appropriate safeguard and security requirements
for persons possessing, using, or transferring a listed agent or
toxin commensurate with the risk such agent or toxin poses to
public health and safety (including the risk of use in domestic
or international terrorism). The Secretary shall establish such
requirements in collaboration with the Secretary of Homeland
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Security and the Attorney General, and shall ensure compliance with such requirements as part of the registration system
under such regulations.
(2) LIMITING ACCESS TO LISTED AGENTS AND TOXINS.—Requirements under paragraph (1) shall include provisions to ensure that registered persons—
(A) provide access to listed agents and toxins to only
those individuals whom the registered person involved determines have a legitimate need to handle or use such
agents and toxins;
(B) submit the names and other identifying information for such individuals to the Secretary and the Attorney
General, promptly after first determining that the individuals need access under subparagraph (A), and periodically
thereafter while the individuals have such access, not less
frequently than once every five years;
(C) deny access to such agents and toxins by individuals whom the Attorney General has identified as restricted persons; and
(D) limit or deny access to such agents and toxins by
individuals whom the Attorney General has identified as
within any category under paragraph (3)(B)(ii), if limiting
or denying such access by the individuals involved is determined appropriate by the Secretary, in consultation with
the Attorney General.
(3) SUBMITTED NAMES; USE OF DATABASES BY ATTORNEY
GENERAL.—
(A) IN GENERAL.—Upon the receipt of names and other
identifying information under paragraph (2)(B), the Attorney General shall, for the sole purpose of identifying
whether the individuals involved are within any of the categories specified in subparagraph (B), promptly use criminal, immigration, national security, and other electronic
databases that are available to the Federal Government
and are appropriate for such purpose.
(B) CERTAIN INDIVIDUALS.—For purposes of subparagraph (A), the categories specified in this subparagraph regarding an individual are that—
(i) the individual is a restricted person; or
(ii) the individual is reasonably suspected by any
Federal law enforcement or intelligence agency of—
(I) committing a crime set forth in section
2332b(g)(5) of title 18, United States Code;
(II) knowing involvement with an organization that engages in domestic or international terrorism (as defined in section 2331 of such title 18)
or with any other organization that engages in intentional crimes of violence; or
(III) being an agent of a foreign power (as defined in section 1801 of title 50, United States
Code).
(C) NOTIFICATION BY ATTORNEY GENERAL REGARDING
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ney General shall promptly notify the Secretary whether
the individual is within any of the categories specified in
subparagraph (B).
(4) NOTIFICATIONS BY SECRETARY.—The Secretary, after receiving notice under paragraph (3) regarding an individual,
shall promptly notify the registered person involved of whether
the individual is granted or denied access under paragraph (2).
If the individual is denied such access, the Secretary shall
promptly notify the individual of the denial.
(5) EXPEDITED REVIEW.—Regulations under subsections (b)
and (c) shall provide for a procedure through which, upon request to the Secretary by a registered person who submits
names and other identifying information under paragraph
(2)(B) and who demonstrates good cause, the Secretary may, as
determined appropriate by the Secretary—
(A) request the Attorney General to expedite the process of identification under paragraph (3)(A) and notification of the Secretary under paragraph (3)(C); and
(B) expedite the notification of the registered person
by the Secretary under paragraph (4).
(6) PROCESS REGARDING PERSONS SEEKING TO REGISTER.—
(A) INDIVIDUALS.—Regulations under subsections (b)
and (c) shall provide that an individual who seeks to register under either of such subsections is subject to the
same processes described in paragraphs (2) through (4) as
apply to names and other identifying information submitted to the Attorney General under paragraph (2)(B).
Paragraph (5) does not apply for purposes of this subparagraph.
(B) OTHER PERSONS.—Regulations under subsections
(b) and (c) shall provide that, in determining whether to
deny or revoke registration by a person other than an individual, the Secretary shall submit the name of such person
to the Attorney General, who shall use criminal, immigration, national security, and other electronic databases
available to the Federal Government, as appropriate for
the purpose of promptly notifying the Secretary whether
the person, or, where relevant, the individual who owns or
controls such person, is a restricted person or is reasonably
suspected by any Federal law enforcement or intelligence
agency of being within any category specified in paragraph
(3)(B)(ii) (as applied to persons, including individuals).
Such regulations shall provide that a person who seeks to
register under either of such subsections is subject to the
same processes described in paragraphs (2) and (4) as
apply to names and other identifying information submitted to the Attorney General under paragraph (2)(B).
Paragraph (5) does not apply for purposes of this subparagraph. The Secretary may exempt Federal, State, or local
governmental agencies from the requirements of this subparagraph.
(7) REVIEW.—
(A) ADMINISTRATIVE REVIEW.—
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(i) IN GENERAL.—Regulations under subsections
(b) and (c) shall provide for an opportunity for a review by the Secretary—
(I) when requested by the individual involved,
of a determination under paragraph (2) to deny
the individual access to listed agents and toxins;
and
(II) when requested by the person involved, of
a determination under paragraph (6) to deny or
revoke registration for such person.
(ii) EX PARTE REVIEW.—During a review under
clause (i), the Secretary may consider information relevant to the review ex parte to the extent that disclosure of the information could compromise national security or an investigation by any law enforcement
agency.
(iii) FINAL AGENCY ACTION.—The decision of the
Secretary in a review under clause (i) constitutes final
agency action for purposes of section 702 of title 5,
United States Code.
(B) CERTAIN PROCEDURES.—
(i) SUBMISSION OF EX PARTE MATERIALS IN JUDICIAL PROCEEDINGS.—When reviewing a decision of the
Secretary under subparagraph (A), and upon request
made ex parte and in writing by the United States, a
court, upon a sufficient showing, may review and consider ex parte documents containing information the
disclosure of which could compromise national security
or an investigation by any law enforcement agency. If
the court determines that portions of the documents
considered ex parte should be disclosed to the person
involved to allow a response, the court shall authorize
the United States to delete from such documents specified items of information the disclosure of which could
compromise national security or an investigation by
any law enforcement agency, or to substitute a summary of the information to which the person may respond. Any order by the court authorizing the disclosure of information that the United States believes
could compromise national security or an investigation
by any law enforcement agency shall be subject to the
processes set forth in subparagraphs (A) and (B)(i) of
section 2339B(f)(5) of title 18, United States Code (relating to interlocutory appeal and expedited consideration).
(ii) DISCLOSURE OF INFORMATION.—In a review
under subparagraph (A), and in any judical proceeding
conducted pursuant to such review, neither the Secretary nor the Attorney General may be required to
disclose to the public any information that under subsection (h) shall not be disclosed under section 552 of
title 5, United States Code.
(8) NOTIFICATIONS REGARDING THEFT OR LOSS OF AGENTS.—
Requirements under paragraph (1) shall include the prompt
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notification of the Secretary, and appropriate Federal, State,
and local law enforcement agencies, of the theft or loss of listed
agents and toxins.
(9) TECHNICAL ASSISTANCE FOR REGISTERED PERSONS.—The
Secretary, in consultation with the Attorney General, may provide technical assistance to registered persons to improve security of the facilities of such persons.
(f) INSPECTIONS.—The Secretary shall have the authority to inspect persons subject to regulations under subsection (b) or (c) to
ensure their compliance with such regulations, including prohibitions on restricted persons and other provisions of subsection (e).
(g) EXEMPTIONS.—
(1) CLINICAL OR DIAGNOSTIC LABORATORIES.—Regulations
under subsections (b) and (c) shall exempt clinical or diagnostic
laboratories and other persons who possess, use, or transfer
listed agents or toxins that are contained in specimens presented for diagnosis, verification, or proficiency testing, provided that—
(A) the identification of such agents or toxins is reported to the Secretary, and when required under Federal,
State, or local law, to other appropriate authorities; and
(B) such agents or toxins are transferred or destroyed
in a manner set forth by the Secretary by regulation.
(2) PRODUCTS.—
(A) IN GENERAL.—Regulations under subsections (b)
and (c) shall exempt products that are, bear, or contain
listed agents or toxins and are cleared, approved, licensed,
or registered under any of the Acts specified in subparagraph (B), unless the Secretary by order determines that
applying additional regulation under subsection (b) or (c)
to a specific product is necessary to protect public health
and safety.
(B) RELEVANT LAWS.—For purposes of subparagraph
(A), the Acts specified in this subparagraph are the following:
(i) The Federal Food, Drug, and Cosmetic Act.
(ii) Section 351 of this Act.
(iii) The Act commonly known as the VirusSerum-Toxin Act (the eighth paragraph under the
heading ‘‘Bureau of Animal Industry’’ in the Act of
March 4, 1913; 21 U.S.C. 151–159).
(iv) The Federal Insecticide, Fungicide, and
Rodenticide Act.
(C) INVESTIGATIONAL USE.—
(i) IN GENERAL.—The Secretary may exempt an investigational product that is, bears, or contains a listed agent or toxin from the applicability of provisions
of regulations under subsection (b) or (c) when such
product is being used in an investigation authorized
under any Federal Act and the Secretary determines
that applying additional regulation under subsection
(b) or (c) to such product is not necessary to protect
public health and safety.
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(ii) CERTAIN PROCESSES.—Regulations under subsections (b) and (c) shall set forth the procedures for
applying for an exemption under clause (i). In the case
of investigational products authorized under any of
the Acts specified in subparagraph (B), the Secretary
shall make a determination regarding a request for an
exemption not later than 14 days after the first date
on which both of the following conditions have been
met by the person requesting the exemption:
(I) The person has submitted to the Secretary
an application for the exemption meeting the requirements established by the Secretary.
(II) The person has notified the Secretary that
the investigation has been authorized under such
an Act.
(3) PUBLIC HEALTH EMERGENCIES.—The Secretary may
temporarily exempt a person from the applicability of the requirements of this section, in whole or in part, if the Secretary
determines that such exemption is necessary to provide for the
timely participation of the person in a response to a domestic
or foreign public health emergency (whether determined under
section 319(a) or otherwise) that involves a listed agent or
toxin. With respect to the emergency involved, such exemption
for a person may not exceed 30 days, except that the Secretary,
after review of whether such exemption remains necessary,
may provide one extension of an additional 30 days.
(4) AGRICULTURAL EMERGENCIES.—Upon request of the
Secretary of Agriculture, after the granting by such Secretary
of an exemption under section 212(g)(1)(D) of the Agricultural
Bioterrorism Protection Act of 2002 pursuant to a finding that
there is an agricultural emergency, the Secretary of Health
and Human Services may temporarily exempt a person from
the applicability of the requirements of this section, in whole
or in part, to provide for the timely participation of the person
in a response to the agricultural emergency. With respect to
the emergency involved, the exemption under this paragraph
for a person may not exceed 30 days, except that upon request
of the Secretary of Agriculture, the Secretary of Health and
Human Services may, after review of whether such exemption
remains necessary, provide one extension of an additional 30
days.
(h) DISCLOSURE OF INFORMATION.—
(1) NONDISCLOSURE OF CERTAIN INFORMATION.—No Federal
agency specified in paragraph (2) shall disclose under section
552 of title 5, United States Code, any of the following:
(A) Any registration or transfer documentation submitted under subsections (b) and (c) for the possession,
use, or transfer of a listed agent or toxin; or information
derived therefrom to the extent that it identifies the listed
agent or toxin possessed, used, or transferred by a specific
registered person or discloses the identity or location of a
specific registered person.
(B) The national database developed pursuant to subsection (d), or any other compilation of the registration or
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transfer information submitted under subsections (b) and
(c) to the extent that such compilation discloses site-specific registration or transfer information.
(C) Any portion of a record that discloses the site-specific or transfer-specific safeguard and security measures
used by a registered person to prevent unauthorized access
to listed agents and toxins.
(D) Any notification of a release of a listed agent or
toxin submitted under subsections (b) and (c), or any notification of theft or loss submitted under such subsections.
(E) Any portion of an evaluation or report of an inspection of a specific registered person conducted under
subsection (f) that identifies the listed agent or toxin possessed by a specific registered person or that discloses the
identity or location of a specific registered person if the
agency determines that public disclosure of the information would endanger public health or safety.
(2) COVERED AGENCIES.—For purposes of paragraph (1)
only, the Federal agencies specified in this paragraph are the
following:
(A) The Department of Health and Human Services,
the Department of Justice, the Department of Agriculture,
and the Department of Transportation.
(B) Any Federal agency to which information specified
in paragraph (1) is transferred by any agency specified in
subparagraph (A) of this paragraph.
(C) Any Federal agency that is a registered person, or
has a sub-agency component that is a registered person.
(D) Any Federal agency that awards grants or enters
into contracts or cooperative agreements involving listed
agents and toxins to or with a registered person, and to
which information specified in paragraph (1) is transferred
by any such registered person.
(3) OTHER EXEMPTIONS.—This subsection may not be construed as altering the application of any exemptions to public
disclosure under section 552 of title 5, United States Code, except as to subsection 552(b)(3) of such title, to any of the information specified in paragraph (1).
(4) RULE OF CONSTRUCTION.—Except as specifically provided in paragraph (1), this subsection may not be construed
as altering the authority of any Federal agency to withhold
under section 552 of title 5, United States Code, or the obligation of any Federal agency to disclose under section 552 of title
5, United States Code, any information, including information
relating to—
(A) listed agents and toxins, or individuals seeking access to such agents and toxins;
(B) registered persons, or persons seeking to register
their possession, use, or transfer of such agents and toxins;
(C) general safeguard and security policies and requirements under regulations under subsections (b) and
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tions, listed agents and toxins, inspection evaluations and
reports, or individuals seeking access to such agents and
toxins.
(5) DISCLOSURES TO CONGRESS; OTHER DISCLOSURES.—This
subsection may not be construed as providing any authority—
(A) to withhold information from the Congress or any
committee or subcommittee thereof; or
(B) to withhold information from any person under
any other Federal law or treaty.
(i) CIVIL MONEY PENALTY.— 1
(1) IN GENERAL.—In addition to any other penalties that
may apply under law, any person who violates any provision
of regulations under subsection (b) or (c) shall be subject to the
United States for a civil money penalty in an amount not exceeding $250,000 in the case of an individual and $500,000 in
the case of any other person.
(2) APPLICABILITY OF CERTAIN PROVISIONS.—The provisions
of section 1128A of the Social Security Act (other than subsections (a), (b), (h), and (i), the first sentence of subsection (c),
and paragraphs (1) and (2) of subsection (f)) shall apply to a
civil money penalty under paragraph (1) in the same manner
as such provisions apply to a penalty or proceeding under section 1128A(a) of such Act. The Secretary may delegate authority under this subsection in the same manner as provided in
section 1128A(j)(2) of the Social Security Act, and such authority shall include all powers as contained in section 6 of the Inspector General Act of 1978 (5 U.S.C. App.).
(j) NOTIFICATION IN EVENT OF RELEASE.—Regulations under
subsections (b) and (c) shall require the prompt notification of the
Secretary by a registered person whenever a release, meeting criteria established by the Secretary, of a listed agent or toxin has occurred outside of the biocontainment area of a facility of the registered person. Upon receipt of such notification and a finding by
the Secretary that the release poses a threat to public health or
safety, the Secretary shall take appropriate action to notify relevant State and local public health authorities, other relevant Federal authorities, and, if necessary, other appropriate persons (including the public). If the released listed agent or toxin is an overlap agent or toxin (as defined in subsection (l)), the Secretary shall
promptly notify the Secretary of Agriculture upon notification by
the registered person.
(k) REPORTS.—The Secretary shall report to the Congress annually on the number and nature of notifications received under
subsection (e)(8) (relating to theft or loss) and subsection (j) (relating to releases).
(l) DEFINITIONS.—For purposes of this section:
(1) The terms ‘‘biological agent’’ and ‘‘toxin’’ have the
meanings given such terms in section 178 of title 18, United
States Code.
1 Section 175b of title 18, United States Code, establishes criminal penalties relating to biological agents or toxins that are listed as select agents in Appendix A of part 72 of title 42,
Code of Federal Regulations, pursuant to section 351A above, and are not exempted under subsection (h) of section 72.6, or Appendix A of part 72, of title 42, Code of Federal Regulations.

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(2) The term ‘‘listed agents and toxins’’ means biological
agents and toxins listed pursuant to subsection (a)(1).
(3) The term ‘‘listed agents or toxins’’ means biological
agents or toxins listed pursuant to subsection (a)(1).
(4) The term ‘‘overlap agents and toxins’’ means biological
agents and toxins that—
(A) are listed pursuant to subsection (a)(1); and
(B) are listed pursuant to section 212(a)(1) of the Agricultural Bioterrorism Protection Act of 2002.
(5) The term ‘‘overlap agent or toxin’’ means a biological
agent or toxin that—
(A) is listed pursuant to subsection (a)(1); and
(B) is listed pursuant to section 212(a)(1) of the Agricultural Bioterrorism Protection Act of 2002.
(6) The term ‘‘person’’ includes Federal, State, and local
governmental entities.
(7) The term ‘‘registered person’’ means a person registered
under regulations under subsection (b) or (c).
(8) The term ‘‘restricted person’’ has the meaning given
such term in section 175b of title 18, United States Code.
(m) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of
carrying out this section, there are authorized to be appropriated
such sums as may be necessary for each of the fiscal years 2002
through 2007.
PREPARATION OF BIOLOGICAL PRODUCTS

SEC. 352. ø263¿ (a) The Service may prepare for its own use
any product described in section 351 and any product necessary to
carrying out any of the purposes of section 301.
(b) The Service may prepare any product described in section
351 for the use of other Federal departments or agencies, and public or private agencies and individuals engaged in work in the field
of medicine when such product is not available from establishments
licensed under such section.
Subpart 2—Clinical Laboratories
CERTIFICATION OF LABORATORIES

SEC. 353. ø263a¿ (a) DEFINITION.—As used in this section, the
term ‘‘laboratory’’ or ‘‘clinical laboratory’’ means a facility for the biological,
microbiological,
serological,
chemical,
immunohematological, hematological, biophysical, cytological, pathological,
or other examination of materials derived from the human body for
the purpose of providing information for the diagnosis, prevention,
or treatment of any disease or impairment of, or the assessment of
the health of, human beings.
(b) CERTIFICATE REQUIREMENT.—No person may solicit or accept materials derived from the human body for laboratory examination or other procedure unless there is in effect for the laboratory a certificate issued by the Secretary under this section applicable to the category of examinations or procedures which includes
such examination or procedure.
(c) ISSUANCE AND RENEWAL OF CERTIFICATES.—
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(1) IN GENERAL.—The Secretary may issue or renew a certificate for a laboratory only if the laboratory meets the requirements of subsection (d).
(2) TERM.—A certificate issued under this section shall be
valid for a period of 2 years or such shorter period as the Secretary may establish.
(d) REQUIREMENTS FOR CERTIFICATES.—
(1) IN GENERAL.—A laboratory may be issued a certificate
or have its certificate renewed if—
(A) the laboratory submits (or if the laboratory is accredited under subsection (e), the accreditation body which
accredited the laboratory submits), an application—
(i) in such form and manner as the Secretary shall
prescribe,
(ii) that describes the characteristics of the laboratory examinations and other procedures performed by
the laboratory including—
(I) the number and types of laboratory examinations and other procedures performed,
(II) the methodologies for laboratory examinations and other procedures employed, and
(III) the qualifications (educational background, training, and experience) of the personnel
directing and supervising the laboratory and performing the laboratory examinations and other
procedures, and
(iii) that contains such other information as the
Secretary may require to determine compliance with
this section, and
the laboratory agrees to provide to the Secretary (or if the
laboratory is accredited, to the accreditation body which
accredited it) a description of any change in the information submitted under clause (ii) not later than 6 months
after the change was put into effect,
(B) the laboratory provides the Secretary—
(i) with satisfactory assurances that the laboratory
will be operated in accordance with standards issued
by the Secretary under subsection (f), or
(ii) with proof of accreditation under subsection
(e),
(C) the laboratory agrees to permit inspections by the
Secretary under subsection (g),
(D) the laboratory agrees to make records available
and submit reports to the Secretary as the Secretary may
reasonably require, and
(E) the laboratory agrees to treat proficiency testing
samples in the same manner as it treats materials derived
from the human body referred to it for laboratory examinations or other procedures in the ordinary course of business, except that no proficiency testing sample shall be referred to another laboratory for analysis as prohibited
under subsection (i)(4).
(2) REQUIREMENTS FOR CERTIFICATES OF WAIVER.—
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(A) IN GENERAL.—A laboratory which only performs
laboratory examinations and procedures described in paragraph (3) shall be issued a certificate of waiver or have its
certificate of waiver renewed if—
(i) the laboratory submits an application—
(I) in such form and manner as the Secretary
shall prescribe,
(II) that describes the characteristics of the
laboratory examinations and other procedures performed by the laboratory, including the number
and types of laboratory examinations and other
procedures performed, the methodologies for laboratory examinations and other procedures employed, and the qualifications (educational background, training, and experience) of the personnel
directing and supervising the laboratory and performing the laboratory examinations and other
procedures, and
(III) that contains such other information as
the Secretary may reasonably require to determine compliance with this section, and
(ii) the laboratory agrees to make records available and submit reports to the Secretary as the Secretary may require.
(B) CHANGES.—If a laboratory makes changes in the
examinations and other procedures performed by it only
with respect to examinations and procedures which are described in paragraph (3), the laboratory shall report such
changes to the Secretary not later than 6 months after the
change has been put into effect. If a laboratory proposes to
make changes in the examinations and procedures performed by it such that the laboratory will perform an examination or procedure not described in paragraph (3), the
laboratory shall report such change to the Secretary before
the change takes effect.
(C) EFFECT.—Subsections (f) and (g) shall not apply to
a laboratory to which has been issued a certificate of waiver.
(3) EXAMINATIONS AND PROCEDURES.—The examinations
and procedures identified in paragraph (2) are laboratory examinations and procedures that have been approved by the
Food and Drug Administration for home use or that, as determined by the Secretary, are simple laboratory examinations
and procedures that have an insignificant risk of an erroneous
result, including those that—
(A) employ methodologies that are so simple and accurate as to render the likelihood of erroneous results by the
user negligible, or
(B) the Secretary has determined pose no unreasonable risk of harm to the patient if performed incorrectly.
(4) DEFINITION.—As used in this section, the term ‘‘certificate’’ includes a certificate of waiver issued under paragraph
(2).
(e) ACCREDITATION.—
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(1) IN GENERAL.—A laboratory may be accredited for purposes of obtaining a certificate if the laboratory—
(A) meets the standards of an approved accreditation
body, and
(B) authorizes the accreditation body to submit to the
Secretary (or such State agency as the Secretary may designate) such records or other information as the Secretary
may require.
(2) APPROVAL OF ACCREDITATION BODIES.—
(A) IN GENERAL.—The Secretary may approve a private nonprofit organization to be an accreditation body for
the accreditation of laboratories if—
(i) using inspectors qualified to evaluate the methodologies used by the laboratories in performing laboratory examinations and other procedures, the accreditation body agrees to inspect a laboratory for purposes of accreditation with such frequency as determined by Secretary, 1
(ii) the standards applied by the body in determining whether or not to accredit a laboratory are
equal to or more stringent than the standards issued
by the Secretary under subsection (f),
(iii) there is adequate provision for assuring that
the standards of the accreditation body continue to be
met by the laboratory,
(iv) in the case of any laboratory accredited by the
body which has had its accreditation denied, suspended, withdrawn, or revoked or which has had any
other action taken against it by the accrediting body,
the accrediting body agrees to submit to the Secretary
the name of such laboratory within 30 days of the action taken,
(v) the accreditation body agrees to notify the Secretary at least 30 days before it changes its standards,
and
(vi) if the accreditation body has its approval withdrawn by the Secretary, the body agrees to notify each
laboratory accredited by the body of the withdrawal
within 10 days of the withdrawal.
(B) CRITERIA AND PROCEDURES.—The Secretary shall
promulgate criteria and procedures for approving an accreditation body and for withdrawing such approval if the
Secretary determines that the accreditation body does not
meet the requirements of subparagraph (A).
(C) EFFECT OF WITHDRAWAL OF APPROVAL.—If the Secretary withdraws the approval of an accreditation body
under subparagraph (B), the certificate of any laboratory
accredited by the body shall continue in effect for 60 days
after the laboratory receives notification of the withdrawal
of the approval, except that the Secretary may extend such
period for a laboratory if it 1 determines that the laboratory submitted an application for accreditation or a certifi1 So

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in law. Probably should be ‘‘the Secretary’’.

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cate in a timely manner after receipt of the notification of
the withdrawal of approval. If an accreditation body withdraws or revokes the accreditation of a laboratory, the certificate of the laboratory shall continue in effect—
(i) for 45 days after the laboratory receives notice
of the withdrawal or revocation of the accreditation, or
(ii) until the effective date of any action taken by
the Secretary under subsection (i).
(D) EVALUATIONS.—The Secretary shall evaluate annually the performance of each approved accreditation
body by—
(i) inspecting under subsection (g) a sufficient
number of the laboratories accredited by such body to
allow a reasonable estimate of the performance of such
body, and
(ii) such other means as the Secretary determines
appropriate.
(3) REPORT.—The Secretary shall annually prepare and
submit, to the Committee on Energy and Commerce of the
House of Representatives and the Committee on Labor and
Human Resources of the Senate, a report that describes the results of the evaluation conducted under paragraph (2)(D).
(f) 1 STANDARDS.—
(1) IN GENERAL.—The Secretary shall issue standards to
assure consistent performance by laboratories issued a certificate under this section of valid and reliable laboratory examinations and other procedures. Such standards shall require
each laboratory issued a certificate under this section—
(A) to maintain a quality assurance and quality control program adequate and appropriate for the validity and
reliability of the laboratory examinations and other procedures of the laboratory and to meet requirements relating
to the proper collection, transportation, and storage of
specimens and the reporting of results,
(B) to maintain records, equipment, and facilities necessary for the proper and effective operation of the laboratory,
(C) in performing and carrying out its laboratory examinations and other procedures, to use only personnel
meeting such qualifications as the Secretary may establish
for the direction, supervision, and performance of examinations and procedures within the laboratory, which qualifications shall take into consideration competency, training, experience, job performance, and education and which
qualifications shall, as appropriate, be different on the
basis of the type of examinations and procedures being
performed by the laboratory and the risks and consequences of erroneous results associated with such examinations and procedures,
1 Section 3 of Public Law 100–578 provides that, with respect to subsection (g)(1) and subsections (h) through (m), any reference made in any of such subsections to the standards established under subsection (f) ‘‘shall be considered a reference to the standards established under
subsection (d) [of section 353], as in effect on December 31, 1988.’’.

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(D) to qualify under a proficiency testing program
meeting the standards established by the Secretary under
paragraph (3), and
(E) to meet such other requirements as the Secretary
determines necessary to assure consistent performance by
such laboratories of accurate and reliable laboratory examinations and procedures.
(2) CONSIDERATIONS.—In developing the standards to be
issued under paragraph (1), the Secretary shall, within the
flexibility provided under subparagraphs (A) through (E) of
paragraph (1), take into consideration—
(A) the examinations and procedures performed and
the methodologies employed,
(B) the degree of independent judgment involved,
(C) the amount of interpretation involved,
(D) the difficulty of the calculations involved,
(E) the calibration and quality control requirements of
the instruments used,
(F) the type of training required to operate the instruments used in the methodology, and
(G) such other factors as the Secretary considers relevant.
(3) PROFICIENCY TESTING PROGRAM.—
(A) IN GENERAL.—The Secretary shall establish standards for the proficiency testing programs for laboratories
issued a certificate under this section which are conducted
by the Secretary, conducted by an organization approved
under subparagraph (C), or conducted by an approved accrediting body. The standards shall require that a laboratory issued a certificate under this section be tested for
each examination and procedure conducted within a category of examinations or procedures for which it has received a certificate, except for examinations and procedures for which the Secretary has determined that a proficiency test cannot reasonably be developed. The testing
shall be conducted on a quarterly basis, except where the
Secretary determines for technical and scientific reasons
that a particular examination or procedure may be tested
less frequently (but not less often than twice per year).
(B) CRITERIA.—The standards established under subparagraph (A) shall include uniform criteria for acceptable
performance under a proficiency testing program, based on
the available technology and the clinical relevance of the
laboratory examination or other procedure subject to such
program. The criteria shall be established for all examinations and procedures and shall be uniform for each examination and procedure. The standards shall also include a
system for grading proficiency testing performance to determine whether a laboratory has performed acceptably for
a particular quarter and acceptably for a particular examination or procedure or category of examination or procedure over a period of successive quarters.
(C) APPROVED PROFICIENCY TESTING PROGRAMS.—For
the purpose of administering proficiency testing programs
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which meet the standards established under subparagraph
(A), the Secretary shall approve a proficiency testing program offered by a private nonprofit organization or a State
if the program meets the standards established under subparagraph (A) and the organization or State provides technical assistance to laboratories seeking to qualify under
the program. The Secretary shall evaluate each program
approved under this subparagraph annually to determine
if the program continues to meet the standards established
under subparagraph (A) and shall withdraw the approval
of any program that no longer meets such standards.
(D) ON-SITE 1 TESTING.—The Secretary shall perform,
or shall direct a program approved under subparagraph
(C) to perform, onsite proficiency testing to assure compliance with the requirements of subsection (d)(5) 2. The Secretary shall perform, on an onsite or other basis, proficiency testing to evaluate the performance of a proficiency testing program approved under subparagraph (C)
and to assure quality performance by a laboratory.
(E) TRAINING, TECHNICAL ASSISTANCE, AND ENHANCED
PROFICIENCY TESTING.—The Secretary may, in lieu of or in
addition to actions authorized under subsection (h), (i), or
(j), require any laboratory which fails to perform acceptably on an individual examination and procedure or a category of examination and procedures—
(i) to undertake training and to obtain the necessary technical assistance to meet the requirements
of the proficency 1 testing program,
(ii) to enroll in a program of enhanced proficiency
testing, or
(iii) to undertake any combination of the training,
technical assistance, or testing described in clauses (i)
and (ii).
(F) TESTING RESULTS.—The Secretary shall establish a
system to make the results of the proficiency testing programs subject to the standards established by the Secretary under subparagraph (A) available, on a reasonable
basis, upon request of any person. The Secretary shall include with results made available under this subparagraph
such explanatory information as may be appropriate to assist in the interpretation of such results.
(4) NATIONAL STANDARDS FOR QUALITY ASSURANCE IN CYTOLOGY SERVICES.—
(A) ESTABLISHMENT.—The Secretary shall establish
national standards for quality assurance in cytology services designed to assure consistent performance by laboratories of valid and reliable cytological services.
(B) STANDARDS.—The standards established under
subparagraph (A) shall include—
(i) the maximum number of cytology slides that
any individual may screen in a 24-hour period,
1 So
2 So
1 So

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in law. Probably should not be hyphenated. Compare with text of subparagraph (D).
in law. Probably should be ‘‘(d)(1)(E)’’.
in law. Probably should be ‘‘proficiency’’.

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(ii) requirements that a clinical laboratory maintain a record of (I) the number of cytology slides
screened during each 24-hour period by each individual who examines cytology slides for the laboratory,
and (II) the number of hours devoted during each 24hour period to screening cytology slides by such individual,
(iii) criteria for requiring rescreening of cytological
preparations, such as (I) random rescreening of cytology specimens determined to be in the benign category, (II) focused rescreening of such preparations in
high risk groups, and (III) for each abnormal
cytological result, rescreening of all prior cytological
specimens for the patient, if available,
(iv) periodic confirmation and evaluation of the
proficiency of individuals involved in screening or interpreting cytological preparations, including announced and unannounced on-site 2 proficiency testing
of such individuals, with such testing to take place, to
the extent practicable, under normal working conditions,
(v) procedures for detecting inadequately prepared
slides, for assuring that no cytological diagnosis is rendered on such slides, and for notifying referring physicians of such slides,
(vi) requirements that all cytological screening be
done on the premises of a laboratory that is certified
under this section,
(vii) requirements for the retention of cytology
slides by laboratories for such periods of time as the
Secretary considers appropriate, and
(viii) standards requiring periodic inspection of cytology services by persons capable of evaluating the
quality of cytology services.
(g) INSPECTIONS.—
(1) IN GENERAL.—The Secretary may, on an announced or
unannounced basis, enter and inspect, during regular hours of
operation, laboratories which have been issued a certificate
under this section. In conducting such inspections the Secretary shall have access to all facilities, equipment, materials,
records, and information that the Secretary determines have a
bearing on whether the laboratory is being operated in accordance with this section. As part of such an inspection the Secretary may copy any such material or require to it be 1 submitted to the Secretary. An inspection under this paragraph
may be made only upon presenting identification to the owner,
operator, or agent in charge of the laboratory being inspected.
(2) COMPLIANCE WITH REQUIREMENTS AND STANDARDS.—
The Secretary shall conduct inspections of laboratories under
paragraph (1) to determine their compliance with the requirements of subsection (d) and the standards issued under sub2 See
1 So

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footnote 1 for paragraph (3)(D).
in law. Probably should be ‘‘require it to be’’.

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section (f). Inspections of laboratories not accredited under subsection (e) shall be conducted on a biennial basis or with such
other frequency as the Secretary determines to be necessary to
assure compliance with such requirements and standards. Inspections of laboratories accredited under subsection (e) shall
be conducted on such basis as the Secretary determines is necessary to assure compliance with such requirements and standards.
(h) INTERMEDIATE SANCTIONS.—
(1) IN GENERAL.—If the Secretary determines that a laboratory which has been issued a certificate under this section
no longer substantially meets the requirements for the
issuance of a certificate, the Secretary may impose intermediate sanctions in lieu of the actions authorized by subsection (i).
(2) TYPES OF SANCTIONS.—The intermediate sanctions
which may be imposed under paragraph (1) shall consist of—
(A) directed plans of correction,
(B) civil money penalties in an amount not to exceed
$10,000 for each violation listed in subsection (i)(1) or for
each day of substantial noncompliance with the requirements of this section,
(C) payment for the costs of onsite monitoring, or
(D) any combination of the actions described in subparagraphs (A), (B), and (C).
(3) PROCEDURES.—The Secretary shall develop and implement procedures with respect to when and how each of the intermediate sanctions is to be imposed under paragraph (1).
Such procedures shall provide for notice to the laboratory and
a reasonable opportunity to respond to the proposed sanction
and appropriate procedures for appealing determinations relating to the imposition of intermediate sanctions 1
(i) SUSPENSION, REVOCATION, AND LIMITATION.—
(1) IN GENERAL.—Except as provided in paragraph (2), the
certificate of a laboratory issued under this section may be suspended, revoked, or limited if the Secretary finds, after reasonable notice and opportunity for hearing to the owner or operator of the laboratory, that such owner or operator or any employee of the laboratory—
(A) has been guilty of misrepresentation in obtaining
the certificate,
(B) has performed or represented the laboratory as entitled to perform a laboratory examination or other procedure which is not within a category of laboratory examinations or other procedures authorized in the certificate,
(C) has failed to comply with the requirements of subsection (d) or the standards prescribed by the Secretary
under subsection (f),
(D) has failed to comply with reasonable requests of
the Secretary for—
(i) any information or materials, or
(ii) work on materials,
1 So

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in law. The sentence lacks a period.

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that the Secretary concludes is necessary to determine the
laboratory’s continued eligibility for its certificate or continued compliance with the Secretary’s standards under
subsection (f),
(E) has refused a reasonable request of the Secretary,
or any Federal officer or employee duly designated by the
Secretary, for permission to inspect the laboratory and its
operations and pertinent records during the hours the laboratory is in operation,
(F) has violated or aided and abetted in the violation
of any provisions of this section or of any regulation promulgated thereunder, or
(G) has not complied with an intermediate sanction
imposed under subsection (h).
(2) ACTION BEFORE A HEARING.—If the Secretary determines that—
(A) the failure of a laboratory to comply with the
standards of the Secretary under subsection (f) presents an
imminent and serious risk to human health, or
(B) a laboratory has engaged in an action described in
subparagraph (D) or (E) of paragraph (1),
the Secretary may suspend or limit the certificate of the laboratory before holding a hearing under paragraph (1) regarding
such failure or refusal. The opportunity for a hearing shall be
provided no later than 60 days from the effective date of the
suspension or limitation. A suspension or limitation under this
paragraph shall stay in effect until the decision of the Secretary made after the hearing under paragraph (1).
(3) INELIGIBILITY TO OWN OR OPERATE LABORATORIES AFTER
REVOCATION.—No person who has owned or operated a laboratory which has had its certificate revoked may, within 2 years
of the revocation of the certificate, own or operate a laboratory
for which a certificate has been issued under this section, except that if the revocation occurs pursuant to paragraph (4) the
Secretary may substitute intermediate sanctions under subsection (h) instead of the 2-year prohibition against ownership
or operation which would otherwise apply under this paragraph. The certificate of a laboratory which has been excluded
from participation under the medicare program under title
XVIII of the Social Security Act because of actions relating to
the quality of the laboratory shall be suspended for the period
the laboratory is so excluded.
(4) IMPROPER REFERRALS.—Any laboratory that the Secretary determines intentionally refers its proficiency testing
samples to another laboratory for analysis may have its certificate revoked for at least one year and shall be subject to appropriate fines and penalties as provided for in subsection (h).
(j) INJUNCTIONS.—Whenever the Secretary has reason to believe that continuation of any activity by a laboratory would constitute a significant hazard to the public health the Secretary may
bring suit in the district court of the United States for the district
in which such laboratory is situated to enjoin continuation of such
activity. Upon proper showing, a temporary injunction or restraining order against continuation of such activity pending issuance of
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a final order under this subsection shall be granted without bond
by such court.
(k) JUDICIAL REVIEW.—
(1) PETITION.—Any laboratory which has had an intermediate sanction imposed under subsection (h) or has had its
certificate suspended, revoked, or limited under subsection (i)
may, at any time within 60 days after the date the action of
the Secretary under subsection (i) or (h) becomes final, file a
petition with the United States court of appeals for the circuit
wherein the laboratory has its principal place of business for
judicial review of such action. As soon as practicable after receipt of the petition, the clerk of the court shall transmit a
copy of the petition to the Secretary or other officer designated
by the Secretary for that purpose. As soon as practicable after
receipt of the copy, the Secretary shall file in the court the
record on which the action of the Secretary is based, as provided in section 2112 of title 28, United States Code.
(2) ADDITIONAL EVIDENCE.—If the petitioner applies to the
court for leave to adduce additional evidence, and shows to the
satisfaction of the court that such additional evidence is material and that there were reasonable grounds for the failure to
adduce such evidence in the proceeding before the Secretary,
the court may order such additional evidence (and evidence in
rebuttal of such additional evidence) to be taken before the
Secretary, and to be adduced upon the hearing in such manner
and upon such terms and conditions as the court may deem
proper. The Secretary may modify the findings of the Secretary
as to the facts, or make new findings, by reason of the additional evidence so taken, and the Secretary shall file such
modified or new findings, and the recommendations of the Secretary, if any, for the modification or setting aside of his original action, with the return of such additional evidence.
(3) JUDGMENT OF COURT.—Upon the filing of the petition
referred to in paragraph (1), the court shall have jurisdiction
to affirm the action, or to set it aside in whole or in part, temporarily or permanently. The findings of the Secretary as to
the facts, if supported by substantial evidence, shall be conclusive.
(4) FINALITY OF JUDGMENT.—The judgment of the court affirming or setting aside, in whole or in part, any such action
of the Secretary shall be final, subject to review by the Supreme Court of the United States upon certiorari or certification as provided in section 1254 of title 28, United States
Code.
(l) SANCTIONS.—Any person who intentionally violates any requirement of this section or any regulation promulgated thereunder
shall be imprisoned for not more than one year or fined under title
18, United States Code or both, except that if the conviction is for
a second or subsequent violation of such a requirement such person
shall be imprisoned for not more than 3 years or fined in accordance with title 18, United States Code or both.
(m) FEES.—
(1) CERTIFICATE FEES.—The Secretary shall require payment of fees for the issuance and renewal of certificates, except
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that the Secretary shall only require a nominal fee for the
issuance and renewal of certificates of waiver.
(2) ADDITIONAL FEES.—The Secretary shall require the
payment of fees for inspections of laboratories which are not
accredited and for the cost of performing proficiency testing on
laboratories which do not participate in proficiency testing programs approved under subsection (f)(3)(C).
(3) CRITERIA.—
(A) FEES UNDER PARAGRAPH (1).—Fees imposed under
paragraph (1) shall be sufficient to cover the general costs
of administering this section, including evaluating and
monitoring proficiency testing programs approved under
subsection (f) and accrediting bodies and implementing
and monitoring compliance with the requirements of this
section.
(B) FEES UNDER PARAGRAPH (2).—Fees imposed under
paragraph (2) shall be sufficient to cover the cost of the
Secretary in carrying out the inspections and proficiency
testing described in paragraph (2).
(C) FEES IMPOSED UNDER PARAGRAPHS (1) AND (2).—
Fees imposed under paragraphs (1) and (2) shall vary by
group or classification of laboratory, based on such considerations as the Secretary determines are relevant, which
may include the dollar volume and scope of the testing
being performed by the laboratories.
(n) INFORMATION.—On April 1, 1990 and annually thereafter,
the Secretary shall compile and make available to physicians and
the general public information, based on the previous calendar
year, which the Secretary determines is useful in evaluating the
performance of a laboratory, including—
(1) a list of laboratories which have been convicted under
Federal or State laws relating to fraud and abuse, false billings, or kickbacks,
(2) a list of laboratories—
(A) which have had their certificates revoked, suspended, or limited under subsection (i), or
(B) which have been the subject of a sanction under
subsection (l),
together with a statement of the reasons for the revocation,
suspension, limitation, or sanction,
(3) a list of laboratories subject to intermediate sanctions
under subsection (h) together with a statement of the reasons
for the sanctions,
(4) a list of laboratories whose accreditation has been withdrawn or revoked together with a statement of the reasons for
the withdrawal or revocation,
(5) a list of laboratories against which the Secretary has
taken action under subsection (j) together with a statement of
the reasons for such action, and
(6) a list of laboratories which have been excluded from
participation under title XVIII or XIX of the Social Security
Act.
The information to be compiled under paragraphs (1) through (6)
shall be information for the calendar year preceding the date the
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information is to be made available to the public and shall be accompanied by such explanatory information as may be appropriate
to assist in the interpretation of the information compiled under
such paragraphs.
(o) DELEGATION.—In carrying out this section, the Secretary
may, pursuant to agreement, use the services or facilities of any
Federal or State or local public agency or nonprofit private organization, and may pay therefor in advance or by way of reimbursement, and in such installments, as the Secretary may determine.
(p) STATE LAWS.—
(1) Except as provided in paragraph (2), nothing in this
section shall be construed as affecting the power of any State
to enact and enforce laws relating to the matters covered by
this section to the extent that such laws are not inconsistent
with this section or with the regulations issued under this section.
(2) If a State enacts laws relating to matters covered by
this section which provide for requirements equal to or more
stringent than the requirements of this section or than the regulations issued under this section, the Secretary may exempt
clinical laboratories in that State from compliance with this
section.
(q) CONSULTATIONS.—In carrying out this section, the Secretary shall consult with appropriate private organizations and
public agencies.
Subpart 3—Mammography Facilities
SEC. 354. ø263b¿ CERTIFICATION OF MAMMOGRAPHY FACILITIES.
(a) DEFINITIONS.—As used in this section:
(1) ACCREDITATION BODY.—The term ‘‘accreditation body’’

means a body that has been approved by the Secretary under
subsection (e)(1)(A) to accredit mammography facilities.
(2) CERTIFICATE.—The term ‘‘certificate’’ means the certificate described in subsection (b)(1).
(3) FACILITY.—
(A) IN GENERAL.—The term ‘‘facility’’ means a hospital,
outpatient department, clinic, radiology practice, or mobile
unit, an office of a physician, or other facility as determined by the Secretary, that conducts breast cancer
screening or diagnosis through mammography activities.
Such term does not include a facility of the Department of
Veterans Affairs.
(B) ACTIVITIES.—For the purposes of this section, the
activities of a facility include the operation of equipment
to produce the mammogram, the processing of the film, the
initial interpretation of the mammogram and the viewing
conditions for that interpretation. Where procedures such
as the film processing, or the interpretation of the mammogram are performed in a location different from where
the mammogram is performed, the facility performing the
mammogram shall be responsible for meeting the quality
standards described in subsection (f).
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(4) INSPECTION.—The term ‘‘inspection’’ means an onsite
evaluation of the facility by the Secretary, or State or local
agency on behalf of the Secretary.
(5) MAMMOGRAM.—The term ‘‘mammogram’’ means a radiographic image produced through mammography.
(6) MAMMOGRAPHY.—The term ‘‘mammography’’ means radiography of the breast.
(7) SURVEY.—The term ‘‘survey’’ means an onsite physics
consultation and evaluation performed by a medical physicist
as described in subsection (f)(1)(E).
(8) REVIEW PHYSICIAN.—The term ‘‘review physician’’
means a physician as prescribed by the Secretary under subsection (f )(1)(D) who meets such additional requirements as
may be established by an accreditation body under subsection
(e) and approved by the Secretary to review clinical images
under subsection (e)(1)(B)(i) on behalf of the accreditation body.
(b) CERTIFICATE REQUIREMENT.—
(1) CERTIFICATE.—No facility may conduct an examination
or procedure described in paragraph (2) involving mammography after October 1, 1994, unless the facility obtains—
(A) a certificate or a temporary renewal certificate—
(i) that is issued, and, if applicable, renewed, by
the Secretary in accordance with paragraphs 1 (1) or
(2) of subsection (c);
(ii) that is applicable to the examination or procedure to be conducted; and
(iii) that is displayed prominently in such facility;
or
(B) a provisional certificate or a limited provisional
certificate—
(i) that is issued by the Secretary in accordance
with paragraphs (3) and (4) of subsection (c);
(ii) that is applicable to the examination or procedure to be conducted; and
(iii) that is displayed prominently in such facility.
The reference to a certificate in this section includes a temporary renewal certificate, provisional certificate, or a 2 limited
provisional certificate.
(2) EXAMINATION OR PROCEDURE.—A facility shall obtain a
certificate in order to—
(A) operate radiological equipment that is used to
image the breast;
(B) provide for the interpretation of a mammogram
produced by such equipment at the facility or under arrangements with a qualified individual at a facility different from where the mammography examination is performed; and
(C) provide for the processing of film produced by such
equipment at the facility or under arrangements with a
1 So in law. Probably should be ‘‘paragraph’’. See section 2(1)(A)(ii) of Public Law 108–365 (118
Stat. 1738).
2 So in law. The article ‘‘a’’ appears before both ‘‘temporary renewal certificate’’ and ‘‘limited
provisional certificate’’. See section 2(1)(C) of Public Law 108–365 (118 Stat. 1738).

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qualified individual at a facility different from where the
mammography examination is performed.
(c) ISSUANCE AND RENEWAL OF CERTIFICATES.—
(1) IN GENERAL.—The Secretary may issue or renew a certificate for a facility if the person or agent described in subsection (d)(1)(A) meets the applicable requirements of subsection (d)(1) with respect to the facility. The Secretary may
issue or renew a certificate under this paragraph for not more
than 3 years.
(2) TEMPORARY RENEWAL CERTIFICATE.—The Secretary
may issue a temporary renewal certificate, for a period of not
to exceed 45 days, to a facility seeking reaccreditation if the accreditation body has issued an accreditation extension, for a
period of not to exceed 45 days, for any of the following:
(A) The facility has submitted the required materials
to the accreditation body within the established time
frames for the submission of such materials but the accreditation body is unable to complete the reaccreditation
process before the certification expires.
(B) The facility has acquired additional or replacement
equipment, or has had significant personnel changes or
other unforeseen situations that have caused the facility to
be unable to meet reaccreditation timeframes, but in the
opinion of the accreditation body have not compromised
the quality of mammography.
(3) LIMITED PROVISIONAL CERTIFICATE.—The Secretary
may, upon the request of an accreditation body, issue a limited
provisional certificate to an entity to enable the entity to conduct examinations for educational purposes while an onsite
visit from an accreditation body is in progress. Such certificate
shall be valid only during the time the site visit team from the
accreditation body is physically in the facility, and in no case
shall be valid for longer than 72 hours. The issuance of a certificate under this paragraph, shall not preclude the entity
from qualifying for a provisional certificate under paragraph
(4).
(4) PROVISIONAL CERTIFICATE.—The Secretary may issue a
provisional certificate for an entity to enable the entity to qualify as a facility. The applicant for a provisional certificate shall
meet the requirements of subsection (d)(1), except providing information required by clauses (iii) and (iv) of subsection
(d)(1)(A). A provisional certificate may be in effect no longer
than 6 months from the date it is issued, except that it may
be extended once for a period of not more than 90 days if the
owner, lessor, or agent of the facility demonstrates to the Secretary that without such extension access to mammography in
the geographic area served by the facility would be significantly reduced and if the owner, lessor, or agent of the facility
will describe in a report to the Secretary steps that will be
taken to qualify the facility for certification under subsection
(b)(1).
(d) APPLICATION FOR CERTIFICATE.—
(1) SUBMISSION.—The Secretary may issue or renew a certificate for a facility if—
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(A) the person who owns or leases the facility or an
authorized agent of the person, submits to the Secretary,
in such form and manner as the Secretary shall prescribe,
an application that contains at a minimum—
(i) a description of the manufacturer, model, and
type of each x-ray machine, image receptor, and processor operated in the performance of mammography
by the facility;
(ii) a description of the procedures currently used
to provide mammography at the facility, including—
(I) the types of procedures performed and the
number of such procedures performed in the prior
12 months;
(II) the methodologies for mammography; and
(III) the names and qualifications (educational
background, training, and experience) of the personnel performing mammography and the physicians reading and interpreting the results from
the procedures;
(iii) proof of on-site survey by a qualified medical
physicist as described in subsection (f)(1)(E); and
(iv) proof of accreditation in such manner as the
Secretary shall prescribe; and
(B) the person or agent submits to the Secretary—
(i) a satisfactory assurance that the facility will be
operated in accordance with standards established by
the Secretary under subsection (f) to assure the safety
and accuracy of mammography;
(ii) a satisfactory assurance that the facility will—
(I) permit inspections under subsection (g);
(II) make such records and information available, and submit such reports, to the Secretary as
the Secretary may require; and
(III) update the information submitted under
subparagraph (A) or assurances submitted under
this subparagraph on a timely basis as required
by the Secretary; and
(iii) such other information as the Secretary may
require.
An applicant shall not be required to provide in an application
under subparagraph (A) any information which the applicant
has supplied to the accreditation body which accredited the applicant, except as required by the Secretary.
(2) APPEAL.—If the Secretary denies an application for the
certification of a facility submitted under paragraph (1)(A), the
Secretary shall provide the owner or lessor of the facility or the
agent of the owner or lessor who submitted such application—
(A) a statement of the grounds on which the denial is
based, and
(B) an opportunity for an appeal in accordance with
the procedures set forth in regulations of the Secretary
published at part 498 of title 42, Code of Federal Regulations.
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(3) EFFECT OF DENIAL.—If the application for the certification of a facility is denied, the facility may not operate unless
the denial of the application is overturned at the conclusion of
the administrative appeals process provided in the regulations
referred to in paragraph (2)(B).
(e) ACCREDITATION.—
(1) APPROVAL OF ACCREDITATION BODIES.—
(A) IN GENERAL.—The Secretary may approve a private nonprofit organization or State agency to accredit facilities for purposes of subsection (d)(1)(A)(iv) if the accreditation body meets the standards for accreditation established by the Secretary as described in subparagraph (B)
and provides the assurances required by subparagraph (C).
(B) STANDARDS.—The Secretary shall establish standards for accreditation bodies, including—
(i) standards that require an accreditation body to
perform—
(I) a review of clinical images from each facility accredited by such body not less often than
every 3 years which review will be made by qualified review physicians; and
(II) a review of a random sample of clinical
images from such facilities in each 3-year period
beginning October 1, 1994, which review will be
made by qualified review physicians;
(ii) standards that prohibit individuals conducting
the reviews described in clause (i) from maintaining
any relationship to the facility undergoing review
which would constitute a conflict of interest;
(iii) standards that limit the imposition of fees for
accreditation to reasonable amounts;
(iv) standards that require as a condition of accreditation that each facility undergo a survey at least
annually by a medical physicist as described in subsection (f)(1)(E) to ensure that the facility meets the
standards described in subparagraphs (A) and (B) of
subsection (f)(1);
(v) standards that require monitoring and evaluation of such survey, as prescribed by the Secretary;
(vi) standards that are equal to standards established under subsection (f) which are relevant to accreditation as determined by the Secretary; and
(vii) such additional standards as the Secretary
may require.
(C) ASSURANCES.—The accrediting body shall provide
the Secretary satisfactory assurances that the body will—
(i) comply with the standards as described in subparagraph (B);
(ii) comply with the requirements described in
paragraph (4);
(iii) submit to the Secretary the name of any facility for which the accreditation body denies, suspends,
or revokes accreditation;
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(iv) notify the Secretary in a timely manner before
the accreditation body changes the standards of the
body;
(v) notify each facility accredited by the accreditation body if the Secretary withdraws approval of the
accreditation body under paragraph (2) in a timely
manner; and
(vi) provide such other additional information as
the Secretary may require.
(D) REGULATIONS.—Not later than 9 months after the
date of the enactment of this section, the Secretary shall
promulgate regulations under which the Secretary may approve an accreditation body.
(2) WITHDRAWAL OF APPROVAL.—
(A) IN GENERAL.—The Secretary shall promulgate regulations under which the Secretary may withdraw the approval of an accreditation body if the Secretary determines
that the accreditation body does not meet the standards
under subparagraph (B) of paragraph (1), the requirements of clauses (i) through (vi) of subparagraph (C) of
paragraph (1), or the requirements of paragraph (4).
(B) EFFECT OF WITHDRAWAL.—If the Secretary withdraws the approval of an accreditation body under subparagraph (A), the certificate of any facility accredited by
the body shall continue in effect until the expiration of a
reasonable period, as determined by the Secretary, for
such facility to obtain another accreditation.
(3) ACCREDITATION.—To be accredited by an approved accreditation body a facility shall meet—
(A) the standards described in paragraph (1)(B) which
the Secretary determines are applicable to the facility, and
(B) such other standards which the accreditation body
may require.
(4) COMPLIANCE.—To ensure that facilities accredited by
an accreditation body will continue to meet the standards of
the accreditation body, the accreditation body shall—
(A) make onsite visits on an annual basis of a sufficient number of the facilities accredited by the body to
allow a reasonable estimate of the performance of the
body; and
(B) take such additional measures as the Secretary determines to be appropriate.
Visits made under subparagraph (A) shall be made after providing such notice as the Secretary may require.
(5) REVOCATION OF ACCREDITATION.—If an accreditation
body revokes the accreditation of a facility, the certificate of
the facility shall continue in effect until such time as may be
determined by the Secretary.
(6) EVALUATION AND REPORT.—
(A) EVALUATION.—The Secretary shall evaluate annually the performance of each approved accreditation body
by—
(i) inspecting under subsection (g)(2) a sufficient
number of the facilities accredited by the body to allow
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a reasonable estimate of the performance of the body;
and
(ii) such additional means as the Secretary determines to be appropriate.
(B) REPORT.—The Secretary shall annually prepare
and submit to the Committee on Labor and Human Resources of the Senate and the Committee on Energy and
Commerce of the House of Representatives a report that
describes the results of the evaluation conducted in accordance with subparagraph (A).
(f) QUALITY STANDARDS.—
(1) IN GENERAL.—The standards referred to in subsection
(d)(1)(B)(i) are standards established by the Secretary which
include—
(A) standards that require establishment and maintenance of a quality assurance and quality control program
at each facility that is adequate and appropriate to ensure
the reliability, clarity, and accuracy of interpretation of
mammograms and standards for appropriate radiation
dose;
(B) standards that require use of radiological equipment specifically designed for mammography, including
radiologic standards and standards for other equipment
and materials used in conjunction with such equipment;
(C) a requirement that personnel who perform mammography—
(i)(I) be licensed by a State to perform radiological
procedures; or
(II) be certified as qualified to perform radiological
procedures by an organization described in paragraph
(2)(A); and
(ii) during the 2-year period beginning October 1,
1994, meet training standards for personnel who perform mammography or meet experience requirements
which shall at a minimum include 1 year of experience
in the performance of mammography; and
(iii) upon the expiration of such 2-year period
meet minimum training standards for personnel who
perform mammograms;
(D) a requirement that mammograms be interpreted
by a physician who is certified as qualified to interpret radiological procedures, including mammography—
(i)(I) by a board described in paragraph (2)(B); or
(II) by a program that complies with the standards described in paragraph (2)(C); and
(ii) who meets training and continuing medical
education requirements as established by the Secretary;
(E) a requirement that individuals who survey mammography facilities be medical physicists—
(i) licensed or approved by a State to perform such
surveys, reviews, or inspections for mammography facilities;
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(ii) certified in diagnostic radiological physics or
certified as qualified to perform such surveys by a
board as described in paragraph (2)(D); or
(iii) in the first 5 years after the date of the enactment of this section, who meet other criteria established by the Secretary which are comparable to the
criteria described in clause (i) or (ii);
(F) a requirement that a medical physicist who is
qualified in mammography as described in subparagraph
(E) survey mammography equipment and oversee quality
assurance practices at each facility;
(G) a requirement that—
(i) a facility that performs any mammogram—
(I) except as provided in subclause (II), maintain the mammogram in the permanent medical
records of the patient for a period of not less than
5 years, or not less than 10 years if no subsequent
mammograms of such patient are performed at
the facility, or longer if mandated by State law;
and
(II) upon the request of or on behalf of the patient, transfer the mammogram to a medical institution, to a physician of the patient, or to the patient directly; and
(ii)(I) a facility must assure the preparation of a
written report of the results of any mammography examination signed by the interpreting physician;
(II) such written report shall be provided to the
patient’s physicians (if any);
(III) if such a physician is not available or if there
is no such physician, the written report shall be sent
directly to the patient; and
(IV) whether or not such a physician is available
or there is no such physician, a summary of the written report shall be sent directly to the patient in terms
easily understood by a lay person; and
(H) standards relating to special techniques for mammography of patients with breast implants.
Subparagraph (G) shall not be construed to limit a patient’s access to the patient’s medical records.
(2) CERTIFICATION OF PERSONNEL.—The Secretary shall by
regulation—
(A) specify organizations eligible to certify individuals
to perform radiological procedures as required by paragraph (1)(C);
(B) specify boards eligible to certify physicians to interpret radiological procedures, including mammography,
as required by paragraph (1)(D);
(C) establish standards for a program to certify physicians described in paragraph (1)(D); and
(D) specify boards eligible to certify medical physicists
who are qualified to survey mammography equipment and
to oversee quality assurance practices at mammography
facilities.
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(g) INSPECTIONS.—
(1) ANNUAL INSPECTIONS.—
(A) IN GENERAL.—The Secretary may enter and inspect facilities to determine compliance with the certification requirements under subsection (b) and the standards established under subsection (f). The Secretary shall,
if feasible, delegate to a State or local agency the authority
to make such inspections.
(B) IDENTIFICATION.—The Secretary, or State or local
agency acting on behalf of the Secretary, may conduct inspections only on presenting identification to the owner,
operator, or agent in charge of the facility to be inspected.
(C) SCOPE OF INSPECTION.—In conducting inspections,
the Secretary or State or local agency acting on behalf of
the Secretary—
(i) shall have access to all equipment, materials,
records, and information that the Secretary or State or
local agency considers necessary to determine whether
the facility is being operated in accordance with this
section; and
(ii) may copy, or require the facility to submit to
the Secretary or the State or local agency, any of the
materials, records, or information.
(D) QUALIFICATIONS OF INSPECTORS.—Qualified individuals, as determined by the Secretary, shall conduct all
inspections. The Secretary may request that a State or
local agency acting on behalf of the Secretary designate a
qualified officer or employee to conduct the inspections, or
designate a qualified Federal officer or employee to conduct inspections. The Secretary shall establish minimum
qualifications and appropriate training for inspectors and
criteria for certification of inspectors in order to inspect facilities for compliance with subsection (f).
(E) FREQUENCY.—The Secretary or State or local agency acting on behalf of the Secretary shall conduct inspections under this paragraph of each facility not less often
than annually, subject to paragraph (6).
(F) RECORDS AND ANNUAL REPORTS.—The Secretary or
a State or local agency acting on behalf of the Secretary
which is responsible for inspecting mammography facilities
shall maintain records of annual inspections required
under this paragraph for a period as prescribed by the Secretary. Such a State or local agency shall annually prepare
and submit to the Secretary a report concerning the inspections carried out under this paragraph. Such reports
shall include a description of the facilities inspected and
the results of such inspections.
(2) INSPECTION OF ACCREDITED FACILITIES.—The Secretary
shall inspect annually a sufficient number of the facilities accredited by an accreditation body to provide the Secretary with
a reasonable estimate of the performance of such body.
(3) INSPECTION OF FACILITIES INSPECTED BY STATE OR
LOCAL AGENCIES.—The Secretary shall inspect annually facilities inspected by State or local agencies acting on behalf of the
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Secretary to assure a reasonable performance by such State or
local agencies.
(4) TIMING.—The Secretary, or State or local agency, may
conduct inspections under paragraphs (1), (2), and (3), during
regular business hours or at a mutually agreeable time and
after providing such notice as the Secretary may prescribe, except that the Secretary may waive such requirements if the
continued performance of mammography at such facility
threatens the public health.
(5) LIMITED REINSPECTION.—Nothing in this section limits
the authority of the Secretary to conduct limited reinspections
of facilities found not to be in compliance with this section.
(6) DEMONSTRATION PROGRAM.—
(A) IN GENERAL.—The Secretary may establish a demonstration program under which inspections under paragraph (1) of selected facilities are conducted less frequently
by the Secretary (or as applicable, by State or local agencies acting on behalf of the Secretary) than the interval
specified in subparagraph (E) of such paragraph.
(B) REQUIREMENTS.—Any demonstration program
under subparagraph (A) shall be carried out in accordance
with the following:
(i) The program may not be implemented before
April 1, 2001. Preparations for the program may be
carried out prior to such date.
(ii) In carrying out the program, the Secretary
may not select a facility for inclusion in the program
unless the facility is substantially free of incidents of
noncompliance with the standards under subsection
(f ). The Secretary may at any time provide that a facility will no longer be included in the program.
(iii) The number of facilities selected for inclusion
in the program shall be sufficient to provide a statistically significant sample, subject to compliance with
clause (ii).
(iv) Facilities that are selected for inclusion in the
program shall be inspected at such intervals as the
Secretary determines will reasonably ensure that the
facilities are maintaining compliance with such standards.
(h) SANCTIONS.—
(1) IN GENERAL.—In order to promote voluntary compliance
with this section, the Secretary may, in lieu of taking the actions authorized by subsection (i), impose one or more of the
following sanctions:
(A) Directed plans of correction which afford a facility
an opportunity to correct violations in a timely manner.
(B) Payment for the cost of onsite monitoring.
(2) PATIENT INFORMATION.—If the Secretary determines
that the quality of mammography performed by a facility
(whether or not certified pursuant to subsection (c)) was so inconsistent with the quality standards established pursuant to
subsection (f ) as to present a significant risk to individual or
public health, the Secretary may require such facility to notify
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patients who received mammograms at such facility, and their
referring physicians, of the deficiencies presenting such risk,
the potential harm resulting, appropriate remedial measures,
and such other relevant information as the Secretary may require.
(3) CIVIL MONEY PENALTIES.—The Secretary may assess
civil money penalties in an amount not to exceed $10,000 for—
(A) failure to obtain a certificate as required by subsection (b),
(B) each failure by a facility to substantially comply
with, or each day on which a facility fails to substantially
comply with, the standards established under subsection
(f) or the requirements described in subclauses (I) through
(III) of subsection (d)(1)(B)(ii),
(C) each failure to notify a patient of risk as required
by the Secretary pursuant to paragraph (2), and
(D) each violation, or for each aiding and abetting in
a violation of, any provision of, or regulation promulgated
under, this section by an owner, operator, or any employee
of a facility required to have a certificate.
(4) PROCEDURES.—The Secretary shall develop and implement procedures with respect to when and how each of the
sanctions is to be imposed under paragraphs (1) through (3).
Such procedures shall provide for notice to the owner or operator of the facility and a reasonable opportunity for the owner
or operator to respond to the proposed sanctions and appropriate procedures for appealing determinations relating to the
imposition of sanctions.
(i) SUSPENSION AND REVOCATION.—
(1) IN GENERAL.—The certificate of a facility issued under
subsection (c) may be suspended or revoked if the Secretary
finds, after providing, except as provided in paragraph (2), reasonable notice and an opportunity for a hearing to the owner
or operator of the facility, that the owner, operator, or any employee of the facility—
(A) has been guilty of misrepresentation in obtaining
the certificate;
(B) has failed to comply with the requirements of subsection (d)(1)(B)(ii)(III) or the standards established by the
Secretary under subsection (f);
(C) has failed to comply with reasonable requests of
the Secretary (or of an accreditation body approved pursuant to subsection (e)) for any record, information, report, or
material that the Secretary (or such accreditation body or
State carrying out certification program requirements pursuant to subsection (q)) concludes is necessary to determine the continued eligibility of the facility for a certificate
or continued compliance with the standards established
under subsection (f);
(D) has refused a reasonable request of the Secretary,
any Federal officer or employee duly designated by the
Secretary, or any State or local officer or employee duly
designated by the State or local agency, for permission to
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inspect the facility or the operations and pertinent records
of the facility in accordance with subsection (g);
(E) has violated or aided and abetted in the violation
of any provision of, or regulation promulgated under, this
section; or
(F) has failed to comply with a sanction imposed under
subsection (h).
(2) ACTION BEFORE A HEARING.—
(A) IN GENERAL.—The Secretary may suspend the certificate of the facility before holding a hearing required by
paragraph (1) if the Secretary has reason to believe that
the circumstance of the case will support one or more of
the findings described in paragraph (1) and that—
(i) the failure or violation was intentional; or
(ii) the failure or violation presents a serious risk
to human health.
(B) HEARING.—If the Secretary suspends a certificate
under subparagraph (A), the Secretary shall provide an opportunity for a hearing to the owner or operator of the facility not later than 60 days from the effective date of the
suspension. The suspension shall remain in effect until the
decision of the Secretary made after the hearing.
(3) INELIGIBILITY TO OWN OR OPERATE FACILITIES AFTER
REVOCATION.—If the Secretary revokes the certificate of a facility on the basis of an act described in paragraph (1), no person
who owned or operated the facility at the time of the act may,
within 2 years of the revocation of the certificate, own or operate a facility that requires a certificate under this section.
(j) INJUNCTIONS.—If the Secretary determines that—
(1) continuation of any activity related to the provision of
mammography by a facility would constitute a serious risk to
human health, the Secretary may bring suit in the district
court of the United States for the district in which the facility
is situated to enjoin continuation of the activity; and
(2) a facility is operating without a certificate as required
by subsection (b), the Secretary may bring suit in the district
court of the United States for the district in which the facility
is situated to enjoin the operation of the facility.
Upon a proper showing, the district court shall grant a temporary
injunction or restraining order against continuation of the activity
or against operation of a facility, as the case may be, without requiring the Secretary to post a bond, pending issuance of a final
order under this subsection.
(k) JUDICIAL REVIEW.—
(1) PETITION.—If the Secretary imposes a sanction on a facility under subsection (h) or suspends or revokes the certificate of a facility under subsection (i), the owner or operator of
the facility may, not later than 60 days after the date the action of the Secretary becomes final, file a petition with the
United States court of appeals for the circuit in which the facility is situated for judicial review of the action. As soon as practicable after receipt of the petition, the clerk of the court shall
transmit a copy of the petition to the Secretary or other officer
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ceipt of the copy, the Secretary shall file in the court the record
on which the action of the Secretary is based, as provided in
section 2112 of title 28, United States Code.
(2) ADDITIONAL EVIDENCE.—If the petitioner applies to the
court for leave to adduce additional evidence, and shows to the
satisfaction of the court that the additional evidence is material and that there were reasonable grounds for the failure to
adduce such evidence in the proceeding before the Secretary,
the court may order the additional evidence (and evidence in
rebuttal of the additional evidence) to be taken before the Secretary, and to be adduced upon the hearing in such manner
and upon such terms and conditions as the court may determine to be proper. The Secretary may modify the findings of
the Secretary as to the facts, or make new findings, by reason
of the additional evidence so taken, and the Secretary shall file
the modified or new findings, and the recommendations of the
Secretary, if any, for the modification or setting aside of the
original action of the Secretary with the return of the additional evidence.
(3) JUDGMENT OF COURT.—Upon the filing of the petition
referred to in paragraph (1), the court shall have jurisdiction
to affirm the action, or to set the action aside in whole or in
part, temporarily or permanently. The findings of the Secretary as to the facts, if supported by substantial evidence,
shall be conclusive.
(4) FINALITY OF JUDGMENT.—The judgment of the court affirming or setting aside, in whole or in part, any action of the
Secretary shall be final, subject to review by the Supreme
Court of the United States upon certiorari or certification, as
provided in section 1254 of title 28, United States Code.
(l) INFORMATION.—
(1) IN GENERAL.—Not later than October 1, 1996, and annually thereafter, the Secretary shall compile and make available to physicians and the general public information that the
Secretary determines is useful in evaluating the performance
of facilities, including a list of facilities—
(A) that have been convicted under Federal or State
laws relating to fraud and abuse, false billings, or kickbacks;
(B) that have been subject to sanctions under subsection (h), together with a statement of the reasons for
the sanctions;
(C) that have had certificates revoked or suspended
under subsection (i), together with a statement of the reasons for the revocation or suspension;
(D) against which the Secretary has taken action
under subsection (j), together with a statement of the reasons for the action;
(E) whose accreditation has been revoked, together
with a statement of the reasons of the revocation;
(F) against which a State has taken adverse action;
and
(G) that meets such other measures of performance as
the Secretary may develop.
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(2) DATE.—The information to be compiled under paragraph (1) shall be information for the calendar year preceding
the date the information is to be made available to the public.
(3) EXPLANATORY INFORMATION.—The information to be
compiled under paragraph (1) shall be accompanied by such explanatory information as may be appropriate to assist in the
interpretation of the information compiled under such paragraph.
(m) STATE LAWS.—Nothing in this section shall be construed to
limit the authority of any State to enact and enforce laws relating
to the matters covered by this section that are at least as stringent
as this section or the regulations issued under this section.
(n) NATIONAL ADVISORY COMMITTEE.—
(1) ESTABLISHMENT.—In carrying out this section, the Secretary shall establish an advisory committee to be known as
the National Mammography Quality Assurance Advisory Committee (hereafter in this subsection referred to as the ‘‘Advisory
Committee’’).
(2) COMPOSITION.—The Advisory Committee shall be composed of not fewer than 13, nor more than 19 individuals, who
are not officers or employees of the Federal Government. The
Secretary shall make appointments to the Advisory Committee
from among—
(A) physicians,
(B) practitioners, and
(C) other health professionals,
whose clinical practice, research specialization, or professional
expertise include a significant focus on mammography. The
Secretary shall appoint at least 4 individuals from among national breast cancer or consumer health organizations with expertise in mammography, at least 2 industry representatives
with expertise in mammography equipment, and at least 2
practicing physicians who provide mammography services.
(3) FUNCTIONS AND DUTIES.—The Advisory Committee
shall—
(A) advise the Secretary on appropriate quality standards and regulations for mammography facilities;
(B) advise the Secretary on appropriate standards and
regulations for accreditation bodies;
(C) advise the Secretary in the development of regulations with respect to sanctions;
(D) assist in developing procedures for monitoring
compliance with standards under subsection (f);
(E) make recommendations and assist in the establishment of a mechanism to investigate consumer complaints;
(F) report on new developments concerning breast imaging that should be considered in the oversight of mammography facilities;
(G) determine whether there exists a shortage of
mammography facilities in rural and health professional
shortage areas and determine the effects of personnel or
other requirements of subsection (f) on access to the services of such facilities in such areas;
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(H) determine whether there will exist a sufficient
number of medical physicists after October 1, 1999, to assure compliance with the requirements of subsection
(f)(1)(E);
(I) determine the costs and benefits of compliance with
the requirements of this section (including the requirements of regulations promulgated under this section); and
(J) perform other activities that the Secretary may require.
The Advisory Committee shall report the findings made under
subparagraphs (G) and (I) to the Secretary and the Congress
no later than October 1, 1993.
(4) MEETINGS.—The Advisory Committee shall meet not
less than quarterly for the first 3 years of the program and
thereafter, at least annually.
(5) CHAIRPERSON.—The Secretary shall appoint a chairperson of the Advisory Committee.
(o) CONSULTATIONS.—In carrying out this section, the Secretary shall consult with appropriate Federal agencies within the
Department of Health and Human Services for the purposes of developing standards, regulations, evaluations, and procedures for
compliance and oversight.
(p) BREAST CANCER SCREENING SURVEILLANCE RESEARCH
GRANTS.—
(1) RESEARCH.—
(A) GRANTS.—The Secretary shall award grants to
such entities as the Secretary may determine to be appropriate to establish surveillance systems in selected geographic areas to provide data to evaluate the functioning
and effectiveness of breast cancer screening programs in
the United States, including assessments of participation
rates in screening mammography, diagnostic procedures,
incidence of breast cancer, mode of detection (mammography screening or other methods), outcome and follow up
information, and such related epidemiologic analyses that
may improve early cancer detection and contribute to reduction in breast cancer mortality. Grants may be awarded
for further research on breast cancer surveillance systems
upon the Secretary’s review of the evaluation of the program.
(B) USE OF FUNDS.—Grants awarded under subparagraph (A) may be used—
(i) to study—
(I) methods to link mammography and clinical
breast examination records with population-based
cancer registry data;
(II) methods to provide diagnostic outcome
data, or facilitate the communication of diagnostic
outcome data, to radiology facilities for purposes
of evaluating patterns of mammography interpretation; and
(III) mechanisms for limiting access and
maintaining confidentiality of all stored data; and
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(ii) to conduct pilot testing of the methods and
mechanisms described in subclauses (I), (II), and (III)
of clause (i) on a limited basis.
(C) GRANT APPLICATION.—To be eligible to receive
funds under this paragraph, an entity shall submit an application to the Secretary at such time, in such manner,
and containing such information as the Secretary may require.
(D) REPORT.—A recipient of a grant under this paragraph shall submit a report to the Secretary containing the
results of the study and testing conducted under clauses (i)
and (ii) of subparagraph (B), along with recommendations
for methods of establishing a breast cancer screening surveillance system.
(2) ESTABLISHMENT.—The Secretary shall establish a
breast cancer screening surveillance system based on the recommendations contained in the report described in paragraph
(1)(D).
(3) STANDARDS AND PROCEDURES.—The Secretary shall establish standards and procedures for the operation of the
breast cancer screening surveillance system, including procedures to maintain confidentiality of patient records.
(4) INFORMATION.—The Secretary shall recruit facilities to
provide to the breast cancer screening surveillance system relevant data that could help in the research of the causes, characteristics, and prevalence of, and potential treatments for,
breast cancer and benign breast conditions, if the information
may be disclosed under section 552 of title 5, United States
Code.
(q) STATE PROGRAM.—
(1) IN GENERAL.—The Secretary may, upon application, authorize a State—
(A) to carry out, subject to paragraph (2), the certification program requirements under subsections (b), (c), (d),
(g)(1), (h), (i), and (j) (including the requirements under
regulations promulgated pursuant to such subsections),
and
(B) to implement the standards established by the Secretary under subsection (f),
with respect to mammography facilities operating within the
State.
(2) APPROVAL.— The Secretary may approve an application
under paragraph (1) if the Secretary determines that—
(A) the State has enacted laws and issued regulations
relating to mammography facilities which are the requirements of this section (including the requirements under
regulations promulgated pursuant to such subsections),
and
(B) the State has provided satisfactory assurances that
the State—
(i) has the legal authority and qualified personnel
necessary to enforce the requirements of and the regulations promulgated pursuant to this section (includMarch 13, 2013

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ing the requirements under regulations promulgated
pursuant to such subsections),
(ii) will devote adequate funds to the administration and enforcement of such requirements, and
(iii) will provide the Secretary with such information and reports as the Secretary may require.
(3) AUTHORITY OF SECRETARY.—In a State with an approved application—
(A) the Secretary shall carry out the Secretary’s functions under subsections (e) and (f);
(B) the Secretary may take action under subsections
(h), (i), and (j); and
(C) the Secretary shall conduct oversight functions
under subsections (g)(2) and (g)(3).
(4) WITHDRAWAL OF APPROVAL.—
(A) IN GENERAL.—The Secretary may, after providing
notice and opportunity for corrective action, withdraw the
approval of a State’s authority under paragraph (1) if the
Secretary determines that the State does not meet the requirements of such paragraph. The Secretary shall promulgate regulations for the implementation of this subparagraph.
(B) EFFECT OF WITHDRAWAL.—If the Secretary withdraws the approval of a State under subparagraph (A), the
certificate of any facility certified by the State shall continue in effect until the expiration of a reasonable period,
as determined by the Secretary, for such facility to obtain
certification by the Secretary.
(r) FUNDING.—
(1) FEES.—
(A) IN GENERAL.—The Secretary shall, in accordance
with this paragraph assess and collect fees from persons
described in subsection (d)(1)(A) (other than persons who
are governmental entities, as determined by the Secretary)
to cover the costs of inspections conducted under subsection (g)(1) by the Secretary or a State acting under a
delegation under subparagraph (A) of such subsection.
Fees may be assessed and collected under this paragraph
only in such manner as would result in an aggregate
amount of fees collected during any fiscal year which
equals the aggregate amount of costs for such fiscal year
for inspections of facilities of such persons under subsection (g)(1). A person’s liability for fees shall be reasonably based on the proportion of the inspection costs which
relate to such person.
(B) DEPOSIT AND APPROPRIATIONS.—
(i) DEPOSIT AND AVAILABILITY.—Fees collected
under subparagraph (A) shall be deposited as an offsetting collection to the appropriations for the Department of Health and Human Services as provided in
appropriation Acts and shall remain available without
fiscal year limitation.
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(ii) APPROPRIATIONS.—Fees collected under subparagraph (A) shall be collected and available only to
the extent provided in advance in appropriation Acts.
(2) AUTHORIZATION OF APPROPRIATIONS.—There are authorized to be appropriated to carry out this section—
(A) to award research grants under subsection (p),
such sums as may be necessary for each of the fiscal years
1993 through 2007; and
(B) for the Secretary to carry out other activities
which are not supported by fees authorized and collected
under paragraph (1), such sums as may be necessary for
fiscal years 1993 through 2007.
PART G—QUARANTINE

AND INSPECTION

CONTROL OF COMMUNICABLE DISEASES

SEC. 361. ø264¿ (a) The Surgeon General, with the approval of
the Secretary is authorized to make and enforce such regulations
as in his judgment are necessary to prevent the introduction, transmission, or spread of communicable diseases from foreign countries
into the States or possessions, or from one State or possession into
any other State or possession. For purposes of carrying out and enforcing such regulations, the Surgeon General may provide for such
inspection, fumigation, disinfection, sanitation, pest extermination,
destruction of animals or articles found to be so infected or contaminated as to be sources of dangerous infection to human beings,
and other measures, as in his judgment may be necessary.
(b) Regulations prescribed under this section shall not provide
for the apprehension, detention, or conditional release of individuals except for the purpose of preventing the introduction, transmission, or spread of such communicable diseases as may be specified from time to time in Executive orders of the President upon
the recommendation of the Secretary, in consultation with the Surgeon General, 1.
(c) Except as provided in subsection (d), regulations prescribed
under this section, insofar as they provide for the apprehension, detention, examination, or conditional release of individuals, shall be
applicable only to individuals coming into a State or possession
from a foreign country or a possession.
(d)(1) Regulations prescribed under this section may provide
for the apprehension and examination of any individual reasonably
believed to be infected with a communicable disease in a qualifying
stage and (A) to be moving or about to move from a State to another State; or (B) to be a probable source of infection to individuals who, while infected with such disease in a qualifying stage,
will be moving from a State to another State. Such regulations may
provide that if upon examination any such individual is found to
be infected, he may be detained for such time and in such manner
as may be reasonably necessary. For purposes of this subsection,
the term ‘‘State’’ includes, in addition to the several States, only
the District of Columbia.
1 The comma is so in law. See the amendment made by section 142(a)(1) of Public Law 107–
188 (116 Stat. 626).

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(2) For purposes of this subsection, the term ‘‘qualifying stage’’,
with respect to a communicable disease, means that such disease—
(A) is in a communicable stage; or
(B) is in a precommunicable stage, if the disease would be
likely to cause a public health emergency if transmitted to
other individuals.
(e) Nothing in this section or section 363, or the regulations
promulgated under such sections, may be construed as superseding
any provision under State law (including regulations and including
provisions established by political subdivisions of States), except to
the extent that such a provision conflicts with an exercise of Federal authority under this section or section 363.
SUSPENSION OF ENTRIES AND IMPORTS FROM DESIGNATED PLACES

SEC. 362. ø265¿ Whenever the Surgeon General determines
that by reason of the existence of any communicable disease in a
foreign country there is serious danger of the introduction of such
disease into the United States, and that this danger is so increased
by the introduction of persons or property from such country that
a suspension of the right to introduce such persons and property
is required in the interest of the public health, the Surgeon General, in accordance with regulations approved by the President,
shall have the power to prohibit, in whole or in part, the introduction of persons and property from such countries or places as he
shall designate in order to avert such danger, and for such period
of time as he may deem necessary for such purpose.
SPECIAL POWERS IN TIME OF WAR

363. 1

SEC.
ø266¿ To protect the military and naval forces and
war workers of the United States, in time of war, against any communicable disease specified in Executive orders as provided in subsection (b) of section 361, the Secretary, in consultation with the
Surgeon General, is authorized to provide by regulations for the apprehension and examination, in time of war, of any individual reasonably believed (1) to be infected with such disease and (2) to be
a probable source of infection to members of the armed forces of the
United States or to individuals engaged in the production or transportation of arms, munitions, ships, food, clothing, or other supplies
for the armed forces. Such regulations may provide that if upon examination any such individual is found to be so infected, he may
be detained for such time and in such manner as may be reasonably necessary.
QUARANTINE STATIONS

SEC. 364. ø267¿ (a) Except as provided in title II of the Act of
June 15, 1917, as amended (U.S.C., 1940 edition, title 50, secs.
191–194), 2 the Surgeon General shall control, direct, and manage
all United States quarantine stations, grounds, and anchorages,
designate their boundaries, and designate the quarantine officers
1 Under section 3 of Public Law 239, 80th Congress, the date of July 25, 1947, is deemed, for
purposes of this section, to be the date of termination of ‘‘any state of war heretofore declared
by the Congress’’.
2 Now codified to sections 191, 192, 194, and 195 of title 50, United States Code.

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to be in charge thereof. With the approval of the President he shall
from time to time select suitable sites for and establish such additional stations, grounds, and anchorages in the States and possessions of the United States as in his judgment are necessary to prevent the introduction of communicable diseases into the States and
possessions of the United States.
(b) The Surgeon General shall establish the hours during
which quarantine service shall be performed at each quarantine
station, and, upon application by any interested party, may establish quarantine inspection during the twenty-four hours of the day,
or any fraction thereof, at such quarantine stations as, in his opinion, require such extended service. He may restrict the performance of quarantine inspection to hours of daylight for such arriving
vessels as cannot, in his opinion, be satisfactorily inspected during
hours of darkness. No vessel shall be required to undergo quarantine inspection during the hours of darkness, unless the quarantine officer at such quarantine station shall deem an immediate
inspection necessary to protect the public health. Uniformity shall
not be required in the hours during which quarantine inspection
may be obtained at the various ports of the United States.
(c) The Surgeon General shall fix a reasonable rate of extra
compensation for overtime services of employees of the United
States Public Health Service, Foreign Quarantine Division, performing overtime duties including the operation of vessels, in connection with the inspection or quarantine treatment of persons
(passengers and crews), conveyances, or goods arriving by land,
water, or air in the United States or any place subject to the jurisdiction thereof, hereinafter referred to as ‘‘employees of the Public
Health Service’’, when required to be on duty between the hours of
6 o’clock postmeridian and 6 o’clock antemeridian (or between the
hours of 7 o’clock postmeridian and 7 o’clock antemeridian at stations which have a declared workday of from 7 o’clock antemeridian
to 7 o’clock postmeridian), or on Sundays or holidays, such rate, in
lieu of compensation under any other provision of law, to be fixed
at two times the basic hourly rate for each hour that the overtime
extends beyond 6 o’clock (or 7 o’clock as the case may be)
postmeridian, and two times the basic hourly rate for each overtime hour worked on Sundays or holidays. As used in this subsection, the term ‘‘basic hourly rate’’ shall mean the regular basic
rate of pay which is applicable to such employees for work performed within their regular scheduled tour of duty.
(d)(1) The said extra compensation shall be paid to the United
States by the owner, agent, consignee, operator, or master or other
person in charge of any conveyance, for whom, at his request, services as described in this subsection (hereinafter referred to as overtime service) are performed. If such employees have been ordered
to report for duty and have so reported, and the requested services
are not performed by reason of circumstances beyond the control of
the employees concerned, such extra compensation shall be paid on
the same basis as though the overtime services had actually been
performed during the period between the time the employees were
ordered to report for duty and did so report, and the time they
were notified that their services would not be required, and in any
case as though their services had continued for not less than one
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hour. The Surgeon General with the approval of the Secretary of
Health, Education, and Welfare may prescribe regulations requiring the owner, agent, consignee, operator, or master or other person for whom the overtime services are performed to file a bond in
such amounts and containing such conditions and with such sureties, or in lieu of a bond, to deposit money or obligations of the
United States in such amount, as will assure the payment of
charges under this subsection, which bond or deposit may cover one
or more transactions or all transactions during a specified period:
Provided, That no charges shall be made for services performed in
connection with the inspection of (1) persons arriving by international highways, ferries, bridges, or tunnels, or the conveyances
in which they arrive, or (2) persons arriving by aircraft or railroad
trains, the operations of which are covered by published schedules,
or the aircraft or trains in which they arrive, or (3) persons arriving by vessels operated between Canadian ports and ports on Puget
Sound or operated on the Great Lakes and connecting waterways,
the operations of which are covered by published schedules, or the
vessels in which they arrive.
(2) Moneys collected under this subsection shall be deposited in
the Treasury of the United States to the credit of the appropriation
charged with the expense of the services, and the appropriations so
credited shall be available for the payment of such compensation
to the said employees for services so rendered.
CERTAIN DUTIES OF CONSULAR AND OTHER OFFICERS

SEC. 365. ø268¿ (a) Any consular or medical officer of the
United States, designated for such purpose by the Secretary, shall
make reports to the Surgeon General, on such forms and at such
intervals as the Surgeon General may prescribe, of the health conditions at the port or place at which such officer is stationed.
(b) It shall be the duty of the customs officers and of Coast
Guard officers to aid in the enforcement of quarantine rules and
regulations; but no additional compensation, except actual and necessary traveling expenses, shall be allowed any such officer by reason of such services.
BILLS OF HEALTH

SEC. 366. ø269¿ (a) Except as otherwise prescribed in regulations, any vessel at any foreign port or place clearing or departing
for any port or place in a State or possession shall be required to
obtain from the consular officer of the United States or from the
Public Health Service officer, or other medical officer of the United
States designated by the Surgeon General, at the port or place of
departure, a bill of health in duplicate, in the form prescribed by
the Surgeon General. The President, from time to time, shall specify the ports at which a medical officer shall be stationed for this
purpose. Such bill of health shall set forth the sanitary history and
condition of said vessel, and shall state that it has in all respects
complied with the regulations prescribed pursuant to subsection (c).
Before granting such duplicate bill of health, such consular or medical officer shall be satisfied that the matters and things therein
stated are true. The consular officer shall be entitled to demand
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and receive the fees for bills of health and such fees shall be established by regulation.
(b) Original bills of health shall be delivered to the collectors
of customs at the port of entry. Duplicate copies of such bills of
health shall be delivered at the time of inspection to quarantine officers at such port. The bills of health herein prescribed shall be
considered as part of the ship’s papers, and when duly certified to
by the proper consular or other officer of the United States, over
his official signature and seal, shall be accepted as evidence of the
statements therein contained in any court of the United States.
(c) The Surgeon General shall from time to time prescribe regulations, applicable to vessels referred to in subsection (a) of this
section for the purpose of preventing the introduction into the
States or possessions of the United States of any communicable disease by securing the best sanitary condition of such vessels, their
cargoes, passengers, and crews. Such regulations shall be observed
by such vessels prior to departure, during the course of the voyage,
and also during inspection, disinfection, or other quarantine procedure upon arrival at any United States quarantine station.
(d) The provisions of subsections (a) and (b) of this section shall
not apply to vessels plying between such foreign ports on or near
the frontiers of the United States and ports of the United States
as are designated by treaty.
(e) It shall be unlawful for any vessel to enter any port in any
State or possession of the United States to discharge its cargo, or
land its passengers, except upon a certificate of the quarantine officer that regulations prescribed under subsection (c) have in all respects been complied with by such officer, the vessel, and its master. The master of every such vessel shall deliver such certificate
to the collector of customs at the port of entry, together with the
original bill of health and other papers of the vessel. The certificate
required by this subsection shall be procurable from the quarantine
officer, upon arrival of the vessel at the quarantine station and satisfactory inspection thereof, at any time within which quarantine
services are performed at such station.
CIVIL AIR NAVIGATION AND CIVIL AIRCRAFT

SEC. 367. ø270¿ The Surgeon General is authorized to provide
by regulations for the application to air navigation and aircraft of
any of the provisions of sections 364, 365, and 366 and regulations
prescribed thereunder (including penalties and forfeitures for violations of such sections and regulations), to such extent and upon
such conditions as he deems necessary for the safeguarding of the
public health.
PENALTIES

SEC. 368. ø271¿ (a) Any person who violates any regulation
prescribed under section 361, 362, or 363, or any provision of section 366 or any regulation prescribed thereunder, or who enters or
departs from the limits of any quarantine station, ground, or anchorage in disregard of quarantine rules and regulations or without
permission of the quarantine officer in charge, shall be punished by
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a fine of not more than $1,000 or by imprisonment for not more
than one year, or both.
(b) Any vessel which violates section 366, or any regulations
thereunder or under section 364, or which enters within or departs
from the limits of any quarantine station, ground, or anchorage in
disregard of the quarantine rules and regulations or without permission of the officer in charge, shall forfeit to the United States
not more than $5,000, the amount to be determined by the court,
which shall be a lien on such vessel, to be recovered by proceedings
in the proper district court of the United States. In all such proceedings the United States attorney shall appear on behalf of the
United States; and all such proceedings shall be conducted in accordance with the rules and laws governing cases of seizure of vessels for violation of the revenue laws of the United States.
(c) With the approval of the Secretary, the Surgeon General
may, upon application therefor, remit or mitigate any forfeiture
provided for under subsection (b) of this section, and he shall have
authority to ascertain the facts upon all such applications.
ADMINISTRATION OF OATHS

SEC. 369. ø272¿ Medical officers of the United States, when
performing duties as quarantine officers at any port or place within
the United States, are authorized to take declarations and administer oaths in matters pertaining to the administration of the quarantine laws and regulations of the United States.
PART H—ORGAN TRANSPLANTS 1
ORGAN PROCUREMENT ORGANIZATIONS

SEC. 371. ø273¿ (a)(1) The Secretary may make grants for the
planning of qualified organ procurement organizations described in
subsection (b).
(2) The Secretary may make grants for the establishment, initial operation, consolidation, and expansion of qualified organ procurement organizations described in subsection (b).
(b)(1) 2 A qualified organ procurement organization for which
grants may be made under subsection (a) is an organization which,
1 Section 301 of the National Organ Transplant Act (Public Law 98–507; 42 U.S.C. 274e) provides:

SEC. 301. (a) It shall be unlawful for any person to knowingly acquire, receive, or otherwise
transfer any human organ for valuable consideration for use in human transplantaion if the
transfer affects interstate commerce.
(b) Any person who violates subsection (a) shall be fined not more than $50,000 or imprisoned
not more than five years, or both.
(c) For purposes of subsection (a):
(1) The term ‘‘human organ’’ means the human (including fetal) kidney, liver, heart, lung,
pancreas, bone marrow, cornea, eye, bone, and skin or any subpart thereof and any other
human organ (or any subpart thereof, including that derived from a fetus) specified by the
Secretary of Health and Human Services by regulation.
(2) The term ‘‘valuable consideration’’ does not include the reasonable payments associated with the removal, transportation, implantation, processing, preservation, quality control, and storage of a human organ or the expenses of travel, housing, and lost wages incurred by the donor of a human organ in connection with the donation of the organ.
(3) The term ‘‘interstate commerce’’ has the meaning prescribed for it by section 201(b)
of the Federal Food, Drug and Cosmetic Act.
2 So in law. Subparagraphs (D) and (E) have the same text, and there are two subparagraphs
(H). This results from the same set of amendments to section 371(b)(1) being enacted twice. The
Continued

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as determined by the Secretary, will carry out the functions described in paragraph (2) 3 and—
(A) is a nonprofit entity,
(B) has accounting and other fiscal procedures (as specified
by the Secretary) necessary to assure the fiscal stability of the
organization,
(C) has an agreement with the Secretary to be reimbursed
under title XVIII of the Social Security Act for the procurement
of kidneys,
(D) notwithstanding any other provision of law, has met
the other requirements of this section and has been certified or
recertified by the Secretary within the previous 4-year period
as meeting the performance standards to be a qualified organ
procurement organization through a process that either—
(i) granted certification or recertification within such
4-year period with such certification or recertification in effect as of January 1, 2000, and remaining in effect through
the earlier of—
(I) January 1, 2002; or
(II) the completion of recertification under the requirements of clause (ii); or
(ii) is defined through regulations that are promulgated by the Secretary by not later than January 1, 2002,
that—
(I) require recertifications of qualified organ procurement organizations not more frequently than once
every 4 years;
(II) rely on outcome and process performance
measures that are based on empirical evidence, obtained through reasonable efforts, of organ donor potential and other related factors in each service area
of qualified organ procurement organizations;
(III) use multiple outcome measures as part of the
certification process; and
(IV) provide for a qualified organ procurement organization to appeal a decertification to the Secretary
on substantive and procedural grounds;
(E) notwithstanding any other provision of law, has met
the other requirements of this section and has been certified or
recertified by the Secretary within the previous 4-year period
as meeting the performance standards to be a qualified organ
procurement organization through a process that either—
(i) granted certification or recertification within such
4-year period with such certification or recertification in effect as of January 1, 2000, and remaining in effect through
the earlier of—
first set of amendments was made by section 701(c) of Public Law 106–505 (114 Stat. 2347).
These amendments redesignated subparagraphs (D) through (G) as subparagraphs (E) through
(H), respectively, and then added a new subparagraph (D). The second set was made by section
219(b) of the Departments of Labor, Health and Human Services, and Education, and Related
Agencies Appropriations Act, 2001 (as enacted into law by section 1(a)(1) of Public Law 106–
554; 114 Stat. 2763A–29). Per the second set of amendments, the subparagraph (D) added by
the first set was redesignated as (E), and the same text was again added as a subparagraph
(D). Per the second set, subparagraphs (F) and (G), as redesignated by the first set, were redesignated as (G) and (H), which resulted in there being two subparagraphs (H).
3 So in law. Probably should be ‘‘paragraph (3)’’.

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(I) January 1, 2002; or
(II) the completion of recertification under the requirements of clause (ii); or
(ii) is defined through regulations that are promulgated by the Secretary by not later than January 1, 2002,
that—
(I) require recertifications of qualified organ procurement organizations not more frequently than once
every 4 years;
(II) rely on outcome and process performance
measures that are based on empirical evidence, obtained through reasonable efforts, of organ donor potential and other related factors in each service area
of qualified organ procurement organizations;
(III) use multiple outcome measures as part of the
certification process; and
(IV) provide for a qualified organ procurement organization to appeal a decertification to the Secretary
on substantive and procedural grounds; 1
(F) has procedures to obtain payment for non-renal organs
provided to transplant centers,
(G) has a defined service area that is of sufficient size to
assure maximum effectiveness in the procurement and equitable distribution of organs, and that either includes an entire
metropolitan statistical area (as specified by the Director of the
Office of Management and Budget) or does not include any
part of the area,
(H) has a director and such other staff, including the organ
donation coordinators and organ procurement specialists necessary to effectively obtain organs from donors in its service
area, and
(H) has a board of directors or an advisory board which—
(i) is composed of—
(I) members who represent hospital administrators, intensive care or emergency room personnel, tissue banks, and voluntary health associations in its
service area,
(II) members who represent the public residing in
such area,
(III) a physician with knowledge, experience, or
skill in the field of histocompatability 1 or an individual with a doctorate degree in a biological science
with knowledge, experience, or skill in the field of
histocompatibility,
(IV) a physician with knowledge or skill in the
field of neurology, and
(V) from each transplant center in its service area
which has arrangements described in paragraph
(2) 2(G) with the organization, a member who is a surgeon who has practicing privileges in such center and
who performs organ transplant surgery,
1 So in law. Subparagraphs (D) and (E) have semicolons at the end of organizational units,
rather than commas.
1 So in law. Probably should be ‘‘histocompatibility’’.

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(ii) has the authority to recommend policies for the
procurement of organs and the other functions described in
paragraph (2) 2, and
(iii) has no authority over any other activity of the organization.
(2)(A) Not later than 90 days after the date of the enactment
of this paragraph, 3 the Secretary shall publish in the Federal Register a notice of proposed rulemaking to establish criteria for determining whether an entity meets the requirement established in
paragraph (1)(E).
(B) Not later than 1 year after the date of enactment of this
paragraph, 3 the Secretary shall publish in the Federal Register a
final rule to establish the criteria described in subparagraph (A).
(3) An organ procurement organization shall—
(A) have effective agreements, to identify potential organ
donors, with a substantial majority of the hospitals and other
health care entities in its service area which have facilities for
organ donations,
(B) conduct and participate in systematic efforts, including
professional education, to acquire all usable organs from potential donors,
(C) arrange for the acquisition and preservation of donated
organs and provide quality standards for the acquisition of organs which are consistent with the standards adopted by the
Organ Procurement and Transplantation Network under section 372(b)(2)(E), including arranging for testing with respect
to preventing the acquisition of organs that are infected with
the etiologic agent for acquired immune deficiency syndrome,
(D) arrange for the appropriate tissue typing of donated organs,
(E) have a system to allocate donated organs equitably
among transplant patients according to established medical criteria,
(F) provide or arrange for the transportation of donated organs to transplant centers,
(G) have arrangements to coordinate its activities with
transplant centers in its service area,
(H) participate in the Organ Procurement Transplantation
Network established under section 372,
(I) have arrangements to cooperate with tissue banks for
the retrieval, processing, preservation, storage, and distribution of tissues as may be appropriate to assure that all usable
tissues are obtained from potential donors,
(J) evaluate annually the effectiveness of the organization
in acquiring potentially available organs, and
(K) assist hospitals in establishing and implementing protocols for making routine inquiries about organ donations by
potential donors.
(c) Pancreata procured by an organ procurement organization
and used for islet cell transplantation or research shall be counted
for purposes of certification or recertification under subsection (b).
2 So

in law. Probably should be paragraph (3).
November 16, 1990. See section 201(d) of Public Law 101–616.

3 Enacted

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SEC. 371A. ø273a¿ NATIONAL LIVING DONOR MECHANISMS.

The Secretary may establish and maintain mechanisms to
evaluate the long-term effects associated with living organ donations by individuals who have served as living donors.
ORGAN PROCUREMENT AND TRANSPLANTATION NETWORK

SEC. 372. ø274¿ (a) The Secretary shall by contract provide for
the establishment and operation of an Organ Procurement and
Transplantation Network which meets the requirements of subsection (b). The amount provided under such contract in any fiscal
year may not exceed $7,000,000. Funds for such contracts shall be
made available from funds available to the Public Health Service
from appropriations for fiscal years beginning after fiscal year
1984.
(b)(1) The Organ Procurement and Transplantation Network
shall carry out the functions described in paragraph (2) and shall—
(A) be a private nonprofit entity that has an expertise in
organ procurement and transplantation, and
(B) have a board of directors—
(i) that includes representatives of organ procurement
organizations (including organizations that have received
grants under section 371), transplant centers, voluntary
health associations, and the general public; and
(ii) that shall establish an executive committee and
other committees, whose chairpersons shall be selected to
ensure continuity of leadership for the board.
(2) The Organ Procurement and Transplantation Network
shall—
(A) establish in one location or through regional centers—
(i) a national list of individuals who need organs, and
(ii) a national system, through the use of computers
and in accordance with established medical criteria, to
match organs and individuals included in the list, especially individuals whose immune system makes it difficult
for them to receive organs,
(B) establish membership criteria and medical criteria for
allocating organs and provide to members of the public an opportunity to comment with respect to such criteria,
(C) maintain a twenty-four-hour telephone service to facilitate matching organs with individuals included in the list,
(D) assist organ procurement organizations in the nationwide distribution of organs equitably among transplant patients,
(E) adopt and use standards of quality for the acquisition
and transportation of donated organs, including standards for
preventing the acquisition of organs that are infected with the
etiologic agent for acquired immune deficiency syndrome,
(F) prepare and distribute, on a regionalized basis (and, to
the extent practicable, among regions or on a national basis),
samples of blood sera from individuals who are included on the
list and whose immune system makes it difficult for them to
receive organs, in order to facilitate matching the compatibility
of such individuals with organ donors,
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(G) coordinate, as appropriate, the transportation of organs
from organ procurement organizations to transplant centers,
(H) provide information to physicians and other health
professionals regarding organ donation,
(I) collect, analyze, and publish data concerning organ donation and transplants,
(J) carry out studies and demonstration projects for the
purpose of improving procedures for organ procurement and allocation,
(K) work actively to increase the supply of donated organs,
(L) submit to the Secretary an annual report containing information on the comparative costs and patient outcomes at
each transplant center affiliated with the organ procurement
and transplantation network,
(M) 1 recognize the differences in health and in organ
transplantation issues between children and adults
throughout the system and adopt criteria, polices, and procedures that address the unique health care needs of children,
(N) 1 carry out studies and demonstration projects for
the purpose of improving procedures for organ donation
procurement and allocation, including but not limited to
projects to examine and attempt to increase transplantation among populations with special needs, including
children and individuals who are members of racial or ethnic minority groups, and among populations with limited
access to transportation, and
(O) 1 provide that for purposes of this paragraph, the
term ‘‘children’’ refers to individuals who are under the age
of 18.
(c) The Secretary shall establish procedures for—
(1) receiving from interested persons critical comments relating to the manner in which the Organ Procurement and
Transplantation Network is carrying out the duties of the Network under subsection (b); and
(2) the consideration by the Secretary of such critical comments.
SCIENTIFIC REGISTRY

SEC. 373. ø274a¿ The Secretary shall, by grant or contract, develop and maintain a scientific registry of the recipients of organ
transplants. The registry shall include such information respecting
patients and transplant procedures as the Secretary deems necessary to an ongoing evaluation of the scientific and clinical status
of organ transplantation. The Secretary shall prepare for inclusion
in the report under section 376 an analysis of information derived
from the registry.

1 Indentation
1 See

March 13, 2013

is so in law. See section 2101(a)(3) of Public Law 106–310 (114 Stat. 1156).
footnote for subparagraph (M).

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GENERAL PROVISIONS RESPECTING GRANTS AND CONTRACTS

SEC. 374. ø274b¿ (a) No grant may be made under this part
or contract entered into under section 372 or 373 unless an application therefor has been submitted to, and approved by, the Secretary. Such an application shall be in such form and shall be submitted in such manner as the Secretary shall by regulation prescribe.
(b)(1) A grant for planning under section 371(a)(1) may be
made for one year with respect to any organ procurement organization and may not exceed $100,000.
(2) Grants under section 371(a)(2) may be made for two years.
No such grant may exceed $500,000 for any year and no organ procurement organization may receive more than $800,000 for initial
operation or expansion.
(3) Grants or contracts under section 371(a)(3) may be made
for not more than 3 years.
(c)(1) The Secretary shall determine the amount of a grant or
contract made under section 371 or 373. Payments under such
grants and contracts may be made in advance on the basis of estimates or by the way of reimbursement, with necessary adjustments
on account of underpayments or overpayments, and in such installments and on such terms and conditions as the Secretary finds necessary to carry out the purposes of such grants and contracts.
(2)(A) Each recipient of a grant or contract under section 371
or 373 shall keep such records as the Secretary shall prescribe, including records which fully disclose the amount and disposition by
such recipient of the proceeds of such grant or contract, the total
cost of the undertaking in connection with which such grant or contract was made, and the amount of that portion of the cost of the
undertaking supplied by other sources, and such other records as
will facilitate an effective audit.
(B) The Secretary and the Comptroller General of the United
States, or any of their duly authorized representatives, shall have
access for the purpose of audit and examination to any books, documents, papers, and records of the recipient of a grant or contract
under section 371 or 373 that are pertinent to such grant or contract.
(d) For purposes of this part:
(1) The term ‘‘transplant center’’ means a health care facility in which transplants of organs are performed.
(2) The term ‘‘organ’’ means the human kidney, liver,
heart, lung, pancreas, and any other human organ (other than
corneas and eyes) specified by the Secretary by regulation and
for purposes of section 373, such term includes bone marrow.
ADMINISTRATION

SEC. 375. ø274c¿ The Secretary shall designate and maintain
an identifiable administrative unit in the Public Health Service
to—
(1) administer this part and coordinate with the organ procurement activities under title XVIII of the Social Security Act,
(2) conduct a program of public information to inform the
public of the need for organ donations,
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(3) provide technical assistance to organ procurement organizations, the Organ Procurement and Transplantation Network established under section 372, and other entities in the
health care system involved in organ donations, procurement,
and transplants, and
(4) provide information—
(i) 1 to patients, their families, and their physicians
about transplantation; and
(ii) 1 to patients and their families about the resources
available nationally and in each State, and the comparative costs and patient outcomes at each transplant center
affiliated with the organ procurement and transplantation
network, in order to assist the patients and families with
the costs associated with transplantation.
REPORT

SEC. 376. ø274d¿ Not later than February 10 of 1991 and of
each second year thereafter, the Secretary shall publish, and submit to the Committee on Energy and Commerce of the House of
Representatives and the Committee on Labor and Human Resources of the Senate. 2 a report on the scientific and clinical status
of organ transplantation. The Secretary shall consult with the Director of the National Institutes of Health and the Commissioner
of the Food and Drug Administration in the preparation of the report.
SEC. 377. ø274f¿ REIMBURSEMENT OF TRAVEL AND SUBSISTENCE EXPENSES INCURRED TOWARD LIVING ORGAN DONATION.
(a) IN GENERAL.—The Secretary may award grants to States,

transplant centers, qualified organ procurement organizations
under section 371, or other public or private entities for the purpose of—
(1) providing for the reimbursement of travel and subsistence expenses incurred by individuals toward making living
donations of their organs (in this section referred to as ‘‘donating individuals’’); and
(2) providing for the reimbursement of such incidental nonmedical expenses that are so incurred as the Secretary determines by regulation to be appropriate.
(b) PREFERENCE.—The Secretary shall, in carrying out subsection (a), give preference to those individuals that the Secretary
determines are more likely to be otherwise unable to meet such expenses.
(c) CERTAIN CIRCUMSTANCES.—The Secretary may, in carrying
out subsection (a), consider—
(1) the term ‘‘donating individuals’’ as including individuals who in good faith incur qualifying expenses toward the intended donation of an organ but with respect to whom, for such
reasons as the Secretary determines to be appropriate, no donation of the organ occurs; and
1 Clauses (i) and (ii) probably should be redesignated as subparagraphs (A) and (B). See section 204(b)(2) of Public Law 101–616 (104 Stat. 3285).
2 So in law. There probably should be a comma after ‘‘Senate’’ rather than a period. See section 205 of Public Law 101–616.

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(2) the term ‘‘qualifying expenses’’ as including the expenses of having relatives or other individuals, not to exceed
2, accompany or assist the donating individual for purposes of
subsection (a) (subject to making payment for only those types
of expenses that are paid for a donating individual).
(d) RELATIONSHIP TO PAYMENTS UNDER OTHER PROGRAMS.—An
award may be made under subsection (a) only if the applicant involved agrees that the award will not be expended to pay the qualifying expenses of a donating individual to the extent that payment
has been made, or can reasonably be expected to be made, with respect to such expenses—
(1) under any State compensation program, under an insurance policy, or under any Federal or State health benefits
program;
(2) by an entity that provides health services on a prepaid
basis; or
(3) by the recipient of the organ.
(e) DEFINITIONS.—For purposes of this section:
(1) The term ‘‘donating individuals’’ has the meaning indicated for such term in subsection (a)(1), subject to subsection
(c)(1).
(2) The term ‘‘qualifying expenses’’ means the expenses authorized for purposes of subsection (a), subject to subsection
(c)(2).
(f) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of
carrying out this section, there is authorized to be appropriated
$5,000,000 for each of the fiscal years 2005 through 2009.
SEC. 377A. ø274f–1¿ PUBLIC AWARENESS; STUDIES AND DEMONSTRATIONS.
(a) ORGAN DONATION PUBLIC AWARENESS PROGRAM.—The Sec-

retary shall, directly or through grants or contracts, establish a
public education program in cooperation with existing national
public awareness campaigns to increase awareness about organ donation and the need to provide for an adequate rate of such donations.
(b) STUDIES AND DEMONSTRATIONS.—The Secretary may make
peer-reviewed grants to, or enter into peer-reviewed contracts with,
public and nonprofit private entities for the purpose of carrying out
studies and demonstration projects to increase organ donation and
recovery rates, including living donation.
(c) GRANTS TO STATES.—
(1) IN GENERAL.—The Secretary may make grants to
States for the purpose of assisting States in carrying out organ
donor awareness, public education, and outreach activities and
programs designed to increase the number of organ donors
within the State, including living donors.
(2) ELIGIBILITY.—To be eligible to receive a grant under
this subsection, a State shall—
(A) submit an application to the Department in the
form prescribed;
(B) establish yearly benchmarks for improvement in
organ donation rates in the State; and
(C) report to the Secretary on an annual basis a description and assessment of the State’s use of funds reMarch 13, 2013

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ceived under this subsection, accompanied by an assessment of initiatives for potential replication in other States.
(3) USE OF FUNDS.—Funds received under this subsection
may be used by the State, or in partnership with other public
agencies or private sector institutions, for education and
awareness efforts, information dissemination, activities pertaining to the State donor registry, and other innovative donation specific initiatives, including living donation.
(d) EDUCATIONAL ACTIVITIES.—The Secretary, in coordination
with the Organ Procurement and Transplantation Network and
other appropriate organizations, shall support the development and
dissemination of educational materials to inform health care professionals and other appropriate professionals in issues surrounding organ, tissue, and eye donation including evidence-based
proven methods to approach patients and their families, cultural
sensitivities, and other relevant issues.
(e) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of
carrying out this section, there are authorized to be appropriated
$15,000,000 for fiscal year 2005, and such sums as may be necessary for each of the fiscal years 2006 through 2009. Such authorization of appropriations is in addition to any other authorizations
of appropriations that are available for such purpose.
SEC. 377B. ø274f–2¿ GRANTS REGARDING HOSPITAL ORGAN DONATION
COORDINATORS.
(a) AUTHORITY.—
(1) IN GENERAL.—The Secretary may award grants to

qualified organ procurement organizations and hospitals under
section 371 to establish programs coordinating organ donation
activities of eligible hospitals and qualified organ procurement
organizations under section 371. Such activities shall be coordinated to increase the rate of organ donations for such hospitals.
(2) ELIGIBLE HOSPITAL.—For purposes of this section, the
term ‘‘eligible hospital’’ means a hospital that performs significant trauma care, or a hospital or consortium of hospitals that
serves a population base of not fewer than 200,000 individuals.
(b) ADMINISTRATION OF COORDINATION PROGRAM.—A condition
for the receipt of a grant under subsection (a) is that the applicant
involved agree that the program under such subsection will be carried out jointly—
(1) by representatives from the eligible hospital and the
qualified organ procurement organization with respect to
which the grant is made; and
(2) by such other entities as the representatives referred to
in paragraph (1) may designate.
(c) REQUIREMENTS.—Each entity receiving a grant under subsection (a) shall—
(1) establish joint organ procurement organization and
hospital designated leadership responsibility and accountability for the project;
(2) develop mutually agreed upon overall project performance goals and outcome measures, including interim outcome
targets; and
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(3) collaboratively design and implement an appropriate
data collection process to provide ongoing feedback to hospital
and organ procurement organization leadership on project
progress and results.
(d) RULE OF CONSTRUCTION.—Nothing in this section shall be
construed to interfere with regulations in force on the date of enactment of the Organ Donation and Recovery Improvement Act.
(e) EVALUATIONS.—Within 3 years after the award of grants
under this section, the Secretary shall ensure an evaluation of programs carried out pursuant to subsection (a) in order to determine
the extent to which the programs have increased the rate of organ
donation for the eligible hospitals involved.
(f) MATCHING REQUIREMENT.—The Secretary may not award a
grant to a qualifying organ donation entity under this section unless such entity agrees that, with respect to costs to be incurred by
the entity in carrying out activities for which the grant was awarded, the entity shall contribute (directly or through donations from
public or private entities) non-Federal contributions in cash or in
kind, in an amount equal to not less than 30 percent of the amount
of the grant awarded to such entity.
(g) FUNDING.—For the purpose of carrying out this section,
there are authorized to be appropriated $3,000,000 for fiscal year
2005, and such sums as may be necessary for each of fiscal years
2006 through 2009.
SEC. 377C. ø274f–3¿ STUDIES RELATING TO ORGAN DONATION AND
THE RECOVERY, PRESERVATION, AND TRANSPORTATION
OF ORGANS.
(a) DEVELOPMENT OF SUPPORTIVE INFORMATION.—The Sec-

retary, acting through the Director of the Agency for Healthcare
Research and Quality, shall develop scientific evidence in support
of efforts to increase organ donation and improve the recovery,
preservation, and transportation of organs.
(b) ACTIVITIES.—In carrying out subsection (a), the Secretary
shall—
(1) conduct or support evaluation research to determine
whether interventions, technologies, or other activities improve
the effectiveness, efficiency, or quality of existing organ donation practice;
(2) undertake or support periodic reviews of the scientific
literature to assist efforts of professional societies to ensure
that the clinical practice guidelines that they develop reflect
the latest scientific findings;
(3) ensure that scientific evidence of the research and
other activities undertaken under this section is readily accessible by the organ procurement workforce; and
(4) work in coordination with the appropriate professional
societies as well as the Organ Procurement and Transplantation Network and other organ procurement and transplantation organizations to develop evidence and promote the adoption of such proven practices.
(c) RESEARCH AND DISSEMINATION.—The Secretary, acting
through the Director of the Agency for Healthcare Research and
Quality, as appropriate, shall provide support for research and dissemination of findings, to—
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(1) develop a uniform clinical vocabulary for organ recovery;
(2) apply information technology and telecommunications
to support the clinical operations of organ procurement organizations;
(3) enhance the skill levels of the organ procurement workforce in undertaking quality improvement activities; and
(4) assess specific organ recovery, preservation, and transportation technologies.
(d) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of
carrying out this section, there are authorized to be appropriated
$2,000,000 for fiscal year 2005, and such sums as may be necessary
for each of fiscal years 2006 through 2009.
SEC. 377D. ø274f–4¿ REPORT RELATING TO ORGAN DONATION AND THE
RECOVERY, PRESERVATION, AND TRANSPORTATION OF
ORGANS.
(a) IN GENERAL.—Not later than December 31, 2005, and every

2 years thereafter, the Secretary shall report to the appropriate
committees of Congress on the activities of the Department carried
out pursuant to this part, including an evaluation describing the
extent to which the activities have affected the rate of organ donation and recovery.
(b) REQUIREMENTS.—To the extent practicable, each report submitted under subsection (a) shall—
(1) evaluate the effectiveness of activities, identify effective
activities, and disseminate such findings with respect to organ
donation and recovery;
(2) assess organ donation and recovery activities that are
recently completed, ongoing, or planned; and
(3) evaluate progress on the implementation of the plan required under subsection (c)(5).
(c) INITIAL REPORT REQUIREMENTS.—The initial report under
subsection (a) shall include the following:
(1) An evaluation of the organ donation practices of organ
procurement organizations, States, other countries, and other
appropriate organizations including an examination across all
populations, including those with low organ donation rates,
of—
(A) existing barriers to organ donation; and
(B) the most effective donation and recovery practices.
(2) An evaluation of living donation practices and procedures. Such evaluation shall include an assessment of issues
relating to informed consent and the health risks associated
with living donation (including possible reduction of long-term
effects).
(3) An evaluation of—
(A) federally supported or conducted organ donation
efforts and policies, as well as federally supported or conducted basic, clinical, and health services research (including research on preservation techniques and organ rejection and compatibility); and
(B) the coordination of such efforts across relevant
agencies within the Department and throughout the Federal Government.
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(4) An evaluation of the costs and benefits of State donor
registries, including the status of existing State donor registries, the effect of State donor registries on organ donation
rates, issues relating to consent, and recommendations regarding improving the effectiveness of State donor registries in increasing overall organ donation rates.
(5) A plan to improve federally supported or conducted
organ donation and recovery activities, including, when appropriate, the establishment of baselines and benchmarks to
measure overall outcomes of these programs. Such plan shall
provide for the ongoing coordination of federally supported or
conducted organ donation and research activities.
SEC. 378. ø274g¿ AUTHORIZATION OF APPROPRIATIONS.

For the purpose of carrying out this part, there are authorized
to be appropriated $8,000,000 for fiscal year 1991, and such sums
as may be necessary for each of the fiscal years 1992 and 1993.

PART I—C.W. BILL YOUNG CELL
TRANSPLANTATION PROGRAM
SEC. 379. ø274k¿ NATIONAL PROGRAM.
(a) ESTABLISHMENT.—The Secretary,

acting through the Administrator of the Health Resources and Services Administration,
shall by one or more contracts establish and maintain a C.W. Bill
Young Cell Transplantation Program (referred to in this section as
the ‘‘Program’’), successor to the National Bone Marrow Donor Registry, that has the purpose of increasing the number of transplants
for recipients suitably matched to biologically unrelated donors of
bone marrow and cord blood, and that meets the requirements of
this section. The Secretary may award a separate contract to perform each of the major functions of the Program described in paragraphs (1) and (2) of subsection (d) if deemed necessary by the Secretary to operate an effective and efficient system that is in the
best interest of patients. The Secretary shall conduct a separate
competition for the initial establishment of the cord blood functions
of the Program. The Program shall be under the general supervision of the Secretary. The Secretary shall establish an Advisory
Council to advise, assist, consult with, and make recommendations
to the Secretary on matters related to the activities carried out by
the Program. The members of the Advisory Council shall be appointed in accordance with the following:
(1) Each member of the Advisory Council shall serve for a
term of 2 years, and each such member may serve as many as
3 consecutive 2-year terms, except that—
(A) such limitations shall not apply to the Chair of the
Advisory Council (or the Chair-elect) or to the member of
the Advisory Council who most recently served as the
Chair; and
(B) one additional consecutive 2-year term may be
served by any member of the Advisory Council who has no
employment, governance, or financial affiliation with any
donor center, recruitment organization, transplant center,
or cord blood bank.
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(2) A member of the Advisory Council may continue to
serve after the expiration of the term of such member until a
successor is appointed.
(3) In order to ensure the continuity of the Advisory Council, the Advisory Council shall be appointed so that each year
the terms of approximately one-third of the members of the
Advisory Council expire.
(4) The membership of the Advisory Council—
(A) shall include as voting members a balanced number of representatives including representatives of marrow
donor centers and marrow transplant centers, representatives of cord blood banks and participating birthing hospitals, recipients of a bone marrow transplant, recipients
of a cord blood transplant, persons who require such transplants, family members of such a recipient or family members of a patient who has requested the assistance of the
Program in searching for an unrelated donor of bone marrow or cord blood, persons with expertise in bone marrow
and cord blood transplantation, persons with expertise in
typing, matching, and transplant outcome data analysis,
persons with expertise in the social sciences, basic scientists with expertise in the biology of adult stem cells,
and members of the general public; and
(B) shall include as nonvoting members representatives from the Department of Defense Marrow Donor Recruitment and Research Program operated by the Department of the Navy, the Division of Transplantation of the
Health Resources and Services Administration, the Food
and Drug Administration, and the National Institutes of
Health.
(5) Members of the Advisory Council shall be chosen so as
to ensure objectivity and balance and reduce the potential for
conflicts of interest. The Secretary shall establish bylaws and
procedures—
(A) to prohibit any member of the Advisory Council
who has an employment, governance, or financial affiliation with a donor center, recruitment organization, transplant center, or cord blood bank from participating in any
decision that materially affects the center, recruitment organization, transplant center, or cord blood bank; and
(B) to limit the number of members of the Advisory
Council with any such affiliation.
(6) The Secretary, acting through the Administrator of the
Health Resources and Services Administration, shall submit to
Congress an annual report on the activities carried out under
this section.
(b) ACCREDITATION.—The Secretary shall, through a public
process, recognize one or more accreditation entities for the accreditation of cord blood banks.
(c) INFORMED CONSENT.—The Secretary shall, through a public
process, examine issues of informed consent, including—
(1) the appropriate timing of such consent; and
(2) the information provided to the maternal donor regarding all of her medically appropriate cord blood options.
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Based on such examination, the Secretary shall require that the
standards used by the accreditation entities recognized under subsection (b) ensure that a cord blood unit is acquired with the informed consent of the maternal donor.
(d) FUNCTIONS.— 1
(1) BONE MARROW FUNCTIONS.—With respect to bone marrow, the Program shall—
(A) operate a system for identifying, matching, and facilitating the distribution of bone marrow that is suitably
matched to candidate patients;
(B) consistent with paragraph (3), permit transplant
physicians, other appropriate health care professionals,
and patients to search by means of electronic access all
available bone marrow donors listed in the Program;
(C) carry out a program for the recruitment of bone
marrow donors in accordance with subsection (e), including
with respect to increasing the representation of racial and
ethnic minority groups (including persons of mixed ancestry) in the enrollment of the Program;
(D) maintain and expand medical contingency response capabilities, in coordination with Federal programs,
to prepare for and respond effectively to biological, chemical, or radiological attacks, and other public health emergencies that can damage marrow, so that the capability of
supporting patients with marrow damage from disease can
be used to support casualties with marrow damage;
(E) carry out informational and educational activities
in accordance with subsection (e);
(F) at least annually update information to account for
changes in the status of individuals as potential donors of
bone marrow;
(G) provide for a system of patient advocacy through
the office established under subsection (h);
1 Section

5 of Public Law 105–196 (112 Stat. 636) provides as follows:

‘‘SEC. 5. STUDY BY GENERAL ACCOUNTING OFFICE.
‘‘(a) IN GENERAL.—During the period indicated pursuant to subsection (b), the Comptroller
General of the United States shall conduct a study of the National Bone Marrow Donor Registry
under section 379 of the Public Health Service Act for purposes of making determinations of
the following:
‘‘(1) The extent to which, relative to the effective date of this Act, such Registry has increased the representation of racial and ethnic minority groups (including persons of mixed
ancestry) among potential donors of bone marrow who are enrolled with the Registry, and
whether the extent of increase results in a level of representation that meets the standard
established in subsection (c)(1)(A) of such section 379 (as added by section 2(c) of this Act).
‘‘(2) The extent to which patients in need of a transplant of bone marrow from a biologically unrelated donor, and the physicians of such patients, have been utilizing the Registry in the search for such a donor.
‘‘(3) The number of such patients for whom the Registry began a preliminary search but
for whom the full search process was not completed, and the reasons underlying such circumstances.
‘‘(4) The extent to which the plan required in section 2(b)(2) of this Act (relating to the
relationship between the Registry and donor centers) has been implemented.
‘‘(5) The extent to which the Registry, donor centers, donor registries, collection centers,
transplant centers, and other appropriate entities have been complying with the standards,
criteria, and procedures under subsection (e) of such section 379 (as redesignated by section
2(c) of this Act).
‘‘(b) REPORT.—A report describing the findings of the study under subsection (a) shall be submitted to the Congress not later than October 1, 2001. The report may not be submitted before
January 1, 2001.’’.

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(H) provide case management services for any potential donor of bone marrow to whom the Program has provided a notice that the potential donor may be suitably
matched to a particular patient through the office established under subsection (h);
(I) with respect to searches for unrelated donors of
bone marrow that are conducted through the system under
subparagraph (A), collect, analyze, and publish data in a
standardized electronic format on the number and percentage of patients at each of the various stages of the search
process, including data regarding the furthest stage
reached, the number and percentage of patients who are
unable to complete the search process, and the reasons underlying such circumstances;
(J) support studies and demonstration and outreach
projects for the purpose of increasing the number of individuals who are willing to be marrow donors to ensure a
genetically diverse donor pool; and
(K) facilitate research with the appropriate Federal
agencies to improve the availability, efficiency, safety, and
cost of transplants from unrelated donors and the effectiveness of Program operations.
(2) CORD BLOOD FUNCTIONS.—
(A) IN GENERAL.—With respect to cord blood, the Program shall—
(i) 1 operate a system for identifying, matching, and facilitating the distribution of donated cord blood units that
are suitably matched to candidate patients and meet all
applicable Federal and State regulations (including informed consent and Food and Drug Administration regulations) from a qualified cord blood bank;
(ii) 1 consistent with paragraph (3), allow transplant
physicians, other appropriate health care professionals,
and patients to search by means of electronic access all
available cord blood units made available through the Program;
(iii) 1 allow transplant physicians and other appropriate health care professionals to reserve, as defined by
the Secretary, a cord blood unit for transplantation;
(iv) support and expand new and existing studies
and demonstration and outreach projects for the purpose of increasing cord blood unit donation and collection from a genetically diverse population and expanding the number of cord blood unit collection sites
partnering with cord blood banks receiving a contract
under the National Cord Blood Inventory program
under section 2 of the Stem Cell Therapeutic and Research Act of 2005, including such studies and projects
that focus on—
1 Margin so in law. The amendment by section 2(b)(2)(A)(ii) of Public Law 111–264 redesignates subpargraphs (A)–(H) as clauses (i)–(viii); however, the amendment did not move the margins of such clauses to the right so that it appears indented 6 ems from the left margin (except
for clause (iv) which was amended in its entirety by section 2(b)(2)(A)(iii) of such Public Law
and as rewritten appears on the correct margin).

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(I) remote collection of cord blood units, consistent with the requirements under the Program
and the National Cord Blood Inventory program
goal described in section 2(a) of the Stem Cell
Therapeutic and Research Act of 2005; and
(II) exploring novel approaches or incentives
to encourage innovative technological advances
that could be used to collect cord blood units, consistent with the requirements under the Program
and such National Cord Blood Inventory program
goal;
(v) 1 provide for a system of patient advocacy through
the office established under subsection (h);
(vi) 1 coordinate with the qualified cord blood banks to
support informational and educational activities in accordance with subsection (g);
(vii) 1 maintain and expand medical contingency response capabilities, in coordination with Federal programs,
to prepare for and respond effectively to biological, chemical, or radiological attacks, and other public health emergencies that can damage marrow, so that the capability of
supporting patients with marrow damage from disease can
be used to support casualties with marrow damage; and
(viii) 1 with respect to the system under subparagraph
(A), collect, analyze, and publish data in a standardized
electronic format, as required by the Secretary, on the
number and percentage of patients at each of the various
stages of the search process, including data regarding the
furthest stage reached, the number and percentage of patients who are unable to complete the search process, and
the reasons underlying such circumstances.
(B) EFFORTS TO INCREASE COLLECTION OF HIGH QUALITY CORD BLOOD UNITS.—In carrying out subparagraph
(A)(iv), not later than 1 year after the date of enactment
of the Stem Cell Therapeutic and Research Reauthorization Act of 2010 and annually thereafter, the Secretary
shall set an annual goal of increasing collections of high
quality cord blood units, consistent with the inventory goal
described in section 2(a) of the Stem Cell Therapeutic and
Research Act of 2005 (referred to in this subparagraph as
the ‘‘inventory goal’’), and shall identify at least one project
under subparagraph (A)(iv) to replicate and expand nationwide, as appropriate. If the Secretary cannot identify a
project as described in the preceding sentence, the Secretary shall submit a plan, not later than 180 days after
the date on which the Secretary was required to identify
such a project, to the Committee on Health, Education,
Labor, and Pensions of the Senate and the Committee on
Energy and Commerce of the House of Representatives for
expanding remote collection of high quality cord blood
units, consistent with the requirements under the National
Cord Blood Inventory program under section 2 of the Stem
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tory goal. Each such plan shall be made available to the
public.
(C) DEFINITION.—In this paragraph, the term ‘‘remote
collection’’ means the collection of cord blood units at locations that do not have written contracts with cord blood
banks for collection support.
(3) SINGLE POINT OF ACCESS; STANDARD DATA.—
(A) SINGLE POINT OF ACCESS.—The Secretary shall ensure that health care professionals and patients are able
to search electronically for and facilitate access to, in the
manner and to the extent defined by the Secretary and
consistent with the functions described in paragraphs
(1)(A) and (2)(A)(i), cells from bone marrow donors and
cord blood units through a single point of access.
(B) STANDARD DATA.—The Secretary shall require all
recipients of contracts under this section to make available
a standard dataset for purposes of subparagraph (A) in a
standardized electronic format that enables transplant
physicians to compare among and between bone marrow
donors and cord blood units to ensure the best possible
match for the patient.
(4) DEFINITION.—The term ‘‘qualified cord blood bank’’
means a cord blood bank that—
(A) has obtained all applicable Federal and State licenses, certifications, registrations (including pursuant to
the regulations of the Food and Drug Administration), and
other authorizations required to operate and maintain a
cord blood bank;
(B) has implemented donor screening, cord blood collection practices, and processing methods intended to protect the health and safety of donors and transplant recipients to improve transplant outcomes, including with respect to the transmission of potentially harmful infections
and other diseases;
(C) is accredited by an accreditation entity recognized
by the Secretary under subsection (b);
(D) has established a system of strict confidentiality to
protect the identity and privacy of patients and donors in
accordance with existing Federal and State law;
(E) has established a system for encouraging donation
by a genetically diverse group of donors; and
(F) has established a system to confidentially maintain
linkage between a cord blood unit and a maternal donor.
(e) BONE MARROW RECRUITMENT; PRIORITIES; INFORMATION
AND EDUCATION.—
(1) RECRUITMENT; PRIORITIES.—The Program shall carry
out activities for the recruitment of bone marrow donors. Such
recruitment program shall identify populations that are underrepresented among potential donors enrolled with the Program. In the case of populations that are identified under the
preceding sentence:
(A) The Program shall give priority to carrying out activities under this part to increase representation for such
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lation, to the extent practicable, to have a probability of
finding a suitable unrelated donor that is comparable to
the probability that an individual who is not a member of
an underrepresented population would have.
(B) The Program shall consider racial and ethnic minority groups (including persons of mixed ancestry) to be
populations that have been identified for purposes of this
paragraph, and shall carry out subparagraph (A) with respect to such populations.
(2) INFORMATION AND EDUCATION REGARDING RECRUITMENT; TESTING AND ENROLLMENT.—
(A) IN GENERAL.—The Program shall carry out informational and educational activities, in coordination with
organ donation public awareness campaigns operated
through the Department of Health and Human Services,
for purposes of recruiting individuals to serve as donors of
bone marrow, and shall test and enroll with the Program
potential bone marrow donors. Such information and educational activities shall include the following:
(i) Making information available to the general
public, including information describing the needs of
patients with respect to donors of bone marrow.
(ii) Educating and providing information to individuals who are willing to serve as potential bone marrow donors.
(iii) Training individuals in requesting individuals
to serve as potential bone marrow donors.
(B) PRIORITIES.—In carrying out informational and
educational activities under subparagraph (A), the Program shall give priority to recruiting individuals to serve
as donors of bone marrow for populations that are identified under paragraph (1).
(3) TRANSPLANTATION AS TREATMENT OPTION.—In addition
to activities regarding recruitment, the recruitment program
under paragraph (1) shall provide information to physicians,
other health care professionals, and the public regarding bone
marrow transplants from unrelated donors as a treatment option.
(4) IMPLEMENTATION OF SUBSECTION.—The requirements of
this subsection shall be carried out by the entity that has been
awarded a contract by the Secretary under subsection (a) to
carry out the functions described in subsection (d)(1).
(f) BONE MARROW CRITERIA, STANDARDS, AND PROCEDURES.—
The Secretary shall enforce, for participating entities, including the
Program, individual marrow donor centers, marrow donor registries, marrow collection centers, and marrow transplant centers—
(1) quality standards and standards for tissue typing, obtaining the informed consent of donors, and providing patient
advocacy;
(2) donor selection criteria, based on established medical
criteria, to protect both the donor and the recipient and to prevent the transmission of potentially harmful infectious diseases
such as the viruses that cause hepatitis and the etiologic agent
for Acquired Immune Deficiency Syndrome;
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(3) procedures to ensure the proper collection and transportation of the marrow;
(4) standards for the system for patient advocacy operated
under subsection (h), including standards requiring the provision of appropriate information (at the start of the search process and throughout the process) to patients and their families
and physicians;
(5) standards that—
(A) require the establishment of a system of strict confidentiality to protect the identity and privacy of patients
and donors in accordance with Federal and State law; and
(B) prescribe the purposes for which the records described in subparagraph (A) may be disclosed, and the circumstances and extent of the disclosure; and
(6) in the case of a marrow donor center or marrow donor
registry participating in the program, procedures to ensure the
establishment of a method for integrating donor files, searches,
and general procedures of the center or registry with the Program.
(g) CORD BLOOD RECRUITMENT; PRIORITIES; INFORMATION AND
EDUCATION.—
(1) RECRUITMENT; PRIORITIES.—The Program shall support
activities, in cooperation with qualified cord blood banks, for
the recruitment of cord blood donors. Such recruitment program shall identify populations that are underrepresented
among cord blood donors. In the case of populations that are
identified under the preceding sentence:
(A) The Program shall give priority to supporting activities under this part to increase representation for such
populations in order to enable a member of such a population, to the extent practicable, to have a probability of
finding a suitable cord blood unit that is comparable to the
probability that an individual who is not a member of an
underrepresented population would have.
(B) The Program shall consider racial and ethnic minority groups (including persons of mixed ancestry) to be
populations that have been identified for purposes of this
paragraph, and shall support activities under subparagraph (A) with respect to such populations.
(2) INFORMATION AND EDUCATION REGARDING RECRUITMENT; TESTING AND DONATION.—
(A) IN GENERAL.—In carrying out the recruitment program under paragraph (1), the Program shall support informational and educational activities in coordination with
qualified cord blood banks and organ donation public
awareness campaigns operated through the Department of
Health and Human Services, for purposes of recruiting
pregnant women to serve as donors of cord blood. Such information and educational activities shall include the following:
(i) Making information available to the general
public, including information describing the needs of
patients with respect to cord blood units.
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(ii) Educating and providing information to pregnant women who are willing to donate cord blood
units.
(iii) Training individuals in requesting pregnant
women to serve as cord blood donors.
(B) PRIORITIES.—In carrying out informational and
educational activities under subparagraph (A), the Program shall give priority to supporting the recruitment of
pregnant women to serve as donors of cord blood for populations that are identified under paragraph (1).
(3) TRANSPLANTATION AS TREATMENT OPTION.—In addition
to activities regarding recruitment, the recruitment program
under paragraph (1) shall provide information to physicians,
other health care professionals, and the public regarding cord
blood transplants from donors as a treatment option.
(4) IMPLEMENTATION OF SUBSECTION.—The requirements of
this subsection shall be carried out by the entity that has been
awarded a contract by the Secretary under subsection (a) to
carry out the functions described in subsection (d)(2).
(h) PATIENT ADVOCACY AND CASE MANAGEMENT FOR BONE
MARROW AND CORD BLOOD.—
(1) IN GENERAL.—The Secretary shall establish and maintain, through a contract or other means determined appropriate by the Secretary, an office of patient advocacy (in this
subsection referred to as the ‘‘Office’’).
(2) GENERAL FUNCTIONS.—The Office shall meet the following requirements:
(A) The Office shall be headed by a director.
(B) The Office shall be staffed by individuals with expertise in bone marrow and cord blood therapy covered
under the Program.
(C) The Office shall operate a system for patient advocacy, which shall be separate from mechanisms for donor
advocacy, and which shall serve patients for whom the
Program is conducting, or has been requested to conduct,
a search for a bone marrow donor or cord blood unit.
(D) In the case of such a patient, the Office shall serve
as an advocate for the patient by directly providing to the
patient (or family members, physicians, or other individuals acting on behalf of the patient) individualized services
with respect to efficiently utilizing the system under paragraphs (1) and (2) of subsection (d) to conduct an ongoing
search for a bone marrow donor or cord blood unit and assist with information regarding third party payor matters.
(E) In carrying out subparagraph (D), the Office shall
monitor the system under paragraphs (1) and (2) of subsection (d) to determine whether the search needs of the
patient involved are being met, including with respect to
the following:
(i) Periodically providing to the patient (or an individual acting on behalf of the patient) information
regarding bone marrow donors or cord blood units that
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mation regarding the progress being made in the
search.
(ii) Informing the patient (or such other individual) if the search has been interrupted or discontinued.
(iii) Identifying and resolving problems in the
search, to the extent practicable.
(F) The Office shall ensure that the following data are
made available to patients:
(i) The resources available through the Program.
(ii) A comparison of transplant centers regarding
search and other costs that prior to transplantation
are charged to patients by transplant centers.
(iii) The post-transplant outcomes for individual
transplant centers.
(iv) Information concerning issues that patients
may face after a transplant.
(v) Such other information as the Program determines to be appropriate.
(G) The Office shall conduct surveys of patients (or
family members, physicians, or other individuals acting on
behalf of patients) to determine the extent of satisfaction
with the system for patient advocacy under this subsection, and to identify ways in which the system can be
improved to best meet the needs of patients.
(3) CASE MANAGEMENT.—
(A) IN GENERAL.—In serving as an advocate for a patient under paragraph (2), the Office shall provide individualized case management services directly to the patient
(or family members, physicians, or other individuals acting
on behalf of the patient), including—
(i) individualized case assessment; and
(ii) the functions described in paragraph (2)(D)
(relating to progress in the search process).
(B) POSTSEARCH FUNCTIONS.—In addition to the case
management services described in paragraph (1) for patients, the Office shall, on behalf of patients who have
completed the search for a bone marrow donor or cord
blood unit, provide information and education on the process of receiving a transplant, including the post-transplant
process.
(i) COMMENT PROCEDURES.—The Secretary shall establish and
provide information to the public on procedures under which the
Secretary shall receive and consider comments from interested persons relating to the manner in which the Program is carrying out
the duties of the Program. The Secretary may promulgate regulations under this section.
(j) CONSULTATION.—In developing policies affecting the Program, the Secretary shall consult with the Advisory Council, the
Department of Defense Marrow Donor Recruitment and Research
Program operated by the Department of the Navy, and the board
of directors of each entity awarded a contract under this section.
(k) CONTRACTS.—
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(1) APPLICATION.—To be eligible to enter into a contract
under this section, an entity shall submit to the Secretary and
obtain approval of an application at such time, in such manner, and containing such information as the Secretary shall by
regulation prescribe.
(2) CONSIDERATIONS.—In awarding contracts under this
section, the Secretary shall give consideration to the continued
safety of donors and patients and other factors deemed appropriate by the Secretary.
(l) ELIGIBILITY.—Entities eligible to receive a contract under
this section shall include private nonprofit entities.
(m) RECORDS.—
(1) RECORDKEEPING.—Each recipient of a contract or subcontract under subsection (a) shall keep such records as the
Secretary shall prescribe, including records that fully disclose
the amount and disposition by the recipient of the proceeds of
the contract, the total cost of the undertaking in connection
with which the contract was made, and the amount of the portion of the cost of the undertaking supplied by other sources,
and such other records as will facilitate an effective audit.
(2) EXAMINATION OF RECORDS.—The Secretary and the
Comptroller General of the United States shall have access to
any books, documents, papers, and records of the recipient of
a contract or subcontract entered into under this section that
are pertinent to the contract, for the purpose of conducting audits and examinations.
(n) PENALTIES FOR DISCLOSURE.—Any person who discloses the
content of any record referred to in subsection (d)(4)(D) or (f)(5)(A)
without the prior written consent of the donor or potential donor
with respect to whom the record is maintained, or in violation of
the standards described in subsection (f)(5)(B), shall be imprisoned
for not more than 2 years or fined in accordance with title 18,
United States Code, or both.
SEC. 379A. ø274l¿ STEM CELL THERAPEUTIC OUTCOMES DATABASE.
(a) ESTABLISHMENT.—The Secretary shall by contract establish

and maintain a scientific database of information relating to patients who have been recipients of a stem cell therapeutics product
(including bone marrow, cord blood, or other such product) from a
donor.
(b) INFORMATION.—The outcomes database shall include information in a standardized electronic format with respect to patients
described in subsection (a), diagnosis, transplant procedures, results, long-term follow-up, and such other information as the Secretary determines to be appropriate, to conduct an ongoing evaluation of the scientific and clinical status of transplantation involving
recipients of a stem cell therapeutics product from a donor.
(c) ANNUAL REPORT ON PATIENT OUTCOMES.—The Secretary
shall require the entity awarded a contract under this section to
submit to the Secretary an annual report concerning patient outcomes with respect to each transplant center, based on data collected and maintained by the entity pursuant to this section.
(d) PUBLICLY AVAILABLE DATA.—The outcomes database shall
make relevant scientific information not containing individually
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identifiable information available to the public in the form of summaries and data sets to encourage medical research and to provide
information to transplant programs, physicians, patients, entities
awarded a contract under section 379 donor registries, and cord
blood banks.
SEC. 379A–1. ø274l–1¿ DEFINITIONS.

In this part:
(1) The term ‘‘Advisory Council’’ means the advisory council established by the Secretary under section 379(a)(1).
(2) The term ‘‘bone marrow’’ means the cells found in adult
bone marrow and peripheral blood.
(3) The term ‘‘outcomes database’’ means the database established by the Secretary under section 379A.
(4) The term ‘‘Program’’ means the C.W. Bill Young Cell
Transplantation Program established under section 379.
SEC. 379B. ø274m¿ AUTHORIZATION OF APPROPRIATIONS.

For the purpose of carrying out this part, there are authorized
to be appropriated $30,000,000 for each of fiscal years 2011
through 2014 and $33,000,000 for fiscal year 2015.
PART J—PREVENTION

AND

CONTROL

OF INJURIES

RESEARCH

SEC. 391. ø280b¿ (a) The Secretary, through the Director of the
Centers for Disease Control and Prevention, shall—
(1) conduct, and give assistance to public and nonprofit
private entities, scientific institutions, and individuals engaged
in the conduct of, research relating to the causes, mechanisms,
prevention, diagnosis, treatment of injuries, and rehabilitation
from injuries;
(2) make grants to, or enter into cooperative agreements or
contracts with, public and nonprofit private entities (including
academic institutions, hospitals, and laboratories) and individuals for the conduct of such research; and
(3) make grants to, or enter into cooperative agreements or
contracts with, academic institutions for the purpose of providing training on the causes, mechanisms, prevention, diagnosis, treatment of injuries, and rehabilitation from injuries.
(b) The Secretary, through the Director of the Centers for Disease Control and Prevention, shall collect and disseminate, through
publications and other appropriate means, information concerning
the practical applications of research conducted or assisted under
subsection (a). In carrying out the preceding sentence, the Secretary shall disseminate such information to the public, including
through elementary and secondary schools.
PREVENTION AND CONTROL ACTIVITIES

SEC. 392. ø280b–1¿ (a) The Secretary, through the Director of
the Centers for Disease Control and Prevention, shall—
(1) assist States and political subdivisions of States in activities for the prevention and control of injuries; and
(2) encourage regional activities between States designed
to reduce injury rates.
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(b) The Secretary, through the Director of the Centers for Disease Control and Prevention, may—
(1) enter into agreements between the Service and public
and private community health agencies which provide for cooperative planning of activities to deal with problems relating to
the prevention and control of injuries;
(2) work in cooperation with other Federal agencies, and
with public and nonprofit private entities, to promote activities
regarding the prevention and control of injuries; and
(3) make grants to States and, after consultation with
State health agencies, to other public or nonprofit private entities for the purpose of carrying out demonstration projects for
the prevention and control of injuries at sites that are not subject to the Occupational Safety and Health Act of 1970, including homes, elementary and secondary schools, and public buildings.
INTERPERSONAL VIOLENCE WITHIN FAMILIES AND AMONG
ACQUAINTANCES

SEC. 393. ø280b–1a¿ (a) With respect to activities that are authorized in sections 391 and 392, the Secretary, acting through the
Director of the Centers for Disease Control and Prevention, shall
carry out such activities with respect to interpersonal violence
within families and among acquaintances. Activities authorized in
the preceding sentence include the following:
(1) Collecting data relating to the incidence of such violence.
(2) Making grants to public and nonprofit private entities
for the evaluation of programs whose purpose is to prevent
such violence, including the evaluation of demonstration
projects under paragraph (6).
(3) Making grants to public and nonprofit private entities
for the conduct of research on identifying effective strategies
for preventing such violence.
(4) Providing to the public information and education on
such violence, including information and education to increase
awareness of the public health consequences of such violence.
(5) Training health care providers as follows:
(A) To identify individuals whose medical conditions or
statements indicate that the individuals are victims of
such violence.
(B) To routinely determine, in examining patients,
whether the medical conditions or statements of the patients so indicate.
(C) To refer individuals so identified to entities that
provide services regarding such violence, including referrals for counseling, housing, legal services, and services of
community organizations.
(6) Making grants to public and nonprofit private entities
for demonstration projects with respect to such violence, including with respect to prevention.
(b) For purposes of this part, the term ‘‘interpersonal violence
within families and among acquaintances’’ includes behavior commonly referred to as domestic violence, sexual assault, spousal
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abuse, woman battering, partner abuse, elder abuse, and acquaintance rape.
SEC. 393A. ø280b–1b¿ USE OF ALLOTMENTS FOR RAPE PREVENTION
EDUCATION.
(a) PERMITTED USE.—The Secretary, acting through the Na-

tional Center for Injury Prevention and Control at the Centers for
Disease Control and Prevention, shall award targeted grants to
States to be used for rape prevention and education programs conducted by rape crisis centers, State sexual assault coalitions, and
other public and private nonprofit entities for—
(1) educational seminars;
(2) the operation of hotlines;
(3) training programs for professionals;
(4) the preparation of informational material;
(5) education and training programs for students and campus personnel designed to reduce the incidence of sexual assault at colleges and universities;
(6) education to increase awareness about drugs used to facilitate rapes or sexual assaults; and
(7) other efforts to increase awareness of the facts about,
or to help prevent, sexual assault, including efforts to increase
awareness in underserved communities and awareness among
individuals with disabilities (as defined in section 3 of the
Americans with Disabilities Act of 1990 (42 U.S.C. 12102)).
(b) COLLECTION AND DISSEMINATION OF INFORMATION ON SEXUAL ASSAULT.—The Secretary shall, through the National Resource
Center on Sexual Assault established under the National Center
for Injury Prevention and Control at the Centers for Disease Control and Prevention, provide resource information, policy, training,
and technical assistance to Federal, State, local, and Indian tribal
agencies, as well as to State sexual assault coalitions and local sexual assault programs and to other professionals and interested parties on issues relating to sexual assault, including maintenance of
a central resource library in order to collect, prepare, analyze, and
disseminate information and statistics and analyses thereof relating to the incidence and prevention of sexual assault.
(c) AUTHORIZATION OF APPROPRIATIONS.—
(1) IN GENERAL.—There is authorized to be appropriated to
carry out this section $80,000,000 for each of fiscal years 2007
through 2011.
(2) NATIONAL SEXUAL VIOLENCE RESOURCE CENTER ALLOTMENT.—Of the total amount made available under this subsection in each fiscal year, not less than $1,500,000 shall be
available for allotment under subsection (b).
(d) LIMITATIONS.—
(1) SUPPLEMENT NOT SUPPLANT.—Amounts provided to
States under this section shall be used to supplement and not
supplant other Federal, State, and local public funds expended
to provide services of the type described in subsection (a).
(2) STUDIES.—A State may not use more than 2 percent of
the amount received by the State under this section for each
fiscal year for surveillance studies or prevalence studies.
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(3) ADMINISTRATION.—A State may not use more than 5
percent of the amount received by the State under this section
for each fiscal year for administrative expenses.
PREVENTION OF TRAUMATIC BRAIN INJURY

SEC. 393B. ø280b–1c¿ (a) IN GENERAL.—The Secretary, acting
through the Director of the Centers for Disease Control and Prevention, may carry out projects to reduce the incidence of traumatic
brain injury. Such projects may be carried out by the Secretary directly or through awards of grants or contracts to public or nonprofit private entities. The Secretary may directly or through such
awards provide technical assistance with respect to the planning,
development, and operation of such projects.
(b) CERTAIN ACTIVITIES.—Activities under subsection (a) may
include—
(1) the conduct of research into identifying effective strategies for the prevention of traumatic brain injury;
(2) the implementation of public information and education
programs for the prevention of such injury and for broadening
the awareness of the public concerning the public health consequences of such injury; and
(3) the implementation of a national education and awareness campaign regarding such injury (in conjunction with the
program of the Secretary regarding health-status goals for
2010, commonly referred to as Healthy People 2010), including—
(A) the national dissemination of information on—
(i) incidence and prevalence; and
(ii) information relating to traumatic brain injury
and the sequelae of secondary conditions arising from
traumatic brain injury upon discharge from hospitals
and emergency departments; and
(B) the provision of information in primary care settings, including emergency rooms and trauma centers, concerning the availability of State level services and resources.
(c) COORDINATION OF ACTIVITIES.—The Secretary shall ensure
that activities under this section are coordinated as appropriate
with other agencies of the Public Health Service that carry out activities regarding traumatic brain injury.
(d) DEFINITION.—For purposes of this section, the term ‘‘traumatic brain injury’’ means an acquired injury to the brain. Such
term does not include brain dysfunction caused by congenital or degenerative disorders, nor birth trauma, but may include brain injuries caused by anoxia due to trauma. The Secretary may revise the
definition of such term as the Secretary determines necessary, after
consultation with States and other appropriate public or nonprofit
private entities.

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NATIONAL PROGRAM FOR TRAUMATIC BRAIN INJURY SURVEILLANCE
AND REGISTRIES

SEC. 393C. 1 ø280b–1d¿ (a) IN GENERAL.—The Secretary, acting through the Director of the Centers for Disease Control and
Prevention, may make grants to States or their designees to develop or operate the State’s traumatic brain injury surveillance system or registry to determine the incidence and prevalence of traumatic brain injury and related disability, to ensure the uniformity
of reporting under such system or registry, to link individuals with
traumatic brain injury to services and supports, and to link such
individuals with academic institutions to conduct applied research
that will support the development of such surveillance systems and
registries as may be necessary. A surveillance system or registry
under this section shall provide for the collection of data concerning—
(1) demographic information about each traumatic brain
injury;
(2) information about the circumstances surrounding the
injury event associated with each traumatic brain injury;
(3) administrative information about the source of the collected information, dates of hospitalization and treatment, and
the date of injury; and
(4) information characterizing the clinical aspects of the
traumatic brain injury, including the severity of the injury,
outcomes of the injury, the types of treatments received, and
the types of services utilized.
(b) Not later than 18 months after the date of enactment of the
Traumatic Brain Injury Act of 2008, the Secretary, acting through
the Director of the Centers for Disease Control and Prevention and
the Director of the National Institutes of Health and in consultation with the Secretary of Defense and the Secretary of Veterans
Affairs, shall submit to the relevant committees of Congress a report that contains the findings derived from an evaluation concerning activities and procedures that can be implemented by the
Centers for Disease Control and Prevention to improve the collection and dissemination of compatible epidemiological studies on the
incidence and prevalence of traumatic brain injury in individuals
who were formerly in the military. The report shall include recommendations on the manner in which such agencies can further
collaborate on the development and improvement of traumatic
brain injury diagnostic tools and treatments.
SEC. 393C–1. ø280b–1e¿ STUDY ON TRAUMATIC BRAIN INJURY.
(a) STUDY.—The Secretary, acting through the Director

of the
Centers for Disease Control and Prevention with respect to paragraph (1) and in consultation with the Director of the National Institutes of Health and other appropriate entities with respect to
paragraphs (2), (3), and (4), may conduct a study with respect to
traumatic brain injury for the purpose of carrying out the following:

1 The amendment by section 2(3) of Public Law 110–206 to redesignate section 393B (relating
to traumatic brain injury registeries) as section 393C could not be executed because such section
had already been redesignated as section 393C by section 2(1) of Public Law 110–202.

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(1) In collaboration with appropriate State and local
health-related agencies—
(A) determining the incidence of traumatic brain injury and prevalence of traumatic brain injury related disability and the clinical aspects of the disability in all age
groups and racial and ethnic minority groups in the general population of the United States, including institutional settings, such as nursing homes, correctional facilities, psychiatric hospitals, child care facilities, and residential institutes for people with developmental disabilities;
and
(B) reporting national trends in traumatic brain injury.
(2) Identifying common therapeutic interventions which
are used for the rehabilitation of individuals with such injuries, and, subject to the availability of information, including
an analysis of—
(A) the effectiveness of each such intervention in improving the functioning, including return to work or school
and community participation, of individuals with brain injuries;
(B) the comparative effectiveness of interventions employed in the course of rehabilitation of individuals with
brain injuries to achieve the same or similar clinical outcome; and
(C) the adequacy of existing measures of outcomes and
knowledge of factors influencing differential outcomes.
(3) Identifying interventions and therapies that can prevent or remediate the development of secondary neurologic conditions related to traumatic brain injury.
(4) Developing practice guidelines for the rehabilitation of
traumatic brain injury at such time as appropriate scientific
research becomes available.
(b) DATES CERTAIN FOR REPORTS.—If the study is conducted
under subsection (a), the Secretary shall, not later than 3 years
after the date of the enactment of the Traumatic Brain Injury Act
of 2008, submit to Congress a report describing findings made as
a result of carrying out such subsection (a).
(c) DEFINITION.—For purposes of this section, the term ‘‘traumatic brain injury’’ means an acquired injury to the brain. Such
term does not include brain dysfunction caused by congenital or degenerative disorders, nor birth trauma, but may include brain injuries caused by anoxia due to trauma including near drowning. The
Secretary may revise the definition of such term as the Secretary
determines necessary.
SEC. 393D. ø28b–1f¿ PREVENTION OF FALLS AMONG OLDER ADULTS.
(a) PUBLIC EDUCATION.—The Secretary may—

(1) oversee and support a national education campaign to
be carried out by a nonprofit organization with experience in
designing and implementing national injury prevention programs, that is directed principally to older adults, their families, and health care providers, and that focuses on reducing
falls among older adults and preventing repeat falls; and
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(2) award grants, contracts, or cooperative agreements to
qualified organizations, institutions, or consortia of qualified
organizations and institutions, specializing, or demonstrating
expertise, in falls or fall prevention, for the purpose of organizing State-level coalitions of appropriate State and local
agencies, safety, health, senior citizen, and other organizations
to design and carry out local education campaigns, focusing on
reducing falls among older adults and preventing repeat falls.
(b) RESEARCH.—
(1) IN GENERAL.—The Secretary may—
(A) conduct and support research to—
(i) improve the identification of older adults who
have a high risk of falling;
(ii) improve data collection and analysis to identify
fall risk and protective factors;
(iii) design, implement, and evaluate the most effective fall prevention interventions;
(iv) improve strategies that are proven to be effective in reducing falls by tailoring these strategies to
specific populations of older adults;
(v) conduct research in order to maximize the dissemination of proven, effective fall prevention interventions;
(vi) intensify proven interventions to prevent falls
among older adults;
(vii) improve the diagnosis, treatment, and rehabilitation of elderly fall victims and older adults at
high risk for falls; and
(viii) assess the risk of falls occurring in various
settings;
(B) conduct research concerning barriers to the adoption of proven interventions with respect to the prevention
of falls among older adults;
(C) conduct research to develop, implement, and evaluate the most effective approaches to reducing falls among
high-risk older adults living in communities and long-term
care and assisted living facilities; and
(D) evaluate the effectiveness of community programs
designed to prevent falls among older adults.
(2) EDUCATIONAL SUPPORT.—The Secretary, either directly
or through awarding grants, contracts, or cooperative agreements to qualified organizations, institutions, or consortia of
qualified organizations and institutions, specializing, or demonstrating expertise, in falls or fall prevention, may provide
professional education for physicians and allied health professionals, and aging service providers in fall prevention, evaluation, and management.
(c) DEMONSTRATION PROJECTS.—The Secretary may carry out
the following:
(1) Oversee and support demonstration and research
projects to be carried out by qualified organizations, institutions, or consortia of qualified organizations and institutions,
specializing, or demonstrating expertise, in falls or fall prevention, in the following areas:
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(A) A multistate demonstration project assessing the
utility of targeted fall risk screening and referral programs.
(B) Programs designed for community-dwelling older
adults that utilize multicomponent fall intervention approaches, including physical activity, medication assessment and reduction when possible, vision enhancement,
and home modification strategies.
(C) Programs that are targeted to new fall victims who
are at a high risk for second falls and which are designed
to maximize independence and quality of life for older
adults, particularly those older adults with functional limitations.
(D) Private sector and public-private partnerships to
develop technologies to prevent falls among older adults
and prevent or reduce injuries if falls occur.
(2)(A) Award grants, contracts, or cooperative agreements
to qualified organizations, institutions, or consortia of qualified
organizations and institutions, specializing, or demonstrating
expertise, in falls or fall prevention, to design, implement, and
evaluate fall prevention programs using proven intervention
strategies in residential and institutional settings.
(B) Award 1 or more grants, contracts, or cooperative
agreements to 1 or more qualified organizations, institutions,
or consortia of qualified organizations and institutions, specializing, or demonstrating expertise, in falls or fall prevention, in
order to carry out a multistate demonstration project to implement and evaluate fall prevention programs using proven
intervention strategies designed for single and multifamily residential settings with high concentrations of older adults, including—
(i) identifying high-risk populations;
(ii) evaluating residential facilities;
(iii) conducting screening to identify high-risk individuals;
(iv) providing fall assessment and risk reduction interventions and counseling;
(v) coordinating services with health care and social
service providers; and
(vi) coordinating post-fall treatment and rehabilitation.
(3) Award 1 or more grants, contracts, or cooperative
agreements to qualified organizations, institutions, or consortia
of qualified organizations and institutions, specializing, or
demonstrating expertise, in falls or fall prevention, to conduct
evaluations of the effectiveness of the demonstration projects
described in this subsection.
(d) PRIORITY.—In awarding grants, contracts, or cooperative
agreements under this section, the Secretary may give priority to
entities that explore the use of cost-sharing with respect to activities funded under the grant, contract, or agreement to ensure the
institutional commitment of the recipients of such assistance to the
projects funded under the grant, contract, or agreement. Such nonFederal cost sharing contributions may be provided directly or
through donations from public or private entities and may be in
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cash or in-kind, fairly evaluated, including plant, equipment, or
services.
(e) STUDY OF EFFECTS OF FALLS ON HEALTH CARE COSTS.—
(1) IN GENERAL.—The Secretary may conduct a review of
the effects of falls on health care costs, the potential for reducing falls, and the most effective strategies for reducing health
care costs associated with falls.
(2) REPORT.—If the Secretary conducts the review under
paragraph (1), the Secretary shall, not later than 36 months
after the date of enactment of the Safety of Seniors Act of
2007, submit to Congress a report describing the findings of
the Secretary in conducting such review.
GENERAL PROVISIONS

SEC. 394. ø280b–2¿ (a) The Secretary, acting through the Director of the Centers for Disease Control and Prevention, shall establish an advisory committee to advise the Secretary and such Director with respect to the prevention and control of injuries.
(b) The Secretary, acting through the Director of the Centers
for Disease Control and Prevention, may provide technical assistance to public and nonprofit private entities with respect to the
planning, development, and operation of any program or service
carried out pursuant to this part. The Secretary may provide such
technical assistance directly or through grants or contracts.
(c) Not later than February 1 of 1995 and of every second year
thereafter, the Secretary, acting through the Director of the Centers for Disease Control and Prevention, shall submit to the Committee on Energy and Commerce of the House of Representatives,
and to the Committee on Labor and Human Resources of the Senate, a report describing the activities carried out under this part
during the preceding 2 fiscal years. Such report shall include a description of such activities that were carried out with respect to
interpersonal violence within families and among acquaintances
and with respect to rural areas.
AUTHORIZATIONS OF APPROPRIATIONS

SEC. 394A. ø280b–3¿ For the purpose of carrying out this part,
there are authorized to be appropriated $50,000,000 for fiscal year
1994, and 1 such sums as may be necessary for each of the fiscal
years 1995 through 1998, and such sums as may be necessary for
each of the fiscal years 2001 through 2005.. 1
PART K—HEALTH CARE SERVICES

IN THE

HOME

Subpart I—Grants for Demonstration Projects
SEC. 395. ø280c¿ ESTABLISHMENT OF PROGRAM.
(a) IN GENERAL.—The Secretary, acting through

the Administrator of the Health Resources and Services Administration, shall
make not less than 5, and not more than 20, grants to States for
1 So in law. Section 1306 of Public Law 106–310 (114 Stat. 1143) attempts to strike ‘‘and’’,
but the amendment cannot be executed because the instructions were to strike ‘‘and’’ after
‘‘1994’’. (The word ‘‘and’’ appears after ‘‘1994,’’, not ‘‘1994’’.) Such section 1306 also added the
superfluous period.

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the purpose of assisting grantees in carrying out demonstration
projects—
(1) to identify low-income individuals who can avoid institutionalization or prolonged hospitalization if 2 skilled nursing
care services, homemaker or home health aide services, or personal care services are provided in the homes of the individuals;
(2) to pay the costs of the provision of such services in the
homes of such individuals; and
(3) to coordinate the provision by public and private entities of such services, and other long-term care services, in the
homes of such individuals.
(b) REQUIREMENT WITH RESPECT TO AGE OF RECIPIENTS OF
SERVICES.—The Secretary may not make a grant under subsection
(a) to a State unless the State agrees to ensure that—
(1) not less than 25 percent of the grant is expended to
provide services under such subsection to individuals who are
not less than 65 years of age; and
(2) of the portion of the grant reserved by the State for
purposes of complying with paragraph (1), not less than 10 percent is expended to provide such services to individuals who
are not less than 85 years of age.
(c) RELATIONSHIP TO ITEMS AND SERVICES UNDER OTHER PROGRAMS.—A State may not make payments from a grant under subsection (a) for any item or service to the extent that payment has
been made, or can reasonably be expected to be made, with respect
to such item or service—
(1) under any State compensation program, under an insurance policy, or under any Federal or State health benefits
program; or
(2) by an entity that provides health services on a prepaid
basis.
SEC. 396. ø280c–1¿ LIMITATION ON DURATION OF GRANT AND REQUIREMENT OF MATCHING FUNDS.
(a) LIMITATION ON DURATION OF GRANT.—The period during

which payments are made to a State from a grant under section
395(a) may not exceed 3 years. Such payments shall be subject to
annual evaluation by the Secretary.
(b) REQUIREMENT OF MATCHING FUNDS.—
(1)(A) For the first year of payments to a State from a
grant under section 395(a), the Secretary may not make such
payments in an amount exceeding 75 percent of the costs of
services to be provided by the State pursuant to such section.
(B) For the second year of such payments to a State, the
Secretary may not make such payments in an amount exceeding 65 percent of the costs of such services.
(C) For the third year of such payments to a State, the
Secretary may not make such payments in an amount exceeding 55 percent of the costs of such services.
2 Section 2(f) of Public Law 102–108 (105 Stat. 550) provides as follows: ‘‘(f) PUBLIC HEALTH
SERVICE ACT TECHNICAL AMENDMENTS.—Section 395. [280c](a)(1) after the word ‘if’ insert the
words ‘skilled medical services,’ ’’. The text of such section 2(f) does not provide sufficient amendatory instructions to execute an amendment. The apparent intent of the Congress was to amend
section 395(a)(1) of the Public Health Service Act (42 U.S.C. 280c(a)(1)).

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(2) The Secretary may not make a grant under section
395(a) to a State unless the State agrees to make available, directly or through donations from public or private entities,
non-Federal contributions toward the costs of services to be
provided pursuant to such section in an amount equal to—
(A) for the first year of payments to the State from the
grant, not less than $25 (in cash or in kind under subsection (c)) for each $75 of Federal funds provided in the
grant;
(B) for the second year of such payments to the State,
not less than $35 (in cash or in kind under subsection (c))
for each $65 of such Federal funds; and
(C) for the third year of such payments to the State,
not less than $45 (in cash or in kind under subsection (c))
for each $55 of such Federal funds.
(c) DETERMINATION OF AMOUNT OF NON-FEDERAL CONTRIBUTION.—Non-Federal contributions required in subsection (b) may be
in cash or in kind, fairly evaluated, including plant, equipment, or
services. Amounts provided by the Federal Government, or services
assisted or subsidized to any significant extent by the Federal Government, may not be included in determining the amount of such
non-Federal contributions.
SEC. 397. ø280c–2¿ GENERAL PROVISIONS.
(a) LIMITATION ON ADMINISTRATIVE

EXPENSES.—The Secretary
may not make a grant under section 395(a) to a State unless the
State agrees that not more than 10 percent of the grant will be expended for administrative expenses with respect to the grant.
(b) DESCRIPTION OF INTENDED USE OF GRANT.—The Secretary
may not make a grant under section 395(a) to a State unless—
(1) the State submits to the Secretary a description of the
purposes for which the State intends to expend the grant; and
(2) such description provides information relating to the
programs and activities to be supported and services to be provided, including—
(A) the number of individuals who will receive services
pursuant to section 395(a) and the average costs of providing such services to each such individual; and
(B) a description of the manner in which such programs and activities will be coordinated with any similar
programs and activities of public and private entities.
(c) REQUIREMENT OF APPLICATION.—The Secretary may not
make a grant under section 395(a) to a State unless the State has
submitted to the Secretary an application for the grant. The application shall—
(1) contain the description of intended expenditures required in subsection (b);
(2) with respect to carrying out the purpose for which the
grant is to be made, provide assurances of compliance satisfactory to the Secretary; and
(3) otherwise be in such form, be made in such manner,
and contain such information and agreements as the Secretary
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(d) EVALUATIONS AND REPORT BY SECRETARY.—The Secretary
shall—
(1) provide for an evaluation of each demonstration project
for which a grant is made under section 395(a); and
(2) not later than 6 months after the completion of such
evaluations, submit to the Congress a report describing the
findings made as a result of the evaluations.
(e) AUTHORIZATIONS OF APPROPRIATIONS.—For the purpose of
carrying out this subpart, there are authorized to be appropriated
$5,000,000 for each of the fiscal years 1988 through 1990,
$7,500,000 for fiscal year 1991, and such sums as may be necessary
for each of the fiscal years 1992 and 1993.
Subpart II—Grants for Demonstrations Projects With Respect to
Alzheimer’s Disease
SEC. 398. ø280c–3¿ ESTABLISHMENT OF PROGRAM.
(a) IN GENERAL.—The Secretary shall make

grants to States
for the purpose of assisting grantees in carrying out demonstration
projects for planning, establishing, and operating programs—
(1) to coordinate the development and operation with public and private organizations of diagnostic, treatment, care
management, respite care, legal counseling, and education
services provided within the State to individuals with Alzheimer’s disease or related disorders and to the families and
care providers of such individuals;
(2) to provide home health care, personal care, day care,
companion services, short-term care in health facilities, and
other respite care to individuals with Alzheimer’s disease or related disorders who are living in single family homes or in congregate settings;
(3) to improve the access of such individuals to home-based
or community-based long-term care services (subject to the
services being provided by entities that were providing such
services in the State involved as of October 1, 1995), particularly such individuals who are members of racial or ethnic minority groups, who have limited proficiency in speaking the
English language, or who live in rural areas; and
(4) to provide to health care providers, to individuals with
Alzheimer’s disease or related disorders, to the families of such
individuals, to organizations established for such individuals
and such families, and to the general public, information with
respect to—
(A) diagnostic services, treatment services, and related
services available to such individuals and to the families
of such individuals;
(B) sources of assistance in obtaining such services, including assistance under entitlement programs; and
(C) the legal rights of such individuals and such families.
(b) REQUIREMENT WITH RESPECT TO CERTAIN EXPENDITURES.—
The Secretary may not make a grant under subsection (a) to a
State unless the State agrees to expend not less than 50 percent
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of the grant for the provision of services described in subsection
(a)(2).
(c) RELATIONSHIP TO ITEMS AND SERVICES UNDER OTHER PROGRAMS.—A State may not make payments from a grant under subsection (a) for any item or service to the extent that payment has
been made, or can reasonably be expected to be made, with respect
to such item or service—
(1) under any State compensation program, under an insurance policy, or under any Federal or State health benefits
program; or
(2) by an entity that provides health services on a prepaid
basis.
SEC. 398A. ø280c–4¿ REQUIREMENT OF MATCHING FUNDS 1
(a) REQUIREMENT OF MATCHING FUNDS.—

(1)(A) For the first year of payments to a State from a
grant under section 398(a), the Secretary may not make such
payments in an amount exceeding 75 percent of the costs of
services to be provided by the State pursuant to such section.
(B) For the second year of such payments to a State, the
Secretary may not make such payments in an amount exceeding 65 percent of the costs of such services.
(C) For the third or subsequent year of such payments to
a State, the Secretary may not make such payments in an
amount exceeding 55 percent of the costs of such services.
(2) The Secretary may not make a grant under section
398(a) to a State unless the State agrees to make available, directly or through donations from public or private entities,
non-Federal contributions toward the costs of services to be
provided pursuant to such section in an amount equal to—
(A) for the first year of payments to the State from the
grant, not less than $25 (in cash or in kind under subsection (c)) for each $75 of Federal funds provided in the
grant;
(B) for the second year of such payments to the State,
not less than $35 (in cash or in kind under subsection (c))
for each $65 of such Federal funds; and
(C) for the third or subsequent year of such payments
to the State, not less than $45 (in cash or in kind under
subsection (c)) for each $55 of such Federal funds.
(b) DETERMINATION OF AMOUNT OF NON-FEDERAL CONTRIBUTION.—Non-Federal contributions required in subsection (b) may be
in cash or in kind, fairly evaluated, including plant, equipment, or
services. Amounts provided by the Federal Government, or services
assisted or subsidized to any significant extent by the Federal Government, may not be included in determining the amount of such
non-Federal contributions.
SEC. 398B. ø280c–5¿ GENERAL PROVISIONS.
(a) LIMITATION ON ADMINISTRATIVE EXPENSES.—The

Secretary
may not make a grant under section 398(a) to a State unless the

1 So in law. The section heading lacks a period. See section 301(b)(1) of Public Law 105–392
(112 Stat. 3586).

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State agrees that not more than 10 percent of the grant will be expended for administrative expenses with respect to the grant.
(b) DESCRIPTION OF INTENDED USE OF GRANT.—The Secretary
may not make a grant under section 398(a) to a State unless—
(1) the State submits to the Secretary a description of the
purposes for which the State intends to expend the grant; and
(2) such description provides information relating to the
programs and activities to be supported and services to be provided, including—
(A) the number of individuals who will receive services
pursuant to section 398(a) and the average costs of providing such services to each such individual; and
(B) a description of the manner in which such programs and activities will be coordinated with any similar
programs and activities of public and private entities.
(c) REQUIREMENT OF APPLICATION.—The Secretary may not
make a grant under section 398(a) to a State unless the State has
submitted to the Secretary an application for the grant. The application shall—
(1) contain the description of intended expenditures required in subsection (b);
(2) with respect to carrying out the purpose for which the
grant is to be made, provide assurances of compliance satisfactory to the Secretary; and
(3) otherwise be in such form, be made in such manner,
and contain such information and agreements as the Secretary
determines to be necessary to carry out this subpart.
(d) EVALUATIONS AND REPORT BY SECRETARY.—The Secretary
shall—
(1) provide for an evaluation of each demonstration project
for which a grant is made under section 398(a); and
(2) not later than 6 months after the completion of such
evaluations, submit to the Congress a report describing the
findings made as a result of the evaluations.
(e) AUTHORIZATIONS OF APPROPRIATIONS.—For the purpose of
carrying out this subpart, there are authorized to be appropriated
$5,000,000 for each of the fiscal years 1988 through 1990,
$7,500,000 for fiscal year 1991, such sums as may be necessary for
each of the fiscal years 1992 and 1993, $8,000,000 for fiscal year
1998, and such sums as may be necessary for each of the fiscal
years 1999 through 2002.
Subpart III—Grants for Home Visiting Services for At-Risk
Families
SEC. 399. ø280c–6¿ PROJECTS TO IMPROVE MATERNAL, INFANT, AND
CHILD HEALTH.
(a) IN GENERAL.—
(1) ESTABLISHMENT OF PROGRAM.—The Secretary, acting

through the Administrator of the Health Resources and Services Administration, shall make grants to eligible entities to
pay the Federal share of the cost of providing the services specified in subsection (b) to families in which a member is—
(A) a pregnant woman at risk of delivering an infant
with a health or developmental complication; or
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(B) a child less than 3 years of age—
(i) who is experiencing or is at risk of a health or
developmental complication, or of child abuse or neglect; or
(ii) who has been prenatally exposed to maternal
substance abuse.
(2) MINIMUM PERIOD OF AWARDS; ADMINISTRATIVE CONSULTATIONS.—
(A) The Secretary shall award grants under paragraph
(1) for periods of at least three years.
(B) The Administrator of the Administration for Children, Youth, and Families and the Director of the National
Commission to Prevent Infant Mortality shall be consulted
regarding the promulgation of program guidelines and
funding priorities under this section.
(3) REQUIREMENT OF STATUS AS MEDICAID PROVIDER.—
(A) Subject to subparagraph (B), the Secretary may
make a grant under paragraph (1) only if, in the case of
any service under such paragraph that is covered in the
State plan approved under title XIX of the Social Security
Act for the State involved—
(i) the entity involved will provide the service directly, and the entity has entered into a participation
agreement under the State plan and is qualified to receive payments under such plan; or
(ii) the entity will enter into an agreement with
an organization under which the organization will provide the service, and the organization has entered into
such a participation agreement and is qualified to receive such payments.
(B)(i) In the case of an organization making an agreement under subparagraph (A)(ii) regarding the provision of
services under paragraph (1), the requirement established
in such subparagraph regarding a participation agreement
shall be waived by the Secretary if the organization does
not, in providing health or mental health services, impose
a charge or accept reimbursement available from any
third-party payor, including reimbursement under any insurance policy or under any Federal or State health benefits program.
(ii) A determination by the Secretary of whether an organization referred to in clause (i) meets the criteria for a
waiver under such clause shall be made without regard to
whether the organization accepts voluntary donations regarding the provision of services to the public.
(b) HOME VISITING SERVICES FOR ELIGIBLE FAMILIES.—With respect to an eligible family, each of the following services shall, directly or through arrangement with other public or nonprofit private entities, be available (as applicable to the family member involved) in each project operated with a grant under subsection (a):
(1) Prenatal and postnatal health care.
(2) Primary health care for the children, including developmental assessments.
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(3) Education for the parents concerning infant care and
child development, including the development and utilization
of parent and teacher resource networks and other family resource and support networks where such networks are available.
(4) Upon the request of a parent, providing the education
described in paragraph (3) to other individuals who have responsibility for caring for the children.
(5) Education for the parents concerning behaviors that adversely affect health.
(6) Assistance in obtaining necessary health, mental
health, developmental, social, housing, and nutrition services
and other assistance, including services and other assistance
under maternal and child health programs; the special supplemental nutrition program for women, infants, and children;
section 17 of the Child Nutrition Act of 1966; title V of the Social Security Act; title XIX of such Act (including the program
for early and periodic screening, diagnostic, and treatment
services described in section 1905(r) of such Act); titles IV and
XIX of the Social Security Act; housing programs; other food
assistance programs; and appropriate alcohol and drug dependency treatment programs, according to need.
(c) CONSIDERATIONS IN MAKING GRANTS.—In awarding grants
under subsection (a), the Secretary shall take into consideration—
(1) the ability of the entity involved to provide, either directly or through linkages, a broad range of preventive and primary health care services and related social, family support,
and developmental services;
(2) different combinations of professional and lay home
visitors utilized within programs that are reflective of the identified service needs and characteristics of target populations;
(3) the extent to which the population to be targeted has
limited access to health care, and related social, family support, and developmental services; and
(4) whether such grants are equitably distributed among
urban and rural settings and whether entities serving Native
American communities are represented among the grantees.
(d) FEDERAL SHARE.—With respect to the costs of carrying out
a project under subsection (a), a grant under such subsection for
the project may not exceed 90 percent of such costs. To be eligible
to receive such a grant, an applicant must provide assurances that
the applicant will obtain at least 10 percent of such costs from nonFederal funds (and such contributions to such costs may be in cash
or in-kind, including facilities and personnel).
(e) RULE OF CONSTRUCTION REGARDING AT-RISK BIRTHS.—For
purposes of subsection (a)(1), a pregnant woman shall be considered to be at risk of delivering an infant with a health or developmental complication if during the pregnancy the woman—
(1) lacks appropriate access to, or information concerning,
early and routine prenatal care;
(2) lacks the transportation necessary to gain access to the
services described in subsection (b);
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(3) lacks appropriate child care assistance, which results in
impeding the ability of such woman to utilize health and related social services;
(4) is fearful of accessing substance abuse services or child
and family support services; or
(5) is a minor with a low income.
(f) DELIVERY OF SERVICES AND CASE MANAGEMENT.—
(1) CASE MANAGEMENT MODEL.—Home visiting services
provided under this section shall be delivered according to a
case management model, and a registered nurse, licensed social worker, or other licensed health care professional with experience and expertise in providing health and related social
services in home and community settings shall be assigned as
the case manager for individual cases under such model.
(2) CASE MANAGER.—A case manager assigned under paragraph (1) shall have primary responsibility for coordinating
and overseeing the development of a plan for each family that
is to receive home visiting services under this section, and for
coordinating the delivery of such services provided through appropriate personnel.
(3) APPROPRIATE PERSONNEL.—In determining which personnel shall be utilized in the delivery of services, the case
manager shall consider—
(A) the stated objective of the project to be operated
with the grant, as determined after considering identified
gaps in the current service delivery system; and
(B) the nature of the needs of the family to be served,
as determined at the initial assessment of the family that
is conducted by the case manager, and through follow-up
contacts by other providers of home visiting services.
(4) FAMILY SERVICE PLAN.—A case manager, in consultation with a team established in accordance with paragraph (5)
for the family involved, shall develop a plan for the family following the initial visit to the home of the family. Such plan
shall reflect—
(A) an assessment of the health and related social
service needs of the family;
(B) a structured plan for the delivery of home visiting
services to meet the identified needs of the family;
(C) the frequency with which such services are to be
provided to the family;
(D) ongoing revisions made as the needs of family
members change; and
(E) the continuing voluntary participation of the family in the plan.
(5) HOME VISITING SERVICES TEAM.—The team to be consulted under paragraph (4) on behalf of a family shall include,
as appropriate, other nursing professionals, physician assistants, social workers, child welfare professionals, infant and
early childhood specialists, nutritionists, and laypersons
trained as home visitors. The case manager shall ensure that
the plan is coordinated with those physician services that may
be required by the mother or child.
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(g) OUTREACH.—Each grantee under subsection (a) shall provide outreach and casefinding services to inform eligible families of
the availability of home visiting services from the project.
(h) CONFIDENTIALITY.—In accordance with applicable State
law, an entity receiving a grant under subsection (a) shall maintain
confidentiality with respect to services provided to families under
this section.
(i) CERTAIN ASSURANCES.—The Secretary may award a grant
under subsection (a) only if the entity involved provides assurances
satisfactory to the Secretary that—
(1) the entity will provide home visiting services with reasonable frequency—
(A) to families with pregnant women, as early in the
pregnancy as is practicable, and until the infant reaches at
least 2 years of age; and
(B) to other eligible families, for at least 2 years; and
(2) the entity will coordinate with public health and related social service agencies to prevent duplication of effort and
improve the delivery of comprehensive health and related social services.
(j) SUBMISSION TO SECRETARY OF CERTAIN INFORMATION.—The
Secretary may award a grant under subsection (a) only if the entity
involved submits to the Secretary—
(1) a description of the population to be targeted for home
visiting services and methods of outreach and casefinding for
identifying eligible families, including the use of lay home visitors where appropriate;
(2) a description of the types and qualifications of home
visitors used by the entity and the process by which the entity
will provide continuing training and sufficient support to the
home visitors; and
(3) such other information as the Secretary determines to
be appropriate.
(k) LIMITATION REGARDING ADMINISTRATIVE EXPENSES.—Not
more than 10 percent of a grant under subsection (a) may be expended for administrative expenses with respect to the grant. The
costs of training individuals to serve in the project involved are not
subject to the preceding sentence.
(l) RESTRICTIONS ON USE OF GRANT.—To be eligible to receive
a grant under this section, an entity must agree that the grant will
not be expended—
(1) to provide inpatient hospital services;
(2) to make cash payments to intended recipients of services;
(3) to purchase or improve land, purchase, construct, or
permanently improve (other than minor remodeling) any building or other facility, or purchase major medical equipment;
(4) to satisfy any requirement for the expenditure of nonFederal funds as a condition for the receipt of Federal funds;
or
(5) to provide financial assistance to any entity other than
a public or nonprofit private entity.
(m) REPORTS TO SECRETARY.—To be eligible to receive a grant
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port on the services provided under this section to the Secretary in
such manner and containing such information as the Secretary by
regulation requires. At a minimum, the entity shall report information concerning eligible families, including—
(1) the characteristics of the families and children receiving services under this section;
(2) the usage, nature, and location of the provider, of preventive health services, including prenatal, primary infant, and
child health care;
(3) the incidence of low birthweight and premature infants;
(4) the length of hospital stays for pre- and post-partum
women and their children;
(5) the incidence of substantiated child abuse and neglect
for all children within participating families;
(6) the number of emergency room visits for routine health
care;
(7) the source of payment for health care services and the
extent to which the utilization of health care services, other
than routine screening and medical care, available to the individuals under the program established under title XIX of the
Social Security Act, and under other Federal, State, and local
programs, is reduced;
(8) the number and type of referrals made for health and
related social services, including alcohol and drug treatment
services, and the utilization of such services provided by the
grantee; and
(9) the incidence of developmental disabilities.
(n) REQUIREMENT OF APPLICATION.—The Secretary may make
a grant under subsection (a) only if—
(1) an application for the grant is submitted to the Secretary;
(2) the application contains the agreements and assurances required in this section, and the information required in
subsection (j);
(3) the application contains evidence that the preparation
of the application has been coordinated with the State agencies
responsible for maternal and child health and child welfare,
and coordinated with services provided under part C of the Individuals with Disabilities Education Act; and
(4) the application is in such form, is made in such manner, and contains such agreements, assurances, and information as the Secretary determines to be necessary to carry out
this section.
(o) PEER REVIEW.—
(1) REQUIREMENT.—In making determinations for awarding grants under subsection (a), the Secretary shall rely on the
recommendations of the peer review panel established under
paragraph (2).
(2) COMPOSITION.—The Secretary shall establish a review
panel to make recommendations under paragraph (1) that
shall be composed of—
(A) national experts in the fields of maternal and child
health, child abuse and neglect, and the provision of community-based primary health services; and
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(B) representatives of relevant Federal agencies, including the Health Resources and Services Administration,
the Substance Abuse and Mental Health Services Administration, the Administration for Children, Youth, and Families, the U.S. Advisory Board on Child Abuse and Neglect,
and the National Commission to Prevent Infant Mortality.
(p) EVALUATIONS.—
(1) IN GENERAL.—The Secretary shall, directly or through
contracts with public or private entities—
(A) conduct evaluations to determine the effectiveness
of projects under subsection (a) in reducing the incidence
of children born with health or developmental complications, the incidence among children less than 3 years of
age of such complications, and the incidence of child abuse
and neglect; and
(B) not less than once during each 3-year period, prepare and submit to the appropriate committees of Congress a report concerning the results of such evaluations.
(2) CONTENTS.—The evaluations conducted under paragraph (1) shall—
(A) include a summary of the data contained in the
annual reports submitted under subsection (m);
(B) assess the relative effectiveness of projects under
subsection (a) in urban and rural areas, and among programs utilizing differing combinations of professionals and
trained home visitors recruited from the community to
meet the needs of defined target service populations; and
(C) make further recommendations necessary or desirable to increase the effectiveness of such projects.
(q) DEFINITIONS.—For purposes of this section:
(1) The term ‘‘eligible entity’’ includes public and nonprofit
private entities that provide health or related social services,
including community-based organizations, visiting nurse organizations, hospitals, local health departments, community
health centers, Native Hawaiian health centers, nurse managed clinics, family service agencies, child welfare agencies, developmental service providers, family resource and support
programs, and resource mothers projects.
(2) The term ‘‘eligible family’’ means a family described in
subsection (a).
(3) The term ‘‘health or developmental complication’’, with
respect to a child, means—
(A) being born in an unhealthy or potentially
unhealthy condition, including premature birth, low birthweight, and prenatal exposure to maternal substance
abuse;
(B) a condition arising from a condition described in
subparagraph (A);
(C) a physical disability or delay; and
(D) a developmental disability or delay.
(4) The term ‘‘home visiting services’’ means the services
specified in subsection (b), provided at the residence of the eligible family involved or provided pursuant to arrangements
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made for the family (including arrangements for services in
community settings).
(5) The term ‘‘home visitors’’ means providers of home visiting services.
(r) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of
carrying out this section, there is authorized to be appropriated
$30,000,000 for each of the fiscal years 1993 and 1994.
øPart L 1—¿
SEC. 399A. ø280d¿ GRANTS FOR SERVICES FOR CHILDREN OF SUBSTANCE ABUSERS.1
(a) ESTABLISHMENT.—
(1) IN GENERAL.—The Secretary, acting through the Ad-

ministrator of the Health Resources and Services Administration, shall make grants to public and nonprofit private entities
for the purpose of carrying out programs—
(A) to provide the services described in subsection (b)
to children of substance abusers;
(B) to provide the applicable services described in subsection (c) to families in which a member is a substance
abuser; and
(C) to identify such children and such families.
(2) ADMINISTRATIVE CONSULTATIONS.—The Administrator
of the Administration for Children, Youth, and Families and
the Administrator of the Substance Abuse and Mental Health
Services Administration shall be consulted regarding the promulgation of program guidelines and funding priorities under
this section.
(3) REQUIREMENT OF STATUS AS MEDICAID PROVIDER.—
(A) Subject to subparagraph (B), the Secretary may
make a grant under paragraph (1) only if, in the case of
any service under such paragraph that is covered in the
State plan approved under title XIX of the Social Security
Act for the State involved—
(i) the entity involved will provide the service directly, and the entity has entered into a participation
agreement under the State plan and is qualified to receive payments under such plan; or
(ii) the entity will enter into an agreement with
an organization under which the organization will pro1 The content of section 399A above, and the placement of the section in this Act, probably
do not reflect the intent of the Congress. Section 399A formerly was section 399D. Section 3106
of Public Law 106–310 (114 Stat. 1175) attempts to make various amendments to section 399D,
but the amendments cannot be executed because section 399D was redesignated as section 399A
by section 502(1) of such Public Law (114 Stat. 1115). (Section 399D now relates to technical
assistance in operations of Statewide cancer registries.)
Further, section 3106(m) of the Public Law (114 Stat. 1179) attempts to transfer section
399D to title V of this Act as a section 519, but this transfer has not been executed because
it applied to section 399D ‘‘as amended by this section’’ (section 3106), and no amendments described in section 3106 have been made to section 399D.
As a conforming amendment, section 3106(n) of the Public Law provided that title III of
this Act ‘‘is amended by striking the heading for part L’’. This amendment has been executed,
but for the convenience of the reader, a designation for a part L is shown above in brackets
to indicate the probable intent of the Congress that section 399A is not included in part K of
title III.
For the convenience of the reader, an italicized note follows section 399A above showing
the section as it would appear if the amendments described in section 3106 of the Public Law
were executed to section 399A.

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vide the service, and the organization has entered into
such a participation agreement and is qualified to receive such payments.
(B)(i) In the case of an organization making an agreement under subparagraph (A)(ii) regarding the provision of
services under paragraph (1), the requirement established
in such subparagraph regarding a participation agreement
shall be waived by the Secretary if the organization does
not, in providing health or mental health services, impose
a charge or accept reimbursement available from any
third-party payor, including reimbursement under any insurance policy or under any Federal or State health benefits program.
(ii) A determination by the Secretary of whether an organization referred to in clause (i) meets the criteria for a
waiver under such clause shall be made without regard to
whether the organization accepts voluntary donations regarding the provision of services to the public.
(b) SERVICES FOR CHILDREN OF SUBSTANCE ABUSERS.—The
Secretary may make a grant under subsection (a) only if the applicant involved agrees to make available (directly or through agreements with other entities) to children of substance abusers each of
the following services:
(1) Periodic evaluation of children for developmental, psychological, and medical problems.
(2) Primary pediatric care.
(3) Other necessary health and mental health services.
(4) Therapeutic intervention services for children, including provision of therapeutic child care.
(5) Preventive counseling services.
(6) Counseling related to the witnessing of chronic violence.
(7) Referrals for, and assistance in establishing eligibility
for, services provided under—
(A) education and special education programs;
(B) Head Start programs established under the Head
Start Act;
(C) other early childhood programs;
(D) employment and training programs;
(E) public assistance programs provided by Federal,
State, or local governments; and
(F) programs offered by vocational rehabilitation agencies, recreation departments, and housing agencies.
(8) Additional developmental services that are consistent
with the provision of early intervention services, as such term
is defined in part C of the Individuals with Disabilities Education Act.
(c) SERVICES FOR AFFECTED FAMILIES.—The Secretary may
make a grant under subsection (a) only if, in the case of families
in which a member is a substance abuser, the applicant involved
agrees to make available (directly or through agreements with
other entities) each of the following services, as applicable to the
family member involved:
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(1) Services as follows, to be provided by a public health
nurse, social worker, or similar professional, or by a trained
worker from the community who is supervised by a professional:
(A) Counseling to substance abusers on the benefits
and availability of substance abuse treatment services and
services for children of substance abusers.
(B) Assistance to substance abusers in obtaining and
using substance abuse treatment services and in obtaining
the services described in subsection (b) for their children.
(C) Visiting and providing support to substance abusers, especially pregnant women, who are receiving substance abuse treatment services or whose children are receiving services under subsection (b).
(2) In the case of substance abusers:
(A) Encouragement and, where necessary, referrals to
participate in appropriate substance abuse treatment.
(B) Primary health care and mental health services,
including prenatal and post partum care for pregnant
women.
(C) Consultation and referral regarding subsequent
pregnancies and life options, including education and career planning.
(D) Where appropriate, counseling regarding family
conflict and violence.
(E) Remedial education services.
(F) Referrals for, and assistance in establishing eligibility for, services described in subsection (b)(7).
(3) In the case of substance abusers, spouses of substance
abusers, extended family members of substance abusers, caretakers of children of substance abusers, and other people significantly involved in the lives of substance abusers or the children of substance abusers:
(A) An assessment of the strengths and service needs
of the family and the assignment of a case manager who
will coordinate services for the family.
(B) Therapeutic intervention services, such as parental
counseling, joint counseling sessions for families and children, and family therapy.
(C) Child care or other care for the child to enable the
parent to attend treatment or other activities and respite
care services.
(D) Parenting education services and parent support
groups.
(E) Support services, including, where appropriate,
transportation services.
(F) Where appropriate, referral of other family members to related services such as job training.
(G) Aftercare services, including continued support
through parent groups and home visits.
(d) CONSIDERATIONS IN MAKING GRANTS.—In making grants
under subsection (a), the Secretary shall ensure that the grants are
reasonably distributed among the following types of entities:
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(1) Alcohol and drug treatment programs, especially those
providing treatment to pregnant women and mothers and their
children.
(2) Public or nonprofit private entities that provide health
or social services to disadvantaged populations, and that
have—
(A) expertise in applying the services to the particular
problems of substance abusers and the children of substance abusers; and
(B) an affiliation or contractual relationship with one
or more substance abuse treatment programs.
(3) Consortia of public or nonprofit private entities that include at least one substance abuse treatment program.
(4) Indian tribes.
(e) FEDERAL SHARE.—The Federal share of a program carried
out under subsection (a) shall be 90 percent. The Secretary shall
accept the value of in-kind contributions, including facilities and
personnel, made by the grant recipient as a part or all of the nonFederal share of grants.
(f) COORDINATION WITH OTHER PROVIDERS.—The Secretary
may make a grant under subsection (a) only if the applicant involved agrees to coordinate its activities with those of the State
lead agency, and the State Interagency Coordinating Council,
under part C of the Individuals with Disabilities Education Act.
(g) RESTRICTIONS ON USE OF GRANT.—The Secretary may make
a grant under subsection (a) only if the applicant involved agrees
that the grant will not be expended—
(1) to provide inpatient hospital services;
(2) to make cash payments to intended recipients of services;
(3) to purchase or improve land, purchase, construct, or
permanently improve (other than minor remodeling) any building or other facility, or purchase major medical equipment;
(4) to satisfy any requirement for the expenditure of nonFederal funds as a condition for the receipt of Federal funds;
or
(5) to provide financial assistance to any entity other than
a public or nonprofit private entity.
(h) SUBMISSION TO SECRETARY OF CERTAIN INFORMATION.—The
Secretary may make a grant under subsection (a) only if the applicant involved submits to the Secretary—
(1) a description of the population that is to receive services under this section and a description of such services that
are to be provided and measurable goals and objectives;
(2) a description of the mechanism that will be used to involve the local public agencies responsible for health, mental
health, child welfare, education, juvenile justice, developmental
disabilities, and substance abuse treatment programs in planning and providing services under this section, as well as evidence that the proposal has been coordinated with the State
agencies responsible for administering those programs and the
State agency responsible for administering public maternal
and child health services;
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(3) information demonstrating that the applicant has established a collaborative relationship with child welfare agencies and child protective services that will enable the applicant,
where appropriate, to—
(A) provide advocacy on behalf of substance abusers
and the children of substance abusers in child protective
services cases;
(B) provide services to help prevent the unnecessary
placement of children in substitute care; and
(C) promote reunification of families or permanent
plans for the placement of the child; and
(4) such other information as the Secretary determines to
be appropriate.
(i) REPORTS TO SECRETARY.—The Secretary may make a grant
under subsection (a) only if the applicant involved agrees that for
each fiscal year for which the applicant receives such a grant the
applicant, in accordance with uniform standards developed by the
Secretary, will submit to the Secretary a report containing—
(1) a description of specific services and activities provided
under the grant;
(2) information regarding progress toward meeting the program’s stated goals and objectives;
(3) information concerning the extent of use of services
provided under the grant, including the number of referrals to
related services and information on other programs or services
accessed by children, parents, and other caretakers;
(4) information concerning the extent to which parents
were able to access and receive treatment for alcohol and drug
abuse and sustain participation in treatment over time until
the provider and the individual receiving treatment agree to
end such treatment, and the extent to which parents re-enter
treatment after the successful or unsuccessful termination of
treatment;
(5) information concerning the costs of the services provided and the source of financing for health care services;
(6) information concerning—
(A) the number and characteristics of families, parents, and children served, including a description of the
type and severity of childhood disabilities, and an analysis
of the number of children served by age;
(B) the number of children served who remained with
their parents during the period in which entities provided
services under this section;
(C) the number of children served who were placed in
out-of-home care during the period in which entities provided services under this section;
(D) the number of children described in subparagraph
(C) who were reunited with their families; and
(E) the number of children described in subparagraph
(C) for whom a permanent plan has not been made or for
whom the permanent plan is other than family reunification;
(7) information on hospitalization or emergency room use
by the family members participating in the program; and
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(8) such other information as the Secretary determines to
be appropriate.
(j) REQUIREMENT OF APPLICATION.—The Secretary may make
any grant under subsection (a) only if—
(1) an application for the grant is submitted to the Secretary;
(2) the application contains the agreements required in
this section and the information required in subsection (h); and
(3) the application is in such form, is made in such manner, and contains such agreements, assurances, and information as the Secretary determines to be necessary to carry out
this section.
(k) PEER REVIEW.—
(1) REQUIREMENT.—In making determinations for awarding grants under subsection (a), the Secretary shall rely on the
recommendations of the peer review panel established under
paragraph (2).
(2) COMPOSITION.—The Secretary shall establish a review
panel to make recommendations under paragraph (1) that
shall be composed of—
(A) national experts in the fields of maternal and child
health, substance abuse treatment, and child welfare; and
(B) representatives of relevant Federal agencies, including the Health Resources and Services Administration,
the Substance Abuse and Mental Health Services Administration, and the Administration for Children, Youth, and
Families.
(l) EVALUATIONS.—The Secretary shall periodically conduct
evaluations to determine the effectiveness of programs supported
under subsection (a)—
(1) in reducing the incidence of alcohol and drug abuse
among substance abusers participating in the programs;
(2) in preventing adverse health conditions in children of
substance abusers;
(3) in promoting better utilization of health and developmental services and improving the health, developmental, and
psychological status of children receiving services under the
program;
(4) in improving parental and family functioning;
(5) in reducing the incidence of out-of-home placement for
children whose parents receive services under the program;
and
(6) in facilitating the reunification of families after children have been placed in out-of-home care.
(m) REPORT TO CONGRESS.—Not later than 2 years after the
date on which amounts are first appropriated under subjection (o),
the Secretary shall prepare and submit to the Committee on Energy and Commerce of the House of Representatives, and to the
Committee on Labor and Human Resources of the Senate, a report
that contains a description of programs carried out under this section. At a minimum, the report shall contain—
(1) information concerning the number and type of programs receiving grants;
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(2) information concerning the type and use of services offered;
(3) information concerning—
(A) the number and characteristics of families, parents, and children served;
(B) the number of children served who remained with
their parents during or after the period in which entities
provided services under this section;
(C) the number of children served who were placed in
out-of-home care during the period in which entities provided services under this section;
(D) the number of children described in subparagraph
(C) who were reunited with their families; and
(E) the number of children described in subparagraph
(C) who were permanently placed in out-of-home care;
analyzed by the type of entity described in subsection (d) that
provided services;
(4) an analysis of the access provided to, and use of, related services and alcohol and drug treatment through programs carried out under this section; and
(5) a comparison of the costs of providing services through
each of the types of entities described in subsection (d).
(n) DATA COLLECTION.—The Secretary shall periodically collect
and report on information concerning the numbers of children in
substance abusing families, including information on the age, gender and ethnicity of the children, the composition and income of the
family, and the source of health care finances.
(o) DEFINITIONS.—For purposes of this section:
(1) The term ‘‘caretaker’’, with respect to a child of a substance abuser, means any individual acting in a parental role
regarding the child (including any birth parent, foster parent,
adoptive parent, relative of such a child, or other individual
acting in such a role).
(2) The term ‘‘children of substance abusers’’ means—
(A) children who have lived or are living in a household with a substance abuser who is acting in a parental
role regarding the children; and
(B) children who have been prenatally exposed to alcohol or other dangerous drugs.
(3) The term ‘‘Indian tribe’’ means any tribe, band, nation,
or other organized group or community of Indians, including
any Alaska Native village (as defined in, or established pursuant to, the Alaska Native Claims Settlement Act), that is recognized as eligible for the special programs and services provided by the United States to Indians because of their status
as Indians.
(4) The term ‘‘public or nonprofit private entities that provide health or social services to disadvantaged populations’’ includes community-based organizations, local public health departments, community action agencies, hospitals, community
health centers, child welfare agencies, developmental disabilities service providers, and family resource and support programs.
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(5) The term ‘‘substance abuse’’ means the abuse of alcohol
or other drugs.
(p) FUNDING.—
(1) AUTHORIZATION OF APPROPRIATIONS.—For the purpose
of carrying out this section, there are authorized to be appropriated $50,000,000 for fiscal year 1993, and such sums as may
be necessary for fiscal year 1994.
(2) CONTINGENT AUTHORITY REGARDING TRAINING OF CERTAIN INDIVIDUALS.—Of the amounts appropriated under paragraph (1) for a fiscal year in excess of $25,000,000, the Secretary may make available not more than 15 percent for the
training of health care professionals and other personnel (including child welfare providers) who provide services to children and families of substance abusers.

NOTE: For the convenience of the reader, the following indicates the probable intent of the Congress by showing section 399A
as the section would appear if the amendments described in section
3106 of Public Law 106–310 (114 Stat. 1175) were executed to section 399A, rather than to section 399D as instructed by such section
3106, including the amendment that redesignates the section as section 519 (toward the purpose of transferring the section to title V of
this Act). See footnote on page 619.
SEC. 519. ƒ280d≈ GRANTS FOR SERVICES FOR CHILDREN OF SUBSTANCE ABUSERS.
(a) ESTABLISHMENT.—
(1) IN GENERAL.—The Secretary, acting through the Admin-

istrator of the Substance Abuse and Mental Health Services Administration, shall make grants to public and nonprofit private
entities for the purpose of carrying out programs—
(A) to provide the services described in subsection (b) to
children of substance abusers;
(B) to provide the applicable services described in subsection (c) to families in which a member is a substance
abuser;
(C) to identify such children and such families through
youth service agencies, family social services, child care
providers, Head Start, schools and after-school programs,
early childhood development programs, community-based
family resource and support centers, the criminal justice
system, health, substance abuse and mental health providers through screenings conducted during regular childhood examinations and other examinations, self and family
member referrals, substance abuse treatment services, and
other providers of services to children and families; and
(D) to provide education and training to health, substance abuse and mental health professionals, and other
providers of services to children and families through youth
service agencies, family social services, child care, Head
Start, schools and after-school programs, early childhood
development programs, community-based family resource
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and support centers, the criminal justice system, and other
providers of services to children and families.
(2) ADMINISTRATIVE CONSULTATIONS.—The Administrator
of the Administration for Children, Youth, and Families and
the Administrator of the Health Resources and Services Administration shall be consulted regarding the promulgation of program guidelines and funding priorities under this section.
(3) REQUIREMENT OF STATUS AS MEDICAID PROVIDER.—
(A) Subject to subparagraph (B), the Secretary may
make a grant under paragraph (1) only if, in the case of
any service under such paragraph that is covered in the
State plan approved under title XIX of the Social Security
Act for the State involved—
(i)(I) the entity involved will provide the service directly, and the entity has entered into a participation
agreement under the State plan and is qualified to receive payments under such plan; or
(II) the entity will enter into an agreement with an
organization under which the organization will provide
the service, and the organization has entered into such
a participation agreement and is qualified to receive
such payments; and
(ii) the entity will identify children who may be eligible for medical assistance under a State program
under title XIX or XXI of the Social Security Act.
(B)(i) In the case of an organization making an agreement under subparagraph (A)(ii) regarding the provision of
services under paragraph (1), the requirement established
in such subparagraph regarding a participation agreement
shall be waived by the Secretary if the organization does
not, in providing health or mental health services, impose
a charge or accept reimbursement available from any thirdparty payor, including reimbursement under any insurance
policy or under any Federal or State health benefits program.
(ii) A determination by the Secretary of whether an organization referred to in clause (i) meets the criteria for a
waiver under such clause shall be made without regard to
whether the organization accepts voluntary donations regarding the provision of services to the public.
(b) SERVICES FOR CHILDREN OF SUBSTANCE ABUSERS.—The
Secretary may make a grant under subsection (a) only if the applicant involved agrees to make available (directly or through agreements with other entities) to children of substance abusers each of
the following services:
(1) Periodic evaluation of children for developmental, psychological, alcohol and drug, and medical problems.
(2) Primary pediatric care.
(3) Other necessary health and mental health services.
(4) Therapeutic intervention services for children, including
provision of therapeutic child care.
(5) Developmentally and age-appropriate drug and alcohol
early intervention, treatment and prevention services.
(6) Counseling related to the witnessing of chronic violence.
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(7) Referrals for, and assistance in establishing eligibility
for, services provided under—
(A) education and special education programs;
(B) Head Start programs established under the Head
Start Act;
(C) other early childhood programs;
(D) employment and training programs;
(E) public assistance programs provided by Federal,
State, or local governments; and
(F) programs offered by vocational rehabilitation agencies, recreation departments, and housing agencies.
(8) Additional developmental services that are consistent
with the provision of early intervention services, as such term
is defined in part H of the Individuals with Disabilities Education Act.
Services shall be provided under paragraphs (2) through (8) by a
public health nurse, social worker, or similar professional, or by a
trained worker from the community who is supervised by a professional, or by an entity, where the professional or entity provides assurances that the professional or entity is licensed or certified by the
State if required and is complying with applicable licensure or certification requirements.
(c) SERVICES FOR AFFECTED FAMILIES.—The Secretary may
make a grant under subsection (a) only if, in the case of families
in which a member is a substance abuser, the applicant involved
agrees to make available (directly or through agreements with other
entities) each of the following services, as applicable to the family
member involved:
(1) Services as follows, to be provided by a public health
nurse, social worker, or similar professional, or by a trained
worker from the community who is supervised by a professional, or by an entity, where the professional or entity provides
assurances that the professional or entity is licensed or certified
by the State if required and is complying with applicable licensure or certification requirements:
(A) Counseling to substance abusers on the benefits
and availability of substance abuse treatment services and
services for children of substance abusers.
(B) Assistance to substance abusers in obtaining and
using substance abuse treatment services and in obtaining
the services described in subsection (b) for their children.
(C) Visiting and providing support to substance abusers, especially pregnant women, who are receiving substance abuse treatment services or whose children are receiving services under subsection (b).
(D) Aggressive outreach to family members with substance abuse problems.
(E) Inclusion of consumer in the development, implementation, and monitoring of Family Services Plan.
(2) In the case of substance abusers:
(A) Alcohol and drug treatment services, including
screening and assessment, diagnosis, detoxification, individual, group and family counseling, relapse prevention,
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pharmacotherapy treatment, after-care services, and case
management.
(B) Primary health care and mental health services, including prenatal and post partum care for pregnant
women.
(C) Consultation and referral regarding subsequent
pregnancies and life options and counseling on the human
immunodeficiency virus and acquired immune deficiency
syndrome.
(D) Where appropriate, counseling regarding family violence.
(E) Career planning and education services.
(F) Referrals for, and assistance in establishing eligibility for, services described in subsection (b)(7).
(3) In the case of substance abusers, spouses of substance
abusers, extended family members of substance abusers, caretakers of children of substance abusers, and other people significantly involved in the lives of substance abusers or the children of substance abusers:
(A) An assessment of the strengths and service needs of
the family and the assignment of a case manager who will
coordinate services for the family.
(B) Therapeutic intervention services, such as parental
counseling, joint counseling sessions for families and children, and family therapy.
(C) Child care or other care for the child to enable the
parent to attend treatment or other activities and respite
care services.
(D) Parenting education services and parent support
groups which include child abuse and neglect prevention
techniques.
(E) Support services, including, where appropriate,
transportation services.
(F) Where appropriate, referral of other family members to related services such as job training.
(G) Aftercare services, including continued support
through parent groups and home visits.
(d) TRAINING FOR PROVIDERS OF SERVICES TO CHILDREN AND
FAMILIES.—The Secretary may make a grant under subsection (a)
for the training of health, substance abuse and mental health professionals and other providers of services to children and families
through youth service agencies, family social services, child care
providers, Head Start, schools and after-school programs, early
childhood development programs, community-based family resource
centers, the criminal justice system, and other providers of services
to children and families. Such training shall be to assist professionals in recognizing the drug and alcohol problems of their clients
and to enhance their skills in identifying and understanding the nature of substance abuse, and obtaining substance abuse early intervention, prevention and treatment resources.
(e) ELIGIBLE ENTITIES.—The Secretary shall distribute the
grants through the following types of entities:
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(1) Alcohol and drug early intervention, prevention or treatment programs, especially those providing treatment to pregnant women and mothers and their children.
(2) Public or nonprofit private entities that provide health
or social services to disadvantaged populations, and that
have—
(A) expertise in applying the services to the particular
problems of substance abusers and the children of substance abusers; or
(B) an affiliation or contractual relationship with one
or more substance abuse treatment programs or pediatric
health or mental health providers and family mental
health providers.
(3) Consortia of public or nonprofit private entities that include at least one substance abuse treatment program.
(4) Indian tribes.
(f) FEDERAL SHARE.—The Federal share of a program carried
out under subsection (a) shall be 90 percent. The Secretary shall accept the value of in-kind contributions, including facilities and personnel, made by the grant recipient as a part or all of the non-Federal share of grants.
(g) RESTRICTIONS ON USE OF GRANT.—The Secretary may make
a grant under subsection (a) only if the applicant involved agrees
that the grant will not be expended—
(1) to provide inpatient hospital services;
(2) to make cash payments to intended recipients of services;
(3) to purchase or improve land, purchase, construct, or
permanently improve (other than minor remodeling) any building or other facility, or purchase major medical equipment;
(4) to satisfy any requirement for the expenditure of nonFederal funds as a condition for the receipt of Federal funds;
or
(5) to provide financial assistance to any entity other than
a public or nonprofit private entity.
(h) SUBMISSION TO SECRETARY OF CERTAIN INFORMATION.—The
Secretary may make a grant under subsection (a) only if the applicant involved submits to the Secretary—
(1) a description of the population that is to receive services
under this section and a description of such services that are to
be provided and measurable goals and objectives;
(2) a description of the mechanism that will be used to involve the local public agencies responsible for health, including
maternal and child health 1 mental health, child welfare, education, juvenile justice, developmental disabilities, and substance abuse in planning and providing services under this section, as well as evidence that the proposal has been coordinated
with the State agencies responsible for administering those programs, the State agency responsible for administering alcohol
and drug programs, the State lead agency, and the State Inter1 The lack of a comma would be so in law. See section 3106(e)(1)(A) of Public Law 106–310
(114 Stat. 1177).

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agency Coordinating Council under part H of the Individuals
with Disabilities Education Act; and; 2
(3) such other information as the Secretary determines to be
appropriate.
(i) REPORTS TO SECRETARY.—The Secretary may make a grant
under subsection (a) only if the applicant involved agrees that for
each fiscal year for which the applicant receives such a grant the
applicant, in accordance with uniform standards developed by the
Secretary, will submit to the Secretary a report containing—
(1) a description of specific services and activities provided
under the grant;
(2) information regarding progress toward meeting the program’s stated goals and objectives;
(3) information concerning the extent of use of services provided under the grant, including the number of referrals to related services and information on other programs or services
accessed by children, parents, and other caretakers;
(4) information concerning the extent to which parents were
able to access and receive treatment for alcohol and drug abuse
and sustain participation in treatment over time until the provider and the individual receiving treatment agree to end such
treatment, and the extent to which parents re-enter treatment
after the successful or unsuccessful termination of treatment;
(5) information concerning the costs of the services provided
and the source of financing for health care services;
(6) information concerning—
(A) the number and characteristics of families, parents,
and children served, including a description of the type and
severity of childhood disabilities, and an analysis of the
number of children served by age;
(B) the number of children served who remained with
their parents during the period in which entities provided
services under this section; and
(C) the number of case workers or other professionals
trained to identify and address substance abuse issues.
(7) information on hospitalization or emergency room use
by the family members participating in the program; and
(8) such other information as the Secretary determines to be
appropriate.
(j) REQUIREMENT OF APPLICATION.—The Secretary may make
any grant under subsection (a) only if—
(1) an application for the grant is submitted to the Secretary;
(2) the application contains the agreements required in this
section and the information required in subsection (h); and
(3) the application is in such form, is made in such manner, and contains such agreements, assurances, and information as the Secretary determines to be necessary to carry out
this section.
2 The superfluous semicolon would be so in law. See section 3106(e)(1)(C) of Public Law 106–
310 (114 Stat. 1177).

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(k) EVALUATIONS.—The Secretary shall periodically conduct
evaluations to determine the effectiveness of programs supported
under subsection (a)—
(1) in reducing the incidence of alcohol and drug abuse
among substance abusers participating in the programs;
(2) in preventing adverse health conditions in children of
substance abusers;
(3) in promoting better utilization of health and developmental services and improving the health, developmental, and
psychological status of children receiving services under the
program; and
(4) in improving parental and family functioning, including increased participation in work or employment-related activities and decreased participation in welfare programs.
(l) REPORT TO CONGRESS.—Not later than 2 years after the date
on which amounts are first appropriated under subjection (o), the
Secretary shall prepare and submit to the Committee on Energy and
Commerce of the House of Representatives, and to the Committee on
Labor and Human Resources of the Senate, a report that contains
a description of programs carried out under this section. At a minimum, the report shall contain—
(1) information concerning the number and type of programs receiving grants;
(2) information concerning the type and use of services offered; and
(3) information concerning—
(A) the number and characteristics of families, parents,
and children served; and
(B) the number of children served who remained with
their parents during or after the period in which entities
provided services under this section. 1
analyzed by the type of entity described in subsection (d) 2 that
provided services; 3
(m) DATA COLLECTION.—The Secretary shall periodically collect
and report on information concerning the numbers of children in
substance abusing families, including information on the age, gender and ethnicity of the children, the composition and income of the
family, and the source of health care finances. The periodic report
shall include a quantitative estimate of the prevalence of alcohol
and drug problems in families involved in the child welfare system,
the barriers to treatment and prevention services facing these families, and policy recommendations for removing the identified barriers, including training for child welfare workers.
(n) DEFINITIONS.—For purposes of this section:
(1) The term ‘‘caretaker’’, with respect to a child of a substance abuser, means any individual acting in a parental role
1 The period at the end of subparagraph (B), and the semicolon at the end of paragraph (3),
would be so in law. See section 3106(h) of Public Law 106–310 (114 Stat. 1178). The period probably should be a semicolon, and the semicolon probably should be a period.
2 The reference to subsection (d) probably should be a reference to subsection (e). Section
3106(l) of Public Law 106–310 (114 Stat. 1178) would redesignate subsection (d) as subsection
(e) and make conforming changes in cross-references. One of the conforming changes would be
to subsection (m), and would strike ‘‘(d)’’ and insert ‘‘(e)’’. The reference to subsection (d) appears
in subsection (l), however, not subsection (m).
3 See footnote for subsection (l)(3)(B).

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regarding the child (including any birth parent, foster parent,
adoptive parent, relative of such a child, or other individual
acting in such a role).
(2) The term ‘‘children of substance abusers’’ means—
(A) children who have lived or are living in a household with a substance abuser who is acting in a parental
role regarding the children; and
(B) children who have been prenatally exposed to alcohol or other drugs.
(3) The term ‘‘Indian tribe’’ means any tribe, band, nation,
or other organized group or community of Indians, including
any Alaska Native village (as defined in, or established pursuant to, the Alaska Native Claims Settlement Act), that is recognized as eligible for the special programs and services provided
by the United States to Indians because of their status as Indians.
(4) The term ‘‘public or nonprofit private entities that provide health or social services to disadvantaged populations’’ includes community-based organizations, local public health departments, community action agencies, hospitals, community
health centers, child welfare agencies, developmental disabilities service providers, and family resource and support programs.
(5) The term ‘‘substance abuse’’ means the abuse of alcohol
or other drugs.
(o) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of
carrying out this section, there are authorized to be appropriated
$50,000,000 for fiscal year 2001, and such sums as may be necessary for each of fiscal years 2002 and 2003.
PART M—NATIONAL PROGRAM

OF

CANCER REGISTRIES

SEC. 399B. ø280e¿ NATIONAL PROGRAM OF CANCER REGISTRIES.
(a) IN GENERAL.—
(1) STATEWIDE CANCER REGISTRIES.—The Secretary, acting

through the Director of the Centers for Disease Control, may
make grants to States, or may make grants or enter into contracts with academic or nonprofit organizations designated by
the State to operate the State’s cancer registry in lieu of making a grant directly to the State, to support the operation of
population-based, statewide registries to collect, for each condition specified in paragraph (2)(A), data concerning—
(A) demographic information about each case of cancer;
(B) information on the industrial or occupational history of the individuals with the cancers, to the extent such
information is available from the same record;
(C) administrative information, including date of diagnosis and source of information;
(D) pathological data characterizing the cancer, including the cancer site, stage of disease (pursuant to Staging
Guide), incidence, and type of treatment; and
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(E) other elements determined appropriate by the Secretary.
(2) CANCER; BENIGN BRAIN-RELATED TUMORS.—
(A) IN GENERAL.—For purposes of paragraph (1), the
conditions referred to in this paragraph are the following:
(i) Each form of in-situ and invasive cancer (with
the exception of basal cell and squamous cell carcinoma of the skin), including malignant brain-related
tumors.
(ii) Benign brain-related tumors.
(B) BRAIN-RELATED TUMOR.—For purposes of subparagraph (A):
(i) The term ‘‘brain-related tumor’’ means a listed
primary tumor (whether malignant or benign) occurring in any of the following sites:
(I) The brain, meninges, spinal cord, cauda
equina, a cranial nerve or nerves, or any other
part of the central nervous system.
(II) The pituitary gland, pineal gland, or
craniopharyngeal duct.
(ii) The term ‘‘listed’’, with respect to a primary
tumor, means a primary tumor that is listed in the
International Classification of Diseases for Oncology
(commonly referred to as the ICD–O).
(iii) The term ‘‘International Classification of Diseases for Oncology’’ means a classification system that
includes topography (site) information and histology
(cell type information) developed by the World Health
Organization, in collaboration with international centers, to promote international comparability in the collection, classification, processing, and presentation of
cancer statistics. The ICD–O system is a supplement
to the International Statistical Classification of Diseases and Related Health Problems (commonly known
as the ICD) and is the standard coding system used by
cancer registries worldwide. Such term includes any
modification made to such system for purposes of the
United States. Such term further includes any published classification system that is internationally recognized as a successor to the classification system referred to in the first sentence of this clause.
(C) STATEWIDE CANCER REGISTRY.—References in this
section to cancer registries shall be considered to be references to registries described in this subsection.
(b) MATCHING FUNDS.—
(1) IN GENERAL.—The Secretary may make a grant under
subsection (a) only if the State, or the academic or nonprofit
private organization designated by the State to operate the
cancer registry of the State, involved agrees, with respect to
the costs of the program, to make available (directly or through
donations from public or private entities) non-Federal contributions toward such costs in an amount that is not less than 25
percent of such costs or $1 for every $3 of Federal funds provided in the grant.
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(2) DETERMINATION OF AMOUNT OF NON-FEDERAL CONTRIBUTION; MAINTENANCE OF EFFORT.—
(A) Non-Federal contributions required in paragraph
(1) may be in cash or in kind, fairly evaluated, including
plant, equipment, or services. Amounts provided by the
Federal Government, or services assisted or subsidized to
any significant extent by the Federal Government, may
not be included in determining the amount of such nonFederal contributions.
(B) With respect to a State in which the purpose described in subsection (a) is to be carried out, the Secretary,
in making a determination of the amount of non-Federal
contributions provided under paragraph (1), may include
only such contributions as are in excess of the amount of
such contributions made by the State toward the collection
of data on cancer for the fiscal year preceding the first
year for which a grant under subsection (a) is made with
respect to the State. The Secretary may decrease the
amount of non-Federal contributions that otherwise would
have been required by this subsection in those cases in
which the State can demonstrate that decreasing such
amount is appropriate because of financial hardship.
(c) ELIGIBILITY FOR GRANTS.—
(1) IN GENERAL.—No grant shall be made by the Secretary
under subsection (a) unless an application has been submitted
to, and approved by, the Secretary. Such application shall be
in such form, submitted in such a manner, and be accompanied
by such information, as the Secretary may specify. No such application may be approved unless it contains assurances that
the applicant will use the funds provided only for the purposes
specified in the approved application and in accordance with
the requirements of this section, that the application will establish such fiscal control and fund accounting procedures as
may be necessary to assure proper disbursement and accounting of Federal funds paid to the applicant under subsection (a)
of this section, and that the applicant will comply with the
peer review requirements under sections 491 and 492.
(2) ASSURANCES.—Each applicant, prior to receiving Federal funds under subsection (a), shall provide assurances satisfactory to the Secretary that the applicant will—
(A) provide for the establishment of a registry in accordance with subsection (a);
(B) comply with appropriate standards of completeness, timeliness, and quality of population-based cancer
registry data;
(C) provide for the annual publication of reports of
cancer data under subsection (a); and
(D) provide for the authorization under State law of
the statewide cancer registry, including promulgation of
regulations providing—
(i) a means to assure complete reporting of cancer
cases (as described in subsection (a)) to the statewide
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viding screening, diagnostic or therapeutic services to
patients with respect to cancer;
(ii) a means to assure the complete reporting of
cancer cases (as defined in subsection (a)) to the statewide cancer registry by physicians, surgeons, and all
other health care practitioners diagnosing or providing
treatment for cancer patients, except for cases directly
referred to or previously admitted to a hospital or
other facility providing screening, diagnostic or therapeutic services to patients in that State and reported
by those facilities;
(iii) a means for the statewide cancer registry to
access all records of physicians and surgeons, hospitals, outpatient clinics, nursing homes, and all other
facilities, individuals, or agencies providing such services to patients which would identify cases of cancer or
would establish characteristics of the cancer, treatment of the cancer, or medical status of any identified
patient;
(iv) for the reporting of cancer case data to the
statewide cancer registry in such a format, with such
data elements, and in accordance with such standards
of quality timeliness and completeness, as may be established by the Secretary;
(v) for the protection of the confidentiality of all
cancer case data reported to the statewide cancer registry, including a prohibition on disclosure to any person of information reported to the statewide cancer
registry that identifies, or could lead to the identification of, an individual cancer patient, except for disclosure to other State cancer registries and local and
State health officers;
(vi) for a means by which confidential case data
may in accordance with State law be disclosed to cancer researchers for the purposes of cancer prevention,
control and research;
(vii) for the authorization or the conduct, by the
statewide cancer registry or other persons and organizations, of studies utilizing statewide cancer registry
data, including studies of the sources and causes of
cancer, evaluations of the cost, quality, efficacy, and
appropriateness of diagnostic, therapeutic, rehabilitative, and preventative services and programs relating
to cancer, and any other clinical, epidemiological, or
other cancer research; and
(viii) for protection for individuals complying with
the law, including provisions specifying that no person
shall be held liable in any civil action with respect to
a cancer case report provided to the statewide cancer
registry, or with respect to access to cancer case information provided to the statewide cancer registry.
(d) RELATIONSHIP TO CERTAIN PROGRAMS.—
(1) IN GENERAL.—This section may not be construed to act
as a replacement for or diminishment of the program carried
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out by the Director of the National Cancer Institute and designated by such Director as the Surveillance, Epidemiology,
and End Results Program (SEER).
(2) SUPPLANTING OF ACTIVITIES.—In areas where both such
programs exist, the Secretary shall ensure that SEER support
is not supplanted and that any additional activities are consistent with the guidelines provided for in subsection (c)(2) (C)
and (D) and are appropriately coordinated with the existing
SEER program.
(3) TRANSFER OF RESPONSIBILITY.—The Secretary may not
transfer administration responsibility for such SEER program
from such Director.
(4) COORDINATION.—To encourage the greatest possible efficiency and effectiveness of Federally supported efforts with
respect to the activities described in this subsection, the Secretary shall take steps to assure the appropriate coordination
of programs supported under this part with existing Federally
supported cancer registry programs.
(e) REQUIREMENT REGARDING CERTAIN STUDY ON BREAST CANCER.—In the case of a grant under subsection (a) to any State specified in subsection (b) of section 399E, the Secretary may establish
such conditions regarding the receipt of the grant as the Secretary
determines are necessary to facilitate the collection of data for the
study carried out under such section.
SEC. 399C. ø280e–1¿ PLANNING GRANTS REGARDING REGISTRIES.
(a) IN GENERAL.—
(1) STATES.—The Secretary, acting through the Director

of
the Centers for Disease Control, may make grants to States for
the purpose of developing plans that meet the assurances required by the Secretary under section 399B(c)(2).
(2) OTHER ENTITIES.—For the purpose described in paragraph (1), the Secretary may make grants to public entities
other than States and to nonprofit private entities. Such a
grant may be made to an entity only if the State in which the
purpose is to be carried out has certified that the State approves the entity as qualified to carry out the purpose.
(b) APPLICATION.—The Secretary may make a grant under subsection (a) only if an application for the grant is submitted to the
Secretary, the application contains the certification required in subsection (a)(2) (if the application is for a grant under such subsection), and the application is in such form, is made in such manner, and contains such agreements, assurances, and information as
the Secretary determines to be necessary to carry out this section.
SEC. 399D. ø280e–2¿ TECHNICAL ASSISTANCE IN OPERATIONS OF
STATEWIDE CANCER REGISTRIES.

The Secretary, acting through the Director of the Centers for
Disease Control, may, directly or through grants and contracts, or
both, provide technical assistance to the States in the establishment and operation of statewide registries, including assistance in
the development of model legislation for statewide cancer registries
and assistance in establishing a computerized reporting and data
processing system.
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SEC. 399E. ø280e–3¿ STUDY IN CERTAIN STATES TO DETERMINE THE
FACTORS CONTRIBUTING TO THE ELEVATED BREAST
CANCER MORTALITY RATES.
(a) IN GENERAL.—Subject to subsections (c) and (d), the Sec-

retary, acting through the Director of the National Cancer Institute, shall conduct a study for the purpose of determining the factors contributing to the fact that breast cancer mortality rates in
the States specified in subsection (b) are elevated compared to
rates in other States.
(b) RELEVANT STATES.—The States referred to in subsection (a)
are Connecticut, Delaware, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Rhode Island, Vermont, and the District of Columbia.
(c) COOPERATION OF STATE.—The Secretary may conduct the
study required in subsection (a) in a State only if the State agrees
to cooperate with the Secretary in the conduct of the study, including providing information from any registry operated by the State
pursuant to section 399B(a).
(d) PLANNING, COMMENCEMENT, AND DURATION.—The Secretary shall, during each of the fiscal years 1993 and 1994, develop
a plan for conducting the study required in subsection (a). The
study shall be initiated by the Secretary not later than fiscal year
1994, and the collection of data under the study may continue
through fiscal year 1998.
SEC. 399E–1. ø280e–3a¿ NATIONAL CHILDHOOD CANCER REGISTRY.
(a) IN GENERAL.—The Secretary, acting through the Director

of
the Centers for Disease Control and Prevention, shall award a
grant to enhance and expand infrastructure to track the epidemiology of pediatric cancer into a comprehensive nationwide registry
of actual occurrences of pediatric cancer. Such registry shall be updated to include an actual occurrence within weeks of the date of
such occurrence.
(b) INFORMED CONSENT AND PRIVACY REQUIREMENTS AND COORDINATION WITH EXISTING PROGRAMS.—The registry established
pursuant to subsection (a) shall be subject to section 552a of title
5, United States Code, the regulations promulgated under section
264(c) of the Health Insurance Portability and Accountability Act
of 1996, applicable Federal and State informed consent regulations,
any other applicable Federal and State laws relating to the privacy
of patient information, and section 399B(d)(4) of this Act.
SEC. 399F. ø280e–4¿ AUTHORIZATION OF APPROPRIATIONS.
(a) REGISTRIES.—For the purpose of carrying out

this part
(other than section 399E–1), there are authorized to be appropriated $30,000,000 for fiscal year 1994, and such sums as may be
necessary for each of the fiscal years 1995 through 2003. Of the
amounts appropriated under the preceding sentence for any such
fiscal year, the Secretary may obligate not more than 25 percent
for carrying out section 399C, and not more than 10 percent may
be expended for assessing the accuracy, completeness and quality
of data collected, and not more than 10 percent of which is to be
expended under section 399D.
(b) BREAST CANCER STUDY.—Of the amounts appropriated for
the National Cancer Institute under subpart 1 of part C of title IV
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for any fiscal year in which the study required in section 399K 1 is
being carried out, the Secretary shall expend not less than
$1,000,000 for the study.
PART N—NATIONAL FOUNDATION FOR THE CENTERS
CONTROL AND PREVENTION

FOR

DISEASE

SEC. 399G. ø280e–11¿ ESTABLISHMENT AND DUTIES OF FOUNDATION.
(a) IN GENERAL.—There shall be established in accordance

with this section a nonprofit private corporation to be known as the
National Foundation for the Centers for Disease Control and Prevention (in this part referred to as the ‘‘Foundation’’). The Foundation shall not be an agency or instrumentality of the Federal Government, and officers, employees, and members of the board of the
Foundation shall not be officers or employees of the Federal Government.
(b) PURPOSE OF FOUNDATION.—The purpose of the Foundation
shall be to support and carry out activities for the prevention and
control of diseases, disorders, injuries, and disabilities, and for promotion of public health.
(c) ENDOWMENT FUND.—
(1) IN GENERAL.—In carrying out subsection (b), the Foundation shall establish a fund for providing endowments for positions that are associated with the Centers for Disease Control
and Prevention and dedicated to the purpose described in such
subsection. Subject to subsection (f)(1)(B), the fund shall consist of such donations as may be provided by non-Federal entities and such non-Federal assets of the Foundation (including
earnings of the Foundation and the fund) as the Foundation
may elect to transfer to the fund.
(2) AUTHORIZED EXPENDITURES OF FUND.—The provision of
endowments under paragraph (1) shall be the exclusive function of the fund established under such paragraph. Such endowments may be expended only for the compensation of individuals holding the positions, for staff, equipment, quarters,
travel, and other expenditures that are appropriate in supporting the positions, and for recruiting individuals to hold the
positions endowed by the fund.
(d) CERTAIN ACTIVITIES OF FOUNDATION.—In carrying out subsection (b), the Foundation may provide for the following with respect to the purpose described in such subsection:
(1) Programs of fellowships for State and local public
health officials to work and study in association with the Centers for Disease Control and Prevention.
(2) Programs of international arrangements to provide opportunities for public health officials of other countries to serve
in public health capacities in the United States in association
with the Centers for Disease Control and Prevention or elsewhere, or opportunities for employees of such Centers (or other
1 Probably should be a reference to section 399E. Section 502(2)(D)(iii) of Public Law 106–310
(114 Stat. 1115) provides that subsection (b) above is amended by striking ‘‘subsection 399K’’
and inserting ‘‘section 399E’’. The amendment cannot be executed because the term to be struck
does not appear in subsection (b). (Compare ‘‘subsection 399K’’ and ‘‘section 399K’’.)

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public health officials in the United States) to serve in such capacities in other countries, or both.
(3) Studies, projects, and research (which may include applied research on the effectiveness of prevention activities,
demonstration projects, and programs and projects involving
international, Federal, State, and local governments).
(4) Forums for government officials and appropriate private entities to exchange information. Participants in such forums may include institutions of higher education and appropriate international organizations.
(5) Meetings, conferences, courses, and training workshops.
(6) Programs to improve the collection and analysis of data
on the health status of various populations.
(7) Programs for writing, editing, printing, and publishing
of books and other materials.
(8) Other activities to carry out the purpose described in
subsection (b).
(e) GENERAL STRUCTURE OF FOUNDATION; NONPROFIT STATUS.—
(1) BOARD OF DIRECTORS.—The Foundation shall have a
board of directors (in this part referred to as the ‘‘Board’’),
which shall be established and conducted in accordance with
subsection (f). The Board shall establish the general policies of
the Foundation for carrying out subsection (b), including the
establishment of the bylaws of the Foundation.
(2) EXECUTIVE DIRECTOR.—The Foundation shall have an
executive director (in this part referred to as the ‘‘Director’’),
who shall be appointed by the Board, who shall serve at the
pleasure of the Board, and for whom the Board shall establish
the rate of compensation. Subject to compliance with the policies and bylaws established by the Board pursuant to paragraph (1), the Director shall be responsible for the daily operations of the Foundation in carrying out subsection (b).
(3) NONPROFIT STATUS.—In carrying out subsection (b), the
Board shall establish such policies and bylaws under paragraph (1), and the Director shall carry out such activities
under paragraph (2), as may be necessary to ensure that the
Foundation maintains status as an organization that—
(A) is described in subsection (c)(3) of section 501 of
the Internal Revenue Code of 1986; and
(B) is, under subsection (a) of such section, exempt
from taxation.
(f) BOARD OF DIRECTORS.—
(1) CERTAIN BYLAWS.—
(A) In establishing bylaws under subsection (e)(1), the
Board shall ensure that the bylaws of the Foundation include bylaws for the following:
(i) Policies for the selection of the officers, employees, agents, and contractors of the Foundation.
(ii) Policies, including ethical standards, for the
acceptance and disposition of donations to the Foundation and for the disposition of the assets of the Foundation.
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(iii) Policies for the conduct of the general operations of the Foundation.
(iv) Policies for writing, editing, printing, and publishing of books and other materials, and the acquisition of patents and licenses for devices and procedures
developed by the Foundation.
(B) In establishing bylaws under subsection (e)(1), the
Board shall ensure that the bylaws of the Foundation (and
activities carried out under the bylaws) do not—
(i) reflect unfavorably upon the ability of the
Foundation, or the Centers for Disease Control and
Prevention, to carry out its responsibilities or official
duties in a fair and objective manner; or
(ii) compromise, or appear to compromise, the integrity of any governmental program or any officer or
employee involved in such program.
(2) COMPOSITION.—
(A) Subject to subparagraph (B), the Board shall be
composed of 7 individuals, appointed in accordance with
paragraph (4), who collectively possess education or experience appropriate for representing the general field of public health, the general field of international health, and the
general public. Each such individual shall be a voting
member of the Board.
(B) The Board may, through amendments to the bylaws of the Foundation, provide that the number of members of the Board shall be a greater number than the number specified in subparagraph (A).
(3) CHAIR.—The Board shall, from among the members of
the Board, designate an individual to serve as the chair of the
Board (in this subsection referred to as the ‘‘Chair’’).
(4) APPOINTMENTS, VACANCIES, AND TERMS.—Subject to
subsection (j) (regarding the initial membership of the Board),
the following shall apply to the Board:
(A) Any vacancy in the membership of the Board shall
be filled by appointment by the Board, after consideration
of suggestions made by the Chair and the Director regarding the appointments. Any such vacancy shall be filled not
later than the expiration of the 180-day period beginning
on the date on which the vacancy occurs.
(B) The term of office of each member of the Board appointed under subparagraph (A) shall be 5 years. A member of the Board may continue to serve after the expiration
of the term of the member until the expiration of the 180day period beginning on the date on which the term of the
member expires.
(C) A vacancy in the membership of the Board shall
not affect the power of the Board to carry out the duties
of the Board. If a member of the Board does not serve the
full term applicable under subparagraph (B), the individual appointed to fill the resulting vacancy shall be appointed for the remainder of the term of the predecessor
of the individual.
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(5) COMPENSATION.—Members of the Board may not receive compensation for service on the Board. The members may
be reimbursed for travel, subsistence, and other necessary expenses incurred in carrying out the duties of the Board.
(g) CERTAIN RESPONSIBILITIES OF EXECUTIVE DIRECTOR.—In
carrying out subsection (e)(2), the Director shall carry out the following functions:
(1) Hire, promote, compensate, and discharge officers and
employees of the Foundation, and define the duties of the officers and employees.
(2) Accept and administer donations to the Foundation,
and administer the assets of the Foundation.
(3) Establish a process for the selection of candidates for
holding endowed positions under subsection (c).
(4) Enter into such financial agreements as are appropriate in carrying out the activities of the Foundation.
(5) Take such action as may be necessary to acquire patents and licenses for devices and procedures developed by the
Foundation and the employees of the Foundation.
(6) Adopt, alter, and use a corporate seal, which shall be
judicially noticed.
(7) Commence and respond to judicial proceedings in the
name of the Foundation.
(8) Other functions that are appropriate in the determination of the Director.
(h) GENERAL PROVISIONS.—
(1) AUTHORITY FOR ACCEPTING FUNDS.—The Director of the
Centers for Disease Control and Prevention may accept and
utilize, on behalf of the Federal Government, any gift, donation, bequest, or devise of real or personal property from the
Foundation for the purpose of aiding or facilitating the work of
such Centers. Funds may be accepted and utilized by such Director under the preceding sentence without regard to whether
the funds are designated as general-purpose funds or specialpurpose funds.
(2) AUTHORITY FOR ACCEPTANCE OF VOLUNTARY SERVICES.—
(A) The Director of the Centers for Disease Control
and Prevention may accept, on behalf of the Federal Government, any voluntary services provided to such Centers
by the Foundation for the purpose of aiding or facilitating
the work of such Centers. In the case of an individual,
such Director may accept the services provided under the
preceding sentence by the individual until such time as the
private funding for such individual ends.
(B) The limitation established in subparagraph (A) regarding the period of time in which services may be accepted applies to each individual who is not an employee
of the Federal Government and who serves in association
with the Centers for Disease Control and Prevention pursuant to financial support from the Foundation.
(3) ADMINISTRATIVE CONTROL.—No officer, employee, or
member of the Board of the Foundation may exercise any administrative or managerial control over any Federal employee.
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(4) APPLICABILITY OF CERTAIN STANDARDS TO NON-FEDERAL
EMPLOYEES.—In the case of any individual who is not an employee of the Federal Government and who serves in association with the Centers for Disease Control and Prevention pursuant to financial support from the Foundation, the Foundation shall negotiate a memorandum of understanding with the
individual and the Director of the Centers for Disease Control
and Prevention specifying that the individual—
(A) shall be subject to the ethical and procedural
standards regulating Federal employment, scientific investigation, and research findings (including publications and
patents) that are required of individuals employed by the
Centers for Disease Control and Prevention, including
standards under this Act, the Ethics in Government Act,
and the Technology Transfer Act; and
(B) shall be subject to such ethical and procedural
standards under chapter 11 of title 18, United States Code
(relating to conflicts of interest), as the Director of such
Centers determines is appropriate, except such memorandum may not provide that the individual shall be subject to the standards of section 209 of such chapter.
(5) FINANCIAL CONFLICTS OF INTEREST.—Any individual
who is an officer, employee, or member of the Board of the
Foundation may not directly or indirectly participate in the
consideration or determination by the Foundation of any question affecting—
(A) any direct or indirect financial interest of the individual; or
(B) any direct or indirect financial interest of any business organization or other entity of which the individual is
an officer or employee or in which the individual has a direct or indirect financial interest.
(6) AUDITS; AVAILABILITY OF RECORDS.—The Foundation
shall—
(A) provide for biennial audits of the financial condition of the Foundation; and
(B) make such audits, and all other records, documents, and other papers of the Foundation, available to
the Secretary and the Comptroller General of the United
States for examination or audit.
(7) REPORTS.—
(A) Not later than February 1 of each fiscal year, the
Foundation shall publish a report describing the activities
of the Foundation during the preceding fiscal year. Each
such report shall include for the fiscal year involved a comprehensive statement of the operations, activities, financial
condition, and accomplishments of the Foundation, including an accounting of the use of amounts provided for under
subsection (i).
(B) With respect to the financial condition of the Foundation, each report under subparagraph (A) shall include
the source, and a description of, all gifts to the Foundation
of real or personal property, and the source and amount of
all gifts to the Foundation of money. Each such report
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shall include a specification of any restrictions on the purposes for which gifts to the Foundation may be used.
(C) The Foundation shall make copies of each report
submitted under subparagraph (A) available—
(i) for public inspection, and shall upon request
provide a copy of the report to any individual for a
charge not to exceed the cost of providing the copy;
and
(ii) to the appropriate committees of Congress.
(8) LIAISON FROM CENTERS FOR DISEASE CONTROL AND PREVENTION.—The Director of the Centers for Disease Control and
Prevention shall serve as the liaison representative of such
Centers to the Board and the Foundation.
(i) FEDERAL FUNDING.—
(1) AUTHORITY FOR ANNUAL GRANTS.—
(A) The Secretary, acting through the Director of the
Centers for Disease Control and Prevention, shall—
(i) for fiscal year 1993, make a grant to an entity
described in subsection (j)(9) (relating to the establishment of a committee to establish the Foundation);
(ii) for fiscal year 1994, make a grant to the committee established under such subsection, or if the
Foundation has been established, to the Foundation;
and
(iii) for fiscal year 1995 and each subsequent fiscal
year, make a grant to the Foundation.
(B) A grant under subparagraph (A) may be expended—
(i) in the case of an entity receiving the grant
under subparagraph (A)(i), only for the purpose of carrying out the duties established in subsection (j)(9) for
the entity;
(ii) in the case of the committee established under
such subsection, only for the purpose of carrying out
the duties established in subsection (j) for the committee; and
(iii) in the case of the Foundation, only for the
purpose of the administrative expenses of the Foundation.
(C) A grant under subparagraph (A) may not be expended to provide amounts for the fund established under
subsection (c).
(D) For the purposes described in subparagraph (B)—
(i) any portion of the grant made under subparagraph (A)(i) for fiscal year 1993 that remains unobligated after the entity receiving the grant completes
the duties established in subsection (j)(9) for the entity
shall be available to the committee established under
such subsection; and
(ii) any portion of a grant under subparagraph (A)
made for fiscal year 1993 or 1994 that remains unobligated after such committee completes the duties established in such subsection for the committee shall be
available to the Foundation.
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(2) FUNDING FOR GRANTS.—
(A) For the purpose of grants under paragraph (1),
there is authorized to be appropriated $1,250,000 for each
fiscal year.
(B) For the purpose of grants under paragraph (1), the
Secretary may for each fiscal year make available not less
than $500,000, and not more than $1,250,000 from the
amounts appropriated for the fiscal year for the programs
of the Department of Health and Human Services. Such
amounts may be made available without regard to whether
amounts have been appropriated under subparagraph (A).
(3) CERTAIN RESTRICTION.—If the Foundation receives Federal funds for the purpose of serving as a fiscal intermediary
between Federal agencies, the Foundation may not receive
such funds for the indirect costs of carrying out such purpose
in an amount exceeding 10 percent of the direct costs of carrying out such purpose. The preceding sentence may not be
construed as authorizing the expenditure of any grant under
paragraph (1) for such purpose.
(4) SUPPORT SERVICES.—The Director of the Centers for
Disease Control and Prevention may provide facilities, utilities,
and support services to the Foundation if it is determined by
the Director to be advantageous to the programs of such Centers.
(j) COMMITTEE FOR ESTABLISHMENT OF FOUNDATION.—
(1) IN GENERAL.—There shall be established in accordance
with this subsection a committee to carry out the functions described in paragraph (2) (which committee is referred to in this
subsection as the ‘‘Committee’’).
(2) FUNCTIONS.—The functions referred to in paragraph (1)
for the Committee are as follows:
(A) To carry out such activities as may be necessary
to incorporate the Foundation under the laws of the State
involved, including serving as incorporators for the Foundation. Such activities shall include ensuring that the articles of incorporation for the Foundation require that the
Foundation be established and operated in accordance
with the applicable provisions of this part (or any successor to this part), including such provisions as may be in
effect pursuant to amendments enacted after the date of
the enactment of the Preventive Health Amendments of
1992 1.
(B) To ensure that the Foundation qualifies for and
maintains the status described in subsection (e)(3) (regarding taxation).
(C) To establish the general policies and initial bylaws
of the Foundation, which bylaws shall include the bylaws
described in subsections (e)(3) and (f)(1).
(D) To provide for the initial operation of the Foundation, including providing for quarters, equipment, and
staff.
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(E) To appoint the initial members of the Board in accordance with the requirements established in subsection
(f)(2)(A) for the composition of the Board, and in accordance with such other qualifications as the Committee may
determine to be appropriate regarding such composition.
Of the members so appointed—
(i) 2 shall be appointed to serve for a term of 3
years;
(ii) 2 shall be appointed to serve for a term of 4
years; and
(iii) 3 shall be appointed to serve for a term of 5
years.
(3) COMPLETION OF FUNCTIONS OF COMMITTEE; INITIAL
MEETING OF BOARD.—
(A) The Committee shall complete the functions required in paragraph (1) not later than September 30, 1994.
The Committee shall terminate upon the expiration of the
30-day period beginning on the date on which the Secretary determines that the functions have been completed.
(B) The initial meeting of the Board shall be held not
later than November 1, 1994.
(4) COMPOSITION.—The Committee shall be composed of 5
members, each of whom shall be a voting member. Of the
members of the Committee—
(A) no fewer than 2 shall have broad, general experience in public health; and
(B) no fewer than 2 shall have broad, general experience in nonprofit private organizations (without regard to
whether the individuals have experience in public health).
(5) CHAIR.—The Committee shall, from among the members of the Committee, designate an individual to serve as the
chair of the Committee.
(6) TERMS; VACANCIES.—The term of members of the Committee shall be for the duration of the Committee. A vacancy
in the membership of the Committee shall not affect the power
of the Committee to carry out the duties of the Committee. If
a member of the Committee does not serve the full term, the
individual appointed to fill the resulting vacancy shall be appointed for the remainder of the term of the predecessor of the
individual.
(7) COMPENSATION.—Members of the Committee may not
receive compensation for service on the Committee. Members
of the Committee may be reimbursed for travel, subsistence,
and other necessary expenses incurred in carrying out the duties of the Committee.
(8) COMMITTEE SUPPORT.—The Director of the Centers for
Disease Control and Prevention may, from amounts available
to the Director for the general administration of such Centers,
provide staff and financial support to assist the Committee
with carrying out the functions described in paragraph (2). In
providing such staff and support, the Director may both detail
employees and contract for assistance.
(9) GRANT FOR ESTABLISHMENT OF COMMITTEE.—
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(A) With respect to a grant under paragraph (1)(A)(i)
of subsection (i) for fiscal year 1993, an entity described in
this paragraph is a private nonprofit entity with significant experience in domestic and international issues of
public health. Not later than 180 days after the date of the
enactment of the Preventive Health Amendments of
1992 1, the Secretary shall make the grant to such an entity (subject to the availability of funds under paragraph (2)
of such subsection).
(B) The grant referred to in subparagraph (A) may be
made to an entity only if the entity agrees that—
(i) the entity will establish a committee that is
composed in accordance with paragraph (4); and
(ii) the entity will not select an individual for
membership on the Committee unless the individual
agrees that the Committee will operate in accordance
with each of the provisions of this subsection that relate to the operation of the Committee.
(C) The Secretary may make a grant referred to in
subparagraph (A) only if the applicant for the grant makes
an agreement that the grant will not be expended for any
purpose other than carrying out subparagraph (B). Such a
grant may be made only if an application for the grant is
submitted to the Secretary containing such agreement, and
the application is in such form, is made in such manner,
and contains such other agreements and such assurances
and information as the Secretary determines to be necessary to carry out this paragraph.

PART O—FETAL ALCOHOL SYNDROME
PREVENTION AND SERVICES PROGRAM
SEC. 399H. ø280f¿ ESTABLISHMENT OF FETAL ALCOHOL SYNDROME
PREVENTION AND SERVICES PROGRAM.
(a) FETAL ALCOHOL SYNDROME PREVENTION, INTERVENTION
AND SERVICES DELIVERY PROGRAM.—The Secretary shall establish

a comprehensive Fetal Alcohol Syndrome and Fetal Alcohol Effect
prevention, intervention and services delivery program that shall
include—
(1) an education and public awareness program to support,
conduct, and evaluate the effectiveness of—
(A) educational programs targeting medical schools,
social and other supportive services, educators and counselors and other service providers in all phases of childhood development, and other relevant service providers,
concerning the prevention, identification, and provision of
services for children, adolescents and adults with Fetal Alcohol Syndrome and Fetal Alcohol Effect;
(B) strategies to educate school-age children, including
pregnant and high risk youth, concerning Fetal Alcohol
Syndrome and Fetal Alcohol Effect;
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(C) public and community awareness programs concerning Fetal Alcohol Syndrome and Fetal Alcohol Effect;
and
(D) strategies to coordinate information and services
across affected community agencies, including agencies
providing social services such as foster care, adoption, and
social work, medical and mental health services, and agencies involved in education, vocational training and civil
and criminal justice;
(2) a prevention and diagnosis program to support clinical
studies, demonstrations and other research as appropriate to—
(A) develop appropriate medical diagnostic methods for
identifying Fetal Alcohol Syndrome and Fetal Alcohol Effect; and
(B) develop effective prevention services and interventions for pregnant, alcohol-dependent women; and
(3) an applied research program concerning intervention
and prevention to support and conduct service demonstration
projects, clinical studies and other research models providing
advocacy, educational and vocational training, counseling, medical and mental health, and other supportive services, as well
as models that integrate and coordinate such services, that are
aimed at the unique challenges facing individuals with Fetal
Alcohol Syndrome or Fetal Alcohol Effect and their families.
(b) GRANTS AND TECHNICAL ASSISTANCE.—The Secretary may
award grants, cooperative agreements and contracts and provide
technical assistance to eligible entities described in section 399I to
carry out subsection (a).
(c) DISSEMINATION OF CRITERIA.—In carrying out this section,
the Secretary shall develop a procedure for disseminating the Fetal
Alcohol Syndrome and Fetal Alcohol Effect diagnostic criteria developed pursuant to section 705 of the ADAMHA Reorganization
Act (42 U.S.C. 485n note) to health care providers, educators, social
workers, child welfare workers, and other individuals.
(d) NATIONAL TASK FORCE.—
(1) IN GENERAL.—The Secretary shall establish a task force
to be known as the National Task Force on Fetal Alcohol Syndrome and Fetal Alcohol Effect (referred to in this subsection
as the ‘‘Task Force’’) to foster coordination among all governmental agencies, academic bodies and community groups that
conduct or support Fetal Alcohol Syndrome and Fetal Alcohol
Effect research, programs, and surveillance, and otherwise
meet the general needs of populations actually or potentially
impacted by Fetal Alcohol Syndrome and Fetal Alcohol Effect.
(2) MEMBERSHIP.—The Task Force established pursuant to
paragraph (1) shall—
(A) be chaired by an individual to be appointed by the
Secretary and staffed by the Administration; and
(B) include the Chairperson of the Interagency Coordinating Committee on Fetal Alcohol Syndrome of the Department of Health and Human Services, individuals with
Fetal Alcohol Syndrome and Fetal Alcohol Effect, and representatives from advocacy and research organizations
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ily Resource Institute, the National Organization of Fetal
Alcohol Syndrome, the Arc, the academic community, and
Federal, State and local government agencies and offices.
(3) FUNCTIONS.—The Task Force shall—
(A) advise Federal, State and local programs and research concerning Fetal Alcohol Syndrome and Fetal Alcohol Effect, including programs and research concerning
education and public awareness for relevant service providers, school-age children, women at-risk, and the general
public, medical diagnosis, interventions for women at-risk
of giving birth to children with Fetal Alcohol Syndrome
and Fetal Alcohol Effect, and beneficial services for individuals with Fetal Alcohol Syndrome and Fetal Alcohol Effect and their families;
(B) coordinate its efforts with the Interagency Coordinating Committee on Fetal Alcohol Syndrome of the Department of Health and Human Services; and
(C) report on a biennial basis to the Secretary and relevant committees of Congress on the current and planned
activities of the participating agencies.
(4) TIME FOR APPOINTMENT.—The members of the Task
Force shall be appointed by the Secretary not later than 6
months after the date of enactment of this part.
SEC. 399I. ø280f–1¿ ELIGIBILITY.

To be eligible to receive a grant, or enter into a cooperative
agreement or contract under this part, an entity shall—
(1) be a State, Indian tribal government, local government,
scientific or academic institution, or nonprofit organization;
and
(2) prepare and submit to the Secretary an application at
such time, in such manner, and containing such information as
the Secretary may prescribe, including a description of the activities that the entity intends to carry out using amounts received under this part.
SEC. 399J. ø280f–2¿ AUTHORIZATION OF APPROPRIATIONS.
(a) IN GENERAL.—There are authorized to be appropriated

to
carry out this part, $27,000,000 for each of the fiscal years 1999
through 2003.
(b) TASK FORCE.—From amounts appropriated for a fiscal year
under subsection (a), the Secretary may use not to exceed
$2,000,000 of such amounts for the operations of the National Task
Force under section 399H(d).
SEC. 399K. ø280f–3¿ SUNSET PROVISION.

This part shall not apply on the date that is 7 years after the
date on which all members of the National Task Force have been
appointed under section 399H(d)(1).

PART P—ADDITIONAL PROGRAMS
SEC. 399L. ø280g¿ CHILDREN’S ASTHMA TREATMENT GRANTS PROGRAM.
(a) AUTHORITY TO MAKE GRANTS.—
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(1) IN GENERAL.—In addition to any other payments made
under this Act or title V of the Social Security Act, the Secretary shall award grants to eligible entities to carry out the
following purposes:
(A) To provide access to quality medical care for children who live in areas that have a high prevalence of asthma and who lack access to medical care.
(B) To provide on-site education to parents, children,
health care providers, and medical teams to recognize the
signs and symptoms of asthma, and to train them in the
use of medications to treat asthma and prevent its exacerbations.
(C) To decrease preventable trips to the emergency
room by making medication available to individuals who
have not previously had access to treatment or education
in the management of asthma.
(D) To provide other services, such as smoking cessation programs, home modification, and other direct and
support services that ameliorate conditions that exacerbate
or induce asthma.
(2) CERTAIN PROJECTS.—In making grants under paragraph (1), the Secretary may make grants designed to develop
and expand the following projects:
(A) Projects to provide comprehensive asthma services
to children in accordance with the guidelines of the National Asthma Education and Prevention Program
(through the National Heart, Lung and Blood Institute),
including access to care and treatment for asthma in a
community-based setting.
(B) Projects to fully equip mobile health care clinics
that provide preventive asthma care including diagnosis,
physical examinations, pharmacological therapy, skin testing, peak flow meter testing, and other asthma-related
health care services.
(C) Projects to conduct validated asthma management
education programs for patients with asthma and their
families, including patient education regarding asthma
management, family education on asthma management,
and the distribution of materials, including displays and
videos, to reinforce concepts presented by medical teams.
(2) 1 AWARD OF GRANTS.—
(A) APPLICATION.—
(i) IN GENERAL.—An eligible entity shall submit
an application to the Secretary for a grant under this
section in such form and manner as the Secretary may
require.
(ii) REQUIRED INFORMATION.—An application submitted under this subparagraph shall include a plan
for the use of funds awarded under the grant and such
other information as the Secretary may require.
1So in law. There are two paragraphs (2) in subsection (a). The second paragraph (2) and
paragraph (3) probably should be redesignated as paragraphs (3) and (4), respectively. See section 501 of Public Law 106–310 (114 Stat. 1113).

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(B) REQUIREMENT.—In awarding grants under this
section, the Secretary shall give preference to eligible entities that demonstrate that the activities to be carried out
under this section shall be in localities within areas of
known or suspected high prevalence of childhood asthma
or high asthma-related mortality or high rate of hospitalization or emergency room visits for asthma (relative
to the average asthma prevalence rates and associated
mortality rates in the United States). Acceptable data sets
to demonstrate a high prevalence of childhood asthma or
high asthma-related mortality may include data from Federal, State, or local vital statistics, claims data under title
XIX or XXI of the Social Security Act, other public health
statistics or surveys, or other data that the Secretary, in
consultation with the Director of the Centers for Disease
Control and Prevention, deems appropriate.
(3) DEFINITION OF ELIGIBLE ENTITY.—For purposes of this
section, the term ‘‘eligible entity’’ means a public or nonprofit
private entity (including a State or political subdivision of a
State), or a consortium of any of such entities.
(b) COORDINATION WITH OTHER CHILDREN’S PROGRAMS.—An eligible entity shall identify in the plan submitted as part of an application for a grant under this section how the entity will coordinate operations and activities under the grant with—
(1) other programs operated in the State that serve children with asthma, including any such programs operated
under title V, XIX, or XXI of the Social Security Act; and
(2) one or more of the following—
(A) the child welfare and foster care and adoption assistance programs under parts B and E of title IV of such
Act;
(B) the head start program established under the
Head Start Act (42 U.S.C. 9831 et seq.);
(C) the program of assistance under the special supplemental nutrition program for women, infants and children (WIC) under section 17 of the Child Nutrition Act of
1966 (42 U.S.C. 1786);
(D) local public and private elementary or secondary
schools; or
(E) public housing agencies, as defined in section 3 of
the United States Housing Act of 1937 (42 U.S.C. 1437a).
(c) EVALUATION.—An eligible entity that receives a grant under
this section shall submit to the Secretary an evaluation of the operations and activities carried out under the grant that includes—
(1) a description of the health status outcomes of children
assisted under the grant;
(2) an assessment of the utilization of asthma-related
health care services as a result of activities carried out under
the grant;
(3) the collection, analysis, and reporting of asthma data
according to guidelines prescribed by the Director of the Centers for Disease Control and Prevention; and
(4) such other information as the Secretary may require.
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(d) PREFERENCE FOR STATES THAT ALLOW STUDENTS TO SELFADMINISTER MEDICATION TO TREAT ASTHMA AND ANAPHYLAXIS.— 1
(1) PREFERENCE.—The Secretary, in making any grant
under this section or any other grant that is asthma-related
(as determined by the Secretary) to a State, shall give preference to any State that satisfies the following:
(A) IN GENERAL.—The State must require that each
public elementary school and secondary school in that
State will grant to any student in the school an authorization for the self-administration of medication to treat that
student’s asthma or anaphylaxis, if—
(i) a health care practitioner prescribed the medication for use by the student during school hours and
instructed the student in the correct and responsible
use of the medication;
(ii) the student has demonstrated to the health
care practitioner (or such practitioner’s designee) and
the school nurse (if available) the skill level necessary
to use the medication and any device that is necessary
to administer such medication as prescribed;
(iii) the health care practitioner formulates a written treatment plan for managing asthma or anaphylaxis episodes of the student and for medication use by
the student during school hours; and
(iv) the student’s parent or guardian has completed and submitted to the school any written documentation required by the school, including the treatment plan formulated under clause (iii) and other documents related to liability.
(B) SCOPE.—An authorization granted under subparagraph (A) must allow the student involved to possess and
use his or her medication—
(i) while in school;
(ii) while at a school-sponsored activity, such as a
sporting event; and
(iii) in transit to or from school or school-sponsored activities.
(C) DURATION OF AUTHORIZATION.—An authorization
granted under subparagraph (A)—
(i) must be effective only for the same school and
school year for which it is granted; and
(ii) must be renewed by the parent or guardian
each subsequent school year in accordance with this
subsection.
(D) BACKUP MEDICATION.—The State must require
that backup medication, if provided by a student’s parent
or guardian, be kept at a student’s school in a location to
which the student has immediate access in the event of an
asthma or anaphylaxis emergency.
1 Subsection (d) was added by section 3(a) of Public Law 108–377 (118 Stat. 2203), which was
enacted October 30, 2004. Section 3(b) of such Public Law provides as follows: ‘‘The amendments
made by this section shall apply only with respect to grants made on or after the date that is
9 months after the date of the enactment of this Act.’’.

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(E) MAINTENANCE OF INFORMATION.—The State must
require that information described in subparagraphs
(A)(iii) and (A)(iv) be kept on file at the student’s school in
a location easily accessible in the event of an asthma or
anaphylaxis emergency.
(2) RULE OF CONSTRUCTION.—Nothing in this subsection
creates a cause of action or in any other way increases or diminishes the liability of any person under any other law.
(3) DEFINITIONS.—For purposes of this subsection:
(A) The terms ‘‘elementary school’’ and ‘‘secondary
school’’ have the meaning given to those terms in section
9101 of the Elementary and Secondary Education Act of
1965.
(B) The term ‘‘health care practitioner’’ means a person authorized under law to prescribe drugs subject to section 503(b) of the Federal Food, Drug, and Cosmetic Act.
(C) The term ‘‘medication’’ means a drug as that term
is defined in section 201 of the Federal Food, Drug, and
Cosmetic Act and includes inhaled bronchodilators and
auto-injectable epinephrine.
(D) The term ‘‘self-administration’’ means a student’s
discretionary use of his or her prescribed asthma or anaphylaxis medication, pursuant to a prescription or written
direction from a health care practitioner.
(e) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of
carrying out this section, there are authorized to be appropriated
such sums as may be necessary for each of the fiscal years 2001
through 2005.
SEC. 399M. ø280g–1¿ EARLY DETECTION, DIAGNOSIS, AND TREATMENT
REGARDING HEARING LOSS IN NEWBORNS AND INFANTS.
(a) STATEWIDE NEWBORN AND INFANT HEARING SCREENING,
EVALUATION AND INTERVENTION PROGRAMS AND SYSTEMS.—The

Secretary, acting through the Administrator of the Health Resources and Services Administration, shall make awards of grants
or cooperative agreements to develop statewide newborn and infant
hearing screening, evaluation, diagnosis, and intervention programs and systems, and to assist in the recruitment, retention,
education, and training of qualified personnel and health care providers, for the following purposes:
(1) To develop and monitor the efficacy of statewide programs and systems for hearing screening of newborns and infants; prompt evaluation and diagnosis of children referred
from screening programs; and appropriate educational,
audiological, and medical interventions for children identified
with hearing loss. Early intervention includes referral to and
delivery of information and services by schools and agencies,
including community, consumer, and parent-based agencies
and organizations and other programs mandated by part C of
the Individuals with Disabilities Education Act, which offer
programs specifically designed to meet the unique language
and communication needs of deaf and hard of hearing
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family support mechanisms that are critical in the first months
after a child is identified with hearing loss.
(2) To collect data on statewide newborn and infant hearing screening, evaluation and intervention programs and systems that can be used for applied research, program evaluation
and policy development.
(3) Other activities may include developing efficient models
to ensure that newborns and infants who are identified with a
hearing loss through screening receive follow-up by a qualified
health care provider, and State agencies shall be encouraged to
adopt models that effectively increase the rate of occurrence of
such follow-up.
(b) TECHNICAL ASSISTANCE, DATA MANAGEMENT, AND APPLIED
RESEARCH.—
(1) CENTERS FOR DISEASE CONTROL AND PREVENTION.—The
Secretary, acting through the Director of the Centers for Disease Control and Prevention, shall make awards of grants or
cooperative agreements to provide technical assistance to State
agencies to complement an intramural program and to conduct
applied research related to newborn and infant hearing screening, evaluation and intervention programs and systems. The
program shall develop standardized procedures for data management and program effectiveness and costs, such as—
(A) to ensure quality monitoring of newborn and infant hearing loss screening, evaluation, diagnosis, and
intervention programs and systems;
(B) to provide technical assistance on data collection
and management;
(C) to study the costs and effectiveness of newborn and
infant hearing screening, evaluation and intervention programs and systems conducted by State-based programs in
order to answer issues of importance to State and national
policymakers;
(D) to identify the causes and risk factors for congenital hearing loss;
(E) to study the effectiveness of newborn and infant
hearing screening, audiologic and medical evaluations and
intervention programs and systems by assessing the
health, intellectual and social developmental, cognitive,
and language status of these children at school age; and
(F) to promote the sharing of data regarding early
hearing loss with State-based birth defects and developmental disabilities monitoring programs for the purpose of
identifying previously unknown causes of hearing loss.
(2) NATIONAL INSTITUTES OF HEALTH.—The Director of the
National Institutes of Health, acting through the Director of
the National Institute on Deafness and Other Communication
Disorders, shall for purposes of this section, continue a program of research and development on the efficacy of new
screening techniques and technology, including clinical studies
of screening methods, studies on efficacy of intervention, and
related research.
(c) COORDINATION AND COLLABORATION.—
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(1) IN GENERAL.—In carrying out programs under this section, the Administrator of the Health Resources and Services
Administration, the Director of the Centers for Disease Control
and Prevention, and the Director of the National Institutes of
Health shall collaborate and consult with other Federal agencies; State and local agencies, including those responsible for
early intervention services pursuant to title XIX of the Social
Security Act (Medicaid Early and Periodic Screening, Diagnosis
and Treatment Program); title XXI of the Social Security Act
(State Children’s Health Insurance Program); title V of the Social Security Act (Maternal and Child Health Block Grant Program); and part C of the Individuals with Disabilities Education Act; consumer groups of and that serve individuals who
are deaf and hard-of-hearing and their families; appropriate
national medical and other health and education specialty organizations; persons who are deaf and hard-of-hearing and
their families; other qualified professional personnel who are
proficient in deaf or hard-of-hearing children’s language and
who possess the specialized knowledge, skills, and attributes
needed to serve deaf and hard-of-hearing newborns, infants,
toddlers, children, and their families; third-party payers and
managed care organizations; and related commercial industries.
(2) POLICY DEVELOPMENT.—The Administrator of the
Health Resources and Services Administration, the Director of
the Centers for Disease Control and Prevention, and the Director of the National Institutes of Health shall coordinate and
collaborate on recommendations for policy development at the
Federal and State levels and with the private sector, including
consumer, medical and other health and education professional-based organizations, with respect to newborn and infant
hearing screening, evaluation, diagnosis, and intervention programs and systems.
(3) STATE EARLY DETECTION, DIAGNOSIS, AND INTERVENTION
PROGRAMS AND SYSTEMS; DATA COLLECTION.—The Administrator of the Health Resources and Services Administration
and the Director of the Centers for Disease Control and Prevention shall coordinate and collaborate in assisting States to
establish newborn and infant hearing screening, evaluation, diagnosis, and intervention programs and systems under subsection (a) and to develop a data collection system under subsection (b).
(d) RULE OF CONSTRUCTION; RELIGIOUS ACCOMMODATION.—
Nothing in this section shall be construed to preempt or prohibit
any State law, including State laws which do not require the
screening for hearing loss of newborn infants or young children of
parents who object to the screening on the grounds that such
screening conflicts with the parents’ religious beliefs.
(e) DEFINITIONS.—For purposes of this section:
(1) The term ‘‘audiologic evaluation’’ refers to procedures to
assess the status of the auditory system; to establish the site
of the auditory disorder; the type and degree of hearing loss,
and the potential effects of hearing loss on communication; and
to identify appropriate treatment and referral options. Referral
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options should include linkage to State coordinating agencies
under part C of the Individuals with Disabilities Education Act
or other appropriate agencies, medical evaluation, hearing aid /
sensory aid assessment, audiologic rehabilitation treatment,
national and local consumer, self-help, parent, and education
organizations, and other family-centered services.
(2) The terms ‘‘audiologic rehabilitation’’ and ‘‘audiologic
intervention’’ refer to procedures, techniques, and technologies
to facilitate the receptive and expressive communication abilities of a child with hearing loss.
(3) The term ‘‘early intervention’’ refers to providing appropriate services for the child with hearing loss, including nonmedical services, and ensuring that families of the child are
provided comprehensive, consumer-oriented information about
the full range of family support, training, information services,
and language and communication options and are given the opportunity to consider and obtain the full range of such appropriate services, educational and program placements, and other
options for their child from highly qualified providers.
(4) The term ‘‘medical evaluation by a physician’’ refers to
key components including history, examination, and medical
decision making focused on symptomatic and related body systems for the purpose of diagnosing the etiology of hearing loss
and related physical conditions, and for identifying appropriate
treatment and referral options.
(5) The term ‘‘medical intervention’’ refers to the process
by which a physician provides medical diagnosis and direction
for medical and /or surgical treatment options of hearing loss
and /or related medical disorder associated with hearing loss.
(6) The term ‘‘newborn and infant hearing screening’’ refers to objective physiologic procedures to detect possible hearing loss and to identify newborns and infants who require further audiologic and medical evaluations.
(f ) AUTHORIZATION OF APPROPRIATIONS.—
(1) STATEWIDE NEWBORN AND INFANT HEARING SCREENING,
EVALUATION AND INTERVENTION PROGRAMS AND SYSTEMS.—For
the purpose of carrying out subsection (a), there are authorized
to be appropriated to the Health Resources and Services Administration such sums as may be necessary for fiscal years
2011 through 2015.
(2) TECHNICAL ASSISTANCE, DATA MANAGEMENT, AND APPLIED RESEARCH; CENTERS FOR DISEASE CONTROL AND PREVENTION.—For the purpose of carrying out subsection (b)(1), there
are authorized to be appropriated to the Centers for Disease
Control and Prevention such sums as may be necessary for fiscal years 2011 through 2015.
(3) TECHNICAL ASSISTANCE, DATA MANAGEMENT, AND APPLIED RESEARCH; NATIONAL INSTITUTE ON DEAFNESS AND OTHER
COMMUNICATION DISORDERS.—For the purpose of carrying out
subsection (b)(2), there are authorized to be appropriated to the
National Institute on Deafness and Other Communication Disorders such sums as may be necessary for fiscal years 2011
through 2015.
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SEC. 399N. ø280g–2¿ CHILDHOOD MALIGNANCIES.
(a) IN GENERAL.—The Secretary, acting as

appropriate through
the Director of the Centers for Disease Control and Prevention and
the Director of the National Institutes of Health, shall study environmental and other risk factors for childhood cancers (including
skeletal malignancies, leukemias, malignant tumors of the central
nervous system, lymphomas, soft tissue sarcomas, and other malignant neoplasms) and carry out projects to improve outcomes among
children with childhood cancers and resultant secondary conditions,
including limb loss, anemia, rehabilitation, and palliative care.
Such projects shall be carried out by the Secretary directly and
through awards of grants or contracts.
(b) CERTAIN ACTIVITIES.—Activities under subsection (a) include—
(1) the expansion of current demographic data collection
and population surveillance efforts to include childhood cancers
nationally;
(2) the development of a uniform reporting system under
which treating physicians, hospitals, clinics, and States report
the diagnosis of childhood cancers, including relevant associated epidemiological data; and
(3) support for the National Limb Loss Information Center
to address, in part, the primary and secondary needs of persons who experience childhood cancers in order to prevent or
minimize the disabling nature of these cancers.
(c) COORDINATION OF ACTIVITIES.—The Secretary shall assure
that activities under this section are coordinated as appropriate
with other agencies of the Public Health Service that carry out activities focused on childhood cancers and limb loss.
(d) DEFINITION.—For purposes of this section, the term ‘‘childhood cancer’’ refers to a spectrum of different malignancies that
vary by histology, site of disease, origin, race, sex, and age. The
Secretary may for purposes of this section revise the definition of
such term to the extent determined by the Secretary to be appropriate.
(e) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of
carrying out this section, there are authorized to be appropriated
such sums as may be necessary for each of the fiscal years 2001
through 2005.
SEC. 399O. ø280g–3¿ CONTROLLED SUBSTANCE MONITORING PROGRAM.
(a) GRANTS.—
(1) IN GENERAL.—Each fiscal year, the Secretary shall

award a grant to each State with an application approved
under this section to enable the State—
(A) to establish and implement a State controlled substance monitoring program; or
(B) to make improvements to an existing State controlled substance monitoring program.
(2) DETERMINATION OF AMOUNT.—
(A) MINIMUM AMOUNT.—In making payments under a
grant under paragraph (1) for a fiscal year, the Secretary
shall allocate to each State with an application approved
under this section an amount that equals 1.0 percent of
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the amount appropriated to carry out this section for that
fiscal year.
(B) ADDITIONAL AMOUNTS.—In making payments
under a grant under paragraph (1) for a fiscal year, the
Secretary shall allocate to each State with an application
approved under this section an additional amount which
bears the same ratio to the amount appropriated to carry
out this section for that fiscal year and remaining after
amounts are made available under subparagraph (A) as
the number of pharmacies of the State bears to the number of pharmacies of all States with applications approved
under this section (as determined by the Secretary), except
that the Secretary may adjust the amount allocated to a
State under this subparagraph after taking into consideration the budget cost estimate for the State’s controlled
substance monitoring program.
(3) TERM OF GRANTS.—Grants awarded under this section
shall be obligated in the year in which funds are allotted.
(b) DEVELOPMENT OF MINIMUM REQUIREMENTS.—Prior to
awarding a grant under this section, and not later than 6 months
after the date on which funds are first appropriated to carry out
this section, after seeking consultation with States and other interested parties, the Secretary shall, after publishing in the Federal
Register proposed minimum requirements and receiving public
comments, establish minimum requirements for criteria to be used
by States for purposes of clauses (ii), (v), (vi), and (vii) of subsection
(c)(1)(A).
(c) APPLICATION APPROVAL PROCESS.—
(1) IN GENERAL.—To be eligible to receive a grant under
this section, a State shall submit an application to the Secretary at such time, in such manner, and containing such assurances and information as the Secretary may reasonably require. Each such application shall include—
(A) with respect to a State that intends to use funds
under the grant as provided for in subsection (a)(1)(A)—
(i) a budget cost estimate for the controlled substance monitoring program to be implemented under
the grant;
(ii) criteria for security for information handling
and for the database maintained by the State under
subsection (e) generally including efforts to use appropriate encryption technology or other appropriate technology to protect the security of such information;
(iii) an agreement to adopt health information
interoperability standards, including health vocabulary and messaging standards, that are consistent
with any such standards generated or identified by the
Secretary or his or her designee;
(iv) criteria for meeting the uniform electronic format requirement of subsection (h);
(v) criteria for availability of information and limitation on access to program personnel;
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(vi) criteria for access to the database, and procedures to ensure that information in the database is accurate;
(vii) criteria for the use and disclosure of information, including a description of the certification process
to be applied to requests for information under subsection (f);
(viii) penalties for the unauthorized use and disclosure of information maintained in the State controlled substance monitoring program in violation of
applicable State law or regulation;
(ix) information on the relevant State laws, policies, and procedures, if any, regarding purging of information from the database; and
(x) assurances of compliance with all other requirements of this section; or
(B) with respect to a State that intends to use funds
under the grant as provided for in subsection (a)(1)(B)—
(i) a budget cost estimate for the controlled substance monitoring program to be improved under the
grant;
(ii) a plan for ensuring that the State controlled
substance monitoring program is in compliance with
the criteria and penalty requirements described in
clauses (ii) through (viii) of subparagraph (A);
(iii) a plan to enable the State controlled substance monitoring program to achieve interoperability
with at least one other State controlled substance
monitoring program; and
(iv) assurances of compliance with all other requirements of this section or a statement describing
why such compliance is not feasible or is contrary to
the best interests of public health in such State.
(2) STATE LEGISLATION.—As part of an application under
paragraph (1), the Secretary shall require a State to demonstrate that the State has enacted legislation or regulations
to permit the implementation of the State controlled substance
monitoring program and the imposition of appropriate penalties for the unauthorized use and disclosure of information
maintained in such program.
(3) INTEROPERABILITY.—If a State that submits an application under this subsection geographically borders another State
that is operating a controlled substance monitoring program
under subsection (a)(1) on the date of submission of such application, and such applicant State has not achieved interoperability for purposes of information sharing between its monitoring program and the monitoring program of such border
State, such applicant State shall, as part of the plan under
paragraph (1)(B)(iii), describe the manner in which the applicant State will achieve interoperability between the monitoring
programs of such States.
(4) APPROVAL.—If a State submits an application in accordance with this subsection, the Secretary shall approve such application.
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(5) RETURN OF FUNDS.—If the Secretary withdraws approval of a State’s application under this section, or the State
chooses to cease to implement or improve a controlled substance monitoring program under this section, a funding agreement for the receipt of a grant under this section is that the
State will return to the Secretary an amount which bears the
same ratio to the overall grant as the remaining time period
for expending the grant funds bears to the overall time period
for expending the grant (as specified by the Secretary at the
time of the grant).
(d) REPORTING REQUIREMENTS.—In implementing or improving
a controlled substance monitoring program under this section, a
State shall comply, or with respect to a State that applies for a
grant under subsection (a)(1)(B) submit to the Secretary for approval a statement of why such compliance is not feasible or is contrary to the best interests of public health in such State, with the
following:
(1) The State shall require dispensers to report to such
State each dispensing in the State of a controlled substance to
an ultimate user not later than 1 week after the date of such
dispensing.
(2) The State may exclude from the reporting requirement
of this subsection—
(A) the direct administration of a controlled substance
to the body of an ultimate user;
(B) the dispensing of a controlled substance in a quantity limited to an amount adequate to treat the ultimate
user involved for 48 hours or less; or
(C) the administration or dispensing of a controlled
substance in accordance with any other exclusion identified by the Secretary for purposes of this paragraph.
(3) The information to be reported under this subsection
with respect to the dispensing of a controlled substance shall
include the following:
(A) Drug Enforcement Administration Registration
Number (or other identifying number used in lieu of such
Registration Number) of the dispenser.
(B) Drug Enforcement Administration Registration
Number (or other identifying number used in lieu of such
Registration Number) and name of the practitioner who
prescribed the drug.
(C) Name, address, and telephone number of the ultimate user or such contact information of the ultimate user
as the Secretary determines appropriate.
(D) Identification of the drug by a national drug code
number.
(E) Quantity dispensed.
(F) Number of refills ordered.
(G) Whether the drug was dispensed as a refill of a
prescription or as a first-time request.
(H) Date of the dispensing.
(I) Date of origin of the prescription.
(J) Such other information as may be required by
State law to be reported under this subsection.
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(4) The State shall require dispensers to report information under this section in accordance with the electronic format
specified by the Secretary under subsection (h), except that the
State may waive the requirement of such format with respect
to an individual dispenser that is unable to submit such information by electronic means.
(e) DATABASE.—In implementing or improving a controlled substance monitoring program under this section, a State shall comply
with the following:
(1) The State shall establish and maintain an electronic
database containing the information reported to the State
under subsection (d).
(2) The database must be searchable by any field or combination of fields.
(3) The State shall include reported information in the
database in a manner consistent with criteria established by
the Secretary, with appropriate safeguards for ensuring the accuracy and completeness of the database.
(4) The State shall take appropriate security measures to
protect the integrity of, and access to, the database.
(f) USE AND DISCLOSURE OF INFORMATION.—
(1) IN GENERAL.—Subject to subsection (g), in implementing or improving a controlled substance monitoring program under this section, a State may disclose information from
the database established under subsection (e) and, in the case
of a request under subparagraph (D), summary statistics of
such information, only in response to a request by—
(A) a practitioner (or the agent thereof) who certifies,
under the procedures determined by the State, that the requested information is for the purpose of providing medical
or pharmaceutical treatment or evaluating the need for
such treatment to a bona fide current patient;
(B) any local, State, or Federal law enforcement, narcotics control, licensure, disciplinary, or program authority,
who certifies, under the procedures determined by the
State, that the requested information is related to an individual investigation or proceeding involving the unlawful
diversion or misuse of a schedule II, III, or IV substance,
and such information will further the purpose of the investigation or assist in the proceeding;
(C) the controlled substance monitoring program of another State or group of States with whom the State has established an interoperability agreement;
(D) any agent of the Department of Health and
Human Services, a State medicaid program, a State health
department, or the Drug Enforcement Administration who
certifies that the requested information is necessary for research to be conducted by such department, program, or
administration, respectively, and the intended purpose of
the research is related to a function committed to such department, program, or administration by law that is not
investigative in nature; or
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nance of that State’s controlled substance monitoring program, who certifies that—
(i) the State has an application approved under
this section; and
(ii) the requested information is for the purpose of
implementing the State’s controlled substance monitoring program under this section.
(2) DRUG DIVERSION.—In consultation with practitioners,
dispensers, and other relevant and interested stakeholders, a
State receiving a grant under subsection (a)—
(A) shall establish a program to notify practitioners
and dispensers of information that will help identify and
prevent the unlawful diversion or misuse of controlled substances; and
(B) may, to the extent permitted under State law, notify the appropriate authorities responsible for carrying
out drug diversion investigations if the State determines
that information in the database maintained by the State
under subsection (e) indicates an unlawful diversion or
abuse of a controlled substance.
(g) LIMITATIONS.—In implementing or improving a controlled
substance monitoring program under this section, a State—
(1) shall limit the information provided pursuant to a valid
request under subsection (f)(1) to the minimum necessary to
accomplish the intended purpose of the request; and
(2) shall limit information provided in response to a request under subsection (f)(1)(D) to nonidentifiable information.
(h) ELECTRONIC FORMAT.—The Secretary shall specify a uniform electronic format for the reporting, sharing, and disclosure of
information under this section.
(i) RULES OF CONSTRUCTION.—
(1) FUNCTIONS OTHERWISE AUTHORIZED BY LAW.—Nothing
in this section shall be construed to restrict the ability of any
authority, including any local, State, or Federal law enforcement, narcotics control, licensure, disciplinary, or program authority, to perform functions otherwise authorized by law.
(2) NO PREEMPTION.—Nothing in this section shall be construed as preempting any State law, except that no such law
may relieve any person of a requirement otherwise applicable
under this Act.
(3) ADDITIONAL PRIVACY PROTECTIONS.—Nothing in this
section shall be construed as preempting any State from imposing any additional privacy protections.
(4) FEDERAL PRIVACY REQUIREMENTS.—Nothing in this section shall be construed to supersede any Federal privacy or
confidentiality requirement, including the regulations promulgated under section 264(c) of the Health Insurance Portability
and Accountability Act of 1996 (Public Law 104–191; 110 Stat.
2033) and section 543 of the Public Health Service Act.
(5) NO FEDERAL PRIVATE CAUSE OF ACTION.—Nothing in
this section shall be construed to create a Federal private
cause of action.
(j) STUDIES AND REPORTS.—
(1) IMPLEMENTATION REPORT.—
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(A) IN GENERAL.—Not later than 180 days after the
date of enactment of this section, the Secretary, based on
a review of existing State controlled substance monitoring
programs and other relevant information, shall determine
whether the implementation of such programs has had a
substantial negative impact on—
(i) patient access to treatment, including therapy
for pain or controlled substance abuse;
(ii) pediatric patient access to treatment; or
(iii) patient enrollment in research or clinical
trials in which, following the protocol that has been
approved by the relevant institutional review board for
the research or clinical trial, the patient has obtained
a controlled substance from either the scientific investigator conducting such research or clinical trial or the
agent thereof.
(B) ADDITIONAL CATEGORIES OF EXCLUSION.—If the
Secretary determines under subparagraph (A) that a substantial negative impact has been demonstrated with regard to one or more of the categories of patients described
in such subparagraph, the Secretary shall identify additional appropriate categories of exclusion from reporting as
authorized under subsection (d)(2)(C).
(2) PROGRESS REPORT.—Not later than 3 years after the
date on which funds are first appropriated under this section,
the Secretary shall—
(A) complete a study that—
(i) determines the progress of States in establishing and implementing controlled substance monitoring programs under this section;
(ii) provides an analysis of the extent to which the
operation of controlled substance monitoring programs
have reduced inappropriate use, abuse, or diversion of
controlled substances or affected patient access to appropriate pain care in States operating such programs;
(iii) determines the progress of States in achieving
interoperability between controlled substance monitoring programs, including an assessment of technical
and legal barriers to such activities and recommendations for addressing these barriers;
(iv) determines the feasibility of implementing a
real-time electronic controlled substance monitoring
program, including the costs associated with establishing such a program;
(v) provides an analysis of the privacy protections
in place for the information reported to the controlled
substance monitoring program in each State receiving
a grant for the establishment or operation of such program, and any recommendations for additional requirements for protection of this information;
(vi) determines the feasibility of implementing
technological alternatives to centralized data storage,
such as peer-to-peer file sharing or data pointer systems, in controlled substance monitoring programs
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and the potential for such alternatives to enhance the
privacy and security of individually identifiable data;
and
(vii) evaluates the penalties that States have enacted for the unauthorized use and disclosure of information maintained in the controlled substance monitoring program, and reports on the criteria used by the
Secretary to determine whether such penalties qualify
as appropriate pursuant to this section; and
(B) submit a report to the Congress on the results of
the study.
(k) PREFERENCE.—Beginning 3 years after the date on which
funds are first appropriated to carry out this section, the Secretary,
in awarding any competitive grant that is related to drug abuse (as
determined by the Secretary) and for which only States are eligible
to apply, shall give preference to any State with an application approved under this section. The Secretary shall have the discretion
to apply such preference to States with existing controlled substance monitoring programs that meet minimum requirements
under this section or to States that put forth a good faith effort to
meet those requirements (as determined by the Secretary).
(l) ADVISORY COUNCIL.—
(1) ESTABLISHMENT.—A State may establish an advisory
council to assist in the establishment, implementation, or improvement of a controlled substance monitoring program under
this section.
(2) LIMITATION.—A State may not use amounts received
under a grant under this section for the operations of an advisory council established under paragraph (1).
(3) SENSE OF CONGRESS.—It is the sense of the Congress
that, in establishing an advisory council under this subsection,
a State should consult with appropriate professional boards
and other interested parties.
(m) DEFINITIONS.—For purposes of this section:
(1) The term ‘‘bona fide patient’’ means an individual who
is a patient of the practitioner involved.
(2) The term ‘‘controlled substance’’ means a drug that is
included in schedule II, III, or IV of section 202(c) of the Controlled Substance Act.
(3) The term ‘‘dispense’’ means to deliver a controlled substance to an ultimate user by, or pursuant to the lawful order
of, a practitioner, irrespective of whether the dispenser uses
the Internet or other means to effect such delivery.
(4) The term ‘‘dispenser’’ means a physician, pharmacist,
or other person that dispenses a controlled substance to an ultimate user.
(5) The term ‘‘interoperability’’ with respect to a State controlled substance monitoring program means the ability of the
program to electronically share reported information, including
each of the required report components described in subsection
(d), with another State if the information concerns either the
dispensing of a controlled substance to an ultimate user who
resides in such other State, or the dispensing of a controlled
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substance prescribed by a practitioner whose principal place of
business is located in such other State.
(6) The term ‘‘nonidentifiable information’’ means information that does not identify a practitioner, dispenser, or an ultimate user and with respect to which there is no reasonable
basis to believe that the information can be used to identify a
practitioner, dispenser, or an ultimate user.
(7) The term ‘‘practitioner’’ means a physician, dentist, veterinarian, scientific investigator, pharmacy, hospital, or other
person licensed, registered, or otherwise permitted, by the
United States or the jurisdiction in which he or she practices
or does research, to distribute, dispense, conduct research with
respect to, administer, or use in teaching or chemical analysis,
a controlled substance in the course of professional practice or
research.
(8) The term ‘‘State’’ means each of the 50 States and the
District of Columbia.
(9) The term ‘‘ultimate user’’ means a person who has obtained from a dispenser, and who possesses, a controlled substance for his or her own use, for the use of a member of his
or her household, or for the use of an animal owned by him or
her or by a member of his or her household.
(n) AUTHORIZATION OF APPROPRIATIONS.—To carry out this section, there are authorized to be appropriated—
(1) $15,000,000 for each of fiscal years 2006 and 2007; and
(2) $10,000,000 for each of fiscal years 2008, 2009, and
2010.
SEC. 399P. ø280g–4¿ GRANTS TO FOSTER PUBLIC HEALTH RESPONSES
TO DOMESTIC VIOLENCE, DATING VIOLENCE, SEXUAL ASSAULT, AND STALKING.
(a) AUTHORITY TO AWARD GRANTS.—
(1) IN GENERAL.—The Secretary, acting through the Direc-

tor of the Centers for Disease Control and Prevention, shall
award grants to eligible State, tribal, territorial, or local entities to strengthen the response of State, tribal, territorial, or
local health care systems to domestic violence, dating violence,
sexual assault, and stalking.
(2) ELIGIBLE ENTITIES.—To be eligible to receive a grant
under this section, an entity shall—
(A) be—
(i) a State department (or other division) of
health, a State domestic or sexual assault coalition or
service-based program, State law enforcement task
force, or any other nonprofit, nongovernmental, tribal,
territorial, or State entity with a history of effective
work in the fields of domestic violence, dating violence,
sexual assault or stalking, and health care; or
(ii) a local, nonprofit domestic violence, dating violence, sexual assault, or stalking service-based program, a local department (or other division) of health,
a local health clinic, hospital, or health system, or any
other nonprofit, tribal, or local entity with a history of
effective work in the field of domestic or sexual violence and health;
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(B) prepare and submit to the Secretary an application
at such time, in such manner, and containing such agreements, assurances, and information as the Secretary determines to be necessary to carry out the purposes for which
the grant is to be made; and
(C) demonstrate that the entity is representing a team
of organizations and agencies working collaboratively to
strengthen the response of the health care system involved
to domestic violence, dating violence, sexual assault, or
stalking and that such team includes domestic violence,
dating violence, sexual assault or stalking and health care
organizations.
(3) DURATION.—A program conducted under a grant
awarded under this section shall not exceed 2 years.
(b) USE OF FUNDS.—
(1) IN GENERAL.—An entity shall use amounts received
under a grant under this section to design and implement comprehensive strategies to improve the response of the health
care system involved to domestic or sexual violence in clinical
and public health settings, hospitals, clinics, managed care settings (including behavioral and mental health), and other
health settings.
(2) MANDATORY STRATEGIES.—Strategies implemented
under paragraph (1) shall include the following:
(A) The implementation, dissemination, and evaluation of policies and procedures to guide health care professionals and behavioral and public health staff in responding to domestic violence, dating violence, sexual assault,
and stalking, including strategies to ensure that health information is maintained in a manner that protects the patient’s privacy and safety and prohibits insurance discrimination.
(B) The development of on-site access to services to address the safety, medical, mental health, and economic
needs of patients either by increasing the capacity of existing health care professionals and behavioral and public
health staff to address domestic violence, dating violence,
sexual assault, and stalking, by contracting with or hiring
domestic or sexual assault advocates to provide the services, or to model other services appropriate to the geographic and cultural needs of a site.
(C) The evaluation of practice and the institutionalization of identification, intervention, and documentation including quality improvement measurements.
(D) The provision of training and followup technical
assistance to health care professionals, behavioral and
public health staff, and allied health professionals to identify, assess, treat, and refer clients who are victims of domestic violence, dating violence, sexual violence, or stalking.
(3) PERMISSIVE STRATEGIES.—Strategies implemented
under paragraph (1) may include the following:
(A) Where appropriate, the development of training
modules and policies that address the overlap of child
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abuse, domestic violence, dating violence, sexual assault,
and stalking and elder abuse as well as childhood exposure
to domestic violence.
(B) The creation, adaptation, and implementation of
public education campaigns for patients concerning domestic violence, dating violence, sexual assault, and stalking
prevention.
(C) The development, adaptation, and dissemination of
domestic violence, dating violence, sexual assault, and
stalking education materials to patients and health care
professionals and behavioral and public health staff.
(D) The promotion of the inclusion of domestic violence, dating violence, sexual assault, and stalking into
health professional training schools, including medical,
dental, nursing school, social work, and mental health curriculum.
(E) The integration of domestic violence, dating violence, sexual assault, and stalking into health care accreditation and professional licensing examinations, such as
medical, dental, social work, and nursing boards.
(c) ALLOCATION OF FUNDS.—Funds appropriated under this
section shall be distributed equally between State and local programs.
(d) AUTHORIZATION OF APPROPRIATIONS.—There is authorized
to be appropriated to award grants under this section, $5,000,000
for each of fiscal years 2007 through 2011.
SEC. 399Q. ø280g–4¿ PUBLIC AND HEALTH CARE PROVIDER EDUCATION AND SUPPORT SERVICES.
(a) IN GENERAL.—The Secretary, directly or through the

awarding of grants to public or private nonprofit entities, may conduct demonstration projects for the purpose of improving the provision of information on prematurity to health professionals and
other health care providers and the public and improving the treatment and outcomes for babies born preterm.
(b) ACTIVITIES.—Activities to be carried out under the demonstration project under subsection (a) may include the establishment of—
(1) programs to test and evaluate various strategies to provide information and education to health professionals, other
health care providers, and the public concerning—
(A) the signs of preterm labor, updated as new research results become available;
(B) the screening for and the treating of infections;
(c) counseling on optimal weight and good nutrition,
including folic acid;
(D) smoking cessation education and counseling;
(E) stress management; and
(F) appropriate prenatal care;
(2) programs to improve the treatment and outcomes for
babies born premature, including the use of evidence-based
standards of care by health care professionals for pregnant
women at risk of preterm labor or other serious complications
and for infants born preterm and at a low birthweight;
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(3) programs to respond to the informational needs of families during the stay of an infant in a neonatal intensive care
unit, during the transition of the infant to the home, and in
the event of a newborn death; and
(4) such other programs as the Secretary determines appropriate to achieve the purpose specified in subsection (a).
(c) AUTHORIZATION OF APPROPRIATIONS.—There is authorized
to be appropriated to carry out this section $5,000,000 for each of
fiscal years 2007 through 2011.
SEC. 399R. ø280g–6¿ CHRONIC KIDNEY DISEASE INITIATIVES.
(a) IN GENERAL.—The Secretary shall establish pilot

projects

to—
(1) increase public and medical community awareness
(particularly of those who treat patients with diabetes and hypertension) regarding chronic kidney disease, focusing on prevention;
(2) increase screening for chronic kidney disease, focusing
on Medicare beneficiaries at risk of chronic kidney disease; and
(3) enhance surveillance systems to better assess the prevalence and incidence of chronic kidney disease.
(b) SCOPE AND DURATION.—
(1) SCOPE.—The Secretary shall select at least 3 States in
which to conduct pilot projects under this section.
(2) DURATION.—The pilot projects under this section shall
be conducted for a period that is not longer than 5 years and
shall begin on January 1, 2009.
(c) EVALUATION AND REPORT.—The Comptroller General of the
United States shall conduct an evaluation of the pilot projects conducted under this section. Not later than 12 months after the date
on which the pilot projects are completed, the Comptroller General
shall submit to Congress a report on the evaluation.
(d) AUTHORIZATION OF APPROPRIATIONS.—There are authorized
to be appropriated such sums as may be necessary for the purpose
of carrying out this section.
SEC. 399S.ø280g–7¿ AMYOTROPHIC LATERAL SCLEROSIS REGISTRY.
(a) ESTABLISHMENT.—
(1) IN GENERAL.—Not later than 1 year after the receipt

of
the report described in subsection (b)(2)(A), the Secretary, acting through the Director of the Centers for Disease Control
and Prevention, may, if scientifically advisable—
(A) develop a system to collect data on amyotrophic
lateral sclerosis (referred to in this section as ‘‘ALS’’) and
other motor neuron disorders that can be confused with
ALS, misdiagnosed as ALS, and in some cases progress to
ALS, including information with respect to the incidence
and prevalence of the disease in the United States; and
(B) establish a national registry for the collection and
storage of such data to develop a population-based registry
of cases in the United States of ALS and other motor neuron disorders that can be confused with ALS, misdiagnosed
as ALS, and in some cases progress to ALS.
(2) PURPOSE.—It is the purpose of the registry established
under paragraph (1)(B) to—

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(A) better describe the incidence and prevalence of
ALS in the United States;
(B) examine appropriate factors, such as environmental and occupational, that may be associated with the
disease;
(C) better outline key demographic factors (such as
age, race or ethnicity, gender, and family history of individuals who are diagnosed with the disease) associated
with the disease;
(D) better examine the connection between ALS and
other motor neuron disorders that can be confused with
ALS, misdiagnosed as ALS, and in some cases progress to
ALS; and
(E) other matters as recommended by the Advisory
Committee established under subsection (b).
(b) ADVISORY COMMITTEE.—
(1) ESTABLISHMENT.—Not later than 180 days after the
date of the enactment of this section, the Secretary, acting
through the Director of the Centers for Disease Control and
Prevention, may establish a committee to be known as the Advisory Committee on the National ALS Registry (referred to in
this section as the ‘‘Advisory Committee’’). The Advisory Committee shall be composed of not more than 27 members to be
appointed by the Secretary, acting through the Centers for Disease Control and Prevention, of which—
(A) two-thirds of such members shall represent governmental agencies—
(i) including at least one member representing—
(I) the National Institutes of Health, to include, upon the recommendation of the Director of
the National Institutes of Health, representatives
from the National Institute of Neurological Disorders and Stroke and the National Institute of
Environmental Health Sciences;
(II) the Department of Veterans Affairs;
(III) the Agency for Toxic Substances and Disease Registry; and
(IV) the Centers for Disease Control and Prevention; and
(ii) of which at least one such member shall be a
clinician with expertise on ALS and related diseases,
an epidemiologist with experience in data registries, a
statistician, an ethicist, and a privacy expert (relating
to the privacy regulations under the Health Insurance
Portability and Accountability Act of 1996); and
(B) one-third of such members shall be public members, including at least one member representing—
(i) national and voluntary health associations;
(ii) patients with ALS or their family members;
(iii) clinicians with expertise on ALS and related
diseases;
(iv) epidemiologists with experience in data registries;
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(v) geneticists or experts in genetics who have experience with the genetics of ALS or other neurological
diseases and
(vi) other individuals with an interest in developing and maintaining the National ALS Registry.
(2) DUTIES.—The Advisory Committee may review information and make recommendations to the Secretary concerning—
(A) the development and maintenance of the National
ALS Registry;
(B) the type of information to be collected and stored
in the Registry;
(C) the manner in which such data is to be collected;
(D) the use and availability of such data including
guidelines for such use; and
(E) the collection of information about diseases and
disorders that primarily affect motor neurons that are considered essential to furthering the study and cure of ALS.
(3) REPORT.—Not later than 270 days after the date on
which the Advisory Committee is established, the Advisory
Committee may submit a report to the Secretary concerning
the review conducted under paragraph (2) that contains the
recommendations of the Advisory Committee with respect to
the results of such review.
(c) GRANTS.—The Secretary, acting through the Director of the
Centers for Disease Control and Prevention, may award grants to,
and enter into contracts and cooperative agreements with, public or
private nonprofit entities for the collection, analysis, and reporting
of data on ALS and other motor neuron disorders that can be confused with ALS, misdiagnosed as ALS, and in some cases progress
to ALS after receiving the report under subsection (b)(3).
(d) COORDINATION WITH STATE, LOCAL, AND FEDERAL REGISTRIES.—
(1) 1 IN GENERAL.—In establishing the National ALS Registry under subsection (a), the Secretary, acting through the
Director of the Centers for Disease Control and Prevention,
may—
(A) identify, build upon, expand, and coordinate among
existing data and surveillance systems, surveys, registries,
and other Federal public health and environmental infrastructure wherever possible, which may include—
(i) any registry pilot projects previously supported
by the Centers for Disease Control and Prevention;
(ii) the Department of Veterans Affairs ALS Registry;
(iii) the DNA and Cell Line Repository of the National Institute of Neurological Disorders and Stroke
Human Genetics Resource Center at the National Institutes of Health;
(iv) Agency for Toxic Substances and Disease Registry studies, including studies conducted in Illinois,
1 So in law. Subsection (d) (as added by section 2 of Public Law 110–373) does not include
a paragraph (2).

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Missouri, El Paso and San Antonio, Texas, and Massachusetts;
(v) State-based ALS registries;
(vi) the National Vital Statistics System; and
(vii) any other existing or relevant databases that
collect or maintain information on those motor neuron
diseases recommended by the Advisory Committee established in subsection (b); and
(B) provide for research access to ALS data as recommended by the Advisory Committee established in subsection (b) to the extent permitted by applicable statutes
and regulations and in a manner that protects personal
privacy consistent with applicable privacy statutes and
regulations.
(C) COORDINATION WITH NIH AND DEPARTMENT OF VETERANS AFFAIRS.—Consistent with applicable privacy statutes and regulations, the Secretary may ensure that epidemiological and other types of information obtained under
subsection (a) is made available to the National Institutes
of Health and the Department of Veterans Affairs.
(e) DEFINITION.—For the purposes of this section, the term ‘‘national voluntary health association’’ means a national non-profit organization with chapters or other affiliated organizations in States
throughout the United States with experience serving the population of individuals with ALS and have demonstrated experience
in ALS research, care, and patient services.
SEC. 399T. ø280g–8¿ SUPPORT FOR PATIENTS RECEIVING A POSITIVE
DIAGNOSIS OF DOWN SYNDROME OR OTHER PRENATALLY
OR POSTNATALLY DIAGNOSED CONDITIONS.
(a) DEFINITIONS.—In this section:
(1) DOWN SYNDROME.—The term ‘‘Down syndrome’’ refers

to a chromosomal disorder caused by an error in cell division
that results in the presence of an extra whole or partial copy
of chromosome 21.
(2) HEALTH CARE PROVIDER.—The term ‘‘health care provider’’ means any person or entity required by State or Federal
law or regulation to be licensed, registered, or certified to provide health care services, and who is so licensed, registered, or
certified.
(3) POSTNATALLY DIAGNOSED CONDITION.—The term
‘‘postnatally diagnosed condition’’ means any health condition
identified during the 12-month period beginning at birth.
(4) PRENATALLY DIAGNOSED CONDITION.—The term ‘‘prenatally diagnosed condition’’ means any fetal health condition
identified by prenatal genetic testing or prenatal screening procedures.
(5) PRENATAL TEST.—The term ‘‘prenatal test’’ means diagnostic or screening tests offered to pregnant women seeking
routine prenatal care that are administered on a required or
recommended basis by a health care provider based on medical
history, family background, ethnic background, previous test
results, or other risk factors.
(b) INFORMATION AND SUPPORT SERVICES.—
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(1) IN GENERAL.—The Secretary, acting through the Director of the National Institutes of Health, the Director of the
Centers for Disease Control and Prevention, or the Administrator of the Health Resources and Services Administration,
may authorize and oversee certain activities, including the
awarding of grants, contracts or cooperative agreements to eligible entities, to—
(A) collect, synthesize, and disseminate current evidence-based information relating to Down syndrome or
other prenatally or postnatally diagnosed conditions; and
(B) coordinate the provision of, and access to, new or
existing supportive services for patients receiving a positive diagnosis for Down syndrome or other prenatally or
postnatally diagnosed conditions, including—
(i) the establishment of a resource telephone hotline accessible to patients receiving a positive test result or to the parents of newly diagnosed infants with
Down syndrome and other diagnosed conditions;
(ii) the expansion and further development of the
National Dissemination Center for Children with Disabilities, so that such Center can more effectively conduct outreach to new and expecting parents and provide them with up-to-date information on the range of
outcomes for individuals living with the diagnosed
condition, including physical, developmental, educational, and psychosocial outcomes;
(iii) the expansion and further development of national and local peer-support programs, so that such
programs can more effectively serve women who receive a positive diagnosis for Down syndrome or other
prenatal conditions or parents of infants with a
postnatally diagnosed condition;
(iv) the establishment of a national registry, or
network of local registries, of families willing to adopt
newborns with Down syndrome or other prenatally or
postnatally diagnosed conditions, and links to adoption
agencies willing to place babies with Down syndrome
or other prenatally or postnatally diagnosed conditions, with families willing to adopt; and
(v) the establishment of awareness and education
programs for health care providers who provide, interpret, or inform parents of the results of prenatal tests
for Down syndrome or other prenatally or postnatally
diagnosed conditions, to patients, consistent with the
purpose described in section 2(b)(1) 1 of the Prenatally
and Postnatally Diagnosed Conditions Awareness Act.
(2) ELIGIBLE ENTITY.—In this subsection, the term ‘‘eligible
entity’’ means—
(A) a State or a political subdivision of a State;
(B) a consortium of 2 or more States or political subdivisions of States;
(C) a territory;
1 So

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in law. Probably should read ‘‘section 2(1)’’.

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(D) a health facility or program operated by or pursuant to a contract with or grant from the Indian Health
Service; or
(E) any other entity with appropriate expertise in prenatally and postnatally diagnosed conditions (including nationally recognized disability groups), as determined by the
Secretary.
(3) DISTRIBUTION.—In distributing funds under this subsection, the Secretary shall place an emphasis on funding partnerships between health care professional groups and disability advocacy organizations.
(c) PROVISION OF INFORMATION TO PROVIDERS.—
(1) IN GENERAL.—A grantee under this section shall make
available to health care providers of parents who receive a prenatal or postnatal diagnosis the following:
(A) Up-to-date, evidence-based, written information
concerning the range of outcomes for individuals living
with the diagnosed condition, including physical, developmental, educational, and psychosocial outcomes.
(B) Contact information regarding support services, including information hotlines specific to Down syndrome or
other prenatally or postnatally diagnosed conditions, resource centers or clearinghouses, national and local peer
support groups, and other education and support programs
as described in subsection (b)(2).
(2) INFORMATIONAL REQUIREMENTS.—Information provided
under this subsection shall be—
(A) culturally and linguistically appropriate as needed
by women receiving a positive prenatal diagnosis or the
family of infants receiving a postnatal diagnosis; and
(B) approved by the Secretary.
(d) REPORT.—Not later than 2 years after the date of enactment of this section, the Government Accountability Office shall
submit a report to Congress concerning the effectiveness of current
healthcare and family support programs serving as resources for
the families of children with disabilities.
SEC.

399U.

ø280g–10¿ COMMUNITY PREVENTIVE SERVICES TASK
FORCE.
ESTABLISHMENT AND PURPOSE.—The Director of the Cen-

(a)
ters for Disease Control and Prevention shall convene an independent Community Preventive Services Task Force (referred to in
this subsection as the ‘‘Task Force’’) to be composed of individuals
with appropriate expertise. Such Task Force shall review the scientific evidence related to the effectiveness, appropriateness, and
cost-effectiveness of community preventive interventions for the
purpose of developing recommendations, to be published in the
Guide to Community Preventive Services (referred to in this section as the ‘‘Guide’’), for individuals and organizations delivering
population-based services, including primary care professionals,
health care systems, professional societies, employers, community
organizations, non-profit organizations, schools, governmental public health agencies, Indian tribes, tribal organizations and urban
Indian organizations, medical groups, Congress and other policymakers. Community preventive services include any policies, proMarch 13, 2013

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grams, processes or activities designed to affect or otherwise affecting health at the population level.
(b) DUTIES.—The duties of the Task Force shall include—
(1) the development of additional topic areas for new recommendations and interventions related to those topic areas,
including those related to specific populations and age groups,
as well as the social, economic and physical environments that
can have broad effects on the health and disease of populations
and health disparities among sub-populations and age groups;
(2) at least once during every 5-year period, review interventions and update recommendations related to existing topic
areas, including new or improved techniques to assess the
health effects of interventions, including health impact assessment and population health modeling;
(3) improved integration with Federal Government health
objectives and related target setting for health improvement;
(4) the enhanced dissemination of recommendations;
(5) the provision of technical assistance to those health
care professionals, agencies, and organizations that request
help in implementing the Guide recommendations; and
(6) providing yearly reports to Congress and related agencies identifying gaps in research and recommending priority
areas that deserve further examination, including areas related to populations and age groups not adequately addressed
by current recommendations.
(c) ROLE OF AGENCY.—The Director shall provide ongoing administrative, research, and technical support for the operations of
the Task Force, including coordinating and supporting the dissemination of the recommendations of the Task Force, ensuring adequate staff resources, and assistance to those organizations requesting it for implementation of Guide recommendations.
(d) COORDINATION WITH PREVENTIVE SERVICES TASK FORCE.—
The Task Force shall take appropriate steps to coordinate its work
with the U.S. Preventive Services Task Force and the Advisory
Committee on Immunization Practices, including the examination
of how each task force’s recommendations interact at the nexus of
clinic and community.
(e) OPERATION.—In carrying out the duties under subsection
(b), the Task Force shall not be subject to the provisions of Appendix 2 of title 5, United States Code.
(f) AUTHORIZATION OF APPROPRIATIONS.—There are authorized
to be appropriated such sums as may be necessary for each fiscal
year to carry out the activities of the Task Force.
SEC. 399V. ø280g–11¿GRANTS TO PROMOTE POSITIVE HEALTH BEHAVIORS AND OUTCOMES.
(a) GRANTS AUTHORIZED.—The Director of the Centers for Dis-

ease 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
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derserved 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 and refer 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 payment system that rewards community health workers for connecting underserved populations with the most appropriate services at the most appropriate time. Nothing in this section shall be
construed to require such a payment.
(g) QUALITY ASSURANCE AND COST EFFECTIVENESS.—The Secretary shall establish guidelines for assuring the quality of the
training and supervision of community health workers under the
programs funded under this section and for assuring the cost-effectiveness of such programs.
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(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’’ means an individual who promotes health or
nutrition within the community in which the individual resides—
(A) by serving as a liaison between communities and
healthcare agencies;
(B) by providing guidance and social assistance to
community residents;
(C) by enhancing community residents’ ability to effectively communicate with healthcare providers;
(D) by providing culturally and linguistically appropriate health or nutrition education;
(E) by advocating for individual and community
health;
(F) by providing referral and follow-up services or otherwise coordinating care; and
(G) by proactively identifying and enrolling eligible individuals in Federal, State, local, private or nonprofit
health and human services programs.
(2) COMMUNITY SETTING.—The term ‘‘community setting’’
means a home or a community organization located in the
neighborhood in which a participant in the program under this
section resides.
(3) ELIGIBLE ENTITY.—The term ‘‘eligible entity’’ means a
public or nonprofit private entity (including a State or public
subdivision of a State, a public health department, a free
health clinic, a hospital, or a Federally-qualified health center
(as defined in section 1861(aa) of the Social Security Act)), or
a consortium of any such entities.
(4) MEDICALLY UNDERSERVED COMMUNITY.—The term
‘‘medically underserved community’’ means a community identified by a State—
(A) that has a substantial number of individuals who
are members of a medically underserved population, as defined by section 330(b)(3); and
(B) a significant portion of which is a health professional shortage area as designated under section 332.
SEC. 399V–1. ø280g–12¿ PRIMARY CARE EXTENSION PROGRAM.
(a) ESTABLISHMENT, PURPOSE AND DEFINITION.—
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(1) IN GENERAL.—The Secretary, acting through the Director of the Agency for Healthcare Research and Quality, shall
establish a Primary Care Extension Program.
(2) PURPOSE.—The Primary Care Extension Program shall
provide support and assistance to primary care providers to
educate providers about preventive medicine, health promotion, chronic disease management, mental and behavioral
health services (including substance abuse prevention and
treatment services), and evidence-based and evidence-informed
therapies and techniques, in order to enable providers to incorporate such matters into their practice and to improve community health by working with community-based health connectors (referred to in this section as ‘‘Health Extension Agents’’).
(3) DEFINITIONS.—In this section:
(A) HEALTH EXTENSION AGENT.—The term ‘‘Health Extension Agent’’ means any local, community-based health
worker who facilitates and provides assistance to primary
care practices by implementing quality improvement or
system redesign, incorporating the principles of the patient-centered medical home to provide high-quality, effective, efficient, and safe primary care and to provide guidance to patients in culturally and linguistically appropriate
ways, and linking practices to diverse health system resources.
(B) PRIMARY CARE PROVIDER.—The term ‘‘primary care
provider’’ means a clinician who provides integrated, accessible health care services and who is accountable for addressing a large majority of personal health care needs, including providing preventive and health promotion services for men, women, and children of all ages, developing
a sustained partnership with patients, and practicing in
the context of family and community, as recognized by a
State licensing or regulatory authority, unless otherwise
specified in this section.
(b) GRANTS TO ESTABLISH STATE HUBS AND LOCAL PRIMARY
CARE EXTENSION AGENCIES.—
(1) GRANTS.—The Secretary shall award competitive
grants to States for the establishment of State- or multistatelevel 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 that train providers in
primary care in 1 or more health professions schools in the
State; 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
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Secretary under section 1153 of the Social Security Act,
consumer groups, and other appropriate entities.
(c) STATE AND LOCAL ACTIVITIES.—
(1) HUB ACTIVITIES.—Hubs established under a grant
under subsection (b) shall—
(A) submit to the Secretary a plan to coordinate functions with quality improvement organizations and area
health education centers if such entities are members of
the Hub not described in subsection (b)(2)(A);
(B) contract with a county- or local-level entity that
shall serve as the Primary Care Extension Agency to administer the services described in paragraph (2);
(C) organize and administer grant funds to county- or
local-level Primary Care Extension Agencies that serve a
catchment area, as determined by the State; and
(D) organize State-wide or multistate networks of
local-level Primary Care Extension Agencies to share and
disseminate information and practices.
(2) LOCAL PRIMARY CARE EXTENSION AGENCY ACTIVITIES.—
(A) REQUIRED ACTIVITIES.—Primary Care Extension
Agencies established by a Hub under paragraph (1) shall—
(i) assist primary care providers to implement a
patient-centered medical home to improve the accessibility, quality, and efficiency of primary care services,
including health homes;
(ii) develop and support primary care learning
communities to enhance the dissemination of research
findings for evidence-based practice, assess implementation of practice improvement, share best practices,
and involve community clinicians in the generation of
new knowledge and identification of important questions for research;
(iii) participate in a national network of Primary
Care Extension Hubs and propose how the Primary
Care Extension Agency will share and disseminate lessons learned and best practices; and
(iv) develop a plan for financial sustainability involving State, local, and private contributions, to provide for the reduction in Federal funds that is expected after an initial 6-year period of program establishment, infrastructure development, and planning.
(B) DISCRETIONARY ACTIVITIES.—Primary Care Extension Agencies established by a Hub under paragraph (1)
may—
(i) provide technical assistance, training, and organizational support for community health teams established under section 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,
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and other community agencies to identify community
health priorities and local health workforce needs, and
participate in community-based efforts to address the
social and primary determinants of health, strengthen
the local primary care workforce, and eliminate health
disparities;
(iv) develop measures to monitor the impact of the
proposed program on the health of practice enrollees
and of the wider community served; and
(v) participate in other activities, as determined
appropriate by the Secretary.
(d) FEDERAL PROGRAM ADMINISTRATION.—
(1) GRANTS; TYPES.—Grants awarded under subsection (b)
shall be—
(A) program grants, that are awarded to State or
multistate entities that submit fully-developed plans for
the implementation of a Hub, for a period of 6 years; or
(B) planning grants, that are awarded to State or
multistate entities with the goal of developing a plan for
a Hub, for a period of 2 years.
(2) APPLICATIONS.—To be eligible for a grant under subsection (b), a State or multistate entity shall submit to the Secretary an application, at such time, in such manner, and containing such information as the Secretary may require.
(3) EVALUATION.—A State that receives a grant under subsection (b) shall be evaluated at the end of the grant period by
an evaluation panel appointed by the Secretary.
(4) CONTINUING SUPPORT.—After the sixth year in which
assistance is provided to a State under a grant awarded under
subsection (b), the State may receive additional support under
this section if the State program has received satisfactory evaluations with respect to program performance and the merits of
the State sustainability plan, as determined by the Secretary.
(5) LIMITATION.—A State shall not use in excess of 10 percent of the amount received under a grant to carry out administrative activities under this section. Funds awarded pursuant
to this section shall not be used for funding direct patient care.
(e) REQUIREMENTS ON THE SECRETARY.—In carrying out this
section, the Secretary shall consult with the heads of other Federal
agencies with demonstrated experience and expertise in health care
and preventive medicine, such as the Centers for Disease Control
and Prevention, the Substance Abuse and Mental Health Administration, the Health Resources and Services Administration, the National Institutes of Health, the Office of the National Coordinator
for Health Information Technology, the Indian Health Service, the
Agricultural Cooperative Extension Service of the Department of
Agriculture, and other entities, as the Secretary determines appropriate.
(f) AUTHORIZATION OF APPROPRIATIONS.—To awards grants as
provided in subsection (d), there are authorized to be appropriated
$120,000,000 for each of fiscal years 2011 and 2012, and such sums
as may be necessary to carry out this section for each of fiscal
years 2013 through 2014.
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SEC. 399V–2. ø280g–13¿ NATIONAL CONGENITAL HEART DISEASE SURVEILLANCE SYSTEM.
(a) IN GENERAL.—The Secretary, acting through the Director of

the Centers for Disease Control and Prevention, may—
(1) enhance and expand infrastructure to track the epidemiology of congenital heart disease and to organize such information into a nationally-representative, population-based surveillance system that compiles data concerning actual occurrences of congenital heart disease, to be known as the ‘‘National Congenital Heart Disease Surveillance System’’; or
(2) award a grant to one eligible entity to undertake the
activities described in paragraph (1).
(b) PURPOSE.—The purpose of the Congenital Heart Disease
Surveillance System shall be to facilitate further research into the
types of health services patients use and to identify possible areas
for educational outreach and prevention in accordance with standard practices of the Centers for Disease Control and Prevention.
(c) CONTENT.—The Congenital Heart Disease Surveillance System—
(1) may include information concerning the incidence and
prevalence of congenital heart disease in the United States;
(2) may be used to collect and store data on congenital
heart disease, including data concerning—
(A) demographic factors associated with congenital
heart disease, such as age, race, ethnicity, sex, and family
history of individuals who are diagnosed with the disease;
(B) risk factors associated with the disease;
(C) causation of the disease;
(D) treatment approaches; and
(E) outcome measures, such that analysis of the outcome measures will allow derivation of evidence-based best
practices and guidelines for congenital heart disease patients; and
(3) may ensure the collection and analysis of longitudinal
data related to individuals of all ages with congenital heart
disease, including infants, young children, adolescents, and
adults of all ages.
(d) PUBLIC ACCESS.—The Congenital Heart Disease Surveillance System shall be made available to the public, as appropriate,
including congenital heart disease researchers.
(e) PATIENT PRIVACY.—The Secretary shall ensure that the
Congenital Heart Disease Surveillance System is maintained in a
manner that complies with the regulations promulgated under section 264 of the Health Insurance Portability and Accountability Act
of 1996.
(f) ELIGIBILITY FOR GRANT.—To be eligible to receive a grant
under subsection (a)(2), an entity shall—
(1) be a public or private nonprofit entity with specialized
experience in congenital heart disease; and
(2) submit to the Secretary an application at such time, in
such manner, and containing such information as the Secretary may require.
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SEC. 399V–3. ø280g–14¿ 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 nonprofits 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.
SEC. 399V–4. ø280g–15¿ STATE DEMONSTRATION PROGRAMS TO EVALUATE ALTERNATIVES TO CURRENT MEDICAL TORT LITIGATION.
(a) IN GENERAL.—The Secretary is authorized to award dem-

onstration grants to States for the development, implementation,
and evaluation of alternatives to current tort litigation for resolving
disputes over injuries allegedly caused by health care providers or
health care organizations. In awarding such grants, the Secretary
shall ensure the diversity of the alternatives so funded.
(b) DURATION.—The Secretary may award grants under subsection (a) for a period not to exceed 5 years.
(c) CONDITIONS FOR DEMONSTRATION GRANTS.—
(1) REQUIREMENTS.—Each State desiring a grant under
subsection (a) shall develop an alternative to current tort litigation that—
(A) allows for the resolution of disputes over injuries
allegedly caused by health care providers or health care organizations; and
(B) promotes a reduction of health care errors by encouraging the collection and analysis of patient safety data
related to disputes resolved under subparagraph (A) by organizations that engage in efforts to improve patient safety and the quality of health care.
(2) ALTERNATIVE TO CURRENT TORT LITIGATION.—Each
State desiring a grant under subsection (a) shall demonstrate
how the proposed alternative described in paragraph (1)(A)—
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(A) makes the medical liability system more reliable
by increasing the availability of prompt and fair resolution
of disputes;
(B) encourages the efficient resolution of disputes;
(C) encourages the disclosure of health care errors;
(D) enhances patient safety by detecting, analyzing,
and helping to reduce medical errors and adverse events;
(E) improves access to liability insurance;
(F) fully informs patients about the differences in the
alternative and current tort litigation;
(G) provides patients the ability to opt out of or voluntarily withdraw from participating in the alternative at
any time and to pursue other options, including litigation,
outside the alternative;
(H) would not conflict with State law at the time of
the application in a way that would prohibit the adoption
of an alternative to current tort litigation; and
(I) would not limit or curtail a patient’s existing legal
rights, ability to file a claim in or access a State’s legal
system, or otherwise abrogate a patient’s ability to file a
medical malpractice claim.
(3) SOURCES OF COMPENSATION.—Each State desiring a
grant under subsection (a) shall identify the sources from and
methods by which compensation would be paid for claims resolved under the proposed alternative to current tort litigation,
which may include public or private funding sources, or a combination of such sources. Funding methods shall to the extent
practicable provide financial incentives for activities that improve patient safety.
(4) SCOPE.—
(A) IN GENERAL.—Each State desiring a grant under
subsection (a) shall establish a scope of jurisdiction (such
as Statewide, designated geographic region, a designated
area of health care practice, or a designated group of
health care providers or health care organizations) for the
proposed alternative to current tort litigation that is sufficient to evaluate the effects of the alternative. No scope of
jurisdiction shall be established under this paragraph that
is based on a health care payer or patient population.
(B) NOTIFICATION OF PATIENTS.—A State shall demonstrate how patients would be notified that they are receiving health care services that fall within such scope,
and the process by which they may opt out of or voluntarily withdraw from participating in the alternative. The
decision of the patient whether to participate or continue
participating in the alternative process shall be made at
any time and shall not be limited in any way.
(5) PREFERENCE IN AWARDING DEMONSTRATION GRANTS.—
In awarding grants under subsection (a), the Secretary shall
give preference to States—
(A) that have developed the proposed alternative
through substantive consultation with relevant stakeholders, including patient advocates, health care providers
and health care organizations, attorneys with expertise in
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representing patients and health care providers, medical
malpractice insurers, and patient safety experts;
(B) that make proposals that are likely to enhance patient safety by detecting, analyzing, and helping to reduce
medical errors and adverse events; and
(C) that make proposals that are likely to improve access to liability insurance.
(d) APPLICATION.—
(1) IN GENERAL.—Each State desiring a grant under subsection (a) shall submit to the Secretary an application, at such
time, in such manner, and containing such information as the
Secretary may require.
(2) REVIEW PANEL.—
(A) IN GENERAL.—In reviewing applications under
paragraph (1), the Secretary shall consult with a review
panel composed of relevant experts appointed by the
Comptroller General.
(B) COMPOSITION.—
(i) NOMINATIONS.—The Comptroller General shall
solicit nominations from the public for individuals to
serve on the review panel.
(ii) APPOINTMENT.—The Comptroller General shall
appoint, at least 9 but not more than 13, highly qualified and knowledgeable individuals to serve on the review panel and shall ensure that the following entities
receive fair representation on such panel:
(I) Patient advocates.
(II) Health care providers and health care organizations.
(III) Attorneys with expertise in representing
patients and health care providers.
(IV) Medical malpractice insurers.
(V) State officials.
(VI) Patient safety experts.
(C) CHAIRPERSON.—The Comptroller General, or an individual within the Government Accountability Office designated by the Comptroller General, shall be the chairperson of the review panel.
(D) AVAILABILITY OF INFORMATION.—The Comptroller
General shall make available to the review panel such information, personnel, and administrative services and assistance as the review panel may reasonably require to
carry out its duties.
(E) INFORMATION FROM AGENCIES.—The review panel
may request directly from any department or agency of the
United States any information that such panel considers
necessary to carry out its duties. To the extent consistent
with applicable laws and regulations, the head of such department or agency shall furnish the requested information to the review panel.
(e) REPORTS.—
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ed under such subsection. Such report shall, at a minimum, include the impact of the activities funded on patient safety and
on the availability and price of medical liability insurance.
(2) BY SECRETARY.—The Secretary shall submit to Congress an annual compendium of the reports submitted under
paragraph (1) and an analysis of the activities funded under
subsection (a) that examines any differences that result from
such activities in terms of the quality of care, number and nature of medical errors, medical resources used, length of time
for dispute resolution, and the availability and price of liability
insurance.
(f) TECHNICAL ASSISTANCE.—
(1) IN GENERAL.—The Secretary shall provide technical assistance to the States applying for or awarded grants under
subsection (a).
(2) REQUIREMENTS.—Technical assistance under paragraph
(1) shall include—
(A) guidance on non-economic damages, including the
consideration of individual facts and circumstances in determining appropriate payment, guidance on identifying
avoidable injuries, and guidance on disclosure to patients
of health care errors and adverse events; and
(B) the development, in consultation with States, of
common definitions, formats, and data collection infrastructure for States receiving grants under this section to
use in reporting to facilitate aggregation and analysis of
data both within and between States.
(3) USE OF COMMON DEFINITIONS, FORMATS, AND DATA COLLECTION INFRASTRUCTURE.—States not receiving grants under
this section may also use the common definitions, formats, and
data collection infrastructure developed under paragraph
(2)(B).
(g) EVALUATION.—
(1) IN GENERAL.—The Secretary, in consultation with the
review panel established under subsection (d)(2), shall enter
into a contract with an appropriate research organization to
conduct an overall evaluation of the effectiveness of grants
awarded under subsection (a) and to annually prepare and submit a report to Congress. Such an evaluation shall begin not
later than 18 months following the date of implementation of
the first program funded by a grant under subsection (a).
(2) CONTENTS.—The evaluation under paragraph (1) shall
include—
(A) an analysis of the effects of the grants awarded
under subsection (a) with regard to the measures described
in paragraph (3);
(B) for each State, an analysis of the extent to which
the alternative developed under subsection (c)(1) is effective in meeting the elements described in subsection (c)(2);
(C) a comparison among the States receiving grants
under subsection (a) of the effectiveness of the various alternatives developed by such States under subsection
(c)(1);
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(D) a comparison, considering the measures described
in paragraph (3), of States receiving grants approved
under subsection (a) and similar States not receiving such
grants; and
(E) a comparison, with regard to the measures described in paragraph (3), of—
(i) States receiving grants under subsection (a);
(ii) States that enacted, prior to the date of enactment of the Patient Protection and Affordable Care
Act, any cap on non-economic damages; and
(iii) States that have enacted, prior to the date of
enactment of the Patient Protection and Affordable
Care Act, a requirement that the complainant obtain
an opinion regarding the merit of the claim, although
the substance of such opinion may have no bearing on
whether the complainant may proceed with a case.
(3) MEASURES.—The evaluations under paragraph (2) shall
analyze and make comparisons on the basis of—
(A) the nature and number of disputes over injuries allegedly caused by health care providers or health care organizations;
(B) the nature and number of claims in which tort litigation was pursued despite the existence of an alternative
under subsection (a);
(C) the disposition of disputes and claims, including
the length of time and estimated costs to all parties;
(D) the medical liability environment;
(E) health care quality;
(F) patient safety in terms of detecting, analyzing, and
helping to reduce medical errors and adverse events;
(G) patient and health care provider and organization
satisfaction with the alternative under subsection (a) and
with the medical liability environment; and
(H) impact on utilization of medical services, appropriately adjusted for risk.
(4) FUNDING.—The Secretary shall reserve 5 percent of the
amount appropriated in each fiscal year under subsection (k)
to carry out this subsection.
(h) MEDPAC AND MACPAC REPORTS.—
(1) MEDPAC.—The Medicare Payment Advisory Commission shall conduct an independent review of the alternatives to
current tort litigation that are implemented under grants
under subsection (a) to determine the impact of such alternatives on the Medicare program under title XVIII of the Social Security Act, and its beneficiaries.
(2) MACPAC.—The Medicaid and CHIP Payment and Access Commission shall conduct an independent review of the
alternatives to current tort litigation that are implemented
under grants under subsection (a) to determine the impact of
such alternatives on the Medicaid or CHIP programs under titles XIX and XXI of the Social Security Act, and their beneficiaries.
(3) REPORTS.—Not later than December 31, 2016, the
Medicare Payment Advisory Commission and the Medicaid and
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CHIP Payment and Access Commission shall each submit to
Congress a report that includes the findings and recommendations of each respective Commission based on independent reviews conducted under paragraphs (1) and (2), including an
analysis of the impact of the alternatives reviewed on the efficiency and effectiveness of the respective programs.
(i) OPTION TO PROVIDE FOR INITIAL PLANNING GRANTS.—Of the
funds appropriated pursuant to subsection (k), the Secretary may
use a portion not to exceed $500,000 per State to provide planning
grants to such States for the development of demonstration project
applications meeting the criteria described in subsection (c). In selecting States to receive such planning grants, the Secretary shall
give preference to those States in which State law at the time of
the application would not prohibit the adoption of an alternative to
current tort litigation.
(j) DEFINITIONS.—In this section:
(1) HEALTH CARE SERVICES.—The term ‘‘health care services’’ means any services provided by a health care provider, or
by any individual working under the supervision of a health
care provider, that relate to—
(A) the diagnosis, prevention, or treatment of any
human disease or impairment; or
(B) the assessment of the health of human beings.
(2) HEALTH CARE ORGANIZATION.—The term ‘‘health care
organization’’ means any individual or entity which is obligated
to provide, pay for, or administer health benefits under any
health plan.
(3) HEALTH CARE PROVIDER.—The term ‘‘health care provider’’ means any individual or entity—
(A) licensed, registered, or certified under Federal or
State laws or regulations to provide health care services;
or
(B) required to be so licensed, registered, or certified
but that is exempted by other statute or regulation.
(k) AUTHORIZATION OF APPROPRIATIONS.—There are authorized
to be appropriated to carry out this section, $50,000,000 for the 5fiscal year period beginning with fiscal year 2011.
(l) CURRENT STATE EFFORTS TO ESTABLISH ALTERNATIVE TO
TORT LITIGATION.—Nothing in this section shall be construed to
limit any prior, current, or future efforts of any State to establish
any alternative to tort litigation.
(m) RULE OF CONSTRUCTION.—Nothing in this section shall be
construed as limiting states’ authority over or responsibility for
their state justice systems.
SEC. 399V–5. ø280g–16¿ FOOD SAFETY INTEGRATED CENTERS OF EXCELLENCE.
(a) IN GENERAL.—Not later than 1 year after the date of enact-

ment of the FDA Food Safety Modernization Act, the Secretary,
acting through the Director of the Centers for Disease Control and
Prevention and in consultation with the working group described
in subsection (b)(2), shall designate 5 Integrated Food Safety Centers of Excellence (referred to in this section as the ‘‘Centers of Excellence’’) to serve as resources for Federal, State, and local public
health professionals to respond to foodborne illness outbreaks. The
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Centers of Excellence shall be headquartered at selected State
health departments.
(b) SELECTION OF CENTERS OF EXCELLENCE.—
(1) ELIGIBLE ENTITIES.—To be eligible to be designated as
a Center of Excellence under subsection (a), an entity shall—
(A) be a State health department;
(B) partner with 1 or more institutions of higher education that have demonstrated knowledge, expertise, and
meaningful experience with regional or national food production, processing, and distribution, as well as leadership
in the laboratory, epidemiological, and environmental detection and investigation of foodborne illness; and
(C) provide to the Secretary such information, at such
time, and in such manner, as the Secretary may require.
(2) WORKING GROUP.—Not later than 180 days after the
date of enactment of the FDA Food Safety Modernization Act,
the Secretary shall establish a diverse working group of experts and stakeholders from Federal, State, and local food safety and health agencies, the food industry, including food retailers and food manufacturers, consumer organizations, and academia to make recommendations to the Secretary regarding
designations of the Centers of Excellence.
(3) ADDITIONAL CENTERS OF EXCELLENCE.—The Secretary
may designate eligible entities to be regional Food Safety Centers of Excellence, in addition to the 5 Centers designated
under subsection (a).
(c) ACTIVITIES.—Under the leadership of the Director of the
Centers for Disease Control and Prevention, each Center of Excellence shall be based out of a selected State health department,
which shall provide assistance to other regional, State, and local
departments of health through activities that include—
(1) providing resources, including timely information concerning symptoms and tests, for frontline health professionals
interviewing individuals as part of routine surveillance and
outbreak investigations;
(2) providing analysis of the timeliness and effectiveness of
foodborne disease surveillance and outbreak response activities;
(3) providing training for epidemiological and environmental investigation of foodborne illness, including suggestions
for streamlining and standardizing the investigation process;
(4) establishing fellowships, stipends, and scholarships to
train future epidemiological and food-safety leaders and to address critical workforce shortages;
(5) training and coordinating State and local personnel;
(6) strengthening capacity to participate in existing or new
foodborne illness surveillance and environmental assessment
information systems; and
(7) conducting research and outreach activities focused on
increasing prevention, communication, and education regarding food safety.
(d) REPORT TO CONGRESS.—Not later than 2 years after the
date of enactment of the FDA Food Safety Modernization Act, the
Secretary shall submit to Congress a report that—
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(1) describes the effectiveness of the Centers of Excellence;
and
(2) provides legislative recommendations or describes additional resources required by the Centers of Excellence.
(e) AUTHORIZATION OF APPROPRIATIONS.—There is authorized
to be appropriated such sums as may be necessary to carry out this
section.
(f) NO DUPLICATION OF EFFORT.—In carrying out activities of
the Centers of Excellence or other programs under this section, the
Secretary shall not duplicate other Federal foodborne illness response efforts.

PART Q—PROGRAMS TO IMPROVE THE
HEALTH OF CHILDREN
SEC. 399W. ø280h¿ GRANTS TO PROMOTE CHILDHOOD NUTRITION AND
PHYSICAL ACTIVITY.
(a) IN GENERAL.—The Secretary, acting though the Director of

the Centers for Disease Control and Prevention, shall award competitive grants to States and political subdivisions of States for the
development and implementation of State and community-based
intervention programs to promote good nutrition and physical activity in children and adolescents.
(b) ELIGIBILITY.—To be eligible to receive a grant under this
section a State or political subdivision of a State shall prepare and
submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require,
including a plan that describes—
(1) how the applicant proposes to develop a comprehensive
program of school- and community-based approaches to encourage and promote good nutrition and appropriate levels of physical activity with respect to children or adolescents in local
communities;
(2) the manner in which the applicant shall coordinate
with appropriate State and local authorities, such as State and
local school departments, State departments of health, chronic
disease directors, State directors of programs under section 17
of the Child Nutrition Act of 1966, 5-a-day coordinators, governors councils for physical activity and good nutrition, and
State and local parks and recreation departments; and
(3) the manner in which the applicant will evaluate the effectiveness of the program carried out under this section.
(c) USE OF FUNDS.—A State or political subdivision of a State
shall use amount received under a grant under this section to—
(1) develop, implement, disseminate, and evaluate schooland community-based strategies in States to reduce inactivity
and improve dietary choices among children and adolescents;
(2) expand opportunities for physical activity programs in
school- and community-based settings; and
(3) develop, implement, and evaluate programs that promote good eating habits and physical activity including opportunities for children with cognitive and physical disabilities.
(d) TECHNICAL ASSISTANCE.—The Secretary may set-aside an
amount not to exceed 10 percent of the amount appropriated for a
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fiscal year under subsection (h) to permit the Director of the Centers for Disease Control and Prevention to—
(1) provide States and political subdivisions of States with
technical support in the development and implementation of
programs under this section; and
(2) disseminate information about effective strategies and
interventions in preventing and treating obesity through the
promotion of good nutrition and physical activity.
(e) LIMITATION ON ADMINISTRATIVE COSTS.—Not to exceed 10
percent of the amount of a grant awarded to the State or political
subdivision under subsection (a) for a fiscal year may be used by
the State or political subdivision for administrative expenses.
(f ) TERM.—A grant awarded under subsection (a) shall be for
a term of 3 years.
(g) DEFINITION.—In this section, the term ‘‘children and adolescents’’ means individuals who do not exceed 18 years of age.
(h) AUTHORIZATION OF APPROPRIATIONS.—There are authorized
to be appropriated to carry out this section such sums as may be
necessary for each of the fiscal years 2001 through 2005.
SEC. 399X. ø280h–1¿ APPLIED RESEARCH PROGRAM.
(a) IN GENERAL.—The Secretary, acting through

the Centers
for Disease Control and Prevention and in consultation with the
Director of the National Institutes of Health, shall—
(1) conduct research to better understand the relationship
between physical activity, diet, and health and factors that influence health-related behaviors;
(2) develop and evaluate strategies for the prevention and
treatment of obesity to be used in community-based interventions and by health professionals;
(3) develop and evaluate strategies for the prevention and
treatment of eating disorders, such as anorexia and bulimia;
(4) conduct research to establish the prevalence, consequences, and costs of childhood obesity and its effects in
adulthood;
(5) identify behaviors and risk factors that contribute to
obesity;
(6) evaluate materials and programs to provide nutrition
education to parents and teachers of children in child care or
pre-school and the food service staff of such child care and preschool entities; and
(7) evaluate materials and programs that are designed to
educate and encourage physical activity in child care and preschool facilities.
(b) AUTHORIZATION OF APPROPRIATIONS.—There are authorized
to be appropriated to carry out this section such sums as may be
necessary for each of the fiscal years 2001 through 2005.
SEC. 399Y. ø280h–2¿ EDUCATION CAMPAIGN.
(a) IN GENERAL.—The Secretary, acting

through the Director of
the Centers for Disease Control and Prevention, and in collaboration with national, State, and local partners, physical activity organizations, nutrition experts, and health professional organizations,
shall develop a national public campaign to promote and educate
children and their parents concerning—
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(1) the health risks associated with obesity, inactivity, and
poor nutrition;
(2) ways in which to incorporate physical activity into daily
living; and
(3) the benefits of good nutrition and strategies to improve
eating habits.
(b) AUTHORIZATION OF APPROPRIATIONS.—There are authorized
to be appropriated to carry out this section such sums as may be
necessary for each of the fiscal years 2001 through 2005.
SEC. 399Z. ø280h–3¿ HEALTH PROFESSIONAL EDUCATION AND TRAINING.
(a) IN GENERAL.—The Secretary, acting through the Director of

the Centers for Disease Control and Prevention, in collaboration
with the Administrator of the Health Resources and Services Administration and the heads of other agencies, and in consultation
with appropriate health professional associations, shall develop and
carry out a program to educate and train health professionals in
effective strategies to—
(1) better identify and assess patients with obesity or an
eating disorder or patients at-risk of becoming obese or developing an eating disorder;
(2) counsel, refer, or treat patients with obesity or an eating disorder; and
(3) educate patients and their families about effective
strategies to improve dietary habits and establish appropriate
levels of physical activity.
(b) AUTHORIZATION OF APPROPRIATIONS.—There are authorized
to be appropriated to carry out this section such sums as may be
necessary for each of the fiscal years 2001 through 2005.
SEC. 399Z–1. ø280h–5¿ SCHOOL-BASED HEALTH CENTERS.
(a) DEFINITIONS; ESTABLISHMENT OF CRITERIA.—In this section:
(1) COMPREHENSIVE PRIMARY HEALTH SERVICES.—The term

‘‘comprehensive primary health services’’ means the core services offered by school-based health centers, which shall include
the following:
(A) PHYSICAL.—Comprehensive health assessments,
diagnosis, and treatment of minor, acute, and chronic medical conditions, and referrals to, and follow-up for, specialty care and oral and vision health services.
(B) MENTAL HEALTH.—Mental health and substance
use disorder assessments, crisis intervention, counseling,
treatment, and referral to a continuum of services including emergency psychiatric care, community support programs, inpatient care, and outpatient programs.
(2) MEDICALLY UNDERSERVED CHILDREN AND ADOLESCENTS.—
(A) IN GENERAL.—The term ‘‘medically underserved
children and adolescents’’ means a population of children
and adolescents who are residents of an area designated as
a medically underserved area or a health professional
shortage area by the Secretary.
(B) CRITERIA.—The Secretary shall prescribe criteria
for determining the specific shortages of personal health
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services for medically underserved children and adolescents under subparagraph (A) that shall—
(i) take into account any comments received by
the Secretary from the chief executive officer of a
State and local officials in a State; and
(ii) include factors indicative of the health status
of such children and adolescents of an area, including
the ability of the residents of such area to pay for
health services, the accessibility of such services, the
availability of health professionals to such children
and adolescents, and other factors as determined appropriate by the Secretary.
(3) SCHOOL-BASED HEALTH CENTER.—The term ‘‘schoolbased health center’’ means a health clinic that—
(A) meets the definition of a school-based health center under section 2110(c)(9)(A) of the Social Security Act
and is administered by a sponsoring facility (as defined in
section 2110(c)(9)(B) of the Social Security Act);
(B) provides, at a minimum, comprehensive primary
health services during school hours to children and adolescents by health professionals in accordance with established standards, community practice, reporting laws, and
other State laws, including parental consent and notification laws that are not inconsistent with Federal law; and
(C) does not perform abortion services.
(b) AUTHORITY TO AWARD GRANTS.—The Secretary shall award
grants for the costs of the operation of school-based health centers
(referred to in this section as ‘‘SBHCs’’) that meet the requirements
of this section.
(c) APPLICATIONS.—To be eligible to receive a grant under this
section, an entity shall—
(1) be an SBHC (as defined in subsection (a)(3)); and
(2) submit to the Secretary an application at such time, in
such manner, and containing—
(A) evidence that the applicant meets all criteria necessary to be designated an SBHC;
(B) evidence of local need for the services to be provided by the SBHC;
(C) an assurance that—
(i) SBHC services will be provided to those children and adolescents for whom parental or guardian
consent has been obtained in cooperation with Federal, State, and local laws governing health care service provision to children and adolescents;
(ii) the SBHC has made and will continue to make
every reasonable effort to establish and maintain collaborative relationships with other health care providers in the catchment area of the SBHC;
(iii) the SBHC will provide on-site access during
the academic day when school is in session and 24hour coverage through an on-call system and through
its backup health providers to ensure access to services on a year-round basis when the school or the
SBHC is closed;
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(iv) the SBHC will be integrated into the school
environment and will coordinate health services with
school personnel, such as administrators, teachers,
nurses, counselors, and support personnel, as well as
with other community providers co-located at the
school;
(v) the SBHC sponsoring facility assumes all responsibility for the SBHC administration, operations,
and oversight; and
(vi) the SBHC will comply with Federal, State,
and local laws concerning patient privacy and student
records, including regulations promulgated under the
Health Insurance Portability and Accountability Act of
1996 and section 444 of the General Education Provisions Act; and
(D) such other information as the Secretary may require.
(d) PREFERENCES AND CONSIDERATION.—In reviewing applications:
(1) The Secretary may give preference to applicants who
demonstrate an ability to serve the following:
(A) Communities that have evidenced barriers to primary health care and mental health and substance use
disorder prevention services for children and adolescents.
(B) Communities with high per capita numbers of children and adolescents who are uninsured, underinsured, or
enrolled in public health insurance programs.
(C) Populations of children and adolescents that have
historically demonstrated difficulty in accessing health and
mental health and substance use disorder prevention services.
(2) The Secretary may give consideration to whether an
applicant has received a grant under subsection (a) of section
4101 of the Patient Protection and Affordable Care Act.
(e) WAIVER OF REQUIREMENTS.—The Secretary may—
(1) under appropriate circumstances, waive the application
of all or part of the requirements of this subsection with respect to an SBHC for not to exceed 2 years; and
(2) upon a showing of good cause, waive the requirement
that the SBHC provide all required comprehensive primary
health services for a designated period of time to be determined by the Secretary.
(f) USE OF FUNDS.—
(1) FUNDS.—Funds awarded under a grant under this section—
(A) may be used for—
(i) acquiring and leasing equipment (including the
costs of amortizing the principle of, and paying interest on, loans for such equipment);
(ii) providing training related to the provision of
required comprehensive primary health services and
additional health services;
(iii) the management and operation of health center programs;
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(iv) the payment of salaries for physicians, nurses,
and other personnel of the SBHC; and
(B) may not be used to provide abortions.
(2) CONSTRUCTION.—The Secretary may award grants
which may be used to pay the costs associated with expanding
and modernizing existing buildings for use as an SBHC, including the purchase of trailers or manufactured buildings to
install on the school property.
(3) LIMITATIONS.—
(A) IN GENERAL.—Any provider of services that is determined by a State to be in violation of a State law described in subsection (a)(3)(B) with respect to activities
carried out at a SBHC shall not be eligible to receive additional funding under this section.
(B) NO OVERLAPPING GRANT PERIOD.—No entity that
has received funding under section 330 for a grant period
shall be eligible for a grant under this section for with respect to the same grant period.
(g) MATCHING REQUIREMENT.—
(1) IN GENERAL.—Each eligible entity that receives a grant
under this section shall provide, from non-Federal sources, an
amount equal to 20 percent of the amount of the grant (which
may be provided in cash or in-kind) to carry out the activities
supported by the grant.
(2) WAIVER.—The Secretary may waive all or part of the
matching requirement described in paragraph (1) for any fiscal
year for the SBHC if the Secretary determines that applying
the matching requirement to the SBHC would result in serious
hardship or an inability to carry out the purposes of this section.
(h) SUPPLEMENT, NOT SUPPLANT.—Grant funds provided under
this section shall be used to supplement, not supplant, other Federal or State funds.
(i) EVALUATION.—The Secretary shall develop and implement a
plan for evaluating SBHCs and monitoring quality performance
under the awards made under this section.
(j) AGE APPROPRIATE SERVICES.—An eligible entity receiving
funds under this section shall only provide age appropriate services
through a SBHC funded under this section to an individual.
(k) PARENTAL CONSENT.—An eligible entity receiving funds
under this section shall not provide services through a SBHC funded under this section to an individual without the consent of the
parent or guardian of such individual if such individual is considered a minor under applicable State law.
(l) AUTHORIZATION OF APPROPRIATIONS.—For purposes of carrying out this section, there are authorized to be appropriated such
sums as may be necessary for each of the fiscal years 2010 through
2014.

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PART R—PROGRAMS RELATING TO AUTISM
SEC. 399AA. ø280i¿ DEVELOPMENTAL DISABILITIES SURVEILLANCE
AND RESEARCH PROGRAM.
(a) AUTISM SPECTRUM DISORDER AND OTHER DEVELOPMENTAL
DISABILITIES.—
(1) IN GENERAL.—The Secretary, acting through the Direc-

tor of the Centers for Disease Control and Prevention, may
award grants or cooperative agreements to eligible entities for
the collection, analysis, and reporting of State epidemiological
data on autism spectrum disorder and other developmental
disabilities. An eligible entity shall assist with the development and coordination of State autism spectrum disorder and
other developmental disability surveillance efforts within a region. In making such awards, the Secretary may provide direct
technical assistance in lieu of cash.
(2) DATA STANDARDS.—In submitting epidemiological data
to the Secretary pursuant to paragraph (1), an eligible entity
shall report data according to guidelines prescribed by the Director of the Centers for Disease Control and Prevention, after
consultation with relevant State and local public health officials, private sector developmental disability researchers, and
advocates for individuals with autism spectrum disorder or
other developmental disabilities.
(3) ELIGIBILITY.—To be eligible to receive an award under
paragraph (1), an entity shall be a public or nonprofit private
entity (including a health department of a State or a political
subdivision of a State, a university, or any other educational
institution), and submit to the Secretary an application at such
time, in such manner, and containing such information as the
Secretary may require.
(b) CENTERS OF EXCELLENCE IN AUTISM SPECTRUM DISORDER
EPIDEMIOLOGY.—
(1) IN GENERAL.—The Secretary, acting through the Director of the Centers for Disease Control and Prevention, shall,
subject to the availability of appropriations, award grants or
cooperative agreements for the establishment of regional centers of excellence in autism spectrum disorder and other developmental disabilities epidemiology for the purpose of collecting
and analyzing information on the number, incidence, correlates, and causes of autism spectrum disorder and other developmental disabilities.
(2) REQUIREMENTS.—To be eligible to receive a grant or cooperative agreement under paragraph (1), an entity shall submit to the Secretary an application containing such agreements
and information as the Secretary may require, including an
agreement that the center to be established under the grant or
cooperative agreement shall operate in accordance with the following:
(A) The center will collect, analyze, and report autism
spectrum disorder and other developmental disability data
according to guidelines prescribed by the Director of the
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cials, private sector developmental disability researchers,
and advocates for individuals with developmental disabilities.
(B) The center will develop or extend an area of special research expertise (including genetics, epigenetics, and
epidemiological research related to environmental exposures), immunology, and other relevant research specialty
areas.
(C) The center will identify eligible cases and controls
through its surveillance system and conduct research into
factors which may cause or increase the risk of autism
spectrum disorder and other developmental disabilities.
(c) FEDERAL RESPONSE.—The Secretary shall coordinate the
Federal response to requests for assistance from State health, mental health, and education department officials regarding potential
or alleged autism spectrum disorder or developmental disability
clusters.
(d) DEFINITIONS.—In this part:
(1) OTHER DEVELOPMENTAL DISABILITIES.—The term ‘‘other
developmental disabilities’’ has the meaning given the term
‘‘developmental disability’’ in section 102(8) of the Developmental Disabilities Assistance and Bill of Rights Act of 2000
(42 U.S.C. 15002(8)).
(2) STATE.—The term ‘‘State’’ means each of the several
States, the District of Columbia, the Commonwealth of Puerto
Rico, American Samoa, Guam, the Commonwealth of the
Northern Mariana Islands, the Virgin Islands, and the Trust
Territory of the Pacific Islands.
(e) SUNSET.—This section shall not apply after September 30,
2014.
SEC. 399BB. ø280i–1¿ AUTISM EDUCATION, EARLY DETECTION, AND
INTERVENTION.
(a) PURPOSE.—It is the purpose of this section—

(1) to increase awareness, reduce barriers to screening and
diagnosis, promote evidence-based interventions for individuals
with autism spectrum disorder or other developmental disabilities, and train professionals to utilize valid and reliable
screening tools to diagnose or rule out and provide evidencebased interventions for children with autism spectrum disorder
and other developmental disabilities; and
(2) to conduct activities under this section with a focus on
an interdisciplinary approach (as defined in programs developed under section 501(a)(2) of the Social Security Act) that
will also focus on specific issues for children who are not receiving an early diagnosis and subsequent interventions.
(b) IN GENERAL.—The Secretary shall, subject to the availability of appropriations, establish and evaluate activities to—
(1) provide information and education on autism spectrum
disorder and other developmental disabilities to increase public
awareness of developmental milestones;
(2) promote research into the development and validation
of reliable screening tools for autism spectrum disorder and
other developmental disabilities and disseminate information
regarding those screening tools;
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(3) promote early screening of individuals at higher risk
for autism spectrum disorder and other developmental disabilities as early as practicable, given evidence-based screening
techniques and interventions;
(4) increase the number of individuals who are able to confirm or rule out a diagnosis of autism spectrum disorder and
other developmental disabilities;
(5) increase the number of individuals able to provide evidence-based interventions for individuals diagnosed with autism spectrum disorder or other developmental disabilities; and
(6) promote the use of evidence-based interventions for individuals at higher risk for autism spectrum disorder and
other developmental disabilities as early as practicable.
(c) INFORMATION AND EDUCATION.—
(1) IN GENERAL.—In carrying out subsection (b)(1), the Secretary, in collaboration with the Secretary of Education and
the Secretary of Agriculture, shall, subject to the availability of
appropriations, provide culturally competent information regarding autism spectrum disorder and other developmental
disabilities, risk factors, characteristics, identification, diagnosis or rule out, and evidence-based interventions to meet the
needs of individuals with autism spectrum disorder or other
developmental disabilities and their families through—
(A) Federal programs, including—
(i) the Head Start program;
(ii) the Early Start program;
(iii) the Healthy Start program;
(iv) programs under the Child Care and Development Block Grant Act of 1990;
(v) programs under title XIX of the Social Security
Act (particularly the Medicaid Early and Periodic
Screening, Diagnosis and Treatment Program);
(vi) the program under title XXI of the Social Security Act (the State Children’s Health Insurance Program);
(vii) the program under title V of the Social Security Act (the Maternal and Child Health Block Grant
Program);
(viii) the program under parts B and C of the Individuals with Disabilities Education Act;
(ix) the special supplemental nutrition program
for women, infants, and children established under
section 17 of the Child Nutrition Act of 1966 (42
U.S.C. 1786); and
(x) the State grant program under the Rehabilitation Act of 1973.
(B) State licensed child care facilities; and
(C) other community-based organizations or points of
entry for individuals with autism spectrum disorder and
other developmental disabilities to receive services.
(2) LEAD AGENCY.—
(A) DESIGNATION.—As a condition on the provision of
assistance or the conduct of activities under this section
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with respect to a State, the Secretary may require the
Governor of the State—
(i) to designate a public agency as a lead agency
to coordinate the activities provided for under paragraph (1) in the State at the State level; and
(ii) acting through such lead agency, to make
available to individuals and their family members,
guardians, advocates, or authorized representatives;
providers; and other appropriate individuals in the
State, comprehensive culturally competent information
about State and local resources regarding autism spectrum disorder and other developmental disabilities,
risk factors, characteristics, identification, diagnosis or
rule out, available services and supports, and evidence-based interventions.
(B) REQUIREMENTS OF AGENCY.—In designating the
lead agency under subparagraph (A)(i), the Governor
shall—
(i) select an agency that has demonstrated experience and expertise in—
(I) autism spectrum disorder and other developmental disability issues; and
(II) developing, implementing, conducting,
and administering programs and delivering education, information, and referral services (including
technology-based
curriculum-development
services) to individuals with developmental disabilities and their family members, guardians, advocates or authorized representatives, providers,
and other appropriate individuals locally and
across the State; and
(ii) consider input from individuals with developmental disabilities and their family members, guardians, advocates or authorized representatives, providers, and other appropriate individuals.
(C) INFORMATION.—Information under subparagraph
(A)(ii) shall be provided through—
(i) toll-free telephone numbers;
(ii) Internet websites;
(iii) mailings; or
(iv) such other means as the Governor may require.
(d) TOOLS.—
(1) IN GENERAL.—To promote the use of valid and reliable
screening tools for autism spectrum disorder and other developmental disabilities, the Secretary shall develop a curriculum
for continuing education to assist individuals in recognizing
the need for valid and reliable screening tools and the use of
such tools.
(2) COLLECTION, STORAGE, COORDINATION, AND AVAILABILITY.—The Secretary, in collaboration with the Secretary of
Education, shall provide for the collection, storage, coordination, and public availability of tools described in paragraph (1),
educational materials and other products that are used by the
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Federal programs referred to in subsection (c)(1)(A), as well
as—
(A) programs authorized under the Developmental
Disabilities Assistance and Bill of Rights Act of 2000;
(B) early intervention programs or interagency coordinating councils authorized under part C of the Individuals
with Disabilities Education Act; and
(C) children with special health care needs programs
authorized under title V of the Social Security Act.
(3) REQUIRED SHARING.—In establishing mechanisms and
entities under this subsection, the Secretary, and the Secretary
of Education, shall ensure the sharing of tools, materials, and
products developed under this subsection among entities receiving funding under this section.
(e) DIAGNOSIS.—
(1) TRAINING.—The Secretary, in coordination with activities conducted under title V of the Social Security Act, shall,
subject to the availability of appropriations, expand existing
interdisciplinary training opportunities or opportunities to increase the number of sites able to diagnose or rule out individuals with autism spectrum disorder or other developmental
disabilities and ensure that—
(A) competitive grants or cooperative agreements are
awarded to public or nonprofit agencies, including institutions of higher education, to expand existing or develop
new maternal and child health interdisciplinary leadership
education in neurodevelopmental and related disabilities
programs (similar to the programs developed under section
501(a)(2) of the Social Security Act) in States that do not
have such a program;
(B) trainees under such training programs—
(i) receive an appropriate balance of academic,
clinical, and community opportunities;
(ii) are culturally competent;
(iii) are ethnically diverse;
(iv) demonstrate a capacity to evaluate, diagnose
or rule out, develop, and provide evidence-based interventions to individuals with autism spectrum disorder
and other developmental disabilities; and
(v) demonstrate an ability to use a family-centered
approach; and
(C) program sites provide culturally competent services.
(2) TECHNICAL ASSISTANCE.—The Secretary may award one
or more grants under this section to provide technical assistance to the network of interdisciplinary training programs.
(3) BEST PRACTICES.—The Secretary shall promote research into additional valid and reliable tools for shortening
the time required to confirm or rule out a diagnosis of autism
spectrum disorder or other developmental disabilities and detecting individuals with autism spectrum disorder or other developmental disabilities at an earlier age.
(f) INTERVENTION.—The Secretary shall promote research,
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tices for interventions for individuals with autism spectrum disorder or other developmental disabilities, develop guidelines for
those interventions, and disseminate information related to such
research and guidelines.
(g) SUNSET.—This section shall not apply after September 30,
2014.
SEC. 399CC. ø280i–2¿ INTERAGENCY AUTISM COORDINATING COMMITTEE.
(a) ESTABLISHMENT.—The Secretary shall establish a com-

mittee, to be known as the ‘‘Interagency Autism Coordinating Committee’’ (in this section referred to as the ‘‘Committee’’), to coordinate all efforts within the Department of Health and Human Services concerning autism spectrum disorder.
(b) RESPONSIBILITIES.—In carrying out its duties under this
section, the Committee shall—
(1) develop and annually update a summary of advances in
autism spectrum disorder research related to causes, prevention, treatment, early screening, diagnosis or rule out, intervention, and access to services and supports for individuals
with autism spectrum disorder;
(2) monitor Federal activities with respect to autism spectrum disorder;
(3) make recommendations to the Secretary regarding any
appropriate changes to such activities, including recommendations to the Director of NIH with respect to the strategic plan
developed under paragraph (5);
(4) make recommendations to the Secretary regarding public participation in decisions relating to autism spectrum disorder;
(5) develop and annually update a strategic plan for the
conduct of, and support for, autism spectrum disorder research,
including proposed budgetary requirements; and
(6) submit to the Congress such strategic plan and any updates to such plan.
(c) MEMBERSHIP.—
(1) IN GENERAL.—The Committee shall be composed of—
(A) the Director of the Centers for Disease Control and
Prevention;
(B) the Director of the National Institutes of Health,
and the Directors of such national research institutes of
the National Institutes of Health as the Secretary determines appropriate;
(C) the heads of such other agencies as the Secretary
determines appropriate;
(D) representatives of other Federal Governmental
agencies that serve individuals with autism spectrum disorder such as the Department of Education; and
(E) the additional members appointed under paragraph (2).
(2) ADDITIONAL MEMBERS.—Not fewer than 6 members of
the Committee, or 1/3 of the total membership of the Committee, whichever is greater, shall be composed of non-Federal
public members to be appointed by the Secretary, of which—
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(A) at least one such member shall be an individual
with a diagnosis of autism spectrum disorder;
(B) at least one such member shall be a parent or
legal guardian of an individual with an autism spectrum
disorder; and
(C) at least one such member shall be a representative
of leading research, advocacy, and service organizations for
individuals with autism spectrum disorder.
(d) ADMINISTRATIVE SUPPORT; TERMS OF SERVICE; OTHER PROVISIONS.—The following provisions shall apply with respect to the
Committee:
(1) The Committee shall receive necessary and appropriate
administrative support from the Secretary.
(2) Members of the Committee appointed under subsection
(c)(2) shall serve for a term of 4 years, and may be reappointed
for one or more additional 4 year term. Any member appointed
to fill a vacancy for an unexpired term shall be appointed for
the remainder of such term. A member may serve after the expiration of the member’s term until a successor has taken office.
(3) The Committee shall meet at the call of the chairperson
or upon the request of the Secretary. The Committee shall
meet not fewer than 2 times each year.
(4) All meetings of the Committee shall be public and shall
include appropriate time periods for questions and presentations by the public.
(e) SUBCOMMITTEES; ESTABLISHMENT AND MEMBERSHIP.—In
carrying out its functions, the Committee may establish subcommittees and convene workshops and conferences. Such subcommittees shall be composed of Committee members and may
hold such meetings as are necessary to enable the subcommittees
to carry out their duties.
(f) SUNSET.—This section shall not apply after September 30,
2014, and the Committee shall be terminated on such date.
SEC. 399DD. ø280i–3¿ REPORT TO CONGRESS.
(a) IN GENERAL.—Not later than 2 years

after the date of enactment of the Combating Autism Reauthorization Act of 2011, the
Secretary, in coordination with the Secretary of Education, shall
prepare and submit to the Health, Education, Labor, and Pensions
Committee of the Senate and the Energy and Commerce Committee of the House of Representatives a progress report on activities related to autism spectrum disorder and other developmental
disabilities.
(b) CONTENTS.—The report submitted under subsection (a)
shall contain—
(1) a description of the progress made in implementing the
provisions of the Combating Autism Act of 2006;
(2) a description of the amounts expended on the implementation of the particular provisions of Combating Autism
Act of 2006;
(3) information on the incidence of autism spectrum disorder and trend data of such incidence since the date of enactment of the Combating Autism Act of 2006;
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(4) information on the average age of diagnosis for children
with autism spectrum disorder and other disabilities, including
how that age may have changed over the 6-year period beginning on the date of enactment of the Combating Autism Act of
2006;
(5) information on the average age for intervention for individuals diagnosed with autism spectrum disorder and other
developmental disabilities, including how that age may have
changed over the 6-year period beginning on the date of enactment of the Combating Autism Act of 2006;
(6) information on the average time between initial screening and then diagnosis or rule out for individuals with autism
spectrum disorder or other developmental disabilities, as well
as information on the average time between diagnosis and evidence-based intervention for individuals with autism spectrum
disorder or other developmental disabilities;
(7) information on the effectiveness and outcomes of interventions for individuals diagnosed with autism spectrum disorder, including by various subtypes, and other developmental
disabilities and how the age of the child may affect such effectiveness;
(8) information on the effectiveness and outcomes of innovative and newly developed intervention strategies for individuals with autism spectrum disorder or other developmental
disabilities; and
(9) information on services and supports provided to individuals with autism spectrum disorder and other developmental disabilities who have reached the age of majority (as
defined for purposes of section 615(m) of the Individuals with
Disabilities Education Act (20 U.S.C. 1415(m)).
SEC. 399EE. ø280i–4¿ AUTHORIZATION OF APPROPRIATIONS.
(a) DEVELOPMENTAL DISABILITIES SURVEILLANCE AND RESEARCH PROGRAM.—To carry out section 399AA, there is authorized

to be appropriated $22,000,000 for each of fiscal years 2012
through 2014.
(b) AUTISM EDUCATION, EARLY DETECTION, AND INTERVENTION.—To carry out section 399BB, there is authorized to be appropriated $48,000,000 for each of fiscal years 2011 through 2014.
(c) INTERAGENCY AUTISM COORDINATING COMMITTEE; CERTAIN
OTHER PROGRAMS.—To carry out sections 399CC, 404H, and 409C,
there is authorized to be appropriated $161,000,000 for each of fiscal years 2011 through 2014.

PART S—HEALTH CARE QUALITY PROGRAMS
Subpart I—National Strategy for Quality
Improvement in Health Care
SEC. 399HH. ø280j¿ NATIONAL STRATEGY FOR QUALITY IMPROVEMENT
IN HEALTH CARE.
(a) ESTABLISHMENT OF NATIONAL STRATEGY AND PRIORITIES.—
(1) NATIONAL STRATEGY.—The Secretary, through a trans-

parent collaborative process, shall establish a national strategy
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to improve the delivery of health care services, patient health
outcomes, and population health.
(2) IDENTIFICATION OF PRIORITIES.—
(A) IN GENERAL.—The Secretary shall identify national
priorities for improvement in developing the strategy
under paragraph (1).
(B) REQUIREMENTS.—The Secretary shall ensure that
priorities identified under subparagraph (A) will—
(i) have the greatest potential for improving the
health outcomes, efficiency, and patient-centeredness
of health care for all populations, including children
and vulnerable populations;
(ii) identify areas in the delivery of health care
services that have the potential for rapid improvement
in the quality and efficiency of patient care;
(iii) address gaps in quality, efficiency, comparative effectiveness information (taking into consideration the limitations set forth in subsections (c) and
(d) of section 1182 of the Social Security Act), and
health outcomes measures and data aggregation techniques;
(iv) improve Federal payment policy to emphasize
quality and efficiency;
(v) enhance the use of health care data to improve
quality, efficiency, transparency, and outcomes;
(vi) address the health care provided to patients
with high-cost chronic diseases;
(vii) improve research and dissemination of strategies and best practices to improve patient safety and
reduce medical errors, preventable admissions and readmissions, and health care-associated infections;
(viii) reduce health disparities across health disparity populations (as defined in section 485E) and geographic areas; and
(ix) address other areas as determined appropriate
by the Secretary.
(C) CONSIDERATIONS.—In identifying priorities under
subparagraph (A), the Secretary shall take into consideration the recommendations submitted by the entity with a
contract under section 1890(a) of the Social Security Act
and other stakeholders.
(D) COORDINATION WITH STATE AGENCIES.—The Secretary shall collaborate, coordinate, and consult with State
agencies responsible for administering the Medicaid program under title XIX of the Social Security Act and the
Children’s Health Insurance Program under title XXI of
such Act with respect to developing and disseminating
strategies, goals, models, and timetables that are consistent with the national priorities identified under subparagraph (A).
(b) STRATEGIC PLAN.—
(1) IN GENERAL.—The national strategy shall include a
comprehensive strategic plan to achieve the priorities described
in subsection (a).
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(2) REQUIREMENTS.—The strategic plan shall include provisions for addressing, at a minimum, the following:
(A) Coordination among agencies within the Department, which shall include steps to minimize duplication of
efforts and utilization of common quality measures, where
available. Such common quality measures shall be measures identified by the Secretary under section 1139A or
1139B of the Social Security Act or endorsed under section
1890 of such Act.
(B) Agency-specific strategic plans to achieve national
priorities.
(C) Establishment of annual benchmarks for each relevant agency to achieve national priorities.
(D) A process for regular reporting by the agencies to
the Secretary on the implementation of the strategic plan.
(E) Strategies to align public and private payers with
regard to quality and patient safety efforts.
(F) Incorporating quality improvement and measurement in the strategic plan for health information technology required by the American Recovery and Reinvestment Act of 2009 (Public Law 111–5).
(c) PERIODIC UPDATE OF NATIONAL STRATEGY.—The Secretary
shall update the national strategy not less than annually. Any such
update shall include a review of short- and long-term goals.
(d) SUBMISSION AND AVAILABILITY OF NATIONAL STRATEGY AND
UPDATES.—
(1) DEADLINE FOR INITIAL SUBMISSION OF NATIONAL STRATEGY.—Not later than January 1, 2011, the Secretary shall submit to the relevant committees of Congress the national strategy described in subsection (a).
(2) UPDATES.—
(A) IN GENERAL.—The Secretary shall submit to the
relevant committees of Congress an annual update to the
strategy described in paragraph (1).
(B) INFORMATION SUBMITTED.—Each update submitted
under subparagraph (A) shall include—
(i) a review of the short- and long-term goals of
the national strategy and any gaps in such strategy;
(ii) an analysis of the progress, or lack of progress,
in meeting such goals and any barriers to such
progress;
(iii) the information reported under section 1139A
of the Social Security Act, consistent with the reporting requirements of such section; and
(iv) in the case of an update required to be submitted on or after January 1, 2014, the information reported under section 1139B(b)(4) of the Social Security
Act, consistent with the reporting requirements of
such section.
(C) SATISFACTION OF OTHER REPORTING REQUIREMENTS.—Compliance with the requirements of clauses (iii)
and (iv) of subparagraph (B) shall satisfy the reporting requirements under sections 1139A(a)(6) and 1139B(b)(4), respectively, of the Social Security Act.
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(e) HEALTH CARE QUALITY INTERNET WEBSITE.—Not later than
January 1, 2011, the Secretary shall create an Internet website to
make public information regarding—
(1) the national priorities for health care quality improvement established under subsection (a)(2);
(2) the agency-specific strategic plans for health care quality described in subsection (b)(2)(B); and
(3) other information, as the Secretary determines to be
appropriate.
SEC. 399II. ø280j–1¿ COLLECTION AND ANALYSIS OF DATA FOR QUALITY AND RESOURCE USE MEASURES.
(a) IN GENERAL.—
(1) ESTABLISHMENT OF STRATEGIC FRAMEWORK.—The Sec-

retary shall establish and implement an overall strategic
framework to carry out the public reporting of performance information, as described in section 399JJ. Such strategic framework may include methods and related timelines for implementing nationally consistent data collection, data aggregation,
and analysis methods.
(2) COLLECTION AND AGGREGATION OF DATA.—The Secretary shall collect and aggregate consistent data on quality
and resource use measures from information systems used to
support health care delivery, and may award grants or contracts for this purpose. The Secretary shall align such collection and aggregation efforts with the requirements and assistance regarding the expansion of health information technology
systems, the interoperability of such technology systems, and
related standards that are in effect on the date of enactment
of the Patient Protection and Affordable Care Act.
(3) SCOPE.—The Secretary shall ensure that the data collection, data aggregation, and analysis systems described in
paragraph (1) involve an increasingly broad range of patient
populations, providers, and geographic areas over time.
(b) GRANTS OR CONTRACTS FOR DATA COLLECTION.—
(1) IN GENERAL.—The Secretary may award grants or contracts to eligible entities to support new, or improve existing,
efforts to collect and aggregate quality and resource use measures described under subsection (c).
(2) ELIGIBLE ENTITIES.—To be eligible for a grant or contract under this subsection, an entity shall—
(A) be—
(i) a multi-stakeholder entity that coordinates the
development of methods and implementation plans for
the consistent reporting of summary quality and cost
information;
(ii) an entity capable of submitting such summary
data for a particular population and providers, such as
a disease registry, regional collaboration, health plan
collaboration, or other population-wide source; or
(iii) a Federal Indian Health Service program or a
health program operated by an Indian tribe (as defined in section 4 of the Indian Health Care Improvement Act);
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(B) promote the use of the systems that provide data
to improve and coordinate patient care;
(C) support the provision of timely, consistent quality
and resource use information to health care providers, and
other groups and organizations as appropriate, with an opportunity for providers to correct inaccurate measures; and
(D) agree to report, as determined by the Secretary,
measures on quality and resource use to the public in accordance with the public reporting process established
under section 399JJ.
(c) CONSISTENT DATA AGGREGATION.—The Secretary may
award grants or contracts under this section only to entities that
enable summary data that can be integrated and compared across
multiple sources. The Secretary shall provide standards for the protection of the security and privacy of patient data.
(d) MATCHING FUNDS.—The Secretary may not award a grant
or contract under this section to an entity unless the entity agrees
that it will make available (directly or through contributions from
other public or private entities) non-Federal contributions toward
the activities to be carried out under the grant or contract in an
amount equal to $1 for each $5 of Federal funds provided under the
grant or contract. Such non-Federal matching funds may be provided directly or through donations from public or private entities
and may be in cash or in-kind, fairly evaluated, including plant,
equipment, or services.
(e) AUTHORIZATION OF APPROPRIATIONS.—To carry out this section, there are authorized to be appropriated such sums as may be
necessary for fiscal years 2010 through 2014.
SEC. 399JJ. ø280j–2¿ PUBLIC REPORTING OF PERFORMANCE INFORMATION.
(a) DEVELOPMENT OF PERFORMANCE WEBSITES.—The Secretary

shall make available to the public, through standardized Internet
websites, performance information summarizing data on quality
measures. Such information shall be tailored to respond to the differing needs of hospitals and other institutional health care providers, physicians and other clinicians, patients, consumers, researchers, policymakers, States, and other stakeholders, as the Secretary may specify.
(b) INFORMATION ON CONDITIONS.—The performance information made publicly available on an Internet website, as described
in subsection (a), shall include information regarding clinical conditions to the extent such information is available, and the information shall, where appropriate, be provider-specific and sufficiently
disaggregated and specific to meet the needs of patients with different clinical conditions.
(c) CONSULTATION.—
(1) IN GENERAL.—In carrying out this section, the Secretary shall consult with the entity with a contract under section 1890(a) of the Social Security Act, and other entities, as
appropriate, to determine the type of information that is useful
to stakeholders and the format that best facilitates use of the
reports and of performance reporting Internet websites.
(2) CONSULTATION WITH STAKEHOLDERS.—The entity with
a contract under section 1890(a) of the Social Security Act
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shall convene multi-stakeholder groups, as described in such
section, to review the design and format of each Internet
website made available under subsection (a) and shall transmit
to the Secretary the views of such multi-stakeholder groups
with respect to each such design and format.
(d) COORDINATION.—Where appropriate, the Secretary shall coordinate the manner in which data are presented through Internet
websites described in subsection (a) and for public reporting of
other quality measures by the Secretary, including such quality
measures under title XVIII of the Social Security Act.
(e) AUTHORIZATION OF APPROPRIATIONS.—To carry out this section, there are authorized to be appropriated such sums as may be
necessary for fiscal years 2010 through 2014.
SEC. 399KK. ø280j–3¿ QUALITY IMPROVEMENT PROGRAM FOR HOSPITALS WITH A HIGH SEVERITY ADJUSTED READMISSION
RATE.
(a) ESTABLISHMENT.—
(1) IN GENERAL.—Not later than 2 years after the date of

enactment of this section, the Secretary shall make available
a program for eligible hospitals to improve their readmission
rates through the use of patient safety organizations (as defined in section 921(4)).
(2) ELIGIBLE HOSPITAL DEFINED.—In this subsection, the
term ‘‘eligible hospital’’ means a hospital that the Secretary determines has a high rate of risk adjusted readmissions for the
conditions described in section 1886(q)(8)(A) of the Social Security Act and has not taken appropriate steps to reduce such readmissions and improve patient safety as evidenced through
historically high rates of readmissions, as determined by the
Secretary.
(3) RISK ADJUSTMENT.—The Secretary shall utilize appropriate risk adjustment measures to determine eligible hospitals.
(b) REPORT TO THE SECRETARY.—As determined appropriate by
the Secretary, eligible hospitals and patient safety organizations
working with those hospitals shall report to the Secretary on the
processes employed by the hospital to improve readmission rates
and the impact of such processes on readmission rates.

PART T—ORAL HEALTHCARE PREVENTION
ACTIVITIES
SEC. 399LL. ø280k¿ ORAL HEALTHCARE PREVENTION EDUCATION
CAMPAIGN.
(a) ESTABLISHMENT.—The Secretary, acting through the Direc-

tor of the Centers for Disease Control and Prevention and in consultation with professional oral health organizations, shall, subject
to the availability of appropriations, establish a 5-year national,
public education campaign (referred to in this section as the ‘‘campaign’’) that is focused on oral healthcare prevention and education,
including prevention of oral disease such as early childhood and
other caries, periodontal disease, and oral cancer.
(b) REQUIREMENTS.—In establishing the campaign, the Secretary shall—
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(1) ensure that activities are targeted towards specific populations such as children, pregnant women, parents, the elderly, individuals with disabilities, and ethnic and racial minority
populations, including Indians, Alaska Natives and Native Hawaiians (as defined in section 4(c) of the Indian Health Care
Improvement Act) in a culturally and linguistically appropriate
manner; and
(2) utilize science-based strategies to convey oral health
prevention messages that include, but are not limited to, community water fluoridation and dental sealants.
(c) PLANNING AND IMPLEMENTATION.—Not later than 2 years
after the date of enactment of this section, the Secretary shall
begin implementing the 5-year campaign. During the 2-year period
referred to in the previous sentence, the Secretary shall conduct
planning activities with respect to the campaign.
SEC. 399LL–1. ø280k–1¿ RESEARCH-BASED DENTAL CARIES DISEASE
MANAGEMENT.
(a) IN GENERAL.—The Secretary, acting through the Director of

the Centers for Disease Control and Prevention, shall award demonstration grants to eligible entities to demonstrate the effectiveness of research-based dental caries disease management activities.
(b) ELIGIBILITY.—To be eligible for a grant under this section,
an entity shall—
(1) be a community-based provider of dental services (as
defined by the Secretary), including a Federally-qualified
health center, a clinic of a hospital owned or operated by a
State (or by an instrumentality or a unit of government within
a State), a State or local department of health, a dental program of the Indian Health Service, an Indian tribe or tribal organization, or an urban Indian organization (as such terms are
defined in section 4 of the Indian Health Care Improvement
Act), a health system provider, a private provider of dental
services, medical, dental, public health, nursing, nutrition educational institutions, or national organizations involved in improving children’s oral health; and
(2) submit to the Secretary an application at such time, in
such manner, and containing such information as the Secretary may require.
(c) USE OF FUNDS.—A grantee shall use amounts received
under a grant under this section to demonstrate the effectiveness
of research-based dental caries disease management activities.
(d) USE OF INFORMATION.—The Secretary shall utilize information generated from grantees under this section in planning and
implementing the public education campaign under section 399LL.
SEC. 399LL–2. ø280k–2¿ AUTHORIZATION OF APPROPRIATIONS.

There is authorized to be appropriated to carry out this part,
such sums as may be necessary.

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PART U—EMPLOYER-BASED WELLNESS
PROGRAM
SEC. 399MM. ø280l¿ TECHNICAL ASSISTANCE FOR EMPLOYER-BASED
WELLNESS PROGRAMS.

In order to expand the utilization of evidence-based prevention
and health promotion approaches in the workplace, the Director
shall—
(1) provide employers (including small, medium, and large
employers, as determined by the Director) with technical assistance, consultation, tools, and other resources in evaluating
such employers’ employer-based wellness programs, including—
(A) measuring the participation and methods to increase participation of employees in such programs;
(B) developing standardized measures that assess policy, environmental and systems changes necessary to have
a positive health impact on employees’ health behaviors,
health outcomes, and health care expenditures; and
(C) evaluating such programs as they relate to
changes in the health status of employees, the absenteeism
of employees, the productivity of employees, the rate of
workplace injury, and the medical costs incurred by employees; and
(2) build evaluation capacity among workplace staff by
training employers on how to evaluate employer-based
wellness programs and ensuring evaluation resources, technical assistance, and consultation are available to workplace
staff as needed through such mechanisms as web portals, call
centers, or other means.
SEC. 399MM–1. ø280l–1¿ NATIONAL WORKSITE HEALTH POLICIES AND
PROGRAMS STUDY.
(a) IN GENERAL.—In order to assess, analyze, and monitor over

time data about workplace policies and programs, and to develop
instruments to assess and evaluate comprehensive workplace
chronic disease prevention and health promotion programs, policies
and practices, not later than 2 years after the date of enactment
of this part, and at regular intervals (to be determined by the Director) thereafter, the Director shall conduct a national worksite
health policies and programs survey to assess employer-based
health policies and programs.
(b) REPORT.—Upon the completion of each study under subsection (a), the Director shall submit to Congress a report that includes the recommendations of the Director for the implementation
of effective employer-based health policies and programs.
SEC. 399MM–2. ø280l–2¿ PRIORITIZATION OF EVALUATION BY SECRETARY.

The Secretary shall evaluate, in accordance with this part, all
programs funded through the Centers for Disease Control and Prevention before conducting such an evaluation of privately funded
programs unless an entity with a privately funded wellness program requests such an evaluation.
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399MM–3. ø280l–3¿ PROHIBITION OF
WELLNESS REQUIREMENTS.

FEDERAL

470
WORKPLACE

Notwithstanding any other provision of this part, any recommendations, data, or assessments carried out under this part
shall not be used to mandate requirements for workplace wellness
programs.

PART V—PROGRAMS RELATING TO BREAST
HEALTH AND CANCER
SEC. 399NN. ø280m¿ YOUNG WOMEN’S BREAST HEALTH AWARENESS
AND SUPPORT OF YOUNG WOMEN DIAGNOSED WITH
BREAST CANCER.
(a) PUBLIC EDUCATION CAMPAIGN.—
(1) IN GENERAL.—The Secretary, acting through the Direc-

tor of the Centers for Disease Control and Prevention, shall
conduct a national evidence-based education campaign to increase awareness of young women’s knowledge regarding—
(A) breast health in young women of all racial, ethnic,
and cultural backgrounds;
(B) breast awareness and good breast health habits;
(C) the occurrence of breast cancer and the general
and specific risk factors in women who may be at high risk
for breast cancer based on familial, racial, ethnic, and cultural backgrounds such as Ashkenazi Jewish populations;
(D) evidence-based information that would encourage
young women and their health care professional to increase early detection of breast cancers; and
(E) the availability of health information and other resources for young women diagnosed with breast cancer.
(2) EVIDENCE-BASED, AGE APPROPRIATE MESSAGES.—The
campaign shall provide evidence-based, age-appropriate messages and materials as developed by the Centers for Disease
Control and Prevention and the Advisory Committee established under paragraph (4).
(3) MEDIA CAMPAIGN.—In conducting the education campaign under paragraph (1), the Secretary shall award grants to
entities to establish national multimedia campaigns oriented to
young women that may include advertising through television,
radio, print media, billboards, posters, all forms of existing and
especially emerging social networking media, other Internet
media, and any other medium determined appropriate by the
Secretary.
(4) ADVISORY COMMITTEE.—
(A) ESTABLISHMENT.—Not later than 60 days after the
date of the enactment of this section, the Secretary, acting
through the Director of the Centers for Disease Control
and Prevention, shall establish an advisory committee to
assist in creating and conducting the education campaigns
under paragraph (1) and subsection (b)(1).
(B) MEMBERSHIP.—The Secretary, acting through the
Director of the Centers for Disease Control and Prevention, shall appoint to the advisory committee under subparagraph (A) such members as deemed necessary to propMarch 13, 2013

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erly advise the Secretary, and shall include organizations
and individuals with expertise in breast cancer, disease
prevention, early detection, diagnosis, public health, social
marketing, genetic screening and counseling, treatment,
rehabilitation, palliative care, and survivorship in young
women.
(b) HEALTH CARE PROFESSIONAL EDUCATION CAMPAIGN.—The
Secretary, acting through the Director of the Centers for Disease
Control and Prevention, and in consultation with the Administrator
of the Health Resources and Services Administration, shall conduct
an education campaign among physicians and other health care
professionals to increase awareness—
(1) of breast health, symptoms, and early diagnosis and
treatment of breast cancer in young women, including specific
risk factors such as family history of cancer and women that
may be at high risk for breast cancer, such as Ashkenazi Jewish population;
(2) on how to provide counseling to young women about
their breast health, including knowledge of their family cancer
history and importance of providing regular clinical breast examinations;
(3) concerning the importance of discussing healthy behaviors, and increasing awareness of services and programs available to address overall health and wellness, and making patient referrals to address tobacco cessation, good nutrition, and
physical activity;
(4) on when to refer patients to a health care provider with
genetics expertise;
(5) on how to provide counseling that addresses long-term
survivorship and health concerns of young women diagnosed
with breast cancer; and
(6) on when to provide referrals to organizations and institutions that provide credible health information and substantive assistance and support to young women diagnosed
with breast cancer.
(c) PREVENTION RESEARCH ACTIVITIES.—The Secretary, acting
through—
(1) the Director of the Centers for Disease Control and
Prevention, shall conduct prevention research on breast cancer
in younger women, including—
(A) behavioral, survivorship studies, and other research on the impact of breast cancer diagnosis on young
women;
(B) formative research to assist with the development
of educational messages and information for the public,
targeted populations, and their families about breast
health, breast cancer, and healthy lifestyles;
(C) testing and evaluating existing and new social
marketing strategies targeted at young women; and
(D) surveys of health care providers and the public regarding knowledge, attitudes, and practices related to
breast health and breast cancer prevention and control in
high-risk populations; and
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(2) the Director of the National Institutes of Health, shall
conduct research to develop and validate new screening tests
and methods for prevention and early detection of breast cancer in young women.
(d) SUPPORT FOR YOUNG WOMEN DIAGNOSED WITH BREAST
CANCER.—
(1) IN GENERAL.—The Secretary shall award grants to organizations and institutions to provide health information from
credible sources and substantive assistance directed to young
women diagnosed with breast cancer and pre-neoplastic breast
diseases.
(2) PRIORITY.—In making grants under paragraph (1), the
Secretary shall give priority to applicants that deal specifically
with young women diagnosed with breast cancer and pre-neoplastic breast disease.
(e) NO DUPLICATION OF EFFORT.—In conducting an education
campaign or other program under subsections (a), (b), (c), or (d),
the Secretary shall avoid duplicating other existing Federal breast
cancer education efforts.
(f) MEASUREMENT; REPORTING.—The Secretary, acting through
the Director of the Centers for Disease Control and Prevention,
shall—
(1) measure—
(A) young women’s awareness regarding breast health,
including knowledge of family cancer history, specific risk
factors and early warning signs, and young women’s
proactive efforts at early detection;
(B) the number or percentage of young women utilizing information regarding lifestyle interventions that
foster healthy behaviors;
(C) the number or percentage of young women receiving regular clinical breast exams; and
(D) the number or percentage of young women who
perform breast self exams, and the frequency of such
exams, before the implementation of this section;
(2) not less than every 3 years, measure the impact of such
activities; and
(3) submit reports to the Congress on the results of such
measurements.
(g) DEFINITION.—In this section, the term ‘‘young women’’
means women 15 to 44 years of age.
(h) AUTHORIZATION OF APPROPRIATIONS.—To carry out subsections (a), (b), (c)(1), and (d), there are authorized to be appropriated $9,000,000 for each of the fiscal years 2010 through 2014.

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TITLE IV—NATIONAL RESEARCH INSTITUTES
PART A—NATIONAL INSTITUTES

OF

HEALTH

SEC. 401. ø281¿ ORGANIZATION OF NATIONAL INSTITUTES OF HEALTH.
(a) RELATION TO PUBLIC HEALTH SERVICE.—The National Insti-

tutes of Health is an agency of the Service. 1
(b) NATIONAL RESEARCH INSTITUTES AND NATIONAL CENTERS.—
The following agencies of the National Institutes of Health are national research institutes or national centers:
(1) The National Cancer Institute.
(2) The National Heart, Lung, and Blood Institute.
(3) The National Institute of Diabetes and Digestive and
Kidney Diseases.
(4) The National Institute of Arthritis and Musculoskeletal
and Skin Diseases.
(5) The National Institute on Aging.
(6) The National Institute of Allergy and Infectious Diseases.
(7) The Eunice Kennedy Shriver National Institute of
Child Health and Human Development.
(8) The National Institute of Dental and Craniofacial Research. 2
(9) The National Eye Institute.
(10) The National Institute of Neurological Disorders and
Stroke.
(11) The National Institute on Deafness and Other Communication Disorders.
(12) The National Institute on Alcohol Abuse and Alcoholism.
(13) The National Institute on Drug Abuse.
(14) The National Institute of Mental Health.
(15) The National Institute of General Medical Sciences.
(16) The National Institute of Environmental Health
Sciences.
(17) The National Institute of Nursing Research.
(18) The National Institute of Biomedical Imaging and Bioengineering.
(19) The National Human Genome Research Institute.
(20) The National Library of Medicine.
(21) The National Center for Advancing Translational
Sciences.
1 See

footnote for section 202.
212 of the Departments of Labor, Health and Human Services, and Education, and
Related Agencies Appropriations Act, 1999 (as contained in section 101(f) of division A of Public
Law 105–277; 112 Stat. 2681–359) amended subparagraph (H) to read as provided above, thereby indicating the intent of the Congress to change the designation of the Institute. (The former
designation was the National Institute of Dental Research.) Conforming changes were not, however, made to section 453 or the related subpart heading, or to the reference in section 409A(a).
2 Section

473
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(22) The John E. Fogarty International Center for Advanced Study in the Health Sciences.
(23) The National Center for Complementary and Alternative Medicine.
(24) The National Institute on Minority Health and Health
Disparities.
(25) Any other national center that, as an agency separate
from any national research institute, was established within
the National Institutes of Health as of the day before the date
of the enactment of the National Institutes of Health Reform
Act of 2006.
(c) DIVISION OF PROGRAM COORDINATION, PLANNING, AND STRATEGIC INITIATIVES.—
(1) IN GENERAL.—Within the Office of the Director of the
National Institutes of Health, there shall be a Division of Program Coordination, Planning, and Strategic Initiatives (referred to in this subsection as the ‘‘Division’’).
(2) OFFICES WITHIN DIVISION.—
(A) OFFICES.—The following offices are within the Division: The Office of AIDS Research, the Office of Research
on Women’s Health, the Office of Behavioral and Social
Sciences Research, the Office of Disease Prevention, the
Office of Dietary Supplements, and any other office located
within the Office of the Director of NIH as of the day before the date of the enactment of the National Institutes
of Health Reform Act of 2006. In addition to such offices,
the Director of NIH may establish within the Division such
additional offices or other administrative units as the Director determines to be appropriate.
(B) AUTHORITIES.—Each office in the Division—
(i) shall continue to carry out the authorities that
were in effect for the office before the date of enactment referred to in subparagraph (A); and
(ii) shall, as determined appropriate by the Director of NIH, support the Division with respect to the
authorities described in section 402(b)(7).
(d) ORGANIZATION.—
(1) NUMBER OF INSTITUTES AND CENTERS.—In the National
Institutes of Health, the number of national research institutes
and national centers may not exceed a total of 27, including
any such institutes or centers established under authority of
paragraph (2) or under authority of this title as in effect on the
day before the date of the enactment of the National Institutes
of Health Reform Act of 2006.
(2) REORGANIZATION OF INSTITUTES.—
(A) IN GENERAL.—The Secretary may establish in the
National Institutes of Health one or more additional national research institutes to conduct and support research,
training, health information, and other programs with respect to any particular disease or groups of diseases or any
other aspect of human health if—
(i) the Secretary determines that an additional institute is necessary to carry out such activities; and
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(ii) the additional institute is not established before the expiration of 180 days after the Secretary has
provided the Committee on Energy and Commerce of
the House of Representatives and the Committee on
Health, Education, Labor, and Pensions of the Senate
written notice of the determination made under clause
(i) with respect to the institute.
(B) ADDITIONAL AUTHORITY.—The Secretary may reorganize the functions of any national research institute and
may abolish any national research institute if the Secretary determines that the institute is no longer required.
A reorganization or abolition may not take effect under
this paragraph before the expiration of 180 days after the
Secretary has provided the Committee on Energy and
Commerce of the House of Representatives and the Committee on Health, Education, Labor, and Pensions of the
Senate written notice of the reorganization or abolition.
(3) REORGANIZATION OF OFFICE OF DIRECTOR.—Notwithstanding subsection (c), the Director of NIH may, after a series
of public hearings, and with the approval of the Secretary, reorganize the offices within the Office of the Director, including
the addition, removal, or transfer of functions of such offices,
and the establishment or termination of such offices, if the Director determines that the overall management and operation
of programs and activities conducted or supported by such offices would be more efficiently carried out under such a reorganization.
(4) INTERNAL REORGANIZATION OF INSTITUTES AND CENTERS.—Notwithstanding any conflicting provisions of this title,
the director of a national research institute or a national center may, after a series of public hearings and with the approval
of the Director of NIH, reorganize the divisions, centers, or
other administrative units within such institute or center, including the addition, removal, or transfer of functions of such
units, and the establishment or termination of such units, if
the director of such institute or center determines that the
overall management and operation of programs and activities
conducted or supported by such divisions, centers, or other
units would be more efficiently carried out under such a reorganization.
(e) SCIENTIFIC MANAGEMENT REVIEW BOARD FOR PERIODIC ORGANIZATIONAL REVIEWS.—
(1) IN GENERAL.—Not later than 60 days after the date of
the enactment of the National Institutes of Health Reform Act
of 2006, the Secretary shall establish an advisory council within the National Institutes of Health to be known as the Scientific Management Review Board (referred to in this subsection as the ‘‘Board’’).
(2) DUTIES.—
(A) REPORTS ON ORGANIZATIONAL ISSUES.—The Board
shall provide advice to the appropriate officials under subsection (d) regarding the use of the authorities established
in paragraphs (2), (3), and (4) of such subsection to reorganize the National Institutes of Health (referred to in this
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subsection as ‘‘organizational authorities’’). Not less frequently than once each 7 years, the Board shall—
(i) determine whether and to what extent the organizational authorities should be used; and
(ii) issue a report providing the recommendations
of the Board regarding the use of the authorities and
the reasons underlying the recommendations.
(B) CERTAIN RESPONSIBILITIES REGARDING REPORTS.—
The activities of the Board with respect to a report under
subparagraph (A) shall include the following:
(i) Reviewing the research portfolio of the National Institutes of Health (referred to in this subsection as ‘‘NIH’’) in order to determine the progress
and effectiveness and value of the portfolio and the allocation among the portfolio activities of the resources
of NIH.
(ii) Determining pending scientific opportunities,
and public health needs, with respect to research within the jurisdiction of NIH.
(iii) For any proposal for organizational changes to
which the Board gives significant consideration as a
possible recommendation in such report—
(I) analyzing the budgetary and operational
consequences of the proposed changes;
(II) taking into account historical funding and
support for research activities at national research
institutes and centers that have been established
recently relative to national research institutes
and centers that have been in existence for more
than two decades;
(III) estimating the level of resources needed
to implement the proposed changes;
(IV) assuming the proposed changes will be
made and making a recommendation for the allocation of the resources of NIH among the national
research institutes and national centers; and
(V) analyzing the consequences for the
progress of research in the areas affected by the
proposed changes.
(C) CONSULTATION.—In carrying out subparagraph
(A), the Board shall consult with—
(i) the heads of national research institutes and
national centers whose directors are not members of
the Board;
(ii) other scientific leaders who are officers or employees of NIH and are not members of the Board;
(iii) advisory councils of the national research institutes and national centers;
(iv) organizations representing the scientific community; and
(v) organizations representing patients.
(3) COMPOSITION OF BOARD.—The Board shall consist of
the Director of NIH, who shall be a permanent nonvoting
member on an ex officio basis, and an odd number of additional
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members, not to exceed 21, all of whom shall be voting members. The voting members of the Board shall be the following:
(A) Not fewer than 9 officials who are directors of national research institutes or national centers. The Secretary shall designate such officials for membership and
shall ensure that the group of officials so designated includes directors of—
(i) national research institutes whose budgets are
substantial relative to a majority of the other institutes;
(ii) national research institutes whose budgets are
small relative to a majority of the other institutes;
(iii) national research institutes that have been in
existence for a substantial period of time without significant organizational change under subsection (d);
(iv) as applicable, national research institutes that
have undergone significant organization changes
under such subsection, or that have been established
under such subsection, other than national research
institutes for which such changes have been in place
for a substantial period of time; and
(v) national centers.
(B) Members appointed by the Secretary from among
individuals who are not officers or employees of the United
States. Such members shall include—
(i) individuals representing the interests of public
or private institutions of higher education that have
historically received funds from NIH to conduct research; and
(ii) individuals representing the interests of private entities that have received funds from NIH to
conduct research or that have broad expertise regarding how the National Institutes of Health functions,
exclusive of private entities to which clause (i) applies.
(4) CHAIR.—The Chair of the Board shall be selected by
the Secretary from among the members of the Board appointed
under paragraph (3)(B). The term of office of the Chair shall
be 2 years.
(5) MEETINGS.—
(A) IN GENERAL.—The Board shall meet at the call of
the Chair or upon the request of the Director of NIH, but
not fewer than 5 times with respect to issuing any particular report under paragraph (2)(A). The location of the
meetings of the Board is subject to the approval of the Director of NIH.
(B) PARTICULAR FORUMS.—Of the meetings held under
subparagraph (A) with respect to a report under paragraph (2)(A)—
(i) one or more shall be directed toward the scientific community to address scientific needs and opportunities related to proposals for organizational
changes under subsection (d), or as the case may be,
related to a proposal that no such changes be made;
and
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(ii) one or more shall be directed toward consumer
organizations to address the needs and opportunities
of patients and their families with respect to proposals
referred to in clause (i).
(C) AVAILABILITY OF INFORMATION FROM FORUMS.—For
each meeting under subparagraph (B), the Director of NIH
shall post on the Internet site of the National Institutes of
Health a summary of the proceedings.
(6) COMPENSATION; TERM OF OFFICE.—The provisions of
subsections (b)(4) and (c) of section 406 apply with respect to
the Board to the same extent and in the same manner as such
provisions apply with respect to an advisory council referred to
in such subsections, except that the reference in such subsection (c) to 4 years regarding the term of an appointed member is deemed to be a reference to 5 years.
(7) REPORTS.—
(A) RECOMMENDATIONS FOR CHANGES.—Each report
under paragraph (2)(A) shall be submitted to—
(i) the Committee on Energy and Commerce and
the Committee on Appropriations of the House of Representatives;
(ii) the Committee on Health, Education, Labor,
and Pensions and the Committee on Appropriations of
the Senate;
(iii) the Secretary; and
(iv) officials with organizational authorities, other
than any such official who served as a member of the
Board with respect to the report involved.
(B) AVAILABILITY TO PUBLIC.—The Director of NIH
shall post each report under paragraph (2) on the Internet
site of the National Institutes of Health.
(C) REPORT ON BOARD ACTIVITIES.—Not later than 18
months after the date of the enactment of the National Institutes of Health Reform Act of 2006, the Board shall submit to the committees specified in subparagraph (A) a report describing the activities of the Board.
(f) ORGANIZATIONAL CHANGES PER RECOMMENDATION OF SCIENTIFIC MANAGEMENT REVIEW BOARD.—
(1) IN GENERAL.—With respect to an official who has organizational authorities within the meaning of subsection
(e)(2)(A), if a recommendation to the official for an organizational change is made in a report under such subsection, the
official shall, except as provided in paragraphs (2), (3), and (4)
of this subsection, make the change in accordance with the following:
(A) Not later than 100 days after the report is submitted under subsection (e)(7)(A), the official shall initiate
the applicable public process required in subsection (d) toward making the change.
(B) The change shall be fully implemented not later
than the expiration of the 3-year period beginning on the
date on which such process is initiated.
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(2) INAPPLICABILITY TO CERTAIN REORGANIZATIONS.—Paragraph (1) does not apply to a recommendation made in a report
under subsection (e)(2)(A) if the recommendation is for—
(A) an organizational change under subsection (d)(2)
that constitutes the establishment, termination, or consolidation of one or more national research institutes or national centers; or
(B) an organizational change under subsection (d)(3).
(3) OBJECTION BY DIRECTOR OF NIH.—
(A) IN GENERAL.—Paragraph (1) does not apply to a
recommendation for an organizational change made in a
report under subsection (e)(2)(A) if, not later than 90 days
after the report is submitted under subsection (e)(7)(A),
the Director of NIH submits to the committees specified in
such subsection a report providing that the Director objects to the change, which report includes the reasons underlying the objection.
(B) SCOPE OF OBJECTION.—For purposes of subparagraph (A), an objection by the Director of NIH may be
made to the entirety of a recommended organizational
change or to 1 or more aspects of the change. Any aspect
of a change not objected to by the Director in a report
under subparagraph (A) shall be implemented in accordance with paragraph (1).
(4) CONGRESSIONAL REVIEW.—An organizational change
under subsection (d)(2) that is initiated pursuant to paragraph
(1) shall be carried out by regulation in accordance with the
procedures for substantive rules under section 553 of title 5,
United States Code. A rule under the preceding sentence shall
be considered a major rule for purposes of chapter 8 of such
title (relating to congressional review of agency rulemaking).
(g) DEFINITIONS.—For purposes of this title:
(1) The term ‘‘Director of NIH’’ means the Director of the
National Institutes of Health.
(2) The terms ‘‘national research institute’’ and ‘‘national
center’’ mean an agency of the National Institutes of Health
that is—
(A) listed in subsection (b) and not terminated under
subsection (d)(2)(A); or
(B) established by the Director of NIH under such subsection.
(h) REFERENCES TO NIH.—For purposes of this title, a reference to the National Institutes of Health includes its agencies.
APPOINTMENT AND AUTHORITY OF DIRECTOR OF NIH

SEC. 402. ø282¿ (a) The National Institutes of Health shall be
headed by the Director of NIH who shall be appointed by the President by and with the advice and consent of the Senate. The Director of NIH shall perform functions as provided under subsection (b)
and as the Secretary may otherwise prescribe.
(b) In carrying out the purposes of section 301, the Secretary,
acting through the Director of NIH—
(1) shall carry out this title, including being responsible for
the overall direction of the National Institutes of Health and
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for the establishment and implementation of general policies
respecting the management and operation of programs and activities within the National Institutes of Health;
(2) shall coordinate and oversee the operation of the national research institutes, national centers, and administrative
entities within the National Institutes of Health;
(3) shall, in consultation with the heads of the national research institutes and national centers, be responsible for program coordination across the national research institutes and
national centers, including conducting priority-setting reviews,
to ensure that the research portfolio of the National Institutes
of Health is balanced and free of unnecessary duplication, and
takes advantage of collaborative, cross-cutting research;
(4) shall assemble accurate data to be used to assess research priorities, including information to better evaluate scientific opportunity, public health burdens, and progress in reducing minority and other health disparities;
(5) shall ensure that scientifically based strategic planning
is implemented in support of research priorities as determined
by the agencies of the National Institutes of Health;
(6) shall ensure that the resources of the National Institutes of Health are sufficiently allocated for research projects
identified in strategic plans;
(7)(A) shall, through the Division of Program Coordination,
Planning, and Strategic Initiatives—
(i) identify research that represents important areas of
emerging scientific opportunities, rising public health challenges, or knowledge gaps that deserve special emphasis
and would benefit from conducting or supporting additional research that involves collaboration between 2 or
more national research institutes or national centers, or
would otherwise benefit from strategic coordination and
planning;
(ii) include information on such research in reports
under section 403; and
(iii) in the case of such research supported with funds
referred to in subparagraph (B)—
(I) require as appropriate that proposals include
milestones and goals for the research;
(II) require that the proposals include timeframes
for funding of the research; and
(III) ensure appropriate consideration of proposals
for which the principal investigator is an individual
who has not previously served as the principal investigator of research conducted or supported by the National Institutes of Health;
(B) may, with respect to funds reserved under section
402A(c)(1) for the Common Fund, allocate such funds to the
national research institutes and national centers for conducting and supporting research that is identified under subparagraph (A); and
(C) may assign additional functions to the Division in support of responsibilities identified in subparagraph (A), as determined appropriate by the Director;
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(8) shall, in coordination with the heads of the national research institutes and national centers, ensure that such institutes and centers—
(A) preserve an emphasis on investigator-initiated research project grants, including with respect to research
involving collaboration between 2 or more such institutes
or centers; and
(B) when appropriate, maximize investigator-initiated
research project grants in their annual research portfolios;
(9) shall ensure that research conducted or supported by
the National Institutes of Health is subject to review in accordance with section 492 and that, after such review, the research
is reviewed in accordance with section 492A(a)(2) by the appropriate advisory council under section 406 before the research
proposals are approved for funding;
(10) shall have authority to review and approve the establishment of all centers of excellence recommended by the national research institutes;
(11)(A) shall oversee research training for all of the national research institutes and National Research Service
Awards in accordance with section 487; and
(B) may conduct and support research training—
(i) for which fellowship support is not provided under
section 487; and
(ii) that does not consist of residency training of physicians or other health professionals;
(12) may, from funds appropriated under section 402A(b),
reserve funds to provide for research on matters that have not
received significant funding relative to other matters, to respond to new issues and scientific emergencies, and to act on
research opportunities of high priority;
(13) may, subject to appropriations Acts, collect and retain
registration fees obtained from third parties to defray expenses
for scientific, educational, and research-related conferences;
(14) for the national research institutes and administrative
entities within the National Institutes of Health—
(A) may acquire, construct, improve, repair, operate,
and maintain, at the site of such institutes and entities,
laboratories, and other research facilities, other facilities,
equipment, and other real or personal property, and
(B) may acquire, without regard to the Act of March
3, 1877 (40 U.S.C. 34), by lease or otherwise through the
Administrator of General Services, buildings or parts of
buildings in the District of Columbia or communities located adjacent to the District of Columbia for use for a period not to exceed ten years;
(15) may secure resources for research conducted by or
through the National Institutes of Health;
(16) may, without regard to the provisions of title 5,
United States Code, governing appointments in the competitive
service, and without regard to the provisions of chapter 51 and
subchapter III of chapter 53 of such title relating to classification and General Schedule pay rates, establish such technical
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sory committees as are needed to carry out the requirements
of this title and appoint and pay the members of such groups,
except that officers and employees of the United States shall
not receive additional compensation for service as members of
such groups;
(17) may secure for the National Institutes of Health consultation services and advice of persons from the United States
or abroad;
(18) may use, with their consent, the services, equipment,
personnel, information, and facilities of other Federal, State, or
local public agencies, with or without reimbursement therefor;
(19) may, for purposes of study, admit and treat at facilities of the National Institutes of Health individuals not otherwise eligible for such treatment;
(20) may accept voluntary and uncompensated services;
(21) may perform such other administrative functions as
the Secretary determines are needed to effectively carry out
this title;
(22) may appoint physicians, dentists, and other health
care professionals, subject to the provisions of title 5, United
States Code, relating to appointments and classifications in the
competitive service, and may compensate such professionals
subject to the provisions of chapter 74 of title 38, United States
Code;
(23) shall designate a contact point or office to help
innovators and physicians identify sources of funding available
for pediatric medical device development; and
(24) implement the Cures Acceleration Network described
in section 480.
The Federal Advisory Committee Act shall not apply to the duration of a peer review group appointed under paragraph (16). The
members of such a group shall be individuals who by virtue of their
training or experience are eminently qualified to perform the review functions of such group. Not more than one-fourth of the
members of any such group shall be officers or employees of the
United States.
(c) The Director of NIH may make available to individuals and
entities, for biomedical and behavioral research, substances and
living organisms. Such substances and organisms shall be made
available under such terms and conditions (including payment for
them) as the Secretary determines appropriate.
(d)(1) The Director of NIH may obtain (in accordance with section 3109 of title 5, United States Code, but without regard to the
limitation in such section on the period of service) the services of
not more than 220 experts or consultants, with scientific or other
professional qualifications, for the National Institutes of Health.
(2)(A) Except as provided in subparagraph (B), experts and
consultants whose services are obtained under paragraph (1) shall
be paid or reimbursed, in accordance with title 5, United States
Code, for their travel to and from their place of service and for
other expenses associated with their assignment.
(B) Expenses specified in subparagraph (A) shall not be allowed in connection with the assignment of an expert or consultant
whose services are obtained under paragraph (1) unless the expert
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or consultant has agreed in writing to complete the entire period
of the assignment or one year of the assignment, whichever is
shorter, unless separated or reassigned for reasons which are beyond the control of the expert or consultant and which are acceptable to the Secretary. If the expert or consultant violates the agreement, the money spent by the United States for such expenses is
recoverable from the expert or consultant as a debt due the United
States. The Secretary may waive in whole or in part a right of recovery under this subparagraph.
(e) The Director of NIH shall—
(1) advise the agencies of the National Institutes of Health
on medical applications of research;
(2) coordinate, review, and facilitate the systematic identification and evaluation of, clinically relevant information from
research conducted by or through the national research institutes;
(3) promote the effective transfer of the information described in paragraph (2) to the health care community and to
entities that require such information;
(4) monitor the effectiveness of the activities described in
paragraph (3); and
(5) ensure that, after January 1, 1994, all new or revised
health education and promotion materials developed or funded
by the National Institutes of Health and intended for the general public are in a form that does not exceed a level of functional literacy, as defined in the National Literacy Act of 1991
(Public Law 102–73) 1.
(f) There shall be in the National Institutes of Health an Associate Director for Prevention. The Director of NIH shall delegate to
the Associate Director for Prevention the functions of the Director
relating to the promotion of the disease prevention research programs of the national research institutes and the coordination of
such programs among the national research institutes and between
the national research institutes and other public and private entities, including elementary, secondary, and post-secondary schools.
The Associate Director shall—
(1) annually review the efficacy of existing policies and
techniques used by the national research institutes to disseminate the results of disease prevention and behavioral research
programs; and
(2) recommend, coordinate, and oversee the modification or
reconstruction of such policies and techniques to ensure maximum dissemination, using advanced technologies to the maximum extent practicable, of research results to such entities.
ø(g) Transferred to section 461, redesignated as subsection (b)
of such section, and amended (as so redesignated) by section
221(b)(5) of division F of Public Law 112–74.¿
(h) The Secretary, acting through the Director of NIH and the
Directors of the agencies of the National Institutes of Health, shall,
in conducting and supporting programs for research, research
training, recruitment, and other activities, provide for an increase
1 So in law. That Act was repealed by section 251(a)(2) of Public Law 105–220 (112 Stat.
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in the number of women and individuals from disadvantaged backgrounds (including racial and ethnic minorities) in the fields of biomedical and behavioral research.
(i)(1)(A) The Secretary, acting through the Director of NIH,
shall establish, maintain, and operate a data bank of information
on clinical trials for drugs for serious or life-threatening diseases
and conditions (in this subsection referred to as the ‘‘data bank’’).
The activities of the data bank shall be integrated and coordinated
with related activities of other agencies of the Department of
Health and Human Services, and to the extent practicable, coordinated with other data banks containing similar information.
(B) The Secretary shall establish the data bank after consultation with the Commissioner of Food and Drugs, the directors of the
appropriate agencies of the National Institutes of Health (including
the National Library of Medicine), and the Director of the Centers
for Disease Control and Prevention.
(2) In carrying out paragraph (1), the Secretary shall collect,
catalog, store, and disseminate the information described in such
paragraph. The Secretary shall disseminate such information
through information systems, which shall include toll-free telephone communications, available to individuals with serious or lifethreatening diseases and conditions, to other members of the public, to health care providers, and to researchers.
(3) The data bank shall include the following:
(A) A registry of clinical trials (whether federally or privately funded) of experimental treatments for serious or lifethreatening diseases and conditions under regulations promulgated pursuant to section 505(i) of the Federal Food, Drug, and
Cosmetic Act, which provides a description of the purpose of
each experimental drug, either with the consent of the protocol
sponsor, or when a trial to test effectiveness begins. Information provided shall consist of eligibility criteria for participation in the clinical trials, a description of the location of trial
sites, and a point of contact for those wanting to enroll in the
trial, and shall be in a form that can be readily understood by
members of the public. 1 Such information shall be forwarded
to the data bank by the sponsor of the trial not later than 21
days after the approval of the protocol.
(B) Information pertaining to experimental treatments for
serious or life-threatening diseases and conditions that may be
available—
(i) under a treatment investigational new drug application that has been submitted to the Secretary under section 561(c) of the Federal Food, Drug, and Cosmetic Act;
or
1 Section 15(c)(2) of Public Law 107–109 (115 Stat. 1420) attempted to make amendments to
the first sentence of subparagraph (A), but the amendments cannot be executed because the
terms to be amended appear in the second sentence, not the first. The following shows the second sentence as it would appear if the amendments were executed to the second sentence: ‘‘Information provided shall consist of eligibility criteria for participation in the clinical trials, a description of the location of trial sites, a point of contact for those wanting to enroll in the trial,
and a description of whether, and through what procedure, the manufacturer or sponsor of the
investigation of a new drug will respond to requests for protocol exception, with appropriate
safeguards, for single-patient and expanded protocol use of the new drug, particularly in children, and shall be in a form that can be readily understood by members of the public.’’.

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(ii) as a Group C cancer drug (as defined by the National Cancer Institute).
The data bank may also include information pertaining to the
results of clinical trials of such treatments, with the consent of
the sponsor, including information concerning potential
toxicities or adverse effects associated with the use or administration of such experimental treatments.
(4) The data bank shall not include information relating to an
investigation if the sponsor has provided a detailed certification to
the Secretary that disclosure of such information would substantially interfere with the timely enrollment of subjects in the investigation, unless the Secretary, after the receipt of the certification,
provides the sponsor with a detailed written determination that
such disclosure would not substantially interfere with such enrollment.
(5) Fees collected under section 736 of the Federal Food, Drug,
and Cosmetic Act shall not be used in carrying out this subsection.
(j) EXPANDED CLINICAL TRIAL REGISTRY DATA BANK.—
(1) DEFINITIONS; REQUIREMENT.—
(A) DEFINITIONS.—In this subsection:
(i) APPLICABLE CLINICAL TRIAL.—The term ‘‘applicable clinical trial’’ means an applicable device clinical
trial or an applicable drug clinical trial.
(ii) APPLICABLE DEVICE CLINICAL TRIAL.—The term
‘‘applicable device clinical trial’’ means—
(I) a prospective clinical study of health outcomes comparing an intervention with a device
subject to section 510(k), 515, or 520(m) of the
Federal Food, Drug, and Cosmetic Act against a
control in human subjects (other than a small
clinical trial to determine the feasibility of a device, or a clinical trial to test prototype devices
where the primary outcome measure relates to
feasibility and not to health outcomes); and
(II) a pediatric postmarket surveillance as required under section 522 of the Federal Food,
Drug, and Cosmetic Act.
(iii) APPLICABLE DRUG CLINICAL TRIAL.—
(I) IN GENERAL.—The term ‘‘applicable drug
clinical trial’’ means a controlled clinical investigation, other than a phase I clinical investigation, of
a drug subject to section 505 of the Federal Food,
Drug, and Cosmetic Act or to section 351 of this
Act.
(II) CLINICAL INVESTIGATION.—For purposes of
subclause (I), the term ‘‘clinical investigation’’ has
the meaning given that term in section 312.3 of
title 21, Code of Federal Regulations (or any successor regulation).
(III) PHASE I.—For purposes of subclause (I),
the term ‘‘phase I’’ has the meaning given that
term in section 312.21 of title 21, Code of Federal
Regulations (or any successor regulation).
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(iv) CLINICAL TRIAL INFORMATION.—The term
‘‘clinical trial information’’ means, with respect to an
applicable clinical trial, those data elements that the
responsible party is required to submit under paragraph (2) or under paragraph (3).
(v) COMPLETION DATE.—The term ‘‘completion
date’’ means, with respect to an applicable clinical
trial, the date that the final subject was examined or
received an intervention for the purposes of final collection of data for the primary outcome, whether the
clinical trial concluded according to the prespecified
protocol or was terminated.
(vi) DEVICE.—The term ‘‘device’’ means a device as
defined in section 201(h) of the Federal Food, Drug,
and Cosmetic Act.
(vii) DRUG.—The term ‘‘drug’’ means a drug as defined in section 201(g) of the Federal Food, Drug, and
Cosmetic Act or a biological product as defined in section 351 of this Act.
(viii) ONGOING.—The term ‘‘ongoing’’ means, with
respect to a clinical trial of a drug or a device and to
a date, that—
(I) 1 or more patients is enrolled in the clinical trial; and
(II) the date is before the completion date of
the clinical trial.
(ix) RESPONSIBLE PARTY.—The term ‘‘responsible
party’’, with respect to a clinical trial of a drug or device, means—
(I) the sponsor of the clinical trial (as defined
in section 50.3 of title 21, Code of Federal Regulations (or any successor regulation)); or
(II) the principal investigator of such clinical
trial if so designated by a sponsor, grantee, contractor, or awardee, so long as the principal investigator is responsible for conducting the trial, has
access to and control over the data from the clinical trial, has the right to publish the results of
the trial, and has the ability to meet all of the requirements under this subsection for the submission of clinical trial information.
(B) REQUIREMENT.—The Secretary shall develop a
mechanism by which the responsible party for each applicable clinical trial shall submit the identity and contact information of such responsible party to the Secretary at the
time of submission of clinical trial information under paragraph (2).
(2) EXPANSION OF CLINICAL TRIAL REGISTRY DATA BANK
WITH RESPECT TO CLINICAL TRIAL INFORMATION.—
(A) IN GENERAL.—
(i) EXPANSION OF DATA BANK.—To enhance patient
enrollment and provide a mechanism to track subsequent progress of clinical trials, the Secretary, acting
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ance with this subsection, the clinical trials registry of
the data bank described under subsection (i)(1) (referred to in this subsection as the ‘‘registry data
bank’’). The Director of NIH shall ensure that the registry data bank is made publicly available through the
Internet.
(ii) CONTENT.—The clinical trial information required to be submitted under this paragraph for an
applicable clinical trial shall include—
(I) descriptive information, including—
(aa) a brief title, intended for the lay public;
(bb) a brief summary, intended for the lay
public;
(cc) the primary purpose;
(dd) the study design;
(ee) for an applicable drug clinical trial,
the study phase;
(ff) study type;
(gg) the primary disease or condition
being studied, or the focus of the study;
(hh) the intervention name and intervention type;
(ii) the study start date;
(jj) the expected completion date;
(kk) the target number of subjects; and
(ll) outcomes, including primary and secondary outcome measures;
(II) recruitment information, including—
(aa) eligibility criteria;
(bb) gender;
(cc) age limits;
(dd) whether the trial accepts healthy volunteers;
(ee) overall recruitment status;
(ff) individual site status; and
(gg) in the case of an applicable drug clinical trial, if the drug is not approved under
section 505 of the Federal Food, Drug, and
Cosmetic Act or licensed under section 351 of
this Act, specify whether or not there is expanded access to the drug under section 561
of the Federal Food, Drug, and Cosmetic Act
for those who do not qualify for enrollment in
the clinical trial and how to obtain information about such access;
(III) location and contact information, including—
(aa) the name of the sponsor;
(bb) the responsible party, by official title;
and
(cc) the facility name and facility contact
information (including the city, State, and zip
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free number through which such location information may be accessed); and
(IV) administrative data (which the Secretary
may make publicly available as necessary), including—
(aa) the unique protocol identification
number;
(bb) other protocol identification numbers,
if any; and
(cc) the Food and Drug Administration
IND/IDE protocol number and the record
verification date.
(iii) MODIFICATIONS.—The Secretary may by regulation modify the requirements for clinical trial information under this paragraph, if the Secretary provides
a rationale for why such a modification improves and
does not reduce such clinical trial information.
(B) FORMAT AND STRUCTURE.—
(i) SEARCHABLE CATEGORIES.—The Director of NIH
shall ensure that the public may, in addition to keyword searching, search the entries in the registry data
bank by 1 or more of the following criteria:
(I) The disease or condition being studied in
the clinical trial, using Medical Subject Headers
(MeSH) descriptors.
(II) The name of the intervention, including
any drug or device being studied in the clinical
trial.
(III) The location of the clinical trial.
(IV) The age group studied in the clinical
trial, including pediatric subpopulations.
(V) The study phase of the clinical trial.
(VI) The sponsor of the clinical trial, which
may be the National Institutes of Health or another Federal agency, a private industry source, or
a university or other organization.
(VII) The recruitment status of the clinical
trial.
(VIII) The National Clinical Trial number or
other study identification for the clinical trial.
(ii) ADDITIONAL SEARCHABLE CATEGORY.—Not later
than 18 months after the date of the enactment of the
Food and Drug Administration Amendments Act of
2007, the Director of NIH shall ensure that the public
may search the entries of the registry data bank by
the safety issue, if any, being studied in the clinical
trial as a primary or secondary outcome.
(iii) OTHER ELEMENTS.—The Director of NIH shall
also ensure that the public may search the entries of
the registry data bank by such other elements as the
Director deems necessary on an ongoing basis.
(iv) FORMAT.—The Director of the NIH shall ensure that the registry data bank is easily used by the
public, and that entries are easily compared.
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(C) DATA SUBMISSION.—The responsible party for an
applicable clinical trial, including an applicable drug clinical trial for a serious or life-threatening disease or condition, that is initiated after, or is ongoing on the date that
is 90 days after, the date of the enactment of the Food and
Drug Administration Amendments Act of 2007, shall submit to the Director of NIH for inclusion in the registry
data bank the clinical trial information described in of subparagraph (A)(ii) not later than the later of—
(i) 90 days after such date of enactment;
(ii) 21 days after the first patient is enrolled in
such clinical trial; or
(iii) in the case of a clinical trial that is not for a
serious or life-threatening disease or condition and
that is ongoing on such date of enactment, 1 year after
such date of enactment.
(D) POSTING OF DATA.—
(i) APPLICABLE DRUG CLINICAL TRIAL.—The Director of NIH shall ensure that clinical trial information
for an applicable drug clinical trial submitted in accordance with this paragraph is posted in the registry
data bank not later than 30 days after such submission.
(ii) APPLICABLE DEVICE CLINICAL TRIAL.—The Director of NIH shall ensure that clinical trial information for an applicable device clinical trial submitted in
accordance with this paragraph is posted publicly in
the registry data bank—
(I) not earlier than the date of clearance
under section 510(k) of the Federal Food, Drug,
and Cosmetic Act, or approval under section 515
or 520(m) of such Act, as applicable, for a device
that was not previously cleared or approved, and
not later than 30 days after such date; or
(II) for a device that was previously cleared or
approved, not later than 30 days after the clinical
trial information under paragraph (3)(C) is required to be posted by the Secretary.
(3) EXPANSION OF REGISTRY DATA BANK TO INCLUDE RESULTS OF CLINICAL TRIALS.—
(A) LINKING REGISTRY DATA BANK TO EXISTING RESULTS.—
(i) IN GENERAL.—Beginning not later than 90 days
after the date of the enactment of the Food and Drug
Administration Amendments Act of 2007, for those
clinical trials that form the primary basis of an efficacy claim or are conducted after the drug involved is
approved or after the device involved is cleared or approved, the Secretary shall ensure that the registry
data bank includes links to results information as described in clause (ii) for such clinical trial—
(I) not earlier than 30 days after the date of
the approval of the drug involved or clearance or
approval of the device involved; or
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(II) not later than 30 days after the results information described in clause (ii) becomes publicly
available.
(ii) REQUIRED INFORMATION.—
(I) FDA INFORMATION.—The Secretary shall
ensure that the registry data bank includes links
to the following information:
(aa) If an advisory committee considered
at a meeting an applicable clinical trial, any
posted Food and Drug Administration summary document regarding such applicable
clinical trial.
(bb) If an applicable drug clinical trial
was conducted under section 505A or 505B of
the Federal Food, Drug, and Cosmetic Act, a
link to the posted Food and Drug Administration assessment of the results of such trial.
(cc) Food and Drug Administration public
health advisories regarding the drug or device
that is the subject of the applicable clinical
trial, if any.
(dd) For an applicable drug clinical trial,
the Food and Drug Administration action
package for approval document required
under section 505(l)(2) of the Federal Food,
Drug, and Cosmetic Act.
(ee) For an applicable device clinical trial,
in the case of a premarket application under
section 515 of the Federal Food, Drug, and
Cosmetic Act, the detailed summary of information respecting the safety and effectiveness
of the device required under section 520(h)(1)
of such Act, or, in the case of a report under
section 510(k) of such Act, the section 510(k)
summary of the safety and effectiveness data
required under section 807.95(d) of title 21,
Code of Federal Regulations (or any successor
regulation).
(II) NIH INFORMATION.—The Secretary shall
ensure that the registry data bank includes links
to the following information:
(aa) Medline citations to any publications
focused on the results of an applicable clinical
trial.
(bb) The entry for the drug that is the
subject of an applicable drug clinical trial in
the National Library of Medicine database of
structured product labels, if available.
(iii) RESULTS FOR EXISTING DATA BANK ENTRIES.—
The Secretary may include the links described in
clause (ii) for data bank entries for clinical trials submitted to the data bank prior to enactment of the Food
and Drug Administration Amendments Act of 2007, as
available.
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(B) INCLUSION OF RESULTS.—The Secretary, acting
through the Director of NIH, shall—
(i) expand the registry data bank to include the
results of applicable clinical trials (referred to in this
subsection as the ‘‘registry and results data bank’’);
(ii) ensure that such results are made publicly
available through the Internet;
(iii) post publicly a glossary for the lay public explaining technical terms related to the results of clinical trials; and
(iv) in consultation with experts on risk communication, provide information with the information included under subparagraph (C) in the registry and results data bank to help ensure that such information
does not mislead the patients or the public.
(C) BASIC RESULTS.—Not later than 1 year after the
date of the enactment of the Food and Drug Administration Amendments Act of 2007, the Secretary shall include
in the registry and results data bank for each applicable
clinical trial for a drug that is approved under section 505
of the Federal Food, Drug, and Cosmetic Act or licensed
under section 351 of this Act or a device that is cleared
under section 510(k) of the Federal Food, Drug, and Cosmetic Act or approved under section 515 or 520(m) of such
Act, the following elements:
(i) DEMOGRAPHIC AND BASELINE CHARACTERISTICS
OF PATIENT SAMPLE.—A table of the demographic and
baseline data collected overall and for each arm of the
clinical trial to describe the patients who participated
in the clinical trial, including the number of patients
who dropped out of the clinical trial and the number
of patients excluded from the analysis, if any.
(ii) PRIMARY AND SECONDARY OUTCOMES.—The primary and secondary outcome measures as submitted
under paragraph (2)(A)(ii)(I)(ll), and a table of values
for each of the primary and secondary outcome measures for each arm of the clinical trial, including the results of scientifically appropriate tests of the statistical
significance of such outcome measures.
(iii) POINT OF CONTACT.—A point of contact for scientific information about the clinical trial results.
(iv) CERTAIN AGREEMENTS.—Whether there exists
an agreement (other than an agreement solely to comply with applicable provisions of law protecting the
privacy of participants) between the sponsor or its
agent and the principal investigator (unless the sponsor is an employer of the principal investigator) that
restricts in any manner the ability of the principal investigator, after the completion date of the trial, to
discuss the results of the trial at a scientific meeting
or any other public or private forum, or to publish in
a scientific or academic journal information concerning
the results of the trial.
(D) EXPANDED REGISTRY AND RESULTS DATA BANK.—
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(i) EXPANSION BY RULEMAKING.—To provide more
complete results information and to enhance patient
access to and understanding of the results of clinical
trials, not later than 3 years after the date of the enactment of the Food and Drug Administration Amendments Act of 2007, the Secretary shall by regulation
expand the registry and results data bank as provided
under this subparagraph.
(ii) CLINICAL TRIALS.—
(I) APPROVED PRODUCTS.—The regulations
under this subparagraph shall require the inclusion of the results information described in clause
(iii) for—
(aa) each applicable drug clinical trial for
a drug that is approved under section 505 of
the Federal Food, Drug, and Cosmetic Act or
licensed under section 351 of this Act; and
(bb) each applicable device clinical trial
for a device that is cleared under section
510(k) of the Federal Food, Drug, and Cosmetic Act or approved under section 515 or
520(m) of such Act.
(II) UNAPPROVED PRODUCTS.—The regulations
under this subparagraph shall establish whether
or not the results information described in clause
(iii) shall be required for—
(aa) an applicable drug clinical trial for a
drug that is not approved under section 505 of
the Federal Food, Drug, and Cosmetic Act and
not licensed under section 351 of this Act
(whether approval or licensure was sought or
not); and
(bb) an applicable device clinical trial for
a device that is not cleared under section
510(k) of the Federal Food, Drug, and Cosmetic Act and not approved under section 515
or section 520(m) of such Act (whether clearance or approval was sought or not).
(iii) REQUIRED ELEMENTS.—The regulations under
this subparagraph shall require, in addition to the elements described in subparagraph (C), information
within each of the following categories:
(I) A summary of the clinical trial and its results that is written in non-technical, understandable language for patients, if the Secretary determines that such types of summary can be included
without being misleading or promotional.
(II) A summary of the clinical trial and its results that is technical in nature, if the Secretary
determines that such types of summary can be included without being misleading or promotional.
(III) The full protocol or such information on
the protocol for the trial as may be necessary to
help to evaluate the results of the trial.
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(IV) Such other categories as the Secretary
determines appropriate.
(iv) RESULTS SUBMISSION.—The results information described in clause (iii) shall be submitted to the
Director of NIH for inclusion in the registry and results data bank as provided by subparagraph (E), except that the Secretary shall by regulation determine—
(I) whether the 1-year period for submission
of clinical trial information described in subparagraph (E)(i) should be increased from 1 year to a
period not to exceed 18 months;
(II) whether the clinical trial information described in clause (iii) should be required to be submitted for an applicable clinical trial for which the
clinical trial information described in subparagraph (C) is submitted to the registry and results
data bank before the effective date of the regulations issued under this subparagraph; and
(III) in the case when the clinical trial information described in clause (iii) is required to be
submitted for the applicable clinical trials described in clause (ii)(II), the date by which such
clinical trial information shall be required to be
submitted, taking into account—
(aa) the certification process under subparagraph (E)(iii) when approval, licensure, or
clearance is sought; and
(bb) whether there should be a delay of
submission when approval, licensure, or clearance will not be sought.
(v) ADDITIONAL PROVISIONS.—The regulations
under this subparagraph shall also establish—
(I) a standard format for the submission of
clinical trial information under this paragraph to
the registry and results data bank;
(II) additional information on clinical trials
and results that is written in nontechnical, understandable language for patients;
(III) considering the experience under the
pilot quality control project described in paragraph (5)(C), procedures for quality control, including using representative samples, with respect
to completeness and content of clinical trial information under this subsection, to help ensure that
data elements are not false or misleading and are
non-promotional;
(IV) the appropriate timing and requirements
for updates of clinical trial information, and
whether and, if so, how such updates should be
tracked;
(V) a statement to accompany the entry for an
applicable clinical trial when the primary and secondary outcome measures for such clinical trial
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are submitted under paragraph (4)(A) after the
date specified for the submission of such information in paragraph (2)(C); and
(VI) additions or modifications to the manner
of reporting of the data elements established
under subparagraph (C).
(vi) CONSIDERATION OF WORLD HEALTH ORGANIZATION DATA SET.—The Secretary shall consider the status of the consensus data elements set for reporting
clinical trial results of the World Health Organization
when issuing the regulations under this subparagraph.
(vii) PUBLIC MEETING.—The Secretary shall hold a
public meeting no later than 18 months after the date
of the enactment of the Food and Drug Administration
Amendments Act of 2007 to provide an opportunity for
input from interested parties with regard to the regulations to be issued under this subparagraph.
(E) SUBMISSION OF RESULTS INFORMATION.—
(i) IN GENERAL.—Except as provided in clauses
(iii), (iv), (v), and (vi) the responsible party for an applicable clinical trial that is described in clause (ii)
shall submit to the Director of NIH for inclusion in the
registry and results data bank the clinical trial information described in subparagraph (C) not later than 1
year, or such other period as may be provided by regulation under subparagraph (D), after the earlier of—
(I) the estimated completion date of the trial
as described in paragraph (2)(A)(ii)(I)(jj)); or
(II) the actual date of completion.
(ii) CLINICAL TRIALS DESCRIBED.—An applicable
clinical trial described in this clause is an applicable
clinical trial subject to—
(I) paragraph (2)(C); and
(II)(aa) subparagraph (C); or
(bb) the regulations issued under subparagraph (D).
(iii) DELAYED SUBMISSION OF RESULTS WITH CERTIFICATION.—If the responsible party for an applicable
clinical trial submits a certification that clause (iv) or
(v) applies to such clinical trial, the responsible party
shall submit to the Director of NIH for inclusion in the
registry and results data bank the clinical trial information described in subparagraphs (C) and (D) as required under the applicable clause.
(iv) SEEKING INITIAL APPROVAL OF A DRUG OR DEVICE.—With respect to an applicable clinical trial that
is completed before the drug is initially approved
under section 505 of the Federal Food, Drug, and Cosmetic Act or initially licensed under section 351 of this
Act, or the device is initially cleared under section
510(k) or initially approved under section 515 or
520(m) of the Federal Food, Drug, and Cosmetic Act,
the responsible party shall submit to the Director of
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NIH for inclusion in the registry and results data
bank the clinical trial information described in subparagraphs (C) and (D) not later than 30 days after
the drug or device is approved under such section 505,
licensed under such section 351, cleared under such
section 510(k), or approved under such section 515 or
520(m), as applicable.
(v) SEEKING APPROVAL OF A NEW USE FOR THE
DRUG OR DEVICE.—
(I) IN GENERAL.—With respect to an applicable clinical trial where the manufacturer of the
drug or device is the sponsor of an applicable clinical trial, and such manufacturer has filed, or will
file within 1 year, an application seeking approval
under section 505 of the Federal Food, Drug, and
Cosmetic Act, licensing under section 351 of this
Act, or clearance under section 510(k), or approval
under section 515 or 520(m), of the Federal Food,
Drug, and Cosmetic Act for the use studied in
such clinical trial (which use is not included in the
labeling of the approved drug or device), then the
responsible party shall submit to the Director of
NIH for inclusion in the registry and results data
bank the clinical trial information described in
subparagraphs (C) and (D) on the earlier of the
date that is 30 days after the date—
(aa) the new use of the drug or device is
approved under such section 505, licensed
under such section 351, cleared under such
section 510(k), or approved under such section
515 or 520(m);
(bb) the Secretary issues a letter, such as
a complete response letter, not approving the
submission or not clearing the submission, a
not approvable letter, or a not substantially
equivalent letter for the new use of the drug
or device under such section 505, 351, 510(k),
515, or 520(m); or
(cc) except as provided in subclause (III),
the application or premarket notification
under such section 505, 351, 510(k), 515, or
520(m) is withdrawn without resubmission for
no less than 210 days.
(II) REQUIREMENT THAT EACH CLINICAL TRIAL
IN APPLICATION BE TREATED THE SAME.—If a manufacturer makes a certification under clause (iii)
that this clause applies with respect to a clinical
trial, the manufacturer shall make such a certification with respect to each applicable clinical trial
that is required to be submitted in an application
or report for licensure, approval, or clearance
(under section 351 of this Act or section 505,
510(k), 515, or 520(m) of the Federal Food, Drug,
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and Cosmetic Act, as applicable) of the use studied in the clinical trial.
(III) TWO-YEAR LIMITATION.—The responsible
party shall submit to the Director of NIH for inclusion in the registry and results data bank the
clinical trial information subject to subclause (I)
on the date that is 2 years after the date a certification under clause (iii) was made to the Director
of NIH, if an action referred to in item (aa), (bb),
or (cc) of subclause (I) has not occurred by such
date.
(vi) EXTENSIONS.—The Director of NIH may provide an extension of the deadline for submission of
clinical trial information under clause (i) if the responsible party for the trial submits to the Director a written request that demonstrates good cause for the extension and provides an estimate of the date on which
the information will be submitted. The Director of
NIH may grant more than one such extension for a
clinical trial.
(F) NOTICE TO DIRECTOR OF NIH.—The Commissioner
of Food and Drugs shall notify the Director of NIH when
there is an action described in subparagraph (E)(iv) or
item (aa), (bb), or (cc) of subparagraph (E)(v)(I) with respect to an application or a report that includes a certification required under paragraph (5)(B) of such action not
later than 30 days after such action.
(G) POSTING OF DATA.—The Director of NIH shall ensure that the clinical trial information described in subparagraphs (C) and (D) for an applicable clinical trial submitted in accordance with this paragraph is posted publicly in the registry and results database not later than 30
days after such submission.
(H) WAIVERS REGARDING CERTAIN CLINICAL TRIAL RESULTS.—The Secretary may waive any applicable requirements of this paragraph for an applicable clinical trial,
upon a written request from the responsible party, if the
Secretary determines that extraordinary circumstances
justify the waiver and that providing the waiver is consistent with the protection of public health, or in the interest of national security. Not later than 30 days after any
part of a waiver is granted, the Secretary shall notify, in
writing, the appropriate committees of Congress of the
waiver and provide an explanation for why the waiver was
granted.
(I) ADVERSE EVENTS.—
(i) REGULATIONS.—Not later than 18 months after
the date of the enactment of the Food and Drug Administration Amendments Act of 2007, the Secretary
shall by regulation determine the best method for including in the registry and results data bank appropriate results information on serious adverse and frequent adverse events for applicable clinical trials described in subparagraph (C) in a manner and form
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that is useful and not misleading to patients, physicians, and scientists.
(ii) DEFAULT.—If the Secretary fails to issue the
regulation required by clause (i) by the date that is 24
months after the date of the enactment of the Food
and Drug Administration Amendments Act of 2007,
clause (iii) shall take effect.
(iii) ADDITIONAL ELEMENTS.—Upon the application
of clause (ii), the Secretary shall include in the registry and results data bank for applicable clinical
trials described in subparagraph (C), in addition to the
clinical trial information described in subparagraph
(C), the following elements:
(I) SERIOUS ADVERSE EVENTS.—A table of anticipated and unanticipated serious adverse events
grouped by organ system, with number and frequency of such event in each arm of the clinical
trial.
(II) FREQUENT ADVERSE EVENTS.—A table of
anticipated and unanticipated adverse events that
are not included in the table described in subclause (I) that exceed a frequency of 5 percent
within any arm of the clinical trial, grouped by
organ system, with number and frequency of such
event in each arm of the clinical trial.
(iv) POSTING OF OTHER INFORMATION.—In carrying
out clause (iii), the Secretary shall, in consultation
with experts in risk communication, post with the tables information to enhance patient understanding
and to ensure such tables do not mislead patients or
the lay public.
(v) RELATION TO SUBPARAGRAPH (C).—Clinical trial
information included in the registry and results data
bank pursuant to this subparagraph is deemed to be
clinical trial information included in such data bank
pursuant to subparagraph (C).
(4) ADDITIONAL SUBMISSIONS OF CLINICAL TRIAL INFORMATION.—
(A) VOLUNTARY SUBMISSIONS.—A responsible party for
a clinical trial that is not an applicable clinical trial, or
that is an applicable clinical trial that is not subject to
paragraph (2)(C), may submit complete clinical trial information described in paragraph (2) or paragraph (3) provided the responsible party submits clinical trial information for each applicable clinical trial that is required to be
submitted under section 351 or under section 505, 510(k),
515, or 520(m) of the Federal Food, Drug, and Cosmetic
Act in an application or report for licensure, approval, or
clearance of the drug or device for the use studied in the
clinical trial.
(B) REQUIRED SUBMISSIONS.—
(i) IN GENERAL.—Notwithstanding paragraphs (2)
and (3) and subparagraph (A), in any case in which
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scribed in clause (ii) that posting in the registry and
results data bank of clinical trial information for such
clinical trial is necessary to protect the public health—
(I) the Secretary may require by notification
that such information be submitted to the Secretary in accordance with paragraphs (2) and (3)
except with regard to timing of submission;
(II) unless the responsible party submits a
certification under paragraph (3)(E)(iii), such information shall be submitted not later than 30
days after the date specified by the Secretary in
the notification; and
(III) failure to comply with the requirements
under subclauses (I) and (II) shall be treated as a
violation of the corresponding requirement of such
paragraphs.
(ii) CLINICAL TRIALS DESCRIBED.—A clinical trial
described in this clause is—
(I) an applicable clinical trial for a drug that
is approved under section 505 of the Federal Food,
Drug, and Cosmetic Act or licensed under section
351 of this Act or for a device that is cleared
under section 510(k) of the Federal Food, Drug,
and Cosmetic Act or approved under section 515
or section 520(m) of such Act, whose completion
date is on or after the date 10 years before the
date of the enactment of the Food and Drug Administration Amendments Act of 2007; or
(II) an applicable clinical trial that is described by both by paragraph (2)(C) and paragraph (3)(D)(ii)(II)).
(C) UPDATES TO CLINICAL TRIAL DATA BANK.—
(i) SUBMISSION OF UPDATES.—The responsible
party for an applicable clinical trial shall submit to
the Director of NIH for inclusion in the registry and
results data bank updates to reflect changes to the
clinical trial information submitted under paragraph
(2). Such updates—
(I) shall be provided not less than once every
12 months, unless there were no changes to the
clinical trial information during the preceding 12month period;
(II) shall include identification of the dates of
any such changes;
(III) not later than 30 days after the recruitment status of such clinical trial changes, shall include an update of the recruitment status; and
(IV) not later than 30 days after the completion date of the clinical trial, shall include notification to the Director that such clinical trial is
complete.
(ii) PUBLIC AVAILABILITY OF UPDATES.—The Director of NIH shall make updates submitted under clause
(i) publicly available in the registry data bank. Except
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with regard to overall recruitment status, individual
site status, location, and contact information, the Director of NIH shall ensure that updates to elements
required under subclauses (I) to (V) of paragraph
(2)(A)(ii) do not result in the removal of any information from the original submissions or any preceding
updates, and information in such databases is presented in a manner that enables users to readily access each original element submission and to track the
changes made by the updates. The Director of NIH
shall provide a link from the table of primary and secondary outcomes required under paragraph (3)(C)(ii)
to the tracked history required under this clause of the
primary and secondary outcome measures submitted
under paragraph (2)(A)(ii)(I)(ll).
(5) COORDINATION AND COMPLIANCE.—
(A) CLINICAL TRIALS SUPPORTED BY GRANTS FROM FEDERAL AGENCIES.—
(i) GRANTS FROM CERTAIN FEDERAL AGENCIES.—If
an applicable clinical trial is funded in whole or in
part by a grant from any agency of the Department of
Health and Human Services, including the Food and
Drug Administration, the National Institutes of
Health, or the Agency for Healthcare Research and
Quality, any grant or progress report forms required
under such grant shall include a certification that the
responsible party has made all required submissions
to the Director of NIH under paragraphs (2) and (3).
(ii) VERIFICATION BY FEDERAL AGENCIES.—The
heads of the agencies referred to in clause (i), as applicable, shall verify that the clinical trial information for
each applicable clinical trial for which a grantee is the
responsible party has been submitted under paragraphs (2) and (3) before releasing any remaining
funding for a grant or funding for a future grant to
such grantee.
(iii) NOTICE AND OPPORTUNITY TO REMEDY.—If the
head of an agency referred to in clause (i), as applicable, verifies that a grantee has not submitted clinical
trial information as described in clause (ii), such agency head shall provide notice to such grantee of such
non-compliance and allow such grantee 30 days to correct such non-compliance and submit the required
clinical trial information.
(iv) CONSULTATION WITH OTHER FEDERAL AGENCIES.—The Secretary shall—
(I) consult with other agencies that conduct
research involving human subjects in accordance
with any section of part 46 of title 45, Code of
Federal Regulations (or any successor regulations), to determine if any such research is an applicable clinical trial; and
(II) develop with such agencies procedures
comparable to those described in clauses (i), (ii),
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and (iii) to ensure that clinical trial information
for such applicable clinical trial is submitted
under paragraphs (2) and (3).
(B) CERTIFICATION TO ACCOMPANY DRUG, BIOLOGICAL
PRODUCT, AND DEVICE SUBMISSIONS.—At the time of submission of an application under section 505 of the Federal
Food, Drug, and Cosmetic Act, section 515 of such Act, section 520(m) of such Act, or section 351 of this Act, or submission of a report under section 510(k) of such Act, such
application or submission shall be accompanied by a certification that all applicable requirements of this subsection have been met. Where available, such certification
shall include the appropriate National Clinical Trial control numbers.
(C) QUALITY CONTROL.—
(i) PILOT QUALITY CONTROL PROJECT.—Until the
effective date of the regulations issued under paragraph (3)(D), the Secretary, acting through the Director of NIH and the Commissioner of Food and Drugs,
shall conduct a pilot project to determine the optimal
method of verification to help to ensure that the clinical trial information submitted under paragraph
(3)(C) is non-promotional and is not false or misleading in any particular under subparagraph (D). The
Secretary shall use the publicly available information
described in paragraph (3)(A) and any other information available to the Secretary about applicable clinical
trials to verify the accuracy of the clinical trial information submitted under paragraph (3)(C).
(ii) NOTICE OF COMPLIANCE.—If the Secretary determines that any clinical trial information was not
submitted as required under this subsection, or was
submitted but is false or misleading in any particular,
the Secretary shall notify the responsible party and
give such party an opportunity to remedy such noncompliance by submitting the required revised clinical
trial information not later than 30 days after such notification.
(D) TRUTHFUL CLINICAL TRIAL INFORMATION.—
(i) IN GENERAL.—The clinical trial information
submitted by a responsible party under this subsection
shall not be false or misleading in any particular.
(ii) EFFECT.—Clause (i) shall not have the effect
of—
(I) requiring clinical trial information with respect to an applicable clinical trial to include information from any source other than such clinical
trial involved; or
(II) requiring clinical trial information described in paragraph (3)(D) to be submitted for
purposes of paragraph (3)(C).
(E) PUBLIC NOTICES.—
(i) NOTICE OF VIOLATIONS.—If the responsible
party for an applicable clinical trial fails to submit
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clinical trial information for such clinical trial as required under paragraphs (2) or (3), the Director of
NIH shall include in the registry and results data
bank entry for such clinical trial a notice—
(I) that the responsible party is not in compliance with this Act by—
(aa) failing to submit required clinical
trial information; or
(bb) submitting false or misleading clinical trial information;
(II) of the penalties imposed for the violation,
if any; and
(III) whether the responsible party has corrected the clinical trial information in the registry
and results data bank.
(ii) NOTICE OF FAILURE TO SUBMIT PRIMARY AND
SECONDARY OUTCOMES.—If the responsible party for an
applicable clinical trial fails to submit the primary and
secondary outcomes as required under section
2(A)(ii)(I)(ll), the Director of NIH shall include in the
registry and results data bank entry for such clinical
trial a notice that the responsible party is not in compliance by failing to register the primary and secondary outcomes in accordance with this act, and that
the primary and secondary outcomes were not publicly
disclosed in the database before conducting the clinical
trial.
(iii) FAILURE TO SUBMIT STATEMENT.—The notice
under clause (i) for a violation described in clause
(i)(I)(aa) shall include the following statement: ‘‘The
entry for this clinical trial was not complete at the
time of submission, as required by law. This may or
may not have any bearing on the accuracy of the information in the entry.’’.
(iv) SUBMISSION OF FALSE INFORMATION STATEMENT.—The notice under clause (i) for a violation described in clause (i)(I)(bb) shall include the following
statement: ‘‘The entry for this clinical trial was found
to be false or misleading and therefore not in compliance with the law.’’.
(v) NON-SUBMISSION OF STATEMENT.—The notice
under clause (ii) for a violation described in clause (ii)
shall include the following statement: ‘‘The entry for
this clinical trial did not contain information on the
primary and secondary outcomes at the time of submission, as required by law. This may or may not have
any bearing on the accuracy of the information in the
entry.’’.
(vi) COMPLIANCE SEARCHES.—The Director of NIH
shall provide that the public may easily search the
registry and results data bank for entries that include
notices required under this subparagraph.
(6) LIMITATION ON DISCLOSURE OF CLINICAL TRIAL INFORMATION.—
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(A) IN GENERAL.—Nothing in this subsection (or under
section 552 of title 5, United States Code) shall require the
Secretary to publicly disclose, by any means other than the
registry and results data bank, information described in
subparagraph (B).
(B) INFORMATION DESCRIBED.—Information described
in this subparagraph is—
(i) information submitted to the Director of NIH
under this subsection, or information of the same general nature as (or integrally associated with) the information so submitted; and
(ii) information not otherwise publicly available,
including because it is protected from disclosure under
section 552 of title 5, United States Code.
(7) AUTHORIZATION OF APPROPRIATIONS.—There are authorized to be appropriated to carry out this subsection $10,000,000
for each fiscal year.
(k)(1) The Director of NIH may establish a program to provide
day care services for the employees of the National Institutes of
Health similar to those services provided by other Federal agencies
(including the availability of day care service on a 24-hour-a-day
basis).
(2) Any day care provider at the National Institutes of Health
shall establish a sliding scale of fees that takes into consideration
the income and needs of the employee.
(3) For purposes regarding the provision of day care services,
the Director of NIH may enter into rental or lease purchase agreements.
(l) COUNCIL OF COUNCILS.—
(1) ESTABLISHMENT.—Not later than 90 days after the date
of the enactment of the National Institutes of Health Reform
Act of 2006, the Director of NIH shall establish within the Office of the Director an advisory council to be known as the
‘‘Council of Councils’’ (referred to in this subsection as the
‘‘Council’’) for the purpose of advising the Director on matters
related to the policies and activities of the Division of Program
Coordination, Planning, and Strategic Initiatives, including
making recommendations with respect to the conduct and support of research described in subsection (b)(7).
(2) MEMBERSHIP.—
(A) IN GENERAL.—The Council shall be composed of 27
members selected by the Director of NIH with approval
from the Secretary from among the list of nominees under
subparagraph (C).
(B) CERTAIN REQUIREMENTS.—In selecting the members of the Council, the Director of NIH shall ensure—
(i) the representation of a broad range of disciplines and perspectives; and
(ii) the ongoing inclusion of at least 1 representative from each national research institute whose budget is substantial relative to a majority of the other institutes.
(C) NOMINATION.—The Director of NIH shall maintain
an updated list of individuals who have been nominated to
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serve on the Council, which list shall consist of the following:
(i) For each national research institute and national center, 3 individuals nominated by the head of
such institute or center from among the members of
the advisory council of the institute or center, of
which—
(I) two shall be scientists; and
(II) one shall be from the general public or
shall be a leader in the field of public policy, law,
health policy, economics, or management.
(ii) For each office within the Division of Program
Coordination, Planning, and Strategic Initiatives, 1 individual nominated by the head of such office.
(iii) Members of the Council of Public Representatives.
(3) TERMS.—
(A) IN GENERAL.—The term of service for a member of
the Council shall be 6 years, except as provided in subparagraphs (B) and (C).
(B) TERMS OF INITIAL APPOINTEES.—Of the initial
members selected for the Council, the Director of NIH
shall designate—
(i) nine for a term of 6 years;
(ii) nine for a term of 4 years; and
(iii) nine for a term of 2 years.
(C) 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.
SEC. 402A. ø282a¿ AUTHORIZATION OF APPROPRIATIONS.
(a) IN GENERAL.—For the purpose of carrying out

this title,
there are authorized to be appropriated—
(1) $30,331,309,000 for fiscal year 2007;
(2) $32,831,309,000 for fiscal year 2008; and
(3) such sums as may be necessary for fiscal year 2009.
(b) OFFICE OF THE DIRECTOR.—Of the amount authorized to be
appropriated under subsection (a) for a fiscal year, there are authorized to be appropriated for programs and activities under this
title carried out through the Office of the Director of NIH such
sums as may be necessary for each of the fiscal years 2007 through
2009.
(c) TRANS-NIH RESEARCH.—
(1) COMMON FUND.—
(A) ACCOUNT.—For the purpose of allocations under
section 402(b)(7)(B) (relating to research identified by the
Division of Program Coordination, Planning, and Strategic
Initiatives), there is established an account to be known as
the Common Fund.
(B) RESERVATION.—
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(i) IN GENERAL.—Of the total amount appropriated
under subsection (a) for fiscal year 2007 or any subsequent fiscal year, the Director of NIH shall reserve an
amount for the Common Fund, subject to any applicable provisions in appropriations Acts.
(ii) MINIMUM AMOUNT.—For each fiscal year, the
percentage constituted by the amount reserved under
clause (i) relative to the total amount appropriated
under subsection (a) for such year may not be less
than the percentage constituted by the amount so reserved for the preceding fiscal year relative to the
total amount appropriated under subsection (a) for
such preceding fiscal year, subject to any applicable
provisions in appropriations Acts.
(C) COMMON FUND STRATEGIC PLANNING REPORT.—Not
later than June 1, 2007, and every 2 years thereafter, the
Secretary, acting through the Director of NIH, shall submit a report to the Congress containing a strategic plan for
funding research described in section 402(b)(7)(A)(i) (including personnel needs) through the Common Fund. Each
such plan shall include the following:
(i) An estimate of the amounts determined by the
Director of NIH to be appropriate for maximizing the
potential of such research.
(ii) An estimate of the amounts determined by the
Director of NIH to be sufficient only for continuing to
fund research activities previously identified by the
Division of Program Coordination, Planning, and Strategic Initiatives.
(iii) An estimate of the amounts determined by
the Director of NIH to be necessary to fund research
described in section 402(b)(7)(A)(i)—
(I) that is in addition to the research activities
described in clause (ii); and
(II) for which there is the most substantial
need.
(D) EVALUATION.—During the 6-month period following the end of the first fiscal year for which the total
amount reserved under subparagraph (B) is equal to 5 percent of the total amount appropriated under subsection (a)
for such fiscal year, the Secretary, acting through the Director of NIH, in consultation with the advisory council established under section 402(k), shall submit recommendations to the Congress for changes regarding amounts for
the Common Fund.
(2) TRANS-NIH RESEARCH REPORTING.—
(A) LIMITATION.—With respect to the total amount appropriated under subsection (a) for fiscal year 2008 or any
subsequent fiscal year, if the head of a national research
institute or national center fails to submit the report required by subparagraph (B) for the preceding fiscal year,
the amount made available for the institute or center for
the fiscal year involved may not exceed the amount made
available for the institute or center for fiscal year 2006.
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(B) REPORTING.—Not later than January 1, 2008, and
each January 1st thereafter—
(i) the head of each national research institute or
national center shall submit to the Director of NIH a
report on the amount made available by the institute
or center for conducting or supporting research that
involves collaboration between the institute or center
and 1 or more other national research institutes or national centers; and
(ii) the Secretary shall submit a report to the Congress identifying the percentage of funds made available by each national research institute and national
center with respect to such fiscal year for conducting
or supporting research described in clause (i).
(C) DETERMINATION.—For purposes of determining the
amount or percentage of funds to be reported under subparagraph (B), any amounts made available to an institute
or center under section 402(b)(7)(B) shall be included.
(D) VERIFICATION OF AMOUNTS.—Upon receipt of each
report submitted under subparagraph (B)(i), the Director
of NIH shall review and, in cases of discrepancy, verify the
accuracy of the amounts specified in the report.
(E) WAIVER.—At the request of any national research
institute or national center, the Director of NIH may waive
the application of this paragraph to such institute or center if the Director finds that the conduct or support of research described in subparagraph (B)(i) is inconsistent
with the mission of such institute or center.
(d) TRANSFER AUTHORITY.—Of the total amount appropriated
under subsection (a) for a fiscal year, the Director of NIH may (in
addition to the reservation under subsection (c)(1) for such year)
transfer not more than 1 percent for programs or activities that are
authorized in this title and identified by the Director to receive
funds pursuant to this subsection. In making such transfers, the
Director may not decrease any appropriation account under subsection (a) by more than 1 percent.
(e) RULE OF CONSTRUCTION.—This section may not be construed as affecting the authorities of the Director of NIH under section 401.
SEC. 402B. ø282b¿ ELECTRONIC CODING OF GRANTS AND ACTIVITIES.

The Secretary, acting through the Director of NIH, shall establish an electronic system to uniformly code research grants and activities of the Office of the Director and of all the national research
institutes and national centers. The electronic system shall be
searchable by a variety of codes, such as the type of research grant,
the research entity managing the grant, and the public health area
of interest. When permissible, the Secretary, acting through the Director of NIH, shall provide information on relevant literature and
patents that are associated with research activities of the National
Institutes of Health.
SEC. 403. ø283¿ BIENNIAL REPORTS OF DIRECTOR OF NIH.
(a) IN GENERAL.—The Director of NIH shall submit

to the Congress on a biennial basis a report in accordance with this section.
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The first report shall be submitted not later than 1 year after the
date of the enactment of the National Institutes of Health Reform
Act of 2006. Each such report shall include the following information:
(1) An assessment of the state of biomedical and behavioral research.
(2) A description of the activities conducted or supported
by the agencies of the National Institutes of Health and policies respecting the programs of such agencies.
(3) Classification and justification for the priorities established by the agencies, including a strategic plan and recommendations for future research initiatives to be carried out
under section 402(b)(7) through the Division of Program Coordination, Planning, and Strategic Initiatives.
(4) A catalog of all the research activities of the agencies,
prepared in accordance with the following:
(A) The catalog shall, for each such activity—
(i) identify the agency or agencies involved;
(ii) state whether the activity was carried out directly by the agencies or was supported by the agencies and describe to what extent the agency was involved; and
(iii) identify whether the activity was carried out
through a center of excellence.
(B) In the case of clinical research, the catalog shall,
as appropriate, identify study populations by demographic
variables and other variables that contribute to research
on minority health and health disparities.
(C) Research activities listed in the catalog shall include, where applicable, the following:
(i) Epidemiological studies and longitudinal studies.
(ii) Disease registries, information clearinghouses,
and other data systems.
(iii) Public education and information campaigns.
(iv) Training activities, including—
(I) National Research Service Awards and
Clinical Transformation Science Awards;
(II) graduate medical education programs, including information on the number and type of
graduate degrees awarded during the period in
which the programs received funding under this
title;
(III)
investigator-initiated
awards
for
postdoctoral training and postdoctoral training
funded through research grants;
(IV) a breakdown by demographic variables
and other appropriate categories; and
(V) an evaluation and comparison of outcomes
and effectiveness of various training programs.
(v) Clinical trials, including a breakdown of participation by study populations and demographic variables and such other information as may be necessary
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ing inclusion of women and minorities in clinical research).
(vi) Translational research activities with other
agencies of the Public Health Service.
(5) A summary of the research activities throughout the
agencies, which summary shall be organized by the following
categories, where applicable:
(A) Cancer.
(B) Neurosciences.
(C) Life stages, human development, and rehabilitation.
(D) Organ systems.
(E) Autoimmune diseases.
(F) Genomics.
(G) Molecular biology and basic science.
(H) Technology development.
(I) Chronic diseases, including pain and palliative
care.
(J) Infectious diseases and bioterrorism.
(K) Minority health and health disparities.
(L) Such additional categories as the Director determines to be appropriate.
(6) A review of each entity receiving funding under this
title in its capacity as a center of excellence (in this paragraph
referred to as a ‘‘center of excellence’’), including the following:
(A) An evaluation of the performance and research
outcomes of each center of excellence.
(B) Recommendations for promoting coordination of information among the centers of excellence.
(C) Recommendations for improving the effectiveness,
efficiency, and outcomes of the centers of excellence.
(D) If no additional centers of excellence have been
funded under this title since the previous report under this
section, an explanation of the reasons for not funding any
additional centers.
(b) REQUIREMENT REGARDING DISEASE-SPECIFIC RESEARCH ACTIVITIES.—In a report under subsection (a), the Director of NIH,
when reporting on research activities relating to a specific disease,
disorder, or other adverse health condition, shall—
(1) present information in a standardized format;
(2) identify the actual dollar amounts obligated for such
activities; and
(3) include a plan for research on the specific disease, disorder, or other adverse health condition, including a statement
of objectives regarding the research, the means for achieving
the objectives, a date by which the objectives are expected to
be achieved, and justifications for revisions to the plan.
(c) ADDITIONAL REPORTS.—In addition to reports required by
subsections (a) and (b), the Director of NIH or the head of a national research institute or national center may submit to the Congress such additional reports as the Director or the head of such
institute or center determines to be appropriate.
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SEC. 403A. ø283a¿ ANNUAL REPORTING TO INCREASE INTERAGENCY
COLLABORATION AND COORDINATION.
(a) COLLABORATION WITH OTHER HHS AGENCIES.—On an an-

nual basis, the Director of NIH shall submit to the Secretary a report on the activities of the National Institutes of Health involving
collaboration with other agencies of the Department of Health and
Human Services.
(b) CLINICAL TRIALS.—Each calendar year, the Director of NIH
shall submit to the Commissioner of Food and Drugs a report that
identifies each clinical trial that is registered during such calendar
year in the databank of information established under section
402(i).
(c) HUMAN TISSUE SAMPLES.—On an annual basis, the Director
of NIH shall submit to the Congress a report that describes how
the National Institutes of Health and its agencies store and track
human tissue samples.
(d) FIRST REPORT.—The first report under subsections (a), (b),
and (c) shall be submitted not later than 1 year after the date of
the enactment of the National Institutes of Health Reform Act of
2006.
SEC. 403B. ø283a–1¿ ANNUAL REPORTING TO PREVENT FRAUD AND
ABUSE.
(a) WHISTLEBLOWER COMPLAINTS.—
(1) IN GENERAL.—On an annual basis, the Director of NIH

shall submit to the Inspector General of the Department of
Health and Human Services, the Secretary, the Committee on
Energy and Commerce and the Committee on Appropriations
of the House of Representatives, and the Committee on Health,
Education, Labor, and Pensions and the Committee on Appropriations of the Senate a report summarizing the activities of
the National Institutes of Health relating to whistleblower
complaints.
(2) CONTENTS.—For each whistleblower complaint pending
during the year for which a report is submitted under this subsection, the report shall identify the following:
(A) Each agency of the National Institutes of Health
involved.
(B) The status of the complaint.
(C) The resolution of the complaint to date.
(b) EXPERTS AND CONSULTANTS.—On an annual basis, the Director of NIH shall submit to the Inspector General of the Department of Health and Human Services, the Secretary, the Committee
on Energy and Commerce and the Committee on Appropriations of
the House of Representatives, and the Committee on Health, Education, Labor, and Pensions and the Committee on Appropriations
of the Senate a report that—
(1) identifies the number of experts and consultants, including any special consultants, whose services are obtained by
the National Institutes of Health or its agencies;
(2) specifies whether such services were obtained under
section 207(f), section 402(d), or other authority;
(3) describes the qualifications of such experts and consultants;
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(4) describes the need for hiring such experts and consultants; and
(5) if such experts and consultants make financial disclosures to the National Institutes of Health or any of its agencies, specifies the income, gifts, assets, and liabilities so disclosed.
(c) FIRST REPORT.—The first report under subsections (a) and
(b) shall be submitted not later than 1 year after the date of the
enactment of the National Institutes of Health Reform Act of 2006.
SEC. 403C. ø283a–2¿ ANNUAL REPORTING REGARDING TRAINING OF
GRADUATE STUDENTS FOR DOCTORAL DEGREES.
(a) IN GENERAL.—Each institution receiving an award under

this title for the training of graduate students for doctoral degrees
shall annually report to the Director of NIH, with respect to graduate students supported by the National Institutes of Health at
such institution—
(1) the percentage of such students admitted for study who
successfully attain a doctoral degree; and
(2) for students described in paragraph (1), the average
time (not including any leaves of absence) between the beginning of graduate study and the receipt of a doctoral degree.
(3) 1 PROVISION OF INFORMATION TO APPLICANTS.—Each institution described in subsection (a) shall provide to each student submitting an application for a program of graduate study
at such institution the information described in paragraphs (1)
and (2) of such subsection with respect to the program or programs to which such student has applied.
DES

SEC. 403D. ø283a–3¿ (a) The Director of NIH shall establish a
program for the conduct and support of research and training, the
dissemination of health information, and other programs with respect to the diagnosis and treatment of conditions associated with
exposure to the drug diethylstilbestrol (in this section referred to
as ‘‘DES’’).
(b) In carrying out subsection (a), the Director of NIH, after
consultation with nonprofit private entities representing individuals who have been exposed to DES, shall conduct or support programs to educate health professionals and the public on the drug,
including the importance of identifying and treating individuals
who have been exposed to the drug.
(c) After consultation with the Office of Research on Women’s
Health, the Director of NIH, acting through the appropriate national research institutes, shall in carrying out subsection (a) conduct or support one or more longitudinal studies to determine the
incidence of the following diseases or disorders in the indicated
populations and the relationship of DES to the diseases or disorders:
(1) In the case of women to whom (on or after January 1,
1938) DES was administered while the women were pregnant,
the incidence of all diseases and disorders (including breast
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cancer, gynecological cancers, and impairments of the immune
system, including autoimmune disease).
(2) In the case of women exposed to DES in utero, the incidence of clear cell cancer (including recurrences), the long-term
health effects of such cancer, and the effects of treatments for
such cancer.
(3) In the case of men and women exposed to DES in
utero, the incidence of all diseases and disorders (including impairments of the reproductive and autoimmune systems).
(4) In the case of children of men or women exposed to
DES in utero, the incidence of all diseases and disorders.
(d) For purposes of this section, an individual shall be considered to have been exposed to DES in utero if, during the pregnancy
that resulted in the birth of such individual, DES was (on or after
January 1, 1938) administered to the biological mother of the individual.
OFFICE OF BEHAVIORAL AND SOCIAL SCIENCES RESEARCH

SEC. 404A. 1 ø283c¿ (a) There is established within the Office
of the Director of NIH an office to be known as the Office of Behavioral and Social Sciences Research (in this section referred to as
the ‘‘Office’’). The Office shall be headed by a director, who shall
be appointed by the Director of NIH.
(b)(1) With respect to research on the relationship between
human behavior and the development, treatment, and prevention
of medical conditions, the Director of the Office shall—
(A) coordinate research conducted or supported by the
agencies of the National Institutes of Health; and
(B) identify projects of behavioral and social sciences research that should be conducted or supported by the national
research institutes, and develop such projects in cooperation
with such institutes.
(2) Research authorized under paragraph (1) includes research
on teen pregnancy, infant mortality, violent behavior, suicide, and
homelessness. Such research does not include neurobiological research, or research in which the behavior of an organism is observed for the purpose of determining activity at the cellular or molecular level.
CHILDREN’S VACCINE INITIATIVE

SEC. 404B. ø283d¿ (a) DEVELOPMENT OF NEW VACCINES.—The
Secretary, in consultation with the Director of the National Vaccine
Program under title XXI and acting through the Directors of the
National Institute for Allergy and Infectious Diseases, the Eunice
Kennedy Shriver National Institute of Child Health and Human
Development, the National Institute for Aging, and other public
and private programs, shall carry out activities, which shall be consistent with the global Children’s Vaccine Initiative, to develop affordable new and improved vaccines to be used in the United
States and in the developing world that will increase the efficacy
and efficiency of the prevention of infectious diseases. In carrying
out such activities, the Secretary shall, to the extent practicable,
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develop and make available vaccines that require fewer contacts to
deliver, that can be given early in life, that provide long lasting
protection, that obviate refrigeration, needles and syringes, and
that protect against a larger number of diseases.
(b) REPORT.—In the report required in section 2104 1, the Secretary, acting through the Director of the National Vaccine Program under title XXI, shall include information with respect to activities and the progress made in implementing the provisions of
this section and achieving its goals.
PLAN FOR USE OF ANIMALS IN RESEARCH

SEC. 404C. ø283e¿ (a) The Director of NIH, after consultation
with the committee established under subsection (e), shall prepare
a plan—
(1) for the National Institutes of Health to conduct or support research into—
(A) methods of biomedical research and experimentation that do not require the use of animals;
(B) methods of such research and experimentation
that reduce the number of animals used in such research;
(C) methods of such research and experimentation
that produce less pain and distress in such animals; and
(D) methods of such research and experimentation
that involve the use of marine life (other than marine
mammals);
(2) for establishing the validity and reliability of the methods described in paragraph (1);
(3) for encouraging the acceptance by the scientific community of such methods that have been found to be valid and reliable; and
(4) for training scientists in the use of such methods that
have been found to be valid and reliable.
(b) Not later than October 1, 1993, the Director of NIH shall
submit to the Committee on Energy and Commerce of the House
of Representatives, and to the Committee on Labor and Human Resources of the Senate, the plan required in subsection (a) and shall
begin implementation of the plan.
(c) The Director of NIH shall periodically review, and as appropriate, make revisions in the plan required under subsection (a). A
description of any revision made in the plan shall be included in
the first biennial report under section 403 that is submitted after
the revision is made.
(d) The Director of NIH shall take such actions as may be appropriate to convey to scientists and others who use animals in biomedical or behavioral research or experimentation information respecting the methods found to be valid and reliable under subsection (a)(2).
(e)(1) The Director of NIH shall establish within the National
Institutes of Health a committee to be known as the Interagency
Coordinating Committee on the Use of Animals in Research (in this
subsection referred to as the ‘‘Committee’’).
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(2) The Committee shall provide advice to the Director of NIH
on the preparation of the plan required in subsection (a).
(3) The Committee shall be composed of—
(A) the Directors of each of the national research institutes
(or the designees of such Directors); and
(B) representatives of the Environmental Protection Agency, the Food and Drug Administration, the Consumer Product
Safety Commission, the National Science Foundation, and such
additional agencies as the Director of NIH determines to be appropriate, which representatives shall include not less than
one veterinarian with expertise in laboratory-animal medicine.
REQUIREMENTS REGARDING SURVEYS OF SEXUAL BEHAVIOR

SEC. 404D. ø283f¿ With respect to any survey of human sexual
behavior proposed to be conducted or supported through the National Institutes of Health, the survey may not be carried out unless—
(1) the proposal has undergone review in accordance with
any applicable requirements of sections 491 and 492; and
(2) the Secretary, in accordance with section 492A, makes
a determination that the information expected to be obtained
through the survey will assist—
(A) in reducing the incidence of sexually transmitted
diseases, the incidence of infection with the human immunodeficiency virus, or the incidence of any other infectious disease; or
(B) in improving reproductive health or other conditions of health.
SEC. 404E. ø283g¿ MUSCULAR DYSTROPHY; INITIATIVE THROUGH DIRECTOR OF NATIONAL INSTITUTES OF HEALTH.
(a) EXPANSION, INTENSIFICATION, AND COORDINATION OF ACTIVITIES.—
(1) IN GENERAL.—The Director of NIH, in coordination

with the Directors of the National Institute of Neurological
Disorders and Stroke, the National Institute of Arthritis and
Muscoskeletal and Skin Diseases, the Eunice Kennedy Shriver
National Institute of Child Health and Human Development,
the National Heart, Lung, and Blood Institute, and the other
national research institutes as appropriate, shall expand and
intensify programs of such Institutes with respect to research
and related activities concerning various forms of muscular
dystrophy, including Duchenne, myotonic, facioscapulohumeral
muscular dystrophy (referred to in this section as ‘‘FSHD’’) and
other forms of muscular dystrophy.
(2) COORDINATION.—The Directors referred to in paragraph
(1) shall jointly coordinate the programs referred to in such
paragraph and consult with the Muscular Dystrophy Interagency Coordinating Committee established under section 6 of
the MD–CARE Act.
(3) ALLOCATIONS BY DIRECTOR OF NIH.—The Director of
NIH shall allocate the amounts appropriated to carry out this
section for each fiscal year among the national research institutes referred to in paragraph (1).
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(b) CENTERS OF EXCELLENCE.—
(1) IN GENERAL.—The Director of NIH shall award grants
and contracts under subsection (a)(1) to public or nonprofit private entities to pay all or part of the cost of planning, establishing, improving, and providing basic operating support for
centers of excellence regarding research on various forms of
muscular dystrophy. Such centers of excellence shall be known
as the ‘‘Paul D. Wellstone Muscular Dystrophy Cooperative Research Centers’’.
(2) RESEARCH.—Each center under paragraph (1) shall
supplement but not replace the establishment of a comprehensive research portfolio in all the muscular dystrophies. As a
whole, the centers shall conduct basic and clinical research in
all forms of muscular dystrophy including early detection, diagnosis, prevention, and treatment, including the fields of muscle
biology, genetics, noninvasive imaging, genetics, pharmacological and other therapies.
(3) COORDINATION OF CENTERS.—The Director of NIH
shall, as appropriate, provide for the coordination of information among centers under paragraph (1) and ensure regular
communication between such centers.
(4) ORGANIZATION OF CENTERS.—Each center under paragraph (1) shall use the facilities of a single institution, or be
formed from a consortium of cooperating institutions, meeting
such requirements as may be prescribed by the Director of
NIH.
(5) DURATION OF SUPPORT.—Support for a center established under paragraph (1) may be provided under this section
for a period of not to exceed 5 years. Such period may be extended for 1 or more additional periods not exceeding 5 years
if the operations of such center have been reviewed by an appropriate technical and scientific peer review group established
by the Director of NIH and if such group has recommended to
the Director that such period should be extended.
(c) FACILITATION OF RESEARCH.—The Director of NIH shall
provide for a program under subsection (a)(1) under which samples
of tissues and genetic materials that are of use in research on muscular dystrophy are donated, collected, preserved, and made available for such research. The program shall be carried out in accordance with accepted scientific and medical standards for the donation, collection, and preservation of such samples.
(d) COORDINATING COMMITTEE.—
(1) IN GENERAL.—The Secretary shall establish the Muscular Dystrophy Coordinating Committee (referred to in this
section as the ‘‘Coordinating Committee’’) to coordinate activities across the National Institutes and with other Federal
health programs and activities relating to the various forms of
muscular dystrophy.
(2) COMPOSITION.—The Coordinating Committee shall consist of not more than 15 members to be appointed by the Secretary, of which—
(A) 2⁄3 of such members shall represent governmental
agencies, including the directors or their designees of each
of the national research institutes involved in research
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with respect to muscular dystrophy and representatives of
all other Federal departments and agencies whose programs involve health functions or responsibilities relevant
to such diseases, including the Centers for Disease Control
and Prevention, the Health Resources and Services Administration and the Food and Drug Administration and representatives of other governmental agencies that serve
children with muscular dystrophy, such as the Department
of Education; and
(B) 1⁄3 of such members shall be public members, including a broad cross section of persons affected with muscular dystrophies including parents or legal guardians, affected individuals, researchers, and clinicians.
Members appointed under subparagraph (B) shall serve for a
term of 3 years, and may serve for an unlimited number of
terms if reappointed.
(3) CHAIR.—
(A) IN GENERAL.—With respect to muscular dystrophy,
the Chair of the Coordinating Committee shall serve as
the principal advisor to the Secretary, the Assistant Secretary for Health, and the Director of NIH, and shall provide advice to the Director of the Centers for Disease Control and Prevention, the Commissioner of Food and Drugs,
and to the heads of other relevant agencies. The Coordinating Committee shall select the Chair for a term not to
exceed 2 years.
(B) APPOINTMENT.—The Chair of the Committee shall
be appointed by and be directly responsible to the Secretary.
(4) ADMINISTRATIVE SUPPORT; TERMS OF SERVICE; OTHER
PROVISIONS.—The following shall apply with respect to the Coordinating Committee:
(A) The Coordinating Committee shall receive necessary and appropriate administrative support from the
Department of Health and Human Services.
(B) The Coordinating Committee shall meet as appropriate as determined by the Secretary, in consultation with
the chair.
(e) PLAN FOR HHS ACTIVITIES.—
(1) IN GENERAL.—Not later than 1 year after the date of
enactment of this section, the Coordinating Committee shall
develop a plan for conducting and supporting research and
education on muscular dystrophy through the national research institutes and shall periodically review and revise the
plan. The plan shall—
(A) provide for a broad range of research and education activities relating to biomedical, epidemiological,
psychosocial, and rehabilitative issues, including studies of
the impact of such diseases in rural and underserved communities;
(B) identify priorities among the programs and activities of the National Institutes of Health regarding such
diseases; and
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(C) reflect input from a broad range of scientists, patients, and advocacy groups.
(2) CERTAIN ELEMENTS OF PLAN.—The plan under paragraph (1) shall, with respect to each form of muscular dystrophy, provide for the following as appropriate:
(A) Research to determine the reasons underlying the
incidence and prevalence of various forms of muscular dystrophy.
(B) Basic research concerning the etiology and genetic
links of the disease and potential causes of mutations.
(C) The development of improved screening techniques.
(D) Basic and clinical research for the development
and evaluation of new treatments, including new biological
agents.
(E) Information and education programs for health
care professionals and the public.
(f) PUBLIC INPUT.—The Secretary shall, under subsection (a)(1),
provide for a means through which the public can obtain information on the existing and planned programs and activities of the Department of Health and Human Services with respect to various
forms of muscular dystrophy and through which the Secretary can
receive comments from the public regarding such programs and activities.
(g) CLINICAL RESEARCH.—The Coordinating Committee may
evaluate the potential need to enhance the clinical research infrastructure required to test emerging therapies for the various forms
of muscular dystrophy by prioritizing the achievement of the goals
related to this topic in the plan under subsection (e)(1).
[Section 404F was transferred and redesignated as section 481
by section 221(c)(2)(A)(i) of Public Law 112–74.]
[Section 404G was transferred and redesignated as section
481A by section 221(c)(3) of Public Law 112–74.]
SEC. 404H. ø283j¿ REVIEW OF CENTERS OF EXCELLENCE.
(a) IN GENERAL.—Not later than April 1, 2008, and

periodically
thereafter, the Secretary, acting through the Director of NIH, shall
conduct a review and submit a report to the appropriate committees of the Congress on the centers of excellence.
(b) REPORT CONTENTS.—Each report under subsection (a) shall
include the following:
(1) Evaluation of the performance and research outcomes
of each center of excellence.
(2) Recommendations for promoting coordination of information among centers of excellence.
(3) Recommendations for improving the effectiveness, efficiency, and outcomes of the centers of excellence.
(c) DEFINITION.—In this section, the term ‘‘center of excellence’’
means an entity receiving funding under this title in its capacity
as a center of excellence.
SEC. 404I. ø283k¿ BIOMEDICAL AND BEHAVIORAL RESEARCH FACILITIES.
(a) MODERNIZATION AND CONSTRUCTION OF FACILITIES.—
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(1) IN GENERAL.—The Director of NIH, acting through the
Office of the Director of NIH or the Director of the National
Institute of Allergy and Infectious Diseases, may make grants
or contracts to public and nonprofit private entities to expand,
remodel, renovate, or alter existing research facilities or construct new research facilities, subject to the provisions of this
section.
(2) CONSTRUCTION AND COST OF CONSTRUCTION.—For purposes of this section, the terms ‘‘construction’’ and ‘‘cost of construction’’ include the construction of new buildings and the expansion, renovation, remodeling, and alteration of existing
buildings, including architects’ fees, but do not include the cost
of acquisition of land or off-site improvements.
(b) SCIENTIFIC AND TECHNICAL REVIEW BOARDS FOR MERITBASED REVIEW OF PROPOSALS.—
(1) IN GENERAL: APPROVAL AS PRECONDITION TO GRANTS.—
(A) ESTABLISHMENT.—There is established a Scientific
and Technical Review Board on Biomedical and Behavioral
Research Facilities (referred to in this section as the
‘‘Board’’).
(B) REQUIREMENT.—The Director of NIH, acting
through the Office of the Director of NIH, may approve an
application for a grant under subsection (a) only if the
Board has under paragraph (2) recommended the application for approval.
(2) DUTIES.—
(A) ADVICE.—The Board shall provide advice to the Director of NIH and the Council of Councils established
under section 402(l) (in this section referred to as the
‘‘Council’’) in carrying out this section.
(B) DETERMINATION OF MERIT.—In carrying out subparagraph (A), the Board shall make a determination of
the merit of each application submitted for a grant under
subsection (a), after consideration of the requirements established in subsection (c), and shall report the results of
the determination to the Director of NIH and the Council.
Such determinations shall be conducted in a manner consistent with procedures established under section 492.
(C) AMOUNT.—In carrying out subparagraph (A), the
Board shall, in the case of applications recommended for
approval, make recommendations to the Director and the
Council on the amount that should be provided under the
grant.
(D) ANNUAL REPORT.—In carrying out subparagraph
(A), the Board shall prepare an annual report for the Director of NIH and the Council describing the activities of
the Board in the fiscal year for which the report is made.
Each such report shall be available to the public, and
shall—
(i) summarize and analyze expenditures made
under this section;
(ii) provide a summary of the types, numbers, and
amounts of applications that were recommended for
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grants under subsection (a) but that were not approved by the Director of NIH; and
(iii) contain the recommendations of the Board for
any changes in the administration of this section.
(3) MEMBERSHIP.—
(A) IN GENERAL.—Subject to subparagraph (B), the
Board shall be composed of 15 members to be appointed by
the Director of NIH, acting through the Office of the Director of NIH, and such ad-hoc or temporary members as the
Director of NIH, acting through the Office of the Director
of NIH, determines to be appropriate. All members of the
Board, including temporary and ad-hoc members, shall be
voting members.
(B) LIMITATION.—Not more than three individuals who
are officers or employees of the Federal Government may
serve as members of the Board.
(4) CERTAIN REQUIREMENTS REGARDING MEMBERSHIP.—In
selecting individuals for membership on the Board, the Director of NIH, acting through the Office of the Director of NIH,
shall ensure that the members are individuals who, by virtue
of their training or experience, are eminently qualified to perform peer review functions. In selecting such individuals for
such membership, the Director of NIH, acting through the Office of the Director of NIH, shall ensure that the members of
the Board collectively—
(A) are experienced in the planning, construction, financing, and administration of entities that conduct biomedical or behavioral research sciences;
(B) are knowledgeable in making determinations of
the need of entities for biomedical or behavioral research
facilities, including such facilities for the dentistry, nursing, pharmacy, and allied health professions;
(C) are knowledgeable in evaluating the relative priorities for applications for grants under subsection (a) in
view of the overall research needs of the United States;
and
(D) are experienced with emerging centers of excellence, as described in subsection (c)(2).
(5) CERTAIN AUTHORITIES.—
(A) WORKSHOPS AND CONFERENCES.—In carrying out
paragraph (2), the Board may convene workshops and conferences, and collect data as the Board considers appropriate.
(B) SUBCOMMITTEES.—In carrying out paragraph (2),
the Board may establish subcommittees within the Board.
Such subcommittees may hold meetings as determined
necessary to enable the subcommittee to carry out its duties.
(6) TERMS.—
(A) IN GENERAL.—Except as provided in subparagraph
(B), each appointed member of the Board shall hold office
for a term of 4 years. Any member appointed to fill a vacancy occurring prior to the expiration of the term for
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which such member’s predecessor was appointed shall be
appointed for the remainder of the term of the predecessor.
(B) STAGGERED TERMS.—Members appointed to the
Board shall serve staggered terms as specified by the Director of NIH, acting through the Office of the Director of
NIH, when making the appointments.
(C) REAPPOINTMENT.—No member of the Board shall
be eligible for reappointment to the Board until 1 year has
elapsed after the end of the most recent term of the member.
(7) COMPENSATION.—Members of the Board who are not officers or employees of the United States shall receive for each
day the members are engaged in the performance of the functions of the Board compensation at the same rate received by
members of other national advisory councils established under
this title.
(c) REQUIREMENTS FOR GRANTS.—
(1) IN GENERAL.—The Director of NIH, acting through the
Office of the Director of NIH or the National Institute of Allergy and Infectious Diseases, may make a grant under subsection (a) only if the applicant for the grant meets the following conditions:
(A) The applicant is determined by such Director to be
competent to engage in the type of research for which the
proposed facility is to be constructed.
(B) The applicant provides assurances satisfactory to
the Director that—
(i) for not less than 20 years after completion of
the construction involved, the facility will be used for
the purposes of the research for which it is to be constructed;
(ii) sufficient funds will be available to meet the
non-Federal share of the cost of constructing the facility;
(iii) sufficient funds will be available, when construction is completed, for the effective use of the facility for the research for which it is being constructed;
and
(iv) the proposed construction will expand the applicant’s capacity for research, or is necessary to improve or maintain the quality of the applicant’s research.
(C) The applicant meets reasonable qualifications established by the Director with respect to—
(i) the relative scientific and technical merit of the
applications, and the relative effectiveness of the proposed facilities, in expanding the capacity for biomedical or behavioral research and in improving the
quality of such research;
(ii) the quality of the research or training, or both,
to be carried out in the facilities involved;
(iii) the congruence of the research activities to be
carried out within the facility with the research and
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investigator manpower needs of the United States;
and
(iv) the age and condition of existing research facilities.
(D) The applicant has demonstrated a commitment to
enhancing and expanding the research productivity of the
applicant.
(2) INSTITUTIONS OF EMERGING EXCELLENCE.—From the
amount appropriated to carry out this section for a fiscal year
up to $50,000,000, the Director of NIH, acting through the Office of the Director of NIH, shall make available 25 percent of
such amount, and from the amount appropriated to carry out
this section for a fiscal year that is over $50,000,000, the Director of NIH, acting through the Office of the Director of NIH,
shall make available up to 25 percent of such amount, for
grants under subsection (a) to applicants that in addition to
meeting the requirements established in paragraph (1), have
demonstrated emerging excellence in biomedical or behavioral
research, as follows:
(A) The applicant has a plan for research or training
advancement and possesses the ability to carry out the
plan.
(B) The applicant carries out research and research
training programs that have a special relevance to a problem, concern, or unmet health need of the United States.
(C) The applicant has been productive in research or
research development and training.
(D) The applicant—
(i) has been designated as a center of excellence
under section 739;
(ii) is located in a geographic area whose population includes a significant number of individuals
with health status deficit, and the applicant provides
health services to such individuals; or
(iii) is located in a geographic area in which a deficit in health care technology, services, or research resources may adversely affect the health status of the
population of the area in the future, and the applicant
is carrying out activities with respect to protecting the
health status of such population.
(d) REQUIREMENT OF APPLICATION.—The Director of NIH, acting through the Office of the Director of NIH or the National Institute of Allergy and Infectious Diseases, may make a grant under
subsection (a) only if an application for the grant is submitted to
the Director and the application is in such form, is made in such
manner, and contains such agreements, assurances, and information as the Director determines to be necessary to carry out this
section.
(e) AMOUNT OF GRANT; PAYMENTS.—
(1) AMOUNT.—The amount of any grant awarded under
subsection (a) shall be determined by the Director of NIH, acting through the Office of the Director of NIH or the National
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Institute of Allergy and Infectious Diseases,, 1 except that such
amount shall not exceed—
(A) 50 percent (or, in the case of the Institute, 75 percent) of the necessary cost of the construction of a proposed
facility as determined by the Director; or
(B) in the case of a multipurpose facility, 40 percent
(or, in the case of the Institute, 75 percent) of that part of
the necessary cost of construction that the Director determines to be proportionate to the contemplated use of the
facility.
(2) RESERVATION OF AMOUNTS.—On the approval of any application for a grant under subsection (a), the Director of NIH,
acting through the Office of the Director of NIH or the National Institute of Allergy and Infectious Diseases, shall reserve, from any appropriation available for such grants, the
amount of such grant, and shall pay such amount, in advance
or by way of reimbursement, and in such installments consistent with the construction progress, as the Director may determine appropriate. The reservation of any amount by the Director under this paragraph may be amended by the Director,
either on the approval of an amendment of the application or
on the revision of the estimated cost of construction of the facility.
(3) EXCLUSION OF CERTAIN COSTS.—In determining the
amount of any grant under subsection (a), there shall be excluded from the cost of construction an amount equal to the
sum of—
(A) the amount of any other Federal grant that the applicant has obtained, or is assured of obtaining, with respect to construction that is to be financed in part by a
grant authorized under this section; and
(B) the amount of any non-Federal funds required to
be expended as a condition of such other Federal grant.
(4) WAIVER OF LIMITATIONS.—The limitations imposed
under paragraph (1) may be waived at the discretion of the Director of NIH, acting through the Office of the Director of NIH
or the National Institute of Allergy and Infectious Diseases, for
applicants meeting the conditions described in subsection (c).
(f ) RECAPTURE OF PAYMENTS.—If, not later than 20 years after
the completion of construction for which a grant has been awarded
under subsection (a)—
(1) in the case of an award by the Director of NIH, acting
through the Office of the Director of NIH, the applicant or
other owner of the facility shall cease to be a public or non
profit private entity; or
(2) the facility shall cease to be used for the research purposes for which it was constructed (unless the Director of NIH,
acting through the Office of the Director of NIH or the National Institute of Allergy and Infectious Diseases, determines,
in accordance with regulations, that there is good cause for releasing the applicant or other owner from obligation to do so),
1 Two commas in subsection (e)(1) so in law. See amendment made by section 221(b)(1)(B)(ii)
of division F of Public Law 112–74.

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the United States shall be entitled to recover from the applicant or
other owner of the facility the amount bearing the same ratio to
the current value (as determined by an agreement between the
parties or by action brought in the United States District Court for
the district in which such facility is situated) of the facility as the
amount of the Federal participation bore to the cost of the construction of such facility.
(g) GUIDELINES.—Not later than 6 months after the date of the
enactment of this section, the Director of NIH, acting through the
Office of the Director of NIH, after consultation with the Council,
shall issue guidelines with respect to grants under subsection (a).
CONSTRUCTION OF REGIONAL CENTERS FOR RESEARCH ON PRIMATES

SEC. 404J. ø283l¿ (a) With respect to activities carried out by
the Director of NIH, acting through the Office of the Director of
NIH, to support regional centers for research on primates, the Director of NIH may, for each of the fiscal years 1994 through 1996 1,
reserve from the amounts appropriated to carry out section 404I up
to $2,500,000 for the purpose of making awards of grants and contracts to public or nonprofit private entities to construct, renovate,
or otherwise improve such regional centers. The reservation of such
amounts for any fiscal year is subject to the availability of qualified
applicants for such awards.
(b) The Director of NIH may not make a grant or enter into
a contract under subsection (a) unless the applicant for such assistance agrees, with respect to the costs to be incurred by the applicant in carrying out the purpose described in such subsection, to
make available (directly or through donations from public or private entities) non-Federal contributions in cash toward such costs
in an amount equal to not less than $1 for each $4 of Federal funds
provided in such assistance.
SEC. 404K. ø283m¿ SANCTUARY SYSTEM FOR SURPLUS CHIMPANZEES.
(a) IN GENERAL.—The Secretary shall provide for the establish-

ment and operation in accordance with this section of a system to
provide for the lifetime care of chimpanzees that have been used,
or were bred or purchased for use, in research conducted or supported by the National Institutes of Health, the Food and Drug Administration, or other agencies of the Federal Government, and
with respect to which it has been determined by the Secretary that
the chimpanzees are not needed for such research (in this section
referred to as ‘‘surplus chimpanzees’’).
(b) ADMINISTRATION OF SANCTUARY SYSTEM.—The Secretary
shall carry out this section, including the establishment of regulations under subsection (d), in consultation with the board of directors of the nonprofit private entity that receives the contract under
subsection (e) (relating to the operation of the sanctuary system).
1 The probable intent of the Congress is that the authorization of appropriations be for fiscals
year 2000 through 2002. Section 304 of Public Law 106–505 (114 Stat. 2335) provided that section 481B(a) ‘‘is amended by striking ‘1994’ and all that follows through ‘$5,000,000’ and inserting ‘2000 through 2002, reserve from the amounts appropriated under section 481A(i) such sums
as necessary’’’. The amendment cannot be executed because a term referenced in the instructions, ‘‘$5,000,000’’, does not appear in section 481B(a). The term ‘‘2,500,000’’ probably should
have been referenced.

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(c) ACCEPTANCE OF CHIMPANZEES INTO SYSTEM.—All surplus
chimpanzees owned by the Federal Government shall be accepted
into the sanctuary system. Subject to standards under subsection
(d)(4), any chimpanzee that is not owned by the Federal Government can be accepted into the system if the owner transfers to the
sanctuary system title to the chimpanzee.
(d) STANDARDS FOR PERMANENT RETIREMENT OF SURPLUS
CHIMPANZEES.—
(1) IN GENERAL.—Not later than 180 days after the date of
the enactment of this section, the Secretary shall by regulation
establish standards for operating the sanctuary system to provide for the permanent retirement of surplus chimpanzees. In
establishing the standards, the Secretary shall consider the
recommendations of the board of directors of the nonprofit private entity that receives the contract under subsection (e), and
shall consider the recommendations of the National Research
Council applicable to surplus chimpanzees that are made in
the report published in 1997 and entitled ‘‘Chimpanzees in Research—Strategies for Their Ethical Care, Management, and
Use’’.
(2) CHIMPANZEES ACCEPTED INTO SYSTEM.—With respect to
chimpanzees that are accepted into the sanctuary system,
standards under paragraph (1) shall include the following:
(A) A prohibition that the chimpanzees may not be
used for research, except as authorized under paragraph
(3).
(B) Provisions regarding the housing of the chimpanzees.
(C) Provisions regarding the behavioral well-being of
the chimpanzees.
(D) A requirement that the chimpanzees be cared for
in accordance with the Animal Welfare Act.
(E) A requirement that the chimpanzees be prevented
from breeding.
(F) A requirement that complete histories be maintained on the health and use in research of the chimpanzees.
(G) A requirement that the chimpanzees be monitored
for the purpose of promptly detecting the presence in the
chimpanzees of any condition that may be a threat to the
public health or the health of other chimpanzees.
(H) A requirement that chimpanzees posing such a
threat be contained in accordance with applicable recommendations of the Director of the Centers for Disease
Control and Prevention.
(I) A prohibition that none of the chimpanzees may be
subjected to euthanasia, except as in the best interests of
the chimpanzee involved, as determined by the system and
an attending veterinarian.
(J) A prohibition that the chimpanzees may not be discharged from the system.
(K) A provision that the Secretary may, in the discretion of the Secretary, accept into the system chimpanzees
that are not surplus chimpanzees.
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(L) Such additional standards as the Secretary determines to be appropriate.
(3) RESTRICTIONS REGARDING RESEARCH.—
(A) IN GENERAL.—For purposes of paragraph (2)(A),
standards under paragraph (1) shall provide that a chimpanzee accepted into the sanctuary system may not be
used for studies or research, except that the chimpanzee
may be used for noninvasive behavioral studies or medical
studies based on information collected during the course of
normal veterinary care that is provided for the benefit of
the chimpanzee, provided that any such study involves
minimal physical and mental harm, pain, distress, and disturbance to the chimpanzee and the social group in which
the chimpanzee lives.
(B) ADDITIONAL RESTRICTION.—For purposes of paragraph (2)(A), a condition for the use in studies or research
of a chimpanzee accepted into the sanctuary system is (in
addition to conditions under subparagraph (A) of this paragraph) that the applicant for such use has not been fined
for, or signed a consent decree for, any violation of the Animal Welfare Act.
(4) NON-FEDERAL CHIMPANZEES OFFERED FOR ACCEPTANCE
INTO SYSTEM.—With respect to a chimpanzee that is not owned
by the Federal Government and is offered for acceptance into
the sanctuary system, standards under paragraph (1) shall include the following:
(A) A provision that the Secretary may authorize the
imposition of a fee for accepting such chimpanzee into the
system, except as follows:
(i) Such a fee may not be imposed for accepting
the chimpanzee if, on the day before the date of the
enactment of this section, the chimpanzee was owned
by the nonprofit private entity that receives the contract under subsection (e) or by any individual sanctuary facility receiving a subcontract or grant under
subsection (e)(1).
(ii) Such a fee may not be imposed for accepting
the chimpanzee if the chimpanzee is owned by an entity that operates a primate center, and if the chimpanzee is housed in the primate center pursuant to
the program for regional centers for research on primates that is carried out by the Director of NIH, acting through the Office of the Director of NIH,. 1
Any fees collected under this subparagraph are available
to the Secretary for the costs of operating the system. Any
other fees received by the Secretary for the long-term care
of chimpanzees (including any Federal fees that are collected for such purpose and are identified in the report
under section 3 of the Chimpanzee Health Improvement,
Maintenance, and Protection Act) are available for oper1 A period followed by a comma in clause (ii) so in law. See amendment made by section
221(b)(3)(B) of division F of Public Law 112–74.

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ating the system, in addition to availability for such other
purposes as may be authorized for the use of the fees.
(B) A provision that the Secretary may deny such
chimpanzee acceptance into the system if the capacity of
the system is not sufficient to accept the chimpanzee, taking into account the physical capacity of the system; the financial resources of the system; the number of individuals
serving as the staff of the system, including the number of
professional staff; the necessity of providing for the safety
of the staff and of the public; the necessity of caring for accepted chimpanzees in accordance with the standards
under paragraph (1); and such other factors as may be appropriate.
(C) A provision that the Secretary may deny such
chimpanzee acceptance into the system if a complete history of the health and use in research of the chimpanzee
is not available to the Secretary.
(D) Such additional standards as the Secretary determines to be appropriate.
(e) AWARD OF CONTRACT FOR OPERATION OF SYSTEM.—
(1) IN GENERAL.—Subject to the availability of funds pursuant to subsection (g), the Secretary shall make an award of
a contract to a nonprofit private entity under which the entity
has the responsibility of operating (and establishing, as applicable) the sanctuary system and awarding subcontracts or
grants to individual sanctuary facilities that meet the standards under subsection (d).
(2) REQUIREMENTS.—The Secretary may make an award
under paragraph (1) to a nonprofit private entity only if the entity meets the following requirements:
(A) The entity has a governing board of directors that
is composed and appointed in accordance with paragraph
(3) and is satisfactory to the Secretary.
(B) The terms of service for members of such board are
in accordance with paragraph (3).
(C) The members of the board serve without compensation. The members may be reimbursed for travel,
subsistence, and other necessary expenses incurred in carrying out the duties of the board.
(D) The entity has an executive director meeting such
requirements as the Secretary determines to be appropriate.
(E) The entity makes the agreement described in paragraph (4) (relating to non-Federal contributions).
(F) The entity agrees to comply with standards under
subsection (d).
(G) The entity agrees to make necropsy reports on
chimpanzees in the sanctuary system available on a reasonable basis to persons who conduct biomedical or behavioral research, with priority given to such persons who are
Federal employees or who receive financial support from
the Federal Government for research.
(H) Such other requirements as the Secretary determines to be appropriate.
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(3) BOARD OF DIRECTORS.—For purposes of subparagraphs
(A) and (B) of paragraph (2):
(A) The governing board of directors of the nonprofit
private entity involved is composed and appointed in accordance with this paragraph if the following conditions
are met:
(i) Such board is composed of not more than 13
voting members.
(ii) Such members include individuals with expertise and experience in the science of managing captive
chimpanzees (including primate veterinary care), appointed from among individuals endorsed by organizations that represent individuals in such field.
(iii) Such members include individuals with expertise and experience in the field of animal protection,
appointed from among individuals endorsed by organizations that represent individuals in such field.
(iv) Such members include individuals with expertise and experience in the zoological field (including
behavioral primatology), appointed from among individuals endorsed by organizations that represent individuals in such field.
(v) Such members include individuals with expertise and experience in the field of the business and
management of nonprofit organizations, appointed
from among individuals endorsed by organizations
that represent individuals in such field.
(vi) Such members include representatives from
entities that provide accreditation in the field of laboratory animal medicine.
(vii) Such members include individuals with expertise and experience in the field of containing biohazards.
(viii) Such members include an additional member
who serves as the chair of the board, appointed from
among individuals who have been endorsed for purposes of clause (ii), (iii), (iv), or (v).
(ix) None of the members of the board has been
fined for, or signed a consent decree for, any violation
of the Animal Welfare Act.
(B) The terms of service for members of the board of
directors are in accordance with this paragraph if the following conditions are met:
(i) The term of the chair of the board is 3 years.
(ii) The initial members of the board select, by a
random method, one member from each of the six
fields specified in subparagraph (A) to serve a term of
2 years and (in addition to the chair) one member
from each of such fields to serve a term of 3 years.
(iii) After the initial terms under clause (ii) expire,
each member of the board (other than the chair) is appointed to serve a term of 2 years.
(iv) An individual whose term of service expires
may be reappointed to the board.
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(v) A vacancy in the membership of the board is
filled in the manner in which the original appointment
was made.
(vi) If a member of the board does not serve the
full term applicable to the member, the individual appointed to fill the resulting vacancy is appointed for
the remainder of the term of the predecessor member.
(4) REQUIREMENT OF MATCHING FUNDS.—The agreement
required in paragraph (2)(E) for a nonprofit private entity (relating to the award of the contract under paragraph (1)) is an
agreement that, with respect to the costs to be incurred by the
entity in establishing and operating the sanctuary system, the
entity will make available (directly or through donations from
public or private entities) non-Federal contributions toward
such costs, in cash or in kind, in an amount not less than the
following, as applicable:
(A) For expenses associated with establishing the
sanctuary system (as determined by the Secretary), 10 percent of such costs ($1 for each $9 of Federal funds provided
under the contract under paragraph (1)).
(B) For expenses associated with operating the sanctuary system (as determined by the Secretary), 25 percent
of such costs ($1 for each $3 of Federal funds provided
under such contract).
(5) ESTABLISHMENT OF CONTRACT ENTITY.—If the Secretary
determines that an entity meeting the requirements of paragraph (2) does not exist, not later than 60 days after the date
of the enactment of this section, the Secretary shall, for purposes of paragraph (1), make a grant for the establishment of
such an entity, including paying the cost of incorporating the
entity under the law of one of the States.
(f ) DEFINITIONS.—For purposes of this section:
(1) PERMANENT RETIREMENT.—The term ‘‘permanent retirement’’, with respect to a chimpanzee that has been accepted
into the sanctuary system, means that under subsection (a) the
system provides for the lifetime care of the chimpanzee, that
under subsection (d)(2) the system does not permit the chimpanzee to be used in research (except as authorized under subsection (d)(3)) or to be euthanized (except as provided in subsection (d)(2)(I)), that under subsection (d)(2) the system will
not discharge the chimpanzee from the system, and that under
such subsection the system otherwise cares for the chimpanzee.
(2) SANCTUARY SYSTEM.—The term ‘‘sanctuary system’’
means the system described in subsection (a).
(3) SECRETARY.—The term ‘‘Secretary’’ means the Secretary of Health and Human Services.
(4) SURPLUS CHIMPANZEES.—The term ‘‘surplus chimpanzees’’ has the meaning given that term in subsection (a).
(g) FUNDING.—
(1) IN GENERAL.—Of the amount appropriated under this
Act for fiscal year 2001 and each subsequent fiscal year, the
Secretary, subject to paragraph (2), shall reserve a portion for
purposes of the operation (and establishment, as applicable) of
the sanctuary system and for purposes of paragraph (3), except
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that the Secretary may not for such purposes reserve any further funds from such amount after the aggregate total of the
funds so reserved for such fiscal years reaches $30,000,000.
The purposes for which funds reserved under the preceding
sentence may be expended include the construction and renovation of facilities for the sanctuary system.
(2) LIMITATION.—Funds may not be reserved for a fiscal
year under paragraph (1) unless the amount appropriated
under this Act for such year equals or exceeds the amount appropriated under this Act for fiscal year 1999.
(3) USE OF FUNDS FOR OTHER COMPLIANT FACILITIES.—With
respect to amounts reserved under paragraph (1) for a fiscal
year, the Secretary may use a portion of such amounts to make
awards of grants or contracts to public or private entities operating facilities that, as determined by the board of directors of
the nonprofit private entity that receives the contract under
subsection (e), provide for the retirement of chimpanzees in accordance with the same standards that apply to the sanctuary
system pursuant to regulations under subsection (d). Such an
award may be expended for the expenses of operating the facilities involved.
SEC. 404L. ø283n¿ SHARED INSTRUMENTATION GRANT PROGRAM.
(a) REQUIREMENTS FOR GRANTS.—In determining whether

to
award a grant to an applicant under the Shared Instrumentation
Grant Program, the Director of NIH, acting through the Office of
the Director of NIH, shall consider—
(1) the extent to which an award for the specific instrument involved would meet the scientific needs and enhance the
planned research endeavors of the major users by providing an
instrument that is unavailable or to which availability is highly limited;
(2) with respect to the instrument involved, the availability and commitment of the appropriate technical expertise
within the major user group or the applicant institution for use
of the instrumentation;
(3) the adequacy of the organizational plan for the use of
the instrument involved and the internal advisory committee
for oversight of the applicant, including sharing arrangements
if any;
(4) the applicant’s commitment for continued support of
the utilization and maintenance of the instrument; and
(5) the extent to which the specified instrument will be
shared and the benefit of the proposed instrument to the overall research community to be served.
(b) PEER REVIEW.—In awarding grants under the program described in subsection (a), the Director of NIH, acting through the
Office of the Director of NIH, shall comply with the peer review requirements in section 492.

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PART B—GENERAL PROVISIONS RESPECTING NATIONAL RESEARCH
INSTITUTES
APPOINTMENT AND AUTHORITY OF THE DIRECTORS OF THE NATIONAL
RESEARCH INSTITUTES

SEC. 405. ø284¿ (a) The Director of the National Cancer Institute shall be appointed by the President and the Directors of the
other national research institutes shall be appointed by the Secretary. Each Director of a national research institute shall report
directly to the Director of NIH.
(b)(1) In carrying out the purposes of section 301 with respect
to human diseases or disorders or other aspects of human health
for which the national research institutes were established, the
Secretary, acting through the Director of each national research institute—
(A) shall encourage and support research, investigations,
experiments, demonstrations, and studies in the health
sciences related to—
(i) the maintenance of health,
(ii) the detection, diagnosis, treatment, and prevention
of human diseases and disorders,
(iii) the rehabilitation of individuals with human diseases, disorders, and disabilities, and
(iv) the expansion of knowledge of the processes underlying human diseases, disorders, and disabilities, the
processes underlying the normal and pathological functioning of the body and its organ systems, and the processes underlying the interactions between the human organism and the environment;
(B) may, subject to the peer review prescribed under section 492(b) and any advisory council review under section
406(a)(3)(A)(i), conduct the research, investigations, experiments, demonstrations, and studies referred to in subparagraph (A);
(C) may conduct and support research training (i) for
which fellowship support is not provided under section 487,
and (ii) which is not residency training of physicians or other
health professionals;
(D) may develop, implement, and support demonstrations
and programs for the application of the results of the activities
of the institute to clinical practice and disease prevention activities;
(E) may develop, conduct, and support public and professional education and information programs;
(F) may secure, develop and maintain, distribute, and support the development and maintenance of resources needed for
research;
(G) may make available the facilities of the institute to appropriate entities and individuals engaged in research activities and cooperate with and assist Federal and State agencies
charged with protecting the public health;
(H) may accept unconditional gifts made to the institute
for its activities, and, in the case of gifts of a value in excess
of $50,000, establish suitable memorials to the donor;
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(I) may secure for the institute consultation services and
advice of persons from the United States or abroad;
(J) may use, with their consent, the services, equipment,
personnel, information, and facilities of other Federal, State, or
local public agencies, with or without reimbursement therefor;
(K) may accept voluntary and uncompensated services; and
(L) may perform such other functions as the Secretary determines are needed to carry out effectively the purposes of the
institute.
The indemnification provisions of section 2354, title 10, United
States Code, shall apply with respect to contracts entered into
under this subsection and section 402(b).
(2) Support for an activity or program under this subsection
may be provided through grants, contracts, and cooperative agreements. The Secretary, acting through the Director of each national
research institute—
(A) may enter into a contract for research, training, or
demonstrations only if the contract has been recommended
after technical and scientific peer review required by regulations under section 492;
(B) may make grants and cooperative agreements under
paragraph (1) for research, training, or demonstrations, except
that—
(i) if the direct cost of the grant or cooperative agreement to be made does not exceed $50,000, such grant or
cooperative agreement may be made only if such grant or
cooperative agreement has been recommended after technical and scientific peer review required by regulations
under section 492, and
(ii) if the direct cost of the grant or cooperative agreement to be made exceeds $50,000, such grant or cooperative agreement may be made only if such grant or cooperative agreement has been recommended after technical and
scientific peer review required by regulations under section
492 and is recommended under section 406(a)(3)(A)(ii) by
the advisory council for the national research institute involved; and
(C) shall, subject to section 2353(d)(2), receive from the
President and the Office of Management and Budget directly
all funds appropriated by the Congress for obligation and expenditure by the Institute.
(c) In carrying out subsection (b), each Director of a national
research institute—
(1) shall coordinate, as appropriate, the activities of the institute with similar programs of other public and private entities;
(2) shall cooperate with the Directors of the other national
research institutes in the development and support of multidisciplinary research and research that involves more than one
institute;
(3) may, in consultation with the advisory council for the
Institute and with the approval of the Director of NIH—
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(A) establish technical and scientific peer review
groups in addition to those appointed under section
402(b)(16); and
(B) appoint the members of peer review groups established under subparagraph (A); and
(4) may publish, or arrange for the publication of, information with respect to the purpose of the Institute without regard
to section 501 of title 44, United States Code.
The Federal Advisory Committee Act shall not apply to the duration of a peer review group appointed under paragraph (3).
ADVISORY COUNCILS

SEC. 406. ø284a¿ (a)(1) Except as provided in subsection (h),
the Secretary shall appoint an advisory council for each national
research institute which (A) shall advise, assist, consult with, and
make recommendations to the Secretary and the Director of such
institute on matters related to the activities carried out by and
through the institute and the policies respecting such activities,
and (B) shall carry out the special functions prescribed by part C.
(2) Each advisory council for a national research institute may
recommend to the Secretary acceptance, in accordance with section
231, of conditional gifts for study, investigation, or research respecting the diseases, disorders, or other aspect of human health
with respect to which the institute was established, for the acquisition of grounds, or for the construction, equipping, or maintenance
of facilities for the institute.
(3) Each advisory council for a national research institute—
(A)(i) may on the basis of the materials provided under
section 492(b)(2) respecting research conducted at the institute,
make recommendations to the Director of the institute respecting such research,
(ii) may review applications for grants and cooperative
agreements for research or training and for which advisory
council approval is required under section 405(b)(2) and recommend for approval applications for projects which show
promise of making valuable contributions to human knowledge,
and
(iii) may review any grant, contract, or cooperative agreement proposed to be made or entered into by the institute;
(B) may collect, by correspondence or by personal investigation, information as to studies which are being carried on
in the United States or any other country as to the diseases,
disorders, or other aspect of human health with respect to
which the institute was established and with the approval of
the Director of the institute make available such information
through appropriate publications for the benefit of public and
private health entities and health professions personnel and
scientists and for the information of the general public; and
(C) may appoint subcommittees and convene workshops
and conferences.
(b)(1) Each advisory council shall consist of ex officio members
and not more than eighteen members appointed by the Secretary.
The ex officio members shall be nonvoting members.
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(2) The ex officio members of an advisory council shall consist
of—
(A) the Secretary, the Director of NIH, the Director of the
national research institute for which the council is established,
the Chief Medical Director of the Department of Veterans Affairs or the Chief Dental Director of the Department of Veterans Affairs, and the Assistant Secretary of Defense for
Health Affairs (or the designees of such officers), and
(B) such additional officers or employees of the United
States as the Secretary determines necessary for the advisory
council to effectively carry out its functions.
(3) The members of an advisory council who are not ex officio
members shall be appointed as follows:
(A) Two-thirds of the members shall be appointed by the
Secretary from among the leading representatives of the health
and scientific disciplines (including not less than two individuals who are leaders in the fields of public health and the behavioral or social sciences) relevant to the activities of the national research institute for which the advisory council is established.
(B) One-third of the members shall be appointed by the
Secretary from the general public and shall include leaders in
fields of public policy, law, health policy, economics, and management.
(4) Members of an advisory council who are officers or employees of the United States shall not receive any compensation for
service on the advisory council. The other members of an advisory
council shall receive, for each day (including traveltime) they are
engaged in the performance of the functions of the advisory council,
compensation at rates not to exceed the daily equivalent of the annual rate in effect for grade GS–18 of the General Schedule.
(c) The term of office of an appointed member of an advisory
council is four years, except that any member appointed to fill a
vacancy for an unexpired term shall be appointed for the remainder of such term and the Secretary shall make appointments to an
advisory council in such a manner as to ensure that the terms of
the members do not all expire in the same year. A member may
serve after the expiration of the member’s term for 180 days after
the date of such expiration. A member who has been appointed for
a term of four years may not be reappointed to an advisory council
before two years from the date of expiration of such term of office.
If a vacancy occurs in the advisory council among the appointed
members, the Secretary shall make an appointment to fill the vacancy within 90 days from the date the vacancy occurs.
(d) The chairman of an advisory council shall be selected by
the Secretary from among the appointed members, except that the
Secretary may select the Director of the national research institute
for which the advisory council is established to be the chairman of
the advisory council. The term of office of the chairman shall be
two years.
(e) The advisory council shall meet at the call of the chairman
or upon the request of the Director of the national research institute for which it was established, but at least three times each fiscal year. The location of the meetings of each advisory council is
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subject to the approval of the Director of the national research institute for which the advisory council was established.
(f) The Director of the national research institute for which an
advisory council is established shall designate a member of the
staff of the institute to serve as the executive secretary of the advisory council. The Director of such institute shall make available to
the advisory council such staff, information, and other assistance
as it may require to carry out its functions. The Director of such
institute shall provide orientation and training for new members of
the advisory council to provide them with such information and
training as may be appropriate for their effective participation in
the functions of the advisory council.
(g) Each advisory council may prepare, for inclusion in the biennial report made under section 407, (1) comments respecting the
activities of the advisory council in the fiscal years respecting
which the report is prepared, (2) comments on the progress of the
national research institute for which it was established in meeting
its objectives, and (3) recommendations respecting the future directions and program and policy emphasis of the institute. Each advisory council may prepare such additional reports as it may determine appropriate.
(h)(1) Except as provided in paragraph (2), this section does
not terminate the membership of any advisory council for a national research institute which was in existence on the date of enactment of the Health Research Extension Act of 1985. After such
date—
(A) the Secretary shall make appointments to each such
advisory council in such a manner as to bring about as soon
as practicable the composition for such council prescribed by
this section;
(B) each advisory council shall organize itself in accordance with this section and exercise the functions prescribed by
this section; and
(C) the Director of each national research institute shall
perform for such advisory council the functions prescribed by
this section.
(2)(A) The National Cancer Advisory Board shall be the advisory council for the National Cancer Institute. This section applies
to the National Cancer Advisory Board, except that—
(i) appointments to such Board shall be made by the President;
(ii) the term of office of an appointed member shall be 6
years;
(iii) of the members appointed to the Board not less than
five members shall be individuals knowledgeable in environmental carcinogenesis (including carcinogenesis involving occupational and dietary factors);
(iv) the chairman of the Board shall be selected by the
President from the appointed members and shall serve as
chairman for a term of two years;
(v) the ex officio members of the Board shall be nonvoting
members and shall be the Secretary, the Director of the Office
of Science and Technology Policy, the Director of NIH, the
Chief Medical Director of the Department of Veterans Affairs,
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the Director of the National Institute for Occupational Safety
and Health, the Director of the National Institute of Environmental Health Sciences, the Secretary of Labor, the Commissioner of the Food and Drug Administration, the Administrator
of the Environmental Protection Agency, the Chairman of the
Consumer Product Safety Commission, the Assistant Secretary
of Defense for Health Affairs, and the Director of the Office of
Science of the Department of Energy (or the designees of such
officers); and
(vi) the Board shall meet at least four times each fiscal
year.
(B) This section applies to the advisory council to the National
Heart, Lung, and Blood Institute, except that the advisory council
shall meet at least four times each fiscal year. 1
CERTAIN USES OF FUNDS

SEC. 408. ø284c¿ (a)(1) Except as provided in paragraph (2),
the sum of the amounts obligated in any fiscal year for administrative expenses of the National Institutes of Health may not exceed
an amount which is 5.5 percent of the total amount appropriated
for such fiscal year for the National Institutes of Health.
(2) Paragraph (1) does not apply to the National Library of
Medicine, the National Center for Nursing Research, 1 the John E.
Fogarty International Center for Advanced Study in the Health
Sciences, the Warren G. Magnuson Clinical Center, and the Office
of Medical Applications of Research.
(3) For purposes of paragraph (1), the term ‘‘administrative expenses’’ means expenses incurred for the support of activities relevant to the award of grants, contracts, and cooperative agreements and expenses incurred for general administration of the scientific programs and activities of the National Institutes of Health.
(b) For fiscal year 1989 and subsequent fiscal years, amounts
made available to the National Institutes of Health shall be available for payment of nurses and allied health professionals in accordance with payment authorities, scheduling options, benefits,
and other authorities provided under chapter 73 of title 38, United
States Code, for nurses of the Department of Veterans Affairs.
DEFINITIONS

SEC. 409. ø284d¿ (a) HEALTH SERVICE RESEARCH.—For purposes of this title, the term ‘‘health services research’’ means research endeavors that study the impact of the organization, financing and management of health services on the quality, cost, access
to and outcomes of care. Such term does not include research on
the efficacy of services to prevent, diagnose, or treat medical conditions.
(b) CLINICAL RESEARCH.—As used in this title, the term ‘‘clinical research’’ means patient oriented clinical research conducted
with human subjects, or research on the causes and consequences
of disease in human populations involving material of human ori1 Section 407 of the Public Health Service Act was repealed by section 104(b)(1)(C) of Public
Law 109–482 (120 Stat. 3693).
1 See footnote 2 for section 403(5).

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gin (such as tissue specimens and cognitive phenomena) for which
an investigator or colleague directly interacts with human subjects
in an outpatient or inpatient setting to clarify a problem in human
physiology, pathophysiology or disease, or epidemiologic or behavioral studies, outcomes research or health services research, or developing new technologies, therapeutic interventions, or clinical
trials.
RESEARCH ON OSTEOPOROSIS, PAGET’S DISEASE, AND RELATED BONE
DISORDERS

SEC. 409A. ø284e¿ (a) ESTABLISHMENT.—The Directors of the
National Institute of Arthritis and Musculoskeletal and Skin Diseases, the National Institute on Aging, the National Institute of
Dental Research, 1 and the National Institute of Diabetes and Digestive and Kidney Diseases, shall expand and intensify the programs of such Institutes with respect to research and related activities concerning osteoporosis, Paget’s disease, and related bone
disorders.
(b) COORDINATION.—The Directors referred to in subsection (a)
shall jointly coordinate the programs referred to in such subsection
and consult with the Arthritis and Musculoskeletal Diseases Interagency Coordinating Committee and the Interagency Task Force on
Aging Research.
(c) INFORMATION CLEARINGHOUSE.—
(1) IN GENERAL.—In order to assist in carrying out the purpose described in subsection (a), the Director of NIH shall provide for the establishment of an information clearinghouse on
osteoporosis and related bone disorders to facilitate and enhance knowledge and understanding on the part of health professionals, patients, and the public through the effective dissemination of information.
(2) ESTABLISHMENT THROUGH GRANT OR CONTRACT.—For
the purpose of carrying out paragraph (1), the Director of NIH
shall enter into a grant, cooperative agreement, or contract
with a nonprofit private entity involved in activities regarding
the prevention and control of osteoporosis and related bone disorders.
PARKINSON’S DISEASE

SEC. 409B. ø42 U.S.C. 284f¿ (a) IN GENERAL.—The Director of
NIH shall establish a program for the conduct and support of research and training with respect to Parkinson’s disease (subject to
the extent of amounts appropriated to carry out this section).
(b) INTER-INSTITUTE COORDINATION.—
(1) IN GENERAL.—The Director of NIH shall provide for the
coordination of the program established under subsection (a)
among all of the national research institutes conducting Parkinson’s disease research.
(2) CONFERENCE.—Coordination under paragraph (1) shall
include the convening of a research planning conference not
less frequently than once every 2 years. Each such conference
shall prepare and submit to the Committee on Appropriations
1See

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and the Committee on Labor and Human Resources of the Senate and the Committee on Appropriations and the Committee
on Commerce of the House of Representatives a report concerning the conference.
(c) MORRIS K. UDALL RESEARCH CENTERS.—
(1) IN GENERAL.—The Director of NIH is authorized to
award Core Center Grants to encourage the development of innovative multidisciplinary research and provide training concerning Parkinson’s disease. The Director is authorized to
award not more than 10 Core Center Grants and designate
each center funded under such grants as a Morris K. Udall
Center for Research on Parkinson’s Disease.
(2) REQUIREMENTS.—
(A) IN GENERAL.—With respect to Parkinson’s disease,
each center assisted under this subsection shall—
(i) use the facilities of a single institution or a consortium of cooperating institutions, and meet such
qualifications as may be prescribed by the Director of
the NIH; and
(ii) conduct basic and clinical research.
(B) DISCRETIONARY REQUIREMENTS.—With respect to
Parkinson’s disease, each center assisted under this subsection may—
(i) conduct training programs for scientists and
health professionals;
(ii) conduct programs to provide information and
continuing education to health professionals;
(iii) conduct programs for the dissemination of information to the public;
(iv) separately or in collaboration with other centers, establish a nationwide data system derived from
patient populations with Parkinson’s disease, and
where possible, comparing relevant data involving
general populations;
(v) separately or in collaboration with other centers, establish a Parkinson’s Disease Information
Clearinghouse to facilitate and enhance knowledge
and understanding of Parkinson’s disease; and
(vi) separately or in collaboration with other centers, establish a national education program that fosters a national focus on Parkinson’s disease and the
care of those with Parkinson’s disease.
(3) STIPENDS REGARDING TRAINING PROGRAMS.—A center
may use funds provided under paragraph (1) to provide stipends for scientists and health professionals enrolled in training programs under paragraph (2)(B).
(4) DURATION OF SUPPORT.—Support of a center under this
subsection may be for a period not exceeding five years. Such
period may be extended by the Director of NIH for one or more
additional periods of not more than five years if the operations
of such center have been reviewed by an appropriate technical
and scientific peer review group established by the Director
and if such group has recommended to the Director that such
period should be extended.
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(d) MORRIS K. UDALL AWARDS FOR EXCELLENCE IN PARKINDISEASE RESEARCH.—The Director of NIH is authorized to establish a grant program to support investigators with a proven
record of excellence and innovation in Parkinson’s disease research
and who demonstrate potential for significant future breakthroughs
in the understanding of the pathogensis, diagnosis, and treatment
of Parkinson’s disease. Grants under this subsection shall be available for a period of not to exceed 5 years.
SON’S

EXPANSION, INTENSIFICATION, AND COORDINATION OF ACTIVITIES OF
NATIONAL INSTITUTES OF HEALTH WITH RESPECT TO RESEARCH ON
AUTISM SPECTRUM DISORDER 1

SEC. 409C. ø284g¿ (a) IN GENERAL.—
(1) EXPANSION OF ACTIVITIES.—The Director of NIH (in
this section referred to as the ‘‘Director’’) shall, subject to the
availability of appropriations, expand, intensify, and coordinate
the activities of the National Institutes of Health with respect
to research on autism spectrum disorder, including basic and
clinical research in fields including pathology, developmental
neurobiology, genetics, epigenetics, pharmacology, nutrition,
immunology, neuroimmunology, neurobehavioral development,
endocrinology, gastroenterology, and toxicology. Such research
shall investigate the cause (including possible environmental
causes), diagnosis or rule out, early detection, prevention, services, supports, intervention, and treatment of autism spectrum
disorder.
(2) CONSOLIDATION.—The Director may consolidate program activities under this section if such consolidation would
improve program efficiencies and outcomes.
(3) ADMINISTRATION OF PROGRAM; COLLABORATION AMONG
AGENCIES.—The Director shall carry out this section acting
through the Director of the National Institute of Mental Health
and in collaboration with any other agencies that the Director
determines appropriate.
(b) CENTERS OF EXCELLENCE.—
(1) IN GENERAL.—The Director shall under subsection
(a)(1) make awards of grants and contracts to public or nonprofit private entities to pay all or part of the cost of planning,
establishing, improving, and providing basic operating support
for centers of excellence regarding research on autism spectrum disorder.
(2) RESEARCH.—Each center under paragraph (1) shall conduct basic and clinical research into autism spectrum disorder.
Such research should include investigations into the cause, diagnosis, early detection, prevention, control, and treatment of
autism spectrum disorder. The centers, as a group, shall conduct research including the fields of developmental
neurobiology, genetics, and psychopharmacology.
(3) SERVICES FOR PATIENTS.—
1 Title I of Public Law 106–310 (114 Stat. 1105) established several programs regarding autism, including the program under section 409C above. Section 105 of the Public Law requires
annual reports to the Congress on the implementation of such title I and the amendments made
by the title.

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(A) IN GENERAL.—A center under paragraph (1) may
expend amounts provided under such paragraph to carry
out a program to make individuals aware of opportunities
to participate as subjects in research conducted by the centers.
(B) REFERRALS AND COSTS.—A program under subparagraph (A) may, in accordance with such criteria as the
Director may establish, provide to the subjects described in
such subparagraph, referrals for health and other services,
and such patient care costs as are required for research.
(C) AVAILABILITY AND ACCESS.—The extent to which a
center can demonstrate availability and access to clinical
services shall be considered by the Director in decisions
about awarding grants to applicants which meet the scientific criteria for funding under this section.
(4) ORGANIZATION OF CENTERS.—Each center under paragraph (1) shall use the facilities of a single institution, or be
formed from a consortium of cooperating institutions, meeting
such requirements as may be prescribed by the Director.
(5) NUMBER OF CENTERS; DURATION OF SUPPORT.—
(A) IN GENERAL.—The Director shall provide for the
establishment of not less than five centers under paragraph (1).
(B) DURATION.—Support for a center established under
paragraph (1) may be provided under this section for a period of not to exceed 5 years. Such period may be extended
for one or more additional periods not exceeding 5 years if
the operations of such center have been reviewed by an appropriate technical and scientific peer review group established by the Director and if such group has recommended
to the Director that such period should be extended.
(c) FACILITATION OF RESEARCH.—The Director shall under subsection (a)(1) provide for a program under which samples of tissues
and genetic materials that are of use in research on autism spectrum disorder are donated, collected, preserved, and made available for such research. The program shall be carried out in accordance with accepted scientific and medical standards for the donation, collection, and preservation of such samples.
(d) PUBLIC INPUT.—The Director shall under subsection (a)(1)
provide for means through which the public can obtain information
on the existing and planned programs and activities of the National Institutes of Health with respect to autism spectrum disorder and through which the Director can receive comments from
the public regarding such programs and activities.
PEDIATRIC RESEARCH INITIATIVE

SEC.

409D. ø284h¿ (a) ESTABLISHMENT.—The Secretary shall
establish within the Office of the Director of NIH a Pediatric Research Initiative (referred to in this section as the ‘‘Initiative’’) to
conduct and support research that is directly related to diseases,
disorders, and other conditions in children. The Initiative shall be
headed by the Director of NIH.
(b) PURPOSE.—The purpose of the Initiative is to provide funds
to enable the Director of NIH—
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538

(1) to increase support for pediatric biomedical research
within the National Institutes of Health to realize the expanding opportunities for advancement in scientific investigations
and care for children;
(2) to enhance collaborative efforts among the Institutes to
conduct and support multidisciplinary research in the areas
that the Director deems most promising; and
(3) in coordination with the Food and Drug Administration, to increase the development of adequate pediatric clinical
trials and pediatric use information to promote the safer and
more effective use of prescription drugs in the pediatric population.
(c) DUTIES.—In carrying out subsection (b), the Director of NIH
shall—
(1) consult with the Director of the Eunice Kennedy Shriver National Institute of Child Health and Human Development
and the other national research institutes, in considering their
requests for new or expanded pediatric research efforts, and
consult with the Administrator of the Health Resources and
Services Administration and other advisors as the Director determines to be appropriate;
(2) have broad discretion in the allocation of any Initiative
assistance among the Institutes, among types of grants, and
between basic and clinical research so long as the assistance
is directly related to the illnesses and conditions of children;
and
(3) be responsible for the oversight of any newly appropriated Initiative funds and annually report to Congress and
the public on the extent of the total funds obligated to conduct
or support pediatric research across the National Institutes of
Health, including the specific support and research awards allocated through the Initiative.
(d) TRANSFER OF FUNDS.—The Director of NIH may transfer
amounts appropriated under this section to any of the Institutes for
a fiscal year to carry out the purposes of the Initiative under this
section.
SEC. 409E. ø284i¿ AUTOIMMUNE DISEASES.
(a) EXPANSION, INTENSIFICATION, AND COORDINATION OF ACTIVITIES.—
(1) IN GENERAL.—The Director of NIH shall expand, inten-

sify, and coordinate research and other activities of the National Institutes of Health with respect to autoimmune diseases.
(2) ALLOCATIONS BY DIRECTOR OF NIH.—With respect to
amounts appropriated to carry out this section for a fiscal year,
the Director of NIH shall allocate the amounts among the national research institutes that are carrying out paragraph (1).
(3) DEFINITION.—The term ‘‘autoimmune disease’’ includes,
for purposes of this section such diseases or disorders with evidence of autoimmune pathogensis as the Secretary determines
to be appropriate.
(b) COORDINATING COMMITTEE.—
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(1) IN GENERAL.—The Secretary shall ensure that the
Autoimmune Diseases Coordinating Committee (referred to in
this section as the ‘‘Coordinating Committee’’) coordinates activities across the National Institutes and with other Federal
health programs and activities relating to such diseases.
(2) COMPOSITION.—The Coordinating Committee shall be
composed of the directors or their designees of each of the national research institutes involved in research with respect to
autoimmune diseases and representatives of all other Federal
departments and agencies whose programs involve health functions or responsibilities relevant to such diseases, including the
Centers for Disease Control and Prevention and the Food and
Drug Administration.
(3) CHAIR.—
(A) IN GENERAL.—With respect to autoimmune diseases, the Chair of the Committee shall serve as the principal advisor to the Secretary, the Assistant Secretary for
Health, and the Director of NIH, and shall provide advice
to the Director of the Centers for Disease Control and Prevention, the Commissioner of Food and Drugs, and other
relevant agencies.
(B) DIRECTOR OF NIH.—The Chair of the Committee
shall be directly responsible to the Director of NIH.
(c) PLAN FOR NIH ACTIVITIES.—
(1) IN GENERAL.—Not later than 1 year after the date of
the enactment of this section, the Coordinating Committee
shall develop a plan for conducting and supporting research
and education on autoimmune diseases through the national
research institutes and shall periodically review and revise the
plan. The plan shall—
(A) provide for a broad range of research and education activities relating to biomedical, psychosocial, and
rehabilitative issues, including studies of the disproportionate impact of such diseases on women;
(B) identify priorities among the programs and activities of the National Institutes of Health regarding such
diseases; and
(C) reflect input from a broad range of scientists, patients, and advocacy groups.
(2) CERTAIN ELEMENTS OF PLAN.—The plan under paragraph (1) shall, with respect to autoimmune diseases, provide
for the following as appropriate:
(A) Research to determine the reasons underlying the
incidence and prevalence of the diseases.
(B) Basic research concerning the etiology and causes
of the diseases.
(C) Epidemiological studies to address the frequency
and natural history of the diseases, including any differences among the sexes and among racial and ethnic
groups.
(D) The development of improved screening techniques.
(E) Clinical research for the development and evaluation of new treatments, including new biological agents.
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540

(F) Information and education programs for health
care professionals and the public.
(3) IMPLEMENTATION OF PLAN.—The Director of NIH shall
ensure that programs and activities of the National Institutes
of Health regarding autoimmune diseases are implemented in
accordance with the plan under paragraph (1).
MUSCULAR DYSTROPHY RESEARCH

SEC. 409F. ø284j¿ (a) COORDINATION OF ACTIVITIES.—The Director of NIH shall expand and increase coordination in the activities of the National Institutes of Health with respect to research
on muscular dystrophies, including Duchenne muscular dystrophy.
(b) ADMINISTRATION OF PROGRAM; COLLABORATION AMONG
AGENCIES.—The Director of NIH shall carry out this section
through the appropriate institutes, including the National Institute
of Neurological Disorders and Stroke and in collaboration with any
other agencies that the Director determines appropriate.
SEC. 409G. ø284k¿ CLINICAL RESEARCH.
(a) IN GENERAL.—The Director of

National Institutes of Health
shall undertake activities to support and expand the involvement
of the National Institutes of Health in clinical research.
(b) REQUIREMENTS.—In carrying out subsection (a), the Director of National Institutes of Health shall—
(1) consider the recommendations of the Division of Research Grants Clinical Research Study Group and other recommendations for enhancing clinical research; and
(2) establish intramural and extramural clinical research
fellowship programs directed specifically at medical and dental
students and a continuing education clinical research training
program at the National Institutes of Health.
(c) SUPPORT FOR THE DIVERSE NEEDS OF CLINICAL RESEARCH.—The Director of National Institutes of Health, in cooperation with the Directors of the Institutes, Centers, and Divisions of
the National Institutes of Health, shall support and expand the resources available for the diverse needs of the clinical research community, including inpatient, outpatient, and critical care clinical research.
(d) PEER REVIEW.—The Director of National Institutes of
Health shall establish peer review mechanisms to evaluate applications for the awards and fellowships provided for in subsection
(b)(2) and section 409D. Such review mechanisms shall include individuals who are exceptionally qualified to appraise the merits of
potential clinical research training and research grant proposals.
SEC. 409H. ø284l¿ ENHANCEMENT AWARDS.
(a) MENTORED PATIENT-ORIENTED RESEARCH CAREER DEVELOPMENT AWARDS.—
(1) GRANTS.—
(A) IN GENERAL.—The Director of the National Insti-

tutes of Health shall make grants (to be referred to as
‘‘Mentored Patient-Oriented Research Career Development
Awards’’) to support individual careers in clinical research
at general clinical research centers or at other institutions
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PUBLIC HEALTH SERVICE ACT

Sec. 409H

that have the infrastructure and resources deemed appropriate for conducting patient-oriented clinical research.
(B) USE.—Grants under subparagraph (A) shall be
used to support clinical investigators in the early phases
of their independent careers by providing salary and such
other support for a period of supervised study.
(2) APPLICATIONS.—An application for a grant under this
subsection shall be submitted by an individual scientist at such
time as the Director may require.
(b) MID-CAREER INVESTIGATOR AWARDS IN PATIENT-ORIENTED
RESEARCH.—
(1) GRANTS.—
(A) IN GENERAL.—The Director of the National Institutes of Health shall make grants (to be referred to as
‘‘Mid-Career Investigator Awards in Patient-Oriented Research’’) to support individual clinical research projects at
general clinical research centers or at other institutions
that have the infrastructure and resources deemed appropriate for conducting patient-oriented clinical research.
(B) USE.—Grants under subparagraph (A) shall be
used to provide support for mid-career level clinicians to
allow such clinicians to devote time to clinical research
and to act as mentors for beginning clinical investigators.
(2) APPLICATIONS.—An application for a grant under this
subsection shall be submitted by an individual scientist at such
time as the Director requires.
(c) GRADUATE TRAINING IN CLINICAL INVESTIGATION AWARD.—
(1) IN GENERAL.—The Director of the National Institutes of
Health shall make grants (to be referred to as ‘‘Graduate
Training in Clinical Investigation Awards’’) to support individuals pursuing master’s or doctoral degrees in clinical investigation.
(2) APPLICATIONS.—An application for a grant under this
subsection shall be submitted by an individual scientist at such
time as the Director may require.
(3) LIMITATIONS.—Grants under this subsection shall be
for terms of 2 years or more and shall provide stipend, tuition,
and institutional support for individual advanced degree programs in clinical investigation.
(4) DEFINITION.—As used in this subsection, the term ‘‘advanced degree programs in clinical investigation’’ means programs that award a master’s or Ph.D. degree in clinical investigation after 2 or more years of training in areas such as the
following:
(A) Analytical methods, biostatistics, and study design.
(B) Principles of clinical pharmacology and pharmacokinetics.
(C) Clinical epidemiology.
(D) Computer data management and medical
informatics.
(E) Ethical and regulatory issues.
(F) Biomedical writing.
(d) CLINICAL RESEARCH CURRICULUM AWARDS.—
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(1) IN GENERAL.—The Director of the National Institutes of
Health shall make grants (to be referred to as ‘‘Clinical Research Curriculum Awards’’) to institutions for the development and support of programs of core curricula for training
clinical investigators, including medical students. Such core
curricula may include training in areas such as the following:
(A) Analytical methods, biostatistics, and study design.
(B) Principles of clinical pharmacology and pharmacokinetics.
(C) Clinical epidemiology.
(D) Computer data management and medical
informatics.
(E) Ethical and regulatory issues.
(F) Biomedical writing.
(2) APPLICATIONS.—An application for a grant under this
subsection shall be submitted by an individual institution or a
consortium of institutions at such time as the Director may require. An institution may submit only one such application.
(3) LIMITATIONS.—Grants under this subsection shall be
for terms of up to 5 years and may be renewable.
SEC. 409I. ø284m¿ PROGRAM FOR PEDIATRIC STUDIES OF DRUGS. 1
(a) LIST OF PRIORITY ISSUES IN PEDIATRIC THERAPEUTICS.—
(1) IN GENERAL.—Not later than one year after the date

of
the enactment of the Best Pharmaceuticals for Children Act of
2007, the Secretary, acting through the Director of the National Institutes of Health and in consultation with the Commissioner of Food and Drugs and experts in pediatric research,
shall develop and publish a priority list of needs in pediatric
therapeutics, including drugs, biological products, or indications that require study. The list shall be revised every three
years.
(2) CONSIDERATION OF AVAILABLE INFORMATION.—In developing and prioritizing the list under paragraph (1), the Secretary shall consider—
(A) therapeutic gaps in pediatrics that may include developmental pharmacology, pharmacogenetic determinants
of drug response, metabolism of drugs and biologics in children, and pediatric clinical trials;
(B) particular pediatric diseases, disorders or conditions where more complete knowledge and testing of therapeutics, including drugs and biologics, may be beneficial in
pediatric populations; and
(C) the adequacy of necessary infrastructure to conduct pediatric pharmacological research, including research networks and trained pediatric investigators.
(b) PEDIATRIC STUDIES AND RESEARCH.—The Secretary, acting
through the National Institutes of Health, shall award funds to entities that have the expertise to conduct pediatric clinical trials or
other research (including qualified universities, hospitals, labora1 Section 16 of Public Law 107–109 (115 Stat. 1421) requires the Comptroller General of the
United States, in consultation with the Secretary of Health and Human Services, to submit to
Congress a report that relates to section 409I and to section 505A of the Federal Food, Drug,
and Cosmetic Act. The report is required to be submitted not later than October 1, 2006.

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tories, contract research organizations, practice groups, federally
funded programs such as pediatric pharmacology research units,
other public or private institutions, or individuals) to enable the entities to conduct the drug studies or other research on the issues
described in subsection (a). The Secretary may use contracts,
grants, or other appropriate funding mechanisms to award funds
under this subsection.
(c) PROCESS FOR PROPOSED PEDIATRIC STUDY REQUESTS AND
LABELING CHANGES.—
(1) SUBMISSION OF PROPOSED PEDIATRIC STUDY REQUEST.—
The Director of the National Institutes of Health shall, as appropriate, submit proposed pediatric study requests for consideration by the Commissioner of Food and Drugs for pediatric
studies of a specific pediatric indication identified under subsection (a). Such a proposed pediatric study request shall be
made in a manner equivalent to a written request made under
subsection (b) or (c) of section 505A of the Federal Food, Drug,
and Cosmetic Act, or section 351(m) of this Act, including with
respect to the information provided on the pediatric studies to
be conducted pursuant to the request. The Director of the National Institutes of Health may submit a proposed pediatric
study request for a drug for which—
(A)(i) there is an approved application under section
505(j) of the Federal Food, Drug, and Cosmetic Act or section 351(k) of this Act; or
(ii) there is a submitted application that could be approved under the criteria of such section; and
(B) there remains no patent listed pursuant to section
505(b)(1) of the Federal Food, Drug, and Cosmetic Act, and
every three-year and five-year period referred to in subsection (c)(3)(E)(ii), (c)(3)(E)(iii), (c)(3)(E)(iv), (j)(5)(F)(ii),
(j)(5)(F)(iii), or (j)(5)(F)(iv) of section 505 of the Federal
Food, Drug, and Cosmetic Act, or applicable twelve-year
period referred to in section 351(k)(7) of this Act, and any
seven-year period referred to in section 527 of the Federal
Food, Drug, and Cosmetic Act has ended for at least one
form of the drug; and
(C) additional studies are needed to assess the safety
and effectiveness of the use of the drug in the pediatric
population.
(2) WRITTEN REQUEST TO HOLDERS OF APPROVED APPLICATIONS.—The Commissioner of Food and Drugs, in consultation
with the Director of the National Institutes of Health, may
issue a written request based on the proposed pediatric study
request for the indication or indications submitted pursuant to
paragraph (1) (which shall include a timeframe for negotiations
for an agreement) for pediatric studies concerning a drug identified under subsection (a) to all holders of an approved application for the drug. Such a written request shall be made in
a manner equivalent to the manner in which a written request
is made under subsection (b) or (c) of section 505A of the Federal Food, Drug, and Cosmetic Act or section 351(m) of this
Act, including with respect to information provided on the pediatric studies to be conducted pursuant to the request and
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using appropriate formulations for each age group for which
the study is requested.
(3) REQUESTS FOR PROPOSALS.—If the Commissioner of
Food and Drugs does not receive a response to a written request issued under paragraph (2) not later than 30 days after
the date on which a request was issued, the Secretary, acting
through the Director of the National Institutes of Health and
in consultation with the Commissioner of Food and Drugs,
shall publish a request for proposals to conduct the pediatric
studies described in the written request in accordance with
subsection (b).
(4) DISQUALIFICATION.—A holder that receives a first right
of refusal shall not be entitled to respond to a request for proposals under paragraph (3).
(5) CONTRACTS, GRANTS, OR OTHER FUNDING MECHANISMS.—A contract, grant, or other funding may be awarded
under this section only if a proposal is submitted to the Secretary in such form and manner, and containing such agreements, assurances, and information as the Secretary determines to be necessary to carry out this section.
(6) REPORTING OF STUDIES.—
(A) IN GENERAL.—On completion of a pediatric study
in accordance with an award under this section, a report
concerning the study shall be submitted to the Director of
the National Institutes of Health and the Commissioner of
Food and Drugs. The report shall include all data generated in connection with the study, including a written
request if issued.
(B) AVAILABILITY OF REPORTS.—Each report submitted
under subparagraph (A) shall be considered to be in the
public domain (subject to section 505A(d)(4) of the Federal
Food, Drug, and Cosmetic Act) and shall be assigned a
docket number by the Commissioner of Food and Drugs.
An interested person may submit written comments concerning such pediatric studies to the Commissioner of Food
and Drugs, and the written comments shall become part of
the docket file with respect to each of the drugs.
(C) ACTION BY COMMISSIONER.—The Commissioner of
Food and Drugs shall take appropriate action in response
to the reports submitted under subparagraph (A) in accordance with paragraph (7).
(7) REQUESTS FOR LABELING CHANGE.—During the 180-day
period after the date on which a report is submitted under
paragraph (6)(A), the Commissioner of Food and Drugs shall—
(A) review the report and such other data as are available concerning the safe and effective use in the pediatric
population of the drug studied;
(B) negotiate with the holders of approved applications
for the drug studied for any labeling changes that the
Commissioner of Food and Drugs determines to be appropriate and requests the holders to make; and
(C)(i) place in the public docket file a copy of the report and of any requested labeling changes; and
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(ii) publish in the Federal Register and through a
posting on the Web site of the Food and Drug Administration a summary of the report and a copy of any requested
labeling changes.
(8) DISPUTE RESOLUTION.—
(A) REFERRAL TO PEDIATRIC ADVISORY COMMITTEE.—If,
not later than the end of the 180-day period specified in
paragraph (7), the holder of an approved application for
the drug involved does not agree to any labeling change requested by the Commissioner of Food and Drugs under
that paragraph, the Commissioner of Food and Drugs shall
refer the request to the Pediatric Advisory Committee.
(B) ACTION BY THE PEDIATRIC ADVISORY COMMITTEE.—
Not later than 90 days after receiving a referral under
subparagraph (A), the Pediatric Advisory Committee
shall—
(i) review the available information on the safe
and effective use of the drug in the pediatric population, including study reports submitted under this
section; and
(ii) make a recommendation to the Commissioner
of Food and Drugs as to appropriate labeling changes,
if any.
(9) FDA DETERMINATION.—Not later than 30 days after receiving a recommendation from the Pediatric Advisory Committee under paragraph (8)(B)(ii) with respect to a drug, the
Commissioner of Food and Drugs shall consider the recommendation and, if appropriate, make a request to the holders of approved applications for the drug to make any labeling
change that the Commissioner of Food and Drugs determines
to be appropriate.
(10) FAILURE TO AGREE.—If a holder of an approved application for a drug, within 30 days after receiving a request to
make a labeling change under paragraph (9), does not agree to
make a requested labeling change, the Commissioner of Food
and Drugs may deem the drug to be misbranded under the
Federal Food, Drug, and Cosmetic Act.
(11) NO EFFECT ON AUTHORITY.—Nothing in this subsection
limits the authority of the United States to bring an enforcement action under the Federal Food, Drug, and Cosmetic Act
when a drug lacks appropriate pediatric labeling. Neither
course of action (the Pediatric Advisory Committee process or
an enforcement action referred to in the preceding sentence)
shall preclude, delay, or serve as the basis to stay the other
course of action.
(d) DISSEMINATION OF PEDIATRIC INFORMATION.—Not later
than one year after the date of the enactment of the Best Pharmaceuticals for Children Act of 2007, the Secretary, acting through
the Director of the National Institutes of Health, shall study the
feasibility of establishing a compilation of information on pediatric
drug use and report the findings to Congress.
(e) AUTHORIZATION OF APPROPRIATIONS.—
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(1) IN GENERAL.—There are authorized to be appropriated
to carry out this section, $25,000,000 for each of fiscal years
2013 through 2017.
(2) AVAILABILITY.—Any amount appropriated under paragraph (1) shall remain available to carry out this section until
expended.
SEC. 409J. ø284q¿ PAIN RESEARCH.
(a) RESEARCH INITIATIVES.—
(1) IN GENERAL.—The Director

of NIH is encouraged to
continue and expand, through the Pain Consortium, an aggressive program of basic and clinical research on the causes of and
potential treatments for pain.
(2) ANNUAL RECOMMENDATIONS.—Not less than annually,
the Pain Consortium, in consultation with the Division of Program Coordination, Planning, and Strategic Initiatives, shall
develop and submit to the Director of NIH recommendations
on appropriate pain research initiatives that could be undertaken with funds reserved under section 402A(c)(1) for the
Common Fund or otherwise available for such initiatives.
(3) DEFINITION.—In this subsection, the term ‘‘Pain Consortium’’ means the Pain Consortium of the National Institutes
of Health or a similar trans-National Institutes of Health coordinating entity designated by the Secretary for purposes of
this subsection.
(b) INTERAGENCY PAIN RESEARCH COORDINATING COMMITTEE.—
(1) ESTABLISHMENT.—The Secretary shall establish not
later than 1 year after the date of the enactment of this section
and as necessary maintain a committee, to be known as the
Interagency Pain Research Coordinating Committee (in this
section referred to as the ‘‘Committee’’), to coordinate all efforts
within the Department of Health and Human Services and
other Federal agencies that relate to pain research.
(2) MEMBERSHIP.—
(A) IN GENERAL.—The Committee shall be composed of
the following voting members:
(i) Not more than 7 voting Federal representatives
appoint by the Secretary from agencies that conduct
pain care research and treatment.
(ii) 12 additional voting members appointed under
subparagraph (B).
(B) ADDITIONAL MEMBERS.—The Committee shall include additional voting members appointed by the Secretary as follows:
(i) 6 non-Federal members shall be appointed from
among scientists, physicians, and other health professionals.
(ii) 6 members shall be appointed from members
of the general public, who are representatives of leading research, advocacy, and service organizations for
individuals with pain-related conditions.
(C) NONVOTING MEMBERS.—The Committee shall include such nonvoting members as the Secretary determines to be appropriate.

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(3) CHAIRPERSON.—The voting members of the Committee
shall select a chairperson from among such members. The selection of a chairperson shall be subject to the approval of the
Director of NIH.
(4) MEETINGS.—The Committee shall meet at the call of
the chairperson of the Committee or upon the request of the
Director of NIH, but in no case less often than once each year.
(5) DUTIES.—The Committee shall—
(A) develop a summary of advances in pain care research supported or conducted by the Federal agencies relevant to the diagnosis, prevention, and treatment of pain
and diseases and disorders associated with pain;
(B) identify critical gaps in basic and clinical research
on the symptoms and causes of pain;
(C) make recommendations to ensure that the activities of the National Institutes of Health and other Federal
agencies are free of unnecessary duplication of effort;
(D) make recommendations on how best to disseminate information on pain care; and
(E) make recommendations on how to expand partnerships between public entities and private entities to expand collaborative, cross-cutting research.
(6) REVIEW.—The Secretary shall review the necessity of
the Committee at least once every 2 years.
PART C—SPECIFIC PROVISIONS RESPECTING NATIONAL RESEARCH
INSTITUTES
Subpart 1—National Cancer Institute
PURPOSE OF INSTITUTE

SEC. 410. ø285¿ The general purpose of the National Cancer
Institute (hereafter in this subpart referred to as the ‘‘Institute’’) is
the conduct and support of research, training, health information
dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer, rehabilitation from cancer, and the continuing care of cancer patients and the families of
cancer patients.
NATIONAL CANCER PROGRAM

SEC. 411. ø285a¿ The National Cancer Program shall consist
of (1) an expanded, intensified, and coordinated cancer research
program encompassing the research programs conducted and supported by the Institute and the related research programs of the
other national research institutes, including an expanded and intensified research program for the prevention of cancer caused by
occupational or environmental exposure to carcinogens, and (2) the
other programs and activities of the Institute.
CANCER CONTROL PROGRAMS

SEC. 412. ø285a–1¿ The Director of the Institute shall establish and support demonstration, education, and other programs for
the detection, diagnosis, prevention, and treatment of cancer and
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for rehabilitation and counseling respecting cancer. Programs established and supported under this section shall include—
(1) locally initiated education and demonstration programs
(and regional networks of such programs) to transmit research
results and to disseminate information respecting—
(A) the detection, diagnosis, prevention, and treatment
of cancer,
(B) the continuing care of cancer patients and the families of cancer patients, and
(C) rehabilitation and counseling respecting cancer,
to physicians and other health professionals who provide care
to individuals who have cancer;
(2) the demonstration of and the education of students of
the health professions and health professionals in—
(A) effective methods for the prevention and early detection of cancer and the identification of individuals with
a high risk of developing cancer, and
(B) improved methods of patient referral to appropriate centers for early diagnosis and treatment of cancer;
and
(3) the demonstration of new methods for the dissemination of information to the general public concerning the prevention, early detection, diagnosis, and treatment and control of
cancer and information concerning unapproved and ineffective
methods, drugs, and devices for the diagnosis, prevention,
treatment, and control of cancer.
SPECIAL AUTHORITIES OF THE DIRECTOR

SEC. 413. ø285a–2¿ (a)(1) The Director of the Institute shall establish an information and education program to collect, identify,
analyze, and disseminate on a timely basis, through publications
and other appropriate means, to cancer patients and their families,
physicians and other health professionals, and the general public,
information on cancer research, diagnosis, prevention, and treatment (including information respecting nutrition programs for cancer patients and the relationship between nutrition and cancer).
The Director of the Institute may take such action as may be necessary to insure that all channels for the dissemination and exchange of scientific knowledge and information are maintained between the Institute and the public and between the Institute and
other scientific, medical, and biomedical disciplines and organizations nationally and internationally.
(2) In carrying out paragraph (1), the Director of the Institute
shall—
(A) provide public and patient information and education
programs, providing information that will help individuals take
personal steps to reduce their risk of cancer, to make them
aware of early detection techniques and to motivate appropriate utilization of those techniques, to help individuals deal
with cancer if it strikes, and to provide information to improve
long-term survival;
(B) continue and expand programs to provide physicians
and the public with state-of-the-art information on the treatment of particular forms of cancers, and to identify those clinMarch 13, 2013

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ical trials that might benefit patients while advancing knowledge of cancer treatment;
(C) assess the incorporation of state-of-the-art cancer treatments into clinical practice and the extent to which cancer patients receive such treatments and include the results of such
assessments in the biennial reports required under section 407;
(D) maintain and operate the International Cancer Research Data Bank, which shall collect, catalog, store, and disseminate insofar as feasible the results of cancer research and
treatment undertaken in any country for the use of any person
involved in cancer research and treatment in any country; and
(E) to the extent practicable, in disseminating the results
of such cancer research and treatment, utilize information systems available to the public.
(b) The Director of the Institute in carrying out the National
Cancer Program—
(1) shall establish or support the large-scale production or
distribution of specialized biological materials and other therapeutic substances for cancer research and set standards of
safety and care for persons using such materials;
(2) shall, in consultation with the advisory council for the
Institute, support (A) research in the cancer field outside the
United States by highly qualified foreign nationals which can
be expected to benefit the American people, (B) collaborative
research involving American and foreign participants, and (C)
the training of American scientists abroad and foreign scientists in the United States;
(3) shall, in consultation with the advisory council for the
Institute, support appropriate programs of education and training (including continuing education and laboratory and clinical
research training);
(4) shall encourage and coordinate cancer research by industrial concerns where such concerns evidence a particular
capability for such research;
(5) may obtain (after consultation with the advisory council
for the Institute and in accordance with section 3109 of title
5, United States Code, but without regard to the limitation in
such section on the period of service) the services of not more
than one hundred and fifty-one experts or consultants who
have scientific or professional qualifications;
(6)(A) may, in consultation with the advisory council for
the Institute, acquire, construct, improve, repair, operate, and
maintain laboratories, other research facilities, equipment, and
such other real or personal property as the Director determines
necessary;
(B) may, in consultation with the advisory council for the
Institute, make grants for construction or renovation of facilities; and
(C) may, in consultation with the advisory council for the
Institute, acquire, without regard to the Act of March 3, 1877
(40 U.S.C. 34), by lease or otherwise through the Administrator of General Services, buildings or parts of buildings in
the District of Columbia or communities located adjacent to the
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District of Columbia for the use of the Institute for a period not
to exceed ten years;
(7) may, in consultation with the advisory council for the
Institute, appoint one or more advisory committees composed
of such private citizens and officials of Federal, State, and local
governments to advise the Director with respect to the Director’s functions;
(8) may, subject to section 405(b)(2) and without regard to
section 3324 of title 31, United States Code, and section 3709
of the Revised Statutes (41 U.S.C. 5), enter into such contracts,
leases, cooperative agreements, as may be necessary in the
conduct of functions of the Director, with any public agency, or
with any person, firm, association, corporation, or educational
institution; and
(9) shall, notwithstanding section 405(a), prepare and submit, directly to the President for review and transmittal to
Congress, an annual budget estimate (including an estimate of
the number and type of personnel needs for the Institute) for
the National Cancer Program, after reasonable opportunity for
comment (but without change) by the Secretary, the Director
of NIH, and the Institute’s advisory council.
Except as otherwise provided, experts and consultants whose services are obtained under paragraph (5) shall be paid or reimbursed,
in accordance with title 5, United States Code, for their travel to
and from their place of service and for other expenses associated
with their assignment. Such expenses shall not be allowed in connection with the assignment of an expert or consultant whose services are obtained under paragraph (5) unless the expert or consultant has agreed in writing to complete the entire period of the assignment or one year of the assignment, whichever is shorter, unless separated or reassigned for reasons which are beyond the control of the expert or consultant and which are acceptable to the Director of the Institute. If the expert or consultant violates the
agreement, the money spent by the United States for such expenses is recoverable from the expert or consultant as a debt due
the United States. The Secretary may waive in whole or in part a
right of recovery under the preceding sentence.
(c) PRE-CLINICAL MODELS TO EVALUATE PROMISING PEDIATRIC
CANCER THERAPIES.—
(1) EXPANSION AND COORDINATION OF ACTIVITIES.—The Director of the National Cancer Institute shall expand, intensify,
and coordinate the activities of the Institute with respect to research on the development of preclinical models to evaluate
which therapies are likely to be effective for treating pediatric
cancer.
(2) COORDINATION WITH OTHER INSTITUTES.—The Director
of the Institute shall coordinate the activities under paragraph
(1) with similar activities conducted by other national research
institutes and agencies of the National Institutes of Health to
the extent that those Institutes and agencies have responsibilities that are related to pediatric cancer.
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NATIONAL CANCER RESEARCH AND DEMONSTRATION CENTERS

SEC. 414. ø285a–3¿ (a)(1) The Director of the Institute may
enter into cooperative agreements with and make grants to public
or private nonprofit entities to pay all or part of the cost of planning, establishing, or strengthening, and providing basic operating
support for centers for basic and clinical research into, training in,
and demonstration of advanced diagnostic, prevention, control, and
treatment methods for cancer.
(2) A cooperative agreement or grant under paragraph (1) shall
be entered into in accordance with policies established by the Director of NIH and after consultation with the Institute’s advisory
council.
(b) Federal payments made under a cooperative agreement or
grant under subsection (a) may be used for—
(1) construction (notwithstanding any limitation under section 496);
(2) staffing and other basic operating costs, including such
patient care costs as are required for research;
(3) clinical training, including training for allied health
professionals, continuing education for health professionals and
allied health professions personnel, and information programs
for the public respecting cancer; and
(4) demonstration purposes.
As used in this paragraph, the term ‘‘construction’’ does not include
the acquisition of land, and the term ‘‘training’’ does not include research training for which National Research Service Awards 1 may
be provided under section 487.
(c) Support of a center under subsection (a) may be for a period
of not to exceed five years. Such period may be extended by the Director for additional periods of not more than five years each if the
operations of such center have been reviewed by an appropriate
technical and scientific peer review group established by the Director and if such group has recommended to the Director that such
period should be extended.
(d) Research centers under this section may not be considered
centers of excellence for purposes of section 402(b)(10).
PRESIDENT’S CANCER PANEL

SEC. 415. ø285a–4¿ (a)(1) The President’s Cancer Panel (hereafter in this section referred to as the ‘‘Panel’’) shall be composed
of three persons appointed by the President who by virtue of their
training, experience, and background are exceptionally qualified to
appraise the National Cancer Program. At least two members of
the Panel shall be distinguished scientists or physicians.
(2)(A) Members of the Panel shall be appointed for three-year
terms, except that (i) any member appointed to fill a vacancy occurring prior to the expiration of the term for which the member’s
predecessor was appointed shall be appointed only for the remainder of such term, and (ii) a member may serve until the member’s
successor has taken office. If a vacancy occurs in the Panel, the
1 Now

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President shall make an appointment to fill the vacancy not later
than 90 days after the date the vacancy occurred.
(B) The President shall designate one of the members to serve
as the chairman of the Panel for a term of one year.
(C) Members of the Panel shall each be entitled to receive the
daily equivalent of the annual rate of basic pay in effect for grade
GS–18 of the General Schedule for each day (including traveltime)
during which they are engaged in the actual performance of duties
as members of the Panel and shall be paid or reimbursed, in accordance with title 5, United States Code, for their travel to and
from their place of service and for other expenses associated with
their assignment.
(3) The Panel shall meet at the call of the chairman, but not
less often than four times a year. A transcript shall be kept of the
proceedings of each meeting of the Panel, and the chairman shall
make such transcript available to the public.
(b) The Panel shall monitor the development and execution of
the activities of the National Cancer Program, and shall report directly to the President. Any delays or blockages in rapid execution
of the Program shall immediately be brought to the attention of the
President. The Panel shall submit to the President periodic
progress reports on the National Cancer Program and shall submit
to the President, the Secretary, and the Congress an annual evaluation of the efficacy of the Program and suggestions for improvements, and shall submit such other reports as the President shall
direct.
ASSOCIATE DIRECTOR FOR PREVENTION

SEC. 416. ø285a–5¿ (a) There shall be in the Institute an Associate Director for Prevention to coordinate and promote the programs in the Institute concerning the prevention of cancer. The Associate Director shall be appointed by the Director of the Institute
from individuals who because of their professional training or experience are experts in public health or preventive medicine.
(b) The Associate Director for Prevention shall prepare for inclusion in the biennial report made under section 407 a description
of the prevention activities of the Institute, including a description
of the staff and resources allocated to those activities.
BREAST AND GYNECOLOGICAL CANCERS

SEC. 417. ø285a–6¿
TIVITIES.—The Director

(a) EXPANSION AND COORDINATION OF ACof the Institute, in consultation with the
National Cancer Advisory Board, shall expand, intensify, and coordinate the activities of the Institute with respect to research on
breast cancer, ovarian cancer, and other cancers of the reproductive
system of women.
(b) COORDINATION WITH OTHER INSTITUTES.—The Director of
the Institute shall coordinate the activities of the Director under
subsection (a) with similar activities conducted by other national
research institutes and agencies of the National Institutes of
Health to the extent that such Institutes and agencies have responsibilities that are related to breast cancer and other cancers of the
reproductive system of women.

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(c) PROGRAMS FOR BREAST CANCER.—
(1) IN GENERAL.—In carrying out subsection (a), the Director of the Institute shall conduct or support research to expand
the understanding of the cause of, and to find a cure for, breast
cancer. Activities under such subsection shall provide for an
expansion and intensification of the conduct and support of—
(A) basic research concerning the etiology and causes
of breast cancer;
(B) clinical research and related activities concerning
the causes, prevention, detection and treatment of breast
cancer;
(C) control programs with respect to breast cancer in
accordance with section 412, including community-based
programs designed to assist women who are members of
medically underserved populations, low-income populations, or minority groups;
(D) information and education programs with respect
to breast cancer in accordance with section 413; and
(E) research and demonstration centers with respect to
breast cancer in accordance with section 414, including the
development and operation of centers for breast cancer research to bring together basic and clinical, biomedical and
behavioral scientists to conduct basic, clinical, epidemiological, psychosocial, prevention and treatment research and
related activities on breast cancer.
Not less than six centers shall be operated under subparagraph (E). Activities of such centers should include supporting
new and innovative research and training programs for new researchers. Such centers shall give priority to expediting the
transfer of research advances to clinical applications.
(2) IMPLEMENTATION OF PLAN FOR PROGRAMS.—
(A) The Director of the Institute shall ensure that the
research programs described in paragraph (1) are implemented in accordance with a plan for the programs. Such
plan shall include comments and recommendations that
the Director of the Institute considers appropriate, with
due consideration provided to the professional judgment
needs of the Institute as expressed in the annual budget
estimate prepared in accordance with section 413(9) 1. The
Director of the Institute, in consultation with the National
Cancer Advisory Board, shall periodically review and revise such plan.
(B) Not later than October 1, 1993, the Director of the
Institute shall submit a copy of the plan to the President’s
Cancer Panel, the Secretary and the Director of NIH.
(C) The Director of the Institute shall submit any revisions of the plan to the President’s Cancer Panel, the Secretary, and the Director of NIH.
(D) The Secretary shall provide a copy of the plan submitted under subparagraph (A), and any revisions submitted under subparagraph (C), to the Committee on En1 So in law. See section 401 of Public Law 103–43 (107 Stat. 153). Probably should be section
‘‘413(b)(9)’’.

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ergy and Commerce of the House of Representatives and
the Committee on Labor and Human Resources of the Senate.
(d) OTHER CANCERS.—In carrying out subsection (a), the Director of the Institute shall conduct or support research on ovarian
cancer and other cancers of the reproductive system of women. Activities under such subsection shall provide for the conduct and
support of—
(1) basic research concerning the etiology and causes of
ovarian cancer and other cancers of the reproductive system of
women;
(2) clinical research and related activities into the causes,
prevention, detection and treatment of ovarian cancer and
other cancers of the reproductive system of women;
(3) control programs with respect to ovarian cancer and
other cancers of the reproductive system of women in accordance with section 412;
(4) information and education programs with respect to
ovarian cancer and other cancers of the reproductive system of
women in accordance with section 413; and
(5) research and demonstration centers with respect to
ovarian cancer and cancers of the reproductive system in accordance with section 414.
(e) REPORT.—The Director of the Institute shall prepare, for inclusion in the biennial report submitted under section 407, a report
that describes the activities of the National Cancer Institute under
the research programs referred to in subsection (a), that shall include—
(1) a description of the research plan with respect to breast
cancer prepared under subsection (c);
(2) an assessment of the development, revision, and implementation of such plan;
(3) a description and evaluation of the progress made, during the period for which such report is prepared, in the research programs on breast cancer and cancers of the reproductive system of women;
(4) a summary and analysis of expenditures made, during
the period for which such report is made, for activities with respect to breast cancer and cancers of the reproductive system
of women conducted and supported by the National Institutes
of Health; and
(5) such comments and recommendations as the Director
considers appropriate.
PROSTATE CANCER

SEC. 417A. ø285a–7¿ (a) EXPANSION AND
TIVITIES.—The Director of the Institute, in

COORDINATION OF ACconsultation with the
National Cancer Advisory Board, shall expand, intensify, and coordinate the activities of the Institute with respect to research on
prostate cancer.
(b) COORDINATION WITH OTHER INSTITUTES.—The Director of
the Institute shall coordinate the activities of the Director under
subsection (a) with similar activities conducted by other national
research institutes and agencies of the National Institutes of

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Health to the extent that such Institutes and agencies have responsibilities that are related to prostate cancer.
(c) PROGRAMS.—
(1) IN GENERAL.—In carrying out subsection (a), the Director of the Institute shall conduct or support research to expand
the understanding of the cause of, and to find a cure for, prostate cancer. Activities under such subsection shall provide for
an expansion and intensification of the conduct and support
of—
(A) basic research concerning the etiology and causes
of prostate cancer;
(B) clinical research and related activities concerning
the causes, prevention, detection and treatment of prostate
cancer;
(C) prevention and control and early detection programs with respect to prostate cancer in accordance with
section 412, particularly as it relates to intensifying research on the role of prostate specific antigen for the
screening and early detection of prostate cancer;
(D) an Inter-Institute Task Force, under the direction
of the Director of the Institute, to provide coordination between relevant National Institutes of Health components
of research efforts on prostate cancer;
(E) control programs with respect to prostate cancer in
accordance with section 412;
(F) information and education programs with respect
to prostate cancer in accordance with section 413; and
(G) research and demonstration centers with respect
to prostate cancer in accordance with section 414, including the development and operation of centers for prostate
cancer research to bring together basic and clinical, biomedical and behavioral scientists to conduct basic, clinical,
epidemiological, psychosocial, prevention and control,
treatment, research, and related activities on prostate cancer.
Not less than six centers shall be operated under subparagraph (G). Activities of such centers should include supporting
new and innovative research and training programs for new researchers. Such centers shall give priority to expediting the
transfer of research advances to clinical applications.
(2) IMPLEMENTATION OF PLAN FOR PROGRAMS.—
(A) The Director of the Institute shall ensure that the
research programs described in paragraph (1) are implemented in accordance with a plan for the programs. Such
plan shall include comments and recommendations that
the Director of the Institute considers appropriate, with
due consideration provided to the professional judgment
needs of the Institute as expressed in the annual budget
estimate prepared in accordance with section 413(9) 1. The
Director of the Institute, in consultation with the National
1 So in law. See section 402 of Public Law 103–43 (107 Stat. 155). Probably should be ‘‘section
413(b)(9)’’.

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Cancer Advisory Board, shall periodically review and revise such plan.
(B) Not later than October 1, 1993, the Director of the
Institute shall submit a copy of the plan to the President’s
Cancer Panel, the Secretary, and the Director of NIH.
(C) The Director of the Institute shall submit any revisions of the plan to the President’s Cancer Panel, the Secretary, and the Director of NIH.
(D) The Secretary shall provide a copy of the plan submitted under subparagraph (A), and any revisions submitted under subparagraph (C), to the Committee on Energy and Commerce of the House of Representatives and
the Committee on Labor and Human Resources of the Senate. 1
SEC. 417C. ø285a–9¿ GRANTS FOR EDUCATION, PREVENTION, AND
EARLY DETECTION OF RADIOGENIC CANCERS AND DISEASES.
(a) DEFINITION.—In this section the term ‘‘entity’’ means any—

(1) National Cancer Institute-designated cancer center;
(2) Department of Veterans Affairs hospital or medical
center;
(3) Federally Qualified Health Center, community health
center, or hospital;
(4) agency of any State or local government, including any
State department of health; or
(5) nonprofit organization.
(b) IN GENERAL.—The Secretary, acting through the Administrator of the Health Resources and Services Administration in consultation with the Director of the National Institutes of Health and
the Director of the Indian Health Service, may make competitive
grants to any entity for the purpose of carrying out programs to—
(1) screen individuals described under section 4(a)(1)(A)(i)
or 5(a)(1)(A) of the Radiation Exposure Compensation Act (42
U.S.C. 2210 note) for cancer as a preventative health measure;
(2) provide appropriate referrals for medical treatment of
individuals screened under paragraph (1) and to ensure, to the
extent practicable, the provision of appropriate follow-up services;
(3) develop and disseminate public information and education programs for the detection, prevention, and treatment of
radiogenic cancers and diseases; and
(4) facilitate putative applicants in the documentation of
claims as described in section 5(a) of the Radiation Exposure
Compensation Act (42 U.S.C. 2210 note).
(c) INDIAN HEALTH SERVICE.—The programs under subsection
(a) shall include programs provided through the Indian Health
Service or through tribal contracts, compacts, grants, or cooperative
agreements with the Indian Health Service and which are determined appropriate to raising the health status of Indians.
(d) GRANT AND CONTRACT AUTHORITY.—Entities receiving a
grant under subsection (b) may expend the grant to carry out the
purpose described in such subsection.
1 Section

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(e) HEALTH COVERAGE UNAFFECTED.—Nothing in this section
shall be construed to affect any coverage obligation of a governmental or private health plan or program relating to an individual
referred to under subsection (b)(1).
SEC. 417D. ƒ285a–10≈ RESEARCH, INFORMATION, AND EDUCATION
WITH RESPECT TO BLOOD CANCER. 1
(a) JOE MOAKLEY RESEARCH EXCELLENCE PROGRAM.—
(1) IN GENERAL.—The Director of NIH shall expand, inten-

sify, and coordinate programs for the conduct and support of
research with respect to blood cancer, and particularly with respect to leukemia, lymphoma, and multiple myeloma.
(2) ADMINISTRATION.—The Director of NIH shall carry out
this subsection through the Director of the National Cancer Institute and in collaboration with any other agencies that the Director determines to be appropriate.
(b) GERALDINE FERRARO CANCER EDUCATION PROGRAM.—
(1) IN GENERAL.—The Secretary shall direct the appropriate
agency within the Department of Health and Human Services,
in collaboration with the Director of NIH, to establish and
carry out a program to provide information and education for
patients and the general public with respect to blood cancer,
and particularly with respect to the treatment of leukemia,
lymphoma, and multiple myeloma.
(2) ADMINISTRATION.—The Agency determined by the Secretary under paragraph (1) shall carry out this subsection in
collaboration with private health organizations that have national education and patient assistance programs on blood-related cancers.
SEC. 417E. ø285a–11¿ PEDIATRIC CANCER RESEARCH AND AWARENESS.
(a) PEDIATRIC CANCER RESEARCH.—
(1) PROGRAMS OF RESEARCH EXCELLENCE IN PEDIATRIC CANCER.—The Secretary, in collaboration with the Director of NIH

and other Federal agencies with interest in prevention and
treatment of pediatric cancer, shall continue to enhance, expand, and intensify pediatric cancer research and other activities related to pediatric cancer, including therapeutically applicable research to generate effective treatments, pediatric preclinical testing, and pediatric clinical trials through National
Cancer Institute-supported pediatric cancer clinical trial
groups and their member institutions. In enhancing, expanding, and intensifying such research and other activities, the
Secretary is encouraged to take into consideration the application of such research and other activities for minority, health
disparity, and medically underserved communities. For purposes of this section, the term ‘‘pediatric cancer research’’
means research on the causes, prevention, diagnosis, recognition, treatment, and long-term effects of pediatric cancer.
1 Section 417D (as amended by Public Law 109–482) is shown after section 417C for the convenience of the reader. Section 3 of Public Law 107–172 (116 Stat. 541) attempts to amend this
part by inserting a new section 417D ‘‘after section 419C’’. The amendment cannot be executed,
as this part does not contain a section 419C.

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(2) PEER REVIEW REQUIREMENTS.—All grants awarded
under this subsection shall be awarded in accordance with section 492.
(b) PUBLIC AWARENESS OF PEDIATRIC CANCERS AND AVAILABLE
TREATMENTS AND RESEARCH.—
(1) IN GENERAL.—The Secretary may award grants to
childhood cancer professional and direct service organizations
for the expansion and widespread implementation of—
(A) activities that provide available information on
treatment protocols to ensure early access to the best
available therapies and clinical trials for pediatric cancers;
(B) activities that provide available information on the
late effects of pediatric cancer treatment to ensure access
to necessary long-term medical and psychological care; and
(C) direct resource services such as educational outreach for parents, peer-to-peer and parent-to-parent support networks, information on school re-entry and postsecondary education, and resource directories or referral services for financial assistance, psychological counseling, and
other support services.
In awarding grants under this paragraph, the Secretary is encouraged to take into consideration the extent to which an entity would use such grant for purposes of making activities and
services described in this paragraph available to minority,
health disparity, and medically underserved communities.
(2) PERFORMANCE MEASUREMENT, TRANSPARENCY, AND ACCOUNTABILITY.—For each grant awarded under this subsection,
the Secretary shall develop and implement metrics-based performance measures to assess the effectiveness of activities
funded under such grant.
(3) INFORMATIONAL REQUIREMENTS.—Any information
made available pursuant to a grant awarded under paragraph
(1) shall be—
(A) culturally and linguistically appropriate as needed
by patients and families affected by childhood cancer; and
(B) approved by the Secretary.
(c) RULE OF CONSTRUCTION.—Nothing in this section shall be
construed as being inconsistent with the goals and purposes of the
Minority Health and Health Disparities Research and Education
Act of 2000 (42 U.S.C. 202 note) 1.
(d) AUTHORIZATION OF APPROPRIATIONS.—For purposes of carrying out this section and section 399E–1, there are authorized to
be appropriated $30,000,000 for each of fiscal years 2009 through
2013. Such authorization of appropriations is in addition to the authorization of appropriations established in section 402A with respect to such purpose. Funds appropriated under this subsection
shall remain available until expended.
SEC. 417F. ø42 U.S.C. 285a–12¿ INTERAGENCY BREAST CANCER AND ENVIRONMENTAL RESEARCH COORDINATING COMMITTEE.
(a) INTERAGENCY BREAST CANCER AND ENVIRONMENTAL RESEARCH COORDINATING COMMITTEE.—
1 The patenthetical reference to 42 U.S.C. 202 note in subsection (c) probably should be stricken or revised to refer to 42 U.S.C. 201 note.

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(1) ESTABLISHMENT.—Not later than 6 months after the
date of the enactment of this section, the Secretary shall establish a committee, to be known as the Interagency Breast Cancer and Environmental Research Coordinating Committee (in
this section referred to as the ‘‘Committee’’).
(2) DUTIES.—The Committee shall—
(A) share and coordinate information on existing research activities, and make recommendations to the National Institutes of Health and other Federal agencies regarding how to improve existing research programs, that
are related to breast cancer research;
(B) develop a comprehensive strategy and advise the
National Institutes of Health and other Federal agencies
in the solicitation of proposals for collaborative, multidisciplinary research, including proposals to evaluate environmental and genomic factors that may be related to the etiology of breast cancer that would—
(i) result in innovative approaches to study emerging scientific opportunities or eliminate knowledge
gaps in research to improve the research portfolio;
(ii) outline key research questions, methodologies,
and knowledge gaps;
(iii) expand the number of research proposals that
involve collaboration between 2 or more national research institutes or national centers, including proposals for Common Fund research described in section
402(b)(7) to improve the research portfolio; and
(iv) expand the number of collaborative, multidisciplinary, and multi-institutional research grants;
(C) develop a summary of advances in breast cancer
research supported or conducted by Federal agencies relevant to the diagnosis, prevention, and treatment of cancer
and other diseases and disorders; and
(D) not later than 2 years after the date of the establishment of the Committee, make recommendations to the
Secretary—
(i) regarding any appropriate changes to research
activities, including recommendations to improve the
research portfolio of the National Institutes of Health
to ensure that scientifically-based strategic planning is
implemented in support of research priorities that impact breast cancer research activities;
(ii) to ensure that the activities of the National Institutes of Health and other Federal agencies, including the Department of Defense, are free of unnecessary duplication of effort;
(iii) regarding public participation in decisions relating to breast cancer research to increase the involvement of patient advocacy and community organizations representing a broad geographical area;
(iv) on how best to disseminate information on
breast cancer research progress; and
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(v) on how to expand partnerships between public
entities, including Federal agencies, and private entities to expand collaborative, cross-cutting research.
(3) RULE OF CONSTRUCTION.—For the purposes of the Committee, when focusing on research to evaluate environmental
and genomic factors that may be related to the etiology of
breast cancer, nothing in this section shall be construed to restrict the Secretary from including other forms of cancer, as
appropriate, when doing so may advance research in breast
cancer or advance research in other forms of cancer.
(4) MEMBERSHIP.—
(A) IN GENERAL.—The Committee shall be composed of
the following voting members:
(i) Not more than 7 voting Federal representatives
as follows:
(I) The Director of the Centers for Disease
Control and Prevention.
(II) The Director of the National Institutes of
Health and the directors of such national research
institutes and national centers (which may include the National Institute of Environmental
Health Sciences) as the Secretary determines appropriate.
(III) One representative from the National
Cancer Institute Board of Scientific Advisors, appointed by the Director of the National Cancer Institute.
(IV) The heads of such other agencies of the
Department of Health and Human Services as the
Secretary determines appropriate.
(V) Representatives of other Federal agencies
that conduct or support cancer research, including
the Department of Defense.
(ii) 12 additional voting members appointed under
subparagraph (B).
(B) ADDITIONAL MEMBERS.—The Committee shall include additional voting members appointed by the Secretary as follows:
(i) 6 members shall be appointed from among scientists, physicians, and other health professionals,
who—
(I) are not officers or employees of the United
States;
(II) represent multiple disciplines, including
clinical, basic, and public health sciences;
(III) represent different geographical regions
of the United States;
(IV) are from practice settings, academia, or
other research settings; and
(V) are experienced in scientific peer review
process.
(ii) 6 members shall be appointed from members
of the general public, who represent individuals with
breast cancer.
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Sec. 417G

(C) NONVOTING MEMBERS.—The Committee shall include such nonvoting members as the Secretary determines to be appropriate.
(5) CHAIRPERSON.—The voting members of the Committee
shall select a chairperson from among such members. The selection of a chairperson shall be subject to the approval of the
Director of NIH.
(6) MEETINGS.—The Committee shall meet at the call of
the chairperson of the Committee or upon the request of the
Director of NIH, but in no case less often than once each year.
(b) REVIEW.—The Secretary shall review the necessity of the
Committee in calendar year 2011 and, thereafter, at least once
every 2 years.
SEC. 417G. ø42 U.S.C. 285a–13¿ SCIENTIFIC FRAMEWORK FOR RECALCITRANT CANCERS.
(a) DEVELOPMENT OF SCIENTIFIC FRAMEWORK.—
(1) IN GENERAL.—For each recalcitrant cancer identified

under subsection (b), the Director of the Institute shall develop
(in accordance with subsection (c)) a scientific framework for
the conduct or support of research on such cancer.
(2) CONTENTS.—The scientific framework with respect to a
recalcitrant cancer shall include the following:
(A) CURRENT STATUS.—
(i) REVIEW OF LITERATURE.—A summary of findings from the current literature in the areas of—
(I) the prevention, diagnosis, and treatment of
such cancer;
(II) the fundamental biologic processes that
regulate such cancer (including similarities and
differences of such processes from the biological
processes that regulate other cancers); and
(III) the epidemiology of such cancer.
(ii) SCIENTIFIC ADVANCES.—The identification of
relevant emerging scientific areas and promising scientific advances in basic, translational, and clinical
science relating to the areas described in subclauses
(I) and (II) of clause (i).
(iii) RESEARCHERS.—A description of the availability of qualified individuals to conduct scientific research in the areas described in clause (i).
(iv) COORDINATED RESEARCH INITIATIVES.—The
identification of the types of initiatives and partnerships for the coordination of intramural and extramural research of the Institute in the areas described
in clause (i) with research of the relevant national research institutes, Federal agencies, and non-Federal
public and private entities in such areas.
(v) RESEARCH RESOURCES.—The identification of
public and private resources, such as patient registries
and tissue banks, that are available to facilitate research relating to each of the areas described in clause
(i).
(B) IDENTIFICATION OF RESEARCH QUESTIONS.—The
identification of research questions relating to basic,
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translational, and clinical science in the areas described in
subclauses (I) and (II) of subparagraph (A)(i) that have not
been adequately addressed with respect to such recalcitrant cancer.
(C) RECOMMENDATIONS.—Recommendations for appropriate actions that should be taken to advance research in
the areas described in subparagraph (A)(i) and to address
the research questions identified in subparagraph (B), as
well as for appropriate benchmarks to measure progress
on achieving such actions, including the following:
(i) RESEARCHERS.—Ensuring adequate availability
of qualified individuals described in subparagraph
(A)(iii).
(ii) COORDINATED RESEARCH INITIATIVES.—Promoting and developing initiatives and partnerships described in subparagraph (A)(iv).
(iii) RESEARCH RESOURCES.—Developing additional
public and private resources described in subparagraph (A)(v) and strengthening existing resources.
(3) TIMING.—
(A) INITIAL DEVELOPMENT AND SUBSEQUENT UPDATE.—
For each recalcitrant cancer identified under subsection
(b)(1), the Director of the Institute shall—
(i) develop a scientific framework under this subsection not later than 18 months after the date of the
enactment of this section; and
(ii) review and update the scientific framework not
later than 5 years after its initial development.
(B) OTHER UPDATES.—The Director of the Institute
may review and update each scientific framework developed under this subsection as necessary.
(4) PUBLIC NOTICE.—With respect to each scientific framework developed under subsection (a), not later than 30 days
after the date of completion of the framework, the Director of
the Institute shall—
(A) submit such framework to the Committee on Energy and Commerce and Committee on Appropriations of
the House of Representatives, and the Committee on
Health, Education, Labor, and Pensions and Committee on
Appropriations of the Senate; and
(B) make such framework publically available on the
Internet website of the Department of Health and Human
Services.
(b) IDENTIFICATION OF RECALCITRANT CANCER.—
(1) IN GENERAL.—Not later than 6 months after the date
of the enactment of this section, the Director of the Institute
shall identify two or more recalcitrant cancers that each—
(A) have a 5-year relative survival rate of less than 20
percent; and
(B) are estimated to cause the death of at least 30,000
individuals in the United States per year.
(2) ADDITIONAL CANCERS.—The Director of the Institute
may, at any time, identify other recalcitrant cancers for purposes of this section. In identifying a recalcitrant cancer pursuMarch 13, 2013

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Sec. 418

ant to the previous sentence, the Director may consider additional metrics of progress (such as incidence and mortality
rates) against such type of cancer.
(c) WORKING GROUPS.—For each recalcitrant cancer identified
under subsection (b), the Director of the Institute shall convene a
working group comprised of representatives of appropriate Federal
agencies and other non-Federal entities to provide expertise on,
and assist in developing, a scientific framework under subsection
(a). The Director of the Institute (or the Director’s designee) shall
participate in the meetings of each such working group.
(d) REPORTING.—
(1) BIENNIAL REPORTS.—The Director of NIH shall ensure
that each biennial report under section 403 includes information on actions undertaken to carry out each scientific framework developed under subsection (a) with respect to a recalcitrant cancer, including the following:
(A) Information on research grants awarded by the
National Institutes of Health for research relating to such
cancer.
(B) An assessment of the progress made in improving
outcomes (including relative survival rates) for individuals
diagnosed with such cancer.
(C) An update on activities pertaining to such cancer
under the authority of section 413(b)(7).
(2) ADDITIONAL ONE-TIME REPORT FOR CERTAIN FRAMEWORKS.—For each recalcitrant cancer identified under subsection (b)(1), the Director of the Institute shall, not later than
6 years after the initial development of a scientific framework
under subsection (a), submit a report to the Congress on the
effectiveness of the framework (including the update required
by subsection (a)(3)(A)(ii)) in improving the prevention, detection, diagnosis, and treatment of such cancer.
(e) RECOMMENDATIONS FOR EXCEPTION FUNDING.—The Director
of the Institute shall consider each relevant scientific framework
developed under subsection (a) when making recommendations for
exception funding for grant applications.
(f) DEFINITION.—In this section, the term ‘‘recalcitrant cancer’’
means a cancer for which the five-year relative survival rate is
below 50 percent.
Subpart 2—National Heart, Lung, and Blood Institute
PURPOSE OF THE INSTITUTE

SEC. 418. ø285b¿ The general purpose of the National Heart,
Lung, and Blood Institute (hereafter in this subpart referred to as
the ‘‘Institute’’) is the conduct and support of research, training,
health information dissemination, and other programs with respect
to heart, blood vessel, lung, and blood diseases and with respect to
the use of blood and blood products and the management of blood
resources.
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564

HEART, BLOOD VESSEL, LUNG, AND BLOOD DISEASE PREVENTION AND
CONTROL PROGRAMS

SEC. 419. ø285b–1¿ (a) The Director of the Institute shall conduct and support programs for the prevention and control of heart,
blood vessel, lung, and blood diseases. Such programs shall include
community-based and population-based programs carried out in cooperation with other Federal agencies, with public health agencies
of State or local governments, with nonprofit private entities that
are community-based health agencies, or with other appropriate
public or nonprofit private entities.
(b) In carrying out programs under subsection (a), the Director
of the Institute shall give special consideration to the prevention
and control of heart, blood vessel, lung, and blood diseases in children, and in populations that are at increased risk with respect to
such diseases.
INFORMATION AND EDUCATION

SEC. 420. ø285b–2¿ The Director of the Institute shall collect,
identify, analyze, and disseminate on a timely basis, through publications and other appropriate means, to patients, families of patients, physicians and other health professionals, and the general
public, information on research, prevention, diagnosis, and treatment of heart, blood vessel, lung, and blood diseases, the maintenance of health to reduce the incidence of such diseases, and on the
use of blood and blood products and the management of blood resources. In carrying out this section, the Director of the Institute
shall place special emphasis upon the utilization of collaborative efforts with both the public and private sectors to—
(1) increase the awareness and knowledge of health care
professionals and the public regarding the prevention of heart
and blood vessel, lung, and blood diseases and the utilization
of blood resources; and
(2) develop and disseminate to health professionals, patients and patient families, and the public information designed to encourage adults and children to adopt healthful
practices concerning the prevention of such diseases.
NATIONAL HEART, BLOOD VESSEL, LUNG, AND BLOOD DISEASES AND
BLOOD RESOURCES PROGRAM

SEC. 421. ø285b–3¿ (a)(1) The National Heart, Blood Vessel,
Lung, and Blood Diseases and Blood Resources Program (hereafter
in this subpart referred to as the ‘‘Program’’ may provide for—
(A) investigation into the epidemiology, etiology, and prevention of all forms and aspects of heart, blood vessel, lung,
and blood diseases, including investigations into the social, environmental, behavioral, nutritional, biological, and genetic determinants and influences involved in the epidemiology, etiology, and prevention of such diseases;
(B) studies and research into the basic biological processes
and mechanisms involved in the underlying normal and abnormal heart, blood vessel, lung, and blood phenomena;
(C) research into the development, trial, and evaluation of
techniques, drugs, and devices (including computers) used in,
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and approaches to, the diagnosis, treatment (including the provision of emergency medical services), and prevention of heart,
blood vessel, lung, and blood diseases and the rehabilitation of
patients suffering from such diseases;
(D) establishment of programs that will focus and apply
scientific and technological efforts involving the biological,
physical, and engineering sciences to all facets of heart, blood
vessel, lung, and blood diseases with emphasis on the refinement, development, and evaluation of technological devices
that will assist, replace, or monitor vital organs and improve
instrumentation for detection, diagnosis, and treatment of and
rehabilitation from such diseases;
(E) establishment of programs for the conduct and direction of field studies, large-scale testing and evaluation, and
demonstration of preventive, diagnostic, therapeutic, and rehabilitative approaches to, and emergency medical services for,
such diseases;
(F) studies and research into blood diseases and blood, and
into the use of blood for clinical purposes and all aspects of the
management of blood resources in the United States, including
the collection, preservation, fractionation, and distribution of
blood and blood products;
(G) the education (including continuing education) and
training of scientists, clinical investigators, and educators, in
fields and specialties (including computer sciences) requisite to
the conduct of clinical programs respecting heart, blood vessel,
lung, and blood diseases and blood resources;
(H) public and professional education relating to all aspects of such diseases, including the prevention of such diseases, and the use of blood and blood products and the management of blood resources;
(I) establishment of programs for study and research into
heart, blood vessel, lung, and blood diseases of children (including cystic fibrosis, hyaline membrane, hemolytic diseases such
as sickle cell anemia and Cooley’s anemia, and hemophilic diseases) and for the development and demonstration of diagnostic, treatment, and preventive approaches to such diseases;
and
(J) establishment of programs for study, research, development, demonstrations and evaluation of emergency medical
services for people who become critically ill in connection with
heart, blood vessel, lung, or blood diseases.
(2) The Program shall be coordinated with other national research institutes to the extent that they have responsibilities respecting such diseases and shall give special emphasis to the continued development in the Institute of programs related to the
causes of stroke and to effective coordination of such programs with
related stroke programs in the National Institute of Neurological
and Communicative Disorders and Stroke. The Director of the Institute, with the advice of the advisory council for the Institute,
shall revise annually the plan for the Program and shall carry out
the Program in accordance with such plan.
(b) In carrying out the Program, the Director of the Institute,
under policies established by the Director of NIH—
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(1) may, after consultation with the advisory council for
the Institute, obtain (in accordance with section 3109 of title
5, United States Code, but without regard to the limitation in
such section on the period of such service) the services of not
more than one hundred experts or consultants who have scientific or professional qualifications;
(2)(A) may, in consultation with the advisory council for
the Institute, acquire and construct, improve, repair, operate,
alter, renovate, and maintain, heart, blood vessel, lung, and
blood disease and blood resource laboratories, research, training, and other facilities, equipment, and such other real or personal property as the Director determines necessary;
(B) may, in consultation with the advisory council for the
Institute, make grants for construction or renovation of facilities; and
(C) may, in consultation with the advisory council for the
Institute, acquire, without regard to the Act of March 3, 1877
(40 U.S.C. 34), by lease or otherwise, through the Administrator of General Services, buildings or parts of buildings in
the District of Columbia or communities located adjacent to the
District of Columbia for the use of the Institute for a period not
to exceed ten years;
(3) subject to section 405(b)(2) and without regard to section 3324 of title 31, United States Code, and section 3709 of
the Revised Statutes (41 U.S.C. 5), may enter into such contracts, leases, cooperative agreements, or other transactions, as
may be necessary in the conduct of the Director’s functions,
with any public agency, or with any person, firm, association,
corporation, or educational institutions;
(4) may make grants to public and nonprofit private entities to assist in meeting the cost of the care of patients in hospitals, clinics, and related facilities who are participating in research projects; and
(5) shall, in consultation with the advisory council for the
Institute, conduct appropriate intramural training and education programs, including continuing education and laboratory
and clinical research training programs.
Except as otherwise provided, experts and consultants whose services are obtained under paragraph (1) shall be paid or reimbursed,
in accordance with title 5, United States Code, for their travel to
and from their place of service and for other expenses associated
with their assignment. Such expenses shall not be allowed in connection with the assignment of an expert or consultant whose services are obtained under paragraph (1) unless the expert or consultant has agreed in writing to complete the entire period of the assignment or one year of the assignment, whichever is shorter, unless separated or reassigned for reasons which are beyond the control of the expert or consultant and which are acceptable to the Director of the Institute. If the expert or consultant violates the
agreement, the money spent by the United States for such expenses is recoverable from the expert or consultant as a debt due
the United States. The Secretary may waive in whole or in part a
right of recovery under the preceding sentence.
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Sec. 422

NATIONAL RESEARCH AND DEMONSTRATION CENTERS FOR HEART,
BLOOD VESSEL, LUNG, AND BLOOD DISEASES, SICKLE CELL ANEMIA,
AND BLOOD RESOURCES

SEC. 422. ø285b–4¿ (a)(1) The Director of the Institute may
provide, in accordance with subsection (c), for the development of—
(A) ten centers for basic and clinical research into, training
in, and demonstration of, advanced diagnostic, prevention, and
treatment and rehabilitation methods (including methods of
providing emergency medical services) for heart and blood vessel diseases;
(B) ten centers for basic and clinical research into, training
in, and demonstration of, advanced diagnostic, prevention, and
treatment and rehabilitation methods (including methods of
providing emergency medical services) for lung diseases (including bronchitis, emphysema, asthma, cystic fibrosis, and
other lung diseases of children);
(C) ten centers for basic and clinical research into, training
in, and demonstration of, advanced diagnostic, prevention, and
treatment methods (including methods of providing emergency
medical services) for blood diseases and research into blood, in
the use of blood products and in the management of blood resources; and
(D) three centers for basic and clinical research into, training in, and demonstration of, advanced diagnostic, prevention,
and treatment (including genetic studies, intrauterine environment studies, postnatal studies, heart arrhythmias, and acquired heart disease and preventive cardiology) for cardiovascular diseases in children.
(2) The centers developed under paragraph (1) shall, in addition to being utilized for research, training, and demonstrations, be
utilized for the following prevention programs for cardiovascular,
pulmonary, and blood diseases:
(A) Programs to develop improved methods of detecting individuals with a high risk of developing cardiovascular, pulmonary, and blood diseases.
(B) Programs to develop improved methods of intervention
against those factors which cause individuals to have a high
risk of developing such diseases.
(C) Programs to develop health professions and allied
health professions personnel highly skilled in the prevention of
such diseases.
(D) Programs to develop improved methods of providing
emergency medical services for persons with such diseases.
(E) Programs of continuing education for health and allied
health professionals in the diagnosis, prevention, and treatment of such diseases and the maintenance of health to reduce
the incidence of such diseases and information programs for
the public respecting the prevention and early diagnosis and
treatment of such diseases and the maintenance of health.
(3) The research, training, and demonstration activities carried
out through any such center may relate to any one or more of the
diseases referred to in paragraph (1) of this subsection.
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(b) The Director of the Institute shall provide, in accordance
with subsection (c), for the development of ten centers for basic and
clinical research into the diagnosis, treatment, and control of sickle
cell anemia.
(c)(1) The Director of the Institute may enter into cooperative
agreements with and make grants to public or private nonprofit entities to pay all or part of the cost of planning, establishing, or
strengthening, and providing basic operating support for centers for
basic and clinical research into, training in, and demonstration of
the management of blood resources and advanced diagnostic, prevention, and treatment methods for heart, blood vessel, lung, or
blood diseases.
(2) A cooperative agreement or grant under paragraph (1) shall
be entered into in accordance with policies established by the Director of NIH and after consultation with the Institute’s advisory
council.
(3) Federal payments made under a cooperative agreement or
grant under paragraph (1) may be used for—
(A) construction (notwithstanding any limitation under
section 496);
(B) staffing and other basic operating costs, including such
patient care costs as are required for research;
(C) training, including training for allied health professionals; and
(D) demonstration purposes.
As used in this subsection, the term ‘‘construction’’ does not include
the acquisition of land, and the term ‘‘training’’ does not include research training for which National Research Service Awards 1 may
be provided under section 487.
(4) Support of a center under paragraph (1) may be for a period
of not to exceed five years. Such period may be extended by the Director for additional periods of not more than five years each if the
operations of such center have been reviewed by an appropriate
technical and scientific peer review group established by the Director and if such group has recommended to the Director that such
period should be extended.
ASSOCIATE DIRECTOR FOR PREVENTION

SEC. 423. ø285b–6¿ (a) There shall be in the Institute an Associate Director for Prevention to coordinate and promote the programs in the Institute concerning the prevention of heart, blood
vessel, lung, and blood diseases. The Associate Director shall be appointed by the Director of the Institute from individuals who because of their professional training or experience are experts in
public health or preventive medicine.
(b) The Associate Director for Prevention shall prepare for inclusion in the biennial report made under section 407 a description
of the prevention activities of the Institute, including a description
of the staff and resources allocated to those activities.
1 Now

March 13, 2013

Ruth L. Kirschstein National Research Service Awards. See section 487.

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Sec. 424

NATIONAL CENTER ON SLEEP DISORDERS RESEARCH

SEC. 424. ø285b–7¿ (a) Not later than 1 year after the date of
the enactment of the National Institutes of Health Revitalization
Act of 1993, the Director of the Institute shall establish the National Center on Sleep Disorders Research (in this section referred
to as the ‘‘Center’’). The Center shall be headed by a director, who
shall be appointed by the Director of the Institute.
(b) The general purpose of the Center is—
(1) the conduct and support of research, training, health
information dissemination, and other activities with respect to
sleep disorders, including biological and circadian rhythm research, basic understanding of sleep, chronobiological and
other sleep related research; and
(2) to coordinate the activities of the Center with similar
activities of other Federal agencies, including the other agencies of the National Institutes of Health, and similar activities
of other public entities and nonprofit entities.
(c)(1) The Director of the National Institutes of Health shall establish a board to be known as the Sleep Disorders Research Advisory Board (in this section referred to as the ‘‘Advisory Board’’).
(2) The Advisory Board shall advise, assist, consult with, and
make recommendations to the Director of the National Institutes
of Health, through the Director of the Institute, and the Director
of the Center concerning matters relating to the scientific activities
carried out by and through the Center and the policies respecting
such activities, including recommendations with respect to the plan
required in subsection (c) 1.
(3)(A) The Director of the National Institutes of Health shall
appoint to the Advisory Board 12 appropriately qualified representatives of the public who are not officers or employees of the Federal
Government. Of such members, eight shall be representatives of
health and scientific disciplines with respect to sleep disorders and
four shall be individuals representing the interests of individuals
with or undergoing treatment for sleep disorders.
(B) The following officials shall serve as ex officio members of
the Advisory Board:
(i) The Director of the National Institutes of Health.
(ii) The Director of the Center.
(iii) The Director of the National Heart, Lung and Blood
Institute.
(iv) The Director of the National Institute of Mental
Health.
(v) The Director of the National Institute on Aging.
(vi) The Director of the Eunice Kennedy Shriver National
Institute of Child Health and Human Development.
(vii) The Director of the National Institute of Neurological
Disorders and Stroke.
(viii) The Assistant Secretary for Health.
(ix) The Assistant Secretary of Defense (Health Affairs).
(x) The Chief Medical Director of the Veterans’ Administration.
1 So in law. See section 503 of Public Law 103–43 (107 Stat. 159). Probably should be ‘‘subsection (d)’’.

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(4) The members of the Advisory Board shall, from among the
members of the Advisory Board, designate an individual to serve
as the chair of the Advisory Board.
(5) Except as inconsistent with, or inapplicable to, this section,
the provisions of section 406 shall apply to the advisory board 2 established under this section in the same manner as such provisions
apply to any advisory council established under such section.
(d)(1) After consultation with the Director of the Center and
the advisory board established under subsection (c), the Director of
the National Institutes of Health shall develop a comprehensive
plan for the conduct and support of sleep disorders research.
(2) The plan developed under paragraph (1) shall identify priorities with respect to such research and shall provide for the coordination of such research conducted or supported by the agencies
of the National Institutes of Health.
(3) The Director of the National Institutes of Health (after consultation with the Director of the Center and the advisory board established under subsection (c)) shall revise the plan developed
under paragraph (1) as appropriate.
(e) The Director of the Center, in cooperation with the Centers
for Disease Control and Prevention, is authorized to coordinate activities with the Department of Transportation, the Department of
Defense, the Department of Education, the Department of Labor,
and the Department of Commerce to collect data, conduct studies,
and disseminate public information concerning the impact of sleep
disorders and sleep deprivation.
HEART ATTACK, STROKE, AND OTHER CARDIOVASCULAR DISEASES IN
WOMEN

SEC. 424A. ø285b–7a¿ (a) IN GENERAL.—The Director of the
Institute shall expand, intensify, and coordinate research and related activities of the Institute with respect to heart attack, stroke,
and other cardiovascular diseases in women.
(b) COORDINATION WITH OTHER INSTITUTES.—The Director of
the Institute shall coordinate activities under subsection (a) with
similar activities conducted by the other national research institutes and agencies of the National Institutes of Health to the extent that such Institutes and agencies have responsibilities that
are related to heart attack, stroke, and other cardiovascular diseases in women.
(c) CERTAIN PROGRAMS.—In carrying out subsection (a), the Director of the Institute shall conduct or support research to expand
the understanding of the causes of, and to develop methods for preventing, cardiovascular diseases in women. Activities under such
subsection shall include conducting and supporting the following:
(1) Research to determine the reasons underlying the prevalence of heart attack, stroke, and other cardiovascular diseases in women, including African-American women and other
women who are members of racial or ethnic minority groups.
(2) Basic research concerning the etiology and causes of
cardiovascular diseases in women.
2 So in law. See section 503 of Public Law 103–43 (107 Stat. 159). Probably should be capitalized.

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Sec. 424C

(3) Epidemiological studies to address the frequency and
natural history of such diseases and the differences among
men and women, and among racial and ethnic groups, with respect to such diseases.
(4) The development of safe, efficient, and cost-effective diagnostic approaches to evaluating women with suspected
ischemic heart disease.
(5) Clinical research for the development and evaluation of
new treatments for women, including rehabilitation.
(6) Studies to gain a better understanding of methods of
preventing cardiovascular diseases in women, including applications of effective methods for the control of blood pressure,
lipids, and obesity.
(7) Information and education programs for patients and
health care providers on risk factors associated with heart attack, stroke, and other cardiovascular diseases in women, and
on the importance of the prevention or control of such risk factors and timely referral with appropriate diagnosis and treatment. Such programs shall include information and education
on health-related behaviors that can improve such important
risk factors as smoking, obesity, high blood cholesterol, and
lack of exercise.
COORDINATION OF FEDERAL ASTHMA ACTIVITIES

SEC. 424B 1 ø285b–7b¿ (a) IN GENERAL.—The Director of Institute shall, through the National Asthma Education Prevention Program Coordinating Committee—
(1) identify all Federal programs that carry out asthma-related activities; and
(2) develop, in consultation with appropriate Federal agencies and professional and voluntary health organizations, a
Federal plan for responding to asthma.
(b) REPRESENTATION OF THE DEPARTMENT OF HOUSING AND
URBAN DEVELOPMENT.—A representative of the Department of
Housing and Urban Development shall be included on the National
Asthma Education Prevention Program Coordinating Committee
for the purpose of performing the tasks described in subsection
(a). 1
SEC. 424C. ø285b–7c¿ TUBERCULOSIS.
(a) IN GENERAL.—The Director

of the National Institutes of
Health may expand, intensify, and coordinate research and development and related activities of the Institutes with respect to tuberculosis including activities toward the goal of eliminating such
disease.
(b) CERTAIN ACTIVITIES.—Activities under subsection (a) may
include—
(1) enhancing basic and clinical research on tuberculosis,
including drug resistant tuberculosis;
(2) expanding research on the relationship between such
disease and the human immunodeficiency virus; and
1 So in law. The section designation lacks a period. See section 521 of Public Law 106–310
(114 Stat. 1116).
1 Section 425 was repealed by section 103(b)(20) of Public Law 109–482 (120 Stat. 3688).

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(3) developing new tools for the elimination of tuberculosis,
including public health interventions and methods to enhance
detection and response to outbreaks of tuberculosis, including
multidrug resistant tuberculosis.
SEC. 425. ø285b–8¿ CONGENITAL HEART DISEASE.
(a) IN GENERAL.—The Director of the Institute

may expand, intensify, and coordinate research and related activities of the Institute with respect to congenital heart disease, which may include
congenital heart disease research with respect to—
(1) causation of congenital heart disease, including genetic
causes;
(2) long-term outcomes in individuals with congenital
heart disease, including infants, children, teenagers, adults,
and elderly individuals;
(3) diagnosis, treatment, and prevention;
(4) studies using longitudinal data and retrospective analysis to identify effective treatments and outcomes for individuals with congenital heart disease; and
(5) identifying barriers to life-long care for individuals with
congenital heart disease.
(b) COORDINATION OF RESEARCH ACTIVITIES.—The Director of
the Institute may coordinate research efforts related to congenital
heart disease among multiple research institutions and may develop research networks.
(c) MINORITY AND MEDICALLY UNDERSERVED COMMUNITIES.—
In carrying out the activities described in this section, the Director
of the Institute shall consider the application of such research and
other activities to minority and medically underserved communities.
Subpart 3—National Institute of Diabetes and Digestive and
Kidney Diseases
PURPOSE OF THE INSTITUTE

SEC. 426. ø285c¿ The general purpose of the National Institute
of Diabetes and Digestive and Kidney Diseases (hereafter in this
subpart referred to as the ‘‘Institute’’) is the conduct and support
of research, training, health information dissemination, and other
programs with respect to diabetes mellitus and endocrine and metabolic diseases, digestive diseases and nutritional disorders, and
kidney, urologic, and hematologic diseases.
DATA SYSTEMS AND INFORMATION CLEARINGHOUSES

SEC. 427. ø285c–1¿ (a) The Director of the Institute shall (1)
establish the National Diabetes Data System for the collection,
storage, analysis, retrieval, and dissemination of data derived from
patient populations with diabetes, including, where possible, data
involving general populations for the purpose of detection of individuals with a risk of developing diabetes, and (2) establish the National Diabetes Information Clearinghouse to facilitate and enhance knowledge and understanding of diabetes on the part of
health professionals, patients, and the public through the effective
dissemination of information.
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(b) The Director of the Institute shall (1) establish the National
Digestive Diseases Data System for the collection, storage, analysis, retrieval, and dissemination of data derived from patient populations with digestive diseases, including, where possible, data involving general populations for the purpose of detection of individuals with a risk of developing digestive diseases, and (2) establish
the National Digestive Diseases Information Clearinghouse to facilitate and enhance knowledge and understanding of digestive diseases on the part of health professionals, patients, and the public
through the effective dissemination of information.
(c) The Director of the Institute shall (1) establish the National
Kidney and Urologic Diseases Data System for the collection, storage, analysis, retrieval, and dissemination of data derived from patient populations with kidney and urologic diseases, including,
where possible, data involving general populations for the purpose
of detection of individuals with a risk of developing kidney and urologic diseases, and (2) establish the National Kidney and Urologic
Diseases Information Clearinghouse to facilitate and enhance
knowledge and understanding of kidney and urologic diseases on
the part of health professionals, patients, and the public through
the effective dissemination of information.
DIVISION DIRECTORS FOR DIABETES, ENDOCRINOLOGY, AND METABOLIC DISEASES, DIGESTIVE DISEASES AND NUTRITION, AND KIDNEY,
UROLOGIC, AND HEMATOLOGIC DISEASES

SEC. 428. ø285c–2¿ (a)(1) In the Institute there shall be a Division Director for Diabetes, Endocrinology, and Metabolic Diseases,
a Division Director for Digestive Diseases and Nutrition, and a Division Director for Kidney, Urologic, and Hematologic Diseases.
Such Division Directors, under the supervision of the Director of
the Institute, shall be responsible for—
(A) developing a coordinated plan (including recommendations for expenditures) for each of the national research institutes within the National Institutes of Health with respect to
research and training concerning diabetes, endocrine and metabolic diseases, digestive diseases and nutrition, and kidney,
urologic, and hematologic diseases;
(B) assessing the adequacy of management approaches for
the activities within such institutes concerning such diseases
and nutrition and developing improved approaches if needed;
(C) monitoring and reviewing expenditures by such institutes concerning such diseases and nutrition; and
(D) identifying research opportunities concerning such diseases and nutrition and recommending ways to utilize such opportunities.
(2) The Director of the Institute shall transmit to the Director
of NIH the plans, recommendations, and reviews of the Division
Directors under subparagraphs (A) through (D) of paragraph (1) together with such comments and recommendations as the Director
of the Institute determines appropriate.
(b) The Director of the Institute, acting through the Division
Director for Diabetes, Endocrinology, and Metabolic Diseases, the
Division Director for Digestive Diseases and Nutrition, and the DiMarch 13, 2013

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vision Director for Kidney, Urologic, and Hematologic Diseases,
shall—
(1) carry out programs of support for research and training
(other than training for which National Research Service
Awards 1 may be made under section 487) in the diagnosis,
prevention, and treatment of diabetes mellitus and endocrine
and metabolic diseases, digestive diseases and nutritional disorders, and kidney, urologic, and hematologic diseases, including support for training in medical schools, graduate clinical
training, graduate training in epidemiology, epidemiology studies, clinical trials, and interdisciplinary research programs; and
(2) establish programs of evaluation, planning, and dissemination of knowledge related to such research and training.
INTERAGENCY COORDINATING COMMITTEES

SEC. 429. ø285c–3¿ (a) For the purpose of—
(1) better coordination of the research activities of all the
national research institutes relating to diabetes mellitus, digestive diseases, and kidney, urologic, and hematologic diseases;
and
(2) coordinating those aspects of all Federal health programs and activities relating to such diseases to assure the
adequacy and technical soundness of such programs and activities and to provide for the full communication and exchange of
information necessary to maintain adequate coordination of
such programs and activities;
the Secretary shall establish a Diabetes Mellitus Interagency Coordinating Committee, a Digestive Diseases Interagency Coordinating Committee, and a Kidney, Urologic, and Hematologic Diseases Coordinating Committee (hereafter in this section individually referred to as a ‘‘Committee’’).
(b) Each Committee shall be composed of the Directors of each
of the national research institutes and divisions involved in research with respect to the diseases for which the Committee is established, the Division Director of the Institute for the diseases for
which the Committee is established, the Chief Medical Director of
the Veterans’ Administration, and the Assistant Secretary of Defense for Health Affairs (or the designees of such officers) and shall
include representation from all other Federal departments and
agencies whose programs involve health functions or responsibilities relevant to such diseases, as determined by the Secretary.
Each Committee shall be chaired by the Director of NIH (or the
designee of the Director). Each Committee shall meet at the call of
the chairman, but not less often than four times a year.
ADVISORY BOARDS

SEC. 430. ø285c–4¿ (a) The Secretary shall establish in the Institute the National Diabetes Advisory Board, the National Digestive Diseases Advisory Board, and the National Kidney and Urologic Diseases Advisory Board (hereafter in this section individually
referred to as an ‘‘Advisory Board’’).
1 Now

March 13, 2013

Ruth L. Kirschstein National Research Service Awards. See section 487.

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(b) Each Advisory Board shall be composed of eighteen appointed members and nonvoting ex officio members as follows:
(1) The Secretary shall appoint—
(A) twelve members from individuals who are scientists, physicians, and other health professionals, who are
not officers or employees of the United States, and who
represent the specialties and disciplines relevant to the
diseases with respect to which the Advisory Board is established; and
(B) six members from the general public who are
knowledgeable with respect to such diseases, including at
least one member who is a person who has such a disease
and one member who is a parent of a person who has such
a disease.
Of the appointed members at least five shall by virtue of training or experience be knowledgeable in the fields of health education, nursing, data systems, public information, and community program development.
(2)(A) The following shall be ex officio members of each Advisory Board:
(i) The Assistant Secretary for Health, the Director of
NIH, the Director of the National Institute of Diabetes and
Digestive and Kidney Diseases, the Director of the Centers
for Disease Control and Prevention, the Chief Medical Director of the Department of Veterans Affairs, the Assistant
Secretary of Defense for Health Affairs, and the Division
Director of the National Institute of Diabetes and Digestive and Kidney Diseases for the diseases for which the
Board is established (or the designees of such officers).
(ii) Such other officers and employees of the United
States as the Secretary determines necessary for the Advisory Board to carry out its functions.
(B) In the case of the National Diabetes Advisory Board,
the following shall also be ex officio members: The Director of
the National Heart, Lung, and Blood Institute, the Director of
the National Eye Institute, the Director of the Eunice Kennedy
Shriver National Institute of Child Health and Human Development, and the Administrator of the Health Resources and
Services Administration (or the designees of such officers).
(c) Members of an Advisory Board who are officers or employees of the Federal Government shall serve as members of the Advisory Board without compensation in addition to that received in
their regular public employment. Other members of the Board shall
receive compensation at rates not to exceed the daily equivalent of
the annual rate in effect for grade GS–18 of the General Schedule
for each day (including traveltime) they are engaged in the performance of their duties as members of the Board.
(d) The term of office of an appointed member of an Advisory
Board is four years, except that no term of office may extend beyond the expiration of the Advisory Board. Any member appointed
to fill a vacancy for an unexpired term shall be appointed for the
remainder of such term. A member may serve after the expiration
of the member’s term until a successor has taken office. If a vacancy occurs in an Advisory Board, the Secretary shall make an apMarch 13, 2013

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pointment to fill the vacancy not later than 90 days from the date
the vacancy occurred.
(e) The members of each Advisory Board shall select a chairman from among the appointed members.
(f) The Secretary shall, after consultation with and consideration of the recommendations of an Advisory Board, provide the
Advisory Board with an executive director and one other professional staff member. In addition, the Secretary shall, after consultation with and consideration of the recommendations of the Advisory Board, provide the Advisory Board with such additional professional staff members, such clerical staff members, such services
of consultants, such information, and (through contracts or other
arrangements) such administrative support services and facilities,
as the Secretary determines are necessary for the Advisory Board
to carry out its functions.
(g) Each Advisory Board shall meet at the call of the chairman
or upon request of the Director of the Institute, but not less often
than four times a year.
(h) The National Diabetes Advisory Board and the National Digestive Diseases Advisory Board shall—
(1) review and evaluate the implementation of the plan
(referred to in section 433) respecting the diseases with respect
to which the Advisory Board was established and periodically
update the plan to ensure its continuing relevance;
(2) for the purpose of assuring the most effective use and
organization of resources respecting such diseases, advise and
make recommendations to the Congress, the Secretary, the Director of NIH, the Director of the Institute, and the heads of
other appropriate Federal agencies for the implementation and
revision of such plan; and
(3) maintain liaison with other advisory bodies related to
Federal agencies involved in the implementation of such plan,
the coordinating committee for such diseases, and with key
non-Federal entities involved in activities affecting the control
of such diseases.
(i) In carrying out its functions, each Advisory Board may establish subcommittees, convene workshops and conferences, and
collect data. Such subcommittees may be composed of Advisory
Board members and nonmember consultants with expertise in the
particular area addressed by such subcommittees. The subcommittees may hold such meetings as are necessary to enable them to
carry out their activities.
(j) The National Diabetes Advisory Board and the National Digestive Diseases Advisory Board in existence on the date of enactment of the Health Research Extension Act of 1985 shall terminate
upon the appointment of a successor Board under subsection (a).
The Secretary shall make appointments to the Advisory Boards established under subsection (a) before the expiration of 90 days after
such date. The members of the Boards in existence on such date
may be appointed, in accordance with subsections (b) and (d), to
the Boards established under subsection (a) for diabetes and digestive diseases, except that at least one-half of the members of the
National Diabetes Advisory Board in existence on the date of enactment of the Health Research Extension Act of 1985 shall be apMarch 13, 2013

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pointed to the National Diabetes Advisory Board first established
under subsection (a).
RESEARCH AND TRAINING CENTERS

SEC. 431. ø285c–5¿ (a)(1) Consistent with applicable recommendations of the National Commission on Diabetes, the Director of the Institute shall provide for the development or substantial
expansion of centers for research and training in diabetes mellitus
and related endocrine and metabolic diseases. Each center developed or expanded under this subsection shall—
(A) utilize the facilities of a single institution, or be formed
from a consortium of cooperating institutions, meeting such research and training qualifications as may be prescribed by the
Secretary; and
(B) conduct—
(i) research in the diagnosis and treatment of diabetes
mellitus and related endocrine and metabolic diseases and
the complications resulting from such diseases;
(ii) training programs for physicians and allied health
personnel in current methods of diagnosis and treatment
of such diseases and complications, and in research in diabetes; and
(iii) information programs for physicians and allied
health personnel who provide primary care for patients
with such diseases or complications.
(2) A center may use funds provided under paragraph (1) to
provide stipends for nurses and allied health professionals enrolled
in research training programs described in paragraph (1)(B)(ii).
(b) Consistent with applicable recommendations of the National Digestive Diseases Advisory Board, the Director shall provide for the development or substantial expansion of centers for research in digestive diseases and related functional, congenital, metabolic disorders, and normal development of the digestive tract.
Each center developed or expanded under this subsection—
(1) shall utilize the facilities of a single institution, or be
formed from a consortium of cooperating institutions, meeting
such research qualifications as may be prescribed by the Secretary;
(2) shall develop and conduct basic and clinical research
into the cause, diagnosis, early detection, prevention, control,
and treatment of digestive diseases and nutritional disorders
and related functional, congenital, or metabolic complications
resulting from such diseases or disorders;
(3) shall encourage research into and programs for—
(A) providing information for patients with such diseases and the families of such patients, physicians and
others who care for such patients, and the general public;
(B) model programs for cost effective and preventive
patient care; and
(C) training physicians and scientists in research on
such diseases, disorders, and complications; and
(4) may perform research and participate in epidemiological studies and data collection relevant to digestive diseases
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and disorders and disseminate such research, studies, and data
to the health care profession and to the public.
(c) The Director shall provide for the development or substantial expansion of centers for research in kidney and urologic diseases. Each center developed or expanded under this subsection—
(1) shall utilize the facilities of a single institution, or be
formed from a consortium of cooperating institutions, meeting
such research qualifications as may be prescribed by the Secretary;
(2) shall develop and conduct basic and clinical research
into the cause, diagnosis, early detection, prevention, control,
and treatment of kidney and urologic diseases;
(3) shall encourage research into and programs for—
(A) providing information for patients with such diseases, disorders, and complications and the families of
such patients, physicians and others who care for such patients, and the general public;
(B) model programs for cost effective and preventive
patient care; and
(C) training physicians and scientists in research on
such diseases; and
(4) may perform research and participate in epidemiological studies and data collection relevant to kidney and urologic
diseases in order to disseminate such research, studies, and
data to the health care profession and to the public.
(d)(1) The Director of the Institute shall, subject to the extent
of amounts made available in appropriations Acts, provide for the
development or substantial expansion of centers for research and
training regarding nutritional disorders, including obesity.
(2) The Director of the Institute shall carry out paragraph (1)
in collaboration with the Director of the National Cancer Institute
and with the Directors of such other agencies of the National Institutes of Health as the Director of NIH determines to be appropriate.
(3) Each center developed or expanded under paragraph (1)
shall—
(A) utilize the facilities of a single institution, or be formed
from a consortium of cooperating institutions, meeting such research and training qualifications as may be prescribed by the
Director;
(B) conduct basic and clinical research into the cause, diagnosis, early detection, prevention, control and treatment of nutritional disorders, including obesity and the impact of nutrition and diet on child development;
(C) conduct training programs for physicians and allied
health professionals in current methods of diagnosis and treatment of such diseases and complications, and in research in
such disorders; and
(D) conduct information programs for physicians and allied
health professionals who provide primary care for patients
with such disorders or complications.
(e) Insofar as practicable, centers developed or expanded under
this section should be geographically dispersed throughout the
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Sec. 434

ties. Support of a center under this section may be for a period of
not to exceed five years and such period may be extended by the
Director of the Institute for additional periods of not more than five
years each if the operations of such center have been reviewed by
an appropriate technical and scientific peer review group established by the Director and if such group has recommended to the
Director that such period should be extended.
ADVISORY COUNCIL SUBCOMMITTEES

SEC. 432. ø285c–6¿ There are established within the advisory
council for the Institute appointed under section 406 a subcommittee on diabetes and endocrine and metabolic diseases, a
subcommittee on digestive diseases and nutrition, and a subcommittee on kidney, urologic, and hematologic diseases. The subcommittees shall be composed of members of the advisory council
who are outstanding in the diagnosis, prevention, and treatment of
the diseases for which the subcommittees are established and
members of the advisory council who are leaders in the fields of
education and public affairs. The subcommittees are authorized to
review applications made to the Director of the Institute for grants
for research and training projects relating to the diagnosis, prevention, and treatment of the diseases for which the subcommittees
are established and shall recommend to the advisory council those
applications and contracts that the subcommittees determine will
best carry out the purposes of the Institute. The subcommittees
shall also review and evaluate the diabetes and endocrine and metabolic diseases, digestive diseases and nutrition, and kidney, urologic, and hematologic diseases programs of the Institute and recommend to the advisory council such changes in the administration
of such programs as the subcommittees determine are necessary.
BIENNIAL REPORT

SEC. 433. ø285c–7¿ The Director of the Institute shall prepare
for inclusion in the biennial report made under section 407 a description of the Institute’s activities—
(1) under the current diabetes plan under the National Diabetes Mellitus Research and Education Act; and
(2) under the current digestive diseases plan formulated
under the Arthritis, Diabetes, and Digestive Diseases Amendments of 1976.
The description submitted by the Director shall include an evaluation of the activities of the centers supported under section 431.
NUTRITIONAL DISORDERS PROGRAM

SEC. 434. ø285c–8¿ (a) The Director of the Institute, in consultation with the Director of NIH, shall establish a program of
conducting and supporting research, training, health information
dissemination, and other activities with respect to nutritional disorders, including obesity.
(b) In carrying out the program established under subsection
(a), the Director of the Institute shall conduct and support each of
the activities described in such subsection.
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(c) In carrying out the program established under subsection
(a), the Director of the Institute shall carry out activities to facilitate and enhance knowledge and understanding of nutritional disorders, including obesity, on the part of health professionals, patients, and the public through the effective dissemination of information.
JUVENILE DIABETES

SEC. 434A. ø285c–9¿ (a) LONG-TERM EPIDEMIOLOGY STUDIES.—
The Director of the Institute shall conduct or support long-term epidemiology studies in which individuals with or at risk for type 1,
or juvenile, diabetes are followed for 10 years or more. Such studies
shall investigate the causes and characteristics of the disease and
its complications.
(b) CLINICAL TRIAL INFRASTRUCTURE/INNOVATIVE TREATMENTS
FOR JUVENILE DIABETES.—The Secretary, acting through the Director of the National Institutes of Health, shall support regional clinical research centers for the prevention, detection, treatment, and
cure of juvenile diabetes.
(c) PREVENTION OF TYPE 1 DIABETES.—The Secretary, acting
through the appropriate agencies, shall provide for a national effort
to prevent type 1 diabetes. Such effort shall provide for a combination of increased efforts in research and development of prevention
strategies, including consideration of vaccine development, coupled
with appropriate ability to test the effectiveness of such strategies
in large clinical trials of children and young adults.
Subpart 4—National Institute of Arthritis and Musculoskeletal and
Skin Diseases
PURPOSE OF THE INSTITUTE

SEC. 435. ø285d¿ The general purpose of the National Institute
of Arthritis and Musculoskeletal and Skin Diseases (hereafter in
this subpart referred to as the ‘‘Institute’’) is the conduct and support of research and training, the dissemination of health information, and other programs with respect to arthritis and musculoskeletal and skin diseases (including sports-related disorders), with
particular attention to the effect of these diseases on children.
NATIONAL ARTHRITIS AND MUSCULOSKELETAL AND SKIN DISEASES
PROGRAM

SEC. 436. ø285d–1¿ (a) The Director of the Institute, with the
advice of the Institute’s advisory council, shall prepare and transmit to the Director of NIH a plan for a national arthritis and musculoskeletal and skin diseases program to expand, intensify, and
coordinate the activities of the Institute respecting arthritis and
musculoskeletal and skin diseases. The plan shall include such
comments and recommendations as the Director of the Institute determines appropriate. The plan shall place particular emphasis
upon expanding research into better understanding the causes and
the development of effective treatments for arthritis affecting children. The Director of the Institute shall periodically review and reMarch 13, 2013

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vise such plan and shall transmit any revisions of such plan to the
Director of NIH.
(b) Activities under the national arthritis and musculoskeletal
and skin diseases program shall be coordinated with the other national research institutes to the extent that such institutes have responsibilities respecting arthritis and musculoskeletal and skin diseases, and shall, at least, provide for—
(1) investigation into the epidemiology, etiology, and prevention of all forms of arthritis and musculoskeletal and skin
diseases, including sports-related disorders, primarily through
the support of basic research in such areas as immunology, genetics, biochemistry, microbiology, physiology, bioengineering,
and any other scientific discipline which can contribute important knowledge to the treatment and understanding of arthritis and musculoskeletal and skin diseases;
(2) research into the development, trial, and evaluation of
techniques, drugs, and devices used in the diagnosis, treatment, including medical rehabilitation, and prevention of arthritis and musculoskeletal and skin diseases;
(3) research on the refinement, development, and evaluation of technological devices that will replace or be a substitute
for damaged bone, muscle, and joints and other supporting
structures;
(4) the establishment of mechanisms to monitor the causes
of athletic injuries and identify ways of preventing such injuries on scholastic athletic fields; and
(5) research into the causes of arthritis affecting children
and the development, trial, and evaluation of techniques, drugs
and devices used in the diagnosis, treatment (including medical rehabilitation), and prevention of arthritis in children.
(c) The Director of the Institute shall carry out the national arthritis and musculoskeletal and skin diseases program in accordance with the plan prepared under subsection (a) and any revisions
of such plan made under such subsection.
RESEARCH AND TRAINING

SEC. 437. ø285d–2¿ The Director of the Institute shall—
(1) carry out programs of support for research and training
(other than training for which National Research Service
Awards 1 may be made under section 487) in the diagnosis,
prevention, and treatment of arthritis and musculoskeletal and
skin diseases, including support for training in medical schools,
graduate clinical training, graduate training in epidemiology,
epidemiology studies, clinical trials, and interdisciplinary research programs; and
(2) establish programs of evaluation, planning, and dissemination of knowledge related to such research and training.
DATA SYSTEM AND INFORMATION CLEARINGHOUSE

SEC. 438. ø285d–3¿ (a) The Director of the Institute shall establish the National Arthritis and Musculoskeletal and Skin Diseases Data System for the collection, storage, analysis, retrieval,
1 Now

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and dissemination of data derived from patient populations with
arthritis and musculoskeletal and skin diseases, including where
possible, data involving general populations for the purpose of detection of individuals with a risk of developing arthritis and musculoskeletal and skin diseases.
(b) The Director of the Institute shall establish the National
Arthritis and Musculoskeletal and Skin Diseases Information
Clearinghouse to facilitate and enhance, through the effective dissemination of information, knowledge and understanding of arthritis and musculoskeletal and skin diseases, including juvenile arthritis and related conditions, by health professionals, patients, and
the public.
INTERAGENCY COORDINATING COMMITTEES

SEC. 439. ø285d–4¿ (a) For the purpose of—
(1) better coordination of the research activities of all the
national research institutes relating to arthritis, musculoskeletal diseases, and skin diseases, including sports-related
disorders; and
(2) coordinating the aspects of all Federal health programs
and activities relating to arthritis, musculoskeletal diseases,
and skin diseases in order to assure the adequacy and technical soundness of such programs and activities and in order
to provide for the full communication and exchange of information necessary to maintain adequate coordination of such programs and activities,
the Secretary shall establish an Arthritis and Musculoskeletal Diseases Interagency Coordinating Committee and a Skin Diseases
Interagency Coordinating Committee (hereafter in this section individually referred to as a ‘‘Committee’’).
(b) Each Committee shall be composed of the Directors of each
of the national research institutes and divisions involved in research regarding the diseases with respect to which the Committee
is established, the Chief Medical Director of the Department of Veterans Affairs, and the Assistant Secretary of Defense for Health Affairs (or the designees of such officers), and representatives of all
other Federal departments and agencies (as determined by the Secretary) whose programs involve health functions or responsibilities
relevant to arthritis and musculoskeletal diseases or skin diseases,
as the case may be. Each Committee shall be chaired by the Director of NIH (or the designee of the Director). Each Committee shall
meet at the call of the chairman, but not less often than four times
a year.
ARTHRITIS AND MUSCULOSKELETAL DISEASES DEMONSTRATION
PROJECTS

SEC. 440. ø285d–5¿ (a) The Director of the Institute may make
grants to public and private nonprofit entities to establish and support projects for the development and demonstration of methods for
screening, detection, and referral for treatment of arthritis and
musculoskeletal diseases and for the dissemination of information
on such methods to the health and allied health professions. Activities under such projects shall be coordinated with Federal, State,
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Sec. 441

local, and regional health agencies, centers assisted under section
441, and the data system established under subsection (c).
(b) Projects supported under this section shall include—
(1) programs which emphasize the development and demonstration of new and improved methods of screening and
early detection, referral for treatment, and diagnosis of individuals with a risk of developing arthritis and musculoskeletal
diseases;
(2) programs which emphasize the development and demonstration of new and improved methods for patient referral
from local hospitals and physicians to appropriate centers for
early diagnosis and treatment;
(3) programs which emphasize the development and demonstration of new and improved means of standardizing patient data and recordkeeping;
(4) programs which emphasize the development and demonstration of new and improved methods of dissemination of
knowledge about the programs, methods, and means referred
to in paragraphs (1), (2), and (3) of this subsection to health
and allied health professionals;
(5) programs which emphasize the development and demonstration of new and improved methods for the dissemination
to the general public of information—
(A) on the importance of early detection of arthritis
and musculoskeletal diseases, of seeking prompt treatment, and of following an appropriate regimen; and
(B) to discourage the promotion and use of unapproved
and ineffective diagnostic, preventive treatment, and control methods for arthritis and unapproved and ineffective
drugs and devices for arthritis and musculoskeletal diseases; and
(6) projects for investigation into the epidemiology of all
forms and aspects of arthritis and musculoskeletal diseases, including investigations into the social, environmental, behavioral, nutritional, and genetic determinants and influences involved in the epidemiology of arthritis and musculoskeletal diseases.
(c) The Director shall provide for the standardization of patient
data and recordkeeping for the collection, storage, analysis, retrieval, and dissemination of such data in cooperation with projects
assisted under this section, centers assisted under section 441, and
other persons engaged in arthritis and musculoskeletal disease programs.
MULTIPURPOSE ARTHRITIS AND MUSCULOSKELETAL DISEASES
CENTERS

SEC. 441. ø285d–6¿ (a) The Director of the Institute shall, after
consultation with the advisory council for the Institute, provide for
the development, modernization, and operation (including staffing
and other operating costs such as the costs of patient care required
for research) of new and existing centers for arthritis and musculoskeletal diseases. For purposes of this section, the term ‘‘modernization’’ means the alteration, remodeling, improvement, expansion, and repair of existing buildings and the provision of equipMarch 13, 2013

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ment for such buildings to the extent necessary to make them suitable for use as centers described in the preceding sentence.
(b) Each center assisted under this section shall—
(1)(A) use the facilities of a single institution or a consortium of cooperating institutions, and (B) meet such qualifications as may be prescribed by the Secretary; and
(2) conduct—
(A) basic and clinical research into the cause, diagnosis, early detection, prevention, control, and treatment of
and rehabilitation from arthritis and musculoskeletal diseases and complications resulting from arthritis and musculoskeletal diseases, including research into implantable
biomaterials and biomechanical and other orthopedic procedures;
(B) training programs for physicians, scientists, and
other health and allied health professionals;
(C) information and continuing education programs for
physicians and other health and allied health professionals
who provide care for patients with arthritis and musculoskeletal diseases; and
(D) programs for the dissemination to the general public of information—
(i) on the importance of early detection of arthritis
and musculoskeletal diseases, of seeking prompt treatment, and of following an appropriate regimen; and
(ii) to discourage the promotion and use of unapproved and ineffective diagnostic, preventive, treatment, and control methods and unapproved and ineffective drugs and devices.
A center may use funds provided under subsection (a) to provide
stipends for health professionals enrolled in training programs described in paragraph (2)(B).
(c) Each center assisted under this section may conduct programs to—
(1) establish the effectiveness of new and improved methods of detection, referral, and diagnosis of individuals with a
risk of developing arthritis and musculoskeletal diseases;
(2) disseminate the results of research, screening, and
other activities, and develop means of standardizing patient
data and recordkeeping; and
(3) develop community consultative services to facilitate
the referral of patients to centers for treatment.
(d) The Director of the Institute shall, insofar as practicable,
provide for an equitable geographical distribution of centers assisted under this section. The Director shall give appropriate consideration to the need for centers especially suited to meeting the
needs of children affected by arthritis and musculoskeletal diseases.
(e) Support of a center under this section may be for a period
of not to exceed five years. Such period may be extended by the Director of the Institute for one or more additional periods of not
more than five years if the operations of such center have been reviewed by an appropriate technical and scientific peer review group
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PUBLIC HEALTH SERVICE ACT

Sec. 442

established by the Director and if such group has recommended to
the Director that such period should be extended.
(f) Not later than October 1, 1993, the Director shall establish
a multipurpose arthritis and musculoskeletal disease center for the
purpose of expanding the level of research into the cause, diagnosis, early detection, prevention, control, and treatment of, and rehabilitation of children with arthritis and musculoskeletal diseases.
LUPUS

SEC. 441A. ø285d–6a¿ (a) IN GENERAL.—The Director of the
Institute shall expand and intensify research and related activities
of the Institute with respect to lupus.
(b) COORDINATION WITH OTHER INSTITUTES.—The Director of
the Institute shall coordinate the activities of the Director under
subsection (a) with similar activities conducted by the other national research institutes and agencies of the National Institutes of
Health to the extent that such Institutes and agencies have responsibilities that are related to lupus.
(c) PROGRAMS FOR LUPUS.—In carrying out subsection (a), the
Director of the Institute shall conduct or support research to expand the understanding of the causes of, and to find a cure for,
lupus. Activities under such subsection shall include conducting
and supporting the following:
(1) Research to determine the reasons underlying the elevated prevalence of lupus in women, including African-American women.
(2) Basic research concerning the etiology and causes of
the disease.
(3) Epidemiological studies to address the frequency and
natural history of the disease and the differences among the
sexes and among racial and ethnic groups with respect to the
disease.
(4) The development of improved diagnostic techniques.
(5) Clinical research for the development and evaluation of
new treatments, including new biological agents.
(6) Information and education programs for health care
professionals and the public.
ADVISORY BOARD

SEC. 442. ø285d–7¿ (a) The Secretary shall establish in the Institute the National Arthritis and Musculoskeletal and Skin Diseases Advisory Board (hereafter in this section referred to as the
‘‘Advisory Board’’).
(b) The Advisory Board shall be composed of twenty appointed
members and nonvoting, ex officio members, as follows:
(1) The Secretary shall appoint—
(A) twelve members from individuals who are scientists, physicians, and other health professionals, who are
not officers or employees of the United States, and who
represent the specialties and disciplines relevant to arthritis, musculoskeletal diseases, and skin diseases; and
(B) eight members from the general public who are
knowledgeable with respect to such diseases, including one
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586

member who is a person who has such a disease, one person who is the parent of an adult with such a disease, and
two members who are parents of children with arthritis.
Of the appointed members at least five shall by virtue of training or experience be knowledgeable in health education, nursing, data systems, public information, or community program
development.
(2) The following shall be ex officio members of the Advisory Board:
(A) the Assistant Secretary for Health, the Director of
NIH, the Director of the National Institute of Arthritis and
Musculoskeletal and Skin Diseases, the Director of the
Centers for Disease Control and Prevention, the Chief
Medical Director of the Department of Veterans Affairs,
and the Assistant Secretary of Defense for Health Affairs
(or the designees of such officers), and
(B) such other officers and employees of the United
States as the Secretary determines necessary for the Advisory Board to carry out its functions.
(c) Members of the Advisory Board who are officers or employees of the Federal Government shall serve as members of the Advisory Board without compensation in addition to that received in
their regular public employment. Other members of the Advisory
Board shall receive compensation at rates not to exceed the daily
equivalent of the annual rate in effect for grade GS–18 of the General Schedule for each day (including traveltime) they are engaged
in the performance of their duties as members of the Advisory
Board.
(d) The term of office of an appointed member of the Advisory
Board is four years. Any member appointed to fill a vacancy for an
unexpired term shall be appointed for the remainder of such term.
A member may serve after the expiration of the member’s term
until a successor has taken office. If a vacancy occurs in the Advisory Board, the Secretary shall make an appointment to fill the vacancy not later than 90 days after the date the vacancy occurred.
(e) The members of the Advisory Board shall select a chairman
from among the appointed members.
(f) The Secretary shall, after consultation with and consideration of the recommendations of the Advisory Board, provide the
Advisory Board with an executive director and one other professional staff member. In addition, the Secretary shall, after consultation with and consideration of the recommendations of the Advisory Board, provide the Advisory Board with such additional professional staff members, such clerical staff members, and (through
contracts or other arrangements) with such administrative support
services and facilities, such information, and such services of consultants, as the Secretary determines are necessary for the Advisory Board to carry out its functions.
(g) The Advisory Board shall meet at the call of the chairman
or upon request of the Director of the Institute, but not less often
than four times a year.
(h) The Advisory Board shall—
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PUBLIC HEALTH SERVICE ACT

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(1) review and evaluate the implementation of the plan
prepared under section 436(a) and periodically update the plan
to ensure its continuing relevance;
(2) for the purpose of assuring the most effective use and
organization of resources respecting arthritis, musculoskeletal
diseases and skin diseases, advise and make recommendations
to the Congress, the Secretary, the Director of NIH, the Director of the Institute, and the heads of other appropriate Federal
agencies for the implementation and revision of such plan; and
(3) maintain liaison with other advisory bodies for Federal
agencies involved in the implementation of such plan, the
interagency coordinating committees for such diseases established under section 439, and with key non-Federal entities involved in activities affecting the control of such diseases.
(i) In carrying out its functions, the Advisory Board may establish subcommittees, convene workshops and conferences, and collect data. Such subcommittees may be composed of Advisory Board
members and nonmember consultants with expertise in the particular area addressed by such subcommittees. The subcommittees
may hold such meetings as are necessary to enable them to carry
out their activities.
(j) The National Arthritis Advisory Board in existence on the
date of enactment of the Health Research Extension Act of 1985
shall terminate upon the appointment of a successor Board under
subsection (a). The Secretary shall make appointments to the Advisory Board established under subsection (a) before the expiration
of 90 days after such date. The members of the Board in existence
on such date may be appointed, in accordance with subsections (b)
and (d), to the Advisory Board established under subsection (a).
JUVENILE ARTHRITIS AND RELATED CONDITIONS

SEC. 442A. ø285d–8¿ (a) EXPANSION AND
TIVITIES.—The Director of the Institute, in

COORDINATION OF ACcoordination with the
Director of the National Institute of Allergy and Infectious Diseases, shall expand and intensify the programs of such Institutes
with respect to research and related activities concerning juvenile
arthritis and related conditions.
(b) COORDINATION.—The Directors referred to in subsection (a)
shall jointly coordinate the programs referred to in such subsection
and consult with the Arthritis and Musculoskeletal Diseases Interagency Coordinating Committee.
Subpart 5—National Institute on Aging
PURPOSE OF THE INSTITUTE

SEC. 443. ø285e¿ The general purpose of the National Institute
on Aging (hereafter in this subpart referred to as the ‘‘Institute’’)
is the conduct and support of biomedical, social, and behavioral research, training, health information dissemination, and other programs with respect to the aging process and the diseases and other
special problems and needs of the aged.
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SPECIAL FUNCTIONS

SEC. 444. ø285e–1¿ (a) In carrying out the training responsibilities under this Act or any other Act for health and allied health
professions personnel, the Secretary shall take appropriate steps to
insure the education and training of adequate numbers of allied
health, nursing, and paramedical personnel in the field of health
care for the aged.
(b) The Director of the Institute shall conduct scientific studies
to measure the impact on the biological, medical, social, and psychological aspects of aging of programs and activities assisted or
conducted by the Department of Health and Human Services.
(c) The Director of the Institute shall carry out public information and education programs designed to disseminate as widely as
possible the findings of research sponsored by the Institute, other
relevant aging research and studies, and other information about
the process of aging which may assist elderly and near-elderly persons in dealing with, and all Americans in understanding, the
problems and processes associated with growing older.
(d) The Director of the Institute shall make grants to public
and private nonprofit institutions to conduct research relating to
Alzheimer’s Disease.
ALZHEIMER’S DISEASE CENTERS

SEC. 445. ø285e–2¿ (a)(1) The Director of the Institute may
enter into cooperative agreements with and make grants to public
or private nonprofit entities (including university medical centers)
to pay all or part of the cost of planning, establishing, or strengthening, and providing basic operating support (including staffing) for
centers for basic and clinical research (including multidisciplinary
research) into, training in, and demonstration of advanced diagnostic, prevention, and treatment methods for Alzheimer’s disease.
(2) A cooperative agreement or grant under paragraph (1) shall
be entered into in accordance with policies established by the Director of NIH and after consultation with the Institute’s advisory
council.
(b)(1) Federal payments made under a cooperative agreement
or grant under subsection (a) may, with respect to Alzheimer’s disease, be used for—
(A) diagnostic examinations, patient assessments, patient
care costs, and other costs necessary for conducting research;
(B) training, including training for allied health professionals;
(C) diagnostic and treatment clinics designed to meet the
special needs of minority and rural populations and other underserved populations;
(D) activities to educate the public; and
(E) the dissemination of information.
(2) For purposes of paragraph (1), the term ‘‘training’’ does not
include research training for which National Research Service
Awards 1 may be provided under section 487.
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(c) Support of a center under subsection (a) may be for a period
of not to exceed five years. Such period may be extended by the Director for additional periods of not more than five years each if the
operations of such center have been reviewed by an appropriate
technical and scientific peer review group established by the Director and if such group has recommended to the Director that such
period should be extended.
CLAUDE D. PEPPER OLDER AMERICANS INDEPENDENCE CENTERS

SEC. 445A. ø285e–3¿ (a) The Director of the Institute shall
enter into cooperative agreements with, and make grants to, public
and private nonprofit entities for the development or expansion of
not less than 10 centers of excellence in geriatric research and
training of researchers. Each such center shall be known as a
Claude D. Pepper Older Americans Independence Center.
(b) Each center developed or expanded under this section
shall—
(1) utilize the facilities of a single institution, or be formed
from a consortium of cooperating institutions, meeting such research and training qualifications as may be prescribed by the
Director; and
(2) conduct—
(A) research into the aging processes and into the diagnosis and treatment of diseases, disorders, and complications related to aging, including menopause, which research includes research on such treatments, and on medical devices and other medical interventions regarding
such diseases, disorders, and complications, that can assist
individuals in avoiding institutionalization and prolonged
hospitalization and in otherwise increasing the independence of the individuals; and
(B) programs to develop individuals capable of conducting research described in subparagraph (A).
(c) In making cooperative agreements and grants under this
section for the development or expansion of centers, the Director of
the Institute shall ensure that, to the extent practicable, any such
centers are distributed equitably among the principal geographic
regions of the United States.
(d) For purposes of this section, the term ‘‘independence’’, with
respect to diseases, disorders, and complications of aging, means
the functional ability of individuals to perform activities of daily
living or instrumental activities of daily living without assistance
or supervision.
AWARDS AUTHORIZED

445B. 1

SEC.
ø285e–4¿ (a) The Director of the Institute shall
make awards to senior researchers who have made distinguished
achievements in biomedical research in areas relating to Alzheimer’s disease and related dementias. Awards under this section
1 Sections 445B through 445F were originally enacted as provisions of title IX of Public Law
99–660, and were transferred to the Public Health Service Act by section 142 of Public Law
100–607. (Various provisions relating to Alzheimer’s disease remain in such title IX, which is
included in this compilation.)

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590

shall be used by the recipients to support research in areas relating
to such disease and dementias, and may be used by the recipients
to train junior researchers who demonstrate exceptional promise to
conduct research in such areas.
(b) The Director of the Institute may make awards under this
section to researchers at centers supported under section 445 and
to researchers at other public and nonprofit private entities.
(c) The Director of the Institute shall make awards under this
section only to researchers who have been recommended for such
awards by the National Advisory Council on Aging.
(d) The Director of the Institute shall establish procedures for
the selection of the recipients of awards under this section.
(e) Awards under this section shall be made for a one-year period, and may be renewed for not more than six additional consecutive one-year periods.
RESEARCH PROGRAM AND PLAN

SEC. 445C. ø285e–5¿ (a) The Director of the Institute shall conduct, or make grants for the conduct of, research relevant to appropriate services for individuals with Alzheimer’s disease and related
dementias and their families.
(b)(1) Within 6 months after the date of enactment of the Alzheimer’s Disease and Related Dementias Services Research Act of
1986, the Director of the Institute shall prepare and transmit to
the Chairman of the Council on Alzheimer’s Disease (in this section
referred to as the ‘‘Council’’) a plan for the research to be conducted
under subsection (a). The plan shall—
(A) provide for research concerning—
(i) the epidemiology of, and the identification of risk
factors for, Alzheimer’s disease and related dementias; and
(ii) the development and evaluation of reliable and
valid multidimensional diagnostic and assessment procedures and instruments; and
(B) ensure that research carried out under the plan is coordinated with, and uses, to the maximum extent feasible, resources of, other Federal programs relating to Alzheimer’s disease and related dementias, including centers supported under
section 445, centers supported by the National Institute of
Mental Health on the psychopathology of the elderly, relevant
activities of the Administration on Aging, other programs and
centers involved in research on Alzheimer’s disease and related
dementias supported by the Department, and other programs
relating to Alzheimer’s disease and related dementias which
are planned or conducted by Federal agencies other than the
Department, State or local agencies, community organizations,
or private foundations.
(2) Within one year after transmitting the plan required under
paragraph (1), and annually thereafter, the Director of the Institute shall prepare and transmit to the Chairman of the Council
such revisions of such plan as the Director considers appropriate.
(c) In preparing and revising the plan required by subsection
(b), the Director of the Institute shall consult with the Chairman
of the Council and the heads of agencies within the Department.
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PUBLIC HEALTH SERVICE ACT

Sec. 445E

(d) the 1 Director of the Institute may develop, or make grants
to develop—
(1) model techniques to—
(A) promote greater independence, including enhanced
independence in performing activities of daily living and
instrumental activities of daily living, for persons with Alzheimer’s disease and related disorders; and
(B) prevent or reduce the severity of secondary disabilities, including confusional episodes, falls, bladder and
bowel incontinence, and adverse effects of prescription and
over-the-counter medications, in such persons; and
(2) model curricula for health care professionals, health
care paraprofessionals, and family caregivers, for training and
application in the use of such techniques.
(e) For purposes of this section, the term ‘‘Council on Alzheimer’s Disease’’ means the council established in section 911(a) 2
of Public Law 99–660.
DISSEMINATION

SEC. 445D. ø285e–6¿ The Director of the Institute shall disseminate the results of research conducted under section 445C and
this section to appropriate professional entities and to the public.
CLEARINGHOUSE ON ALZHEIMER’S DISEASE

SEC. 445E. ø285e–7¿ (a) The Director of the Institute shall establish the Clearinghouse on Alzheimer’s Disease (hereinafter referred to as the ‘‘Clearinghouse’’). The purpose of the Clearinghouse
is the dissemination of information concerning services available
for individuals with Alzheimer’s disease and related dementias and
their families. The Clearinghouse shall—
(1) compile, archive, and disseminate information concerning research, demonstration, evaluation, and training programs and projects concerning Alzheimer’s disease and related
dementias; and
(2) annually publish a summary of the information compiled under paragraph (1) during the preceding 12-month period, and make such information available upon request to appropriate individuals and entities, including educational institutions, research entities, and Federal and public agencies.
(b) The Clearinghouse may charge an appropriate fee for information provided through the toll-free telephone line established
under subsection (a)(3). 1
(c) The Director of the Institute, the Director of the National
Institute of Mental Health, and the Director of the National Center
for Health Services Research and Health Care Technology Assessment shall provide to the Clearinghouse summaries of the findings
of research conducted under part D.
1 So

in law. See section 9 of Public Law 102–507 (106 Stat. 3287). Probably should be ‘‘The’’.
911 was repealed by section 601(a)(2)(E) of Public Law 105–362 (112 Stat. 3286).
1 So in law. Section 445E does not contain a subsection (a)(3). Section 445F(b)(2) provides for
a toll-free telephone line.
2 Section

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Sec. 445F

PUBLIC HEALTH SERVICE ACT

592

DISSEMINATION PROJECT

SEC. 445F. ø285e–8¿ (a) The Director of the Institute shall
make a grant to, or enter into a contract with, a national organization representing individuals with Alzheimer’s disease and related
dementias for the conduct of the activities described in subsection
(b).
(b) The organization receiving a grant or contract under this
section shall—
(1) establish a central computerized information system
to—
(A) compile and disseminate information concerning
initiatives by State and local governments and private entities to provide programs and services for individuals with
Alzheimer’s disease and related dementias; and
(B) translate scientific and technical information concerning such initiatives into information readily understandable by the general public, and make such information available upon request; and
(2) establish a national toll-free telephone line to make
available the information described in paragraph (1), and information concerning Federal programs, services and benefits for
individuals with Alzheimer’s disease and related dementias
and their families.
(c) The organization receiving a grant or contract under this
section may charge appropriate fees for information provided
through the toll-free telephone line established under subsection
(b)(2), and may make exceptions to such fees for individuals and organizations who are not financially able to pay such fees.
(d) In order to receive a grant or contract under this section,
an organization shall submit an application to the Director of the
Institute. Such application shall contain—
(1) information demonstrating that such organization has
a network of contacts which will enable such organization to
receive information necessary to the operation of the central
computerized information system described in subsection (b)(1);
(2) information demonstrating that, by the end of fiscal
year 1991, such organization will be financially able to, and
will, carry out the activities described in subsection (b) without
a grant or contract from the Federal Government; and
(3) such other information as the Director may prescribe.
ALZHEIMER’S DISEASE REGISTRY

SEC. 445G. ø285e–9¿ (a) IN GENERAL.—The Director of the Institute may make a grant to develop a registry for the collection of
epidemiological data about Alzheimer’s disease and its incidence in
the United States, to train personnel in the collection of such data,
and for other matters respecting such disease.
(b) QUALIFICATIONS.—To qualify for a grant under subsection
(a) an applicant shall—
(1) be an accredited school of medicine or public health
which has expertise in the collection of epidemiological data
about individuals with Alzheimer’s disease and in the development of disease registries, and
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Sec. 446

(2) have access to a large patient population, including a
patient population representative of diverse ethnic backgrounds.
AGING PROCESSES REGARDING WOMEN

SEC. 445H. ø285e–10¿ The Director of the Institute, in addition
to other special functions specified in section 444 and in cooperation with the Directors of the other national research institutes and
agencies of the National Institutes of Health, shall conduct research into the aging processes of women, with particular emphasis
given to the effects of menopause and the physiological and behavioral changes occurring during the transition from pre- to postmenopause, and into the diagnosis, disorders, and complications related to aging and loss of ovarian hormones in women.
SEC. 445I. ø285e–10a¿ ALZHEIMER’S CLINICAL RESEARCH AND TRAINING AWARDS.
(a) IN GENERAL.—The Director of the Institute is authorized to

establish and maintain a program to enhance and promote the
translation of new scientific knowledge into clinical practice related
to the diagnosis, care and treatment of individuals with Alzheimer’s disease.
(b) SUPPORT OF PROMISING CLINICIANS.—In order to foster the
application of the most current developments in the etiology, pathogenesis, diagnosis, prevention and treatment of Alzheimer’s disease, amounts made available under this section shall be directed
to the support of promising clinicians through awards for research,
study, and practice at centers of excellence in Alzheimer’s disease
research and treatment.
(c) EXCELLENCE IN CERTAIN FIELDS.—Research shall be carried
out under awards made under subsection (b) in environments of
demonstrated excellence in neuroscience, neurobiology, geriatric
medicine, and psychiatry and shall foster innovation and integration of such disciplines or other environments determined suitable
by the Director of the Institute.
Subpart 6—National Institute of Allergy and Infectious Diseases
PURPOSE OF THE INSTITUTE

SEC. 446. ø285f¿ The general purpose of the National Institute
of Allergy and Infectious Diseases is the conduct and support of research, training, health information dissemination, and other programs with respect to allergic and immunologic diseases and disorders and infectious diseases, including tropical diseases.
RESEARCH CENTERS REGARDING CHRONIC FATIGUE SYNDROME

SEC. 447. ø285f–1¿ (a) The Director of the Institute, after consultation with the advisory council for the Institute, may make
grants to, or enter into contracts with, public or nonprofit private
entities for the development and operation of centers to conduct
basic and clinical research on chronic fatigue syndrome.
(b) Each center assisted under this section shall use the facilities of a single institution, or be formed from a consortium of coMarch 13, 2013

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Sec. 447A

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594

operating institutions, meeting such requirements as may be prescribed by the Director of the Institute.
RESEARCH AND RESEARCH TRAINING REGARDING TUBERCULOSIS

SEC. 447A. ø285f–2¿ In carrying out section 446, the Director
of the Institute shall conduct or support research and research
training regarding the cause, diagnosis, early detection, prevention
and treatment of tuberculosis.
SEC. 447B. ø285f–3¿ SEXUALLY TRANSMITTED DISEASE CLINICAL RESEARCH AND TRAINING AWARDS.
(a) IN GENERAL.—The Director of the Institute is authorized to

establish and maintain a program to enhance and promote the
translation of new scientific knowledge into clinical practice related
to the diagnosis, care and treatment of individuals with sexually
transmitted diseases.
(b) SUPPORT OF PROMISING CLINICIANS.—In order to foster the
application of the most current developments in the etiology, pathogenesis, diagnosis, prevention and treatment of sexually transmitted diseases, amounts made available under this section shall
be directed to the support of promising clinicians through awards
for research, study, and practice at centers of excellence in sexually
transmitted disease research and treatment.
(c) EXCELLENCE IN CERTAIN FIELDS.—Research shall be carried
out under awards made under subsection (b) in environments of
demonstrated excellence in the etiology and pathogenesis of sexually transmitted diseases and shall foster innovation and integration of such disciplines or other environments determined suitable
by the Director of the Institute.
SEC. 447C. ø285f–4¿ MICROBICIDE RESEARCH AND DEVELOPMENT.

The Director of the Institute, acting through the head of the
Division of AIDS, shall, consistent with the peer-review process of
the National Institutes of Health, carry out research on, and development of, safe and effective methods for use by women to prevent
the transmission of the human immunodeficiency virus, which may
include microbicides.
Subpart 7—Eunice Kennedy Shriver National Institute of Child
Health and Human Development 1
PURPOSE OF THE INSTITUTE

SEC. 448. ø285g¿ The general purpose of the National Institute
of Child Health and Human Development 1 (hereafter in this subpart referred to as the ‘‘Institute’’) is the conduct and support of re1 Section 1004 of Public Law 106–310 (114 Stat. 1130) authorizes the Director of the Institute
to conduct a national longitudinal study of environmental influences (including physical, chemical, biological, and psychosocial) on children’s health and development. Subsection (d) of such
section requires periodic reports to the Congress regarding the study. The first report is required
to be submitted not later than three years after the date of the enactment of the Public Law,
which was enacted October 17, 2000.
1 The probable intent of the Congress is to refer to the ‘‘Eunice Kennedy Shriver National Institute of Child Health and Human Development’’. Section 1(b)(7) of Public Law 110–154 (121
Stat 1827) struck the term ‘‘National Institute of Child Health and Human Development’’ and
inserted ‘‘Eunice Kennedy Shriver National Institute of Child Health and Human Development’’
each place such term appeared in the heading of subpart 7 of part C of title IV, but not in the
text of section 448.

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PUBLIC HEALTH SERVICE ACT

Sec. 452

search, training, health information dissemination, and other programs with respect to gynecologic health, maternal health, child
health, intellectual disabilities, human growth and development,
including prenatal development, population research, and special
health problems and requirements of mothers and children.
SUDDEN INFANT DEATH SYNDROME

SEC. 449. ø285g–1¿ The Director of the Institute shall conduct
and support research which specifically relates to sudden infant
death syndrome.
SEC. 450. ø285g–2¿ RESEARCH ON INTELLECTUAL DISABILITIES.

The Director of the Institute shall conduct and support research and related activities into the causes, prevention, and treatment of intellectual disabilities.
ASSOCIATE DIRECTOR FOR PREVENTION

SEC. 451. ø285g–3¿ There shall be in the Institute an Associate
Director for Prevention to coordinate and promote the programs in
the Institute concerning the prevention of health problems of mothers and children. The Associate Director shall be appointed by the
Director of the Institute from individuals who because of their professional training or experience are experts in public health or preventive medicine.
NATIONAL CENTER FOR MEDICAL REHABILITATION RESEARCH

SEC. 452. ø285g–4¿ (a) There shall be in the Institute an agency to be known as the National Center for Medical Rehabilitation
Research (hereafter in this section referred to as the ‘‘Center’’) 1.
The Director of the Institute shall appoint a qualified individual to
serve as Director of the Center. The Director of the Center shall
report directly to the Director of the Institute.
(b) The general purpose of the Center is the conduct and support of research and research training (including research on the
development of orthotic and prosthetic devices), the dissemination
of health information, and other programs with respect to the rehabilitation of individuals with physical disabilities resulting from
diseases or disorders of the neurological, musculoskeletal, cardiovascular, pulmonary, or any other physiological system (hereafter
in this section referred to as ‘‘medical rehabilitation’’).
(c)(1) In carrying out the purpose described in subsection (b),
the Director of the Center may—
(A) provide for clinical trials regarding medical rehabilitation;
(B) provide for research regarding model systems of medical rehabilitation;
(C) coordinate the activities of the Center with similar activities of other agencies of the Federal Government, including
the other agencies of the National Institutes of Health, and
1 Section 3(b) of Public Law 101–613 requires that Federal agencies, as appropriate, enter into
agreements for preventing duplication among Federal programs regarding medical rehabilitation. Such section requires that the agreements be made not later than one year after the date
of the enactment of the Public Law, which was enacted November 16, 1990.

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Sec. 452

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596

with similar activities of other public entities and of private
entities;
(D) support multidisciplinary medical rehabilitation research conducted or supported by more than one such agency;
(E) in consultation with the advisory council for the Institute and with the approval of the Director of NIH—
(i) establish technical and scientific peer review groups
in addition to those appointed under section 402(b)(16);
and
(ii) appoint the members of peer review groups established under subparagraph (A); and
(F) support medical rehabilitation research and training
centers.
The Federal Advisory Committee Act shall not apply to the duration of a peer review group appointed under subparagraph (E).
(2) In carrying out this section, the Director of the Center may
make grants and enter into cooperative agreements and contracts.
(d)(1) In consultation with the Director of the Center, the coordinating committee established under subsection (e), and the advisory board established under subsection (f), the Director of the
Institute shall develop a comprehensive plan for the conduct and
support of medical rehabilitation research (hereafter in this section
referred to as the ‘‘Research Plan’’).
(2) The Research Plan shall—
(A) identify current medical rehabilitation research activities conducted or supported by the Federal Government, opportunities and needs for additional research, and priorities for
such research; and
(B) make recommendations for the coordination of such research conducted or supported by the National Institutes of
Health and other agencies of the Federal Government.
(3)(A) Not later than 18 months after the date of the enactment of the National Institutes of Health Revitalization Amendments of 1990, 1 the Director of the Institute shall transmit the Research Plan to the Director of NIH, who shall submit the Plan to
the President and the Congress.
(B) Subparagraph (A) shall be carried out independently of the
process of reporting that is required in sections 403 and 407.
(4) The Director of the Institute shall periodically revise and
update the Research Plan as appropriate, after consultation with
the Director of the Center, the coordinating committee established
under subsection (e), and the advisory board established under subsection (f). A description of any revisions in the Research Plan shall
be contained in each report prepared under section 407 by the Director of the Institute.
(e)(1) The Director of NIH shall establish a committee to be
known as the Medical Rehabilitation Coordinating Committee
(hereafter in this section referred to as the ‘‘Coordinating Committee’’).
(2) The Coordinating Committee shall make recommendations
to the Director of the Institute and the Director of the Center with
1 So in law. No Act with such a short title was enacted during 1990. The probable intent of
the Congress was to make a reference to Public Law 101–613, the National Institutes of Health
Amendments of 1990, which added section 452 and which was enacted November 16, 1990.

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PUBLIC HEALTH SERVICE ACT

Sec. 452

respect to the content of the Research Plan and with respect to the
activities of the Center that are carried out in conjunction with
other agencies of the National Institutes of Health and with other
agencies of the Federal Government.
(3) The Coordinating Committee shall be composed of the Director of the Center, the Director of the Institute, and the Directors
of the National Institute on Aging, the National Institute of Arthritis and Musculoskeletal and Skin Diseases, the National Heart,
Lung, and Blood Institute, the National Institute of Neurological
Disorders and Stroke, and such other national research institutes
and such representatives of other agencies of the Federal Government as the Director of NIH determines to be appropriate.
(4) The Coordinating Committee shall be chaired by the Director of the Center.
(f)(1) Not later than 90 days after the date of the enactment
of the National Institutes of Health Revitalization Amendments of
1990, 1 the Director of NIH shall establish a National Advisory
Board on Medical Rehabilitation Research (hereafter in this section
referred to as the ‘‘Advisory Board’’).
(2) The Advisory Board shall review and assess Federal research priorities, activities, and findings regarding medical rehabilitation research, and shall advise the Director of the Center and
the Director of the Institute on the provisions of the Research Plan.
(3)(A) The Director of NIH shall appoint to the Advisory Board
18 qualified representatives of the public who are not officers or
employees of the Federal Government. Of such members, 12 shall
be representatives of health and scientific disciplines with respect
to medical rehabilitation and 6 shall be individuals representing
the interests of individuals undergoing, or in need of, medical rehabilitation.
(B) The following officials shall serve as ex officio members of
the Advisory Board:
(i) The Director of the Center.
(ii) The Director of the Institute.
(iii) The Director of the National Institute on Aging.
(iv) The Director of the National Institute of Arthritis and
Musculoskeletal and Skin Diseases.
(v) The Director of the National Institute on Deafness and
Other Communication Disorders.
(vi) The Director of the National Heart, Lung, and Blood
Institute.
(vii) The Director of the National Institute of Neurological
Disorders and Stroke.
(viii) The Director of the National Institute on Disability
and Rehabilitation Research.
(ix) The Commissioner for Rehabilitation Services Administration.
(x) The Assistant Secretary of Defense (Health Affairs).
(xi) The Chief Medical Director of the Department of Veterans Affairs.
1 See

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footnote for subsection (d)(3)(A).

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Sec. 452A

PUBLIC HEALTH SERVICE ACT

598

(4) The members of the Advisory Board shall, from among the
members appointed under paragraph (3)(A), designate an individual to serve as the chair of the Advisory Board.
RESEARCH CENTERS WITH RESPECT TO CONTRACEPTION AND
INFERTILITY

SEC. 452A. ø285g–5¿ (a) The Director of the Institute, after
consultation with the advisory council for the Institute, shall make
grants to, or enter into contracts with, public or nonprofit private
entities for the development and operation of centers to conduct activities for the purpose of improving methods of contraception and
centers to conduct activities for the purpose of improving methods
of diagnosis and treatment of infertility.
(b) In carrying out subsection (a), the Director of the Institute
shall, subject to the extent of amounts made available in appropriations Acts, provide for the establishment of three centers with respect to contraception and for two centers with respect to infertility.
(c)(1) Each center assisted under this section shall, in carrying
out the purpose of the center involved—
(A) conduct clinical and other applied research, including—
(i) for centers with respect to contraception, clinical
trials of new or improved drugs and devices for use by
males and females (including barrier methods); and
(ii) for centers with respect to infertility, clinical trials
of new or improved drugs and devices for the diagnosis
and treatment of infertility in males and females;
(B) develop protocols for training physicians, scientists,
nurses, and other health and allied health professionals;
(C) conduct training programs for such individuals;
(D) develop model continuing education programs for such
professionals; and
(E) disseminate information to such professionals and the
public.
(2) A center may use funds provided under subsection (a) to
provide stipends for health and allied health professionals enrolled
in programs described in subparagraph (C) of paragraph (1), and
to provide fees to individuals serving as subjects in clinical trials
conducted under such paragraph.
(d) The Director of the Institute shall, as appropriate, provide
for the coordination of information among the centers assisted
under this section.
(e) Each center assisted under subsection (a) shall use the facilities of a single institution, or be formed from a consortium of cooperating institutions, meeting such requirements as may be prescribed by the Director of the Institute.
(f) Support of a center under subsection (a) may be for a period
not exceeding 5 years. Such period may be extended for one or
more additional periods not exceeding 5 years if the operations of
such center have been reviewed by an appropriate technical and
scientific peer review group established by the Director and if such
group has recommended to the Director that such period should be
extended.
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PUBLIC HEALTH SERVICE ACT

Sec. 452E

PROGRAM REGARDING OBSTETRICS AND GYNECOLOGY

SEC. 452B. ø285g–6¿ The Director of the Institute shall establish and maintain within the Institute an intramural laboratory
and clinical research program in obstetrics and gynecology.
CHILD HEALTH RESEARCH CENTERS

SEC. 452C. ø285g–7¿ The Director of the Institute shall develop and support centers for conducting research with respect to
child health. Such centers shall give priority to the expeditious
transfer of advances from basic science to clinical applications and
improving the care of infants and children.
PROSPECTIVE LONGITUDINAL STUDY ON ADOLESCENT HEALTH

SEC. 452D. ø285g–8¿ (a) IN GENERAL.—Not later than October
1, 1993, the Director of the Institute shall commence a study for
the purpose of providing information on the general health and
well-being of adolescents in the United States, including, with respect to such adolescents, information on—
(1) the behaviors that promote health and the behaviors
that are detrimental to health; and
(2) the influence on health of factors particular to the communities in which the adolescents reside.
(b) DESIGN OF STUDY.—
(1) IN GENERAL.—The study required in subsection (a)
shall be a longitudinal study in which a substantial number of
adolescents participate as subjects. With respect to the purpose
described in such subsection, the study shall monitor the subjects throughout the period of the study to determine the
health status of the subjects and any change in such status
over time.
(2) POPULATION-SPECIFIC ANALYSES.—The study required
in subsection (a) shall be conducted with respect to the population of adolescents who are female, the population of adolescents who are male, various socioeconomic populations of adolescents, and various racial and ethnic populations of adolescents. The study shall be designed and conducted in a manner
sufficient to provide for a valid analysis of whether there are
significant differences among such populations in health status
and whether and to what extent any such differences are due
to factors particular to the populations involved.
(c) COORDINATION WITH WOMEN’S HEALTH INITIATIVE.—With
respect to the national study of women being conducted by the Secretary and known as the Women’s Health Initiative, the Secretary
shall ensure that such study is coordinated with the component of
the study required in subsection (a) that concerns adolescent females, including coordination in the design of the 2 studies.
FRAGILE X

SEC. 452E. ø285g–9¿ (a) EXPANSION AND COORDINATION OF RESEARCH ACTIVITIES.—The Director of the Institute, after consultation with the advisory council for the Institute, shall expand, intensify, and coordinate the activities of the Institute with respect to
research on the disease known as fragile X.
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Sec. 452G

PUBLIC HEALTH SERVICE ACT

600

(b) RESEARCH CENTERS.—
(1) IN GENERAL.—The Director of the Institute shall make
grants or enter into contracts for the development and operation of centers to conduct research for the purposes of improving the diagnosis and treatment of, and finding the cure for,
fragile X.
(2) NUMBER OF CENTERS.—
(A) IN GENERAL.—In carrying out paragraph (1), the
Director of the Institute shall, to the extent that amounts
are appropriated, and subject to subparagraph (B), provide
for the establishment of at least three fragile X research
centers.
(B) PEER REVIEW REQUIREMENT.—The Director of the
Institute shall make a grant to, or enter into a contract
with, an entity for purposes of establishing a center under
paragraph (1) only if the grant or contract has been recommended after technical and scientific peer review required by regulations under section 492.
(3) ACTIVITIES.—The Director of the Institute, with the assistance of centers established under paragraph (1), shall conduct and support basic and biomedical research into the detection and treatment of fragile X.
(4) COORDINATION AMONG CENTERS.—The Director of the
Institute shall, as appropriate, provide for the coordination of
the activities of the centers assisted under this section, including providing for the exchange of information among the centers.
(5) CERTAIN ADMINISTRATIVE REQUIREMENTS.—Each center
assisted under paragraph (1) shall use the facilities of a single
institution, or be formed from a consortium of cooperating institutions, meeting such requirements as may be prescribed by
the Director of the Institute.
(6) DURATION OF SUPPORT.—Support may be provided to a
center under paragraph (1) for a period not exceeding 5 years.
Such period may be extended for one or more additional periods, each of which may not exceed 5 years, if the operations
of such center have been reviewed by an appropriate technical
and scientific peer review group established by the Director
and if such group has recommended to the Director that such
period be extended.
INVESTMENT IN TOMORROW’S PEDIATRIC RESEARCHERS

SEC. 452G. 1 ø285g–10¿ In order to ensure the future supply of
researchers dedicated to the care and research needs of children,
the Director of the Institute, after consultation with the Administrator of the Health Resources and Services Administration, shall
support activities to provide for—
(1) an increase in the number and size of institutional
training grants to institutions supporting pediatric training;
and
1So in law. Probably should be ‘‘SEC. 452F.’’. See amendments made by sections 201 and 1002
of Public Law 106–310 (114 Stat. 1109, 1128). (In amending this subpart to add section 452G
above, such section 1002 made a reference to this subpart ‘‘as amended by section 921’’ of Public
Law 106–310, but no section 921 appeared in the Public Law.)

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PUBLIC HEALTH SERVICE ACT

Sec. 456

(2) an increase in the number of career development
awards for health professionals who intend to build careers in
pediatric basic and clinical research, including pediatric pharmacological research.
Subpart 8—National Institute of Dental Research 1
PURPOSE OF THE INSTITUTE

SEC. 453. ø285h¿ The general purpose of the National Institute
of Dental Research 1 is the conduct and support of research, training, health information dissemination, and other programs with respect to the cause, prevention, and methods of diagnosis and treatment of dental and oral diseases and conditions.
Subpart 9—National Eye Institute
PURPOSE OF THE INSTITUTE

SEC. 455. ø285i¿ The general purpose of the National Eye Institute (hereafter in this subpart referred to as the ‘‘Institute’’) is
the conduct and support of research, training, health information
dissemination, and other programs with respect to blinding eye diseases, visual disorders, mechanisms of visual function, preservation
of sight, and the special health problems and requirements of the
blind. Subject to section 456, the Director of the Institute may
carry out a program of grants for public and private nonprofit vision research facilities.
CLINICAL RESEARCH ON EYE CARE AND DIABETES

SEC. 456. ø285i–1¿ (a) PROGRAM OF GRANTS.—The Director of
the Institute, in consultation with the advisory council for the Institute, may award research grants to one or more Diabetes Eye
Research Institutions for the support of programs in clinical or
health services aimed at—
(1) providing comprehensive eye care services for people
with diabetes, including a full complement of preventive, diagnostic and treatment procedures;
(2) developing new and improved techniques of patient
care through basic and clinical research;
(3) assisting in translation of the latest research advances
into clinical practice; and
(4) expanding the knowledge of the eye and diabetes
through further research.
(b) USE OF FUNDS.—Amounts received under a grant awarded
under this section shall be used for the following:
(1) Establishing the biochemical, cellular, and genetic
mechanisms associated with diabetic eye disease and the earlier detection of pending eye abnormalities. The focus of work
under this paragraph shall require that ophthalmologists have
training in the most up-to-date molecular and cell biological
methods.
(2) Establishing new frontiers in technology, such as videobased diagnostic and research resources, to—
1See

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602

(A) provide improved patient care;
(B) provide for the evaluation of retinal physiology and
its affect on diabetes; and
(C) provide for the assessment of risks for the development and progression of diabetic eye disease and a more
immediate evaluation of various therapies aimed at preventing diabetic eye disease.
Such technologies shall be designed to permit evaluations to be
performed both in humans and in animal models.
(3) The translation of the results of vision research into
the improved care of patients with diabetic eye disease. Such
translation shall require the application of institutional resources that encompass patient care, clinical research and
basic laboratory research.
(4) The conduct of research concerning the outcomes of eye
care treatments and eye health education programs as they relate to patients with diabetic eye disease, including the evaluation of regional approaches to such research.
(c) AUTHORIZED EXPENDITURES.—The purposes for which a
grant under subsection (a) may be expended include equipment for
the research described in such subsection.
Subpart 10—National Institute of Neurological Disorders and
Stroke
PURPOSE OF THE INSTITUTE

SEC. 457. ø285j¿ The general purpose of the National Institute
of Neurological Disorders and Stroke (hereafter in this subpart referred to as the ‘‘Institute’’) is the conduct and support of research,
training, health information dissemination, and other programs
with respect to neurological disease and disorder and stroke.
SPINAL CORD REGENERATION RESEARCH

SEC. 458. ø285j–1¿ The Director of the Institute shall conduct
and support research into spinal cord regeneration.
BIOENGINEERING RESEARCH

SEC. 459. ø285j–2¿ The Director of the Institute shall make
grants or enter into contracts for research on the means to overcome paralysis of the extremities through electrical stimulation and
the use of computers.
RESEARCH ON MULTIPLE SCLEROSIS

SEC. 460. ø285j–3¿ The Director of the Institute shall conduct
and support research on multiple sclerosis, especially research on
effects of genetics and hormonal changes on the progress of the disease.
Subpart 11—National Institute of General Medical Sciences
SEC.

461.

ø285k¿ NATIONAL INSTITUTE OF GENERAL MEDICAL
SCIENCES.
GENERAL PURPOSE.—The general purpose of the National

(a)
Institute of General Medical Sciences is the conduct and support of
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PUBLIC HEALTH SERVICE ACT

Sec. 463A

research, training, and, as appropriate, health information dissemination, and other programs with respect to general or basic medical
sciences and related natural or behavioral sciences which have significance for two or more other national research institutes or are
outside the general area of responsibility of any other national research institute.
(b) INSTITUTIONAL DEVELOPMENT AWARD PROGRAM.—
(1)(A) In the case of entities described in subparagraph
(B), the Director of NIH, acting through the Director of the National Institute of General Medical Sciences, shall establish a
program to enhance the competitiveness of such entities in obtaining funds from the national research institutes for conducting biomedical and behavioral research.
(B) The entities referred to in subparagraph (A) are entities that conduct biomedical and behavioral research and are
located in a State in which the aggregate success rate for applications to the national research institutes for assistance for
such research by the entities in the State has historically constituted a low success rate of obtaining such funds, relative to
such aggregate rate for such entities in other States.
(C) With respect to enhancing competitiveness for purposes
of subparagraph (A), the Director of NIH, in carrying out the
program established under such subparagraph, may—
(i) provide technical assistance to the entities involved,
including technical assistance in the preparation of applications for obtaining funds from the national research institutes;
(ii) assist the entities in developing a plan for biomedical or behavioral research proposals; and
(iii) assist the entities in implementing such plan.
(2) The Director of NIH shall establish a program of supporting projects of biomedical or behavioral research whose
principal researchers are individuals who have not previously
served as the principal researchers of such projects supported
by the Director.
Subpart 12—National Institute of Environmental Health Sciences
PURPOSE OF THE INSTITUTE

SEC. 463. ø285l¿ The general purpose of the National Institute
of Environmental Health Sciences (in this subpart referred to as
the ‘‘Institute’’) is the conduct and support of research, training,
health information dissemination, and other programs with respect
to factors in the environment that affect human health, directly or
indirectly.
APPLIED TOXICOLOGICAL RESEARCH AND TESTING PROGRAM

SEC. 463A. ø285l–1¿ (a) There is established within the Institute a program for conducting applied research and testing regarding toxicology, which program shall be known as the Applied Toxicological Research and Testing Program.
(b) In carrying out the program established under subsection
(a), the Director of the Institute shall, with respect to toxicology,
carry out activities—
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(1) to expand knowledge of the health effects of environmental agents;
(2) to broaden the spectrum of toxicology information that
is obtained on selected chemicals;
(3) to develop and validate assays and protocols, including
alternative methods that can reduce or eliminate the use of
animals in acute or chronic safety testing;
(4) to establish criteria for the validation and regulatory
acceptance of alternative testing and to recommend a process
through which scientifically validated alternative methods can
be accepted for regulatory use;
(5) to communicate the results of research to government
agencies, to medical, scientific, and regulatory communities,
and to the public; and
(6) to integrate related activities of the Department of
Health and Human Services.
METHODS OF CONTROLLING CERTAIN INSECT AND VERMIN
POPULATIONS

SEC. 463B. ø285l–6¿ The Director of the Institute shall conduct
or support research to identify or develop methods of controlling insect and vermin populations that transmit to humans diseases that
have significant adverse health consequences.
Subpart 13—National Institute on Deafness and Other
Communication Disorders
PURPOSE OF THE INSTITUTE

SEC. 464. ø285m¿ The general purpose of the National Institute on Deafness and Other Communication Disorders (hereafter
referred to in this subpart as the ‘‘Institute’’) is the conduct and
support of research and training, the dissemination of health information, and other programs with respect to disorders of hearing
and other communication processes, including diseases affecting
hearing, balance, voice, speech, language, taste, and smell.
NATIONAL DEAFNESS AND OTHER COMMUNICATION DISORDERS
PROGRAM

SEC. 464A. ø285m–1¿ (a) The Director of the Institute, with
the advice of the Institute’s advisory council, shall establish a National Deafness and Other Communication Disorders Program
(hereafter in this section referred to as the ‘‘Program’’). The Director or 1 the Institute shall, with respect to the Program, prepare
and transmit to the Director of NIH a plan to initiate, expand, intensify and coordinate activities of the Institute respecting disorders of hearing (including tinnitus) and other communication
processes, including diseases affecting hearing, balance, voice,
speech, language, taste, and smell. The plan shall include such
comments and recommendations as the Director of the Institute determines appropriate. The Director of the Institute shall periodi1 So in law. See section 2(4) of Public Law 100–553 (102 Stat. 2769). Probably should be ‘‘Director of’’.

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cally review and revise the plan and shall transmit any revisions
of the plan to the Director of NIH.
(b) Activities under the Program shall include—
(1) investigation into the etiology, pathology, detection,
treatment, and prevention of all forms of disorders of hearing
and other communication processes, primarily through the support of basic research in such areas as anatomy, audiology, biochemistry, bioengineering, epidemiology, genetics, immunology,
microbiology, molecular biology, the neurosciences, otolaryngology, psychology, pharmacology, physiology, speech and language pathology, and any other scientific disciplines that can
contribute important knowledge to the understanding and
elimination of disorders of hearing and other communication
processes;
(2) research into the evaluation of techniques (including
surgical, medical, and behavioral approaches) and devices (including hearing aids, implanted auditory and nonauditory
prosthetic devices and other communication aids) used in diagnosis, treatment, rehabilitation, and prevention of disorders of
hearing and other communication processes;
(3) research into prevention, and early detection and diagnosis, of hearing loss and speech and language disturbances
(including stuttering) and research into preventing the effects
of such disorders on learning and learning disabilities with extension of programs for appropriate referral and rehabilitation;
(4) research into the detection, treatment, and prevention
of disorders of hearing and other communication processes in
the growing elderly population with extension of rehabilitative
programs to ensure continued effective communication skills in
such population;
(5) research to expand knowledge of the effects of environmental agents that influence hearing or other communication
processes; and
(6) developing and facilitating intramural programs on
clinical and fundamental aspects of disorders of hearing and all
other communication processes.
DATA SYSTEM AND INFORMATION CLEARINGHOUSE

SEC. 464B. ø285m–2¿ (a) The Director of the Institute shall establish a National Deafness and Other Communication Disorders
Data System for the collection, storage, analysis, retrieval, and dissemination of data derived from patient populations with disorders
of hearing or other communication processes, including where possible, data involving general populations for the purpose of identifying individuals at risk of developing such disorders.
(b) The Director of the Institute shall establish a National
Deafness and Other Communication Disorders Information Clearinghouse to facilitate and enhance, through the effective dissemination of information, knowledge and understanding of disorders of
hearing and other communication processes by health professionals, patients, industry, and the public.
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MULTIPURPOSE DEAFNESS AND OTHER COMMUNICATION DISORDERS
CENTER

SEC. 464C. ø285m–3¿ (a) The Director of the Institute shall,
after consultation with the advisory council for the Institute, provide for the development, modernization, and operation (including
care required for research) of new and existing centers for studies
of disorders of hearing and other communication processes. For
purposes of this section, the term ‘‘modernization’’ means the alteration, remodeling, improvement, expansion, and repair of existing
buildings and the provision of equipment for such buildings to the
extent necessary to make them suitable for use as centers described in the preceding sentence.
(b) Each center assisted under this section shall—
(1) use the facilities of a single institution or a consortium
of cooperating institutions; and
(2) meet such qualifications as may be prescribed by the
Secretary.
(c) Each center assisted under this section shall, at least, conduct—
(1) basic and clinical research into the cause diagnosis,
early detection, prevention, control and treatment of disorders
of hearing and other communication processes and complications resulting from such disorders, including research into rehabilitative aids, implantable biomaterials, auditory speech
processors,
speech
production
devices,
and
other
otolaryngologic procedures;
(2) training programs for physicians, scientists, and other
health and allied health professionals;
(3) information and continuing education programs for
physicians and other health and allied health professionals
who will provide care for patients with disorders of hearing or
other communication processes; and
(4) programs for the dissemination to the general public of
information—
(A) on the importance of early detection of disorders of
hearing and other communication processes, of seeking
prompt treatment, rehabilitation, and of following an appropriate regimen; and
(B) on the importance of avoiding exposure to noise
and other environmental toxic agents that may affect disorders of hearing or other communication processes.
(d) A center may use funds provided under subsection (a) to
provide stipends for health professionals enrolled in training programs described in subsection (c)(2).
(e) Each center assisted under this section may conduct programs—
(1) to establish the effectiveness of new and improved
methods of detection, referral, and diagnosis of individuals at
risk of developing disorders of hearing or other communication
processes; and
(2) to disseminate the results of research, screening, and
other activities, and develop means of standardizing patient
data and recordkeeping.
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(f) The Director of the Institute shall, to the extent practicable,
provide for an equitable geographical distribution of centers assisted under this section. The Director shall give appropriate consideration to the need for centers especially suited to meeting the
needs of the elderly, and of children (particularly with respect to
their education and training), affected by disorders of hearing or
other communication processes.
(g) Support of a center under this section may be for a period
not to exceed seven years. Such period may be extended by the Director of the Institute for one or more additional periods of not
more than five years if the operations of such center have been reviewed by an appropriate technical and scientific peer review group
established by the Director, with the advice of the Institute’s advisory council, if such group has recommended to the Director that
such period should be extended.
NATIONAL INSTITUTE ON DEAFNESS AND OTHER COMMUNICATION
DISORDERS ADVISORY BOARD

SEC. 464D. ø285m–4¿ (a) The Secretary shall establish in the
Institute the National Deafness and Other Communications Disorders Advisory Board (hereafter in this section referred to as the
‘‘Advisory Board’’).
(b) The Advisory Board shall be composed of eighteen appointed members and nonvoting ex officio members as follows:
(1) The Secretary shall appoint—
(A) twelve members from individuals who are scientists, physicians, and other health and rehabilitation
professionals, who are not officers or employees of the
United States, and who represent the specialties and disciplines relevant to deafness and other communication disorders, including not less than two persons with a communication disorder; and
(B) six members from the general public who are
knowledgeable with respect to such disorders, including
not less than one person with a communication disorder
and not less than one person who is a parent of an individual with such a disorder.
Of the appointed members, not less than five shall by virtue
of training or experience be knowledgeable in diagnoses and rehabilitation of communication disorders, education of the hearing, speech, or language impaired, public health, public information, community program development, occupational hazards to communications senses, or the aging process.
(2) The following shall be ex officio members of each Advisory Board:
(A) The Assistant Secretary for Health, the Director of
NIH, the Director of the National Institute on Deafness
and Other Communication Disorders, the Director of the
Centers for Disease Control and Prevention, the Chief
Medical Director of the Department of Veterans Affairs,
and the Assistant Secretary of Defense for Health Affairs
(or the designees of such officers).
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(B) Such other officers and employees of the United
States as the Secretary determines necessary for the Advisory Board to carry out its functions.
(c) Members of an Advisory Board who are officers or employees of the Federal Government shall serve as members of the Advisory Board without compensation in addition to that received in
their regular public employment. Other members of the Board shall
receive compensation at rates not to exceed the daily equivalent of
the annual rate in effect for grade GS–18 of the General Schedule
for each day (including traveltime) they are engaged in the performance of their duties as members of the Board.
(d) The term of office of an appointed member of the Advisory
Board is four years, except that no term of office may extend beyond the expiration of the Advisory Board. Any member appointed
to fill a vacancy for an unexpired term shall be appointed for the
remainder of such term. A member may serve after the expiration
of the member’s term until a successor has taken office. If a vacancy occurs in the Advisory Board, the Secretary shall make an
appointment to fill the vacancy not later than 90 days from the
date the vacancy occurred.
(e) The members of the Advisory Board shall select a chairman
from among the appointed members.
(f) The Secretary shall, after consultation with and consideration of the recommendations of the Advisory Board, provide the
Advisory Board with an executive director and one other professional staff member. In addition, the Secretary shall, after consultation with and consideration of the recommendations of the Advisory Board, provide the Advisory Board with such additional professional staff members, such clerical staff members, such services
of consultants, such information, and (through contracts or other
arrangements) such administrative support services and facilities,
as the Secretary determines are necessary for the Advisory Board
to carry out its functions.
(g) The Advisory Board shall meet at the call of the chairman
or upon request of the Director of the Institute, but not less often
than four times a year.
(h) The Advisory Board shall—
(1) review and evaluate the implementation of the plan
prepared under section 464A(a) and periodically update the
plan to ensure its continuing relevance;
(2) for the purpose of assuring the most effective use and
organization of resources respecting deafness and other communication disorders, advise and make recommendations to
the Congress, the Secretary, the Director of NIH, the Director
of the Institute, and the heads of other appropriate Federal
agencies for the implementation and revision of such plan; and
(3) maintain liaison with other advisory bodies related to
Federal agencies involved in the implementation of such plan
and with key non-Federal entities involved in activities affecting the control of such disorders.
(i) In carrying out its functions, the Advisory Board may establish subcommittees, convene workshops and conferences, and collect data. Such subcommittees may be composed of Advisory Board
members and nonmember consultants with expertise in the parMarch 13, 2013

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Sec. 464H

ticular area addressed by such subcommittees. The subcommittees
may hold such meetings as are necessary to enable them to carry
out their activities.
(k) 1 The National Deafness and Other Communication Disorders Advisory Board shall be established not later than April 1,
1989.
INTERAGENCY COORDINATING COMMITTEE

SEC. 464E. ø285m–5¿ (a) The Secretary may establish a committee to be known as the Deafness and Other Communication Disorders Interagency Coordinating Committee (hereafter in this section referred to as the ‘‘Coordinating Committee’’).
(b) The Coordinating Committee shall, with respect to deafness
and other communication disorders—
(1) provide for the coordination of the activities of the national research institutes; and
(2) coordinate the aspects of all Federal health programs
and activities relating to deafness and other communication
disorders in order to assure the adequacy and technical soundness of such programs and activities and in order to provide for
the full communication and exchange of information necessary
to maintain adequate coordination of such programs and activities.
(c) The Coordinating Committee shall be composed of the directors of each of the national research institutes and divisions involved in research with respect to deafness and other communication disorders and representatives of all other Federal departments
and agencies whose programs involve health functions or responsibilities relevant to deafness and other communication disorders.
(d) The Coordinating Committee shall be chaired by the Director of NIH (or the designee of the Director). The Committee shall
meet at the call of the chair, but not less often than four times a
year.
LIMITATION ON ADMINISTRATIVE EXPENSES

SEC. 464F. ø285m–6¿ With respect to amounts appropriated
for a fiscal year for the National Institutes of Health, the limitation
established in section 408(a)(1) on the expenditure of such amounts
for administrative expenses shall apply to administrative expenses
of the National Institute on Deafness and Other Communication
Disorders.
Subpart 14—National Institute on Alcohol Abuse and Alcoholism
PURPOSE OF INSTITUTE

SEC. 464H. ø285n¿ (a) IN GENERAL.—The general purpose of
the National Institute on Alcohol Abuse and Alcoholism (hereafter
in this subpart referred to as the ‘‘Institute’’) is the conduct and
support of biomedical and behavioral research, health services research, research training, and health information dissemination
with respect to the prevention of alcohol abuse and the treatment
of alcoholism.
1 So

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in law. There is no subsection (j) in section 464D.

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(b) RESEARCH PROGRAM.—The research program established
under this subpart shall encompass the social, behavioral, and biomedical etiology, mental and physical health consequences, and social and economic consequences of alcohol abuse and alcoholism. In
carrying out the program, the Director of the Institute is authorized to—
(1) collect and disseminate through publications and other
appropriate means (including the development of curriculum
materials), information as to, and the practical application of,
the research and other activities under the program;
(2) make available research facilities of the Public Health
Service to appropriate public authorities, and to health officials
and scientists engaged in special study;
(3) make grants to universities, hospitals, laboratories, and
other public or nonprofit institutions, and to individuals for
such research projects as are recommended by the National
Advisory Council on Alcohol Abuse and Alcoholism, giving special consideration to projects relating to—
(A) the relationship between alcohol abuse and domestic violence,
(B) the effects of alcohol use during pregnancy,
(C) the impact of alcoholism and alcohol abuse on the
family, the workplace, and systems for the delivery of
health services,
(D) the relationship between the abuse of alcohol and
other drugs,
(E) the effect on the incidence of alcohol abuse and alcoholism of social pressures, legal requirements respecting
the use of alcoholic beverages, the cost of such beverages,
and the economic status and education of users of such
beverages,
(F) the interrelationship between alcohol use and
other health problems,
(G) the comparison of the cost and effectiveness of various treatment methods for alcoholism and alcohol abuse
and the effectiveness of prevention and intervention programs for alcoholism and alcohol abuse, and
(H) alcoholism and alcohol abuse among women;
(4) secure from time to time and for such periods as he
deems advisable, the assistance and advice of experts, scholars,
and consultants from the United States or abroad;
(5) promote the coordination of research programs conducted by the Institute, and similar programs conducted by the
National Institute of Drug Abuse and by other departments,
agencies, organizations, and individuals, including all National
Institutes of Health research activities which are or may be related to the problems of individuals suffering from alcoholism
or alcohol abuse or those of their families or the impact of alcohol abuse on other health problems;
(6) conduct an intramural program of biomedical, behavioral, epidemiological, and social research, including research
into the most effective means of treatment and service delivery, and including research involving human subjects, which
is—
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PUBLIC HEALTH SERVICE ACT

Sec. 464J

(A) located in an institution capable of providing all
necessary medical care for such human subjects, including
complete 24-hour medical diagnostic services by or under
the supervision of physicians, acute and intensive medical
care, including 24-hour emergency care, psychiatric care,
and such other care as is determined to be necessary for
individuals suffering from alcoholism and alcohol abuse;
and
(B) associated with an accredited medical or research
training institution;
(7) for purposes of study, admit and treat at institutions,
hospitals, and stations of the Public Health Service, persons
not otherwise eligible for such treatment;
(8) provide to health officials, scientists, and appropriate
public and other nonprofit institutions and organizations, technical advice and assistance on the application of statistical and
other scientific research methods to experiments, studies, and
surveys in health and medical fields;
(9) enter into contracts under this title without regard to
sections 3648 and 3709 of the Revised Statutes (31 U.S.C.
529; 1 41 U.S.C. 5); and
(10) adopt, upon recommendation of the National Advisory
Council on Alcohol Abuse and Alcoholism, such additional
means as he deems necessary or appropriate to carry out the
purposes of this section.
(c) COLLABORATION.—The Director of the Institute shall collaborate with the Administrator of the Substance Abuse and Mental Health Services Administration in focusing the services research activities of the Institute and in disseminating the results
of such research to health professionals and the general public.
ASSOCIATE DIRECTOR FOR PREVENTION

SEC. 464I. ø285n–1¿ (a) IN GENERAL.—There shall be in the
Institute an Associate Director for Prevention who shall be responsible for the full-time coordination and promotion of the programs
in the Institute concerning the prevention of alcohol abuse and alcoholism. The Associate Director shall be appointed by the Director
of the Institute from individuals who because of their professional
training or expertise are experts in alcohol abuse and alcoholism or
the prevention of such.
(b) BIENNIAL REPORT.—The Associate Director for Prevention
shall prepare for inclusion in the biennial report made under section 407 a description of the prevention activities of the Institute,
including a description of the staff and resources allocated to those
activities.
NATIONAL ALCOHOL RESEARCH CENTER

SEC. 464J. ø285n–2¿ (a) The Secretary acting through the Institute may designate National Alcohol Research Centers for the
purpose of interdisciplinary research relating to alcoholism and
other biomedical, behavioral, and social issues related to alcoholism
1 Now

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codified to section 3324 of title 31, United States Code.

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and alcohol abuse. No entity may be designated as a Center unless
an application therefor has been submitted to, and approved by,
the Secretary. Such an application shall be submitted in such manner and contain such information as the Secretary may reasonably
require. The Secretary may not approve such an application unless—
(1) the application contains or is supported by reasonable
assurances that—
(A) the applicant has the experience, or capability, to
conduct, through biomedical, behavioral, social, and related disciplines, long-term research on alcoholism and
other alcohol problems and to provide coordination of such
research among such disciplines;
(B) the applicant has available to it sufficient facilities
(including laboratory, reference, and data analysis facilities) to carry out the research plan contained in the application,
(C) the applicant has facilities and personnel to provide training in the prevention and treatment of alcoholism and other alcohol problems;
(D) the applicant has the capacity to train predoctoral
and postdoctoral students for careers in research on alcoholism and other alcohol problems;
(E) the applicant has the capacity to conduct courses
on alcohol problems and research on alcohol problems for
undergraduate and graduate students, and medical and osteopathic, nursing, social work, and other specialized graduate students; and
(F) the applicant has the capacity to conduct programs
of continuing education in such medical, legal, and social
service fields as the Secretary may require. 1
(2) the application contains a detailed five-year plan for research relating to alcoholism and other alcohol problems.
(b) The Secretary shall, under such conditions as the Secretary
may reasonably require, make annual grants to Centers which
have been designated under this section. No funds provided under
a grant under this subsection may be used for the purchase of any
land or the purchase, construction, preservation, or repair of any
building. For the purposes of the preceding sentence, the term ‘‘construction’’ has the meaning given that term by section 701(1). 2 The
Secretary shall include in the grants made under this section for
fiscal year beginning after September 30, 1981, a grant to a designated Center for research on the effects of alcohol on the elderly.

1 So in law. See section 16(a)(5) of Public Law 96–180 (93 Stat. 1305). The period probably
should be ‘‘; and’’. (Section 464J formerly was section 504 of another law. The amendment made
by Public Law 96–180 was directed to section 504 of that other law, which was Public Law 91–
616.)
2 So in law. See section 2(a) of Public Law 102–352 (106 Stat. 938). Section 701(1) does not
provide a definition for the term ‘‘construction’’, but former section 701(1) did provide such a
definition. Public Law 102–408 amended title VII generally; definitions for the title are now provided in section 799, and that section does not define the term ‘‘construction’’.

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Subpart 15—National Institute on Drug Abuse
PURPOSE OF INSTITUTE

SEC. 464L. ø285o¿ (a) IN GENERAL.—The general purpose of
the National Institute on Drug Abuse (hereafter in this subpart referred to as the ‘‘Institute’’) is the conduct and support of biomedical and behavioral research, health services research, research
training, and health information dissemination with respect to the
prevention of drug abuse and the treatment of drug abusers.
(b) RESEARCH PROGRAM.—The research program established
under this subpart shall encompass the social, behavioral, and biomedical etiology, mental and physical health consequences, and social and economic consequences of drug abuse. In carrying out the
program, the Director of the Institute shall give special consideration to projects relating to drug abuse among women (particularly
with respect to pregnant women).
(c) COLLABORATION.—The Director of the Institute shall collaborate with the Substance Abuse and Mental Health Services Administration in focusing the services research activities of the Institute and in disseminating the results of such research to health
professionals and the general public.
ASSOCIATE DIRECTOR FOR PREVENTION

SEC. 464M. ø285o–1¿ (a) IN GENERAL.—There shall be in the
Institute an Associate Director for Prevention who shall be responsible for the full-time coordination and promotion of the programs
in the Institute concerning the prevention of drug abuse. The Associate Director shall be appointed by the Director of the Institute
from individuals who because of their professional training or expertise are experts in drug abuse and the prevention of such abuse.
(b) REPORT.—The Associate Director for Prevention shall prepare for inclusion in the biennial report made under section 407 a
description of the prevention activities of the Institute, including a
description of the staff and resources allocated to those activities.
DRUG ABUSE RESEARCH CENTERS

SEC. 464N. ø285o–2¿ (a) AUTHORITY.—The Director of the Institute may designate National Drug Abuse Research Centers for
the purpose of interdisciplinary research relating to drug abuse and
other biomedical, behavioral, and social issues related to drug
abuse. No entity may be designated as a Center unless an application therefore has been submitted to, and approved by, the Secretary. Such an application shall be submitted in such manner and
contain such information as the Secretary may reasonably require.
The Secretary may not approve such an application unless—
(1) the application contains or is supported by reasonable
assurances that—
(A) the applicant has the experience, or capability, to
conduct, through biomedical, behavioral, social, and related disciplines, long-term research on drug abuse and to
provide coordination of such research among such disciplines;
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(B) the applicant has available to it sufficient facilities
(including laboratory, reference, and data analysis facilities) to carry out the research plan contained in the application;
(C) the applicant has facilities and personnel to provide training in the prevention and treatment of drug
abuse;
(D) the applicant has the capacity to train predoctoral
and postdoctoral students for careers in research on drug
abuse;
(E) the applicant has the capacity to conduct courses
on drug abuse problems and research on drug abuse for
undergraduate and graduate students, and medical and osteopathic, nursing, social work, and other specialized graduate students; and
(F) the applicant has the capacity to conduct programs
of continuing education in such medical, legal, and social
service fields as the Secretary may require. 1
(2) the application contains a detailed five-year plan for research relating to drug abuse.
(b) GRANTS.—The Director of the Institute shall, under such
conditions as the Secretary may reasonably require, make annual
grants to Centers which have been designated under this section.
No funds provided under a grant under this subsection may be
used for the purchase of any land or the purchase, construction,
preservation, or repair of any building. For the purposes of the preceding sentence, the term ‘‘construction’’ has the meaning given
that term by section 701(1). 2
(c) DRUG ABUSE AND ADDITION 3 RESEARCH.—
(1) GRANTS OR COOPERATIVE AGREEMENTS.—The Director of
the Institute may make grants or enter into cooperative agreements to expand the current and ongoing interdisciplinary research and clinical trials with treatment centers of the National Drug Abuse Treatment Clinical Trials Network relating
to drug abuse and addiction, including related biomedical, behavioral, and social issues.
(2) USE OF FUNDS.—Amounts made available under a
grant or cooperative agreement under paragraph (1) for drug
abuse and addiction may be used for research and clinical
trials relating to—
(A) the effects of drug abuse on the human body, including the brain;
(B) the addictive nature of drugs and how such effects
differ with respect to different individuals;
(C) the connection between drug abuse and mental
health;
(D) the identification and evaluation of the most effective methods of prevention of drug abuse and addiction;
1 So in law. See section 123(b) of Public Law 102–321 (106 Stat. 361). The period probably
should be ‘‘; and’’.
2 See footnote for section 464J(b).
3 Probably should be ‘‘ADDICTION’’. See section 2203 of Public Law 107–273 (116 Stat. 1794).

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PUBLIC HEALTH SERVICE ACT

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(E) the identification and development of the most effective methods of treatment of drug addiction, including
pharmacological treatments;
(F) risk factors for drug abuse;
(G) effects of drug abuse and addiction on pregnant
women and their fetuses; and
(H) cultural, social, behavioral, neurological, and psychological reasons that individuals abuse drugs, or refrain
from abusing drugs.
(3) RESEARCH RESULTS.—The Director shall promptly disseminate research results under this subsection to Federal,
State, and local entities involved in combating drug abuse and
addiction.
OFFICE ON AIDS

SEC. 464O. ø285o–3¿ The Director of the Institute shall establish within the Institute an Office on AIDS. The Office shall be responsible for the coordination of research and determining the direction of the Institute with respect to AIDS research related to—
(1) primary prevention of the spread of HIV, including
transmission via drug abuse;
(2) drug abuse services research; and
(3) other matters determined appropriate by the Director.
MEDICATION DEVELOPMENT PROGRAM

SEC. 464P. ø285o–4¿ (a) ESTABLISHMENT.—There is established
in the Institute a Medication Development Program through which
the Director of such Institute shall—
(1) conduct periodic meetings with the Commissioner of
Food and Drugs to discuss measures that may facilitate the approval process of drug abuse treatments;
(2) encourage and promote (through grants, contracts,
international collaboration, or otherwise) expanded research
programs, investigations, experiments, community trials, and
studies, into the development and use of medications to treat
drug addiction;
(3) establish or provide for the establishment of research
facilities;
(4) report on the activities of other relevant agencies relating to the development and use of pharmacotherapeutic treatments for drug addiction;
(5) collect, analyze, and disseminate data useful in the development and use of pharmacotherapeutic treatments for drug
addiction and collect, catalog, analyze, and disseminate
through international channels, the results of such research;
ctly or through grants, contracts, or cooperative agreements, support training in the fundamental sciences and clinical disciplines related to the pharmacotherapeutic treatment
of drug abuse, including the use of training stipends, fellowships, and awards where appropriate; and
(7) coordinate the activities conducted under this section
with related activities conducted within the National Institute
on Alcohol Abuse and Alcoholism, the National Institute of
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Mental Health, and other appropriate institutes and shall consult with the Directors of such Institutes.
(b) DUTIES.—In carrying out the activities described in subsection (a), the Director of the Institute—
(1) shall collect and disseminate through publications and
other appropriate means, information pertaining to the research and other activities under this section;
(2) shall make grants to or enter into contracts and cooperative agreements with individuals and public and private entities to further the goals of the program;
(3) may, in accordance with section 496, and in consultation with the National Advisory Council on Drug Abuse, acquire, construct, improve, repair, operate, and maintain
pharmacotherapeutic research centers, laboratories, and other
necessary facilities and equipment, and such other real or personal property as the Director determines necessary, and may,
in consultation with such Advisory Council, make grants for
the construction or renovation of facilities to carry out the purposes of this section;
(4) may accept voluntary and uncompensated services;
(5) may accept gifts, or donations of services, money, or
property, real, personal, or mixed, tangible or intangible; and
(6) shall take necessary action to ensure that all channels
for the dissemination and exchange of scientific knowledge and
information are maintained between the Institute and the
other scientific, medical, and biomedical disciplines and organizations nationally and internationally.
(c) REPORT.—
(1) IN GENERAL.—Not later than December 31, 1992, and
each December 31 thereafter, the Director of the Institute shall
submit to the Office of National Drug Control Policy established under section 1002 of the Anti-Drug Abuse Act of 1988
(21 U.S.C. 1501) a report, in accordance with paragraph (3),
that describes the objectives and activities of the program assisted under this section.
(2) NATIONAL DRUG CONTROL STRATEGY.—The Director of
National Drug Control Policy shall incorporate, by reference or
otherwise, each report submitted under this subsection in the
National Drug Control Strategy submitted the following February 1 under section 1005 of the Anti-Drug Abuse Act of 1988
(21 U.S.C. 1504).
(d) DEFINITION.—For purposes of this section, the term
‘‘pharmacotherapeutics’’ means medications used to treat the symptoms and disease of drug abuse, including medications to—
(1) block the effects of abused drugs;
(2) reduce the craving for abused drugs;
(3) moderate or eliminate withdrawal symptoms;
(4) block or reverse the toxic effect of abused drugs; or
(5) prevent relapse in persons who have been detoxified
from drugs of abuse.
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Subpart 16—National Institute of Mental Health
PURPOSE OF INSTITUTE

SEC. 464R. ø285p¿ (a) IN GENERAL.—The general purpose of
the National Institute of Mental Health (hereafter in this subpart
referred to as the ‘‘Institute’’) is the conduct and support of biomedical and behavioral research, health services research, research
training, and health information dissemination with respect to the
cause, diagnosis, treatment, control and prevention of mental illness.
(b) RESEARCH PROGRAM.—The research program established
under this subpart shall include support for biomedical and behavioral neuroscience and shall be designed to further the treatment
and prevention of mental illness, the promotion of mental health,
and the study of the psychological, social and legal factors that influence behavior.
(c) COLLABORATION.—The Director of the Institute shall collaborate with the Administrator of the Substance Abuse and Mental Health Services Administration in focusing the services research activities of the Institute and in disseminating the results
of such research to health professionals and the general public.
(d) INFORMATION WITH RESPECT TO SUICIDE.—
(1) IN GENERAL.—The Director of the Institute shall—
(A) develop and publish information with respect to
the causes of suicide and the means of preventing suicide;
and
(B) make such information generally available to the
public and to health professionals.
(2) YOUTH SUICIDE.—Information described in paragraph
(1) shall especially relate to suicide among individuals under
24 years of age.
(e) ASSOCIATE DIRECTOR FOR SPECIAL POPULATIONS.—
(1) IN GENERAL.—The Director of the Institute shall designate an Associate Director for Special Populations.
(2) DUTIES.—The Associate Director for Special Populations shall—
(A) develop and coordinate research policies and programs to assure increased emphasis on the mental health
needs of women and minority populations;
(B) support programs of basic and applied social and
behavioral research on the mental health problems of
women and minority populations;
(C) study the effects of discrimination on institutions
and individuals, including majority institutions and individuals;
(D) support and develop research designed to eliminate institutional discrimination; and
(E) provide increased emphasis on the concerns of
women and minority populations in training programs,
service delivery programs, and research endeavors of the
Institute.
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ASSOCIATE DIRECTOR FOR PREVENTION

SEC. 464S. ø285p–1¿ (a) IN GENERAL.—There shall be in the
Institute an Associate Director for Prevention who shall be responsible for the full-time coordination and promotion of the programs
in the Institute concerning the prevention of mental disorder. The
Associate Director shall be appointed by the Director of the Institute from individuals who because of their professional training or
expertise are experts in mental disorder and the prevention of
such.
(b) REPORT.—The Associate Director for Prevention shall prepare for inclusion in the biennial report made under section 407 a
description of the prevention activities of the Institute, including a
description of the staff and resources allocated to those activities.
OFFICE OF RURAL MENTAL HEALTH RESEARCH

SEC. 464T. ø285p–2¿ (a) IN GENERAL.—There is established
within the Institute an office to be known as the Office of Rural
Mental Health Research (hereafter in this section referred to as the
‘‘Office’’). The Office shall be headed by a director, who shall be appointed by the Director of such Institute from among individuals
experienced or knowledgeable in the provision of mental health
services in rural areas. The Secretary shall carry out the authorities established in this section acting through the Director of the
Office.
(b) COORDINATION OF ACTIVITIES.—The Director of the Office,
in consultation with the Director of the Institute and with the Director of the Office of Rural Health Policy, shall—
(1) coordinate the research activities of the Department of
Health and Human Services as such activities relate to the
mental health of residents of rural areas; and
(2) coordinate the activities of the Office with similar activities of public and nonprofit private entities.
(c) RESEARCH, DEMONSTRATIONS, EVALUATIONS, AND DISSEMINATION.—The Director of the Office may, with respect to the mental health of adults and children residing in rural areas—
(1) conduct research on conditions that are unique to the
residents of rural areas, or more serious or prevalent in such
residents;
(2) conduct research on improving the delivery of services
in such areas; and
(3) disseminate information to appropriate public and nonprofit private entities.
(d) AUTHORITY REGARDING GRANTS AND CONTRACTS.—The Director of the Office may carry out the authorities established in
subsection (c) directly and through grants, cooperative agreements,
or contracts with public or nonprofit private entities.
OFFICE ON AIDS

Sec. 464U. ø285p–3¿ The Director of the Institute shall establish within the Institute an Office on AIDS. The Office shall be responsible for the coordination of research and determining the direction of the Institute with respect to AIDS research related to—
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(1) primary prevention of the spread of HIV, including
transmission via sexual behavior;
(2) mental health services research; and
(3) other matters determined appropriate by the Director.
Subpart 17—National Institute of Nursing Research
PURPOSE OF THE INSTITUTE

SEC. 464V. ø285q¿ The general purpose of the National Institute of Nursing Research (in this subpart referred to as the ‘‘Institute’’) is the conduct and support of, and dissemination of information respecting, basic and clinical nursing research, training, and
other programs in patient care research.
SPECIFIC AUTHORITIES

SEC. 464W. ø285q–1¿ To carry out section 464V, the Director
of the Institute may provide research training and instruction and
establish, in the Institute and other nonprofit institutions, research
traineeships and fellowships in the study and investigation of the
prevention of disease, health promotion, and the nursing care of individuals with and the families of individuals with acute and
chronic illnesses. The Director of the Institute may provide individuals receiving such training and instruction or such traineeships or
fellowships with such stipends and allowances (including amounts
for travel and subsistence and dependency allowances) as the Director determines necessary. The Director may make grants to nonprofit institutions to provide such training and instruction and
traineeships and fellowships.
ADVISORY COUNCIL

SEC. 464X. ø285q–2¿ (a)(1) The Secretary shall appoint an advisory council for the Institute which shall advise, assist, consult
with, and make recommendations to the Secretary and the Director
of the Institute on matters related to the activities carried out by
and through the Institute and the policies respecting such activities.
(2) The advisory council for the Institute may recommend to
the Secretary acceptance, in accordance with section 2701, 1 of conditional gifts for study, investigations, and research and for the acquisition of grounds or construction, equipping, or maintenance of
facilities for the Institute.
(3) The advisory council for the Institute—
(A)(i) may make recommendations to the Director of the
Institute respecting research conducted at the Institute,
(ii) may review applications for grants and cooperative
agreements for research or training and recommend for approval applications for projects which show promise of making
valuable contributions to human knowledge, and
1 Probably should be section 231. That section formerly was section 2701, and was redesignated by subsection (a)(2) of section 2010 of Public Law 103–43 (107 Stat. 213). Subsection (b)(5)
of such section purported to conform the above reference, but the amendment cannot be executed because the amendment applied to the incorrect section. (The conforming amendment applied to section 485. Section 464X formerly was section 485, and was redesignated by section
1511(b)(2)(B) of Public Law 103–43 (107 Stat. 179).)

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(iii) may review any grant, contract, or cooperative agreement proposed to be made or entered into by the Institute;
(B) may collect, by correspondence or by personal investigation, information as to studies which are being carried on
in the United States or any other country as to the diseases,
disorders, or other aspects of human health with respect to
which the Institute is concerned and with the approval of the
Director of the Institute make available such information
through appropriate publications for the benefit of public and
private health entities and health professions personnel and
scientists and for the information of the general public; and
(C) may appoint subcommittees and convene workshops
and conferences.
(b)(1) The advisory council shall consist of ex officio members
and not more than eighteen members appointed by the Secretary.
(2) The ex officio members of the advisory council shall consist
of—
(A) the Secretary, the Director of NIH, the Director of the
Institute, the chief nursing officer of the Department of Veterans Affairs, the Assistant Secretary of Defense for Health Affairs, the Director of the Division of Nursing of the Health Resources and Services Administration (or the designees of such
officers), and
(B) such additional officers or employees of the United
States as the Secretary determines necessary for the advisory
council to effectively carry out its functions.
(3) The members of the advisory council who are not ex officio
members shall be appointed as follows:
(A) Two-thirds of the members shall be appointed by the
Secretary from among the leading representatives of the health
and scientific disciplines (including public health and the behavioral or social sciences) relevant to the activities of the Institute. Of the members appointed pursuant to this subparagraph, at least seven shall be professional nurses who are recognized experts in the area of clinical practice, education, or research.
(B) One-third of the members shall be appointed by the
Secretary from the general public and shall include leaders in
fields of public policy, law, health policy, economics, and management.
(4) Members of the advisory council who are officers or employees of the United States shall not receive any compensation for
service on the advisory council. The other members of the advisory
council shall receive, for each day (including traveltime) they are
engaged in the performance of the functions of the advisory council,
compensation at rates not to exceed the daily equivalent of the annual rate in effect for grade GS–18 of the General Schedule.
(c) The term of office of an appointed member of the advisory
council is four years, except that any member appointed to fill a
vacancy for an unexpired term shall be appointed for the remainder of such term and the Secretary shall make appointments to an
advisory council in such a manner as to ensure that the terms of
the members do not all expire in the same year. A member may
serve after the expiration of the member’s term until a successor
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has taken office. A member who has been appointed for a term of
four years may not be reappointed to an advisory council before
two years from the date of expiration of such term of office. If a
vacancy occurs in the advisory council among the appointed members, the Secretary shall make an appointment to fill the vacancy
within 90 days from the date the vacancy occurs.
(d) The chairman of the advisory council shall be selected by
the Secretary from among the appointed members, except that the
Secretary may select the Director of the Institute to be the chairman of the advisory council. The term of office of the chairman
shall be two years.
(e) The advisory council shall meet at the call of the chairman
or upon the request of the Director of the Institute, but at least
three times each fiscal year. The location of the meetings of the advisory council is subject to the approval of the Director of the Institute.
(f) The Director of the Institute shall designate a member of
the staff of the Institute to serve as the executive secretary of the
advisory council. The Director of the Institute shall make available
to the advisory council such staff, information, and other assistance
as it may require to carry out its functions. The Director of the Institute shall provide orientation and training for new members of
the advisory council to provide them with such information and
training as may be appropriate for their effective participation in
the functions of the advisory council.
(g) The advisory council may prepare, for inclusion in the biennial report made under section 464Y, (1) comments respecting the
activities of the advisory council in the fiscal years respecting
which the report is prepared, (2) comments on the progress of the
Institute in meeting its objectives, and (3) recommendations respecting the future directions and program and policy emphasis of
the Institute. The advisory council may prepare such additional reports as it may determine appropriate.
BIENNIAL REPORT

SEC. 464Y. ø285q–3¿ The Director of the Institute after consultation with the advisory council for the Institute, shall prepare
for inclusion in the biennial report made under section 403 a biennial report which shall consist of a description of the activities of
the Institute and program policies of the Director of the Institute
in the fiscal years respecting which the report is prepared. The Director of the Institute may prepare such additional reports as the
Director determines appropriate. The Director of the Institute shall
provide the advisory council of the Institute an opportunity for the
submission of the written comments referred to in section 464X(g).
Subpart 18—National Institute of Biomedical Imaging and
Bioengineering
PURPOSE OF THE INSTITUTE

SEC. 464z. ø285r¿ (a) The general purpose of the National Institute of Biomedical Imaging and Bioengineering (in this section
referred to as the ‘‘Institute’’) is the conduct and support of research, training, the dissemination of health information, and other
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programs with respect to biomedical imaging, biomedical engineering, and associated technologies and modalities with biomedical applications (in this section referred to as ‘‘biomedical imaging and
bioengineering’’).
(b)(1) The Director of the Institute, with the advice of the Institute’s advisory council, shall establish a National Biomedical Imaging and Bioengineering Program (in this section referred to as the
‘‘Program’’).
(2) Activities under the Program shall include the following
with respect to biomedical imaging and bioengineering:
(A) Research into the development of new techniques and
devices.
(B) Related research in physics, engineering, mathematics,
computer science, and other disciplines.
(C) Technology assessments and outcomes studies to evaluate the effectiveness of biologics, materials, processes, devices,
procedures, and informatics.
(D) Research in screening for diseases and disorders.
(E) The advancement of existing imaging and bioengineering modalities, including imaging, biomaterials, and
informatics.
(F) The development of target-specific agents to enhance
images and to identify and delineate disease.
(G) The development of advanced engineering and imaging
technologies and techniques for research from the molecular
and genetic to the whole organ and body levels.
(H) The development of new techniques and devices for
more effective interventional procedures (such as image-guided
interventions).
(3)(A) With respect to the Program, the Director of the Institute shall prepare and transmit to the Secretary and the Director
of NIH a plan to initiate, expand, intensify, and coordinate activities of the Institute with respect to biomedical imaging and bioengineering. The plan shall include such comments and recommendations as the Director of the Institute determines appropriate. The Director of the Institute shall periodically review and
revise the plan and shall transmit any revisions of the plan to the
Secretary and the Director of NIH.
(B) The plan under subparagraph (A) shall include the recommendations of the Director of the Institute with respect to the
following:
(i) Where appropriate, the consolidation of programs of the
National Institutes of Health for the express purpose of enhancing support of activities regarding basic biomedical imaging and bioengineering research.
(ii) The coordination of the activities of the Institute with
related activities of the other agencies of the National Institutes of Health and with related activities of other Federal
agencies.
(c) The establishment under section 406 of an advisory council
for the Institute is subject to the following:
(1) The number of members appointed by the Secretary
shall be 12.
(2) Of such members—
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(A) six members shall be scientists, engineers, physicians, and other health professionals who represent disciplines in biomedical imaging and bioengineering and who
are not officers or employees of the United States; and
(B) six members shall be scientists, engineers, physicians, and other health professionals who represent other
disciplines and are knowledgeable about the applications
of biomedical imaging and bioengineering in medicine, and
who are not officers or employees of the United States.
(3) In addition to the ex officio members specified in section 406(b)(2), the ex officio members of the advisory council
shall include the Director of the Centers for Disease Control
and Prevention, the Director of the National Science Foundation, and the Director of the National Institute of Standards
and Technology (or the designees of such officers).
Subpart 19—National Human Genome Research Institute
PURPOSE OF THE CENTER 1

SEC. 464z–1. ø285s¿ (a) The general purpose of the National
Human Genome Research Institute (in this subpart referred to as
the ‘‘Institute’’) is to characterize the structure and function of the
human genome, including the mapping and sequencing of individual genes. Such purpose includes—
(1) planning and coordinating the research goal of the genome project;
(2) reviewing and funding research proposals;
(3) developing training programs;
(4) coordinating international genome research;
(5) communicating advances in genome science to the public; and
(6) reviewing and funding proposals to address the ethical
and legal issues associated with the genome project (including
legal issues regarding patents).
(b) The Director of the Institute may conduct and support research training—
(1) for which fellowship support is not provided under section 487; and
(2) that is not residency training of physicians or other
health professionals.
(c)(1) Except as provided in paragraph (2), of the amounts appropriated to carry out subsection (a) for a fiscal year, the Director
of the Institute shall make available not less than 5 percent for
carrying out paragraph (6) of such subsection.
(2) With respect to providing funds under subsection (a)(6) for
proposals to address the ethical issues associated with the genome
project, paragraph (1) shall not apply for a fiscal year if the Director of the Institute certifies to the Committee on Energy and Commerce of the House of Representatives, and to the Committee on
Labor and Human Resources of the Senate, that the Director has
1 The word ‘‘CENTER’’ in the section heading probably should read ‘‘INSTITUTE’’. Section
101(c)(4)(C) of Public Law 109–482 (120 Stat. 3675) struck ‘‘center’’ each place such term appeared in this subpart and inserted ‘‘institute’’. However, this amendment was not effective with
respect to the section heading because the word ‘‘CENTER’’ appears in small caps.

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determined that an insufficient number of such proposals meet the
applicable requirements of sections 491 and 492.
Subpart 20—National Institute on Minority Health and Health
Disparities
SEC. 464z–3. ø285t¿ PURPOSE OF CENTER 1.
(a) IN GENERAL.—The general purpose

of the National Institute on Minority Health and Health Disparities (in this subpart referred to as the ‘‘Institute’’) is the conduct and support of research,
training, dissemination of information, and other programs with respect to minority health conditions and other populations with
health disparities.
(b) PRIORITIES.—The Director of the Institute shall in expending amounts appropriated under this subpart give priority to conducting and supporting minority health disparities research.
(c) MINORITY HEALTH DISPARITIES RESEARCH.—For purposes of
this subpart:
(1) The term ‘‘minority health disparities research’’ means
basic, clinical, and behavioral research on minority health conditions (as defined in paragraph (2)), including research to prevent, diagnose, and treat such conditions.
(2) The term ‘‘minority health conditions’’, with respect to
individuals who are members of minority groups, means all
diseases, disorders, and conditions (including with respect to
mental health and substance abuse)—
(A) unique to, more serious, or more prevalent in such
individuals;
(B) for which the factors of medical risk or types of
medical intervention may be different for such individuals,
or for which it is unknown whether such factors or types
are different for such individuals; or
(C) with respect to which there has been insufficient
research involving such individuals as subjects or insufficient data on such individuals.
(3) The term ‘‘minority group’’ has the meaning given the
term ‘‘racial and ethnic minority group’’ in section 1707.
(4) The terms ‘‘minority’’ and ‘‘minorities’’ refer to individuals from a minority group.
(d) HEALTH DISPARITY POPULATIONS.—For purposes of this
subpart:
(1) A population is a health disparity population if, as determined by the Director of the Institute after consultation
with the Director of the Agency for Healthcare Research and
Quality, there is a significant disparity in the overall rate of
disease incidence, prevalence, morbidity, mortality, or survival
rates in the population as compared to the health status of the
general population.
(2) The Director shall give priority consideration to determining whether minority groups qualify as health disparity
populations under paragraph (1).
1 The word ‘‘CENTER’’ in the section heading for section 464z–3 probably should read ‘‘INSTITUTE’’. See amendment made by section 10334(c)(1)(D)(iii) of Public Law 111–148.

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(3) The term ‘‘health disparities research’’ means basic,
clinical, and behavioral research on health disparity populations (including individual members and communities of such
populations) that relates to health disparities as defined under
paragraph (1), including the causes of such disparities and
methods to prevent, diagnose, and treat such disparities.
(e) COORDINATION OF ACTIVITIES.—The Director of the Institute
shall act as the primary Federal official with responsibility for coordinating all minority health disparities research and other health
disparities research conducted or supported by the National Institutes of Health, and—
(1) shall represent the health disparities research program
of the National Institutes of Health, including the minority
health disparities research program, at all relevant Executive
branch task forces, committees and planning activities; and
(2) shall maintain communications with all relevant Public
Health Service agencies, including the Indian Health Service,
and various other departments of the Federal Government to
ensure the timely transmission of information concerning advances in minority health disparities research and other health
disparities research between these various agencies for dissemination to affected communities and health care providers.
(f) COLLABORATIVE COMPREHENSIVE PLAN AND BUDGET.—
(1) IN GENERAL.—Subject to the provisions of this section
and other applicable law, the Director of NIH, the Director of
the Institute, and the directors of the other agencies of the National Institutes of Health in collaboration (and in consultation
with the advisory council for the Institute) shall—
(A) establish a comprehensive plan and budget for the
conduct and support of all minority health disparities research and other health disparities research activities of
the agencies of the National Institutes of Health (which
plan and budget shall be first established under this subsection not later than 12 months after the date of the enactment of this subpart);
(B) ensure that the plan and budget establish priorities among the health disparities research activities that
such agencies are authorized to carry out;
(C) ensure that the plan and budget establish objectives regarding such activities, describes the means for
achieving the objectives, and designates the date by which
the objectives are expected to be achieved;
(D) ensure that, with respect to amounts appropriated
for activities of the Institute, the plan and budget give priority in the expenditure of funds to conducting and supporting minority health disparities research;
(E) ensure that all amounts appropriated for such activities are expended in accordance with the plan and
budget;
(F) review the plan and budget not less than annually,
and revise the plan and budget as appropriate;
(G) ensure that the plan and budget serve as a broad,
binding statement of policies regarding minority health
disparities research and other health disparities research
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activities of the agencies, but do not remove the responsibility of the heads of the agencies for the approval of specific programs or projects, or for other details of the daily
administration of such activities, in accordance with the
plan and budget; and
(H) promote coordination and collaboration among the
agencies conducting or supporting minority health or other
health disparities research.
(2) CERTAIN COMPONENTS OF PLAN AND BUDGET.—With respect to health disparities research activities of the agencies of
the National Institutes of Health, the Director of the Institute
shall ensure that the plan and budget under paragraph (1) provide for—
(A) basic research and applied research, including research and development with respect to products;
(B) research that is conducted by the agencies;
(C) research that is supported by the agencies;
(D) proposals developed pursuant to solicitations by
the agencies and for proposals developed independently of
such solicitations; and
(E) behavioral research and social sciences research,
which may include cultural and linguistic research in each
of the agencies.
(3) MINORITY HEALTH DISPARITIES RESEARCH.—The plan
and budget under paragraph (1) shall include a separate statement of the plan and budget for minority health disparities research.
(g) PARTICIPATION IN CLINICAL RESEARCH.—The Director of the
Institute shall work with the Director of NIH and the directors of
the agencies of the National Institutes of Health to carry out the
provisions of section 492B that relate to minority groups.
(h) RESEARCH ENDOWMENTS.—
(1) IN GENERAL.—The Director of the Institute may carry
out a program to facilitate minority health disparities research
and other health disparities research by providing for research
endowments—
(1) at centers of excellence under section 736; and
(2) at centers of excellence under section 464z–4. 1
(2) ELIGIBILITY.—The Director of the Institute may provide
for a research endowment under paragraph (1) only if the institution involved meets the following conditions:
(A) The institution does not have an endowment that
is worth in excess of an amount equal to 50 percent of the
national median of endowment funds at institutions that
conduct similar biomedical research or training of health
professionals.
(B) The application of the institution under paragraph
(1) regarding a research endowment has been recommended pursuant to technical and scientific peer review
1 So in law. Section 10334(c)(2)(A) of Public Law 111–148 amends (h)(1) by striking and inserting text that results in two paragraphs (1) and (2). The second paragraph (1) and the first paragraph (2) proabbly should be redesignated as subparagraphs (A) and (B), respectively (and moving margins to the right so that they align with subparagraphs cpmtaomed in paragraph (2)).

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and has been approved by the advisory council under subsection (j).
(i) CERTAIN ACTIVITIES.—In carrying out subsection (a), the Director of the Institute—
(1) shall assist the Director of NIH 1 in carrying out section
404I(c)(2) and in committing resources for construction at Institutions of Emerging Excellence under such section;
(2) shall establish projects to promote cooperation among
Federal agencies, State, local, tribal, and regional public health
agencies, and private entities in health disparities research;
and
(3) may utilize information from previous health initiatives
concerning minorities and other health disparity populations.
(j) ADVISORY COUNCIL.—
(1) IN GENERAL.—The Secretary shall, in accordance with
section 406, establish an advisory council to advise, assist, consult with, and make recommendations to the Director of the Institute on matters relating to the activities described in subsection (a), and with respect to such activities to carry out any
other functions described in section 406 for advisory councils
under such section. Functions under the preceding sentence
shall include making recommendations on budgetary allocations made in the plan under subsection (f), and shall include
reviewing reports under subsection (k) before the reports are
submitted under such subsection.
(2) MEMBERSHIP.—With respect to the membership of the
advisory council under paragraph (1), a majority of the members shall be individuals with demonstrated expertise regarding minority health disparity and other health disparity issues;
representatives of communities impacted by minority and other
health disparities shall be included; and a diversity of health
professionals shall be represented. The membership shall in
addition include a representative of the Office of Behavioral
and Social Sciences Research under section 404A.
(h) 1 INTERAGENCY COORDINATION.—The Director of the Institute, as the primary Federal officials with responsibility for coordinating all research and activities conducted or supported by the
National Institutes of Health on minority health and health disparities, shall plan, coordinate, review and evaluate research and
other activities conducted or supported by the Institutes and Centers of the National Institutes of Health.
SEC. 464z–4. ø285t–1¿ CENTERS OF EXCELLENCE FOR RESEARCH EDUCATION AND TRAINING.
(a) IN GENERAL.—The Director of the Institute shall make

awards of grants or contracts to designated biomedical and behavioral research institutions under paragraph (1) of subsection (c), or
to consortia under paragraph (2) of such subsection, for the purpose
of assisting the institutions in supporting programs of excellence in
1 Section 221(d)(3)(A) of division F of Public Law 112–74 provided for an amendment to strike
‘‘Director of National Institute for Research Resources’’ and inserting ‘‘Director of NIH’’. The
amendment probably should have been to strike ‘‘Director of [the] National Institute for Research Resources’’, but was carried out to reflect the probable intent of Congress.
1 So in law. Section 10334(c)(2)(C) of Public Law 111–148 amends section 464z–3 (as redesignated) by adding a subsection (h) at the end. Probably should be a subsection (k).

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biomedical and behavioral research training for individuals who
are members of minority health disparity populations or other
health disparity populations.
(b) REQUIRED USE OF FUNDS.—An award may be made under
subsection (a) only if the applicant involved agrees that the grant
will be expended—
(1) to train members of minority health disparity populations or other health disparity populations as professionals in
the area of biomedical or behavioral research or both; or
(2) to expand, remodel, renovate, or alter existing research
facilities or construct new research facilities for the purpose of
conducting minority health disparities research and other
health disparities research.
(c) CENTERS OF EXCELLENCE.—
(1) IN GENERAL.—For purposes of this section, a designated
biomedical and behavioral research institution is a biomedical
and behavioral research institution that—
(A) has a significant number of members of minority
health disparity populations or other health disparity populations enrolled as students in the institution (including
individuals accepted for enrollment in the institution);
(B) has been effective in assisting such students of the
institution to complete the program of education or training and receive the degree involved;
(C) has made significant efforts to recruit minority
students to enroll in and graduate from the institution,
which may include providing means-tested scholarships
and other financial assistance as appropriate; and
(D) has made significant recruitment efforts to increase the number of minority or other members of health
disparity populations serving in faculty or administrative
positions at the institution.
(2) CONSORTIUM.—Any designated biomedical and behavioral research institution involved may, with other biomedical
and behavioral institutions (designated or otherwise), including
tribal health programs, form a consortium to receive an award
under subsection (a).
(3) APPLICATION OF CRITERIA TO OTHER PROGRAMS.—In the
case of any criteria established by the Director of the Institute
for purposes of determining whether institutions meet the conditions described in paragraph (1), this section may not, with
respect to minority health disparity populations or other health
disparity populations, be construed to authorize, require, or
prohibit the use of such criteria in any program other than the
program established in this section.
(d) DURATION OF GRANT.—The period during which payments
are made under a grant under subsection (a) may not exceed 5
years. Such payments shall be subject to annual approval by the
Director of the Institute and to the availability of appropriations
for the fiscal year involved to make the payments.
(e) MAINTENANCE OF EFFORT.—
(1) IN GENERAL.—With respect to activities for which an
award under subsection (a) is authorized to be expended, the
Director of the Institute may not make such an award to a desMarch 13, 2013

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ignated research institution or consortium for any fiscal year
unless the institution, or institutions in the consortium, as the
case may be, 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 institutions involved for the fiscal year preceding the fiscal year for which
such institutions receive such an award.
(2) USE OF FEDERAL FUNDS.—With respect to any Federal
amounts received by a designated research institution or consortium and available for carrying out activities for which an
award under subsection (a) is authorized to be expended, the
Director of the Institute may make such an award only if the
institutions involved agree that the institutions will, before expending the award, expend the Federal amounts obtained from
sources other than the award.
(f) CERTAIN EXPENDITURES.—The Director of the Institute may
authorize a designated biomedical and behavioral research institution to expend a portion of an award under subsection (a) for research endowments.
(g) DEFINITIONS.—For purposes of this section:
(1) The term ‘‘designated biomedical and behavioral research institution’’ has the meaning indicated for such term in
subsection (c)(1). Such term includes any health professions
school receiving an award of a grant or contract under section
736.
(2) The term ‘‘program of excellence’’ means any program
carried out by a designated biomedical and behavioral research
institution with an award under subsection (a), if the program
is for purposes for which the institution involved is authorized
in subsection (b) to expend the grant.
SEC. 464z–5.

ø285t–2¿ LOAN REPAYMENT PROGRAM FOR MINORITY
HEALTH DISPARITIES RESEARCH.
IN GENERAL.—The Director of the Institute shall establish

(a)
a program of entering into contracts with qualified health professionals under which such health professionals agree to engage in
minority health disparities research or other health disparities research in consideration of the Federal Government agreeing to
repay, for each year of engaging in such research, not more than
$35,000 of the principal and interest of the educational loans of
such health professionals.
(b) SERVICE PROVISIONS.—The provisions of sections 338B,
338C, and 338E shall, except as inconsistent with subsection (a),
apply to the program established in such subsection to the same
extent and in the same manner as such provisions apply to the National Health Service Corps Loan Repayment Program established
in subpart III of part D of title III.
(c) REQUIREMENT REGARDING HEALTH DISPARITY POPULATIONS.—The Director of the Institute shall ensure that not fewer
than 50 percent of the contracts entered into under subsection (a)
are for appropriately qualified health professionals who are members of a health disparity population.
(d) PRIORITY.—With respect to minority health disparities research and other health disparities research under subsection (a),
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the Secretary shall ensure that priority is given to conducting
projects of biomedical research.
SEC. 464z–6. ø285t–3¿ GENERAL PROVISIONS REGARDING THE CENTER.

The Secretary, acting through the Director of the National Institutes of Health, shall provide administrative support and support services to the Director of the Institute and shall ensure that
such support takes maximum advantage of existing administrative
structures at the agencies of the National Institutes of Health.
PART D—NATIONAL LIBRARY

OF

MEDICINE

Subpart 1—General Provisions
PURPOSE, ESTABLISHMENT, AND FUNCTIONS OF THE NATIONAL
LIBRARY OF MEDICINE

SEC. 465. ø286¿ (a) In order to assist the advancement of medical and related sciences and to aid the dissemination and exchange
of scientific and other information important to the progress of
medicine and to the public health, there is established the National
Library of Medicine (hereafter in this part referred to as the ‘‘Library’’).
(b) The Secretary, through the Library and subject to subsection (d), shall—
(1) acquire and preserve books, periodicals, prints, films,
recordings, and other library materials pertinent to medicine;
(2) organize the materials specified in paragraph (1) by appropriate cataloging, indexing, and bibliographical listings;
(3) publish and disseminate the catalogs, indexes, and bibliographies referred to in paragraph (2);
(4) make available, through loans, photographic or other
copying procedures, or otherwise, such materials in the Library
as the Secretary determines appropriate;
(5) provide reference and research assistance;
(6) publicize the availability from the Library of the products and services described in any of paragraphs (1) through
(5);
(7) promote the use of computers and telecommunications
by health professionals (including health professionals in rural
areas) for the purpose of improving access to biomedical information for health care delivery and medical research; and
(8) engage in such other activities as the Secretary determines appropriate and as the Library’s resources permit.
(c) The Secretary may exchange, destroy, or otherwise dispose
of any books, periodicals, films, and other library materials not
needed for the permanent use of the Library.
(d)(1) The Secretary may, after obtaining the advice and recommendations of the Board of Regents, prescribe rules under which
the Library will—
(A) provide copies of its publications or materials,
(B) will make available its facilities for research, or
(C) will make available its bibliographic, reference, or
other services,
to public and private entities and individuals.
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(2) Rules prescribed under paragraph (1) may provide for making available such publications, materials, facilities, or services—
(A) without charge as a public service,
(B) upon a loan, exchange, or charge basis, or
(C) in appropriate circumstances, under contract arrangements made with a public or other nonprofit entity.
(e) Whenever the Secretary, with the advice of the Board of Regents, determines that—
(1) in any geographic area of the United States there is no
regional medical library adequate to serve such area;
(2) under criteria prescribed for the administration of section 475, there is a need for a regional medical library to serve
such area; and
(3) because there is no medical library located in such area
which, with financial assistance under section 475, can feasibly
be developed into a regional medical library adequate to serve
such area,
the Secretary may establish, as a branch of the Library, a regional
medical library to serve the needs of such area.
(f) Section 231 shall be applicable to the acceptance and administration of gifts made for the benefit of the Library or for carrying
out any of its functions, and the Board of Regents shall make recommendations to the Secretary relating to establishment within
the Library of suitable memorials to the donors.
(g) For purposes of this part, the terms ‘‘medicine’’ and ‘‘medical’’, except when used in section 466, include preventive and
therapeutic medicine, dentistry, pharmacy, hospitalization, nursing, public health, and the fundamental sciences related thereto,
and other related fields of study, research, or activity.
BOARD OF REGENTS

SEC. 466. ø286a¿ (a)(1)(A) The Board of Regents of the National Library of Medicine consists of ex officio members and ten
members appointed by the Secretary.
(B) The ex officio members are the Surgeons General of the
Public Health Service, the Army, the Navy, and the Air Force, the
Chief Medical Director of the Department of Veterans Affairs, the
Dean of the Uniformed Services University of the Health Sciences,
the Assistant Director for Biological, Behavioral, and Social
Sciences of the National Science Foundation, the Director of the
National Agricultural Library, and the Librarian of Congress (or
their designees).
(C) The appointed members shall be selected from among leaders in the various fields of the fundamental sciences, medicine, dentistry, public health, hospital administration, pharmacology, health
communications technology, or scientific or medical library work, or
in public affairs. At least six of the appointed members shall be selected from among leaders in the fields of medical, dental, or public
health research or education.
(2) The Board shall annually elect one of the appointed members to serve as chairman until the next election. The Secretary
shall designate a member of the Library staff to act as executive
secretary of the Board.
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(b) The Board shall advise, consult with, and make recommendations to the Secretary on matters of policy in regard to
the Library, including such matters as the acquisition of materials
for the Library, the scope, content, and organization of the Library’s services, and the rules under which its materials, publications, facilities, and services shall be made available to various
kinds of users. The Secretary shall include in the annual report of
the Secretary to the Congress a statement covering the recommendations made by the Board and the disposition thereof. The
Secretary may use the services of any member of the Board in connection with matters related to the work of the Library, for such
periods, in addition to conference periods, as the Secretary may determine.
(c) Each appointed member of the Board shall hold office for
a term of four years, except that any member appointed to fill a
vacancy occurring prior to the expiration of the term for which the
predecessor of such member was appointed shall be appointed for
the remainder of such term. None of the appointed members shall
be eligible for reappointment within one year after the end of the
preceding term of such member.
LIBRARY FACILITIES

SEC. 467. ø286a–1¿ The Administrator of General Services
may acquire, by purchase, condemnation, donation, or otherwise, a
suitable site or sites, selected by the Secretary in accordance with
the direction of the Board, for suitable and adequate buildings and
facilities for use of the Library and to erect thereon, furnish, and
equip such buildings and facilities. Amounts appropriated to carry
out this section may be used for the cost of preparation of drawings
and specifications, supervision of construction, and other administrative expenses incident to the work. The Administrator of General Services shall prepare the plans and specifications, make all
necessary contracts, and supervise construction.
Subpart 2—Financial Assistance
DEFINITIONS

SEC. 470. ø286b–1¿ As used in this subpart—
(1) the term ‘‘medical library’’ means a library related to
the sciences related to health; and
(2) the term ‘‘sciences related to health’’ includes medicine,
osteopathy, dentistry, and public health, and fundamental and
applied sciences when related thereto.
NATIONAL MEDICAL LIBRARIES ASSISTANCE ADVISORY BOARD

SEC. 471. ø286b–2¿ (a) The Board of Regents of the National
Library of Medicine shall also serve as the National Medical Libraries Assistance Advisory Board (hereafter in this subpart referred to as the ‘‘Board’’).
(b) The Board shall advise and assist the Secretary in the
preparation of general regulations and with respect to policy matters arising in the administration of this subpart.
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(c) The Secretary may use the services of any member of the
Board, in connection with matters related to the administration of
this part for such periods, in addition to conference periods, as the
Secretary may determine.
(d) Appointed members of the Board who are not otherwise in
the employ of the United States, while attending conferences of the
Board or otherwise serving at the request of the Secretary in connection with the administration of this subpart, shall be entitled to
receive compensation, per diem in lieu of subsistence, and travel
expenses in the same manner and under the same conditions as
that prescribed under section 208(c) when attending conferences,
traveling, or serving at the request of the Secretary in connection
with the Board’s function under this section.
GRANTS FOR TRAINING IN MEDICAL LIBRARY SCIENCES

SEC. 472. ø286b–3¿ The Secretary shall make grants—
(1) to individuals to enable them to accept traineeships
and fellowships leading to postbaccalaureate academic degrees
in the field of medical library science, in related fields pertaining to sciences related to health, or in the field of the communication of information;
(2) to individuals who are librarians or specialists in information on sciences relating to health, to enable them to undergo intensive training or retraining so as to attain greater competence in their occupations (including competence in the fields
of automatic data processing and retrieval);
(3) to assist appropriate public and private nonprofit institutions in developing, expanding, and improving training programs in library science and the field of communications of information pertaining to sciences relating to health; and
(4) to assist in the establishment of internship programs in
established medical libraries meeting standards which the Secretary shall prescribe.
ASSISTANCE FOR SPECIAL SCIENTIFIC PROJECTS, AND FOR RESEARCH
AND DEVELOPMENT IN MEDICAL LIBRARY SCIENCE AND RELATED
FIELDS

SEC. 473. ø286b–4¿ (a) The Secretary shall make grants to
physicians and other practitioners in the sciences related to health,
to scientists, and to public or nonprofit private institutions on behalf of such physicians, other practitioners, and scientists for the
compilation of existing, or the writing of original, contributions relating to scientific, social, or cultural advancements in sciences related to health. In making such grants, the Secretary shall make
appropriate arrangements under which the facilities of the Library
and the facilities of libraries of public and private nonprofit institutions of higher learning may be made available in connection with
the projects for which such grants are made.
(b) The Secretary shall make grants to appropriate public or
private nonprofit institutions and enter into contracts with appropriate persons, for purposes of carrying out projects of research, investigations, and demonstrations in the field of medical library
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niques, systems, and equipment, for processing, storing, retrieving,
and distributing information pertaining to sciences related to
health.
(c)(1) The Secretary shall make grants to public or nonprofit
private institutions for the purpose of carrying out projects of research on, and development and demonstration of, new education
technologies.
(2) The purposes for which a grant under paragraph (1) may
be made include projects concerning—
(A) computer-assisted teaching and testing of clinical competence at health professions and research institutions;
(B) the effective transfer of new information from research
laboratories to appropriate clinical applications;
(C) the expansion of the laboratory and clinical uses of
computer-stored research databases; and
(D) the testing of new technologies for training health care
professionals.
(3) The Secretary may not make a grant under paragraph (1)
unless the applicant for the grant agrees to make the projects
available with respect to—
(A) assisting in the training of health professions students;
and
(B) enhancing and improving the capabilities of health professionals regarding research and teaching.
GRANTS FOR ESTABLISHING, EXPANDING, AND IMPROVING THE BASIC
RESOURCES OF MEDICAL LIBRARIES AND RELATED INSTRUMENTALITIES

SEC. 474. ø286b–5¿ (a) The Secretary shall make grants of
money, materials, or both, to public or private nonprofit medical libraries and related scientific communication instrumentalities for
the purpose of establishing, expanding, and improving their basic
medical library or related resources. A grant under this subsection
may be used for—
(1) the acquisition of books, journals, photographs, motion
picture and other films, and other similar materials;
(2) cataloging, binding, and other services and procedures
for processing library resource materials for use by those who
are served by the library or related instrumentality;
(3) the acquisition of duplication devices, facsimile equipment, film projectors, recording equipment, and other equipment to facilitate the use of the resources of the library or related instrumentality by those who are served by it; and
(4) the introduction of new technologies in medical librarianship.
(b)(1) The amount of any grant under this section to any medical library or related instrumentality shall be determined by the
Secretary on the basis of the scope of library or related services
provided by such library or instrumentality in relation to the population and purposes served by it. In making a determination of the
scope of services served by any medical library or related instrumentality, the Secretary shall take into account—
(A) the number of graduate and undergraduate students
making use of the resources of such library or instrumentality;
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(B) the number of physicians and other practitioners in the
sciences related to health utilizing the resources of such library
or instrumentality;
(C) the type of supportive staffs, if any, available to such
library or instrumentality;
(D) the type, size, and qualifications of the faculty of any
school with which such library or instrumentality is affiliated;
(E) the staff of any hospital or hospitals or of any clinic or
clinics with which such library or instrumentality is affiliated;
and
(F) the geographic area served by such library or instrumentality and the availability within such area of medical library or related services provided by other libraries or related
instrumentalities.
(2) Grants to such medical libraries or related instrumentalities under this section shall be in such amounts as the Secretary
may by regulation prescribe with a view to assuring adequate continuing financial support for such libraries or instrumentalities
from other sources during and after the period for which grants are
provided, except that in no case shall any grant under this section
to a medical library or related instrumentality for any fiscal year
exceed $1,000,000.
GRANTS AND CONTRACTS FOR ESTABLISHMENT OF REGIONAL MEDICAL
LIBRARIES

SEC. 475. ø286b–6¿ (a) The Secretary, with the advice of the
Board, shall make grants to and enter into contracts with existing
public or private nonprofit medical libraries so as to enable each
of them to serve as the regional medical library for the geographical area in which it is located.
(b) The uses for which grants and contracts under this section
may be employed include the—
(1) acquisition of books, journals, and other similar materials;
(2) cataloging, binding, and other procedures for processing
library resource materials for use by those who are served by
the library;
(3) acquisition of duplicating devices and other equipment
to facilitate the use of the resources of the library by those who
are served by it;
(4) acquisition of mechanisms and employment of personnel for the speedy transmission of materials from the regional library to local libraries in the geographic area served
by the regional library; and
(5) planning for services and activities under this section.
(c)(1) Grants and contracts under this section shall only be
made to or entered into with medical libraries which agree—
(A) to modify and increase their library resources, and to
supplement the resources of cooperating libraries in the region,
so as to be able to provide adequate supportive services to all
libraries in the region as well as to individual users of library
services; and
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(B) to provide free loan services to qualified users and
make available photoduplicated or facsimile copies of biomedical materials which qualified requesters may retain.
(2) The Secretary, in awarding grants and contracts under this
section, shall give priority to medical libraries having the greatest
potential of fulfilling the needs for regional medical libraries. In determining the priority to be assigned to any medical library, the
Secretary shall consider—
(A) the adequacy of the library (in terms of collections, personnel, equipment, and other facilities) as a basis for a regional
medical library; and
(B) the size and nature of the population to be served in
the region in which the library is located.
(d) Grants and contracts under this section for basic resource
materials to a library may not exceed—
(1) 50 percent of the library’s annual operating expense
(exclusive of Federal financial assistance under this part) for
the preceding year; or
(2) in case of the first year in which the library receives
a grant under this section for basic resource materials, 50 percent of its average annual operating expenses over the past
three years (or if it had been in operation for less than three
years, its annual operating expenses determined by the Secretary in accordance with regulations).
FINANCIAL SUPPORT OF BIOMEDICAL SCIENTIFIC PUBLICATIONS

SEC. 476. ø286b–7¿ (a) The Secretary, with the advice of the
Board, shall make grants to, and enter into appropriate contracts
with, public or private nonprofit institutions of higher education
and individual scientists for the purpose of supporting biomedical
scientific publications of a nonprofit nature and to procure the compilation, writing, editing, and publication of reviews, abstracts, indices, handbooks, bibliographies, and related matter pertaining to
scientific works and scientific developments.
(b) Grants under subsection (a) in support of any single periodical publication may not be made for more than three years, except in those cases in which the Secretary determines that further
support is necessary to carry out the purposes of subsection (a).
GRANT PAYMENTS, RECORDS, AND AUDIT

SEC. 477. ø286b–8¿ (a) Payments under grants made under
sections 472, 473, 474, 475, and 476 may be made in advance or
by way of reimbursement and in such installments as the Secretary
shall prescribe by regulation after consultation with the Board.
(b)(1) Each recipient of a grant under this subpart shall keep
such records as the Secretary shall prescribe, including records
which fully disclose the amount and disposition by such recipient
of the proceeds of such grant, the total cost of the project or undertaking in connection with which such grant is given or used, and
the amount of that portion of the cost of the project or undertaking
supplied by other sources, and such other records as will facilitate
an effective audit.
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(2) The Secretary and the Comptroller General of the United
States, or any of their duly authorized representatives, shall have
access for the purpose of audit and examination to any books, documents, papers, and records of such recipients that are pertinent to
any grant received under this subpart.
Subpart 3—National Center for Biotechnology Information
PURPOSE, ESTABLISHMENT, FUNCTIONS, AND FUNDING OF THE
NATIONAL CENTER FOR BIOTECHNOLOGY INFORMATION

SEC. 478. ø286c¿ (a) In order to focus and expand the collection, storage, retrieval, and dissemination of the results of biotechnology research by information systems, and to support and enhance the development of new information technologies to aid in
the understanding of the molecular processes that control health
and disease, there is established the National Center for Biotechnology Information (hereinafter in this section referred to as
the ‘‘Center’’) in the National Library of Medicine.
(b) The Secretary, through the Center and subject to section
465(d), shall—
(1) design, develop, implement, and manage automated
systems for the collection, storage, retrieval, analysis, and dissemination of knowledge concerning human molecular biology,
biochemistry, and genetics;
(2) perform research into advanced methods of computerbased information processing capable of representing and analyzing the vast number of biologically important molecules and
compounds;
(3) enable persons engaged in biotechnology research and
medical care to use systems developed under paragraph (1) and
methods described in paragraph (2); and
(4) coordinate, as much as is practicable, efforts to gather
biotechnology information on an international basis.
Subpart 4—National Information Center on Health Services
Research and Health Care Technology
NATIONAL INFORMATION CENTER

SEC.

478A. ø286d¿ (a) There is established within the Library
an entity to be known as the National Information Center on
Health Services Research and Health Care Technology (in this section referred to as the ‘‘Center’’).
(b) The purpose of the Center is the collection, storage, analysis, retrieval, and dissemination of information on health services
research, clinical practice guidelines, and on health care technology, including the assessment of such technology. Such purpose
includes developing and maintaining data bases and developing
and implementing methods of carrying out such purpose.
(c) The Director of the Center shall ensure that information
under subsection (b) concerning clinical practice guidelines is collected and maintained electronically and in a convenient format.
Such Director shall develop and publish criteria for the inclusion
of practice guidelines and technology assessments in the information center database.
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(d) The Secretary, acting through the Center, shall coordinate
the activities carried out under this section through the Center
with related activities of the Administrator for Health Care Policy
and Research.
PART E—OTHER AGENCIES

OF

NIH

Subpart 1—National Center for Advancing Translational Sciences
SEC. 479. ø287¿ NATIONAL CENTER FOR ADVANCING TRANSLATIONAL
SCIENCES.
(a) PURPOSE.—The purpose of the National Center for Advanc-

ing Translational Sciences (in this subpart referred to as the ‘‘Center’’) is to advance translational sciences, including by—
(1) coordinating and developing resources that leverage
basic research in support of translational science; and
(2) developing partnerships and working cooperatively to
foster synergy in ways that do not create duplication, redundancy, and competition with industry activities.
(b) CLINICAL TRIAL ACTIVITIES.—
(1) IN GENERAL.—The Center may develop and provide infrastructure and resources for all phases of clinical trials research. Except as provided in paragraph (2), the Center may
support clinical trials only through the end of phase IIA.
(2) EXCEPTION.—The Center may support clinical trial activities through the end of phase IIB for a treatment for a rare
disease or condition (as defined in section 526 of the Federal
Food, Drug, and Cosmetic Act) so long as—
(A) the Center gives public notice for a period of at
least 120 days of the Center’s intention to support the clinical trial activities in phase IIB;
(B) no public or private organization provides credible
written intent to the Center that the organization has
timely plans to further the clinical trial activities or conduct clinical trials of a similar nature beyond phase IIA;
and
(C) the Center ensures that support of the clinical trial
activities in phase IIB will not increase the Federal Government’s liability beyond the award value of the Center’s
support.
(c) ANNUAL REPORT.—The Center shall publish an annual report that, with respect to all research supported by the Center, includes a complete list of—
(1) the molecules being studied;
(2) clinical trial activities being conducted;
(3) the methods and tools in development;
(4) ongoing partnerships, including—
(A) the rationale for each partnership;
(B) the status of each partnership;
(C) the funding provided by the Center to other entities pursuant to each partnership, and
(D) the activities which have been transferred to industry pursuant to each partnership; and
(5) known research activity of other entities that is or will
expand upon research activity of the Center.
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SEC. 480. ø287a¿ CURES ACCELERATION NETWORK.
(a) DEFINITIONS.—In this section:
(1) BIOLOGICAL PRODUCT.—The term ‘‘biological

Sec. 480

product’’
has the meaning given such term in section 351 of the Public
Health Service Act.
(2) DRUG; DEVICE.—The terms ‘‘drug’’ and ‘‘device’’ have
the meanings given such terms in section 201 of the Federal
Food, Drug, and Cosmetic Act.
(3) HIGH NEED CURE.—The term ‘‘high need cure’’ means
a drug (as that term is defined by section 201(g)(1) of the Federal Food, Drug, and Cosmetic Act, biological product (as that
term is defined by section 262(i)), or device (as that term is defined by section 201(h) of the Federal Food, Drug, and Cosmetic Act) that, in the determination of the Director of the
Center—
(A) is a priority to diagnose, mitigate, prevent, or treat
harm from any disease or condition; and
(B) for which the incentives of the commercial market
are unlikely to result in its adequate or timely development.
(4) MEDICAL PRODUCT.—The term ‘‘medical product’’ means
a drug, device, biological product, or product that is a combination of drugs, devices, and biological products.
(b) ESTABLISHMENT OF THE CURES ACCELERATION NETWORK.—
Subject to the appropriation of funds as described in subsection (g),
there is established within the Center a program to be known as
the Cures Acceleration Network (referred to in this section as
‘‘CAN’’), which shall—
(1) be under the direction of the Director of the Center,
taking into account the recommendations of a CAN Review
Board (referred to in this section as the ‘‘Board’’), described in
subsection (d); and
(2) award grants and contracts to eligible entities, as described in subsection (e), to accelerate the development of high
need cures, including through the development of medical
products and behavioral therapies.
(c) FUNCTIONS.—The functions of the CAN are to—
(1) conduct and support revolutionary advances in basic research, translating scientific discoveries from bench to bedside;
(2) award grants and contracts to eligible entities to accelerate the development of high need cures;
(3) provide the resources necessary for government agencies, independent investigators, research organizations, biotechnology companies, academic research institutions, and
other entities to develop high need cures;
(4) reduce the barriers between laboratory discoveries and
clinical trials for new therapies; and
(5) facilitate review in the Food and Drug Administration
for the high need cures funded by the CAN, through activities
that may include—
(A) the facilitation of regular and ongoing communication with the Food and Drug Administration regarding the
status of activities conducted under this section;
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(B) ensuring that such activities are coordinated with
the approval requirements of the Food and Drug Administration, with the goal of expediting the development and
approval of countermeasures and products; and
(C) connecting interested persons with additional technical assistance made available under section 565 of the
Federal Food, Drug, and Cosmetic Act.
(d) CAN BOARD.—
(1) ESTABLISHMENT.—There is established a Cures Acceleration Network Review Board (referred to in this section as
the ‘‘Board’’), which shall advise the Director of the Center on
the conduct of the activities of the Cures Acceleration Network.
(2) MEMBERSHIP.—
(A) IN GENERAL.—
(i) APPOINTMENT.—The Board shall be comprised
of 24 members who are appointed by the Secretary
and who serve at the pleasure of the Secretary.
(ii) CHAIRPERSON AND VICE CHAIRPERSON.—The
Secretary shall designate, from among the 24 members appointed under clause (i), one Chairperson of the
Board (referred to in this section as the ‘‘Chairperson’’)
and one Vice Chairperson.
(B) TERMS.—
(i) IN GENERAL.—Each member shall be appointed
to serve a 4-year term, except that any member appointed to fill a vacancy occurring prior to the expiration of the term for which the member’s predecessor
was appointed shall be appointed for the remainder of
such term.
APPOINTMENTS;
MAXIMUM
(ii)
CONSECUTIVE
TERMS.—A member may be appointed to serve not
more than 3 terms on the Board, and may not serve
more than 2 such terms consecutively.
(C) QUALIFICATIONS.—
(i) IN GENERAL.—The Secretary shall appoint individuals to the Board based solely upon the individual’s
established record of distinguished service in one of
the areas of expertise described in clause (ii). Each individual appointed to the Board shall be of distinguished achievement and have a broad range of disciplinary interests.
(ii) EXPERTISE.—The Secretary shall select individuals based upon the following requirements:
(I) For each of the fields of—
(aa) basic research;
(bb) medicine;
(cc) biopharmaceuticals;
(dd) discovery and delivery of medical
products;
(ee) bioinformatics and gene therapy;
(ff) medical instrumentation; and
(gg) regulatory review and approval of
medical products,
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the Secretary shall select at least 1 individual who
is eminent in such fields.
(II) At least 4 individuals shall be recognized
leaders in professional venture capital or private
equity organizations and have demonstrated experience in private equity investing.
(III) At least 8 individuals shall represent disease advocacy organizations.
(3) EX-OFFICIO MEMBERS.—
(A) APPOINTMENT.—In addition to the 24 Board members described in paragraph (2), the Secretary shall appoint as ex-officio members of the Board—
(i) a representative of the National Institutes of
Health, recommended by the Secretary of the Department of Health and Human Services;
(ii) a representative of the Office of the Assistant
Secretary of Defense for Health Affairs, recommended
by the Secretary of Defense;
(iii) a representative of the Office of the Under
Secretary for Health for the Veterans Health Administration, recommended by the Secretary of Veterans Affairs;
(iv) a representative of the National Science Foundation, recommended by the Chair of the National
Science Board; and
(v) a representative of the Food and Drug Administration, recommended by the Commissioner of Food
and Drugs.
(B) TERMS.—Each ex-officio member shall serve a 3year term on the Board, except that the Chairperson may
adjust the terms of the initial ex-officio members in order
to provide for a staggered term of appointment for all such
members.
(4) RESPONSIBILITIES OF THE BOARD AND THE DIRECTOR OF
THE CENTER.—
(A) RESPONSIBILITIES OF THE BOARD.—
(i) IN GENERAL.—The Board shall advise, and provide recommendations to, the Director of the Center
with respect to—
(I) policies, programs, and procedures for carrying out the duties of the Director of the Center
under this section; and
(II) significant barriers to successful translation of basic science into clinical application (including issues under the purview of other agencies
and departments).
(ii) REPORT.—In the case that the Board identifies
a significant barrier, as described in clause (i)(II), the
Board shall submit to the Secretary a report regarding
such barrier.
(B) RESPONSIBILITIES OF THE DIRECTOR OF THE CENTER.—With respect to each recommendation provided by
the Board under subparagraph (A)(i), the Director of the
Center shall respond in writing to the Board, indicating
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whether such Director will implement such recommendation. In the case that the Director of the Center indicates
a recommendation of the Board will not be implemented,
such Director shall provide an explanation of the reasons
for not implementing such recommendation.
(5) MEETINGS.—
(A) IN GENERAL.—The Board shall meet 4 times per
calendar year, at the call of the Chairperson.
(B) QUORUM; REQUIREMENTS; LIMITATIONS.—
(i) QUORUM.—A quorum shall consist of a total of
13 members of the Board, excluding ex-officio members, with diverse representation as described in
clause (iii).
(ii) CHAIRPERSON OR VICE CHAIRPERSON.—Each
meeting of the Board shall be attended by either the
Chairperson or the Vice Chairperson.
(iii) DIVERSE REPRESENTATION.—At each meeting
of the Board, there shall be not less than one scientist,
one representative of a disease advocacy organization,
and one representative of a professional venture capital or private equity organization.
(6) COMPENSATION AND TRAVEL EXPENSES.—
(A) COMPENSATION.—Members shall receive compensation at a rate to be fixed by the Chairperson but not to exceed a rate equal to the daily equivalent of the annual rate
of basic pay prescribed for level IV of the Executive Schedule under section 5315 of title 5, United States Code, for
each day (including travel time) during which the member
is engaged in the performance of the duties of the Board.
All members of the Board who are officers or employees of
the United States shall serve without compensation in addition to that received for their services as officers or employees of the United States.
(B) TRAVEL EXPENSES.—Members of the Board shall be
allowed travel expenses, including per diem in lieu of subsistence, at rates authorized for persons employed intermittently by the Federal Government under section
5703(b) of title 5, United States Code, while away from
their homes or regular places of business in the performance of services for the Board.
(e) GRANT PROGRAM.—
(1) SUPPORTING INNOVATION.—To carry out the purposes
described in this section, the Director of the Center shall
award contracts, grants, or cooperative agreements to the entities described in paragraph (2), to—
(A) promote innovation in technologies supporting the
advanced research and development and production of
high need cures, including through the development of
medical products and behavioral therapies.
(B) accelerate the development of high need cures, including through the development of medical products, behavioral therapies, and biomarkers that demonstrate the
safety or effectiveness of medical products; or
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(C) help the award recipient establish protocols that
comply with Food and Drug Administration standards and
otherwise permit the recipient to meet regulatory requirements at all stages of development, manufacturing, review,
approval, and safety surveillance of a medical product.
(2) ELIGIBLE ENTITIES.—To receive assistance under paragraph (1), an entity shall—
(A) be a public or private entity, which may include a
private or public research institution, an institution of
higher education, a medical center, a biotechnology company, a pharmaceutical company, a disease advocacy organization, a patient advocacy organization, or an academic
research institution;
(B) submit an application containing—
(i) a detailed description of the project for which
the entity seeks such grant or contract;
(ii) a timetable for such project;
(iii) an assurance that the entity will submit—
(I) interim reports describing the entity’s—
(aa) progress in carrying out the project;
and
(bb) compliance with all provisions of this
section and conditions of receipt of such grant
or contract; and
(II) a final report at the conclusion of the
grant period, describing the outcomes of the
project; and
(iv) a description of the protocols the entity will
follow to comply with Food and Drug Administration
standards and regulatory requirements at all stages of
development, manufacturing, review, approval, and
safety surveillance of a medical product; and
(C) provide such additional information as the Director
of the Center may require.
(3) AWARDS.—
(A) THE CURES ACCELERATION PARTNERSHIP AWARDS.—
(i) INITIAL AWARD AMOUNT.—Each award under
this subparagraph shall be not more than $15,000,000
per project for the first fiscal year for which the
project is funded, which shall be payable in one payment.
(ii) FUNDING IN SUBSEQUENT FISCAL YEARS.—An
eligible entity receiving an award under clause (i) may
apply for additional funding for such project by submitting to the Director of the Center the information
required under subparagraphs (B) and (C) of paragraph (2). The Director may fund a project of such eligible entity in an amount not to exceed $15,000,000
for a fiscal year subsequent to the initial award under
clause (i).
(iii) MATCHING FUNDS.—As a condition for receiving an award under this subsection, an eligible entity
shall contribute to the project non-Federal funds in
the amount of $1 for every $3 awarded under clauses
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(i) and (ii), except that the Director of the Center may
waive or modify such matching requirement in any
case where the Director determines that the goals and
objectives of this section cannot adequately be carried
out unless such requirement is waived.
(B) THE CURES ACCELERATION GRANT AWARDS.—
(i) INITIAL AWARD AMOUNT.—Each award under
this subparagraph shall be not more than $15,000,000
per project for the first fiscal year for which the
project is funded, which shall be payable in one payment.
(ii) FUNDING IN SUBSEQUENT FISCAL YEARS.—An
eligible entity receiving an award under clause (i) may
apply for additional funding for such project by submitting to the Board the information required under
subparagraphs (B) and (C) of paragraph (2). The Director of the Center may fund a project of such eligible
entity in an amount not to exceed $15,000,000 for a
fiscal year subsequent to the initial award under
clause (i).
(C) THE CURES ACCELERATION FLEXIBLE RESEARCH
AWARDS.—If the Director of the Center determines that the
goals and objectives of this section cannot adequately be
carried out through a contract, grant, or cooperative agreement, the Director of the Center shall have flexible research authority to use other transactions to fund projects
in accordance with the terms and conditions of this section. Awards made under such flexible research authority
for a fiscal year shall not exceed 20 percent of the total
funds appropriated under subsection (g)(1) for such fiscal
year.
(4) SUSPENSION OF AWARDS FOR DEFAULTS, NONCOMPLIANCE WITH PROVISIONS AND PLANS, AND DIVERSION OF FUNDS;
REPAYMENT OF FUNDS.—The Director of the Center may suspend the award to any entity upon noncompliance by such entity with provisions and plans under this section or diversion
of funds.
(5) AUDITS.—The Director of the Center may enter into
agreements with other entities to conduct periodic audits of the
projects funded by grants or contracts awarded under this subsection.
(6) CLOSEOUT PROCEDURES.—At the end of a grant or contract period, a recipient shall follow the closeout procedures
under section 74.71 of title 45, Code of Federal Regulations (or
any successor regulation).
(7) REVIEW.—A determination by the Director of the Center as to whether a drug, device, or biological product is a high
need cure (for purposes of subsection (a)(3)) shall not be subject
to judicial review.
(f) COMPETITIVE BASIS OF AWARDS.—Any grant, cooperative
agreement, or contract awarded under this section shall be awarded on a competitive basis.
(g) AUTHORIZATION OF APPROPRIATIONS.—
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(1) IN GENERAL.—For purposes of carrying out this section,
there are authorized to be appropriated $500,000,000 for fiscal
year 2010, and such sums as may be necessary for subsequent
fiscal years. Funds appropriated under this section shall be
available until expended.
(2) LIMITATION ON USE OF FUNDS OTHERWISE APPROPRIATED.—No funds appropriated under this Act, other than
funds appropriated under paragraph (1), may be allocated to
the Cures Acceleration Network.
OFFICE OF RARE DISEASES

SEC. 481. ø287a–1¿ (a) ESTABLISHMENT.—There is established
within the Center an office to be known as the Office of Rare Diseases (in this section referred to as the ‘‘Office’’), which shall be
headed by a Director (in this section referred to as the ‘‘Director’’),
appointed by the Director of the Center.
(b) DUTIES.—
(1) IN GENERAL.—The Director of the Office shall carry out
the following:
(A) The Director shall recommend an agenda for conducting and supporting research on rare diseases through
the national research institutes and centers. The agenda
shall provide for a broad range of research and education
activities, including scientific workshops and symposia to
identify research opportunities for rare diseases.
(B) The Director shall, with respect to rare diseases,
promote coordination and cooperation among the national
research institutes and centers and entities whose research is supported by such institutes.
(C) The Director, in collaboration with the directors of
the other relevant institutes and centers of the National
Institutes of Health, may enter into cooperative agreements with and make grants for regional centers of excellence on rare diseases in accordance with section 481A.
(D) The Director shall promote the sufficient allocation
of the resources of the National Institutes of Health for
conducting and supporting research on rare diseases.
(E) The Director shall promote and encourage the establishment of a centralized clearinghouse for rare and genetic disease information that will provide understandable
information about these diseases to the public, medical
professionals, patients and families.
(2) PRINCIPAL ADVISOR REGARDING ORPHAN DISEASES.—
With respect to rare diseases, the Director shall serve as the
principal advisor to the Director of NIH and shall provide advice to other relevant agencies. The Director shall provide liaison with national and international patient, health and scientific organizations concerned with rare diseases.
(c) DEFINITION.—For purposes of this section, the term ‘‘rare
disease’’ means any disease or condition that affects less than
200,000 persons in the United States.
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RARE DISEASE REGIONAL CENTERS OF EXCELLENCE

SEC. 481A. ø287a–2¿ (a) COOPERATIVE AGREEMENTS AND
GRANTS.—
(1) IN GENERAL.—The Director of the Office of Rare Diseases (in this section referred to as the ‘‘Director’’), in collaboration with the directors of the other relevant institutes and
centers of the National Institutes of Health, may enter into cooperative agreements with and make grants to public or private nonprofit entities to pay all or part of the cost of planning,
establishing, or strengthening, and providing basic operating
support for regional centers of excellence for clinical research
into, training in, and demonstration of diagnostic, prevention,
control, and treatment methods for rare diseases.
(2) POLICIES.—A cooperative agreement or grant under
paragraph (1) shall be entered into in accordance with policies
established by the Director of NIH.
(b) COORDINATION WITH OTHER INSTITUTES.—The Director
shall coordinate the activities under this section with similar activities conducted by other national research institutes, centers and
agencies of the National Institutes of Health and by the Food and
Drug Administration to the extent that such institutes, centers and
agencies have responsibilities that are related to rare diseases.
(c) USES FOR FEDERAL PAYMENTS UNDER COOPERATIVE AGREEMENTS OR GRANTS.—Federal payments made under a cooperative
agreement or grant under subsection (a) may be used for—
(1) staffing, administrative, and other basic operating
costs, including such patient care costs as are required for research;
(2) clinical training, including training for allied health
professionals, continuing education for health professionals and
allied health professions personnel, and information programs
for the public with respect to rare diseases; and
(3) clinical research and demonstration programs.
(d) PERIOD OF SUPPORT; ADDITIONAL PERIODS.—Support of a
center under subsection (a) may be for a period of not to exceed 5
years. Such period may be extended by the Director for additional
periods of not more than 5 years if the operations of such center
have been reviewed by an appropriate technical and scientific peer
review group established by the Director and if such group has recommended to the Director that such period should be extended.
SEC. 481B. ø287a–3¿ GENERAL CLINICAL RESEARCH CENTERS.
(a) GRANTS.—The Director of the Center shall award grants

for
the establishment of general clinical research centers to provide the
infrastructure for clinical research including clinical research training and career enhancement. Such centers shall support clinical
studies and career development in all settings of the hospital or
academic medical center involved.
(b) ACTIVITIES.—In carrying out subsection (a), the Director of
National Institutes of Health shall expand the activities of the general clinical research centers through the increased use of telecommunications and telemedicine initiatives.
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Subpart 2—John E. Fogarty International Center for Advanced
Study in the Health Sciences
GENERAL PURPOSE

SEC. 482. ø287b¿ The general purpose of the John E. Fogarty
International Center for Advanced Study in the Health Sciences is
to—
(1) facilitate the assembly of scientists and others in the
biomedical, behavioral, and related fields for discussion, study,
and research relating to the development of health science
internationally;
(2) provide research programs, conferences, and seminars
to further international cooperation and collaboration in the
life sciences;
(3) provide postdoctorate fellowships for research training
in the United States and abroad and promote exchanges of
senior scientists between the United States and other countries;
(4) coordinate the activities of the National Institutes of
Health concerned with the health sciences internationally; and
(5) receive foreign visitors to the National Institutes of
Health.
Subpart 4—Office of Dietary Supplements 1
SEC. 485C. ø287c–11¿ DIETARY SUPPLEMENTS.
(a) ESTABLISHMENT.—The Secretary shall

establish an Office of
Dietary Supplements within the National Institutes of Health.
(b) PURPOSE.—The purposes of the Office are—
(1) to explore more fully the potential role of dietary supplements as a significant part of the efforts of the United
States to improve health care; and
(2) to promote scientific study of the benefits of dietary
supplements in maintaining health and preventing chronic disease and other health-related conditions.
(c) DUTIES.—The Director of the Office of Dietary Supplements
shall—
(1) conduct and coordinate scientific research within the
National Institutes of Health relating to dietary supplements
and the extent to which the use of dietary supplements can
limit or reduce the risk of diseases such as heart disease, cancer, birth defects, osteoporosis, cataracts, or prostatism;
(2) collect and compile the results of scientific research relating to dietary supplements, including scientific data from
foreign sources or the Office of Alternative Medicine;
(3) serve as the principal advisor to the Secretary and to
the Assistant Secretary for Health and provide advice to the
Director of the National Institutes of Health, the Director of
the Centers for Disease Control and Prevention, and the Commissioner of Food and Drugs on issues relating to dietary supplements including—
(A) dietary intake regulations;
1 Subpart 3 of this part was transferred and redesignated as subpart 19 of part C by section
101(c) of Public Law 109–482.

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(B) the safety of dietary supplements;
(C) claims characterizing the relationship between—
(i) dietary supplements; and
(ii)(I) prevention of disease or other health-related
conditions; and
(II) maintenance of health; and
(D) scientific issues arising in connection with the labeling and composition of dietary supplements;
(4) compile a database of scientific research on dietary supplements and individual nutrients; and
(5) coordinate funding relating to dietary supplements for
the National Institutes of Health.
(d) DEFINITION.—As used in this section, the term ‘‘dietary supplement’’ has the meaning given the term in section 201(ff) of the
Federal Food, Drug, and Cosmetic Act.
Subpart 5—National Center for Complementary and Alternative
Medicine
SEC. 485D. ø287c–21¿ PURPOSE OF CENTER.
(a) IN GENERAL.—The general purposes

of the National Center
for Complementary and Alternative Medicine (in this subpart referred to as the ‘‘Center’’) are the conduct and support of basic and
applied research (including both intramural and extramural research), research training, the dissemination of health information,
and other programs with respect to identifying, investigating, and
validating complementary and alternative treatment, diagnostic
and prevention modalities, disciplines and systems. The Center
shall be headed by a director, who shall be appointed by the Secretary. The Director of the Center shall report directly to the Director of NIH.
(b) ADVISORY COUNCIL.—The Secretary shall establish an advisory council for the Center in accordance with section 406, except
that at least half of the members of the advisory council who are
not ex officio members shall include practitioners licensed in one or
more of the major systems with which the Center is concerned, and
at least 3 individuals representing the interests of individual consumers of complementary and alternative medicine.
(c) COMPLEMENT TO CONVENTIONAL MEDICINE.—In carrying
out subsection (a), the Director of the Center shall, as appropriate,
study the integration of alternative treatment, diagnostic and prevention systems, modalities, and disciplines with the practice of
conventional medicine as a complement to such medicine and into
health care delivery systems in the United States.
(d) APPROPRIATE SCIENTIFIC EXPERTISE AND COORDINATION
WITH INSTITUTES AND FEDERAL AGENCIES.—The Director of the
Center, after consultation with the advisory council for the Center
and the division of research grants, shall ensure that scientists
with appropriate expertise in research on complementary and alternative medicine are incorporated into the review, oversight, and
management processes of all research projects and other activities
funded by the Center. In carrying out this subsection, the Director
of the Center, as necessary, may establish review groups with appropriate scientific expertise. The Director of the Center shall coMarch 13, 2013

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ordinate efforts with other Institutes and Federal agencies to ensure appropriate scientific input and management.
(e) EVALUATION OF VARIOUS DISCIPLINES AND SYSTEMS.—In
carrying out subsection (a), the Director of the Center shall identify
and evaluate alternative and complementary medical treatment, diagnostic and prevention modalities in each of the disciplines and
systems with which the Center is concerned, including each discipline and system in which accreditation, national certification, or
a State license is available.
(f) ENSURING HIGH QUALITY, RIGOROUS SCIENTIFIC REVIEW.—
In order to ensure high quality, rigorous scientific review of complementary and alternative, diagnostic and prevention modalities,
disciplines and systems, the Director of the Center shall conduct or
support the following activities:
(1) Outcomes research and investigations.
(2) Epidemiological studies.
(3) Health services research.
(4) Basic science research.
(5) Clinical trials.
(6) Other appropriate research and investigational activities.
The Director of NIH, in coordination with the Director of the Center, shall designate specific personnel in each Institute to serve as
full-time liaisons with the Center in facilitating appropriate coordination and scientific input.
(g) DATA SYSTEM; INFORMATION CLEARINGHOUSE.—
(1) DATA SYSTEM.—The Director of the Center shall establish a bibliographic system for the collection, storage, and retrieval of worldwide research relating to complementary and
alternative treatment, diagnostic and prevention modalities,
disciplines and systems. Such a system shall be regularly updated and publicly accessible.
(2) CLEARINGHOUSE.—The Director of the Center shall establish an information clearinghouse to facilitate and enhance,
through the effective dissemination of information, knowledge
and understanding of alternative medical treatment, diagnostic
and prevention practices by health professionals, patients, industry, and the public.
(h) RESEARCH CENTERS.—The Director of the Center, after consultation with the advisory council for the Center, shall provide
support for the development and operation of multipurpose centers
to conduct research and other activities described in subsection (a)
with respect to complementary and alternative treatment, diagnostic and prevention modalities, disciplines and systems. The provision of support for the development and operation of such centers
shall include accredited complementary and alternative medicine
research and education facilities.
(i) AVAILABILITY OF RESOURCES.—After consultation with the
Director of the Center, the Director of NIH shall ensure that resources of the National Institutes of Health, including laboratory
and clinical facilities, fellowships (including research training fellowship and junior and senior clinical fellowships), and other resources are sufficiently available to enable the Center to appropriately and effectively carry out its duties as described in subMarch 13, 2013

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section (a). The Director of NIH, in coordination with the Director
of the Center, shall designate specific personnel in each Institute
to serve as full-time liaisons with the Center in facilitating appropriate coordination and scientific input.
(j) AVAILABILITY OF APPROPRIATIONS.—Amounts appropriated
to carry out this section for fiscal year 1999 are available for obligation through September 30, 2001. Amounts appropriated to carry
out this section for fiscal year 2000 are available for obligation
through September 30, 2001.
PART F—RESEARCH

ON

WOMEN’S HEALTH

SEC. 486. ø287d¿ OFFICE OF RESEARCH ON WOMEN’S HEALTH.
(a) ESTABLISHMENT.—There is established within the Office

of
the Director of NIH an office to be known as the Office of Research
on Women’s Health (in this part referred to as the ‘‘Office’’). The
Office shall be headed by a director, who shall be appointed by the
Director of NIH and who shall report directly to the Director.
(b) PURPOSE.—The Director of the Office shall—
(1) identify projects of research on women’s health that
should be conducted or supported by the national research institutes;
(2) identify multidisciplinary research relating to research
on women’s health that should be so conducted or supported;
(3) carry out paragraphs (1) and (2) with respect to the
aging process in women, with priority given to menopause;
(4) promote coordination and collaboration among entities
conducting research identified under any of paragraphs (1)
through (3);
(5) encourage the conduct of such research by entities receiving funds from the national research institutes;
(6) recommend an agenda for conducting and supporting
such research;
(7) promote the sufficient allocation of the resources of the
national research institutes for conducting and supporting such
research;
(8) assist in the administration of section 492B with respect to the inclusion of women as subjects in clinical research;
and
(9) prepare the report required in section 486B.
(c) COORDINATING COMMITTEE.—
(1) In carrying out subsection (b), the Director of the Office
shall establish a committee to be known as the Coordinating
Committee on Research on Women’s Health (in this subsection
referred to as the ‘‘Coordinating Committee’’).
(2) The Coordinating Committee shall be composed of the
Directors of the national research institutes (or the designees
of the Directors).
(3) The Director of the Office shall serve as the chair of the
Coordinating Committee.
(4) With respect to research on women’s health, the Coordinating Committee shall assist the Director of the Office
in—
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(A) identifying the need for such research, and making
an estimate each fiscal year of the funds needed to adequately support the research;
(B) identifying needs regarding the coordination of research activities, including intramural and extramural
multidisciplinary activities;
(C) supporting the development of methodologies to
determine the circumstances in which obtaining data specific to women (including data relating to the age of
women and the membership of women in ethnic or racial
groups) is an appropriate function of clinical trials of treatments and therapies;
(D) supporting the development and expansion of clinical trials of treatments and therapies for which obtaining
such data has been determined to be an appropriate function; and
(E) encouraging the national research institutes to
conduct and support such research, including such clinical
trials.
(d) ADVISORY COMMITTEE.—
(1) In carrying out subsection (b), the Director of the Office
shall establish an advisory committee to be known as the Advisory Committee on Research on Women’s Health (in this subsection referred to as the ‘‘Advisory Committee’’).
(2) The Advisory Committee shall be composed of no fewer
than 12, and not more than 18 individuals, who are not officers
or employees of the Federal Government. The Director of NIH
shall make appointments to the Advisory Committee from
among physicians, practitioners, scientists, and other health
professionals, whose clinical practice, research specialization,
or professional expertise includes a significant focus on research on women’s health. A majority of the members of the
Advisory Committee shall be women.
(3) The Director of the Office shall serve as the chair of the
Advisory Committee.
(4) The Advisory Committee shall—
(A) advise the Director of the Office on appropriate research activities to be undertaken by the national research
institutes with respect to—
(i) research on women’s health;
(ii) research on gender differences in clinical drug
trials, including responses to pharmacological drugs;
(iii) research on gender differences in disease etiology, course, and treatment;
(iv) research on obstetrical and gynecological
health conditions, diseases, and treatments; and
(v) research on women’s health conditions which
require a multidisciplinary approach;
(B) report to the Director of the Office on such research;
(C) provide recommendations to such Director regarding activities of the Office (including recommendations on
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section (c)(4)(C) and recommendations on priorities in carrying out research described in subparagraph (A)); and
(D) assist in monitoring compliance with section 492B
regarding the inclusion of women in clinical research.
(5)(A) The Advisory Committee shall prepare a biennial report describing the activities of the Committee, including findings made by the Committee regarding—
(i) compliance with section 492B;
(ii) the extent of expenditures made for research on
women’s health by the agencies of the National Institutes
of Health; and
(iii) the level of funding needed for such research.
(B) The report required in subparagraph (A) shall be submitted to the Director of NIH for inclusion in the report required in section 403.
(e) REPRESENTATION OF WOMEN AMONG RESEARCHERS.—The
Secretary, acting through the Assistant Secretary for Personnel
and in collaboration with the Director of the Office, shall determine
the extent to which women are represented among senior physicians and scientists of the national research institutes and among
physicians and scientists conducting research with funds provided
by such institutes, and as appropriate, carry out activities to increase the extent of such representation.
(f) DEFINITIONS.—For purposes of this part:
(1) The term ‘‘women’s health conditions’’, with respect to
women of all age, ethnic, and racial groups, means all diseases,
disorders, and conditions (including with respect to mental
health)—
(A) unique to, more serious, or more prevalent in
women;
(B) for which the factors of medical risk or types of
medical intervention are different for women, or for which
it is unknown whether such factors or types are different
for women; or
(C) with respect to which there has been insufficient
clinical research involving women as subjects or insufficient clinical data on women.
(2) The term ‘‘research on women’s health’’ means research
on women’s health conditions, including research on preventing
such conditions.
SEC. 486A. ø287d–1¿ NATIONAL DATA SYSTEM AND CLEARINGHOUSE
ON RESEARCH ON WOMEN’S HEALTH.
(a) DATA SYSTEM.—

(1) The Director of NIH, in consultation with the Director
of the Office and the Director of the National Library of Medicine, shall establish a data system for the collection, storage,
analysis, retrieval, and dissemination of information regarding
research on women’s health that is conducted or supported by
the national research institutes. Information from the data system shall be available through information systems available
to health care professionals and providers, researchers, and
members of the public.
(2) The data system established under paragraph (1) shall
include a registry of clinical trials of experimental treatments
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that have been developed for research on women’s health. Such
registry shall include information on subject eligibility criteria,
sex, age, ethnicity or race, and the location of the trial site or
sites. Principal investigators of such clinical trials shall provide
this information to the registry within 30 days after it is available. Once a trial has been completed, the principal investigator shall provide the registry with information pertaining to
the results, including potential toxicities or adverse effects associated with the experimental treatment or treatments evaluated.
(b) CLEARINGHOUSE.—The Director of NIH, in consultation
with the Director of the Office and with the National Library of
Medicine, shall establish, maintain, and operate a program to provide information on research and prevention activities of the national research institutes that relate to research on women’s
health.
SEC. 486B. ø287d–2¿ BIENNIAL REPORT.
(a) IN GENERAL.—With respect to

research on women’s health,
the Director of the Office shall, not later than February 1, 1994,
and biennially thereafter, prepare a report—
(1) describing and evaluating the progress made during
the preceding 2 fiscal years in research and treatment conducted or supported by the National Institutes of Health;
(2) describing and analyzing the professional status of
women physicians and scientists of such Institutes, including
the identification of problems and barriers regarding advancements;
(3) summarizing and analyzing expenditures made by the
agencies of such Institutes (and by such Office) during the preceding 2 fiscal years; and
(4) making such recommendations for legislative and administrative initiatives as the Director of the Office determines
to be appropriate.
(b) INCLUSION IN BIENNIAL REPORT OF DIRECTOR OF NIH.—The
Director of the Office shall submit each report prepared under subsection (a) to the Director of NIH for inclusion in the report submitted to the President and the Congress under section 403.
PART G—AWARDS

AND

TRAINING

Ruth L. Kirschstein National Research Service Awards 1
SEC. 487. ø288¿ (a)(1) The Secretary shall—
(A) provide Ruth L. Kirschstein National Research Service
Awards 2 for—
(i) biomedical and behavioral research at the National
Institutes of Health in matters relating to the cause, diagnosis, prevention, and treatment of the diseases or other
health problems to which the activities of the National Institutes of Health and Administration 1 are directed;
1 The

typeface is so in law. See section 804(b) of Public Law 107–206 (116 Stat. 874).
804(c) of Public Law 107–206 (116 Stat. 874) provides as follows:
‘‘(c) Any reference in any law (other than this Act), regulation, document, record, map, or
other paper of the United States to ‘National Research Service Awards’ shall be considered to
be a reference to ‘Ruth L. Kirschstein National Research Service Awards’’’.
2 Section

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(ii) training at the National Institutes of Health and
at the Administration 1 of individuals to undertake such
research;
(iii) biomedical and behavioral research and health
services research (including research in primary medical
care) at public and nonprofit private entities; and
(iv) pre-doctoral and post-doctoral training at public
and private institutions of individuals to undertake biomedical and behavioral research;
(B) make grants to public and nonprofit private institutions to enable such institutions to make Ruth L. Kirschstein
National Research Service Awards for research (and training
to undertake biomedical and behavioral research) in the matters described in subparagraph (A)(i) to individuals selected by
such institutions; and
(C) provide contracts for scholarships and loan repayments
in accordance with sections 487D and 487E, subject to providing not more than an aggregate 50 such contracts during
the fiscal years 1994 through 1996.
A reference in this subsection to the National Institutes of Health
shall be considered to include the institutes, agencies, divisions,
and bureaus included in the National Institutes of Health or under
the Administration, 1 as the case may be.
(2) Ruth L. Kirschstein National Research Service Awards may
not be used to support residency training of physicians and other
health professionals.
(3) In awarding Ruth L. Kirschstein National Research Service
Awards under this section, the Secretary shall take account of the
Nation’s overall need for biomedical research personnel by giving
special consideration to physicians who agree to undertake a minimum of two years of biomedical research.
(4) The Secretary shall carry out paragraph (1) in a manner
that will result in the recruitment of women, and individuals from
disadvantaged backgrounds (including racial and ethnic minorities), into fields of biomedical or behavioral research and in the
provision of research training to women and such individuals.
(b)(1) No Ruth L. Kirschstein National Research Service Award
may be made by the Secretary to any individual unless—
(A) the individual has submitted to the Secretary an application therefor and the Secretary has approved the application;
(B) the individual provides, in such form and manner as
the Secretary shall by regulation prescribe, assurances satisfactory to the Secretary that the individual will meet the service requirement of subsection (c); and
(C) in the case of a Ruth L. Kirschstein National Research
Service Award for a purpose described in subsection
(a)(1)(A)(iii), the individual has been sponsored (in such manner as the Secretary may by regulation require) by the institution at which the research or training under the award will be
conducted.
1 So in law. Section 163(b)(4)(B) of Public Law 102–321 (106 Stat. 376) struck a reference in
paragraph (1) to the former Alcohol, Drug Abuse, and Mental Health Administration, but failed
to conform related references.

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An application for an award shall be in such form, submitted in
such manner, and contain such information, as the Secretary may
by regulation prescribe.
(2) The making of grants under subsection (a)(1)(B) for Ruth
L. Kirschstein National Research Service Awards shall be subject
to review and approval by the appropriate advisory councils within
the Department of Health and Human Services (A) whose activities
relate to the research or training under the awards, or (B) for the
entity at which such research or training will be conducted.
(3) No grant may be made under subsection (a)(1)(B) unless an
application therefor has been submitted to and approved by the
Secretary. Such application shall be in such form, submitted in
such manner, and contain such information, as the Secretary may
by regulation prescribe. Subject to the provisions of this section
(other than paragraph (1)), Ruth L. Kirschstein National Research
Service Awards made under a grant under subsection (a)(1)(B)
shall be made in accordance with such regulations as the Secretary
shall prescribe.
(4) The period of any Ruth L. Kirschstein National Research
Service Award made to any individual under subsection (a) may
not exceed—
(A) five years in the aggregate for pre-doctoral training;
and
(B) three years in the aggregate for post-doctoral training;
unless the Secretary for good cause shown waives the application
of such limit to such individual.
(5) Ruth L. Kirschstein National Research Service Awards
shall provide for such stipends, tuition, fees, and allowances (including travel and subsistence expenses and dependency allowances), adjusted periodically to reflect increases in the cost of living, for the recipients of the awards as the Secretary may deem
necessary. A Ruth L. Kirschstein National Research Service Award
made to an individual for research or research training at a nonFederal public or nonprofit private institution shall also provide for
payments to be made to the institution for the cost of support services (including the cost of faculty salaries, supplies, equipment,
general research support, and related items) provided such individual by such institution. The amount of any such payments to
any institution shall be determined by the Secretary and shall bear
a direct relationship to the reasonable costs of the institution for
establishing and maintaining the quality of its biomedical and behavioral research and training programs.
(c)(1) Each individual who is awarded a Ruth L. Kirschstein
National Research Service Award for postdoctoral research training
shall, in accordance with paragraph (3), engage in research training, research, or teaching that is health-related (or any combination thereof) for the period specified in paragraph (2). Such period
shall be served in accordance with the usual patterns of scientific
employment.
(2)(A) The period referred to in paragraph (1) is 12 months, or
one month for each month for which the individual involved receives a Ruth L. Kirschstein National Research Service Award for
postdoctoral research training, whichever is less.
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(B) With respect to postdoctoral research training, in any case
in which an individual receives a Ruth L. Kirschstein National Research Service Award for more than 12 months, the 13th month
and each subsequent month of performing activities under the
Award shall be considered to be activities engaged in toward satisfaction of the requirement established in paragraph (1) regarding
a period of service.
(3) The requirement of paragraph (1) shall be complied with by
any individual to whom it applies within such reasonable period of
time, after the completion of such individual’s award, as the Secretary shall by regulation prescribe. The Secretary shall by regulation prescribe the type of research and teaching in which an individual may engage to comply with such requirement and such
other requirements respecting research and teaching as the Secretary considers appropriate.
(4)(A) If any individual to whom the requirement of paragraph
(1) is applicable fails, within the period prescribed by paragraph
(3), to comply with such requirements, the United States shall be
entitled to recover from such individual an amount determined in
accordance with the formula—

A=φ

+

t—s
t

,

in which ‘‘A’’ is the amount the United States is entitled to recover;
‘‘φ’’ is the sum of the total amount paid under one or more Ruth
L. Kirschstein National Research Service Awards to such individual; ‘‘t’’ is the total number of months in such individual’s service obligation; and ‘‘s’’ is the number of months of such obligation
served by such individual in accordance with paragraphs (1) and
(2) of this subsection.
(B) Any amount which the United States is entitled to recover
under subparagraph (A) shall, within the three-year period beginning on the date the United States becomes entitled to recover such
amount, be paid to the United States. Until any amount due the
United States under subparagraph (A) on account of any Ruth L.
Kirschstein National Research Service Award is paid, there shall
accrue to the United States interest on such amount at a rate fixed
by the Secretary of the Treasury after taking into consideration
private consumer rates of interest prevailing on the date the
United States becomes entitled to such amount.
(5)(A) Any obligation of an individual under paragraph (1)
shall be canceled upon the death of such individual.
(B) The Secretary shall by regulation provide for the waiver or
suspension of any such obligation applicable to any individual
whenever compliance by such individual is impossible or would involve substantial hardship to such individual or would be against
equity and good conscience.
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LOAN REPAYMENT PROGRAM FOR RESEARCH WITH RESPECT TO
ACQUIRED IMMUNE DEFICIENCY SYNDROME

SEC. 487A. ø288–1¿ (a) IN GENERAL.—The Secretary shall
carry out a program of entering into agreements with appropriately
qualified health professionals under which such health professionals agree to conduct, as employees of the National Institutes of
Health, research with respect to acquired immune deficiency syndrome in consideration of the Federal Government agreeing to
repay, for each year of such service, not more than $35,000 of the
principal and interest of the educational loans of such health professionals.
(b) APPLICABILITY OF CERTAIN PROVISIONS.—With respect to
the National Health Service Corps Loan Repayment Program established in subpart III of part D of title III, the provisions of such
subpart shall, except as inconsistent with subsection (a) of this section, apply to the program established in such subsection (a) in the
same manner and to the same extent as such provisions apply to
the National Health Service Corps Loan Repayment Program established in such subpart.
LOAN REPAYMENT PROGRAM FOR RESEARCH WITH RESPECT TO
CONTRACEPTION AND INFERTILITY

SEC. 487B. ø288–2¿ (a) The Secretary, in consultation with the
Director of the Eunice Kennedy Shriver National Institute of Child
Health and Human Development, shall establish a program of entering into contracts with qualified health professionals (including
graduate students) under which such health professionals agree to
conduct research with respect to contraception, or with respect to
infertility, in consideration of the Federal Government agreeing to
repay, for each year of such service, not more than $35,000 of the
principal and interest of the educational loans of such health professionals.
(b) The provisions of sections 338B, 338C, and 338E shall, except as inconsistent with subsection (a) of this section, apply to the
program established in subsection (a) to the same extent and in the
same manner as such provisions apply to the National Health
Service Corps Loan Repayment Program established in subpart III
of part D of title III.
(c) Amounts available for carrying out this section shall remain
available until the expiration of the second fiscal year beginning
after the fiscal year for which the amounts were made available.
LOAN REPAYMENT PROGRAM FOR RESEARCH GENERALLY

SEC. 487C. ø288–3¿ (a) IN GENERAL.—
(1) AUTHORITY FOR PROGRAM.—Subject to paragraph (2),
the Secretary shall carry out a program of entering into contracts with appropriately qualified health professionals under
which such health professionals agree to conduct research, as
employees of the National Institutes of Health, in consideration of the Federal Government agreeing to repay, for each
year of such service, not more than $35,000 of the principal
and interest of the educational loans of such health professionals.
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(2) LIMITATION.—The Secretary may not enter into an
agreement with a health professional pursuant to paragraph
(1) unless such professional—
(A) has a substantial amount of educational loans relative to income; and
(B) agrees to serve as an employee of the National Institutes of Health for purposes of paragraph (1) for a period of not less than 3 years.
(b) APPLICABILITY OF CERTAIN PROVISIONS.—With respect to
the National Health Service Corps Loan Repayment Program established in subpart III of part D of title III, the provisions of such
subpart shall, except as inconsistent with subsection (a) of this section, apply to the program established in such subsection (a) in the
same manner and to the same extent as such provisions apply to
the National Health Service Corps Loan Repayment Program established in such subpart.
UNDERGRADUATE SCHOLARSHIP PROGRAM REGARDING PROFESSIONS
NEEDED BY NATIONAL RESEARCH INSTITUTES

SEC. 487D. ø288–4¿ (a) ESTABLISHMENT OF PROGRAM.—
(1) IN GENERAL.—Subject to section 487(a)(1)(C), the Secretary, acting through the Director of NIH, may carry out a
program of entering into contracts with individuals described
in paragraph (2) under which—
(A) the Director of NIH agrees to provide to the individuals scholarships for pursuing, as undergraduates at
accredited institutions of higher education, academic programs appropriate for careers in professions needed by the
National Institutes of Health; and
(B) the individuals agree to serve as employees of the
National Institutes of Health, for the period described in
subsection (c), in positions that are needed by the National
Institutes of Health and for which the individuals are
qualified.
(2) INDIVIDUALS FROM DISADVANTAGED BACKGROUNDS.—
The individuals referred to in paragraph (1) are individuals
who—
(A) are enrolled or accepted for enrollment as full-time
undergraduates at accredited institutions of higher education; and
(B) are from disadvantaged backgrounds.
(b) FACILITATION OF INTEREST OF STUDENTS IN CAREERS AT NATIONAL INSTITUTES OF HEALTH.—In providing employment to individuals pursuant to contracts under subsection (a)(1), the Director
of NIH shall carry out activities to facilitate the interest of the individuals in pursuing careers as employees of the National Institutes of Health.
(c) PERIOD OF OBLIGATED SERVICE.—
(1) DURATION OF SERVICE.—For purposes of subparagraph
(B) of subsection (a)(1), the period of service for which an individual is obligated to serve as an employee of the National Institutes of Health is, subject to paragraph (2)(A), 12 months for
each academic year for which the scholarship under such subsection is provided.
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(2) SCHEDULE FOR SERVICE.—
(A) Subject to subparagraph (B), the Director of NIH
may not provide a scholarship under subsection (a) unless
the individual applying for the scholarship agrees that—
(i) the individual will serve as an employee of the
National Institutes of Health full-time for not less
than 10 consecutive weeks of each year during which
the individual is attending the educational institution
involved and receiving such a scholarship;
(ii) the period of service as such an employee that
the individual is obligated to provide under clause (i)
is in addition to the period of service as such an employee that the individual is obligated to provide
under subsection (a)(1)(B); and
(iii) not later than 60 days after obtaining the
educational degree involved, the individual will begin
serving full-time as such an employee in satisfaction of
the period of service that the individual is obligated to
provide under subsection (a)(1)(B).
(B) The Director of NIH may defer the obligation of an
individual to provide a period of service under subsection
(a)(1)(B), if the Director determines that such a deferral is
appropriate.
(3) APPLICABILITY OF CERTAIN PROVISIONS RELATING TO APPOINTMENT AND COMPENSATION.—For any period in which an
individual provides service as an employee of the National Institutes of Health in satisfaction of the obligation of the individual under subsection (a)(1)(B) or paragraph (2)(A)(i), the individual may be appointed as such an employee without regard
to the provisions of title 5, United States Code, relating to appointment and compensation.
(d) PROVISIONS REGARDING SCHOLARSHIP.—
(1) APPROVAL OF ACADEMIC PROGRAM.—The Director of
NIH may not provide a scholarship under subsection (a) for an
academic year unless—
(A) the individual applying for the scholarship has
submitted to the Director a proposed academic program for
the year and the Director has approved the program; and
(B) the individual agrees that the program will not be
altered without the approval of the Director.
(2) ACADEMIC STANDING.—The Director of NIH may not
provide a scholarship under subsection (a) for an academic
year unless the individual applying for the scholarship agrees
to maintain an acceptable level of academic standing, as determined by the educational institution involved in accordance
with regulations issued by the Secretary.
(3) LIMITATION ON AMOUNT.—The Director of NIH may not
provide a scholarship under subsection (a) for an academic
year in an amount exceeding $20,000.
(4) AUTHORIZED USES.—A scholarship provided under subsection (a) may be expended only for tuition expenses, other
reasonable educational expenses, and reasonable living expenses incurred in attending the school involved.
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(5) CONTRACT REGARDING DIRECT PAYMENTS TO INSTITUthe case of an institution of higher education with
respect to which a scholarship under subsection (a) is provided,
the Director of NIH may enter into a contract with the institution under which the amounts provided in the scholarship for
tuition and other educational expenses are paid directly to the
institution.
(e) PENALTIES FOR BREACH OF SCHOLARSHIP CONTRACT.—The
provisions of section 338E shall apply to the program established
in subsection (a) to the same extent and in the same manner as
such provisions apply to the National Health Service Corps Loan
Repayment Program established in section 338B.
(f) REQUIREMENT OF APPLICATION.—The Director of NIH may
not provide a scholarship under subsection (a) unless an application for the scholarship is submitted to the Director and the application is in such form, is made in such manner, and contains such
agreements, assurances, and information as the Director determines to be necessary to carry out this section.
(g) AVAILABILITY OF AUTHORIZATION OF APPROPRIATIONS.—
Amounts appropriated for a fiscal year for scholarships under this
section shall remain available until the expiration of the second fiscal year beginning after the fiscal year for which the amounts were
appropriated.
TION.—In

LOAN REPAYMENT PROGRAM REGARDING CLINICAL RESEARCHERS
FROM DISADVANTAGED BACKGROUNDS

SEC. 487E. ø288–5¿ (a) IMPLEMENTATION OF PROGRAM.—
(1) IN GENERAL.—Subject to section 487(a)(1)(C), the Secretary, acting through the Director of NIH may, subject to
paragraph (2), carry out a program of entering into contracts
with appropriately qualified health professionals who are from
disadvantaged backgrounds under which such health professionals agree to conduct clinical research in consideration of
the Federal Government agreeing to pay, for each year of such
service, not more than $35,000 of the principal and interest of
the educational loans of the health professionals.
(2) LIMITATION.—The Director of NIH may not enter into
a contract with a health professional pursuant to paragraph (1)
unless such professional has a substantial amount of education
loans relative to income.
(3) APPLICABILITY OF CERTAIN PROVISIONS REGARDING OBLIGATED SERVICE.—Except to the extent inconsistent with this
section, the provisions of sections 338B, 338C 1 and 338E shall
apply to the program established in paragraph (1) to the same
extent and in the same manner as such provisions apply to the
National Health Service Corps Loan Repayment Program established in section 338B.
(b) AVAILABILITY OF AUTHORIZATION OF APPROPRIATIONS.—
Amounts appropriated for a fiscal year for contracts under subsection (a) shall remain available until the expiration of the second
fiscal year beginning after the fiscal year for which the amounts
were appropriated.
1 So

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SEC. 487F. ø288–5a¿ LOAN REPAYMENT PROGRAM REGARDING CLINICAL RESEARCHERS.
(a) IN GENERAL.—The Secretary, acting through the Director of

the National Institutes of Health, shall establish a program to
enter into contracts with qualified health professionals under
which such health professionals agree to conduct clinical research,
in consideration of the Federal Government agreeing to repay, for
each year of service conducting such research, not more than
$35,000 of the principal and interest of the educational loans of
such health professionals.
(b) APPLICATION OF PROVISIONS.—The provisions of sections
338B, 338C, and 338E shall, except as inconsistent with subsection
(a) of this section, apply to the program established under subsection (a) to the same extent and in the same manner as such provisions apply to the National Health Service Corps Loan Repayment Program established in subpart III of part D of title III.
PEDIATRIC RESEARCH LOAN REPAYMENT PROGRAM

SEC. 487F. 2 ø288–6¿ (a) IN GENERAL.—The Secretary, in consultation with the Director of NIH, may establish a pediatric research loan repayment program. Through such program—
(1) the Secretary shall enter into contracts with qualified
health professionals under which such professionals will agree
to conduct pediatric research, including pediatric pharmacological research, in consideration of the Federal Government
agreeing to repay, for each year of such service, not more than
$35,000 of the principal and interest of the educational loans
of such professionals; and
(2) the Secretary shall, for the purpose of providing reimbursements for tax liability resulting from payments made
under paragraph (1) on behalf of an individual, make payments, in addition to payments under such paragraph, to the
individual in an amount equal to 39 percent of the total
amount of loan repayments made for the taxable year involved.
(b) APPLICATION OF OTHER PROVISIONS.—The provisions of sections 338B, 338C, and 338E shall, except as inconsistent with paragraph (1), apply to the program established under such paragraph
to the same extent and in the same manner as such provisions
apply to the National Health Service Corps Loan Repayment Program established under subpart III of part D of title III.
(c) FUNDING.—
(1) IN GENERAL.—For the purpose of carrying out this section with respect to a national research institute the Secretary
may reserve, from amounts appropriated for such institute for
the fiscal year involved, such amounts as the Secretary determines to be appropriate.
(2) AVAILABILITY OF FUNDS.—Amounts made available to
carry out this section shall remain available until the expiration of the second fiscal year beginning after the fiscal year for
which such amounts were made available.
2 So in law. There are two sections 487F. Section 1002(b) of Public Law 106–310 (114 Stat.
1129) inserted section 487F above. Subsequently, section 205 of Public Law 106–505 (114 Stat.
2329), which relates to a loan repayment program regarding clinical researchers, inserted a section 487F after section 487E.

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VISITING SCIENTIST AWARDS

SEC. 488. ø288a¿ (a) The Secretary may make awards (hereafter in this section referred to as ‘‘Visiting Scientist Awards’’) to
outstanding scientists who agree to serve as visiting scientists at
institutions of postsecondary education which have significant enrollments of disadvantaged students. Visiting Scientist Awards
shall be made by the Secretary to enable the faculty and students
of such institutions to draw upon the special talents of scientists
from other institutions for the purpose of receiving guidance, advice, and instruction with regard to research, teaching, and curriculum development in the biomedical and behavioral sciences and
such other aspects of these sciences as the Secretary shall deem appropriate.
(b) The amount of each Visiting Scientist Award shall include
such sum as shall be commensurate with the salary or remuneration which the individual receiving the award would have been entitled to receive from the institution with which the individual has,
or had, a permanent or immediately prior affiliation. Eligibility for
and terms of Visiting Scientist Awards shall be determined in accordance with regulations the Secretary shall prescribe.
STUDIES RESPECTING BIOMEDICAL AND BEHAVIORAL RESEARCH
PERSONNEL

SEC. 489. ø288b¿ (a) The Secretary shall, in accordance with
subsection (b), arrange for the conduct of a continuing study to—
(1) establish (A) the Nation’s overall need for biomedical
and behavioral research personnel, (B) the subject areas in
which such personnel are needed and the number of such personnel needed in each such area, and (C) the kinds and extent
of training which should be provided such personnel;
(2) assess (A) current training programs available for the
training of biomedical and behavioral research personnel which
are conducted under this Act, at or through national research
institutes under the National Institutes of Health, and (B)
other current training programs available for the training of
such personnel;
(3) identify the kinds of research positions available to and
held by individuals completing such programs;
(4) determine, to the extent feasible, whether the programs
referred to in clause (B) of paragraph (2) would be adequate to
meet the needs established under paragraph (1) if the programs referred to in clause (A) of paragraph (2) were terminated; and
(5) determine what modifications in the programs referred
to in paragraph (2) are required to meet the needs established
under paragraph (1).
(b)(1) The Secretary shall request the National Academy of
Sciences to conduct the study required by subsection (a) under an
arrangement under which the actual expenses incurred by such
Academy in conducting such study will be paid by the Secretary.
If the National Academy of Sciences is willing to do so, the Secretary shall enter into such an arrangement with such Academy for
the conduct of such study.
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(2) If the National Academy of Sciences is unwilling to conduct
such study under such an arrangement, then the Secretary shall
enter into a similar arrangement with other appropriate nonprofit
private groups or associations under which such groups or associations will conduct such study and prepare and submit the reports
thereon as provided in subsection (c).
(3) The National Academy of Sciences or other group or association conducting the study required by subsection (a) shall conduct such study in consultation with the Director of NIH.
(c) A report on the results of the study required under subsection (a) shall be submitted by the Secretary to the Committee
on Energy and Commerce of the House of Representatives and the
Committee on Labor and Human Resources of the Senate at least
once every four years.
PART H—GENERAL PROVISIONS
INSTITUTIONAL REVIEW BOARDS; ETHICS GUIDANCE PROGRAM

SEC. 491. ø289¿ (a) The Secretary shall by regulation require
that each entity which applies for a grant, contract, or cooperative
agreement under this Act for any project or program which involves the conduct of biomedical or behavioral research involving
human subjects submit in or with its application for such grant,
contract, or cooperative agreement assurances satisfactory to the
Secretary that it has established (in accordance with regulations
which the Secretary shall prescribe) a board (to be known as an
‘‘Institutional Review Board’’) to review biomedical and behavioral
research involving human subjects conducted at or supported by
such entity in order to protect the rights of the human subjects of
such research.
(b)(1) The Secretary shall establish a program within the Department of Health and Human Services under which requests for
clarification and guidance with respect to ethical issues raised in
connection with biomedical or behavioral research involving human
subjects are responded to promptly and appropriately.
(2) The Secretary shall establish a process for the prompt and
appropriate response to information provided to the Director of
NIH respecting incidences of violations of the rights of human subjects of research for which funds have been made available under
this Act. The process shall include procedures for the receiving of
reports of such information from recipients of funds under this Act
and taking appropriate action with respect to such violations.
PEER REVIEW REQUIREMENTS

SEC. 492. ø289a¿ (a)(1) The Secretary, acting through the Director of NIH, shall by regulation require appropriate technical and
scientific peer review of—
(A) applications made for grants and cooperative agreements under this Act for biomedical and behavioral research;
and
(B) applications made for biomedical and behavioral research and development contracts to be administered through
the National Institutes of Health.
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(2) Regulations promulgated under paragraph (1) shall require
that the review of applications made for grants, contracts, and cooperative agreements required by the regulations be conducted—
(A) to the extent practical, in a manner consistent with the
system for technical and scientific peer review applicable on
the date of the date of enactment of the Health Research Extension Act of 1985 to grants under this Act for biomedical and
behavioral research, and
(B) to the extent practical, by technical and scientific peer
review groups performing such review on or before such date,
and shall authorize such review to be conducted by groups appointed under sections 402(b)(16) and 405(c)(3).
(b) The Director of NIH shall establish procedures for periodic
technical and scientific peer review of research at the National Institutes of Health. Such procedures shall require that—
(1) the reviewing entity be provided a written description
of the research to be reviewed, and
(2) the reviewing entity provide the advisory council of the
national research institute involved with such description and
the results of the review by the entity,
and shall authorize such review to be conducted by groups appointed under sections 402(b)(6) and 405(c)(3).
(c)(1) In technical and scientific peer review under this section
of proposals for clinical research, the consideration of any such proposal (including the initial consideration) shall, except as provided
in paragraph (2), include an evaluation of the technical and scientific merit of the proposal regarding compliance with section
492B.
(2) Paragraph (1) shall not apply to any proposal for clinical research that, pursuant to subsection (b) of section 492B, is not subject to the requirement of subsection (a) of such section regarding
the inclusion of women and members of minority groups as subjects
in clinical research.
CERTAIN PROVISIONS REGARDING REVIEW AND APPROVAL OF
PROPOSALS FOR RESEARCH

SEC. 492A. ø289a–1¿ (a) REVIEW AS PRECONDITION TO
SEARCH.—
(1) PROTECTION OF HUMAN RESEARCH SUBJECTS.—

RE-

(A) In the case of any application submitted to the
Secretary for financial assistance to conduct research, the
Secretary may not approve or fund any application that is
subject to review under section 491(a) by an Institutional
Review Board unless the application has undergone review
in accordance with such section and has been recommended for approval by a majority of the members of
the Board conducting such review.
(B) In the case of research that is subject to review
under procedures established by the Secretary for the protection of human subjects in clinical research conducted by
the National Institutes of Health, the Secretary may not
authorize the conduct of the research unless the research
has, pursuant to such procedures, been recommended for
approval.
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(2) PEER REVIEW.—In the case of any proposal for the National Institutes of Health to conduct or support research, the
Secretary may not approve or fund any proposal that is subject
to technical and scientific peer review under section 492 unless
the proposal has undergone such review in accordance with
such section and has been recommended for approval by a majority of the members of the entity conducting such review, and
unless a majority of the voting members of the appropriate advisory council under section 406, or as applicable, of the advisory council under section 402(k), has recommended the proposal for approval.
(b) ETHICAL REVIEW OF RESEARCH.—
(1) PROCEDURES REGARDING WITHHOLDING OF FUNDS.—If
research has been recommended for approval for purposes of
subsection (a), the Secretary may not withhold funds for the
research because of ethical considerations unless—
(A) the Secretary convenes an advisory board in accordance with paragraph (5) to study such considerations;
and
(B)(i) the majority of the advisory board recommends
that, because of such considerations, the Secretary withhold funds for the research; or
(ii) the majority of such board recommends that the
Secretary not withhold funds for the research because of
such considerations, but the Secretary finds, on the basis
of the report submitted under paragraph (5)(B)(ii), that the
recommendation is arbitrary and capricious.
(2) RULES OF CONSTRUCTION.—Paragraph (1) may not be
construed as prohibiting the Secretary from withholding funds
for research on the basis of—
(A) the inadequacy of the qualifications of the entities
that would be involved with the conduct of the research
(including the entity that would directly receive the funds
from the Secretary), subject to the condition that, with respect to the process of review through which the research
was recommended for approval for purposes of subsection
(a), all findings regarding such qualifications made in such
process are conclusive; or
(B) the priorities established by the Secretary for the
allocation of funds among projects of research that have
been so recommended.
(3) APPLICABILITY.—The limitation established in paragraph (1) regarding the authority to withhold funds because of
ethical considerations shall apply without regard to whether
the withholding of funds on such basis is characterized as a
disapproval, a moratorium, a prohibition, or other characterization.
(4) PRELIMINARY MATTERS REGARDING USE OF PROCEDURES.—
(A) If the Secretary makes a determination that an advisory board should be convened for purposes of paragraph
(1), the Secretary shall, through a statement published in
the Federal Register, announce the intention of the Secretary to convene such a board.
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(B) A statement issued under subparagraph (A) shall
include a request that interested individuals submit to the
Secretary recommendations specifying the particular individuals who should be appointed to the advisory board involved. The Secretary shall consider such recommendations in making appointments to the board.
(C) The Secretary may not make appointments to an
advisory board under paragraph (1) until the expiration of
the 30-day period beginning on the date on which the
statement required in subparagraph (A) is made with respect to the board.
(5) ETHICS ADVISORY BOARDS.—
(A) Any advisory board convened for purposes of paragraph (1) shall be known as an ethics advisory board (in
this paragraph referred to as an ‘‘ethics board’’).
(B)(i) An ethics board shall advise, consult with, and
make recommendations to the Secretary regarding the ethics of the project of biomedical or behavioral research with
respect to which the board has been convened.
(ii) Not later than 180 days after the date on which
the statement required in paragraph (4)(A) is made with
respect to an ethics board, the board shall submit to the
Secretary, and to the Committee on Energy and Commerce
of the House of Representatives and the Committee on
Labor and Human Resources of the Senate, a report describing the findings of the board regarding the project of
research involved and making a recommendation under
clause (i) of whether the Secretary should or should not
withhold funds for the project. The report shall include the
information considered in making the findings.
(C) An ethics board shall be composed of no fewer than
14, and no more than 20, individuals who are not officers
or employees of the United States. The Secretary shall
make appointments to the board from among individuals
with special qualifications and competence to provide advice and recommendations regarding ethical matters in
biomedical and behavioral research. Of the members of the
board—
(i) no fewer than 1 shall be an attorney;
(ii) no fewer than 1 shall be an ethicist;
(iii) no fewer than 1 shall be a practicing physician;
(iv) no fewer than 1 shall be a theologian; and
(v) no fewer than one-third, and no more than
one-half, shall be scientists with substantial accomplishments in biomedical or behavioral research.
(D) The term of service as a member of an ethics
board shall be for the life of the board. If such a member
does not serve the full term of such service, the individual
appointed to fill the resulting vacancy shall be appointed
for the remainder of the term of the predecessor of the individual.
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(E) A member of an ethics board shall be subject to removal from the board by the Secretary for neglect of duty
or malfeasance or for other good cause shown.
(F) The Secretary shall designate an individual from
among the members of an ethics board to serve as the
chair of the board.
(G) In carrying out subparagraph (B)(i) with respect to
a project of research, an ethics board shall conduct inquiries and hold public hearings.
(H) In carrying out subparagraph (B)(i) with respect to
a project of research, an ethics board shall have access to
all relevant information possessed by the Department of
Health and Human Services, or available to the Secretary
from other agencies.
(I) Members of an ethics board shall receive compensation for each day engaged in carrying out the duties of the
board, including time engaged in traveling for purposes of
such duties. Such compensation may not be provided in an
amount in excess of the maximum rate of basic pay payable for GS–18 of the General Schedule.
(J) The Secretary, acting through the Director of the
National Institutes of Health, shall provide to each ethics
board reasonable staff and assistance to carry out the duties of the board.
(K) An ethics board shall terminate 30 days after the
date on which the report required in subparagraph (B)(ii)
is submitted to the Secretary and the congressional committees specified in such subparagraph.
(6) DEFINITION.—For purposes of this subsection, the term
‘‘ethical considerations’’ means considerations as to whether
the nature of the research involved is such that it is unethical
to conduct or support the research.
INCLUSION OF WOMEN AND MINORITIES IN CLINICAL RESEARCH

SEC. 492B. ø289a–2¿ (a) REQUIREMENT OF INCLUSION.—
(1) IN GENERAL.—In conducting or supporting clinical research for purposes of this title, the Director of NIH shall, subject to subsection (b), ensure that—
(A) women are included as subjects in each project of
such research; and
(B) members of minority groups are included as subjects in such research.
(2) OUTREACH REGARDING PARTICIPATION AS SUBJECTS.—
The Director of NIH, in consultation with the Director of the
Office of Research on Women’s Health and the Director of the
Office of Research on Minority Health, shall conduct or support
outreach programs for the recruitment of women and members
of minority groups as subjects in projects of clinical research.
(b) INAPPLICABILITY OF REQUIREMENT.—The requirement established in subsection (a) regarding women and members of minority
groups shall not apply to a project of clinical research if the inclusion, as subjects in the project, of women and members of minority
groups, respectively—
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(1) is inappropriate with respect to the health of the subjects;
(2) is inappropriate with respect to the purpose of the research; or
(3) is inappropriate under such other circumstances as the
Director of NIH may designate.
(c) DESIGN OF CLINICAL TRIALS.—In the case of any clinical
trial in which women or members of minority groups will under
subsection (a) be included as subjects, the Director of NIH shall ensure that the trial is designed and carried out in a manner sufficient to provide for a valid analysis of whether the variables being
studied in the trial affect women or members of minority groups,
as the case may be, differently than other subjects in the trial.
(d) GUIDELINES.—
(1) IN GENERAL.—Subject to paragraph (2), the Director of
NIH, in consultation with the Director of the Office of Research
on Women’s Health and the Director of the Office of Research
on Minority Health, shall establish guidelines regarding the requirements of this section. The guidelines shall include guidelines regarding—
(A) the circumstances under which the inclusion of
women and minorities as subjects in projects of clinical research is inappropriate for purposes of subsection (b);
(B) the manner in which clinical trials are required to
be designed and carried out for purposes of subsection (c);
and
(C) the operation of outreach programs under subsection (a).
(2) CERTAIN PROVISIONS.—With respect to the circumstances under which the inclusion of women or members of
minority groups (as the case may be) as subjects in a project
of clinical research is inappropriate for purposes of subsection
(b), the following applies to guidelines under paragraph (1):
(A)(i) In the case of a clinical trial, the guidelines shall
provide that the costs of such inclusion in the trial is not
a permissible consideration in determining whether such
inclusion is inappropriate.
(ii) In the case of other projects of clinical research,
the guidelines shall provide that the costs of such inclusion
in the project is not a permissible consideration in determining whether such inclusion is inappropriate unless the
data regarding women or members of minority groups, respectively, that would be obtained in such project (in the
event that such inclusion were required) have been or are
being obtained through other means that provide data of
comparable quality.
(B) In the case of a clinical trial, the guidelines may
provide that such inclusion in the trial is not required if
there is substantial scientific data demonstrating that
there is no significant difference between—
(i) the effects that the variables to be studied in
the trial have on women or members of minority
groups, respectively; and
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(ii) the effects that the variables have on the individuals who would serve as subjects in the trial in the
event that such inclusion were not required.
(e) DATE CERTAIN FOR GUIDELINES; APPLICABILITY.—
(1) DATE CERTAIN.—The guidelines required in subsection
(d) shall be established and published in the Federal Register
not later than 180 days after the date of the enactment of the
National Institutes of Health Revitalization Act of 1993.
(2) APPLICABILITY.—For fiscal year 1995 and subsequent
fiscal years, the Director of NIH may not approve any proposal
of clinical research to be conducted or supported by any agency
of the National Institutes of Health unless the proposal specifies the manner in which the research will comply with this
section.
(f) REPORTS BY ADVISORY COUNCILS.—The advisory council of
each national research institute shall prepare biennial reports describing the manner in which the institute has complied with this
section. Each such report shall be submitted to the Director of the
institute involved for inclusion in the biennial report under section
403.
(g) DEFINITIONS.—For purposes of this section:
(1) The term ‘‘project of clinical research’’ includes a clinical trial.
(2) The term ‘‘minority group’’ includes subpopulations of
minority groups. The Director of NIH shall, through the guidelines established under subsection (d), define the terms ‘‘minority group’’ and ‘‘subpopulation’’ for purposes of the preceding
sentence.
OFFICE OF RESEARCH INTEGRITY

SEC. 493. ø289b¿ (a) IN GENERAL.—
(1) ESTABLISHMENT OF OFFICE.—Not later than 90 days
after the date of enactment of this section, the Secretary shall
establish an office to be known as the Office of Research Integrity (referred to in this section as the ‘‘Office’’), which shall be
established as an independent entity in the Department of
Health and Human Services.
(2) APPOINTMENT OF DIRECTOR.—The Office shall be headed by a Director, who shall be appointed by the Secretary, be
experienced and specially trained in the conduct of research,
and have experience in the conduct of investigations of research misconduct. The Secretary shall carry out this section
acting through the Director of the Office. The Director shall report to the Secretary.
(3) DEFINITIONS.—
(A) The Secretary shall by regulation establish a definition for the term ‘‘research misconduct’’ for purposes of
this section.
(B) For purposes of this section, the term ‘‘financial assistance’’ means a grant, contract, or cooperative agreement.
(b) EXISTENCE OF ADMINISTRATIVE PROCESSES AS CONDITION OF
FUNDING FOR RESEARCH.—The Secretary shall by regulation require that each entity that applies for financial assistance under
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this Act for any project or program that involves the conduct of biomedical or behavioral research submit in or with its application for
such assistance—
(1) assurances satisfactory to the Secretary that such entity has established and has in effect (in accordance with regulations which the Secretary shall prescribe) an administrative
process to review reports of research misconduct in connection
with biomedical and behavioral research conducted at or sponsored by such entity;
(2) an agreement that the entity will report to the Director
any investigation of alleged research misconduct in connection
with projects for which funds have been made available under
this Act that appears substantial; and
(3) an agreement that the entity will comply with regulations issued under this section.
(c) PROCESS FOR RESPONSE OF DIRECTOR.—The Secretary shall
by regulation establish a process to be followed by the Director for
the prompt and appropriate—
(1) response to information provided to the Director respecting research misconduct in connection with projects for
which funds have been made available under this Act;
(2) receipt of reports by the Director of such information
from recipients of funds under this Act;
(3) conduct of investigations, when appropriate; and
(4) taking of other actions, including appropriate remedies,
with respect to such misconduct.
(d) MONITORING BY DIRECTOR.—The Secretary shall by regulation establish procedures for the Director to monitor administrative
processes and investigations that have been established or carried
out under this section.
(e) PROTECTION OF WHISTLEBLOWERS.—
(1) IN GENERAL.—In the case of any entity required to establish administrative processes under subsection (b), the Secretary shall by regulation establish standards for preventing,
and for responding to the occurrence of retaliation by such entity, its officials or agents, against an employee in the terms
and conditions of employment in response to the employee having in good faith—
(A) made an allegation that the entity, its officials or
agents, has engaged in or failed to adequately respond to
an allegation of research misconduct; or
(B) cooperated with an investigation of such an allegation.
(2) MONITORING BY SECRETARY.—The Secretary shall by
regulation establish procedures for the Director to monitor the
implementation of the standards established by an entity
under paragraph (1) for the purpose of determining whether
the procedures have been established, and are being utilized,
in accordance with the standards established under such paragraph.
(3) NONCOMPLIANCE.—The Secretary shall by regulation
establish remedies for noncompliance by an entity, its officials
or agents, which has engaged in retaliation in violation of the
standards established under paragraph (1). Such remedies may
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include termination of funding provided by the Secretary for
such project or recovery of funding being provided by the Secretary for such project, or other actions as appropriate.
PROTECTION AGAINST FINANCIAL CONFLICTS OF INTEREST IN CERTAIN
PROJECTS OF RESEARCH

SEC. 493A. ø289b–1¿ (a) ISSUANCE OF REGULATIONS.—The Secretary shall by regulation define the specific circumstances that
constitute the existence of a financial interest in a project on the
part of an entity or individual that will, or may be reasonably expected to, create a bias in favor of obtaining results in such project
that are consistent with such financial interest. Such definition
shall apply uniformly to each entity or individual conducting a research project under this Act. In the case of any entity or individual receiving assistance from the Secretary for a project of research described in subsection (b), the Secretary shall by regulation
establish standards for responding to, including managing, reducing, or eliminating, the existence of such a financial interest. The
entity may adopt individualized procedures for implementing the
standards.
(b) RELEVANT PROJECTS.—A project of research referred to in
subsection (a) is a project of clinical research whose purpose is to
evaluate the safety or effectiveness of a drug, medical device, or
treatment and for which such entity is receiving assistance from
the Secretary.
(c) IDENTIFYING AND REPORTING TO SECRETARY.—The Secretary
shall by regulation require that each entity described in subsection
(a) that applies for assistance under this Act for any project described in subsection (b) submit in or with its application for such
assistance—
(1) assurances satisfactory to the Secretary that such entity has established and has in effect an administrative process
under subsection (a) to identify financial interests (as defined
under subsection (a)) that exist regarding the project; and
(2) an agreement that the entity will report to the Secretary such interests identified by the entity and how any such
interests identified by the entity will be managed or eliminated
in order that the project in question will be protected from bias
that may stem from such interests; and
(3) an agreement that the entity will comply with regulations issued under this section.
(d) MONITORING OF PROCESS.—The Secretary shall monitor the
establishment and conduct of the administrative process established by an entity pursuant to subsection (a).
(e) RESPONSE.—In any case in which the Secretary determines
that an entity has failed to comply with subsection (c) regarding a
project of research described in subsection (b), the Secretary—
(1) shall require that, as a condition of receiving assistance, the entity disclose the existence of a financial interest (as
defined under subsection (a)) in each public presentation of the
results of such project; and
(2) may take such other actions as the Secretary determines to be appropriate.
(f) DEFINITIONS.—For purposes of this section:
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(1) The term ‘‘financial interest’’ includes the receipt of
consulting fees or honoraria and the ownership of stock or equity.
(2) The term ‘‘assistance’’, with respect to conducting a
project of research, means a grant, contract, or cooperative
agreement.
RESEARCH ON PUBLIC HEALTH EMERGENCIES

SEC. 494. ø289c¿ If the Secretary determines, after consultation with the Director of NIH, the Commissioner of the Food and
Drug Administration, or the Director of the Centers for Disease
Control and Prevention, that a disease or disorder constitutes a
public health emergency, the Secretary, acting through the Director
of NIH—
(1) shall expedite the review by advisory councils under
section 406 and by peer review groups under section 492 of applications for grants for research on such disease or disorder
or proposals for contracts for such research;
(2) shall exercise the authority in section 3709 of the Revised Statutes (41 U.S.C. 5) respecting public exigencies to
waive the advertising requirements of such section in the case
of proposals for contracts for such research;
(3) may provide administrative supplemental increases in
existing grants and contracts to support new research relevant
to such disease or disorder; and
(4) shall disseminate, to health professionals and the public, information on the cause, prevention, and treatment of
such disease or disorder that has been developed in research
assisted under this section.
The amount of an increase in a grant or contract provided under
paragraph (3) may not exceed one-half the original amount of the
grant or contract.
COLLABORATIVE USE OF CERTAIN HEALTH SERVICES RESEARCH FUNDS

SEC. 494A. ø289c–1¿ The Secretary shall ensure that amounts
made available under subparts 14, 15 and 16 of part C for health
services research relating to alcohol abuse and alcoholism, drug
abuse and mental health be used collaboratively, as appropriate,
and in consultation with the Agency for Health Care Policy Research.
ANIMALS IN RESEARCH

SEC. 495. ø289d¿ (a) The Secretary, acting through the Director of NIH, shall establish guidelines for the following:
(1) The proper care of animals to be used in biomedical
and behavioral research.
(2) The proper treatment of animals while being used in
such research. Guidelines under this paragraph shall require—
(A) the appropriate use of tranquilizers, analgesics,
anesthetics, paralytics, and euthanasia for animals in such
research; and
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(B) appropriate pre-surgical and post-surgical veterinary medical and nursing care for animals in such research.
Such guidelines shall not be construed to prescribe methods of
research.
(3) The organization and operation of animal care committees in accordance with subsection (b).
(b)(1) Guidelines of the Secretary under subsection (a)(3) shall
require animal care committees at each entity which conducts biomedical and behavioral research with funds provided under this
Act (including the National Institutes of Health and the national
research institutes) to assure compliance with the guidelines established under subsection (a).
(2) Each animal care committee shall be appointed by the chief
executive officer of the entity for which the committee is established, shall be composed of not fewer than three members, and
shall include at least one individual who has no association with
such entity and at least one doctor of veterinary medicine.
(3) Each animal care committee of a research entity shall—
(A) review the care and treatment of animals in all animal
study areas and facilities of the research entity at least semiannually to evaluate compliance with applicable guidelines established under subsection (a) for appropriate animal care and
treatment;
(B) keep appropriate records of reviews conducted under
subparagraph (A); and
(C) for each review conducted under subparagraph (A), file
with the Director of NIH at least annually (i) a certification
that the review has been conducted, and (ii) reports of any violations of guidelines established under subsection (a) or assurances required under paragraph (1) which were observed in
such review and which have continued after notice by the committee to the research entity involved of the violations.
Reports filed under subparagraph (C) shall include any minority
views filed by members of the committee.
(c) The Director of NIH shall require each applicant for a
grant, contract, or cooperative agreement involving research on animals which is administered by the National Institutes of Health or
any national research institute to include in its application or contract proposal, submitted after the expiration of the twelve-month
period beginning on the date of enactment of this section—
(1) assurances satisfactory to the Director of NIH that—
(A) the applicant meets the requirements of the guidelines established under paragraphs (1) and (2) of subsection (a) and has an animal care committee which meets
the requirements of subsection (b); and
(B) scientists, animal technicians, and other personnel
involved with animal care, treatment, and use by the applicant have available to them instruction or training in
the humane practice of animal maintenance and experimentation, and the concept, availability, and use of research or testing methods that limit the use of animals or
limit animal distress; and
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(2) a statement of the reasons for the use of animals in the
research to be conducted with funds provided under such grant
or contract.
Notwithstanding subsection (a)(2) of section 553 of title 5, United
States Code, regulations under this subsection shall be promulgated in accordance with the notice and comment requirements of
such section.
(d) If the Director of NIH determines that—
(1) the conditions of animal care, treatment, or use in an
entity which is receiving a grant, contract, or cooperative
agreement involving research on animals under this title do
not meet applicable guidelines established under subsection
(a);
(2) the entity has been notified by the Director of NIH of
such determination and has been given a reasonable opportunity to take corrective action; and
(3) no action has been taken by the entity to correct such
conditions;
the Director of NIH shall suspend or revoke such grant or contract
under such conditions as the Director determines appropriate.
(e) No guideline or regulation promulgated under subsection
(a) or (c) may require a research entity to disclose publicly trade
secrets or commercial or financial information which is privileged
or confidential.
USE OF APPROPRIATIONS UNDER THIS TITLE

SEC. 496. ø289e¿ (a) Appropriations to carry out the purposes
of this title, unless otherwise expressly provided, may be expended
in the District of Columbia for—
(1) personal services;
(2) stenographic recording and translating services;
(3) travel expenses (including the expenses of attendance
at meetings when specifically authorized by the Secretary);
(4) rental;
(5) supplies and equipment;
(6) purchase and exchange of medical books, books of reference, directories, periodicals, newspapers, and press clippings;
(7) purchase, operation, and maintenance of passenger
motor vehicles;
(8) printing and binding (in addition to that otherwise provided by law); and
(9) all other necessary expenses in carrying out this title.
Such appropriations may be expended by contract if deemed necessary, without regard to section 3709 of the Revised Statutes (41
U.S.C. 5).
(b)(1) None of the amounts appropriated under this Act for the
purposes of this title may be obligated for the construction of facilities (including the acquisition of land) unless a provision of this
title establishes express authority for such purpose and unless the
Act making appropriations under such provision specifies that the
amounts appropriated are available for such purpose.
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(2) Any grants, cooperative agreements, or contracts authorized
in this title for the construction of facilities may be awarded only
on a competitive basis.
GIFTS

SEC. 497. ø289f¿ The Secretary may, in accordance with section 231, accept conditional gifts for the National Institutes of
Health or a national research institute or for the acquisition of
grounds or for the erection, equipment, or maintenance of facilities
for the National Institutes of Health or a national research institute. Donations of $50,000 or over for the National Institutes of
Health or a national research institute for carrying out the purposes of this title may be acknowledged by the establishment within the National Institutes of Health or a national research institute
of suitable memorials to the donors.
FETAL RESEARCH

SEC. 498. ø289g¿ (a) The Secretary may not conduct or support
any research or experimentation, in the United States or in any
other country, on a nonviable living human fetus ex utero or a living human fetus ex utero for whom viability has not been
ascertained unless the research or experimentation—
(1) may enhance the well-being or meet the health needs
of the fetus or enhance the probability of its survival to viability; or
(2) will pose no added risk of suffering, injury, or death to
the fetus and the purpose of the research or experimentation
is the development of important biomedical knowledge which
cannot be obtained by other means.
(b) In administering the regulations for the protection of
human research subjects which—
(1) apply to research conducted or supported by the Secretary;
(2) involve living human fetuses in utero; and
(3) are published in section 46.208 of part 46 of title 45 of
the Code of Federal Regulations;
or any successor to such regulations, the Secretary shall require
that the risk standard (published in section 46.102(g) of such part
46 or any successor to such regulations) be the same for fetuses
which are intended to be aborted and fetuses which are intended
to be carried to term.
RESEARCH ON TRANSPLANTATION OF FETAL TISSUE

SEC. 498A. ø289g–1¿ (a) ESTABLISHMENT OF PROGRAM.—
(1) IN GENERAL.—The Secretary may conduct or support
research on the transplantation of human fetal tissue for
therapeutic purposes.
(2) SOURCE OF TISSUE.—Human fetal tissue may be used
in research carried out under paragraph (1) regardless of
whether the tissue is obtained pursuant to a spontaneous or
induced abortion or pursuant to a stillbirth.
(b) INFORMED CONSENT OF DONOR.—
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(1) IN GENERAL.—In research carried out under subsection
(a), human fetal tissue may be used only if the woman providing the tissue makes a statement, made in writing and
signed by the woman, declaring that—
(A) the woman donates the fetal tissue for use in research described in subsection (a);
(B) the donation is made without any restriction regarding the identity of individuals who may be the recipients of transplantations of the tissue; and
(C) the woman has not been informed of the identity
of any such individuals.
(2) ADDITIONAL STATEMENT.—In research carried out under
subsection (a), human fetal tissue may be used only if the attending physician with respect to obtaining the tissue from the
woman involved makes a statement, made in writing and
signed by the physician, declaring that—
(A) in the case of tissue obtained pursuant to an induced abortion—
(i) the consent of the woman for the abortion was
obtained prior to requesting or obtaining consent for a
donation of the tissue for use in such research;
(ii) no alteration of the timing, method, or procedures used to terminate the pregnancy was made solely for the purposes of obtaining the tissue; and
(iii) the abortion was performed in accordance
with applicable State law;
(B) the tissue has been donated by the woman in accordance with paragraph (1); and
(C) full disclosure has been provided to the woman
with regard to—
(i) such physician’s interest, if any, in the research
to be conducted with the tissue; and
(ii) any known medical risks to the woman or
risks to her privacy that might be associated with the
donation of the tissue and that are in addition to risks
of such type that are associated with the woman’s
medical care.
(c) INFORMED CONSENT OF RESEARCHER AND DONEE.—In research carried out under subsection (a), human fetal tissue may be
used only if the individual with the principal responsibility for conducting the research involved makes a statement, made in writing
and signed by the individual, declaring that the individual—
(1) is aware that—
(A) the tissue is human fetal tissue;
(B) the tissue may have been obtained pursuant to a
spontaneous or induced abortion or pursuant to a stillbirth; and
(C) the tissue was donated for research purposes;
(2) has provided such information to other individuals with
responsibilities regarding the research;
(3) will require, prior to obtaining the consent of an individual to be a recipient of a transplantation of the tissue, written acknowledgment of receipt of such information by such recipient; and
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(4) has had no part in any decisions as to the timing,
method, or procedures used to terminate the pregnancy made
solely for the purposes of the research.
(d) AVAILABILITY OF STATEMENTS FOR AUDIT.—
(1) IN GENERAL.—In research carried out under subsection
(a), human fetal tissue may be used only if the head of the
agency or other entity conducting the research involved certifies to the Secretary that the statements required under subsections (b)(2) and (c) will be available for audit by the Secretary.
(2) CONFIDENTIALITY OF AUDIT.—Any audit conducted by
the Secretary pursuant to paragraph (1) shall be conducted in
a confidential manner to protect the privacy rights of the individuals and entities involved in such research, including such
individuals and entities involved in the donation, transfer, receipt, or transplantation of human fetal tissue. With respect to
any material or information obtained pursuant to such audit,
the Secretary shall—
(A) use such material or information only for the purposes of verifying compliance with the requirements of this
section;
(B) not disclose or publish such material or information, except where required by Federal law, in which case
such material or information shall be coded in a manner
such that the identities of such individuals and entities are
protected; and
(C) not maintain such material or information after
completion of such audit, except where necessary for the
purposes of such audit.
(e) APPLICABILITY OF STATE AND LOCAL LAW.—
(1) RESEARCH CONDUCTED BY RECIPIENTS OF ASSISTANCE.—
The Secretary may not provide support for research under subsection (a) unless the applicant for the financial assistance involved agrees to conduct the research in accordance with applicable State law.
(2) RESEARCH CONDUCTED BY SECRETARY.—The Secretary
may conduct research under subsection (a) only in accordance
with applicable State and local law.
(f) REPORT.—The Secretary shall annually submit to the Committee on Energy and Commerce of the House of Representatives,
and to the Committee on Labor and Human Resources of the Senate, a report describing the activities carried out under this section
during the preceding fiscal year, including a description of whether
and to what extent research under subsection (a) has been conducted in accordance with this section.
(g) DEFINITION.—For purposes of this section, the term ‘‘human
fetal tissue’’ means tissue or cells obtained from a dead human embryo or fetus after a spontaneous or induced abortion, or after a
stillbirth.
PROHIBITIONS REGARDING HUMAN FETAL TISSUE

SEC. 498B. ø289g–2¿ (a) PURCHASE OF TISSUE.—It shall be unlawful for any person to knowingly acquire, receive, or otherwise
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transfer any human fetal tissue for valuable consideration if the
transfer affects interstate commerce.
(b) SOLICITATION OR ACCEPTANCE OF TISSUE AS DIRECTED DONATION FOR USE IN TRANSPLANTATION.—It shall be unlawful for
any person to solicit or knowingly acquire, receive, or accept a donation of human fetal tissue for the purpose of transplantation of
such tissue into another person if the donation affects interstate
commerce, the tissue will be or is obtained pursuant to an induced
abortion, and—
(1) the donation will be or is made pursuant to a promise
to the donating individual that the donated tissue will be
transplanted into a recipient specified by such individual;
(2) the donated tissue will be transplanted into a relative
of the donating individual; or
(3) the person who solicits or knowingly acquires, receives,
or accepts the donation has provided valuable consideration for
the costs associated with such abortion.
(c) SOLICITATION OR ACCEPTANCE OF TISSUE FROM FETUSES
GESTATED FOR RESEARCH PURPOSES.—It shall be unlawful for any
person or entity involved or engaged in interstate commerce to—
(1) solicit or knowingly acquire, receive, or accept a donation of human fetal tissue knowing that a human pregnancy
was deliberately initiated to provide such tissue; or
(2) knowingly acquire, receive, or accept tissue or cells obtained from a human embryo or fetus that was gestated in the
uterus of a nonhuman animal.
(d) CRIMINAL PENALTIES FOR VIOLATIONS.—
(1) IN GENERAL.—Any person who violates subsection (a),
(b), or (c) shall be fined in accordance with title 18, United
States Code, subject to paragraph (2), or imprisoned for not
more than 10 years, or both.
(2) PENALTIES APPLICABLE TO PERSONS RECEIVING CONSIDERATION.—With respect to the imposition of a fine under paragraph (1), if the person involved violates subsection (a) or
(b)(3), a fine shall be imposed in an amount not less than twice
the amount of the valuable consideration received.
(e) DEFINITIONS.—For purposes of this section:
(1) The term ‘‘human fetal tissue’’ has the meaning given
such term in section 498A(g).
(2) The term ‘‘interstate commerce’’ has the meaning given
such term in section 201(b) of the Federal Food, Drug, and
Cosmetic Act.
(3) The term ‘‘valuable consideration’’ does not include reasonable payments associated with the transportation, implantation, processing, preservation, quality control, or storage of
human fetal tissue.
SEC. 498C. ø289g–3¿ BREAST IMPLANT RESEARCH.
(a) IN GENERAL.—The Director of NIH may

conduct or support
research to examine the long-term health implications of silicone
breast implants, both gel and saline filled. Such research studies
may include the following:
(1) Developing and examining techniques to measure concentrations of silicone in body fluids and tissues.
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(2) Surveillance of recipients of silicone breast implants,
including long-term outcomes and local complications.
(b) DEFINITION.—For purposes of this section, the term ‘‘breast
implant’’ means a breast prosthesis that is implanted to augment
or reconstruct the female breast.
SEC. 498D. ø289g–4¿ SUPPORT FOR EMERGENCY MEDICINE RESEARCH.
(a) EMERGENCY MEDICAL RESEARCH.—The Secretary shall sup-

port Federal programs administered by the National Institutes of
Health, the Agency for Healthcare Research and Quality, the
Health Resources and Services Administration, the Centers for Disease Control and Prevention, and other agencies involved in improving the emergency care system to expand and accelerate research in emergency medical care systems and emergency medicine, including—
(1) the basic science of emergency medicine;
(2) the model of service delivery and the components of
such models that contribute to enhanced patient health outcomes;
(3) the translation of basic scientific research into improved practice; and
(4) the development of timely and efficient delivery of
health services.
(b) PEDIATRIC EMERGENCY MEDICAL RESEARCH.—The Secretary
shall support Federal programs administered by the National Institutes of Health, the Agency for Healthcare Research and Quality,
the Health Resources and Services Administration, the Centers for
Disease Control and Prevention, and other agencies to coordinate
and expand research in pediatric emergency medical care systems
and pediatric emergency medicine, including—
(1) an examination of the gaps and opportunities in pediatric emergency care research and a strategy for the optimal
organization and funding of such research;
(2) the role of pediatric emergency services as an integrated component of the overall health system;
(3) system-wide pediatric emergency care planning, preparedness, coordination, and funding;
(4) pediatric training in professional education; and
(5) research in pediatric emergency care, specifically on the
efficacy, safety, and health outcomes of medications used for
infants, children, and adolescents in emergency care settings in
order to improve patient safety.
(c) IMPACT RESEARCH.—The Secretary shall support research to
determine the estimated economic impact of, and savings that result from, the implementation of coordinated emergency care systems.
(d) AUTHORIZATION OF APPROPRIATIONS.—There are authorized
to be appropriated to carry out this section such sums as may be
necessary for each of fiscal years 2010 through 2014.

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PART I—FOUNDATION FOR THE NATIONAL
INSTITUTES OF HEALTH
SEC. 499. ø290b¿ ESTABLISHMENT AND DUTIES OF FOUNDATION.
(a) IN GENERAL.—The Secretary shall, acting through the

Director of NIH, establish a nonprofit corporation to be known as the
Foundation for the National Institutes of Health (hereafter in this
section referred to as the ‘‘Foundation’’). The Foundation shall not
be an agency or instrumentality of the United States Government.
(b) PURPOSE OF FOUNDATION.—The purpose of the Foundation
shall be to support the National Institutes of Health in its mission
(including collection of funds for pediatric pharmacologic research),
and to advance collaboration with biomedical researchers from universities, industry, and nonprofit organizations.
(c) CERTAIN ACTIVITIES OF FOUNDATION.—
(1) IN GENERAL.—In carrying out subsection (b), the Foundation may solicit and accept gifts, grants, and other donations, establish accounts, and invest and expend funds in support of the following activities with respect to the purpose described in such subsection:
(A) A program to provide and administer endowed positions that are associated with the research program of
the National Institutes of Health. Such endowments may
be expended for the compensation of individuals holding
the positions, for staff, equipment, quarters, travel, and
other expenditures that are appropriate in supporting the
endowed positions.
(B) A program to provide and administer fellowships
and grants to research personnel in order to work and
study in association with the National Institutes of Health.
Such fellowships and grants may include stipends, travel,
health insurance benefits and other appropriate expenses.
The recipients of fellowships shall be selected by the donors and the Foundation upon the recommendation of the
National Institutes of Health employees in the laboratory
where the fellow would serve, and shall be subject to the
agreement of the Director of the National Institutes of
Health and the Executive Director of the Foundation.
(C) A program to collect funds for pediatric pharmacologic research and studies.
(D) Supplementary programs to provide for—
(i) scientists of other countries to serve in research
capacities in the United States in association with the
National Institutes of Health or elsewhere, or opportunities for employees of the National Institutes of
Health or other public health officials in the United
States to serve in such capacities in other countries, or
both;
(ii) the conduct and support of studies, projects,
and research, which may include stipends, travel and
other support for personnel in collaboration with national and international non-profit and for-profit organizations;
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(iii) the conduct and support of forums, meetings,
conferences, courses, and training workshops that may
include undergraduate, graduate, post-graduate, and
post-doctoral accredited courses and the maintenance
of accreditation of such courses by the Foundation at
the State and national level for college or continuing
education credits or for degrees;
(iv) programs to support and encourage teachers
and students of science at all levels of education and
programs for the general public which promote the understanding of science;
(v) programs for writing, editing, printing, publishing, and vending of books and other materials; and
(vi) the conduct of other activities to carry out and
support the purpose described in subsection (b).
(E) The Cures Acceleration Network described in section 480.
(2) FEES.—The Foundation may assess fees for the provision of professional, administrative and management services
by the Foundation in amounts determined reasonable and appropriate by the Executive Director.
(3) AUTHORITY OF FOUNDATION.—The Foundation shall be
the sole entity responsible for carrying out the activities described in this subsection.
(d) BOARD OF DIRECTORS.—
(1) COMPOSITION.—
(A) The Foundation shall have a Board of Directors
(hereafter referred to in this section as the ‘‘Board’’), which
shall be composed of ex officio and appointed members in
accordance with this subsection. All appointed members of
the Board shall be voting members.
(B) The ex officio members of the Board shall be—
(i) the Chairman and ranking minority member of
the Subcommittee on Health and the Environment
(Committee on Energy and Commerce) or their designees, in the case of the House of Representatives;
(ii) the Chairman and ranking minority member
of the Committee on Labor and Human Resources or
their designees, in the case of the Senate;
(iii) the Director of the National Institutes of
Health; and
(iv) the Commissioner of Food and Drugs.
(C) The ex officio members of the Board under subparagraph (B) shall appoint to the Board individuals from
among a list of candidates to be provided by the National
Academy of Science. Such appointed members shall include—
(i) representatives of the general biomedical field;
(ii) representatives of experts in pediatric medicine and research;
(iii) representatives of the general biobehavioral
field, which may include experts in biomedical ethics;
and
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(iv) representatives of the general public, which
may include representatives of affected industries.
(D)(i) Not later than 30 days after the date of the enactment of the National Institutes of Health Revitalization
Act of 1993, the Director of the National Institutes of
Health shall convene a meeting of the ex officio members
of the Board to—
(I) incorporate the Foundation and establish the
general policies of the Foundation for carrying out the
purposes of subsection (b), including the establishment
of the bylaws of the Foundation; and
(II) appoint the members of the Board in accordance with subparagraph (C).
(ii) Upon the appointment of the appointed members of the Board under clause (i)(II), the terms of
service as members of the Board of the ex officio members of the Board described in clauses (i) and (ii) of
subparagraph (B) shall terminate. The ex officio members of the Board described in clauses (iii) and (iv) of
subparagraph (B) shall continue to serve as ex officio
members of the Board.
(E) The agreement of not less than three-fifths of the
members of the ex officio members of the Board shall be
required for the appointment of each member to the initial
Board.
(F) No employee of the National Institutes of Health
shall be appointed as a member of the Board.
(G) The Board may, through amendments to the bylaws of the Foundation, provide that the number of appointed members of the Board shall be greater than the
number specified in subparagraph (C).
(2) CHAIR.—
(A) The ex officio members of the Board under paragraph (1)(B) shall designate an individual to serve as the
initial Chair of the Board.
(B) Upon the termination of the term of service of the
initial Chair of the Board, the appointed members of the
Board shall elect a member of the Board to serve as the
Chair of the Board.
(3) TERMS AND VACANCIES.—
(A) The term of office of each member of the Board appointed under paragraph (1)(C) shall be 5 years, except
that the terms of offices for the initial appointed members
of the Board shall expire as determined by the ex officio
members and the Chair.
(B) Any vacancy in the membership of the appointed
members of the Board shall be filled in accordance with
the bylaws of the Foundation established in accordance
with paragraph (6), and shall not affect the power of the
remaining appointed members to execute the duties of the
Board.
(C) If a member of the Board does not serve the full
term applicable under subparagraph (A), the individual
appointed to fill the resulting vacancy shall be appointed
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for the remainder of the term of the predecessor of the individual.
(D) A member of the Board may continue to serve
after the expiration of the term of the member until a successor is appointed.
(4) COMPENSATION.—Members of the Board may not receive compensation for service on the Board. Such members
may be reimbursed for travel, subsistence, and other necessary
expenses incurred in carrying out the duties of the Board, as
set forth in the bylaws issued by the Board.
(5) MEETINGS AND QUORUM.—A majority of the appointed
members of the Board shall constitute a quorum for purposes
of conducting the business of the Board.
(6) CERTAIN BYLAWS.—
(A) In establishing bylaws under this subsection, the
Board shall ensure that the following are provided for:
(i) Policies for the selection of the officers, employees, agents, and contractors of the Foundation.
(ii) Policies, including ethical standards, for the
acceptance, solicitation, and disposition of donations
and grants to the Foundation and for the disposition
of the assets of the Foundation. Policies with respect
to ethical standards shall ensure that officers, employees and agents of the Foundation (including members
of the Board) avoid encumbrances that would result in
a conflict of interest, including a financial conflict of
interest or a divided allegiance. Such policies shall include requirements for the provision of information
concerning any ownership or controlling interest in entities related to the activities of the Foundation by
such officers, employees and agents and their spouses
and relatives.
(iii) Policies for the conduct of the general operations of the Foundation.
(iv) Policies for writing, editing, printing, publishing, and vending of books and other materials.
(B) In establishing bylaws under this subsection, the
Board shall ensure that such bylaws (and activities carried
out under the bylaws) do not—
(i) reflect unfavorably upon the ability of the
Foundation or the National Institutes of Health to
carry out its responsibilities or official duties in a fair
and objective manner; or
(ii) compromise, or appear to compromise, the integrity of any governmental agency or program, or any
officer or employee involved in such program.
(e) INCORPORATION.—The initial members of the Board shall
serve as incorporators and shall take whatever actions necessary to
incorporate the Foundation.
(f) NONPROFIT STATUS.—The Foundation shall be considered to
be a corporation under section 501(c) of the Internal Revenue Code
of 1986, and shall be subject to the provisions of such section.
(g) EXECUTIVE DIRECTOR.—
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(1) IN GENERAL.—The Foundation shall have an Executive
Director who shall be appointed by the Board and shall serve
at the pleasure of the Board. The Executive Director shall be
responsible for the day-to-day operations of the Foundation
and shall have such specific duties and responsibilities as the
Board shall prescribe.
(2) COMPENSATION.—The rate of compensation of the Executive Director shall be fixed by the Board.
(h) POWERS.—In carrying out subsection (b), the Foundation
may—
(1) operate under the direction of its Board;
(2) adopt, alter, and use a corporate seal, which shall be
judicially noticed;
(3) provide for 1 or more officers, employees, and agents,
as may be necessary, define their duties, and require surety
bonds or make other provisions against losses occasioned by
acts of such persons;
(4) hire, promote, compensate, and discharge officers and
employees of the Foundation, and define the duties of the officers and employees;
(5) with the consent of any executive department or independent agency, use the information, services, staff, and facilities of such in carrying out this section;
(6) sue and be sued in its corporate name, and complain
and defend in courts of competent jurisdiction;
(7) modify or consent to the modification of any contract or
agreement to which it is a party or in which it has an interest
under this part;
(8) establish a process for the selection of candidates for
positions under subsection (c);
(9) enter into contracts with public and private organizations for the writing, editing, printing, and publishing of books
and other material;
(10) take such action as may be necessary to obtain patents and licenses for devices and procedures developed by the
Foundation and its employees;
(11) solicit, accept, hold, administer, invest, and spend any
gift, devise, or bequest of real or personal property made to the
Foundation;
(12) enter into such other contracts, leases, cooperative
agreements, and other transactions as the Executive Director
considers appropriate to conduct the activities of the Foundation;
(13) appoint other groups of advisors as may be determined necessary from time to time to carry out the functions
of the Foundation;
(14) enter into such other contracts, leases, cooperative
agreements, and other transactions as the Executive Director
considers appropriate to conduct the activities of the Foundation; and
(15) exercise other powers as set forth in this section, and
such other incidental powers as are necessary to carry out its
powers, duties, and functions in accordance with this part.
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(i) ADMINISTRATIVE CONTROL.—No participant in the program
established under this part shall exercise any administrative control over any Federal employee.
(7) in paragraphs (1) and (2) of subsection (j) (as so redesignated), by striking ‘‘(including those developed under subsection (d)(2)(B)(i)(II))’’ each place it appears.
(j) GENERAL PROVISIONS.—
(1) FOUNDATION INTEGRITY.—The members of the Board
shall be accountable for the integrity of the operations of the
Foundation and shall ensure such integrity through the development and enforcement of criteria and procedures relating to
standards of conduct, financial disclosure statements, conflict
of interest rules, recusal and waiver rules, audits and other
matter determined appropriate by the Board.
(2) FINANCIAL CONFLICTS OF INTEREST.—Any individual
who is an officer, employee, or member of the Board of the
Foundation may not (in accordance with policies and requirements developed under subsection (d)(6)) 1 personally or substantially participate in the consideration or determination by
the Foundation of any matter that would directly or predictably affect any financial interest of the individual or a relative
(as such term is defined in section 109(16) of the Ethics in Government Act of 1978) of the individual, of any business organization or other entity, or of which the individual is an officer
or employee, or is negotiating for employment, or in which the
individual has any other financial interest.
(3) AUDITS; AVAILABILITY OF RECORDS.—The Foundation
shall—
(A) provide for annual audits of the financial condition
of the Foundation; and
(B) make such audits, and all other records, documents, and other papers of the Foundation, available to
the Secretary and the Comptroller General of the United
States for examination or audit.
(4) REPORTS.—
(A) Not later than 5 months following the end of each
fiscal year, the Foundation shall publish a report describing the activities of the Foundation during the preceding
fiscal year. Each such report shall include for the fiscal
year involved a comprehensive statement of the operations, activities, financial condition, and accomplishments
of the Foundation, including an accounting of the use of
amounts transferred under subsection (l).
(B) With respect to the financial condition of the Foundation, each report under subparagraph (A) shall include
the source, and a description of, all gifts or grants to the
Foundation of real or personal property, and the source
and amount of all gifts or grants to the Foundation of
money. Each such report shall include a specification of
1 Section 13(7) of Public Law 107–109 (115 Stat. 1419) provided that paragraphs (1) and (2)
of section 499(j) are amended ‘‘by striking ‘(including those developed under subsection
(d)(2)(B)(i)(II))’ each place it appears’’. The term to be struck appeared in paragraph (1), but not
in paragraph (2).

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any restrictions on the purposes for which gifts or grants
to the Foundation may be used.
(C) The Foundation shall make copies of each report
submitted under subparagraph (A) available—
(i) for public inspection, and shall upon request
provide a copy of the report to any individual for a
charge that shall not exceed the cost of providing the
copy; and
(ii) to the appropriate committees of Congress.
(D) The Board shall annually hold a public meeting to
summarize the activities of the Foundation and distribute
written reports concerning such activities and the scientific
results derived from such activities.
(5) SERVICE OF FEDERAL EMPLOYEES.—Federal employees
may serve on committees advisory to the Foundation and otherwise cooperate with and assist the Foundation in carrying
out its function, so long as the employees do not direct or control Foundation activities.
(6) RELATIONSHIP WITH EXISTING ENTITIES.—The Foundation may, pursuant to appropriate agreements, merge with, acquire, or use the resources of existing nonprofit private corporations with missions similar to the purposes of the Foundation, such as the Foundation for Advanced Education in the
Sciences.
(7) INTELLECTUAL PROPERTY RIGHTS.—The Board shall
adopt written standards with respect to the ownership of any
intellectual property rights derived from the collaborative efforts of the Foundation prior to the commencement of such efforts.
(8) NATIONAL INSTITUTES OF HEALTH AMENDMENTS OF
1990.—The activities conducted in support of the National Institutes of Health Amendments of 1990 (Public Law 101–613),
and the amendments made by such Act, shall not be nullified
by the enactment of this section.
(9) LIMITATION OF ACTIVITIES.—
(A) IN GENERAL.—The Foundation shall exist solely as
an entity to work in collaboration with the research programs of the National Institutes of Health. The Foundation may not undertake activities (such as the operation of
independent laboratories or competing for Federal research
funds) that are independent of those of the National Institutes of Health research programs.
(B) GIFTS, GRANTS, AND OTHER DONATIONS.—
(i) IN GENERAL.—Gifts, grants, and other donations to the Foundation may be designated for pediatric research and studies on drugs, and funds so designated shall be used solely for grants for research and
studies under subsection (c)(1)(C).
(ii) OTHER GIFTS.—Other gifts, grants, or donations received by the Foundation and not described in
clause (i) may also be used to support such pediatric
research and studies.
(iii) REPORT.—The recipient of a grant for research
and studies shall agree to provide the Director of the
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National Institutes of Health and the Commissioner of
Food and Drugs, at the conclusion of the research and
studies—
(I) a report describing the results of the research and studies; and
(II) all data generated in connection with the
research and studies.
(iv) ACTION BY THE COMMISSIONER OF FOOD AND
DRUGS.—The Commissioner of Food and Drugs shall
take appropriate action in response to a report received under clause (iii) in accordance with paragraphs (7) through (12) of section 409I(c), including
negotiating with the holders of approved applications
for the drugs studied for any labeling changes that the
Commissioner determines to be appropriate and requests the holders to make.
(C) APPLICABILITY.—Subparagraph (A) does not apply
to the program described in subsection (c)(1)(C).
(10) TRANSFER OF FUNDS.—The Foundation may transfer
funds to the National Institutes of Health and the National Institutes of Health may accept transfers of funds from the Foundation. Any funds transferred under this paragraph shall be
subject to all Federal limitations relating to federally-funded
research.
(k) DUTIES OF THE DIRECTOR.—
(1) APPLICABILITY OF CERTAIN STANDARDS TO NON-FEDERAL
EMPLOYEES.—In the case of any individual who is not an employee of the Federal Government and who serves in association with the National Institutes of Health, with respect to financial assistance received from the Foundation, the Foundation may not provide the assistance of, or otherwise permit the
work at the National Institutes of Health to begin until a
memorandum of understanding between the individual and the
Director of the National Institutes of Health, or the designee
of such Director, has been executed specifying that the individual shall be subject to such ethical and procedural standards of conduct relating to duties performed at the National Institutes of Health, as the Director of the National Institutes of
Health determines is appropriate.
(2) SUPPORT SERVICES.—The Director of the National Institutes of Health may provide facilities, utilities and support
services to the Foundation if it is determined by the Director
to be advantageous to the research programs of the National
Institutes of Health.
(l) FUNDING.—From amounts appropriated to the National Institutes of Health, for each fiscal year, the Director of NIH shall
transfer not less than $500,000 and not more than $1,250,000 to
the Foundation.

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TITLE V—SUBSTANCE ABUSE AND MENTAL HEALTH
SERVICES ADMINISTRATION
PART A—ORGANIZATION

AND

GENERAL AUTHORITIES

SEC. 501. ø290aa¿ SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES
ADMINISTRATION.
(a) ESTABLISHMENT.—The Substance Abuse and Mental Health

Services Administration (hereafter referred to in this title as the
‘‘Administration’’) is an agency of the Service.
(b) AGENCIES.—The following entities are agencies of the Administration:
(1) The Center for Substance Abuse Treatment.
(2) The Center for Substance Abuse Prevention.
(3) The Center for Mental Health Services.
(c) ADMINISTRATOR AND DEPUTY ADMINISTRATOR.—
(1) ADMINISTRATOR.—The Administration shall be headed
by an Administrator (hereinafter in this title referred to as the
‘‘Administrator’’) who shall be appointed by the President, by
and with the advice and consent of the Senate.
(2) DEPUTY ADMINISTRATOR.—The Administrator, with the
approval of the Secretary, may appoint a Deputy Administrator and may employ and prescribe the functions of such officers and employees, including attorneys, as are necessary to
administer the activities to be carried out through the Administration.
(d) AUTHORITIES.—The Secretary, acting through the Administrator, shall—
(1) supervise the functions of the agencies of the Administration in order to assure that the programs carried out
through each such agency receive appropriate and equitable
support and that there is cooperation among the agencies in
the implementation of such programs;
(2) establish and implement, through the respective agencies, a comprehensive program to improve the provision of
treatment and related services to individuals with respect to
substance abuse and mental illness and to improve prevention
services, promote mental health and protect the legal rights of
individuals with mental illnesses and individuals who are substance abusers;
(3) carry out the administrative and financial management, policy development and planning, evaluation, knowledge
dissemination, and public information functions that are required for the implementation of this title;
(4) assure that the Administration conduct and coordinate
demonstration projects, evaluations, and service system assessments and other activities necessary to improve the avail688
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ability and quality of treatment, prevention and related services;
(5) support activities that will improve the provision of
treatment, prevention and related services, including the development of national mental health and substance abuse goals
and model programs;
(6) in cooperation with the National Institutes of Health,
the Centers for Disease Control and the Health Resources and
Services Administration develop educational materials and
intervention strategies to reduce the risks of HIV or tuberculosis among substance abusers and individuals with mental
illness and to develop appropriate mental health services for
individuals with such illnesses;
(7) coordinate Federal policy with respect to the provision
of treatment services for substance abuse utilizing anti-addiction medications, including methadone;
(8) conduct programs, and assure the coordination of such
programs with activities of the National Institutes of Health
and the Agency for Health Care Policy Research 1, as appropriate, to evaluate the process, outcomes and community impact of treatment and prevention services and systems of care
in order to identify the manner in which such services can
most effectively be provided;
(9) collaborate with the Director of the National Institutes
of Health in the development of a system by which the relevant research findings of the National Institute on Drug
Abuse, the National Institute on Alcohol Abuse and Alcoholism, the National Institute of Mental Health, and, as appropriate, the Agency for Health Care Policy Research 1 are disseminated to service providers in a manner designed to improve the delivery and effectiveness of treatment and prevention services;
(10) encourage public and private entities that provide
health insurance to provide benefits for substance abuse and
mental health services;
(11) promote the integration of substance abuse and mental health services into the mainstream of the health care delivery system of the United States;
(12) monitor compliance by hospitals and other facilities
with the requirements of sections 542 and 543;
(13) with respect to grant programs authorized under this
title, assure that—
(A) all grants that are awarded for the provision of
services are subject to performance and outcome evaluations; and
(B) all grants that are awarded to entities other than
States are awarded only after the State in which the entity
intends to provide services—
(i) is notified of the pendency of the grant application; and
1 So in law. See section 101(a) of Public Law 102–321 (106 Stat. 324). Probably should have
been ‘‘Agency for Health Care Policy and Research’’. The Agency, however, was redesignated as
the Agency for Health Care Policy and Research by Public Law 106–129 (see 113 Stat. 1653).

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(ii) is afforded an opportunity to comment on the
merits of the application;
(14) assure that services provided with amounts appropriated under this title are provided bilingually, if appropriate;
(15) improve coordination among prevention programs,
treatment facilities and nonhealth care systems such as employers, labor unions, and schools, and encourage the adoption
of employee assistance programs and student assistance programs;
(16) maintain a clearinghouse for substance abuse and
mental health information to assure the widespread dissemination of such information to States, political subdivisions, educational agencies and institutions, treatment providers, and
the general public;
(17) in collaboration with the National Institute on Aging,
and in consultation with the National Institute on Drug Abuse,
the National Institute on Alcohol Abuse and Alcoholism and
the National Institute of Mental Health, as appropriate, promote and evaluate substance abuse services for older Americans in need of such services, and mental health services for
older Americans who are seriously mentally ill; and
(18) promote the coordination of service programs conducted by other departments, agencies, organizations and individuals that are or may be related to the problems of individuals suffering from mental illness or substance abuse, including liaisons with the Social Security Administration, Centers
for Medicare & Medicaid Services, and other programs of the
Department, as well as liaisons with the Department of Education, Department of Justice, and other Federal Departments
and offices, as appropriate.
(e) ASSOCIATE ADMINISTRATOR FOR ALCOHOL PREVENTION AND
TREATMENT POLICY.—
(1) IN GENERAL.—There may be in the Administration an
Associate Administrator for Alcohol Prevention and Treatment
Policy to whom the Administrator may delegate the functions
of promoting, monitoring, and evaluating service programs for
the prevention and treatment of alcoholism and alcohol abuse
within the Center for Substance Abuse Prevention, the Center
for Substance Abuse Treatment and the Center for Mental
Health Services, and coordinating such programs among the
Centers, and among the Centers and other public and private
entities. The Associate Administrator also may ensure that alcohol prevention, education, and policy strategies are integrated into all programs of the Centers that address substance
abuse prevention, education, and policy, and that the Center
for Substance Abuse Prevention addresses the Healthy People
2010 goals and the National Dietary Guidelines of the Department of Health and Human Services and the Department of
Agriculture related to alcohol consumption.
(2) PLAN.—
(A) The Administrator, acting through the Associate
Administrator for Alcohol Prevention and Treatment Policy, shall develop, and periodically review and as appropriate revise, a plan for programs and policies to treat and
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prevent alcoholism and alcohol abuse. The plan shall be
developed (and reviewed and revised) in collaboration with
the Directors of the Centers of the Administration and in
consultation with members of other Federal agencies and
public and private entities.
(B) Not later than 1 year after the date of the enactment of the ADAMHA Reorganization Act, the Administrator shall submit to the Congress the first plan developed under subparagraph (A).
(3) REPORT.—
(A) Not less than once during each 2 years, the Administrator, acting through the Associate Administrator
for Alcohol Prevention and Treatment Policy, shall prepare
a report describing the alcoholism and alcohol abuse prevention and treatment programs undertaken by the Administration and its agencies, and the report shall include
a detailed statement of the expenditures made for the activities reported on and the personnel used in connection
with such activities.
(B) Each report under subparagraph (A) shall include
a description of any revisions in the plan under paragraph
(2) made during the preceding 2 years.
(C) Each report under subparagraph (A) shall be submitted to the Administrator for inclusion in the biennial
report under subsection (k).
(f) ASSOCIATE ADMINISTRATOR FOR WOMEN’S SERVICES.—
(1) APPOINTMENT.—The Administrator, with the approval
of the Secretary, shall appoint an Associate Administrator for
Women’s Services who shall report directly to the Administrator.
(2) DUTIES.—The Associate Administrator appointed under
paragraph (1) shall—
(A) establish a committee to be known as the Coordinating Committee for Women’s Services (hereafter in this
subparagraph referred to as the ‘‘Coordinating Committee’’), which shall be composed of the Directors of the
agencies of the Administration (or the designees of the Directors);
(B) acting through the Coordinating Committee, with
respect to women’s substance abuse and mental health
services—
(i) identify the need for such services, and make
an estimate each fiscal year of the funds needed to
adequately support the services;
(ii) identify needs regarding the coordination of
services;
(iii) encourage the agencies of the Administration
to support such services; and
(iv) assure that the unique needs of minority
women, including Native American, Hispanic, AfricanAmerican and Asian women, are recognized and addressed within the activities of the Administration;
and
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(C) establish an advisory committee to be known as
the Advisory Committee for Women’s Services, which shall
be composed of not more than 10 individuals, a majority
of whom shall be women, who are not officers or employees
of the Federal Government, to be appointed by the Administrator from among physicians, practitioners, treatment
providers, and other health professionals, whose clinical
practice, specialization, or professional expertise includes a
significant focus on women’s substance abuse and mental
health conditions, that shall—
(i) advise the Associate Administrator on appropriate activities to be undertaken by the agencies of
the Administration with respect to women’s substance
abuse and mental health services, including services
which require a multidisciplinary approach;
(ii) collect and review data, including information
provided by the Secretary (including the material referred to in paragraph (3)), and report biannually to
the Administrator regarding the extent to which
women are represented among senior personnel, and
make recommendations regarding improvement in the
participation of women in the workforce of the Administration; and
(iii) prepare, for inclusion in the biennial report
required pursuant to subsection (k), a description of
activities of the Committee, including findings made
by the Committee regarding—
(I) the extent of expenditures made for women’s substance abuse and mental health services
by the agencies of the Administration; and
(II) the estimated level of funding needed for
substance abuse and mental health services to
meet the needs of women;
(D) improve the collection of data on women’s health
by—
(i) reviewing the current data at the Administration to determine its uniformity and applicability;
(ii) developing standards for all programs funded
by the Administration so that data are, to the extent
practicable, collected and reported using common reporting formats, linkages and definitions; and
(iii) reporting to the Administrator a plan for incorporating the standards developed under clause (ii)
in all Administration programs and a plan to assure
that the data so collected are accessible to health professionals, providers, researchers, and members of the
public; and
(E) shall establish, maintain, and operate a program
to provide information on women’s substance abuse and
mental health services.
(3) STUDY.—
(A) The Secretary, acting through the Assistant Secretary for Personnel, shall conduct a study to evaluate the
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extent to which women are represented among senior personnel at the Administration.
(B) Not later than 90 days after the date of the enactment of the ADAMHA Reorganization Act, the Assistant
Secretary for Personnel shall provide the Advisory Committee for Women’s Services with a study plan, including
the methodology of the study and any sampling frames.
Not later than 180 days after such date of enactment, the
Assistant Secretary shall prepare and submit directly to
the Advisory Committee a report concerning the results of
the study conducted under subparagraph (A).
(C) The Secretary shall prepare and provide to the Advisory Committee for Women’s Services any additional
data as requested.
(4) OFFICE.—Nothing in this subsection shall be construed
to preclude the Secretary from establishing within the Substance Abuse and Mental Health Administration an Office of
Women’s Health.
(5) DEFINITION.—For purposes of this subsection, the term
‘‘women’s substance abuse and mental health conditions’’, with
respect to women of all age, ethnic, and racial groups, means
all aspects of substance abuse and mental illness—
(A) unique to or more prevalent among women; or
(B) with respect to which there have been insufficient
services involving women or insufficient data.
(g) SERVICES OF EXPERTS.—
(1) IN GENERAL.—The Administrator may obtain (in accordance with section 3109 of title 5, United States Code, but
without regard to the limitation in such section on the number
of days or the period of service) the services of not more than
20 experts or consultants who have professional qualifications.
Such experts and consultants shall be obtained for the Administration and for each of its agencies.
(2) COMPENSATION AND EXPENSES.—
(A) Experts and consultants whose services are obtained under paragraph (1) shall be paid or reimbursed for
their expenses associated with traveling to and from their
assignment location in accordance with sections 5724,
5724a(a), 5724a(c), and 5726(c) of title 5, United States
Code.
(B) Expenses specified in subparagraph (A) may not be
allowed in connection with the assignment of an expert or
consultant whose services are obtained under paragraph
(1), unless and until the expert or consultant agrees in
writing to complete the entire period of assignment or one
year, whichever is shorter, unless separated or reassigned
for reasons beyond the control of the expert or consultant
that are acceptable to the Secretary. If the expert or consultant violates the agreement, the money spent by the
United States for the expenses specified in subparagraph
(A) is recoverable from the expert or consultant as a debt
of the United States. The Secretary may waive in whole or
in part a right of recovery under this subparagraph.
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(h) PEER REVIEW GROUPS.—The Administrator shall, without
regard to the provisions of title 5, United States Code, governing
appointments in the competitive service, and without regard to the
provisions of chapter 51 and subchapter III of chapter 53 of such
title, relating to classification and General Schedule pay rates, establish such peer review groups and program advisory committees
as are needed to carry out the requirements of this title and appoint and pay members of such groups, except that officers and employees of the United States shall not receive additional compensation for services as members of such groups. The Federal Advisory
Committee Act shall not apply to the duration of a peer review
group appointed under this subsection.
(i) VOLUNTARY SERVICES.—The Administrator may accept voluntary and uncompensated services.
(j) ADMINISTRATION.—The Administrator shall ensure that programs and activities assigned under this title to the Administration
are fully administered by the respective Centers to which such programs and activities are assigned.
(k) REPORT CONCERNING ACTIVITIES AND PROGRESS.—Not later
than February 10, 1994, and once every 2 years thereafter, the Administrator shall prepare and submit to the Committee on Energy
and Commerce of the House of Representatives, and to the Committee on Labor and Human Resources of the Senate, the report
containing—
(1) a description of the activities carried out by the Administration;
(2) a description of any measurable progress made in improving the availability and quality of substance abuse and
mental health services;
(3) a description of the mechanisms by which relevant research findings of the National Institute on Drug Abuse, the
National Institute on Alcohol Abuse and Alcoholism, and the
National Institute of Mental Health have been disseminated to
service providers or otherwise utilized by the Administration to
further the purposes of this title; and
(4) any report required in this title to be submitted to the
Adminstrator 1 for inclusion in the report under this subsection.
(l) APPLICATIONS FOR GRANTS AND CONTRACTS.—With respect
to awards of grants, cooperative agreements, and contracts under
this title, the Administrator, or the Director of the Center involved,
as the case may be, may not make such an award unless—
(1) an application for the award is submitted to the official
involved;
(2) with respect to carrying out the purpose for which the
award is to be provided, the application provides assurances of
compliance satisfactory to such official; and
(3) the application is otherwise in such form, is made in
such manner, and contains such agreements, assurances, and
information as the official determines to be necessary to carry
out the purpose for which the award is to be provided.
1 So in law. See section 101(a) of Public Law 102–321 (106 Stat. 324). Probably should be ‘‘Administrator’’.

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(m) EMERGENCY RESPONSE.—
(1) IN GENERAL.—Notwithstanding section 504 and except
as provided in paragraph (2), the Secretary may use not to exceed 2.5 percent of all amounts appropriated under this title
for a fiscal year to make noncompetitive grants, contracts or
cooperative agreements to public entities to enable such entities to address emergency substance abuse or mental health
needs in local communities.
(2) EXCEPTIONS.—Amounts appropriated under part C
shall not be subject to paragraph (1).
(3) EMERGENCIES.—The Secretary shall establish criteria
for determining that a substance abuse or mental health emergency exists and publish such criteria in the Federal Register
prior to providing funds under this subsection.
(n) LIMITATION ON THE USE OF CERTAIN INFORMATION.—No information, if an establishment or person supplying the information
or described in it is identifiable, obtained in the course of activities
undertaken or supported under section 505 may be used for any
purpose other than the purpose for which it was supplied unless
such establishment or person has consented (as determined under
regulations of the Secretary) to its use for such other purpose. Such
information may not be published or released in other form if the
person who supplied the information or who is described in it is
identifiable unless such person has consented (as determined under
regulations of the Secretary) to its publication or release in other
form.
(o) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of
providing grants, cooperative agreements, and contracts under this
section, there are authorized to be appropriated $25,000,000 for fiscal year 2001, and such sums as may be necessary for each of the
fiscal years 2002 and 2003.
ADVISORY COUNCILS

SEC. 502. ø290aa–1¿ (a) APPOINTMENT.—
(1) IN GENERAL.—The Secretary shall appoint an advisory
council for—
(A) the Substance Abuse and Mental Health Services
Administration;
(B) the Center for Substance Abuse Treatment;
(C) the Center for Substance Abuse Prevention; and
(D) the Center for Mental Health Services.
Each such advisory council shall advise, consult with, and
make recommendations to the Secretary and the Administrator
or Director of the Administration or Center for which the advisory council is established concerning matters relating to the
activities carried out by and through the Administration or
Center and the policies respecting such activities.
(2) FUNCTION AND ACTIVITIES.—An advisory council—
(A)(i) may on the basis of the materials provided by
the organization respecting activities conducted at the organization, make recommendations to the Administrator or
Director of the Administration or Center for which it was
established respecting such activities;
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(ii) shall review applications submitted for grants and
cooperative agreements for activities for which advisory
council approval is required under section 504(d)(2) and
recommend for approval applications for projects that show
promise of making valuable contributions to the Administration’s mission; and
(iii) may review any grant, contract, or cooperative
agreement proposed to be made or entered into by the organization;
(B) may collect, by correspondence or by personal investigation, information as to studies and services that are
being carried on in the United States or any other country
as to the diseases, disorders, or other aspects of human
health with respect to which the organization was established and with the approval of the Administrator or Director, whichever is appropriate, make such information
available through appropriate publications for the benefit
of public and private health entities and health professions
personnel and for the information of the general public;
and
(C) may appoint subcommittees and convene workshops and conferences.
(b) MEMBERSHIP.—
(1) IN GENERAL.—Each advisory council shall consist of
nonvoting ex officio members and not more than 12 members
to be appointed by the Secretary under paragraph (3).
(2) EX OFFICIO MEMBERS.—The ex officio members of an
advisory council shall consist of—
(A) the Secretary;
(B) the Administrator;
(C) the Director of the Center for which the council is
established;
(D) the Under Secretary for Health of the Department
of Veterans Affairs;
(E) the Assistant Secretary for Defense for Health Affairs (or the designates of such officers); and
(F) such additional officers or employees of the United
States as the Secretary determines necessary for the advisory council to effectively carry out its functions.
(3) APPOINTED MEMBERS.—Individuals shall be appointed
to an advisory council under paragraph (1) as follows:
(A) Nine of the members shall be appointed by the
Secretary from among the leading representatives of the
health disciplines (including public health and behavioral
and social sciences) relevant to the activities of the Administration or Center for which the advisory council is established.
(B) Three of the members shall be appointed by the
Secretary from the general public and shall include leaders
in fields of public policy, public relations, law, health policy
economics, or management.
(4) COMPENSATION.—Members of an advisory council who
are officers or employees of the United States shall not receive
any compensation for service on the advisory council. The reMarch 13, 2013

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maining members of an advisory council shall receive, for each
day (including travel time) they are engaged in the performance of the functions of the advisory council, compensation at
rates not to exceed the daily equivalent to the annual rate in
effect for grade GS–18 of the General Schedule.
(c) TERMS OF OFFICE.—
(1) IN GENERAL.—The term of office of a member of an advisory council appointed under subsection (b) shall be 4 years,
except that any member appointed to fill a vacancy for an unexpired term shall serve for the remainder of such term. The
Secretary shall make appointments to an advisory council in
such a manner as to ensure that the terms of the members not
all expire in the same year. A member of an advisory council
may serve after the expiration of such member’s term until a
successor has been appointed and taken office.
(2) REAPPOINTMENTS.—A member who has been appointed
to an advisory council for a term of 4 years may not be reappointed to an advisory council during the 2-year period beginning on the date on which such 4-year term expired.
(3) TIME FOR APPOINTMENT.—If a vacancy occurs in an advisory council among the members under subsection (b), the
Secretary shall make an appointment to fill such vacancy within 90 days from the date the vacancy occurs.
(d) CHAIR.—The Secretary shall select a member of an advisory
council to serve as the chair of the council. The Secretary may so
select an individual from among the appointed members, or may
select the Administrator or the Director of the Center involved. The
term of office of the chair shall be 2 years.
(e) MEETINGS.—An advisory council shall meet at the call of
the chairperson or upon the request of the Administrator or Director of the Administration or Center for which the advisory council
is established, but in no event less than 2 times during each fiscal
year. The location of the meetings of each advisory council shall be
subject to the approval of the Administrator or Director of Administration or Center for which the council was established.
(f) EXECUTIVE SECRETARY AND STAFF.—The Administrator or
Director of the Administration or Center for which the advisory
council is established shall designate a member of the staff of the
Administration or Center for which the advisory council is established to serve as the Executive Secretary of the advisory council.
The Administrator or Director shall make available to the advisory
council such staff, information, and other assistance as it may require to carry out its functions. The Administrator or Director shall
provide orientation and training for new members of the advisory
council to provide for their effective participation in the functions
of the advisory council.
REPORTS ON ALCOHOLISM, ALCOHOL ABUSE, AND DRUG ABUSE

SEC. 503. ø290aa–2¿ (a) The Secretary shall submit to Congress on or before January 15, 1984, and every three years thereafter a report—
(1) containing current information on the health consequences of using alcoholic beverages,
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(2) containing a description of current research findings
made with respect to alcohol abuse and alcoholism, and
(3) containing such recommendations for legislation and
administrative action as the Secretary may deem appropriate.
(b) The Secretary shall submit to Congress on or before January 15, 1984, and every three years thereafter a report—
(1) describing the health consequences and extent of drug
abuse in the United States;
(2) describing current research findings made with respect
to drug abuse, including current findings on the health effects
of marihuana and the addictive property of tobacco; and
(3) containing such recommendations for legislation and
administrative action as the Secretary may deem appropriate.
SEC. 503A. ø290aa–2a¿ REPORT ON INDIVIDUALS WITH CO-OCCURRING
MENTAL ILLNESS AND SUBSTANCE ABUSE DISORDERS.
(a) IN GENERAL.—Not later than 2 years after the date of the

enactment of this section, the Secretary shall, after consultation
with organizations representing States, mental health and substance abuse treatment providers, prevention specialists, individuals receiving treatment services, and family members of such individuals, prepare and submit to the Committee on Health, Education, Labor, and Pensions of the Senate and the Committee on
Commerce of the House of Representatives, a report on prevention
and treatment services for individuals who have co-occurring mental illness and substance abuse disorders.
(b) REPORT CONTENT.—The report under subsection (a) shall be
based on data collected from existing Federal and State surveys regarding the treatment of co-occurring mental illness and substance
abuse disorders and shall include—
(1) a summary of the manner in which individuals with cooccurring disorders are receiving treatment, including the most
up-to-date information available regarding the number of children and adults with co-occurring mental illness and substance
abuse disorders and the manner in which funds provided
under sections 1911 and 1921 are being utilized, including the
number of such children and adults served with such funds;
(2) a summary of improvements necessary to ensure that
individuals with co-occurring mental illness and substance
abuse disorders receive the services they need;
(3) a summary of practices for preventing substance abuse
among individuals who have a mental illness and are at risk
of having or acquiring a substance abuse disorder; and
(4) a summary of evidenced-based practices for treating individuals with co-occurring mental illness and substance abuse
disorders and recommendations for implementing such practices.
(c) FUNDS FOR REPORT.—The Secretary may obligate funds to
carry out this section with such appropriations as are available.
SEC. 504. 1 ø290aa–3¿ PEER REVIEW.
(a) IN GENERAL.—The Secretary,

after consultation with the
Administrator, shall require appropriate peer review of grants, co1 Section 504 appears according to the probable intent of the Congress. Section 3401(b) of Public Law 106–310 (114 Stat. 1218) provides that the section ‘‘is amended as follows:’’. No amend-

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operative agreements, and contracts to be administered through
the agency which exceed the simple acquisition threshold as defined in section 4(11) of the Office of Federal Procurement Policy
Act.
(b) MEMBERS.—The members of any peer review group established under subsection (a) shall be individuals who by virtue of
their training or experience are eminently qualified to perform the
review functions of the group. Not more than one-fourth of the
members of any such peer review group shall be officers or employees of the United States.
(c) ADVISORY COUNCIL REVIEW.—If the direct cost of a grant or
cooperative agreement (described in subsection (a)) exceeds the
simple acquisition threshold as defined by section 4(11) of the Office of Federal Procurement Policy Act, the Secretary may make
such a grant or cooperative agreement only if such grant or cooperative agreement is recommended—
(1) after peer review required under subsection (a); and
(2) by the appropriate advisory council.
(d) CONDITIONS.—The Secretary may establish limited exceptions to the limitations contained in this section regarding participation of Federal employees and advisory council approval. The circumstances under which the Secretary may make such an exception shall be made public.
DATA COLLECTION 1

SEC. 505. ø290aa–4¿ (a) The Secretary, acting through the Administrator, shall collect data each year on—
(1) the national incidence and prevalence of the various
forms of mental illness and substance abuse; and
(2) the incidence and prevalence of such various forms in
major metropolitan areas selected by the Administrator.
(b) With respect to the activities of the Administrator under
subsection (a) relating to mental health, the Administrator shall
ensure that such activities include, at a minimum, the collection of
data on—
(1) the number and variety of public and nonprofit private
treatment programs;
(2) the number and demographic characteristics of individuals receiving treatment through such programs;
(3) the type of care received by such individuals; and
(4) such other data as may be appropriate.
(c)(1) With respect to the activities of the Administrator under
subsection (a) relating to substance abuse, the Administrator shall
ensure that such activities include, at a minimum, the collection of
data on—
(A) the number of individuals admitted to the emergency
rooms of hospitals as a result of the abuse of alcohol or other
drugs;
atory instructions were then given, but a substitute text was provided. The amendment probably
should have instructed that section 504 ‘‘is amended to read as follows:’’.
1 Section 502 of Public Law 104–237 (110 Stat. 3112) provides as follows:
‘‘The Secretary of Health and Human Services shall develop a public health monitoring program to monitor methamphetamine abuse in the United States. The program shall include the
collection and dissemination of data related to methamphetamine abuse which can be used by
public health officials in policy development.’’.

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(B) the number of deaths occurring as a result of substance
abuse, as indicated in reports by coroners;
(C) the number and variety of public and private nonprofit
treatment programs, including the number and type of patient
slots available;
(D) the number of individuals seeking treatment through
such programs, the number and demographic characteristics of
individuals receiving such treatment, the percentage of individuals who complete such programs, and, with respect to individuals receiving such treatment, the length of time between an
individual’s request for treatment and the commencement of
treatment;
(E) the number of such individuals who return for treatment after the completion of a prior treatment in such programs and the method of treatment utilized during the prior
treatment;
(F) the number of individuals receiving public assistance
for such treatment programs;
(G) the costs of the different types of treatment modalities
for drug and alcohol abuse and the aggregate relative costs of
each such treatment modality provided within a State in each
fiscal year;
(H) to the extent of available information, the number of
individuals receiving treatment for alcohol or drug abuse who
have private insurance coverage for the costs of such treatment;
(I) the extent of alcohol and drug abuse among high school
students and among the general population; and
(J) the number of alcohol and drug abuse counselors and
other substance abuse treatment personnel employed in public
and private treatment facilities.
(2) Annual surveys shall be carried out in the collection of data
under this subsection. Summaries and analyses of the data collected shall be made available to the public.
(d) After consultation with the States and with appropriate national organizations, the Administrator shall develop uniform criteria for the collection of data, using the best available technology,
pursuant to this section.
SEC. 506. ø290aa–5¿ GRANTS FOR THE BENEFIT OF HOMELESS INDIVIDUALS.
(a) IN GENERAL.—The Secretary shall award grants, contracts

and cooperative agreements to community-based public and private
nonprofit entities for the purposes of providing mental health and
substance abuse services for homeless individuals. In carrying out
this section, the Secretary shall consult with the Interagency Council on the Homeless, established under section 201 of the Stewart
B. McKinney Homeless Assistance Act (42 U.S.C. 11311).
(b) PREFERENCES.—In awarding grants, contracts, and cooperative agreements under subsection (a), the Secretary shall give a
preference to—
(1) entities that provide integrated primary health, substance abuse, and mental health services to homeless individuals;
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(2) entities that demonstrate effectiveness in serving runaway, homeless, and street youth;
(3) entities that have experience in providing substance
abuse and mental health services to homeless individuals;
(4) entities that demonstrate experience in providing housing for individuals in treatment for or in recovery from mental
illness or substance abuse; and
(5) entities that demonstrate effectiveness in serving
homeless veterans.
(c) SERVICES FOR CERTAIN INDIVIDUALS.—In awarding grants,
contracts, and cooperative agreements under subsection (a), the
Secretary shall not—
(1) prohibit the provision of services under such subsection
to homeless individuals who are suffering from a substance
abuse disorder and are not suffering from a mental health disorder; and
(2) make payments under subsection (a) to any entity that
has a policy of—
(A) excluding individuals from mental health services
due to the existence or suspicion of substance abuse; or
(B) has a policy of excluding individuals from substance abuse services due to the existence or suspicion of
mental illness.
(d) TERM OF THE AWARDS.—No entity may receive a grant, contract, or cooperative agreement under subsection (a) for more than
5 years.
(e) AUTHORIZATION OF APPROPRIATIONS.—There is authorized
to be appropriated to carry out this section, $50,000,000 for fiscal
year 2001, and such sums as may be necessary for each of the fiscal years 2002 and 2003.
SEC. 506A. ø290aa–5a¿ ALCOHOL AND DRUG PREVENTION OR TREATMENT SERVICES FOR INDIANS AND NATIVE ALASKANS. 1
(a) IN GENERAL.—The Secretary shall award grants, contracts,

or cooperative agreements to public and private nonprofit entities,
including Native Alaskan entities and Indian tribes and tribal organizations, for the purpose of providing alcohol and drug prevention or treatment services for Indians and Native Alaskans.
(b) PRIORITY.—In awarding grants, contracts, or cooperative
agreements under subsection (a), the Secretary shall give priority
to applicants that—
(1) propose to provide alcohol and drug prevention or treatment services on reservations;
(2) propose to employ culturally-appropriate approaches, as
determined by the Secretary, in providing such services; and
(3) have provided prevention or treatment services to Native Alaskan entities and Indian tribes and tribal organizations
for at least 1 year prior to applying for a grant under this section.
1 Section 3307 of Public Law 106–310 (114 Stat. 1216) establishes a Commission on Indian
and Native Alaskan Health Care and provides that the Commission ‘‘shall examine the health
concerns of Indians and Native Alaskans who reside on reservations and tribal lands’’.

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(c) DURATION.—The Secretary shall award grants, contracts, or
cooperative agreements under subsection (a) for a period not to exceed 5 years.
(d) APPLICATION.—An entity desiring a grant, contract, or cooperative agreement 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 reasonably require.
(e) EVALUATION.—An entity that receives a grant, contract, or
cooperative agreement under subsection (a) shall submit, in the application for such grant, a plan for the evaluation of any project undertaken with funds provided under this section. Such entity shall
provide the Secretary with periodic evaluations of the progress of
such project and such evaluation at the completion of such project
as the Secretary determines to be appropriate. The final evaluation
submitted by such entity shall include a recommendation as to
whether such project shall continue.
(f ) REPORT.—Not later than 3 years after the date of the enactment of this section and annually thereafter, the Secretary shall
prepare and submit, to the Committee on Health, Education,
Labor, and Pensions of the Senate, a report describing the services
provided pursuant to this section.
(g) AUTHORIZATION OF APPROPRIATIONS.—There are authorized
to be appropriated to carry out this section, $15,000,000 for fiscal
year 2001, and such sums as may be necessary for fiscal years 2002
and 2003.
SEC. 506B. ø290aa–5b¿ GRANTS FOR ECSTASY AND OTHER CLUB DRUGS
ABUSE PREVENTION.
(a) AUTHORITY.—The Administrator may make grants to, and

enter into contracts and cooperative agreements with, public and
nonprofit private entities to enable such entities—
(1) to carry out school-based programs concerning the dangers of the abuse of and addiction to 3,4-methylenedioxy methamphetamine, related drugs, and other drugs commonly referred to as ‘‘club drugs’’ using methods that are effective and
science-based, including initiatives that give students the responsibility to create their own anti-drug abuse education programs for their schools; and
(2) to carry out community-based abuse and addiction prevention programs relating to 3,4-methylenedioxy methamphetamine, related drugs, and other club drugs that are effective
and science-based.
(b) USE OF FUNDS.—Amounts made available under a grant,
contract or cooperative agreement under subsection (a) shall be
used for planning, establishing, or administering prevention programs relating to 3,4-methylenedioxy methamphetamine, related
drugs, and other club drugs.
(c) USE OF FUNDS.—
(1) DISCRETIONARY FUNCTIONS.—Amounts provided to an
entity under this section may be used—
(A) to carry out school-based programs that are focused on those districts with high or increasing rates of
abuse and addiction to 3,4-methylenedioxy methamphetamine, related drugs, and other club drugs and targeted at
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populations that are most at risk to start abusing these
drugs;
(B) to carry out community-based prevention programs
that are focused on those populations within the community that are most at-risk for abuse of and addiction to 3,4methylenedioxy methamphetamine, related drugs, and
other club drugs;
(C) to assist local government entities to conduct appropriate
prevention
activities
relating
to
3,4methylenedioxy methamphetamine, related drugs, and
other club drugs;
(D) to train and educate State and local law enforcement officials, prevention and education officials, health
professionals, members of community anti-drug coalitions
and parents on the signs of abuse of and addiction to 3,4methylenedioxy methamphetamine, related drugs, and
other club drugs and the options for treatment and prevention;
(E) for planning, administration, and educational activities related to the prevention of abuse of and addiction
to 3,4-methylenedioxy methamphetamine, related drugs,
and other club drugs;
(F) for the monitoring and evaluation of prevention activities relating to 3,4-methylenedioxy methamphetamine,
related drugs, and other club drugs and reporting and disseminating resulting information to the public; and
(G) for targeted pilot programs with evaluation components to encourage innovation and experimentation with
new methodologies.
(2) PRIORITY.—The Administrator shall give priority in
awarding grants under this section to rural and urban areas
that are experiencing a high rate or rapid increases in abuse
and addiction to 3,4-methylenedioxy methamphetamine, related drugs, and other club drugs.
(d) ALLOCATION AND REPORT.—
(1) PREVENTION PROGRAM ALLOCATION.—Not less than
$500,000 of the amount appropriated in each fiscal year to
carry out this section shall be made available to the Administrator, acting in consultation with other Federal agencies, to
support and conduct periodic analyses and evaluations of effective prevention programs for abuse of and addiction to 3,4methylenedioxy methamphetamine, related drugs, and other
club drugs and the development of appropriate strategies for
disseminating information about and implementing such programs.
(2) REPORT.—The Administrator shall annually prepare
and submit to the Committee on Health, Education, Labor, and
Pensions, the Committee on the Judiciary, and the Committee
on Appropriations of the Senate, and the Committee on Commerce, the Committee on the Judiciary, and the Committee on
Appropriations of the House of Representatives, a report containing the results of the analyses and evaluations conducted
under paragraph (1).
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(e) AUTHORIZATION OF APPROPRIATIONS.—There is authorized
to be appropriated to carry out this section—
(1) $10,000,000 for fiscal year 2001; and
(2) such sums as may be necessary for each succeeding fiscal year.
PART B—CENTERS

AND

PROGRAMS

Subpart 1—Center for Substance Abuse Treatment
CENTER FOR SUBSTANCE ABUSE TREATMENT 1

SEC. 507. ø290bb¿ (a) ESTABLISHMENT.—There is established
in the Administration a Center for Substance Abuse Treatment
(hereafter in this section referred to as the ‘‘Center’’). The Center
shall be headed by a Director (hereafter in this section referred to
as the ‘‘Director’’) appointed by the Secretary from among individuals with extensive experience or academic qualifications in the
treatment of substance abuse or in the evaluation of substance
abuse treatment systems.
(b) DUTIES.—The Director of the Center shall—
(1) administer the substance abuse treatment block grant
program authorized in section 1921;
(2) ensure that emphasis is placed on children and adolescents in the development of treatment programs;
(3) collaborate with the Attorney General to develop programs to provide substance abuse treatment services to individuals who have had contact with the Justice system, especially adolescents;
(4) collaborate with the Director of the Center for Substance Abuse Prevention in order to provide outreach services
to identify individuals in need of treatment services, with emphasis on the provision of such services to pregnant and
postpartum women and their infants and to individuals who
abuse drugs intravenously;
(5) collaborate with the Director of the National Institute
on Drug Abuse, with the Director of the National Institute on
Alcohol Abuse and Alcoholism, and with the States to promote
the study, dissemination, and implementation of research findings that will improve the delivery and effectiveness of treatment services;
(6) collaborate with the Administrator of the Health Resources and Services Administration and the Administrator of
the Centers for Medicare & Medicaid Services to promote the
increased integration into the mainstream of the health care
system of the United States of programs for providing treatment services;
(7) evaluate plans submitted by the States pursuant to section 1932(a)(6) in order to determine whether the plans ade1 Section 4 of Public Law 108–358 (118 Stat. 1664) authorizes the Secretary of Health and
Human Services to ‘‘award grants to public and nonprofit private entities to enable such entities
to carry out science-based education programs in elementary and secondary schools to highlight
the harmful effects of anabolic steroids’’. Subsection (d) of such section provides that there is
authorized to be appropriated to carry out the section $15,000,000 for each of the fiscal years
2005 through 2010.

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quately provide for the availability, allocation, and effectiveness of treatment services;
(8) sponsor regional workshops on improving the quality
and availability of treatment services;
(9) provide technical assistance to public and nonprofit private entities that provide treatment services, including technical assistance with respect to the process of submitting to the
Director applications for any program of grants or contracts
carried out by the Director;
(10) encourage the States to expand the availability (relative to fiscal year 1992) of programs providing treatment services through self-run, self-supported recovery based on the programs of housing operated pursuant to section 1925;
(11) carry out activities to educate individuals on the need
for establishing treatment facilities within their communities;
(12) encourage public and private entities that provide
health insurance to provide benefits for outpatient treatment
services and other nonhospital-based treatment services;
(13) evaluate treatment programs to determine the quality
and appropriateness of various forms of treatment, which shall
be carried out through grants, contracts, or cooperative agreements provided to public or nonprofit private entities; and
(14) in carrying out paragraph (13), assess the quality, appropriateness, and costs of various treatment forms for specific
patient groups.
(c) GRANTS AND CONTRACTS.—In carrying out the duties established in subsection (b), the Director may make grants to and enter
into contracts and cooperative agreements with public and nonprofit private entities.
RESIDENTIAL TREATMENT PROGRAMS FOR PREGNANT AND
POSTPARTUM WOMEN

SEC. 508. ø290bb–1¿ (a) IN GENERAL.—The Director of the
Center for Substance Abuse Treatment shall provide awards of
grants, cooperative agreement, or contracts to public and nonprofit
private entities for the purpose of providing to pregnant and
postpartum women treatment for substance abuse through programs in which, during the course of receiving treatment—
(1) the women reside in facilities provided by the programs;
(2) the minor children of the women reside with the
women in such facilities, if the women so request; and
(3) the services described in subsection (d) are available to
or on behalf of the women.
(b) AVAILABILITY OF SERVICES FOR EACH PARTICIPANT.—A
funding agreement for an award under subsection (a) for an applicant is that, in the program operated pursuant to such subsection—
(1) treatment services and each supplemental service will
be available through the applicant, either directly or through
agreements with other public or nonprofit private entities; and
(2) the services will be made available to each woman admitted to the program.
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(c) INDIVIDUALIZED PLAN OF SERVICES.—A funding agreement
for an award under subsection (a) for an applicant is that—
(1) in providing authorized services for an eligible woman
pursuant to such subsection, the applicant will, in consultation
with the women, prepare an individualized plan for the provision to the woman of the services; and
(2) treatment services under the plan will include—
(A) individual, group, and family counseling, as appropriate, regarding substance abuse; and
(B) follow-up services to assist the woman in preventing a relapse into such abuse.
(d) REQUIRED SUPPLEMENTAL SERVICES.—In the case of an eligible woman, the services referred to in subsection (a)(3) are as follows:
(1) Prenatal and postpartum health care.
(2) Referrals for necessary hospital services.
(3) For the infants and children of the woman—
(A) pediatric health care, including treatment for any
perinatal effects of maternal substance abuse and including screenings regarding the physical and mental development of the infants and children;
(B) counseling and other mental health services, in the
case of children; and
(C) comprehensive social services.
(4) Providing supervision of children during periods in
which the woman is engaged in therapy or in other necessary
health or rehabilitative activities.
(5) Training in parenting.
(6) Counseling on the human immunodeficiency virus and
on acquired immune deficiency syndrome.
(7) Counseling on domestic violence and sexual abuse.
(8) Counseling on obtaining employment, including the importance of graduating from a secondary school.
(9) Reasonable efforts to preserve and support the family
units of the women, including promoting the appropriate involvement of parents and others, and counseling the children
of the women.
(10) Planning for and counseling to assist reentry into society, both before and after discharge, including referrals to any
public or nonprofit private entities in the community involved
that provide services appropriate for the women and the children of the women.
(11) Case management services, including—
(A) assessing the extent to which authorized services
are appropriate for the women and their children;
(B) in the case of the services that are appropriate, ensuring that the services are provided in a coordinated
manner; and
(C) assistance in establishing eligibility for assistance
under Federal, State, and local programs providing health
services, mental health services, housing services, employment services, educational services, or social services.
(e) MINIMUM QUALIFICATIONS FOR RECEIPT OF AWARD.—
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(1) CERTIFICATION BY RELEVANT STATE AGENCY.—With respect to the principal agency of the State involved that administers programs relating to substance abuse, the Director may
make an award under subsection (a) to an applicant only if the
agency has certified to the Director that—
(A) the applicant has the capacity to carry out a program described in subsection (a);
(B) the plans of the applicant for such a program are
consistent with the policies of such agency regarding the
treatment of substance abuse; and
(C) the applicant, or any entity through which the applicant will provide authorized services, meets all applicable State licensure or certification requirements regarding
the provision of the services involved.
(2) STATUS AS MEDICAID PROVIDER.—
(A) Subject to subparagraphs (B) and (C), the Director
may make an award under subsection (a) only if, in the
case of any authorized service that is available pursuant
to the State plan approved under title XIX of the Social
Security Act for the State involved—
(i) the applicant for the award will provide the
service directly, and the applicant has entered into a
participation agreement under the State plan and is
qualified to receive payments under such plan; or
(ii) the applicant will enter into an agreement
with a public or nonprofit private entity under which
the entity will provide the service, and the entity has
entered into such a participation agreement plan and
is qualified to receive such payments.
(B)(i) In the case of an entity making an agreement
pursuant to subparagraph (A)(ii) regarding the provision of
services, the requirement established in such subparagraph regarding a participation agreement shall be waived
by the Director if the entity does not, in providing health
care services, impose a charge or accept reimbursement
available from any third-party payor, including reimbursement under any insurance policy or under any Federal or
State health benefits plan.
(ii) A determination by the Director of whether an entity referred to in clause (i) meets the criteria for a waiver
under such clause shall be made without regard to whether the entity accepts voluntary donations regarding the
provision of services to the public.
(C) With respect to any authorized service that is
available pursuant to the State plan described in subparagraph (A), the requirements established in such subparagraph shall not apply to the provision of any such service
by an institution for mental diseases to an individual who
has attained 21 years of age and who has not attained 65
years of age. For purposes of the preceding sentence, the
term ‘‘institution for mental diseases’’ has the meaning
given such term in section 1905(i) of the Social Security
Act.
(f) REQUIREMENT OF MATCHING FUNDS.—
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(1) IN GENERAL.—With respect to the costs of the program
to be carried out by an applicant pursuant to subsection (a), a
funding agreement for an award under such subsection is that
the applicant will make available (directly or through donations from public or private entities) non-Federal contributions
toward such costs in an amount that—
(A) for the first fiscal year for which the applicant receives payments under an award under such subsection, is
not less than $1 for each $9 of Federal funds provided in
the award;
(B) for any second such fiscal year, is not less than $1
for each $9 of Federal funds provided in the award; and
(C) for any subsequent such fiscal year, is not less
than $1 for each $3 of Federal funds provided in the
award.
(2) DETERMINATION OF AMOUNT CONTRIBUTED.—Non-Federal contributions required in paragraph (1) may be in cash or
in kind, fairly evaluated, including plant, equipment, or services. Amounts provided by the Federal Government, or services
assisted or subsidized to any significant extent by the Federal
Government, may not be included in determining the amount
of such non-Federal contributions.
(g) OUTREACH.—A funding agreement for an award under subsection (a) for an applicant is that the applicant will provide outreach services in the community involved to identify women who
are engaging in substance abuse and to encourage the women to
undergo treatment for such abuse.
(h) ACCESSIBILITY OF PROGRAM; CULTURAL CONTEXT OF SERVICES.—A funding agreement for an award under subsection (a) for
an applicant is that—
(1) the program operated pursuant to such subsection will
be operated at a location that is accessible to low-income pregnant and postpartum women; and
(2) authorized services will be provided in the language
and the cultural context that is most appropriate.
(i) CONTINUING EDUCATION.—A funding agreement for an
award under subsection (a) is that the applicant involved will provide for continuing education in treatment services for the individuals who will provide treatment in the program to be operated by
the applicant pursuant to such subsection.
(j) IMPOSITION OF CHARGES.—A funding agreement for an
award under subsection (a) for an applicant is that, if a charge is
imposed for the provision of authorized services to on 1 behalf of an
eligible woman, such charge—
(1) will be made according to a schedule of charges that is
made available to the public;
(2) will be adjusted to reflect the income of the woman involved; and
(3) will not be imposed on any such woman with an income
of less than 185 percent of the official poverty line, as established by the Director of the Office for Management and Budg1 So in law. See section 108(a) of Public Law 102–321 (106 Stat. 336). Probably should be ‘‘to
or on’’.

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et and revised by the Secretary in accordance with section
673(2) of the Omnibus Budget Reconciliation Act of 1981.
(k) REPORTS TO DIRECTOR.—A funding agreement for an award
under subsection (a) is that the applicant involved will submit to
the Director a report—
(1) describing the utilization and costs of services provided
under the award;
(2) specifying the number of women served, the number of
infants served, and the type and costs of services provided; and
(3) providing such other information as the Director determines to be appropriate.
(l) REQUIREMENT OF APPLICATION.—The Director may make an
award under subsection (a) only if an application for the award is
submitted to the Director containing such agreements, and the application is in such form, is made in such manner, and contains
such other agreements and such assurances and information as the
Director determines to be necessary to carry out this section.
(m) EQUITABLE ALLOCATION OF AWARDS.—In making awards
under subsection (a), the Director shall ensure that the awards are
equitably allocated among the principal geographic regions of the
United States, subject to the availability of qualified applicants for
the awards.
(n) DURATION OF AWARD.—The period during which payments
are made to an entity from an award under subsection (a) may not
exceed 5 years. The provision of such payments shall be subject to
annual approval by the Director of the payments and subject to the
availability of appropriations for the fiscal year involved to make
the payments. This subsection may not be construed to establish a
limitation on the number of awards under such subsection that
may be made to an entity.
(o) EVALUATIONS; DISSEMINATION OF FINDINGS.—The Director
shall, directly or through contract, provide for the conduct of evaluations of programs carried out pursuant to subsection (a). The Director shall disseminate to the States the findings made as a result
of the evaluations.
(p) REPORTS TO CONGRESS.—Not later than October 1, 1994,
the Director shall submit to the Committee on Energy and Commerce of the House of Representatives, and to the Committee on
Labor and Human Resources of the Senate, a report describing programs carried out pursuant to this section. Every 2 years thereafter, the Director shall prepare a report describing such programs
carried out during the preceding 2 years, and shall submit the report to the Administrator for inclusion in the biennial report under
section 501(k). Each report under this subsection shall include a
summary of any evaluations conducted under subsection (m) during
the period with respect to which the report is prepared.
(q) DEFINITIONS.—For purposes of this section:
(1) The term ‘‘authorized services’’ means treatment services and supplemental services.
(2) The term ‘‘eligible woman’’ means a woman who has
been admitted to a program operated pursuant to subsection
(a).
(3) The term ‘‘funding agreement under subsection (a)’’,
with respect to an award under subsection (a), means that the
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Director may make the award only if the applicant makes the
agreement involved.
(4) The term ‘‘treatment services’’ means treatment for
substance abuse, including the counseling and services described in subsection (c)(2).
(5) The term ‘‘supplemental services’’ means the services
described in subsection (d).
(r) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of
carrying out this section, there are authorized to be appropriated
such sums as may be necessary to 1 fiscal years 2001 through 2003.
SEC. 509. ø290bb–2¿ PRIORITY SUBSTANCE ABUSE TREATMENT NEEDS
OF REGIONAL AND NATIONAL SIGNIFICANCE.
(a) PROJECTS.—The Secretary shall address priority substance

abuse treatment needs of regional and national significance (as determined under subsection (b)) through the provision of or through
assistance for—
(1) knowledge development and application projects for
treatment and rehabilitation and the conduct or support of
evaluations of such projects;
(2) training and technical assistance; and
(3) targeted capacity response programs.
The Secretary may carry out the activities described in this section
directly or through grants or cooperative agreements with States,
political subdivisions of States, Indian tribes and tribal organizations, other public or nonprofit private entities.
(b) PRIORITY SUBSTANCE ABUSE TREATMENT NEEDS.—
(1) IN GENERAL.—Priority substance abuse treatment
needs of regional and national significance shall be determined
by the Secretary after consultation with States and other interested groups. The Secretary shall meet with the States and interested groups on an annual basis to discuss program priorities.
(2) SPECIAL CONSIDERATION.—In developing program priorities under paragraph (1), the Secretary shall give special consideration to promoting the integration of substance abuse
treatment services into primary health care systems.
(c) REQUIREMENTS.—
(1) IN GENERAL.—Recipients of grants, contracts, or cooperative agreements under this section shall comply with information and application requirements determined appropriate by
the Secretary.
(2) DURATION OF AWARD.—With respect to a grant, contract, or cooperative agreement awarded under this section, the
period during which payments under such award are made to
the recipient may not exceed 5 years.
(3) MATCHING FUNDS.—The Secretary may, for projects
carried out under subsection (a), require that entities that
apply for grants, contracts, or cooperative agreements under
that project provide non-Federal matching funds, as determined appropriate by the Secretary, to ensure the institutional
commitment of the entity to the projects funded under the
1 So in law. Probably should be ‘‘for’’. See section 3301(a) of Public Law 106–310 (114 Stat.
1207).

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grant, contract, or cooperative agreement. Such non-Federal
matching funds may be provided directly or through donations
from public or private entities and may be in cash or in kind,
fairly evaluated, including plant, equipment, or services.
(4) MAINTENANCE OF EFFORT.—With respect to activities
for which a grant, contract, or cooperative agreement is awarded under this section, the Secretary may require that recipients for specific projects under subsection (a) 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 such a grant, contract, or cooperative agreement.
(d) EVALUATION.—The Secretary shall evaluate each project
carried out under subsection (a)(1) and shall disseminate the findings with respect to each such evaluation to appropriate public and
private entities.
(e) INFORMATION AND EDUCATION.—The Secretary shall establish comprehensive information and education programs to disseminate and apply the findings of the knowledge development and application, training and technical assistance programs, and targeted
capacity response programs under this section to the general public, to health professionals and other interested groups. The Secretary shall make every effort to provide linkages between the findings of supported projects and State agencies responsible for carrying out substance abuse prevention and treatment programs.
(f ) AUTHORIZATION OF APPROPRIATION.—There are authorized
to be appropriated to carry out this section, $300,000,000 for fiscal
year 2001 and such sums as may be necessary for each of the fiscal
years 2002 and 2003.
ACTION BY NATIONAL INSTITUTE ON DRUG ABUSE AND STATES
CONCERNING MILITARY FACILITIES

SEC. 513. 1 ø290bb–6¿ (a) CENTER FOR SUBSTANCE ABUSE
TREATMENT.—The Director of the Center for Substance Abuse
Treatment shall—
(1) coordinate with the agencies represented on the Commission on Alternative Utilization of Military Facilities the utilization of military facilities or parts thereof, as identified by
such Commission, established under the National Defense Authorization Act of 1989, that could be utilized or renovated to
house nonviolent persons for drug treatment purposes;
(2) notify State agencies responsible for the oversight of
drug abuse treatment entities and programs of the availability
of space at the installations identified in paragraph (1); and
(3) assist State agencies responsible for the oversight of
drug abuse treatment entities and programs in developing
methods for adapting the installations described in paragraph
(1) into residential treatment centers.
(b) STATES.—With regard to military facilities or parts thereof,
as identified by the Commission on Alternative Utilization of Mili1 Sections 510 through 512 were repealed by section 3301(c) of Public Law 106–310 (114 Stat.
1209).

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tary Facilities established under section 3042 of the Comprehensive
Alcohol Abuse, Drug Abuse, and Mental Health Amendments Act
of 1988, that could be utilized or renovated to house nonviolent persons for drug treatment purposes, State agencies responsible for
the oversight of drug abuse treatment entities and programs
shall—
(1) establish eligibility criteria for the treatment of individuals at such facilities;
(2) select treatment providers to provide drug abuse treatment at such facilities;
(3) provide assistance to treatment providers selected
under paragraph (2) to assist such providers in securing financing to fund the cost of the programs at such facilities; and
(4) establish, regulate, and coordinate with the military official in charge of the facility, work programs for individuals
receiving treatment at such facilities.
(c) RESERVATION OF SPACE.—Prior to notifying States of the
availability of space at military facilities under subsection (a)(2),
the Director may reserve space at such facilities to conduct research or demonstration projects.
SEC. 514. ø290bb–7¿ SUBSTANCE ABUSE TREATMENT SERVICES FOR
CHILDREN AND ADOLESCENTS.
(a) IN GENERAL.—The Secretary shall award grants, contracts,

or cooperative agreements to public and private nonprofit entities,
including Native Alaskan entities and Indian tribes and tribal organizations, for the purpose of providing substance abuse treatment services for children and adolescents.
(b) PRIORITY.—In awarding grants, contracts, or cooperative
agreements under subsection (a), the Secretary shall give priority
to applicants who propose to—
(1) apply evidenced-based and cost effective methods for
the treatment of substance abuse among children and adolescents;
(2) coordinate the provision of treatment services with
other social service agencies in the community, including educational, juvenile justice, child welfare, and mental health
agencies;
(3) provide a continuum of integrated treatment services,
including case management, for children and adolescents with
substance abuse disorders and their families;
(4) provide treatment that is gender-specific and culturally
appropriate;
(5) involve and work with families of children and adolescents receiving treatment;
(6) provide aftercare services for children and adolescents
and their families after completion of substance abuse treatment; and
(7) address the relationship between substance abuse and
violence.
(c) DURATION OF GRANTS.—The Secretary shall award grants,
contracts, or cooperative agreements under subsection (a) for periods not to exceed 5 fiscal years.
(d) APPLICATION.—An entity desiring a grant, contract, or cooperative agreement under subsection (a) shall submit an application
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Sec. 514A

to the Secretary at such time, in such manner, and accompanied
by such information as the Secretary may reasonably require.
(e) EVALUATION.—An entity that receives a grant, contract, or
cooperative agreement under subsection (a) shall submit, in the application for such grant, contract, or cooperative agreement, a plan
for the evaluation of any project undertaken with funds provided
under this section. Such entity shall provide the Secretary with
periodic evaluations of the progress of such project and such evaluation at the completion of such project as the Secretary determines to be appropriate.
(f ) AUTHORIZATION OF APPROPRIATIONS.—There are authorized
to be appropriated to carry out this section, $40,000,000 for fiscal
year 2001, and such sums as may be necessary for fiscal years 2002
and 2003.
SEC. 514A. ø290bb–8¿ EARLY INTERVENTION SERVICES FOR CHILDREN
AND ADOLESCENTS.
(a) IN GENERAL.—The Secretary shall award grants, contracts,

or cooperative agreements to public and private nonprofit entities,
including local educational agencies (as defined in section 14101 of
the Elementary and Secondary Education Act of 1965 (20 U.S.C.
8801)), for the purpose of providing early intervention substance
abuse services for children and adolescents.
(b) PRIORITY.—In awarding grants, contracts, or cooperative
agreements under subsection (a), the Secretary shall give priority
to applicants who demonstrate an ability to—
(1) screen for and assess substance use and abuse by children and adolescents;
(2) make appropriate referrals for children and adolescents
who are in need of treatment for substance abuse;
(3) provide early intervention services, including counseling and ancillary services, that are designed to meet the developmental needs of children and adolescents who are at risk
for substance abuse; and
(4) develop networks with the educational, juvenile justice,
social services, and other agencies and organizations in the
State or local community involved that will work to identify
children and adolescents who are in need of substance abuse
treatment services.
(c) CONDITION.—In awarding grants, contracts, or cooperative
agreements under subsection (a), the Secretary shall ensure that
such grants, contracts, or cooperative agreements are allocated,
subject to the availability of qualified applicants, among the principal geographic regions of the United States, to Indian tribes and
tribal organizations, and to urban and rural areas.
(d) DURATION OF GRANTS.—The Secretary shall award grants,
contracts, or cooperative agreements under subsection (a) for periods not to exceed 5 fiscal years.
(e) APPLICATION.—An entity desiring a grant, contract, or cooperative agreement 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 reasonably require.
(f ) EVALUATION.—An entity that receives a grant, contract, or
cooperative agreement under subsection (a) shall submit, in the application for such grant, contract, or cooperative agreement, a plan
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for the evaluation of any project undertaken with funds provided
under this section. Such entity shall provide the Secretary with
periodic evaluations of the progress of such project and such evaluation at the completion of such project as the Secretary determines to be appropriate.
(g) AUTHORIZATION OF APPROPRIATIONS.—There are authorized
to be appropriated to carry out this section, $20,000,000 for fiscal
year 2001, and such sums as may be necessary for fiscal years 2002
and 2003.
METHAMPHETAMINE AND AMPHETAMINE TREATMENT INITIATIVE

SEC. 514. 1 ø290bb–9¿ (a) GRANTS.—
(1) AUTHORITY TO MAKE GRANTS.—The Director of the Center for Substance Abuse Treatment may make grants to States
and Indian tribes recognized by the United States that have a
high rate, or have had a rapid increase, in methamphetamine
or amphetamine abuse or addiction in order to permit such
States and Indian tribes to expand activities in connection with
the treatment of methamphetamine or amphetamine abuser or
addiction in the specific geographical areas of such States or
Indian tribes, as the case may be, where there is such a rate
or has been such an increase.
(2) RECIPIENTS.—Any grants under paragraph (1) shall be
directed to the substance abuse directors of the States, and of
the appropriate tribal government authorities of the Indian
tribes, selected by the Director to receive such grants.
(3) NATURE OF ACTIVITIES.—Any activities under a grant
under paragraph (1) shall be based on reliable scientific evidence of their efficacy in the treatment of methamphetamine
or amphetamine abuse or addiction.
(b) GEOGRAPHIC DISTRIBUTION.—The Director shall ensure that
grants under subsection (a) are distributed equitably among the
various regions of the country and among rural, urban, and suburban areas that are affected by methamphetamine or amphetamine
abuse or addiction.
(c) ADDITIONAL ACTIVITIES.—The Director shall—
(1) evaluate the activities supported by grants under subsection (a);
(2) disseminate widely such significant information derived
from the evaluation as the Director considers appropriate to
assist States, Indian tribes, and private providers of treatment
services for methamphetamine or amphetamine abuser or addiction in the treatment of methamphetamine or amphetamine
abuse or addiction; and
(3) provide States, Indian tribes, and such providers with
technical assistance in connection with the provision of such
treatment.
(d) AUTHORIZATION OF APPROPRIATIONS.—
(1) IN GENERAL.—There are authorized to be appropriated
to carry out this section $10,000,000 for fiscal year 2000 and
1 So in law. There are two sections 514. The first was added at the end of this subpart (subpart 1 of part B) by section 3104(a) of Public Law 106–310 (114 Stat. 1171). That section also
added section 514A. Section 3632 of such Public Law (114 Stat. 1236) then added at the end
of this subpart section 514 above.

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Sec. 515

such sums as may be necessary for each of fiscal years 2001
and 2002.
(2) USE OF CERTAIN FUNDS.—Of the funds appropriated to
carry out this section in any fiscal year, the lesser of 5 percent
of such funds or $1,000,000 shall be available to the Director
for purposes of carrying out subsection (c).
Subpart 2—Center for Substance Abuse Prevention
OFFICE FOR SUBSTANCE ABUSE PREVENTION

SEC. 515. ø290bb–21¿ (a) There is established in the Administration an Office for Substance Abuse Prevention (hereafter referred to in this part as the ‘‘Prevention Center’’). The Office 1 shall
be headed by a Director appointed by the Secretary from individuals with extensive experience or academic qualifications in the
prevention of drug or alcohol abuse.
(b) The Director of the Prevention Center shall—
(1) sponsor regional workshops on the prevention of drug
and alcohol abuse;
(2) coordinate the findings of research sponsored by agencies of the Service on the prevention of drug and alcohol abuse;
(3) develop effective drug and alcohol abuse prevention literature (including literature on the adverse effects of cocaine
free base (known as crack));
(4) in cooperation with the Secretary of Education, assure
the widespread dissemination of prevention materials among
States, political subdivisions, and school systems;
(5) support clinical training programs for substance abuse
counselors and other health professionals involved in drug
abuse education, prevention,; 2
(6) in cooperation with the Director of the Centers for Disease Control 3, develop educational materials to reduce the
risks of acquired immune deficiency syndrome among intravenous drug abusers;
(7) conduct training, technical assistance, data collection,
and evaluation activities of programs supported under the
Drug Free Schools and Communities Act of 1986;
(8) support the development of model, innovative, community-based programs to discourage alcohol and drug abuse
among young people;
(9) collaborate with the Attorney General of the Department of Justice to develop programs to prevent drug abuse
among high risk youth;
(10) prepare for distribution documentary films and public
service announcements for television and radio to educate the
public, especially adolescent audiences, concerning the dangers
to health resulting from the consumption of alcohol and drugs
and, to the extent feasible, use appropriate private organiza1 So in law. See subsections (a), (d), and (e) of section 113 of Public Law 102–321 (106 Stat.
345). Probably should be ‘‘Prevention Center’’.
2 So in law. See section 113(c)(1) of Public Law 102-321 (106 Stat. 345).
3 So in law. See section 113(b) of Public Law 102–321 (106 Stat. 345). Probably should be
‘‘Centers for Disease Control and Prevention’’. Section 515 formerly was section 508, and after
such redesignation, section 312(d)(10) of Public Law 102–531 (106 Stat. 3505) attempted to
amend ‘‘section 508(b)(6)’’ with respect to adding ‘‘and Prevention’’.

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tions and business concerns in the preparation of such announcements; and
(11) develop and support innovative demonstration programs designed to identify and deter the improper use or
abuse of anabolic steroids by students, especially students in
secondary schools.
(c) The Director may make grants and enter into contracts and
cooperative agreements in carrying out subsection (b).
(d) The Director of the Prevention Center shall establish a national data base providing information on programs for the prevention of substance abuse. The data base shall contain information
appropriate for use by public entities and information appropriate
for use by nonprofit private entities.
SEC. 516. ø290bb–22¿ PRIORITY SUBSTANCE ABUSE PREVENTION
NEEDS OF REGIONAL AND NATIONAL SIGNIFICANCE.
(a) PROJECTS.—The Secretary shall address priority substance

abuse prevention needs of regional and national significance (as determined under subsection (b)) through the provision of or through
assistance for—
(1) knowledge development and application projects for
prevention and the conduct or support of evaluations of such
projects;
(2) training and technical assistance; and
(3) targeted capacity response programs.
The Secretary may carry out the activities described in this section
directly or through grants or cooperative agreements with States,
political subdivisions of States, Indian tribes and tribal organizations, or other public or nonprofit private entities.
(b) PRIORITY SUBSTANCE ABUSE PREVENTION NEEDS.—
(1) IN GENERAL.—Priority substance abuse prevention
needs of regional and national significance shall be determined
by the Secretary in consultation with the States and other interested groups. The Secretary shall meet with the States and
interested groups on an annual basis to discuss program priorities.
(2) SPECIAL CONSIDERATION.—In developing program priorities under paragraph (1), the Secretary shall give special consideration to—
(A) applying the most promising strategies and research-based primary prevention approaches; and
(B) promoting the integration of substance abuse prevention information and activities into primary health care
systems.
(c) REQUIREMENTS.—
(1) IN GENERAL.—Recipients of grants, contracts, and cooperative agreements under this section shall comply with information and application requirements determined appropriate
by the Secretary.
(2) DURATION OF AWARD.—With respect to a grant, contract, or cooperative agreement awarded under this section, the
period during which payments under such award are made to
the recipient may not exceed 5 years.
(3) MATCHING FUNDS.—The Secretary may, for projects
carried out under subsection (a), require that entities that
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Sec. 517

apply for grants, contracts, or cooperative agreements under
that project provide non-Federal matching funds, as determined appropriate by the Secretary, to ensure the institutional
commitment of the entity to the projects funded under the
grant, contract, or cooperative agreement. Such non-Federal
matching funds may be provided directly or through donations
from public or private entities and may be in cash or in kind,
fairly evaluated, including plant, equipment, or services.
(4) MAINTENANCE OF EFFORT.—With respect to activities
for which a grant, contract, or cooperative agreement is awarded under this section, the Secretary may require that recipients for specific projects under subsection (a) 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 such a grant, contract, or cooperative agreement.
(d) EVALUATION.—The Secretary shall evaluate each project
carried out under subsection (a)(1) and shall disseminate the findings with respect to each such evaluation to appropriate public and
private entities.
(e) INFORMATION AND EDUCATION.—The Secretary shall establish comprehensive information and education programs to disseminate the findings of the knowledge development and application,
training and technical assistance programs, and targeted capacity
response programs under this section to the general public and to
health professionals. The Secretary shall make every effort to provide linkages between the findings of supported projects and State
agencies responsible for carrying out substance abuse prevention
and treatment programs.
(f ) AUTHORIZATION OF APPROPRIATION.—There are authorized
to be appropriated to carry out this section, $300,000,000 for fiscal
year 2001, and such sums as may be necessary for each of the fiscal years 2002 and 2003.
PREVENTION, TREATMENT, AND REHABILITATION MODEL PROJECTS
FOR HIGH RISK YOUTH

SEC. 517. ø290bb–23¿ (a) The Secretary, through the Director
of the Prevention Center, shall make grants to public and nonprofit
private entities for projects to demonstrate effective models for the
prevention, treatment, and rehabilitation of drug abuse and alcohol
abuse among high risk youth.
(b)(1) In making grants for drug abuse and alcohol abuse prevention projects under this section, the Secretary shall give priority
to applications for projects directed at children of substance abusers, latchkey children, children at risk of abuse or neglect, preschool children eligible for services under the Head Start Act, children at risk of dropping out of school, children at risk of becoming
adolescent parents, and children who do not attend school and who
are at risk of being unemployed.
(2) In making grants for drug abuse and alcohol abuse treatment and rehabilitation projects under this section, the Secretary
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tween drug abuse or alcohol abuse and physical child abuse, sexual
child abuse, emotional child abuse, dropping out of school, unemployment, delinquency, pregnancy, violence, suicide, or mental
health problems.
(3) In making grants under this section, the Secretary shall
give priority to applications from community based organizations
for projects to develop innovative models with multiple, coordinated
services for the prevention or for the treatment and rehabilitation
of drug abuse or alcohol abuse by high risk youth.
(4) In making grants under this section, the Secretary shall
give priority to applications for projects to demonstrate effective
models with multiple, coordinated services which may be replicated
and which are for the prevention or for the treatment and rehabilitation of drug abuse or alcohol abuse by high risk youth.
(5) In making grants under this section, the Secretary shall
give priority to applications that employ research designs adequate
for evaluating the effectiveness of the program.
(c) The Secretary shall ensure that projects under subsection
(a) include strategies for reducing the use of alcoholic beverages
and tobacco products by individuals to whom it is unlawful to sell
or distribute such beverages or products.
(d) To the extent feasible, the Secretary shall make grants
under this section in all regions of the United States, and shall ensure the distribution of grants under this section among urban and
rural areas.
(e) In order to receive a grant for a project under this section
for a fiscal year, a public or nonprofit private entity shall submit
an application to the Secretary, acting through the Office. The Secretary may provide to the Governor of the State the opportunity to
review and comment on such application. Such application shall be
in such form, shall contain such information, and shall be submitted at such time as the Secretary may by regulation prescribe.
(f) The Director 1 of the Office shall evaluate projects conducted
with grants under this section.
(g) For purposes of this section, the term ‘‘high risk youth’’
means an individual who has not attained the age of 21 years, who
is at high risk of becoming, or who has become, a drug abuser or
an alcohol abuser, and who—
(1) is identified as a child of a substance abuser;
(2) is a victim of physical, sexual, or psychological abuse;
(3) has dropped out of school;
(4) has become pregnant;
(5) is economically disadvantaged;
(6) has committed a violent or delinquent act;
(7) has experienced mental health problems;
(8) has attempted suicide;
(9) has experienced long-term physical pain due to injury;
or
(10) has experienced chronic failure in school.
1 So in law. See section 114, and subsections (a), (d), and (e) of section 113, of Public Law
102–321 (106 Stat. 346, 345). Probably should be ‘‘Prevention Center’’.

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(h) For the purpose of carrying out this section, there are authorized to be appropriated such sums as may be necessary for
each of the fiscal years 2001 through 2003.
SEC. 519A. 1 ø290bb–25a¿ GRANTS FOR STRENGTHENING FAMILIES.
(a) PROGRAM AUTHORIZED.—The Secretary, acting through

the
Director of the Prevention Center, may make grants to public and
nonprofit private entities to develop and implement model substance abuse prevention programs to provide early intervention
and substance abuse prevention services for individuals of highrisk families and the communities in which such individuals reside.
(b) PRIORITY.—In awarding grants under subsection (a), the
Secretary shall give priority to applicants that—
(1) have proven experience in preventing substance abuse
by individuals of high-risk families and reducing substance
abuse in communities of such individuals;
(2) have demonstrated the capacity to implement community-based partnership initiatives that are sensitive to the diverse backgrounds of individuals of high-risk families and the
communities of such individuals;
(3) have experience in providing technical assistance to
support substance abuse prevention programs that are community-based;
(4) have demonstrated the capacity to implement researchbased substance abuse prevention strategies; and
(5) have implemented programs that involve families, residents, community agencies, and institutions in the implementation and design of such programs.
(c) DURATION OF GRANTS.—The Secretary shall award grants
under subsection (a) for a period not to exceed 5 years.
(d) USE OF FUNDS.—An applicant that is awarded a grant
under subsection (a) shall—
(1) in the first fiscal year that such funds are received
under the grant, use such funds to develop a model substance
abuse prevention program; and
(2) in the fiscal year following the first fiscal year that
such funds are received, use such funds to implement the program developed under paragraph (1) to provide early intervention and substance abuse prevention services to—
(A) strengthen the environment of children of high
risk families by targeting interventions at the families of
such children and the communities in which such children
reside;
(B) strengthen protective factors, such as—
(i) positive adult role models;
(ii) messages that oppose substance abuse;
(iii) community actions designed to reduce accessibility to and use of illegal substances; and
1 The probable intent of the Congress is that section 399A of this Act appear before section
519A as a section 519. See footnote for section 399A. (Section 399A relates to grants for services
for children of substance abusers.)
Section 518 was repealed by section 3202(b) of Public Law 106–310 (114 Stat. 1210).

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(iv) willingness of individuals of families in which
substance abuse occurs to seek treatment for substance abuse;
(C) reduce family and community risks, such as family
violence, alcohol or drug abuse, crime, and other behaviors
that may effect healthy child development and increase the
likelihood of substance abuse; and
(D) build collaborative and formal partnerships between community agencies, institutions, and businesses to
ensure that comprehensive high quality services are provided, such as early childhood education, health care, family support programs, parent education programs, and
home visits for infants.
(e) APPLICATION.—To be eligible to receive a grant under subsection (a), an applicant shall prepare and submit to the Secretary
an application that—
(1) describes a model substance abuse prevention program
that such applicant will establish;
(2) describes the manner in which the services described in
subsection (d)(2) will be provided; and
(3) describe in as much detail as possible the results that
the entity expects to achieve in implementing such a program.
(f ) MATCHING FUNDING.—The Secretary may not make a grant
to a entity under subsection (a) unless that entity agrees that, with
respect to the costs to be incurred by the entity in carrying out the
program for which the grant was awarded, the entity will make
available non-Federal contributions in an amount that is not less
than 40 percent of the amount provided under the grant.
(g) REPORT TO SECRETARY.—An applicant that is awarded a
grant under subsection (a) shall prepare and submit to the Secretary a report in such form and containing such information as
the Secretary may require, including an assessment of the efficacy
of the model substance abuse prevention program implemented by
the applicant and the short, intermediate, and long term results of
such program.
(h) EVALUATIONS.—The Secretary shall conduct evaluations,
based in part on the reports submitted under subsection (g), to determine the effectiveness of the programs funded under subsection
(a) in reducing substance use in high-risk families and in making
communities in which such families reside in stronger. The Secretary shall submit such evaluations to the appropriate committees
of Congress.
(i) HIGH-RISK FAMILIES.—In this section, the term ‘‘high-risk
family’’ means a family in which the individuals of such family are
at a significant risk of using or abusing alcohol or any illegal substance.
( j) AUTHORIZATION OF APPROPRIATIONS.—There is authorized
to be appropriated to carry out this section, $3,000,000 for fiscal
year 2001, and such sums as may be necessary for each of the fiscal years 2002 and 2003.
SEC. 519B. ø290bb–25b¿ PROGRAMS TO REDUCE UNDERAGE DRINKING.
(a) DEFINITIONS.—For purposes of this section:
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(1) The term ‘‘alcohol beverage industry’’ means the brewers, vintners, distillers, importers, distributors, and retail or
online outlets that sell or serve beer, wine, and distilled spirits.
(2) The term ‘‘school-based prevention’’ means programs,
which are institutionalized, and run by staff members or
school-designated persons or organizations in any grade of
school, kindergarten through 12th grade.
(3) The term ‘‘youth’’ means persons under the age of 21.
(4) The term ‘‘IOM report’’ means the report released in
September 2003 by the National Research Council, Institute of
Medicine, and entitled ‘‘Reducing Underage Drinking: A Collective Responsibility’’.
(b) SENSE OF CONGRESS.—It is the sense of the Congress that:
(1) A multi-faceted effort is needed to more successfully address the problem of underage drinking in the United States.
A coordinated approach to prevention, intervention, treatment,
enforcement, and research is key to making progress. This Act
recognizes the need for a focused national effort, and addresses
particulars of the Federal portion of that effort, as well as Federal support for State activities.
(2) The Secretary of Health and Human Services shall continue to conduct research and collect data on the short and
long-range impact of alcohol use and abuse upon adolescent
brain development and other organ systems.
(3) States and communities, including colleges and universities, are encouraged to adopt comprehensive prevention approaches, including—
(A) evidence-based screening, programs and curricula;
(B) brief intervention strategies;
(C) consistent policy enforcement; and
(D) environmental changes that limit underage access
to alcohol.
(4) Public health groups, consumer groups, and the alcohol
beverage industry should continue and expand evidence-based
efforts to prevent and reduce underage drinking.
(5) The entertainment industries have a powerful impact
on youth, and they should use rating systems and marketing
codes to reduce the likelihood that underage audiences will be
exposed to movies, recordings, or television programs with unsuitable alcohol content.
(6) The National Collegiate Athletic Association, its member colleges and universities, and athletic conferences should
affirm a commitment to a policy of discouraging alcohol use
among underage students and other young fans.
(7) Alcohol is a unique product and should be regulated
differently than other products by the States and Federal Government. States have primary authority to regulate alcohol distribution and sale, and the Federal Government should support and supplement these State efforts. States also have a responsibility to fight youth access to alcohol and reduce underage drinking. Continued State regulation and licensing of the
manufacture, importation, sale, distribution, transportation
and storage of alcoholic beverages are clearly in the public interest and are critical to promoting responsible consumption,
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preventing illegal access to alcohol by persons under 21 years
of age from commercial and non-commercial sources, maintaining industry integrity and an orderly marketplace, and furthering effective State tax collection.
(c) INTERAGENCY COORDINATING COMMITTEE; ANNUAL REPORT
ON STATE UNDERAGE DRINKING PREVENTION AND ENFORCEMENT
ACTIVITIES.—
(1) INTERAGENCY COORDINATING COMMITTEE ON THE PREVENTION OF UNDERAGE DRINKING.—
(A) IN GENERAL.—The Secretary, in collaboration with
the Federal officials specified in subparagraph (B), shall
formally establish and enhance the efforts of the interagency coordinating committee, that began operating in
2004, focusing on underage drinking (referred to in this
subsection as the ‘‘Committee’’).
(B) OTHER AGENCIES.—The officials referred to in
paragraph (1) are the Secretary of Education, the Attorney
General, the Secretary of Transportation, the Secretary of
the Treasury, the Secretary of Defense, the Surgeon General, the Director of the Centers for Disease Control and
Prevention, the Director of the National Institute on Alcohol Abuse and Alcoholism, the Administrator of the Substance Abuse and Mental Health Services Administration,
the Director of the National Institute on Drug Abuse, the
Assistant Secretary for Children and Families, the Director of the Office of National Drug Control Policy, the Administrator of the National Highway Traffic Safety Administration, the Administrator of the Office of Juvenile Justice and Delinquency Prevention, the Chairman of the Federal Trade Commission, and such other Federal officials as
the Secretary of Health and Human Services determines to
be appropriate.
(C) CHAIR.—The Secretary of Health and Human Services shall serve as the chair of the Committee.
(D) DUTIES.—The Committee shall guide policy and
program development across the Federal Government with
respect to underage drinking, provided, however, that
nothing in this section shall be construed as transferring
regulatory or program authority from an Agency to the Coordinating Committee.
(E) CONSULTATIONS.—The Committee shall actively
seek the input of and shall consult with all appropriate
and interested parties, including States, public health research and interest groups, foundations, and alcohol beverage industry trade associations and companies.
(F) ANNUAL REPORT.—
(i) IN GENERAL.—The Secretary, on behalf of the
Committee, shall annually submit to the Congress a
report that summarizes—
(I) all programs and policies of Federal agencies designed to prevent and reduce underage
drinking;
(II) the extent of progress in preventing and
reducing underage drinking nationally;
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(III) data that the Secretary shall collect with
respect to the information specified in clause (ii);
and
(IV) such other information regarding underage drinking as the Secretary determines to be appropriate.
(ii) CERTAIN INFORMATION.—The report under
clause (i) shall include information on the following:
(I) Patterns and consequences of underage
drinking as reported in research and surveys such
as, but not limited to Monitoring the Future,
Youth Risk Behavior Surveillance System, the National Survey on Drug Use and Health, and the
Fatality Analysis Reporting System.
(II) Measures of the availability of alcohol
from commercial and non-commercial sources to
underage populations.
(III) Measures of the exposure of underage
populations to messages regarding alcohol in advertising and the entertainment media as reported by the Federal Trade Commission.
(IV) Surveillance data, including information
on the onset and prevalence of underage drinking,
consumption patterns and the means of underage
access. The Secretary shall develop a plan to improve the collection, measurement and consistency
of reporting Federal underage alcohol data.
(V) Any additional findings resulting from research conducted or supported under subsection
(f).
(VI) Evidence-based best practices to prevent
and reduce underage drinking and provide treatment services to those youth who need them.
(2) ANNUAL REPORT ON STATE UNDERAGE DRINKING PREVENTION AND ENFORCEMENT ACTIVITIES.—
(A) IN GENERAL.—The Secretary shall, with input and
collaboration from other appropriate Federal agencies,
States, Indian tribes, territories, and public health, consumer, and alcohol beverage industry groups, annually
issue a report on each State’s performance in enacting, enforcing, and creating laws, regulations, and programs to
prevent or reduce underage drinking.
(B) STATE PERFORMANCE MEASURES.—
(i) IN GENERAL.—The Secretary shall develop, in
consultation with the Committee, a set of measures to
be used in preparing the report on best practices.
(ii) CATEGORIES.—In developing these measures,
the Secretary shall consider categories including, but
not limited to:
(I) Whether or not the State has comprehensive anti-underage drinking laws such as for the
illegal sale, purchase, attempt to purchase, consumption, or possession of alcohol; illegal use of
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cohol for an individual under 21 years; the degree
of strictness of the penalties for such offenses; and
the prevalence of the enforcement of each of these
infractions.
(II) Whether or not the State has comprehensive liability statutes pertaining to underage access to alcohol such as dram shop, social host, and
house party laws, and the prevalence of enforcement of each of these laws.
(III) Whether or not the State encourages and
conducts comprehensive enforcement efforts to
prevent underage access to alcohol at retail outlets, such as random compliance checks and shoulder tap programs, and the number of compliance
checks within alcohol retail outlets measured
against the number of total alcohol retail outlets
in each State, and the result of such checks.
(IV) Whether or not the State encourages
training on the proper selling and serving of alcohol for all sellers and servers of alcohol as a condition of employment.
(V) Whether or not the State has policies and
regulations with regard to direct sales to consumers and home delivery of alcoholic beverages.
(VI) Whether or not the State has programs
or laws to deter adults from purchasing alcohol for
minors; and the number of adults targeted by
these programs.
(VII) Whether or not the State has programs
targeted to youths, parents, and caregivers to
deter underage drinking; and the number of individuals served by these programs.
(VIII) Whether or not the State has enacted
graduated drivers licenses and the extent of those
provisions.
(IX) The amount that the State invests, per
youth capita, on the prevention of underage drinking, further broken down by the amount spent
on—
(aa) compliance check programs in retail
outlets, including providing technology to prevent and detect the use of false identification
by minors to make alcohol purchases;
(bb) checkpoints and saturation patrols
that include the goal of reducing and deterring underage drinking;
(cc) community-based, school-based, and
higher-education-based programs to prevent
underage drinking;
(dd) underage drinking prevention programs that target youth within the juvenile
justice and child welfare systems; and
(ee) other State efforts or programs as
deemed appropriate.
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(3) AUTHORIZATION OF APPROPRIATIONS.—There are authorized to be appropriated to carry out this subsection $1,000,000
for fiscal year 2007, and $1,000,000 for each of the fiscal years
2008 through 2010.
(d) NATIONAL MEDIA CAMPAIGN TO PREVENT UNDERAGE DRINKING.—
(1) SCOPE OF THE CAMPAIGN.—The Secretary shall continue
to fund and oversee the production, broadcasting, and evaluation of the national adult-oriented media public service campaign if the Secretary determines that such campaign is effective in achieving the media campaign’s measurable objectives.
(2) REPORT.—The Secretary shall provide a report to the
Congress annually detailing the production, broadcasting, and
evaluation of the campaign referred to in paragraph (1), and to
detail in the report the effectiveness of the campaign in reducing underage drinking, the need for and likely effectiveness of
an expanded adult-oriented media campaign, and the feasibility and the likely effectiveness of a national youth-focused
media campaign to combat underage drinking.
(3) CONSULTATION REQUIREMENT.—In carrying out the
media campaign, the Secretary shall direct the entity carrying
out the national adult-oriented media public service campaign
to consult with interested parties including both the alcohol
beverage industry and public health and consumer groups. The
progress of this consultative process is to be covered in the report under paragraph (2).
(4) AUTHORIZATION OF APPROPRIATIONS.—There are authorized to be appropriated to carry out this subsection, $1,000,000
for fiscal year 2007 and $1,000,000 for each of the fiscal years
2008 through 2010.
(e) INTERVENTIONS.—
(1) COMMUNITY-BASED COALITION ENHANCEMENT GRANTS
TO PREVENT UNDERAGE DRINKING.—
(A) AUTHORIZATION OF PROGRAM.—The Administrator
of the Substance Abuse and Mental Health Services Administration, in consultation with the Director of the Office
of National Drug Control Policy, shall award, if the Administrator determines that the Department of Health and
Human Services is not currently conducting activities that
duplicate activities of the type described in this subsection,
‘‘enhancement grants’’ to eligible entities to design, test,
evaluate and disseminate effective strategies to maximize
the effectiveness of community-wide approaches to preventing and reducing underage drinking. This subsection
is subject to the availability of appropriations.
(B) PURPOSES.—The purposes of this paragraph are
to—
(i) prevent and reduce alcohol use among youth in
communities throughout the United States;
(ii) strengthen collaboration among communities,
the Federal Government, and State, local, and tribal
governments;
(iii) enhance intergovernmental cooperation and
coordination on the issue of alcohol use among youth;
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(iv) serve as a catalyst for increased citizen participation and greater collaboration among all sectors
and organizations of a community that first demonstrates a long-term commitment to reducing alcohol
use among youth;
(v) disseminate to communities timely information
regarding state-of-the-art practices and initiatives that
have proven to be effective in preventing and reducing
alcohol use among youth; and
(vi) enhance, not supplant, effective local community initiatives for preventing and reducing alcohol use
among youth.
(C) APPLICATION.—An eligible entity desiring an enhancement grant under this paragraph shall submit an application to the Administrator at such time, and in such
manner, and accompanied by such information as the Administrator may require. Each application shall include—
(i) a complete description of the entity’s current
underage alcohol use prevention initiatives and how
the grant will appropriately enhance the focus on underage drinking issues; or
(ii) a complete description of the entity’s current
initiatives, and how it will use this grant to enhance
those initiatives by adding a focus on underage drinking prevention.
(D) USES OF FUNDS.—Each eligible entity that receives
a grant under this paragraph shall use the grant funds to
carry out the activities described in such entity’s application submitted pursuant to subparagraph (C). Grants
under this paragraph shall not exceed $50,000 per year
and may not exceed four years.
(E) SUPPLEMENT NOT SUPPLANT.—Grant funds provided under this paragraph shall be used to supplement,
not supplant, Federal and non-Federal funds available for
carrying out the activities described in this paragraph.
(F) EVALUATION.—Grants under this paragraph shall
be subject to the same evaluation requirements and procedures as the evaluation requirements and procedures imposed on recipients of drug free community grants.
(G) DEFINITIONS.—For purposes of this paragraph, the
term ‘‘eligible entity’’ means an organization that is currently receiving or has received grant funds under the
Drug-Free Communities Act of 1997 (21 U.S.C. 1521 et
seq.).
(H) ADMINISTRATIVE EXPENSES.—Not more than 6 percent of a grant under this paragraph may be expended for
administrative expenses.
(I) AUTHORIZATION OF APPROPRIATIONS.—There are authorized to be appropriated to carry out this paragraph
$5,000,000 for fiscal year 2007, and $5,000,000 for each of
the fiscal years 2008 through 2010.
(2) GRANTS DIRECTED AT PREVENTING AND REDUCING ALCOHOL ABUSE AT INSTITUTIONS OF HIGHER EDUCATION.—
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(A) AUTHORIZATION OF PROGRAM.—The Secretary shall
award grants to eligible entities to enable the entities to
prevent and reduce the rate of underage alcohol consumption including binge drinking among students at institutions of higher education.
(B) APPLICATIONS.—An eligible entity that desires to
receive a grant under this paragraph shall submit an application to the Secretary at such time, in such manner,
and accompanied by such information as the Secretary
may require. Each application shall include—
(i) a description of how the eligible entity will
work to enhance an existing, or where none exists to
build a, statewide coalition;
(ii) a description of how the eligible entity will target underage students in the State;
(iii) a description of how the eligible entity intends
to ensure that the statewide coalition is actually implementing the purpose of this section and moving toward indicators described in subparagraph (D);
(iv) a list of the members of the statewide coalition or interested parties involved in the work of the
eligible entity;
(v) a description of how the eligible entity intends
to work with State agencies on substance abuse prevention and education;
(vi) the anticipated impact of funds provided
under this paragraph in preventing and reducing the
rates of underage alcohol use;
(vii) outreach strategies, including ways in which
the eligible entity proposes to—
(I) reach out to students and community
stakeholders;
(II) promote the purpose of this paragraph;
(III) address the range of needs of the students and the surrounding communities; and
(IV) address community norms for underage
students regarding alcohol use; and
(viii) such additional information as required by
the Secretary.
(C) USES OF FUNDS.—Each eligible entity that receives
a grant under this paragraph shall use the grant funds to
carry out the activities described in such entity’s application submitted pursuant to subparagraph (B).
(D) ACCOUNTABILITY.—On the date on which the Secretary first publishes a notice in the Federal Register soliciting applications for grants under this paragraph, the Secretary shall include in the notice achievement indicators
for the program authorized under this paragraph. The
achievement indicators shall be designed—
(i) to measure the impact that the statewide coalitions assisted under this paragraph are having on the
institutions of higher education and the surrounding
communities, including changes in the number of incidents of any kind in which students have abused alcoMarch 13, 2013

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hol or consumed alcohol while under the age of 21 (including violations, physical assaults, sexual assaults,
reports of intimidation, disruptions of school functions,
disruptions of student studies, mental health referrals,
illnesses, or deaths);
(ii) to measure the quality and accessibility of the
programs or information offered by the eligible entity;
and
(iii) to provide such other measures of program
impact as the Secretary determines appropriate.
(E) SUPPLEMENT NOT SUPPLANT.—Grant funds provided under this paragraph shall be used to supplement,
and not supplant, Federal and non-Federal funds available
for carrying out the activities described in this paragraph.
(F) DEFINITIONS.—For purposes of this paragraph:
(i) ELIGIBLE ENTITY.—The term ‘‘eligible entity’’
means a State, institution of higher education, or nonprofit entity.
(ii) INSTITUTION OF HIGHER EDUCATION.—The term
‘‘institution of higher education’’ has the meaning
given the term in section 101(a) of the Higher Education Act of 1965 (20 U.S.C. 1001(a)).
(iii) SECRETARY.—The term ‘‘Secretary’’ means the
Secretary of Education.
(iv) STATE.—The term ‘‘State’’ means each of the
50 States, the District of Columbia, and the Commonwealth of Puerto Rico.
(v) STATEWIDE COALITION.—The term ‘‘statewide
coalition’’ means a coalition that—
(I) includes, but is not limited to—
(aa) institutions of higher education within a State; and
(bb) a nonprofit group, a community underage drinking prevention coalition, or another substance abuse prevention group within a State; and
(II) works toward lowering the alcohol abuse
rate by targeting underage students at institutions of higher education throughout the State
and in the surrounding communities.
(vi) SURROUNDING COMMUNITY.—The term ‘‘surrounding community’’ means the community—
(I) that surrounds an institution of higher
education participating in a statewide coalition;
(II) where the students from the institution of
higher education take part in the community; and
(III) where students from the institution of
higher education live in off-campus housing.
(G) ADMINISTRATIVE EXPENSES.—Not more than 5 percent of a grant under this paragraph may be expended for
administrative expenses.
(H) AUTHORIZATION OF APPROPRIATIONS.—There are
authorized to be appropriated to carry out this paragraph
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$5,000,000 for fiscal year 2007, and $5,000,000 for each of
the fiscal years 2008 through 2010.
(f) ADDITIONAL RESEARCH.—
(1) ADDITIONAL RESEARCH ON UNDERAGE DRINKING.—
(A) IN GENERAL.—The Secretary shall, subject to the
availability of appropriations, collect data, and conduct or
support research that is not duplicative of research currently being conducted or supported by the Department of
Health and Human Services, on underage drinking, with
respect to the following:
(i) Comprehensive community-based programs or
strategies and statewide systems to prevent and reduce underage drinking, across the underage years
from early childhood to age 21, including programs
funded and implemented by government entities, public health interest groups and foundations, and alcohol
beverage companies and trade associations.
(ii) Annually obtain and report more precise information than is currently collected on the scope of the
underage drinking problem and patterns of underage
alcohol consumption, including improved knowledge
about the problem and progress in preventing, reducing and treating underage drinking; as well as information on the rate of exposure of youth to advertising
and other media messages encouraging and discouraging alcohol consumption.
(iii) Compiling information on the involvement of
alcohol in unnatural deaths of persons ages 12 to 20
in the United States, including suicides, homicides,
and unintentional injuries such as falls, drownings,
burns, poisonings, and motor vehicle crash deaths.
(B) CERTAIN MATTERS.—The Secretary shall carry out
activities toward the following objectives with respect to
underage drinking:
(i) Obtaining new epidemiological data within the
national or targeted surveys that identify alcohol use
and attitudes about alcohol use during pre- and early
adolescence, including harm caused to self or others as
a result of adolescent alcohol use such as violence,
date rape, risky sexual behavior, and prenatal alcohol
exposure.
(ii) Developing or identifying successful clinical
treatments for youth with alcohol problems.
(C) PEER REVIEW.—Research under subparagraph (A)
shall meet current Federal standards for scientific peer review.
(2) AUTHORIZATION OF APPROPRIATIONS.—There are authorized to be appropriated to carry out this subsection $6,000,000
for fiscal year 2007, and $6,000,000 for each of the fiscal years
2008 through 2010.
SEC. 519C. ø290bb–25c¿ SERVICES FOR INDIVIDUALS WITH FETAL ALCOHOL SYNDROME.
(a) IN GENERAL.—The Secretary shall make awards of grants,

cooperative agreements, or contracts to public and nonprofit private
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entities, including Indian tribes and tribal organizations, to provide
services to individuals diagnosed with fetal alcohol syndrome or alcohol-related birth defects.
(b) USE OF FUNDS.—An award under subsection (a) may, subject to subsection (d), be used to—
(1) screen and test individuals to determine the type and
level of services needed;
(2) develop a comprehensive plan for providing services to
the individual;
(3) provide mental health counseling;
(4) provide substance abuse prevention services and treatment, if needed;
(5) coordinate services with other social programs including social services, justice system, educational services, health
services, mental health and substance abuse services, financial
assistance programs, vocational services and housing assistance programs;
(6) provide vocational services;
(7) provide health counseling;
(8) provide housing assistance;
(9) parenting skills training;
(10) overall case management;
(11) supportive services for families of individuals with
Fetal Alcohol Syndrome; and
(12) provide other services and programs, to the extent authorized by the Secretary after consideration of recommendations made by the National Task Force on Fetal Alcohol Syndrome.
(c) REQUIREMENTS.—To be eligible to receive an award under
subsection (a), an applicant shall—
(1) demonstrate that the program will be part of a coordinated, comprehensive system of care for such individuals;
(2) demonstrate an established communication with other
social programs in the community including social services,
justice system, financial assistance programs, health services,
educational services, mental health and substance abuse services, vocational services and housing assistance services;
(3) show a history of working with individuals with fetal
alcohol syndrome or alcohol-related birth defects;
(4) provide assurance that the services will be provided in
a culturally and linguistically appropriate manner; and
(5) provide assurance that at the end of the 5-year award
period, other mechanisms will be identified to meet the needs
of the individuals and families served under such award.
(d) RELATIONSHIP TO PAYMENTS UNDER OTHER PROGRAMS.—An
award may be made under subsection (a) only if the applicant involved agrees that the award will not be expended to pay the expenses of providing any service under this section to an individual
to the extent that payment has been made, or can reasonably be
expected to be made, with respect to such expenses—
(1) under any State compensation program, under an insurance policy, or under any Federal or State health benefits
program; or
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Sec. 519D

(2) by an entity that provides health services on a prepaid
basis.
(e) DURATION OF AWARDS.—With respect to an award under
subsection (a), the period during which payments under such
award are made to the recipient may not exceed 5 years.
(f ) EVALUATION.—The Secretary shall evaluate each project
carried out under subsection (a) and shall disseminate the findings
with respect to each such evaluation to appropriate public and private entities.
(g) FUNDING.—
(1) AUTHORIZATION OF APPROPRIATIONS.—For the purpose
of carrying out this section, there are authorized to be appropriated $25,000,000 for fiscal year 2001, and such sums as may
be necessary for each of the fiscal years 2002 and 2003.
(2) ALLOCATION.—Of the amounts appropriated under
paragraph (1) for a fiscal year, not less than $300,000 shall, for
purposes relating to fetal alcohol syndrome and alcohol-related
birth defects, be made available for collaborative, coordinated
interagency efforts with the National Institute on Alcohol
Abuse and Alcoholism, the Eunice Kennedy Shriver National
Institute of Child Health and Human Development, the Health
Resources and Services Administration, the Agency for
Healthcare Research and Quality, the Centers for Disease Control and Prevention, the Department of Education, and the Department of Justice.
SEC. 519D. ø290bb–25d¿ CENTERS OF EXCELLENCE ON SERVICES FOR
INDIVIDUALS WITH FETAL ALCOHOL SYNDROME AND ALCOHOL-RELATED BIRTH DEFECTS AND TREATMENT FOR
INDIVIDUALS WITH SUCH CONDITIONS AND THEIR FAMILIES.
(a) IN GENERAL.—The Secretary shall make awards of grants,

cooperative agreements, or contracts to public or nonprofit private
entities for the purposes of establishing not more than four centers
of excellence to study techniques for the prevention of fetal alcohol
syndrome and alcohol-related birth defects and adaptations of innovative clinical interventions and service delivery improvements for
the provision of comprehensive services to individuals with fetal alcohol syndrome or alcohol-related birth defects and their families
and for providing training on such conditions.
(b) USE OF FUNDS.—An award under subsection (a) may be
used to—
(1) study adaptations of innovative clinical interventions
and service delivery improvements strategies for children and
adults with fetal alcohol syndrome or alcohol-related birth defects and their families;
(2) identify communities which have an exemplary comprehensive system of care for such individuals so that they can
provide technical assistance to other communities attempting
to set up such a system of care;
(3) provide technical assistance to communities who do not
have a comprehensive system of care for such individuals and
their families;
(4) train community leaders, mental health and substance
abuse professionals, families, law enforcement personnel,
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judges, health professionals, persons working in financial assistance programs, social service personnel, child welfare professionals, and other service providers on the implications of
fetal alcohol syndrome and alcohol-related birth defects, the
early identification of and referral for such conditions;
(5) develop innovative techniques for preventing alcohol
use by women in child bearing years; 1
(6) perform other functions, to the extent authorized by the
Secretary after consideration of recommendations made by the
National Task Force on Fetal Alcohol Syndrome.
(c) REPORT.—
(1) IN GENERAL.—A recipient of an award under subsection
(a) shall at the end of the period of funding report to the Secretary on any innovative techniques that have been discovered
for preventing alcohol use among women of child bearing
years.
(2) DISSEMINATION OF FINDINGS.—The Secretary shall upon
receiving a report under paragraph (1) disseminate the findings to appropriate public and private entities.
(d) DURATION OF AWARDS.—With respect to an award under
subsection (a), the period during which payments under such
award are made to the recipient may not exceed 5 years.
(e) EVALUATION.—The Secretary shall evaluate each project
carried out under subsection (a) and shall disseminate the findings
with respect to each such evaluation to appropriate public and private entities.
(f ) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of
carrying out this section, there are authorized to be appropriated
$5,000,000 for fiscal year 2001, and such sums as may be necessary
for each of the fiscal years 2002 and 2003.
SEC. 519E. 1 ø290bb–25e¿ PREVENTION OF METHAMPHETAMINE AND INHALANT ABUSE AND ADDICTION.
(a) GRANTS.—The Director of the Center for Substance Abuse

Prevention (referred to in this section as the ‘‘Director’’) may make
grants to and enter into contracts and cooperative agreements with
public and nonprofit private entities to enable such entities—
(1) to carry out school-based programs concerning the dangers of methamphetamine or inhalant abuse and addiction,
using methods that are effective and evidence-based, including
initiatives that give students the responsibility to create their
own anti-drug abuse education programs for their schools; and
(2) to carry out community-based methamphetamine or inhalant abuse and addiction prevention programs that are effective and evidence-based.
(b) USE OF FUNDS.—Amounts made available under a grant,
contract or cooperative agreement under subsection (a) shall be
used for planning, establishing, or administering methamphetamine or inhalant prevention programs in accordance with subsection (c).
1So in law. Probably should read ‘‘; and’’. See section 3110 of Public Law 106–310 (114 Stat.
1185).
1 The placement of section 519E is according to the probable intent of the Congress. Section
3104(c) of Public Law 106–310 (114 Stat. 1173) added the section to this subpart, but did not
specify the specific placement of the section.

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(c) PREVENTION PROGRAMS AND ACTIVITIES.—
(1) IN GENERAL.—Amounts provided under this section
may be used—
(A) to carry out school-based programs that are focused on those districts with high or increasing rates of
methamphetamine or inhalant abuse and addiction and
targeted at populations which are most at risk to start
methamphetamine or inhalant abuse;
(B) to carry out community-based prevention programs
that are focused on those populations within the community that are most at-risk for methamphetamine or inhalant abuse and addiction;
(C) to assist local government entities to conduct appropriate methamphetamine or inhalant prevention activities;
(D) to train and educate State and local law enforcement officials, prevention and education officials, members
of community anti-drug coalitions and parents on the signs
of methamphetamine or inhalant abuse and addiction and
the options for treatment and prevention;
(E) for planning, administration, and educational activities related to the prevention of methamphetamine or
inhalant abuse and addiction;
(F) for the monitoring and evaluation of methamphetamine or inhalant prevention activities, and reporting and
disseminating resulting information to the public; and
(G) for targeted pilot programs with evaluation components to encourage innovation and experimentation with
new methodologies.
(2) PRIORITY.—The Director shall give priority in making
grants under this section to rural and urban areas that are experiencing a high rate or rapid increases in methamphetamine
or inhalant abuse and addiction.
(d) ANALYSES AND EVALUATION.—
(1) IN GENERAL.—Up to $500,000 of the amount available
in each fiscal year to carry out this section shall be made available to the Director, acting in consultation with other Federal
agencies, to support and conduct periodic analyses and evaluations of effective prevention programs for methamphetamine or
inhalant abuse and addiction and the development of appropriate strategies for disseminating information about and implementing these programs.
(2) ANNUAL REPORTS.—The Director shall submit to the
Committee on Health, Education, Labor, and Pensions and the
Committee on Appropriations of the Senate and the Committee
on Commerce and Committee on Appropriations of the House
of Representatives, an annual report with the results of the
analyses and evaluation under paragraph (1).
(e) AUTHORIZATION OF APPROPRIATIONS.—There is authorized
to be appropriated to carry out subsection (a), $10,000,000 for fiscal
year 2001, and such sums as may be necessary for each of fiscal
years 2002 and 2003.
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Subpart 3—Center for Mental Health Services
CENTER FOR MENTAL HEALTH SERVICES

SEC. 520. ø290bb–31¿ (a) ESTABLISHMENT.—There is established in the Administration a Center for Mental Health Services
(hereafter in this section referred to as the ‘‘Center’’). The Center
shall be headed by a Director (hereafter in this section referred to
as the ‘‘Director’’) appointed by the Secretary from among individuals with extensive experience or academic qualifications in the
provision of mental health services or in the evaluation of mental
health service systems.
(b) DUTIES.—The Director of the Center shall—
(1) design national goals and establish national priorities
for—
(A) the prevention of mental illness; and
(B) the promotion of mental health;
(2) encourage and assist local entities and State agencies
to achieve the goals and priorities described in paragraph (1);
(3) collaborate with the Department of Education and the
Department of Justice to develop programs to assist local communities in addressing violence among children and adolescents;
(4) develop and coordinate Federal prevention policies and
programs and to assure increased focus on the prevention of
mental illness and the promotion of mental health;
(5) develop improved methods of treating individuals with
mental health problems and improved methods of assisting the
families of such individuals;
(6) administer the mental health services block grant program authorized in section 1911;
(7) promote policies and programs at Federal, State, and
local levels and in the private sector that foster independence
and protect the legal rights of persons with mental illness, including carrying out the provisions of the Protection and Advocacy of Mentally Ill Individuals Act;
(8) carry out the programs under part C;
(9) carry out responsibilities for the Human Resource Development program, and programs of clinical training for professional and paraprofessional personnel pursuant to section
303 1;
(10) conduct services-related assessments, including evaluations of the organization and financing of care, self-help and
consumer-run programs, mental health economics, mental
health service systems, rural mental health, and improve the
capacity of State to conduct evaluations of publicly funded
mental health programs;
(11) establish a clearinghouse for mental health information to assure the widespread dissemination of such informa1 The probable intent of the Congress is that the paragraph read ‘‘(9) carry out responsibilities
for the Human Resource Development Program;’’. See section 3112(c)(4) of Public Law 106–310
(114 Stat. 1188), which provides that paragraph (9) is amended ‘‘by striking ‘program and programs’ and all that follows through ‘303’ and inserting ‘programs’ ’’. The amendment cannot be
executed because the term to be struck does not appear in paragraph (9). (Compare ‘‘program
and programs’’ and ‘‘program, and programs’’.)

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Sec. 520A

tion to States, political subdivisions, educational agencies and
institutions, treatment and prevention service providers, and
the general public, including information concerning the practical application of research supported by the National Institute of Mental Health that is applicable to improving the delivery of services;
(12) provide technical assistance to public and private entities that are providers of mental health services;
(13) monitor and enforce obligations incurred by community mental health centers pursuant to the Community Mental
Health Centers Act (as in effect prior to the repeal of such Act
on August 13, 1981, by section 902(e)(2)(B) of Public Law 97–
35 (95 Stat. 560));
(14) conduct surveys with respect to mental health, such
as the National Reporting Program; and
(15) assist States in improving their mental health data
collection.
(c) GRANTS AND CONTRACTS.—In carrying out the duties established in subsection (b), the Director may make grants to and enter
into contracts and cooperative agreements with public and nonprofit private entities.
SEC. 520A. ø290bb–32¿ PRIORITY MENTAL HEALTH NEEDS OF REGIONAL AND NATIONAL SIGNIFICANCE.
(a) PROJECTS.—The Secretary shall address priority mental

health needs of regional and national significance (as determined
under subsection (b)) through the provision of or through assistance for—
(1) knowledge development and application projects for
prevention, treatment, and rehabilitation, and the conduct or
support of evaluations of such projects;
(2) training and technical assistance programs;
(3) targeted capacity response programs; and
(4) systems change grants including statewide family network grants and client-oriented and consumer run self-help activities.
The Secretary may carry out the activities described in this subsection directly or through grants or cooperative agreements with
States, political subdivisions of States, Indian tribes and tribal organizations, other public or private nonprofit entities.
(b) PRIORITY MENTAL HEALTH NEEDS.—
(1) DETERMINATION OF NEEDS.—Priority mental health
needs of regional and national significance shall be determined
by the Secretary in consultation with States and other interested groups. The Secretary shall meet with the States and interested groups on an annual basis to discuss program priorities.
(2) SPECIAL CONSIDERATION.—In developing program priorities described in paragraph (1), the Secretary shall give special consideration to promoting the integration of mental
health services into primary health care systems.
(c) REQUIREMENTS.—
(1) IN GENERAL.—Recipients of grants, contracts, and cooperative agreements under this section shall comply with inforMarch 13, 2013

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mation and application requirements determined appropriate
by the Secretary.
(2) DURATION OF AWARD.—With respect to a grant, contract, or cooperative agreement awarded under this section, the
period during which payments under such award are made to
the recipient may not exceed 5 years.
(3) MATCHING FUNDS.—The Secretary may, for projects
carried out under subsection (a), require that entities that
apply for grants, contracts, or cooperative agreements under
this section provide non-Federal matching funds, as determined appropriate by the Secretary, to ensure the institutional
commitment of the entity to the projects funded under the
grant, contract, or cooperative agreement. Such non-Federal
matching funds may be provided directly or through donations
from public or private entities and may be in cash or in kind,
fairly evaluated, including plant, equipment, or services.
(4) MAINTENANCE OF EFFORT.—With respect to activities
for which a grant, contract or cooperative agreement is awarded under this section, the Secretary may require that recipients for specific projects under subsection (a) 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 such a grant, contract, or cooperative agreement.
(d) EVALUATION.—The Secretary shall evaluate each project
carried out under subsection (a)(1) and shall disseminate the findings with respect to each such evaluation to appropriate public and
private entities.
(e) INFORMATION AND EDUCATION.—
(1) IN GENERAL.—The Secretary shall establish information
and education programs to disseminate and apply the findings
of the knowledge development and application, training, and
technical assistance programs, and targeted capacity response
programs, under this section to the general public, to health
care professionals, and to interested groups. The Secretary
shall make every effort to provide linkages between the findings of supported projects and State agencies responsible for
carrying out mental health services.
(2) RURAL AND UNDERSERVED AREAS.—In disseminating information on evidence-based practices in the provision of children’s mental health services under this subsection, the Secretary shall ensure that such information is distributed to
rural and medically underserved areas.
(f ) AUTHORIZATION OF APPROPRIATION.—
(1) IN GENERAL.—There are authorized to be appropriated
to carry out this section, $300,000,000 for fiscal year 2001, and
such sums as may be necessary for each of the fiscal years
2002 and 2003.
(2) DATA INFRASTRUCTURE.—If amounts are not appropriated for a fiscal year to carry out section 1971 with respect
to mental health, then the Secretary shall make available,
from the amounts appropriated for such fiscal year under paragraph (1), an amount equal to the sum of $6,000,000 and 10
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percent of all amounts appropriated for such fiscal year under
such paragraph in excess of $100,000,000, to carry out such
section 1971.
SEC. 520B. ø290bb–33¿ NATIONAL CENTERS OF EXCELLENCE FOR DEPRESSION.
(a) DEPRESSIVE DISORDER DEFINED.—In this section, the term

‘‘depressive disorder’’ means a mental or brain disorder relating to
depression, including major depression, bipolar disorder, and related mood disorders.
(b) GRANT PROGRAM.—
(1) IN GENERAL.—The Secretary, acting through the Administrator, shall award grants on a competitive basis to eligible entities to establish national centers of excellence for depression (referred to in this section as ‘‘Centers’’), which shall
engage in activities related to the treatment of depressive disorders.
(2) ALLOCATION OF AWARDS.—If the funds authorized
under subsection (f) are appropriated in the amounts provided
for under such subsection, the Secretary shall allocate such
amounts so that—
(A) not later than 1 year after the date of enactment
of the ENHANCED Act of 2009, not more than 20 Centers
may be established; and
(B) not later than September 30, 2016, not more than
30 Centers may be established.
(3) GRANT PERIOD.—
(A) IN GENERAL.—A grant awarded under this section
shall be for a period of 5 years.
(B) RENEWAL.—A grant awarded under subparagraph
(A) may be renewed, on a competitive basis, for 1 additional 5-year period, at the discretion of the Secretary. In
determining whether to renew a grant, the Secretary shall
consider the report cards issued under subsection (e)(2).
(4) USE OF FUNDS.—Grant funds awarded under this subsection shall be used for the establishment and ongoing activities of the recipient of such funds.
(5) ELIGIBLE ENTITIES.—
(A) REQUIREMENTS.—To be eligible to receive a grant
under this section, an entity shall—
(i) be an institution of higher education or a public
or private nonprofit research institution; and
(ii) submit an application to the Secretary at such
time and in such manner as the Secretary may require, as described in subparagraph (B).
(B) APPLICATION.—An application described in subparagraph (A)(ii) shall include—
(i) evidence that such entity—
(I) provides, or is capable of coordinating with
other entities to provide, comprehensive health
services with a focus on mental health services
and subspecialty expertise for depressive disorders;
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(II) collaborates with other mental health providers, as necessary, to address co-occurring mental illnesses;
(III) is capable of training health professionals
about mental health; and
(ii) such other information, as the Secretary may
require.
(C) PRIORITIES.—In awarding grants under this section, the Secretary shall give priority to eligible entities
that meet 1 or more of the following criteria:
(i) Demonstrated capacity and expertise to serve
the targeted population.
(ii) Existing infrastructure or expertise to provide
appropriate, evidence-based and culturally and linguistically competent services.
(iii) A location in a geographic area with disproportionate numbers of underserved and at-risk populations in medically underserved areas and health
professional shortage areas.
(iv) Proposed innovative approaches for outreach
to initiate or expand services.
(v) Use of the most up-to-date science, practices,
and interventions available.
(vi) Demonstrated capacity to establish cooperative and collaborative agreements with community
mental health centers and other community entities to
provide mental health, social, and human services to
individuals with depressive disorders.
(6) NATIONAL COORDINATING CENTER.—
(A) IN GENERAL.—The Secretary, acting through the
Administrator, shall designate 1 recipient of a grant under
this section to be the coordinating center of excellence for
depression (referred to in this section as the ‘‘coordinating
center’’). The Secretary shall select such coordinating center on a competitive basis, based upon the demonstrated
capacity of such center to perform the duties described in
subparagraph (C).
(B) APPLICATION.—A Center that has been awarded a
grant under paragraph (1) may apply for designation as
the coordinating center by submitting an application to the
Secretary at such time, in such manner, and containing
such information as the Secretary may require.
(C) DUTIES.—The coordinating center shall—
(i) develop, administer, and coordinate the network of Centers under this section;
(ii) oversee and coordinate the national database
described in subsection (d);
(iii) lead a strategy to disseminate the findings
and activities of the Centers through such database;
and
(iv) serve as a liaison with the Administration, the
National Registry of Evidence-based Programs and
Practices of the Administration, and any Federal
interagency or interagency forum on mental health.
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(7) MATCHING FUNDS.—The Secretary may not award a
grant or contract under this section to an entity unless the entity agrees that it will make available (directly or through contributions from other public or private entities) non-Federal
contributions toward the activities to be carried out under the
grant or contract in an amount equal to $1 for each $5 of Federal funds provided under the grant or contract. Such non-Federal matching funds may be provided directly or through donations from public or private entities and may be in cash or inkind, fairly evaluated, including plant, equipment, or services.
(c) ACTIVITIES OF THE CENTERS.—Each Center shall carry out
the following activities:
(1) GENERAL ACTIVITIES.—Each Center shall—
(A) integrate basic, clinical, or health services interdisciplinary research and practice in the development, implementation, and dissemination of evidence-based interventions;
(B) involve a broad cross-section of stakeholders, such
as researchers, clinicians, consumers, families of consumers, and voluntary health organizations, to develop a
research agenda and disseminate findings, and to provide
support in the implementation of evidence-based practices;
(C) provide training and technical assistance to mental
health professionals, and engage in and disseminate
translational research with a focus on meeting the needs
of individuals with depressive disorders; and
(D) educate policy makers, employers, community
leaders, and the public about depressive disorders to reduce stigma and raise awareness of treatments.
(2) IMPROVED TREATMENT STANDARDS, CLINICAL GUIDELINES, DIAGNOSTIC PROTOCOLS, AND CARE COORDINATION PRACTICE.—Each Center shall collaborate with other Centers in the
network to—
(A) develop and implement treatment standards, clinical guidelines, and protocols that emphasize primary prevention, early intervention, treatment for, and recovery
from, depressive disorders;
(B) foster communication with other providers attending to co-occurring physical health conditions such as cardiovascular, diabetes, cancer, and substance abuse disorders;
(C) leverage available community resources, develop
and implement improved self-management programs, and,
when appropriate, involve family and other providers of social support in the development and implementation of
care plans; and
(D) use electronic health records and telehealth technology to better coordinate and manage, and improve access to, care, as determined by the coordinating center.
(3) TRANSLATIONAL RESEARCH THROUGH COLLABORATION OF
CENTERS AND COMMUNITY-BASED ORGANIZATIONS.—Each Center
shall—
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work and community-based organizations such as community mental health centers and other social and human
services providers;
(B) expand interdisciplinary, translational, and patient-oriented research and treatment; and
(C) coordinate with accredited academic programs to
provide ongoing opportunities for the professional and continuing education of mental health providers.
(d) NATIONAL DATABASE.—
(1) IN GENERAL.—The coordinating center shall establish
and maintain a national, publicly available database to improve prevention programs, evidence-based interventions, and
disease management programs for depressive disorders, using
data collected from the Centers, as described in paragraph (2).
(2) DATA COLLECTION.—Each Center shall submit data
gathered at such center, as appropriate, to the coordinating
center regarding—
(A) the prevalence and incidence of depressive disorders;
(B) the health and social outcomes of individuals with
depressive disorders;
(C) the effectiveness of interventions designed, tested,
and evaluated;
(D) other information, as the Secretary may require.
(3) SUBMISSION OF DATA TO THE ADMINISTRATOR.—The coordinating center shall submit to the Administrator the data
and financial information gathered under paragraph (2).
(4) PUBLICATION USING DATA FROM THE DATABASE.—A Center, or an individual affiliated with a Center, may publish findings using the data described in paragraph (2) only if such center submits such data to the coordinating center, as required
under such paragraph.
(e) ESTABLISHMENT OF STANDARDS; REPORT CARDS AND RECOMMENDATIONS; THIRD PARTY REVIEW.—
(1) ESTABLISHMENT OF STANDARDS.—The Secretary, acting
through the Administrator, shall establish performance standards for—
(A) each Center; and
(B) the network of Centers as a whole.
(2) REPORT CARDS.—The Secretary, acting through the Administrator, shall—
(A) for each Center, not later than 3 years after the
date on which such center of excellence is established and
annually thereafter, issue a report card to the coordinating
center to rate the performance of such Center; and
(B) not later than 3 years after the date on which the
first grant is awarded under subsection (b)(1) and annually
thereafter, issue a report card to Congress to rate the performance of the network of centers of excellence as a
whole.
(3) RECOMMENDATIONS.—Based upon the report cards described in paragraph (2), the Secretary shall, not later than
September 30, 2015—
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(A) make recommendations to the Centers regarding
improvements such centers shall make; and
(B) make recommendations to Congress for expanding
the Centers to serve individuals with other types of mental
disorders.
(4) THIRD PARTY REVIEW.—Not later than 3 years after the
date on which the first grant is awarded under subsection
(b)(1) and annually thereafter, the Secretary shall arrange for
an independent third party to conduct an evaluation of the network of Centers to ensure that such centers are meeting the
goals of this section.
(f) AUTHORIZATION OF APPROPRIATIONS.—
(1) IN GENERAL.—To carry out this section, there are authorized to be appropriated—
(A) $100,000,000 for each of the fiscal years 2011
through 2015; and
(B) $150,000,000 for each of the fiscal years 2016
through 2020.
(2) ALLOCATION OF FUNDS AUTHORIZED.—Of the amount
appropriated under paragraph (1) for a fiscal year, the Secretary shall determine the allocation of each Center receiving
a grant under this section, but in no case may the allocation
be more than $5,000,000, except that the Secretary may allocate not more than $10,000,000 to the coordinating center.
SEC. 520C. ø290bb–34¿ YOUTH INTERAGENCY RESEARCH, TRAINING,
AND TECHNICAL ASSISTANCE CENTERS.
(a) PROGRAM AUTHORIZED.—The Secretary, acting through the

Administrator of the Substance Abuse and Mental Health Services
Administration, and in consultation with the Administrator of the
Office of Juvenile Justice and Delinquency Prevention, the Director
of the Bureau of Justice Assistance and the Director of the National Institutes of Health—
(1) shall award grants or contracts to public or nonprofit
private entities to establish not more than four research, training, and technical assistance centers to carry out the activities
described in subsection (c); and
(2) shall award a competitive grant to 1 additional research, training, and technical assistance center to carry out
the activities described in subsection (d).
(b) APPLICATION.—A public or private nonprofit entity desiring
a grant or contract under subsection (a) shall prepare and submit
an application to the Secretary at such time, in such manner, and
containing such information as the Secretary may require.
(c) AUTHORIZED ACTIVITIES.—A center established under a
grant or contract under subsection (a)(1) shall—
(1) provide training with respect to state-of-the-art mental
health and justice-related services and successful mental
health and substance abuse-justice collaborations that focus on
children and adolescents, to public policymakers, law enforcement administrators, public defenders, police, probation officers, judges, parole officials, jail administrators and mental
health and substance abuse providers and administrators;
(2) engage in research and evaluations concerning State
and local justice and mental health systems, including system
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redesign initiatives, and disseminate information concerning
the results of such evaluations;
(3) provide direct technical assistance, including assistance
provided through toll-free telephone numbers, concerning
issues such as how to accommodate individuals who are being
processed through the courts under the Americans with Disabilities Act of 1990 (42 U.S.C. 12101 et seq.), what types of
mental health or substance abuse service approaches are effective within the judicial system, and how community-based
mental health or substance abuse services can be more effective, including relevant regional, ethnic, and gender-related
considerations; and
(4) provide information, training, and technical assistance
to State and local governmental officials to enhance the capacity of such officials to provide appropriate services relating to
mental health or substance abuse.
(d) ADDITIONAL CENTER.—The additional research, training,
and technical assistance center established under subsection (a)(2)
shall provide appropriate information, training, and technical assistance to States, political subdivisions of a State, Federally recognized Indian tribes, tribal organizations, institutions of higher education, public organizations, or private nonprofit organizations
for—
(1) the development or continuation of statewide or tribal
youth suicide early intervention and prevention strategies;
(2) ensuring the surveillance of youth suicide early intervention and prevention strategies;
(3) studying the costs and effectiveness of statewide youth
suicide early intervention and prevention strategies in order to
provide information concerning relevant issues of importance
to State, tribal, and national policymakers;
(4) further identifying and understanding causes and associated risk factors for youth suicide;
(5) analyzing the efficacy of new and existing youth suicide
early intervention techniques and technology;
(6) ensuring the surveillance of suicidal behaviors and
nonfatal suicidal attempts;
(7) studying the effectiveness of State-sponsored statewide
and tribal youth suicide early intervention and prevention
strategies on the overall wellness and health promotion strategies related to suicide attempts;
(8) promoting the sharing of data regarding youth suicide
with Federal agencies involved with youth suicide early intervention and prevention, and State-sponsored statewide or tribal youth suicide early intervention and prevention strategies
for the purpose of identifying previously unknown mental
health causes and associated risk factors for suicide in youth;
(9) evaluating and disseminating outcomes and best practices of mental and behavioral health services at institutions of
higher education; and
(10) other activities determined appropriate by the Secretary.
(e) AUTHORIZATION OF APPROPRIATIONS.—
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(1) For the purpose of awarding grants or contracts under
subsection (a)(1), there is authorized to be appropriated
$4,000,000 for fiscal year 2001, and such sums as may be necessary for fiscal years 2002 and 2003.
(2) For the purpose of awarding a grant under subsection
(a)(2), there are authorized to be appropriated $3,000,000 for
fiscal year 2005, $4,000,000 for fiscal year 2006, and
$5,000,000 for fiscal year 2007.
SEC. 520D. ø290bb–35¿ SERVICES FOR YOUTH OFFENDERS.
(a) IN GENERAL.—The Secretary, acting through the

Director of
the Center for Mental Health Services, and in consultation with
the Director of the Center for Substance Abuse Treatment, the Administrator of the Office of Juvenile Justice and Delinquency Prevention, and the Director of the Special Education Programs, shall
award grants on a competitive basis to State or local juvenile justice agencies to enable such agencies to provide aftercare services
for youth offenders who have been discharged from facilities in the
juvenile or criminal justice system and have serious emotional disturbances or are at risk of developing such disturbances.
(b) USE OF FUNDS.—A State or local juvenile justice agency receiving a grant under subsection (a) shall use the amounts provided under the grant—
(1) to develop a plan describing the manner in which the
agency will provide services for each youth offender who has
a serious emotional disturbance and has been detained or incarcerated in facilities within the juvenile or criminal justice
system;
(2) to provide a network of core or aftercare services or access to such services for each youth offender, including diagnostic and evaluation services, substance abuse treatment
services, outpatient mental health care services, medication
management services, intensive home-based therapy, intensive
day treatment services, respite care, and therapeutic foster
care;
(3) to establish a program that coordinates with other
State and local agencies providing recreational, social, educational, vocational, or operational services for youth, to enable
the agency receiving a grant under this section to provide community-based system of care services for each youth offender
that addresses the special needs of the youth and helps the
youth access all of the aforementioned services; and
(4) using not more than 20 percent of funds received, to
provide planning and transition services as described in paragraph (3) for youth offenders while such youth are incarcerated
or detained.
(c) APPLICATION.—A State or local juvenile justice agency that
desires 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 reasonably require.
(d) REPORT.—Not later than 3 years after the date of the enactment of this section and annually thereafter, the Secretary shall
prepare and submit, to the Committee on Health, Education,
Labor, and Pensions of the Senate and the Committee on ComMarch 13, 2013

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merce of the House of Representatives, a report that describes the
services provided pursuant to this section.
(e) DEFINITIONS.—In this section:
(1) SERIOUS EMOTIONAL DISTURBANCE.—The term ‘‘serious
emotional disturbance’’ with respect to a youth offender means
an offender who currently, or at any time within the 1-year period ending on the day on which services are sought under this
section, has a diagnosable mental, behavioral, or emotional disorder that functionally impairs the offender’s life by substantially limiting the offender’s role in family, school, or community activities, and interfering with the offender’s ability to
achieve or maintain one or more developmentally-appropriate
social, behavior, cognitive, communicative, or adaptive skills.
(2) COMMUNITY-BASED SYSTEM OF CARE.—The term ‘‘community-based system of care’’ means the provision of services
for the youth offender by various State or local agencies that
in an interagency fashion or operating as a network addresses
the recreational, social, educational, vocational, mental health,
substance abuse, and operational needs of the youth offender.
(3) YOUTH OFFENDER.—The term ‘‘youth offender’’ means
an individual who is 21 years of age or younger who has been
discharged from a State or local juvenile or criminal justice
system, except that if the individual is between the ages of 18
and 21 years, such individual has had contact with the State
or local juvenile or criminal justice system prior to attaining 18
years of age and is under the jurisdiction of such a system at
the time services are sought.
(f ) AUTHORIZATION OF APPROPRIATIONS.—There is authorized
to be appropriated to carry out this section $40,000,000 for fiscal
year 2001, and such sums as may be necessary for each of fiscal
years 2002 and 2003.
SEC. 520E. ø290bb–36¿ YOUTH SUICIDE EARLY INTERVENTION AND
PREVENTION STRATEGIES.
(a) IN GENERAL.—The Secretary, acting through the Adminis-

trator of the Substance Abuse and Mental Health Services
Administration, shall award grants or cooperative agreements to
eligible entities to—
(1) develop and implement State-sponsored statewide or
tribal youth suicide early intervention and prevention strategies in schools, educational institutions, juvenile justice systems, substance abuse programs, mental health programs, foster care systems, and other child and youth support organizations;
(2) support public organizations and private nonprofit organizations actively involved in State-sponsored statewide or
tribal youth suicide early intervention and prevention strategies and in the development and continuation of State-sponsored statewide youth suicide early intervention and prevention strategies;
(3) provide grants to institutions of higher education to coordinate the implementation of State-sponsored statewide or
tribal youth suicide early intervention and prevention strategies;
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(4) collect and analyze data on State-sponsored statewide
or tribal youth suicide early intervention and prevention services that can be used to monitor the effectiveness of such services and for research, technical assistance, and policy development; and
(5) assist eligible entities, through State-sponsored statewide or tribal youth suicide early intervention and prevention
strategies, in achieving targets for youth suicide reductions
under title V of the Social Security Act.
(b) ELIGIBLE ENTITY.—
(1) DEFINITION.—In this section, the term ‘‘eligible entity’’
means—
(A) a State;
(B) a public organization or private nonprofit organization designated by a State to develop or direct the Statesponsored statewide youth suicide early intervention and
prevention strategy; or
(C) a Federally recognized Indian tribe or tribal organization (as defined in the Indian Self-Determination and
Education Assistance Act) or an urban Indian organization
(as defined in the Indian Health Care Improvement Act)
that is actively involved in the development and continuation of a tribal youth suicide early intervention and prevention strategy.
(2) LIMITATION.—In carrying out this section, the Secretary
shall ensure that each State is awarded only 1 grant or cooperative agreement under this section. For purposes of the preceding sentence, a State shall be considered to have been
awarded a grant or cooperative agreement if the eligible entity
involved is the State or an entity designated by the State
under paragraph (1)(B). Nothing in this paragraph shall be
construed to apply to entities described in paragraph (1)(C).
(c) PREFERENCE.—In providing assistance under a grant or cooperative agreement under this section, an eligible entity shall give
preference to public organizations, private nonprofit organizations,
political subdivisions, institutions of higher education, and tribal
organizations actively involved with the State-sponsored statewide
or tribal youth suicide early intervention and prevention strategy
that—
(1) provide early intervention and assessment services, including screening programs, to youth who are at risk for mental or emotional disorders that may lead to a suicide attempt,
and that are integrated with school systems, educational institutions, juvenile justice systems, substance abuse programs,
mental health programs, foster care systems, and other child
and youth support organizations;
(2) demonstrate collaboration among early intervention
and prevention services or certify that entities will engage in
future collaboration;
(3) employ or include in their applications a commitment
to evaluate youth suicide early intervention and prevention
practices and strategies adapted to the local community;
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(4) provide timely referrals for appropriate communitybased mental health care and treatment of youth who are at
risk for suicide in child-serving settings and agencies;
(5) provide immediate support and information resources
to families of youth who are at risk for suicide;
(6) offer access to services and care to youth with diverse
linguistic and cultural backgrounds;
(7) offer appropriate postsuicide intervention services, care,
and information to families, friends, schools, educational institutions, juvenile justice systems, substance abuse programs,
mental health programs, foster care systems, and other child
and youth support organizations of youth who recently completed suicide;
(8) offer continuous and up-to-date information and awareness campaigns that target parents, family members, child
care professionals, community care providers, and the general
public and highlight the risk factors associated with youth suicide and the life-saving help and care available from early
intervention and prevention services;
(9) ensure that information and awareness campaigns on
youth suicide risk factors, and early intervention and prevention services, use effective communication mechanisms that are
targeted to and reach youth, families, schools, educational institutions, and youth organizations;
(10) provide a timely response system to ensure that childserving professionals and providers are properly trained in
youth suicide early intervention and prevention strategies and
that child-serving professionals and providers involved in early
intervention and prevention services are properly trained in effectively identifying youth who are at risk for suicide;
(11) provide continuous training activities for child care
professionals and community care providers on the latest youth
suicide early intervention and prevention services practices
and strategies;
(12) conduct annual self-evaluations of outcomes and activities, including consulting with interested families and advocacy organizations;
(13) provide services in areas or regions with rates of
youth suicide that exceed the national average as determined
by the Centers for Disease Control and Prevention; and
(14) obtain informed written consent from a parent or legal
guardian of an at-risk child before involving the child in a
youth suicide early intervention and prevention program.
(d) REQUIREMENT FOR DIRECT SERVICES.—Not less than 85 percent of grant funds received under this section shall be used to provide direct services, of which not less than 5 percent shall be used
for activities authorized under subsection (a)(3).
(e) COORDINATION AND COLLABORATION.—
(1) IN GENERAL.—In carrying out this section, the Secretary shall collaborate with relevant Federal agencies and suicide working groups responsible for early intervention and prevention services relating to youth suicide.
(2) CONSULTATION.—In carrying out this section, the Secretary shall consult with—
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(A) State and local agencies, including agencies responsible for early intervention and prevention services
under title XIX of the Social Security Act, the State Children’s Health Insurance Program under title XXI of the
Social Security Act, and programs funded by grants under
title V of the Social Security Act;
(B) local and national organizations that serve youth
at risk for suicide and their families;
(C) relevant national medical and other health and
education specialty organizations;
(D) youth who are at risk for suicide, who have survived suicide attempts, or who are currently receiving care
from early intervention services;
(E) families and friends of youth who are at risk for
suicide, who have survived suicide attempts, who are currently receiving care from early intervention and prevention services, or who have completed suicide;
(F) qualified professionals who possess the specialized
knowledge, skills, experience, and relevant attributes
needed to serve youth at risk for suicide and their families;
and
(G) third-party payers, managed care organizations,
and related commercial industries.
(3) POLICY DEVELOPMENT.—In carrying out this section,
the Secretary shall—
(A) coordinate and collaborate on policy development
at the Federal level with the relevant Department of
Health and Human Services agencies and suicide working
groups; and
(B) consult on policy development at the Federal level
with the private sector, including consumer, medical, suicide prevention advocacy groups, and other health and
education professional-based organizations, with respect to
State-sponsored statewide or tribal youth suicide early
intervention and prevention strategies.
(f) RULE OF CONSTRUCTION; RELIGIOUS AND MORAL ACCOMMODATION.—Nothing in this section shall be construed to require suicide assessment, early intervention, or treatment services for youth
whose parents or legal guardians object based on the parents’ or
legal guardians’ religious beliefs or moral objections.
(g) EVALUATIONS AND REPORT.—
(1) EVALUATIONS BY ELIGIBLE ENTITIES.—Not later than 18
months after receiving a grant or cooperative agreement under
this section, 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.
(2) REPORT.—Not later than 2 years after the date of enactment of this section, the Secretary shall submit to the appropriate committees of Congress a report concerning the results of—
(A) the evaluations conducted under paragraph (1);
and
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(B) an evaluation conducted by the Secretary to analyze the effectiveness and efficacy of the activities conducted with grants, collaborations, and consultations
under this section.
(h) RULE OF CONSTRUCTION; STUDENT MEDICATION.—Nothing
in this section or section 520E–1 shall be construed to allow school
personnel to require that a student obtain any medication as a condition of attending school or receiving services.
(i) PROHIBITION.—Funds appropriated to carry out this section,
section 520C, section 520E–1, or section 520E–2 shall not be used
to pay for or refer for abortion.
(j) PARENTAL CONSENT.—States and entities receiving funding
under this section and section 520E–1 shall obtain prior written,
informed consent from the child’s parent or legal guardian for assessment services, school-sponsored programs, and treatment involving medication related to youth suicide conducted in elementary and secondary schools. The requirement of the preceding sentence does not apply in the following cases:
(1) In an emergency, where it is necessary to protect the
immediate health and safety of the student or other students.
(2) Other instances, as defined by the State, where parental consent cannot reasonably be obtained.
(k) RELATION TO EDUCATION PROVISIONS.—Nothing in this section or section 520E–1 shall be construed to supersede section 444
of the General Education Provisions Act, including the requirement
of prior parental consent for the disclosure of any education
records. Nothing in this section or section 520E–1 shall be construed to modify or affect parental notification requirements for
programs authorized under the Elementary and Secondary Education Act of 1965 (as amended by the No Child Left Behind Act
of 2001; Public Law 107–110).
(l) DEFINITIONS.—In this section:
(1) EARLY INTERVENTION.—The term ‘‘early intervention’’
means a strategy or approach that is intended to prevent an
outcome or to alter the course of an existing condition.
(2) EDUCATIONAL INSTITUTION; INSTITUTION OF HIGHER
EDUCATION; SCHOOL.—The term—
(A) ‘‘educational institution’’ means a school or institution of higher education;
(B) ‘‘institution of higher education’’ has the meaning
given such term in section 101 of the Higher Education
Act of 1965; and
(C) ‘‘school’’ means an elementary or secondary school
(as such terms are defined in section 9101 of the Elementary and Secondary Education Act of 1965).
(3) PREVENTION.—The term ‘‘prevention’’ means a strategy
or approach that reduces the likelihood or risk of onset, or
delays the onset, of adverse health problems that have been
known to lead to suicide.
(4) YOUTH.—The term ‘‘youth’’ means individuals who are
between 10 and 24 years of age.
(m) AUTHORIZATION OF APPROPRIATIONS.—
(1) IN GENERAL.—For the purpose of carrying out this section, there are authorized to be appropriated $7,000,000 for fisMarch 13, 2013

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cal year 2005, $18,000,000 for fiscal year 2006, and
$30,000,000 for fiscal year 2007.
(2) PREFERENCE.—If less than $3,500,000 is appropriated
for any fiscal year to carry out this section, in awarding grants
and cooperative agreements under this section during the fiscal
year, the Secretary shall give preference to States that have
rates of suicide that significantly exceed the national average
as determined by the Centers for Disease Control and Prevention.
SEC. 520E–1. ø290bb–36a¿ SUICIDE PREVENTION FOR CHILDREN AND
ADOLESCENTS 1.
(a) IN GENERAL.—The Secretary shall award grants or

cooperative agreements to public organizations, private nonprofit
organizations, political subdivisions, consortia of political subdivisions, consortia of States, or Federally recognized Indian tribes or
tribal organizations to design early intervention and prevention
strategies that will complement the State-sponsored statewide or
tribal youth suicide early intervention and prevention strategies
developed pursuant to section 520E.
(b) COLLABORATION.—In carrying out subsection (a), the Secretary shall ensure that activities under this section are coordinated with the relevant Department of Health and Human Services
agencies and suicide working groups.
(c) REQUIREMENTS.—A public organization, private nonprofit
organization, political subdivision, consortium of political subdivisions, consortium of States, or federally recognized Indian tribe or
tribal organization desiring a grant, contract, or cooperative agreement under this section shall demonstrate that the suicide prevention program such entity proposes will—
(1)(A) comply with the State-sponsored statewide early
intervention and prevention strategy as developed under section 520E; and
(B) in the case of a consortium of States, receive the support of all States involved;
(2) provide for the timely assessment, treatment, or referral for mental health or substance abuse services of youth at
risk for suicide;
(3) be based on suicide prevention practices and strategies
that are adapted to the local community;
(4) integrate its suicide prevention program into the existing health care system in the community including general,
mental, and behavioral health services, and substance abuse
services;
(5) be integrated into other systems in the community that
address the needs of youth including the school systems, educational institutions, juvenile justice system, substance abuse
programs, mental health programs, foster care systems, and
community child and youth support organizations;
1 The probable intent of the Congress is that the heading be ‘‘SUICIDE PREVENTION FOR
YOUTH’’. See the amendment described in section 3(b)(1)(A) of Public Law 108–355 (118 Stat.
1407). The amendment cannot be executed because the matter in the heading to be struck does
not appear, as the amendatory instruction used the wrong font. The amendment referred to
‘‘CHILDREN AND ADOLESCENTS’’ rather than ‘‘CHILDREN AND ADOLESCENTS’’. (The
amendment is directed to section ‘‘520E’’. Section 520E–1 above formerly was section 520E, and
was redesignated by section 3(b)(2) of such Public Law.)

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(6) use primary prevention methods to educate and raise
awareness in the local community by disseminating evidencebased information about suicide prevention;
(7) include suicide prevention, mental health, and related
information and services for the families and friends of those
who completed suicide, as needed;
(8) offer access to services and care to youth with diverse
linguistic and cultural backgrounds;
(9) conduct annual self-evaluations of outcomes and activities, including consulting with interested families and advocacy
organizations; 1
(10) ensure that staff used in the program are trained in
suicide prevention and that professionals involved in the system of care have received training in identifying persons at
risk of suicide.
(d) USE OF FUNDS.—Amounts provided under a grant or cooperative agreement under this section shall be used to supplement,
and not supplant, Federal and non-Federal funds available for carrying out the activities described in this section. Applicants shall
provide financial information to demonstrate compliance with this
section.
(e) CONDITION.—An applicant for a grant or cooperative agreement under subsection (a) shall demonstrate to the Secretary that
the application complies with the State-sponsored statewide early
intervention and prevention strategy as developed under section
520E and the applicant has the support of the local community and
relevant public health officials.
(f ) SPECIAL POPULATIONS.—In awarding grants and cooperative
agreements under subsection (a), the Secretary shall ensure that
such awards are made in a manner that will focus on the needs
of communities or groups that experience high or rapidly rising
rates of suicide.
(g) APPLICATION.—A public organization, private nonprofit organization, political subdivision, consortium of political subdivisions, consortium of States, or Federally recognized Indian tribe or
tribal organization receiving a grant or cooperative agreement
under subsection (a) shall prepare and submit an application to the
Secretary at such time, in such manner, and containing such information as the Secretary may reasonably require. Such application
shall include a plan for the rigorous evaluation of activities funded
under the grant or cooperative agreement, including a process and
outcome evaluation.
(h) DISTRIBUTION OF AWARDS.—In awarding grants and cooperative agreements under subsection (a), the Secretary shall ensure
that such awards are distributed among the geographical regions
of the United States and between urban and rural settings.
(i) EVALUATION.—A public organization, private nonprofit organization, political subdivision, consortium of political subdivisions,
consortium of States, or Federally recognized Indian tribe or tribal
organization receiving a grant or cooperative agreement under subsection (a) shall prepare and submit to the Secretary at the end of
1 So in law. Probably should include ‘‘and’’ after the semicolon at the end of paragraph (9).
See section 3(b)(1)(D)(ix) of Public Law 108–355 (118 Stat. 1408).

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the program period, an evaluation of all activities funded under
this section.
( j) DISSEMINATION AND EDUCATION.—The Secretary shall ensure that findings derived from activities carried out under this
section are disseminated to State, county and local governmental
agencies and public and private nonprofit organizations active in
promoting suicide prevention and family support activities.
(k) DURATION OF PROJECTS.—With respect to a grant, contract,
or cooperative agreement 1 awarded under this section, the period
during which payments under such award may be made to the recipient may not exceed 3 years.
(l) STUDY.—Within 1 year after the date of the enactment of
this section, the Secretary shall, directly or by grant or contract,
initiate a study to assemble and analyze data to identify—
(1) unique profiles of children under 13 who attempt or
complete suicide;
(2) unique profiles of youths between ages 13 and 24 who
attempt or complete suicide; and
(3) a profile of services available to these groups and the
use of these services by children and youths from paragraphs
(1) and (2).
(m) DEFINITIONS.—In this section, the terms ‘‘early intervention’’, ‘‘educational institution’’, ‘‘institution of higher education’’,
‘‘prevention’’, ‘‘school’’, and ‘‘youth’’ have the meanings given to
those terms in section 520E.
(n) AUTHORIZATION OF APPROPRIATION.—For purposes of carrying out this section, there is authorized to be appropriated
$75,000,000 for fiscal year 2001 and such sums as may be necessary for each of the fiscal years 2002 through 2003.
SEC. 520E–2. ø290bb–36b¿ MENTAL AND BEHAVIORAL HEALTH SERVICES ON CAMPUS.
(a) IN GENERAL.—The Secretary, acting through the Director of

the Center for Mental Health Services, in consultation with the
Secretary of Education, may award grants on a competitive basis
to institutions of higher education to enhance services for students
with mental and behavioral health problems that can lead to school
failure, such as depression, substance abuse, and suicide attempts,
so that students will successfully complete their studies.
(b) USE OF FUNDS.—The Secretary may not make a grant to
an institution of higher education under this section unless the institution agrees to use the grant only for—
(1) educational seminars;
(2) the operation of hot lines;
(3) preparation of informational material;
(4) preparation of educational materials for families of students to increase awareness of potential mental and behavioral
health issues of students enrolled at the institution of higher
education;
(5) training programs for students and campus personnel
to respond effectively to students with mental and behavioral
1 So in law. Probably should be ‘‘grant or cooperative agreement’’. See the amendments made
by section 3(b) of Public Law 108–355 (118 Stat. 1407).

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health problems that can lead to school failure, such as depression, substance abuse, and suicide attempts; or
(6) the creation of a networking infrastructure to link colleges and universities that do not have mental health services
with health care providers who can treat mental and behavioral health problems.
(c) ELIGIBLE GRANT RECIPIENTS.—Any institution of higher education receiving a grant under this section may carry out activities
under the grant through—
(1) college counseling centers;
(2) college and university psychological service centers;
(3) mental health centers;
(4) psychology training clinics; or
(5) institution of higher education supported, evidencebased, mental health and substance abuse programs.
(d) APPLICATION.—An institution of higher education desiring a
grant under this section shall prepare and submit an application
to the Secretary at such time and in such manner as the Secretary
may require. At a minimum, the application shall include the following:
(1) A description of identified mental and behavioral
health needs of students at the institution of higher education.
(2) A description of Federal, State, local, private, and institutional resources currently available to address the needs described in paragraph (1) at the institution of higher education.
(3) A description of the outreach strategies of the institution of higher education for promoting access to services, including a proposed plan for reaching those students most in
need of mental health services.
(4) A plan to evaluate program outcomes, including a description of the proposed use of funds, the program objectives,
and how the objectives will be met.
(5) An assurance that the institution will submit a report
to the Secretary each fiscal year on the activities carried out
with the grant and the results achieved through those activities.
(e) REQUIREMENT OF MATCHING FUNDS.—
(1) IN GENERAL.—The Secretary may make a grant under
this section to an institution of higher education only if the institution agrees to make available (directly or through donations from public or private entities) non-Federal contributions
in an amount that is not less than $1 for each $1 of Federal
funds provided in the grant, toward the costs of activities carried out with the grant (as described in subsection (b)) and
other activities by the institution to reduce student mental and
behavioral health problems.
(2) DETERMINATION OF AMOUNT CONTRIBUTED.—Non-Federal contributions required under paragraph (1) may be in cash
or in kind. Amounts provided by the Federal Government, or
services assisted or subsidized to any significant extent by the
Federal Government, may not be included in determining the
amount of such non-Federal contributions.
(3) WAIVER.—The Secretary may waive the requirement
established in paragraph (1) with respect to an institution of
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higher education if the Secretary determines that extraordinary need at the institution justifies the waiver.
(f) REPORTS.—For each fiscal year that grants are awarded
under this section, the Secretary shall conduct a study on the results of the grants and submit to the Congress a report on such results that includes the following:
(1) An evaluation of the grant program outcomes, including a summary of activities carried out with the grant and the
results achieved through those activities.
(2) Recommendations on how to improve access to mental
and behavioral health services at institutions of higher education, including efforts to reduce the incidence of suicide and
substance abuse.
(g) DEFINITION.—In this section, the term ‘‘institution of higher
education’’ has the meaning given such term in section 101 of the
Higher Education Act of 1965.
(h) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of
carrying out this section, there are authorized to be appropriated
$5,000,000 for fiscal year 2005, $5,000,000 for fiscal year 2006, and
$5,000,000 for fiscal year 2007.
SEC. 520F. ø290bb–37¿ GRANTS FOR EMERGENCY MENTAL HEALTH
CENTERS.
(a) PROGRAM AUTHORIZED.—The Secretary shall award grants

to States, political subdivisions of States, Indian tribes, and tribal
organizations to support the designation of hospitals and health
centers as Emergency Mental Health Centers.
(b) HEALTH CENTER.—In this section, the term ‘‘health center’’
has the meaning given such term in section 330, and includes community health centers and community mental health centers.
(c) DISTRIBUTION OF AWARDS.—The Secretary shall ensure that
such grants awarded under subsection (a) are equitably distributed
among the geographical regions of the United States, between
urban and rural populations, and between different settings of care
including health centers, mental health centers, hospitals, and
other psychiatric units or facilities.
(d) APPLICATION.—A State, political subdivision of a State, Indian tribe, or tribal organization that desires a grant under subsection (a) shall submit an application to the Secretary at such
time, in such manner, and containing such information as the Secretary may require, including a plan for the rigorous evaluation of
activities carried out with funds received under this section.
(e) USE OF FUNDS.—
(1) IN GENERAL.—A State, political subdivision of a State,
Indian tribe, or tribal organization receiving a grant under
subsection (a) shall use funds from such grant to establish or
designate hospitals and health centers as Emergency Mental
Health Centers.
(2) EMERGENCY MENTAL HEALTH CENTERS.—Such Emergency Mental Health Centers described in paragraph (1)—
(A) shall—
(i) serve as a central receiving point in the community for individuals who may be in need of emergency mental health services;
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(ii) purchase, if needed, any equipment necessary
to evaluate, diagnose and stabilize an individual with
a mental illness;
(iii) provide training, if needed, to the medical personnel staffing the Emergency Mental Health Center
to evaluate, diagnose, stabilize, and treat an individual with a mental illness; and
(iv) provide any treatment that is necessary for an
individual with a mental illness or a referral for such
individual to another facility where such treatment
may be received; and
(B) may establish and train a mobile crisis intervention team to respond to mental health emergencies within
the community.
(f ) EVALUATION.—A State, political subdivision of a State, Indian tribe, or tribal organization that receives a grant under subsection (a) shall prepare and submit an evaluation to the Secretary
at such time, in such manner, and containing such information as
the Secretary may reasonably require, including an evaluation of
activities carried out with funds received under this section and a
process and outcomes evaluation.
(g) AUTHORIZATION OF APPROPRIATIONS.—There is authorized
to be appropriated to carry out this section, $25,000,000 for fiscal
year 2001 and such sums as may be necessary for each of the fiscal
years 2002 through 2003.
SEC. 520G. ø290bb–38¿ GRANTS FOR JAIL DIVERSION PROGRAMS.
(a) PROGRAM AUTHORIZED.—The Secretary shall make

up to
125 grants to States, political subdivisions of States, Indian tribes,
and tribal organizations, acting directly or through agreements
with other public or nonprofit entities, to develop and implement
programs to divert individuals with a mental illness from the
criminal justice system to community-based services.
(b) ADMINISTRATION.—
(1) CONSULTATION.—The Secretary shall consult with the
Attorney General and any other appropriate officials in carrying out this section.
(2) REGULATORY AUTHORITY.—The Secretary shall issue
regulations and guidelines necessary to carry out this section,
including methodologies and outcome measures for evaluating
programs carried out by States, political subdivisions of States,
Indian tribes, and tribal organizations receiving grants under
subsection (a).
(c) APPLICATIONS.—
(1) IN GENERAL.—To receive a grant under subsection (a),
the chief executive of a State, chief executive of a subdivision
of a State, Indian tribe or tribal organization shall prepare and
submit an application to the Secretary at such time, in such
manner, and containing such information as the Secretary
shall reasonably require.
(2) CONTENT.—Such application shall—
(A) contain an assurance that—
(i) community-based mental health services will
be available for the individuals who are diverted from
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the criminal justice system, and that such services are
based on the best known practices, reflect current research findings, include case management, assertive
community treatment, medication management and
access, integrated mental health and co-occurring substance abuse treatment, and psychiatric rehabilitation,
and will be coordinated with social services, including
life skills training, housing placement, vocational
training, education job placement, and health care;
(ii) there has been relevant interagency collaboration between the appropriate criminal justice, mental
health, and substance abuse systems; and
(iii) the Federal support provided will be used to
supplement, and not supplant, State, local, Indian
tribe, or tribal organization sources of funding that
would otherwise be available;
(B) demonstrate that the diversion program will be integrated with an existing system of care for those with
mental illness;
(C) explain the applicant’s inability to fund the program adequately without Federal assistance;
(D) specify plans for obtaining necessary support and
continuing the proposed program following the conclusion
of Federal support; and
(E) describe methodology and outcome measures that
will be used in evaluating the program.
(d) USE OF FUNDS.—A State, political subdivision of a State,
Indian tribe, or tribal organization that receives a grant under subsection (a) may use funds received under such grant to—
(1) integrate the diversion program into the existing system of care;
(2) create or expand community-based mental health and
co-occurring mental illness and substance abuse services to accommodate the diversion program;
(3) train professionals involved in the system of care, and
law enforcement officers, attorneys, and judges; and
(4) provide community outreach and crisis intervention.
(e) FEDERAL SHARE.—
(1) IN GENERAL.—The Secretary shall pay to a State, political subdivision of a State, Indian tribe, or tribal organization
receiving a grant under subsection (a) the Federal share of the
cost of activities described in the application.
(2) FEDERAL SHARE.—The Federal share of a grant made
under this section shall not exceed 75 percent of the total cost
of the program carried out by the State, political subdivision
of a State, Indian tribe, or tribal organization. Such share shall
be used for new expenses of the program carried out by such
State, political subdivision of a State, Indian tribe, or tribal organization.
(3) NON-FEDERAL SHARE.—The non-Federal share of payments made under this section may be made in cash or in kind
fairly evaluated, including planned equipment or services. The
Secretary may waive the requirement of matching contributions.
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(f ) GEOGRAPHIC DISTRIBUTION.—The Secretary shall ensure
that such grants awarded under subsection (a) are equitably distributed among the geographical regions of the United States and
between urban and rural populations.
(g) TRAINING AND TECHNICAL ASSISTANCE.—Training and technical assistance may be provided by the Secretary to assist a State,
political subdivision of a State, Indian tribe, or tribal organization
receiving a grant under subsection (a) in establishing and operating
a diversion program.
(h) EVALUATIONS.—The programs described in subsection (a)
shall be evaluated not less than one time in every 12-month period
using the methodology and outcome measures identified in the
grant application.
(i) AUTHORIZATION OF APPROPRIATIONS.—There are authorized
to be appropriated to carry out this section $10,000,000 for fiscal
year 2001, and such sums as may be necessary for fiscal years 2002
through 2003.
SEC. 520H. ø290bb–39¿ IMPROVING OUTCOMES FOR CHILDREN AND
ADOLESCENTS THROUGH SERVICES INTEGRATION BETWEEN CHILD WELFARE AND MENTAL HEALTH SERVICES.
(a) IN GENERAL.—The Secretary shall award grants, contracts

or cooperative agreements to States, political subdivisions of
States, Indian tribes, and tribal organizations to provide integrated
child welfare and mental health services for children and adolescents under 19 years of age in the child welfare system or at risk
for becoming part of the system, and parents or caregivers with a
mental illness or a mental illness and a co-occurring substance
abuse disorder.
(b) DURATION.—With respect to a grant, contract or cooperative
agreement awarded under this section, the period during which
payments under such award are made to the recipient may not exceed 5 years.
(c) APPLICATION.—
(1) IN GENERAL.—To be eligible to receive an award under
subsection (a), a State, political subdivision of a State, Indian
tribe, or tribal organization shall submit an application to the
Secretary at such time, in such manner, and accompanied by
such information as the Secretary may reasonably require.
(2) CONTENT.—An application submitted under paragraph
(1) shall—
(A) describe the program to be funded under the grant,
contract or cooperative agreement;
(B) explain how such program reflects best practices in
the provision of child welfare and mental health services;
and
(C) provide assurances that—
(i) persons providing services under the grant,
contract or cooperative agreement are adequately
trained to provide such services; and
(ii) the services will be provided in accordance
with subsection (d).
(d) USE OF FUNDS.—A State, political subdivision of a State,
Indian tribe, or tribal organization that receives a grant, contract,
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or cooperative agreement under subsection (a) shall use amounts
made available through such grant, contract or cooperative agreement to—
(1) provide family-centered, comprehensive, and coordinated child welfare and mental health services, including prevention, early intervention and treatment services for children
and adolescents, and for their parents or caregivers;
(2) ensure a single point of access for such coordinated
services;
(3) provide integrated mental health and substance abuse
treatment for children, adolescents, and parents or caregivers
with a mental illness and a co-occurring substance abuse disorder;
(4) provide training for the child welfare, mental health
and substance abuse professionals who will participate in the
program carried out under this section;
(5) provide technical assistance to child welfare and mental health agencies;
(6) develop cooperative efforts with other service entities in
the community, including education, social services, juvenile
justice, and primary health care agencies;
(7) coordinate services with services provided under the
Medicaid program and the State Children’s Health Insurance
Program under titles XIX and XXI of the Social Security Act;
(8) provide linguistically appropriate and culturally competent services; and
(9) evaluate the effectiveness and cost-efficiency of the integrated services that measure the level of coordination, outcome measures for parents or caregivers with a mental illness
or a mental illness and a co-occurring substance abuse disorder, and outcome measures for children.
(e) DISTRIBUTION OF AWARDS.—The Secretary shall ensure that
grants, contracts, and cooperative agreements awarded under subsection (a) are equitably distributed among the geographical regions of the United States and between urban and rural populations.
(f ) EVALUATION.—The Secretary shall evaluate each program
carried out by a State, political subdivision of a State, Indian tribe,
or tribal organization under subsection (a) and shall disseminate
the findings with respect to each such evaluation to appropriate
public and private entities.
(g) AUTHORIZATION OF APPROPRIATIONS.—There is authorized
to be appropriated to carry out this section, $10,000,000 for fiscal
year 2001, and such sums as may be necessary for each of fiscal
years 2002 and 2003.
SEC. 520I. ø290bb–40¿ GRANTS FOR THE INTEGRATED TREATMENT OF
SERIOUS MENTAL ILLNESS AND CO-OCCURRING SUBSTANCE ABUSE.
(a) IN GENERAL.—The Secretary shall award grants, contracts,

or cooperative agreements to States, political subdivisions of
States, Indian tribes, tribal organizations, and private nonprofit organizations for the development or expansion of programs to provide integrated treatment services for individuals with a serious
mental illness and a co-occurring substance abuse disorder.
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(b) PRIORITY.—In awarding grants, contracts, and cooperative
agreements under subsection (a), the Secretary shall give priority
to applicants that emphasize the provision of services for individuals with a serious mental illness and a co-occurring substance
abuse disorder who—
(1) have a history of interactions with law enforcement or
the criminal justice system;
(2) have recently been released from incarceration;
(3) have a history of unsuccessful treatment in either an
inpatient or outpatient setting;
(4) have never followed through with outpatient services
despite repeated referrals; or
(5) are homeless.
(c) USE OF FUNDS.—A State, political subdivision of a State, Indian tribe, tribal organization, or private nonprofit organization
that receives a grant, contract, or cooperative agreement under
subsection (a) shall use funds received under such grant—
(1) to provide fully integrated services rather than serial or
parallel services;
(2) to employ staff that are cross-trained in the diagnosis
and treatment of both serious mental illness and substance
abuse;
(3) to provide integrated mental health and substance
abuse services at the same location;
(4) to provide services that are linguistically appropriate
and culturally competent;
(5) to provide at least 10 programs for integrated treatment of both mental illness and substance abuse at sites that
previously provided only mental health services or only substance abuse services; and
(6) to provide services in coordination with other existing
public and private community programs.
(d) CONDITION.—The Secretary shall ensure that a State, political subdivision of a State, Indian tribe, tribal organization, or private nonprofit organization that receives a grant, contract, or cooperative agreement under subsection (a) maintains the level of effort
necessary to sustain existing mental health and substance abuse
programs for other populations served by mental health systems in
the community.
(e) DISTRIBUTION OF AWARDS.—The Secretary shall ensure that
grants, contracts, or cooperative agreements awarded under subsection (a) are equitably distributed among the geographical regions of the United States and between urban and rural populations.
(f ) DURATION.—The Secretary shall award grants, contract, or
cooperative agreements under this subsection for a period of not
more than 5 years.
(g) APPLICATION.—A State, political subdivision of a State, Indian tribe, tribal organization, or private nonprofit organization
that desires a grant, contract, or cooperative agreement under this
subsection shall prepare and submit an application to the Secretary
at such time, in such manner, and containing such information as
the Secretary may require. Such application shall include a plan
for the rigorous evaluation of activities funded with an award
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under such subsection, including a process and outcomes evaluation.
(h) EVALUATION.—A State, political subdivision of a State, Indian tribe, tribal organization, or private nonprofit organization
that receives a grant, contract, or cooperative agreement under this
subsection shall prepare and submit a plan for the rigorous evaluation of the program funded under such grant, contract, or agreement, including both process and outcomes evaluation, and the
submission of an evaluation at the end of the project period.
(i) AUTHORIZATION OF APPROPRIATION.—There is authorized to
be appropriated to carry out this subsection $40,000,000 for fiscal
year 2001, and such sums as may be necessary for fiscal years 2002
through 2003.
SEC. 520J. ø290bb–41¿ TRAINING GRANTS.
(a) IN GENERAL.—The Secretary shall

award grants in accordance with the provisions of this section.
(b) MENTAL ILLNESS AWARENESS TRAINING GRANTS.—
(1) IN GENERAL.—The Secretary shall award grants to
States, political subdivisions of States, Indian tribes, tribal organizations, and nonprofit private entities to train teachers
and other relevant school personnel to recognize symptoms of
childhood and adolescent mental disorders, to refer family
members to the appropriate mental health services if necessary, to train emergency services personnel to identify and
appropriately respond to persons with a mental illness, and to
provide education to such teachers and personnel regarding resources that are available in the community for individuals
with a mental illness.
(2) EMERGENCY SERVICES PERSONNEL 1.—In this subsection, the term ‘‘emergency services personnel’’ includes paramedics, firefighters, and emergency medical technicians.
(3) DISTRIBUTION OF AWARDS 1.—The Secretary shall ensure that such grants awarded under this subsection are equitably distributed among the geographical regions of the United
States and between urban and rural populations.
(4) APPLICATION.—A State, political subdivision of a State,
Indian tribe, tribal organization, or nonprofit private entity
that desires a grant under this subsection shall submit an application to the Secretary at such time, in such manner, and
containing such information as the Secretary may require, including a plan for the rigorous evaluation of activities that are
carried out with funds received under a grant under this subsection.
(5) USE OF FUNDS.—A State, political subdivision of a
State, Indian tribe, tribal organization, or nonprofit private entity receiving a grant under this subsection shall use funds
from such grant to—
(A) train teachers and other relevant school personnel
to recognize symptoms of childhood and adolescent mental
disorders and appropriately respond;
1So in law. Words in the heading (except the first) probably should be all small caps. See section 3213 of Public Law 106–310 (114 Stat. 1206).

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Sec. 520K

PUBLIC HEALTH SERVICE ACT

760

(B) train emergency services personnel to identify and
appropriately respond to persons with a mental illness;
and
(C) provide education to such teachers and personnel
regarding resources that are available in the community
for individuals with a mental illness.
(6) EVALUATION.—A State, political subdivision of a State,
Indian tribe, tribal organization, or nonprofit private entity
that receives a grant under this subsection shall prepare and
submit an evaluation to the Secretary at such time, in such
manner, and containing such information as the Secretary may
reasonably require, including an evaluation of activities carried
out with funds received under the grant under this subsection
and a process and outcome evaluation.
(7) AUTHORIZATION OF APPROPRIATIONS.—There is authorized to be appropriated to carry out this subsection,
$25,000,000 for fiscal year 2001 and such sums as may be necessary for each of fiscal years 2002 through 2003.
SEC. 520K. ø290bb–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) PROGRAM AUTHORIZED.—The Secretary, acting through the
Administrator shall award grants and cooperative agreements to
eligible entities to establish demonstration projects for the provision of coordinated and integrated services to special populations
through the co-location of primary and specialty care services in
community-based mental and behavioral health settings.
(c) APPLICATION.—To be eligible to receive a grant or cooperative agreement under this section, an eligible entity shall submit
an application to the Administrator at such time, in such manner,
and accompanied by such information as the Administrator may require, including a description of partnerships, or other arrangements with local primary care providers, including community
health centers, to provide services to special populations.
(d) USE OF FUNDS.—
(1) IN GENERAL.—For the benefit of special populations, an
eligible entity shall use funds awarded under this section for—
(A) the provision, by qualified primary care professionals, of on site primary care services;
(B) reasonable costs associated with medically necessary referrals to qualified specialty care professionals,
other coordinators of care or, if permitted by the terms of
the grant or cooperative agreement, by qualified specialty
care professionals on a reasonable cost basis on site at the
eligible entity;
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PUBLIC HEALTH SERVICE ACT

Sec. 522

(C) information technology required to accommodate
the clinical needs of primary and specialty care professionals; or
(D) facility modifications needed to bring primary and
specialty care professionals on site at the eligible entity.
(2) LIMITATION.—Not to exceed 15 percent of grant or cooperative agreement funds may be used for activities described in
subparagraphs (C) and (D) of paragraph (1).
(e) EVALUATION.—Not later than 90 days after a grant or cooperative agreement awarded under this section expires, an eligible
entity shall submit to the Secretary the results of an evaluation to
be conducted by the entity concerning the effectiveness of the activities carried out under the grant or agreement.
(f) AUTHORIZATION OF APPROPRIATIONS.—There are authorized
to be appropriated to carry out this section, $50,000,000 for fiscal
year 2010 and such sums as may be necessary for each of fiscal
years 2011 through 2014.
PART C—PROJECTS

FOR ASSISTANCE IN
HOMELESSNESS

TRANSITION FROM

SEC. 521. ø290cc–21¿ FORMULA GRANTS TO STATES.

For the purpose of carrying out section 522, the Secretary, acting through the Director of the Center for Mental Health Services,
shall for each of the fiscal years 1991 through 1994 1 make an allotment for each State in an amount determined in accordance with
section 524. The Secretary shall make payments, as grants, each
such fiscal year to each State from the allotment for the State if
the Secretary approves for the fiscal year involved an application
submitted by the State pursuant to section 529.
SEC. 522. ø290cc–22¿ PURPOSE OF GRANTS.
(a) IN GENERAL.—The Secretary may

not make payments
under section 521 unless the State involved agrees that the payments will be expended solely for making grants to political subdivisions of the State, and to nonprofit private entities (including
community-based veterans organizations and other community organizations), for the purpose of providing the services specified in
subsection (b) to individuals who—
(1)(A) are suffering from serious mental illness; or
(B) are suffering from serious mental illness and from substance abuse; and
(2) are homeless or at imminent risk of becoming homeless.
(b) SPECIFICATION OF SERVICES.—The services referred to in
subsection (a) are—
(1) outreach services;
(2) screening and diagnostic treatment services;
(3) habilitation and rehabilitation services;
(4) community mental health services;
(5) alcohol or drug treatment services;
1 Probably should be ‘‘2001 through 2003’’. Section 3203(b) of Public Law 106–310 (114 Stat.
1191) amended section 535(a) of this Act, which provides the authorization of appropriations for
this part, by striking ‘‘1991 through 1994’’ and inserting ‘‘2001 through 2003’’. Such Public Law
did not conform the reference in section 521 above.

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Sec. 522

PUBLIC HEALTH SERVICE ACT

762

(6) staff training, including the training of individuals who
work in shelters, mental health clinics, substance abuse programs, and other sites where homeless individuals require
services;
(7) case management services, including—
(A) preparing a plan for the provision of community
mental health services to the eligible homeless individual
involved, and reviewing such plan not less than once every
3 months;
(B) providing assistance in obtaining and coordinating
social and maintenance services for the eligible homeless
individuals, including services relating to daily living activities, personal financial planning, transportation services, and habilitation and rehabilitation services,
prevocational and vocational services, and housing services;
(C) providing assistance to the eligible homeless individual in obtaining income support services, including
housing assistance, supplemental nutrition assistance program benefits, and supplemental security income benefits;
(D) referring the eligible homeless individual for such
other services as may be appropriate; and
(E) providing representative payee services in accordance with section 1631(a)(2) of the Social Security Act if
the eligible homeless individual is receiving aid under title
XVI of such act and if the applicant is designated by the
Secretary to provide such services;
(8) supportive and supervisory services in residential settings;
(9) referrals for primary health services, job training, educational services, and relevant housing services;
(10) subject to subsection (h)(1)—
(A) minor renovation, expansion, and repair of housing;
(B) planning of housing;
(C) technical assistance in applying for housing assistance;
(D) improving the coordination of housing services;
(E) security deposits;
(F) the costs associated with matching eligible homeless individuals with appropriate housing situations; and
(G) 1-time rental payments to prevent eviction; and
(11) other appropriate services, as determined by the Secretary.
(c) COORDINATION.—The Secretary may not make payments
under section 521 unless the State involved agrees to make grants
pursuant to subsection (a) only to entities that have the capacity
to provide, directly or through arrangements, the services specified
in section 522(b), including coordinating the provision of services in
order to meet the needs of eligible homeless individuals who are
both mentally ill and suffering from substance abuse.
(d) SPECIAL CONSIDERATION REGARDING VETERANS.—The Secretary may not make payments under section 521 unless the State
involved agrees that, in making grants to entities pursuant to subMarch 13, 2013

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PUBLIC HEALTH SERVICE ACT

Sec. 523

section (a), the State will give special consideration to entities with
a demonstrated effectiveness in serving homeless veterans.
(e) SPECIAL RULES.—The Secretary may not make payments
under section 521 unless the State involved agrees that grants pursuant to subsection (a) will not be made to any entity that—
(1) has a policy of excluding individuals from mental
health services due to the existence or suspicion of substance
abuse; or
(2) has a policy of excluding individuals from substance
abuse services due to the existence or suspicion of mental illness.
(f) ADMINISTRATIVE EXPENSES.—The Secretary may not make
payments under section 521 unless the State involved agrees that
not more than 4 percent of the payments will be expended for administrative expenses regarding the payments.
(g) MAINTENANCE OF EFFORT.—The Secretary may not make
payments under section 521 unless the State involved agrees that
the State will maintain State expenditures for services specified in
subsection (b) at a level that is not less than the average level of
such expenditures maintained by the State for the 2-year period
preceding the fiscal year for which the State is applying to receive
such payments.
(h) RESTRICTIONS ON USE OF FUNDS.—The Secretary may not
make payments under section 521 unless the State involved agrees
that—
(1) not more than 20 percent of the payments will be expended for housing services under subsection (b)(10); and
(2) the payments will not be expended—
(A) to support emergency shelters or construction of
housing facilities;
(B) for inpatient psychiatric treatment costs or inpatient substance abuse treatment costs; or
(C) to make cash payments to intended recipients of
mental health or substance abuse services.
(i) WAIVER FOR TERRITORIES.—With respect to the United
States Virgin Islands, Guam, American Samoa, Palau, the Marshall Islands, and the Commonwealth of the Northern Mariana Islands, the Secretary may waive the provisions of this part that the
Secretary determines to be appropriate.
SEC. 523. ø290cc–23¿ REQUIREMENT OF MATCHING FUNDS.
(a) IN GENERAL.—The Secretary may not make

payments
under section 521 unless, with respect to the costs of providing
services pursuant to section 522, the State involved agrees to make
available, directly or through donations from public or private entities, non-Federal contributions toward such costs in an amount
that is not less than $1 for each $3 of Federal funds provided in
such payments.
(b) DETERMINATION OF AMOUNT.—Non-Federal contributions
required in subsection (a) may be in cash or in kind, fairly evaluated, including plant, equipment, or services. Amounts provided by
the Federal Government, or services assisted or subsidized to any
significant extent by the Federal Government, shall not be included
in determining the amount of such non-Federal contributions.
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Sec. 524

PUBLIC HEALTH SERVICE ACT

764

(c) LIMITATION REGARDING GRANTS BY STATES.—The Secretary
may not make payments under section 521 unless the State involved agrees that the State will not require the entities to which
grants are provided pursuant to section 522(a) to provide non-Federal contributions in excess of the non-Federal contributions described in subsection (a).
SEC. 524. ø290cc–24¿ DETERMINATION OF AMOUNT OF ALLOTMENT.
(a) MINIMUM ALLOTMENT.—The allotment for a State under

section 521 for a fiscal year shall be the greater of—
(1) $300,000 for each of the several States, the District of
Columbia, and the Commonwealth of Puerto Rico, and $50,000
for each of Guam, the Virgin Islands, American Samoa, and
the Commonwealth of the Northern Mariana Islands; and
(2) an amount determined in accordance with subsection
(b).
(b) DETERMINATION UNDER FORMULA.—The amount referred to
in subsection (a)(2) is the product of—
(1) an amount equal to the amount appropriated under
section 535(a) for the fiscal year; and
(2) a percentage equal to the quotient of—
(A) an amount equal to the population living in urbanized areas of the State involved, as indicated by the most
recent data collected by the Bureau of the Census; and
(B) an amount equal to the population living in urbanized areas of the United States, as indicated by the sum
of the respective amounts determined for the States under
subparagraph (A).
SEC. 525. ø290cc–25¿ CONVERSION TO CATEGORICAL PROGRAM IN
EVENT OF FAILURE OF STATE REGARDING EXPENDITURE
OF GRANTS.
(a) IN GENERAL.—Subject to subsection (c), the Secretary shall,

from the amounts specified in subsection (b), make grants to public
and nonprofit private entities for the purpose of providing to eligible homeless individuals the services specified in section 522(b).
(b) 1 SPECIFICATION OF FUNDS.—The amounts referred to in
subsection (a) are any amounts made available in appropriations
Acts for allotments under section 521 that are not paid to a State
as a result of—
(A) the failure of the State to submit an application
under section 529;
(B) the failure of the State, in the determination of the
Secretary, to prepare the application in accordance with
such section or to submit the application within a reasonable period of time; or
(C) the State informing the Secretary that the State
does not intend to expend the full amount of the allotment
made to the State.
(c) REQUIREMENT OF PROVISION OF SERVICES IN STATE INVOLVED.—With respect to grants under subsection (a), amounts
made available under subsection (b) as a result of the State in1 So in law. Subparagraphs (A) through (C) probably should be redesignated as paragraphs
(1) through (3), respectively. See section 511 of Public Law 104–645 (104 Stat. 4729).

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765

PUBLIC HEALTH SERVICE ACT

Sec. 527

volved shall be available only for grants to provide services in such
State.
SEC. 526. ø290cc–26¿ PROVISION OF CERTAIN INFORMATION FROM
STATE.

The Secretary may not make payments under section 521 to a
State unless, as part of the application required in section 529, the
State submits to the Secretary a statement—
(1) identifying existing programs providing services and
housing to eligible homeless individuals and identify gaps in
the delivery systems of such programs;
(2) containing a plan for providing services and housing to
eligible homeless individuals, which plan—
(A) describes the coordinated and comprehensive
means of providing services and housing to homeless individuals; and
(B) includes documentation that suitable housing for
eligible homeless individuals will accompany the provision
of services to such individuals;
(3) describes the source of the non-Federal contributions
described in section 523;
(4) contains assurances that the non-Federal contributions
described in section 523 will be available at the beginning of
the grant period;
(5) describe any voucher system that may be used to carry
out this part; and
(6) contain such other information or assurances as the
Secretary may reasonably require.
SEC. 527. ø290cc–27¿ DESCRIPTION OF INTENDED EXPENDITURES OF
GRANT.
(a) IN GENERAL.—The Secretary may not make payments

under section 521 unless—
(1) as part of the application required in section 529, the
State involved submits to the Secretary a description of the intended use for the fiscal year of the amounts for which the
State is applying pursuant to such section;
(2) such description identifies the geographic areas within
the State in which the greatest numbers of homeless individuals with a need for mental health, substance abuse, and housing services are located;
(3) such description provides information relating to the
programs and activities to be supported and services to be provided, including information relating to coordinating such programs and activities with any similar programs and activities
of public and private entities; and
(4) the State agrees that such description will be revised
throughout the year as may be necessary to reflect substantial
changes in the programs and activities assisted by the State
pursuant to section 522.
(b) OPPORTUNITY FOR PUBLIC COMMENT.—The Secretary may
not make payments under section 521 unless the State involved
agrees that, in developing and carrying out the description required
in subsection (a), the State will provide public notice with respect
to the description (including any revisions) and such opportunities
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Sec. 528

PUBLIC HEALTH SERVICE ACT

766

as may be necessary to provide interested persons, such as family
members, consumers, and mental health, substance abuse, and
housing agencies, an opportunity to present comments and recommendations with respect to the description.
(c) RELATIONSHIP TO STATE COMPREHENSIVE MENTAL HEALTH
SERVICES PLAN.—
(1) IN GENERAL.—The Secretary may not make payments
under section 521 unless the services to be provided pursuant
to the description required in subsection (a) are consistent with
the State comprehensive mental health services plan required
in subpart 2 of part B of title XIX.
(2) SPECIAL RULE.—The Secretary may not make payments
under section 521 unless the services to be provided pursuant
to the description required in subsection (a) have been considered in the preparation of, have been included in, and are consistent with, the State comprehensive mental health services
plan referred to in paragraph (1).
SEC. 528. ø290cc–28¿ REQUIREMENT OF REPORTS BY STATES.
(a) IN GENERAL.—The Secretary may not make payments

under section 521 unless the State involved agrees that, by not
later than January 31 of each fiscal year, the State will prepare
and submit to the Secretary a report in such form and containing
such information as the Secretary determines (after consultation
with the Administrator of the Substance Abuse and Mental Health
Services Administration) to be necessary for—
(1) securing a record and a description of the purposes for
which amounts received under section 521 were expended during the preceding fiscal year and of the recipients of such
amounts; and
(2) determining whether such amounts were expended in
accordance with the provisions of this part.
(b) AVAILABILITY TO PUBLIC OF REPORTS.—The Secretary may
not make payments under section 521 unless the State involved
agrees to make copies of the reports described in subsection (a)
available for public inspection.
(c) EVALUATIONS BY COMPTROLLER GENERAL.—The Administrator of the Substance Abuse and Mental Health Services Administration shall evaluate at least once every 3 years the expenditures of grants under this part by eligible entities in order to ensure that expenditures are consistent with the provisions of this
part, and shall include in such evaluation recommendations regarding changes needed in program design or operations.
SEC. 529. ø290cc–29¿ REQUIREMENT OF APPLICATION.

The Secretary may not make payments under section 521 unless the State involved—
(1) submits to the Secretary an application for the payments containing agreements and information in accordance
with this part;
(2) the agreements are made through certification from the
chief executive officer of the State; and
(3) the application otherwise is in such form, is made in
such manner, and contains such agreements, assurances, and
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767

PUBLIC HEALTH SERVICE ACT

Sec. 531

information as the Secretary determines to be necessary to
carry out this part.
SEC. 530. ø290cc–30¿ TECHNICAL ASSISTANCE.

The Secretary, through 1 the National Institute of Mental
Health, the National Institute of Alcohol Abuse and Alcoholism,
and the National Institute on Drug Abuse, shall provide technical
assistance to eligible entities in developing planning and operating
programs in accordance with the provisions of this part.
SEC. 531. ø290cc–31¿ FAILURE TO COMPLY WITH AGREEMENTS.
(a) REPAYMENT OF PAYMENTS.—

(1) The Secretary may, subject to subsection (c), require a
State to repay any payments received by the State under section 521 that the Secretary determines were not expended by
the State in accordance with the agreements required to be
contained in the application submitted by the State pursuant
to section 529.
(2) If a State fails to make a repayment required in paragraph (1), the Secretary may offset the amount of the repayment against the amount of any payment due to be paid to the
State under section 521.
(b) WITHHOLDING OF PAYMENTS.—
(1) The Secretary may, subject to subsection (c), withhold
payments due under section 521 if the Secretary determines
that the State involved is not expending amounts received
under such section in accordance with the agreements required
to be contained in the application submitted by the State pursuant to section 529.
(2) The Secretary shall cease withholding payments from
a State under paragraph (1) if the Secretary determines that
there are reasonable assurances that the State will expend
amounts received under section 521 in accordance with the
agreements referred to in such paragraph.
(3) The Secretary may not withhold funds under paragraph (1) from a State for a minor failure to comply with the
agreements referred to in such paragraph.
(c) OPPORTUNITY FOR HEARING.—Before requiring repayment of
payments under subsection (a)(1), or withholding payments under
subsection (b)(1), the Secretary shall provide to the State an opportunity for a hearing.
(d) RULE OF CONSTRUCTION.—Notwithstanding any other provision of this part, a State receiving payments under section 521
may not, with respect to any agreements required to be contained
in the application submitted under section 529, be considered to be
in violation of any such agreements by reason of the fact that the
State, in the regular course of providing services under section
522(b) to eligible homeless individuals, incidentally provides serv1 Section 162(2) of Public Law 102–321 (106 Stat. 375) provides that section 530 is amended
by striking out ‘‘through the National’’ and all that follows through ‘‘Abuse’’ and inserting in
lieu thereof ‘‘through the agencies of the Administration’’. The amendment cannot be executed
because it does not specify to which instance of the term ‘‘Abuse’’ the amendment applies. Additionally, section 163(a)(3) of such law described an amendment that could not be executed, as
the amendment included instructions to strike ‘‘on Alcohol Abuse’’ while ‘‘of Alcohol Abuse’’ is
the term in section 530. This latter amendment attempted to insert ‘‘Administrator of the Substance Abuse and Mental Health Services Administration’’. Subsequently, such section 163(a)(3)
was struck by section 2(b)(2) of Public Law 102–352 (106 Stat. 939).

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Sec. 532

PUBLIC HEALTH SERVICE ACT

768

ices to homeless individuals who are not eligible homeless individuals.
SEC. 532. ø290cc–32¿ PROHIBITION AGAINST CERTAIN FALSE STATEMENTS.
(a) IN GENERAL.—

(1) A person may not knowingly make or cause to be made
any false statement or representation of a material fact in connection with the furnishing of items or services for which
amounts may be paid by a State from payments received by
the State under section 521.
(2) A person with knowledge of the occurrence of any event
affecting the right of the person to receive any amounts from
payments made to the State under section 521 may not conceal
or fail to disclose any such event with the intent of securing
such an amount that the person is not authorized to receive or
securing such an amount in an amount greater than the
amount the person is authorized to receive.
(b) CRIMINAL PENALTY FOR VIOLATION OF PROHIBITION.—Any
person who violates a prohibition established in subsection (a) may
for each violation be fined in accordance with title 18, United
States Code, or imprisoned for not more than 5 years, or both.
SEC. 533. ø290cc–33¿ NONDISCRIMINATION.
(a) IN GENERAL.—
(1) RULE OF CONSTRUCTION REGARDING CERTAIN CIVIL
RIGHTS LAWS.—For the purpose of applying the prohibitions

against discrimination on the basis of age under the Age Discrimination Act of 1975, on the basis of handicap under section
504 of the Rehabilitation Act of 1973, on the basis of sex under
title IX of the Education Amendments of 1972, or on the basis
of race, color, or national origin under title VI of the Civil
Rights Act of 1964, programs and activities funded in whole or
in part with funds made available under section 521 shall be
considered to be programs and activities receiving Federal financial assistance.
(2) PROHIBITION.—No person shall on the ground of sex or
religion be excluded from participation in, be denied the benefits of, or be subjected to discrimination under, any program or
activity funded in whole or in part with funds made available
under section 521.
(b) ENFORCEMENT.—
(1) REFERRALS TO ATTORNEY GENERAL AFTER NOTICE.—
Whenever the Secretary finds that a State, or an entity that
has received a payment pursuant to section 521, has failed to
comply with a provision of law referred to in subsection (a)(1),
with subsection (a)(2), or with an applicable regulation (including one prescribed to carry out subsection (a)(2)), the Secretary
shall notify the chief executive officer of the State and shall request the chief executive officer to secure compliance. If within
a reasonable period of time, not to exceed 60 days, the chief executive officer fails or refuses to secure compliance, the Secretary may—
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769

PUBLIC HEALTH SERVICE ACT

Sec. 535

(A) refer the matter to the Attorney General with a
recommendation that an appropriate civil action be instituted;
(B) exercise the powers and functions provided by the
Age Discrimination Act of 1975, section 504 of the Rehabilitation Act of 1973, title IX of the Education Amendments of 1972, or title VI of the Civil Rights Act of 1964,
as may be applicable; or
(C) take such other actions as may be authorized by
law.
(2) AUTHORITY OF ATTORNEY GENERAL.—When a matter is
referred to the Attorney General pursuant to paragraph (1)(A),
or whenever the Attorney General has reason to believe that
a State or an entity is engaged in a pattern or practice in violation of a provision of law referred to in subsection (a)(1) or in
violation of subsection (a)(2), the Attorney General may bring
a civil action in any appropriate district court of the United
States for such relief as may be appropriate, including injunctive relief.
SEC. 534. ø290cc–34¿ DEFINITIONS.

For purposes of this part:
(1) ELIGIBLE HOMELESS INDIVIDUAL.—The term ‘‘eligible
homeless individual’’ means an individual described in section
522(a).
(2) HOMELESS INDIVIDUAL.—The term ‘‘homeless individual’’ has the meaning given such term in section 330(h)(5).
(3) STATE.—The term ‘‘State’’ means each of the several
States, the District of Columbia, the Commonwealth of Puerto
Rico, the Virgin Islands, Guam, American Samoa, and the
Commonwealth of the Northern Mariana Islands.
(4) SUBSTANCE ABUSE.—The term ‘‘substance abuse’’ means
the abuse of alcohol or other drugs.
SEC. 535. ø290cc–35¿ FUNDING.
(a) AUTHORIZATION OF APPROPRIATIONS.—For

the purpose of
carrying out this part, there is authorized to be appropriated
$75,000,000 for each of the fiscal years 2001 through 2003.
(b) EFFECT OF INSUFFICIENT APPROPRIATIONS FOR MINIMUM
ALLOTMENTS.—
(1) IN GENERAL.—If the amounts made available under
subsection (a) for a fiscal year are insufficient for providing
each State with an allotment under section 521 of not less than
the applicable amount under section 524(a)(1), the Secretary
shall, from such amounts as are made available under such
subsection, make grants to the States for providing to eligible
homeless individuals the services specified in section 522(b).
(2) RULE OF CONSTRUCTION.—Paragraph (1) may not be
construed to require the Secretary to make a grant under such
paragraph to each State.

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Sec. 541

PUBLIC HEALTH SERVICE ACT

PART D—MISCELLANEOUS PROVISIONS RELATING
ABUSE AND MENTAL HEALTH

770
TO

SUBSTANCE

SEC. 541. ø290dd¿ SUBSTANCE ABUSE AMONG GOVERNMENT AND
OTHER EMPLOYEES.
(a) PROGRAMS AND SERVICES.—
(1) DEVELOPMENT.—The Secretary, acting through the Ad-

ministrator of the Substance Abuse and Mental Health Services Administration, shall be responsible for fostering substance abuse prevention and treatment programs and services
in State and local governments and in private industry.
(2) MODEL PROGRAMS.—
(A) IN GENERAL.—Consistent with the responsibilities
described in paragraph (1), the Secretary, acting through
the Administrator of the Substance Abuse and Mental
Health Services Administration, shall develop a variety of
model programs suitable for replication on a cost-effective
basis in different types of business concerns and State and
local governmental entities.
(B) DISSEMINATION OF INFORMATION.—The Secretary,
acting through the Administrator of the Substance Abuse
and Mental Health Services Administration, shall disseminate information and materials relative to such model programs to the State agencies responsible for the administration of substance abuse prevention, treatment, and rehabilitation activities and shall, to the extent feasible provide
technical assistance to such agencies as requested.
(b) DEPRIVATION OF EMPLOYMENT.—
(1) PROHIBITION.—No person may be denied or deprived of
Federal civilian employment or a Federal professional or other
license or right solely on the grounds of prior substance abuse.
(2) APPLICATION.—This subsection shall not apply to employment in—
(A) the Central Intelligence Agency;
(B) the Federal Bureau of Investigation;
(C) the National Security Agency;
(D) any other department or agency of the Federal
Government designated for purposes of national security
by the President; or
(E) in any position in any department or agency of the
Federal Government, not referred to in subparagraphs (A)
through (D), which position is determined pursuant to regulations prescribed by the head of such agency or department to be a sensitive position.
(3) REHABILITATION ACT.—The inapplicability of the prohibition described in paragraph (1) to the employment described
in paragraph (2) shall not be construed to reflect on the applicability of the Rehabilitation Act of 1973 or other anti-discrimination laws to such employment.
(c) CONSTRUCTION.—This section shall not be construed to prohibit the dismissal from employment of a Federal civilian employee
who cannot properly function in his employment.
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SEC. 542. ø290dd–1¿ ADMISSION OF SUBSTANCE ABUSERS TO PRIVATE
AND PUBLIC HOSPITALS AND OUTPATIENT FACILITIES.
(a) NONDISCRIMINATION.—Substance abusers who are suffering

from medical conditions shall not be discriminated against in admission or treatment, solely because of their substance abuse, by
any private or public general hospital, or outpatient facility (as defined in section 1624(4)) which receives support in any form from
any program supported in whole or in part by funds appropriated
to any Federal department or agency.
(b) REGULATIONS.—
(1) IN GENERAL.—The Secretary shall issue regulations for
the enforcement of the policy of subsection (a) with respect to
the admission and treatment of substance abusers in hospitals
and outpatient facilities which receive support of any kind
from any program administered by the Secretary. Such regulations shall include procedures for determining (after opportunity for a hearing if requested) if a violation of subsection (a)
has occurred, notification of failure to comply with such subsection, and opportunity for a violator to comply with such subsection. If the Secretary determines that a hospital or outpatient facility subject to such regulations has violated subsection (a) and such violation continues after an opportunity
has been afforded for compliance, the Secretary may suspend
or revoke, after opportunity for a hearing, all or part of any
support of any kind received by such hospital from any program administered by the Secretary. The Secretary may consult with the officials responsible for the administration of any
other Federal program from which such hospital or outpatient
facility receives support of any kind, with respect to the suspension or revocation of such other Federal support for such
hospital or outpatient facility.
(2) DEPARTMENT OF VETERANS AFFAIRS.—The Secretary of
Veterans Affairs, acting through the Under Secretary for
Health, shall, to the maximum feasible extent consistent with
their responsibilities under title 38, United States Code, prescribe regulations making applicable the regulations prescribed
by the Secretary under paragraph (1) to the provision of hospital care, nursing home care, domiciliary care, and medical
services under such title 38 to veterans suffering from substance abuse. In prescribing and implementing regulations
pursuant to this paragraph, the Secretary shall, from time to
time, consult with the Secretary of Health and Human Services in order to achieve the maximum possible coordination of
the regulations, and the implementation thereof, which they
each prescribe.
SEC. 543. ø290dd–2¿ CONFIDENTIALITY OF RECORDS.
(a) REQUIREMENT.—Records of the identity,

diagnosis, prognosis, or treatment of any patient which are maintained in connection with the performance of any program or activity relating to
substance abuse education, prevention, training, treatment, rehabilitation, or research, which is conducted, regulated, or directly or
indirectly assisted by any department or agency of the United
States shall, except as provided in subsection (e), be confidential
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and be disclosed only for the purposes and under the circumstances
expressly authorized under subsection (b).
(b) PERMITTED DISCLOSURE.—
(1) CONSENT.—The content of any record referred to in
subsection (a) may be disclosed in accordance with the prior
written consent of the patient with respect to whom such
record is maintained, but only to such extent, under such circumstances, and for such purposes as may be allowed under
regulations prescribed pursuant to subsection (g).
(2) METHOD FOR DISCLOSURE.—Whether or not the patient,
with respect to whom any given record referred to in subsection (a) is maintained, gives written consent, the content of
such record may be disclosed as follows:
(A) To medical personnel to the extent necessary to
meet a bona fide medical emergency.
(B) To qualified personnel for the purpose of conducting scientific research, management audits, financial
audits, or program evaluation, but such personnel may not
identify, directly or indirectly, any individual patient in
any report of such research, audit, or evaluation, or otherwise disclose patient identities in any manner.
(C) If authorized by an appropriate order of a court of
competent jurisdiction granted after application showing
good cause therefor, including the need to avert a substantial risk of death or serious bodily harm. In assessing good
cause the court shall weigh the public interest and the
need for disclosure against the injury to the patient, to the
physician-patient relationship, and to the treatment services. Upon the granting of such order, the court, in determining the extent to which any disclosure of all or any
part of any record is necessary, shall impose appropriate
safeguards against unauthorized disclosure.
(c) USE OF RECORDS IN CRIMINAL PROCEEDINGS.—Except as authorized by a court order granted under subsection (b)(2)(C), no
record referred to in subsection (a) may be used to initiate or substantiate any criminal charges against a patient or to conduct any
investigation of a patient.
(d) APPLICATION.—The prohibitions of this section continue to
apply to records concerning any individual who has been a patient,
irrespective of whether or when such individual ceases to be a patient.
(e) NONAPPLICABILITY.—The prohibitions of this section do not
apply to any interchange of records—
(1) within the Uniformed Services or within those components of the Department of Veterans Affairs furnishing health
care to veterans; or
(2) between such components and the Uniformed Services.
The prohibitions of this section do not apply to the reporting under
State law of incidents of suspected child abuse and neglect to the
appropriate State or local authorities.
(f) PENALTIES.—Any person who violates any provision of this
section or any regulation issued pursuant to this section shall be
fined in accordance with title 18, United States Code.
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(g) REGULATIONS.—Except as provided in subsection (h), the
Secretary shall prescribe regulations to carry out the purposes of
this section. Such regulations may contain such definitions, and
may provide for such safeguards and procedures, including procedures and criteria for the issuance and scope of orders under subsection (b)(2)(C), as in the judgment of the Secretary are necessary
or proper to effectuate the purposes of this section, to prevent circumvention or evasion thereof, or to facilitate compliance therewith.
(h) APPLICATION TO DEPARTMENT OF VETERANS AFFAIRS.—The
Secretary of Veterans Affairs, acting through the Chief Medical Director, shall, to the maximum feasible extent consistent with their
responsibilities under title 38, United States Code, prescribe regulations making applicable the regulations prescribed by the Secretary of Health and Human Services under subsection (g) of this
section to records maintained in connection with the provision of
hospital care, nursing home care, domiciliary care, and medical
services under such title 38 to veterans suffering from substance
abuse. In prescribing and implementing regulations pursuant to
this subsection, the Secretary of Veterans Affairs shall, from time
to time, consult with the Secretary of Health and Human Services
in order to achieve the maximum possible coordination of the regulations, and the implementation thereof, which they each prescribe.
PART E—CHILDREN WITH SERIOUS EMOTIONAL DISTURBANCES
SEC. 561. ø290ff¿ COMPREHENSIVE COMMUNITY MENTAL HEALTH
SERVICES FOR CHILDREN WITH SERIOUS EMOTIONAL
DISTURBANCES.
(a) GRANTS TO CERTAIN PUBLIC ENTITIES.—
(1) IN GENERAL.—The Secretary, acting through the Direc-

tor of the Center for Mental Health Services, shall make
grants to public entities for the purpose of providing comprehensive community mental health services to children with
a serious emotional disturbance.
(2) DEFINITION OF PUBLIC ENTITY.—For purposes of this
part, the term ‘‘public entity’’ means any State, any political
subdivision of a State, and any Indian tribe or tribal organization (as defined in section 4(b) and section 4(c) of the Indian
Self-Determination and Education Assistance Act).
(b) CONSIDERATIONS IN MAKING GRANTS.—
(1) REQUIREMENT OF STATUS AS GRANTEE UNDER PART B OF
TITLE XIX.—The Secretary may make a grant under subsection
(a) to a public entity only if—
(A) in the case of a public entity that is a State, the
State is such a grantee under section 1911;
(B) in the case of a public entity that is a political subdivision of a State, the State in which the political subdivision is located is such a grantee; and
(C) in the case of a public entity that is an Indian
tribe or tribal organization, the State in which the tribe or
tribal organization is located is such a grantee.
(2) REQUIREMENT OF STATUS AS MEDICAID PROVIDER.—
(A) Subject to subparagraph (B), the Secretary may
make a grant under subsection (a) only if, in the case of
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any service under such subsection that is covered in the
State plan approved under title XIX of the Social Security
Act for the State involved—
(i) the public entity involved will provide the service directly, and the entity has entered into a participation agreement under the State plan and is qualified to receive payments under such plan; or
(ii) the public entity will enter into an agreement
with an organization under which the organization
will provide the service, and the organization has entered into such a participation agreement and is qualified to receive such payments.
(B)(i) In the case of an organization making an agreement under subparagraph (A)(ii) regarding the provision of
services under subsection (a), the requirement established
in such subparagraph regarding a participation agreement
shall be waived by the Secretary if the organization does
not, in providing health or mental health services, impose
a charge or accept reimbursement available from any
third-party payor, including reimbursement under any insurance policy or under any Federal or State health benefits program.
(ii) A determination by the Secretary of whether an organization referred to in clause (i) meets the criteria for a
waiver under such clause shall be made without regard to
whether the organization accepts voluntary donations regarding the provision of services to the public.
(3) CERTAIN CONSIDERATIONS.—In making grants under
subsection (a), the Secretary shall—
(A) equitably allocate such assistance among the principal geographic regions of the United States;
(B) consider the extent to which the public entity involved has a need for the grant; and
(C) in the case of any public entity that is a political
subdivision of a State or that is an Indian tribe or tribal
organization—
(i) shall consider any comments regarding the application of the entity for such a grant that are received by the Secretary from the State in which the
entity is located; and
(ii) shall give special consideration to the entity if
the State agrees to provide a portion of the non-Federal contributions required in subsection (c) regarding
such a grant.
(c) MATCHING FUNDS.—
(1) IN GENERAL.—A funding agreement for a grant under
subsection (a) is that the public entity involved will, with respect to the costs to be incurred by the entity in carrying out
the purpose described in such subsection, make available (directly or through donations from public or private entities)
non-Federal contributions toward such costs in an amount
that—
(A) for the first fiscal year for which the entity receives payments from a grant under such subsection, is not
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less than $1 for each $3 of Federal funds provided in the
grant;
(B) for any second or third such fiscal year, is not less
than $1 for each $3 of Federal funds provided in the grant;
(C) for any fourth such fiscal year, is not less than $1
for each $1 of Federal funds provided in the grant; and
(D) for any fifth and sixth such fiscal year, is not less
than $2 for each $1 of Federal funds provided in the grant.
(2) DETERMINATION OF AMOUNT CONTRIBUTED.—
(A) Non-Federal contributions required in paragraph
(1) may be in cash or in kind, fairly evaluated, including
plant, equipment, or services. Amounts provided by the
Federal Government, or services assisted or subsidized to
any significant extent by the Federal Government, may
not be included in determining the amount of such nonFederal contributions.
(B) In making a determination of the amount of nonFederal contributions for purposes of subparagraph (A),
the Secretary may include only non-Federal contributions
in excess of the average amount of non-Federal contributions made by the public entity involved toward the purpose described in subsection (a) for the 2-year period preceding the first fiscal year for which the entity receives a
grant under such section.
SEC. 562. ø290ff–1¿ REQUIREMENTS WITH RESPECT TO CARRYING OUT
PURPOSE OF GRANTS.
(a) SYSTEMS OF COMPREHENSIVE CARE.—
(1) IN GENERAL.—A funding agreement for a grant under

section 561(a) is that, with respect to children with a serious
emotional disturbance, the public entity involved will carry out
the purpose described in such section only through establishing
and operating 1 or more systems of care for making each of the
mental health services specified in subsection (c) available to
each child provided access to the system. In providing for such
a system, the public entity may make grants to, and enter into
contracts with, public and nonprofit private entities.
(2) STRUCTURE OF SYSTEM.—A funding agreement for a
grant under section 561(a) is that a system of care under paragraph (1) will—
(A) be established in a community selected by the public entity involved;
(B) consist of such public agencies and nonprofit private entities in the community as are necessary to ensure
that each of the services specified in subsection (c) is available to each child provided access to the system;
(C) be established pursuant to agreements that the
public entity enters into with the agencies and entities described in subparagraph (B);
(D) coordinate the provision of the services of the system; and
(E) establish an office whose functions are to serve as
the location through which children are provided access to
the system, to coordinate the provision of services of the
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system, and to provide information to the public regarding
the system.
(3) COLLABORATION OF LOCAL PUBLIC ENTITIES.—A funding
agreement for a grant under section 561(a) is that, for purposes of the establishment and operation of a system of care
under paragraph (1), the public entity involved will seek collaboration among all public agencies that provide human services in the community in which the system is established, including but not limited to those providing mental health services, educational services, child welfare services, or juvenile
justice services.
(b) LIMITATION ON AGE OF CHILDREN PROVIDED ACCESS TO SYSTEM.—A funding agreement for a grant under section 561(a) is that
a system of care under subsection (a) will not provide an individual
with access to the system if the individual is more than 21 years
of age.
(c) REQUIRED MENTAL HEALTH SERVICES OF SYSTEM.—A funding agreement for a grant under section 561(a) is that mental
health services provided by a system of care under subsection (a)
will include, with respect to a serious emotional disturbance in a
child—
(1) diagnostic and evaluation services;
(2) outpatient services provided in a clinic, office, school or
other appropriate location, including individual, group and
family counseling services, professional consultation, and review and management of medications;
(3) emergency services, available 24-hours a day, 7 days a
week;
(4) intensive home-based services for children and their
families when the child is at imminent risk of out-of-home
placement;
(5) intensive day-treatment services;
(6) respite care;
(7) therapeutic foster care services, and services in therapeutic foster family homes or individual therapeutic residential
homes, and groups homes caring for not more than 10 children;
and
(8) assisting the child in making the transition from the
services received as a child to the services to be received as an
adult.
(d) REQUIRED ARRANGEMENTS REGARDING OTHER APPROPRIATE
SERVICES.—
(1) IN GENERAL.—A funding agreement for a grant under
section 561(a) is that—
(A) a system of care under subsection (a) will enter
into a memorandum of understanding with each of the
providers specified in paragraph (2) in order to facilitate
the availability of the services of the provider involved to
each child provided access to the system; and
(B) the grant under such section 561(a), and the nonFederal contributions made with respect to the grant, will
not be expended to pay the costs of providing such nonmental health services to any individual.
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(2) SPECIFICATION OF NON-MENTAL HEALTH SERVICES.—The
providers referred to in paragraph (1) are providers of medical
services other than mental health services, providers of educational services, providers of vocational counseling and vocational rehabilitation services, and providers of protection and
advocacy services with respect to mental health.
(3) FACILITATION OF SERVICES OF CERTAIN PROGRAMS.—A
funding agreement for a grant under section 561(a) is that a
system of care under subsection (a) will, for purposes of paragraph (1), enter into a memorandum of understanding regarding facilitation of—
(A) services available pursuant to title XIX of the Social Security Act, including services regarding early periodic screening, diagnosis, and treatment;
(B) services available under parts B and C of the Individuals with Disabilities Education Act; and
(C) services available under other appropriate programs, as identified by the Secretary.
(e) GENERAL PROVISIONS REGARDING SERVICES OF SYSTEM.—
(1) CASE MANAGEMENT SERVICES.—A funding agreement
for a grant under section 561(a) is that a system of care under
subsection (a) will provide for the case management of each
child provided access to the system in order to ensure that—
(A) the services provided through the system to the
child are coordinated and that the need of each such child
for the services is periodically reassessed;
(B) information is provided to the family of the child
on the extent of progress being made toward the objectives
established for the child under the plan of services implemented for the child pursuant to section 563; and
(C) the system provides assistance with respect to—
(i) establishing the eligibility of the child, and the
family of the child, for financial assistance and services under Federal, State, or local programs providing
for health services, mental health services, educational
services, social services, or other services; and
(ii) seeking to ensure that the child receives appropriate services available under such programs.
(2) OTHER PROVISIONS.—A funding agreement for a grant
under section 561(a) is that a system of care under subsection
(a), in providing the services of the system, will—
(A) provide the services of the system in the cultural
context that is most appropriate for the child and family
involved;
(B) ensure that individuals providing such services to
the child can effectively communicate with the child and
family in the most direct manner;
(C) provide the services without discriminating against
the child or the family of the child on the basis of race, religion, national origin, sex, disability, or age;
(D) seek to ensure that each child provided access to
the system of care remains in the least restrictive, most
normative environment that is clinically appropriate; and
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(E) provide outreach services to inform individuals, as
appropriate, of the services available from the system, including identifying children with a serious emotional disturbance who are in the early stages of such disturbance.
(3) RULE OF CONSTRUCTION.—An agreement made under
paragraph (2) may not be construed—
(A) with respect to subparagraph (C) of such paragraph—
(i) to prohibit a system of care under subsection
(a) from requiring that, in housing provided by the
grantee for purposes of residential treatment services
authorized under subsection (c), males and females be
segregated to the extent appropriate in the treatment
of the children involved; or
(ii) to prohibit the system of care from complying
with the agreement made under subsection (b); or
(B) with respect to subparagraph (D) of such paragraph, to authorize the system of care to expend the grant
under section 561(a) (or the non-Federal contributions
made with respect to the grant) to provide legal services
or any service with respect to which expenditures regarding the grant are prohibited under subsection (d)(1)(B).
(f) RESTRICTIONS ON USE OF GRANT.—A funding agreement for
a grant under section 561(a) is that the grant, and the non-Federal
contributions made with respect to the grant, will not be expended—
(1) to purchase or improve real property (including the
construction or renovation of facilities);
(2) to provide for room and board in residential programs
serving 10 or fewer children;
(3) to provide for room and board or other services or expenditures associated with care of children in residential treatment centers serving more than 10 children or in inpatient
hospital settings, except intensive home-based services and
other services provided on an ambulatory or outpatient basis;
or
(4) to provide for the training of any individual, except
training authorized in section 564(a)(2) and training provided
through any appropriate course in continuing education whose
duration does not exceed 2 days.
(g) WAIVERS.—The Secretary may waive one or more of the requirements of subsection (c) for a public entity that is an Indian
Tribe or tribal organization, or American Samoa, Guam, the Marshall Islands, the Federated States of Micronesia, the Commonwealth of the Northern Mariana Islands, the Republic of Palau, or
the United States Virgin Islands if the Secretary determines, after
peer review, that the system of care is family-centered and uses the
least restrictive environment that is clinically appropriate.
SEC. 563. ø290ff–2¿ INDIVIDUALIZED PLAN FOR SERVICES.
(a) IN GENERAL.—A funding agreement for a grant

under section 561(a) is that a system of care under section 562(a) will develop and carry out an individualized plan of services for each child
provided access to the system, and that the plan will be developed
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and carried out with the participation of the family of the child
and, unless clinically inappropriate, with the participation of the
child.
(b) MULTIDISCIPLINARY TEAM.—A funding agreement for a
grant under section 561(a) is that the plan required in subsection
(a) will be developed, and reviewed and as appropriate revised not
less than once each year, by a multidisciplinary team of appropriately qualified individuals who provide services through the system, including as appropriate mental health services, other health
services, educational services, social services, and vocational counseling and rehabilitation; 1
(c) COORDINATION WITH SERVICES UNDER INDIVIDUALS WITH
DISABILITIES EDUCATION ACT.—A funding agreement for a grant
under section 561(a) is that, with respect to a plan under subsection (a) for a child, the multidisciplinary team required in subsection (b) will—
(1) in developing, carrying out, reviewing, and revising the
plan consider any individualized education program in effect
for the child pursuant to part B of the Individuals with Disabilities Education Act;
(2) ensure that the plan is consistent with such individualized education program and provides for coordinating services
under the plan with services under such program; and
(3) ensure that the memorandum of understanding entered
into under section 562(d)(3)(B) regarding such Act includes
provisions regarding compliance with this subsection.
(d) CONTENTS OF PLAN.—A funding agreement for a grant
under section 561(a) is that the plan required in subsection (a) for
a child will—
(1) identify and state the needs of the child for the services
available pursuant to section 562 through the system;
(2) provide for each of such services that is appropriate to
the circumstances of the child, including, except in the case of
children who are less than 14 years of age, the provision of appropriate vocational counseling and rehabilitation, and transition services (as defined in section 602 of the Individuals with
Disabilities Education Act);
(3) establish objectives to be achieved regarding the needs
of the child and the methodology for achieving the objectives;
and
(4) designate an individual to be responsible for providing
the case management required in section 562(e)(1) or certify
that case management services will be provided to the child as
part of the individualized education program of the child under
the Individuals with Disabilities Education Act.
SEC. 564. ø290ff–3¿ ADDITIONAL PROVISIONS.
(a) OPTIONAL SERVICES.—In addition

to services described in
subsection (c) of section 562, a system of care under subsection (a)
of such section may, in expending a grant under section 561(a),
provide for—

1 So in law. See section 119 of Public Law 102–321 (106 Stat. 349). Probably should be a period.

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(1) preliminary assessments to determine whether a child
should be provided access to the system;
(2) training in—
(A) the administration of the system;
(B) the provision of intensive home-based services
under paragraph (4) of section 562(c), intensive day treatment under paragraph (5) of such section, and foster care
or group homes under paragraph (7) of such section; and
(C) the development of individualized plans for purposes of section 563;
(3) recreational activities for children provided access to
the system; and
(4) such other services as may be appropriate in providing
for the comprehensive needs with respect to mental health of
children with a serious emotional disturbance.
(b) COMPREHENSIVE PLAN.—The Secretary may make a grant
under section 561(a) only if, with respect to the jurisdiction of the
public entity involved, the entity has submitted to the Secretary,
and has had approved by the Secretary, a plan for the development
of a jurisdiction-wide system of care for community-based services
for children with a serious emotional disturbance that specifies the
progress the public entity has made in developing the jurisdictionwide system, the extent of cooperation across agencies serving children in the establishment of the system, the Federal and non-Federal resources currently committed to the establishment of the system, and the current gaps in community services and the manner
in which the grant under section 561(a) will be expended to address such gaps and establish local systems of care.
(c) LIMITATION ON IMPOSITION OF FEES FOR SERVICES.—A funding agreement for a grant under section 561(a) is that, if a charge
is imposed for the provision of services under the grant, such
charge—
(1) will be made according to a schedule of charges that is
made available to the public;
(2) will be adjusted to reflect the income of the family of
the child involved; and
(3) will not be imposed on any child whose family has income and resources of equal to or less than 100 percent of the
official poverty line, as established by the Director of the Office
of Management and Budget and revised by the Secretary in accordance with section 673(2) of the Omnibus Budget Reconciliation Act of 1981.
(d) RELATIONSHIP TO ITEMS AND SERVICES UNDER OTHER PROGRAMS.—A funding agreement for a grant under section 561(a) is
that the grant, and the non-Federal contributions made with respect to the grant, will not be expended to make payment for any
item or service to the extent that payment has been made, or can
reasonably be expected to be made, with respect to such item or
service—
(1) under any State compensation program, under an insurance policy, or under any Federal or State health benefits
program; or
(2) by an entity that provides health services on a prepaid
basis.
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(e) LIMITATION ON ADMINISTRATIVE EXPENSES.—A funding
agreement for a grant under section 561(a) is that not more than
2 percent of the grant will be expended for administrative expenses
incurred with respect to the grant by the public entity involved.
(f) REPORTS TO SECRETARY.—A funding agreement for a grant
under section 561(a) is that the public entity involved will annually
submit to the Secretary a report on the activities of the entity
under the grant that includes a description of the number of children provided access to systems of care operated pursuant to the
grant, the demographic characteristics of the children, the types
and costs of services provided pursuant to the grant, the availability and use of third-party reimbursements, estimates of the
unmet need for such services in the jurisdiction of the entity, and
the manner in which the grant has been expended toward the establishment of a jurisdiction-wide system of care for children with
a serious emotional disturbance, and such other information as the
Secretary may require with respect to the grant.
(g) DESCRIPTION OF INTENDED USES OF GRANT.—The Secretary
may make a grant under section 561(a) only if—
(1) the public entity involved submits to the Secretary a
description of the purposes for which the entity intends to expend the grant;
(2) the description identifies the populations, areas, and localities in the jurisdiction of the entity with a need for services
under this section; and
(3) the description provides information relating to the
services and activities to be provided, including a description
of the manner in which the services and activities will be coordinated with any similar services or activities of public or
nonprofit entities.
(h) REQUIREMENT OF APPLICATION.—The Secretary may make
a grant under section 561(a) only if an application for the grant is
submitted to the Secretary, the application contains the description
of intended uses required in subsection (g), and the application is
in such form, is made in such manner, and contains such agreements, assurances, and information as the Secretary determines to
be necessary to carry out this section.
SEC. 565. ø290ff–4¿ GENERAL PROVISIONS.
(a) DURATION OF SUPPORT.—The

period during which payments are made to a public entity from a grant under section
561(a) may not exceed 6 fiscal years.
(b) TECHNICAL ASSISTANCE.—
(1) IN GENERAL.—The Secretary shall, upon the request of
a public entity receiving a grant under section 561(a)—
(A) provide technical assistance to the entity regarding
the process of submitting to the Secretary applications for
grants under section 561(a); and
(B) provide to the entity training and technical assistance with respect to the planning, development, and operation of systems of care pursuant to section 562.
(2) AUTHORITY FOR GRANTS AND CONTRACTS.—The Secretary may provide technical assistance under subsection (a)
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782

directly or through grants to, or contracts with, public and nonprofit private entities.
(c) EVALUATIONS AND REPORTS BY SECRETARY.—
(1) IN GENERAL.—The Secretary shall, directly or through
contracts with public or private entities, provide for annual
evaluations of programs carried out pursuant to section 561(a).
The evaluations shall assess the effectiveness of the systems of
care operated pursuant to such section, including longitudinal
studies of outcomes of services provided by such systems, other
studies regarding such outcomes, the effect of activities under
this part on the utilization of hospital and other institutional
settings, the barriers to and achievements resulting from interagency collaboration in providing community-based services to
children with a serious emotional disturbance, and assessments by parents of the effectiveness of the systems of care.
(2) REPORT TO CONGRESS.—The Secretary shall, not later
than 1 year after the date on which amounts are first appropriated under subsection (c), and annually thereafter, submit
to the Congress a report summarizing evaluations carried out
pursuant to paragraph (1) during the preceding fiscal year and
making such recommendations for administrative and legislative initiatives with respect to this section as the Secretary determines to be appropriate.
(d) DEFINITIONS.—For purposes of this part:
(1) The term ‘‘child’’ means an individual not more than 21
years of age.
(2) The term ‘‘family’’, with respect to a child provided access to a system of care under section 562(a), means—
(A) the legal guardian of the child; and
(B) as appropriate regarding mental health services
for the child, the parents of the child (biological or adoptive, as the case may be) and any foster parents of the
child.
(3) The term ‘‘funding agreement’’, with respect to a grant
under section 561(a) to a public entity, means that the Secretary may make such a grant only if the public entity makes
the agreement involved.
(4) The term ‘‘serious emotional disturbance’’ includes,
with respect to a child, any child who has a serious emotional
disorder, a serious behavioral disorder, or a serious mental disorder.
(e) RULE OF CONSTRUCTION.—Nothing in this part shall be construed as limiting the rights of a child with a serious emotional disturbance under the Individuals with Disabilities Education Act.
(f) FUNDING.—
(1) AUTHORIZATION OF APPROPRIATIONS.—For the purpose
of carrying out this part, there are authorized to be appropriated $100,000,000 for fiscal year 2001, and such sums as
may be necessary for each of the fiscal years 2002 and 2003.
(2) 1 LIMITATION REGARDING TECHNICAL ASSISTANCE.—Not more
than 10 percent of the amounts appropriated under paragraph (1)
for a fiscal year may be expended for carrying out subsection (b).
1 Indentation

March 13, 2013

is so in law. See section 2017(2)(C)(ii) of Public Law 103–43 (107 Stat. 218).

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783

PUBLIC HEALTH SERVICE ACT

PART F—MODEL COMPREHENSIVE PROGRAM
SUBSTANCE ABUSE 2
PART G 3—PROJECTS

FOR

CHILDREN

Sec. 581
FOR

AND

TREATMENT

OF

VIOLENCE

SEC. 581. 3 ø290hh¿ CHILDREN AND VIOLENCE.
(a) IN GENERAL.—The Secretary, in consultation

with the Secretary of Education and the Attorney General, shall carry out directly or through grants, contracts or cooperative agreements with
public entities a program to assist local communities in developing
ways to assist children in dealing with violence.
(b) ACTIVITIES.—Under the program under subsection (a), the
Secretary may—
(1) provide financial support to enable local communities to
implement programs to foster the health and development of
children;
(2) provide technical assistance to local communities with
respect to the development of programs described in paragraph
(1);
(3) provide assistance to local communities in the development of policies to address violence when and if it occurs;
(4) assist in the creation of community partnerships among
law enforcement, education systems and mental health and
substance abuse service systems; and
(5) establish mechanisms for children and adolescents to
report incidents of violence or plans by other children or adolescents to commit violence.
(c) REQUIREMENTS.—An application for a grant, contract or cooperative agreement under subsection (a) shall demonstrate that—
(1) the applicant will use amounts received to create a
partnership described in subsection (b)(4) to address issues of
violence in schools;
(2) the activities carried out by the applicant will provide
a comprehensive method for addressing violence, that will include—
(A) security;
(B) educational reform;
(C) the review and updating of school policies;
(D) alcohol and drug abuse prevention and early intervention services;
(E) mental health prevention and treatment services;
and
(F) early childhood development and psychosocial services; and
(3) the applicant will use amounts received only for the
services described in subparagraphs (D), (E), and (F) of paragraph (2).
2 The part designation and heading for part F are so in law. Part F formerly consisted of section 571. That section was repealed by section 3301(c)(4) of Public Law 106–310 (114 Stat.
1209), but there was no conforming amendment to strike the designation and heading for part
F.
3 There is another part G in this title, which also begins with a section 581. See page 677.
That part G relates to services provided through religious organizations.

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Sec. 582

PUBLIC HEALTH SERVICE ACT

784

(d) GEOGRAPHICAL DISTRIBUTION.—The Secretary shall ensure
that grants, contracts or cooperative agreements under subsection
(a) will be distributed equitably among the regions of the country
and among urban and rural areas.
(e) DURATION OF AWARDS.—With respect to a grant, contract or
cooperative agreement under subsection (a), the period during
which payments under such an award will be made to the recipient
may not exceed 5 years.
(f ) EVALUATION.—The Secretary shall conduct an evaluation of
each project carried out under this section and shall disseminate
the results of such evaluations to appropriate public and private
entities.
(g) INFORMATION AND EDUCATION.—The Secretary shall establish comprehensive information and education programs to disseminate the findings of the knowledge development and application
under this section to the general public and to health care professionals.
(h) AUTHORIZATION OF APPROPRIATIONS.—There is authorized
to be appropriated to carry out this section, $100,000,000 for fiscal
year 2001, and such sums as may be necessary for each of fiscal
years 2002 and 2003.
SEC. 582. ø290hh–1¿ GRANTS TO ADDRESS THE PROBLEMS OF PERSONS WHO EXPERIENCE VIOLENCE RELATED STRESS.
(a) IN GENERAL.—The Secretary shall award grants, contracts

or cooperative agreements to public and nonprofit private entities,
as well as to Indian tribes and tribal organizations, for the purpose
of developing programs focusing on the behavioral and biological
aspects of psychological trauma response and for developing knowledge with regard to evidence-based practices for treating psychiatric disorders of children and youth resulting from witnessing
or experiencing a traumatic event.
(b) PRIORITIES.—In awarding grants, contracts or cooperative
agreements under subsection (a) related to the development of
knowledge on evidence-based practices for treating disorders associated with psychological trauma, the Secretary shall give priority to
mental health agencies and programs that have established clinical
and basic research experience in the field of trauma-related mental
disorders.
(c) GEOGRAPHICAL DISTRIBUTION.—The Secretary shall ensure
that grants, contracts or cooperative agreements under subsection
(a) with respect to centers of excellence are distributed equitably
among the regions of the country and among urban and rural
areas.
(d) EVALUATION.—The Secretary, as part of the application
process, shall require that each applicant for a grant, contract or
cooperative agreement under subsection (a) submit a plan for the
rigorous evaluation of the activities funded under the grant, contract or agreement, including both process and outcomes evaluation, and the submission of an evaluation at the end of the project
period.
(e) DURATION OF AWARDS.—With respect to a grant, contract or
cooperative agreement under subsection (a), the period during
which payments under such an award will be made to the recipient
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785

PUBLIC HEALTH SERVICE ACT

Sec. 591

may not exceed 5 years. Such grants, contracts or agreements may
be renewed.
(f ) AUTHORIZATION OF APPROPRIATIONS.—There is authorized
to be appropriated to carry out this section, $50,000,000 for fiscal
year 2001, and such sums as may be necessary for each of fiscal
years 2003 through 2006.
(g) SHORT TITLE.—This section may be cited as the ‘‘Donald J.
Cohen National Child Traumatic Stress Initiative’’.

PART H—REQUIREMENT RELATING TO THE
RIGHTS OF RESIDENTS OF CERTAIN FACILITIES
SEC. 591. ø290ii¿ REQUIREMENT RELATING TO THE RIGHTS OF RESIDENTS OF CERTAIN FACILITIES.
(a) IN GENERAL.—A public or private general hospital, nursing

facility, intermediate care facility, or other health care facility, that
receives support in any form from any program supported in whole
or in part with funds appropriated to any Federal department or
agency shall protect and promote the rights of each resident of the
facility, including the right to be free from physical or mental
abuse, corporal punishment, and any restraints or involuntary seclusions imposed for purposes of discipline or convenience.
(b) REQUIREMENTS.—Restraints and seclusion may only be imposed on a resident of a facility described in subsection (a) if—
(1) the restraints or seclusion are imposed to ensure the
physical safety of the resident, a staff member, or others; and
(2) the restraints or seclusion are imposed only upon the
written order of a physician, or other licensed practitioner permitted by the State and the facility to order such restraint or
seclusion, that specifies the duration and circumstances under
which the restraints are to be used (except in emergency circumstances specified by the Secretary until such an order
could reasonably be obtained).
(c) CURRENT LAW.—This part shall not be construed to affect
or impede any Federal or State law or regulations that provide
greater protections than this part regarding seclusion and restraint.
(d) DEFINITIONS.—In this section:
(1) RESTRAINTS.—The term ‘‘restraints’’ means—
(A) any physical restraint that is a mechanical or personal restriction that immobilizes or reduces the ability of
an individual to move his or her arms, legs, or head freely,
not including devices, such as orthopedically prescribed devices, surgical dressings or bandages, protective helmets,
or any other methods that involves the physical holding of
a resident for the purpose of conducting routine physical
examinations or tests or to protect the resident from falling out of bed or to permit the resident to participate in
activities without the risk of physical harm to the resident
(such term does not include a physical escort); and
(B) a drug or medication that is used as a restraint to
control behavior or restrict the resident’s freedom of moveMarch 13, 2013

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Sec. 592

PUBLIC HEALTH SERVICE ACT

786

ment that is not a standard treatment for the resident’s
medical or psychiatric condition.
(2) SECLUSION.—The term ‘‘seclusion’’ means a behavior
control technique involving locked isolation. Such term does
not include a time out.
(3) PHYSICAL ESCORT.—The term ‘‘physical escort’’ means
the temporary touching or holding of the hand, wrist, arm,
shoulder or back for the purpose of inducing a resident who is
acting out to walk to a safe location.
(4) TIME OUT.—The term ‘‘time out’’ means a behavior
management technique that is part of an approved treatment
program and may involve the separation of the resident from
the group, in a non-locked setting, for the purpose of calming.
Time out is not seclusion.
SEC. 592. ø290ii–1¿ REPORTING REQUIREMENT.
(a) IN GENERAL.—Each facility to which

the Protection and Advocacy for Mentally Ill Individuals Act of 1986 1 applies shall notify
the appropriate agency, as determined by the Secretary, of each
death that occurs at each such facility while a patient is restrained
or in seclusion, of each death occurring within 24 hours after the
patient has been removed from restraints and seclusion, or where
it is reasonable to assume that a patient’s death is a result of such
seclusion or restraint. A notification under this section shall include the name of the resident and shall be provided not later than
7 days after the date of the death of the individual involved.
(b) FACILITY.—In this section, the term ‘‘facility’’ has the meaning given the term ‘‘facilities’’ in section 102(3) of the Protection
and Advocacy for Mentally Ill Individuals Act of 1986 1 (42 U.S.C.
10802(3)).
SEC. 593. 2 ø290ii–3¿ REGULATIONS AND ENFORCEMENT.
(a) TRAINING.—Not later than 1 year after the date

of the enactment of this part, the Secretary, after consultation with appropriate State and local protection and advocacy organizations, physicians, facilities, and other health care professionals and patients,
shall promulgate regulations that require facilities to which the
Protection and Advocacy for Mentally Ill Individuals Act of 1986 1
(42 U.S.C. 10801 et seq.) applies, to meet the requirements of subsection (b).
(b) REQUIREMENTS.—The regulations promulgated under subsection (a) shall require that—
(1) facilities described in subsection (a) ensure that there
is an adequate number of qualified professional and supportive
staff to evaluate patients, formulate written individualized,
comprehensive treatment plans, and to provide active treatment measures;
1 Probably should be Protection and Advocacy for Individuals with Mental Illness Act. See section 3206(a) of Public Law 106–310 (114 Stat. 1193).
2 Section 593 appears according to the probable intent of the Congress. Section 3207 of Public
Law 106–310 (114 Stat. 1196) added sections 591 and 592, and closing quotations were provided
at the end of section 592. Immediately following that section, however, section 593 appeared in
quotations, and closing quotations were provided at the end of the section. The probable intent
of the Congress is that closing quotations should not have been provided at the end of section
592.
1 See footnote for subsection (a).

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787

PUBLIC HEALTH SERVICE ACT

Sec. 595

(2) appropriate training be provided for the staff of such
facilities in the use of restraints and any alternatives to the
use of restraints; and
(3) such facilities provide complete and accurate notification of deaths, as required under section 592(a).
(c) ENFORCEMENT.—A facility to which this part applies that
fails to comply with any requirement of this part, including a failure to provide appropriate training, shall not be eligible for participation in any program supported in whole or in part by funds appropriated to any Federal department or agency.

PART I—REQUIREMENT RELATING TO THE
RIGHTS OF RESIDENTS OF CERTAIN NONMEDICAL, COMMUNITY-BASED FACILITIES
FOR CHILDREN AND YOUTH
SEC. 595. ø290jj¿ REQUIREMENT RELATING TO THE RIGHTS OF RESIDENTS OF CERTAIN NON-MEDICAL, COMMUNITY-BASED
FACILITIES FOR CHILDREN AND YOUTH.
(a) PROTECTION OF RIGHTS.—
(1) IN GENERAL.—A public or private non-medical, commu-

nity-based facility for children and youth (as defined in regulations to be promulgated by the Secretary) that receives support
in any form from any program supported in whole or in part
with funds appropriated under this Act shall protect and promote the rights of each resident of the facility, including the
right to be free from physical or mental abuse, corporal punishment, and any restraints or involuntary seclusions imposed for
purposes of discipline or convenience.
(2) NONAPPLICABILITY.—Notwithstanding this part, a facility that provides inpatient psychiatric treatment services for
individuals under the age of 21, as authorized and defined in
subsections (a)(16) and (h) of section 1905 of the Social Security Act, shall comply with the requirements of part H.
(3) APPLICABILITY OF MEDICAID PROVISIONS.—A non-medical, community-based facility for children and youth funded
under the Medicaid program under title XIX of the Social Security Act shall continue to meet all existing requirements for
participation in such program that are not affected by this
part.
(b) REQUIREMENTS.—
(1) IN GENERAL.—Physical restraints and seclusion may
only be imposed on a resident of a facility described in subsection (a) if—
(A) the restraints or seclusion are imposed only in
emergency circumstances and only to ensure the immediate physical safety of the resident, a staff member, or
others and less restrictive interventions have been determined to be ineffective; and
(B) the restraints or seclusion are imposed only by an
individual trained and certified, by a State-recognized body
(as defined in regulation promulgated by the Secretary)
and pursuant to a process determined appropriate by the
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Sec. 595

PUBLIC HEALTH SERVICE ACT

788

State and approved by the Secretary, in the prevention
and use of physical restraint and seclusion, including the
needs and behaviors of the population served, relationship
building, alternatives to restraint and seclusion, de-escalation methods, avoiding power struggles, thresholds for
restraints and seclusion, the physiological and psychological impact of restraint and seclusion, monitoring physical signs of distress and obtaining medical assistance,
legal issues, position asphyxia, escape and evasion techniques, time limits, the process for obtaining approval for
continued restraints, procedures to address problematic restraints, documentation, processing with children, and follow-up with staff, and investigation of injuries and complaints.
(2) INTERIM PROCEDURES RELATING TO TRAINING AND CERTIFICATION.—
(A) IN GENERAL.—Until such time as the State develops a process to assure the proper training and certification of facility personnel in the skills and competencies
referred in paragraph (1)(B), the facility involved shall develop and implement an interim procedure that meets the
requirements of subparagraph (B).
(B) REQUIREMENTS.—A procedure developed under
subparagraph (A) shall—
(i) ensure that a supervisory or senior staff person
with training in restraint and seclusion who is competent to conduct a face-to-face assessment (as defined
in regulations promulgated by the Secretary), will assess the mental and physical well-being of the child or
youth being restrained or secluded and assure that the
restraint or seclusion is being done in a safe manner;
(ii) ensure that the assessment required under
clause (i) take place as soon as practicable, but in no
case later than 1 hour after the initiation of the restraint or seclusion; and
(iii) ensure that the supervisory or senior staff
person continues to monitor the situation for the duration of the restraint and seclusion.
(3) LIMITATIONS.—
(A) IN GENERAL.—The use of a drug or medication that
is used as a restraint to control behavior or restrict the
resident’s freedom of movement that is not a standard
treatment for the resident’s medical or psychiatric condition in nonmedical community-based facilities for children
and youth described in subsection (a)(1) is prohibited.
(B) PROHIBITION.—The use of mechanical restraints in
non-medical, community-based facilities for children and
youth described in subsection (a)(1) is prohibited.
(C) LIMITATION.—A non-medical, community-based facility for children and youth described in subsection (a)(1)
may only use seclusion when a staff member is continuously face-to-face monitoring the resident and when strong
licensing or accreditation and internal controls are in
place.
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789

PUBLIC HEALTH SERVICE ACT

Sec. 595B

(c) RULE OF CONSTRUCTION.—
(1) IN GENERAL.—Nothing in this section shall be construed as prohibiting the use of restraints for medical immobilization, adaptive support, or medical protection.
(2) CURRENT LAW.—This part shall not be construed to affect or impede any Federal or State law or regulations that
provide greater protections than this part regarding seclusion
and restraint.
(d) DEFINITIONS.—In this section:
(1) MECHANICAL RESTRAINT.—The term ‘‘mechanical restraint’’ means the use of devices as a means of restricting a
resident’s freedom of movement.
(2) PHYSICAL ESCORT.—The term ‘‘physical escort’’ means
the temporary touching or holding of the hand, wrist, arm,
shoulder or back for the purpose of inducing a resident who is
acting out to walk to a safe location.
(3) PHYSICAL RESTRAINT.—The term ‘‘physical restraint’’
means a personal restriction that immobilizes or reduces the
ability of an individual to move his or her arms, legs, or head
freely. Such term does not include a physical escort.
(4) SECLUSION.—The term ‘‘seclusion’’ means a behavior
control technique involving locked isolation. Such term does
not include a time out.
(5) TIME OUT.—The term ‘‘time out’’ means a behavior
management technique that is part of an approved treatment
program and may involve the separation of the resident from
the group, in a non-locked setting, for the purpose of calming.
Time out is not seclusion.
SEC. 595A. ø290jj–1¿ REPORTING REQUIREMENT.

Each facility to which this part applies shall notify the appropriate State licensing or regulatory agency, as determined by the
Secretary—
(1) of each death that occurs at each such facility. A notification under this section shall include the name of the resident
and shall be provided not later than 24 hours after the time
of the individuals death; and
(2) of the use of seclusion or restraints in accordance with
regulations promulgated by the Secretary, in consultation with
the States.
SEC. 595B. ø290jj–2¿ REGULATIONS AND ENFORCEMENT.
(a) TRAINING.—Not later than 6 months after the

date of the
enactment of this part, the Secretary, after consultation with appropriate State, local, public and private protection and advocacy
organizations, health care professionals, social workers, facilities,
and patients, shall promulgate regulations that—
(1) require States that license non-medical, communitybased residential facilities for children and youth to develop licensing rules and monitoring requirements concerning behavior management practice that will ensure compliance with Federal regulations and to meet the requirements of subsection
(b);
(2) require States to develop and implement such licensing
rules and monitoring requirements within 1 year after the pro-

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Sec. 581

PUBLIC HEALTH SERVICE ACT

790

mulgation of the regulations referred to in the matter preceding paragraph (1); and
(3) support the development of national guidelines and
standards on the quality, quantity, orientation and training,
required under this part, as well as the certification or licensure of those staff responsible for the implementation of behavioral intervention concepts and techniques.
(b) REQUIREMENTS.—The regulations promulgated under subsection (a) shall require—
(1) that facilities described in subsection (a) ensure that
there is an adequate number of qualified professional and supportive staff to evaluate residents, formulate written individualized, comprehensive treatment plans, and to provide active
treatment measures;
(2) the provision of appropriate training and certification of
the staff of such facilities in the prevention and use of physical
restraint and seclusion, including the needs and behaviors of
the population served, relationship building, alternatives to restraint, de-escalation methods, avoiding power struggles,
thresholds for restraints, the physiological impact of restraint
and seclusion, monitoring physical signs of distress and obtaining medical assistance, legal issues, position asphyxia, escape
and evasion techniques, time limits for the use of restraint and
seclusion, the process for obtaining approval for continued restraints and seclusion, procedures to address problematic restraints, documentation, processing with children, and followup with staff, and investigation of injuries and complaints; and
(3) that such facilities provide complete and accurate notification of deaths, as required under section 595A(1).
(c) ENFORCEMENT.—A State to which this part applies that
fails to comply with any requirement of this part, including a failure to provide appropriate training and certification, shall not be
eligible for participation in any program supported in whole or in
part by funds appropriated under this Act.
PART G 1—SERVICES PROVIDED THROUGH RELIGIOUS
ORGANIZATIONS 2
SEC. 581. 1 ø290kk¿ APPLICABILITY TO DESIGNATED PROGRAMS.
(a) DESIGNATED PROGRAMS.—Subject to subsection (b),

this
part applies to discretionary and formula grant programs administered by the Substance Abuse and Mental Health Services Administration that make awards of financial assistance to public or private entities for the purpose of carrying out activities to prevent or
treat substance abuse (in this part referred to as a ‘‘designated pro1 There are two parts G in this title. The first was added by section 3101 of Public Law 106–
310 (114 Stat. 1168) and relates to projects for children and violence; that part also begins with
section 581. See page 669. Sections 3207 and 3208 of such Public Law (114 Stat. 1195, 1197)
added parts H and I, respectively.
Subsequently, part G above was added by section 144 of the Community Renewal Tax Relief
Act of 2000 (as enacted into law by section 1(a)(7) of Public Law 106–554; 114 Stat. 2763A–
619), which provides that title V of this Act ‘‘is amended by adding at the end the following
part:’’, thereby placing that part G after the part I added by Public Law 106–310.
2 Section 1955 of this Act also relates to religious organizations as providers of substance
abuse services. That section was added by section 3305 of Public Law 106–310 (114 Stat. 1212).

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791

PUBLIC HEALTH SERVICE ACT

Sec. 582

gram’’). Designated programs include the program under subpart II
of part B of title XIX (relating to formula grants to the States).
(b) LIMITATION.—This part does not apply to any award of financial assistance under a designated program for a purpose other
than the purpose specified in subsection (a).
(c) DEFINITIONS.—For purposes of this part (and subject to subsection (b)):
(1) The term ‘‘designated program’’ has the meaning given
such term in subsection (a).
(2) The term ‘‘financial assistance’’ means a grant, cooperative agreement, or contract.
(3) The term ‘‘program beneficiary’’ means an individual
who receives program services.
(4) The term ‘‘program participant’’ means a public or private entity that has received financial assistance under a designated program.
(5) The term ‘‘program services’’ means treatment for substance abuse, or preventive services regarding such abuse, provided pursuant to an award of financial assistance under a
designated program.
(6) The term ‘‘religious organization’’ means a nonprofit religious organization.
SEC. 582. ø290kk–1¿ RELIGIOUS ORGANIZATIONS AS PROGRAM PARTICIPANTS.
(a) IN GENERAL.—Notwithstanding any other provision of law,

a religious organization, on the same basis as any other nonprofit
private provider—
(1) may receive financial assistance under a designated
program; and
(2) may be a provider of services under a designated program.
(b) RELIGIOUS ORGANIZATIONS.—The purpose of this section is
to allow religious organizations to be program participants on the
same basis as any other nonprofit private provider without impairing the religious character of such organizations, and without diminishing the religious freedom of program beneficiaries.
(c) NONDISCRIMINATION AGAINST RELIGIOUS ORGANIZATIONS.—
(1) ELIGIBILITY AS PROGRAM PARTICIPANTS.—Religious organizations are eligible to be program participants on the same
basis as any other nonprofit private organization as long as the
programs are implemented consistent with the Establishment
Clause and Free Exercise Clause of the First Amendment to
the United States Constitution. Nothing in this Act shall be
construed to restrict the ability of the Federal Government, or
a State or local government receiving funds under such programs, to apply to religious organizations the same eligibility
conditions in designated programs as are applied to any other
nonprofit private organization.
(2) NONDISCRIMINATION.—Neither the Federal Government
nor a State or local government receiving funds under designated programs shall discriminate against an organization
that is or applies to be a program participant on the basis that
the organization has a religious character.
(d) RELIGIOUS CHARACTER AND FREEDOM.—
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Sec. 582

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(1) RELIGIOUS ORGANIZATIONS.—Except as provided in this
section, any religious organization that is a program participant shall retain its independence from Federal, State, and
local government, including such organization’s control over
the definition, development, practice, and expression of its religious beliefs.
(2) ADDITIONAL SAFEGUARDS.—Neither the Federal Government nor a State shall require a religious organization to—
(A) alter its form of internal governance; or
(B) remove religious art, icons, scripture, or other symbols,
in order to be a program participant.
(e) EMPLOYMENT PRACTICES.—Nothing in this section shall be
construed to modify or affect the provisions of any other Federal or
State law or regulation that relates to discrimination in employment. A religious organization’s exemption provided under section
702 of the Civil Rights Act of 1964 regarding employment practices
shall not be affected by its participation in, or receipt of funds
from, a designated program.
(f ) RIGHTS OF PROGRAM BENEFICIARIES.—
(1) IN GENERAL.—If an individual who is a program beneficiary or a prospective program beneficiary objects to the religious character of a program participant, within a reasonable
period of time after the date of such objection such program
participant shall refer such individual to, and the appropriate
Federal, State, or local government that administers a designated program or is a program participant shall provide to
such individual (if otherwise eligible for such services), program services that—
(A) are from an alternative provider that is accessible
to, and has the capacity to provide such services to, such
individual; and
(B) have a value that is not less than the value of the
services that the individual would have received from the
program participant to which the individual had such objection.
Upon referring a program beneficiary to an alternative provider, the program participant shall notify the appropriate
Federal, State, or local government agency that administers
the program of such referral.
(2) NOTICES.—Program participants, public agencies that
refer individuals to designated programs, and the appropriate
Federal, State, or local governments that administer designated programs or are program participants shall ensure
that notice is provided to program beneficiaries or prospective
program beneficiaries of their rights under this section.
(3) ADDITIONAL REQUIREMENTS.—A program participant
making a referral pursuant to paragraph (1) shall—
(A) prior to making such referral, consider any list
that the State or local government makes available of entities in the geographic area that provide program services;
and
(B) ensure that the individual makes contact with the
alternative provider to which the individual is referred.
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PUBLIC HEALTH SERVICE ACT

Sec. 584

(4) NONDISCRIMINATION.—A religious organization that is a
program participant shall not in providing program services or
engaging in outreach activities under designated programs discriminate against a program beneficiary or prospective program beneficiary on the basis of religion or religious belief.
(g) FISCAL ACCOUNTABILITY.—
(1) IN GENERAL.—Except as provided in paragraph (2), any
religious organization that is a program participant shall be
subject to the same regulations as other recipients of awards
of Federal financial assistance to account, in accordance with
generally accepted auditing principles, for the use of the funds
provided under such awards.
(2) LIMITED AUDIT.—With respect to the award involved, a
religious organization that is a program participant shall segregate Federal amounts provided under award into a separate
account from non-Federal funds. Only the award funds shall be
subject to audit by the government.
(h) COMPLIANCE.—With respect to compliance with this section
by an agency, a religious organization may obtain judicial review
of agency action in accordance with chapter 7 of title 5, United
States Code.
SEC. 583. ø290kk–2¿ LIMITATIONS ON USE OF FUNDS FOR CERTAIN
PURPOSES.

No funds provided under a designated program shall be expended for sectarian worship, instruction, or proselytization.
SEC. 584. ø290kk–3¿ EDUCATIONAL REQUIREMENTS FOR PERSONNEL
IN DRUG TREATMENT PROGRAMS.
(a) FINDINGS.—The Congress finds that—

(1) establishing unduly rigid or uniform educational qualification for counselors and other personnel in drug treatment
programs may undermine the effectiveness of such programs;
and
(2) such educational requirements for counselors and other
personnel may hinder or prevent the provision of needed drug
treatment services.
(b) NONDISCRIMINATION.—In determining whether personnel of
a program participant that has a record of successful drug treatment for the preceding three years have satisfied State or local requirements for education and training, a State or local government
shall not discriminate against education and training provided to
such personnel by a religious organization, so long as such education and training includes basic content substantially equivalent
to the content provided by nonreligious organizations that the
State or local government would credit for purposes of determining
whether the relevant requirements have been satisfied.

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TITLE VI—ASSISTANCE FOR CONSTRUCTION AND MODERNIZATION OF HOSPITALS AND OTHER MEDICAL FACILITIES
DECLARATION OF PURPOSE

SEC. 600. ø291¿ The purpose of this title is—
(a) to assist the several States in the carrying out of their
programs for the construction and modernization of such public
or other nonprofit community hospitals and other medical facilities as may be necessary, in conjunction with existing facilities, to furnish adequate hospital, clinic, or similar services to
all their people;
(b) to stimulate the development of new or improved types
of physical facilities for medical, diagnostic, preventive, treatment, or rehabilitative services; and
(c) to promote research, experiments, and demonstrations
relating to the effective development and utilization of hospital,
clinic, or similar services, facilities, and resources, and to promote the coordination of such research, experiments, and demonstrations and the useful application of their results.
PART A—GRANTS AND LOANS FOR CONSTRUCTION AND
MODERNIZATION OF HOSPITALS AND OTHER MEDICAL FACILITIES
AUTHORIZATION OF APPROPRIATIONS FOR CONSTRUCTION AND
MODERNIZATION GRANTS

SEC. 601. ø291a¿ In order to assist the States in carrying out
the purposes of section 600, there are authorized to be appropriated—
(a) for the fiscal year ending June 30, 1974—
(1) $20,800,000 for grants for the construction of public or
other nonprofit facilities for long-term care;
(2) $70,000,000 for grants for the construction of public or
other nonprofit outpatient facilities;
(3) $15,000,000 for grants for the construction of public or
other nonprofit rehabilitation facilities;
(b) for grants for the construction of public or other nonprofit
hospitals and public health centers, $150,000,000 for the fiscal year
ending June 30, 1965, $160,000,000 for the fiscal year ending June
30, 1966, $170,000,000 for the fiscal year ending June 30, 1967,
$180,000,000 each for the next two fiscal years, $195,000,000 for
the fiscal year ending June 30, 1970, $147,500,000 for the fiscal
year ending June 30, 1971, $152,500,000 for the fiscal year ending
June 30, 1972, $157,500,000 for the fiscal year ending June 30,
1973, and $41,400,000 for the fiscal year ending June 30, 1974; and
(c) for grants for modernization of the facilities referred to in
paragraphs (a) and (b), $65,000,000 for the fiscal year ending June
794
March 13, 2013

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795

PUBLIC HEALTH SERVICE ACT

Sec. 602

30, 1971, $80,000,000 for the fiscal year ending June 30, 1972,
$90,000,000 for the fiscal year ending June 30, 1973, and
$50,000,000 for the fiscal year ending June 30, 1974.
STATE ALLOTMENTS

SEC. 602. ø291b¿ (a)(1) Each State shall be entitled for each
fiscal year to an allotment bearing the same ratio to the sums appropriated for such year pursuant to subparagraphs (1), (2), and
(3), respectively, of section 601(a), and to an allotment bearing the
same ratio to the sums appropriated for such year pursuant to section 601(b), as the product of—
(A) the population of such State, and
(B) the square of its allotment percentage,
bears to the sum of the corresponding products for all of the States.
(2) For each fiscal year, the Secretary shall, in accordance with
regulations, make allotments among the States, from the sums appropriated for such year under section 601(c), on the basis of the
population, the financial need, and the extent of the need for modernization of the facilities referred to in paragraphs (a) and (b) of
section 601, of the respective States.
(b)(1) The allotment to any State under subsection (a) for any
fiscal year which is less than—
(A) $50,000 for the Virgin Islands, American Samoa, the
Trust Territory of the Pacific Islands, or Guam and $100,000
for any other State, in the case of an allotment for grants for
the construction of public or other nonprofit rehabilitation facilities.
(B) $100,000 for the Virgin Islands, American Samoa, the
Trust Territory of the Pacific Islands, or Guam and $200,000
for any other State in the case of an allotment for grants for
the construction of public or other nonprofit outpatient facilities.
(C) $200,000 for the Virgin Islands, American Samoa, the
Trust Territory of the Pacific Islands, or Guam and $300,000
for any other State in the case of an allotment for grants for
the construction of public or other nonprofit facilities for longterm care or for the construction of public or other nonprofit
hospitals and public health centers, or for the modernization of
facilities referred to in paragraph (a) or (b) of section 601, or
(D) $200,000 for the Virgin Islands, American Samoa, the
Trust Territory of the Pacific Islands, or Guam and $300,000
for any other State in the case of an allotment for grants for
the modernization of facilities referred to in paragraphs (a) and
(b) of section 601,
shall be increased to that amount, the total of the increases thereby required being derived by proportionately reducing the allotment from appropriations under such subparagraph or paragraph
to each of the remaining States under subsection (a) of this section,
but with such adjustments as may be necessary to prevent the allotment of any of such remaining States from appropriations under
such subparagraph or paragraph from being thereby reduced to
less than that amount.
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Sec. 602

PUBLIC HEALTH SERVICE ACT

796

(2) An allotment of the Virgin Islands, American Samoa, the
Trust Territory of the Pacific Islands, or Guam for any fiscal year
may be increased as provided in paragraph (1) only to the extent
it satisfies the Surgeon General, at such time prior to the beginning of such year as the Surgeon General may designate, that such
increase will be used for payments under and in accordance with
the provisions of this part.
(c) For the purposes of this part—
(1) The ‘‘allotment percentage’’ for any State shall be 100
per centum less that percentage which bears the same ratio to
50 per centum as the per capita income of such State bears to
the per capita income of the United States, except that (A) the
allotment percentage shall in no case be more than 75 per centum or less than 331⁄3 per centum, and (B) the allotment percentage for the Commonwealth of Puerto Rico, Guam, American Samoa, the Trust Territory of the Pacific Islands, and the
Virgin Islands shall be 75 per centum.
(2) The allotment percentages shall be determined by the
Surgeon General between July 1 and September 30 of each
even-numbered year, on the basis of the average of the per capita incomes of each of the States and of the United States for
the three most recent consecutive years for which satisfactory
data are available from the Department of Commerce, and the
States shall be notified promptly thereof. Such determination
shall be conclusive for each of the two fiscal years in the period
beginning July 1 next succeeding such determination.
(3) The population of the several States shall be determined on the basis of the latest figures certified by the Department of Commerce.
(4) The term ‘‘United States’’ means (but only for purposes
of paragraphs (1) and (2)) the fifty States and the District of
Columbia.
(d)(1) Any sum allotted to a State, other than the Virgin Islands, American Samoa, the Trust Territory of the Pacific Islands,
and Guam for a fiscal year under this section and remaining unobligated at the end of such year shall remain available to such
State, for the purpose for which made, for the next two fiscal years
(and for such years only), in addition to the sums allotted to such
State for such purposes for such next two fiscal years.
(2) Any sum allotted to the Virgin Islands, American Samoa,
the Trust Territory of the Pacific Islands, or Guam for a fiscal year
under this section and remaining unobligated at the end of such
year shall remain available to it, for the purpose for which made,
for the next two fiscal years (and for such years only), in addition
to the sums allotted to it for such purpose for each of such next
two fiscal years.
(e)(1) Upon the request of any State that a specified portion of
any allotment of such State under subsection (a) for any fiscal year
be added to any other allotment or allotments of such State under
such subsection for such year, the Secretary shall promptly (but
after application of subsection (b)) adjust the allotments of such
State in accordance with such request and shall notify the State
agency; except that the aggregate of the portions so transferred
from an allotment for a fiscal year pursuant to this paragraph may
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797

PUBLIC HEALTH SERVICE ACT

Sec. 602

not exceed the amount specified with respect to such allotment in
clause (A), (B), (C), or (D), as the case may be, of subsection (b)(1)
which is applicable to such State.
(2) In addition to the transfer of portions of allotments under
paragraph (1), upon the request of any State that a specified portion of any allotment of such State under subsection (a), other than
an allotment for grants for the construction of public or other nonprofit rehabilitation facilities, be added to another allotment of
such State under such subsection, other than an allotment for
grants for the construction of public or other nonprofit hospitals
and public health centers, and upon simultaneous certification to
the Secretary by the State agency in such State to the effect that—
(A) it has afforded a reasonable opportunity to make applications for the portion so specified and there have been no approvable applications for such portions, or
(B) in the case of a request to transfer a portion of an allotment for grants for the construction of public or other nonprofit hospitals and public health centers, use of such portion
as requested by such State agency will better carry out the
purposes of this title,
the Secretary shall promptly (but after application of subsection
(b)) adjust the allotments of such State in accordance with such request and shall notify the State agency.
(3) In addition to the transfer of portions of allotments under
paragraph (1) or (2), upon the request of any State that a specified
portion of an allotment of such State under paragraph (2) of subsection (a) be added to an allotment of such State under paragraph
(1) of such subsection for grants for the construction of public or
other nonprofit hospitals and public health centers, and upon simultaneous certification by the State agency in such State to the
effect that the need for new public or other nonprofit hospitals and
public health centers is substantially greater than the need for
modernization of facilities referred to in paragraph (a) or (b) of section 601, the Secretary shall promptly (but after application of subsection (b) of this section) adjust the allotments of such State in accordance with such request and shall notify the State agency.
(4) After adjustment of allotments of any State, as provided in
paragraph (1), (2), or (3) of this subsection, the allotments as so adjusted shall be deemed to be the State’s allotments under this section.
(f) In accordance with regulations, any State may file with the
Surgeon General a request that a specified portion of an allotment
to it under this part for grants for construction of any type of facility, or for modernization of facilities, be added to the corresponding
allotment of another State for the purpose of meeting a portion of
the Federal share of the cost of a project for the construction of a
facility of that type in such other State, or for modernization of a
facility in such other State, as the case may be. If it is found by
the Surgeon General (or, in the case of a rehabilitation facility, by
the Surgeon General and the Secretary) that construction or modernization of the facility with respect to which the request is made
would meet needs of the State making the request and that use of
the specified portion of such State’s allotment, as requested by it,
would assist in carrying out the purposes of this title, such portion
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Sec. 603

PUBLIC HEALTH SERVICE ACT

798

of such State’s allotment shall be added to the corresponding allotment of the other State, to be used for the purpose referred to
above.
GENERAL REGULATIONS

SEC. 603. ø291c¿ The Surgeon General, with the approval of
the Federal Hospital Council and the Secretary of Health, Education, and Welfare, shall by general regulations prescribe—
(a) the general manner in which the State agency shall determine the priority of projects based on the relative need of different
areas lacking adequate facilities of various types for which assistance is available under this part, giving special consideration—
(1) in the case of projects for the construction of hospitals,
to facilities serving areas with relatively small financial resources and, at the option of the State, rural communities;
(2) in the case of projects for the construction of rehabilitation facilities, to facilities operated in connection with a university teaching hospital which will provide an integrated program of medical, psychological, social, and vocational evaluation and services under competent supervision;
(3) in the case of projects for modernization of facilities, to
facilities serving densely populated areas;
(4) in the case of projects for construction or modernization
of outpatient facilities, to any outpatient facility that will be located in, and provide services for residents of, an area determined by the Secretary to be a rural or urban poverty area;
(5) to projects for facilities which, alone or in conjunction
with other facilities, will provide comprehensive health care,
including outpatient and preventive care as well as hospitalization;
(6) to facilities which will provide training in health or allied health professions; and
(7) to facilities which will provide to a significant extent,
for the treatment of alcoholism;
(b) general standards of construction and equipment for facilities of different classes and in different types of location, for which
assistance is available under this part;
(c) criteria for determining needs for general hospital and longterm care beds, and needs for hospitals and other facilities for
which aid under this part is available, and for developing plans for
the distribution of such beds and facilities;
(d) criteria for determining the extent to which existing facilities, for which aid under this part is available, are in need of modernization; and
(e) that the State plan shall provide for adequate hospitals,
and other facilities for which aid under this part is available, for
all persons residing in the State, and adequate hospitals (and such
other facilities) to furnish needed services for persons unable to pay
therefor. Such regulations may also require that before approval of
an application for a project is recommended by a State agency to
the Surgeon General for approval under this part, assurance shall
be received by the State from the applicant that (1) the facility or
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799

PUBLIC HEALTH SERVICE ACT

Sec. 604

able to all persons residing in the territorial area of the applicant;
and (2) there will be made available in the facility or portion thereof to be constructed or modernized a reasonable volume of services
to persons unable to pay therefor, but an exception shall be made
if such a requirement is not feasible from a financial viewpoint.
STATE PLANS

SEC. 604. ø291d¿ (a) Any State desiring to participate in this
part may submit a State plan. Such plan must—
(1) designate a single State agency as the sole agency for
the administration of the plan, or designate such agency as the
sole agency for supervising the administration of the plan;
(2) contain satisfactory evidence that the State agency designated in accordance with paragraph (1) will have authority
to carry out such plan in conformity with this part;
(3) provide for the designation of a State advisory council
which shall include (A) representatives of nongovernmental organizations or groups, and of public agencies, concerned with
the operation, construction, or utilization of hospital or other
facilities for diagnosis, prevention, or treatment of illness or
disease, or for provision of rehabilitation services, and representatives particularly concerned with education or training
of health professions personnel, and (B) an equal number of
representatives of consumers familiar with the need for the
services provided by such facilities, to consult with the State
agency in carrying out the plan, and provide, if such council
does not include any representatives of nongovernmental organizations or groups, or State agencies, concerned with rehabilitation, for consultation with organizations, groups, and State
agencies so concerned;
(4) set forth, in accordance with criteria established in regulations prescribed under section 603 and on the basis of a
statewide inventory of existing facilities, a survey of need, and
(except to the extent provided by or pursuant to such regulations) community, area, or regional plans—
(A) the number of general hospital beds and long-term
care beds, and the number and types of hospital facilities
and facilities for long-term care, needed to provide adequate facilities for inpatient care of people residing in the
State, and a plan for the distribution of such beds and facilities in service areas throughout the State;
(B) the public health centers needed to provide adequate public health services for people residing in the
State, and a plan for the distribution of such centers
throughout the State;
(C) the outpatient facilities needed to provide adequate diagnostic or treatment services to ambulatory patients residing in the State, and a plan for distribution of
such facilities throughout the State;
(D) the rehabilitation facilities needed to assure adequate rehabilitation services for disabled persons residing
in the State, and a plan for distribution of such facilities
throughout the State; and
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Sec. 604

PUBLIC HEALTH SERVICE ACT

800

(E) effective January 1, 1966, the extent to which existing facilities referred to in section 601 (a) or (b) in the
State are in need of modernization;
(5) set forth a construction and modernization program
conforming to the provisions set forth pursuant to paragraph
(4) and regulations prescribed under section 603 and providing
for construction or modernization of the hospital or long-term
care facilities, public health centers, outpatient facilities and
rehabilitation facilities which are needed, as determined under
the provisions so set forth pursuant to paragraph (4);
(6) set forth, with respect to each of such types of medical
facilities, the relative need, determined in accordance with regulations prescribed under section 603, for projects for facilities
of that type, and provide for the construction or modernization,
insofar as financial resources available therefor and for maintenance and operation make possible, in the order of such relative need;
(7) provide minimum standards (to be fixed in the discretion of the State) for the maintenance and operation of facilities providing inpatient care which receive aid under this part
and, effective July 1, 1966, provide for enforcement of such
standards with respect to projects approved by the Surgeon
General under this part after June 30, 1964;
(8) provide such methods of administration of the State
plan, including methods relating to the establishment and
maintenance of personnel standards on a merit basis (except
that the Surgeon General shall exercise no authority with respect to the selection, tenure of office, or compensation of any
individual employed in accordance with such methods), as are
found by the Surgeon General to be necessary for the proper
and efficient operation of the plan;
(9) provide for affording to every applicant for a construction or modernization project an opportunity for a hearing before the State agency;
(10) provide that the State agency will make such reports,
in such form and containing such information, as the Surgeon
General may from time to time reasonably require, and will
keep such records and afford such access thereto as the Surgeon General may find necessary to assure the correctness and
verification of such reports;
(11) provide that the Comptroller General of the United
States or his duly authorized representatives shall have access
for the purpose of audit and examination to the records specified in paragraph (10);
(12) provide that the State agency will from time to time,
but not less often than annually, review its State plan and submit to the Surgeon General any modifications thereof which it
considers necessary; and
(13) effective July 1, 1971, provide that before any project
for construction or modernization of any general hospital is approved by the State agency there will be reasonable assurance
of adequate provision for extended care services (as determined
in accordance with regulations) to patients of such hospital
when such services are medically appropriate for them, with
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801

PUBLIC HEALTH SERVICE ACT

Sec. 605

such services being provided in facilities which (A) are structurally part of, physically connected with, or in immediate
proximity to, such hospital, and (B) either (i) are under the supervision of the professional staff of such hospital or (ii) have
organized medical staffs and have in effect transfer agreements
with such hospital; except that the Secretary may, at the request of the State agency, waive compliance with clause (A) or
(B), or both such clauses, as the case may be, in the case of
any project if the State agency has determined that compliance
with such clause or clauses in such case would be inadvisable.
(b) The Surgeon General shall approve any State plan and any
modification thereof which complies with the provisions of subsection (a). If any such plan or modification thereof shall have been
disapproved by the Surgeon General for failure to comply with subsection (a), the Federal Hospital Council shall, upon request of the
State agency, afford it an opportunity for hearing. If such Council
determines that the plan or modification complies with the provisions of such subsection, the Surgeon General shall thereupon approve such plan or modification.
APPROVAL OF PROJECTS FOR CONSTRUCTION OR MODERNIZATION

SEC. 605. ø291e¿ (a) For each project pursuant to a State plan
approved under this part, there shall be submitted to the Surgeon
General, through the State agency, an application by the State or
a political subdivision thereof or by a public or other nonprofit
agency. If two or more such agencies join in the project, the application may be filed by one or more of such agencies. Such application shall set forth—
(1) a description of the site for such project;
(2) plans and specifications therefor, in accordance with
regulations prescribed under section 603;
(3) reasonable assurance that title to such site is or will be
vested on one or more of the agencies filing the application or
in a public or other nonprofit agency which is to operate the
facility on completion of the project;
(4) reasonable assurance that adequate financial support
will be available for the completion of the project and for its
maintenance and operation when completed;
(5) reasonable assurance that all laborers and mechanics
employed by contractors or subcontractors in the performance
of construction or modernization on the project will be paid
wages at rates not less than those prevailing on similar work
in the locality as determined by the Secretary of Labor in accordance with the Davis-Bacon Act, as amended (40 U.S.C.
276a—276a–5); and the Secretary of Labor shall have with respect to the labor standards specified in this paragraph the authority and functions set forth in Reorganization Plan Numbered 14 of 1950 (15 F.R. 3176; 5 U.S.C. 133z–15) and section
2 of the Act of June 13, 1934, as amended (40 U.S.C. 276c);
and
(6) a certification by the State agency of the Federal share
for the project.
(b) The Surgeon General shall approve such application if sufficient funds to pay the Federal share of the cost of such project are
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Sec. 605

PUBLIC HEALTH SERVICE ACT

802

available from the appropriate allotment to the State, and if the
Surgeon General finds (1) that the application contains such reasonable assurance as to title, financial support, and payment of
prevailing rates of wages; (2) that the plans and specifications are
in accord with the regulations prescribed pursuant to section 603;
(3) that the application is in conformity with the State plan approved under section 604 and contains an assurance that in the operation of the project there will be compliance with the applicable
requirements of the regulations prescribed under section 603(e),
and with State standards for operation and maintenance; and (4)
that the application has been approved and recommended by the
State agency, opportunity has been provided, prior to such approval
and recommendation, for consideration of the project by the public
or nonprofit private agency or organization which has developed
the comprehensive regional, metropolitan area, or other local area
plan or plans referred to in section 314(b) covering the area in
which such project is to be located or, if there is no such agency
or organization, by the State agency administering or supervising
the administration of the State plan approved under section 314(a),
and the application is for a project which is entitled to priority over
other projects within the State in accordance with the regulations
prescribed pursuant to section 603(a). Notwithstanding the preceding sentence, the Surgeon General may approve such an application for a project for construction or modernization of a rehabilitation facility only if it is also approved by the Secretary of Health,
Education, and Welfare.
(c) No application shall be disapproved until the Surgeon General has afforded the State agency an opportunity for a hearing.
(d) Amendment of any approved application shall be subject to
approval in the same manner as an original application.
(e) Notwithstanding any other provision of this title, no application for an outpatient facility shall be approved under this section unless the applicant is (1) a State, political subdivision, or
public agency, or (2) a corporation or association which owns and
operates a nonprofit hospital (as defined in section 645) or which
provides reasonable assurance that the services of a general hospital will be available to patients of such facility who are in need
of hospital care.
PAYMENTS FOR CONSTRUCTION OR MODERNIZATION

SEC. 606. ø291f¿ (a) Upon certification to the Surgeon General
by the State agency, based upon inspection by it, that work has
been performed upon a project, or purchases have been made, in
accordance with the approved plans and specifications, and that
payment of an installment is due to the applicant, such installment
shall be paid to the State, from the applicable allotment of such
State, except that (1) if the State is not authorized by law to make
payments to the applicant, or if the State so requests, the payment
shall be made directly to the applicant, (2) if the Surgeon General,
after investigation or otherwise, has reason to believe that any act
(or failure to act) has occurred requiring action pursuant to section
607, payment may, after he has given the State agency notice of
opportunity for hearing pursuant to such section, be withheld, in
whole or in part, pending corrective action or action based on such
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803

PUBLIC HEALTH SERVICE ACT

Sec. 607

hearing, and (3) the total of payments under this subsection with
respect to such project may not exceed an amount equal to the Federal share of the cost of construction of such project.
(b) In case an amendment to an approved application is approved as provided in section 605 or the estimated cost of a project
is revised upward, any additional payment with respect thereto
may be made from the applicable allotment of the State for the fiscal year in which such amendment or revision is approved.
(c)(1) At the request of any State, a portion of any allotment
or allotments of such State under this part shall be available to
pay one-half (or such smaller share as the State may request) of
the expenditures found necessary by the Surgeon General for the
proper and efficient administration during such year of the State
plan approved under this part; except that not more than 4 per
centum of the total of the allotments of such State for a year, or
$100,000, whichever is less, shall be available for such purpose for
such year. Payments of amounts due under this paragraph may be
made in advance or by way of reimbursement, and in such installments, as the Surgeon General may determine.
(2) Any amount paid under paragraph (1) to any State for any
fiscal year shall be paid on condition that there shall be expended
from State sources for such year for administration of the State
plan approved under this part not less than the total amount expended for such purposes from such sources during the fiscal year
ending June 30, 1970.
WITHHOLDING OF PAYMENTS

SEC. 607. ø291g¿ Whenever the Surgeon General, after reasonable notice and opportunity for hearing to the State agency designated as provided in section 604(a)(1), finds—
(a) that the State agency is not complying substantially
with the provisions required by section 604 to be included in
its State plan; or
(b) that any assurance required to be given in an application filed under section 605 is not being or cannot be carried
out; or
(c) that there is a substantial failure to carry out plans
and specifications approved by the Surgeon General under section 605; or
(d) that adequate State funds are not being provided annually for the direct administration of the State plan,
the Surgeon General may forthwith notify the State agency that—
(e) no further payments will be made to the State under
this part, or
(f) no further payments will be made from the allotments
of such State from appropriations under any one or more subparagraphs or paragraphs of section 601, or for any project or
projects, designated by the Surgeon General as being affected
by the action or inaction referred to in paragraph (a), (b), (c),
or (d) of this section, as the Surgeon General may determine
to be appropriate under the circumstances; and, except with regard to any project for which the application has already been
approved and which is not directly affected, further payments
may be withheld, in whole or in part, until there is no longer
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Sec. 608

PUBLIC HEALTH SERVICE ACT

804

any failure to comply (or carry out the assurance or plans and
specifications or provide adequate State funds, as the case may
be) or, if such compliance (or other action) is impossible, until
the State repays or arranges for the repayment of Federal
moneys to which the recipient was not entitled.
JUDICIAL REVIEW

SEC. 608. ø291h¿ (a) If the Surgeon General refuses to approve
any application for a project submitted under section 605 or section
610, the State agency through which such application was submitted, or if any State is dissatisfied with his action under section
607 such State may appeal to the United States court of appeals
for the circuit in which such State is located, by filing a petition
with such court within sixty days after such action. A copy of the
petition shall be forthwith transmitted by the clerk of the court to
the Surgeon General, or any officer designated by him for that purpose. The Surgeon General shall thereupon file in the court the
record of the proceedings on which he based his action, as provided
in section 2112 of title 28, United States Code. Upon the filing of
such petition, the court shall have jurisdiction to affirm the action
of the Surgeon General or to set it aside, in whole or in part, temporarily or permanently, but until the filing of the record, the Surgeon General may modify or set aside his order.
(b) The findings of the Surgeon General as to the facts, if supported by substantial evidence, shall be conclusive, but the court,
for good cause shown, may remand the case to the Surgeon General
to take further evidence, and the Surgeon General may thereupon
make new or modified findings of fact and may modify his previous
action, and shall file in the court the record of the further proceedings. Such new or modified findings of fact shall likewise be
conclusive if supported by substantial evidence.
(c) The judgment of the court affirming or setting aside, in
whole or in part, any action of the Surgeon General shall be final,
subject to review by the Supreme Court of the United States upon
certiorari or certification as provided in section 1254 of title 28,
United States Code. The commencement of proceedings under this
section shall not, unless so specifically ordered by the court, operate as a stay of the Surgeon General’s action.
RECOVERY

SEC. 609. 1 ø291i¿ (a) If any facility with respect to which
funds have been paid under section 606 shall, at any time within
20 years after the completion of construction or modernization—
(1) be sold or transferred to any entity (A) which is not
qualified to file an application under section 605, or (B) which
is not approved as a transferee by the State agency designated
pursuant to section 604, or its successor, or
1 Subtitle D of title VII of Public Law 100–607 waived the applicability of section 609 regarding a specified medical facility if certain conditions relating to satisfaction of the obligations
under section 603(e) were met. (The text of such subtitle D is provided in this compilation under
the heading ‘‘Waiver Regarding Title VI of Public Health Service Act’’.) Private Law 99–21 provided such a waiver regarding another specified medical facility.

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Sec. 609

(2) cease to be a public health center or a public or other
nonprofit hospital, outpatient facility, facility for long-term
care, or rehabilitation facility,
the United States shall be entitled to recover, whether from the
transferor or the transferee (or, in the case of a facility which has
ceased to be public or nonprofit, from the owners thereof) an
amount determined under subsection (c).
(b) The transferor of a facility which is sold or transferred as
described in subsection (a)(1), or the owner of a facility the use of
which is changed as described in subsection (a)(2), shall provide the
Secretary written notice of such sale, transfer, or change not later
than the expiration of 10 days from the date on which such sale,
transfer, or change occurs.
(c)(1) except as provided in paragraph (2), the amount the
United States shall be entitled to recover under subsection (a) is
an amount bearing the same ratio to the then value (as determined
by the agreement of the parties or in an action brought in the district court of the United States for the district for which the facility
involved is situated) of so much of the facility as constituted an approved project or projects as the amount of the Federal participation bore to the cost of the construction or modernization of such
project or projects.
(2)(A) After the expiration of—
(i) 180 days after the date of the sale, transfer, or change
of use for which a notice is required by subsection (b), in the
case of a facility which is sold or transferred or the use of
which changes after the date of the enactment of this subsection, or
(ii) thirty days after the date of the enactment of this subsection or if later 180 days after the date of the sale, transfer,
or change of use for which a notice is required by subsection
(b), in the case of a facility which was sold or transferred or
the use of which changed before the date of the enactment of
this subsection. 1
the amount which the United States is entitled to recover under
paragraph (1) with respect to a facility shall be the amount prescribed by paragraph (1) plus interest, during the period described
in subparagraph (B), at a rate (determined by the Secretary) based
on the average of the bond equivalent of the weekly ninety-day
Treasury bill auction rate.
(B) The period referred to in subparagraph (A) is the period beginning—
(i) in the case of a facility which was sold or transferred
or the use of which changed before the date of the enactment
of this subsection, thirty days after such date or if later 180
days after the date of the sale, transfer, or change of use for
which a notice is required by subsection (b),
(ii) in the case of a facility with respect to which notice is
provided in accordance with subsection (b), upon the expiration
of 180 days after the receipt of such notice, or
(iii) in the case of a facility with respect to which such notice is not provided as prescribed by subsection (b), on the date
1 So

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in law. The period probably should be a comma.

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PUBLIC HEALTH SERVICE ACT

806

of the sale, transfer, or change of use for which such notice was
to be provided,
and ending on the date the amount the United States is entitled
to under paragraph (1) is collected.
(d)(1) The Secretary may waive the recovery rights of the
United States under subsection (a)(1) with respect to a facility in
any State if the Secretary determines, in accordance with regulations, that the entity to which the facility was sold or transferred—
(A) has established an irrevocable trust—
(i) in an amount equal to the greater of twice the cost
of the remaining obligation of the facility under clause (2)
of section 603(e) or the amount, determined under subsection (c), that the United States is entitled to recover,
and
(ii) which will only be used by the entity to provide the
care required by clause (2) of section 603(e); and
(B) will meet the obligation of the facility under clause (1)
of section 603(e).
(2) The Secretary may waive the recovery rights of the United
States under subsection (a)(2) with respect to a facility in any State
if the Secretary determines, in accordance with regulations, that
there is good cause for waiving such rights with respect to such facility.
(e) The right of recovery of the United States under subsection
(a) shall not constitute a lien on any facility with respect to which
funds have been paid under section 606.
LOANS FOR CONSTRUCTION OR MODERNIZATION OF HOSPITALS AND
OTHER MEDICAL FACILITIES

SEC. 610. ø291j¿ (a) In order further to assist the States in carrying out the purposes of this title, the Surgeon General is authorized to make a loan of funds to the applicant for any project for
construction or modernization which meets all of the conditions
specified for a grant under this part.
(b) Except as provided in this section, an application for a loan
with respect to any project under this part shall be submitted, and
shall be approved by the Surgeon General, in accordance with the
same procedures and subject to the same limitations and conditions
as would be applicable to the making of a grant under this part for
such project. Any such application may be approved in any fiscal
year only if sufficient funds are available from the allotment for the
type of project involved. All loans under this section shall be paid
directly to the applicant.
(c)(1) The amount of a loan under this part shall not exceed an
amount equal to the Federal share of the estimated cost of construction or modernization under the project. Where a loan and a
grant are made under this part with respect to the same project,
the aggregate amount of such loan and such grant shall not exceed
an amount equal to the Federal share of the estimated cost of construction or modernization under the project. Each loan shall bear
interest at the rate arrived at by adding one-quarter of 1 per centum per annum to the rate which the Secretary of the Treasury determines to be equal to the current average yield on all outstanding
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Sec. 621

marketable obligations of the United States as of the last day of
the month preceding the date the application for the loan is approved and by adjusting the result so obtained to the nearest oneeighth of 1 per centum. Each loan made under this part shall mature not more than forty years after the date on which such loan
is made, except that nothing in this part shall prohibit the payment of all or part of the loan at any time prior to the maturity
date. In addition to the terms and conditions provided for, each
loan under this part shall be made subject to such terms, conditions, and covenants relating to repayment of principal, payment of
interest, and other matters as may be agreed upon by the applicant
and the Surgeon General.
(2) The Surgeon General may enter into agreements modifying
any of the terms and conditions of a loan made under this part
whenever he determines such action is necessary to protect the financial interest of the United States.
(3) If, at any time before a loan for a project has been repaid
in full, any of the events specified in clause (a) or clause (b) of section 609 occurs with respect to such project, the unpaid balance of
the loan shall become immediately due and payable by the applicant, and any transferee of the facility shall be liable to the United
States for such repayment.
(d) Any loan under this part shall be made out of the allotment
from which a grant for the project concerned would be made. Payments of interest and repayments of principal on loans under this
part shall be deposited in the Treasury as miscellaneous receipts.
PART B—LOAN GUARANTEES AND LOANS FOR MODERNIZATION AND
CONSTRUCTION OF HOSPITALS AND OTHER MEDICAL FACILITIES
AUTHORIZATION OF LOAN GUARANTEES AND LOANS

SEC. 621. ø291j–1¿ (a)(1) In order to assist nonprofit private
agencies to carry out needed projects for the modernization or construction of nonprofit private hospitals, facilities for long-term care,
outpatient facilities, and rehabilitation facilities, the Secretary,
during the period July 1, 1970, through June 30, 1974, may, in accordance with the provisions of this part, guarantee to non-Federal
lenders making loans to such agencies for such projects, payment
of principal of and interest on loans, made by such lenders, which
are approved under this part.
(2) In order to assist public agencies to carry out needed
projects for the modernization or construction of public health centers, and public hospitals, facilities for long-term care, outpatient
facilities, and rehabilitation facilities, the Secretary, during the period July 1, 1970, through June 30, 1974, may, in accordance with
the provisions of this part, make loans to such agencies which shall
be sold and guaranteed in accordance with section 627.
(b)(1) No loan guarantee under this part with respect to any
modernization or construction project may apply to so much of the
principal amount thereof as, when added to the amount of any
grant or loan under part A with respect to such project, exceeds 90
per centum of the cost of such project.
(2) No loan to a public agency under this part shall be made
in an amount which, when added to the amount of any grant or
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Sec. 622

PUBLIC HEALTH SERVICE ACT

808

loan under part A with respect to such project, exceeds 90 per centum of the cost of such project.
(c) The Secretary, with the consent of the Secretary of Housing
and Urban Development, shall obtain from the Department of
Housing and Urban Development such assistance with respect to
the administration of this part as will promote efficiency and economy thereof.
ALLOCATION AMONG THE STATES

SEC. 622. ø291j–2¿ (a) For each fiscal year, the total amount
of principal of loans to nonprofit private agencies which may be
guaranteed or loans to public agencies which may be directly made
under this part shall be allotted by the Secretary among the States,
in accordance with regulations, on the basis of each State’s relative
population, financial need, need for construction of the facilities referred to in section 621(a), and need for modernization of such facilities.
(b) Any amount allotted under subsection (a) to a State for a
fiscal year ending before July 1, 1973, and remaining unobligated
at the end of such year shall remain available to such State, for
the purpose for which made, for the next two fiscal years (and for
such years only), and any such amount shall be in addition to the
amounts allotted to such State for such purpose for each of such
next two fiscal years; except that, with the consent of any such
State, any such amount remaining unobligated at the end of the
first of such next fiscal year may be reallotted (on such basis as the
Secretary deems equitable and consistent with the purposes of this
title) to other States which have need therefor. Any amounts so reallotted to a State shall be available for the purposes for which
made until the close of the second such next two fiscal years and
shall be in addition to the amount allotted and available to such
State for the same period.
(c) Any amount allotted or reallotted to a State under this section for a fiscal year shall not, until the expiration of the period
during which it is available for obligation, be considered as available for allotment for a subsequent fiscal year.
(d) The allotments of any State under subsection (a) for the fiscal year ending June 30, 1971, and the succeeding fiscal year shall
also be available to guarantee loans with respect to any project, for
modernization or construction of a nonprofit private hospital or
other health facility referred to in section 621(a)(1), if the modernization or construction of such facility was not commenced earlier than January 1, 1968, and if the State certifies and the Secretary finds that without such guaranteed loan such facility could
not be completed and begin to operate or could not continue to operate, but with such guaranteed loan would be able to do so: Provided, That this subsection shall not apply to more than two
projects in any one State.
APPLICATIONS AND CONDITIONS

SEC. 623. ø291j–3¿ (a) For each project for which a guarantee
of a loan to a nonprofit private agency or a direct loan to a public
agency is sought under this part, there shall be submitted to the
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809

PUBLIC HEALTH SERVICE ACT

Sec. 623

Secretary, through the State agency designated in accordance with
section 604, an application by such private nonprofit agency or by
such public agency. If two or more private nonprofit agencies, or
two or more public agencies, join in the project, the application may
be filed by one or more such agencies. Such application shall (1) set
forth all of the descriptions, plans, specifications, assurances, and
information which are required by the third sentence of section
605(a) (other than clause (6) thereof) with respect to applications
submitted under that section, (2) contain such other information as
the Secretary may require to carry out the purposes of this part,
and (3) include a certification by the State agency of the total cost
of the project and the amount of the loan for which a guarantee
is sought under this part, or the amount of the direct loan sought
under this part, as the case may be.
(b) The Secretary may approve such application only if—
(1) there remains sufficient balance in the allotment determined for such State pursuant to section 622 to cover the
amount of the loan for which a guarantee is sought, or the
amount of the direct loan sought (as the case may be), in such
application,
(2) he makes each of the findings which are required by
clauses (1) through (4) of section 605(b) for the approval of applications for projects thereunder (except that, in the case of
the finding required under such clause (4) of entitlement of a
project to a priority established under section 603(a), such finding shall be made without regard to the provisions of clauses
(1) and (3) of such section),
(3) he finds that there is compliance with section 605(e),
(4) he obtains assurances that the applicant will keep such
records, and afford such access thereto, and make such reports,
in such form and containing such information, as the Secretary
may reasonably require, and
(5) he also determines, in the case of a loan for which a
guarantee is sought, that the terms, conditions, maturity, security (if any), and schedule and amounts of repayments with respect to the loan are sufficient to protect the financial interests
of the United States and are otherwise reasonable and in accord with regulations, including a determination that the rate
of interest does not exceed such per centum per annum on the
principal obligation outstanding as the Secretary determines to
be reasonable, taking into account the range of interest rates
prevailing in the private market for similar loans and the risks
assumed by the United States.
(c) No application under this section shall be disapproved until
the Secretary has afforded the State agency an opportunity for a
hearing.
(d) Amendment of an approved application shall be subject to
approval in the same manner as an original application.
(e)(1) In the case of any loan to a nonprofit private agency, the
United States shall be entitled to recover from the applicant the
amount of any payments made pursuant to any guarantee of such
loan under this part, unless the Secretary for good cause waives its
right of recovery, and, upon making any such payment, the United
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Sec. 624

PUBLIC HEALTH SERVICE ACT

810

States shall be subrogated to all of the rights of the recipient of the
payments with respect to which the guarantee was made.
(2) Guarantees of loans to nonprofit private agencies under this
part shall be subject to such further terms and conditions as the
Secretary determines to be necessary to assure that the purposes
of this part will be achieved, and, to the extent permitted by subsection (f), any of such terms and conditions may be modified by
the Secretary to the extent he determines it to be consistent with
the financial interest of the United States.
(f) Any guarantee of a loan to a nonprofit private agency made
by the Secretary pursuant to this part shall be incontestable in the
hands of an applicant on whose behalf such guarantee is made, and
as to any person who makes or contracts to make a loan to such
applicant in reliance thereon, except for fraud or misrepresentation
on the part of such applicant or such other person.
PAYMENT OF INTEREST ON GUARANTEED LOAN

SEC. 624. ø291j–4¿ (a) Subject to the provisions of subsection
(b), in the case of a guarantee of any loan to a nonprofit private
agency under this part with respect to a hospital or other medical
facility, the Secretary shall pay, to the holder of such loan and for
and on behalf of such hospital or other medical facility amounts
sufficient to reduce by 3 per centum per annum the net effective
interest rate otherwise payable on such loan. Each holder of a loan,
to a nonprofit private agency, which is guaranteed under this part
shall have a contractual right to receive from the United States interest payments required by the preceding sentence.
(b) Contracts to make the payments provided for in this section
shall not carry an aggregate amount greater than such amount as
may be provided in appropriations Acts.
LIMITATION ON AMOUNT OF LOANS GUARANTEED OR DIRECTLY MADE

SEC. 625. ø291j–5¿ The cumulative total of the principal of the
loans outstanding at any time with respect to which guarantees
have been issued, or which have been directly made, under this
part may not exceed the lesser of—
(1) such limitations as may be specified in appropriations
Acts, or
(2) in the case of loans covered by allotments for the fiscal
year ending June 30, 1971, $500,000,000; for the fiscal year
ending June 30, 1972, $1,000,000,000; and for each of the fiscal
years ending June 30, 1973, and June 30, 1974.
LOAN GUARANTEE AND LOAN FUND

SEC. 626. ø291j–6¿ (a)(1) There is hereby established in the
Treasury a loan guarantee and loan fund (hereinafter in this section referred to as the ‘‘fund’’) which shall be available to the Secretary without fiscal year limitation, in such amounts as may be
specified from time to time in appropriations Acts, (i) to enable him
to discharge his responsibilities under guarantees issued by him
under this part, (ii) for payment of interest on the loans to nonprofit agencies which are guaranteed, (iii) for direct loans to public
agencies which are sold and guaranteed, (iv) for payment of interMarch 13, 2013

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811

PUBLIC HEALTH SERVICE ACT

Sec. 626

est with respect to such loans, and (v) for repurchase by him of direct loans to public agencies which have been sold and guaranteed.
There are authorized to be appropriated to the fund from time to
time such amounts as may be necessary to provide capital required
for the fund. To the extent authorized from time to time in appropriation Acts, there shall be deposited in the fund amounts received by the Secretary as interest payments or repayments of
principal on loans and any other moneys, property, or assets derived by him from his operations under this part, including any
moneys derived from the sale of assets.
(2) Of the moneys in the fund, there shall be available to the
Secretary for the purpose of making of direct loans to public agencies only such sums as shall have been appropriated for such purpose pursuant to section 627 or sums received by the Secretary
from the sale of such loans (in accordance with such section) and
authorized in appropriations Acts to be used for such purpose.
(b) If at any time the moneys in the fund are insufficient to
enable the Secretary to discharge his responsibilities under this
part—
(i) 1 to make payments of interest on loans to nonprofit private agencies which he has guaranteed under this part;
(ii) 1 to otherwise comply with guarantees under this part
of loans to nonprofit private agencies;
(iii) 1 to make payments of interest subsidies with respect
to loans to public agencies which he has made, sold, and guaranteed under this part;
(iv) 1 in the event of default by public agencies to make
payments of principal and interest on loans which the Secretary has made, sold, and guaranteed, under this part, to
make such payments to the purchaser of such loan;
(v) 1 to repurchase loans to public agencies which have
been sold and guaranteed under this part,
he is authorized to issue to the Secretary of the Treasury notes or
other obligations in such forms and denominations, bearing such
maturities, and subject to such terms and conditions, as may be
prescribed by the Secretary with the approval of the Secretary of
the Treasury, but only in such amounts as may be specified from
time to time in appropriations Acts. Such notes or other obligations
shall bear interest at a rate determined by the Secretary of the
Treasury, taking into consideration the current average market
yield on outstanding marketable obligations of the United States of
comparable maturities during the month preceding the issuance of
the notes or other obligations. The Secretary of the Treasury is authorized and directed to purchase any notes and other obligations
issued hereunder and for that purpose he is authorized to use as
a public debt transaction the proceeds from the sale of any securities issued under the Second Liberty Bond Act, as amended, and
the purposes for which securities may be issued under that Act, as
amended, are extended to include any purchase of such notes and
obligations. The Secretary of the Treasury may at any time sell any
of the notes or other obligations acquired by him under this sub1 Clauses (i) through (v) probably should be redesignated as paragraphs (1) through (5), respectively. See section 201 of Public Law 91–296 (84 Stat. 347).

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PUBLIC HEALTH SERVICE ACT

812

section. All redemptions, purchases, and sales by the Secretary of
the Treasury of such notes or other obligations shall be treated as
public debt transactions of the United States. Sums borrowed
under this subsection shall be deposited in the fund and redemption of such notes and obligations shall be made by the Secretary
from such fund.
PROVISIONS APPLICABLE TO LOANS TO PUBLIC FACILITIES

SEC. 627. ø291j–7¿ (a)(1) Any loan made by the Secretary to
a public agency under this part for the modernization or construction of a public hospital or other health facility shall require such
public agency to pay interest thereon at a rate comparable to the
current rate of interest prevailing with respect to loans, to nonprofit private agencies, which are guaranteed under this part, for
the modernization or construction of similar facilities in the same
or similar areas, minus 3 per centum per annum.
(2)(A) No loan to a public agency shall be made under this part
unless—
(i) the Secretary is reasonably satisfied that such agency
will be able to make payments of principal and interest thereon when due, and
(ii) such agency provides the Secretary with reasonable assurances that there will be available to such agency such additional funds as may be necessary to complete the project with
respect to which such loan is requested.
(B) Any loan to a public agency shall have such security, have
such maturity date, be repayable in such installments, and be subject to such other terms and conditions (including provision for recovery in case of default) as the Secretary determines to be necessary to carry out the purposes of this part while adequately protecting the financial interests of the United States.
(3) In making loans to public agencies under this part, the Secretary shall give due regard to achieving an equitable geographical
distribution of such loans.
(b)(1) The Secretary shall from time to time, but with due regard to the financial interests of the United States, sell loans referred to in subsection (a)(1) either on the private market or to the
Federal National Mortgage Association in accordance with section
302 of the Federal National Mortgage Association Charter Act.
(2) Any loan so sold shall be sold for an amount which is equal
(or approximately equal) to the amount of the unpaid principal of
such loan as of the time of sale.
(c)(1) The Secretary is authorized to enter into an agreement
with the purchaser of any loan sold under this part under which
the Secretary agrees—
(A) to guarantee to such purchaser (and any successor in
interest to such purchaser) payments of the principal and interest payable under such loan, and
(B) to pay as an interest subsidy to such purchaser (and
any successor in interest of such purchaser) amounts which
when added to the amount of interest payable on such loan,
are equivalent to a reasonable rate of interest on such loan as
determined by the Secretary, after taking into account the
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813

PUBLIC HEALTH SERVICE ACT

Sec. 631

range of prevailing interest rates in the private market on
similar loans and the risks assumed by the United States.
(2) Any such agreement—
(A) may provide that the Secretary shall act as agent of
any such purchaser, for the purpose of collecting from the public agency to which such loan was made and paying over to
such purchaser, any payments of principal and interest payable by such agency under such loan;
(B) may provide for the repurchase by the Secretary of any
such loan on such terms and conditions as may be specified in
the agreement;
(C) shall provide that, in the event of any default by the
public agency to which such loan was made in payment of principal and interest due on such loan, the Secretary shall, upon
notification to the purchaser (or to the successor in interest of
such purchaser), have the option to close out such loan (and
any obligations of the Secretary with respect thereto) by paying
to the purchaser (or his successor in interest) the total amount
of outstanding principal and interest due thereon at the time
of such notification; and
(D) shall provide that, in the event such loan is closed out
as provided in subparagraph (C), or in the event of any other
loss incurred by the Secretary by reason of the failure of such
public agency to make payments of principal and interest on
such loan, the Secretary shall be subrogated to all rights of
such purchaser for recovery of such loss from such public agency.
(d) The Secretary may, for good cause, waive any right of recovery which he has against a public agency by reason of the failure of such agency to make payments of principal and interest on
a loan made to such agency under this part.
(e) After any loan to a public agency under this part has been
sold and guaranteed, interest paid on such loan and any interest
subsidy paid by the Secretary with respect to such loan which is
received by the purchaser thereof (or his successor in interest) shall
be included in gross income for the purposes of chapter 1 of the Internal Revenue Code of 1954.
(f) Amounts received by the Secretary as proceeds from the
sale of loans under this section shall be deposited in the loan fund
established by section 626, and shall be available to the Secretary
for the making of further loans under this part in accordance with
the provisions of subsection (a)(2) of such section.
(g) There is authorized to be appropriated to the Secretary, for
deposit in the loan fund established by section 626, $30,000,000 to
provide initial capital for the making of direct loans by the Secretary to public agencies for the modernization or construction of
facilities referred to in subsection (a)(1).
PART C—CONSTRUCTION

OR

MODERNIZATION

OF

EMERGENCY ROOMS

AUTHORIZATION

SEC. 631. ø291j–8¿ In order to assist in the provision of adequate emergency room service in various communities of the Nation for treatment of accident victims and handling of other medMarch 13, 2013

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Sec. 632

PUBLIC HEALTH SERVICE ACT

814

ical emergencies through special project grants for the construction
or modernization of emergency rooms of general hospitals, there
are authorized to be appropriated $20,000,000 each for the fiscal
year ending June 30, 1971, and the next two fiscal years.
ELIGIBILITY FOR GRANTS

SEC. 632. ø291j–9¿ Funds appropriated pursuant to section 631
shall be available for grants by the Secretary for not to exceed 50
per centum of the cost of construction or modernization of emergency rooms of public or nonprofit general hospitals, including provision or replacement of medical transportation facilities. Such
grants shall be made by the Secretary only after consultation with
the State agency designated in accordance with section 604(a)(1) of
the Public Health Service Act. In order to be eligible for a grant
under this part, the project, and the applicant therefor, must meet
such criteria as may be prescribed by regulations. Such regulations
shall be so designed as to provide aid only with respect to projects
for which adequate assistance is not readily available from other
Federal, State, local, or other sources, and to assist in providing
modern, efficient, and effective emergency room service needed to
care for victims of highway, industrial, agricultural, or other accidents and to handle other medical emergencies, and to assist in
providing such service in geographical areas which have special
need therefor.
PAYMENTS

SEC. 633. ø291j–10¿ Grants under this part shall be paid in
advance or by way of reimbursement, in such installments and on
such conditions, as in the judgment of the Secretary will best carry
out the purposes of this part.
PART D—GENERAL
FEDERAL HOSPITAL COUNCIL AND ADVISORY COMMITTEES

SEC. 641. ø291k¿ (a) In administering this title, the Surgeon
General shall consult with a Federal Hospital Council consisting of
the Surgeon General, who shall serve as Chairman ex officio, and
twelve members appointed by the Secretary of Health, Education,
and Welfare. Six of the twelve appointed members shall be persons
who are outstanding in fields pertaining to medical facility and
health activities, and three of these six shall be authorities in matters relating to the operation of hospitals or other medical facilities,
one of them shall be an authority in matters relating to individuals
with intellectual disabilities, and one of them shall be an authority
in matters relating to mental health, and the other six members
shall be appointed to represent the consumers of services provided
by such facilities and shall be persons familiar with the need for
such services in urban or rural areas.
(b) Each appointed member shall hold office for a term of four
years, except that any member appointed to fill a vacancy occurring
prior to the expiration of the term for which his predecessor was
appointed shall be appointed for the remainder of such term. An
appointed member shall not be eligible to serve continuously for
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Sec. 643A

more than two terms (whether beginning before or after enactment
of this section) but shall be eligible for reappointment if he has not
served immediately preceding his reappointment.
(c) The Council shall meet as frequently as the Surgeon General deems necessary, but not less than once each year. Upon request by three or more members, it shall be the duty of the Surgeon General to call a meeting of the Council.
(d) The Council is authorized to appoint such special advisory
or technical committees as may be useful in carrying out its functions.
CONFERENCE OF STATE AGENCIES

SEC. 642. ø291l¿ Whenever in his opinion the purposes of this
title would be promoted by a conference, the Surgeon General may
invite representatives of as many State agencies, designated in accordance with section 604, to confer as he deems necessary or proper. A conference of the representatives of all such State agencies
shall be called annually by the Surgeon General. Upon the application of five or more of such State agencies, it shall be the duty of
the Surgeon General to call a conference of representatives of all
State agencies joining in the request.
STATE CONTROL OF OPERATIONS

SEC. 643. ø291m¿ Except as otherwise specifically provided,
nothing in this title shall be construed as conferring on any Federal
office or employee the right to exercise any supervision or control
over the administration, personnel, maintenance, or operation of
any facility with respect to which any funds have been or may be
expended under this title.
LOANS FOR CERTAIN HOSPITAL EXPERIMENTATION PROJECTS

SEC. 643A. ø291m–1¿ (a) In order to alleviate hardship on any
recipient of a grant under section 636 of this title (as in effect immediately before the enactment of the Hospital and Medical Facilities Amendments of 1964) for a project for the construction of an
experimental or demonstration facility having as its specific purpose the application of novel means for the reduction of hospital
costs with respect to which there has been a substantial increase
in the cost of such construction (over the estimated cost of such
project on the basis of which such grant was made) through no
fault of such recipient, the Secretary is authorized to make a loan
to such recipient not exceeding 662⁄3 per centum of such increased
costs, as determined by the Secretary, if the Secretary determines
that such recipient is unable to obtain such an amount for such
purpose from other public or private sources.
(b) Any such loan shall be made only on the basis of an application submitted to the Secretary in such form and containing such
information and assurances as he may prescribe.
(c) Each such loan shall bear interest at the rate of 21⁄2 per
centum per annum on the unpaid balance thereof and shall be repayable over a period determined by the Secretary to be appropriate, but not exceeding fifty years.
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(d) There are hereby authorized to be appropriated $3,500,000
to carry out the provisions of this section.
DEFINITIONS

SEC. 645. 1

ø291o¿ For the purposes of this title—
(a) The term ‘‘State’’ includes the Commonwealth of Puerto
Rico, Guam, American Samoa, the Trust Territory of the Pacific Islands, the Virgin Islands, and the District of Columbia.
(b)(1) The term ‘‘Federal share’’ with respect to any project
means the proportion of the cost of such project to be paid by the
Federal Government under this title.
(2) With respect to any project in any State for which a grant
is made from an allotment from an appropriation under section
601, the Federal share shall be the amount determined by the
State agency designated in accordance with section 604, but not
more than 662⁄3 per centum or the State’s allotment percentage,
whichever is the lower, except that, if the State’s allotment percentage is lower than 50 per centum, such allotment percentage
shall be deemed to be 50 per centum for purposes of this paragraph.
(3) Prior to the approval of the first project in a State during
any fiscal year the State agency designated in accordance with section 604 shall give the Secretary written notification of the maximum Federal share established pursuant to paragraph (2) for
projects in such State to be approved by the Secretary during such
fiscal year and the method for determining the actual Federal
share to be paid with respect to such projects; and such maximum
Federal share and such method of determination for projects in
such State approved during such fiscal year shall not be changed
after such approval.
(4) Notwithstanding the provisions of paragraphs (2) and (3) of
this subsection, the Federal share shall, at the option of the State
agency, be equal to the per centum provided under such paragraphs plus an incentive per centum (which when combined with
the per centum provided under such paragraphs shall not exceed
90 per centum) specified by the State agency in the case of (A)
projects that will provide services primarily for persons in an area
determined by the Secretary to be a rural or urban poverty area,
and (B) projects that offer potential for reducing health care costs
through shared services among health care facilities, through interfacility cooperation, or through the construction or modernization of
free-standing outpatient facilities.
(c) The term ‘‘hospital’’ includes general, tuberculosis, and
other types of hospitals, and related facilities, such as laboratories,
outpatient departments, nurses’ home facilities, extended care facilities, facilities related to programs for home health services, selfcare units, and central service facilities, operated in connection
with hospitals, and also includes education or training facilities for
health professions personnel operated as an integral part of a hospital, but does not include any hospital furnishing primarily domiciliary care.
1 Section

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644 was repealed by section 3(b) of Public Law 90–174.

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Sec. 645

(d) The term ‘‘public health center’’ means a publicly owned facility for the provision of public health services, including related
publicly owned facilities such as laboratories, clinics, and administrative offices operated in connection with such a facility.
(e) The term ‘‘nonprofit’’ as applied to any facility means a facility which is owned and operated by one or more nonprofit corporations or associations no part of the net earnings of which inures, or may lawfully inure, to the benefit of any private shareholder or individual.
(f) The term ‘‘outpatient facility’’ means a facility (located in or
apart from a hospital) for the diagnosis or diagnosis and treatment
of ambulatory patients (including ambulatory inpatients)—
(1) which is operated in connection with a hospital, or
(2) in which patient care is under the professional supervision of persons licensed to practice medicine or surgery in the
State, or in the case of dental diagnosis or treatment, under
the professional supervision of persons licensed to practice dentistry in the State; or
(3) which offers to patients not requiring hospitalization
the services of licensed physicians in various medical specialties, and which provides to its patients a reasonably full-range
of diagnostic and treatment services.
(g) The term ‘‘rehabilitation facility’’ means a facility which is
operated for the primary purpose of assisting in the rehabilitation
of disabled persons through an integrated program of—
(1) medical evaluation and services, and
(2) psychological, social, or vocational evaluation and services,
under competent professional supervision, and in the case of
which—
(3) the major portion of the required evaluation and services is furnished within the facility; and
(4) either (A) the facility is operated in connection with a
hospital, or (B) all medical and related health services are prescribed by, or are under the general direction of, persons licensed to practice medicine or surgery in the State.
(h) The term ‘‘facility for long-term care’’ means a facility (including an extended care facility) providing in-patient care for convalescent or chronic disease patients who require skilled nursing
care and related medical services—
(1) which is a hospital (other than a hospital primarily for
the care and treatment of mentally ill or tuberculous patients)
or is operated in connection with a hospital, or
(2) in which such nursing care and medical services are
prescribed by, or are performed under the general direction of,
persons licensed to practice medicine or surgery in the State.
(i) The term ‘‘construction’’ includes construction of new buildings, expansion, remodeling, and alteration of existing buildings,
and initial equipment of any such buildings (including medical
transportation facilities) and, in any case in which it will help to
provide a service not previously provided in the community, equipment of any buildings; including architects’ fees, but excluding the
cost of off-site improvements and, except with respect to public
health centers, the cost of the acquisition of land.
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(j) The term ‘‘cost’’ as applied to construction or modernization
means the amount found by the Surgeon General to be necessary
for construction and modernization respectively, under a project,
except that such term, as applied to a project for modernization of
a facility for which a grant or loan is to be made from an allotment
under section 602(a)(2), does not include any amount found by the
Surgeon General to be attributable to expansion of the bed capacity
of such facility.
(k) The term ‘‘modernization’’ includes alteration, major repair
(to the extent permitted by regulations), remodeling, replacement,
and renovation of existing buildings (including initial equipment
thereof), and replacement of obsolete, built-in (as determined in accordance with regulations) equipment of existing buildings.
(l) The term ‘‘title,’’ when used with reference to a site for a
project, means a fee simple, or such other estate or interest (including a leasehold on which the rental does not exceed 4 per centum
of the value of the land) as the Surgeon General finds sufficient to
assure for a period of not less than fifty years’ undisturbed use and
possession for the purposes of construction and operation of the
project.
FINANCIAL STATEMENTS

SEC. 646. ø291o–1¿ In the case of any facility for which a
grant, loan, or loan guarantee has been made under this title, the
applicant for such grant, loan, or loan guarantee (or, if appropriate,
such other person as the Secretary may prescribe) shall file at least
annually with the State agency for the State in which the facility
is located a statement which shall be in such form, and contain
such information, as the Secretary may require to accurately
show—
(1) the financial operations of the facility, and
(2) the costs to the facility of providing health services in
the facility and the charges made by the facility for providing
such services,
during the period with respect to which the statement is filed.

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TITLE VII—HEALTH PROFESSIONS
EDUCATION
PART A—STUDENT LOANS
Subpart I—Insured Health Education Assistance
Loans to Graduate Students
SEC. 701. ø292¿ STATEMENT OF PURPOSE.

The purpose of this subpart is to enable the Secretary to provide a Federal program of student loan insurance for students in
(and certain former students of) eligible institutions (as defined in
section 719).
SEC. 702. ø292a¿ SCOPE AND DURATION OF LOAN INSURANCE PROGRAM.
(a) IN GENERAL.—The total principal amount of new loans

made and installments paid pursuant to lines of credit (as defined
in section 719) to borrowers covered by Federal loan insurance
under this subpart shall not exceed $350,000,000 for fiscal year
1993, $375,000,000 for fiscal year 1994, and $425,000,000 for fiscal
year 1995. If the total amount of new loans made and installments
paid pursuant to lines of credit in any fiscal year is less than the
ceiling established for such year, the difference between the loans
made and installments paid and the ceiling shall be carried over
to the next fiscal year and added to the ceiling applicable to that
fiscal year, and if in any fiscal year no ceiling has been established,
any difference carried over shall constitute the ceiling for making
new loans (including loans to new borrowers) and paying installments for such fiscal year. Thereafter, Federal loan insurance pursuant to this subpart may be granted only for loans made (or for
loan installments paid pursuant to lines of credit) to enable students, who have obtained prior loans insured under this subpart,
to continue or complete their educational program or to obtain a
loan under section 705(a)(1)(B) to pay interest on such prior loans;
but no insurance may be granted for any loan made or installment
paid after September 30, 1998. The total principal amount of Federal loan insurance available under this subsection shall be granted by the Secretary without regard to any apportionment for the
purpose of chapter 15 of title 31, United States Code, and without
regard to any similar limitation.
(b) CERTAIN LIMITATIONS AND PRIORITIES.—
(1) LIMITATIONS REGARDING LENDERS, STATES, OR AREAS.—
The Secretary may, if necessary to assure an equitable distribution of the benefits of this subpart, assign, within the
maximum amounts specified in subsection (a), Federal loan insurance quotas applicable to eligible lenders, or to States or
819
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820

areas, and may from time to time reassign unused portions of
these quotas.
(2) PRIORITY FOR CERTAIN LENDERS.—In providing certificates of insurance under section 706 through comprehensive
contracts, the Secretary shall give priority to eligible lenders
that agree—
(A) to make loans to students at interest rates below
the rates prevailing, during the period involved, for loans
covered by Federal loan insurance pursuant to this subpart; or
(B) to make such loans under terms that are otherwise
favorable to the student relative to the terms under which
eligible lenders are generally making such loans during
such period.
(c) AUTHORITY OF STUDENT LOAN MARKETING ASSOCIATION.—
(1) IN GENERAL.—Subject to paragraph (2), the Student
Loan Marketing Association, established under part B of title
IV of the Higher Education Act of 1965, is authorized to make
advances on the security of, purchase, service, sell, consolidate,
or otherwise deal in loans which are insured by the Secretary
under this subpart, except that if any loan made under this
subpart is included in a consolidated loan pursuant to the authority of the Association under part B of title IV of the Higher
Education Act of 1965, the interest rate on such consolidated
loan shall be set at the weighted average interest rate of all
such loans offered for consolidation and the resultant per centum shall be rounded downward to the nearest one-eighth of
1 per centum, except that the interest rate shall be no less
than the applicable interest rate of the guaranteed student
loan program established under part B of title IV of the Higher
Education Act of 1965. In the case of such a consolidated loan,
the borrower shall be responsible for any interest which accrues prior to the beginning of the repayment period of the
loan, or which accrues during a period in which principal need
not be paid (whether or not such principal is in fact paid) by
reason of any provision of the Higher Education Act of 1965.
(2) APPLICABILITY OF CERTAIN FEDERAL REGULATIONS.—
With respect to Federal regulations for lenders, this subpart
may not be construed to preclude the applicability of such regulations to the Student Loan Marketing Association or to any
other entity in the business of purchasing student loans, including such regulations with respect to applications, contracts,
and due diligence.
SEC. 703. ø292b¿ LIMITATIONS ON INDIVIDUAL INSURED LOANS AND
ON LOAN INSURANCE.
(a) IN GENERAL.—The total of the loans made to a student in

any academic year or its equivalent (as determined by the Secretary) which may be covered by Federal loan insurance under this
subpart may not exceed $20,000 in the case of a student enrolled
in a school of medicine, osteopathic medicine, dentistry, veterinary
medicine, optometry, or podiatric medicine, and $12,500 in the case
of a student enrolled in a school of pharmacy, public health, allied
health, or chiropractic, or a graduate program in health administration or behavioral and mental health practice, including clinical
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PUBLIC HEALTH SERVICE ACT

Sec. 705

psychology. The aggregate insured unpaid principal amount for all
such insured loans made to any borrower shall not at any time exceed $80,000 in the case of a borrower who is or was a student enrolled in a school of medicine, osteopathic medicine, dentistry, veterinary medicine, optometry, or podiatric medicine, and $50,000 in
the case of a borrower who is or was a student enrolled in a school
of pharmacy, public health, allied health, or chiropractic, or a graduate program in health administration or clinical psychology. The
annual insurable limit per student shall not be exceeded by a line
of credit under which actual payments by the lender to the borrower will not be made in any year in excess of the annual limit.
(b) EXTENT OF INSURANCE LIABILITY.—The insurance liability
on any loan insured by the Secretary under this subpart shall be
100 percent of the unpaid balance of the principal amount of the
loan plus interest. The full faith and credit of the United States is
pledged to the payment of all amounts which may be required to
be paid under the provisions of section 707 or 714.
SEC. 704. ø292c¿ SOURCES OF FUNDS.

Loans made by eligible lenders in accordance with this subpart
shall be insurable by the Secretary whether made from funds fully
owned by the lender or from funds held by the lender in a trust
or similar capacity and available for such loans.
SEC. 705. ø292d¿ ELIGIBILITY OF BORROWERS AND TERMS OF INSURED LOANS.
(a) IN GENERAL.—A loan by an eligible lender shall be insur-

able by the Secretary under the provisions of this subpart only if—
(1) made to—
(A) a student who—
(i)(I) has been accepted for enrollment at an eligible institution, or (II) in the case of a student attending an eligible institution, is in good standing at that
institution, as determined by the institution;
(ii) is or will be a full-time student at the eligible
institution;
(iii) has agreed that all funds received under such
loan shall be used solely for tuition, other reasonable
educational expenses, including fees, books, and laboratory expenses, and reasonable living expenses, incurred by such students;
(iv) if required under section 3 of the Military Selective Service Act to present himself for and submit
to registration under such section, has presented himself and submitted to registration under such section;
and
(v) in the case of a pharmacy student, has satisfactorily completed three years of training; or
(B) an individual who—
(i) has previously had a loan insured under this
subpart when the individual was a full-time student at
an eligible institution;
(ii) is in a period during which, pursuant to paragraph (2), the principal amount of such previous loan
need not be paid;
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Sec. 705

PUBLIC HEALTH SERVICE ACT

822

(iii) has agreed that all funds received under the
proposed loan shall be used solely for repayment of interest due on previous loans made under this subpart;
and
(iv) if required under section 3 of the Military Selective Service Act to present himself for and submit
to registration under such section, has presented himself and submitted to registration under such section;
(2) evidenced by a note or other written agreement
which—
(A) is made without security and without endorsement, except that if the borrower is a minor and such note
or other written agreement executed by him would not,
under the applicable law, create a binding obligation, an
endorsement may be required;
(B) provides for repayment of the principal amount of
the loan in installments over a period of not less than 10
years (unless sooner repaid) nor more than 25 years beginning not earlier than 9 months nor later than 12 months
after the date of—
(i) the date on which—
(I) the borrower ceases to be a participant in
an accredited internship or residency program of
not more than four years in duration;
(II) the borrower completes the fourth year of
an accredited internship or residency program of
more than four years in duration; or
(III) the borrower, if not a participant in a
program described in subclause (I) or (II), ceases
to carry, at an eligible institution, the normal fulltime academic workload as determined by the institution; or
(ii) the date on which a borrower who is a graduate of an eligible institution ceases to be a participant in a fellowship training program not in excess of
two years or a participant in a full-time educational
activity not in excess of two years, which—
(I) is directly related to the health profession
for which the borrower prepared at an eligible institution, as determined by the Secretary; and
(II) may be engaged in by the borrower during
such a two-year period which begins within twelve
months after the completion of the borrower’s participation in a program described in subclause (I)
or (II) of clause (i) or prior to the completion of the
borrower’s participation in such program,
except as provided in subparagraph (C), except that the
period of the loan may not exceed 33 years from the date
of execution of the note or written agreement evidencing it,
and except that the note or other written instrument may
contain such provisions relating to repayment in the event
of default in the payment of interest or in the payment of
the costs of insurance premiums, or other default by the
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PUBLIC HEALTH SERVICE ACT

Sec. 705

borrower, as may be authorized by regulations of the Secretary in effect at the time the loan is made;
(C) provides that periodic installments of principal and
interest need not be paid, but interest shall accrue, during
any period (i) during which the borrower is pursuing a
full-time course of study at an eligible institution (or at an
institution defined by section 102(a) of the Higher Education Act of 1965); (ii) not in excess of four years during
which the borrower is a participant in an accredited internship or residency program (including any period in
such a program described in subclause (I) or subclause (II)
of subparagraph (B)(i)); (iii) not in excess of three years,
during which the borrower is a member of the Armed
Forces of the United States; (iv) not in excess of three
years during which the borrower is in service as a volunteer under the Peace Corps Act; (v) not in excess of three
years during which the borrower is a member of the National Health Service Corps; (vi) not in excess of three
years during which the borrower is in service as a full-time
volunteer under title I of the Domestic Volunteer Service
Act of 1973; (vii) not in excess of 3 years, for a borrower
who has completed an accredited internship or residency
training program in osteopathic general practice, family
medicine, general internal medicine, preventive medicine,
or general pediatrics and who is practicing primary care;
(viii) not in excess of 1 year, for borrowers who are graduates of schools of chiropractic; (ix) any period not in excess of two years which is described in subparagraph
(B)(ii); (x) not in excess of three years, during which the
borrower is providing health care services to Indians
through an Indian health program (as defined in section
108(a)(2)(A) of the Indian Health Care Improvement Act
(25 U.S.C. 1616a(a)(2)(A)) 1; and (xi) in addition to all other
deferments for which the borrower is eligible under clauses
(i) through (x), any period during which the borrower is a
member of the Armed Forces on active duty during the
Persian Gulf conflict, and any period described in clauses
(i) through (xi) shall not be included in determining the
25-year period described in subparagraph (B);
(D) provides for interest on the unpaid principal balance of the loan at a yearly rate, not exceeding the applicable maximum rate prescribed and defined by the Secretary
(within the limits set forth in subsection (b)) on a national,
regional, or other appropriate basis, which interest shall
be compounded not more frequently than annually and
payable in installments over the period of the loan except
as provided in subparagraph (C), except that the note or
other written agreement may provide that payment of any
interest may be deferred until not later than the date upon
which repayment of the first installment of principal falls
due or the date repayment of principal is required to resume (whichever is applicable) and may further provide
1 So

March 13, 2013

in law. Probably should include another closing parenthesis.

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Sec. 705

PUBLIC HEALTH SERVICE ACT

824

that, on such date, the amount of the interest which has
so accrued may be added to the principal for the purposes
of calculating a repayment schedule;
(E) offers, in accordance with criteria prescribed by
regulation by the Secretary, a schedule for repayment of
principal and interest under which payment of a portion of
the principal and interest otherwise payable at the beginning of the repayment period (as defined in such regulations) is deferred until a later time in the period;
(F) entitles the borrower to accelerate without penalty
repayment of the whole or any part of the loan;
(G) provides that the check for the proceeds of the loan
shall be made payable jointly to the borrower and the eligible institution in which the borrower is enrolled; and
(H) contains such other terms and conditions consistent with the provisions of this subpart and with the
regulations issued by the Secretary pursuant to this subpart, as may be agreed upon by the parties to such loan,
including, if agreed upon, a provision requiring the borrower to pay to the lender, in addition to principal and interest, amounts equal to the insurance premiums payable
by the lender to the Secretary with respect to such loan;
and
(3) subject to the consent of the student and subject to applicable law, the eligible lender has obtained from the student
appropriate demographic information regarding the student,
including racial or ethnic background.
(b) LIMITATION ON RATE OF INTEREST.—The rate of interest
prescribed and defined by the Secretary for the purpose of subsection (a)(2)(D) may not exceed the average of the bond equivalent
rates of the 91-day Treasury bills auctioned for the previous quarter plus 3 percentage points, rounded to the next higher one-eighth
of 1 percent.
(c) MINIMUM ANNUAL PAYMENT BY BORROWER.—The total of
the payments by a borrower during any year or any repayment period with respect to the aggregate amount of all loans to that borrower which are insured under this subpart shall not be less than
the annual interest on the outstanding principal, except as provided in subsection (a)(2)(C), unless the borrower, in the written
agreement described in subsection (a)(2), agrees to make payments
during any year or any repayment period in a lesser amount.
(d) APPLICABILITY OF CERTAIN LAWS ON RATE OR AMOUNT OF
INTEREST.—No provision of any law of the United States (other
than subsections (a)(2)(D) and (b)) or of any State that limits the
rate or amount of interest payable on loans shall apply to a loan
insured under this subpart.
(e) DETERMINATION REGARDING FORBEARANCE.—Any period of
time granted to a borrower under this subpart in the form of forbearance on the loan shall not be included in the 25-year total loan
repayment period under subsection (a)(2)(C).
(f) LOAN REPAYMENT SCHEDULE.—Lenders and holders under
this subpart shall offer borrowers graduated loan repayment schedules that, during the first 5 years of loan repayment, are based on
the borrower’s debt-to-income ratio.
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PUBLIC HEALTH SERVICE ACT

Sec. 706

(g) RULE OF CONSTRUCTION REGARDING DETERMINATION OF
NEED OF STUDENTS.—With respect to any determination of the financial need of a student for a loan covered by Federal loan insurance under this subpart, this subpart may not be construed to limit
the authority of any school to make such allowances for students
with special circumstances as the school determines appropriate.
(h) DEFINITIONS.—For purposes of this section:
(1) The term ‘‘active duty’’ has the meaning given such
term in section 101(18) of title 37, United States Code, except
that such term does not include active duty for training.
(2) The term ‘‘Persian Gulf conflict’’ means the period beginning on August 2, 1990, and ending on the date thereafter
prescribed by Presidential proclamation or by law.
SEC. 706. ø292e¿ CERTIFICATE OF LOAN INSURANCE; EFFECTIVE
DATE OF INSURANCE.
(a) IN GENERAL.—
(1) AUTHORITY FOR ISSUANCE OF CERTIFICATE.—If, upon ap-

plication by an eligible lender, made upon such form, containing such information, and supported by such evidence as
the Secretary may require, and otherwise in conformity with
this section, the Secretary finds that the applicant has made
a loan to an eligible borrower which is insurable under the provisions of this subpart, he may issue to the applicant a certificate of insurance covering the loan and setting forth the
amount and terms of the insurance.
(2) EFFECTIVE DATE OF INSURANCE.—Insurance evidenced
by a certificate of insurance pursuant to subsection (a)(1) shall
become effective upon the date of issuance of the certificate, except that the Secretary is authorized, in accordance with regulations, to issue commitments with respect to proposed loans,
or with respect to lines (or proposed lines) of credit, submitted
by eligible lenders, and in that event, upon compliance with
subsection (a)(1) by the lender, the certificate of insurance may
be issued effective as of the date when any loan, or any payment by the lender pursuant to a line of credit, to be covered
by such insurance is made to a student described in section
705(a)(1). Such insurance shall cease to be effective upon 60
days’ default by the lender in the payment of any installment
of the premiums payable pursuant to section 708.
(3) CERTAIN AGREEMENTS FOR LENDERS.—An application
submitted pursuant to subsection (a)(1) shall contain—
(A) an agreement by the applicant to pay, in accordance with regulations, the premiums fixed by the Secretary pursuant to section 708; and
(B) an agreement by the applicant that if the loan is
covered by insurance the applicant will submit such supplementary reports and statements during the effective period of the loan agreement, upon such forms, at such
times, and containing such information as the Secretary
may prescribe by or pursuant to regulation.
(b) AUTHORITY REGARDING COMPREHENSIVE INSURANCE COVERAGE.—
(1) IN GENERAL.—In lieu of requiring a separate insurance
application and issuing a separate certificate of insurance for
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Sec. 706

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826

each loan made by an eligible lender as provided in subsection
(a), the Secretary may, in accordance with regulations consistent with section 702, issue to any eligible lender applying
therefor a certificate of comprehensive insurance coverage
which shall, without further action by the Secretary, insure all
insurable loans made by that lender, on or after the date of the
certificate and before a specified cutoff date, within the limits
of an aggregate maximum amount stated in the certificate.
Such regulations may provide for conditioning such insurance,
with respect to any loan, upon compliance by the lender with
such requirements (to be stated or incorporated by reference in
the certificate) as in the Secretary’s judgment will best achieve
the purpose of this subsection while protecting the financial interest of the United States and promoting the objectives of this
subpart, including (but not limited to) provisions as to the reporting of such loans and information relevant thereto to the
Secretary and as to the payment of initial and other premiums
and the effect of default therein, and including provision for
confirmation by the Secretary from time to time (through endorsement of the certificate) of the coverage of specific new
loans by such certificate, which confirmation shall be incontestable by the Secretary in the absence of fraud or misrepresentation of fact or patent error.
(2) LINES OF CREDIT BEYOND CUTOFF DATE.—If the holder
of a certificate of comprehensive insurance coverage issued
under this subsection grants to a borrower a line of credit extending beyond the cutoff date specified in that certificate,
loans or payments thereon made by the holder after that date
pursuant to the line of credit shall not be deemed to be included in the coverage of that certificate except as may be specifically provided therein; but, subject to the limitations of section 702, the Secretary may, in accordance with regulations,
make commitments to insure such future loans or payments,
and such commitments may be honored either as provided in
subsection (a) or by inclusion of such insurance in comprehensive coverage under this subsection for the period or periods in
which such future loans or payments are made.
(c) ASSIGNMENT OF INSURANCE RIGHTS.—The rights of an eligible lender arising under insurance evidenced by a certificate of insurance issued to it under this section may be assigned by such
lender, subject to regulation by the Secretary, only to—
(1) another eligible lender (including a public entity in the
business of purchasing student loans); or
(2) the Student Loan Marketing Association.
(d) EFFECT OF REFINANCING OR CONSOLIDATION OF OBLIGATIONS.—The consolidation of the obligations of two or more federally insured loans obtained by a borrower in any fiscal year into
a single obligation evidenced by a single instrument of indebtedness or the refinancing of a single loan shall not affect the insurance by the United States. If the loans thus consolidated are covered by separate certificates of insurance issued under subsection
(a), the Secretary may upon surrender of the original certificates
issue a new certificate of insurance in accordance with that subsection upon the consolidated obligation. If the loans thus consoliMarch 13, 2013

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dated are covered by a single comprehensive certificate issued
under subsection (b), the Secretary may amend that certificate accordingly.
(e) RULE OF CONSTRUCTION REGARDING CONSOLIDATION OF
DEBTS AND REFINANCING.—Nothing in this section shall be construed to preclude the lender and the borrower, by mutual agreement, from consolidating all of the borrower’s loans insured under
this subpart into a single instrument (or, if the borrower obtained
only 1 loan insured under this subpart, refinancing the loan 1 time)
under the terms applicable to an insured loan made at the same
time as the consolidation. The lender or loan holder should provide
full information to the borrower concerning the advantages and disadvantages of loan consolidation or refinancing. Nothing in this
section shall be construed to preclude the consolidation of the borrower’s loans insured under this subpart under section 428C of the
Higher Education Act of 1965. Any loans insured pursuant to this
subpart that are consolidated under section 428C of such Act shall
not be eligible for special allowance payments under section 438 of
such Act.
SEC. 707. ø292f¿ DEFAULT OF BORROWER.
(a) CONDITIONS FOR PAYMENT TO BENEFICIARY.—
(1) IN GENERAL.—Upon default by the borrower

on any
loan covered by Federal loan insurance pursuant to this subpart, and after a substantial collection effort (including, subject
to subsection (h), commencement and prosecution of an action)
as determined under regulations of the Secretary, the insurance beneficiary shall promptly notify the Secretary and the
Secretary shall, if requested (at that time or after further collection efforts) by the beneficiary, or may on his own motion,
if the insurance is still in effect, pay to the beneficiary the
amount of the loss sustained by the insured upon that loan as
soon as that amount has been determined, except that, if the
insurance beneficiary including any servicer of the loan is not
designated for ‘‘exceptional performance’’, as set forth in paragraph (2), the Secretary shall pay to the beneficiary a sum
equal to 98 percent of the amount of the loss sustained by the
insured upon that loan.
(2) EXCEPTIONAL PERFORMANCE.—
(A) AUTHORITY.—Where the Secretary determines that
an eligible lender, holder, or servicer has a compliance performance rating that equals or exceeds 97 percent, the Secretary shall designate that eligible lender, holder, or
servicer, as the case may be, for exceptional performance.
(B) COMPLIANCE PERFORMANCE RATING.—For purposes
of subparagraph (A), a compliance performance rating is
determined with respect to compliance with due diligence
in the disbursement, servicing, and collection of loans
under this subpart for each year for which the determination is made. Such rating shall be equal to the percentage
of all due diligence requirements applicable to each loan,
on average, as established by the Secretary, with respect
to loans serviced during the period by the eligible lender,
holder, or servicer.

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PUBLIC HEALTH SERVICE ACT
(C) ANNUAL AUDITS
SERVICERS.—Each eligible

828

FOR LENDERS, HOLDERS, AND
lender, holder, or servicer desiring a designation under subparagraph (A) shall have an
annual financial and compliance audit conducted with respect to the loan portfolio of such eligible lender, holder,
or servicer, by a qualified independent organization from a
list of qualified organizations identified by the Secretary
and in accordance with standards established by the Secretary. The standards shall measure the lender’s, holder’s,
or servicer’s compliance with due diligence standards and
shall include a defined statistical sampling technique designed to measure the performance rating of the eligible
lender, holder, or servicer for the purpose of this section.
Each eligible lender, holder, or servicer shall submit the
audit required by this section to the Secretary.
(D) SECRETARY’S DETERMINATIONS.—The Secretary
shall make the determination under subparagraph (A)
based upon the audits submitted under this paragraph and
any information in the possession of the Secretary or submitted by any other agency or office of the Federal Government.
(E) QUARTERLY COMPLIANCE AUDIT.—To maintain its
status as an exceptional performer, the lender, holder, or
servicer shall undergo a quarterly compliance audit at the
end of each quarter (other than the quarter in which status as an exceptional performer is established through a financial and compliance audit, as described in subparagraph (C)), and submit the results of such audit to the Secretary. The compliance audit shall review compliance with
due diligence requirements for the period beginning on the
day after the ending date of the previous audit, in accordance with standards determined by the Secretary.
(F) REVOCATION AUTHORITY.—The Secretary shall revoke the designation of a lender, holder, or servicer under
subparagraph (A) if any quarterly audit required under
subparagraph (E) is not received by the Secretary by the
date established by the Secretary or if the audit indicates
the lender, holder, or servicer has failed to meet the standards for designation as an exceptional performer under
subparagraph (A). A lender, holder, or servicer receiving a
compliance audit not meeting the standard for designation
as an exceptional performer may reapply for designation
under subparagraph (A) at any time.
(G) DOCUMENTATION.—Nothing in this section shall
restrict or limit the authority of the Secretary to require
the submission of claims documentation evidencing servicing performed on loans, except that the Secretary may
not require exceptional performers to submit greater documentation than that required for lenders, holders, and
servicers not designated under subparagraph (A).
(H) COST OF AUDITS.—Each eligible lender, holder, or
servicer shall pay for all the costs associated with the audits required under this section.

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(I) ADDITIONAL REVOCATION AUTHORITY.—Notwithstanding any other provision of this section, a designation
under subparagraph (A) may be revoked at any time by
the Secretary if the Secretary determines that the eligible
lender, holder, or servicer has failed to maintain an overall
level of compliance consistent with the audit submitted by
the eligible lender, holder, or servicer under this paragraph or if the Secretary asserts that the lender, holder,
or servicer may have engaged in fraud in securing designation under subparagraph (A) or is failing to service loans
in accordance with program requirements.
(J) NONCOMPLIANCE.—A lender, holder, or servicer
designated under subparagraph (A) that fails to service
loans or otherwise comply with applicable program regulations shall be considered in violation of the Federal False
Claims Act.
(b) SUBROGATION.—Upon payment by the Secretary of the
amount of the loss pursuant to subsection (a), the United States
shall be subrogated for all of the rights of the holder of the obligation upon the insured loan and shall be entitled to an assignment
of the note or other evidence of the insured loan by the insurance
beneficiary. If the net recovery made by the Secretary on a loan
after deduction of the cost of that recovery (including reasonable
administrative costs) exceeds the amount of the loss, the excess
shall be paid over to the insured. The Secretary may sell without
recourse to eligible lenders (or other entities that the Secretary determines are capable of dealing in such loans) notes or other evidence of loans received through assignment under the first sentence.
(c) FORBEARANCE.—Nothing in this section or in this subpart
shall be construed to preclude any forbearance for the benefit of the
borrower which may be agreed upon by the parties to the insured
loan and approved by the Secretary or to preclude forbearance by
the Secretary in the enforcement of the insured obligation after
payment on that insurance.
(d) REASONABLE CARE AND DILIGENCE REGARDING LOANS.—
Nothing in this section or in this subpart shall be construed to excuse the eligible lender or holder of a federally insured loan from
exercising reasonable care and diligence in the making of loans
under the provisions of this subpart and from exercising a substantial effort in the collection of loans under the provisions of this subpart. If the Secretary, after reasonable notice and opportunity for
hearing to an eligible lender, finds that the lender has failed to exercise such care and diligence, to exercise such substantial efforts,
to make the reports and statements required under section
706(a)(3), or to pay the required Federal loan insurance premiums,
he shall disqualify that lender from obtaining further Federal insurance on loans granted pursuant to this subpart until he is satisfied that its failure has ceased and finds that there is reasonable
assurance that the lender will in the future exercise necessary care
and diligence, exercise substantial effort, or comply with such requirements, as the case may be.
(e) DEFINITIONS.—For purposes of this section:
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PUBLIC HEALTH SERVICE ACT

830

(1) The term ‘‘insurance beneficiary’’ means the insured or
its authorized assignee in accordance with section 706(c).
(2) The term ‘‘amount of the loss’’ means, with respect to
a loan, unpaid balance of the principal amount and interest on
such loan, less the amount of any judgment collected pursuant
to default proceedings commenced by the eligible lender or
holder involved.
(3) The term ‘‘default’’ includes only such defaults as have
existed for 120 days.
(4) The term ‘‘servicer’’ means any agency acting on behalf
of the insurance beneficiary.
(f) REDUCTIONS IN FEDERAL REIMBURSEMENTS OR PAYMENTS
FOR DEFAULTING BORROWERS.—The Secretary shall, after notice
and opportunity for a hearing, cause to be reduced Federal reimbursements or payments for health services under any Federal law
to borrowers who are practicing their professions and have defaulted on their loans insured under this subpart in amounts up to
the remaining balance of such loans. Procedures for reduction of
payments under the medicare program are provided under section
1892 of the Social Security Act. Notwithstanding such section 1892,
any funds recovered under this subsection shall be deposited in the
insurance fund established under section 710.
(g) CONDITIONS FOR DISCHARGE OF DEBT IN BANKRUPTCY.—
Notwithstanding any other provision of Federal or State law, a
debt that is a loan insured under the authority of this subpart may
be released by a discharge in bankruptcy under any chapter of title
11, United States Code, only if such discharge is granted—
(1) after the expiration of the seven-year period beginning
on the first date when repayment of such loan is required, exclusive of any period after such date in which the obligation to
pay installments on the loan is suspended;
(2) upon a finding by the Bankruptcy Court that the nondischarge of such debt would be unconscionable; and
(3) upon the condition that the Secretary shall not have
waived the Secretary’s rights to apply subsection (f) to the borrower and the discharged debt.
(h) REQUIREMENT REGARDING ACTIONS FOR DEFAULT.—
(1) IN GENERAL.—With respect to the default by a borrower
on any loan covered by Federal loan insurance under this subpart, the Secretary shall, under subsection (a), require an eligible lender or holder to commence and prosecute an action for
such default unless—
(A) in the determination of the Secretary—
(i) the eligible lender or holder has made reasonable efforts to serve process on the borrower involved
and has been unsuccessful with respect to such efforts,
or
(ii) prosecution of such an action would be fruitless because of the financial or other circumstances of
the borrower;
(B) for such loans made before the date of the enactment of the Health Professions Reauthorization Act of
1988, the loan involved was made in an amount of less
than $5,000; or
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PUBLIC HEALTH SERVICE ACT

Sec. 708

(C) for such loans made after such date, the loan involved was made in an amount of less than $2,500.
(2) RELATIONSHIP TO CLAIM FOR PAYMENT.—With respect to
an eligible lender or holder that has commenced an action pursuant to subsection (a), the Secretary shall make the payment
required in such subsection, or deny the claim for such payment, not later than 60 days after the date on which the Secretary determines that the lender or holder has made reasonable efforts to secure a judgment and collect on the judgment
entered into pursuant to this subsection.
(3) STATE COURT JUDGMENTS.—With respect to any State
court judgment that is obtained by a lender or holder against
a borrower for default on a loan insured under this subpart
and that is subrogated to the United States under subsection
(b), any United States attorney may register such judgment
with the Federal courts for enforcement.
(i) INAPPLICABILITY OF FEDERAL AND STATE STATUTE OF LIMITATIONS ON ACTIONS FOR LOAN COLLECTION.—Notwithstanding any
other provision of Federal or State law, there shall be no limitation
on the period within which suit may be filed, a judgment may be
enforced, or an offset, garnishment, or other action may be initiated
or taken by the Secretary, the Attorney General, or other administrative head of another Federal agency, as the case may be, for the
repayment of the amount due from a borrower on a loan made
under this subpart that has been assigned to the Secretary under
subsection (b).
(j) SCHOOL COLLECTION ASSISTANCE.—An institution or postgraduate training program attended by a borrower may assist in
the collection of any loan of that borrower made under this subpart
which becomes delinquent, including providing information concerning the borrower to the Secretary and to past and present lenders and holders of the borrower’s loans, contacting the borrower in
order to encourage repayment, and withholding services in accordance with regulations issued by the Secretary under section
715(a)(7). The institution or postgraduate training program shall
not be subject to section 809 of the Fair Debt Collection Practices
Act for purposes of carrying out activities authorized by this section.
SEC. 708. ø292g¿ RISK-BASED PREMIUMS.
(a) AUTHORITY.—With respect to a

loan made under this subpart on or after January 1, 1993, the Secretary, in accordance with
subsection (b), shall assess a risk-based premium on an eligible
borrower and, if required under this section, an eligible institution
that is based on the default rate of the eligible institution involved
(as defined in section 719).
(b) ASSESSMENT OF PREMIUM.—Except as provided in subsection (d)(2), the risk-based premium to be assessed under subsection (a) shall be as follows:
(1) LOW-RISK RATE.—With respect to an eligible borrower
seeking to obtain a loan for attendance at an eligible institution that has a default rate of not to exceed five percent, such
borrower shall be assessed a risk-based premium in an amount
equal to 6 percent of the principal amount of the loan.
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Sec. 708

PUBLIC HEALTH SERVICE ACT

832

(2) MEDIUM-RISK RATE.—
(A) IN GENERAL.—With respect to an eligible borrower
seeking to obtain a loan for attendance at an eligible institution that has a default rate of in excess of five percent
but not to exceed 10 percent—
(i) such borrower shall be assessed a risk-based
premium in an amount equal to 8 percent of the principal amount of the loan; and
(ii) such institution shall be assessed a risk-based
premium in an amount equal to 5 percent of the principal amount of the loan.
(B) DEFAULT MANAGEMENT PLAN.—An institution of
the type described in subparagraph (A) shall prepare and
submit to the Secretary for approval, an annual default
management plan, that shall specify the detailed shortterm and long-term procedures that such institution will
have in place to minimize defaults on loans to borrowers
under this subpart. Under such plan the institution shall,
among other measures, provide an exit interview to all
borrowers that includes information concerning repayment
schedules, loan deferments, forbearance, and the consequences of default.
(3) HIGH-RISK RATE.—
(A) IN GENERAL.—With respect to an eligible borrower
seeking to obtain a loan for attendance at an eligible institution that has a default rate of in excess of 10 percent but
not to exceed 20 percent—
(i) such borrower shall be assessed a risk-based
premium in an amount equal to 8 percent of the principal amount of the loan; and
(ii) such institution shall be assessed a risk-based
premium in an amount equal to 10 percent of the principal amount of the loan.
(B) DEFAULT MANAGEMENT PLAN.—An institution of
the type described in subparagraph (A) shall prepare and
submit to the Secretary for approval a plan that meets the
requirements of paragraph (2)(B).
(4) INELIGIBILITY.—An individual shall not be eligible to
obtain a loan under this subpart for attendance at an institution that has a default rate in excess of 20 percent.
(c) REDUCTION OF RISK-BASED PREMIUM.—Lenders shall reduce
by 50 percent the risk-based premium to eligible borrowers if a
credit worthy parent or other responsible party co-signs the loan
note.
(d) ADMINISTRATIVE WAIVERS.—
(1) HEARING.—The Secretary shall afford an institution not
less than one hearing, and may consider mitigating circumstances, prior to making such institution ineligible for participation in the program under this subpart.
(2) EXCEPTIONS.—In carrying out this section with respect
to an institution, the Secretary may grant an institution a
waiver of requirements of paragraphs (2) through (4) of subsection (b) if the Secretary determines that the default rate for
such institution is not an accurate indicator because the volMarch 13, 2013

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PUBLIC HEALTH SERVICE ACT

Sec. 709

ume of the loans under this subpart made by such institution
has been insufficient.
(3) TRANSITION FOR CERTAIN INSTITUTIONS.—During the 3year period beginning on the effective date of the Health Professions Education Extension Amendments of 1992—
(A) subsection (b)(4) shall not apply with respect to
any eligible institution that is a Historically Black College
or University; and
(B) any such institution that has a default rate in excess of 20 percent, and any eligible borrower seeking a
loan for attendance at the institution, shall be subject to
subsection (b)(3) to the same extent and in the same manner as eligible institutions and borrowers described in such
subsection.
(e) PAYOFF TO REDUCE RISK CATEGORY.—An institution may
pay off the outstanding principal and interest owed by the borrowers of such institution who have defaulted on loans made under
this subpart in order to reduce the risk category of the institution.
SEC. 709. ø292h¿ OFFICE FOR HEALTH EDUCATION ASSISTANCE LOAN
DEFAULT REDUCTION.
(a) ESTABLISHMENT.—The Secretary shall establish, within the

Division of Student Assistance of the Bureau of Health Professions,
an office to be known as the Office for Health Education Assistance
Loan Default Reduction (in this section referred to as the ‘‘Office’’).
(b) PURPOSE AND FUNCTIONS.—It shall be the purpose of the
Office to achieve a reduction in the number and amounts of defaults on loans guaranteed under this subpart. In carrying out such
purpose the Office shall—
(1) conduct analytical and evaluative studies concerning
loans and loan defaults;
(2) carry out activities designed to reduce loan defaults;
(3) respond to special circumstances that may exist in the
financial lending environment that may lead to loan defaults;
(4) coordinate with other Federal entities that are involved
with student loan programs, including—
(A) with respect to the Department of Education, in
the development of a single student loan application form,
a single student loan deferment form, a single disability
form, and a central student loan database; and
(B) with respect to the Department of Justice, in the
recovery of payments from health professionals who have
defaulted on loans guaranteed under this subpart; and
(5) provide technical assistance to borrowers, lenders, holders, and institutions concerning deferments and collection activities.
(c) ADDITIONAL DUTIES.—In conjunction with the report submitted under subsection (b), the Office shall—
(1) compile, and publish in the Federal Register, a list of
the borrowers who are in default under this subpart; and
(2) send the report and notices of default with respect to
these borrowers to relevant Federal agencies and to schools,
school associations, professional and specialty associations,
State licensing boards, hospitals with which such borrowers
may be associated, and any other relevant organizations.
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Sec. 710

PUBLIC HEALTH SERVICE ACT

834

(d) ALLOCATION OF FUNDS FOR OFFICE.—In the case of
amounts reserved under section 710(a)(2)(B) for obligation under
this subsection, the Secretary may obligate the amounts for the
purpose of administering the Office, including 7 full-time equivalent employment positions for such Office. With respect to such
purpose, amounts made available under the preceding sentence are
in addition to amounts made available to the Health Resources and
Services Administration for program management for the fiscal
year involved. With respect to such employment positions, the positions are in addition to the number of full-time equivalent employment positions that otherwise is authorized for the Department of
Health and Human Services for the fiscal year involved.
SEC. 710. ø292i¿ INSURANCE ACCOUNT.
(a) IN GENERAL.—
(1) ESTABLISHMENT.—There

is hereby established a student loan insurance account (in this section referred to as the
‘‘Account’’) which shall be available without fiscal year limitation to the Secretary for making payments in connection with
the collection and default of loans insured under this subpart
by the Secretary.
(2) FUNDING.—
(A) Except as provided in subparagraph (B), all
amounts received by the Secretary as premium charges for
insurance and as receipts, earnings, or proceeds derived
from any claim or other assets acquired by the Secretary
in connection with his operations under this subpart, and
any other moneys, property, or assets derived by the Secretary from the operations of the Secretary in connection
with this section, shall be deposited in the Account.
(B) With respect to amounts described in subparagraph (A) that are received by the Secretary for fiscal year
1993 and subsequent fiscal years, the Secretary may, before depositing such amounts in the Account, reserve from
the amounts each such fiscal year not more than
$1,000,000 for obligation under section 709(d).
(3) EXPENDITURES.—All payments in connection with the
default of loans insured by the Secretary under this subpart
shall be paid from the Account.
(b) CONTINGENT AUTHORITY FOR ISSUANCE OF NOTES OR OTHER
OBLIGATIONS.—If at any time the moneys in the Account are insufficient to make payments in connection with the collection or default of any loan insured by the Secretary under this subpart, the
Secretary of the Treasury may lend the Account such amounts as
may be necessary to make the payments involved, subject to the
Federal Credit Reform Act of 1990.
SEC. 711. ø292j¿ POWERS AND RESPONSIBILITIES OF SECRETARY.
(a) IN GENERAL.—In the performance of, and with respect

to,
the functions, powers, and duties vested in the Secretary by this
subpart, the Secretary is authorized as follows:
(1) To prescribe such regulations as may be necessary to
carry out the purposes of this subpart.
(2) To sue and be sued in any district court of the United
States. Such district courts shall have jurisdiction of civil acMarch 13, 2013

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Sec. 713

tions arising under this subpart without regard to the amount
in controversy, and any action instituted under this subsection
by or against the Secretary shall survive notwithstanding any
change in the person occupying the office of Secretary or any
vacancy in that office. No attachment, injunction, garnishment,
or other similar process, mesne or final, shall be issued against
the Secretary or property under the control of the Secretary.
Nothing herein shall be constructed to except litigation arising
out of activities under this subpart from the application of sections 517 and 547 of title 28 of the United States Code.
(3) To include in any contract for Federal loan insurance
such terms, conditions, and covenants relating to repayment of
principal and payments of interest, relating to his obligations
and rights and to those of eligible lenders, and borrowers in
case of default, and relating to such other matters as the Secretary determines to be necessary to assure that the purposes
of this subpart will be achieved. Any term, condition, and covenant made pursuant to this paragraph or any other provisions
of this subpart may be modified by the Secretary if the Secretary determines that modification is necessary to protect the
financial interest of the United States.
(4) Subject to the specific limitations in the subpart, to
consent to the modification of any note or other instrument evidencing a loan which has been insured by him under this subpart (including modifications with respect to the rate of interest, time of payment of any installment of principal and interest or any portion thereof, or any other provision).
(5) To enforce, pay, compromise, waive, or release any
right, title, claim, lien, or demand, however acquired, including
any equity or any right or 1 redemption.
(b) ANNUAL BUDGET; ACCOUNTS.—The Secretary shall, with respect to the financial operations arising by reason of this subpart—
(1) prepare annually and submit a budget program as provided for wholly owned Government corporations by the Government Corporation Control Act; and
(2) maintain with respect to insurance under this subpart
an integral set of accounts.
SEC. 712. ø292k¿ PARTICIPATION BY FEDERAL CREDIT UNIONS IN
FEDERAL, STATE, AND PRIVATE STUDENT LOAN INSURANCE PROGRAMS.

Notwithstanding any other provision of law, Federal credit
unions shall, pursuant to regulations of the Administrator of the
National Credit Union Administration, have power to make insured loans to eligible students in accordance with the provisions
of this subpart relating to Federal insured loans.
SEC. 713. ø292l¿ DETERMINATION OF ELIGIBLE STUDENTS.

For purposes of determining eligible students under this part,
in the case of a public school in a State that offers an accelerated,
integrated program of study combining undergraduate premedical
education and medical education leading to advanced entry, by contractual agreement, into an accredited four-year school of medicine
1 So in law. See section 102 of Public Law 102–408 (106 Stat. 1994). Probably should be ‘‘right
of redemption’’.

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PUBLIC HEALTH SERVICE ACT

836

which provides the remaining training leading to a degree of doctor
of medicine, whenever in this part a provision refers to a student
at a school of medicine, such reference shall include only a student
enrolled in any of the last four years of such accelerated, integrated
program of study.
SEC. 714. ø292m¿ REPAYMENT BY SECRETARY OF LOANS OF DECEASED
OR DISABLED BORROWERS.

If a borrower who has received a loan dies or becomes permanently and totally disabled (as determined in accordance with regulations of the Secretary), the Secretary shall discharge the borrower’s liability on the loan by repaying the amount owed on the
loan from the account established under section 710.
SEC. 715. ø292n¿ ADDITIONAL REQUIREMENTS FOR INSTITUTIONS
AND LENDERS.
(a) IN GENERAL.—Notwithstanding any other provision of this

subpart, the Secretary is authorized to prescribe such regulations
as may be necessary to provide for—
(1) a fiscal audit of an eligible institution with regard to
any funds obtained from a borrower who has received a loan
insured under this subpart;
(2) the establishment of reasonable standards of financial
responsibility and appropriate institutional capability for the
administration by an eligible institution of a program of student financial aid with respect to funds obtained from a student who has received a loan insured under this subpart;
(3) the limitation, suspension, or termination of the eligibility under this subpart of any otherwise eligible institution,
whenever the Secretary has determined, after notice and affording an opportunity for hearing, that such institution has
violated or failed to carry out any regulation prescribed under
this subpart;
(4) the collection of information from the borrower, lender,
or eligible institution to assure compliance with the provisions
of section 705;
(5) the assessing of tuition or fees to borrowers in amounts
that are the same or less than the amount of tuition and fees
assessed to nonborrowers;
(6) the submission, by the institution or the lender to the
Office of Health Education Assistance Loan Default Reduction,
of information concerning each loan made under this subpart,
including the date when each such loan was originated, the
date when each such loan is sold, the identity of the loan holder and information concerning a change in the borrower’s status;
(7) the withholding of services, including academic transcripts, financial aid transcripts, and alumni services, by an institution from a borrower upon the default of such borrower of
a loan under this subpart, except in case of a borrower who has
filed for bankruptcy; and
(8) the offering, by the lender to the borrower, of a variety
of repayment options, including fixed-rate, graduated repayment with negative amortization permitted, and income deMarch 13, 2013

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Sec. 719

pendent payments for a limited period followed by level monthly payments.
(b) RECORDING BY INSTITUTION OF INFORMATION ON STUDENTS.—The Secretary shall require an eligible institution to
record, and make available to the lender and to the Secretary upon
request, the name, address, postgraduate destination, and other
reasonable identifying information for each student of such institution who has a loan insured under this subpart.
(c) WORKSHOP FOR STUDENT BORROWERS.—Each participating
eligible institution must have, at the beginning of each academic
year, a workshop concerning the provisions of this subpart that all
student borrowers shall be required to attend.
SEC. 719. ø292o¿ DEFINITIONS.

For purposes of this subpart:
(1) The term ‘‘eligible institution’’ means, with respect to
a fiscal year, a school of medicine, osteopathic medicine, dentistry, veterinary medicine, optometry, podiatric medicine,
pharmacy, public health, allied health, or chiropractic, or a
graduate program in health administration or behavioral and
mental health practice, including clinical psychology.
(2) The term ‘‘eligible lender’’ means an eligible institution
that became a lender under this subpart prior to September
15, 1992, an agency or instrumentality of a State, a financial
or credit institution (including an insurance company) which is
subject to examination and supervision by an agency of the
United States or of any State, a pension fund approved by the
Secretary for this purpose, or a nonprofit private entity designated by the State, regulated by the State, and approved by
the Secretary.
(3) The term ‘‘line of credit’’ means an arrangement or
agreement between the lender and the borrower whereby a
loan is paid out by the lender to the borrower in annual installments, or whereby the lender agrees to make, in addition
to the initial loan, additional loans in subsequent years.
(4) The term ‘‘school of allied health’’ means a program in
a school of allied health (as defined in section 799) which leads
to a masters’ degree or a doctoral degree.
(5)(A) The term ‘‘default rate’’, in the case of an eligible entity, means the percentage constituted by the ratio of—
(i) the principal amount of loans insured under this
subpart—
(I) that are made with respect to the entity and
that enter repayment status after April 7, 1987; and
(II) for which amounts have been paid under section 707(a) to insurance beneficiaries, exclusive of any
loan for which amounts have been so paid as a result
of the death or total and permanent disability of the
borrower; exclusive of any loan for which the borrower
begins payments to the Secretary on the loan pursuant to section 707(b) and maintains payments for 12
consecutive months in accordance with the agreement
involved (with the loan subsequently being included or
excluded, as the case may be, as amounts paid under
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section 707(a) according to whether further defaults
occur and whether with respect to the default involved
compliance with such requirement regarding 12 consecutive months occurs); and exclusive of any loan on
which payments may not be recovered by reason of the
obligation under the loan being discharged in bankruptcy under title 11, United States Code; to
(ii) the total principal amount of loans insured under
this subpart that are made with respect to the entity and
that enter repayment status after April 7, 1987.
(B) For purposes of subparagraph (A), a loan insured
under this subpart shall be considered to have entered repayment status if the applicable period described in subparagraph
(B) of section 705(a)(2) regarding the loan has expired (without
regard to whether any period described in subparagraph (C) of
such section is applicable regarding the loan).
(C) For purposes of subparagraph (A), the term ‘‘eligible
entity’’ means an eligible institution, an eligible lender, or a
holder, as the case may be.
(D) For purposes of subparagraph (A), a loan is made with
respect to an eligible entity if—
(i) in the case of an eligible institution, the loan was made
to students of the institution;
(ii) in the case of an eligible lender, the loan was made by
the lender; and
(iii) in the case of a holder, the loan was purchased by the
holder.
SEC. 720. ø292p¿ AUTHORIZATION OF APPROPRIATIONS.
(a) IN GENERAL.—For fiscal year 1993 and subsequent

fiscal
years, there are authorized to be appropriated such sums as may
be necessary for the adequacy of the student loan insurance account under this subpart and for the purpose of administering this
subpart.
(b) AVAILABILITY OF SUMS.—Sums appropriated under subsection (a) shall remain available until expended.

Subpart II—Federally-Supported Student Loan
Funds
SEC. 721. ø292q¿ AGREEMENTS FOR OPERATION OF SCHOOL LOAN
FUNDS.
(a) FUND AGREEMENTS.—The Secretary is authorized to enter

into an agreement for the establishment and operation of a student
loan fund in accordance with this subpart with any public or other
nonprofit school of medicine, osteopathic medicine, dentistry, pharmacy, podiatric medicine, optometry, or veterinary medicine.
(b) REQUIREMENTS.—Each agreement entered into under this
section shall—
(1) provide for establishment of a student loan fund by the
school;
(2) provide for deposit in the fund of—
(A) the Federal capital contributions to the fund;
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(B) an amount equal to not less than one-ninth of such
Federal capital contributions, contributed by such institution;
(C) collections of principal and interest on loans made
from the fund;
(D) collections pursuant to section 722(j); and
(E) any other earnings of the fund;
(3) provide that the fund shall be used only for loans to
students of the school in accordance with the agreement and
for costs of collection of such loans and interest thereon;
(4) provide that loans may be made from such funds only
to students pursuing a full-time course of study at the school
leading to a degree of doctor of medicine, doctor of dentistry or
an equivalent degree, doctor of osteopathy, bachelor of science
in pharmacy or an equivalent degree, doctor of pharmacy or an
equivalent degree, doctor of podiatric medicine or an equivalent degree, doctor of optometry or an equivalent degree, or
doctor of veterinary medicine or an equivalent degree;
(5) provide that the school shall advise, in writing, each
applicant for a loan from the student loan fund of the provisions of section 722 under which outstanding loans from the
student loan fund may be paid (in whole or in part) by the Secretary; and
(6) contain such other provisions as are necessary to protect the financial interests of the United States.
(c) FAILURE OF SCHOOL TO COLLECT LOANS.—
(1) IN GENERAL.—Any standard established by the Secretary by regulation for the collection by schools of medicine,
osteopathic medicine, dentistry, pharmacy, podiatric medicine,
optometry, or veterinary medicine of loans made pursuant to
loan agreements under this subpart shall provide that the failure of any such school to collect such loans shall be measured
in accordance with this subsection. This subsection may not be
construed to require such schools to reimburse the student
loan fund under this subpart for loans that became
uncollectible prior to August 1985 or to penalize such schools
with respect to such loans.
(2) EXTENT OF FAILURE.—The measurement of a school’s
failure to collect loans made under this subpart shall be the
ratio (stated as a percentage) that the defaulted principal
amount outstanding of such school bears to the matured loans
of such school.
(3) DEFINITIONS.—For purposes of this subsection:
(A) The term ‘‘default’’ means the failure of a borrower
of a loan made under this subpart to—
(i) make an installment payment when due; or
(ii) comply with any other term of the promissory
note for such loan,
except that a loan made under this subpart shall not be
considered to be in default if the loan is discharged in
bankruptcy or if the school reasonably concludes from
written contracts with the borrower that the borrower intends to repay the loan.
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(B) The term ‘‘defaulted principal amount outstanding’’
means the total amount borrowed from the loan fund of a
school that has reached the repayment stage (minus any
principal amount repaid or canceled) on loans—
(i) repayable monthly and in default for at least
120 days; and
(ii) repayable less frequently than monthly and in
default for at least 180 days;
(C) The term ‘‘grace period’’ means the period of one
year beginning on the date on which the borrower ceases
to pursue a full-time course of study at a school of medicine, osteopathic medicine, dentistry, pharmacy, podiatric
medicine, optometry, or veterinary medicine; and
(D) The term ‘‘matured loans’’ means the total principal amount of all loans made by a school under this subpart minus the total principal amount of loans made by
such school to students who are—
(i) enrolled in a full-time course of study at such
school; or
(ii) in their grace period.
SEC. 722. ø292r¿ LOAN PROVISIONS.
(a) AMOUNT OF LOAN.—
(1) IN GENERAL.—Loans from

a student loan fund (established under an agreement with a school under section 721)
may not, subject to paragraph (2), exceed for any student for
a school year (or its equivalent) the cost of attendance (including tuition, other reasonable educational expenses, and reasonable living costs) for that year at the educational institution attended by the student (as determined by such educational institution).
(2) THIRD AND FOURTH YEARS OF MEDICAL SCHOOL.—For
purposes of paragraph (1), the amount of the loan may, in the
case of the third or fourth year of a student at a school of medicine or osteopathic medicine, be increased to the extent necessary to pay the balances of loans that, from sources other
than the student loan fund under section 721, were made to
the individual for attendance at the school. The authority to
make such an increase is subject to the school and the student
agreeing that such amount (as increased) will be expended to
pay such balances.
(b) TERMS AND CONDITIONS.—Subject to section 723, any such
loans shall be made on such terms and conditions as the school
may determine, but may be made only to a student—
(1) who is in need of the amount thereof to pursue a fulltime course of study at the school leading to a degree of doctor
of medicine, doctor of dentistry or an equivalent degree, doctor
of osteopathy, bachelor of science in pharmacy or an equivalent
degree, doctor of pharmacy or an equivalent degree, doctor of
podiatric medicine or an equivalent degree, doctor of optometry
or an equivalent degree, or doctor of veterinary medicine or an
equivalent degree; and
(2) who, if required under section 3 of the Military Selective Service Act to present himself for and submit to registraMarch 13, 2013

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tion under such section, has presented himself and submitted
to registration under such section.
(c) REPAYMENT; EXCLUSIONS FROM REPAYMENT PERIOD.—Such
loans shall be repayable in equal or graduated periodic installments (with the right of the borrower to accelerate repayment) over
the period of not less than 10 years nor more than 25 years, at the
discretion of the institution, which begins one year after the student ceases to pursue a full-time course of study at a school of medicine, osteopathic medicine, dentistry, pharmacy, podiatry, optometry, or veterinary medicine, excluding from such period—
(1) all periods—
(A) not in excess of three years of active duty performed by the borrower as a member of a uniformed service;
(B) not in excess of three years during which the borrower serves as a volunteer under the Peace Corps Act;
(C) during which the borrower participates in advanced professional training, including internships and
residencies; and
(D) during which the borrower is pursuing a full-time
course of study at such a school; and
(2) a period—
(A) not in excess of two years during which a borrower
who is a full-time student in such a school leaves the
school, with the intent to return to such school as a fulltime student, in order to engage in a full-time educational
activity which is directly related to the health profession
for which the borrower is preparing, as determined by the
Secretary; or
(B) not in excess of two years during which a borrower
who is a graduate of such a school is a participant in a fellowship training program or a full-time educational activity which—
(i) is directly related to the health profession for
which such borrower prepared at such school, as determined by the Secretary; and
(ii) may be engaged in by the borrower during
such a two-year period which begins within twelve
months after the completion of the borrower’s participation in advanced professional training described in
paragraph (1)(C) or prior to the completion of such
borrower’s participation in such training.
(d) CANCELLATION OF LIABILITY.—The liability to repay the unpaid balance of such a loan and accrued interest thereon shall be
canceled upon the death of the borrower, or if the Secretary determines that he has become permanently, and totally disabled.
(e) RATE OF INTEREST.—Such loans shall bear interest, on the
unpaid balance of the loan, computed only for periods for which the
loan is repayable, at the rate of 5 percent per year.
(f) SECURITY OR ENDORSEMENT.—Loans shall be made under
this subpart without security or endorsement, except that if the
borrower is a minor and the note or other evidence of obligation executed by him would not, under the applicable law, create a binding obligation, either security or endorsement may be required.
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(g) TRANSFERRING AND ASSIGNING LOANS.—No note or other
evidence of a loan made under this subpart may be transferred or
assigned by the school making the loan except that, if the borrowers transfer to another school participating in the program
under this subpart, such note or other evidence of a loan may be
transferred to such other school.
(h) CHARGE WITH RESPECT TO INSURANCE FOR CERTAIN CANCELLATIONS.—Subject to regulations of the Secretary, a school may
assess a charge with respect to loans made this 1 subpart to cover
the costs of insuring against cancellation of liability under subsection (d).
(i) CHARGE WITH RESPECT TO LATE PAYMENTS.—Subject to regulations of the Secretary, and in accordance with this section, a
school shall assess a charge with respect to a loan made under this
subpart for failure of the borrower to pay all or any part of an installment when it is due and, in the case of a borrower who is entitled to deferment of the loan under subsection (c), for any failure
to file timely and satisfactory evidence of such entitlement. No such
charge may be made if the payment of such installment or the filing of such evidence is made within 60 days after the date on
which such installment or filing is due. The amount of any such
charge may not exceed an amount equal to 6 percent of the amount
of such installment. The school may elect to add the amount of any
such charge to the principal amount of the loan as of the first day
after the day on which such installment or evidence was due, or to
make the amount of the charge payable to the school not later than
the due date of the next installment after receipt by the borrower
of notice of the assessment of the charge.
(j) AUTHORITY OF SCHOOLS REGARDING RATE OF PAYMENT.—A
school may provide, in accordance with regulations of the Secretary, that during the repayment period of a loan from a loan fund
established pursuant to an agreement under this subpart payments
of principal and interest by the borrower with respect to all the
outstanding loans made to him from loan funds so established shall
be at a rate equal to not less than $40 per month.
(k) AUTHORITY REGARDING REPAYMENTS BY SECRETARY.—Upon
application by a person who received, and is under an obligation
to repay, any loan made to such person as a health professions student to enable him to study medicine, osteopathy, dentistry, veterinary medicine, optometry, pharmacy, or podiatry, the Secretary
may undertake to repay (without liability to the applicant) all or
any part of such loan, and any interest or portion thereof outstanding thereon, upon his determination, pursuant to regulations
establishing criteria therefor, that the applicant—
(1) failed to complete such studies leading to his first professional degree;
(2) is in exceptionally needy circumstances;
(3) is from a low-income or disadvantaged family as those
terms may be defined by such regulations; and
(4) has not resumed, or cannot reasonably be expected to
resume, the study of medicine, osteopathy, dentistry, veteri1 So in law. See section 102 of Public Law 102–408 (106 Stat. 1994). Probably should be ‘‘made
under this subpart’’.

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nary medicine, optometry, pharmacy, or podiatric medicine,
within two years following the date upon which he terminated
such studies.
(l) COLLECTION EFFORTS BY SECRETARY.—The Secretary is authorized to attempt to collect any loan which was made under this
subpart, which is in default, and which was referred to the Secretary by a school with which the Secretary has an agreement
under this subpart, on behalf of that school under such terms and
conditions as the Secretary may prescribe (including reimbursement from the school’s student loan fund for expenses the Secretary may reasonably incur in attempting collection), but only if
the school has complied with such requirements as the Secretary
may specify by regulation with respect to the collection of loans
under this subpart. A loan so referred shall be treated as a debt
subject to section 5514 of title 5, United States Code. Amounts collected shall be deposited in the school’s student loan fund. Whenever the Secretary desires the institution of a civil action regarding
any such loan, the Secretary shall refer the matter to the Attorney
General for appropriate action.
(m) ELIMINATION OF STATUTE OF LIMITATION FOR LOAN COLLECTIONS.—
(1) PURPOSE.—It is the purpose of this subsection to ensure that obligations to repay loans under this section are enforced without regard to any Federal or State statutory, regulatory, or administrative limitation on the period within which
debts may be enforced.
(2) PROHIBITION.—Notwithstanding any other provision of
Federal or State law, no limitation shall terminate the period
within which suit may be filed, a judgment may be enforced,
or an offset, garnishment, or other action may be initiated or
taken by a school that has an agreement with the Secretary
pursuant to section 721 that is seeking the repayment of the
amount due from a borrower on a loan made under this subpart after the default of the borrower on such loan.
SEC. 723. ø292s¿ MEDICAL SCHOOLS AND PRIMARY HEALTH CARE.
(a) REQUIREMENTS FOR STUDENTS.—
(1) IN GENERAL.—Subject to the provisions of this sub-

section, in the case of student loan funds established under
section 721 by schools of medicine or osteopathic medicine,
each agreement entered into under such section with such a
school shall provide (in addition to the provisions required in
subsection (b) of such section) that the school will make a loan
from such fund to a student only if the student agrees—
(A) to enter and complete a residency training program in primary health care not later than 4 years after
the date on which the student graduates from such school;
and
(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.
(2) INAPPLICABILITY TO CERTAIN STUDENTS.—
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(A) The requirement established in paragraph (1) regarding the student loan fund of a school does not apply
to a student if—
(i) the first loan to the student from such fund is
made before July 1, 1993; or
(ii) the loan is made from—
(I) a Federal capital contribution under section 721 that is made from amounts appropriated
under section 724(f) (in this section referred to as
an ‘‘exempt Federal capital contribution’’); or
(II) a school contribution made under section
721 pursuant to such a Federal capital contribution (in this section referred to as an ‘‘exempt
school contribution’’).
(B) A Federal capital contribution under section 721
may not be construed as being an exempt Federal capital
contribution if the contribution was made from amounts
appropriated before October 1, 1990. A school contribution
under section 721 may not be construed as being an exempt school contribution if the contribution was made pursuant to a Federal capital contribution under such section
that was made from amounts appropriated before such
date.
(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.
(4) WAIVERS.—
(A) With respect to the obligation of an individual
under an agreement made under paragraph (1) as a student, the Secretary shall provide for the partial or total
waiver or suspension of the obligation whenever compliance by the individual is impossible, or would involve extreme hardship to the individual, and if enforcement of the
obligation with respect to the individual would be unconscionable.
(B) For purposes of subparagraph (A), the obligation of
an individual shall be waived if—
(i) the status of the individual as a student of the
school involved is terminated before graduation from
the school, whether voluntarily or involuntarily; and
(ii) the individual does not, after such termination,
resume attendance at the school or begin attendance
at any other school of medicine or osteopathic medicine.
(C) If an individual resumes or begins attendance for
purposes of subparagraph (B), the obligation of the individual under the agreement under paragraph (1) shall be
considered to have been suspended for the period in which
the individual was not in attendance.
(D) This paragraph may not be construed as authorizing the waiver or suspension of the obligation of a stuMarch 13, 2013

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dent to repay, in accordance with section 722, loans from
student loan funds under section 721.
(b) REQUIREMENTS FOR SCHOOLS.—
(1) IN GENERAL.—Subject to the provisions of this subsection, in the case of student loan funds established under
section 721 by schools of medicine or osteopathic medicine,
each agreement entered into under such section with such a
school shall provide (in addition to the provisions required in
subsection (b) of such section) that, for the 1-year period ending on June 30, 1997; 1 and for the 1-year period ending on
June 30 of each subsequent fiscal year, the school will meet not
less than 1 of the conditions described in paragraph (2) with
respect to graduates of the school whose date of graduation
from the school occurred approximately 4 years before the end
of the 1-year period involved.
(2) DESCRIPTION OF CONDITIONS.—With respect to graduates described in paragraph (1) (in this paragraph referred to
as ‘‘designated graduates’’), the conditions referred to in such
paragraph for a school for a 1-year period are as follows:
(A) Not less than 50 percent of designated graduates
of the school meet the criterion of either being in a residency training program in primary health care, or being
engaged in a practice in such care (having completed such
a program).
(B) Not less than 25 percent of the designated graduates of the school meet such criterion, and such percentage is not less than 5 percentage points above the percentage of such graduates meeting such criterion for the preceding 1-year period.
(C) In the case of schools of medicine or osteopathic
medicine with student loans funds under section 721, the
school involved is at or above the 75th percentile of such
schools whose designated graduates meet such criterion.
(3) DETERMINATIONS BY SECRETARY.—Not later than 90
days after the close of each 1-year period described in paragraph (1), the Secretary shall make a determination of whether
the school involved has for such period complied with such
paragraph and shall in writing inform the school of the determination. Such determination shall be made only after consideration of the report submitted to the Secretary by the school
under paragraph (6).
(4) NONCOMPLIANCE BY SCHOOL.—
(A)(i) Subject to subparagraph (C), each agreement
under section 721 with a school of medicine or osteopathic
medicine shall provide that, if the school fails to comply
with paragraph (1) for a 1-year period under such paragraph, the school—
(I) will pay to the Secretary the amount applicable under subparagraph (B) for the period; and
(II) will pay such amount not later than 90
days after the school is informed under paragraph
1 So in law. See section 2014(c)(2)(A)(i) of Public Law 103–43 (107 Stat. 216). The semicolon
probably should be a comma.

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(3) of the determination of the Secretary regarding
such period.
(ii) Any amount that a school is required to pay under
clause (i) may be paid from the student loan fund of the
school under section 721.
(B) For purposes of subparagraph (A), the amount applicable for a school, subject to subparagraph (C), is—
(i) for the 1-year period ending June 30, 1997, an
amount equal to 10 percent of the income received
during such period by the student loan fund of the
school under section 721;
(ii) for the 1-year period ending June 30, 1998, an
amount equal to 20 percent of the income received
during such period by the student loan fund; and
(iii) for any subsequent 1-year period under paragraph (1), an amount equal to 30 percent of the income received during such period by the student loan
fund.
(C) In determining the amount of income that a student loan fund has received for purposes of subparagraph
(B), the Secretary shall exclude any income derived from
exempt contributions. Payments made to the Secretary
under subparagraph (A) may not be made with such contributions or with income derived from such contributions.
(5) EXPENDITURE OF PAYMENTS.—
(A) Amounts paid to the Secretary under paragraph
(4) shall be expended to make Federal capital contributions to student loan funds under section 721 of schools
that are in compliance with paragraph (1).
(B) A Federal capital contribution under section 721
may not be construed as being an exempt Federal capital
contribution if the contribution is made from payments
under subparagraph (A). A school contribution under such
section may not be construed as being an exempt school
contribution if the contribution is made pursuant to a Federal capital contribution from such payments.
(6) REPORTS BY SCHOOLS.—Each agreement under section
721 with a school of medicine or osteopathic medicine shall
provide that the school will submit to the Secretary a report
for each 1-year period under paragraph (1) that provides such
information as the Secretary determines to be necessary for
carrying out this subsection. Each such report shall include
statistics concerning the current training or practice status of
all graduates of such school whose date of graduation from the
school occurred approximately 4 years before the end of the 1year period involved.
(c) DEFINITIONS.—For purposes of this section:
(1) The term ‘‘exempt contributions’’ means exempt Federal capital contributions and exempt school contributions.
(2) The term ‘‘exempt Federal capital contribution’’ means
a Federal capital contribution described in subclause (I) of subsection (a)(2)(A)(ii).
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(3) The term ‘‘exempt school contribution’’ means a school
contribution described in subclause (II) of subsection
(a)(2)(A)(ii).
(4) The term ‘‘income’’, with respect to a student fund
under section 721, means payments of principal and interest
on any loan made from the fund, and any other earnings of the
fund.
(5) The term ‘‘primary health care’’ means family medicine,
general internal medicine, general pediatrics, preventive medicine, or osteopathic general practice.
(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.
SEC. 724. ø292t¿ INDIVIDUALS FROM DISADVANTAGED BACKGROUNDS.
(a) FUND AGREEMENTS REGARDING CERTAIN AMOUNTS.—With

respect to amounts appropriated under subsection (f), each agreement entered into under section 721 with a school shall provide (in
addition to the provisions required in subsection (b) of such section)
that—
(1) any Federal capital contribution made to the student
loan fund of the school from such amounts, together with the
school contribution appropriate under subsection (b)(2)(B) of
such section to the amount of the Federal capital contribution,
will be utilized only for the purpose of—
(A) making loans to individuals from disadvantaged
backgrounds; and
(B) the costs of the collection of the loans and interest
on the loans; and
(2) collections of principal and interest on loans made pursuant to paragraph (1), and any other earnings of the student
loan fund attributable to amounts that are in the fund pursuant to such paragraph, will be utilized only for the purpose described in such paragraph.
(b) MINIMUM QUALIFICATIONS FOR SCHOOLS.—The Secretary
may not make a Federal capital contribution for purposes of subsection (a) for a fiscal year unless the health professions school involved—
(1) is carrying out a program for recruiting and retaining
students from disadvantaged backgrounds, including racial and
ethnic minorities; and
(2) is carrying out a program for recruiting and retaining
minority faculty.
(c) CERTAIN AGREEMENTS REGARDING EDUCATION OF STUDENTS; DATE CERTAIN FOR COMPLIANCE.—The Secretary may not
make a Federal capital contribution for purposes of subsection (a)
for a fiscal year unless the health professions school involved
agrees—
(1) to ensure that adequate instruction regarding minority
health issues is provided for in the curricula of the school;
(2) with respect to health clinics providing services to a
significant number of individuals who are from disadvantaged
backgrounds, including members of minority groups, to enter
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into arrangements with 1 or more such clinics for the purpose
of providing students of the school with experience in providing
clinical services to such individuals;
(3) with respect to public or nonprofit private secondary
educational institutions and undergraduate institutions of
higher education, to enter into arrangements with 1 or more
such institutions for the purpose of carrying out programs regarding the educational preparation of disadvantaged students,
including minority students, to enter the health professions
and regarding the recruitment of such individuals into the
health professions;
(4) to establish a mentor program for assisting disadvantaged students, including minority students, regarding the
completion of the educational requirements for degrees from
the school;
(5) to be carrying out each of the activities specified in any
of paragraphs (1) through (4) by not later than 1 year after the
date on which the first Federal capital contribution is made to
the school for purposes of subsection (a); and
(6) to continue carrying out such activities, and the activities specified in paragraphs (1) and (2) of subsection (b),
throughout the period during which the student loan fund established pursuant to section 721(b) is in operation.
(d) AVAILABILITY OF OTHER AMOUNTS.—With respect to Federal
capital contributions to student loan funds under agreements
under section 721(b), any such contributions made before October
1, 1990, together with the school contributions appropriate under
paragraph (2)(B) of such section to the amount of the Federal capital contributions, may be utilized for the purpose of making loans
to individuals from disadvantaged backgrounds, subject to section
723(a)(2)(B).
(e) DEFINITION.—For purposes of this section, the term ‘‘disadvantaged’’, with respect to an individual, shall be defined by the
Secretary.
(f) AUTHORIZATION OF APPROPRIATIONS.—
ø(1) Repealed by section 132(b) of Public Law 105–392
(112 Stat. 3575).¿
(2) SPECIAL CONSIDERATION FOR CERTAIN SCHOOLS.—In
making Federal capital contributions to student loan funds for
purposes of subsection (a), the Secretary shall give special consideration to health professions schools that have enrollments
of underrepresented minorities above the national average for
health professions schools.
SEC. 725. ø292u¿ ADMINISTRATIVE PROVISIONS.

The Secretary may agree to modifications of agreements or
loans made under this subpart, and may compromise, waive, or release any right, title, claim, or demand of the United States arising
or acquired under this subpart.
SEC. 726. ø292v¿ PROVISION BY SCHOOLS OF INFORMATION TO STUDENTS.
(a) IN GENERAL.—With respect to loans made by a school

under this subpart after June 30, 1986, each school, in order to
carry out the provisions of sections 721 and 722, shall, at any time
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such school makes such a loan to a student under this subpart,
provide thorough and adequate loan information on loans made
under this subpart to the student. The loan information required
to be provided to the student by this subsection shall include—
(1) the yearly and cumulative maximum amounts that may
be borrowed by the student;
(2) the terms under which repayment of the loan will
begin;
(3) the maximum number of years in which the loan must
be repaid;
(4) the interest rate that will be paid by the borrower and
the minimum amount of the required monthly payment;
(5) the amount of any other fees charged to the borrower
by the lender;
(6) any options the borrower may have for deferral, cancellation, prepayment, consolidation, or other refinancing of the
loan;
(7) a definition of default on the loan and a specification
of the consequences which will result to the borrower if the
borrower defaults, including a description of any arrangements
which may be made with credit bureau organizations;
(8) to the extent practicable, the effect of accepting the
loan on the eligibility of the borrower for other forms of student assistance; and
(9) a description of the actions that may be taken by the
Federal Government to collect the loan, including a description
of the type of information concerning the borrower that the
Federal Government may disclose to (A) officers, employees, or
agents of the Department of Health and Human Services, (B)
officers, employees, or agents of schools with which the Secretary has an agreement under this subpart, or (C) any other
person involved in the collection of a loan under this subpart.
(b) STATEMENT REGARDING LOAN.—Each school shall, immediately prior to the graduation from such school of a student who
receives a loan under this subpart after June 30, 1986, provide
such student with a statement specifying—
(1) each amount borrowed by the student under this subpart;
(2) the total amount borrowed by the student under this
subpart; and
(3) a schedule for the repayment of the amounts borrowed
under this subpart, including the number, amount, and frequency of payments to be made.
SEC. 727. ø292w¿ PROCEDURES FOR APPEAL OF TERMINATION OF
AGREEMENTS.

In any case in which the Secretary intends to terminate an
agreement with a school under this subpart, the Secretary shall
provide the school with a written notice specifying such intention
and stating that the school may request a formal hearing with respect to such termination. If the school requests such a hearing
within 30 days after the receipt of such notice, the Secretary shall
provide such school with a hearing conducted by an administrative
law judge.
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SEC. 728. ø292x¿ DISTRIBUTION OF ASSETS FROM LOAN FUNDS.
(a) DISTRIBUTION AFTER TERMINATION OF FUND.—If a

school
terminates a loan fund established under an agreement pursuant
to section 721(b), or if the Secretary for good cause terminates the
agreement with the school, there shall be a capital distribution as
follows:
(1) The Secretary shall first be paid an amount which
bears the same ratio to such balance in such fund on the date
of termination of the fund as the total amount of the Federal
capital contributions to such fund by the Secretary pursuant to
section 721(b)(2)(A) bears to the total amount in such fund derived from such Federal capital contributions and from funds
deposited therein pursuant to section 721(b)(2)(B).
(2) The remainder of such balance shall be paid to the
school.
(b) PAYMENT OF PROPORTIONATE SHARE TO SECRETARY.—If a
capital distribution is made under subsection (a), the school involved shall, after the capital distribution, pay to the Secretary, not
less often than quarterly, the same proportionate share of amounts
received by the school in payment of principal or interest on loans
made from the loan fund established pursuant to section 721(b) as
was determined by the Secretary under subsection (a).
SEC. 735. 1 ø292y¿ GENERAL PROVISIONS.
(a) DATE CERTAIN FOR APPLICATIONS.—The

Secretary shall
from time to time set dates by which schools must file applications
for Federal capital contributions.
(b) CONTINGENT REDUCTION IN ALLOTMENTS.—If the total of
the amounts requested for any fiscal year in such applications exceeds the amounts appropriated under this section for that fiscal
year, the allotment to the loan fund of each such school shall be
reduced to whichever of the following is the smaller: (A) the
amount requested in its application; or (B) an amount which bears
the same ratio to the amounts appropriated as the number of students estimated by the Secretary to be enrolled in such school during such fiscal year bears to the estimated total number of students
in all such schools during such year. Amounts remaining after allotment under the preceding sentence shall be reallotted in accordance with clause (B) of such sentence among schools whose applications requested more than the amounts so allotted to their loan
funds, but with such adjustments as may be necessary to prevent
the total allotted to any such school’s loan fund from exceeding the
total so requested by it.
(c) ALLOTMENT OF EXCESS FUNDS.—Funds available in any fiscal year for payment to schools under this subpart which are in excess of the amount appropriated pursuant to this section for that
year shall be allotted among schools in such manner as the Secretary determines will best carry out the purposes of this subpart.
(d) PAYMENT OF INSTALLMENTS TO SCHOOLS.—Allotments to a
loan fund of a school shall be paid to it from time to time in such
installments as the Secretary determines will not result in unnecessary accumulations in the loan fund at such school.
1 Title VII does not have sections 729 through 734. See section 102 of Public Law 102–408
(106 Stat. 1994, 2021).

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(e) DISPOSITION OF FUNDS RETURNED TO SECRETARY.—
(1) EXPENDITURE FOR FEDERAL CAPITAL CONTRIBUTIONS.—
Subject to section 723(b)(5), any amounts from student loan
funds under section 721 that are returned to the Secretary by
health professions schools shall be expended to make Federal
capital contributions to such funds.
(2) DATE CERTAIN FOR CONTRIBUTIONS.—Amounts described in paragraph (1) that are returned to the Secretary
shall be obligated before the end of the succeeding fiscal year.
(3) PREFERENCE IN MAKING CONTRIBUTIONS.—In making
Federal capital contributions to student loans funds under section 721 for a fiscal year from amounts described in paragraph
(1), the Secretary shall give preference to health professions
schools of the same disciplines as the health professions
schools returning such amounts for the period during which
the amounts expended for such contributions were received by
the Secretary. Any such amounts that, prior to being so returned, were available only for the purpose of loans under this
subpart to individuals from disadvantaged backgrounds shall
be available only for such purpose.
(f) FUNDING FOR CERTAIN MEDICAL SCHOOLS.—
(1) AUTHORIZATION OF APPROPRIATIONS.—For the purpose
of making Federal capital contributions to student loan funds
established under section 721 by schools of medicine or osteopathic medicine, there is authorized to be appropriated
$10,000,000 for each of the fiscal years 1994 through 1996.
(2) MINIMUM REQUIREMENTS.—
(A) Subject to subparagraph (B), the Secretary may
make a Federal capital contribution pursuant to paragraph
(1) only if the school of medicine or osteopathic medicine
involved meets the conditions described in subparagraph
(A) of section 723(b)(2) or the conditions described in subparagraph (C) of such section.
(B) For purposes of subparagraph (A), the conditions
referred to in such subparagraph shall be applied with respect to graduates of the school involved whose date of
graduation occurred approximately 3 years before June 30
of the fiscal year preceding the fiscal year for which the
Federal capital contribution involved is made.

PART B—HEALTH PROFESSIONS TRAINING
FOR DIVERSITY
SEC. 736. ø293¿ CENTERS OF EXCELLENCE.
(a) IN GENERAL.—The Secretary shall

make grants to, and
enter into contracts with, designated health professions schools described in subsection (c), and other public and nonprofit health or
educational entities, for the purpose of assisting the schools in supporting programs of excellence in health professions education for
under-represented minority individuals.
(b) REQUIRED USE OF FUNDS.—The Secretary may not make a
grant under subsection (a) unless the designated health professions
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school involved agrees, subject to subsection (c)(1)(C), to expend the
grant—
(1) to develop a large competitive applicant pool through
linkages with institutions of higher education, local school districts, and other community-based entities and establish an
education pipeline for health professions careers;
(2) to establish, strengthen, or expand programs to enhance the academic performance of under-represented minority
students attending the school;
(3) to improve the capacity of such school to train, recruit,
and retain under-represented minority faculty including the
payment of such stipends and fellowships as the Secretary may
determine appropriate;
(4) to carry out activities to improve the information resources, clinical education, curricula and cultural competence
of the graduates of the school, as it relates to minority health
issues;
(5) to facilitate faculty and student research on health
issues particularly affecting under-represented minority
groups, including research on issues relating to the delivery of
health care;
(6) to carry out a program to train students of the school
in providing health services to a significant number of underrepresented minority individuals through training provided to
such students at community-based health facilities that—
(A) provide such health services; and
(B) are located at a site remote from the main site of
the teaching facilities of the school; and
(7) to provide stipends as the Secretary determines appropriate, in amounts as the Secretary determines appropriate.
(c) CENTERS OF EXCELLENCE.—
(1) DESIGNATED SCHOOLS.—
(A) IN GENERAL.—The designated health professions
schools referred to in subsection (a) are such schools that
meet each of the conditions specified in subparagraphs (B)
and (C), and that—
(i) meet each of the conditions specified in paragraph (2)(A);
(ii) meet each of the conditions specified in paragraph (3);
(iii) meet each of the conditions specified in paragraph (4); or
(iv) meet each of the conditions specified in paragraph (5).
(B) GENERAL CONDITIONS.—The conditions specified in
this subparagraph are that a designated health professions
school—
(i) has a significant number of under-represented
minority individuals enrolled in the school, including
individuals accepted for enrollment in the school;
(ii) has been effective in assisting under-represented minority students of the school to complete
the program of education and receive the degree involved;
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(iii) has been effective in recruiting under-represented minority individuals to enroll in and graduate from the school, including providing scholarships
and other financial assistance to such individuals and
encouraging under-represented minority students from
all levels of the educational pipeline to pursue health
professions careers; and
(iv) has made significant recruitment efforts to increase the number of under-represented minority individuals serving in faculty or administrative positions
at the school.
(C) CONSORTIUM.—The condition specified in this subparagraph is that, in accordance with subsection (e)(1), the
designated health profession school involved has with
other health profession schools (designated or otherwise)
formed a consortium to carry out the purposes described in
subsection (b) at the schools of the consortium.
(D) APPLICATION OF CRITERIA TO OTHER PROGRAMS.—In
the case of any criteria established by the Secretary for
purposes of determining whether schools meet the conditions described in subparagraph (B), this section may not,
with respect to racial and ethnic minorities, be construed
to authorize, require, or prohibit the use of such criteria in
any program other than the program established in this
section.
(2) CENTERS OF EXCELLENCE AT CERTAIN HISTORICALLY
BLACK COLLEGES AND UNIVERSITIES.—
(A) CONDITIONS.—The conditions specified in this subparagraph are that a designated health professions
school—
(i) is a school described in section 799B(1); and
(ii) received a contract under section 788B for fiscal year 1987, as such section was in effect for such
fiscal year.
(B) USE OF GRANT.—In addition to the purposes described in subsection (b), a grant under subsection (a) to
a designated health professions school meeting the conditions described in subparagraph (A) may be expended—
(i) to develop a plan to achieve institutional improvements, including financial independence, to enable the school to support programs of excellence in
health professions education for under-represented minority individuals; and
(ii) to provide improved access to the library and
informational resources of the school.
(C) EXCEPTION.—The requirements of paragraph (1)(C)
shall not apply to a historically black college or university
that receives funding under paragraphs (2) or (5) 1.
(3) HISPANIC CENTERS OF EXCELLENCE.—The conditions
specified in this paragraph are that—
1 So

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(A) with respect to Hispanic individuals, each of
clauses (i) through (iv) of paragraph (1)(B) applies to the
designated health professions school involved;
(B) the school agrees, as a condition of receiving a
grant under subsection (a), that the school will, in carrying
out the duties described in subsection (b), give priority to
carrying out the duties with respect to Hispanic individuals; and
(C) the school agrees, as a condition of receiving a
grant under subsection (a), that—
(i) the school will establish an arrangement with
1 or more public or nonprofit community based Hispanic serving organizations, or public or nonprofit private institutions of higher education, including schools
of nursing, whose enrollment of students has traditionally included a significant number of Hispanic individuals, the purposes of which will be to carry out a
program—
(I) to identify Hispanic students who are interested in a career in the health profession involved; and
(II) to facilitate the educational preparation of
such students to enter the health professions
school; and
(ii) the school will make efforts to recruit Hispanic
students, including students who have participated in
the undergraduate or other matriculation program
carried out under arrangements established by the
school pursuant to clause (i)(II) and will assist Hispanic students regarding the completion of the educational requirements for a degree from the school.
(4) NATIVE AMERICAN CENTERS OF EXCELLENCE.—Subject to
subsection (e), the conditions specified in this paragraph are
that—
(A) with respect to Native Americans, each of clauses
(i) through (iv) of paragraph (1)(B) applies to the designated health professions school involved;
(B) the school agrees, as a condition of receiving a
grant under subsection (a), that the school will, in carrying
out the duties described in subsection (b), give priority to
carrying out the duties with respect to Native Americans;
and
(C) the school agrees, as a condition of receiving a
grant under subsection (a), that—
(i) the school will establish an arrangement with
1 or more public or nonprofit private institutions of
higher education, including schools of nursing, whose
enrollment of students has traditionally included a
significant number of Native Americans, the purpose
of which arrangement will be to carry out a program—
(I) to identify Native American students, from
the institutions of higher education referred to in
clause (i), who are interested in health professions
careers; and
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(II) to facilitate the educational preparation of
such students to enter the designated health professions school; and
(ii) the designated health professions school will
make efforts to recruit Native American students, including students who have participated in the undergraduate program carried out under arrangements established by the school pursuant to clause (i) and will
assist Native American students regarding the completion of the educational requirements for a degree from
the designated health professions school.
(5) OTHER CENTERS OF EXCELLENCE.—The conditions specified in this paragraph are—
(A) with respect to other centers of excellence, the conditions described in clauses (i) through (iv) of paragraph
(1)(B); and
(B) that the health professions school involved has an
enrollment of under-represented minorities above the national average for such enrollments of health professions
schools.
(d) DESIGNATION AS CENTER OF EXCELLENCE.—
(1) IN GENERAL.—Any designated health professions school
receiving a grant under subsection (a) and meeting the conditions described in paragraph (2) or (5) of subsection (c) shall,
for purposes of this section, be designated by the Secretary as
a Center of Excellence in Under-Represented Minority Health
Professions Education.
(2) HISPANIC CENTERS OF EXCELLENCE.—Any designated
health professions school receiving a grant under subsection (a)
and meeting the conditions described in subsection (c)(3) shall,
for purposes of this section, be designated by the Secretary as
a Hispanic Center of Excellence in Health Professions Education.
(3) NATIVE AMERICAN CENTERS OF EXCELLENCE.—Any designated health professions school receiving a grant under subsection (a) and meeting the conditions described in subsection
(c)(4) shall, for purposes of this section, be designated by the
Secretary as a Native American Center of Excellence in Health
Professions Education. Any consortium receiving such a grant
pursuant to subsection (e) shall, for purposes of this section, be
so designated.
(e) AUTHORITY REGARDING NATIVE AMERICAN CENTERS OF EXCELLENCE.—With respect to meeting the conditions specified in
subsection (c)(4), the Secretary may make a grant under subsection
(a) to a designated health professions school that does not meet
such conditions if—
(1) the school has formed a consortium in accordance with
subsection (d)(1); and
(2) the schools of the consortium collectively meet such
conditions, without regard to whether the schools individually
meet such conditions.
(f) DURATION OF GRANT.—The period during which payments
are made under a grant under subsection (a) may not exceed 5
years. Such payments shall be subject to annual approval by the
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Secretary and to the availability of appropriations for the fiscal
year involved to make the payments.
(g) DEFINITIONS.—In this section:
(1) DESIGNATED HEALTH PROFESSIONS SCHOOL.—
(A) IN GENERAL.—The term ‘‘health professions school’’
means, except as provided in subparagraph (B), a school of
medicine, a school of osteopathic medicine, a school of dentistry, a school of pharmacy, or a graduate program in behavioral or mental health.
(B) EXCEPTION.—The definition established in subparagraph (A) shall not apply to the use of the term ‘‘designated health professions school’’ for purposes of subsection (c)(2).
(2) PROGRAM OF EXCELLENCE.—The term ‘‘program of excellence’’ means any program carried out by a designated
health professions school with a grant made under subsection
(a), if the program is for purposes for which the school involved
is authorized in subsection (b) or (c) to expend the grant.
(3) NATIVE AMERICANS.—The term ‘‘Native Americans’’
means American Indians, Alaskan Natives, Aleuts, and Native
Hawaiians.
(h) FORMULA FOR ALLOCATIONS.—
(1) ALLOCATIONS.—Based on the amount appropriated
under subsection (i) for a fiscal year, the following subparagraphs shall apply as appropriate:
(A) IN GENERAL.—If the amounts appropriated under
subsection (i) for a fiscal year are $24,000,000 or less—
(i) the Secretary shall make available $12,000,000
for grants under subsection (a) to health professions
schools that meet the conditions described in subsection (c)(2)(A); and
(ii) and available after grants are made with
funds under clause (i), the Secretary shall make available—
(I) 60 percent of such amount for grants
under subsection (a) to health professions schools
that meet the conditions described in paragraph
(3) or (4) of subsection (c) (including meeting the
conditions under subsection (e)); and
(II) 40 percent of such amount for grants
under subsection (a) to health professions schools
that meet the conditions described in subsection
(c)(5).
(B) FUNDING IN EXCESS OF $24,000,000.—If amounts appropriated under subsection (i) for a fiscal year exceed
$24,000,000 but are less than $30,000,000—
(i) 80 percent of such excess amounts shall be
made available for grants under subsection (a) to
health professions schools that meet the requirements
described in paragraph (3) or (4) of subsection (c) (including meeting conditions pursuant to subsection (e));
and
(ii) 20 percent of such excess amount shall be
made available for grants under subsection (a) to
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health professions schools that meet the conditions described in subsection (c)(5).
(C) FUNDING IN EXCESS OF $30,000,000.—If amounts appropriated under subsection (i) for a fiscal year exceed
$30,000,000 but are less than $40,000,000, the Secretary
shall make available—
(i) not less than $12,000,000 for grants under subsection (a) to health professions schools that meet the
conditions described in subsection (c)(2)(A);
(ii) not less than $12,000,000 for grants under
subsection (a) to health professions schools that meet
the conditions described in paragraph (3) or (4) of subsection (c) (including meeting conditions pursuant to
subsection (e));
(iii) not less than $6,000,000 for grants under subsection (a) to health professions schools that meet the
conditions described in subsection (c)(5); and
(iv) after grants are made with funds under
clauses (i) through (iii), any remaining excess amount
for grants under subsection (a) to health professions
schools that meet the conditions described in paragraph (2)(A), (3), (4), or (5) of subsection (c).
(D) FUNDING IN EXCESS OF $40,000,000.—If amounts appropriated under subsection (i) for a fiscal year are
$40,000,000 or more, the Secretary shall make available—
(i) not less than $16,000,000 for grants under subsection (a) to health professions schools that meet the
conditions described in subsection (c)(2)(A);
(ii) not less than $16,000,000 for grants under
subsection (a) to health professions schools that meet
the conditions described in paragraph (3) or (4) of subsection (c) (including meeting conditions pursuant to
subsection (e));
(iii) not less than $8,000,000 for grants under subsection (a) to health professions schools that meet the
conditions described in subsection (c)(5); and
(iv) after grants are made with funds under
clauses (i) through (iii), any remaining funds for
grants under subsection (a) to health professions
schools that meet the conditions described in paragraph (2)(A), (3), (4), or (5) of subsection (c).
(2) NO LIMITATION.—Nothing in this subsection shall be
construed as limiting the centers of excellence referred to in
this section to the designated amount, or to preclude such entities from competing for grants under this section.
(3) MAINTENANCE OF EFFORT.—
(A) IN GENERAL.—With respect to activities for which
a grant made under this part are authorized to be expended, the Secretary may not make such a grant to a center of excellence for any fiscal year unless the center
agrees to maintain expenditures of non-Federal amounts
for such activities at a level that is not less than the level
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858

cal year preceding the fiscal year for which the school receives such a grant.
(B) USE OF FEDERAL FUNDS.—With respect to any Federal amounts received by a center of excellence and available for carrying out activities for which a grant under this
part is authorized to be expended, the center shall, before
expending the grant, expend the Federal amounts obtained
from sources other than the grant, unless given prior approval from the Secretary.
(i) AUTHORIZATION OF APPROPRIATIONS.—There are authorized
to be appropriated to carry out this section—
(1) $50,000,000 for each of the fiscal years 2010 through
2015; and
(2) and such sums as are necessary for each subsequent
fiscal year.
SEC. 737. ø293a¿ SCHOLARSHIPS FOR DISADVANTAGED STUDENTS.
(a) IN GENERAL.—The Secretary may make a grant to an eligi-

ble entity (as defined in subsection (d)(1)) under this section for the
awarding of scholarships by schools to any full-time student who
is an eligible individual as defined in subsection (d). Such scholarships may be expended only for tuition expenses, other reasonable
educational expenses, and reasonable living expenses incurred in
the attendance of such school.
(b) PREFERENCE IN PROVIDING SCHOLARSHIPS.—The Secretary
may not make a grant to an entity under subsection (a) unless the
health professions and nursing schools involved agree that, in providing scholarships pursuant to the grant, the schools will give
preference to students for whom the costs of attending the schools
would constitute a severe financial hardship and, notwithstanding
other provisions of this section, to former recipients of scholarships
under sections 736 and 740(d)(2)(B) (as such sections existed on the
day before the date of enactment of this section).
(c) AMOUNT OF AWARD.—In awarding grants to eligible entities
that are health professions and nursing schools, the Secretary shall
give priority to eligible entities based on the proportion of graduating students going into primary care, the proportion of underrepresented minority students, and the proportion of graduates
working in medically underserved communities.
(d) DEFINITIONS.—In this section:
(1) ELIGIBLE ENTITIES.—The term ‘‘eligible entities’’ means
an entity that—
(A) is a school of medicine, osteopathic medicine, dentistry, nursing (as defined in section 801), pharmacy,
podiatric medicine, optometry, veterinary medicine, public
health, chiropractic, or allied health, a school offering a
graduate program in behavioral and mental health practice, or an entity providing programs for the training of
physician assistants; and
(B) is carrying out a program for recruiting and retaining students from disadvantaged backgrounds, including
students who are members of racial and ethnic minority
groups.
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(2) ELIGIBLE INDIVIDUAL.—The term ‘‘eligible individual’’
means an individual who—
(A) is from a disadvantaged background;
(B) has a financial need for a scholarship; and
(C) is enrolled (or accepted for enrollment) at an eligible health professions or nursing school as a full-time student in a program leading to a degree in a health profession or nursing.
SEC. 738. ø293b¿ LOAN REPAYMENTS AND FELLOWSHIPS REGARDING
FACULTY POSITIONS.
(a) LOAN REPAYMENTS.—
(1) ESTABLISHMENT OF PROGRAM.—The Secretary shall es-

tablish a program of entering into contracts with individuals
described in paragraph (2) under which the individuals agree
to serve as members of the faculties of schools described in
paragraph (3) in consideration of the Federal Government
agreeing to pay, for each year of such service, not more than
$30,000 of the principal and interest of the educational loans
of such individuals.
(2) ELIGIBLE INDIVIDUALS.—The individuals referred to in
paragraph (1) are individuals from disadvantaged backgrounds
who—
(A) have a degree in medicine, osteopathic medicine,
dentistry, nursing, or another health profession;
(B) are enrolled in an approved graduate training program in medicine, osteopathic medicine, dentistry, nursing,
or other health profession; or
(C) are enrolled as full-time students—
(i) in an accredited (as determined by the Secretary) school described in paragraph (3); and
(ii) in the final year of a course of a study or program, offered by such institution and approved by the
Secretary, leading to a degree from such a school.
(3) ELIGIBLE HEALTH PROFESSIONS SCHOOLS.—The schools
described in this paragraph are schools of medicine, nursing
(as schools of nursing are defined in section 801), osteopathic
medicine, dentistry, pharmacy, allied health, podiatric medicine, optometry, veterinary medicine, or public health, schools
offering physician assistant education programs, or schools offering graduate programs in behavioral and mental health.
(4) REQUIREMENTS REGARDING FACULTY POSITIONS.—The
Secretary may not enter into a contract under paragraph (1)
unless—
(A) the individual involved has entered into a contract
with a school described in paragraph (3) to serve as a
member of the faculty of the school for not less than 2
years; and
(B) the contract referred to in subparagraph (A) provides that—
(i) the school will, for each year for which the individual will serve as a member of the faculty under the
contract with the school, make payments of the principal and interest due on the educational loans of the
individual for such year in an amount equal to the
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860

amount of such payments made by the Secretary for
the year;
(ii) the payments made by the school pursuant to
clause (i) on behalf of the individual will be in addition
to the pay that the individual would otherwise receive
for serving as a member of such faculty; and
(iii) the school, in making a determination of the
amount of compensation to be provided by the school
to the individual for serving as a member of the faculty, will make the determination without regard to
the amount of payments made (or to be made) to the
individual by the Federal Government under paragraph (1).
(5) APPLICABILITY OF CERTAIN PROVISIONS.—The provisions
of sections 338C, 338G, and 338I shall apply to the program
established in paragraph (1) to the same extent and in the
same manner as such provisions apply to the National Health
Service Corps Loan Repayment Program established in subpart
III of part D of title III, including the applicability of provisions regarding reimbursements for increased tax liability and
regarding bankruptcy.
(6) WAIVER REGARDING SCHOOL CONTRIBUTIONS.—The Secretary may waive the requirement established in paragraph
(4)(B) if the Secretary determines that the requirement will
impose an undue financial hardship on the school involved.
(b) FELLOWSHIPS.—
(1) IN GENERAL.—The Secretary may make grants to and
enter into contracts with eligible entities to assist such entities
in increasing the number of underrepresented minority individuals who are members of the faculty of such schools.
(2) APPLICATIONS.—To be eligible to receive a grant or contract under this subsection, an entity shall provide an assurance, in the application submitted by the entity, that—
(A) amounts received under such a grant or contract
will be used to award a fellowship to an individual only if
the individual meets the requirements of paragraphs (3)
and (4); and
(B) each fellowship awarded pursuant to the grant or
contract will include—
(i) a stipend in an amount not exceeding 50 percent of the regular salary of a similar faculty member
for not to exceed 3 years of training; and
(ii) an allowance for other expenses, such as travel
to professional meetings and costs related to specialized training.
(3) ELIGIBILITY.—To be eligible to receive a grant or contract under paragraph (1), an applicant shall demonstrate to
the Secretary that such applicant has or will have the ability
to—
(A) identify, recruit and select underrepresented minority individuals who have the potential for teaching, administration, or conducting research at a health professions institution;
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(B) provide such individuals with the skills necessary
to enable them to secure a tenured faculty position at such
institution, which may include training with respect to
pedagogical skills, program administration, the design and
conduct of research, grants writing, and the preparation of
articles suitable for publication in peer reviewed journals;
(C) provide services designed to assist such individuals
in their preparation for an academic career, including the
provision of counselors; and
(D) provide health services to rural or medically underserved populations.
(4) REQUIREMENTS.—To be eligible to receive a grant or
contract under paragraph (1) an applicant shall—
(A) provide an assurance that such applicant will
make available (directly through cash donations) $1 for
every $1 of Federal funds received under this section for
the fellowship;
(B) provide an assurance that institutional support
will be provided for the individual for the second and third
years at a level that is equal to the total amount of institutional funds provided in the year in which the grant or
contract was awarded;
(C) provide an assurance that the individual that will
receive the fellowship will be a member of the faculty of
the applicant school; and
(D) provide an assurance that the individual that will
receive the fellowship will have, at a minimum, appropriate advanced preparation (such as a master’s or doctoral degree) and special skills necessary to enable such individual to teach and practice.
(5) DEFINITION.—For purposes of this subsection, the term
‘‘underrepresented minority individuals’’ means individuals
who are members of racial or ethnic minority groups that are
underrepresented in the health professions including nursing.
SEC. 739. ø293c¿ EDUCATIONAL ASSISTANCE IN THE HEALTH PROFESSIONS REGARDING INDIVIDUALS FROM DISADVANTAGED
BACKGROUNDS.
(a) IN GENERAL.—
(1) AUTHORITY FOR GRANTS.—For the purpose of assisting

individuals from disadvantaged backgrounds, as determined in
accordance with criteria prescribed by the Secretary, to undertake education to enter a health profession, the Secretary may
make grants to and enter into contracts with schools of medicine, osteopathic medicine, public health, dentistry, veterinary
medicine, optometry, pharmacy, allied health, chiropractic, and
podiatric medicine, public and nonprofit private schools that
offer graduate programs in behavioral and mental health, programs for the training of physician assistants, and other public
or private nonprofit health or educational entities to assist in
meeting the costs described in paragraph (2).
(2) AUTHORIZED EXPENDITURES.—A grant or contract under
paragraph (1) may be used by the entity to meet the cost of—
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(A) identifying, recruiting, and selecting individuals
from disadvantaged backgrounds, as so determined, for
education and training in a health profession;
(B) facilitating the entry of such individuals into such
a school;
(C) providing counseling, mentoring, or other services
designed to assist such individuals to complete successfully
their education at such a school;
(D) providing, for a period prior to the entry of such
individuals into the regular course of education of such a
school, preliminary education and health research training
designed to assist them to complete successfully such regular course of education at such a school, or referring such
individuals to institutions providing such preliminary education;
(E) publicizing existing sources of financial aid available to students in the education program of such a school
or who are undertaking training necessary to qualify them
to enroll in such a program;
(F) paying such scholarships as the Secretary may determine for such individuals for any period of health professions education at a health professions school;
(G) paying such stipends as the Secretary may approve for such individuals for any period of education in
student-enhancement programs (other than regular
courses), except that such a stipend may not be provided
to an individual for more than 12 months, and such a stipend shall be in an amount determined appropriate by the
Secretary (notwithstanding any other provision of law regarding the amount of stipends);
(H) carrying out programs under which such individuals gain experience regarding a career in a field of primary health care through working at facilities of public or
private nonprofit community-based providers of primary
health services; and
(I) conducting activities to develop a larger and more
competitive applicant pool through partnerships with institutions of higher education, school districts, and other
community-based entities.
(3) DEFINITION.—In this section, the term ‘‘regular course
of education of such a school’’ as used in subparagraph (D) includes a graduate program in behavioral or mental health.
(b) REQUIREMENTS FOR AWARDS.—In making awards to eligible
entities under subsection (a)(1), the Secretary shall give preference
to approved applications for programs that involve a comprehensive
approach by several public or nonprofit private health or educational entities to establish, enhance and expand educational programs that will result in the development of a competitive applicant pool of individuals from disadvantaged backgrounds who desire to pursue health professions careers. In considering awards for
such a comprehensive partnership approach, the following shall
apply with respect to the entity involved:
(1) The entity shall have a demonstrated commitment to
such approach through formal agreements that have common
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PUBLIC HEALTH SERVICE ACT

Sec. 740

objectives with institutions of higher education, school districts, and other community-based entities.
(2) Such formal agreements shall reflect the coordination
of educational activities and support services, increased linkages, and the consolidation of resources within a specific geographic area.
(3) The design of the educational activities involved shall
provide for the establishment of a competitive health professions applicant pool of individuals from disadvantaged backgrounds by enhancing the total preparation (academic and social) of such individuals to pursue a health professions career.
(4) The programs or activities under the award shall focus
on developing a culturally competent health care workforce
that will serve the unserved and underserved populations
within the geographic area.
(c) EQUITABLE ALLOCATION OF FINANCIAL ASSISTANCE.—The
Secretary, to the extent practicable, shall ensure that services and
activities under subsection (a) are adequately allocated among the
various racial and ethnic populations who are from disadvantaged
backgrounds.
(d) MATCHING REQUIREMENTS.—The Secretary may require
that an entity that applies for a grant or contract under subsection
(a), provide non-Federal matching funds, as appropriate, to ensure
the institutional commitment of the entity to the projects funded
under the grant or contract. As determined by the Secretary, such
non-Federal matching funds may be provided directly or through
donations from public or private entities and may be in cash or inkind, fairly evaluated, including plant, equipment, or services.
SEC. 740. ø293d¿ AUTHORIZATION OF APPROPRIATION.
(a) SCHOLARSHIPS.—There are authorized to be appropriated

to
carry out section 737, $51,000,000 for fiscal year 2010, and such
sums as may be necessary for each of the fiscal years 2011 through
2014. Of the amount appropriated in any fiscal year, the Secretary
shall ensure that not less than 16 percent shall be distributed to
schools of nursing.
(b) LOAN REPAYMENTS AND FELLOWSHIPS.—For the purpose of
carrying out section 738, there is authorized to be appropriated,
$5,000,000 for each of the fiscal years 2010 through 2014.
(c) EDUCATIONAL ASSISTANCE IN HEALTH PROFESSIONS REGARDING INDIVIDUALS FOR DISADVANTAGED BACKGROUNDS.—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. The Secretary may use not to exceed 20 percent of
the amount appropriated for a fiscal year under this subsection to
provide scholarships under section 739(a)(2)(F).
(d) REPORT.—Not later than 6 months after the date of enactment of this part, the Secretary shall prepare and submit to the
appropriate committees of Congress a report concerning the efforts
of the Secretary to address the need for a representative mix of individuals from historically minority health professions schools, or
from institutions or other entities that historically or by geographic
location have a demonstrated record of training or educating
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underrepresented minorities, within various health professions disciplines, on peer review councils.
SEC. 741. ø293e¿ GRANTS FOR HEALTH PROFESSIONS EDUCATION.
(a) CULTURAL COMPETENCY, PREVENTION, AND PUBLIC HEALTH
AND INDIVIDUALS WITH DISABILITY GRANTS.—
(1) IN GENERAL.—The Secretary, acting through the Ad-

ministrator of the Health Resources and Services Administration, may make awards of grants, contracts, or cooperative
agreements to public and nonprofit private entities (including
tribal entities) 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.
(2) ELIGIBLE ENTITIES.—Unless specifically required otherwise in this title, the Secretary shall accept applications for
grants or contracts under this section from health professions
schools, academic health centers, State or local governments,
or other appropriate public or private nonprofit entities (or consortia of entities, including entities promoting multidisciplinary
approaches) for funding and participation in health professions
training activities. The Secretary may accept applications from
for-profit private entities as determined appropriate by the
Secretary.
(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.

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865

PUBLIC HEALTH SERVICE ACT

Sec. 747

PART C—TRAINING IN FAMILY MEDICINE,
GENERAL INTERNAL MEDICINE, GENERAL
PEDIATRICS, PHYSICIAN ASSISTANTS, GENERAL DENTISTRY, AND PEDIATRIC DENTISTRY
Subpart I—Medical Training Generally
SEC. 747. ø293k¿ PRIMARY CARE TRAINING AND ENHANCEMENT.
(a) SUPPORT AND DEVELOPMENT OF PRIMARY CARE TRAINING
PROGRAMS.—
(1) IN GENERAL.—The Secretary may make grants to, or

enter into contracts with, an accredited public or nonprofit private hospital, school of medicine or osteopathic medicine, academically affiliated physician assistant training program, or a
public or private nonprofit entity which the Secretary has determined is capable of carrying out such grant or contract—
(A) to plan, develop, operate, or participate in an accredited professional training program, including an accredited residency or internship program in the field of
family medicine, general internal medicine, or general pediatrics for medical students, interns, residents, or practicing physicians as defined by the Secretary;
(B) to provide need-based financial assistance in the
form of traineeships and fellowships to medical students,
interns, residents, practicing physicians, or other medical
personnel, who are participants in any such program, and
who plan to specialize or work in the practice of the fields
defined in subparagraph (A);
(C) to plan, develop, and operate a program for the
training of physicians who plan to teach in family medicine, general internal medicine, or general pediatrics training programs;
(D) to plan, develop, and operate a program for the
training of physicians teaching in community-based settings;
(E) to provide financial assistance in the form of
traineeships and fellowships to physicians who are participants in any such programs and who plan to teach or conduct research in a family medicine, general internal medicine, or general pediatrics training program;
(F) to plan, develop, and operate a physician assistant
education program, and for the training of individuals who
will teach in programs to provide such training;
(G) to plan, develop, and operate a demonstration program that provides training in new competencies, as recommended by the Advisory Committee on Training in Primary Care Medicine and Dentistry and the National
Health Care Workforce Commission established in section
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
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866

medical homes (as defined by the Secretary for purposes of this section);
(ii) developing tools and curricula relevant to patient-centered medical homes; and
(iii) providing continuing education to primary
care physicians relevant to patient-centered medical
homes; and
(H) to plan, develop, and operate joint degree programs to provide interdisciplinary and interprofessional
graduate training in public health and other health professions to provide training in environmental health, infectious disease control, disease prevention and health promotion, epidemiological studies and injury control.
(2) DURATION OF AWARDS.—The period during which payments are made to an entity from an award of a grant or contract under this subsection shall be 5 years.
(b) CAPACITY BUILDING IN PRIMARY CARE.—
(1) IN GENERAL.—The Secretary may make grants to or
enter into contracts with accredited schools of medicine or osteopathic medicine to establish, maintain, or improve—
(A) academic units or programs that improve clinical
teaching and research in fields defined in subsection
(a)(1)(A); or
(B) programs that integrate academic administrative
units in fields defined in subsection (a)(1)(A) to enhance
interdisciplinary recruitment, training, and faculty development.
(2) PREFERENCE IN MAKING AWARDS UNDER THIS SUBSECTION.—In making awards of grants and contracts under
paragraph (1), the Secretary shall give preference to any qualified applicant for such an award that agrees to expend the
award for the purpose of—
(A) establishing academic units or programs in fields
defined in subsection (a)(1)(A); or
(B) substantially expanding such units or programs.
(3) PRIORITIES IN MAKING AWARDS.—In awarding grants or
contracts under paragraph (1), the Secretary shall give priority
to qualified applicants that—
(A) proposes a collaborative project between academic
administrative units of primary care;
(B) proposes innovative approaches to clinical teaching
using models of primary care, such as the patient centered
medical home, team management of chronic disease, and
interprofessional integrated models of health care that incorporate transitions in health care settings and integration physical and mental health provision;
(C) have a record of training the greatest percentage
of providers, or that have demonstrated significant improvements in the percentage of providers trained, who
enter and remain in primary care practice;
(D) have a record of training individuals who are from
underrepresented minority groups or from a rural or disadvantaged background;
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PUBLIC HEALTH SERVICE ACT

Sec. 747A

(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. 747A. ø293k–1¿ TRAINING OPPORTUNITIES FOR DIRECT CARE
WORKERS.
(a) IN GENERAL.—The Secretary shall award grants to eligible

entities to enable such entities to provide new training opportunities for direct care workers who are employed in long-term care settings such as nursing homes (as defined in section 1908(e)(1) of the
Social Security Act (42 U.S.C. 1396g(e)(1)), assisted living facilities
and skilled nursing facilities, intermediate care facilities for individuals with mental retardation, home and community based settings, and any other setting the Secretary determines to be appropriate.
(b) ELIGIBILITY.—To be eligible to receive a grant under this
section, an entity shall—
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868

(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. 748. ø293k–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 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;
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Sec. 748

(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 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:
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(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 riskbased clinical disease management of all populations.
(6) Qualified applicants that include educational activities
in cultural competency and health literacy.
(7) Qualified applicants that have a high rate for placing
graduates in practice settings that serve underserved areas or
health disparity populations, or who achieve a significant increase in the rate of placing graduates in such settings.
(8) Qualified applicants that intend to establish a special
populations oral health care education center or training program for the didactic and clinical education of dentists, dental
health professionals, and dental hygienists who plan to teach
oral health care for people with developmental disabilities, cognitive impairment, complex medical problems, significant physical limitations, and vulnerable elderly.
(d) APPLICATION.—An eligible entity desiring a grant under
this section shall submit to the Secretary an application at such
time, in such manner, and containing such information as the Secretary may require.
(e) DURATION OF AWARD.—The period during which payments
are made to an entity from an award of a grant or contract under
subsection (a) shall be 5 years. The provision of such payments
shall be subject to annual approval by the Secretary and subject to
the availability of appropriations for the fiscal year involved to
make the payments.
(f) AUTHORIZATIONS OF APPROPRIATIONS.—For the purpose of
carrying out subsections (a) and (b), there is authorized to be appropriated $30,000,000 for fiscal year 2010 and such sums as may
be necessary for each of fiscal years 2011 through 2015.
(g) CARRYOVER FUNDS.—An entity that receives an award
under this section may carry over funds from 1 fiscal year to another without obtaining approval from the Secretary. In no case
may any funds be carried over pursuant to the preceding sentence
for more than 3 years.
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871

PUBLIC HEALTH SERVICE ACT

Sec. 749

SEC. 749. ø293l¿ ADVISORY COMMITTEE ON TRAINING IN PRIMARY
CARE MEDICINE AND DENTISTRY.
(a) ESTABLISHMENT.—The Secretary shall establish an advisory

committee to be known as the Advisory Committee on Training in
Primary Care Medicine and Dentistry (in this section referred to as
the ‘‘Advisory Committee’’).
(b) COMPOSITION.—
(1) IN GENERAL.—The Secretary shall determine the appropriate number of individuals to serve on the Advisory Committee. Such individuals shall not be officers or employees of
the Federal Government.
(2) APPOINTMENT.—Not later than 90 days after the date
of enactment of this Act 1, the Secretary shall appoint the
members of the Advisory Committee from among individuals
who are health professionals. In making such appointments,
the Secretary shall ensure a fair balance between the health
professions, that at least 75 percent of the members of the Advisory Committee are health professionals, a broad geographic
representation of members and a balance between urban and
rural members. Members shall be appointed based on their
competence, interest, and knowledge of the mission of the profession involved.
(3) MINORITY REPRESENTATION.—In appointing the members of the Advisory Committee under paragraph (2), the Secretary shall ensure the adequate representation of women and
minorities.
(c) TERMS.—
(1) IN GENERAL.—A member of the Advisory Committee
shall be appointed for a term of 3 years, except that of the
members first appointed—
(A) 1⁄3 of such members shall serve for a term of 1
year;
(B) 1⁄3 of such members shall serve for a term of 2
years; and
(C) 1⁄3 of such members shall serve for a term of 3
years.
(2) VACANCIES.—
(A) IN GENERAL.—A vacancy on the Advisory Committee shall be filled in the manner in which the original
appointment was made and shall be subject to any conditions which applied with respect to the original appointment.
(B) FILLING UNEXPIRED TERM.—An individual chosen
to fill a vacancy shall be appointed for the unexpired term
of the member replaced.
(d) DUTIES.—The Advisory Committee shall—
(1) provide advice and recommendations to the Secretary
concerning policy and program development and other matters
of significance concerning the activities under section 747;
1 So in law. The reference to ‘‘this Act’’ means the Public Health Service Act, which was enacted July 1, 1944. Probably should be a reference to the Health Professions Education Partnerships Act of 1998, which added section 748. That Act is Public Law 105–392, enacted November
13, 1998. (Section 102(4) of that Public Law (112 Stat. 3539) added section 748.)

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872

(2) not later than 3 years after the date of enactment of
this section, and annually thereafter, prepare and submit to
the Secretary, and the Committee on Labor and Human Resources of the Senate, and the Committee on Commerce of the
House of Representatives, a report describing the activities of
the Committee, including findings and recommendations made
by the Committee concerning the activities under section 747;
(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.
(e) MEETINGS AND DOCUMENTS.—
(1) MEETINGS.—The Advisory Committee shall meet not
less than 2 times each year. Such meetings shall be held jointly with other related entities established under this title where
appropriate.
(2) DOCUMENTS.—Not later than 14 days prior to the convening of a meeting under paragraph (1), the Advisory Committee shall prepare and make available an agenda of the matters to be considered by the Advisory Committee at such meeting. At any such meeting, the Advisory Council 1 shall distribute materials with respect to the issues to be addressed at
the meeting. Not later than 30 days after the adjourning of
such a meeting, the Advisory Committee shall prepare and
make available a summary of the meeting and any actions
taken by the Committee based upon the meeting.
(f) COMPENSATION AND EXPENSES.—
(1) COMPENSATION.—Each member of the Advisory Committee shall be compensated at a rate equal to the daily equivalent of the annual rate of basic pay prescribed for level IV of
the Executive Schedule under section 5315 of title 5, United
States Code, for each day (including travel time) during which
such member is engaged in the performance of the duties of
the Committee.
(2) EXPENSES.—The members of the Advisory Committee
shall be allowed travel expenses, including per diem in lieu of
subsistence, at rates authorized for employees of agencies
under subchapter I of chapter 57 of title 5, United States Code,
while away from their homes or regular places of business in
the performance of services for the Committee.
(g) FACA.—The Federal Advisory Committee Act shall apply to
the Advisory Committee under this section only to the extent that
the provisions of such Act do not conflict with the requirements of
this section.
SEC. 749A. ø293l–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 es1 So in law. Probably should be ‘‘Advisory Committee’’. See section 102(4) of Public Law 105–
392 (112 Stat. 3539).

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tablishing new accredited or expanded primary care residency programs.
(b) AMOUNT AND DURATION.—Grants awarded under this section shall be for a term of not more than 3 years and the maximum
award may not be more than $500,000.
(c) USE OF FUNDS.—Amounts provided under a grant under
this section shall be used to cover the costs of—
(1) establishing or expanding a primary care residency
training program described in subsection (a), including costs
associated with—
(A) curriculum development;
(B) recruitment, training and retention of residents
and faculty:
(C) accreditation by the Accreditation Council for
Graduate Medical Education (ACGME), the American Dental Association (ADA), or the American Osteopathic Association (AOA); and
(D) faculty salaries during the development phase; and
(2) technical assistance provided by an eligible entity.
(d) APPLICATION.—A teaching health center seeking a grant
under this section shall submit an application to the Secretary at
such time, in such manner, and containing such information as the
Secretary may require.
(e) PREFERENCE FOR CERTAIN APPLICATIONS.—In selecting recipients for grants under this section, the Secretary shall give preference to any such application that documents an existing affiliation agreement with an area health education center program as
defined in sections 751 and 799B.
(f) DEFINITIONS.—In this section:
(1) ELIGIBLE ENTITY.—The term ‘‘eligible entity’’ means an
organization capable of providing technical assistance including an area health education center program as defined in sections 751 and 799B.
(2) PRIMARY CARE RESIDENCY PROGRAM.—The term ‘‘primary care residency program’’ means an approved graduate
medical residency training program (as defined in section
340H) in family medicine, internal medicine, pediatrics, internal medicine-pediatrics, obstetrics and gynecology, psychiatry,
general dentistry, pediatric dentistry, and geriatrics.
(3) TEACHING HEALTH CENTER.—
(A) IN GENERAL.—The term ‘‘teaching health center’’
means an entity that—
(i) is a community based, ambulatory patient care
center; and
(ii) operates a primary care residency program.
(B) INCLUSION OF CERTAIN ENTITIES.—Such term includes the following:
(i) A Federally qualified health center (as defined
in section 1905(l)(2)(B), of the Social Security Act).
(ii) A community mental health center (as defined
in section 1861(ff)(3)(B) of the Social Security Act).
(iii) A rural health clinic, as defined in section
1861(aa) of the Social Security Act.
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(iv) A health center operated by the Indian Health
Service, an Indian tribe or tribal organization, or an
urban Indian organization (as defined in section 4 of
the Indian Health Care Improvement Act).
(v) An entity receiving funds under title X of the
Public Health Service Act.
(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.

Subpart II—Training in Underserved
Communities
SEC. 749B. ø293m¿ 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.—
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(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 enMarch 13, 2013

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tity 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.

PART D—INTERDISCIPLINARY, COMMUNITYBASED LINKAGES
SEC. 750. ø294¿ GENERAL PROVISIONS.
(a) COLLABORATION.—To be eligible

to receive assistance under
this part, an academic institution shall use such assistance in collaboration with 2 or more disciplines.
(b) ACTIVITIES.—An entity shall use assistance under this part
to carry out innovative demonstration projects for strategic workforce supplementation activities as needed to meet national goals
for interdisciplinary, community-based linkages. Such assistance
may be used consistent with this part—
(1) to develop and support training programs;
(2) for faculty development;
(3) for model demonstration programs;
(4) for the provision of stipends for fellowship trainees;
(5) to provide technical assistance; and
(6) for other activities that will produce outcomes consistent with the purposes of this part.
SEC. 751. ø294a¿ 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) 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
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a school. With respect to a State in which no area health
education center program is in operation, the Secretary
may award a grant or contract under subsection (a)(1) to
a school of nursing.
(B) POINT OF SERVICE MAINTENANCE AND ENHANCEMENT.—For purposes of subsection (a)(2), the term ‘‘eligible
entity’’ means an entity that has received funds under this
section, is operating an area health education center program, including an area health education center or centers, and has a center or centers that are no longer eligible
to receive financial assistance under subsection (a)(1).
(2) APPLICATION.—An eligible entity desiring to receive an
award under this section shall submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require.
(c) USE OF FUNDS.—
(1) REQUIRED ACTIVITIES.—An eligible entity shall use
amounts awarded under a grant under subsection (a)(1) or
(a)(2) to carry out the following activities:
(A) Develop and implement strategies, in coordination
with the applicable one-stop delivery system under section
134(c) of the Workforce Investment Act of 1998, to recruit
individuals from underrepresented minority populations or
from disadvantaged or rural backgrounds into health professions, and support such individuals in attaining such
careers.
(B) Develop and implement strategies to foster and
provide community-based training and education to individuals seeking careers in health professions within underserved areas for the purpose of developing and maintaining a diverse health care workforce that is prepared to deliver high-quality care, with an emphasis on primary care,
in underserved areas or for health disparity populations,
in collaboration with other Federal and State health care
workforce development programs, the State workforce
agency, and local workforce investment boards, and in
health care safety net sites.
(C) Prepare individuals to more effectively provide
health services to underserved areas and health disparity
populations through field placements or preceptorships in
conjunction with community-based organizations, accredited primary care residency training programs, Federally
qualified health centers, rural health clinics, public health
departments, or other appropriate facilities.
(D) Conduct and participate in interdisciplinary training that involves physicians, physician assistants, nurse
practitioners, nurse midwives, dentists, psychologists,
pharmacists, optometrists, community health workers,
public and allied health professionals, or other health professionals, as practicable.
(E) Deliver or facilitate continuing education and information dissemination programs for health care professionals, with an emphasis on individuals providing care in
underserved areas and for health disparity populations.
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(F) Propose and implement effective program and outcomes measurement and evaluation strategies.
(G) Establish a youth public health program to expose
and recruit high school students into health careers, with
a focus on careers in public health.
(2) INNOVATIVE OPPORTUNITIES.—An eligible entity may
use amounts awarded under a grant under subsection (a)(1) or
subsection (a)(2) to carry out any of the following activities:
(A) Develop and implement innovative curricula in collaboration with community-based accredited primary care
residency training programs, Federally qualified health
centers, rural health clinics, behavioral and mental health
facilities, public health departments, or other appropriate
facilities, with the goal of increasing the number of primary care physicians and other primary care providers
prepared to serve in underserved areas and health disparity populations.
(B) Coordinate community-based participatory research with academic health centers, and facilitate rapid
flow and dissemination of evidence-based health care information, research results, and best practices to improve
quality, efficiency, and effectiveness of health care and
health care systems within community settings.
(C) Develop and implement other strategies to address
identified workforce needs and increase and enhance the
health care workforce in the area served by the area
health education center program.
(d) REQUIREMENTS.—
(1) AREA HEALTH EDUCATION CENTER PROGRAM.—In carrying out this section, the Secretary shall ensure the following:
(A) An entity that receives an award under this section shall conduct at least 10 percent of clinical education
required for medical students in community settings that
are removed from the primary teaching facility of the contracting institution for grantees that operate a school of
medicine or osteopathic medicine. In States in which an
entity that receives an award under this section is a nursing school or its parent institution, the Secretary shall alternatively ensure that—
(i) the nursing school conducts at least 10 percent
of clinical education required for nursing students in
community settings that are remote from the primary
teaching facility of the school; and
(ii) the entity receiving the award maintains a
written agreement with a school of medicine or osteopathic medicine to place students from that school in
training sites in the area health education center program area.
(B) An entity receiving funds under subsection (a)(2)
does not distribute such funding to a center that is eligible
to receive funding under subsection (a)(1).
(2) AREA HEALTH EDUCATION CENTER.—The Secretary shall
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cludes at least 1 area health education center, and that each
such center—
(A) is a public or private organization whose structure,
governance, and operation is independent from the awardee and the parent institution of the awardee;
(B) is not a school of medicine or osteopathic medicine,
the parent institution of such a school, or a branch campus
or other subunit of a school of medicine or osteopathic
medicine or its parent institution, or a consortium of such
entities;
(C) designates an underserved area or population to be
served by the center which is in a location removed from
the main location of the teaching facilities of the schools
participating in the program with such center and does not
duplicate, in whole or in part, the geographic area or population served by any other center;
(D) fosters networking and collaboration among communities and between academic health centers and community-based centers;
(E) serves communities with a demonstrated need of
health professionals in partnership with academic medical
centers;
(F) addresses the health care workforce needs of the
communities served in coordination with the public workforce investment system; and
(G) has a community-based governing or advisory
board that reflects the diversity of the communities involved.
(e) MATCHING FUNDS.—With respect to the costs of operating
a program through a grant under this section, to be eligible for financial assistance under this section, an entity shall make available (directly or through contributions from State, county or municipal governments, or the private sector) recurring non-Federal contributions in cash or in kind, toward such costs in an amount that
is equal to not less than 50 percent of such costs. At least 25 percent of the total required non-Federal contributions shall be in
cash. An entity may apply to the Secretary for a waiver of not more
than 75 percent of the matching fund amount required by the entity for each of the first 3 years the entity is funded through a grant
under subsection (a)(1).
(f) LIMITATION.—Not less than 75 percent of the total amount
provided to an area health education center program under subsection (a)(1) or (a)(2) shall be allocated to the area health education centers participating in the program under this section. To
provide needed flexibility to newly funded area health education
center programs, the Secretary may waive the requirement in the
sentence for the first 2 years of a new area health education center
program funded under subsection (a)(1).
(g) AWARD.—An award to an entity under this section shall be
not less than $250,000 annually per area health education center
included in the program involved. If amounts appropriated to carry
out this section are not sufficient to comply with the preceding sentence, the Secretary may reduce the per center amount provided for
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in such sentence as necessary, provided the distribution established
in subsection (j)(2) is maintained.
(h) PROJECT TERMS.—
(1) IN GENERAL.—Except as provided in paragraph (2), the
period during which payments may be made under an award
under subsection (a)(1) may not exceed—
(A) in the case of a program, 12 years; or
(B) in the case of a center within a program, 6 years.
(2) EXCEPTION.—The periods described in paragraph (1)
shall not apply to programs receiving point of service maintenance and enhancement awards under subsection (a)(2) to
maintain existing centers and activities.
(i) INAPPLICABILITY OF PROVISION.—Notwithstanding any other
provision of this title, section 791(a) shall not apply to an area
health education center funded under this section.
(j) AUTHORIZATION OF APPROPRIATIONS.—
(1) IN GENERAL.—There is authorized to be appropriated to
carry out this section $125,000,000 for each of the fiscal years
2010 through 2014.
(2) REQUIREMENTS.—Of the amounts appropriated for a fiscal year under paragraph (1)—
(A) not more than 35 percent shall be used for awards
under subsection (a)(1);
(B) not less than 60 percent shall be used for awards
under subsection (a)(2);
(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.
SEC. 752. ø294b¿ CONTINUING EDUCATIONAL SUPPORT FOR HEALTH
PROFESSIONALS SERVING IN UNDERSERVED COMMUNITIES.
(a) IN GENERAL.—The Secretary shall make grants to, and

enter into contracts with, eligible entities to improve health care,
increase retention, increase representation of minority faculty
members, enhance the practice environment, and provide information dissemination and educational support to reduce professional
isolation through the timely dissemination of research findings
using relevant resources.
(b) ELIGIBLE ENTITIES.—For purposes of this section, the term
‘‘eligible entity’’ means an entity described in section 799(b).
(c) APPLICATION.—An eligible entity desiring to receive an
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tion at such time, in such manner, and containing such information
as the Secretary may require.
(d) USE OF FUNDS.—An eligible entity shall use amounts
awarded under a grant or contract under this section to provide innovative supportive activities to enhance education through distance learning, continuing educational activities, collaborative conferences, and electronic and telelearning activities, with priority for
primary care.
(e) AUTHORIZATION.—There is authorized to be appropriated to
carry out this section $5,000,000 for each of the fiscal years 2010
through 2014, and such sums as may be necessary for each subsequent fiscal year.
SEC. 753. ø294c¿ EDUCATION AND TRAINING RELATING TO GERIATRICS.
(a) GERIATRIC EDUCATION CENTERS.—
(1) IN GENERAL.—The Secretary shall award grants or con-

tracts under this section to entities described in paragraphs 1
(1), (3), or (4) of section 799B, and section 801(2), for the establishment or operation of geriatric education centers.
(2) REQUIREMENTS.—A geriatric education center is a program that—
(A) improves the training of health professionals in
geriatrics, including geriatric residencies, traineeships, or
fellowships;
(B) develops and disseminates curricula relating to the
treatment of the health problems of elderly individuals;
(C) supports the training and retraining of faculty to
provide instruction in geriatrics;
(D) supports continuing education of health professionals who provide geriatric care; and
(E) provides students with clinical training in geriatrics in nursing homes, chronic and acute disease hospitals, ambulatory care centers, and senior centers.
(b) GERIATRIC TRAINING REGARDING PHYSICIANS AND DENTISTS.—
(1) IN GENERAL.—The Secretary may make grants to, and
enter into contracts with, schools of medicine, schools of osteopathic medicine, teaching hospitals, and graduate medical education programs, for the purpose of providing support (including residencies, traineeships, and fellowships) for geriatric
training projects to train physicians, dentists and behavioral
and mental health professionals who plan to teach geriatric
medicine, geriatric behavioral or mental health, or geriatric
dentistry.
(2) REQUIREMENTS.—Each project for which a grant or contract is made under this subsection shall—
(A) be staffed by full-time teaching physicians who
have experience or training in geriatric medicine or geriatric behavioral or mental health;
(B) be staffed, or enter into an agreement with an institution staffed by full-time or part-time teaching dentists
who have experience or training in geriatric dentistry;
1 So

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in law. Probably should read ‘‘paragraph’’.

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(C) be staffed, or enter into an agreement with an institution staffed by full-time or part-time teaching behavioral mental health professionals who have experience or
training in geriatric behavioral or mental health;
(D) be based in a graduate medical education program
in internal medicine or family medicine or in a department
of geriatrics or behavioral or mental health;
(E) provide training in geriatrics and exposure to the
physical and mental disabilities of elderly individuals
through a variety of service rotations, such as geriatric
consultation services, acute care services, dental services,
geriatric behavioral or mental health units, day and home
care programs, rehabilitation services, extended care facilities, geriatric ambulatory care and comprehensive evaluation units, and community care programs for elderly individuals with intellectual disabilities; and
(F) provide training in geriatrics through one or both
of the training options described in subparagraphs (A) and
(B) of paragraph (3).
(3) TRAINING OPTIONS.—The training options referred to in
subparagraph (F) of paragraph (2) shall be as follows:
(A) A 1-year retraining program in geriatrics for—
(i) physicians who are faculty members in departments of internal medicine, family medicine, gynecology, geriatrics, and behavioral or mental health at
schools of medicine and osteopathic medicine;
(ii) dentists who are faculty members at schools of
dentistry or at hospital departments of dentistry; and
(iii) behavioral or mental health professionals who
are faculty members in departments of behavioral or
mental health; and
(B) A 2-year internal medicine or family medicine fellowship program providing emphasis in geriatrics, which
shall be designed to provide training in clinical geriatrics
and geriatrics research for—
(i) physicians who have completed graduate medical education programs in internal medicine, family
medicine, behavioral or mental health, neurology, gynecology, or rehabilitation medicine;
(ii) dentists who have demonstrated a commitment to an academic career and who have completed
postdoctoral dental training, including postdoctoral
dental education programs or who have relevant advanced training or experience; and
(iii) behavioral or mental health professionals who
have completed graduate medical education programs
in behavioral or mental health.
(4) DEFINITIONS.—For purposes of this subsection:
(A) The term ‘‘graduate medical education program’’
means a program sponsored by a school of medicine, a
school of osteopathic medicine, a hospital, or a public or
private institution that—
(i) offers postgraduate medical training in the specialties and subspecialties of medicine; and
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(ii) has been accredited by the Accreditation Council for Graduate Medical Education or the American
Osteopathic Association through its Committee on
Postdoctoral Training.
(B) The term ‘‘post-doctoral dental education program’’
means a program sponsored by a school of dentistry, a hospital, or a public or private institution that—
(i) offers post-doctoral training in the specialties of
dentistry, advanced education in general dentistry, or
a dental general practice residency; and
(ii) has been accredited by the Commission on
Dental Accreditation.
(c) GERIATRIC FACULTY FELLOWSHIPS.—
(1) ESTABLISHMENT OF PROGRAM.—The Secretary shall establish a program to provide Geriatric Academic Career
Awards to eligible individuals to promote the career development of such individuals as academic geriatricians.
(2) ELIGIBLE INDIVIDUALS.—To be eligible to receive an
Award under paragraph (1), an individual shall—
(A) be board certified or board eligible in internal medicine, family practice, psychiatry, or licensed dentistry, or
have completed any required training in a discipline and
employed in an accredited health professions school that is
approved by the Secretary;
(B) have completed an approved fellowship program in
geriatrics or have completed specialty training in geriatrics
as required by the discipline and any addition geriatrics
training as required by the Secretary; and
(C) have a junior (non-tenured) faculty appointment at
an accredited (as determined by the Secretary) school of
medicine, osteopathic medicine, nursing, social work, psychology, dentistry, pharmacy, or other allied health disciplines in an accredited health professions school that is
approved by the Secretary.
(3) LIMITATIONS.—No Award under paragraph (1) may be
made to an eligible individual unless the individual—
(A) has submitted to the Secretary an application, at
such time, in such manner, and containing such information as the Secretary may require, and the Secretary has
approved such application;
(B) provides, in such form and manner as the Secretary may require, assurances that the individual will
meet the service requirement described in paragraph (6);
and
(C) provides, in such form and manner as the Secretary may require, assurances that the individual has a
full-time faculty appointment in a health professions institution and documented commitment from such institution
to spend 75 percent of the total time of such individual on
teaching and developing skills in interdisciplinary education in geriatrics.
(4) MAINTENANCE OF EFFORT.—An eligible individual that
receives an Award under paragraph (1) shall provide assurances to the Secretary that funds provided to the eligible indiMarch 13, 2013

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vidual 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.
(5) AMOUNT AND TERM.—
(A) AMOUNT.—The amount of an Award under this
section for individuals who are physicians shall equal
$50,000 for fiscal year 1998, adjusted for subsequent fiscal
years to reflect the increase in the Consumer Price Index.
The Secretary shall determine the amount of an Award
under this section for individuals who are not physicians.
(B) TERM.—The term of any Award made under this
subsection shall not exceed 5 years.
(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.
(6) SERVICE REQUIREMENT.—An individual who receives an
Award under this subsection shall provide training in clinical
geriatrics, including the training of interdisciplinary teams of
health care professionals. The provision of such training shall
constitute at least 75 percent of the obligations of such individual under the Award.
(d) GERIATRIC WORKFORCE DEVELOPMENT.—
(1) IN GENERAL.—The Secretary shall award grants or contracts under this subsection to entities that operate a geriatric
education center pursuant to subsection (a)(1).
(2) APPLICATION.—To be eligible for an award under paragraph (1), an entity described in such paragraph shall submit
to the Secretary an application at such time, in such manner,
and containing such information as the Secretary may require.
(3) USE OF FUNDS.—Amounts awarded under a grant or
contract under paragraph (1) shall be used to—
(A) carry out the fellowship program described in
paragraph (4); and
(B) carry out 1 of the 2 activities described in paragraph (5).
(4) FELLOWSHIP PROGRAM.—
(A) IN GENERAL.—Pursuant to paragraph (3), a geriatric education center that receives an award under this
subsection shall use such funds to offer short-term intensive courses (referred to in this subsection as a ‘‘fellowship’’) that focus on geriatrics, chronic care management,
and long-term care that provide supplemental training for
faculty members in medical schools and other health professions schools with programs in psychology, pharmacy,
nursing, social work, dentistry, public health, allied health,
or other health disciplines, as approved by the Secretary.
Such a fellowship shall be open to current faculty, and appropriately credentialed volunteer faculty and practitioners, who do not have formal training in geriatrics, to
upgrade their knowledge and clinical skills for the care of
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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. 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.
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(8) MAINTENANCE OF EFFORT.—A geriatric education center
that receives an award under this subsection shall provide assurances to the Secretary that funds provided to the geriatric
education center under this subsection will be used only to
supplement, not to supplant, the amount of Federal, State, and
local funds otherwise expended by the geriatric education center.
(9) AUTHORIZATION OF APPROPRIATIONS.—In addition to
any other funding available to carry out this section, there is
authorized to be appropriated to carry out this subsection,
$10,800,000 for the period of fiscal year 2011 through 2014.
(e) GERIATRIC CAREER INCENTIVE AWARDS.—
(1) IN GENERAL.—The Secretary shall award grants or contracts under this section to individuals described in paragraph
(2) to foster greater interest among a variety of health professionals in entering the field of geriatrics, long-term care, and
chronic care management.
(2) ELIGIBLE INDIVIDUALS.—To be eligible to received an
award under paragraph (1), an individual shall—
(A) be an advanced practice nurse, a clinical social
worker, a pharmacist, or student of psychology who is pursuing a doctorate or other advanced degree in geriatrics or
related fields in an accredited health professions school;
and
(B) submit to the Secretary an application at such
time, in such manner, and containing such information as
the Secretary may require.
(3) CONDITION OF AWARD.—As a condition of receiving an
award under this subsection, an individual shall agree that,
following completion of the award period, the individual will
teach or practice in the field of geriatrics, long-term care, or
chronic care management for a minimum of 5 years under
guidelines set by the Secretary.
(4) AUTHORIZATION OF APPROPRIATIONS.—There is authorized to be appropriated to carry out this subsection,
$10,000,000 for the period of fiscal years 2011 through 2013.
SEC. 754. ø294d¿ QUENTIN N. BURDICK PROGRAM FOR RURAL INTERDISCIPLINARY TRAINING.
(a) GRANTS.—The Secretary may make grants or contracts

under this section to help entities fund authorized activities under
an application approved under subsection (c).
(b) USE OF AMOUNTS.—
(1) IN GENERAL.—Amounts provided under subsection (a)
shall be used by the recipients to fund interdisciplinary training projects designed to—
(A) use new and innovative methods to train health
care practitioners to provide services in rural areas;
(B) demonstrate and evaluate innovative interdisciplinary methods and models designed to provide access to
cost-effective comprehensive health care;
(C) deliver health care services to individuals residing
in rural areas;
(D) enhance the amount of relevant research conducted concerning health care issues in rural areas; and
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(E) increase the recruitment and retention of health
care practitioners from rural areas and make rural practice a more attractive career choice for health care practitioners.
(2) METHODS.—A recipient of funds under subsection (a)
may use various methods in carrying out the projects described
in paragraph (1), including—
(A) the distribution of stipends to students of eligible
applicants;
(B) the establishment of a post-doctoral fellowship program;
(C) the training of faculty in the economic and
logistical problems confronting rural health care delivery
systems; or
(D) the purchase or rental of transportation and telecommunication equipment where the need for such equipment due to unique characteristics of the rural area is
demonstrated by the recipient.
(3) ADMINISTRATION.—
(A) IN GENERAL.—An applicant shall not use more
than 10 percent of the funds made available to such applicant under subsection (a) for administrative expenses.
(B) TRAINING.—Not more than 10 percent of the individuals receiving training with funds made available to an
applicant under subsection (a) shall be trained as doctors
of medicine or doctors of osteopathy.
(C) LIMITATION.—An institution that receives a grant
under this section shall use amounts received under such
grant to supplement, not supplant, amounts made available by such institution for activities of the type described
in subsection (b)(1) in the fiscal year preceding the year for
which the grant is received.
(c) APPLICATIONS.—Applications submitted for assistance under
this section shall—
(1) be jointly submitted by at least two eligible applicants
with the express purpose of assisting individuals in academic
institutions in establishing long-term collaborative relationships with health care providers in rural areas; and
(2) designate a rural health care agency or agencies for
clinical treatment or training, including hospitals, community
health centers, migrant health centers, rural health clinics,
community behavioral and mental health centers, long-term
care facilities, Native Hawaiian health centers, or facilities operated by the Indian Health Service or an Indian tribe or tribal
organization or Indian organization under a contract with the
Indian Health Service under the Indian Self-Determination
Act.
(d) DEFINITIONS.—For the purposes of this section, the term
‘‘rural’’ means geographic areas that are located outside of standard
metropolitan statistical areas.
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SEC. 755. ø294e¿ ALLIED HEALTH AND OTHER DISCIPLINES.
(a) IN GENERAL.—The Secretary may make grants or

888

contracts
under this section to help entities fund activities of the type described in subsection (b).
(b) ACTIVITIES.—Activities of the type described in this subsection include the following:
(1) Assisting entities in meeting the costs associated with
expanding or establishing programs that will increase the
number of individuals trained in allied health professions. Programs and activities funded under this paragraph may include—
(A) those that expand enrollments in allied health professions with the greatest shortages or whose services are
most needed by the elderly;
(B) those that provide rapid transition training programs in allied health fields to individuals who have baccalaureate degrees in health-related sciences;
(C) those that establish community-based allied health
training programs that link academic centers to rural clinical settings;
(D) those that provide career advancement training for
practicing allied health professionals;
(E) those that expand or establish clinical training
sites for allied health professionals in medically underserved or rural communities in order to increase the number of individuals trained;
(F) those that develop curriculum that will emphasize
knowledge and practice in the areas of prevention and
health promotion, geriatrics, long-term care, home health
and hospice care, and ethics;
(G) those that expand or establish interdisciplinary
training programs that promote the effectiveness of allied
health practitioners in geriatric assessment and the rehabilitation of the elderly;
(H) those that expand or establish demonstration centers to emphasize innovative models to link allied health
clinical practice, education, and research;
(I) those that provide financial assistance (in the form
of traineeships) to students who are participants in any
such program; and
(i) who plan to pursue a career in an allied health
field that has a demonstrated personnel shortage; and
(ii) who agree upon completion of the training program to practice in a medically underserved community;
that shall be utilized to assist in the payment of all or part
of the costs associated with tuition, fees and such other stipends as the Secretary may consider necessary; and
(J) those to meet the costs of projects to plan, develop,
and operate or maintain graduate programs in behavioral
and mental health practice.
(2) Planning and implementing projects in preventive and
primary care training for podiatric physicians in approved or
provisionally approved residency programs that shall provide
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financial assistance in the form of traineeships to residents
who participate in such projects and who plan to specialize in
primary care.
(3) Carrying out demonstration projects in which chiropractors and physicians collaborate to identify and provide effective treatment for spinal and lower-back conditions.
SEC. 756. ø294e–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 be historically black colleges or universities or other minority-serving institutions.
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(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
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(4) $5,000,000 for training in paraprofessional child and
adolescent work in subsection (a)(4).
SEC. 757. ø294f¿ ADVISORY COMMITTEE ON INTERDISCIPLINARY, COMMUNITY-BASED LINKAGES.
(a) ESTABLISHMENT.—The Secretary shall establish an advisory

committee to be known as the Advisory Committee on Interdisciplinary, Community-Based Linkages (in this section referred to as the
‘‘Advisory Committee’’).
(b) COMPOSITION.—
(1) IN GENERAL.—The Secretary shall determine the appropriate number of individuals to serve on the Advisory Committee. Such individuals shall not be officers or employees of
the Federal Government.
(2) APPOINTMENT.—Not later than 90 days after the date
of enactment of this Act 1, the Secretary shall appoint the
members of the Advisory Committee from among individuals
who are health professionals from schools of the types described in sections 751(b)(1)(A), 753(b), and 755(b). In making
such appointments, the Secretary shall ensure a fair balance
between the health professions, that at least 75 percent of the
members of the Advisory Committee are health professionals,
a broad geographic representation of members and a balance
between urban and rural members. Members shall be appointed based on their competence, interest, and knowledge of
the mission of the profession involved.
(3) MINORITY REPRESENTATION.—In appointing the members of the Advisory Committee under paragraph (2), the Secretary shall ensure the adequate representation of women and
minorities.
(c) TERMS.—
(1) IN GENERAL.—A member of the Advisory Committee
shall be appointed for a term of 3 years, except that of the
members first appointed—
(A) 1⁄3 of the members shall serve for a term of 1 year;
(B) 1⁄3 of the members shall serve for a term of 2
years; and
(C) 1⁄3 of the members shall serve for a term of 3
years.
(2) VACANCIES.—
(A) IN GENERAL.—A vacancy on the Advisory Committee shall be filled in the manner in which the original
appointment was made and shall be subject to any conditions which applied with respect to the original appointment.
(B) FILLING UNEXPIRED TERM.—An individual chosen
to fill a vacancy shall be appointed for the unexpired term
of the member replaced.
(d) DUTIES.—The Advisory Committee shall—
1 So in law. The reference to ‘‘this Act’’ means the Public Health Service Act, which was enacted July 1, 1944. Probably should be a reference to the Health Professions Education Partnerships Act of 1998, which added section 756. That Act is Public Law 105–392, enacted November
13, 1998. (Section 103 of that Public Law (112 Stat. 3541) added section 756.)

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(1) provide advice and recommendations to the Secretary
concerning policy and program development and other matters
of significance concerning the activities under this part;
(2) not later than 3 years after the date of enactment of
this section, and annually thereafter, prepare and submit to
the Secretary, and the Committee on Labor and Human Resources of the Senate, and the Committee on Commerce of the
House of Representatives, a report describing the activities of
the Committee, including findings and recommendations made
by the Committee concerning the activities under this part;
(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.
(e) MEETINGS AND DOCUMENTS.—
(1) MEETINGS.—The Advisory Committee shall meet not
less than 3 times each year. Such meetings shall be held jointly with other related entities established under this title where
appropriate.
(2) DOCUMENTS.—Not later than 14 days prior to the convening of a meeting under paragraph (1), the Advisory Committee shall prepare and make available an agenda of the matters to be considered by the Advisory Committee at such meeting. At any such meeting, the Advisory Council 1 shall distribute materials with respect to the issues to be addressed at
the meeting. Not later than 30 days after the adjourning of
such a meeting, the Advisory Committee shall prepare and
make available a summary of the meeting and any actions
taken by the Committee based upon the meeting.
(f) COMPENSATION AND EXPENSES.—
(1) COMPENSATION.—Each member of the Advisory Committee shall be compensated at a rate equal to the daily equivalent of the annual rate of basic pay prescribed for level IV of
the Executive Schedule under section 5315 of title 5, United
States Code, for each day (including travel time) during which
such member is engaged in the performance of the duties of
the Committee.
(2) EXPENSES.—The members of the Advisory Committee
shall be allowed travel expenses, including per diem in lieu of
subsistence, at rates authorized for employees of agencies
under subchapter I of chapter 57 of title 5, United States Code,
while away from their homes or regular places of business in
the performance of services for the Committee.
(g) FACA.—The Federal Advisory Committee Act shall apply to
the Advisory Committee under this section only to the extent that
the provisions of such Act do not conflict with the requirements of
this section.
1 So in law. Probably should be ‘‘Advisory Committee’’. See section 103 of Public Law 105–
392 (112 Stat. 3541).

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SEC. 758. ø294h¿ INTERDISCIPLINARY TRAINING AND EDUCATION ON
DOMESTIC VIOLENCE AND OTHER TYPES OF VIOLENCE
AND ABUSE.
(a) GRANTS.—The Secretary, acting through the Director of the

Health Resources and Services Administration, shall award grants
under this section to develop interdisciplinary training and education programs that provide undergraduate, graduate, post-graduate medical, nursing (including advanced practice nursing students), and other health professions students with an understanding of, and clinical skills pertinent to, domestic violence, sexual assault, stalking, and dating violence.
(b) ELIGIBILITY.—To be eligible to receive a grant under this
section an entity shall—
(1) be an accredited school of allopathic or osteopathic
medicine;
(2) prepare and submit to the Secretary an application at
such time, in such manner, and containing such information as
the Secretary may require, including—
(A) information to demonstrate that the applicant includes the meaningful participation of a school of nursing
and at least one other school of health professions or graduate program in public health, dentistry, social work, midwifery, or behavioral and mental health;
(B) strategies for the dissemination and sharing of curricula and other educational materials developed under the
grant to other interested medical and nursing schools and
national resource repositories for materials on domestic violence and sexual assault; and
(C) a plan for consulting with community-based coalitions or individuals who have experience and expertise in
issues related to domestic violence, sexual assault, dating
violence, and stalking for services provided under the program carried out under the grant.
(c) USE OF FUNDS.—
(1) REQUIRED USES.—Amounts provided under a grant
under this section shall be used to—
(A) fund interdisciplinary training and education
projects that are designed to train medical, nursing, and
other health professions students and residents to identify
and provide health care services (including mental or behavioral health care services and referrals to appropriate
community services) to individuals who are experiencing 1
or who have experienced domestic violence, sexual assault,
and stalking or dating violence; and
(B) plan and develop culturally competent clinical
components for integration into approved residency training programs that address health issues related to domestic violence, sexual assault, dating violence, and stalking,
along with other forms of violence as appropriate, and include the primacy of victim safety and confidentiality.
1 Section 4(c) of Public Law 109–271 amended section 758(c)(1)(A) of the Public Health
Service[s] Act. The reference to the amended law should have been made to the Public Health
Service Act but was executed to reflect the probable intent of Congress.

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(2) PERMISSIVE USES.—Amounts provided under a grant
under this section may be used to—
(A) offer community-based training opportunities in
rural areas for medical, nursing, and other students and
residents on domestic violence, sexual assault, stalking,
and dating violence, and other forms of violence and abuse,
which may include the use of distance learning networks
and other available technologies needed to reach isolated
rural areas; or
(B) provide stipends to students who are underrepresented in the health professions as necessary to promote
and enable their participation in clerkships, preceptorships, or other offsite training experiences that are designed to develop health care clinical skills related to domestic violence, sexual assault, dating violence, and stalking.
(3) REQUIREMENTS.—
(A) CONFIDENTIALITY AND SAFETY.—Grantees under
this section shall ensure that all educational programs developed with grant funds address issues of confidentiality
and patient safety, and that faculty and staff associated
with delivering educational components are fully trained
in procedures that will protect the immediate and ongoing
security of the patients, patient records, and staff. Advocacy-based coalitions or other expertise available in the
community shall be consulted on the development and adequacy of confidentially and security procedures, and shall
be fairly compensated by grantees for their services.
(B) RURAL PROGRAMS.—Rural training programs carried out under paragraph (2)(A) shall reflect adjustments
in protocols and procedures or referrals that may be needed to protect the confidentiality and safety of patients who
live in small or isolated communities and who are currently or have previously experienced violence or abuse.
(4) CHILD AND ELDER ABUSE.—Issues related to child and
elder abuse may be addressed as part of a comprehensive programmatic approach implemented under a grant under this
section.
(d) REQUIREMENTS OF GRANTEES.—
(1) LIMITATION ON ADMINISTRATIVE EXPENSES.—A grantee
shall not use more than 10 percent of the amounts received
under a grant under this section for administrative expenses.
(2) CONTRIBUTION OF FUNDS.—A grantee under this section, and any entity receiving assistance under the grant for
training and education, shall contribute non-Federal funds, either directly or through in-kind contributions, to the costs of
the activities to be funded under the grant in an amount that
is not less than 25 percent of the total cost of such activities.
(e) AUTHORIZATION OF APPROPRIATIONS.—There is authorized
to be appropriated to carry out this section, $3,000,000 for each of
fiscal years 2007 through 2011. Amounts appropriated under this
subsection shall remain available until expended.
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Sec. 761

SEC. 759. ø294i¿ PROGRAM FOR EDUCATION AND TRAINING IN PAIN
CARE.
(a) IN GENERAL.—The Secretary may make awards of grants,

cooperative agreements, and contracts to health professions
schools, hospices, and other public and private entities for the development and implementation of programs to provide education
and training to health care professionals in pain care.
(b) CERTAIN TOPICS.—An award may be made under subsection
(a) only if the applicant for the award agrees that the program carried out with the award will include information and education
on—
(1) recognized means for assessing, diagnosing, treating,
and managing pain and related signs and symptoms, including
the medically appropriate use of controlled substances;
(2) applicable laws, regulations, rules, and policies on controlled substances, including the degree to which misconceptions and concerns regarding such laws, regulations, rules, and
policies, or the enforcement thereof, may create barriers to patient access to appropriate and effective pain care;
(3) interdisciplinary approaches to the delivery of pain
care, including delivery through specialized centers providing
comprehensive pain care treatment expertise;
(4) cultural, linguistic, literacy, geographic, and other barriers to care in underserved populations; and
(5) recent findings, developments, and improvements in
the provision of pain care.
(c) EVALUATION OF PROGRAMS.—The Secretary shall (directly
or through grants or contracts) provide for the evaluation of programs implemented under subsection (a) in order to determine the
effect of such programs on knowledge and practice of pain care.
(d) PAIN CARE DEFINED.—For purposes of this section the term
‘‘pain care’’ means the assessment, diagnosis, treatment, or management of acute or chronic pain regardless of causation or body
location.
(e) AUTHORIZATION OF APPROPRIATIONS.—There is authorized
to be appropriated to carry out this section, such sums as may be
necessary for each of the fiscal years 2010 through 2012. Amounts
appropriated under this subsection shall remain available until expended.

PART E—HEALTH PROFESSIONS AND PUBLIC
HEALTH WORKFORCE
Subpart 1—Health Professions Workforce
Information and Analysis
SEC. 761. ø294n¿ HEALTH PROFESSIONS WORKFORCE INFORMATION
AND ANALYSIS.
(a) PURPOSE.—It is the purpose of this section to—

(1) provide for the development of information describing
the health professions workforce and the analysis of workforce
related issues; and
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(2) provide necessary information for decision-making regarding future directions in health professions and nursing
programs in response to societal and professional needs.
(b) NATIONAL CENTER FOR HEALTH CARE WORKFORCE ANALYSIS.—
(1) ESTABLISHMENT.—The Secretary shall establish the National Center for Health Workforce Analysis (referred to in this
section as the ‘‘National Center’’).
(2) PURPOSES.—The National Center, in coordination to the
extent practicable with the National Health Care Workforce
Commission (established in section 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, maintain, and publicize a national Internet registry of each grant awarded under this title and a
database to collect data from longitudinal evaluations (as
described in subsection (d)(2)) on performance measures
(as developed under sections 749(d)(3), 757(d)(3), and
762(a)(3)).
(3) COLLABORATION AND DATA SHARING.—
(A) IN GENERAL.—The National Center shall collaborate with Federal agencies and relevant professional and
educational organizations or societies for the purpose of
linking data regarding grants awarded under this title.
(B) CONTRACTS FOR HEALTH WORKFORCE ANALYSIS.—
For the purpose of carrying out the activities described in
subparagraph (A), the National Center may enter into contracts with relevant professional and educational organizations or societies.
(c) STATE AND REGIONAL CENTERS FOR HEALTH WORKFORCE
ANALYSIS.—
(1) IN GENERAL.—The Secretary shall award grants to, or
enter into contracts with, eligible entities for purposes of—
(A) collecting, analyzing, and reporting data regarding
programs under this title to the National Center and to
the public; and
(B) providing technical assistance to local and regional
entities on the collection, analysis, and reporting of data.
(2) ELIGIBLE ENTITIES.—To be eligible for a grant or contract under this subsection, an entity shall—
(A) be a State, a State workforce investment board, a
public health or health professions school, an academic
health center, or an appropriate public or private nonprofit
entity; and
(B) submit to the Secretary an application at such
time, in such manner, and containing such information as
the Secretary may require.
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(d) INCREASE IN GRANTS FOR LONGITUDINAL EVALUATIONS.—
(1) IN GENERAL.—The Secretary shall increase the amount
awarded to an eligible entity under this title for a longitudinal
evaluation of individuals who have received education, training, or financial assistance from programs under this title.
(2) CAPABILITY.—A longitudinal evaluation shall be capable of—
(A) studying practice patterns; and
(B) collecting and reporting data on performance
measures developed under sections 749(d)(3), 757(d)(3),
and 762(a)(3).
(3) GUIDELINES.—A longitudinal evaluation shall comply
with guidelines issued under sections 749(d)(4), 757(d)(4), and
762(a)(4).
(4) ELIGIBLE ENTITIES.—To be eligible to obtain an increase
under this section, an entity shall be a recipient of a grant or
contract under this title.
(e) AUTHORIZATION OF APPROPRIATIONS.—
(1) IN GENERAL.—
(A) NATIONAL CENTER.—To carry out subsection (b),
there are authorized to be appropriated $7,500,000 for
each of fiscal years 2010 through 2014.
(B) STATE AND REGIONAL CENTERS.—To carry out subsection (c), there are authorized to be appropriated
$4,500,000 for each of fiscal years 2010 through 2014.
(C) GRANTS FOR LONGITUDINAL EVALUATIONS.—To
carry out subsection (d), there are authorized to be appropriated such sums as may be necessary for fiscal years
2010 through 2014.
(2) RESERVATION.—Of the amounts appropriated under
subsection (a) 1 for a fiscal year, the Secretary shall reserve not
less than $600,000 for conducting health professions research
and for carrying out data collection and analysis in accordance
with section 792.
(3) AVAILABILITY OF ADDITIONAL FUNDS.—Amounts otherwise appropriated for programs or activities under this title
may be used for activities under subsection (b) with respect to
the programs or activities from which such amounts were
made available.
SEC. 762. ø294o¿ ADVISORY COUNCIL ON GRADUATE MEDICAL EDUCATION.
(a) ESTABLISHMENT; DUTIES.—There is established the Council

on Graduate Medical Education (in this section referred to as the
‘‘Council’’). The Council shall—
(1) make recommendations to the Secretary of Health and
Human Services (in this section referred to as the ‘‘Secretary’’),
and to the Committee on Labor and Human Resources of the
Senate, and the Committee on Energy and Commerce of the
House of Representatives, with respect to—
1 The reference to ‘‘subsection (a)’’ in subsection (e)(2) probably should read ‘‘paragraph (1)’’.
Paragraph (4) of section 5103(a) of PL 111–148 probably should have been designated as a subparagraph (B) of paragraph (3) of such section. As such, the amendment instruction in paragraph (4) to strike ‘‘subsection (a)’’ and insert ‘‘paragraph (1)’’ could not be executed since it did
not specify to which subsection to carry out the amendment.

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(A) the supply and distribution of physicians in the
United States;
(B) current and future shortages or excesses of physicians in medical and surgical specialties and subspecialties;
(C) issues relating to foreign medical school graduates;
(D) appropriate Federal policies with respect to the
matters specified in subparagraphs (A), (B), and (C), including policies concerning changes in the financing of undergraduate and graduate medical education programs
and changes in the types of medical education training in
graduate medical education programs;
(E) appropriate efforts to be carried out by hospitals,
schools of medicine, schools of osteopathic medicine, and
accrediting bodies with respect to the matters specified in
subparagraphs (A), (B), and (C), including efforts for
changes in undergraduate and graduate medical education
programs; and
(F) deficiencies in, and needs for improvements in, existing data bases concerning the supply and distribution
of, and postgraduate training programs for, physicians in
the United States and steps that should be taken to eliminate those deficiencies;
(2) encourage entities providing graduate medical education to conduct activities to voluntarily achieve the recommendations of the Council under paragraph (1)(E);
(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.
(b) COMPOSITION.—The Council shall be composed of—
(1) the Assistant Secretary for Health or the designee of
the Assistant Secretary;
(2) the Administrator of the Health Care Financing Administration;
(3) the Chief Medical Director of the Department of Veterans Affairs;
(4) 6 members appointed by the Secretary to include representatives of practicing primary care physicians, national
and specialty physician organizations, foreign medical graduates, and medical student and house staff associations;
(5) 4 members appointed by the Secretary to include representatives of schools of medicine and osteopathic medicine
and public and private teaching hospitals; and
(6) 4 members appointed by the Secretary to include representatives of health insurers, business, and labor.
(c) TERMS OF APPOINTED MEMBERS.—
(1) IN GENERAL; STAGGERED ROTATION.—Members of the
Council appointed under paragraphs (4), (5), and (6) of subsection (b) shall be appointed for a term of 4 years, except that
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the term of office of the members first appointed shall expire,
as designated by the Secretary at the time of appointment, 4
at the end of 1 year, 4 at the end of 2 years, 3 at the end of
3 years, and 3 at the end of 4 years.
(2) DATE CERTAIN FOR APPOINTMENT.—The Secretary shall
appoint the first members to the Council under paragraphs (4),
(5), and (6) of subsection (b) within 60 days after the date of
enactment of this section.
(d) CHAIR.—The Council shall elect one of its members as
Chairman of the Council.
(e) QUORUM.—Nine members of the Council shall constitute a
quorum, but a lesser number may hold hearings.
(f) VACANCIES.—Any vacancy in the Council shall not affect its
power to function.
(g) COMPENSATION.—Each member of the Council who is not
otherwise employed by the United States Government shall receive
compensation at a rate equal to the daily rate prescribed for GS–
18 under the General Schedule under section 5332 of title 5,
United States Code, for each day, including traveltime, such member is engaged in the actual performance of duties as a member of
the Council. A member of the Council who is an officer or employee
of the United States Government shall serve without additional
compensation. All members of the Council shall be reimbursed for
travel, subsistence, and other necessary expenses incurred by them
in the performance of their duties.
(h) CERTAIN AUTHORITIES AND DUTIES.—
(1) AUTHORITIES.—In order to carry out the provisions of
this section, the Council is authorized to—
(A) collect such information, hold such hearings, and
sit and act at such times and places, either as a whole or
by subcommittee, and request the attendance and testimony of such witnesses and the production of such books,
records, correspondence, memoranda, papers, and documents as the Council or such subcommittee may consider
available; and
(B) request the cooperation and assistance of Federal
departments, agencies, and instrumentalities, and such departments, agencies, and instrumentalities are authorized
to provide such cooperation and assistance.
(2) COORDINATION OF ACTIVITIES.—The Council shall coordinate its activities with the activities of the Secretary under
section 792 of the Public Health Service Act. The Secretary
shall, in cooperation with the Council and pursuant to the recommendations of the Council, take such steps as are practicable to eliminate deficiencies in the data base established
under such section 792 and shall make available in its reports
such comprehensive data sets as are developed pursuant to
this section.
(i) REQUIREMENT REGARDING REPORTS.—In the reports required under subsection (a), the Council shall specify its activities
during the period for which the report is made.
(j) FINAL REPORT.—Not later than April 1, 2002, the Council
shall submit a final report under subsection (a).
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(k) TERMINATION.—The Council shall terminate September 30, 2003 1.
(l) FUNDING.—Amounts otherwise appropriated under this title
may be utilized by the Secretary to support the activities of the
Council.
SEC. 763. ø294p¿ PEDIATRIC RHEUMATOLOGY.
(a) IN GENERAL.—The Secretary, acting

through the appropriate agencies, shall evaluate whether the number of pediatric
rheumatologists is sufficient to address the health care needs of
children with arthritis and related conditions, and if the Secretary
determines that the number is not sufficient, shall develop strategies to help address the shortfall.
(b) REPORT TO CONGRESS.—Not later than October 1, 2001, the
Secretary shall submit to the Congress a report describing the results of the evaluation under subsection (a), and as applicable, the
strategies developed under such subsection.
(c) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of
carrying out this section, there are authorized to be appropriated
such sums as may be necessary for each of the fiscal years 2001
through 2005.

Subpart 2—Public Health Workforce
SEC. 765. ø295¿ GENERAL PROVISIONS.
(a) IN GENERAL.—The Secretary

may award grants or contracts
to eligible entities to increase the number of individuals in the public health workforce, to enhance the quality of such workforce, and
to enhance the ability of the workforce to meet national, State, and
local health care needs.
(b) ELIGIBILITY.—To be eligible to receive a grant or contract
under subsection (a) an entity shall—
(1) be—
(A) a health professions school, including an accredited
school or program of public health, health administration,
preventive medicine, or dental public health or a school
providing health management programs;
(B) an academic health center;
(C) a State or local government; or
(D) any other appropriate public or private nonprofit
entity; and
(2) prepare and submit to the Secretary an application at
such time, in such manner, and containing such information as
the Secretary may require.
(c) PREFERENCE.—In awarding grants or contracts under this
section the Secretary may grant a preference to entities—
(1) serving individuals who are from disadvantaged backgrounds (including underrepresented racial and ethnic minorities); and
1 Appropriations Acts for the Department of Health and Human Services for fiscal years 2004
and 2005 provided for the continued operation of the Council. See section 219 of division E of
Public Law 108–199 (118 Stat. 255) and section 218 of division F of Public Law 108–447 (118
Stat. 3141). Each of such sections refers to ‘‘the Council on Graduate Education established by
section 301 of Public Law 102–408’’. Such section 301 was transferred to the Public Health Service Act as section 762 above by section 104(b) of Public Law 105–392 (112 Stat. 3552).

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(2) graduating large proportions of individuals who serve
in underserved communities.
(d) ACTIVITIES.—Amounts provided under a grant or contract
awarded under this section may be used for—
(1) the costs of planning, developing, or operating demonstration training programs;
(2) faculty development;
(3) trainee support;
(4) technical assistance;
(5) to meet the costs of projects—
(A) to plan and develop new residency training programs and to maintain or improve existing residency
training programs in preventive medicine and dental public health, that have available full-time faculty members
with training and experience in the fields of preventive
medicine and dental public health; and
(B) to provide financial assistance to residency trainees enrolled in such programs;
(6) the retraining of existing public health workers as well
as for increasing the supply of new practitioners to address priority public health, preventive medicine, public health dentistry, and health administration needs;
(7) preparing public health professionals for employment
at the State and community levels;
(8) public health workforce loan repayment programs; or
(9) other activities that may produce outcomes that are
consistent with the purposes of this section.
(e) TRAINEESHIPS.—
(1) IN GENERAL.—With respect to amounts used under this
section for the training of health professionals, such training
programs shall be designed to—
(A) make public health education more accessible to
the public and private health workforce;
(B) increase the relevance of public health academic
preparation to public health practice in the future;
(C) provide education or training for students from
traditional on-campus programs in practice-based sites; or
(D) develop educational methods and distance-based
approaches or technology that address adult learning requirements and increase knowledge and skills related to
community-based cultural diversity in public health education.
(2) SEVERE SHORTAGE DISCIPLINES.—Amounts provided
under grants or contracts under this section may be used for
the operation of programs designed to award traineeships to
students in accredited schools of public health who enter educational programs in fields where there is a severe shortage of
public health professionals, including epidemiology, biostatistics, environmental health, toxicology, public health nursing,
nutrition, preventive medicine, maternal and child health, and
behavioral and mental health professions.
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SEC. 766. ø295a¿ PUBLIC HEALTH TRAINING CENTERS.
(a) IN GENERAL.—The Secretary may make grants

or contracts
for the operation of public health training centers.
(b) ELIGIBLE ENTITIES.—
(1) IN GENERAL.—A public health training center shall be
an accredited school of public health, or another public or nonprofit private institution accredited for the provision of graduate or specialized training in public health, that plans, develops, operates, and evaluates projects that are in furtherance of
the goals established by the Secretary for the year 2000 in the
areas of preventive medicine, health promotion and disease
prevention, or improving access to and quality of health services in medically underserved communities.
(2) PREFERENCE.—In awarding grants or contracts under
this section the Secretary shall give preference to accredited
schools of public health.
(c) CERTAIN REQUIREMENTS.—With respect to a public health
training center, an award may not be made under subsection (a)
unless the program agrees that it—
(1) will establish or strengthen field placements for students in public or nonprofit private health agencies or organizations;
(2) will involve faculty members and students in collaborative projects to enhance public health services to medically
underserved communities;
(3) will specifically designate a geographic area or medically underserved population to be served by the center that
shall be in a location removed from the main location of the
teaching facility of the school that is participating in the program with such center; and
(4) will assess the health personnel needs of the area to be
served by the center and assist in the planning and development of training programs to meet such needs.
SEC. 767. ø295b¿ PUBLIC HEALTH TRAINEESHIPS.
(a) IN GENERAL.—The Secretary may make

grants to accredited schools of public health, and to other public or nonprofit private institutions accredited for the provision of graduate or specialized training in public health, for the purpose of assisting such
schools and institutions in providing traineeships to individuals described in subsection (b)(3).
(b) CERTAIN REQUIREMENTS.—
(1) AMOUNT.—The amount of any grant under this section
shall be determined by the Secretary.
(2) USE OF GRANT.—Traineeships awarded under grants
made under subsection (a) shall provide for tuition and fees
and such stipends and allowances (including travel and subsistence expenses and dependency allowances) for the trainees
as the Secretary may deem necessary.
(3) ELIGIBLE INDIVIDUALS.—The individuals referred to in
subsection (a) are individuals who are pursuing a course of
study in a health professions field in which there is a severe
shortage of health professionals (which fields include the fields
of epidemiology, environmental health, biostatistics, toxicology,
nutrition, and maternal and child health).
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SEC. 768. ø295c¿ 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.
SEC. 769. ø295d¿ HEALTH ADMINISTRATION TRAINEESHIPS AND SPECIAL PROJECTS.
(a) IN GENERAL.—The Secretary may make grants to State or

local governments (that have in effect preventive medical and dental public health residency programs) or public or nonprofit private
educational entities (including graduate schools of social work and
business schools that have health management programs) that
offer a program described in subsection (b)—
(1) to provide traineeships for students enrolled in such a
program; and
(2) to assist accredited programs health administration in
the development or improvement of programs to prepare students for employment with public or nonprofit private entities.
(b) RELEVANT PROGRAMS.—The program referred to in subsection (a) is an accredited program in health administration, hospital administration, or health policy analysis and planning, which
program is accredited by a body or bodies approved for such purpose by the Secretary of Education and which meets such other
quality standards as the Secretary of Health and Human Services
by regulation may prescribe.
(c) PREFERENCE IN MAKING GRANTS.—In making grants under
subsection (a), the Secretary shall give preference to qualified applicants that meet the following conditions:
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(1) Not less than 25 percent of the graduates of the applicant are engaged in full-time practice settings in medically underserved communities.
(2) The applicant recruits and admits students from medically underserved communities.
(3) For the purpose of training students, the applicant has
established relationships with public and nonprofit providers of
health care in the community involved.
(4) In training students, the applicant emphasizes employment with public or nonprofit private entities.
(d) CERTAIN PROVISIONS REGARDING TRAINEESHIPS.—
(1) USE OF GRANT.—Traineeships awarded under grants
made under subsection (a) shall provide for tuition and fees
and such stipends and allowances (including travel and subsistence expenses and dependency allowances) for the trainees
as the Secretary may deem necessary.
(2) PREFERENCE FOR CERTAIN STUDENTS.—Each entity applying for a grant under subsection (a) for traineeships shall
assure to the satisfaction of the Secretary that the entity will
give priority to awarding the traineeships to students who
demonstrate a commitment to employment with public or nonprofit private entities in the fields with respect to which the
traineeships are awarded.
SEC. 770. ø295e¿ AUTHORIZATION OF APPROPRIATIONS.
(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.
(b) LIMITATION REGARDING CERTAIN PROGRAM.—In obligating
amounts appropriated under subsection (a), the Secretary may not
obligate more than 30 percent for carrying out section 767.

Subpart 3—Recruitment and Retention Programs
SEC. 775. ø295f¿ INVESTMENT IN TOMORROW’S PEDIATRIC HEALTH
CARE WORKFORCE.
(a) ESTABLISHMENT.—The Secretary shall establish and carry

out a pediatric specialty loan repayment program under which the
eligible individual agrees to be employed full-time for a specified
period (which shall not be less than 2 years) in providing pediatric
medical subspecialty, pediatric surgical specialty, or child and adolescent mental and behavioral health care, including substance
abuse prevention and treatment services.
(b) PROGRAM ADMINISTRATION.—Through the program established under this section, the Secretary shall enter into contracts
with qualified health professionals under which—
(1) such qualified health professionals will agree to provide
pediatric medical subspecialty, pediatric surgical specialty, or
child and adolescent mental and behavioral health care in an
area with a shortage of the specified pediatric subspecialty that
has a sufficient pediatric population to support such pediatric
subspecialty, as determined by the Secretary; and
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(2) the Secretary agrees to make payments on the principal and interest of undergraduate, graduate, or graduate
medical education loans of professionals described in paragraph (1) of not more than $35,000 a year for each year of
agreed upon service under such paragraph for a period of not
more than 3 years during the qualified health professional’s—
(A) participation in an accredited pediatric medical
subspecialty, pediatric surgical specialty, or child and adolescent mental health subspecialty residency or fellowship;
or
(B) employment as a pediatric medical subspecialist,
pediatric surgical specialist, or child and adolescent mental
health professional serving an area or population described
in such paragraph.
(c) IN GENERAL.—
(1) ELIGIBLE INDIVIDUALS.—
(A) PEDIATRIC MEDICAL SPECIALISTS AND PEDIATRIC
SURGICAL SPECIALISTS.—For purposes of contracts with respect to pediatric medical specialists and pediatric surgical
specialists, the term ‘‘qualified health professional’’ means
a licensed physician who—
(i) is entering or receiving training in an accredited pediatric medical subspecialty or pediatric surgical specialty residency or fellowship; or
(ii) has completed (but not prior to the end of the
calendar year in which this section is enacted) the
training described in subparagraph (B).
(B) CHILD AND ADOLESCENT MENTAL AND BEHAVIORAL
HEALTH.—For purposes of contracts with respect to child
and adolescent mental and behavioral health care, the
term ‘‘qualified health professional’’ means a health care
professional who—
(i) has received specialized training or clinical experience in child and adolescent mental health in psychiatry, psychology, school psychology, behavioral pediatrics, psychiatric nursing, social work, school social
work, substance abuse disorder prevention and treatment, marriage and family therapy, school counseling,
or professional counseling;
(ii) has a license or certification in a State to practice allopathic medicine, osteopathic medicine, psychology, school psychology, psychiatric nursing, social
work, school social work, marriage and family therapy,
school counseling, or professional counseling; or
(iii) is a mental health service professional who
completed (but not before the end of the calendar year
in which this section is enacted) specialized training or
clinical experience in child and adolescent mental
health described in clause (i).
(2) ADDITIONAL ELIGIBILITY REQUIREMENTS.—The Secretary
may not enter into a contract under this subsection with an eligible individual unless—
(A) the individual agrees to work in, or for a provider
serving, a health professional shortage area or medically
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underserved area, or to serve a medically underserved population;
(B) the individual is a United States citizen or a permanent legal United States resident; and
(C) if the individual is enrolled in a graduate program,
the program is accredited, and the individual has an acceptable level of academic standing (as determined by the
Secretary).
(d) PRIORITY.—In entering into contracts under this subsection,
the Secretary shall give priority to applicants who—
(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. 776. ø295f–1¿ PUBLIC HEALTH WORKFORCE LOAN REPAYMENT
PROGRAM.
(a) ESTABLISHMENT.—The Secretary shall establish the Public

Health Workforce Loan Repayment Program (referred to in this
section as the ‘‘Program’’) to assure an adequate supply of public
health professionals to eliminate critical public health workforce
shortages in Federal, State, local, and tribal public health agencies.
(b) ELIGIBILITY.—To be eligible to participate in the Program,
an individual shall—
(1)(A) be accepted for enrollment, or be enrolled, as a student in an accredited academic educational institution in a
State or territory in the final year of a course of study or program leading to a public health or health professions degree or
certificate; and have accepted employment with a Federal,
State, local, or tribal public health agency, or a related training
fellowship, as recognized by the Secretary, to commence upon
graduation; 1
(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.
1 So

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(c) CONTRACT.—The written contract (referred to in this section
as the ‘‘written contract’’) between the Secretary and an individual
shall contain—
(1) an agreement on the part of the Secretary that the Secretary will repay on behalf of the individual loans incurred by
the individual in the pursuit of the relevant degree or certificate in accordance with the terms of the contract;
(2) an agreement on the part of the individual that the individual will serve in the full-time employment of a Federal,
State, local, or tribal public health agency or a related fellowship program in a position related to the course of study or
program for which the contract was awarded for a period of
time (referred to in this section as the ‘‘period of obligated service’’) equal to the greater of—
(A) 3 years; or
(B) such longer period of time as determined appropriate by the Secretary and the individual;
(3) an agreement, as appropriate, on the part of the individual to relocate to a priority service area (as determined by
the Secretary) in exchange for an additional loan repayment
incentive amount to be determined by the Secretary;
(4) a provision that any financial obligation of the United
States arising out of a contract entered into under this section
and any obligation of the individual that is conditioned thereon, is contingent on funds being appropriated for loan repayments under this section;
(5) a statement of the damages to which the United States
is entitled, under this section for the individual’s breach of the
contract; and
(6) such other statements of the rights and liabilities of the
Secretary and of the individual, not inconsistent with this section.
(d) PAYMENTS.—
(1) IN GENERAL.—A loan repayment provided for an individual under a written contract under the Program shall consist of payment, in accordance with paragraph (2), on behalf of
the individual of the principal, interest, and related expenses
on government and commercial loans received by the individual regarding the undergraduate or graduate education of
the individual (or both), which loans were made for tuition expenses incurred by the individual.
(2) PAYMENTS FOR YEARS SERVED.—For each year of obligated service that an individual contracts to serve under subsection (c) the Secretary may pay up to $35,000 on behalf of
the individual for loans described in paragraph (1). With respect to participants under the Program whose total eligible
loans are less than $105,000, the Secretary shall pay an
amount that does not exceed 1⁄3 of the eligible loan balance for
each year of obligated service of the individual.
(3) TAX LIABILITY.—For the purpose of providing reimbursements for tax liability resulting from payments under
paragraph (2) on behalf of an individual, the Secretary shall,
in addition to such payments, make payments to the individual
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in an amount not to exceed 39 percent of the total amount of
loan repayments made for the taxable year involved.
(e) POSTPONING OBLIGATED SERVICE.—With respect to an individual receiving a degree or certificate from a health professions or
other related school, the date of the initiation of the period of obligated service may be postponed as approved by the Secretary.
(f) BREACH OF CONTRACT.—An individual who fails to comply
with the contract entered into under subsection (c) shall be subject
to the same financial penalties as provided for under section 338E
for breaches of loan repayment contracts under section 338B.
(g) AUTHORIZATION OF APPROPRIATIONS.—There is authorized
to be appropriated to carry out this section $195,000,000 for fiscal
year 2010, and such sums as may be necessary for each of fiscal
years 2011 through 2015.
SEC. 777. ø295f–2¿ TRAINING FOR MID-CAREER PUBLIC AND ALLIED
HEALTH PROFESSIONALS.
(a) IN GENERAL.—The Secretary may make grants to, or enter

into contracts with, any eligible entity to award scholarships to eligible individuals to enroll in degree or professional training programs for the purpose of enabling mid-career professionals in the
public health and allied health workforce to receive additional
training in the field of public health and allied health.
(b) ELIGIBILITY.—
(1) ELIGIBLE ENTITY.—The term ‘‘eligible entity’’ indicates
an accredited educational institution that offers a course of
study, certificate program, or professional training program in
public or allied health or a related discipline, as determined by
the Secretary
(2) ELIGIBLE INDIVIDUALS.—The term ‘‘eligible individuals’’
includes those individuals employed in public and allied health
positions at the Federal, State, tribal, or local level who are interested in retaining or upgrading their education.
(c) AUTHORIZATION OF APPROPRIATIONS.—There is authorized
to be appropriated to carry out this section, $60,000,000 for fiscal
year 2010 and such sums as may be necessary 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.

778.

ø295f–3¿ FELLOWSHIP TRAINING IN APPLIED PUBLIC
HEALTH EPIDEMIOLOGY, PUBLIC HEALTH LABORATORY
SCIENCE, PUBLIC HEALTH INFORMATICS, AND EXPANSION OF THE EPIDEMIC INTELLIGENCE SERVICE.
IN GENERAL.—The Secretary may carry out activities to ad-

(a)
dress 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
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PUBLIC HEALTH SERVICE ACT

Sec. 791

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).

PART F—GENERAL PROVISIONS
SEC. 791. ø295j¿ PREFERENCES AND REQUIRED INFORMATION IN
CERTAIN PROGRAMS.
(a) PREFERENCES IN MAKING AWARDS.—
(1) IN GENERAL.—Subject to paragraph (2), in making

awards of grants or contracts under any of sections 747 and
750, the Secretary shall give preference to any qualified applicant that—
(A) has a high rate for placing graduates in practice
settings having the principal focus of serving residents of
medically underserved communities;
(B) during the 2-year period preceding the fiscal year
for which such an award is sought, has achieved a significant increase in the rate of placing graduates in such settings; or
(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)).
(2) LIMITATION REGARDING PEER REVIEW.—For purposes of
paragraph (1), the Secretary may not give an applicant preference if the proposal of the applicant is ranked at or below the
20th percentile of proposals that have been recommended for
approval by peer review groups.
(b) DEFINITION.—For purposes of this section, the term ‘‘graduate’’ means, unless otherwise specified, an individual who has successfully completed all training and residency requirements necMarch 13, 2013

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essary for full certification in the health profession selected by the
individual.
(c) EXCEPTIONS FOR NEW PROGRAMS.—
(1) IN GENERAL.—To permit new programs to compete equitably for funding under this section, those new programs
that meet at least 4 of the criteria described in paragraph (3)
shall qualify for a funding preference under this section.
(2) DEFINITION.—As used in this subsection, the term ‘‘new
program’’ means any program that has graduated less than
three classes. Upon graduating at least three classes, a program shall have the capability to provide the information necessary to qualify the program for the general funding preferences described in subsection (a).
(3) CRITERIA.—The criteria referred to in paragraph (1) are
the following:
(A) The mission statement of the program identifies a
specific purpose of the program as being the preparation of
health professionals to serve underserved populations.
(B) The curriculum of the program includes content
which will help to prepare practitioners to serve underserved populations.
(C) Substantial clinical training experience is required
under the program in medically underserved communities.
(D) A minimum of 20 percent of the clinical faculty of
the program spend at least 50 percent of their time providing or supervising care in medically underserved communities.
(E) The entire program or a substantial portion of the
program is physically located in a medically underserved
community.
(F) Student assistance, which is linked to service in
medically underserved communities following graduation,
is available to the students in the program.
(G) The program provides a placement mechanism for
deploying graduates to medically underserved communities.
SEC. 792. ø295k¿ HEALTH PROFESSIONS DATA.
(a) IN GENERAL.—The Secretary shall establish

a program, including a uniform health professions data reporting system, to collect, compile, and analyze data on health professions personnel
which program shall initially include data respecting all physicians
and dentists in the States. The Secretary is authorized to expand
the program to include, whenever he determines it necessary, the
collection, compilation, and analysis of data respecting pharmacists, optometrists, podiatrists, veterinarians, public health personnel, audiologists, speech pathologists, health care administration personnel, nurses, allied health personnel, medical technologists, chiropractors, clinical psychologists, professional counselors, and any other health personnel in States designated by the
Secretary to be included in the program. Such data shall include
data respecting the training, licensure status (including permanent, temporary, partial, limited, or institutional), place or places
of practice, professional specialty, practice characteristics, place
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PUBLIC HEALTH SERVICE ACT

Sec. 792

and date of birth, sex, and socioeconomic background of health professions personnel and such other demographic information regarding health professions personnel as the Secretary may require.
(b) CERTAIN AUTHORITIES AND REQUIREMENTS.—
(1) SOURCES OF INFORMATION.—In carrying out subsection
(a), the Secretary shall collect available information from appropriate local, State, and Federal agencies and other appropriate sources.
(2) CONTRACTS FOR STUDIES OF HEALTH PROFESSIONS.—The
Secretary shall conduct or enter into contracts for the conduct
of analytic and descriptive studies of the health professions, including evaluations and projections of the supply of, and requirements for, the health professions by specialty and geographic location. Such studies shall include studies determining by specialty and geographic location the number of
health professionals (including allied health professionals and
health care administration personnel) who are members of minority groups, including Hispanics, and studies providing by
specialty and geographic location evaluations and projections of
the supply of, and requirements for, health professionals (including allied health professionals and health care administration personnel) to serve minority groups, including Hispanics.
(3) GRANTS AND CONTRACTS REGARDING STATES.—The Secretary is authorized to make grants and to enter into contracts
with States (or an appropriate nonprofit private entity in any
State) for the purpose of participating in the program established under subsection (a). The Secretary shall determine the
amount and scope of any such grant or contract. To be eligible
for a grant or contract under this paragraph a State or entity
shall submit an application in such form and manner and containing such information as the Secretary shall require. Such
application shall include reasonable assurance, satisfactory to
the Secretary, that—
(A) such State (or nonprofit entity within a State) will
establish a program of mandatory annual registration of
the health professions personnel described in subsection
(a) who reside or practice in such State and of health institutions licensed by such State, which registration shall include such information as the Secretary shall determine to
be appropriate;
(B) such State or entity shall collect such information
and report it to the Secretary in such form and manner as
the Secretary shall prescribe; and
(C) such State or entity shall comply with the requirements of subsection (e).
(d) 1 REPORTS TO CONGRESS.—The Secretary shall submit to
the Congress on October 1, 1993, and biennially thereafter, the following reports:
(1) A comprehensive report regarding the status of health
personnel according to profession, including a report regarding
the analytic and descriptive studies conducted under this section.
1 So

March 13, 2013

in law. Probably should be redesignated as (c).

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(2) A comprehensive report regarding applicants to, and
students enrolled in, programs and institutions for the training
of health personnel, including descriptions and analyses of student indebtedness, student need for financial assistance, financial resources to meet the needs of students, student career
choices such as practice specialty and geographic location and
the relationship, if any, between student indebtedness and career choices.
(e) 1 REQUIREMENTS REGARDING PERSONAL DATA.—
(1) IN GENERAL.—The Secretary and each program entity
shall in securing and maintaining any record of individually
identifiable personal data (hereinafter in this subsection referred to as ‘‘personal data’’) for purposes of this section—
(A) inform any individual who is asked to supply personal data whether he is legally required, or may refuse,
to supply such data and inform him of any specific consequences, known to the Secretary or program entity, as
the case may be, of providing or not providing such data;
(B) upon request, inform any individual if he is the
subject of personal data secured or maintained by the Secretary or program entity, as the case may be, and make
the data available to him in a form comprehensible to him;
(C) assure that no use is made of personal data which
use is not within the purposes of this section unless an informed consent has been obtained from the individual who
is the subject of such data; and
(D) upon request, inform any individual of the use
being made of personal data respecting such individual
and of the identity of the individuals and entities which
will use the data and their relationship to the programs
under this section.
(2) CONSENT AS PRECONDITION TO DISCLOSURE.—Any entity
which maintains a record of personal data and which receives
a request from the Secretary or a program entity for such data
for purposes of this section shall not transfer any such data to
the Secretary or to a program entity unless the individual
whose personal data is to be so transferred gives an informed
consent for such transfer.
(3) DISCLOSURE BY SECRETARY.—
(A) Notwithstanding any other provision of law, personal data collected by the Secretary or any program entity under this section may not be made available or disclosed by the Secretary or any program entity to any person other than the individual who is the subject of such
data unless (i) such person requires such data for purposes
of this section, or (ii) in response to a demand for such
data made by means of compulsory legal process. Any individual who is the subject of personal data made available
or disclosed under clause (ii) shall be notified of the demand for such data.
(B) Subject to all applicable laws regarding confidentiality, only the data collected by the Secretary under this
1 So

March 13, 2013

in law. Probably should be redesignated as (d).

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913

PUBLIC HEALTH SERVICE ACT

Sec. 794

section which is not personal data shall be made available
to bona fide researchers and policy analysts (including the
Congress) for the purposes of assisting in the conduct of
studies respecting health professions personnel.
(4) DEFINITION.—For purposes of this subsection, the term
‘‘program entity’’ means any public or private entity which collects, compiles, or analyzes health professions data under a
grant, contract, or other arrangement with the Secretary under
this section.
(g) 1 TECHNICAL ASSISTANCE.—The Secretary shall provide
technical assistance to the States and political subdivisions thereof
in the development of systems (including model laws) concerning
confidentiality and comparability of data collected pursuant to this
section.
(h) 2 GRANTS AND CONTRACTS REGARDING NONPROFIT ENTITIES.—
(1) IN GENERAL.—In carrying out subsection (a), the Secretary may make grants, or enter into contracts and cooperative agreements with, and provide technical assistance to, any
nonprofit entity in order to establish a uniform allied health
professions data reporting system to collect, compile, and analyze data on the allied health professions personnel.
(2) REPORTS.—With respect to reports required in subsection (d), each such report made on or after October 1, 1991,
shall include a description and analysis of data collected pursuant to paragraph (1).
SEC. 794. 3 ø295m¿ PROHIBITION AGAINST DISCRIMINATION ON BASIS
OF SEX.

The Secretary may not make a grant, loan guarantee, or interest subsidy payment under this title to, or for the benefit of, any
school of medicine, osteopathic medicine, dentistry, veterinary medicine, optometry, pharmacy, podiatric medicine, or public health or
any training center for allied health personnel, or graduate program in clinical psychology, unless the application for the grant,
loan guarantee, or interest subsidy payment contains assurances
satisfactory to the Secretary that the school or training center will
not discriminate on the basis of sex in the admission of individuals
to its training programs. The Secretary may not enter into a contract under this title with any such school or training center unless
the school, training center, or graduate program furnishes assurances satisfactory to the Secretary that it will not discriminate on
the basis of sex in the admission of individuals to its training programs. In the case of a school of medicine which—
(1) on the date of the enactment of this sentence is in the
process of changing its status as an institution which admits
only female students to that of an institution which admits
students without regard to their sex, and
(2) is carrying out such change in accordance with a plan
approved by the Secretary,
1 So

in law. Probably should be redesignated as (e).
in law. Probably should be redesignated as (f).
3 Section 793 was repealed by section 106(a)(2)(C) of Public Law 105–392 (112 Stat. 3557).
2 So

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Sec. 796

PUBLIC HEALTH SERVICE ACT

914

the provisions of the preceding sentences of this section shall apply
only with respect to a grant, contract, loan guarantee, or interest
subsidy to, or for the benefit of such a school for a fiscal year beginning after June 30, 1979.
SEC. 796. 1 ø295n–1¿ APPLICATION.
(a) IN GENERAL.—To be eligible

to receive a grant or contract
under this title, an eligible entity shall prepare and submit to the
Secretary an application that meets the requirements of this section, at such time, in such manner, and containing such information as the Secretary may require.
(b) PLAN.—An application submitted under this section shall
contain the plan of the applicant for carrying out a project with
amounts received under this title. Such plan shall be consistent
with relevant Federal, State, or regional health professions program plans.
(c) PERFORMANCE OUTCOME STANDARDS.—An application submitted under this section shall contain a specification by the applicant entity of performance outcome standards that the project to be
funded under the grant or contract will be measured against. Such
standards shall address relevant health workforce needs that the
project will meet. The recipient of a grant or contract under this
section shall meet the standards set forth in the grant or contract
application.
(d) LINKAGES.—An application submitted under this section
shall contain a description of the linkages with relevant educational and health care entities, including training programs for
other health professionals as appropriate, that the project to be
funded under the grant or contract will establish. To the extent
practicable, grantees under this section shall establish linkages
with health care providers who provide care for underserved communities and populations.
SEC. 797. ø295n–2¿ USE OF FUNDS.
(a) IN GENERAL.—Amounts

provided under a grant or contract
awarded under this title may be used for training program development and support, faculty development, model demonstrations,
trainee support including tuition, books, program fees and reasonable living expenses during the period of training, technical assistance, workforce analysis, dissemination of information, and exploring new policy directions, as appropriate to meet recognized health
workforce objectives, in accordance with this title.
(b) MAINTENANCE OF EFFORT.—With respect to activities for
which a grant awarded under this title is 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 such a grant.
SEC. 798. ø295o¿ MATCHING REQUIREMENT.

The Secretary may require that an entity that applies for a
grant or contract under this title provide non-Federal matching
funds, as appropriate, to ensure the institutional commitment of
the entity to the projects funded under the grant. As determined
1 Section

March 13, 2013

795 was repealed by section 101(b)(1) of Public Law 105–392 (112 Stat. 3537).

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PUBLIC HEALTH SERVICE ACT

Sec. 799

by the Secretary, such non-Federal matching funds may be provided directly or through donations from public or private entities
and may be in cash or in-kind, fairly evaluated, including plant,
equipment, or services.
SEC. 799. ø295o–1¿ GENERALLY APPLICABLE PROVISIONS.
(a) AWARDING OF GRANTS AND CONTRACTS.—The

Secretary
shall ensure that grants and contracts under this title are awarded
on a competitive basis, as appropriate, to carry out innovative demonstration projects or provide for strategic workforce supplementation activities as needed to meet health workforce goals and in
accordance with this title. Contracts may be entered into under
this title with public or private entities as may be necessary.
(b) ELIGIBLE ENTITIES.—Unless specifically required otherwise
in this title, the Secretary shall accept applications for grants or
contracts under this title from health professions schools, academic
health centers, State or local governments, or other appropriate
public or private nonprofit entities for funding and participation in
health professions and nursing training activities. The Secretary
may accept applications from for-profit private entities if determined appropriate by the Secretary.
(c) INFORMATION REQUIREMENTS.—
(1) IN GENERAL.—Recipients of grants and contracts under
this title shall meet information requirements as specified by
the Secretary.
(2) DATA COLLECTION.—The Secretary shall establish procedures to ensure that, with respect to any data collection required under this title, such data is collected in a manner that
takes into account age, sex, race, and ethnicity.
(3) USE OF FUNDS.—The Secretary shall establish procedures to permit the use of amounts appropriated under this
title to be used for data collection purposes.
(4) EVALUATIONS.—The Secretary shall establish procedures to ensure the annual evaluation of programs and
projects operated by recipients of grants or contracts under this
title. Such procedures shall ensure that continued funding for
such programs and projects will be conditioned upon a demonstration that satisfactory progress has been made by the program or project in meeting the objectives of the program or
project.
(d) TRAINING PROGRAMS.—Training programs conducted with
amounts received under this title shall meet applicable accreditation and quality standards.
(e) DURATION OF ASSISTANCE.—
(1) IN GENERAL.—Subject to paragraph (2), in the case of
an award to an entity of a grant, cooperative agreement, or
contract under this title, the period during which payments are
made to the entity under the award may not exceed 5 years.
The provision of payments under the award shall be subject to
annual approval by the Secretary of the payments and subject
to the availability of appropriations for the fiscal year involved
to make the payments. This paragraph may not be construed
as limiting the number of awards under the program involved
that may be made to the entity.
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PUBLIC HEALTH SERVICE ACT

916

(2) LIMITATION.—In the case of an award to an entity of a
grant, cooperative agreement, or contract under this title,
paragraph (1) shall apply only to the extent not inconsistent
with any other provision of this title that relates to the period
during which payments may be made under the award.
(f) PEER REVIEW REGARDING CERTAIN PROGRAMS.—
(1) IN GENERAL.—Each application for a grant under this
title, except any scholarship or loan program, including those
under sections 1 701, 721, or 723, shall be submitted to a peer
review group for an evaluation of the merits of the proposals
made in the application. The Secretary may not approve such
an application unless a peer review group has recommended
the application for approval.
(2) COMPOSITION.—Each peer review group under this subsection shall be composed principally of individuals who are
not officers or employees of the Federal Government. In providing for the establishment of peer review groups and procedures, the Secretary shall ensure sex, racial, ethnic, and geographic balance among the membership of such groups.
(3) ADMINISTRATION.—This subsection shall be carried out
by the Secretary acting through the Administrator of the
Health Resources and Services Administration.
(g) PREFERENCE OR PRIORITY CONSIDERATIONS.—In considering
a preference or priority for funding which is based on outcome
measures for an eligible entity under this title, the Secretary may
also consider the future ability of the eligible entity to meet the
outcome preference or priority through improvements in the eligible entity’s program design.
(h) ANALYTIC ACTIVITIES.—The Secretary shall ensure that—
(1) cross-cutting workforce analytical activities are carried
out as part of the workforce information and analysis activities
under section 761; and
(2) discipline-specific workforce information and analytical
activities are carried out as part of—
(A) the community-based linkage program under part
D; and
(B) the health workforce development program under
subpart 2 of part E.
(i) OSTEOPATHIC SCHOOLS.—For purposes of this title, any reference to—
(1) medical schools shall include osteopathic medical
schools; and
(2) medical students shall include osteopathic medical students.
SEC. 799A. ø295o–2¿ TECHNICAL ASSISTANCE.

Funds appropriated under this title may be used by the Secretary to provide technical assistance in relation to any of the authorities under this title.
SEC. 799B. ø295p¿ DEFINITIONS.

For purposes of this title:
1 So

March 13, 2013

in law. Probably should read ‘‘section’’.

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917

PUBLIC HEALTH SERVICE ACT

Sec. 799B

(1)(A) The terms ‘‘school of medicine’’, ‘‘school of dentistry’’,
‘‘school of osteopathic medicine’’, ‘‘school of pharmacy’’, ‘‘school
of optometry’’, ‘‘school of podiatric medicine’’, ‘‘school of veterinary medicine’’, ‘‘school of public health’’, and ‘‘school of chiropractic’’ mean an accredited public or nonprofit private school
in a State that provides training leading, respectively, to a degree of doctor of medicine, a degree of doctor of dentistry or an
equivalent degree, a degree of doctor of osteopathy, a degree of
bachelor of science in pharmacy or an equivalent degree or a
degree of doctor of pharmacy or an equivalent degree, a degree
of doctor of optometry or an equivalent degree, a degree of doctor of podiatric medicine or an equivalent degree, a degree of
doctor of veterinary medicine or an equivalent degree, a graduate degree in public health or an equivalent degree, and a degree of doctor of chiropractic or an equivalent degree, and including advanced training related to such training provided by
any such school.
(B) The terms ‘‘graduate program in health administration’’ and ‘‘graduate program in clinical psychology’’ mean an
accredited graduate program in a public or nonprofit private
institution in a State that provides training leading, respectively, to a graduate degree in health administration or an
equivalent degree and a doctoral degree in clinical psychology
or an equivalent degree.
(C) The terms ‘‘graduate program in clinical social work’’
and ‘‘graduate program in marriage and family therapy’’ and
‘‘graduate program in professional counseling’’ mean an accredited graduate program in a public or nonprofit private institution in a State that provides training, respectively, in a concentration in health or mental health care leading to a graduate degree in social work and a concentration leading to a
graduate degree in marriage and family therapy and a concentration leading to a graduate degree in counseling.
(D) 1 The term ‘‘graduate program in behavioral health and
mental health practice’’ means a graduate program in clinical
psychology, clinical social work, professional counseling, or
marriage and family therapy.
(E) The term ‘‘accredited’’, when applied to a school of
medicine, osteopathic medicine, dentistry, veterinary medicine,
optometry, podiatry, pharmacy, public health, or chiropractic,
or a graduate program in health administration, clinical psychology, clinical social work, professional counseling, or marriage and family therapy, means a school or program that is
accredited by a recognized body or bodies approved for such
purpose by the Secretary of Education, except that a new
school or program that, by reason of an insufficient period of
operation, is not, at the time of application for a grant or contract under this title, eligible for accreditation by such a recognized body or bodies, shall be deemed accredited for purposes
of this title, if the Secretary of Education finds, after consulta1 Section 108(a)(2) of Public Law 105–392 (112 Stat. 3560) provides that paragraph (1)(D) is
amended by inserting ‘‘behavioral health and mental health practice,’’ before ‘‘clinical’’. The
amendment cannot be executed because the amendment does not specify to which instance of
the term ‘‘clinical’’ the amendment applies.

March 13, 2013

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Sec. 799B

PUBLIC HEALTH SERVICE ACT

918

tion with the appropriate accreditation body or bodies, that
there is reasonable assurance that the school or program will
meet the accreditation standards of such body or bodies prior
to the beginning of the academic year following the normal
graduation date of the first entering class in such school or
program.
(2) The term ‘‘teaching facilities’’ means areas dedicated
for use by students, faculty, or administrative or maintenance
personnel for clinical purposes, research activities, libraries,
classrooms, offices, auditoriums, dining areas, student activities, or other related purposes necessary for, and appropriate
to, the conduct of comprehensive programs of education. Such
term includes interim facilities but does not include off-site improvements or living quarters.
(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.
(4) The term ‘‘school of allied health’’ means a public or
nonprofit private college, junior college, or university or hospital-based educational entity that—
(A) provides, or can provide, programs of education to
enable individuals to become allied health professionals or
to provide additional training for allied health professionals;
(B) provides training for not less than a total of twenty
persons in the allied health curricula (except that this subparagraph shall not apply to any hospital-based educational entity);
(C) includes or is affiliated with a teaching hospital;
and
(D) is accredited by a recognized body or bodies approved for such purposes by the Secretary of Education, or
which provides to the Secretary satisfactory assurance by
such accrediting body or bodies that reasonable progress is
being made toward accreditation.
(5) The term ‘‘allied health professionals’’ means a health
professional (other than a registered nurse or physician assistant)—
(A) who has received a certificate, an associate’s degree, a bachelor’s degree, a master’s degree, a doctoral degree, or postbaccalaureate training, in a science relating to
health care;
(B) who shares in the responsibility for the delivery of
health care services or related services, including—
(i) services relating to the identification, evaluation, and prevention of disease and disorders;
(ii) dietary and nutrition services;
(iii) health promotion services;
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(iv) rehabilitation services; or
(v) health systems management services; and
(C) who has not received a degree of doctor of medicine, a degree of doctor of osteopathy, a degree of doctor
of dentistry or an equivalent degree, a degree of doctor of
veterinary medicine or an equivalent degree, a degree of
doctor of optometry or an equivalent degree, a degree of
doctor of podiatric medicine or an equivalent degree, a degree of bachelor of science in pharmacy or an equivalent
degree, a degree of doctor of pharmacy or an equivalent degree, a graduate degree in public health or an equivalent
degree, a degree of doctor of chiropractic or an equivalent
degree, a graduate degree in health administration or an
equivalent degree, a doctoral degree in clinical psychology
or an equivalent degree, or a degree in social work or an
equivalent degree or a degree in counseling or an equivalent degree.
(6) The term ‘‘medically underserved community’’ means
an urban or rural area or population that—
(A) is eligible for designation under section 332 as a
health professional shortage area;
(B) 1 is eligible to be served by a migrant health center
under section 329, a community health center under section 330, a grantee under section 330(h) (relating to homeless individuals), or a grantee under section 340A (relating
to residents of public housing);
(C) has a shortage of personal health services, as determined under criteria issued by the Secretary under section 1861(aa)(2) of the Social Security Act (relating to rural
health clinics); or
(D) is designated by a State Governor (in consultation
with the medical community) as a shortage area or medically underserved community.
(7) The term ‘‘Department’’ means the Department of
Health and Human Services.
(8) The term ‘‘nonprofit’’ refers to the status of an entity
owned and operated by one or more corporations or associations no part of the net earnings of which inures, or may lawfully inure, to the benefit of any private shareholder or individual.
(9) The term ‘‘State’’ includes, in addition to the several
States, only the District of Columbia, the Commonwealth of
Puerto Rico, the Commonwealth of the Northern Mariana Islands, the Virgin Islands, Guam, American Samoa, and the
Trust Territory of the Pacific Islands.
(10)(A) Subject to subparagraph (B), the term ‘‘underrepresented minorities’’ means, with respect to a health profession, racial and ethnic populations that are underrepresented
in the health profession relative to the number of individuals
who are members of the population involved.
1 See

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920

(B) For purposes of subparagraph (A), Asian individuals
shall be considered by the various subpopulations of such individuals.
(11) The term ‘‘psychologist’’ means an individual who—
(A) holds a doctoral degree in psychology; and
(B) is licensed or certified on the basis of the doctoral
degree in psychology, by the State in which the individual
practices, at the independent practice level of psychology
to furnish diagnostic, assessment, preventive, and therapeutic services directly to individuals.
(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].
(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
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(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 ‘‘onestop 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)).

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TITLE VIII—NURSING WORKFORCE
DEVELOPMENT
PART A—GENERAL PROVISIONS
SEC. 801. ø296¿ DEFINITIONS.

As used in this title:
(1) ELIGIBLE ENTITIES.—The term ‘‘eligible entities’’ means
schools of nursing, nursing centers, academic health centers,
State or local governments, and other public or private nonprofit entities determined appropriate by the Secretary that
submit to the Secretary an application in accordance with section 802.
(2) SCHOOL OF NURSING.—The term ‘‘school of nursing’’
means an accredited (as defined in paragraph 6) collegiate, associate degree, or diploma school of nursing in a State where
graduates are—
(A) authorized to sit for the National Council Licensure EXamination-Registered Nurse (NCLEX–RN); or
(B) licensed registered nurses who will receive a graduate or equivalent degree or training to become an advanced education nurse as defined by section 811(b).
(3) COLLEGIATE SCHOOL OF NURSING.—The term ‘‘collegiate
school of nursing’’ means a department, division, or other administrative unit in a college or university which provides primarily or exclusively a program of education in professional
nursing and related subjects leading to the degree of bachelor
of arts, bachelor of science, bachelor of nursing, or to an equivalent degree, or to a graduate degree in nursing, or to an
equivalent degree, and including advanced training related to
such program of education provided by such school, but only if
such program, or such unit, college or university is accredited.
(4) ASSOCIATE DEGREE SCHOOL OF NURSING.—The term ‘‘associate degree school of nursing’’ means a department, division,
or other administrative unit in a junior college, community college, college, or university which provides primarily or exclusively a two-year program of education in professional nursing
and allied subjects leading to an associate degree in nursing or
to an equivalent degree, but only if such program, or such unit,
college, or university is accredited.
(5) DIPLOMA SCHOOL OF NURSING.—The term ‘‘diploma
school of nursing’’ means a school affiliated with a hospital or
university, or an independent school, which provides primarily
or exclusively a program of education in professional nursing
and allied subjects leading to a diploma or to equivalent indicia
that such program has been satisfactorily completed, but only
922
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Sec. 801

if such program, or such affiliated school or such hospital or
university or such independent school is accredited.
(6) ACCREDITED.—
(A) IN GENERAL.—Except as provided in subparagraph
(B), the term ‘‘accredited’’ when applied to any program of
nurse education means a program accredited by a recognized body or bodies, or by a State agency, approved for
such purpose by the Secretary of Education and when applied to a hospital, school, college, or university (or a unit
thereof) means a hospital, school, college, or university (or
a unit thereof) which is accredited by a recognized body or
bodies, or by a State agency, approved for such purpose by
the Secretary of Education. For the purpose of this paragraph, the Secretary of Education shall publish a list of
recognized accrediting bodies, and of State agencies, which
the Secretary of Education determines to be reliable authority as to the quality of education offered.
(B) NEW PROGRAMS.—A new program of nursing that,
by reason of an insufficient period of operation, is not, at
the time of the submission of an application for a grant or
contract under this title, eligible for accreditation by such
a recognized body or bodies or State agency, shall be
deemed accredited for purposes of this title if the Secretary
of Education finds, after consultation with the appropriate
accreditation body or bodies, that there is reasonable assurance that the program will meet the accreditation
standards of such body or bodies prior to the beginning of
the academic year following the normal graduation date of
students of the first entering class in such a program.
(7) NONPROFIT.—The term ‘‘nonprofit’’ as applied to any
school, agency, organization, or institution means one which is
a corporation or association, or is owned and operated by one
or more corporations or associations, no part of the net earnings of which inures, or may lawfully inure, to the benefit of
any private shareholder or individual.
(8) STATE.—The term ‘‘State’’ means a State, the Commonwealth of Puerto Rico, the District of Columbia, the Commonwealth of the Northern Mariana Islands, Guam, American
Samoa, the Virgin Islands, or the Trust Territory of the Pacific
Islands.
(9) AMBULATORY SURGICAL CENTER.—The term ‘‘ambulatory surgical center’’ has the meaning applicable to such term
under title XVIII of the Social Security Act.
(10) FEDERALLY QUALIFIED HEALTH CENTER.—The term
‘‘Federally qualified health center’’ has the meaning given such
term under section 1861(aa)(4) of the Social Security Act.
(11) HEALTH CARE FACILITY.—The term ‘‘health care facility’’ means an Indian Health Service health center, a Native
Hawaiian health center, a hospital, a Federally qualified
health center, a rural health clinic, a nursing home, a home
health agency, a hospice program, a public health clinic, a
State or local department of public health, a skilled nursing facility, an ambulatory surgical center, or any other facility designated by the Secretary.
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Sec. 802

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924

(12) HOME HEALTH AGENCY.—The term ‘‘home health agency’’ has the meaning given such term in section 1861(o) of the
Social Security Act.
(13) HOSPICE PROGRAM.—The term ‘‘hospice program’’ has
the meaning given such term in section 1861(dd)(2) of the Social Security Act.
(14) RURAL HEALTH CLINIC.—The term ‘‘rural health clinic’’
has the meaning given such term in section 1861(aa)(2) of the
Social Security Act.
(15) SKILLED NURSING FACILITY.—The term ‘‘skilled nursing facility’’ has the meaning given such term in section
1819(a) of the Social Security Act.
(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.
SEC. 802. ø296a¿ APPLICATION.
(a) IN GENERAL.—To be

eligible to receive a grant or contract
under this title, an eligible entity shall prepare and submit to the
Secretary an application that meets the requirements of this section, at such time, in such manner, and containing such information as the Secretary may require.
(b) PLAN.—An application submitted under this section shall
contain the plan of the applicant for carrying out a project with
amounts received under this title. Such plan shall be consistent
with relevant Federal, State, or regional program plans.
(c) PERFORMANCE OUTCOME STANDARDS.—An application submitted under this section shall contain a specification by the applicant entity of performance outcome standards that the project to be
funded under the grant or contract will be measured against. Such
standards shall address relevant national nursing needs that the
project will meet. The recipient of a grant or contract under this
section shall meet the standards set forth in the grant or contract
application.
(d) LINKAGES.—An application submitted under this section
shall contain a description of the linkages with relevant educational and health care entities, including training programs for
other health professionals as appropriate, that the project to be
funded under the grant or contract will establish.
SEC. 803. ø296b¿ USE OF FUNDS.
(a) IN GENERAL.—Amounts

provided under a grant or contract
awarded under this title may be used for training program developMarch 13, 2013

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PUBLIC HEALTH SERVICE ACT

Sec. 806

ment and support, faculty development, model demonstrations,
trainee support including tuition, books, program fees and reasonable living expenses during the period of training, technical assistance, workforce analysis, and dissemination of information, as appropriate to meet recognized nursing objectives, in accordance with
this title.
(b) MAINTENANCE OF EFFORT.—With respect to activities for
which a grant awarded under this title is 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 such a grant.
SEC. 804. ø296c¿ MATCHING REQUIREMENT.

The Secretary may require that an entity that applies for a
grant or contract under this title provide non-Federal matching
funds, as appropriate, to ensure the institutional commitment of
the entity to the projects funded under the grant. Such non-Federal
matching funds may be provided directly or through donations
from public or private entities and may be in cash or in-kind, fairly
evaluated, including plant, equipment, or services.
SEC. 805. ø296d¿ PREFERENCE.

In awarding grants or contracts under this title, the Secretary
shall give preference to applicants with projects that will substantially benefit rural or underserved populations, or help meet public
health nursing needs in State or local health departments.
SEC. 806. ø296e¿ GENERALLY APPLICABLE PROVISIONS.
(a) AWARDING OF GRANTS AND CONTRACTS.—The

Secretary
shall ensure that grants and contracts under this title are awarded
on a competitive basis, as appropriate, to carry out innovative demonstration projects or provide for strategic workforce supplementation activities as needed to meet national nursing service goals
and in accordance with this title. Contracts may be entered into
under this title with public or private entities as determined necessary by the Secretary.
(b) INFORMATION REQUIREMENTS.—
(1) IN GENERAL.—Recipients of grants and contracts under
this title shall meet information requirements as specified by
the Secretary.
(2) EVALUATIONS.—The Secretary shall establish procedures to ensure the annual evaluation of programs and
projects operated by recipients of grants under this title. Such
procedures shall ensure that continued funding for such programs and projects will be conditioned upon a demonstration
that satisfactory progress has been made by the program or
project in meeting the objectives of the program or project.
(c) TRAINING PROGRAMS.—Training programs conducted with
amounts received under this title shall meet applicable accreditation and quality standards.
(d) DURATION OF ASSISTANCE.—
(1) IN GENERAL.—Subject to paragraph (2), in the case of
an award to an entity of a grant, cooperative agreement, or
contract under this title, the period during which payments are
made to the entity under the award may not exceed 5 years.
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Sec. 806

PUBLIC HEALTH SERVICE ACT

926

The provision of payments under the award shall be subject to
annual approval by the Secretary of the payments and subject
to the availability of appropriations for the fiscal year involved
to make the payments. This paragraph may not be construed
as limiting the number of awards under the program involved
that may be made to the entity.
(2) LIMITATION.—In the case of an award to an entity of a
grant, cooperative agreement, or contract under this title,
paragraph (1) shall apply only to the extent not inconsistent
with any other provision of this title that relates to the period
during which payments may be made under the award.
(e) PEER REVIEW REGARDING CERTAIN PROGRAMS.—
(1) IN GENERAL.—Each application for a grant under this
title, except advanced nurse traineeship grants under section
811(a)(2), shall be submitted to a peer review group for an
evaluation of the merits of the proposals made in the application. The Secretary may not approve such an application unless a peer review group has recommended the application for
approval.
(2) COMPOSITION.—Each peer review group under this subsection shall be composed principally of individuals who are
not officers or employees of the Federal Government. In providing for the establishment of peer review groups and procedures, the Secretary shall, except as otherwise provided, ensure sex, racial, ethnic, and geographic representation among
the membership of such groups.
(3) ADMINISTRATION.—This subsection shall be carried out
by the Secretary acting through the Administrator of the
Health Resources and Services Administration.
(f) ANALYTIC ACTIVITIES.—The Secretary shall ensure that—
(1) cross-cutting workforce analytical activities are carried
out as part of the workforce information and analysis activities
under this title; and
(2) discipline-specific workforce information is developed
and analytical activities are carried out as part of—
(A) the advanced education nursing activities under
part B;
(B) the workforce diversity activities under part C;
and
(C) basic nursing education and practice activities
under part D.
(g) STATE AND REGIONAL PRIORITIES.—Activities under grants
or contracts under this title shall, to the extent practicable, be consistent with related Federal, State, or regional nursing professions
program plans and priorities.
(h) FILING OF APPLICATIONS.—
(1) IN GENERAL.—Applications for grants or contracts
under this title may be submitted by health professions
schools, schools of nursing, academic health centers, State or
local governments, or other appropriate public or private nonprofit entities as determined appropriate by the Secretary in
accordance with this title.
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PUBLIC HEALTH SERVICE ACT

Sec. 809

(2) FOR-PROFIT ENTITIES.—Notwithstanding paragraph (1),
a for-profit entity may be eligible for a grant or contract under
this title as determined appropriate by the Secretary.
SEC. 807. ø296e–1¿ GRANTS FOR HEALTH PROFESSIONS EDUCATION.
(a) CULTURAL COMPETENCY, PREVENTION, AND PUBLIC HEALTH
AND INDIVIDUALS WITH DISABILITY GRANTS.—The Secretary, acting

through the Administrator of the Health Resources and Services
Administration, may make awards of grants, contracts, or cooperative agreements to eligible entities 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. Grants under this section shall be the same as provided in section 741.
(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.
(d) AUTHORIZATION OF APPROPRIATIONS.—There are to be appropriated to carry out this section such sums as may be necessary
for each of the fiscal years 2010 through 2015.
SEC. 808. ø296f¿ TECHNICAL ASSISTANCE.

Funds appropriated under this title may be used by the Secretary to provide technical assistance in relation to any of the authorities under this title.
PROHIBITION AGAINST DISCRIMINATION BY SCHOOLS ON THE BASIS OF
SEX

SEC. 809. ø296g¿ The Secretary may not make a grant, loan
guarantee, or interest subsidy payment under this title to, or for
the benefit of, any school of nursing unless the application for the
grant, loan guarantee, or interest subsidy payment contains assurances satisfactory to the Secretary that the school will not discriminate on the basis of sex in the admission of individuals to its training programs. The Secretary may not enter into a contract under
this title with any school unless the school furnishes assurances
satisfactory to the Secretary that it will not discriminate on the
basis of sex in the admission of individuals to its training programs.

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Sec. 811

PUBLIC HEALTH SERVICE ACT

928

PART B—NURSE PRACTITIONERS, NURSE MIDWIVES, NURSE ANESTHETISTS, AND OTHER
ADVANCED EDUCATION NURSES
SEC. 811. ø296j¿ ADVANCED EDUCATION NURSING GRANTS.
(a) IN GENERAL.—The Secretary may award grants

to and
enter into contracts with eligible entities to meet the costs of—
(1) projects that support the enhancement of advanced
nursing education and practice; and
(2) traineeships for individuals in advanced nursing education programs.
(b) DEFINITION OF ADVANCED EDUCATION NURSES.—For purposes of this section, the term ‘‘advanced education nurses’’ means
individuals trained in advanced degree programs including individuals in combined R.N./Master’s degree programs, post-nursing master’s certificate programs, or, in the case of nurse midwives, in certificate programs in existence on the date that is one day prior to
the date of enactment of this section, to serve as nurse practitioners, clinical nurse specialists, nurse midwives, nurse anesthetists, nurse educators, nurse administrators, or public health
nurses, or in other nurse specialties determined by the Secretary
to require advanced education.
(c) AUTHORIZED NURSE PRACTITIONER.—Nurse practitioner programs eligible for support under this section are educational programs for registered nurses (irrespective of the type of school of
nursing in which the nurses received their training) that—
(1) meet guidelines prescribed by the Secretary; and
(2) have as their objective the education of nurses who will
upon completion of their studies in such programs, be qualified
to effectively provide primary health care, including primary
health care in homes and in ambulatory care facilities, longterm care facilities, acute care, and other health care settings.
(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.
(e) AUTHORIZED NURSE ANESTHESIA PROGRAMS.—Nurse anesthesia programs eligible for support under this section are education programs that—
(1) provide registered nurses with full-time anesthetist
education; and
(2) are accredited by the Council on Accreditation of Nurse
Anesthesia Educational Programs.
(f) OTHER AUTHORIZED EDUCATIONAL PROGRAMS.—The Secretary shall prescribe guidelines as appropriate for other advanced
nurse education programs eligible for support under this section.
(g) TRAINEESHIPS.—
(1) IN GENERAL.—The Secretary may not award a grant to
an applicant under subsection (a) unless the applicant involved
agrees that traineeships provided with the grant will only pay
all or part of the costs of—
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PUBLIC HEALTH SERVICE ACT

Sec. 821

(A) the tuition, books, and fees of the program of advanced nurse education with respect to which the
traineeship is provided; and
(B) the reasonable living expenses of the individual
during the period for which the traineeship is provided.
(2) SPECIAL CONSIDERATION.—In making awards of grants
and contracts under subsection (a)(2), the Secretary shall give
special consideration to an eligible entity that agrees to expend
the award to train advanced education nurses who will practice
in health professional shortage areas designated under section
332.

PART C—INCREASING NURSING WORKFORCE
DIVERSITY
SEC. 821. ø296m¿ WORKFORCE DIVERSITY GRANTS.
(a) 1 IN GENERAL.—
(1) AUTHORITY.—The Secretary may award

grants to and
enter into contracts with eligible entities to meet the costs of
special projects to increase nursing education opportunities for
individuals who are from disadvantaged backgrounds (including racial and ethnic minorities underrepresented among registered nurses) by providing student scholarships or stipends,
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.
(b) GUIDANCE.—In carrying out subsection (a), the Secretary
shall take into consideration the recommendations of the National
Advisory Council on Nurse Education and Practice and consult
with nursing associations including the National Coalition of Ethnic Minority Nurse Associations, American Nurses Association, the
National League for Nursing, the American Association of Colleges
of Nursing, the National Black Nurses Association, the National
Association of Hispanic Nurses, the Association of Asian American
and Pacific Islander Nurses, the Native American Indian and Alaskan Nurses Association, and the National Council of State Boards
of Nursing, and other organizations determined appropriate by the
Secretary.
(c) REQUIRED INFORMATION AND CONDITIONS FOR AWARD RECIPIENTS.—
(1) IN GENERAL.—Recipients of awards under this section
may be required, where requested, to report to the Secretary
concerning the annual admission, retention, and graduation
rates for individuals from disadvantaged backgrounds and ethnic and racial minorities in the school or schools involved in
the projects.
(2) FALLING RATES.—If any of the rates reported under
paragraph (1) fall below the average of the two previous years,
1 So

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Sec. 831

PUBLIC HEALTH SERVICE ACT

930

the grant or contract recipient shall provide the Secretary with
plans for immediately improving such rates.
(3) INELIGIBILITY.—A recipient described in paragraph (2)
shall be ineligible for continued funding under this section if
the plan of the recipient fails to improve the rates within the
1-year period beginning on the date such plan is implemented.

PART D—STRENGTHENING CAPACITY FOR
BASIC NURSE EDUCATION AND PRACTICE
SEC.

831.

ø296p¿ NURSE EDUCATION, PRACTICE, AND QUALITY
GRANTS.
EDUCATION PRIORITY AREAS.—The Secretary may award

(a)
grants to or enter into contracts with eligible entities for—
(1) expanding the enrollment in baccalaureate nursing programs; or
(2) providing education in new technologies, including distance learning methodologies.
(b) PRACTICE PRIORITY AREAS.—The Secretary may award
grants to or enter into contracts with eligible entities for—
(1) establishing or expanding nursing practice arrangements in noninstitutional settings to demonstrate methods to
improve access to primary health care in medically underserved communities;
(2) providing care for underserved populations and other
high-risk groups such as the elderly, individuals with HIV/
AIDS, substance abusers, the homeless, and victims of domestic violence;
(3) providing coordinated care, and other skills needed to
practice in existing and emerging organized health care systems; or
(4) developing cultural competencies among nurses.
(c) 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 paragraph (1) or (2).
(1) GRANTS FOR CAREER LADDER PROGRAMS.—The Secretary may award grants to and enter into contracts with eligible entities for programs—
(A) to promote career advancement for nursing personnel in a variety of training settings, cross training or
specialty training among diverse population groups, and
the advancement of individuals including to become professional nurses, advanced education nurses, licensed practical nurses, certified nurse assistants, and home health
aides; and
(B) to assist individuals in obtaining education and
training required to enter the nursing profession and advance within such profession, such as by providing career
counseling and mentoring.
(2) ENHANCING PATIENT CARE DELIVERY SYSTEMS.—
(A) 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 acMarch 13, 2013

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931

PUBLIC HEALTH SERVICE ACT

Sec. 831A

tivities by enhancing collaboration and communication
among nurses and other health care professionals, and by
promoting nurse involvement in the organizational and
clinical decisionmaking processes of a health care facility.
(B) PREFERENCE.—In making awards of grants under
this paragraph, the Secretary shall give a preference to applicants that have not previously received an award under
this paragraph.
(C) CONTINUATION OF AN AWARD.—The Secretary shall
make continuation of any award under this paragraph 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 education, practice, and retention, as determined by the Secretary.
(e) PREFERENCE.—For purposes of any amount of funds appropriated to carry out this section for fiscal year 2003, 2004, or 2005
that is in excess of the amount of funds appropriated to carry out
this section for fiscal year 2002, the Secretary shall give preference
to awarding grants or entering into contracts under subsections
(a)(2) and (c).
(f) 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.
(g) ELIGIBLE ENTITY.—For purposes of this section, the term
‘‘eligible entity’’ includes a school of nursing, as defined in section
801(2),, 1 a health care facility, or a partnership of such a school
and facility.
(h) 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. 831A. ø296p–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;
1 So

March 13, 2013

in law.

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Sec. 835

PUBLIC HEALTH SERVICE ACT

932

(2) developing and implementing internships and residency
programs in collaboration with an accredited school of nursing,
as defined by section 801(2), to encourage mentoring and the
development of specialties; or
(3) to assist individuals in obtaining education and training required to enter the nursing profession and advance within such profession.
(c) ENHANCING PATIENT CARE DELIVERY SYSTEMS.—
(1) GRANTS.—The Secretary may award grants to eligible
entities to improve the retention of nurses and enhance patient
care that is directly related to nursing activities by enhancing
collaboration and communication among nurses and other
health care professionals, and by promoting nurse involvement
in the organizational and clinical decision-making processes of
a health care facility.
(2) PRIORITY.—In making awards of grants under this subsection, the Secretary shall give preference to applicants that
have not previously received an award under this subsection
(or section 831(c) as such section existed on the day before the
date of enactment of this section).
(3) CONTINUATION OF AN AWARD.—The Secretary shall
make continuation of any award under this subsection beyond
the second year of such award contingent on the recipient of
such award having demonstrated to the Secretary measurable
and substantive improvement in nurse retention or patient
care.
(d) OTHER PRIORITY AREAS.—The Secretary may award grants
to, or enter into contracts with, eligible entities to address other
areas that are of high priority to nurse retention, as determined by
the Secretary.
(e) REPORT.—The Secretary shall submit to the Congress before the end of each fiscal year a report on the grants awarded and
the contracts entered into under this section. Each such report
shall identify the overall number of such grants and contracts and
provide an explanation of why each such grant or contract will
meet the priority need of the nursing workforce.
(f) ELIGIBLE ENTITY.—For purposes of this section, the term
‘‘eligible entity’’ includes an accredited school of nursing, as defined
by section 801(2), a health care facility, or a partnership of such
a school and facility.
(g) AUTHORIZATION OF APPROPRIATIONS.—There are authorized
to be appropriated to carry out this section such sums as may be
necessary for each of fiscal years 2010 through 2012.

PART E—STUDENT LOANS 1
LOAN AGREEMENTS

SEC. 835. ø297a¿ (a) The Secretary is authorized to enter into
an agreement for the establishment and operation of a student loan
1 Section 936(e) of Public Law 94–63 repealed a section of this title that provided for a revolving fund. This former section was section 827. With respect to the revolving fund, such section
936(e) provided as follows: ‘‘The nurse training fund created within the Treasury by section
827(d)(1) of the Act shall remain available to the Secretary of Health, Education, and Welfare

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PUBLIC HEALTH SERVICE ACT

Sec. 835

fund in accordance with this part with any public or nonprofit private school of nursing which is located in a State.
(b) Each agreement entered into under this section shall—
(1) provide for establishment of a student loan fund by the
school;
(2) provide for deposit in the fund, except as provided in
section 871, of (A) the Federal capital contributions paid from
allotments under section 838 to the school by the Secretary, (B)
an additional amount from other sources equal to not less than
one-ninth of such Federal capital contributions, (C) collections
of principal and interest on loans made from the fund, (D) collections pursuant to section 836(f), and (E) any other earnings
of the fund;
(3) provide that the fund, except as provided in section
871, shall be used only for loans to students of the school in
accordance with the agreement and for costs of collection of
such loans and interest thereon;
(4) provide that loans may be made from such fund only
to students pursuing a full-time or half-time course of study at
the school leading to a baccalaureate or associate degree in
nursing or an equivalent degree or a diploma in nursing, or to
a graduate degree in nursing; and
(5) contain such other provisions as are necessary to protect the financial interests of the United States.
(c)(1) Any standard established by the Secretary by regulation
for the collection by schools of nursing of loans made pursuant to
loan agreements under this part shall provide that the failure of
any such school to collect such loans shall be measured in accordance with this subsection. With respect to the student loan fund established pursuant to such agreements, this subsection may not be
construed to require such schools to reimburse such loan fund for
loans that became uncollectable prior to 1983.
(2) The measurement of a school’s failure to collect loans made
under this part shall be the ratio (stated as a percentage) that the
defaulted principal amount outstanding of such school bears to the
matured loans of such school.
(3) For purposes of this subsection—
(A) the term ‘‘default’’ means the failure of a borrower of
a loan made under this part to—
(i) make an installment payment when due; or
(ii) comply with any other term of the promissory note
for such loan,
except that a loan made under this part shall not be considered
to be in default if the loan is discharged in bankruptcy or if
the school reasonably concludes from written contacts with the
borrower that the borrower intends to repay the loan;
for the purpose of meeting his responsibilities respecting participations in obligations acquired
under section 827 of the Act. The Secretary shall continue to deposit in such fund all amounts
received by him as interest payments or repayments of principal on loans under such section
827. If at any time the Secretary determines the moneys in the funds exceed the present and
any reasonable prospective further requirements of such fund, such excess may be transferred
to the general fund of the Treasury.’’. Such section further provided that ‘‘[t]here are authorized
to be appropriated without fiscal year limitation such sums as may be necessary to enable the
Secretary to make payments under agreements entered into under section 827(b) of the Act before [July 27, 1975]’’.

March 13, 2013

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Sec. 836

PUBLIC HEALTH SERVICE ACT

934

(B) the term ‘‘defaulted principal amount outstanding’’
means the total amount borrowed from the loan fund of a
school that has reached the repayment stage (minus any principal amount repaid or cancelled) on loans—
(i) repayable monthly and in default for at least 120
days; and
(ii) repayable less frequently than monthly and in default for at least 180 days;
(C) the term ‘‘grace period’’ means the period of nine
months beginning on the date on which the borrower ceases to
pursue a full-time or half-time course of study at a school of
nursing; and
(D) the term ‘‘matured loans’’ means the total principal
amount of all loans made by a school of nursing under this
part minus the total principal amount of loans made by such
school to students who are—
(i) enrolled in a full-time or half-time course of study
at such school; or
(ii) in their grace period.
LOAN PROVISIONS

SEC. 836. ø297b¿ (a) The total of the loans for any academic
year (or its equivalent, as determined under regulations of the Secretary) made by schools of nursing from loan funds established pursuant to agreements under this part may not exceed $3,300 in the
case of any student, except that for the final two academic years
of the program involved, such total may not exceed $5,200. The aggregate of the loans for all years from such funds may not exceed
$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) Loans from any such student loan fund by any school shall
be made on such terms and conditions as the school may determine; subject, however, to such conditions, limitations, and requirements as the Secretary may prescribe (by regulation or in the
agreement with the school) with a view to preventing impairment
of the capital of such fund to the maximum extent practicable in
the light of the objective of enabling the student to complete his
course of study; and except that—
(1) such a loan may be made only to a student who (A) is
in need of the amount of the loan to pursue a full-time or halftime course of study at the school leading to a baccalaureate
or associate degree in nursing or an equivalent degree, or a diploma in nursing, or a graduate degree in nursing, (B) is capable, in the opinion of the school, of maintaining good standing
in such course of study, and (C) with respect to any student enrolling in the school after June 30, 2000, is of financial need
(as defined in regulations issued by the Secretary);
(2) such a loan shall be repayable in equal or graduated
periodic installments (with the right of the borrower to accelerate repayment) over the ten-year period which begins nine
months after the student ceases to pursue a full-time or halfMarch 13, 2013

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PUBLIC HEALTH SERVICE ACT

Sec. 836

time course of study at a school of nursing, excluding from
such 10-year period all (A) periods (up to three years) of (i) active duty performed by the borrower as a member of a uniformed service, or (ii) service as a volunteer under the Peace
Corps Act, (B) periods (up to ten years) during which the borrower is pursuing a full-time or half-time course of study at a
collegiate school of nursing leading to baccalaureate degree in
nursing or an equivalent degree, or to graduate degree in nursing, or is otherwise pursuing advanced professional training in
nursing (or training to be a nurse anesthetist), and (C) such
additional periods under the terms of paragraph (8) of this subsection;
(3) in the case of a student who received such a loan before
September 29, 1995, an amount up to 85 per centum of any
such loan made before such date (plus interest thereon) shall
be canceled for full-time employment as a professional nurse
(including teaching in any of the fields of nurse training and
service as an administrator, supervisor, or consultant in any of
the fields of nursing) in any public or nonprofit private agency,
institution, or organization (including neighborhood health centers), at the rate of 15 per centum of the amount of such loan
(plus interest) unpaid on the first day of such service for each
of the first, second, and third complete year of such service,
and 20 per centum of such amount (plus interest) for each complete fourth and fifth year of such service;
(4) the liability to repay the unpaid balance of such loan
and accrued interest thereon shall be canceled upon the death
of the borrower, or if the Secretary determines that he has become permanently and totally disabled;
(5) such a loan shall bear interest on the unpaid balance
of the loan, computed only for periods during which the loan
is repayable, at the rate of 5 percent per annum;
(6) such a loan shall be made without security or endorsement, except that if the borrower is a minor and the note or
other evidence of obligation executed by him would not, under
the applicable law, create a binding obligation, either security
or endorsement may be required;
(7) no note or other evidence of any such loan may be
transferred or assigned by the school making the loan except
that, if the borrower transfers to another school participating
in the program under this part, such note or other evidence of
a loan may be transferred to such other school; and
(8) pursuant to uniform criteria established by the Secretary, the repayment period established under paragraph (2)
for any student borrower who during the repayment period
failed to make consecutive payments and who, during the last
12 months of the repayment period, has made at least 12 consecutive payments may be extended for a period not to exceed
10 years.
(c) Where all or any part of a loan, or interest, is canceled
under this section, the Secretary shall pay to the school an amount
equal to the school’s proportionate share of the canceled portion, as
determined by the Secretary.
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Sec. 836

PUBLIC HEALTH SERVICE ACT

936

(d) Any loan for any year by a school from a student loan fund
established pursuant to an agreement under this part shall be
made in such installments as may be provided in regulations of the
Secretary or such agreement and, upon notice to the Secretary by
the school that any recipient of a loan is failing to maintain satisfactory standing, any or all further installments of his loans shall
be withheld, as may be appropriate.
(e) An agreement under this part with any school shall include
provisions designed to make loans from the student loan fund established thereunder reasonably available (to the extent of the
available funds in such fund) to all eligible students in the school
in need thereof.
(f) Subject to regulations of the Secretary and in accordance
with this section, a school shall assess a charge with respect to a
loan from the loan fund established pursuant to an agreement
under this part for failure of the borrower to pay all or any part
of an installment when it is due and, in the case of a borrower who
is entitled to deferment of the loan under subsection (b)(2) or cancellation of part or all of the loan under subsection (b)(3), for any
failure to file timely and satisfactory evidence of such entitlement.
No such charge may be made if the payment of such installment
or the filing of such evidence is made within 60 days after the date
on which such installment or filing is due. The amount of any such
charge may not exceed an amount equal to 6 percent of the amount
of such installment. The school may elect to add the amount of any
such charge to the principal amount of the loan as of the first day
after the day on which such installment or evidence was due, or to
make the amount of the charge payable to the school not later than
the due date of the next installment after receipt by the borrower
of notice of the assessment of the charge.
(g) A school may provide in accordance with regulations of the
Secretary, that during the repayment period of a loan from a loan
fund established pursuant to an agreement under this part payments of principal and interest by the borrower with respect to all
the outstanding loans made to him from loan funds so established
shall be at a rate equal to not less than $40 per month.
(h) Notwithstanding the amendment made by section 6(b) of
the Nurse Training Act of 1971 to this section—
(A) any person who obtained one or more loans from a loan
fund established under this part, who before the date of the enactment of the Nurse Training Act of 1971 became eligible for
cancellation of all or part of such loans (including accrued interest) under this section (as in effect on the day before such
date), and who on such date was not engaged in a service for
which loan cancellation was authorized under this section (as
so in effect), may at any time elect to receive such cancellation
in accordance with this subsection (as so in effect); and
(B) in the case of any person who obtained one or more
loans from a loan fund established under this part and who on
such date was engaged in a service for which cancellation of
all or part of such loans (including accrued interest) was authorized under this section (as so in effect), this section (as so
in effect) shall continue to apply to such person for purposes
March 13, 2013

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PUBLIC HEALTH SERVICE ACT

Sec. 836

of providing such loan cancellation until he terminates such
service.
(i) Upon application by a person who received and is under an
obligation to repay, any loan made to such person as a nursing student, the Secretary may undertake to repay (without liability to the
applicant) all or any part of such loan, and any interest or portion
thereof outstanding thereon, upon his determination, pursuant to
regulations establishing criteria therefor, that the applicant—
(1) failed to complete the nursing studies with respect to
which such loan was made;
(2) is in exceptionally needy circumstances; and
(3) has not resumed, or cannot reasonably be expected to
resume, such nursing studies within two years following the
date upon which the applicant terminated the studies with respect to which such loan was made.
(j) The Secretary is authorized to attempt to collect any loan
which was made under this part, which is in default, and which
was referred to the Secretary by a school of nursing with which the
Secretary has an agreement under this part, on behalf of that
school under such terms and conditions as the Secretary may prescribe (including reimbursement from the school’s student loan
fund for expenses the Secretary may reasonably incur in attempting collection), but only if the school has complied with such requirements as the Secretary may specify by regulation with respect
to the collection of loans under this part. A loan so referred shall
be treated as a debt subject to section 5514 of title 5, United States
Code. Amounts collected shall be deposited in the school’s student
loan fund. Whenever the Secretary desires the institution of a civil
action regarding any such loan, the Secretary shall refer the matter to the Attorney General for appropriate action.
(k) 3 ELIMINATION OF STATUTE OF LIMITATION FOR LOAN COLLECTIONS.—
(1) PURPOSE.—It is the purpose of this subsection to ensure that obligations to repay loans under this section are enforced without regard to any Federal or State statutory, regulatory, or administrative limitation on the period within which
debts may be enforced.
(2) PROHIBITION.—Notwithstanding any other provision of
Federal or State law, no limitation shall terminate the period
within which suit may be filed, a judgment may be enforced,
or an offset, garnishment, or other action may be initiated or
taken by a school of nursing that has an agreement with the
Secretary pursuant to section 835 that is seeking the repayment of the amount due from a borrower on a loan made under
this part after the default of the borrower on such loan.

3 Paragraph (2) of section 133(c) of Public Law 105–392 provides as follows: ‘‘The amendment
made by paragraph (1) shall be effective with respect to actions pending on or after the date
of enactment of this Act.’’.

March 13, 2013

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Sec. 838

PUBLIC HEALTH SERVICE ACT

938

ALLOTMENTS AND PAYMENTS OF FEDERAL CAPITAL CONTRIBUTIONS

SEC. 838. 2 ø297d¿ (a)(1) The Secretary shall from time to time
set dates by which schools of nursing in a State must file applications for Federal capital contributions.
(2)(A) If the total of the amounts requested for any fiscal year
in such applications exceeds the total amount appropriated under
section 837 2 for that fiscal year, the allotment from such total
amount to the loan fund of each school of nursing shall be reduced
to whichever of the following is the smaller:
(i) The amount requested in its application.
(ii) An amount which bears the same ratio to the total
amount appropriated as the number of students estimated by
the Secretary to be enrolled on a full-time basis in such school
during such fiscal year bears to the estimated total number of
students enrolled in all such schools on a full-time basis during
such year.
(B) Amounts remaining after allotment under subparagraph
(A) shall be reallotted in accordance with clause (ii) of such subparagraph among schools whose applications requested more than
the amounts so allotted to their loan funds, but with such adjustments as may be necessary to prevent the total allotted to any such
school’s loan fund under this paragraph and paragraph (3) from exceeding the total so requested by it.
(3) Funds which, pursuant to section 839(c) or pursuant to a
loan agreement under section 835, are returned to the Secretary in
any fiscal year, shall be available for allotment until expended.
Funds described in the preceding sentence shall be allotted among
schools of nursing in such manner as the Secretary determines will
best carry out this part.
(b) Allotments to a loan fund of a school shall be paid to it from
time to time in such installments as the Secretary determines will
not result in unnecessary accumulations in the loan fund at such
school.
(c) The Federal capital contributions to a loan fund of a school
under this part shall be paid to it from time to time in such installments as the Secretary determines will not result in unnecessary
accumulations in the loan fund at such school.
DISTRIBUTION OF ASSETS FROM LOAN FUNDS

SEC. 839. ø297e¿ (a) If a school terminates a loan fund established under an agreement pursuant to section 835(b), or if the Secretary for good cause terminates the agreement with the school,
there shall be a capital distribution as follows:
(1) The Secretary shall first be paid an amount which
bears the same ratio to such balance in such fund on the date
of termination of the fund as the total amount of the Federal
capital contributions to such fund by the Secretary pursuant to
section 835(b)(2)(A) bears to the total amount in such fund derived from such Federal capital contributions and from funds
deposited therein pursuant to section 835(b)(2)(B).
2 Section

March 13, 2013

837 was repealed by section 123(3) of Public Law 105–392 (112 Stat. 3562).

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PUBLIC HEALTH SERVICE ACT

Sec. 846

(2) The remainder of such balance shall be paid to the
school.
(b) If a capital distribution is made under subsection (a), the
school involved shall, after such capital distribution, pay to the Secretary, not less often than quarterly, the same proportionate share
of amounts received by the school in payment of principal or interest on loans made from the loan fund established under section
835(b) as determined by the Secretary under subsection (a).
(c)(1) Within 90 days after the termination of any agreement
with a school under section 835 or the termination in any other
manner of a school’s participation in the loan program under this
subpart 1, such school shall pay to the Secretary from the balance
of the loan fund of such school established under section 835, an
amount which bears the same ratio to the balance in such fund on
the date of such termination as the total amount of the Federal
capital contributions to such fund by the Secretary pursuant to section 835(b)(2)(A) bears to the total amount in such fund on such
date derived from such Federal capital contributions and from
funds deposited in the fund pursuant to section 835(b)(2)(B). The
remainder of such balance shall be paid to the school.
(2) A school to which paragraph (1) applies shall pay to the
Secretary after the date on which payment is made under such
paragraph and not less than quarterly, the same proportionate
share of amounts received by the school after the date of termination referred to in paragraph (1) in payment of principal or interest on loans made from the loan fund as was determined for the
Secretary under such paragraph.
ADMINISTRATIVE PROVISIONS

SEC. 840. ø297g¿ The Secretary may agree to modifications of
agreements made under this part, and may compromise, waive, or
release any right, title, claim, or demand of the United States arising or acquired under this part.
PROCEDURES FOR APPEAL OF TERMINATIONS

SEC. 842. 2 ø297i¿ In any case in which the Secretary intends
to terminate an agreement with a school of nursing under this
part, the Secretary shall provide the school with a written notice
specifying such intention and stating that the school may request
a formal hearing with respect to such termination. If the school requests such a hearing within 30 days after the receipt of such notice, the Secretary shall provide such school with a hearing conducted by an administrative law judge.
LOAN REPAYMENT AND SCHOLARSHIP PROGRAMS

SEC. 846. 1
vidual—
1 So

ø297n¿ (a) IN GENERAL.—In the case of any indi-

in law. Probably should read ‘‘part’’.
is no section 841 between sections 840 and 842. Section 5310(b)(7) of Public Law 111–
148 redesignates section 841 as section 871. Such amendment also redesignates part F as part
I and transfers part I (as redesignated) to the end of this title.
1 Title VIII does not contain a section 843 or 844. A section 845 appears in part G on page
810.
2 There

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940

(1) who has received a baccalaureate or associate degree in
nursing (or an equivalent degree), a diploma in nursing, or a
graduate degree in nursing;
(2) who obtained (A) one or more loans from a loan fund
established under subpart II 2, or (B) any other educational
loan for nurse training costs; and
(3) who enters into an agreement with the Secretary to
serve as nurse for a period of not less than two years at a
health care facility with a critical shortage of nurses, or in a
accredited school of nursing, as defined by section 801(2), as
nurse faculty;
the Secretary shall make payments in accordance with subsection
(b), for and on behalf of that individual, on the principal of and interest on any loan of that individual described in paragraph (2) of
this subsection which is outstanding on the date the individual begins the service specified in the agreement described in paragraph
(3) of this subsection. After fiscal year 2007, the Secretary may not,
pursuant to any agreement entered into under this subsection, assign a nurse to any private entity unless that entity is nonprofit.
(b) MANNER OF PAYMENTS.—The payments described in subsection (a) shall be made by the Secretary as follows:
(1) Upon completion by the individual for whom the payments are to be made of the first year of the service specified
in the agreement entered into with the Secretary under subsection (a), the Secretary shall pay 30 percent of the principal
of, and the interest on each loan of such individual described
in subsection (a)(2) which is outstanding on the date he began
such practice.
(2) Upon completion by that individual of the second year
of such service, the Secretary shall pay another 30 percent of
the principal of, and the interest on each such loan.
(3) Upon completion by that individual of a third year of
such service, the Secretary shall pay another 25 percent of the
principal of, and the interest on each such loan.
(c) PAYMENT BY DUE DATE.—Notwithstanding the requirement
of completion of practice specified in subsection (b), the Secretary
shall, on or before the due date thereof, pay any loan or loan installment which may fall due within the period of service for which
the borrower may receive payments under this subsection, upon
the declaration of such borrower, at such times and in such manner
as the Secretary may prescribe (and supported by such other evidence as the Secretary may reasonably require), that the borrower
is then serving as described by subsection (a)(3), and that the borrower will continue to so serve for the period required (in the absence of this subsection) to entitle the borrower to have made the
payments provided by this subsection for such period; except that
not more than 85 percent of the principal of any such loan shall
be paid pursuant to this subsection.
(d) SCHOLARSHIP PROGRAM.—
(1) IN GENERAL.—The Secretary shall (for fiscal years 2003
and 2004) and may (for fiscal years thereafter) carry out a program of entering into contracts with eligible individuals under
2 So

March 13, 2013

in law. Probably should read ‘‘part’’.

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which such individuals agree to serve as nurses for a period of
not less than 2 years at a health care facility with a critical
shortage of nurses, in consideration of the Federal Government
agreeing to provide to the individuals scholarships for attendance at schools of nursing.
(2) ELIGIBLE INDIVIDUALS.—In this subsection, the term
‘‘eligible individual’’ means an individual who is enrolled or accepted for enrollment as a full-time or part-time student in a
school of nursing.
(3) SERVICE REQUIREMENT.—
(A) IN GENERAL.—The Secretary may not enter into a
contract with an eligible individual under this subsection
unless the individual agrees to serve as a nurse at a
health care facility with a critical shortage of nurses for a
period of full-time service of not less than 2 years, or for
a period of part-time service in accordance with subparagraph (B).
(B) PART-TIME SERVICE.—An individual may complete
the period of service described in subparagraph (A) on a
part-time basis if the individual has a written agreement
that—
(i) is entered into by the facility and the individual and is approved by the Secretary; and
(ii) provides that the period of obligated service
will be extended so that the aggregate amount of service performed will equal the amount of service that
would be performed through a period of full-time service of not less than 2 years.
(4) APPLICABILITY OF CERTAIN PROVISIONS.—The provisions
of subpart III of part D of title III shall, except as inconsistent
with this section, apply to the program established in paragraph (1) in the same manner and to the same extent as such
provisions apply to the National Health Service Corps Scholarship Program established in such subpart.
(e) PREFERENCES REGARDING PARTICIPANTS.—In entering into
agreements under subsection (a) or (d), the Secretary shall give
preference to qualified applicants with the greatest financial need.
(f) BREACH OF AGREEMENT.—The Secretary may make payments under subsection (a) on behalf of an individual only if the
agreement under such subsection provides that section 860(c) is applicable to the individual.
(g) BREACH OF AGREEMENT.—
(1) IN GENERAL.—In the case of any program under this
section under which an individual makes an agreement to provide health services for a period of time in accordance with
such program in consideration of receiving an award of Federal
funds regarding education as a nurse (including an award for
the repayment of loans), the following applies if the agreement
provides that this subsection is applicable:
(A) In the case of a program under this section that
makes an award of Federal funds for attending an accredited program of nursing (in this section referred to as a
‘‘nursing program’’), the individual is liable to the Federal
Government for the amount of such award (including
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amounts provided for expenses related to such attendance), and for interest on such amount at the maximum
legal prevailing rate, if the individual—
(i) fails to maintain an acceptable level of academic standing in the nursing program (as indicated
by the program in accordance with requirements established by the Secretary);
(ii) is dismissed from the nursing program for disciplinary reasons; or
(iii) voluntarily terminates the nursing program.
(B) The individual is liable to the Federal Government
for the amount of such award (including amounts provided
for expenses related to such attendance), and for interest
on such amount at the maximum legal prevailing rate, if
the individual fails to provide health services in accordance with the program under this section for the period of
time applicable under the program.
(2) WAIVER OR SUSPENSION OF LIABILITY.—In the case of an
individual or health facility making an agreement for purposes
of paragraph (1), the Secretary shall provide for the waiver or
suspension of liability under such subsection if compliance by
the individual or the health facility, as the case may be, with
the agreements involved is impossible, or would involve extreme hardship to the individual or facility, and if enforcement
of the agreements with respect to the individual or facility
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)
with respect to a program under this section shall be available
for the purposes of such program, and shall remain available
for such purposes until expended.
(h) REPORTS.—Not later than 18 months after the date of enactment of the Nurse Reinvestment Act, and annually thereafter,
the Secretary shall prepare and submit to the Congress a report
describing the programs carried out under this section, including
statements regarding—
(1) the number of enrollees, scholarships, loan repayments,
and grant recipients;
(2) the number of graduates;
(3) the amount of scholarship payments and loan repayments made;
(4) which educational institution the recipients attended;
(5) the number and placement location of the scholarship
and loan repayment recipients at health care facilities with a
critical shortage of nurses;
(6) the default rate and actions required;
(7) the amount of outstanding default funds of both the
scholarship and loan repayment programs;
(8) to the extent that it can be determined, the reason for
the default;
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PUBLIC HEALTH SERVICE ACT

Sec. 846A

(9) the demographics of the individuals participating in the
scholarship and loan repayment programs;
(10) justification for the allocation of funds between the
scholarship and loan repayment programs; and
(11) an evaluation of the overall costs and benefits of the
programs.
(i) FUNDING.—
(1) AUTHORIZATION OF APPROPRIATIONS.—For the purpose
of payments under agreements entered into under subsection
(a) or (d), there are authorized to be appropriated such sums
as may be necessary for each of fiscal years 2003 through 2007.
(2) ALLOCATIONS.—Of the amounts appropriated under
paragraph (1), the Secretary may, as determined appropriate
by the Secretary, allocate amounts between the program under
subsection (a) and the program under subsection (d).
NURSE FACULTY LOAN PROGRAM

SEC. 846A. ø297n–1¿ (a) SCHOOL OF NURSING STUDENT LOAN
FUND.—The Secretary, acting through the Administrator of the
Health Resources and Services Administration, may enter into an
agreement with any accredited school of nursing for the establishment and operation of a student loan fund in accordance with this
section, to increase the number of qualified nursing faculty.
(b) AGREEMENTS.—Each agreement entered into under subsection (a) shall—
(1) provide for the establishment of a student loan fund by
the school involved;
(2) provide for deposit in the fund of—
(A) the Federal capital contributions to the fund;
(B) an amount equal to not less than one-ninth of such
Federal capital contributions, contributed by such school;
(C) collections of principal and interest on loans made
from the fund; and
(D) any other earnings of the fund;
(3) provide that the fund will be used only for loans to students of the school in accordance with subsection (c) and for
costs of collection of such loans and interest thereon;
(4) provide that loans may be made from such fund only
to students pursuing a full-time course of study or, at the discretion of the Secretary, a part-time course of study in an advanced degree program described in section 811(b); and
(5) contain such other provisions as are necessary to protect the financial interests of the United States.
(c) LOAN PROVISIONS.—Loans from any student loan fund established by a school pursuant to an agreement under subsection
(a) shall be made to an individual on such terms and conditions as
the school may determine, except that—
(1) such terms and conditions are subject to any conditions, limitations, and requirements prescribed by the Secretary;
(2) in the case of any individual, the total of the loans for
any academic year made by schools of nursing from loan funds
established pursuant to agreements under subsection (a) may
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not exceed $35,500, during fiscal years 2010 and 2011 fiscal
years (after fiscal year 2011, such amounts shall be adjusted
to provide for a cost-of-attendance increase for the yearly loan
rate and the aggregate loan;
(3) an amount up to 85 percent of any such loan (plus interest thereon) shall be canceled by the school as follows:
(A) upon completion by the individual of each of the
first, second, and third year of full-time employment, required by the loan agreement entered into under this subsection, as a faculty member in an accredited a 1 school of
nursing, the school shall cancel 20 percent of the principle
of, and the interest on, the amount of such loan unpaid on
the first day of such employment; and
(B) upon completion by the individual of the fourth
year of full-time employment, required by the loan agreement entered into under this subsection, as a faculty member in a school of nursing, the school shall cancel 25 percent of the principle of, and the interest on, the amount of
such loan unpaid on the first day of such employment;
(4) such a loan may be used to pay the cost of tuition, fees,
books, laboratory expenses, and other reasonable education expenses;
(5) such a loan shall be repayable in equal or graduated
periodic installments (with the right of the borrower to accelerate repayment) over the 10-year period that begins 9 months
after the individual ceases to pursue a course of study at a
school of nursing; and
(6) such a loan shall—
(A) beginning on the date that is 3 months after the
individual ceases to pursue a course of study at a school
of nursing, bear interest on the unpaid balance of the loan
at the rate of 3 percent per annum; or
(B) subject to subsection (e), if the school of nursing
determines that the individual will not complete such
course of study or serve as a faculty member as required
under the loan agreement under this subsection, bear interest on the unpaid balance of the loan at the prevailing
market rate.
(d) PAYMENT OF PROPORTIONATE SHARE.—Where all or any
part of a loan, or interest, is canceled under this section, the Secretary shall pay to the school an amount equal to the school’s proportionate share of the canceled portion, as determined by the Secretary.
(e) REVIEW BY SECRETARY.—At the request of the individual involved, the Secretary may review any determination by an accredited school of nursing under subsection (c)(6)(B).
(f) 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. 847. ø297o¿ ELIGIBLE INDIVIDUAL STUDENT LOAN REPAYMENT.
(a) IN GENERAL.—The Secretary, acting through the Adminis-

trator of the Health Resources and Services Administration, may
1 So

March 13, 2013

in law. Probably should read ‘‘...as a faculty member in an accredited school of nursing...’’.

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PUBLIC HEALTH SERVICE ACT

Sec. 847

enter into an agreement with eligible individuals for the repayment
of education loans, in accordance with this section, to increase the
number of qualified nursing faculty.
(b) AGREEMENTS.—Each agreement entered into under this
subsection shall require that the eligible individual shall serve as
a full-time member of the faculty of an accredited school of nursing,
for a total period, in the aggregate, of at least 4 years during the
6-year period beginning on the later of—
(1) the date on which the individual receives a master’s or
doctorate nursing degree from an accredited school of nursing;
or
(2) the date on which the individual enters into an agreement under this subsection.
(c) AGREEMENT PROVISIONS.—Agreements entered into pursuant to subsection (b) shall be entered into on such terms and conditions as the Secretary may determine, except that—
(1) not more than 10 months after the date on which the
6-year period described under subsection (b) begins, but in no
case before the individual starts as a full-time member of the
faculty of an accredited school of nursing the Secretary shall
begin making payments, for and on behalf of that individual,
on the outstanding principal of, and interest on, any loan of
that individual obtained to pay for such degree;
(2) for an individual who has completed a master’s in nursing or equivalent degree in nursing—
(A) payments may not exceed $10,000 per calendar
year; and
(B) total payments may not exceed $40,000 during the
2010 and 2011 fiscal years (after fiscal year 2011, such
amounts shall be adjusted to provide for a cost-of-attendance increase for the yearly loan rate and the aggregate
loan); and
(3) for an individual who has completed a doctorate or
equivalent degree in nursing—
(A) payments may not exceed $20,000 per calendar
year; and
(B) total payments may not exceed $80,000 during the
2010 and 2011 fiscal years (adjusted for subsequent fiscal
years as provided for in the same manner as in paragraph
(2)(B)).
(d) BREACH OF AGREEMENT.—
(1) IN GENERAL.—In the case of any agreement made
under subsection (b), the individual is liable to the Federal
Government for the total amount paid by the Secretary under
such agreement, and for interest on such amount at the maximum legal prevailing rate, if the individual fails to meet the
agreement terms required under such subsection.
(2) WAIVER OR SUSPENSION OF LIABILITY.—In the case of an
individual making an agreement for purposes of paragraph (1),
the Secretary shall provide for the waiver or suspension of liability under such paragraph if compliance by the individual
with the agreement involved is impossible or would involve extreme hardship to the individual or if enforcement of the agreement with respect to the individual would be unconscionable.
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(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.

PART F—NATIONAL ADVISORY COUNCIL ON
NURSE EDUCATION AND PRACTICE
SEC. 851. ø297t¿ NATIONAL ADVISORY COUNCIL ON NURSE EDUCATION
AND PRACTICE.
(a) ESTABLISHMENT.—The Secretary shall establish an advisory

council to be known as the National Advisory Council on Nurse
Education and Practice (in this section referred to as the ‘‘Advisory
Council’’).
(b) COMPOSITION.—
(1) IN GENERAL.—The Advisory Council shall be composed
of—
(A) not less than 21, nor more than 23 individuals,
who are not officers or employees of the Federal Government, appointed by the Secretary without regard to the
Federal civil service laws, of which—
(i) 2 shall be selected from full-time students enrolled in schools of nursing;
(ii) 2 shall be selected from the general public;
(iii) 2 shall be selected from practicing professional nurses; and
(iv) 9 shall be selected from among the leading authorities in the various fields of nursing, higher, secondary education, and associate degree schools of
nursing, and from representatives of advanced education nursing groups (such as nurse practitioners,
nurse midwives, and nurse anesthetists), hospitals,
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PUBLIC HEALTH SERVICE ACT

Sec. 851

and other institutions and organizations which provide
nursing services; and
(B) the Secretary (or the delegate of the Secretary
(who shall be an ex officio member and shall serve as the
Chairperson)).
(2) APPOINTMENT.—Not later than 90 days after the date
of enactment of this Act 1, the Secretary shall appoint the
members of the Advisory Council and each such member shall
serve a 4 year term. In making such appointments, the Secretary shall ensure a fair balance between the nursing professions, a broad geographic representation of members and a balance between urban and rural members. Members shall be appointed based on their competence, interest, and knowledge of
the mission of the profession involved. A majority of the members shall be nurses.
(3) MINORITY REPRESENTATION.—In appointing the members of the Advisory Council under paragraph (1), the Secretary shall ensure the adequate representation of minorities.
(c) VACANCIES.—
(1) IN GENERAL.—A vacancy on the Advisory Council shall
be filled in the manner in which the original appointment was
made and shall be subject to any conditions which applied with
respect to the original appointment.
(2) FILLING UNEXPIRED TERM.—An individual chosen to fill
a vacancy shall be appointed for the unexpired term of the
member replaced.
(d) DUTIES.—The Advisory Council shall—
(1) provide advice and recommendations to the Secretary
and Congress concerning policy matters arising in the administration of this title, including the range of issues relating to
the nurse workforce, education, and practice improvement;
(2) provide advice to the Secretary and Congress in the
preparation of general regulations and with respect to policy
matters arising in the administration of this title, including
the range of issues relating to nurse supply, education and
practice improvement; and
(3) not later than 3 years after the date of enactment of
this section, and annually thereafter, prepare and submit to
the Secretary, the Committee on Labor and Human Resources
of the Senate, and the Committee on Commerce of the House
of Representatives, a report describing the activities of the
Council, including findings and recommendations made by the
Council concerning the activities under this title.
(e) MEETINGS AND DOCUMENTS.—
(1) MEETINGS.—The Advisory Council shall meet not less
than 2 times each year. Such meetings shall be held jointly
with other related entities established under this title where
appropriate.
(2) DOCUMENTS.—Not later than 14 days prior to the convening of a meeting under paragraph (1), the Advisory Council
1 So in law. The reference to ‘‘this Act’’ means the Public Health Service Act, which was enacted July 1, 1944. Probably should be a reference to the Health Professions Education Partnerships Act of 1998, which added section 845. That Act is Public Law 105–392, enacted November
13, 1998. (Section 123(5) of that Public Law (112 Stat. 3569) added section 845.)

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shall prepare and make available an agenda of the matters to
be considered by the Advisory Council at such meeting. At any
such meeting, the Advisory Council shall distribute materials
with respect to the issues to be addressed at the meeting. Not
later than 30 days after the adjourning of such a meeting, the
Advisory Council shall prepare and make available a summary
of the meeting and any actions taken by the Council based
upon the meeting.
(f) COMPENSATION AND EXPENSES.—
(1) COMPENSATION.—Each member of the Advisory Council
shall be compensated at a rate equal to the daily equivalent of
the annual rate of basic pay prescribed for level IV of the Executive Schedule under section 5315 of title 5, United States
Code, for each day (including travel time) during which such
member is engaged in the performance of the duties of the
Council. All members of the Council who are officers or employees of the United States shall serve without compensation
in addition to that received for their services as officers or employees of the United States.
(2) EXPENSES.—The members of the Advisory Council shall
be allowed travel expenses, including per diem in lieu of subsistence, at rates authorized for employees of agencies under
subchapter I of chapter 57 of title 5, United States Code, while
away from their homes or regular places of business in the performance of services for the Council.
(g) FUNDING.—Amounts appropriated under this title may be
utilized by the Secretary to support the nurse education and practice activities of the Council.
(h) FACA.—The Federal Advisory Committee Act shall apply
to the Advisory Committee under this section only to the extent
that the provisions of such Act do not conflict with the requirements of this section.

PART G—PUBLIC SERVICE ANNOUNCEMENTS
SEC. 861. ø297w¿ PUBLIC SERVICE ANNOUNCEMENTS.
(a) IN GENERAL.—The Secretary shall develop

and issue public
service announcements that advertise and promote the nursing
profession, highlight the advantages and rewards of nursing, and
encourage individuals to enter the nursing profession.
(b) METHOD.—The public service announcements described in
subsection (a) shall be broadcast through appropriate media outlets, including television or radio, in a manner intended to reach
as wide and diverse an audience as possible.
(c) 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 2003 through 2007.
SEC. 862. ø297x¿ STATE AND LOCAL PUBLIC SERVICE ANNOUNCEMENTS.
(a) IN GENERAL.—The Secretary may award grants to eligible

entities to support State and local advertising campaigns through
appropriate media outlets to promote the nursing profession, highlight the advantages and rewards of nursing, and encourage indiMarch 13, 2013

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PUBLIC HEALTH SERVICE ACT

Sec. 865

viduals from disadvantaged backgrounds to enter the nursing profession.
(b) USE OF FUNDS.—An eligible entity that receives a grant
under subsection (a) shall use funds received through such grant
to acquire local television and radio time, place advertisements in
local newspapers, or post information on billboards or on the Internet in a manner intended to reach as wide and diverse an audience
as possible, in order to—
(1) advertise and promote the nursing profession;
(2) promote nursing education programs;
(3) inform the public of financial assistance regarding such
education programs;
(4) highlight individuals in the community who are practicing nursing in order to recruit new nurses; or
(5) provide any other information to recruit individuals for
the nursing profession.
(c) LIMITATION.—An eligible entity that receives a grant under
subsection (a) shall not use funds received through such grant to
advertise particular employment opportunities.
(d) AUTHORIZATION OF APPROPRIATIONS.—There are authorized
to be appropriated to carry out this section such sums as may be
necessary for each of fiscal years 2003 through 2007.

PART H—COMPREHENSIVE GERIATRIC
EDUCATION
SEC. 865. ø298¿ COMPREHENSIVE GERIATRIC EDUCATION.
(a) PROGRAM AUTHORIZED.—The Secretary shall award

grants
to eligible entities to develop and implement, in coordination with
programs under section 753, programs and initiatives to train and
educate individuals in providing geriatric care for the elderly.
(b) USE OF FUNDS.—An eligible entity that receives a grant
under subsection (a) shall use funds under such grant to—
(1) provide training to individuals who will provide geriatric care for the elderly;
(2) develop and disseminate curricula relating to the treatment of the health problems of elderly individuals;
(3) train faculty members in geriatrics;
(4) provide continuing education to individuals who provide geriatric care; or
(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.
(c) APPLICATION.—An eligible entity desiring a grant under
subsection (a) shall submit an application to the Secretary at such
time, in such manner, and containing such information as the Secretary may reasonably require.
(d) ELIGIBLE ENTITY.—For purposes of this section, the term
‘‘eligible entity’’ includes a school of nursing, a health care facility,
a program leading to certification as a certified nurse assistant, a
partnership of such a school and facility, or a partnership of such
a program and facility.
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PUBLIC HEALTH SERVICE ACT

950

(e) 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.

PART I—FUNDING
SEC. 871. ø298d¿ 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.

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TITLE IX—AGENCY FOR HEALTHCARE
RESEARCH AND QUALITY 1
PART A—ESTABLISHMENT AND GENERAL
DUTIES
SEC. 901. ø299¿ MISSION AND DUTIES.
(a) IN GENERAL.—There is established

within the Public
Health Service an agency to be known as the Agency for
Healthcare Research and Quality, which shall be headed by a director appointed by the Secretary. The Secretary shall carry out
this title acting through the Director.
(b) MISSION.—The purpose of the Agency is to enhance the
quality, appropriateness, and effectiveness of health services, and
access to such services, through the establishment of a broad base
of scientific research and through the promotion of improvements
in clinical and health system practices, including the prevention of
diseases and other health conditions. The Agency shall promote
health care quality improvement by conducting and supporting—
(1) research that develops and presents scientific evidence
regarding all aspects of health care, including—
(A) the development and assessment of methods for
enhancing patient participation in their own care and for
facilitating shared patient-physician decision-making;
(B) the outcomes, effectiveness, and cost-effectiveness
of health care practices, including preventive measures
and long-term care;
(C) existing and innovative technologies;
(D) the costs and utilization of, and access to health
care;
(E) the ways in which health care services are organized, delivered, and financed and the interaction and impact of these factors on the quality of patient care;
(F) methods for measuring quality and strategies for
improving quality; and
(G) ways in which patients, consumers, purchasers,
and practitioners acquire new information about best practices and health benefits, the determinants and impact of
their use of this information;
(2) the synthesis and dissemination of available scientific
evidence for use by patients, consumers, practitioners, providers, purchasers, policy makers, and educators; and
1 Section 2 of Public Law 106–129 (113 Stat. 1653) designated the Agency as the Agency for
Healthcare Research and Quality. Formerly it was designated as the Agency for Health Care
Policy and Research. See section 6103 of Public Law 101–239 (103 Stat. 2189).

951
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952

(3) initiatives to advance private and public efforts to improve health care quality.
(c) REQUIREMENTS WITH RESPECT TO RURAL AND INNER-CITY
AREAS AND PRIORITY POPULATIONS.—
(1) RESEARCH, EVALUATIONS AND DEMONSTRATION
PROJECTS.—In carrying out this title, the Director shall conduct and support research and evaluations, and support demonstration projects, with respect to—
(A) the delivery of health care in inner-city areas, and
in rural areas (including frontier areas); and
(B) health care for priority populations, which shall include—
(i) low-income groups;
(ii) minority groups;
(iii) women;
(iv) children;
(v) the elderly; and
(vi) individuals with special health care needs, including individuals with disabilities and individuals
who need chronic care or end-of-life health care.
(2) PROCESS TO ENSURE APPROPRIATE RESEARCH.—The Director shall establish a process to ensure that the requirements
of paragraph (1) are reflected in the overall portfolio of research conducted and supported by the Agency.
(3) OFFICE OF PRIORITY POPULATIONS.—The Director shall
establish an Office of Priority Populations to assist in carrying
out the requirements of paragraph (1).
SEC. 902. ø299a¿ GENERAL AUTHORITIES.
(a) IN GENERAL.—In carrying out

section 901(b), the Director
shall conduct and support research, evaluations, and training, support demonstration projects, research networks, and multidisciplinary centers, provide technical assistance, and disseminate information on health care and on systems for the delivery of such
care, including activities with respect to—
(1) the quality, effectiveness, efficiency, appropriateness
and value of health care services;
(2) quality measurement and improvement;
(3) the outcomes, cost, cost-effectiveness, and use of health
care services and access to such services;
(4) clinical practice, including primary care and practiceoriented research;
(5) health care technologies, facilities, and equipment;
(6) health care costs, productivity, organization, and market forces;
(7) health promotion and disease prevention, including
clinical preventive services;
(8) health statistics, surveys, database development, and
epidemiology; and
(9) medical liability.
(b) HEALTH SERVICES TRAINING GRANTS.—
(1) IN GENERAL.—The Director may provide training grants
in the field of health services research related to activities authorized under subsection (a), to include pre- and post-doctoral
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PUBLIC HEALTH SERVICE ACT

Sec. 903

fellowships and training programs, young investigator awards,
and other programs and activities as appropriate. In carrying
out this subsection, the Director shall make use of funds made
available under section 487(d)(3) as well as other appropriated
funds.
(2) REQUIREMENTS.—In developing priorities for the allocation of training funds under this subsection, the Director shall
take into consideration shortages in the number of trained researchers who are addressing health care issues for the priority populations identified in section 901(c)(1)(B) and in addition, shall take into consideration indications of long-term commitment, amongst applicants for training funds, to addressing
health care needs of the priority populations.
(c) MULTIDISCIPLINARY CENTERS.—The Director may provide financial assistance to assist in meeting the costs of planning and establishing new centers, and operating existing and new centers, for
multidisciplinary health services research, demonstration projects,
evaluations, training, and policy analysis with respect to the matters referred to in subsection (a).
(d) RELATION TO CERTAIN AUTHORITIES REGARDING SOCIAL SECURITY.—Activities authorized in this section shall be appropriately
coordinated with experiments, demonstration projects, and other
related activities authorized by the Social Security Act and the Social Security Amendments of 1967. Activities under subsection
(a)(2) of this section that affect the programs under titles XVIII,
XIX and XXI of the Social Security Act shall be carried out consistent with section 1142 of such Act.
(e) DISCLAIMER.—The Agency shall not mandate national
standards of clinical practice or quality health care standards. Recommendations resulting from projects funded and published by the
Agency shall include a corresponding disclaimer.
(f) RULE OF CONSTRUCTION.—Nothing in this section shall be
construed to imply that the Agency’s role is to mandate a national
standard or specific approach to quality measurement and reporting. In research and quality improvement activities, the Agency
shall consider a wide range of choices, providers, health care delivery systems, and individual preferences.
SEC. 903. ø299a–1¿ RESEARCH ON HEALTH DISPARITIES.
(a) IN GENERAL.—The Director shall—

(1) conduct and support research to identify populations
for which there is a significant disparity in the quality, outcomes, cost, or use of health care services or access to and satisfaction with such services, as compared to the general population;
(2) conduct and support research on the causes of and barriers to reducing the health disparities identified in paragraph
(1), taking into account such factors as socioeconomic status,
attitudes toward health, the language spoken, the extent of formal education, the area or community in which the population
resides, and other factors the Director determines to be appropriate;
(3) conduct and support research and support demonstration projects to identify, test, and evaluate strategies for reducMarch 13, 2013

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ing or eliminating health disparities, including development or
identification of effective service delivery models, and disseminate effective strategies and models;
(4) develop measures and tools for the assessment and improvement of the outcomes, quality, and appropriateness of
health care services provided to health disparity populations;
(5) in carrying out section 902(c), provide support to increase the number of researchers who are members of health
disparity populations, and the health services research capacity of institutions that train such researchers; and
(6) beginning with fiscal year 2003, annually submit to the
Congress a report regarding prevailing disparities in health
care delivery as it relates to racial factors and socioeconomic
factors in priority populations.
(b) RESEARCH AND DEMONSTRATION PROJECTS.—
(1) IN GENERAL.—In carrying out subsection (a), the Director shall conduct and support research and support demonstrations to—
(A) identify the clinical, cultural, socioeconomic, geographic, and organizational factors that contribute to
health disparities, including minority health disparity populations, which research shall include behavioral research,
such as examination of patterns of clinical decisionmaking,
and research on access, outreach, and the availability of
related support services (such as cultural and linguistic
services);
(B) identify and evaluate clinical and organizational
strategies to improve the quality, outcomes, and access to
care for health disparity populations, including minority
health disparity populations;
(C) test such strategies and widely disseminate those
strategies for which there is scientific evidence of effectiveness; and
(D) determine the most effective approaches for disseminating research findings to health disparity populations, including minority populations.
(2) USE OF CERTAIN STRATEGIES.—In carrying out this section, the Director shall implement research strategies and
mechanisms that will enhance the involvement of individuals
who are members of minority health disparity populations or
other health disparity populations, health services researchers
who are such individuals, institutions that train such individuals as researchers, members of minority health disparity populations or other health disparity populations for whom the
Agency is attempting to improve the quality and outcomes of
care, and representatives of appropriate tribal or other community-based organizations with respect to health disparity populations. Such research strategies and mechanisms may include
the use of—
(A) centers of excellence that can demonstrate, either
individually or through consortia, a combination of multidisciplinary expertise in outcomes or quality improvement
research, linkages to relevant sites of care, and a demonstrated capacity to involve members and communities of
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health disparity populations, including minority health
disparity populations, in the planning, conduct, dissemination, and translation of research;
(B) provider-based research networks, including health
plans, facilities, or delivery system sites of care (especially
primary care), that make extensive use of health care providers who are members of health disparity populations or
who serve patients in such populations and have the capacity to evaluate and promote quality improvement;
(C) service delivery models (such as health centers
under section 330 and the Indian Health Service) to reduce
health disparities; and
(D) innovative mechanisms or strategies that will facilitate the translation of past research investments into
clinical practices that can reasonably be expected to benefit these populations.
(c) QUALITY MEASUREMENT DEVELOPMENT.—
(1) IN GENERAL.—To ensure that health disparity populations, including minority health disparity populations, benefit
from the progress made in the ability of individuals to measure
the quality of health care delivery, the Director shall support
the development of quality of health care measures that assess
the experience of such populations with health care systems,
such as measures that assess the access of such populations to
health care, the cultural competence of the care provided, the
quality of the care provided, the outcomes of care, or other aspects of health care practice that the Director determines to be
important.
(2) EXAMINATION OF CERTAIN PRACTICES.—The Director
shall examine the practices of providers that have a record of
reducing health disparities or have experience in providing culturally competent health services to minority health disparity
populations or other health disparity populations. In examining such practices of providers funded under the authorities
of this Act, the Director shall consult with the heads of the relevant agencies of the Public Health Service.
(3) REPORT.—Not later than 36 months after the date of
the enactment of this section, the Secretary, acting through the
Director, shall prepare and submit to the appropriate committees of Congress a report describing the state-of-the-art of quality measurement for minority and other health disparity populations that will identify critical unmet needs, the current activities of the Department to address those needs, and a description of related activities in the private sector.
(d) DEFINITION.—For purposes of this section:
(1) The term ‘‘health disparity population’’ has the meaning given such term in section 464z–3, except that in addition
to the meaning so given, the Director may determine that such
term includes populations for which there is a significant disparity in the quality, outcomes, cost, or use of health care services or access to or satisfaction with such services as compared
to the general population.
(2) The term ‘‘minority’’, with respect to populations, refers
to racial and ethnic minority groups as defined in section 1707.
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PART B—HEALTH CARE IMPROVEMENT
RESEARCH
SEC. 911. ø299b¿ HEALTH CARE OUTCOME IMPROVEMENT RESEARCH.
(a) EVIDENCE RATING SYSTEMS.—In collaboration with experts

from the public and private sector, the Agency shall identify and
disseminate methods or systems to assess health care research results, particularly methods or systems to rate the strength of the
scientific evidence underlying health care practice, recommendations in the research literature, and technology assessments. The
Agency shall make methods or systems for evidence rating widely
available. Agency publications containing health care recommendations shall indicate the level of substantiating evidence using such
methods or systems.
(b) HEALTH CARE IMPROVEMENT RESEARCH CENTERS AND PROVIDER-BASED RESEARCH NETWORKS.—
(1) IN GENERAL.—In order to address the full continuum of
care and outcomes research, to link research to practice improvement, and to speed the dissemination of research findings
to community practice settings, the Agency shall employ research strategies and mechanisms that will link research directly with clinical practice in geographically diverse locations
throughout the United States, including—
(A) health care improvement research centers that
combine demonstrated multidisciplinary expertise in outcomes or quality improvement research with linkages to
relevant sites of care;
(B) provider-based research networks, including plan,
facility, or delivery system sites of care (especially primary
care), that can evaluate outcomes and evaluate and promote quality improvement; and
(C) other innovative mechanisms or strategies to link
research with clinical practice.
(2) REQUIREMENTS.—The Director is authorized to establish the requirements for entities applying for grants under
this subsection.
SEC. 912. ø299b–1¿ PRIVATE-PUBLIC PARTNERSHIPS TO IMPROVE ORGANIZATION AND DELIVERY.
(a) SUPPORT FOR EFFORTS TO DEVELOP INFORMATION ON QUALITY.—
(1) SCIENTIFIC AND TECHNICAL SUPPORT.—In its role as the

principal agency for health care research and quality, the
Agency may provide scientific and technical support for private
and public efforts to improve health care quality, including the
activities of accrediting organizations.
(2) ROLE OF THE AGENCY.—With respect to paragraph (1),
the role of the Agency shall include—
(A) the identification and assessment of methods for
the evaluation of the health of—
(i) enrollees in health plans by type of plan, provider, and provider arrangements; and
(ii) other populations, including those receiving
long-term care services;
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(B) the ongoing development, testing, and dissemination of quality measures, including measures of health and
functional outcomes;
(C) the compilation and dissemination of health care
quality measures developed in the private and public sector;
(D) assistance in the development of improved health
care information systems;
(E) the development of survey tools for the purpose of
measuring participant and beneficiary assessments of their
health care; and
(F) identifying and disseminating information on
mechanisms for the integration of information on quality
into purchaser and consumer decision-making processes.
(b) CENTERS FOR EDUCATION AND RESEARCH ON THERAPEUTICS.—
(1) IN GENERAL.—The Secretary, acting through the Director and in consultation with the Commissioner of Food and
Drugs, shall establish a program for the purpose of making one
or more grants for the establishment and operation of one or
more centers to carry out the activities specified in paragraph
(2).
(2) REQUIRED ACTIVITIES.—The activities referred to in this
paragraph are the following:
(A) The conduct of state-of-the-art research for the following purposes:
(i) To increase awareness of—
(I) new uses of drugs, biological products, and
devices;
(II) ways to improve the effective use of drugs,
biological products, and devices; and
(III) risks of new uses and risks of combinations of drugs and biological products.
(ii) To provide objective clinical information to the
following individuals and entities:
(I) Health care practitioners and other providers of health care goods or services.
(II) Pharmacists, pharmacy benefit managers
and purchasers.
(III) Health maintenance organizations and
other managed health care organizations.
(IV) Health care insurers and governmental
agencies.
(V) Patients and consumers.
(iii) To improve the quality of health care while
reducing the cost of health care through—
(I) an increase in the appropriate use of
drugs, biological products, or devices; and
(II) the prevention of adverse effects of drugs,
biological products, and devices and the consequences of such effects, such as unnecessary
hospitalizations.
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(B) The conduct of research on the comparative effectiveness, cost-effectiveness, and safety of drugs, biological
products, and devices.
(C) Such other activities as the Secretary determines
to be appropriate, except that a grant may not be expended to assist the Secretary in the review of new drugs,
biological products, and devices.
(c) REDUCING ERRORS IN MEDICINE.—The Director shall, in accordance with part C, conduct and support research and build private-public partnerships to—
(1) identify the causes of preventable health care errors
and patient injury in health care delivery;
(2) develop, demonstrate, and evaluate strategies for reducing errors and improving patient safety; and
(3) disseminate such effective strategies throughout the
health care industry.
SEC. 913. ø299b–2¿ INFORMATION ON QUALITY AND COST OF CARE.
(a) IN GENERAL.—The Director shall—

(1) conduct a survey to collect data on a nationally representative sample of the population on the cost, use and, for
fiscal year 2001 and subsequent fiscal years, quality of health
care, including the types of health care services Americans use,
their access to health care services, frequency of use, how
much is paid for the services used, the source of those payments, the types and costs of private health insurance, access,
satisfaction, and quality of care for the general population including rural residents and also for populations identified in
section 901(c); and
(2) develop databases and tools that provide information to
States on the quality, access, and use of health care services
provided to their residents.
(b) QUALITY AND OUTCOMES INFORMATION.—
(1) IN GENERAL.—Beginning in fiscal year 2001, the Director shall ensure that the survey conducted under subsection
(a)(1) will—
(A) identify determinants of health outcomes and functional status, including the health care needs of populations identified in section 901(c), provide data to study
the relationships between health care quality, outcomes,
access, use, and cost, measure changes over time, and
monitor the overall national impact of Federal and State
policy changes on health care;
(B) provide information on the quality of care and patient outcomes for frequently occurring clinical conditions
for a nationally representative sample of the population including rural residents; and
(C) provide reliable national estimates for children and
persons with special health care needs through the use of
supplements or periodic expansions of the survey.
In expanding the Medical Expenditure Panel Survey, as in existence on the date of the enactment of this title in fiscal year
2001 to collect information on the quality of care, the Director
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shall take into account any outcomes measurements generally
collected by private sector accreditation organizations.
(2) ANNUAL REPORT.—Beginning in fiscal year 2003, the
Secretary, acting through the Director, shall submit to Congress an annual report on national trends in the quality of
health care provided to the American people.
SEC. 914. ø299b–3¿ INFORMATION SYSTEMS FOR HEALTH CARE IMPROVEMENT.
(a) IN GENERAL.—In order to foster a range of innovative ap-

proaches to the management and communication of health information, the Agency shall conduct and support research, evaluations,
and initiatives to advance—
(1) the use of information systems for the study of health
care quality and outcomes, including the generation of both individual provider and plan-level comparative performance
data;
(2) training for health care practitioners and researchers
in the use of information systems;
(3) the creation of effective linkages between various
sources of health information, including the development of information networks;
(4) the delivery and coordination of evidence-based health
care services, including the use of real-time health care decision-support programs;
(5) the utility and comparability of health information data
and medical vocabularies by addressing issues related to the
content, structure, definitions and coding of such information
and data in consultation with appropriate Federal, State and
private entities;
(6) the use of computer-based health records in all settings
for the development of personal health records for individual
health assessment and maintenance, and for monitoring public
health and outcomes of care within populations; and
(7) the protection of individually identifiable information in
health services research and health care quality improvement.
(b) DEMONSTRATION.—The Agency shall support demonstrations into the use of new information tools aimed at improving
shared decision-making between patients and their care-givers.
(c) FACILITATING PUBLIC ACCESS TO INFORMATION.—The Director shall work with appropriate public and private sector entities
to facilitate public access to information regarding the quality of
and consumer satisfaction with health care.
SEC. 915. ø299b–4¿ RESEARCH SUPPORTING PRIMARY CARE AND ACCESS IN UNDERSERVED AREAS.
(a) PREVENTIVE SERVICES TASK FORCE.—
(1) ESTABLISHMENT AND PURPOSE.—The Director shall con-

vene an independent Preventive Services Task Force (referred
to in this subsection as the ‘‘Task Force’’) to be composed of individuals with appropriate expertise. Such Task Force shall review the scientific evidence related to the effectiveness, appropriateness, and cost-effectiveness of clinical preventive services
for the purpose of developing recommendations for the health
care community, and updating previous clinical preventive recMarch 13, 2013

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ommendations, to be published in the Guide to Clinical Preventive Services (referred to in this section as the ‘‘Guide’’), for individuals and organizations delivering clinical services, including primary care professionals, health care systems, professional societies, employers, community organizations, non-profit organizations, Congress and other policy-makers, governmental public health agencies, health care quality organizations, and organizations developing national health objectives.
Such recommendations shall consider clinical preventive best
practice recommendations from the Agency for Healthcare Research and Quality, the National Institutes of Health, the Centers for Disease Control and Prevention, the Institute of Medicine, specialty medical associations, patient groups, and scientific societies.
(2) DUTIES.—The duties of the Task Force shall include—
(A) the development of additional topic areas for new
recommendations and interventions related to those topic
areas, including those related to specific sub-populations
and age groups;
(B) at least once during every 5-year period, review
interventions and update recommendations related to existing topic areas, including new or improved techniques to
assess the health effects of interventions;
(C) improved integration with Federal Government
health objectives and related target setting for health improvement;
(D) the enhanced dissemination of recommendations;
(E) the provision of technical assistance to those
health care professionals, agencies and organizations that
request help in implementing the Guide recommendations;
and
(F) the submission of yearly reports to Congress and
related agencies identifying gaps in research, such as preventive services that receive an insufficient evidence statement, and recommending priority areas that deserve further examination, including areas related to populations
and age groups not adequately addressed by current recommendations.
(3) ROLE OF AGENCY.—The Agency shall provide ongoing
administrative, research, and technical support for the operations of the Task Force, including coordinating and supporting the dissemination of the recommendations of the Task
Force, ensuring adequate staff resources, and assistance to
those organizations requesting it for implementation of the
Guide’s recommendations.
(4) COORDINATION WITH COMMUNITY PREVENTIVE SERVICES
TASK FORCE.—The Task Force shall take appropriate steps to
coordinate its work with the Community Preventive Services
Task Force and the Advisory Committee on Immunization
Practices, including the examination of how each task force’s
recommendations interact at the nexus of clinic and community.
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(5) OPERATION.—Operation. In carrying out the duties
under paragraph (2), the Task Force is not subject to the provisions of Appendix 2 of title 5, United States Code.
(6) INDEPENDENCE.—All members of the Task Force convened under this subsection, and any recommendations made
by such members, shall be independent and, to the extent practicable, not subject to political pressure.
(7) AUTHORIZATION OF APPROPRIATIONS.—There are authorized to be appropriated such sums as may be necessary for
each fiscal year to carry out the activities of the Task Force.
(b) PRIMARY CARE RESEARCH.—
(1) IN GENERAL.—There is established within the Agency a
Center for Primary Care Research (referred to in this subsection as the ‘‘Center’’) that shall serve as the principal source
of funding for primary care practice research in the Department of Health and Human Services. For purposes of this
paragraph, primary care research focuses on the first contact
when illness or health concerns arise, the diagnosis, treatment
or referral to specialty care, preventive care, and the relationship between the clinician and the patient in the context of the
family and community.
(2) RESEARCH.—In carrying out this section, the Center
shall conduct and support research concerning—
(A) the nature and characteristics of primary care
practice;
(B) the management of commonly occurring clinical
problems;
(C) the management of undifferentiated clinical problems; and
(D) the continuity and coordination of health services.
SEC. 916. ø299b–5¿ HEALTH CARE PRACTICE AND TECHNOLOGY INNOVATION.
(a) IN GENERAL.—The Director shall promote innovation in evi-

dence-based health care practices and technologies by—
(1) conducting and supporting research on the development, diffusion, and use of health care technology;
(2) developing, evaluating, and disseminating methodologies for assessments of health care practices and technologies;
(3) conducting intramural and supporting extramural assessments of existing and new health care practices and technologies;
(4) promoting education and training and providing technical assistance in the use of health care practice and technology assessment methodologies and results; and
(5) working with the National Library of Medicine and the
public and private sector to develop an electronic clearinghouse
of currently available assessments and those in progress.
(b) SPECIFICATION OF PROCESS.—
(1) IN GENERAL.—Not later than December 31, 2000, the
Director shall develop and publish a description of the methods
used by the Agency and its contractors for health care practice
and technology assessment.
(2) CONSULTATIONS.—In carrying out this subsection, the
Director shall cooperate and consult with the Assistant SecMarch 13, 2013

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retary for Health, the Administrator of the Centers for Medicare & Medicaid Services, the Director of the National Institutes of Health, the Commissioner of Food and Drugs, and the
heads of any other interested Federal department or agency,
and shall seek input, where appropriate, from professional societies and other private and public entities.
(3) METHODOLOGY.—The Director shall, in developing the
methods used under paragraph (1), consider—
(A) safety, efficacy, and effectiveness;
(B) legal, social, and ethical implications;
(C) costs, benefits, and cost-effectiveness;
(D) comparisons to alternate health care practices and
technologies; and
(E) requirements of Food and Drug Administration approval to avoid duplication.
(c) SPECIFIC ASSESSMENTS.—
(1) IN GENERAL.—The Director shall conduct or support
specific assessments of health care technologies and practices.
(2) REQUESTS FOR ASSESSMENTS.—The Director is authorized to conduct or support assessments, on a reimbursable
basis, for the Centers for Medicare & Medicaid Services, the
Department of Defense, the Department of Veterans Affairs,
the Office of Personnel Management, and other public or private entities.
(3) GRANTS AND CONTRACTS.—In addition to conducting assessments, the Director may make grants to, or enter into cooperative agreements or contracts with, entities described in
paragraph (4) for the purpose of conducting assessments of experimental, emerging, existing, or potentially outmoded health
care technologies, and for related activities.
(4) ELIGIBLE ENTITIES.—An entity described in this paragraph is an entity that is determined to be appropriate by the
Director, including academic medical centers, research institutions and organizations, professional organizations, third party
payers, governmental agencies, minority institutions of higher
education (such as Historically Black Colleges and Universities, and Hispanic institutions), and consortia of appropriate
research entities established for the purpose of conducting
technology assessments.
(d) MEDICAL EXAMINATION OF CERTAIN VICTIMS.—
(1) IN GENERAL.—The Director shall develop and disseminate a report on evidence-based clinical practices for—
(A) the examination and treatment by health professionals of individuals who are victims of sexual assault (including child molestation) or attempted sexual assault; and
(B) the training of health professionals, in consultation
with the Health Resources and Services Administration,
on performing medical evidentiary examinations of individuals who are victims of child abuse or neglect, sexual assault, elder abuse, or domestic violence.
(2) CERTAIN CONSIDERATIONS.—In identifying the issues to
be addressed by the report, the Director shall, to the extent
practicable, take into consideration the expertise and experience of Federal and State law enforcement officials regarding
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the victims referred to in paragraph (1), and of other appropriate public and private entities (including medical societies,
victim services organizations, sexual assault prevention organizations, and social services organizations).
SEC. 917. ø299b–6¿ COORDINATION OF FEDERAL GOVERNMENT QUALITY IMPROVEMENT EFFORTS.
(a) REQUIREMENT.—
(1) IN GENERAL.—To avoid duplication and ensure that

Federal resources are used efficiently and effectively, the Secretary, acting through the Director, shall coordinate all research, evaluations, and demonstrations related to health services research, quality measurement and quality improvement
activities undertaken and supported by the Federal Government.
(2) SPECIFIC ACTIVITIES.—The Director, in collaboration
with the appropriate Federal officials representing all concerned executive agencies and departments, shall develop and
manage a process to—
(A) improve interagency coordination, priority setting,
and the use and sharing of research findings and data pertaining to Federal quality improvement programs, technology assessment, and health services research;
(B) strengthen the research information infrastructure, including databases, pertaining to Federal health
services research and health care quality improvement initiatives;
(C) set specific goals for participating agencies and departments to further health services research and health
care quality improvement; and
(D) strengthen the management of Federal health care
quality improvement programs.
(b) STUDY BY THE INSTITUTE OF MEDICINE.—
(1) IN GENERAL.—To provide Congress, the Department of
Health and Human Services, and other relevant departments
with an independent, external review of their quality oversight, quality improvement and quality research programs, the
Secretary shall enter into a contract with the Institute of Medicine—
(A) to describe and evaluate current quality improvement, quality research and quality monitoring processes
through—
(i) an overview of pertinent health services research activities and quality improvement efforts conducted by all Federal programs, with particular attention paid to those under titles XVIII, XIX, and XXI of
the Social Security Act; and
(ii) a summary of the partnerships that the Department of Health and Human Services has pursued
with private accreditation, quality measurement and
improvement organizations; and
(B) to identify options and make recommendations to
improve the efficiency and effectiveness of quality improvement programs through—
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(i) the improved coordination of activities across
the medicare, medicaid and child health insurance
programs under titles XVIII, XIX and XXI of the Social Security Act and health services research programs;
(ii) the strengthening of patient choice and participation by incorporating state-of-the-art quality monitoring tools and making information on quality available; and
(iii) the enhancement of the most effective programs, consolidation as appropriate, and elimination
of duplicative activities within various Federal agencies.
(2) REQUIREMENTS.—
(A) IN GENERAL.—The Secretary shall enter into a contract with the Institute of Medicine for the preparation—
(i) not later than 12 months after the date of the
enactment of this title, of a report providing an overview of the quality improvement programs of the Department of Health and Human Services for the medicare, medicaid, and CHIP programs under titles XVIII,
XIX, and XXI of the Social Security Act; and
(ii) not later than 24 months after the date of the
enactment of this title, of a final report containing recommendations.
(B) REPORTS.—The Secretary shall submit the reports
described in subparagraph (A) to the Committee on Finance and the Committee on Health, Education, Labor,
and Pensions of the Senate and the Committee on Ways
and Means and the Committee on Commerce of the House
of Representatives.

PART C—PATIENT SAFETY IMPROVEMENT
SEC. 921. ø299b–21¿ DEFINITIONS.

In this part:
(1) HIPAA CONFIDENTIALITY REGULATIONS.—The term
‘‘HIPAA confidentiality regulations’’ means regulations promulgated under section 264(c) of the Health Insurance Portability
and Accountability Act of 1996 (Public Law 104–191; 110 Stat.
2033).
(2) IDENTIFIABLE PATIENT SAFETY WORK PRODUCT.—The
term ‘‘identifiable patient safety work product’’ means patient
safety work product that—
(A) is presented in a form and manner that allows the
identification of any provider that is a subject of the work
product, or any providers that participate in activities that
are a subject of the work product;
(B) constitutes individually identifiable health information as that term is defined in the HIPAA confidentiality regulations; or
(C) is presented in a form and manner that allows the
identification of an individual who reported information in
the manner specified in section 922(e).
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(3) NONIDENTIFIABLE PATIENT SAFETY WORK PRODUCT.—
The term ‘‘nonidentifiable patient safety work product’’ means
patient safety work product that is not identifiable patient
safety work product (as defined in paragraph (2)).
(4) PATIENT SAFETY ORGANIZATION.—The term ‘‘patient
safety organization’’ means a private or public entity or component thereof that is listed by the Secretary pursuant to section
924(d).
(5) PATIENT SAFETY ACTIVITIES.—The term ‘‘patient safety
activities’’ means the following activities:
(A) Efforts to improve patient safety and the quality
of health care delivery.
(B) The collection and analysis of patient safety work
product.
(C) The development and dissemination of information
with respect to improving patient safety, such as recommendations, protocols, or information regarding best
practices.
(D) The utilization of patient safety work product for
the purposes of encouraging a culture of safety and of providing feedback and assistance to effectively minimize patient risk.
(E) The maintenance of procedures to preserve confidentiality with respect to patient safety work product.
(F) The provision of appropriate security measures
with respect to patient safety work product.
(G) The utilization of qualified staff.
(H) Activities related to the operation of a patient
safety evaluation system and to the provision of feedback
to participants in a patient safety evaluation system.
(6) PATIENT SAFETY EVALUATION SYSTEM.—The term ‘‘patient safety evaluation system’’ means the collection, management, or analysis of information for reporting to or by a patient
safety organization.
(7) PATIENT SAFETY WORK PRODUCT.—
(A) IN GENERAL.—Except as provided in subparagraph
(B), the term ‘‘patient safety work product’’ means any
data, reports, records, memoranda, analyses (such as root
cause analyses), or written or oral statements—
(i) which—
(I) are assembled or developed by a provider
for reporting to a patient safety organization and
are reported to a patient safety organization; or
(II) are developed by a patient safety organization for the conduct of patient safety activities;
and which could result in improved patient safety,
health care quality, or health care outcomes; or
(ii) which identify or constitute the deliberations
or analysis of, or identify the fact of reporting pursuant to, a patient safety evaluation system.
(B) CLARIFICATION.—
(i) Information described in subparagraph (A) does
not include a patient’s medical record, billing and disMarch 13, 2013

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charge information, or any other original patient or
provider record.
(ii) Information described in subparagraph (A)
does not include information that is collected, maintained, or developed separately, or exists separately,
from a patient safety evaluation system. Such separate information or a copy thereof reported to a patient safety organization shall not by reason of its reporting be considered patient safety work product.
(iii) Nothing in this part shall be construed to
limit—
(I) the discovery of or admissibility of information described in this subparagraph in a criminal,
civil, or administrative proceeding;
(II) the reporting of information described in
this subparagraph to a Federal, State, or local
governmental agency for public health surveillance, investigation, or other public health purposes or health oversight purposes; or
(III) a provider’s recordkeeping obligation
with respect to information described in this subparagraph under Federal, State, or local law.
(8) PROVIDER.—The term ‘‘provider’’ means—
(A) an individual or entity licensed or otherwise authorized under State law to provide health care services,
including—
(i) a hospital, nursing facility, comprehensive outpatient rehabilitation facility, home health agency,
hospice program, renal dialysis facility, ambulatory
surgical center, pharmacy, physician or health care
practitioner’s office, long term care facility, behavior
health residential treatment facility, clinical laboratory, or health center; or
(ii) a physician, physician assistant, nurse practitioner, clinical nurse specialist, certified registered
nurse anesthetist, certified nurse midwife, psychologist, certified social worker, registered dietitian or nutrition professional, physical or occupational therapist,
pharmacist, or other individual health care practitioner; or
(B) any other individual or entity specified in regulations promulgated by the Secretary.
SEC. 922. ø299b–22¿ PRIVILEGE AND CONFIDENTIALITY PROTECTIONS.
(a) PRIVILEGE.—Notwithstanding any other provision of Fed-

eral, State, or local law, and subject to subsection (c), patient safety
work product shall be privileged and shall not be—
(1) subject to a Federal, State, or local civil, criminal, or
administrative subpoena or order, including in a Federal,
State, or local civil or administrative disciplinary proceeding
against a provider;
(2) subject to discovery in connection with a Federal, State,
or local civil, criminal, or administrative proceeding, including
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in a Federal, State, or local civil or administrative disciplinary
proceeding against a provider;
(3) subject to disclosure pursuant to section 552 of title 5,
United States Code (commonly known as the Freedom of Information Act) or any other similar Federal, State, or local law;
(4) admitted as evidence in any Federal, State, or local
governmental civil proceeding, criminal proceeding, administrative rulemaking proceeding, or administrative adjudicatory
proceeding, including any such proceeding against a provider;
or
(5) admitted in a professional disciplinary proceeding of a
professional disciplinary body established or specifically authorized under State law.
(b) CONFIDENTIALITY OF PATIENT SAFETY WORK PRODUCT.—
Notwithstanding any other provision of Federal, State, or local law,
and subject to subsection (c), patient safety work product shall be
confidential and shall not be disclosed.
(c) EXCEPTIONS.—Except as provided in subsection (g)(3)—
(1) EXCEPTIONS FROM PRIVILEGE AND CONFIDENTIALITY.—
Subsections (a) and (b) shall not apply to (and shall not be construed to prohibit) one or more of the following disclosures:
(A) Disclosure of relevant patient safety work product
for use in a criminal proceeding, but only after a court
makes an in camera determination that such patient safety work product contains evidence of a criminal act and
that such patient safety work product is material to the
proceeding and not reasonably available from any other
source.
(B) Disclosure of patient safety work product to the extent required to carry out subsection (f)(4)(A).
(C) Disclosure of identifiable patient safety work product if authorized by each provider identified in such work
product.
(2) EXCEPTIONS FROM CONFIDENTIALITY.—Subsection (b)
shall not apply to (and shall not be construed to prohibit) one
or more of the following disclosures:
(A) Disclosure of patient safety work product to carry
out patient safety activities.
(B) Disclosure of nonidentifiable patient safety work
product.
(C) Disclosure of patient safety work product to grantees, contractors, or other entities carrying out research,
evaluation, or demonstration projects authorized, funded,
certified, or otherwise sanctioned by rule or other means
by the Secretary, for the purpose of conducting research to
the extent that disclosure of protected health information
would be allowed for such purpose under the HIPAA confidentiality regulations.
(D) Disclosure by a provider to the Food and Drug Administration with respect to a product or activity regulated
by the Food and Drug Administration.
(E) Voluntary disclosure of patient safety work product by a provider to an accrediting body that accredits that
provider.
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(F) Disclosures that the Secretary may determine, by
rule or other means, are necessary for business operations
and are consistent with the goals of this part.
(G) Disclosure of patient safety work product to law
enforcement authorities relating to the commission of a
crime (or to an event reasonably believed to be a crime) if
the person making the disclosure believes, reasonably
under the circumstances, that the patient safety work
product that is disclosed is necessary for criminal law enforcement purposes.
(H) With respect to a person other than a patient safety organization, the disclosure of patient safety work product that does not include materials that—
(i) assess the quality of care of an identifiable provider; or
(ii) describe or pertain to one or more actions or
failures to act by an identifiable provider.
(3) EXCEPTION FROM PRIVILEGE.—Subsection (a) shall not
apply to (and shall not be construed to prohibit) voluntary disclosure of nonidentifiable patient safety work product.
(d) CONTINUED PROTECTION OF INFORMATION AFTER DISCLOSURE.—
(1) IN GENERAL.—Patient safety work product that is disclosed under subsection (c) shall continue to be privileged and
confidential as provided for in subsections (a) and (b), and such
disclosure shall not be treated as a waiver of privilege or confidentiality, and the privileged and confidential nature of such
work product shall also apply to such work product in the possession or control of a person to whom such work product was
disclosed.
(2) EXCEPTION.—Notwithstanding paragraph (1), and subject to paragraph (3)—
(A) if patient safety work product is disclosed in a
criminal proceeding, the confidentiality protections provided for in subsection (b) shall no longer apply to the
work product so disclosed; and
(B) if patient safety work product is disclosed as provided for in subsection (c)(2)(B) (relating to disclosure of
nonidentifiable patient safety work product), the privilege
and confidentiality protections provided for in subsections
(a) and (b) shall no longer apply to such work product.
(3) CONSTRUCTION.—Paragraph (2) shall not be construed
as terminating or limiting the privilege or confidentiality protections provided for in subsection (a) or (b) with respect to patient safety work product other than the specific patient safety
work product disclosed as provided for in subsection (c).
(4) LIMITATIONS ON ACTIONS.—
(A) PATIENT SAFETY ORGANIZATIONS.—
(i) IN GENERAL.—A patient safety organization
shall not be compelled to disclose information collected
or developed under this part whether or not such information is patient safety work product unless such
information is identified, is not patient safety work
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product, and is not reasonably available from another
source.
(ii) NONAPPLICATION.—The limitation contained in
clause (i) shall not apply in an action against a patient
safety organization or with respect to disclosures pursuant to subsection (c)(1).
(B) PROVIDERS.—An accrediting body shall not take an accrediting action against a provider based on the good faith participation of the provider in the collection, development, reporting, or maintenance of patient safety work product in accordance with this part. An accrediting body may not require a provider to reveal its communications with any patient safety organization established in accordance with this part.
(e) REPORTER PROTECTION.—
(1) IN GENERAL.—A provider may not take an adverse employment action, as described in paragraph (2), against an individual based upon the fact that the individual in good faith reported information—
(A) to the provider with the intention of having the information reported to a patient safety organization; or
(B) directly to a patient safety organization.
(2) ADVERSE EMPLOYMENT ACTION.—For purposes of this
subsection, an ‘‘adverse employment action’’ includes—
(A) loss of employment, the failure to promote an individual, or the failure to provide any other employment-related benefit for which the individual would otherwise be
eligible; or
(B) an adverse evaluation or decision made in relation
to accreditation, certification, credentialing, or licensing of
the individual.
(f) ENFORCEMENT.—
(1) CIVIL MONETARY PENALTY.—Subject to paragraphs (2)
and (3), a person who discloses identifiable patient safety work
product in knowing or reckless violation of subsection (b) shall
be subject to a civil monetary penalty of not more than $10,000
for each act constituting such violation.
(2) PROCEDURE.—The provisions of section 1128A of the
Social Security Act, other than subsections (a) and (b) and the
first sentence of subsection (c)(1), shall apply to civil money
penalties under this subsection in the same manner as such
provisions apply to a penalty or proceeding under section
1128A of the Social Security Act.
(3) RELATION TO HIPAA.—Penalties shall not be imposed
both under this subsection and under the regulations issued
pursuant to section 264(c)(1) of the Health Insurance Portability and Accountability Act of 1996 (42 U.S.C. 1320d-2 note)
for a single act or omission.
(4) EQUITABLE RELIEF.—
(A) IN GENERAL.—Without limiting remedies available
to other parties, a civil action may be brought by any aggrieved individual to enjoin any act or practice that violates subsection (e) and to obtain other appropriate equitable relief (including reinstatement, back pay, and restoration of benefits) to redress such violation.
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(B) AGAINST STATE EMPLOYEES.—An entity that is a
State or an agency of a State government may not assert
the privilege described in subsection (a) unless before the
time of the assertion, the entity or, in the case of and with
respect to an agency, the State has consented to be subject
to an action described in subparagraph (A), and that consent has remained in effect.
(g) RULE OF CONSTRUCTION.—Nothing in this section shall be
construed—
(1) to limit the application of other Federal, State, or local
laws that provide greater privilege or confidentiality protections than the privilege and confidentiality protections provided for in this section;
(2) to limit, alter, or affect the requirements of Federal,
State, or local law pertaining to information that is not privileged or confidential under this section;
(3) except as provided in subsection (i), to alter or affect
the implementation of any provision of the HIPAA confidentiality regulations or section 1176 of the Social Security Act (or
regulations promulgated under such section);
(4) to limit the authority of any provider, patient safety organization, or other entity to enter into a contract requiring
greater confidentiality or delegating authority to make a disclosure or use in accordance with this section;
(5) as preempting or otherwise affecting any State law requiring a provider to report information that is not patient
safety work product; or
(6) to limit, alter, or affect any requirement for reporting
to the Food and Drug Administration information regarding
the safety of a product or activity regulated by the Food and
Drug Administration.
(h) CLARIFICATION.—Nothing in this part prohibits any person
from conducting additional analysis for any purpose regardless of
whether such additional analysis involves issues identical to or
similar to those for which information was reported to or assessed
by a patient safety organization or a patient safety evaluation system.
(i) CLARIFICATION OF APPLICATION OF HIPAA CONFIDENTIALITY
REGULATIONS TO PATIENT SAFETY ORGANIZATIONS.—For purposes of
applying the HIPAA confidentiality regulations—
(1) patient safety organizations shall be treated as business associates; and
(2) patient safety activities of such organizations in relation to a provider are deemed to be health care operations (as
defined in such regulations) of the provider.
(j) REPORTS ON STRATEGIES TO IMPROVE PATIENT SAFETY.—
(1) DRAFT REPORT.—Not later than the date that is 18
months after any network of patient safety databases is operational, the Secretary, in consultation with the Director, shall
prepare a draft report on effective strategies for reducing medical errors and increasing patient safety. The draft report shall
include any measure determined appropriate by the Secretary
to encourage the appropriate use of such strategies, including
use in any federally funded programs. The Secretary shall
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make the draft report available for public comment and submit
the draft report to the Institute of Medicine for review.
(2) FINAL REPORT.—Not later than 1 year after the date described in paragraph (1), the Secretary shall submit a final report to the Congress.
SEC. 923. ø299b–23¿ NETWORK OF PATIENT SAFETY DATABASES.
(a) IN GENERAL.—The Secretary shall facilitate the creation

of,
and maintain, a network of patient safety databases that provides
an interactive evidence-based management resource for providers,
patient safety organizations, and other entities. The network of
databases shall have the capacity to accept, aggregate across the
network, and analyze nonidentifiable patient safety work product
voluntarily reported by patient safety organizations, providers, or
other entities. The Secretary shall assess the feasibility of providing for a single point of access to the network for qualified researchers for information aggregated across the network and, if
feasible, provide for implementation.
(b) DATA STANDARDS.—The Secretary may determine common
formats for the reporting to and among the network of patient safety databases maintained under subsection (a) of nonidentifiable patient safety work product, including necessary work product elements, common and consistent definitions, and a standardized computer interface for the processing of such work product. To the extent practicable, such standards shall be consistent with the administrative simplification provisions of part C of title XI of the Social Security Act.
(c) USE OF INFORMATION.—Information reported to and among
the network of patient safety databases under subsection (a) shall
be used to analyze national and regional statistics, including trends
and patterns of health care errors. The information resulting from
such analyses shall be made available to the public and included
in the annual quality reports prepared under section 913(b)(2).
SEC. 924. ø299b–24¿ PATIENT SAFETY ORGANIZATION CERTIFICATION
AND LISTING.
(a) CERTIFICATION.—
(1) INITIAL CERTIFICATION.—An entity that seeks to be a

patient safety organization shall submit an initial certification
to the Secretary that the entity—
(A) has policies and procedures in place to perform
each of the patient safety activities described in section
921(5); and
(B) upon being listed under subsection (d), will comply
with the criteria described in subsection (b).
(2) SUBSEQUENT CERTIFICATIONS.—An entity that is a patient safety organization shall submit every 3 years after the
date of its initial listing under subsection (d) a subsequent certification to the Secretary that the entity—
(A) is performing each of the patient safety activities
described in section 921(5); and
(B) is complying with the criteria described in subsection (b).
(b) CRITERIA.—
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(1) IN GENERAL.—The following are criteria for the initial
and subsequent certification of an entity as a patient safety organization:
(A) The mission and primary activity of the entity are
to conduct activities that are to improve patient safety and
the quality of health care delivery.
(B) The entity has appropriately qualified staff
(whether directly or through contract), including licensed
or certified medical professionals.
(C) The entity, within each 24-month period that begins after the date of the initial listing under subsection
(d), has bona fide contracts, each of a reasonable period of
time, with more than 1 provider for the purpose of receiving and reviewing patient safety work product.
(D) The entity is not, and is not a component of, a
health insurance issuer (as defined in section 2791(b)(2)).
(E) The entity shall fully disclose—
(i) any financial, reporting, or contractual relationship between the entity and any provider that contracts with the entity; and
(ii) if applicable, the fact that the entity is not
managed, controlled, and operated independently from
any provider that contracts with the entity.
(F) To the extent practical and appropriate, the entity
collects patient safety work product from providers in a
standardized manner that permits valid comparisons of
similar cases among similar providers.
(G) The utilization of patient safety work product for
the purpose of providing direct feedback and assistance to
providers to effectively minimize patient risk.
(2) ADDITIONAL CRITERIA FOR COMPONENT ORGANIZATIONS.—If an entity that seeks to be a patient safety organization is a component of another organization, the following are
additional criteria for the initial and subsequent certification of
the entity as a patient safety organization:
(A) The entity maintains patient safety work product
separately from the rest of the organization, and establishes appropriate security measures to maintain the confidentiality of the patient safety work product.
(B) The entity does not make an unauthorized disclosure under this part of patient safety work product to the
rest of the organization in breach of confidentiality.
(C) The mission of the entity does not create a conflict
of interest with the rest of the organization.
(c) REVIEW OF CERTIFICATION.—
(1) IN GENERAL.—
(A) INITIAL CERTIFICATION.—Upon the submission by
an entity of an initial certification under subsection (a)(1),
the Secretary shall determine if the certification meets the
requirements of subparagraphs (A) and (B) of such subsection.
(B) SUBSEQUENT CERTIFICATION.—Upon the submission by an entity of a subsequent certification under subsection (a)(2), the Secretary shall review the certification
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with respect to requirements of subparagraphs (A) and (B)
of such subsection.
(2) NOTICE OF ACCEPTANCE OR NON-ACCEPTANCE.—If the
Secretary determines that—
(A) an entity’s initial certification meets requirements
referred to in paragraph (1)(A), the Secretary shall notify
the entity of the acceptance of such certification; or
(B) an entity’s initial certification does not meet such
requirements, the Secretary shall notify the entity that
such certification is not accepted and the reasons therefor.
(3) DISCLOSURES REGARDING RELATIONSHIP TO PROVIDERS.—The Secretary shall consider any disclosures under
subsection (b)(1)(E) by an entity and shall make public findings
on whether the entity can fairly and accurately perform the patient safety activities of a patient safety organization. The Secretary shall take those findings into consideration in determining whether to accept the entity’s initial certification and
any subsequent certification submitted under subsection (a)
and, based on those findings, may deny, condition, or revoke
acceptance of the entity’s certification.
(d) LISTING.—The Secretary shall compile and maintain a listing of entities with respect to which there is an acceptance of a certification pursuant to subsection (c)(2)(A) that has not been revoked
under subsection (e) or voluntarily relinquished.
(e) REVOCATION OF ACCEPTANCE OF CERTIFICATION.—
(1) IN GENERAL.—If, after notice of deficiency, an opportunity for a hearing, and a reasonable opportunity for correction, the Secretary determines that a patient safety organization does not meet the certification requirements under subsection (a)(2), including subparagraphs (A) and (B) of such subsection, the Secretary shall revoke the Secretary’s acceptance
of the certification of such organization.
(2) SUPPLYING CONFIRMATION OF NOTIFICATION TO PROVIDERS.—Within 15 days of a revocation under paragraph (1),
a patient safety organization shall submit to the Secretary a
confirmation that the organization has taken all reasonable actions to notify each provider whose patient safety work product
is collected or analyzed by the organization of such revocation.
(3) PUBLICATION OF DECISION.—If the Secretary revokes
the certification of an organization under paragraph (1), the
Secretary shall—
(A) remove the organization from the listing maintained under subsection (d); and
(B) publish notice of the revocation in the Federal Register.
(f) STATUS OF DATA AFTER REMOVAL FROM LISTING.—
(1) NEW DATA.—With respect to the privilege and confidentiality protections described in section 922, data submitted to
an entity within 30 days after the entity is removed from the
listing under subsection (e)(3)(A) shall have the same status as
data submitted while the entity was still listed.
(2) PROTECTION TO CONTINUE TO APPLY.—If the privilege
and confidentiality protections described in section 922 applied
to patient safety work product while an entity was listed, or to
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data described in paragraph (1), such protections shall continue to apply to such work product or data after the entity is
removed from the listing under subsection (e)(3)(A).
(g) DISPOSITION OF WORK PRODUCT AND DATA.—If the Secretary removes a patient safety organization from the listing as
provided for in subsection (e)(3)(A), with respect to the patient safety work product or data described in subsection (f)(1) that the patient safety organization received from another entity, such former
patient safety organization shall—
(1) with the approval of the other entity and a patient
safety organization, transfer such work product or data to such
patient safety organization;
(2) return such work product or data to the entity that
submitted the work product or data; or
(3) if returning such work product or data to such entity
is not practicable, destroy such work product or data.
SEC. 925. ø299b–24a¿ ACTIVITIES REGARDING WOMEN’S HEALTH.
(a) ESTABLISHMENT.—There is established within the Office

of
the Director, an Office of Women’s Health and Gender-Based Research (referred to in this section as the ‘‘Office’’). The Office shall
be headed by a director who shall be appointed by the Director of
Healthcare and Research Quality.
(b) PURPOSE.—The official designated under subsection (a)
shall—
(1) report to the Director on the current Agency level of activity regarding women’s health, across, where appropriate,
age, biological, and sociocultural contexts, in all aspects of
Agency work, including the development of evidence reports
and clinical practice protocols and the conduct of research into
patient outcomes, delivery of health care services, quality of
care, and access to health care;
(2) establish short-range and long-range goals and objectives within the Agency for research important to women’s
health and, as relevant and appropriate, coordinate with other
appropriate offices on activities within the Agency that relate
to health services and medical effectiveness research, for issues
of particular concern to women;
(3) identify projects in women’s health that should be conducted or supported by the Agency;
(4) consult with health professionals, nongovernmental organizations, consumer organizations, women’s health professionals, and other individuals and groups, as appropriate, on
Agency policy with regard to women; and
(5) serve as a member of the Department of Health and
Human Services Coordinating Committee on Women’s Health
(established under section 229(b)(4)).
(c) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of
carrying out this section, there are authorized to be appropriated
such sums as may be necessary for each of the fiscal years 2010
through 2014.
SEC. 926. ø299b–25¿ TECHNICAL ASSISTANCE.

The Secretary, acting through the Director, may provide technical assistance to patient safety organizations, including conMarch 13, 2013

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vening annual meetings for patient safety organizations to discuss
methodology, communication, data collection, or privacy concerns.
SEC. 927. ø299b–26¿ SEVERABILITY.

If any provision of this part is held to be unconstitutional, the
remainder of this part shall not be affected.

PART D—HEALTH CARE QUALITY
IMPROVEMENT
Subpart I—Quality Measure Development
SEC. 931. ø299b–31¿ QUALITY MEASURE DEVELOPMENT.
(a) QUALITY MEASURE.—In this subpart, the

term ‘‘quality
measure’’ means a standard for measuring the performance and
improvement of population health or of health plans, providers of
services, and other clinicians in the delivery of health care services.
(b) IDENTIFICATION OF QUALITY MEASURES.—
(1) IDENTIFICATION.—The Secretary, in consultation with
the Director of the Agency for Healthcare Research and Quality and the Administrator of the Centers for Medicare & Medicaid Services, shall identify, not less often than triennially,
gaps where no quality measures exist and existing quality
measures that need improvement, updating, or expansion, consistent with the national strategy under section 399HH, to the
extent available, for use in Federal health programs. In identifying such gaps and existing quality measures that need improvement, the Secretary shall take into consideration—
(A) the gaps identified by the entity with a contract
under section 1890(a) of the Social Security Act and other
stakeholders;
(B) quality measures identified by the pediatric quality measures program under section 1139A of the Social
Security Act; and
(C) quality measures identified through the Medicaid
Quality Measurement Program under section 1139B of the
Social Security Act.
(2) PUBLICATION.—The Secretary shall make available to
the public on an Internet website a report on any gaps identified under paragraph (1) and the process used to make such
identification.
(c) GRANTS OR CONTRACTS FOR QUALITY MEASURE DEVELOPMENT.—
(1) IN GENERAL.—The Secretary shall award grants, contracts, or intergovernmental agreements to eligible entities for
purposes of developing, improving, updating, or expanding
quality measures identified under subsection (b).
(2) PRIORITIZATION IN THE DEVELOPMENT OF QUALITY MEASURES.—In awarding grants, contracts, or agreements under
this subsection, the Secretary shall give priority to the development of quality measures that allow the assessment of—
(A) health outcomes and functional status of patients;
(B) the management and coordination of health care
across episodes of care and care transitions for patients
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across the continuum of providers, health care settings,
and health plans;
(C) the experience, quality, and use of information provided to and used by patients, caregivers, and authorized
representatives to inform decisionmaking about treatment
options, including the use of shared decisionmaking tools
and preference sensitive care (as defined in section 936);
(D) the meaningful use of health information technology;
(E) the safety, effectiveness, patient-centeredness, appropriateness, and timeliness of care;
(F) the efficiency of care;
(G) the equity of health services and health disparities
across health disparity populations (as defined in section
485E) and geographic areas;
(H) patient experience and satisfaction;
(I) the use of innovative strategies and methodologies
identified under section 933; and
(J) other areas determined appropriate by the Secretary.
(3) ELIGIBLE ENTITIES.—To be eligible for a grant or contract under this subsection, an entity shall—
(A) have demonstrated expertise and capacity in the
development and evaluation of quality measures;
(B) have adopted procedures to include in the quality
measure development process—
(i) the views of those providers or payers whose
performance will be assessed by the measure; and
(ii) the views of other parties who also will use the
quality measures (such as patients, consumers, and
health care purchasers);
(C) collaborate with the entity with a contract under
section 1890(a) of the Social Security Act and other stakeholders, as practicable, and the Secretary so that quality
measures developed by the eligible entity will meet the requirements to be considered for endorsement by the entity
with a contract under such section 1890(a);
(D) have transparent policies regarding governance
and conflicts of interest; and
(E) submit an application to the Secretary at such
time and in such manner, as the Secretary may require.
(4) USE OF FUNDS.—An entity that receives a grant, contract, or agreement under this subsection shall use such award
to develop quality measures that meet the following requirements:
(A) Such measures support measures required to be
reported under the Social Security Act, where applicable,
and in support of gaps and existing quality measures that
need improvement, as described in subsection (b)(1)(A).
(B) Such measures support measures developed under
section 1139A of the Social Security Act and the Medicaid
Quality Measurement Program under section 1139B of
such Act, where applicable.
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(C) To the extent practicable, data on such quality
measures is able to be collected using health information
technologies.
(D) Each quality measure is free of charge to users of
such measure.
(E) Each quality measure is publicly available on an
Internet website.
(d) OTHER ACTIVITIES BY THE SECRETARY.—The Secretary may
use amounts available under this section to update and test, where
applicable, quality measures endorsed by the entity with a contract
under section 1890(a) of the Social Security Act or adopted by the
Secretary.
(e) COORDINATION OF GRANTS.—The Secretary shall ensure
that grants or contracts awarded under this section are coordinated
with grants and contracts awarded under sections 1139A(5) and
1139B(4)(A) of the Social Security Act.
(f) DEVELOPMENT OF OUTCOME MEASURES.—
(1) IN GENERAL.—The Secretary shall develop, and periodically update (not less than every 3 years), provider-level outcome measures for hospitals and physicians, as well as other
providers as determined appropriate by the Secretary.
(2) CATEGORIES OF MEASURES.—The measures developed
under this subsection shall include, to the extent determined
appropriate by the Secretary—
(A) outcome measurement for acute and chronic diseases, including, to the extent feasible, the 5 most prevalent and resource-intensive acute and chronic medical conditions; and
(B) outcome measurement for primary and preventative care, including, to the extent feasible, measurements
that cover provision of such care for distinct patient populations (such as healthy children, chronically ill adults, or
infirm elderly individuals).
(3) GOALS.—In developing such measures, the Secretary
shall seek to—
(A) address issues regarding risk adjustment, accountability, and sample size;
(B) include the full scope of services that comprise a
cycle of care; and
(C) include multiple dimensions.
(4) TIMEFRAME.—
(A) ACUTE AND CHRONIC DISEASES.—Not later than 24
months after the date of enactment of this Act, the Secretary shall develop not less than 10 measures described
in paragraph (2)(A).
(B) PRIMARY AND PREVENTIVE CARE.—Not later than
36 months after the date of enactment of this Act, the Secretary shall develop not less than 10 measures described
in paragraph (2)(B).

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Subpart II—Health Care Quality Improvement
Programs
SEC. 933. ø299b–33¿ HEALTH CARE DELIVERY SYSTEM RESEARCH.
(a) PURPOSE.—The purposes of this section are to—

(1) enable the Director to identify, develop, evaluate, disseminate, and provide training in innovative methodologies
and strategies for quality improvement practices in the delivery of health care services that represent best practices (referred to as ‘‘best practices’’) in health care quality, safety, and
value; and
(2) ensure that the Director is accountable for implementing a model to pursue such research in a collaborative
manner with other related Federal agencies.
(b) GENERAL FUNCTIONS OF THE CENTER.—The Center for
Quality Improvement and Patient Safety of the Agency for
Healthcare Research and Quality (referred to in this section as the
‘‘Center’’), or any other relevant agency or department designated
by the Director, shall—
(1) carry out its functions using research from a variety of
disciplines, which may include epidemiology, health services,
sociology, psychology, human factors engineering, biostatistics,
health economics, clinical research, and health informatics;
(2) conduct or support activities consistent with the purposes described in subsection (a), and for—
(A) best practices for quality improvement practices in
the delivery of health care services; and
(B) that include changes in processes of care and the
redesign of systems used by providers that will reliably result in intended health outcomes, improve patient safety,
and reduce medical errors (such as skill development for
health care providers in team-based health care delivery
and rapid cycle process improvement) and facilitate adoption of improved workflow;
(3) identify health care providers, including health care
systems, single institutions, and individual providers, that—
(A) deliver consistently high-quality, efficient health
care services (as determined by the Secretary); and
(B) employ best practices that are adaptable and scalable to diverse health care settings or effective in improving care across diverse settings;
(4) assess research, evidence, and knowledge about what
strategies and methodologies are most effective in improving
health care delivery;
(5) find ways to translate such information rapidly and effectively into practice, and document the sustainability of those
improvements;
(6) create strategies for quality improvement through the
development of tools, methodologies, and interventions that
can successfully reduce variations in the delivery of health
care;
(7) identify, measure, and improve organizational, human,
or other causative factors, including those related to the culMarch 13, 2013

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ture and system design of a health care organization, that contribute to the success and sustainability of specific quality improvement and patient safety strategies;
(8) provide for the development of best practices in the delivery of health care services that—
(A) have a high likelihood of success, based on structured review of empirical evidence;
(B) are specified with sufficient detail of the individual
processes, steps, training, skills, and knowledge required
for implementation and incorporation into workflow of
health care practitioners in a variety of settings;
(C) are designed to be readily adapted by health care
providers in a variety of settings; and
(D) where applicable, assist health care providers in
working with other health care providers across the continuum of care and in engaging patients and their families
in improving the care and patient health outcomes;
(9) provide for the funding of the activities of organizations
with recognized expertise and excellence in improving the delivery of health care services, including children’s health care,
by involving multiple disciplines, managers of health care entities, broad development and training, patients, caregivers and
families, and frontline health care workers, including activities
for the examination of strategies to share best quality improvement practices and to promote excellence in the delivery of
health care services; and
(10) build capacity at the State and community level to
lead quality and safety efforts through education, training, and
mentoring programs to carry out the activities under paragraphs (1) through (9).
(c) RESEARCH FUNCTIONS OF CENTER.—
(1) IN GENERAL.—The Center shall support, such as
through a contract or other mechanism, research on health
care delivery system improvement and the development of
tools to facilitate adoption of best practices that improve the
quality, safety, and efficiency of health care delivery services.
Such support may include establishing a Quality Improvement
Network Research Program for the purpose of testing, scaling,
and disseminating of interventions to improve quality and efficiency in health care. Recipients of funding under the Program
may include national, State, multi-State, or multi-site quality
improvement networks.
(2) RESEARCH REQUIREMENTS.—The research conducted
pursuant to paragraph (1) shall—
(A) address the priorities identified by the Secretary in
the national strategic plan established under section
399HH;
(B) identify areas in which evidence is insufficient to
identify strategies and methodologies, taking into consideration areas of insufficient evidence identified by the entity
with a contract under section 1890(a) of the Social Security
Act in the report required under section 399JJ;
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(C) address concerns identified by health care institutions and providers and communicated through the Center
pursuant to subsection (d);
(D) reduce preventable morbidity, mortality, and associated costs of morbidity and mortality by building capacity for patient safety research;
(E) support the discovery of processes for the reliable,
safe, efficient, and responsive delivery of health care, taking into account discoveries from clinical research and
comparative effectiveness research;
(F) allow communication of research findings and
translate evidence into practice recommendations that are
adaptable to a variety of settings, and which, as soon as
practicable after the establishment of the Center, shall include—
(i) the implementation of a national application of
Intensive Care Unit improvement projects relating to
the adult (including geriatric), pediatric, and neonatal
patient populations;
(ii) practical methods for addressing health care
associated infections, including Methicillin-Resistant
Staphylococcus Aureus and Vancomycin-Resistant
Entercoccus infections and other emerging infections;
and
(iii) practical methods for reducing preventable
hospital admissions and readmissions;
(G) expand demonstration projects for improving the
quality of children’s health care and the use of health information technology, such as through Pediatric Quality
Improvement Collaboratives and Learning Networks, consistent with provisions of section 1139A of the Social Security Act for assessing and improving quality, where applicable;
(H) identify and mitigate hazards by—
(i) analyzing events reported to patient safety reporting systems and patient safety organizations; and
(ii) using the results of such analyses to develop
scientific methods of response to such events;
(I) include the conduct of systematic reviews of existing practices that improve the quality, safety, and efficiency of health care delivery, as well as new research on
improving such practices; and
(J) include the examination of how to measure and
evaluate the progress of quality and patient safety activities.
(d) DISSEMINATION OF RESEARCH FINDINGS.—
(1) PUBLIC AVAILABILITY.—The Director shall make the research findings of the Center available to the public through
multiple media and appropriate formats to reflect the varying
needs of health care providers and consumers and diverse levels of health literacy.
(2) LINKAGE TO HEALTH INFORMATION TECHNOLOGY.—The
Secretary shall ensure that research findings and results generated by the Center are shared with the Office of the National
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Coordinator of Health Information Technology and used to inform the activities of the health information technology extension program under section 3012, as well as any relevant
standards, certification criteria, or implementation specifications.
(e) PRIORITIZATION.—The Director shall identify and regularly
update a list of processes or systems on which to focus research
and dissemination activities of the Center, taking into account—
(1) the cost to Federal health programs;
(2) consumer assessment of health care experience;
(3) provider assessment of such processes or systems and
opportunities to minimize distress and injury to the health
care workforce;
(4) the potential impact of such processes or systems on
health status and function of patients, including vulnerable
populations including children;
(5) the areas of insufficient evidence identified under subsection (c)(2)(B); and
(6) the evolution of meaningful use of health information
technology, as defined in section 3000.
(f) COORDINATION.—The Center shall coordinate its activities
with activities conducted by the Center for Medicare and Medicaid
Innovation established under section 1115A of the Social Security
Act.
(g) FUNDING.—There is authorized to be appropriated to carry
out this section $20,000,000 for fiscal years 2010 through 2014.
SEC. 934. ø299b–34¿ QUALITY IMPROVEMENT TECHNICAL ASSISTANCE
AND IMPLEMENTATION.
(a) IN GENERAL.—The Director, through the Center for Quality

Improvement and Patient Safety of the Agency for Healthcare Research and Quality (referred to in this section as the ‘‘Center’’),
shall award—
(1) technical assistance grants or contracts to eligible entities to provide technical support to institutions that deliver
health care and health care providers (including rural and
urban providers of services and suppliers with limited infrastructure and financial resources to implement and support
quality improvement activities, providers of services and suppliers with poor performance scores, and providers of services
and suppliers for which there are disparities in care among
subgroups of patients) so that such institutions and providers
understand, adapt, and implement the models and practices
identified in the research conducted by the Center, including
the Quality Improvement Networks Research Program; and
(2) implementation grants or contracts to eligible entities
to implement the models and practices described under paragraph (1).
(b) ELIGIBLE ENTITIES.—
(1) TECHNICAL ASSISTANCE AWARD.—To be eligible to receive a technical assistance grant or contract under subsection
(a)(1), an entity—
(A) may be a health care provider, health care provider association, professional society, health care worker
organization, Indian health organization, quality improveMarch 13, 2013

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ment organization, patient safety organization, local quality improvement collaborative, the Joint Commission, academic health center, university, physician-based research
network, primary care extension program established
under section 399V–1, a Federal Indian Health Service
program or a health program operated by an Indian tribe
(as defined in section 4 of the Indian Health Care Improvement Act), or any other entity identified by the Secretary;
and
(B) shall have demonstrated expertise in providing information and technical support and assistance to health
care providers regarding quality improvement.
(2) IMPLEMENTATION AWARD.—To be eligible to receive an
implementation grant or contract under subsection (a)(2), an
entity—
(A) may be a hospital or other health care provider or
consortium or providers, as determined by the Secretary;
and
(B) shall have demonstrated expertise in providing information and technical support and assistance to health
care providers regarding quality improvement.
(c) APPLICATION.—
(1) TECHNICAL ASSISTANCE AWARD.—To receive a technical
assistance grant or contract under subsection (a)(1), an eligible
entity shall submit an application to the Secretary at such
time, in such manner, and containing—
(A) a plan for a sustainable business model that may
include a system of—
(i) charging fees to institutions and providers that
receive technical support from the entity; and
(ii) reducing or eliminating such fees for such institutions and providers that serve low-income populations; and
(B) such other information as the Director may require.
(2) IMPLEMENTATION AWARD.—To receive a grant or contract under subsection (a)(2), an eligible entity shall submit an
application to the Secretary at such time, in such manner, and
containing—
(A) a plan for implementation of a model or practice
identified in the research conducted by the Center including—
(i) financial cost, staffing requirements, and
timeline for implementation; and
(ii) pre- and projected post-implementation quality
measure performance data in targeted improvement
areas identified by the Secretary; and
(B) such other information as the Director may require.
(d) MATCHING FUNDS.—The Director may not award a grant or
contract under this section to an entity unless the entity agrees
that it will make available (directly or through contributions from
other public or private entities) non-Federal contributions toward
the activities to be carried out under the grant or contract in an
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Sec. 935

amount equal to $1 for each $5 of Federal funds provided under the
grant or contract. Such non-Federal matching funds may be provided directly or through donations from public or private entities
and may be in cash or in-kind, fairly evaluated, including plant,
equipment, or services.
(e) EVALUATION.—
(1) IN GENERAL.—The Director shall evaluate the performance of each entity that receives a grant or contract under this
section. The evaluation of an entity shall include a study of—
(A) the success of such entity in achieving the implementation, by the health care institutions and providers
assisted by such entity, of the models and practices identified in the research conducted by the Center under section
933;
(B) the perception of the health care institutions and
providers assisted by such entity regarding the value of
the entity; and
(C) where practicable, better patient health outcomes
and lower cost resulting from the assistance provided by
such entity.
(2) EFFECT OF EVALUATION.—Based on the outcome of the
evaluation of the entity under paragraph (1), the Director shall
determine whether to renew a grant or contract with such entity under this section.
(f) COORDINATION.—The entities that receive a grant or contract under this section shall coordinate with health information
technology regional extension centers under section 3012(c) and the
primary care extension program established under section 399V–1
regarding the dissemination of quality improvement, system delivery reform, and best practices information.
SEC. 935. ø299b–35¿ GRANTS OR CONTRACTS TO IMPLEMENT MEDICATION MANAGEMENT SERVICES IN TREATMENT OF
CHRONIC DISEASES.
(a) IN GENERAL.—The Secretary, acting through the Patient

Safety Research Center established in section 933 (referred to in
this section as the ‘‘Center’’), shall establish a program to provide
grants or contracts to eligible entities to implement medication
management (referred to in this section as ‘‘MTM’’) services provided by licensed pharmacists, as a collaborative, multidisciplinary,
inter-professional approach to the treatment of chronic diseases for
targeted individuals, to improve the quality of care and reduce
overall cost in the treatment of such diseases. The Secretary shall
commence the program under this section not later than May 1,
2010.
(b) ELIGIBLE ENTITIES.—To be eligible to receive a grant or
contract under subsection (a), an entity shall—
(1) provide a setting appropriate for MTM services, as recommended by the experts described in subsection (e);
(2) submit to the Secretary a plan for achieving long-term
financial sustainability;
(3) where applicable, submit a plan for coordinating MTM
services through local community health teams established in
section 3502 of the Patient Protection and Affordable Care Act
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or in collaboration with primary care extension programs established in section 399V–1;
(4) submit a plan for meeting the requirements under subsection (c); and
(5) submit to the Secretary such other information as the
Secretary may require.
(c) MTM SERVICES TO TARGETED INDIVIDUALS.—The MTM
services provided with the assistance of a grant or contract awarded under subsection (a) shall, as allowed by State law including applicable collaborative pharmacy practice agreements, include—
(1) performing or obtaining necessary assessments of the
health and functional status of each patient receiving such
MTM services;
(2) formulating a medication treatment plan according to
therapeutic goals agreed upon by the prescriber and the patient or caregiver or authorized representative of the patient;
(3) selecting, initiating, modifying, recommending changes
to, or administering medication therapy;
(4) monitoring, which may include access to, ordering, or
performing laboratory assessments, and evaluating the response of the patient to therapy, including safety and effectiveness;
(5) performing an initial comprehensive medication review
to identify, resolve, and prevent medication-related problems,
including adverse drug events, quarterly targeted medication
reviews for ongoing monitoring, and additional followup interventions on a schedule developed collaboratively with the prescriber;
(6) documenting the care delivered and communicating essential information about such care, including a summary of
the medication review, and the recommendations of the pharmacist to other appropriate health care providers of the patient
in a timely fashion;
(7) providing education and training designed to enhance
the understanding and appropriate use of the medications by
the patient, caregiver, and other authorized representative;
(8) providing information, support services, and resources
and strategies designed to enhance patient adherence with
therapeutic regimens;
(9) coordinating and integrating MTM services within the
broader health care management services provided to the patient; and
(10) such other patient care services allowed under pharmacist scopes of practice in use in other Federal programs that
have implemented MTM services.
(d) TARGETED INDIVIDUALS.—MTM services provided by licensed pharmacists under a grant or contract awarded under subsection (a) shall be offered to targeted individuals who—
(1) take 4 or more prescribed medications (including overthe-counter medications and dietary supplements);
(2) take any ‘‘high risk’’ medications;
(3) have 2 or more chronic diseases, as identified by the
Secretary; or
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(4) have undergone a transition of care, or other factors, as
determined by the Secretary, that are likely to create a high
risk of medication-related problems.
(e) CONSULTATION WITH EXPERTS.—In designing and implementing MTM services provided under grants or contracts awarded
under subsection (a), the Secretary shall consult with Federal,
State, private, public-private, and academic entities, pharmacy and
pharmacist organizations, health care organizations, consumer advocates, chronic disease groups, and other stakeholders involved
with the research, dissemination, and implementation of pharmacist-delivered MTM services, as the Secretary determines appropriate. The Secretary, in collaboration with this group, shall determine whether it is possible to incorporate rapid cycle process improvement concepts in use in other Federal programs that have implemented MTM services.
(f) REPORTING TO THE SECRETARY.—An entity that receives a
grant or contract under subsection (a) shall submit to the Secretary
a report that describes and evaluates, as requested by the Secretary, the activities carried out under subsection (c), including
quality measures endorsed by the entity with a contract under section 1890 of the Social Security Act, as determined by the Secretary.
(g) EVALUATION AND REPORT.—The Secretary shall submit to
the relevant committees of Congress a report which shall—
(1) assess the clinical effectiveness of pharmacist-provided
services under the MTM services program, as compared to
usual care, including an evaluation of whether enrollees maintained better health with fewer hospitalizations and emergency
room visits than similar patients not enrolled in the program;
(2) assess changes in overall health care resource use by
targeted individuals;
(3) assess patient and prescriber satisfaction with MTM
services;
(4) assess the impact of patient-cost sharing requirements
on medication adherence and recommendations for modifications;
(5) identify and evaluate other factors that may impact
clinical and economic outcomes, including demographic characteristics, clinical characteristics, and health services use of the
patient, as well as characteristics of the regimen, pharmacy
benefit, and MTM services provided; and
(6) evaluate the extent to which participating pharmacists
who maintain a dispensing role have a conflict of interest in
the provision of MTM services, and if such conflict is found,
provide recommendations on how such a conflict might be appropriately addressed.
(h) GRANTS OR CONTRACTS TO FUND DEVELOPMENT OF PERFORMANCE MEASURES.—The Secretary may, through the quality
measure development program under section 931 of the Public
Health Service Act, award grants or contracts to eligible entities for
the purpose of funding the development of performance measures
that assess the use and effectiveness of medication therapy management services.
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SEC. 936. ø299b–36¿ PROGRAM TO FACILITATE SHARED DECISIONMAKING.
(a) PURPOSE.—The purpose of this section is to facilitate col-

laborative processes between patients, caregivers or authorized representatives, and clinicians that engages the patient, caregiver or
authorized representative in decisionmaking, provides patients,
caregivers or authorized representatives with information about
trade-offs among treatment options, and facilitates the incorporation of patient preferences and values into the medical plan.
(b) DEFINITIONS.—In this section:
(1) PATIENT DECISION AID.—The term ‘‘patient decision aid’’
means an educational tool that helps patients, caregivers or
authorized representatives understand and communicate their
beliefs and preferences related to their treatment options, and
to decide with their health care provider what treatments are
best for them based on their treatment options, scientific evidence, circumstances, beliefs, and preferences.
(2) PREFERENCE SENSITIVE CARE.—The term ‘‘preference
sensitive care’’ means medical care for which the clinical evidence does not clearly support one treatment option such that
the appropriate course of treatment depends on the values of
the patient or the preferences of the patient, caregivers or authorized representatives regarding the benefits, harms and scientific evidence for each treatment option, the use of such care
should depend on the informed patient choice among clinically
appropriate treatment options.
(c) ESTABLISHMENT OF INDEPENDENT STANDARDS FOR PATIENT
DECISION AIDS FOR PREFERENCE SENSITIVE CARE.—
(1) CONTRACT WITH ENTITY TO ESTABLISH STANDARDS AND
CERTIFY PATIENT DECISION AIDS.—
(A) IN GENERAL.—For purposes of supporting consensus-based standards for patient decision aids for preference sensitive care and a certification process for patient
decision aids for use in the Federal health programs and
by other interested parties, the Secretary shall have in effect a contract with the entity with a contract under section 1890 of the Social Security Act. Such contract shall
provide that the entity perform the duties described in
paragraph (2).
(B) TIMING FOR FIRST CONTRACT.—As soon as practicable after the date of the enactment of this section, the
Secretary shall enter into the first contract under subparagraph (A).
(C) PERIOD OF CONTRACT.—A contract under subparagraph (A) shall be for a period of 18 months (except such
contract may be renewed after a subsequent bidding process).
(2) DUTIES.—The following duties are described in this
paragraph:
(A) DEVELOP AND IDENTIFY STANDARDS FOR PATIENT
DECISION AIDS.—The entity shall synthesize evidence and
convene a broad range of experts and key stakeholders to
develop and identify consensus-based standards to evaluate patient decision aids for preference sensitive care.
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(B) ENDORSE PATIENT DECISION AIDS.—The entity shall
review patient decision aids and develop a certification
process whether patient decision aids meet the standards
developed and identified under subparagraph (A). The entity shall give priority to the review and certification of patient decision aids for preference sensitive care.
(d) PROGRAM TO DEVELOP, UPDATE AND PATIENT DECISION
AIDS TO ASSIST HEALTH CARE PROVIDERS AND PATIENTS.—
(1) IN GENERAL.—The Secretary, acting through the Director, and in coordination with heads of other relevant agencies,
such as the Director of the Centers for Disease Control and
Prevention and the Director of the National Institutes of
Health, shall establish a program to award grants or contracts—
(A) to develop, update, and produce patient decision
aids for preference sensitive care to assist health care providers in educating patients, caregivers, and authorized
representatives concerning the relative safety, relative effectiveness (including possible health outcomes and impact
on functional status), and relative cost of treatment or,
where appropriate, palliative care options;
(B) to test such materials to ensure such materials are
balanced and evidence based in aiding health care providers and patients, caregivers, and authorized representatives to make informed decisions about patient care and
can be easily incorporated into a broad array of practice
settings; and
(C) to educate providers on the use of such materials,
including through academic curricula.
(2) REQUIREMENTS FOR PATIENT DECISION AIDS.—Patient
decision aids developed and produced pursuant to a grant or
contract under paragraph (1)—
(A) shall be designed to engage patients, caregivers,
and authorized representatives in informed decisionmaking with health care providers;
(B) shall present up-to-date clinical evidence about the
risks and benefits of treatment options in a form and manner that is age-appropriate and can be adapted for patients, caregivers, and authorized representatives from a
variety of cultural and educational backgrounds to reflect
the varying needs of consumers and diverse levels of
health literacy;
(C) shall, where appropriate, explain why there is a
lack of evidence to support one treatment option over another; and
(D) shall address health care decisions across the age
span, including those affecting vulnerable populations including children.
(3) DISTRIBUTION.—The Director shall ensure that patient
decision aids produced with grants or contracts under this section are available to the public.
(4) NONDUPLICATION OF EFFORTS.—The Director shall ensure that the activities under this section of the Agency and
other agencies, including the Centers for Disease Control and
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Prevention and the National Institutes of Health, are free of
unnecessary duplication of effort.
(e) GRANTS TO SUPPORT SHARED DECISIONMAKING IMPLEMENTATION.—
(1) IN GENERAL.—The Secretary shall establish a program
to provide for the phased-in development, implementation, and
evaluation of shared decisionmaking using patient decision
aids to meet the objective of improving the understanding of
patients of their medical treatment options.
(2) SHARED DECISIONMAKING RESOURCE CENTERS.—
(A) IN GENERAL.—The Secretary shall provide grants
for the establishment and support of Shared Decisionmaking Resource Centers (referred to in this subsection as
‘‘Centers’’) to provide technical assistance to providers and
to develop and disseminate best practices and other information to support and accelerate adoption, implementation, and effective use of patient decision aids and shared
decisionmaking by providers.
(B) OBJECTIVES.—The objective of a Center is to enhance and promote the adoption of patient decision aids
and shared decisionmaking through—
(i) providing assistance to eligible providers with
the implementation and effective use of, and training
on, patient decision aids; and
(ii) the dissemination of best practices and research on the implementation and effective use of patient decision aids.
(3) SHARED DECISIONMAKING PARTICIPATION GRANTS.—
(A) IN GENERAL.—The Secretary shall provide grants
to health care providers for the development and implementation of shared decisionmaking techniques and to assess the use of such techniques.
(B) PREFERENCE.—In order to facilitate the use of best
practices, the Secretary shall provide a preference in making grants under this subsection to health care providers
who participate in training by Shared Decisionmaking Resource Centers or comparable training.
(C) LIMITATION.—Funds under this paragraph shall
not be used to purchase or implement use of patient decision aids other than those certified under the process identified in subsection (c).
(4) GUIDANCE.—The Secretary may issue guidance to eligible grantees under this subsection on the use of patient decision aids.
(f) FUNDING.—For purposes of carrying out this section there
are authorized to be appropriated such sums as may be necessary
for fiscal year 2010 and each subsequent fiscal year.
SEC. 937. ø299b–37¿ DISSEMINATION AND BUILDING CAPACITY FOR RESEARCH.
(a) IN GENERAL.—
(1) DISSEMINATION.—The Office of Communication and

Knowledge Transfer (referred to in this section as the ‘‘Office’’)
at the Agency for Healthcare Research and Quality (or any
other relevant office designated by Agency for Healthcare ReMarch 13, 2013

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search and Quality), in consultation with the National Institutes of Health, shall broadly disseminate the research findings that are published by the Patient Centered Outcomes Research Institute established under section 1181(b) of the Social
Security Act (referred to in this section as the ‘‘Institute’’) and
other government-funded research relevant to comparative
clinical effectiveness research. The Office shall create informational tools that organize and disseminate research findings for
physicians, health care providers, patients, payers, and policy
makers. The Office shall also develop a publicly available resource database that collects and contains government-funded
evidence and research from public, private, not-for profit, and
academic sources.
(2) REQUIREMENTS.—The Office shall provide for the dissemination of the Institute’s research findings and government-funded research relevant to comparative clinical effectiveness research to physicians, health care providers, patients,
vendors of health information technology focused on clinical decision support, appropriate professional associations, and Federal and private health plans. Materials, forums, and media
used to disseminate the findings, informational tools, and resource databases shall—
(A) include a description of considerations for specific
subpopulations, the research methodology, and the limitations of the research, and the names of the entities, agencies, instrumentalities, and individuals who conducted any
research which was published by the Institute; and
(B) not be construed as mandates, guidelines, or recommendations for payment, coverage, or treatment.
(b) INCORPORATION OF RESEARCH FINDINGS.—The Office, in
consultation with relevant medical and clinical associations, shall
assist users of health information technology focused on clinical decision support to promote the timely incorporation of research findings disseminated under subsection (a) into clinical practices and
to promote the ease of use of such incorporation.
(c) FEEDBACK.—The Office shall establish a process to receive
feedback from physicians, health care providers, patients, and vendors of health information technology focused on clinical decision
support, appropriate professional associations, and Federal and private health plans about the value of the information disseminated
and the assistance provided under this section.
(d) RULE OF CONSTRUCTION.—Nothing in this section shall preclude the Institute from making its research findings publicly
available as required under section 1181(d)(8) of the Social Security
Act.
(e) TRAINING OF RESEARCHERS.—The Agency for Health Care
Research and Quality, in consultation with the National Institutes
of Health, shall build capacity for comparative clinical effectiveness
research by establishing a grant program that provides for the
training of researchers in the methods used to conduct such research, including systematic reviews of existing research and primary research such as clinical trials. At a minimum, such training
shall be in methods that meet the methodological standards adopted under section 1181(d)(9) of the Social Security Act.
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(f) BUILDING DATA FOR RESEARCH.—The Secretary shall provide for the coordination of relevant Federal health programs to
build data capacity for comparative clinical effectiveness research,
including the development and use of clinical registries and health
outcomes research data networks, in order to develop and maintain
a comprehensive, interoperable data network to collect, link, and
analyze data on outcomes and effectiveness from multiple sources,
including electronic health records.
(g) AUTHORITY TO CONTRACT WITH THE INSTITUTE.—Agencies
and instrumentalities of the Federal Government may enter into
agreements with the Institute, and accept and retain funds, for the
conduct and support of research described in this part, provided
that the research to be conducted or supported under such agreements is authorized under the governing statutes of such agencies
and instrumentalities.

PART E—GENERAL PROVISIONS
SEC. 941. ø299c¿ ADVISORY COUNCIL FOR HEALTHCARE RESEARCH
AND QUALITY.
(a) ESTABLISHMENT.—There is established an advisory council

to be known as the National Advisory Council for Healthcare Research and Quality.
(b) DUTIES.—
(1) IN GENERAL.—The Advisory Council shall advise the
Secretary and the Director with respect to activities proposed
or undertaken to carry out the mission of the Agency under
section 901(b).
(2) CERTAIN RECOMMENDATIONS.—Activities of the Advisory Council under paragraph (1) shall include making recommendations to the Director regarding—
(A) priorities regarding health care research, especially studies related to quality, outcomes, cost and the utilization of, and access to, health care services;
(B) the field of health care research and related disciplines, especially issues related to training needs, and
dissemination of information pertaining to health care
quality; and
(C) the appropriate role of the Agency in each of these
areas in light of private sector activity and identification
of opportunities for public-private sector partnerships.
(c) MEMBERSHIP.—
(1) IN GENERAL.—The Advisory Council shall, in accordance with this subsection, be composed of appointed members
and ex officio members. All members of the Advisory Council
shall be voting members other than the individuals designated
under paragraph (3)(B) as ex officio members.
(2) APPOINTED MEMBERS.—The Secretary shall appoint to
the Advisory Council 21 appropriately qualified individuals. At
least 17 members of the Advisory Council shall be representatives of the public who are not officers or employees of the
United States and at least 1 member who shall be a specialist
in the rural aspects of 1 or more of the professions or fields described in subparagraphs (A) through (G). The Secretary shall
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ensure that the appointed members of the Council, as a group,
are representative of professions and entities concerned with,
or affected by, activities under this title and under section
1142 of the Social Security Act. Of such members—
(A) three shall be individuals distinguished in the conduct of research, demonstration projects, and evaluations
with respect to health care;
(B) three shall be individuals distinguished in the
fields of health care quality research or health care improvement;
(C) three shall be individuals distinguished in the
practice of medicine of which at least one shall be a primary care practitioner;
(D) three shall be individuals distinguished in the
other health professions;
(E) three shall be individuals either representing the
private health care sector, including health plans, providers, and purchasers or individuals distinguished as administrators of health care delivery systems;
(F) three shall be individuals distinguished in the
fields of health care economics, information systems, law,
ethics, business, or public policy; and
(G) three shall be individuals representing the interests of patients and consumers of health care.
(3) EX OFFICIO MEMBERS.—The Secretary shall designate
as ex officio members of the Advisory Council—
(A) the Assistant Secretary for Health, the Director of
the National Institutes of Health, the Director of the Centers for Disease Control and Prevention, the Administrator
of the Centers for Medicare & Medicaid Services, the Commissioner of the Food and Drug Administration, the Director of the Office of Personnel Management, the Assistant
Secretary of Defense (Health Affairs), and the Under Secretary for Health of the Department of Veterans Affairs;
and
(B) such other Federal officials as the Secretary may
consider appropriate.
(d) TERMS.—
(1) IN GENERAL.—Members of the Advisory Council appointed under subsection (c)(2) shall serve for a term of 3
years.
(2) STAGGERED TERMS.—To ensure the staggered rotation
of one-third of the members of the Advisory Council each year,
the Secretary is authorized to appoint the initial members of
the Advisory Council for terms of 1, 2, or 3 years.
(3) SERVICE BEYOND TERM.—A member of the Council appointed under subsection (c)(2) may continue to serve after the
expiration of the term of the members until a successor is appointed.
(e) VACANCIES.—If a member of the Advisory Council appointed
under subsection (c)(2) does not serve the full term applicable
under subsection (d), the individual appointed to fill the resulting
vacancy shall be appointed for the remainder of the term of the
predecessor of the individual.
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(f) CHAIR.—The Director shall, from among the members of the
Advisory Council appointed under subsection (c)(2), designate an
individual to serve as the chair of the Advisory Council.
(g) MEETINGS.—The Advisory Council shall meet not less than
once during each discrete 4-month period and shall otherwise meet
at the call of the Director or the chair.
(h) COMPENSATION AND REIMBURSEMENT OF EXPENSES.—
(1) APPOINTED MEMBERS.—Members of the Advisory Council appointed under subsection (c)(2) shall receive compensation
for each day (including travel time) engaged in carrying out
the duties of the Advisory Council unless declined by the member. Such compensation may not be in an amount in excess of
the daily equivalent of the annual rate of basic pay prescribed
for level IV of the Executive Schedule under section 5315 of
title 5, United States Code, for each day during which such
member is engaged in the performance of the duties of the Advisory Council.
(2) EX OFFICIO MEMBERS.—Officials designated under subsection (c)(3) as ex officio members of the Advisory Council
may not receive compensation for service on the Advisory
Council in addition to the compensation otherwise received for
duties carried out as officers of the United States.
(i) STAFF.—The Director shall provide to the Advisory Council
such staff, information, and other assistance as may be necessary
to carry out the duties of the Council.
(j) DURATION.—Notwithstanding section 14(a) of the Federal
Advisory Committee Act, the Advisory Council shall continue in existence until otherwise provided by law.
SEC. 942. ø299c–1¿ PEER REVIEW WITH RESPECT TO GRANTS AND CONTRACTS.
(a) REQUIREMENT OF REVIEW.—
(1) IN GENERAL.—Appropriate technical and scientific peer

review shall be conducted with respect to each application for
a grant, cooperative agreement, or contract under this title.
(2) REPORTS TO DIRECTOR.—Each peer review group to
which an application is submitted pursuant to paragraph (1)
shall report its finding and recommendations respecting the
application to the Director in such form and in such manner
as the Director shall require.
(b) APPROVAL AS PRECONDITION OF AWARDS.—The Director
may not approve an application described in subsection (a)(1) unless the application is recommended for approval by a peer review
group established under subsection (c).
(c) ESTABLISHMENT OF PEER REVIEW GROUPS.—
(1) IN GENERAL.—The Director shall establish such technical and scientific peer review groups as may be necessary to
carry out this section. Such groups shall be established without
regard to the provisions of title 5, United States Code, that
govern appointments in the competitive service, and without
regard to the provisions of chapter 51, and subchapter III of
chapter 53, of such title that relate to classification and pay
rates under the General Schedule.
(2) MEMBERSHIP.—The members of any peer review group
established under this section shall be appointed from among
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individuals who by virtue of their training or experience are
eminently qualified to carry out the duties of such peer review
group. Officers and employees of the United States may not
constitute more than 25 percent of the membership of any such
group. Such officers and employees may not receive compensation for service on such groups in addition to the compensation
otherwise received for these duties carried out as such officers
and employees.
(3) DURATION.—Notwithstanding section 14(a) of the Federal Advisory Committee Act, peer review groups established
under this section may continue in existence until otherwise
provided by law.
(4) QUALIFICATIONS.—Members of any peer review group
shall, at a minimum, meet the following requirements:
(A) Such members shall agree in writing to treat information received, pursuant to their work for the group, as
confidential information, except that this subparagraph
shall not apply to public records and public information.
(B) Such members shall agree in writing to recuse
themselves from participation in the peer review of specific
applications which present a potential personal conflict of
interest or appearance of such conflict, including employment in a directly affected organization, stock ownership,
or any financial or other arrangement that might introduce bias in the process of peer review.
(d) AUTHORITY FOR PROCEDURAL ADJUSTMENTS IN CERTAIN
CASES.—In the case of applications for financial assistance whose
direct costs will not exceed $100,000, the Director may make appropriate adjustments in the procedures otherwise established by the
Director for the conduct of peer review under this section. Such adjustments may be made for the purpose of encouraging the entry
of individuals into the field of research, for the purpose of encouraging clinical practice-oriented or provider-based research, and for
such other purposes as the Director may determine to be appropriate.
(e) REGULATIONS.—The Director shall issue regulations for the
conduct of peer review under this section.
SEC. 943. ø299c–2¿ CERTAIN PROVISIONS WITH RESPECT TO DEVELOPMENT, COLLECTION, AND DISSEMINATION OF DATA.
(a) STANDARDS WITH RESPECT TO UTILITY OF DATA.—
(1) IN GENERAL.—To ensure the utility, accuracy, and suffi-

ciency of data collected by or for the Agency for the purpose described in section 901(b), the Director shall establish standard
methods for developing and collecting such data, taking into
consideration—
(A) other Federal health data collection standards; and
(B) the differences between types of health care plans,
delivery systems, health care providers, and provider arrangements.
(2) RELATIONSHIP WITH OTHER DEPARTMENT PROGRAMS.—In
any case where standards under paragraph (1) may affect the
administration of other programs carried out by the Department of Health and Human Services, including the programs
under title XVIII, XIX or XXI of the Social Security Act, or
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may affect health information that is subject to a standard developed under part C of title XI of the Social Security Act, they
shall be in the form of recommendations to the Secretary for
such program.
(b) STATISTICS AND ANALYSES.—The Director shall—
(1) take appropriate action to ensure that statistics and
analyses developed under this title are of high quality, timely,
and duly comprehensive, and that the statistics are specific,
standardized, and adequately analyzed and indexed; and
(2) publish, make available, and disseminate such statistics and analyses on as wide a basis as is practicable.
(c) AUTHORITY REGARDING CERTAIN REQUESTS.—Upon request
of a public or private entity, the Director may conduct or support
research or analyses otherwise authorized by this title pursuant to
arrangements under which such entity will pay the cost of the services provided. Amounts received by the Director under such arrangements shall be available to the Director for obligation until
expended.
SEC. 944. ø299c–3¿ DISSEMINATION OF INFORMATION.
(a) IN GENERAL.—The Director shall—

(1) without regard to section 501 of title 44, United States
Code, promptly publish, make available, and otherwise disseminate, in a form understandable and on as broad a basis as
practicable so as to maximize its use, the results of research,
demonstration projects, and evaluations conducted or supported under this title;
(2) ensure that information disseminated by the Agency is
science-based and objective and undertakes consultation as
necessary to assess the appropriateness and usefulness of the
presentation of information that is targeted to specific audiences;
(3) promptly make available to the public data developed
in such research, demonstration projects, and evaluations;
(4) provide, in collaboration with the National Library of
Medicine where appropriate, indexing, abstracting, translating,
publishing, and other services leading to a more effective and
timely dissemination of information on research, demonstration projects, and evaluations with respect to health care to
public and private entities and individuals engaged in the improvement of health care delivery and the general public, and
undertake programs to develop new or improved methods for
making such information available; and
(5) as appropriate, provide technical assistance to State
and local government and health agencies and conduct liaison
activities to such agencies to foster dissemination.
(b) PROHIBITION AGAINST RESTRICTIONS.—Except as provided
in subsection (c), the Director may not restrict the publication or
dissemination of data from, or the results of, projects conducted or
supported under this title.
(c) LIMITATION ON USE OF CERTAIN INFORMATION.—No information, if an establishment or person supplying the information or
described in it is identifiable, obtained in the course of activities
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pose other than the purpose for which it was supplied unless such
establishment or person has consented (as determined under regulations of the Director) to its use for such other purpose. Such information may not be published or released in other form if the
person who supplied the information or who is described in it is
identifiable unless such person has consented (as determined under
regulations of the Director) to its publication or release in other
form.
(d) PENALTY.—Any person who violates subsection (c) shall be
subject to a civil monetary penalty of not more than $10,000 for
each such violation involved. Such penalty shall be imposed and
collected in the same manner as civil money penalties under subsection (a) of section 1128A of the Social Security Act are imposed
and collected.
SEC. 945. ø299c–4¿ ADDITIONAL PROVISIONS WITH RESPECT TO
GRANTS AND CONTRACTS.
(a) FINANCIAL CONFLICTS OF INTEREST.—With respect to

projects for which awards of grants, cooperative agreements, or
contracts are authorized to be made under this title, the Director
shall by regulation define—
(1) the specific circumstances that constitute financial interests in such projects that will, or may be reasonably expected to, create a bias in favor of obtaining results in the
projects that are consistent with such interests; and
(2) the actions that will be taken by the Director in response to any such interests identified by the Director.
(b) REQUIREMENT OF APPLICATION.—The Director may not,
with respect to any program under this title authorizing the provision of grants, cooperative agreements, or contracts, provide any
such financial assistance unless an application for the assistance is
submitted to the Secretary and the application is in such form, is
made in such manner, and contains such agreements, assurances,
and information as the Director determines to be necessary to carry
out the program involved.
(c) PROVISION OF SUPPLIES AND SERVICES IN LIEU OF FUNDS.—
(1) IN GENERAL.—Upon the request of an entity receiving
a grant, cooperative agreement, or contract under this title, the
Secretary may, subject to paragraph (2), provide supplies,
equipment, and services for the purpose of aiding the entity in
carrying out the project involved and, for such purpose, may
detail to the entity any officer or employee of the Department
of Health and Human Services.
(2) CORRESPONDING REDUCTION IN FUNDS.—With respect to
a request described in paragraph (1), the Secretary shall reduce the amount of the financial assistance involved by an
amount equal to the costs of detailing personnel and the fair
market value of any supplies, equipment, or services provided
by the Director. The Secretary shall, for the payment of expenses incurred in complying with such request, expend the
amounts withheld.
(d) APPLICABILITY OF CERTAIN PROVISIONS WITH RESPECT TO
CONTRACTS.—Contracts may be entered into under this part without regard to sections 3648 and 3709 of the Revised Statutes (31
U.S.C. 529 and 41 U.S.C. 5).
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SEC. 946. ø299c–5¿ CERTAIN ADMINISTRATIVE AUTHORITIES.
(a) DEPUTY DIRECTOR AND OTHER OFFICERS AND EMPLOYEES.—
(1) DEPUTY DIRECTOR.—The Director may appoint a deputy

director for the Agency.
(2) OTHER OFFICERS AND EMPLOYEES.—The Director may
appoint and fix the compensation of such officers and employees as may be necessary to carry out this title. Except as otherwise provided by law, such officers and employees shall be appointed in accordance with the civil service laws and their compensation fixed in accordance with title 5, United States Code.
(b) FACILITIES.—The Secretary, in carrying out this title—
(1) may acquire, without regard to the Act of March 3,
1877 (40 U.S.C. 34), by lease or otherwise through the Administrator of General Services, buildings or portions of buildings
in the District of Columbia or communities located adjacent to
the District of Columbia for use for a period not to exceed 10
years; and
(2) may acquire, construct, improve, repair, operate, and
maintain laboratory, research, and other necessary facilities
and equipment, and such other real or personal property (including patents) as the Secretary deems necessary.
(c) PROVISION OF FINANCIAL ASSISTANCE.—The Director, in carrying out this title, may make grants to public and nonprofit entities and individuals, and may enter into cooperative agreements or
contracts with public and private entities and individuals.
(d) UTILIZATION OF CERTAIN PERSONNEL AND RESOURCES.—
(1) DEPARTMENT OF HEALTH AND HUMAN SERVICES.—The
Director, in carrying out this title, may utilize personnel and
equipment, facilities, and other physical resources of the Department of Health and Human Services, permit appropriate
(as determined by the Secretary) entities and individuals to
utilize the physical resources of such Department, and provide
technical assistance and advice.
(2) OTHER AGENCIES.—The Director, in carrying out this
title, may use, with their consent, the services, equipment, personnel, information, and facilities of other Federal, State, or
local public agencies, or of any foreign government, with or
without reimbursement of such agencies.
(e) CONSULTANTS.—The Secretary, in carrying out this title,
may secure, from time to time and for such periods as the Director
deems advisable but in accordance with section 3109 of title 5,
United States Code, the assistance and advice of consultants from
the United States or abroad.
(f) EXPERTS.—
(1) IN GENERAL.—The Secretary may, in carrying out this
title, obtain the services of not more than 50 experts or consultants who have appropriate scientific or professional qualifications. Such experts or consultants shall be obtained in accordance with section 3109 of title 5, United States Code, except that the limitation in such section on the duration of service shall not apply.
(2) TRAVEL EXPENSES.—
(A) IN GENERAL.—Experts and consultants whose services are obtained under paragraph (1) shall be paid or reMarch 13, 2013

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PUBLIC HEALTH SERVICE ACT

Sec. 948

imbursed for their expenses associated with traveling to
and from their assignment location in accordance with sections 5724, 5724a(a), 5724a(c), and 5726(c) of title 5,
United States Code.
(B) LIMITATION.—Expenses specified in subparagraph
(A) may not be allowed in connection with the assignment
of an expert or consultant whose services are obtained
under paragraph (1) unless and until the expert agrees in
writing to complete the entire period of assignment, or 1
year, whichever is shorter, unless separated or reassigned
for reasons that are beyond the control of the expert or
consultant and that are acceptable to the Secretary. If the
expert or consultant violates the agreement, the money
spent by the United States for the expenses specified in
subparagraph (A) is recoverable from the expert or consultant as a statutory obligation owed to the United
States. The Secretary may waive in whole or in part a
right of recovery under this subparagraph.
(g) VOLUNTARY AND UNCOMPENSATED SERVICES.—The Director,
in carrying out this title, may accept voluntary and uncompensated
services.
SEC. 947. ø299c–6¿ FUNDING.
(a) INTENT.—To ensure

that the United States investment in
biomedical research is rapidly translated into improvements in the
quality of patient care, there must be a corresponding investment
in research on the most effective clinical and organizational strategies for use of these findings in daily practice. The authorization
levels in subsections (b) and (c) provide for a proportionate increase
in health care research as the United States investment in biomedical research increases.
(b) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of
carrying out this title, there are authorized to be appropriated
$250,000,000 for fiscal year 2000, and such sums as may be necessary for each of the fiscal years 2001 through 2005.
(c) EVALUATIONS.—In addition to amounts available pursuant
to subsection (b) for carrying out this title, there shall be made
available for such purpose, from the amounts made available pursuant to section 241 (relating to evaluations), an amount equal to
40 percent of the maximum amount authorized in such section 241
to be made available for a fiscal year.
(d) HEALTH DISPARITIES RESEARCH.—For the purpose of carrying out the activities under section 903, there are authorized to
be appropriated $50,000,000 for fiscal year 2001, and such sums as
may be necessary for each of the fiscal years 2002 through 2005.
(e) PATIENT SAFETY AND QUALITY IMPROVEMENT.—For the purpose of carrying out part C, there are authorized to be appropriated
such sums as may be necessary for each of the fiscal years 2006
through 2010.
SEC. 948. ø299c–7¿ DEFINITIONS.

In this title:
(1) ADVISORY COUNCIL.—The term ‘‘Advisory Council’’
means the National Advisory Council on Healthcare Research
and Quality established under section 941.
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(2) AGENCY.—The term ‘‘Agency’’ means the Agency for
Healthcare Research and Quality.
(3) DIRECTOR.—The term ‘‘Director’’ means the Director of
the Agency for Healthcare Research and Quality.

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TITLE X—POPULATION RESEARCH AND VOLUNTARY
FAMILY PLANNING PROGRAMS
PROJECT GRANTS AND CONTRACTS FOR FAMILY PLANNING SERVICES

SEC. 1001. ø300¿ (a) The Secretary is authorized to make
grants to and enter into contracts with public or nonprofit private
entities to assist in the establishment and operation of voluntary
family planning projects which shall offer a broad range of acceptable and effective family planning methods and services (including
natural family planning methods, infertility services, and services
for adolescents). To the extent practicable, entities which receive
grants or contracts under this subsection shall encourage familiy 1
participation in projects assisted under this subsection.
(b) In making grants and contracts under this section the Secretary shall take into account the number of patients to be served,
the extent to which family planning services are needed locally, the
relative need of the applicant, and its capacity to make rapid and
effective use of such assistance. Local and regional entities shall be
assured the right to apply for direct grants and contracts under
this section, and the Secretary shall by regulation fully provide for
and protect such right.
(c) The Secretary, at the request of a recipient of a grant under
subsection (a), may reduce the amount of such grant by the fair
market value of any supplies or equipment furnished the grant recipient by the Secretary. The amount by which any such grant is
so reduced shall be available for payment by the Secretary of the
costs incurred in furnishing the supplies or equipment on which
the reduction of such grant is based. Such amount shall be deemed
as part of the grant and shall be deemed to have been paid to the
grant recipient.
(d) For the purpose of making grants and contracts under this
section, there are authorized to be appropriated $30,000,000 for the
fiscal year ending June 30, 1971; $60,000,000 for the fiscal year
ending June 30, 1972; $111,500,000 for the fiscal year ending June
30, 1973; $111,500,000 each for the fiscal years ending June 30,
1974, and June 30, 1975; $115,000,000 for fiscal year 1976;
$115,000,000 for the fiscal year ending September 30, 1977;
$136,400,000 for the fiscal year ending September 30, 1978;
$200,000,000 for the fiscal year ending September 30, 1979;
$230,000,000 for the fiscal year ending September 30, 1980;
$264,500,000 for the fiscal year ending September 30, 1981;
$126,510,000 for the fiscal year ending September 30, 1982;
$139,200,000 for the fiscal year ending September 30, 1983;
$150,030,000 for the fiscal year ending September 30, 1984; and
$158,400,000 for the fiscal year ending September 30, 1985.
1 So in law. See section 931(b)(1) of Public Law 97–35 (95 Stat. 570). Probably should be ‘‘family’’.

999
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PUBLIC HEALTH SERVICE ACT

1000

FORMULA GRANTS TO STATES FOR FAMILY PLANNING SERVICES

SEC. 1002. ø300a¿ (a) The Secretary is authorized to make
grants, from allotments made under subsection (b), to State health
authorities to assist in planning, establishing, maintaining, coordinating, and evaluating family planning services. No grant may be
made to a State health authority under this section unless such authority has submitted, and had approved by the Secretary, a State
plan for a coordinated and comprehensive program of family planning services.
(b) The sums appropriated to carry out the provisions of this
section shall be allotted to the States by the Secretary on the basis
of the population and the financial need of the respective States.
(c) For the purposes of this section, the term ‘‘State’’ includes
the Commonwealth of Puerto Rico, the Northern Mariana Islands,
Guam, American Samoa, the Virgin Islands, the District of Columbia, and the Trust Territory of the Pacific Islands.
(d) For the purpose of making grants under this section, there
are authorized to be appropriated $10,000,000 for the fiscal year
ending June 30, 1971; $15,000,000 for the fiscal year ending June
30, 1972; and $20,000,000 for the fiscal year ending June 30, 1973.
TRAINING GRANTS AND CONTRACTS

SEC. 1003. ø300a–1¿ (a) The Secretary is authorized to make
grants to public or nonprofit private entities and to enter into contracts with public or private entities and individuals to provide the
training for personnel to carry out family planning service programs described in section 1001 or 1002.
(b) For the purpose of making payments pursuant to grants
and contracts under this section, there are authorized to be appropriated $2,000,000 for the fiscal year ending June 30, 1971;
$3,000,000 for the fiscal year ending June 30, 1972; $4,000,000 for
the fiscal year ending June 30, 1973; and $3,000,000 each for the
fiscal years ending June 30, 1974, and June 30, 1975; $4,000,000
for fiscal year 1976; $5,000,000 for the fiscal year ending September 30, 1977; $3,000,000 for the fiscal year ending September
30, 1978; $3,100,000 for the fiscal year ending September 30, 1979;
$3,600,000 for the fiscal year ending September 30, 1980;
$4,100,000 for the fiscal year ending September 30, 1981;
$2,920,000 for the fiscal year ending September 30, 1982;
$3,200,000 for the fiscal year ending September 30, 1983;
$3,500,000 for the fiscal year ending September 30, 1984; and
$3,500,000 for the fiscal year ending September 30, 1985.
RESEARCH

SEC.

1004. ø300a–2¿ The Secretary may—
(1) conduct, and
(2) make grants to public or nonprofit private entities and
enter into contracts with public or private entities and individuals for projects for,
research in the biomedical, contraceptive development, behavioral,
and program implementation fields related to family planning and
population.
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PUBLIC HEALTH SERVICE ACT

Sec. 1006

INFORMATIONAL AND EDUCATIONAL MATERIALS

SEC. 1005. ø300a–3¿ (a) The Secretary is authorized to make
grants to public or nonprofit private entities and to enter into contracts with public or private entities and individuals to assist in developing and making available family planning and population
growth information (including educational materials) to all persons
desiring such information (or materials).
(b) For the purpose of making payments pursuant to grants
and contracts under this section, there are authorized to be appropriated $750,000 for the fiscal year ending June 30, 1971;
$1,000,000 for the fiscal year ending June 30, 1972; $1,250,000 for
the fiscal year ending June 30, 1973; $909,000 each for the fiscal
years ending June 30, 1974, and June 30, 1975; $2,000,000 for fiscal year 1976; $2,500,000 for the fiscal year ending September 30,
1977; $600,000 for the fiscal year ending September 30, 1978;
$700,000 for the fiscal year ending September 30, 1979; $805,000
for the fiscal year ending September 30, 1980; $926,000 for the fiscal year ending September 30, 1981; $570,000 for the fiscal year
ending September 30, 1982; $600,000 for the fiscal year ending
September 30, 1983; $670,000 for the fiscal year ending September
30, 1984; and $700,000 for the fiscal year ending September 30,
1985.
REGULATIONS AND PAYMENTS

SEC. 1006. ø300a–4¿ (a) Grants and contracts made under this
title shall be made in accordance with such regulations as the Secretary may promulgate. The amount of any grant under any section of this title shall be determined by the Secretary; except that
no grant under any such section for any program or project for a
fiscal year beginning after June 30, 1975, may be made for less
than 90 per centum of its costs (as determined under regulations
of the Secretary) unless the grant is to be made for a program or
project for which a grant was made (under the same section) for
the fiscal year ending June 30, 1975, for less than 90 per centum
of its costs (as so determined), in which case a grant under such
section for that program or project for a fiscal year beginning after
that date may be made for a percentage which shall not be less
than the percentage of its costs for which the fiscal year 1975 grant
was made.
(b) Grants under this title shall be payable in such installments and subject to such conditions as the Secretary may determine to be appropriate to assure that such grants will be effectively
utilized for the purposes for which made.
(c) A grant may be made or contract entered into under section
1001 or 1002 for a family planning service project or program only
upon assurances satisfactory to the Secretary that—
(1) priority will be given in such project or program to the
furnishing of such services to persons from low-income families; and
(2) no charge will be made in such project or program for
services provided to any person from a low-income family except to the extent that payment will be made by a third party
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PUBLIC HEALTH SERVICE ACT

1002

(including a government agency) which is authorized or is
under legal obligation to pay such charge.
For purposes of this subsection, the term ‘‘low-income family’’ shall
be defined by the Secretary in accordance with such criteria as he
may prescribe so as to insure that economic status shall not be a
deterrent to participation in the programs assisted under this title.
(d)(1) A grant may be made or a contract entered into under
section 1001 or 1005 only upon assurances satisfactory to the Secretary that informational or educational materials developed or
made available under the grant or contract will be suitable for the
purposes of this title and for the population or community to which
they are to be made available, taking into account the educational
and cultural background of the individuals to whom such materials
are addressed and the standards of such population or community
with respect to such materials.
(2) In the case of any grant or contract under section 1001,
such assurances shall provide for the review and approval of the
suitability of such materials, prior to their distribution, by an advisory committee established by the grantee or contractor in accordance with the Secretary’s regulations. Such a committee shall include individuals broadly representative of the population or community to which the materials are to be made available.
VOLUNTARY PARTICIPATION

SEC. 1007. ø300a–5¿ The acceptance by any individual of family planning services or family planning or population growth information (including educational materials) provided through financial assistance under this title (whether by grant or contract) shall
be voluntary and shall not be a prerequisite to eligibility for or receipt of any other service or assistance from, or to participation in,
any other program of the entity or individual that provided such
service or information.
PROHIBITION OF ABORTION

1008. 1

SEC.
ø300a–6¿ None of the funds appropriated under
this title shall be used in programs where abortion is a method of
family planning.

1 Section

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1009 was repealed by section 601(a)(1)(G) of Public Law 105–362 (112 Stat. 3285).

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TITLE XI—GENETIC DISEASES, HEMOPHILIA PROGRAMS,
AND SUDDEN INFANT DEATH SYNDROME
PART A—GENETIC DISEASES
RESEARCH PROJECT GRANTS AND CONTRACTS

SEC. 1102. ø300b–1¿ In carrying out section 301, the Secretary,
may make grants to public and nonprofit private entities, and may
enter into contracts with public and private entities and individuals, for projects for (1) basic or applied research leading to the understanding, diagnosis, treatment, and control of genetic diseases,
(2) planning, establishing, demonstrating, and developing special
programs for the training of genetic counselors, social and behavioral scientists, and other health professionals, (3) the development
of programs to educate practicing physicians, other health professionals and the public regarding the nature of genetic processes,
the inheritance patterns of genetic diseases, and the means, methods, and facilities available to diagnose, control, counsel, and treat
genetic diseases, and (4) the development of counseling and testing
programs and other programs for the diagnosis, control, and treatment of genetic diseases. In making grants and entering into contracts for projects described in clause (1) of the preceding sentence,
the Secretary shall give priority to applications for such grants or
contracts which are submitted for research on sickle cell anemia
and for research on Cooley’s anemia.
VOLUNTARY PARTICIPATION

SEC. 1103. ø300b–2¿ The participation by any individual in
any program or portion thereof under this part shall be wholly voluntary and shall not be a prerequisite to eligibility for or receipt
of any other service or assistance from, or to participation in, any
other program.
APPLICATION; ADMINISTRATION OF GRANTS AND CONTRACT PROGRAMS

SEC. 1104. ø300b–3¿ (a) A grant or contract under this part
may be made upon application submitted to the Secretary at such
time, in such manner, and containing and accompanied by such information, as the Secretary may require including assurances for
an evaluation whether performed by the applicant or by the Secretary. Such grant or contract may be made available on less than
a state-wide or regional basis. Each applicant shall—
(1) provide that the programs and activities for which assistance under this part is sought will be administered by or
under the supervision of the applicant;
(2) provide for strict confidentiality of all test results, medical records, and other information regarding testing, diagnosis, counseling, or treatment of any person treated, except
1003
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PUBLIC HEALTH SERVICE ACT

1004

for (A) such information as the patient (or his guardian) gives
informed consent to be released, or (B) statistical data compiled without reference to the identity of any such patient;
(3) provide for community representation where appropriate in the development and operation of voluntary genetic
testing or counseling programs funded by a grant or contract
under this part; and
(4) establish fiscal control and fund accounting procedures
as may be necessary to assure proper disbursement of and accounting of Federal funds paid to the applicant under this part.
(b) In making grants and entering into contracts for any fiscal
year under section 301 for projects described in section 1102 the
Secretary shall give special consideration to applications from entities that received grants from, or entered into contracts with, the
Secretary for the preceding fiscal year for the conduct of comprehensive sickle cell centers or sickle cell screening and education
clinics.
PUBLIC HEALTH SERVICE FACILITIES

SEC. 1105. ø300b–4¿ The Secretary shall establish a program
within the Service to provide voluntary testing, diagnosis, counseling, and treatment of individuals respecting genetic diseases.
Services under such program shall be made available through facilities of the Service to persons requesting such services, and the
program shall provide appropriate publicity of the availability and
voluntary nature of such services.
SEC. 1106. [Repealed].
APPLIED TECHNOLOGY

SEC. 1107. ø300b–6¿ The Secretary, acting through an identifiable administrative unit, shall—
(1) conduct epidemiological assessments and surveillance
of genetic diseases to define the scope and extent of such diseases and the need for programs for the diagnosis, treatment,
and control of such diseases, screening for such diseases, and
the counseling of persons with such diseases;
(2) on the basis of the assessments and surveillance described in paragraph (1), develop for use by the States programs which combine in an effective manner diagnosis, treatment, and control of such diseases, screening for such diseases,
and counseling of persons with such diseases; and
(3) on the basis of the assessments and surveillance described in paragraph (1), provide technical assistance to States
to implement the programs developed under paragraph (2) and
train appropriate personnel for such programs.
In carrying out this section, the Secretary may, from funds allotted
for use under section 502(a) of the Social Security Act, make grants
to or contracts with public or nonprofit private entities (including
grants and contracts for demonstration projects).
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1005

PUBLIC HEALTH SERVICE ACT

Sec. 1109

TOURETTE SYNDROME

SEC. 1108. ø300b–7¿ (a) IN GENERAL.—The Secretary shall develop and implement outreach programs to educate the public,
health care providers, educators and community based organizations about the etiology, symptoms, diagnosis and treatment of
Tourette Syndrome, with a particular emphasis on children with
Tourette Syndrome. Such programs may be carried out by the Secretary directly and through awards of grants or contracts to public
or nonprofit private entities.
(b) CERTAIN ACTIVITIES.—Activities under subsection (a) shall
include—
(1) the production and translation of educational materials,
including public service announcements;
(2) the development of training material for health care
providers, educators and community based organizations; and
(3) outreach efforts directed at the misdiagnosis and
underdiagnosis of Tourette Syndrome in children and in minority groups.
(c) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of
carrying out this section, there are authorized to be appropriated
such sums as may be necessary for each of the fiscal years 2001
through 2005.
SEC. 1109. ø300b–8¿ IMPROVED NEWBORN AND CHILD SCREENING FOR
HERITABLE DISORDERS.
(a) AUTHORIZATION OF GRANT PROGRAM.—From amounts ap-

propriated under subsection (j), the Secretary, acting through the
Administrator of the Health Resources and Services Administration
(referred to in this section as the ‘‘Administrator’’) and in consultation with the Advisory Committee on Heritable Disorders in
Newborns and Children (referred to in this section as the ‘‘Advisory
Committee’’), shall award grants to eligible entities to enable such
entities—
(1) to enhance, improve or expand the ability of State and
local public health agencies to provide screening, counseling, or
health care services to newborns and children having or at risk
for heritable disorders;
(2) to assist in providing health care professionals and
newborn screening laboratory personnel with education in newborn screening and training in relevant and new technologies
in newborn screening and congenital, genetic, and metabolic
disorders;
(3) to develop and deliver educational programs (at appropriate literacy levels) about newborn screening counseling,
testing, follow-up, treatment, and specialty services to parents,
families, and patient advocacy and support groups; and
(4) to establish, maintain, and operate a system to assess
and coordinate treatment relating to congenital, genetic, and
metabolic disorders.
(b) ELIGIBLE ENTITY.—In this section, the term ‘‘eligible entity’’
means—
(1) a State or a political subdivision of a State;
(2) a consortium of 2 or more States or political subdivisions of States;
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PUBLIC HEALTH SERVICE ACT

1006

(3) a territory;
(4) a health facility or program operated by or pursuant to
a contract with or grant from the Indian Health Service; or
(5) any other entity with appropriate expertise in newborn
screening, as determined by the Secretary.
(c) APPROVAL FACTORS.—An application submitted for a grant
under subsection (a)(1) shall not be approved by the Secretary unless the application contains assurances that the eligible entity has
adopted and implemented, is in the process of adopting and implementing, or will use amounts received under such grant to adopt
and implement the guidelines and recommendations of the Advisory Committee that are adopted by the Secretary and in effect at
the time the grant is awarded or renewed under this section, which
shall include the screening of each newborn for the heritable disorders recommended by the Advisory Committee and adopted by
the Secretary.
(d) COORDINATION.—The Secretary shall take all necessary
steps to coordinate programs funded with grants received under
this section and to coordinate with existing newborn screening activities.
(e) LIMITATION.—An eligible entity may not use amounts received under this section to—
(1) provide cash payments to or on behalf of affected individuals;
(2) provide inpatient services;
(3) purchase land or make capital improvements to property; or
(4) provide for proprietary research or training.
(f ) VOLUNTARY PARTICIPATION.—The participation by any individual in any program or portion thereof established or operated
with funds received under this section shall be wholly voluntary
and shall not be a prerequisite to eligibility for or receipt of any
other service or assistance from, or to participation in, another Federal or State program.
(g) SUPPLEMENT NOT SUPPLANT.—Funds appropriated under
this section shall be used to supplement and not supplant other
Federal, State, and local public funds provided for activities of the
type described in this section.
(h) PUBLICATION.—
(1) IN GENERAL.—An application submitted under subsection (c)(2) 1 shall be made public by the State in such a
manner as to facilitate comment from any person, including
through hearings and other methods used to facilitate comments from the public.
(2) COMMENTS.—Comments received by the State after the
publication described in paragraph (1) shall be addressed in
the application submitted under subsection (c)(2) 1.
(i) TECHNICAL ASSISTANCE.—The Secretary shall provide to entities receiving grants under subsection (a) such technical assistance as may be necessary to ensure the quality of programs conducted under this section.
1 Subsection (c)(2) was stricken by section 2(1) of the Newborn Screening Saves Lives Act of
2007 (Public Law 110–204).

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1007

PUBLIC HEALTH SERVICE ACT

Sec. 1111

(j) AUTHORIZATION OF APPROPRIATIONS.—There are authorized
to be appropriated—
(1) to provide grants for the purpose of carrying out activities under subsection (a)(1), $15,000,000 for fiscal year 2009; 1
$15,187,500 for fiscal year 2010, $15,375,000 for fiscal year
2011, $15,562,500 for fiscal year 2012, and $15,750,000 for fiscal year 2013; and
(2) to provide grants for the purpose of carrying out activities under paragraphs (2), (3), and (4) of subsection (a),
$15,000,000 for fiscal year 2009, $15,187,500 for fiscal year
2010, $15,375,000 for fiscal year 2011, $15,562,500 for fiscal
year 2012, and $15,750,000 for fiscal year 2013.
SEC. 1110. ø300b–9¿ EVALUATING THE EFFECTIVENESS OF NEWBORN
AND CHILD SCREENING PROGRAMS.
(a) IN GENERAL.—The Secretary shall award grants to eligible

entities to provide for the conduct of demonstration programs to
evaluate the effectiveness of screening, counseling or health care
services in reducing the morbidity and mortality caused by heritable disorders in newborns and children.
(b) DEMONSTRATION PROGRAMS.—A demonstration program
conducted under a grant under this section shall be designed to
evaluate and assess, within the jurisdiction of the entity receiving
such grant—
(1) the effectiveness of screening, counseling, testing or
specialty services for newborns and children at risk for heritable disorders in reducing the morbidity and mortality associated with such disorders;
(2) the effectiveness of screening, counseling, testing or
specialty services in accurately and reliably diagnosing heritable disorders in newborns and children; or
(3) the availability of screening, counseling, testing or specialty services for newborns and children at risk for heritable
disorders.
(c) ELIGIBLE ENTITIES.—To be eligible to receive a grant under
subsection (a) an entity shall be a State or political subdivision of
a State, or a consortium of two or more States or political subdivisions of States.
(d) AUTHORIZATION OF APPROPRIATIONS.—There are authorized
to be appropriated to carry out this section $5,000,000 for fiscal
year 2009, $5,062,500 for fiscal year 2010, $5,125,000 for fiscal
year 2011, $5,187,500 for fiscal year 2012, and $5,250,000 for fiscal
year 2013.
SEC. 1111. ø300b–10¿ ADVISORY COMMITTEE ON HERITABLE DISORDERS IN NEWBORNS AND CHILDREN.
(a) ESTABLISHMENT.—The Secretary shall establish an advisory

committee to be known as the ‘‘Advisory Committee on Heritable
Disorders in Newborns and Children’’ (referred to in this section as
the ‘‘Advisory Committee’’).
(b) DUTIES.—The Advisory Committee shall—
(1) provide advice and recommendations to the Secretary
concerning grants and projects awarded or funded under section 1109;
1 So

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in law. The semicolon after the dollar amount for fiscal year 2009 should be a comma.

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PUBLIC HEALTH SERVICE ACT

1008

(2) provide technical information to the Secretary for the
development of policies and priorities for the administration of
grants under section 1109;
(3) make systematic evidence-based and peer-reviewed recommendations that include the heritable disorders that have
the potential to significantly impact public health for which all
newborns should be screened, including secondary conditions
that may be identified as a result of the laboratory methods
used for screening;
(4) develop a model decision-matrix for newborn screening
expansion, including an evaluation of the potential public
health impact of such expansion, and periodically update the
recommended uniform screening panel, as appropriate, based
on such decision-matrix;
(5) consider ways to ensure that all States attain the capacity to screen for the conditions described in paragraph (3),
and include in such consideration the results of grant funding
under section 1109; and
(6) provide such recommendations, advice or information
as may be necessary to enhance, expand or improve the ability
of the Secretary to reduce the mortality or morbidity from heritable disorders, which may include recommendations, advice,
or information dealing with—
(A) follow-up activities, including those necessary to
achieve rapid diagnosis in the short-term, and those that
ascertain long-term case management outcomes and appropriate access to related services;
(B) implementation, monitoring, and evaluation of
newborn screening activities, including diagnosis, screening, follow-up, and treatment activities;
(C) diagnostic and other technology used in screening;
(D) the availability and reporting of testing for conditions for which there is no existing treatment;
(E) conditions not included in the recommended uniform screening panel that are treatable with Food and
Drug Administration-approved products or other safe and
effective treatments, as determined by scientific evidence
and peer review;
(F) minimum standards and related policies and procedures used by State newborn screening programs, such as
language and terminology used by State newborn screening programs to include standardization of case definitions
and names of disorders for which newborn screening tests
are performed;
(G) quality assurance, oversight, and evaluation of
State newborn screening programs, including ensuring
that tests and technologies used by each State meet established standards for detecting and reporting positive
screening results;
(H) public and provider awareness and education;
(I) the cost and effectiveness of newborn screening and
medical evaluation systems and intervention programs
conducted by State-based programs;
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1009

PUBLIC HEALTH SERVICE ACT

Sec. 1111

(J) identification of the causes of, public health impacts of, and risk factors for heritable disorders; and
(K) coordination of surveillance activities, including
standardized data collection and reporting, harmonization
of laboratory definitions for heritable disorders and testing
results, and confirmatory testing and verification of positive results, in order to assess and enhance monitoring of
newborn diseases.
(c) MEMBERSHIP.—
(1) IN GENERAL.—The Secretary shall appoint not to exceed
15 members to the Advisory Committee. In appointing such
members, the Secretary shall ensure that the total membership of the Advisory Committee is an odd number.
(2) REQUIRED MEMBERS.—The Secretary shall appoint to
the Advisory Committee under paragraph (1)—
(A) the Administrator of the Health Resources and
Services Administration;
(B) the Director of the Centers for Disease Control and
Prevention;
(C) the Director of the National Institutes of Health;
(D) the Director of the Agency for Healthcare Research
and Quality;
(E) the Commissioner of the Food and Drug Administration;
(F) medical, technical, or scientific professionals with
special expertise in heritable disorders, or in providing
screening, counseling, testing or specialty services for
newborns and children at risk for heritable disorders;
(G) individuals with expertise in ethics and infectious
diseases who have worked and published material in the
area of newborn screening;
(H) members of the public having special expertise
about or concern with heritable disorders; and
(I) representatives from such Federal agencies, public
health constituencies, and medical professional societies as
determined to be necessary by the Secretary, to fulfill the
duties of the Advisory Committee, as established under
subsection (b).
(d) DECISION ON RECOMMENDATIONS.—
(1) IN GENERAL.—Not later than 180 days after the Advisory Committee issues a recommendation pursuant to this section, the Secretary shall adopt or reject such recommendation.
(2) PENDING RECOMMENDATIONS.—The Secretary shall
adopt or reject any recommendation issued by the Advisory
Committee that is pending on the date of enactment of the
Newborn Screening Saves Lives Act of 2008 by not later than
180 days after the date of enactment of such Act.
(3) DETERMINATIONS TO BE MADE PUBLIC.—The Secretary
shall publicize any determination on adopting or rejecting a
recommendation of the Advisory Committee pursuant to this
subsection, including the justification for the determination.
(e) ANNUAL REPORT.—Not later than 3 years after the date of
enactment of the Newborn Screening Saves Lives Act of 2008, and
each fiscal year thereafter, the Advisory Committee shall—
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PUBLIC HEALTH SERVICE ACT

1010

(1) publish a report on peer-reviewed newborn screening
guidelines, including follow-up and treatment, in the United
States;
(2) submit such report to the appropriate committees of
Congress, the Secretary, the Interagency Coordinating Committee established under Section 1114, and the State departments of health; and
(3) disseminate such report on as wide a basis as practicable, including through posting on the internet clearinghouse established under section 1112.
(f) CONTINUATION OF OPERATION OF COMMITTEE.—Notwithstanding section 14 of the Federal Advisory Committee Act (5
U.S.C. App.), the Advisory Committee shall continue to operate
during the 5-year period beginning on the date of enactment of the
Newborn Screening Saves Lives Act of 2008.
(g) AUTHORIZATION OF APPROPRIATIONS.—There are authorized
to be appropriated to carry out this section, $1,000,000 for fiscal
year 2009, $1,012,500 for fiscal year 2010, $1,025,000 for fiscal
year 2011, $1,037,500 for fiscal year 2012, and $1,050,000 for fiscal
year 2013.
SEC. 1112. ø300b–11¿ CLEARINGHOUSE OF NEWBORN SCREENING INFORMATION.
(a) IN GENERAL.—The Secretary, acting through the Adminis-

trator of the Health Resources and Services Administration (referred to in this part as the ‘‘Administrator’’), in consultation with
the Director of the Centers for Disease Control and Prevention and
the Director of the National Institutes of Health, shall establish
and maintain a central clearinghouse of current educational and
family support and services information, materials, resources, research, and data on newborn screening to—
(1) enable parents and family members of newborns,
health professionals, industry representatives, and other members of the public to increase their awareness, knowledge, and
understanding of newborn screening;
(2) increase awareness, knowledge, and understanding of
newborn diseases and screening services for expectant individuals and families; and
(3) maintain current data on quality indicators to measure
performance of newborn screening, such as false-positive rates
and other quality indicators as determined by the Advisory
Committee under section 1111.
(b) INTERNET AVAILABILITY.—The Secretary, acting through the
Administrator, shall ensure that the clearinghouse described under
subsection (a)—
(1) is available on the Internet;
(2) includes an interactive forum;
(3) is updated on a regular basis, but not less than quarterly; and
(4) provides—
(A) links to Government-sponsored, non-profit, and
other Internet websites of laboratories that have demonstrated expertise in newborn screening that supply research-based information on newborn screening tests currently available throughout the United States;
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PUBLIC HEALTH SERVICE ACT

Sec. 1114

(B) information about newborn conditions and screening services available in each State from laboratories certified under subpart 2 of part F of title III, including information about supplemental screening that is available but
not required, in the State where the infant is born;
(C) current research on both treatable and not-yet
treatable conditions for which newborn screening tests are
available;
(D) the availability of Federal funding for newborn
and child screening for heritable disorders including
grants authorized under the Newborn Screening Saves
Lives Act of 2008; and
(E) other relevant information as determined appropriate by the Secretary.
(c) NONDUPLICATION.—In developing the clearinghouse under
this section, the Secretary shall ensure that such clearinghouse
minimizes duplication and supplements, not supplants, existing information sharing efforts.
(d) AUTHORIZATION OF APPROPRIATIONS.—There are authorized
to be appropriated to carry out this section, $2,500,000 for fiscal
year 2009, $2,531,250 for fiscal year 2010, $2,562,500 for fiscal
year 2011, $2,593,750 for fiscal year 2012, and $2,625,000 for fiscal
year 2013.
SEC. 1113. ø300b–12¿ LABORATORY QUALITY.
(a) IN GENERAL.—The Secretary, acting

through the Director of
the Centers for Disease Control and Prevention and in consultation
with the Advisory Committee on Heritable Disorders in Newborns
and Children established under section 1111, shall provide for—
(1) quality assurance for laboratories involved in screening
newborns and children for heritable disorders, including quality assurance for newborn-screening tests, performance evaluation services, and technical assistance and technology transfer
to newborn screening laboratories to ensure analytic validity
and utility of screening tests; and
(2) appropriate quality control and other performance test
materials to evaluate the performance of new screening tools.
(b) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of
carrying out this section, there are authorized to be appropriated
$5,000,000 for fiscal year 2009, $5,062,500 for fiscal year 2010,
$5,125,000 for fiscal year 2011, $5,187,500 for fiscal year 2012, and
$5,250,000 for fiscal year 2013.
SEC. 1114. ø300b–13¿ INTERAGENCY COORDINATING COMMITTEE ON
NEWBORN AND CHILD SCREENING.
(a) PURPOSE.—It is the purpose of this section to—

(1) assess existing activities and infrastructure, including
activities on birth defects and developmental disabilities authorized under section 317C, in order to make recommendations for programs to collect, analyze, and make available data
on the heritable disorders recommended by the Advisory Committee on Heritable Disorders in Newborns and Children under
section 1111, including data on the incidence and prevalence
of, as well as poor health outcomes resulting from, such disorders; and
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1012

(2) make recommendations for the establishment of regional centers for the conduct of applied epidemiological research on effective interventions to promote the prevention of
poor health outcomes resulting from such disorders as well as
providing information and education to the public on such effective interventions.
(b) ESTABLISHMENT.—The Secretary shall establish an Interagency Coordinating Committee on Newborn and Child Screening
(referred to in this section as the ‘‘Interagency Coordinating Committee’’) to carry out the purpose of this section.
(c) COMPOSITION.—The Interagency Coordinating Committee
shall be composed of the Director of the Centers for Disease Control and Prevention, the Administrator, the Director of the Agency
for Healthcare Research and Quality, and the Director of the National Institutes of Health, or their designees.
(d) ACTIVITIES.—The Interagency Coordinating Committee
shall—
(1) report to the Secretary and the appropriate committees
of Congress on its recommendations related to the purpose described in subsection (a); and
(2) carry out other activities determined appropriate by the
Secretary.
(e) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of
carrying out this section, there are authorized to be appropriated
$1,000,000 for fiscal year 2009, $1,012,500 for fiscal year 2010,
$1,025,000 for fiscal year 2011, $1,037,500 for fiscal year 2012, and
$1,050,000 for fiscal year 2013.
SEC. 1115. ø300b–14¿ NATIONAL CONTINGENCY PLAN FOR NEWBORN
SCREENING.
(a) IN GENERAL.—Not later than 180 days after the date of en-

actment of this section, the Secretary, acting through the Director
of the Centers for Disease Control and Prevention and in consultation with the Administrator and State departments of health (or related agencies), shall develop a national contingency plan for newborn screening for use by a State, region, or consortia 1 of States
in the event of a public health emergency.
(b) CONTENTS.—The contingency plan developed under subsection (a) shall include a plan for—
(1) the collection and transport of specimens;
(2) the shipment of specimens to State newborn screening
laboratories;
(3) the processing of specimens;
(4) the reporting of screening results to physicians and
families;
(5) the diagnostic confirmation of positive screening results;
(6) ensuring the availability of treatment and management
resources;
(7) educating families about newborn screening; and
(8) carrying out other activities determined appropriate by
the Secretary.
1 The reference to ‘‘consortia of States’’ in subsection (a) probably should refer to the ‘‘consortium of States’’.

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PUBLIC HEALTH SERVICE ACT

Sec. 1122

SEC. 1116. ø300b–15¿ HUNTER KELLY RESEARCH PROGRAM.
(a) NEWBORN SCREENING ACTIVITIES.—
(1) IN GENERAL.—The Secretary, in conjunction

with the
Director of the National Institutes of Health and taking into
consideration the recommendations of the Advisory Committee,
may continue carrying out, coordinating, and expanding research in newborn screening (to be known as ‘‘Hunter Kelly
Newborn Screening Research Program’’) including—
(A) identifying, developing, and testing the most promising new screening technologies, in order to improve already existing screening tests, increase the specificity of
newborn screening, and expand the number of conditions
for which screening tests are available;
(B) experimental treatments and disease management
strategies for additional newborn conditions, and other genetic, metabolic, hormonal, or functional conditions that
can be detected through newborn screening for which
treatment is not yet available; and
(C) other activities that would improve newborn
screening, as identified by the Director.
(2) ADDITIONAL NEWBORN CONDITION.—For purposes of this
subsection, the term ‘‘additional newborn condition’’ means any
condition that is not one of the core conditions recommended
by the Advisory Committee and adopted by the Secretary.
(b) FUNDING.—In carrying out the research program under this
section, the Secretary and the Director shall ensure that entities
receiving funding through the program will provide assurances, as
practicable, that such entities will work in consultation with the
appropriate State departments of health, and, as practicable, focus
their research on screening technology not currently performed in
the States in which the entities are located, and the conditions on
the uniform screening panel (or the standard test existing on the
uniform screening panel).
(c) REPORTS.—The Director is encouraged to include information about the activities carried out under this section in the biennial report required under section 403 of the National Institutes of
Health Reform Act of 2006. If such information is included, the Director shall make such information available to be included on the
Internet Clearinghouse established under section 1112.
(d) NONDUPLICATION.—In carrying out programs under this
section, the Secretary shall minimize duplication and supplement,
not supplant, existing efforts of the type carried out under this section.
(e) PEER REVIEW.—Nothing in this section shall be construed
to interfere with the scientific peer-review process at the National
Institutes of Health.
PART B—SUDDEN INFANT DEATH SYNDROME
SUDDEN INFANT DEATH SYNDROME RESEARCH AND RESEARCH
REPORTS

SEC. 1122. ø300c–12¿ From the sums appropriated to the Eunice Kennedy Shriver National Institute of Child Health and
Human Development, the Secretary shall assure that there are apMarch 13, 2013

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PUBLIC HEALTH SERVICE ACT

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plied to research of the type described in subparagraphs (A) and
(B) of subsection (b)(1) of this section such amounts each year as
will be adequate, given the leads and findings then available from
such research, in order to make maximum feasible progress toward
identification of infants at risk of sudden infant death syndrome
and prevention of sudden infant death syndrome.
PART C—HEMOPHILIA PROGRAMS
BLOOD SEPARATION CENTERS

SEC. 1132. ø300c–22¿ (a) The Secretary may make grants to
and enter into contracts with public and nonprofit private entities
for projects to develop and expand, within existing facilities, bloodseparation centers to separate and make available for distribution
blood components to providers of blood services and manufacturers
of blood fractions. For purposes of this section—
(1) the term ‘‘blood components’’ means those constituents
of whole blood which are used for therapy and which are obtained by physical separation processes which result in licensed products such as red blood cells, platelets, white blood
cells, AHF-rich plasma, fresh-frozen plasma, cryoprecipitate,
and single unit plasma for infusion; and
(2) the term ‘‘blood fractions’’ means those constituents of
plasma which are used for therapy and which are obtained by
licensed fractionation processes presently used in manufacturing which result in licensed products such as normal serum
albumin, plasma, protein fraction, prothrombin complex,
fibrinogen, AHF concentrate, immune serum globulin, and
hyperimmune globulins.
(b) In the event the Secretary finds that there is an insufficient
supply of blood fractions available to meet the needs for treatment
of persons suffering from hemophilia, and that public and other
nonprofit private centers already engaged in the production of
blood fractions could alleviate such insufficiency with assistance
under this subsection, he may make grants not to exceed $500,000
to such centers for the purposes of alleviating the insufficiency.
(c) No grant or contract may be made under subsection (a) or
(b) unless an application therefor has been submitted to and approved by the Secretary. Such an application shall be in such form,
submitted in such manner, and contain such information as the
Secretary shall by regulation prescribe.
(d) Contracts may be entered into under subsection (a) without
regard to section 3648 and 3709 of the Revised Statutes (31 U.S.C.
529; 41 U.S.C. 5).
(e) For the purpose of making payments under grants and contracts under subsections (a) and (b), there are authorized to be appropriated $4,000,000 for fiscal year 1976, $5,000,000 for the fiscal
year ending September 30, 1977, $3,450,000 for the fiscal year ending September 30, 1978, $2,500,000 for the fiscal year ending September 30, 1979, $3,000,000 for the fiscal year ending September
30, 1980, $3,500,000 for the fiscal year ending September 30, 1981.
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TITLE XII—TRAUMA CARE
PART A—GENERAL AUTHORITY

AND

SEC. 1201. ø300d¿ ESTABLISHMENT.
(a) IN GENERAL.—The Secretary

DUTIES

OF

SECRETARY

shall, with respect to trauma

care—
(1) conduct and support research, training, evaluations,
and demonstration projects;
(2) foster the development of appropriate, modern systems
of such care through the sharing of information among agencies and individuals involved in the study and provision of such
care;
(3) collect, compile, and disseminate information on the
achievements of, and problems experienced by, State and local
agencies and private entities in providing trauma care and
emergency medical services and, in so doing, give special consideration to the unique needs of rural areas;
(4) provide to State and local agencies technical assistance
to enhance each State’s capability to develop, implement, and
sustain the trauma care component of each State’s plan for the
provision of emergency medical services;
(5) sponsor workshops and conferences; and
(6) promote the collection and categorization of trauma
data in a consistent and standardized manner.
(b) GRANTS, COOPERATIVE AGREEMENTS, AND CONTRACTS.—The
Secretary may make grants, and enter into cooperative agreements
and contracts, for the purpose of carrying out subsection (a).
SEC. 1202. ø300d–3¿ ESTABLISHMENT OF PROGRAMS FOR IMPROVING
TRAUMA CARE IN RURAL AREAS.
(a) IN GENERAL.—The Secretary may make grants to public

and nonprofit private entities for the purpose of carrying out research and demonstration projects with respect to improving the
availability and quality of emergency medical services in rural
areas—
(1) by developing innovative uses of communications technologies and the use of new communications technology;
(2) by developing model curricula, such as advanced trauma life support, for training emergency medical services personnel, including first responders, emergency medical technicians, emergency nurses and physicians, and paramedics—
(A) in the assessment, stabilization, treatment, preparation for transport, and resuscitation of seriously injured
patients, with special attention to problems that arise during long transports and to methods of minimizing delays
in transport to the appropriate facility; and
(B) in the management of the operation of the emergency medical services system;
1015
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(3) by making training for original certification, and continuing education, in the provision and management of emergency medical services more accessible to emergency medical
personnel in rural areas through telecommunications, home
studies, providing teachers and training at locations accessible
to such personnel, and other methods;
(4) by developing innovative protocols and agreements to
increase access to prehospital care and equipment necessary
for the transportation of seriously injured patients to the appropriate facilities;
(5) by evaluating the effectiveness of protocols with respect
to emergency medical services and systems; and
(6) by increasing communication and coordination with
State trauma systems.
(b) SPECIAL CONSIDERATION FOR CERTAIN RURAL AREAS.—In
making grants under subsection (a), the Secretary shall give special consideration to any applicant for the grant that will provide
services under the grant in any rural area identified by a State
under section 1214(d)(1).
(c) REQUIREMENT OF APPLICATION.—The Secretary may not
make a grant under subsection (a) unless an application for the
grant is submitted to the Secretary and the application is in such
form, is made in such manner, and contains such agreements, assurances, and information as the Secretary determines to be necessary to carry out this section.
SEC. 1203. ø300d–5¿ COMPETITIVE GRANTS FOR TRAUMA SYSTEMS
FOR THE IMPROVEMENT OF TRAUMA CARE.
(a) IN GENERAL.—The Secretary, acting through the Assistant

Secretary for Preparedness and Response, may make grants to
States, political subdivisions, or consortia of States or political subdivisions for the purpose of improving access to and enhancing the
development of trauma care systems.
(b) USE OF FUNDS.—The Secretary may make a grant under
this section only if the applicant agrees to use the grant—
(1) to integrate and broaden the reach of a trauma care
system, such as by developing innovative protocols to increase
access to prehospital care;
(2) to strengthen, develop, and improve an existing trauma
care system;
(3) to expand communications between the trauma care
system and emergency medical services through improved
equipment or a telemedicine system;
(4) to improve data collection and retention; or
(5) to increase education, training, and technical assistance
opportunities, such as training and continuing education in the
management of emergency medical services accessible to emergency medical personnel in rural areas through telehealth,
home studies, and other methods.
(c) PREFERENCE.—In selecting among States, political subdivisions, and consortia of States or political subdivisions for purposes
of making grants under this section, the Secretary shall give preference to applicants that—
(1) have developed a process, using national standards, for
designating trauma centers;
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PUBLIC HEALTH SERVICE ACT

Sec. 1204

(2) recognize protocols for the delivery of seriously injured
patients to trauma centers;
(3) implement a process for evaluating the performance of
the trauma system; and
(4) agree to participate in information systems described in
section 1202 by collecting, providing, and sharing information.
(d) PRIORITY.—In making grants under this section, the Secretary shall give priority to applicants that will use the grants to
focus on improving access to trauma care systems.
(e) SPECIAL CONSIDERATION.—In awarding grants under this
section, the Secretary shall give special consideration to projects
that demonstrate strong State or local support, including availability of non-Federal contributions.
SEC. 1204. ø300d–6¿ COMPETITIVE GRANTS FOR REGIONALIZED SYSTEMS FOR EMERGENCY CARE RESPONSE.
(a) IN GENERAL.—The Secretary, acting through the Assistant

Secretary for Preparedness and Response, shall award not fewer
than 4 multiyear contracts or competitive grants to eligible entities
to support pilot projects that design, implement, and evaluate innovative models of regionalized, comprehensive, and accountable
emergency care and trauma systems.
(b) ELIGIBLE ENTITY; REGION.—In this section:
(1) ELIGIBLE ENTITY.—The term ‘‘eligible entity’’ means—
(A) a State or a partnership of 1 or more States and
1 or more local governments; or
(B) an Indian tribe (as defined in section 4 of the Indian Health Care Improvement Act) or a partnership of 1
or more Indian tribes.
(2) REGION.—The term ‘‘region’’ means an area within a
State, an area that lies within multiple States, or a similar
area (such as a multicounty area), as determined by the Secretary.
(3) EMERGENCY SERVICES.—The term ‘‘emergency services’’
includes acute, prehospital, and trauma care.
(c) PILOT PROJECTS.—The Secretary shall award a contract or
grant under subsection (a) to an eligible entity that proposes a pilot
project to design, implement, and evaluate an emergency medical
and trauma system that—
(1) coordinates with public health and safety services,
emergency medical services, medical facilities, trauma centers,
and other entities in a region to develop an approach to emergency medical and trauma system access throughout the region, including 9–1–1 Public Safety Answering Points and
emergency medical dispatch;
(2) includes a mechanism, such as a regional medical direction or transport communications system, that operates
throughout the region to ensure that the patient is taken to
the medically appropriate facility (whether an initial facility or
a higher-level facility) in a timely fashion;
(3) allows for the tracking of prehospital and hospital resources, including inpatient bed capacity, emergency department capacity, trauma center capacity, on-call specialist coverage, ambulance diversion status, and the coordination of
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1018

such tracking with regional communications and hospital destination decisions; and
(4) includes a consistent region-wide prehospital, hospital,
and interfacility data management system that—
(A) submits data to the National EMS Information
System, the National Trauma Data Bank, and others;
(B) reports data to appropriate Federal and State
databanks and registries; and
(C) contains information sufficient to evaluate key elements of prehospital care, hospital destination decisions,
including initial hospital and interfacility decisions, and
relevant health outcomes of hospital care.
(d) APPLICATION.—
(1) IN GENERAL.—An eligible entity that seeks a contract
or grant described in subsection (a) shall submit to the Secretary an application at such time and in such manner as the
Secretary may require.
(2) APPLICATION INFORMATION.—Each application shall include—
(A) an assurance from the eligible entity that the proposed system—
(i) has been coordinated with the applicable State
Office of Emergency Medical Services (or equivalent
State office);
(ii) includes consistent indirect and direct medical
oversight of prehospital, hospital, and interfacility
transport throughout the region;
(iii) coordinates prehospital treatment and triage,
hospital destination, and interfacility transport
throughout the region;
(iv) includes a categorization or designation system for special medical facilities throughout the region
that is integrated with transport and destination protocols;
(v) includes a regional medical direction, patient
tracking, and resource allocation system that supports
day-to-day emergency care and surge capacity and is
integrated with other components of the national and
State emergency preparedness system; and
(vi) addresses pediatric concerns related to integration, planning, preparedness, and coordination of
emergency medical services for infants, children and
adolescents; and
(B) such other information as the Secretary may require.
(e) REQUIREMENT OF MATCHING FUNDS.—
(1) IN GENERAL.—The Secretary may not make a grant
under this section unless the State (or consortia of States) involved agrees, with respect to the costs to be incurred by the
State (or consortia) in carrying out the purpose for which such
grant was made, to make available non-Federal contributions
(in cash or in kind under paragraph (2)) toward such costs in
an amount equal to not less than $1 for each $3 of Federal
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PUBLIC HEALTH SERVICE ACT

Sec. 1211

funds provided in the grant. Such contributions may be made
directly or through donations from public or private entities.
(2) NON-FEDERAL CONTRIBUTIONS.—Non-Federal contributions required in paragraph (1) may be in cash or in kind, fairly evaluated, including equipment or services (and excluding
indirect or overhead costs). Amounts provided by the Federal
Government, or services assisted or subsidized to any significant extent by the Federal Government, may not be included
in determining the amount of such non-Federal contributions.
(f) PRIORITY.—The Secretary shall give priority for the award
of the contracts or grants described in subsection (a) to any eligible
entity that serves a population in a medically underserved area (as
defined in section 330(b)(3)).
(g) REPORT.—Not later than 90 days after the completion of a
pilot project under subsection (a), the recipient of such contract or
grant described in shall submit to the Secretary a report containing
the results of an evaluation of the program, including an identification of—
(1) the impact of the regional, accountable emergency care
and trauma system on patient health outcomes for various critical care categories, such as trauma, stroke, cardiac emergencies, neurological emergencies, and pediatric emergencies;
(2) the system characteristics that contribute to the effectiveness and efficiency of the program (or lack thereof);
(3) methods of assuring the long-term financial sustainability of the emergency care and trauma system;
(4) the State and local legislation necessary to implement
and to maintain the system;
(5) the barriers to developing regionalized, accountable
emergency care and trauma systems, as well as the methods
to overcome such barriers; and
(6) recommendations on the utilization of available funding
for future regionalization efforts.
(h) DISSEMINATION OF FINDINGS.—The Secretary shall, as appropriate, disseminate to the public and to the appropriate Committees of the Congress, the information contained in a report
made under subsection (g).
PART B—FORMULA GRANTS WITH RESPECT
STATE PLANS

TO

MODIFICATIONS

SEC. 1211. ø300d–11¿ ESTABLISHMENT OF PROGRAM.
(a) REQUIREMENT OF ALLOTMENTS FOR STATES.—The

OF

Secretary
shall for each fiscal year make an allotment for each State in an
amount determined in accordance with section 1218. The Secretary
shall make payments, as grants, each fiscal year to each State from
the allotment for the State if the Secretary approves for the fiscal
year involved an application submitted by the State pursuant to
section 1217.
(b) PURPOSE.—Except as provided in section 1233, the Secretary may not make payments under this part for a fiscal year unless the State involved agrees that, with respect to the trauma care
component of the State plan for the provision of emergency medical
services, the payments will be expended only for the purpose of de-

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PUBLIC HEALTH SERVICE ACT

1020

veloping, implementing, and monitoring the modifications to such
component described in section 1213.
SEC. 1212. ø300d–12¿ REQUIREMENT OF MATCHING FUNDS FOR FISCAL YEARS SUBSEQUENT TO FIRST FISCAL YEAR OF PAYMENTS.
(a) NON-FEDERAL CONTRIBUTIONS.—
(1) IN GENERAL.—The Secretary may not make payments

under section 1211(a) unless the State involved agrees, with
respect to the costs described in paragraph (2), to make available non-Federal contributions (in cash or in kind under subsection (b)(1)) toward such costs in an amount that—
(A) for the second and third fiscal years of such payments to the State, is not less than $1 for each $1 of Federal funds provided in such payments for such fiscal years;
and
(B) for the fourth and subsequent fiscal years of such
payments to the State, is not less than $2 for each $1 of
Federal funds provided in such payments for such fiscal
years.
(2) PROGRAM COSTS.—The costs referred to in paragraph
(1) are—
(A) the costs to be incurred by the State in carrying
out the purpose described in section 1211(b); or
(B) the costs of improving the quality and availability
of emergency medical services in rural areas of the State.
(3) INITIAL YEAR OF PAYMENTS.—The Secretary may not require a State to make non-Federal contributions as a condition
of receiving payments under section 1211(a) for the first fiscal
year of such payments to the State.
(b) DETERMINATION OF AMOUNT OF NON-FEDERAL CONTRIBUTION.—With respect to compliance with subsection (a) as a condition of receiving payments under section 1211(a)—
(1) a State may make the non-Federal contributions required in such subsection in cash or in kind, fairly evaluated,
including plant, equipment, or services; and
(2) the Secretary may not, in making a determination of
the amount of non-Federal contributions, include amounts provided by the Federal Government or services assisted or subsidized to any significant extent by the Federal Government.
SEC. 1213. ø300d–13¿ REQUIREMENTS WITH RESPECT TO CARRYING
OUT PURPOSE OF ALLOTMENTS.
(a) TRAUMA CARE MODIFICATIONS TO STATE PLAN FOR EMERGENCY MEDICAL SERVICES.—With respect to the trauma care com-

ponent of a State plan for the provision of emergency medical services, the modifications referred to in section 1211(b) are such modifications to the State plan as may be necessary for the State involved to ensure that the plan provides for access to the highest
possible quality of trauma care, and that the plan—
(1) specifies that the modifications required pursuant to
paragraphs (2) through (11) will be implemented by the principal State agency with respect to emergency medical services
or by the designee of such agency;
(2) specifies a public or private entity that will designate
trauma care regions and trauma centers in the State;
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Sec. 1213

(3) subject to subsection (b), contains national standards
and requirements of the American College of Surgeons or another appropriate entity for the designation of level I and level
II trauma centers, and in the case of rural areas level III trauma centers (including trauma centers with specified capabilities and expertise in the care of pediatric trauma patients), by
such entity, including standards and requirements for—
(A) the number and types of trauma patients for whom
such centers must provide care in order to ensure that
such centers will have sufficient experience and expertise
to be able to provide quality care for victims of injury;
(B) the resources and equipment needed by such centers; and
(C) the availability of rehabilitation services for trauma patients;
(4) contains standards and requirements for the implementation of regional trauma care systems, including standards
and guidelines (consistent with the provisions of section 1867
of the Social Security Act) for medically directed triage and
transportation of trauma patients (including patients injured
in rural areas) prior to care in designated trauma centers;
(5) subject to subsection (b), contains national standards
and requirements, including those of the American Academy of
Pediatrics and the American College of Emergency Physicians,
for medically directed triage and transport of severely injured
children to designated trauma centers with specified capabilities and expertise in the care of pediatric trauma patients;
(6) utilizes a program with procedures for the evaluation
of designated trauma centers (including trauma centers described in paragraph (5)) and trauma care systems;
(7) provides for the establishment and collection of data in
accordance with data collection requirements developed in consultation with surgical, medical, and nursing specialty groups,
State and local emergency medical services directors, and other
trained professionals in trauma care, from each designated
trauma center in the State of a central data reporting and
analysis system—
(A) to identify the number of severely injured trauma
patients and the number of deaths from trauma within
trauma care systems in the State;
(B) to identify the cause of the injury and any factors
contributing to the injury;
(C) to identify the nature and severity of the injury;
(D) to monitor trauma patient care (including
prehospital care) in each designated trauma center within
regional trauma care systems in the State (including relevant emergency-department discharges and rehabilitation
information) for the purpose of evaluating the diagnosis,
treatment, and treatment outcome of such trauma patients;
(E) to identify the total amount of uncompensated
trauma care expenditures for each fiscal year by each designated trauma center in the State; and
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PUBLIC HEALTH SERVICE ACT

1022

(F) to identify patients transferred within a regional
trauma system, including reasons for such transfer and
the outcomes of such patients;
(8) provides for the use of procedures by paramedics and
emergency medical technicians to assess the severity of the injuries incurred by trauma patients;
(9) provides for appropriate transportation and transfer
policies to ensure the delivery of patients to designated trauma
centers and other facilities within and outside of the jurisdiction of such system, including policies to ensure that only individuals appropriately identified as trauma patients are transferred to designated trauma centers, and to provide periodic reviews of the transfers and the auditing of such transfers that
are determined to be appropriate;
(10) conducts public education activities concerning injury
prevention and obtaining access to trauma care;
(11) coordinates planning for trauma systems with State
disaster emergency planning and bioterrorism hospital preparedness planning; and
(12) with respect to the requirements established in this
subsection, provides for coordination and cooperation between
the State and any other State with which the State shares any
standard metropolitan statistical area.
(b) CERTAIN STANDARDS WITH RESPECT TO TRAUMA CARE CENTERS AND SYSTEMS.—
(1) IN GENERAL.—The Secretary may not make payments
under section 1211(a) for a fiscal year unless the State involved agrees that, in carrying out paragraphs (3) through (5)
of subsection (a), the State will adopt standards for the designation of trauma centers, and for triage, transfer, and transportation policies, and that the State will, in adopting such
standards—
(A) take into account national standards that outline
resources for optimal care of injured patients;
(B) consult with medical, surgical, and nursing speciality groups, hospital associations, emergency medical
services State and local directors, concerned advocates,
and other interested parties;
(C) conduct hearings on the proposed standards after
providing adequate notice to the public concerning such
hearing; and
(D) beginning in fiscal year 2008, take into account
the model plan described in subsection (c).
(2) QUALITY OF TRAUMA CARE.—The highest quality of
trauma care shall be the primary goal of State standards
adopted under this subsection.
(3) APPROVAL BY THE SECRETARY.—The Secretary may not
make payments under section 1211(a) to a State if the Secretary determines that—
(A) in the case of payments for fiscal year 2008 and
subsequent fiscal years, the State has not taken into account national standards, including those of the American
College of Surgeons, the American College of Emergency
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PUBLIC HEALTH SERVICE ACT

Sec. 1214

Physicians, and the American Academy of Pediatrics, in
adopting standards under this subsection; or
(B) in the case of payments for fiscal year 2008 and
subsequent fiscal years, the State has not, in adopting
such standards, taken into account the model plan developed under subsection (c).
(c) MODEL TRAUMA CARE PLAN.—
(1) IN GENERAL.—Not later than 1 year after the date of
the enactment of the Trauma Care Systems Planning and Development Act of 2007, the Secretary shall update the model
plan for the designation of trauma centers and for triage,
transfer, and transportation policies that may be adopted for
guidance by the State. Such plan shall—
(A) take into account national standards, including
those of the American College of Surgeons, American College of Emergency Physicians, and the American Academy
of Pediatrics;
(B) take into account existing State plans;
(C) be developed in consultation with medical, surgical, and nursing speciality groups, hospital associations,
emergency medical services State directors and associations, and other interested parties; and
(D) include standards for the designation of rural
health facilities and hospitals best able to receive, stabilize, and transfer trauma patients to the nearest appropriate designated trauma center, and for triage, transfer,
and transportation policies as they relate to rural areas.
(2) APPLICABILITY.—Standards described in paragraph
(1)(D) shall be applicable to all rural areas in the State, including both non-metropolitan areas and frontier areas that have
populations of less than 6,000 per square mile.
(d) RULE OF CONSTRUCTION WITH RESPECT TO NUMBER OF
DESIGNATED TRAUMA CENTERS.—With respect to compliance with
subsection (a) as a condition of the receipt of a grant under section
1211(a), such subsection may not be construed to specify the number of trauma care centers designated pursuant to such subsection.
SEC. 1214. ø300d–14¿ REQUIREMENT OF SUBMISSION TO SECRETARY
OF TRAUMA PLAN AND CERTAIN INFORMATION.
(a) IN GENERAL.—For each fiscal year, the Secretary may not

make payments to a State under section 1211(a) unless, subject to
subsection (b), the State submits to the Secretary the trauma care
component of the State plan for the provision of emergency medical
services, including any changes to the trauma care component and
any plans to address deficiencies in the trauma care component.
(b) INTERIM PLAN OR DESCRIPTION OF EFFORTS.—For each fiscal year, if a State has not completed the trauma care component
of the State plan described in subsection (a), the State may provide,
in lieu of such completed component, an interim component or a description of efforts made toward the completion of the component.
(c) INFORMATION RECEIVED BY STATE REPORTING AND ANALYSIS
SYSTEM.—The Secretary may not make payments to a State under
section 1211(a) unless the State agrees that the State will, not less
than once each year, provide to the Secretary the information received by the State pursuant to section 1213(a)(7).
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Sec. 1215

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1024

(d) AVAILABILITY OF EMERGENCY MEDICAL SERVICES IN RURAL
AREAS.—The Secretary may not make payments to a State under
section 1211(a) unless—
(1) the State identifies any rural area in the State for
which—
(A) there is no system of access to emergency medical
services through the telephone number 911;
(B) there is no basic life-support system; or
(C) there is no advanced life-support system; and
(2) the State submits to the Secretary a list of rural areas
identified pursuant to paragraph (1) or, if there are no such
areas, a statement that there are no such areas.
SEC. 1215. ø300d–15¿ RESTRICTIONS ON USE OF PAYMENTS.
(a) IN GENERAL.—The Secretary may not, except as provided

in
subsection (b), make payments under section 1211(a) for a fiscal
year unless the State involved agrees that the payments will not
be expended—
(1) for any purpose other than developing, implementing,
and monitoring the modifications required by section 1211(b) to
be made to the State plan for the provision of emergency medical services;
(2) to make cash payments to intended recipients of services provided pursuant to this section;
(3) to purchase or improve real property (other than minor
remodeling of existing improvements to real property);
(4) to satisfy any requirement for the expenditure of nonFederal funds as a condition for the receipt of Federal funds;
or
(5) to provide financial assistance to any entity other than
a public or nonprofit private entity.
(b) WAIVER.—The Secretary may waive a restriction under subsection (a) only if the Secretary determines that the activities outlined by the State plan submitted under section 1214(a) by the
State involved cannot otherwise be carried out.
SEC. 1217. ø300d–17¿ REQUIREMENT OF SUBMISSION OF APPLICATION CONTAINING CERTAIN AGREEMENTS AND ASSURANCES.

The Secretary may not make payments under section 1211(a)
to a State for a fiscal year unless—
(1) the State submits to the Secretary an application for
the payments containing agreements in accordance with this
part;
(2) the agreements are made through certification from the
chief executive officer of the State;
(3) with respect to such agreements, the application provides assurances of compliance satisfactory to the Secretary;
(4) the application contains the plan provisions and the information required to be submitted to the Secretary pursuant
to section 1214; and
(5) the application otherwise is in such form, is made in
such manner, and contains such agreements, assurances, and
information as the Secretary determines to be necessary to
carry out this part.
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Sec. 1218

SEC. 1218. ø300d–18¿ DETERMINATION OF AMOUNT OF ALLOTMENT.
(a) MINIMUM ALLOTMENT.—Subject to the extent of amounts

made available in appropriations Acts, the amount of an allotment
under section 1211(a) for a State for a fiscal year shall be the
greater of—
(1) the amount determined under subsection (b)(1); and
(2) $250,000 in the case of each of the several States, the
District of Columbia, and the Commonwealth of Puerto Rico,
and $50,000 in the case of each of the Virgin Islands, Guam,
American Samoa, and the Commonwealth of the Northern
Mariana Islands.
(b) DETERMINATION UNDER FORMULA.—
(1) IN GENERAL.—The amount referred to in subsection
(a)(1) for a State for a fiscal year is the sum of—
(A) an amount determined under paragraph (2); and
(B) an amount determined under paragraph (3).
(2) AMOUNT RELATING TO POPULATION.—The amount referred to in subparagraph (A) of paragraph (1) for a State for
a fiscal year is the product of—
(A) an amount equal to 80 percent of the amounts appropriated under section 1232(a) for the fiscal year and
available for allotment under section 1211(a); and
(B) a percentage equal to the quotient of—
(i) an amount equal to the population of the State;
divided by
(ii) an amount equal to the population of all
States.
(3) AMOUNT RELATING TO SQUARE MILEAGE.—The amount
referred to in subparagraph (B) of paragraph (1) for a State for
a fiscal year is the product of—
(A) an amount equal to 20 percent of the amounts appropriated under section 1232(a) for the fiscal year and
available for allotment under section 1211(a); and
(B) a percentage equal to the quotient of—
(i) an amount equal to the lesser of 266,807 and
the amount of the square mileage of the State; divided
by
(ii) an amount equal to the sum of the respective
amounts determined for the States under clause (i).
(c) DISPOSITION OF CERTAIN FUNDS APPROPRIATED FOR ALLOTMENTS.—
(1) IN GENERAL.—Amounts described in paragraph (2)
shall, in accordance with paragraph (3), be allotted by the Secretary to States receiving payments under section 1211(a) for
the fiscal year (other than any State referred to in paragraph
(2)(C)).
(2) TYPE OF AMOUNTS.—The amounts referred to in paragraph (1) are any amounts made available pursuant to
1232(b)(3) that are not paid under section 1211(a) to a State
as a result of—
(A) the failure of the State to submit an application
under section 1217;
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(B) the failure, in the determination of the Secretary,
of the State to prepare within a reasonable period of time
such application in compliance with such section; or
(C) the State informing the Secretary that the State
does not intend to expend the full amount of the allotment
made for the State.
(3) AMOUNT.—The amount of an allotment under paragraph (1) for a State for a fiscal year shall be an amount equal
to the product of—
(A) an amount equal to the amount described in paragraph (2) for the fiscal year involved; and
(B) the percentage determined under subsection (b)(2)
for the State.
SEC. 1219. ø300d–19¿ FAILURE TO COMPLY WITH AGREEMENTS.
(a) REPAYMENT OF PAYMENTS.—
(1) REQUIREMENT.—The Secretary may, in accordance

with
subsection (b), require a State to repay any payments received
by the State pursuant to section 1211(a) that the Secretary determines were not expended by the State in accordance with
the agreements required to be made by the State as a condition of the receipt of payments under such section.
(2) OFFSET OF AMOUNTS.—If a State fails to make a repayment required in paragraph (1), the Secretary may offset the
amount of the repayment against any amount due to be paid
to the State under section 1211(a).
(b) OPPORTUNITY FOR A HEARING.—Before requiring repayment
of payments under subsection (a)(1), the Secretary shall provide to
the State an opportunity for a hearing.

SEC. 1220. ø300d–20¿ PROHIBITION AGAINST CERTAIN FALSE STATEMENTS.
(a) IN GENERAL.—
(1) FALSE STATEMENTS OR REPRESENTATIONS.—A person

may not knowingly and willfully make or cause to be made any
false statement or representation of a material fact in connection with the furnishing of items or services for which payments may be made by a State from amounts paid to the State
under section 1211(a).
(2) CONCEALING OR FAILING TO DISCLOSE INFORMATION.—A
person with knowledge of the occurrence of any event affecting
the right of the person to receive any payments from amounts
paid to the State under section 1211(a) may not conceal or fail
to disclose any such event with the intent of fraudulently securing such amount.
(b) CRIMINAL PENALTY FOR VIOLATION OF PROHIBITION.—Any
person who violates a prohibition established in subsection (a) may
for each violation be fined in accordance with title 18, United
States Code, or imprisoned for not more than 5 years, or both.
SEC. 1221. ø300d–21¿ TECHNICAL ASSISTANCE AND PROVISION BY
SECRETARY OF SUPPLIES AND SERVICES IN LIEU OF
GRANT FUNDS.
(a) TECHNICAL ASSISTANCE.—The Secretary shall, without

charge to a State receiving payments under section 1211(a), provide to the State (or to any public or nonprofit private entity desMarch 13, 2013

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ignated by the State) technical assistance with respect to the planning, development, and operation of any program carried out pursuant to section 1211(b). The Secretary may provide such technical
assistance directly, through contract, or through grants.
(b) PROVISION BY SECRETARY OF SUPPLIES AND SERVICES IN
LIEU OF GRANT FUNDS.—
(1) IN GENERAL.—Upon the request of a State receiving
payments under section 1211(a), the Secretary may, subject to
paragraph (2), provide supplies, equipment, and services for
the purpose of aiding the State in carrying out section 1211(b)
and, for such purpose, may detail to the State any officer or
employee of the Department of Health and Human Services.
(2) REDUCTION IN PAYMENTS.—With respect to a request
described in paragraph (1), the Secretary shall reduce the
amount of payments to the State under section 1211(a) by an
amount equal to the costs of detailing personnel and the fair
market value of any supplies, equipment, or services provided
by the Secretary. The Secretary shall, for the payment of expenses incurred in complying with such request, expend the
amounts withheld.
SEC. 1222. ø300d–22¿ REPORT BY SECRETARY.

Not later than October 1, 2008, the Secretary shall report to
the appropriate committees of Congress on the activities of the
States carried out pursuant to section 1211. Such report shall include an assessment of the extent to which Federal and State efforts to develop systems of trauma care and to designate trauma
centers have reduced the incidence of mortality, and the incidence
of permanent disability, resulting from trauma. Such report may
include any recommendations of the Secretary for appropriate administrative and legislative initiatives with respect to trauma care.
PART C—GENERAL PROVISIONS REGARDING PARTS A

AND

B

SEC. 1231. ø300d–31¿ DEFINITIONS.

For purposes of this part and parts A and B:
(1) DESIGNATED TRAUMA CENTER.—The term ‘‘designated
trauma center’’ means a trauma center designated in accordance with the modifications to the State plan described in section 1213.
(2) STATE PLAN REGARDING EMERGENCY MEDICAL SERVICES.—The term ‘‘State plan’’, with respect to the provision of
emergency medical services, means a plan for a comprehensive,
organized system to provide for the access, response, triage,
field stabilization, transport, hospital stabilization, definitive
care, and rehabilitation of patients of all ages with respect to
emergency medical services.
(3) STATE.—The term ‘‘State’’ means each of the several
States, the District of Columbia, the Commonwealth of Puerto
Rico, the Virgin Islands, Guam, American Samoa, and the
Commonwealth of the Northern Mariana Islands.
(4) TRAUMA.—The term ‘‘trauma’’ means an injury resulting from exposure to a mechanical force.
(5) TRAUMA CARE COMPONENT OF STATE PLAN.—The term
‘‘trauma care component’’, with respect to components of the
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State plan for the provision of emergency medical services,
means a plan for a comprehensive health care system, within
rural and urban areas of the State, for the prompt recognition,
prehospital care, emergency medical care, acute surgical and
medical care, rehabilitation, and outcome evaluation of seriously injured patients.
SEC. 1232. ø300d–32¿ FUNDING.
(a) AUTHORIZATION OF APPROPRIATIONS.—For

the purpose of
carrying out parts A and B, subject to subsections (b) and (c), there
are authorized to be appropriated $24,000,000 for each of fiscal
years 2010 through 2014.
(b) RESERVATION OF FUNDS.—If the amount appropriated
under subsection (a) for a fiscal year is equal to or less than
$1,000,000, such appropriation is available only for the purpose of
carrying out part A. If the amount so appropriated is greater than
$1,000,000, 50 percent of such appropriation shall be made available for the purpose of carrying out part A and 50 percent shall be
made available for the purpose of carrying out part B.
(c) ALLOCATION OF PART A FUNDS.—Of the amounts appropriated under subsection (a) for a fiscal year to carry out part A—
(1) 10 percent of such amounts for such year shall be allocated for administrative purposes; and
(2) 10 percent of such amounts for such year shall be allocated for the purpose of carrying out section 1202.
(d) AUTHORITY.—For the purpose of carrying out parts A
through C, beginning on the date of enactment of the Patient Protection and Affordable Care Act, the Secretary shall transfer authority in administering grants and related authorities under such
parts from the Administrator of the Health Resources and Services
Administration to the Assistant Secretary for Preparedness and Response.
PART D—TRAUMA CENTERS OPERATING IN AREAS SEVERELY
AFFECTED BY DRUG-RELATED VIOLENCE
SEC. 1241. ø300d–41¿ GRANTS FOR CERTAIN TRAUMA CENTERS.
(a) IN GENERAL.—The Secretary shall establish 3 programs

to
award grants to qualified public, nonprofit Indian Health Service,
Indian tribal, and urban Indian trauma centers—
(1) to assist in defraying substantial uncompensated care
costs;
(2) to further the core missions of such trauma centers, including by addressing costs associated with patient stabilization and transfer, trauma education and outreach, coordination
with local and regional trauma systems, essential personnel
and other fixed costs, and expenses associated with employee
and non-employee physician services; and
(3) to provide emergency relief to ensure the continued and
future availability of trauma services.
(b) MINIMUM QUALIFICATIONS OF TRAUMA CENTERS.—
(1) PARTICIPATION IN TRAUMA CARE SYSTEM OPERATING
UNDER CERTAIN PROFESSIONAL GUIDELINES.—Except as provided in paragraph (2), the Secretary may not award a grant
to a trauma center under subsection (a) unless the trauma cenMarch 13, 2013

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ter is a participant in a trauma system that substantially complies with section 1213.
(2) EXEMPTION.—Paragraph (1) shall not apply to trauma
centers that are located in States with no existing trauma care
system.
(3) QUALIFICATION FOR SUBSTANTIAL UNCOMPENSATED CARE
COSTS.—The Secretary shall award substantial uncompensated
care grants under subsection (a)(1) only to trauma centers
meeting at least 1 of the criteria in 1 of the following 3 categories:
(A) CATEGORY A.—The criteria for category A are as
follows:
(i) At least 40 percent of the visits in the emergency department of the hospital in which the trauma
center is located were charity or self-pay patients.
(ii) At least 50 percent of the visits in such emergency department were Medicaid (under title XIX of
the Social Security Act (42 U.S.C. 1396 et seq.)) and
charity and self-pay patients combined.
(B) CATEGORY B.—The criteria for category B are as
follows:
(i) At least 35 percent of the visits in the emergency department were charity or self-pay patients.
(ii) At least 50 percent of the visits in the emergency department were Medicaid and charity and selfpay patients combined.
(C) CATEGORY C.—The criteria for category C are as
follows:
(i) At least 20 percent of the visits in the emergency department were charity or self-pay patients.
(ii) At least 30 percent of the visits in the emergency department were Medicaid and charity and selfpay patients combined.
(4) TRAUMA CENTERS IN 1115 WAIVER STATES.—Notwithstanding paragraph (3), the Secretary may award a substantial
uncompensated care grant to a trauma center under subsection
(a)(1) if the trauma center qualifies for funds under a Low Income Pool or Safety Net Care Pool established through a waiver approved under section 1115 of the Social Security Act (42
U.S.C. 1315).
(5) DESIGNATION.—The Secretary may not award a grant
to a trauma center unless such trauma center is verified by the
American College of Surgeons or designated by an equivalent
State or local agency.
(c) ADDITIONAL REQUIREMENTS.—The Secretary may not award
a grant to a trauma center under subsection (a)(1) unless such
trauma center—
(1) submits to the Secretary a plan satisfactory to the Secretary that demonstrates a continued commitment to serving
trauma patients regardless of their ability to pay; and
(2) has policies in place to assist patients who cannot pay
for part or all of the care they receive, including a sliding fee
scale, and to ensure fair billing and collection practices.
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SEC. 1242. ø300d–42¿ PREFERENCES IN MAKING GRANTS.
(a) SUBSTANTIAL UNCOMPENSATED CARE AWARDS.—
(1) IN GENERAL.—The Secretary shall establish

an award
basis for each eligible trauma center for grants under section
1241(a)(1) according to the percentage described in paragraph
(2), subject to the requirements of section 1241(b)(3).
(2) PERCENTAGES.—The applicable percentages are as follows:
(A) With respect to a category A trauma center, 100
percent of the uncompensated care costs.
(B) With respect to a category B trauma center, not
more than 75 percent of the uncompensated care costs.
(C) With respect to a category C trauma center, not
more than 50 percent of the uncompensated care costs.
(b) 1 CORE MISSION AWARDS.—
(1) IN GENERAL.—In awarding grants under section
1241(a)(2), the Secretary shall—
(A) reserve 25 percent of the amount allocated for core
mission awards for Level III and Level IV trauma centers;
and
(B) reserve 25 percent of the amount allocated for core
mission awards for large urban Level I and II trauma centers—
(i) that have at least 1 graduate medical education
fellowship in trauma or trauma related specialties for
which demand is exceeding supply;
(ii) for which—
(I) annual uncompensated care costs exceed
$10,000,000; or
(II) at least 20 percent of emergency department visits are charity or self-pay or Medicaid patients; and
(iii) that are not eligible for substantial uncompensated care awards under section 1241(a)(1).
(c) EMERGENCY AWARDS.—In awarding grants under section
1241(a)(3), the Secretary shall—
(1) give preference to any application submitted by a trauma center that provides trauma care in a geographic area in
which the availability of trauma care has significantly decreased or will significantly decrease if the center is forced to
close or downgrade service or growth in demand for trauma
services exceeds capacity; and
(2) reallocate any emergency awards funds not obligated
due to insufficient, or a lack of qualified, applications to the
significant uncompensated care award program.
SEC. 1243. ø300d–43¿ CERTAIN AGREEMENTS.
(a) MAINTENANCE OF FINANCIAL SUPPORT.—The

Secretary may
require a trauma center receiving a grant under section 1241(a) to
maintain access to trauma services at comparable levels to the
prior year during the grant period.

1 So in law. Subsection (b) includes a paragraph (1) but does not include subsequent
paragaraphs.

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(b) TRAUMA CARE REGISTRY.—The Secretary may require the
trauma center receiving a grant under section 1241(a) to provide
data to a national and centralized registry of trauma cases, in accordance with guidelines developed by the American College of Surgeons, and as the Secretary may otherwise require.
SEC. 1244. ø300d–44¿ GENERAL PROVISIONS.
(a) APPLICATION.—The Secretary may

not award a grant to a
trauma center under section 1241(a) unless such center submits an
application for the grant to the Secretary and the application is in
such form, is made in such manner, and contains such agreements,
assurances, and information as the Secretary determines to be necessary to carry out this part.
(b) LIMITATION ON DURATION OF SUPPORT.—The period during
which a trauma center receives payments under a grant under section 1241(a)(3) shall be for 3 fiscal years, except that the Secretary
may waive such requirement for a center and authorize such center
to receive such payments for 1 additional fiscal year.
(c) LIMITATION ON AMOUNT OF GRANT.—Notwithstanding section 1242(a), a grant under section 1241 may not be made in an
amount exceeding $2,000,000 for each fiscal year.
as
provided
in
section
(d)
ELIGIBILITY.—Except
1242(b)(1)(B)(iii), acquisition of, or eligibility for, a grant under section 1241(a) shall not preclude a trauma center from being eligible
for other grants described in such section.
(e) FUNDING DISTRIBUTION.—Of the total amount appropriated
for a fiscal year under section 1245, 70 percent shall be used for
substantial uncompensated care awards under section 1241(a)(1),
20 percent shall be used for core mission awards under section
1241(a)(2), and 10 percent shall be used for emergency awards
under section 1241(a)(3).
(f) MINIMUM ALLOWANCE.—Notwithstanding subsection (e), if
the amount appropriated for a fiscal year under section 1245 is less
than $25,000,000, all available funding for such fiscal year shall be
used for substantial uncompensated care awards under section
1241(a)(1).
(g) SUBSTANTIAL UNCOMPENSATED CARE AWARD DISTRIBUTION
AND PROPORTIONAL SHARE.—Notwithstanding section 1242(a), of
the amount appropriated for substantial uncompensated care
grants for a fiscal year, the Secretary shall—
(1) make available—
(A) 50 percent of such funds for category A trauma
center grantees;
(B) 35 percent of such funds for category B trauma
center grantees; and
(C) 15 percent of such funds for category C trauma
center grantees; and
(2) provide available funds within each category in a manner proportional to the award basis specified in section
1242(a)(2) to each eligible trauma center.
(h) REPORT.—Beginning 2 years after the date of enactment of
the Patient Protection and Affordable Care Act, and every 2 years
thereafter, the Secretary shall biennially report to Congress regardMarch 13, 2013

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ing the status of the grants made under section 1241 and on the
overall financial stability of trauma centers.
SEC. 1245. ø300d–45¿ AUTHORIZATION OF APPROPRIATIONS.

For the purpose of carrying out this part, there are authorized
to be appropriated $100,000,000 for fiscal year 2009, and such
sums as may be necessary for each of fiscal years 2010 through
2015. Such authorization of appropriations is in addition to any
other authorization of appropriations or amounts that are available
for such purpose.
SEC. 1246. ø300d–46¿ DEFINITION.

In this part, the term ‘‘uncompensated care costs’’ means unreimbursed costs from serving self-pay, charity, or Medicaid patients,
without regard to payment under section 1923 of the Social Security Act, all of which are attributable to emergency care and trauma care, including costs related to subsequent inpatient admissions
to the hospital.

Part E—Miscellaneous Programs 1
SEC. 1251. ø300d–51¿ RESIDENCY TRAINING PROGRAMS IN EMERGENCY MEDICINE.
(a) IN GENERAL.—The Secretary may make grants to public

and nonprofit private entities for the purpose of planning and developing approved residency training programs in emergency medicine.
(b) IDENTIFICATION AND REFERRAL OF DOMESTIC VIOLENCE.—
The Secretary may make a grant under subsection (a) only if the
applicant involved agrees that the training programs under subsection (a) will provide education and training in identifying and
referring cases of domestic violence.
(c) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of
carrying out this section, there is authorized to be appropriated
$400,000 for each of the fiscal years 2008 though 2012.
SEC. 1252. ø300d–52¿ STATE GRANTS FOR PROJECTS REGARDING
TRAUMATIC BRAIN INJURY.
(a) IN GENERAL.—The Secretary, acting through the Adminis-

trator of the Health Resources and Services Administration, may
make grants to States and American Indian consortia for the purpose of carrying out projects to improve access to rehabilitation and
other services regarding traumatic brain injury.
(b) STATE ADVISORY BOARD.—
(1) IN GENERAL.—The Secretary may make a grant under
subsection (a) only if the State or American Indian consortium
involved agrees to establish an advisory board within the appropriate health department of the State or American Indian
consortium or within another department as designated by the
chief executive officer of the State or American Indian consortium.
(2) FUNCTIONS.—An advisory board established under
paragraph (1) shall advise and make recommendations to the
State or American Indian consortium on ways to improve services coordination regarding traumatic brain injury. Such advisory boards shall encourage citizen participation through the
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establishment of public hearings and other types of community
outreach programs. In developing recommendations under this
paragraph, such boards shall consult with Federal, State, and
local governmental agencies and with citizens groups and other
private entities.
(3) COMPOSITION.—An advisory board established under
paragraph (1) shall be composed of—
(A) representatives of—
(i) the corresponding State or American Indian
consortium agencies involved;
(ii) public and nonprofit private health related organizations;
(iii) other disability advisory or planning groups
within the State or American Indian consortium;
(iv) members of an organization or foundation representing individuals with traumatic brain injury in
that State or American Indian consortium; and
(v) injury control programs at the State or local
level if such programs exist; and
(B) a substantial number of individuals with traumatic
brain injury, or the family members of such individuals.
(c) MATCHING FUNDS.—
(1) IN GENERAL.—With respect to the costs to be incurred
by a State or American Indian consortium in carrying out the
purpose described in subsection (a), the Secretary may make a
grant under such subsection only if the State or American Indian consortium agrees to make available non-Federal contributions toward such costs in an amount that is not less than
$1 for each $2 of Federal funds provided under the grant.
(2) DETERMINATION OF AMOUNT CONTRIBUTED.—Non-Federal contributions under paragraph (1) may be in cash or in
kind, fairly evaluated, including plant, equipment, or services.
Amounts provided by the Federal Government, or services assisted or subsidized to any significant extent by the Federal
Government, may not be included in determining the amount
of such contributions.
(d) APPLICATION FOR GRANT.—The Secretary may make a grant
under subsection (a) only if an application for the grant is submitted to the Secretary and the application is in such form, is
made in such manner, and contains such agreements, assurances,
and information as the Secretary determines to be necessary to
carry out this section.
(e) CONTINUATION OF PREVIOUSLY AWARDED DEMONSTRATION
PROJECTS.—A State or American Indian consortium that received
a grant under this section prior to the date of the enactment of the
Traumatic Brain Injury Act of 2008 may complete the activities
funded by the grant.
(f) USE OF STATE AND AMERICAN INDIAN CONSORTIUM
GRANTS.—
(1) COMMUNITY SERVICES AND SUPPORTS.—A State or
American Indian consortium shall (directly or through awards
of contracts to nonprofit private entities) use amounts received
under a grant under this section for the following:
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(A) To develop, change, or enhance community-based
service delivery systems that include timely access to comprehensive appropriate services and supports. Such service
and supports—
(i) shall promote full participation by individuals
with brain injury and their families in decision making regarding the services and supports; and
(ii) shall be designed for children, youth, and
adults with traumatic brain injury.
(B) To focus on outreach to underserved and inappropriately served individuals, such as individuals in institutional settings, individuals with low socioeconomic resources, individuals in rural communities, and individuals
in culturally and linguistically diverse communities.
(C) To award contracts to nonprofit entities for consumer or family service access training, consumer support,
peer mentoring, and parent to parent programs.
(D) To develop individual and family service coordination or case management systems.
(E) To support other needs identified by the advisory
board under subsection (b) for the State or American Indian consortium involved.
(2) BEST PRACTICES.—
(A) IN GENERAL.—State or American Indian consortium services and supports provided under a grant under
this section shall reflect the best practices in the field of
traumatic brain injury, shall be in compliance with title II
of the Americans with Disabilities Act of 1990, and shall
be supported by quality assurance measures as well as
state-of-the-art health care and integrated community supports, regardless of the severity of injury.
(B) DEMONSTRATION BY STATE AGENCY.—The State or
American Indian consortium agency responsible for administering amounts received under a grant under this section
shall demonstrate that it has obtained knowledge and expertise of traumatic brain injury and the unique needs associated with traumatic brain injury.
(3) STATE CAPACITY BUILDING.—A State or American Indian consortium may use amounts received under a grant
under this section to—
(A) educate consumers and families;
(B) train professionals in public and private sector financing (such as third party payers, State agencies, community-based providers, schools, and educators);
(C) develop or improve case management or service coordination systems;
(D) develop best practices in areas such as family or
consumer support, return to work, housing or supportive
living personal assistance services, assistive technology
and devices, behavioral health services, substance abuse
services, and traumatic brain injury treatment and rehabilitation;
(E) tailor existing State or American Indian consortium systems to provide accommodations to the needs of
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individuals with brain injury (including systems administered by the State or American Indian consortium departments responsible for health, mental health, labor/employment, education, intellectual disabilities or developmental
disorders, transportation, and correctional systems);
(F) improve data sets coordinated across systems and
other needs identified by a State or American Indian consortium plan supported by its advisory council; and
(G) develop capacity within targeted communities.
(g) COORDINATION OF ACTIVITIES.—The Secretary shall ensure
that activities under this section are coordinated as appropriate
with other Federal agencies that carry out activities regarding
traumatic brain injury.
(h) REPORT.—Not less than biennially, the Secretary shall submit to the Committee on Energy and Commerce of the House of
Representatives, and to the Committee on Health, Education,
Labor, and Pensions of the Senate, a report describing the findings
and results of the programs established under this section, 1 and
section 1253 including measures of outcomes and consumer and
surrogate satisfaction.
(i) DEFINITIONS.—For purposes of this section:
(1) The terms ‘‘American Indian consortium’’ and ‘‘State’’
have the meanings given to those terms in section 1253.
(2) The term ‘‘traumatic brain injury’’ means an acquired
injury to the brain. Such term does not include brain dysfunction caused by congenital or degenerative disorders, nor birth
trauma, but may include brain injuries caused by anoxia due
to trauma. The Secretary may revise the definition of such
term as the Secretary determines necessary, after consultation
with States and other appropriate public or nonprofit private
entities.
(j) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of
carrying out this section, there are authorized to be appropriated
such sums as may be necessary for each of the fiscal years 2001
through 2005, and such sums as may be necessary for each of the
fiscal years 2009 through 2012.
SEC. 1253. ø300d–53¿ STATE GRANTS FOR PROTECTION AND ADVOCACY
SERVICES.
(a) IN GENERAL.—The Secretary, acting through the Adminis-

trator of the Health Resources and Services Administration (referred to in this section as the ‘‘Administrator’’), shall make grants
to protection and advocacy systems for the purpose of enabling
such systems to provide services to individuals with traumatic
brain injury.
(b) SERVICES PROVIDED.—Services provided under this section
may include the provision of—
(1) information, referrals, and advice;
(2) individual and family advocacy;
(3) legal representation; and
(4) specific assistance in self-advocacy.
1 The comma after ‘‘this section’’ probably should be moved to follow the reference to ‘‘section
1253’’.

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(c) APPLICATION.—To be eligible to receive a grant under this
section, a protection and advocacy system shall submit an application to the Administrator at such time, in such form and manner,
and accompanied by such information and assurances as the Administrator may require.
(d) APPROPRIATIONS LESS THAN $2,700,000.—
(1) IN GENERAL.—With respect to any fiscal year in which
the amount appropriated under subsection (l) to carry out this
section is less than $2,700,000, the Administrator shall make
grants from such amount to individual protection and advocacy
systems within States to enable such systems to plan for, develop outreach strategies for, and carry out services authorized
under this section for individuals with traumatic brain injury.
(2) AMOUNT.—The amount of each grant provided under
paragraph (1) shall be determined as set forth in paragraphs
(2) and (3) of subsection (e).
(e) APPROPRIATIONS OF $2,700,000 OR MORE.—
(1) POPULATION BASIS.—Except as provided in paragraph
(2), with respect to each fiscal year in which the amount appropriated under subsection (l) to carry out this section is
$2,700,000 or more, the Administrator shall make a grant to
a protection and advocacy system within each State.
(2) AMOUNT.—The amount of a grant provided to a system
under paragraph (1) shall be equal to an amount bearing the
same ratio to the total amount appropriated for the fiscal year
involved under subsection (l) as the population of the State in
which the grantee is located bears to the population of all
States.
(3) MINIMUMS.—Subject to the availability of appropriations, the amount of a grant a protection and advocacy system
under paragraph (1) for a fiscal year shall—
(A) in the case of a protection and advocacy system located in American Samoa, Guam, the United States Virgin
Islands, or the Commonwealth of the Northern Mariana
Islands, and the protection and advocacy system serving
the American Indian consortium, not be less than $20,000;
and
(B) in the case of a protection and advocacy system in
a State not described in subparagraph (A), not be less than
$50,000.
(4) INFLATION ADJUSTMENT.—For each fiscal year in which
the total amount appropriated under subsection (l) to carry out
this section is $5,000,000 or more, and such appropriated
amount exceeds the total amount appropriated to carry out
this section in the preceding fiscal year, the Administrator
shall increase each of the minimum grants amount described
in subparagraphs (A) and (B) of paragraph (3) by a percentage
equal to the percentage increase in the total amount appropriated under subsection (l) to carry out this section between
the preceding fiscal year and the fiscal year involved.
(f) CARRYOVER.—Any amount paid to a protection and advocacy
system that serves a State or the American Indian consortium for
a fiscal year under this section that remains unobligated at the end
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tion during the next fiscal year for the purposes for which such
amount was originally provided.
(g) DIRECT PAYMENT.—Notwithstanding any other provision of
law, each fiscal year not later than October 1, the Administrator
shall pay directly to any protection and advocacy system that complies with the provisions of this section, the total amount of the
grant for such system, unless the system provides otherwise for
such payment.
(h) ANNUAL REPORT.—Each protection and advocacy system
that receives a payment under this section shall submit an annual
report to the Administrator concerning the services provided to individuals with traumatic brain injury by such system.
(i) DATA COLLECTION.—The Administrator of the Health Resources and Services Administration and the Commissioner of the
Administration on Developmental Disabilities shall enter into an
agreement to coordinate the collection of data by the Administrator
and the Commissioner regarding protection and advocacy services.
(j) TRAINING AND TECHNICAL ASSISTANCE.—
(1) GRANTS.—For any fiscal year for which the amount appropriated to carry out this section is $6,000,000 or greater,
the Administrator shall use 2 percent of such amount to make
a grant to an eligible national association for providing for
training and technical assistance to protection and advocacy
systems.
(2) DEFINITION.—In this subsection, the term ‘‘eligible national association’’ means a national association with demonstrated experience in providing training and technical assistance to protection and advocacy systems.
(k) SYSTEM AUTHORITY.—In providing services under this section, a protection and advocacy system shall have the same authorities, including access to records, as such system would have
for purposes of providing services under subtitle C of the Developmental Disabilities Assistance and Bill of Rights Act of 2000 1.
(l) AUTHORIZATION OF APPROPRIATIONS.—There are authorized
to be appropriated to carry out this section $5,000,000 for fiscal
year 2001, and such sums as may be necessary for each the fiscal
years 2009 through 2012.
(m) DEFINITIONS.—In this section:
(1) AMERICAN INDIAN CONSORTIUM.—The term ‘‘American
Indian consortium’’ means a consortium established under part
C of the Developmental Disabilities Assistance Bill of Rights
Act (42 U.S.C. 6042 et seq.).
(2) PROTECTION AND ADVOCACY SYSTEM.—The term ‘‘protection and advocacy system’’ means a protection and advocacy
system established under part C of the Developmental Disabilities Assistance and Bill of Rights Act (42 U.S.C. 6042 et seq.).
(3) STATE.—The term ‘‘State’’, unless otherwise specified,
means the several States of the United States, the District of
Columbia, the Commonwealth of Puerto Rico, the United
States Virgin Islands, Guam, American Samoa, and the Commonwealth of the Northern Mariana Islands.
1 The reference to subtitle C of the Developmental Disabilities Assistance and Bill of Rights
Act of 2000 should refer to subtitle C of ‘‘title I’’ of such Act.

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Sec. 1261

PUBLIC HEALTH SERVICE ACT

PART F—INTERAGENCY PROGRAM

FOR

1038

TRAUMA RESEARCH

SEC. 1261. ø300d–61¿ ESTABLISHMENT OF PROGRAM.
(a) IN GENERAL.—The Secretary, acting through

the Director of
the National Institutes of Health (in this section referred to as the
‘‘Director’’), shall establish a comprehensive program of conducting
basic and clinical research on trauma (in this section referred to as
the ‘‘Program’’). The Program shall include research regarding the
diagnosis, treatment, rehabilitation, and general management of
trauma.
(b) PLAN FOR PROGRAM.—
(1) IN GENERAL.—The Director, in consultation with the
Trauma Research Interagency Coordinating Committee established under subsection (g), shall establish and implement a
plan for carrying out the activities of the Program, including
the activities described in subsection (d). All such activities
shall be carried out in accordance with the plan. The plan shall
be periodically reviewed, and revised as appropriate.
(2) SUBMISSION TO CONGRESS.—Not later than December 1,
1993, the Director shall submit the plan required in paragraph
(1) to the Committee on Energy and Commerce of the House
of Representatives, and to the Committee on Health, Education, Labor, and Pensions of the Senate, together with an estimate of the funds needed for each of the fiscal years 1994
through 1996 to implement the plan.
(c) PARTICIPATING AGENCIES; COORDINATION AND COLLABORATION.—The Director—
(1) shall provide for the conduct of activities under the
Program by the Directors of the agencies of the National Institutes of Health involved in research with respect to trauma;
(2) shall ensure that the activities of the Program are coordinated among such agencies; and
(3) shall, as appropriate, provide for collaboration among
such agencies in carrying out such activities.
(d) CERTAIN ACTIVITIES OF PROGRAM.—The Program shall include—
(1) studies with respect to all phases of trauma care, including prehospital, resuscitation, surgical intervention, critical
care, infection control, wound healing, nutritional care and
support, and medical rehabilitation care;
(2) basic and clinical research regarding the response of
the body to trauma and the acute treatment and medical rehabilitation of individuals who are the victims of trauma;
(3) basic and clinical research regarding trauma care for
pediatric and geriatric patients; and
(4) the authority to make awards of grants or contracts to
public or nonprofit private entities for the conduct of basic and
applied research regarding traumatic brain injury, which research may include—
(A) the development of new methods and modalities
for the more effective diagnosis, measurement of degree of
brain injury, post-injury monitoring and prognostic assessment of head injury for acute, subacute and later phases
of care;
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(B) the development, modification and evaluation of
therapies that retard, prevent or reverse brain damage
after acute head injury 1, that arrest further deterioration
following injury and that provide the restitution of function for individuals with long-term injuries;
(C) the development of research on a continuum of
care from acute care through rehabilitation, designed, to
the extent practicable, to integrate rehabilitation and longterm outcome evaluation with acute care research;
(D) the development of programs that increase the
participation of academic centers of excellence in brain injury treatment and rehabilitation research and training;
and
(E) carrying out subparagraphs (A) through (D) with
respect to cognitive disorders and neurobehavioral consequences arising from traumatic brain injury, including
the development, modification, and evaluation of therapies
and programs of rehabilitation toward reaching or restoring normal capabilities in areas such as reading, comprehension, speech, reasoning, and deduction.
(e) MECHANISMS OF SUPPORT.—In carrying out the Program,
the Director, acting through the Directors of the agencies referred
to in subsection (c)(1), may make grants to public and nonprofit entities, including designated trauma centers.
(f) RESOURCES.—The Director shall assure the availability of
appropriate resources to carry out the Program, including the plan
established under subsection (b) (including the activities described
in subsection (d)).
(g) COORDINATING COMMITTEE.—
(1) IN GENERAL.—There shall be established a Trauma Research Interagency Coordinating Committee (in this section referred to as the ‘‘Coordinating Committee’’).
(2) DUTIES.—The Coordinating Committee shall make recommendations regarding—
(A) the activities of the Program to be carried out by
each of the agencies represented on the Committee and the
amount of funds needed by each of the agencies for such
activities; and
(B) effective collaboration among the agencies in carrying out the activities.
(3) COMPOSITION.—The Coordinating Committee shall be
composed of the Directors of each of the agencies that, under
subsection (c), have responsibilities under the Program, and
any other individuals who are practitioners in the trauma field
as designated by the Director of the National Institutes of
Health.
(h) DEFINITIONS.—For purposes of this section:
(1) The term ‘‘designated trauma center’’ has the meaning
given such term in section 1231(1).
1 Section 1303(a)(2) of Public Law 106–310 (114 Stat. 1138) provides that subparagraph (B)
is amended by striking ‘‘acute injury’’ and inserting ‘‘acute brain injury’’. The amendment cannot
be executed because the term to be struck does not appear in subparagraph (B). (Compare
‘‘acute injury’’ and ‘‘acute head injury’’.)

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Sec. 1271

PUBLIC HEALTH SERVICE ACT

1040

(2) The term ‘‘Director’’ means the Director of the National
Institutes of Health.
(3) The term ‘‘trauma’’ means any serious injury that could
result in loss of life or in significant disability and that would
meet pre-hospital triage criteria for transport to a designated
trauma center.
(4) The term ‘‘traumatic brain injury’’ means an acquired
injury to the brain. Such term does not include brain dysfunction caused by congenital or degenerative disorders, nor birth
trauma, but may include brain injuries caused by anoxia due
to trauma. The Secretary may revise the definition of such
term as the Secretary determines necessary, after consultation
with States and other appropriate public or nonprofit private
entities.
(i) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of
carrying out this section, there are authorized to be appropriated
such sums as may be necessary for each of the fiscal years 2001
through 2005, and such sums as may be necessary for each of the
fiscal years 2009 through 2012.
PART G—POISON CONTROL
SEC. 1271. ø300d–71¿ MAINTENANCE OF THE NATIONAL TOLL-FREE
NUMBER.
(a) IN GENERAL.—The Secretary shall provide coordination and

assistance to poison control centers for the establishment of a nationwide toll-free phone number, and the maintenance of such
number, to be used to access such centers.
(b) AUTHORIZATION OF APPROPRIATIONS.—There is authorized
to be appropriated $2,000,000 for fiscal year 2009 to carry out this
section, and $700,000 for each of fiscal years 2010 through 2014 for
the maintenance of the nationwide toll free phone number under
subsection (a).
SEC. 1272. ø300d–72¿ NATIONWIDE MEDIA CAMPAIGN TO PROMOTE
POISON CONTROL CENTER UTILIZATION.
(a) IN GENERAL.—The Secretary shall carry out, and expand

upon, a national media campaign to educate the public and health
care providers about poison prevention and the availability of poison control center resources in local communities and to conduct
advertising campaigns concerning the nationwide toll-free number
established under section 1271(a).
(b) CONTRACT WITH ENTITY.—The Secretary may carry out
subsection (a) by entering into contracts with one or more public
or private entities, including nationally recognized organizations in
the field of poison control and national media firms, for the development and implementation of a nationwide poison prevention and
poison control center awareness campaign, which may include—
(1) the development and distribution of poison prevention
and poison control center awareness materials;
(2) television, radio, Internet, and newspaper public service announcements; and
(3) other activities to provide for public and professional
awareness and education.
(c) EVALUATION.—The Secretary shall—
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Sec. 1273

(1) establish baseline measures and benchmarks to quantitatively evaluate the impact of the nationwide media campaign carried out under this section; and
(2) on an annual basis, prepare and submit to the appropriate committees of Congress, 1 an evaluation of the nationwide media campaign.
(d) AUTHORIZATION OF APPROPRIATIONS.—There is authorized
to be appropriated to carry out this section, such sums as may be
necessary for fiscal year 2009, and $800,000 for each of fiscal years
2010 through 2014.
SEC. 1273. ø300d–73¿ MAINTENANCE OF THE POISON CONTROL CENTER GRANT PROGRAM.
(a) AUTHORIZATION OF PROGRAM.—The Secretary shall award

grants to poison control centers certified under subsection (c) (or
granted a waiver under subsection (d)) and professional organizations in the field of poison control for the purposes of preventing,
and providing treatment recommendations for, poisonings and complying with the operational requirements needed to sustain the certification of the center under subsection (c).
(b) ADDITIONAL USES OF FUNDS.—In addition to the purposes
described in subsection (a), a poison center or professional organization awarded a grant, contract, or cooperative agreement under
such subsection may also use amounts received under such grant,
contract, or cooperative agreement—
(1) to establish and evaluate best practices in the United
States for poison prevention, poison control center outreach,
and emergency and preparedness programs;
(2) to research, develop, implement, revise, and communicate standard patient management guidelines for commonly
encountered toxic exposures;
(3) to improve national toxic exposure surveillance by enhancing cooperative activities between poison control centers in
the United States and the Centers for Disease Control and
Prevention;
(4) to develop, support, and enhance technology and capabilities of professional organizations in the field of poison control to collect national poisoning, toxic occurrence, and related
public health data;
(5) to develop initiatives to foster the enhanced public
health utilization of national poison data collected by organizations described in paragraph (4);
(6) to support and expand the toxicologic expertise within
poison control centers; and
(7) to improve the capacity of poison control centers to answer high volumes of calls and respond during times of national crisis or other public health emergencies.
(c) CERTIFICATION.—Except as provided in subsection (d), the
Secretary may award a grant to a poison control center under subsection (a) only if—
(1) the center has been certified by a professional organization in the field of poison control, and the Secretary has approved the organization as having in effect standards for cer1 The

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comma after ‘‘Congress’’ probably should not appear.

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PUBLIC HEALTH SERVICE ACT

1042

tification that reasonably provide for the protection of the public health with respect to poisoning; or
(2) the center has been certified by a State government,
and the Secretary has approved the State government as having in effect standards for certification that reasonably provide
for the protection of the public health with respect to poisoning.
(d) WAIVER OF CERTIFICATION REQUIREMENTS.—
(1) IN GENERAL.—The Secretary may grant a waiver of the
certification requirements of subsection (c) with respect to a
noncertified poison control center that applies for a grant
under this section if such center can reasonably demonstrate
that the center will obtain such a certification within a reasonable period of time as determined appropriate by the Secretary.
(2) RENEWAL.—The Secretary may renew a waiver under
paragraph (1).
(3) LIMITATION.—In no case may the sum of the number of
years for a waiver under paragraph (1) and a renewal under
paragraph (2) exceed 5 years. The preceding sentence shall
take effect as of the date of the enactment of the Poison Center
Support, Enhancement, and Awareness Act of 2008.
(e) SUPPLEMENT NOT SUPPLANT.—Amounts made available to
a poison control center under this section shall be used to supplement and not supplant other Federal, State or local funds provided
for such center.
(f) MAINTENANCE OF EFFORT.—A poison control center, in utilizing the proceeds of a grant under this section, shall maintain the
expenditures of the center for activities of the center at a level that
is not less than the level of expenditures maintained by the center
for the fiscal year preceding the fiscal year for which the grant is
received.
(g) AUTHORIZATION OF APPROPRIATIONS.—There is authorized
to be appropriated to carry out this section, $27,500,000 for fiscal
year 2009, and $28,600,000 for each of fiscal years 2010 through
2014. The Secretary may utilize not to exceed 8 percent of the
amount appropriated under this preceding sentence in each fiscal
year for coordination, dissemination, technical assistance, program
evaluation, data activities, and other program administration functions that do not include grants, contracts, or cooperative agreements under subsections (a) and (b), which are determined by the
Secretary to be appropriate for carrying out the program under this
section.
SEC. 1274. ø300d–74¿ RULE OF CONSTRUCTION.

Nothing in this part may be construed to ease any restriction
in Federal law applicable to the amount or percentage of funds appropriated to carry out this part that may be used to prepare or
submit a report.

PART H—TRAUMA SERVICE AVAILABILITY
SEC. 1281. ø300d–81¿ GRANTS TO STATES.
(a) ESTABLISHMENT.—To promote

universal access to trauma
care services provided by trauma centers and trauma-related physiMarch 13, 2013

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cian specialties, the Secretary shall provide funding to States to enable such States to award grants to eligible entities for the purposes described in this section.
(b) AWARDING OF GRANTS BY STATES.—Each State may award
grants to eligible entities within the State for the purposes described in subparagraph (d).
(c) ELIGIBILITY.—
(1) IN GENERAL.—To be eligible to receive a grant under
subsection (b) an entity shall—
(A) be—
(i) a public or nonprofit trauma center or consortium thereof that meets that requirements of paragraphs (1), (2), and (5) of section 1241(b);
(ii) a safety net public or nonprofit trauma center
that meets the requirements of paragraphs (1) through
(5) of section 1241(b); or
(iii) a hospital in an underserved area (as defined
by the State) that seeks to establish new trauma services; and
(B) submit to the State an application at such time, in
such manner, and containing such information as the
State may require.
(2) LIMITATION.—A State shall use at least 40 percent of
the amount available to the State under this part for a fiscal
year to award grants to safety net trauma centers described in
paragraph (1)(A)(ii).
(d) USE OF FUNDS.—The recipient of a grant under subsection
(b) shall carry out 1 or more of the following activities consistent
with subsection (b):
(1) Providing trauma centers with funding to support physician compensation in trauma-related physician specialties
where shortages exist in the region involved, with priority provided to safety net trauma centers described in subsection
(c)(1)(A)(ii).
(2) Providing for individual safety net trauma center fiscal
stability and costs related to having service that is available 24
hours a day, 7 days a week, with priority provided to safety net
trauma centers described in subsection (c)(1)(A)(ii) located in
urban, border, and rural areas.
(3) Reducing trauma center overcrowding at specific trauma centers related to throughput of trauma patients.
(4) Establishing new trauma services in underserved areas
as defined by the State.
(5) Enhancing collaboration between trauma centers and
other hospitals and emergency medical services personnel related to trauma service availability.
(6) Making capital improvements to enhance access and
expedite trauma care, including providing helipads and associated safety infrastructure.
(7) Enhancing trauma surge capacity at specific trauma
centers.
(8) Ensuring expedient receipt of trauma patients transported by ground or air to the appropriate trauma center.
(9) Enhancing interstate trauma center collaboration.
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(e) LIMITATION.—
(1) IN GENERAL.—A State may use not more than 20 percent of the amount available to the State under this part for
a fiscal year for administrative costs associated with awarding
grants and related costs.
(2) MAINTENANCE OF EFFORT.—The Secretary may not provide funding to a State under this part unless the State agrees
that such funds will be used to supplement and not supplant
State funding otherwise available for the activities and costs
described in this part.
(f) DISTRIBUTION OF FUNDS.—The following shall apply with respect to grants provided in this part:
(1) LESS THAN $10,000,000.—If the amount of appropriations
for this part in a fiscal year is less than $10,000,000, the Secretary shall divide such funding evenly among only those
States that have 1 or more trauma centers eligible for funding
under section 1241(b)(3)(A).
(2) LESS THAN $20,000,000.—If the amount of appropriations
in a fiscal year is less than $20,000,000, the Secretary shall divide such funding evenly among only those States that have 1
or more trauma centers eligible for funding under subparagraphs (A) and (B) of section 1241(b)(3).
(3) LESS THAN $30,000,000.—If the amount of appropriations
for this part in a fiscal year is less than $30,000,000, the Secretary shall divide such funding evenly among only those
States that have 1 or more trauma centers eligible for funding
under section 1241(b)(3).
(4) $30,000,000 OR MORE.—If the amount of appropriations
for this part in a fiscal year is $30,000,000 or more, the Secretary shall divide such funding evenly among all States.
SEC. 1282. ø300d–82¿ AUTHORIZATION OF APPROPRIATIONS.

For the purpose of carrying out this part, there is authorized
to be appropriated $100,000,000 for each of fiscal years 2010
through 2015.

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TITLE XIII—HEALTH MAINTENANCE ORGANIZATIONS
REQUIREMENTS FOR HEALTH MAINTENANCE ORGANIZATIONS

SEC. 1301. ø300e¿ (a) For purposes of this title, the term
‘‘health maintenance organization’’ means a public or private entity
which is organized under the laws of any State and which (1) provides basic and supplemental health services to its members in the
manner prescribed by subsection (b), and (2) is organized and operated in the manner prescribed by subsection (c).
(b) A health maintenance organization shall provide, without
limitations as to time or cost other than those prescribed by or
under this title, basic and supplemental health services to its members in the following manner:
(1) Each member is to be provided basic health services for
a basic health services payment which (A) is to be paid on a
periodic basis without regard to the dates health services
(within the basic health services) are provided; (B) is fixed
without regard to the frequency, extent, or kind of health service (within the basic health services) actually furnished; (C) except in the case of basic health services provided a member
who is a full-time student (as defined by the Secretary) at an
accredited institution of higher education, is fixed under a community rating system; and (D) may be supplemented by additional nominal payments which may be required for the provision of specific services (within the basic health services), except that such payments may not be required where or in such
a manner that they serve (as determined under regulations of
the Secretary) as a barrier to the delivery of health services.
Such additional nominal payments shall be fixed in accordance
with the regulations of the Secretary. If a health maintenance
organization offers to its members the opportunity to obtain
basic health services through a physician not described in subsection (b)(3)(A), the organization may require, in addition to
payments described in clause (D) of this paragraph, a reasonable deductible to be paid by a member when obtaining a basic
health service from such a physician. A health maintenance organization may include a health service, defined as a supplemental health service by section 1302(2), in the basic health
services provided its members for a basic health services payment described in the first sentence. In the case of an entity
which before it became a qualified health maintenance organization (within the meaning of section 1310(d)) provided comprehensive health services on a prepaid basis, the requirement
of clause (C) shall not apply to such entity until the expiration
of the forty-eight month period beginning with the month following the month in which the entity became such a qualified
health organization. The requirements of this paragraph re1045
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Sec. 1301

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1046

specting the basic health services payment shall not apply to
the provision of basic health services to a member for an illness or injury for which the member is entitled to benefits
under a workmen’s compensation law or an insurance policy
but only to the extent such benefits apply to such services. For
the provision of such services for an illness or injury for which
a member is entitled to benefits under such a law, the health
maintenance organization may, if authorized by such law,
charge or authorize the provider of such services to charge, in
accordance with the charges allowed under such law, the insurance carrier, employer, or other entity which under such law
is to pay for the provision of such services or, to the extent that
such member has been paid under such law for such services,
such member. For the provision of such services for an illness
or injury for which a member is entitled to benefits under an
insurance policy, a health maintenance organization may
charge or authorize the provider of such services to charge the
insurance carrier under such policy or, to the extent that such
member has been paid under such policy for such services,
such member.
(2) For such payment or payments (hereinafter in this title
referred to as ‘‘supplemental health services payments’’) as the
health maintenance organization may require in addition to
the basic health services payment, the organization may provide to each of its members any of the health services which
are included in supplemental health services (as defined in section 1302(2)). Supplemental health services payments which
are fixed on a prepayment basis shall be fixed under a community rating system unless the supplemental health services
payment is for a supplemental health service provided a member who is a full-time student (as defined by the Secretary) at
an accredited institution of higher education, except that, in
the case of an entity which before it became a qualified health
maintenance organization (within the meaning of section
1310(d)) provided comprehensive health services on a prepaid
basis, the requirement of this sentence shall not apply to such
entity during the forty-eight month period beginning with the
month following the month in which the entity became such a
qualified health maintenance organization.
(3)(A) Except as provided in subparagraph (B), at least 90
percent of the services of a physician which are provided as
basic health services shall be provided through—
(i) members of the staff of the health maintenance organization,
(ii) a medical group (or groups),
(iii) an individual practice association (or associations),
(iv) physicians or other health professionals who have
contracted with the health maintenance organization for
the provision of such services, or
(v) any combination of such staff, medical group (or
groups), individual practice association (or associations) or
physicians or other health professionals under contract
with the organization.
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(B) Subparagraph (A) does not apply to the provision of the
services of a physician—
(i) which the health maintenance organization determines, in conformity with regulations of the Secretary, are
unusual or infrequently used, or
(ii) which are provided a member of the organization
in a manner other than that prescribed by subparagraph
(A) because of an emergency which made it medically necessary that the service be provided to the member before
it could be provided in a manner prescribed by subparagraph (A).
(C) Contracts between a health maintenance organization
and health professionals for the provision of basic and supplemental health services shall include such provisions as the Secretary may require (including provisions requiring appropriate
continuing education).
(D) Contracts between a health maintenance organization
and health professionals for the provision of basic and supplemental health services shall include such provisions as the Secretary may require, but only to the extent that such requirements are designed to insure the delivery of quality health
care services and sound fiscal management.
(4) Basic health services (and only such supplemental
health services as members have contracted for) shall within
the area served by the health maintenance organization be
available and accessible to each of its members with reasonable
promptness and in a manner which assures continuity, and
when medically necessary be available and accessible twentyfour hours a day and seven days a week, except that a health
maintenance organization which has a service area located
wholly in a nonmetropolitan area may make a basic health
service available outside its service area if that basic health
service is not a primary care or emergency health care service
and if there is an insufficient number of providers of that basic
health service within the service area who will provide such
service to members of the health maintenance organization. A
member of a health maintenance organization shall be reimbursed by the organization for his expenses in securing basic
and supplemental health services other than through the organization if the services were medically necessary and immediately required because of an unforeseen illness, injury, or
condition.
(5) To the extent that a natural disaster, war, riot, civil insurrection, or any other similar event not within the control of
a health maintenance organization (as determined under regulations of the Secretary) results in the facilities, personnel, or
financial resources of a health maintenance organization not
being available to provide or arrange for the provision of a
basic or supplemental health service in accordance with the requirements of paragraphs (1) through (4) of this subsection,
such requirements only require the organization to make a
good-faith effort to provide or arrange for the provision of such
service within such limitation on its facilities, personnel, or resources.
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(6) A health maintenance organization that otherwise
meets the requirements of this title may offer a high-deductible
health plan (as defined in section 220(c)(2) of the Internal Revenue Code of 1986).
(c) Each health maintenance organization shall—
(1)(A) have—
(i) a fiscally sound operation, and
(ii) adequate provision against the risk of insolvency,
which is satisfactory to the Secretary, and (B) have administrative and managerial arrangements satisfactory to the Secretary;
(2) assume full financial risk on a prospective basis for the
provision of basic health services, except that a health maintenance organization may (A) obtain insurance or make other arrangements for the cost of providing to any member basic
health services the aggregate value of which exceeds $5,000 in
any year, (B) obtain insurance or make other arrangements for
the cost of basic health services provided to its members other
than through the organization because medical necessity required their provision before they could be secured through the
organization, (C) obtain insurance or make other arrangements
for not more than 90 per centum of the amount by which its
costs for any of its fiscal years exceed 115 per centum of its income for such fiscal year, and (D) make arrangements with
physicians or other health professionals, health care institutions, or any combination of such individuals or institutions to
assume all or part of the financial risk on a prospective basis
for the provision of basic health services by the physicians or
other health professionals or through the institutions;
(3)(A) enroll persons who are broadly representative of the
various age, social, and income groups within the area it
serves, except that in the case of a health maintenance organization which has a medically underserved population located
(in whole or in part) in the area it serves, not more than 75
per centum of the members of that organization may be enrolled from the medically underserved population unless the
area in which such population resides is also a rural area (as
designated by the Secretary), and (B) carry out enrollment of
members who are entitled to medical assistance under a State
plan approved under title XIX of the Social Security Act in accordance with procedures approved under regulations promulgated by the Secretary;
(4) not expel or refuse to re-enroll any member because of
his health status or his requirements for health services;
(5) be organized in such a manner that provides meaningful procedures for hearing and resolving grievances between
the health maintenance organization (including the medical
group or groups and other health delivery entities providing
health services for the organization) and the members of the
organization;
(6) have organizational arrangements, established in accordance with regulations of the Secretary, for an ongoing
quality assurance program for its health services which program (A) stresses health outcomes, and (B) provides review by
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physicians and other health professionals of the process followed in the provision of health services;
(7) adopt at least one of the following arrangements to protect its members from incurring liability for payment of any
fees which are the legal obligation of such organization—
(A) a contractual arrangement with any hospital that
is regularly used by the members of such organization prohibiting such hospital from holding any such member liable for payment of any fees which are the legal obligation
of such organization;
(B) insolvency insurance, acceptable to the Secretary;
(C) adequate financial reserve, acceptable to the Secretary; and
(D) other arrangements, acceptable to the Secretary,
to protect members,
except that the requirements of this paragraph shall not apply to
a health maintenance organization if applicable State law provides
the members of such organization with protection from liability for
payment of any fees which are the legal obligation of such organization; and
(8) provide, in accordance with regulations of the Secretary (including safeguards concerning the confidentiality of the doctor-patient relationship), an effective procedure for developing, compiling,
evaluating, and reporting to the Secretary, statistics and other information (which the Secretary shall publish and disseminate on
an annual basis and which the health maintenance organization
shall disclose, in a manner acceptable to the Secretary, to its members and the general public) relating to (A) the cost of its operations, (B) the patterns of utilization of its services, (C) the availability, accessibility, and acceptability of its services, (D) to the extent practical, developments in the health status of its members,
and (E) such other matters as the Secretary may require.
The Secretary shall issue regulations stating the circumstances
under which the Secretary, in administering paragraph (1)(A), will
consider the resources of an organization which owns or controls a
health maintenance organization. Such regulations shall require as
a condition to consideration of resources that an organization which
owns or controls a health maintenance organization shall provide
satisfactory assurances that it will assume the financial obligations
of the health maintenance organization.
(d) An organization that offers health benefits coverage shall
not be considered as failing to meet the requirements of this section notwithstanding that it provides, with respect to coverage offered in connection with a group health plan in the small or large
group market (as defined in section 2791(e)), an affiliation period
consistent with the provisions of section 2701(g).
DEFINITIONS

SEC. 1302. ø300e–1¿ For purposes of this title:
(1) The term ‘‘basic health services’’ means—
(A) physician services (including consultant and referral
services by a physician);
(B) inpatient and outpatient hospital services;
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(C) medically necessary emergency health services;
(D) short-term (not to exceed twenty visits), outpatient
evaluative and crisis intervention mental health services;
(E) medical treatment and referral services (including referral services to appropriate ancillary services) for the abuse
of or addiction to alcohol and drugs;
(F) diagnostic laboratory and diagnostic and therapeutic
radiologic services;
(G) home health services; and
(H) preventive health services (including (i) immunizations, (ii) well-child care from birth, (iii) periodic health evaluations for adults, (iv) voluntary family planning services, (v) infertility services, and (vi) children’s eye and ear examinations
conducted to determine the need for vision and hearing correction).
Such term does not include a health service which the Secretary,
upon application of a health maintenance organization, determines
is unusual and infrequently provided and not necessary for the protection of individual health. The Secretary shall publish in the Federal Register each determination made by him under the preceding
sentence. If a service of a physician described in the preceding sentence may also be provided under applicable State law by a dentist,
optometrist, podiatrist, psychologist, or other health care personnel
a health maintenance organization may provide such service
through a dentist, optometrist, podiatrist, psychologist, or other
health care personnel (as the case may be) licensed to provide such
service. Such term includes a health service directly associated
with an organ transplant only if such organ transplant was required to be included in basic health services on April 15, 1985. For
purposes of this paragraph, the term ‘‘home health services’’ means
health services provided at a member’s home by health care personnel, as prescribed or directed by the responsible physician or
other authority designated by the health maintenance organization.
(2) The term ‘‘supplemental health services’’ means any health
service which is not included as a basic health service under paragraph (1) of this section. If a health service provided by a physician
may also be provided under applicable State law by a dentist, optometrist, podiatrist, psychologist, or other health care personnel,
a health maintenance organization may provide such service
through an optometrist, dentist, podiatrist, psychologist, or other
health care personnel (as the case may be) licensed to provide such
service.
(3) The term ‘‘member’’ when used in connection with a health
maintenance organization means an individual who has entered
into a contractual agreement, or on whose behalf a contractual arrangement has been entered into, with the organization under
which the organization assumes the responsibility for the provision
to such individual of basic health services and of such supplemental health services as may be contracted for.
(4) The term ‘‘medical group’’ means a partnership, association,
or other group—
(A) which is composed of health professionals licensed to
practice medicine or osteopathy and of such other licensed
health professionals (including dentists, optometrists, podiaMarch 13, 2013

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trists, and psychologists) as are necessary for the provision of
health services for which the group is responsible;
(B) a majority of the members of which are licensed to
practice medicine or osteopathy; and
(C) the members of which (i) as their principal professional
activity engage in the coordinated practice of their profession
and as a group responsibility have substantial responsibility
for the delivery of health services to members of a health
maintenance organization, except that this clause does not
apply before the end of the forty-eight month period beginning
after the month in which the health maintenance oranization 1
becomes a qualified health maintenance organization as defined in section 1310(d), or as authorized by the Secretary in
accordance with regulations that take into consideration the
usual circumstances of the group; (ii) pool their income from
practice as members of the group and distribute it among
themselves according to a prearranged salary or drawing account or other similar plan unrelated to the provision of specific health services; (iii) share medical and other records and
substantial portions of major equipment and of professional,
technical, and administrative staff; (iv) arrange for and encourage continuing education in the field of clinical medicine and
related areas for the members of the group; and (v) establish
an arrangement whereby a member’s enrollment status is not
known to the health professional who provides health services
to the member.
(5) The term ‘‘individual practice association’’ means a partnership, corporation, association, or other legal entity which has entered into a services arrangement (or arrangements) with persons
who are licensed to practice medicine, osteopathy, dentistry, podiatry, optometry, psychology, or other health profession in a State
and a majority of whom are licensed to practice medicine or osteopathy. Such an arrangement shall provide—
(A) that such persons shall provide their professional services in accordance with a compensation arrangement established by the entity; and
(B) to the extent feasible, for the sharing by such persons
of medical and other records, equipment, and professional,
technical, and administrative staff.
(6) The term ‘‘health systems agency’’ means an entity which
is designated in accordance with section 1515 of this Act.
(7) The term ‘‘medically underserved population’’ means the
population of an urban or rural area designated by the Secretary
as an area with a shortage of personal health services or a population group designated by the Secretary as having a shortage of
such services. Such a designation may be made by the Secretary
only after consideration of the comments (if any) of (A) each State
health planning and development agency which covers (in whole or
in part) such urban or rural area or the area in which such population group resides, and (B) each health systems agency designated for a health service area which covers (in whole or in part)
1 So

March 13, 2013

in law. Probably should be ‘‘organization’’.

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such urban or rural area or the area in which such population
group resides.
(8)(A) The term ‘‘community rating system’’ means the systems, described in subparagraphs (B) and (C), of fixing rates of
payments for health services. A health maintenance organization
may fix its rates of payments under the system described in subparagraph (B) or (C) or under both such systems, but a health
maintenance organization may use only one such system for fixing
its rates of payments for any one group.
(B) A system of fixing rates of payment for health services may
provide that the rates shall be fixed on a per-person or per-family
basis and may authorize the rates to vary with the number of persons in a family, but, except as authorized in subparagraph (D),
such rates must be equivalent for all individuals and for all families of similar composition.
(C) A system of fixing rates of payment for health services may
provide that the rates shall be fixed for individuals and families by
groups. Except as authorized in subparagraph (D), such rates must
be equivalent for all individuals in the same group and for all families of similar composition in the same group. If a health maintenance organization is to fix rates of payment for individuals and
families by groups, it shall—
(i)(I) classify all of the members of the organization
into classes based on factors which the health maintenance
organization determines predict the differences in the use
of health services by the individuals or families in each
class and which have not been disapproved by the Secretary,
(II) determine its revenue requirements for providing
services to the members of each class established under
subclause (I), and
(III) fix the rates of payments for the individuals and
families of a group on the basis of a composite of the organization’s revenue requirements determined under subclause (II) for providing services to them as members of
the classes established under subclause (I), or
(ii) fix the rates of payments for the individuals and
families of a group on the basis of the organization’s revenue requirements for providing services to the group, except that the rates of payments for the individuals and
families of a group of less than 100 persons may not be
fixed at rates greater than 110 percent of the rate that
would be fixed for such individuals and families under subparagraph (B) or clause (i) of this subparagraph.
The Secretary shall review the factors used by each health maintenance organization to establish classes under clause (i). If the Secretary determines that any such factor may not reasonably be used
to predict the use of the health services by individuals and families,
the Secretary shall disapprove such factor for such purpose. If a
health maintenance organization is to fix rates of payment for a
group under clause (ii), it shall, upon request of the entity with
which it contracts to provide services to such group, disclose to that
entity the method and data used in calculating the rates of payment.
March 13, 2013

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Sec. 1305

(D) The following differentials in rates of payments may be established under the systems described in subparagraphs (B) and
(C):
(i) Nominal differentials in such rates may be established
to reflect differences in marketing costs and the different administrative costs of collecting payments from the following
categories of members:
(I) Individual members (including their families).
(II) Small groups of members (as determined under
regulations of the Secretary).
(III) Large groups of members (as determined under
regulations of the Secretary).
(ii) Nominal differentials in such rates may be established
to reflect the compositing of the rates of payment in a systematic manner to accommodate group purchasing practices of the
various employers.
(iii) Differentials in such rates may be established for
members enrolled in a health maintenance organization pursuant to a contract with a governmental authority under section
1079 or 1086 of title 10, United States Code, or under any
other governmental program (other than the health benefits
program authorized by chapter 89 of title 5, United States
Code) or any health benefits program for employees of States,
political subdivision of States, and other public entities.
(9) The term ‘‘non-metropolitan area’’ means an area no part
of which is within an area designated as a standard metropolitan
statistical area by the Office of Management and Budget and which
does not contain a city whose population exceeds fifty thousand individuals.
LOANS AND LOAN GUARANTEES FOR INITIAL COSTS OF OPERATION

SEC. 1305. ø300e–4¿ (a) The Secretary may—
(1) make loans to public or private health maintenance organizations to assist them in meeting the amount by which
their costs of operation during a period not to exceed the first
sixty months of their operation exceed their revenues in that
period;
(2) make loans to public or private health maintenance organizations to assist them in meeting the amount by which
their costs of operation, which the Secretary determines are attributable to significant expansion in their membership or area
served and which are incurred during a period not to exceed
the first sixty months of their operation after such expansion,
exceed their revenues in that period which the Secretary determines are attributable to such expansion; and
(3) guarantee to non-Federal lenders payment of the principal of and the interest on loans made to private health maintenance organizations for the amounts referred to in paragraphs (1) and (2).
No loan or loan guarantee may be made under this subsection for
the costs of operation of a health maintenance organization unless
the Secretary determines that the organization has made all reasonable attempts to meet such costs, and unless the Secretary has
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made a grant or loan to, entered into a contract with, or guaranteed a loan for, the organization in fiscal year 1981, 1982, 1983,
1984, or 1985 under this section or section 1304(b) (as in effect before October 1, 1985).
(b)(1) Except as provided in paragraph (2), the aggregate
amount of principal of loans made or guaranteed, or both, under
subsection (a) for a health maintenance organization may not exceed $7,000,000. In any twelve-month period the amount disbursed
to a health maintenance organization under this section (either directly by the Secretary, by an escrow agent under the terms of an
escrow agreement, or by a lender under a guaranteed loan) may
not exceed $3,000,000.
(2) The cumulative total of the principal of the loans outstanding at any time which have been directly made or with respect to which guarantees have been issued under subsection (a)
may not exceed such limitations as may be specified in appropriation Acts.
(c) Loans under this section shall be made from the fund established under section 1308(e).
(d) No loan may be made or guaranteed under this section
after September 30, 1986.
(e) Of the sums used for loans under this section in any fiscal
year from the loan fund established under section 1308(e), not less
than 20 per centum shall be used for loans for projects (1) for the
initial operation of health maintenance organizations which the
Secretary determines have not less than 66 per centum of their
membership drawn from residents of nonmetropolitan areas, and
(2) the applications for which meet the requirements of this title
for approval.
(f) In considering applications for loan guarantees under this
section, the Secretary shall give special consideration to applications for health maintenance organizations which will serve medically underserved populations.
APPLICATION REQUIREMENTS

SEC. 1306. ø300e–5¿ (a) No loan or loan guarantee may be
made under this title unless an application therefor has been submitted to and approved by the Secretary.
(b) The Secretary may not approve an application for a loan or
loan guarantee under this title unless—
(1) such application meets the requirements of section
1308;
(2) in the case of an application for assistance under section 1305, he determines that the applicant making the application would not be able to complete the project or undertaking
for which the application is submitted without the assistance
applied for;
(3) the application contains satisfactory specification of the
existing or anticipated (A) population group or groups to be
served by the proposed or existing health maintenance organization described in the application, (B) membership of such organization, (C) methods, terms, and periods of the enrollment
of members of such organization, (D) estimated costs per memMarch 13, 2013

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Sec. 1306

ber of the health and educational services to be provided by
such organization and the nature of such costs, (E) sources of
professional services for such organization, and organizational
arrangements of such organization for providing health and
educational services, (F) organizational arrangements of such
organization for an ongoing quality assurance program in conformity with the requirements of section 1301(c), (G) sources of
prepayment and other forms of payment for the services to be
provided by such organization, (H) facilities, and additional
capital investments and sources of financing therefor, available
to such organization to provide the level and scope of services
proposed, (I) administrative, managerial, and financial arrangements and capabilities of such organization, (J) role for
members in the planning and policymaking for such organization, (K) grievance procedures for members of such organization, and (L) evaluations of the support for and acceptance of
such organization by the population to be served, the sources
of operating support, and the professional groups to be involved or affected thereby;
(4) contains or is supported by assurances satisfactory to
the Secretary that the applicant making the application will,
in accordance with such criteria as the Secretary shall by regulation prescribe, enroll, and maintain an enrollment of the
maximum number of members that its available and potential
resources (as determined under regulations of the Secretary)
will enable it to effectively serve;
(5) in the case of an application made for a project which
previously received a grant, contract, loan, or loan guarantee
under this title, such application contains or is supported by
assurances satisfactory to the Secretary that the applicant
making the application has the financial capability to adequately carry out the purposes of such project and has developed and operated such project in accordance with the requirements of this title and with the plans contained in previous applications for such assistance;
(6) the application contains such assurances as the Secretary may require respecting the intent and the ability of the
applicant to meet the requirements of paragraphs (1) and (2)
of section 1301(b) respecting the fixing of basic health services
payments and supplemental health services payments under a
community rating system; and
(7) the application is submitted in such form and manner,
and contains such additional information, as the Secretary
shall prescribe in regulations.
An organization making multiple applications for more than one
loan or loan guarantee under this title, simultaneously or over the
course of time, shall not be required to submit duplicate or redundant information but shall be required to update the specifications
(required by paragraph (3)) respecting the existing or proposed
health maintenance organization in such manner and with such
frequency as the Secretary may by regulation prescribe. In determining, for purposes of paragraph (2), whether an applicant would
be able to complete a project or undertaking without the assistance
applied for, the Secretary shall not consider any asset of the appliMarch 13, 2013

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cant the obligation of which for such undertaking or project would
jeopardize the fiscal soundness of the applicant.
(c) The Secretary shall by regulation establish standards and
procedures for health systems agencies to follow in reviewing and
commenting on applications for loans and loan guarantees under
this title.
ADMINISTRATION OF ASSISTANCE PROGRAMS

SEC. 1307. ø300e–6¿ (a)(1) Each recipient of a loan or loan
guarantee under this title shall keep such records as the Secretary
shall prescribe, including records which fully disclose the amount
and disposition by such recipient of the proceeds of the loan (directly made or guaranteed), the total cost of the undertaking in
connection with which the loan was given or used, the amount of
that portion of the cost of the undertaking supplied by other
sources, and such other records as will facilitate an effective audit.
(2) The Secretary, or any of his duly authorized representatives, shall have access for the purpose of audit and examination
to any books, documents, papers, and records of the recipients of
a loan or loan guarantee under this title which relate to such assistance.
(b) Upon expiration of the period for which a loan or loan guarantee was provided an entity under this title, such entity shall
make a full and complete report to the Secretary in such manner
as he may by regulation prescribe. Each such report shall contain,
among such other matters as the Secretary may by regulation require, descriptions of plans, developments, and operations relating
to the matters referred to in section 1306(b)(3).
(d) 1 An entity which provides health services to a defined population on a prepaid basis and which has members who are entitled to insurance benefits under title XVIII of the Social Security
Act or to medical assistance under a State plan approved under
title XIX of such Act may be considered as a health maintenance
organization for purposes of receiving assistance under this title
if—
(1) with respect to its members who are entitled to such
insurance benefits or to such medical assistance it (A) provides
health services in accordance with section 1301(b), except that
(i) it does not furnish to those members the health services
(within the basic health services) for which it may not be compensated under such title XVIII or such State plan, and (ii) it
does not fix the basic or supplemental health services payment
for such members under a community rating system, and (B)
is organized and operated in the manner prescribed by section
1301(c), except that it does not assume full financial risk on a
prospective basis for the provision to such members of basic or
supplemental health services with respect to which it is not required under such title XVIII or such State plan to assume
such financial risk; and
(2) with respect to its other members it provides health
services in accordance with section 1301(b) and is organized
and operated in the manner prescribed by section 1301(c).
1 Former

March 13, 2013

subsection (c) was repealed by section 803(a) of Public Law 99–660.

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PUBLIC HEALTH SERVICE ACT

Sec. 1308

An entity which provides health services to a defined population on
a prepaid basis and which has members who are enrolled under
the health benefits program authorized by chapter 89 of title 5,
United States Code, may be considered as a health maintenance organization for purposes of receiving assistance under this title if
with respect to its other members it provides health services in accordance with section 1301(b) and is organized and operated in the
manner prescribed by section 1301(c).
GENERAL PROVISIONS RELATING TO LOAN GUARANTEES AND LOANS

SEC. 1308. ø300e–7¿ (a)(1) The Secretary may not approve an
application for a loan guarantee under this title unless he determines that (A) the terms, conditions, security (if any), and schedule
and amount of repayments with respect to the loan are sufficient
to protect the financial interests of the United States and are otherwise reasonable, including a determination that the rate of interest does not exceed such per centum per annum on the principal
obligation outstanding as the Secretary determines to be reasonable, taking into account the range of interest rates prevailing in
the private market for loans with similar maturities, terms, conditions, and security and the risks assumed by the United States,
and (B) the loan would not be available on reasonable terms and
conditions without the guarantee under this title.
(2)(A) The United States shall be entitled to recover from the
applicant for a loan guarantee under this title the amount of any
payment made pursuant to such guarantee, unless the Secretary
for good cause waives such right of recovery; and, upon making any
such payment, the United States shall be subrogated to all of the
rights of the recipient of the payments with respect to which the
guarantee was made.
(B) To the extent permitted by subparagraph (C), any terms
and conditions applicable to a loan guarantee under this title (including terms and conditions imposed under subparagraph (D))
may be modified by the Secretary to the extent he determines it
to be consistent with the financial interest of the United States.
(C) Any loan guarantee made by the Secretary under this title
shall be incontestable (i) in the hands of an applicant on whose behalf such guarantee is made unless the applicant engaged in fraud
or misrepresentation in securing such guarantee, and (ii) as to any
person (or his successor in interest) who makes or contracts to
make a loan to such applicant in reliance thereon unless such person (or his successor in interest) engaged in fraud or misrepresentation in making or contracting to make such loan.
(D) guarantees of loans under this title shall be subject to such
further terms and conditions as the Secretary determines to be necessary to assure that the purposes of this title will be achieved.
(b)(1) The Secretary may not approve an application for a loan
under this title unless—
(A) the Secretary is reasonably satisfied that the applicant
therefor will be able to make payments of principal and interest thereon when due, and
(B) the applicant provides the Secretary with reasonable
assurances that there will be available to it such additional
March 13, 2013

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funds as may be necessary to complete the project or undertaking with respect to which such loan is requested.
(2) Any loan made under this title shall (A) have such security,
(B) have such maturity date, (C) be repayable in such installments,
(D) on the date the loan is made, bear interest at a rate comparable to the rate of interest prevailing on such date with respect
to marketable obligations of the United States of comparable maturities, adjusted to provide for appropriate administrative charges,
and (E) be subject to such other terms and conditions (including
provisions for recovery in case of default), as the Secretary determines to be necessary to carry out the purposes of this title while
adequately protecting the financial interests of the United States.
On the date disbursements are made under a loan after the initial
disbursement under the loan, the Secretary may change the rate
of interest on the amount of the loan disbursed on that date to a
rate which is comparable to the rate of interest prevailing on the
date the subsequent disbursement is made with respect to marketable obligations of the United States of comparable maturities, adjusted to provide for appropriate administrative charges.
(3) The Secretary may, for good cause but with due regard to
the financial interests of the United States, waive any right of recovery which he has by reason of the failure of a borrower to make
payments of principal of and interest on a loan made under this
title, except that if such loan is sold and guaranteed, any such
waiver shall have no effect upon the Secretary’s guarantee of timely payment of principal and interest.
(c)(1) The Secretary may from time to time, but with due regard to the financial interests of the United States, sell loans made
by him under this title.
(2) The Secretary may agree, prior to his sale of any such loan,
to guarantee to the purchaser (and any successor in interest of the
purchaser) compliance by the borrower with the terms and conditions of such loan. Any such agreement shall contain such terms
and conditions as the Secretary considers necessary to protect the
financial interests of the United States or as otherwise appropriate.
Any such agreement may (A) provide that the Secretary shall act
as agent of any such purchaser for the purpose of collecting from
the borrower to which such loan was made and paying over to such
purchaser, any payments of principal and interest payable by such
organization under such loan; and (B) provide for the repurchase
by the Secretary of any such loan on such terms and conditions as
may be specified in the agreement. The full faith and credit of the
United States is pledged to the payment of all amounts which may
be required to be paid under any guarantee under this paragraph.
(3) After any loan under this title to a public health maintenance organization has been sold and guaranteed under this subsection, interest paid on such loan which is received by the purchaser thereof (or his successor in interest) shall be included in the
gross income of the purchaser of the loan (or his successor in interest) for the purpose of chapter 1 of the Internal Revenue Code of
1954.
(4) Amounts received by the Secretary as proceeds from the
sale of loans under this subsection shall be deposited in the loan
fund established under subsection (e).
March 13, 2013

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(5) Any reference in this title (other than in this subsection
and in subsection (d)) to a loan guarantee under this title does not
include a loan guarantee made under this subsection.
(d)(1) There is established in the Treasury a loan guarantee
fund (hereinafter in this subsection referred to as the ‘‘fund’’) which
shall be available to the Secretary without fiscal year limitation, in
such amounts as may be specified from time to time in appropriation Acts, to enable him to discharge his responsibilities under loan
guarantees issued by him under this title and to take the action
authorized by subsection (f). There are authorized to be appropriated from time to time such amounts as may be necessary to
provide the sums required for the fund. To the extent authorized
in appropriation Acts, there shall also be deposited in the fund
amounts received by the Secretary in connection with loan guarantees under this title and other property or assets derived by him
from his operations respecting such loan guarantees, including any
money derived from the sale of assets.
(2) If at any time the sums in the funds are insufficient to enable the Secretary to discharge his responsibilities under guarantees issued by him before October 1, 1986, under this title and to
take the action authorized by subsection (f), he is authorized to
issue to the Secretary of the Treasury notes or other obligations in
such forms and denominations, bearing such maturities, and subject to such terms and conditions, as may be prescribed by the Secretary with the approval of the Secretary of Treasury. Such notes
or other obligations shall bear interest at a rate determined by the
Secretary of the Treasury, taking into consideration the current average market yield on outstanding marketable obligations of the
United States of comparable maturities during the month preceding the issuance of the notes or other obligations. The Secretary
of the Treasury shall purchase any notes and other obligations
issued under this paragraph and for that purpose he may use as
a public debt transaction the proceeds from the sale of any securities issued under the Second Liberty Bond Act, and the purposes
for which the securities may be issued under that Act are extended
to include any purchase of such notes and obligations. The Secretary of the Treasury may at any time sell any of the notes or
other obligations acquired by him under this paragraph. All redemptions, purchases, and sales by the Secretary of the Treasury
of such notes or other obligations shall be treated as public debt
transactions of the United States. Sums borrowed under this paragraph shall be deposited in the fund and redemption of such notes
and obligations shall be made by the Secretary from the fund.
(e) There is established in the Treasury a loan fund (hereinafter in this subsection referred to as the ‘‘fund’’) which shall be
available to the Secretary without fiscal year limitation, in such
amounts as may be specified from time to time in appropriation
Acts, to enable him to make loans under this title and to take the
action authorized by subsection (f). There shall also be deposited in
the fund amounts received by the Secretary as interest payments
and repayment of principal on loans made under this title and
other property or assets derived by him from his operations respecting such loans, from the sale of loans under subsection (c) of
this section, or from the sale of assets.
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(f) The Secretary may take such action as he deems appropriate to protect the interest of the United States in the event of
a default on a loan made or guaranteed under this title, including
taking possession of, holding, and using real property pledged as
security for such a loan or loan guarantee.
AUTHORIZATIONS OF APPROPRIATIONS

SEC. 1309. ø300e–8¿ (a) For grants under section 1317 there
is authorized to be appropriated $1,000,000 for each of the fiscal
years 1982, 1983, and 1984.
(b) To meet the obligations of the loan fund established under
section 1308(e) resulting from defaults on loans made from the
fund and to meet the other obligations of the fund, there is authorized to be appropriated to the loan fund for fiscal years 1987, 1988,
and 1989, such sums as may be necessary.
EMPLOYEES’ HEALTH BENEFITS PLANS

SEC. 1310. 1

ø300e–9¿ (a) In accordance with regulations which
the Secretary shall prescribe—
(1) each employer—
(A) which is required during any calendar quarter to
pay its employees the minimum wage prescribed by section
6 of the Fair Labor Standards Act of 1938 (or would be required to pay its employees such wage but for section 13(a)
of such Act), and
(B) which during such calendar quarter employed an
average number of employees of not less than 25, and
(2) any State and each political subdivision thereof which
during any calendar quarter employed an average number of
employees of not less than 25, as a condition of payment to the
State of funds under section 317, 318, or 1002,
which offers to its employees in the calendar year beginning after
such calendar quarter the option of membership in a qualified
health maintenance organization which is engaged in the provision
of basic health services in a health maintenance organization service area in which at least 25 of such employees reside shall meet
the requirements of subsection (b) with respect to any qualified
health maintenance organization offered by the employer or State
or political subdivision.
(b)(1) If a health benefits plan offered by an employer or a
State or political subdivision includes contributions for services offered under the plan, the employer or State or political subdivision
shall make a contribution under the plan for services offered by a
qualified health maintenance organization in an amount which
1 Section 1310 as shown above was added by section 7(b) of Public Law 100–517. Such section
provided in part as follows: ‘‘Effective 7 years after the date of the enactment of this Act [October 24, 1988], section 1310 (42 U.S.C. 300e–9) is amended to read as follows’’.

Section 7(a)(3) of such Public Law provides that nothing in section 1310 shall be construed
to supersede any provision of a collective bargaining agreement in effect on [October 24, 1988].
Section 9 of such Public Law provides as follows: ‘‘With respect to abortion services, the Secretary of Health and Human Services shall not promulgate or issue any regulations, policy
statements, or interpretations or develop any practices concerning the performance of medically
necessary procedures if such regulations, policy statements, interpretations, or practices would
be inconsistent with those in effect on [October 24, 1988].’’.

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does not financially discriminate against an employee who enrolls
in such organization. For purposes of the preceding sentence, an
employer’s or a State’s or political subdivision’s contribution does
not financially discriminate if the employer’s or State’s or political
subdivision’s method of determining the contributions on behalf of
all employees is reasonable and is designed to assure employees a
fair choice among health benefits plans.
(2) Each employer or State or political subdivision which provides payroll deductions as a means of paying employees’ contributions for health benefits or which provides a health benefits plan
to which an employee contribution is not required shall, with the
consent of an employee who exercises option of membership in a
qualified health maintenance organization, arrange for the employee’s contribution for membership in the organization to be paid
through payroll deductions.
(3) No employer or State or political subdivision shall be required to pay more for health benefits as a result of the application
of this subsection than would otherwise be required by any prevailing collective bargaining agreement or other legally enforceable
contract for the provision of health benefits between the employer
or State or political subdivision and its employees.
(c) For purposes of this section, the term ‘‘qualified health
maintenance organization’’ means (1) a health maintenance organization which has provided assurances satisfactory to the Secretary
that it provides basic and supplemental health services to its members in the manner prescribed by section 1301(b) and that it is organized and operated in the manner prescribed by section 1301(c),
and (2) an entity which proposes to become a health maintenance
organization and which the Secretary determines will when it becomes operational provide basic and supplemental health services
to its members in the manner prescribed by section 1301(b) and
will be organized and operated in the manner prescribed by section
1301(c).
(d)(1) Any employer who knowingly does not comply with one
or more of the requirements of paragraph (1) or (2) of subsection
(b) shall be subject to a civil penalty of not more than $10,000. If
such noncompliance continues, a civil penalty may be assessed and
collected under this subsection for each thirty-day period such noncompliance continues. Such penalty may be assessed by the Secretary and collected in a civil action brought by the United States
in a United States district court.
(2) In any proceeding by the Secretary to assess a civil penalty
under this subsection, no penalty shall be assessed until the employer charged shall have been given notice and an opportunity to
present its views on such charge. In determining the amount of the
penalty, or the amount agreed upon in compromise, the Secretary
shall consider the gravity of the noncompliance and the demonstrated good faith of the employer charged in attempting to
achieve rapid compliance after notification by the Secretary of a
noncompliance.
(3) In any civil action brought to review the assessment of a
civil penalty assessed under this subsection, the court shall, at the
request of any party to such action, hold a trial de novo on the assessment of such civil penalty and in any civil action to collect such
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a civil penalty, the court shall, at the request of any party to such
action, hold a trial de novo on the assessment of such civil penalty
unless in a prior civil action to review the assessment of such penalty the court held a trial de novo on such assessment.
(e) For purposes of this section, the term ‘‘employer’’ does not
include (1) the Government of the United States, the government
of the District of Columbia or any territory or possession of the
United States, a State or any political subdivision thereof, or any
agency or instrumentality (including the United States Postal Service and Postal Rate Commission) of any of the foregoing, except
that such term includes nonappropriated fund instrumentalities of
the Government of the United States; or (2) a church, convention
or association of churches, or any organization operated, supervised
or controlled by a church, convention or association of churches
which organization (A) is an organization described in section
501(c)(3) of the Internal Revenue Code of 1986, and (B) does not
discriminate (i) in the employment, compensation, promotion, or
termination of employment of any personnel, or (ii) in the extension
of staff or other privileges to any physician or other health personnel, because such persons seek to obtain or obtained health
care, or participate in providing health care, through a health
maintenance organization.
(f) If the Secretary, after reasonable notice and opportunity for
a hearing to a State, finds that it or any of its political subdivisions
has failed to comply with paragraph (1) or (2) of subsection (b), the
Secretary shall terminate payments to such State under sections
317, 318, and 1002 and notify the Governor of such State that further payments under such sections will not be made to the State
until the Secretary is satisfied that there will no longer be any
such failure to comply.
RESTRICTIVE STATE LAWS AND PRACTICES

SEC. 1311. ø300e–10¿ (a) In the case of any entity—
(1) which cannot do business as a health maintenance organization in a State in which it proposes to furnish basic and
supplemental health services because that State by law, regulation, or otherwise—
(A) requires as a condition to doing business in that
State that a medical society approve the furnishing of
services by the entity,
(B) requires that physicians constitute all or a percentage of its governing body,
(C) requires that all physicians or a percentage of physicians in the locale participate or be permitted to participate in the provision of services for the entity,
(D) requires that the entity meet requirements for insurers of health care services doing business in that State
respecting initial capitalization and establishment of financial reserves against insolvency, or
(E) imposes requirements which would prohibit the
entity from complying with the requirements of this title,
and
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Sec. 1312

(2) for which a grant, contract, loan, or loan guarantee was
made under this title or which is a qualified health maintenance organization for purposes of section 1310 (relating to employees’ health benefits plans),
such requirements shall not apply to that entity so as to prevent
it from operating as a health maintenance organization in accordance with section 1301.
(b) No State may establish or enforce any law which prevents
a health maintenance organization for which a grant, contract,
loan, or loan guarantee was made under this title or which is a
qualified health maintenance organization for purposes of section
1310 (relating to employees’ health benefits plans), from soliciting
members through advertising its services, charges, or other nonprofessional aspects of its operation. This subsection does not authorize any advertising which identifies, refers to, or makes any
qualitative judgment concerning, any health professional who provides services for a health maintenance organization.
(c) The Secretary shall, within 6 months after the date of the
enactment of this subsection, develop a digest of State laws, regulations, and practices pertaining to development, establishment, and
operation of health maintenance organizations which shall be updated at least annually and relevant sections of which shall be provided to the Governor of each State annually. Such digest shall indicate which State laws, regulations, and practices appear to be inconsistent with the operation of this section. The Secretary shall
also insure that appropriate legal consultative assistance is available to the States for the purpose of complying with the provisions
of this section.
CONTINUED REGULATION OF HEALTH MAINTENANCE ORGANIZATIONS

SEC. 1312. ø300e–11¿ (a) If the Secretary determines that an
entity which received a grant, contract, loan, or loan guarantee
under this title as a health maintenance organization or which was
included in a health benefits plan offered to employees pursuant to
section 1310—
(1) fails to provide basic and supplemental services to its
members,
(2) fails to provide such services in the manner prescribed
by section 1301(b), or
(3) is not organized or operated in the manner prescribed
by section 1301(c),
the Secretary may take the action authorized by subsection (b).
(b)(1) If the Secretary makes, with respect to any entity which
provided assurances to the Secretary under section 1310(d)(1), a
determination described in subsection (a), the Secretary shall notify
the entity in writing of the determination. Such notice shall specify
the manner in which the entity has not complied with such assurances and direct that the entity initiate (within 30 days of the date
the notice is issued by the Secretary or within such longer period
as the Secretary determines is reasonable) such action as may be
necessary to bring (within such period as the Secretary shall prescribe) the entity into compliance with the assurances. If the entity
fails to initiate corrective action within the period prescribed by the
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notice or fails to comply with the assurances within such period as
the Secretary prescribes, then after the Secretary provides the entity a reasonable opportunity for reconsideration of his determination, including, at the entity’s election, a fair hearing (A) the entity
shall not be a qualified health maintenance organization for purposes of section 1310 until such date as the Secretary determines
that it is in compliance with the assurances, and (B) each employer
which has offered membership in the entity in compliance with section 1310, each lawfully recognized collective bargaining representative or other employee representative which represents the employees of each such employer, and the members of such entity
shall be notified by the entity that the entity is not a qualified
health maintenance organization for purposes of such section. The
notice required by clause (B) of the preceding sentence shall contain, in readily understandable language, the reasons for the determination that the entity is not a qualified health maintenance organization. The Secretary shall publish in the Federal Register
each determination referred to in this paragraph.
(2) If the Secretary makes, with respect to an entity which has
received a grant, contract, loan, or loan guarantee under this title,
a determination described in subsection (a), the Secretary may, in
addition to any other remedies available to him, bring a civil action
in the United States district court for the district in which such entity is located to enforce its compliance with the assurances it furnished respecting the provision of basic and supplemental health
services or its organization or operation, as the case may be, which
assurances were made in connection with its application under this
title for the grant, contract, loan, or loan guarantee.
LIMITATION ON SOURCE OF FUNDING FOR HEALTH MAINTENANCE
ORGANIZATIONS

SEC. 1313. ø300e–12¿ No funds appropriated under any provision of this Act (except as provided in sections 329 and 330) other
than this title may be used—
(1) for grants or contracts for surveys or other activities to
determine the feasibility of developing or expanding health
maintenance organizations or other entities which provide, directly or indirectly, health services to a defined population on
a prepaid basis;
(2) for grants or contracts, or for payments under loan
guarantees, for planning projects for the establishment or expansion of such organizations or entities;
(3) for grants or contracts, or for payments under loan
guarantees, for projects for the initial development or expansion of such organizations or entities; or
(4) for loans, or for payments under loan guarantees, to assist in meeting the costs of the initial operation after establishment or expansion of such organizations or entities or in meeting the costs of such organizations in acquiring or constructing
ambulatory health care facilities.
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PUBLIC HEALTH SERVICE ACT

Sec. 1317

ANNUAL REPORT

SEC. 1315. ø300e–14¿ (a) The Secretary shall periodically review the programs of assistance authorized by this title and make
an annual report to the Congress of a summary of the activities
under each program. The Secretary shall include in such summary—
(1) a summary of each grant, contract, loan, or loan guarantee made under this title in the period covered by the report
and a list of the health maintenance organizations which during such period became qualified health maintenance organizations for purposes of section 1310;
(2) the statistics and other information reported in such
period to the Secretary in accordance with section 1301(c)(11);
(3) findings with respect to the ability of the health maintenance organizations assisted under this title—
(A) to operate on a fiscally sound basis without continued Federal financial assistance,
(B) to meet the requirements of section 1301(c) respecting their organization and operation,
(C) to provide basic and supplemental health services
in the manner prescribed by section 1301(b),
(D) to include indigent and high-risk individuals in
their membership, and
(E) to provide services to medically underserved populations; and
(4) findings with respect to—
(A) the operation of distinct categories of health maintenance organizations in comparison with each other,
(B) health maintenance organizations as a group in
comparison with alternative forms of health care delivery,
and
(C) the impact that health maintenance organizations,
individually, by category, and as a group, have on the
health of the public.
(b) The Office of Management and Budget may review the Secretary’s report under subsection (a) before its submission to the
Congress, but the Office may not revise the report or delay its submission, and it may submit to the Congress its comments (and
those of other departments or agencies of the Government) respecting such report.
TRAINING AND TECHNICAL ASSISTANCE

SEC. 1317. ø300e–16¿ (a)(1) The Secretary shall establish a
National Health Maintenance Organization Intern Program (hereinafter in this subsection referred to as the ‘‘Program’’) for the purpose of providing training to individuals to become administrators
and medical directors of health maintenance organizations or to assume other managerial positions with health maintenance organizations. Under the Program the Secretary may directly provide internships for such training and may make grants to or enter into
contracts with health maintenance organizations and other entities
to provide such internships.
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1066

(2) No internship may be provided by the Secretary and no
grant may be made or contract entered into by the Secretary for
the provision of internships unless an application therefor has been
submitted to and approved by the Secretary. Such an application
shall be in such form and contain such information, and be submitted to the Secretary in such manner, as the Secretary shall prescribe. Section 1306 does not apply to an application submitted
under this section.
(3) Internships under the Program shall provide for such stipends and allowances (including travel and subsistence expenses
and dependency allowances) for the recipients of the internships as
the Secretary deems necessary. An internship provided an individual for training at a health maintenance organization or any
other entity shall also provide for payments to be made to the organization or other entity for the cost of support services (including
the cost of salaries, supplies, equipment, and related items) provided such individual by such organization or other entity. The
amount of any such payments to any organization or other entity
shall be determined by the Secretary and shall bear a direct relationship to the reasonable costs of the organization or other entity
for establishing and maintaining its training programs.
(4) Payments under grants under the Program may be made
in advance or by way of reimbursement, and at such intervals and
on such conditions, as the Secretary finds necessary.
(b) The Secretary shall provide technical assistance (1) to entities intending to become a qualified health maintenance organization within the meaning of section 1310(d), and (2) to health maintenance organizations. The Secretary may provide such technical
assistance through grants to public and nonprofit private entities
and contracts with public and private entities.
(c) The authority of the Secretary to enter into contracts under
subsections (a) and (b) shall be effective for any fiscal year only to
such extent or in such amounts as are provided in advance by appropriation Acts.
FINANCIAL DISCLOSURE

SEC. 1318. ø300e–17¿ (a) Each health maintenance organization shall, in accordance with regulations of the Secretary, report
to the Secretary financial information which shall include the following:
(1) Such information as the Secretary may require demonstrating that the health maintenance organization has a fiscally sound operation.
(2) A copy of the report, if any, filed with the Centers for
Medicare & Medicaid Services containing the information required to be reported under section 1124 of the Social Security
Act by disclosing entities and the information required to be
supplied under section 1902(a)(38) of such Act.
(3) A description of transactions, as specified by the Secretary, between the health maintenance organization and a
party in interest. Such transactions shall include—
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PUBLIC HEALTH SERVICE ACT

Sec. 1318

(A) any sale or exchange, or leasing of any property
between the health maintenance organization and a party
in interest;
(B) any furnishing for consideration of goods, services
(including management services), or facilities between the
health maintenance organization and a party in interest,
but not including salaries paid to employees for services
provided in the normal course of their employment and
health services provided to members by hospitals and
other providers and by staff, medical group (or groups), individual practice association (or associations), or any combination thereof; and
(C) any lending of money or other extension of credit
between a health maintenance organization and a party in
interest.
The Secretary may require that information reported respecting a
health maintenance organization which controls, is controlled by,
or is under common control with, another entity be in the form of
a consolidated financial statement for the organization and such
entity.
(b) For the purposes of this section the term ‘‘party in interest’’
means:
(1) any director, officer, partner, or employee responsible
for management or administration of a health maintenance organization, any person who is directly or indirectly the beneficial owner of more than 5 per centum of the equity of the organization, any person who is the beneficial owner of a mortgage, deed of trust, note, or other interest secured by, and valuing more than 5 per centum of the health maintenance organization, and, in the case of a health maintenance organization
organized as a nonprofit corporation, an incorporator or member of such corporation under applicable State corporation law;
(2) any entity in which a person described in paragraph
(1)—
(A) is an officer or director;
(B) is a partner (if such entity is organized as a partnership);
(C) has directly or indirectly a beneficial interest of
more than 5 per centum of the equity; or
(D) has a mortgage, deed of trust, note, or other interest valuing more than 5 per centum of the assets of such
entity;
(3) any person directly or indirectly controlling, controlled
by, or under common control with a health maintenance organization; and
(4) any spouse, child, or parent of an individual described
in paragraph (1).
(c) Each health maintenance organization shall make the information reported pursuant to subsection (a) available to its enrollees
upon reasonable request.
(d) The Secretary shall, as he deems necessary, conduct an
evaluation of transactions reported to the Secretary under subsection (a)(3) for the purpose of determining their adverse impact,
if any, on the fiscal soundness and reasonableness of charges to the
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health maintenance organization with respect to which they transpired. The Secretary shall evaluate the reported transactions of
not less than five, or if there are more than twenty health maintenance organizations reporting such transactions, not less than onefourth of the health maintenance organizations reporting any such
transactions under subsection (a)(3).
(f) 1 Nothing in this section shall be construed to confer upon
the Secretary any authority to approve or disapprove the rates
charged by any health maintenance organization.
(g) Any health maintenance organization failing to file with the
Secretary the annual financial statement required in subsection (a)
shall be ineligible for any Federal assistance under this title until
such time as such statement is received by the Secretary and shall
not be a qualified health maintenance organization for purposes of
section 1310.
(h) Whoever knowingly and willfully makes or causes to be
made any false statement or representation of a material fact in
any statement filed pursuant to this section shall be guilty of a felony and upon conviction thereof shall be fined not more than
$25,000 or imprisoned for not more than five years, or both.

1 Subsection

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(e) was repealed by section 810 of Public Law 99–660.

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TITLE XIV—SAFETY OF PUBLIC WATER SYSTEMS
[For Text of This Title See Volume 2 of the Environmental
Law Compilation]

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TITLE XV—PREVENTIVE HEALTH MEASURES WITH RESPECT TO BREAST AND
CERVICAL CANCERS
SEC. 1501. ø300k¿ ESTABLISHMENT OF PROGRAM OF GRANTS TO
STATES.
(a) IN GENERAL.—The Secretary, acting through the Director of

the Centers for Disease Control and Prevention, may make grants
to States on the basis of an established competitive review process
for the purpose of carrying out programs—
(1) to screen women for breast and cervical cancer as a
preventive health measure;
(2) to provide appropriate referrals for medical treatment
of women screened pursuant to paragraph (1) and to ensure,
to the extent practicable, the provision of appropriate follow-up
services and support services such as case management;
(3) to develop and disseminate public information and education programs for the detection and control of breast and cervical cancer;
(4) to improve the education, training, and skills of health
professionals (including allied health professionals) in the detection and control of breast and cervical cancer;
(5) to establish mechanisms through which the States can
monitor the quality of screening procedures for breast and cervical cancer, including the interpretation of such procedures;
and
(6) to evaluate activities conducted under paragraphs (1)
through (5) through appropriate surveillance or program-monitoring activities.
(b) GRANT AND CONTRACT AUTHORITY OF STATES.—
(1) IN GENERAL.—A State receiving a grant under subsection (a) may, subject to paragraphs (2) and (3), expend the
grant to carry out the purpose described in such subsection
through grants to public and nonprofit private entities and
through contracts with public and private entities.
(2) CERTAIN APPLICATIONS.—If a nonprofit private entity
and a private entity that is not a nonprofit entity both submit
applications to a State to receive an award of a grant or contract pursuant to paragraph (1), the State may give priority to
the application submitted by the nonprofit private entity in
any case in which the State determines that the quality of
such application is equivalent to the quality of the application
submitted by the other private entity.
(3) PAYMENTS FOR SCREENINGS.—The amount paid by a
State to an entity under this subsection for a screening procedure under subsection (a)(1) may not exceed the amount that
1070
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PUBLIC HEALTH SERVICE ACT

Sec. 1502

would be paid under part B of title XVIII of the Social Security
Act if payment were made under such part for furnishing the
procedure to a woman enrolled under such part.
(c) SPECIAL CONSIDERATION FOR CERTAIN STATES.—In making
grants under subsection (a) to States whose initial grants under
such subsection are made for fiscal year 1995 or any subsequent
fiscal year, the Secretary shall give special consideration to any
State whose proposal for carrying out programs under such subsection—
(1) has been approved through a process of peer review;
and
(2) is made with respect to geographic areas in which there
is—
(A) a substantial rate of mortality from breast or cervical cancer; or
(B) a substantial incidence of either of such cancers.
(d) COORDINATING COMMITTEE REGARDING YEAR 2020 HEALTH
OBJECTIVES.—The Secretary, acting through the Director of the
Centers for Disease Control and Prevention, shall establish a committee to coordinate the activities of the agencies of the Public
Health Service (and other appropriate Federal agencies) that are
carried out toward achieving the objectives established by the Secretary for reductions in the rate of mortality from breast and cervical cancer in the United States by the year 2020. Such committee
shall be comprised of Federal officers or employees designated by
the heads of the agencies involved to serve on the committee as
representatives of the agencies, and such representatives from
other public or private entities as the Secretary determines to be
appropriate.
SEC. 1502. ø300l¿ REQUIREMENT OF MATCHING FUNDS.
(a) IN GENERAL.—The Secretary may not make

a grant under
section 1501 unless the State involved agrees, with respect to the
costs to be incurred by the State in carrying out the purpose described in such section, to make available non-Federal contributions (in cash or in kind under subsection (b)) toward such costs in
an amount equal to not less than $1 for each $3 of Federal funds
provided in the grant. Such contributions may be made directly or
through donations from public or private entities.
(b) DETERMINATION OF AMOUNT OF NON-FEDERAL CONTRIBUTION.—
(1) IN GENERAL.—Non-Federal contributions required in
subsection (a) may be in cash or in kind, fairly evaluated, including equipment or services (and excluding indirect or overhead costs). Amounts provided by the Federal Government, or
services assisted or subsidized to any significant extent by the
Federal Government, may not be included in determining the
amount of such non-Federal contributions.
(2) MAINTENANCE OF EFFORT.—In making a determination
of the amount of non-Federal contributions for purposes of subsection (a), the Secretary may include only non-Federal contributions in excess of the average amount of non-Federal contributions made by the State involved toward the purpose described in section 1501 for the 2-year period preceding the first
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PUBLIC HEALTH SERVICE ACT

1072

fiscal year for which the State is applying to receive a grant
under such section.
(3) INCLUSION OF RELEVANT NON-FEDERAL CONTRIBUTIONS
FOR MEDICAID.—In making a determination of the amount of
non-Federal contributions for purposes of subsection (a), the
Secretary shall, subject to paragraphs (1) and (2) of this subsection, include any non-Federal amounts expended pursuant
to title XIX of the Social Security Act by the State involved toward the purpose described in paragraphs (1) and (2) of section
1501(a).
SEC. 1502A. ø300l–1¿ REQUIREMENT REGARDING MEDICAID.

The Secretary may not make a grant under section 1501 for a
program in a State unless the State plan under title XIX of the Social Security Act for the State includes the screening procedures
specified in subparagraphs (A) and (B) of section 1503(a)(2) as medical assistance provided under the plan.
SEC. 1503. ø300m¿ REQUIREMENTS WITH RESPECT TO TYPE AND QUALITY OF SERVICES.
(a) REQUIREMENT OF PROVISION OF ALL SERVICES BY DATE
CERTAIN.—The Secretary may not make a grant under section 1501

unless the State involved agrees—
(1) to ensure that, initially and throughout the period during which amounts are received pursuant to the grant, not less
than 60 percent of the grant is expended to provide each of the
services or activities described in paragraphs (1) and (2) of section 1501(a), including making available screening procedures
for both breast and cervical cancers;
(2) subject to subsection (b), to ensure that—
(A) in the case of breast cancer, both a physical examination of the breasts and the screening procedure known
as a mammography are conducted; and
(B) in the case of cervical cancer, both a pelvic examination and the screening procedure known as a pap smear
are conducted;
(3) to ensure that, by the end of any second fiscal year of
payments pursuant to the grant, each of the services or activities described in section 1501(a) is provided; and
(4) to ensure that not more than 40 percent of the grant
is expended to provide the services or activities described in
paragraphs (3) through (6) of such section.
(b) USE OF IMPROVED SCREENING PROCEDURES.—The Secretary
may not make a grant under section 1501 unless the State involved
agrees that, if any screening procedure superior to a procedure described in subsection (a)(2) becomes commonly available and is recommended for use, any entity providing screening procedures pursuant to the grant will utilize the superior procedure rather than
the procedure described in such subsection.
(c) 1 QUALITY ASSURANCE REGARDING SCREENING PROCEDURES.—The Secretary may not make a grant under section 1501
1 Section

101(c)(2) of Public Law 103–183 (107 Stat. 2228) provides as follows:
‘‘(2) TRANSITION RULE REGARDING MAMMOGRAPHIES.—With respect to the screening procedure for breast cancer known as a mammography, the requirements in effect on the day
before the date of the enactment of this Act under section 1503(c) of the Public Health Service Act remain in effect (for an individual or facility conducting such procedures pursuant

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Sec. 1503

unless the State involved agrees that the State will, in accordance
with applicable law, assure the quality of screening procedures conducted pursuant to such section.
(d) WAIVER OF SERVICES REQUIREMENT ON DIVISION OF
FUNDS.—
(1) IN GENERAL.—The Secretary shall establish a demonstration project under which the Secretary may waive the requirements of paragraphs (1) and (4) of subsection (a) for not
more than 5 States, if—
(A) the State involved will use the waiver to leverage
non-Federal funds to supplement each of the services or
activities described in paragraphs (1) and (2) of section
1501(a);
(B) the application of such requirement would result
in a barrier to the enrollment of qualifying women;
(C) the State involved—
(i) demonstrates, to the satisfaction of the Secretary, the manner in which the State will use such
waiver to expand the level of screening and follow-up
services provided immediately prior to the date on
which the waiver is granted; and
(ii) provides assurances, satisfactory to the Secretary, that the State will, on an annual basis, demonstrate, through such documentation as the Secretary
may require, that the State has used such waiver as
described in clause (i);
(D) the State involved submits to the Secretary—
(i) assurances, satisfactory to the Secretary, that
the State will maintain the average annual level of
State fiscal year expenditures for the services and activities described in paragraphs (1) and (2) of section
1501(a) for the period for which the waiver is granted,
and for the period for which any extension of such
wavier is granted, at a level that is not less than—
(I) the level of the State fiscal year expenditures for such services and activities for the fiscal
year preceding the first fiscal year for which the
waiver is granted; or
(II) at the option of the State and upon approval by the Secretary, the average level of the
State expenditures for such services and activities
for the 3-fiscal year period preceding the first fiscal year for which the waiver is granted; and
(ii) a plan, satisfactory to the Secretary, for maintaining the level of activities carried out under the
waiver after the expiration of the waiver and any extension of such waiver;
(E) the Secretary finds that granting such a waiver to
a State will increase the number of women in the State
that receive each of the services or activities described in
paragraphs (1) and (2) of section 1501(a), including making
to a grant to a State under section 1501 of such Act) until there is in effect for the facility
a certificate (or provisional certificate) issued under section 354 of such Act.’’.

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available screening procedures for both breast and cervical
cancers; and
(F) the Secretary finds that granting such a waiver to
a State will not adversely affect the quality of each of the
services or activities described in paragraphs (1) and (2) of
section 1501(a).
(2) DURATION OF WAIVER.—
(A) IN GENERAL.—In granting waivers under paragraph (1), the Secretary—
(i) shall grant such waivers for a period that is not
less than 1 year but not more than 2 years; and
(ii) upon request of a State, may extend a waiver
for an additional period that is not less than 1 year
but not more than 2 years in accordance with subparagraph (B).
(B) ADDITIONAL PERIOD.—The Secretary, upon the request of a State that has received a waiver under paragraph (1), shall, at the end of the waiver period described
in subparagraph (A)(i), review performance under the
waiver and may extend the waiver for an additional period
if the Secretary determines that—
(i) without an extension of the waiver, there will
be a barrier to the enrollment of qualifying women;
(ii) the State requesting such extended waiver will
use the waiver to leverage non-Federal funds to supplement the services or activities described in paragraphs (1) and (2) of section 1501(a);
(iii) the waiver has increased, and will continue to
increase, the number of women in the State that receive the services or activities described in paragraphs
(1) and (2) of section 1501(a);
(iv) the waiver has not, and will not, result in
lower quality in the State of the services or activities
described in paragraphs (1) and (2) of section 1501(a);
and
(v) the State has maintained the average annual
level of State fiscal expenditures for the services and
activities described in paragraphs (1) and (2) of section
1501(a) for the period for which the waiver was granted at a level that is not less than—
(I) the level of the State fiscal year expenditures for such services and activities for the fiscal
year preceding the first fiscal year for which the
waiver is granted; or
(II) at the option of the State and upon approval by the Secretary, the average level of the
State expenditures for such services and activities
for the 3-fiscal year period preceding the first fiscal year for which the waiver is granted.
(3) REPORTING REQUIREMENTS.—The Secretary shall include as part of the evaluations and reports required under
section 1508, the following:
(A) A description of the total amount of dollars leveraged annually from Non-Federal entities in States receivMarch 13, 2013

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ing a waiver under paragraph (1) and how these amounts
were used.
(B) With respect to States receiving a waiver under
paragraph (1), a description of the percentage of the grant
that is expended on providing each of the services or activities described in—
(i) paragraphs (1) and (2) of section 1501(a); and
(ii) paragraphs (3) through (6) of section 1501(a).
(C) A description of the number of States receiving
waivers under paragraph (1) annually.
(D) With respect to States receiving a waiver under
paragraph (1), a description of—
(i) the number of women receiving services under
paragraphs (1), (2), and (3) of section 1501(a) in programs before and after the granting of such waiver;
and
(ii) the average annual level of State fiscal expenditures for the services and activities described in
paragraphs (1) and (2) of section 1501(a) for the year
preceding the first year for which the waiver was
granted.
(4) LIMITATION.—Amounts to which a waiver applies under
this subsection shall not be used to increase the number of salaried employees.
(5) DEFINITIONS.—In this subsection:
(A) INDIAN TRIBE.—The term ‘‘Indian tribe’’ has the
meaning given the term in section 4 of the Indian Health
Care Improvement Act (25 U.S.C. 1603).
(B) TRIBAL ORGANIZATION.—The term ‘‘tribal organization’’ has the meaning given the term in section 4 of the
Indian Health Care Improvement Act.
(C) STATE.—The term ‘‘State’’ means each of the several States of the United States, the District of Columbia,
the Commonwealth of Puerto Rico, American Samoa, the
Commonwealth of the Northern Mariana Islands, the Republic of the Marshall Islands, the Federated States of Micronesia, the Republic of Palau, an Indian tribe, and a
tribal organization.
(6) SUNSET.—The Secretary may not grant a waiver or extension under this subsection after September 30, 2012.
SEC. 1504. ø300n¿ ADDITIONAL REQUIRED AGREEMENTS.
(a) PRIORITY FOR LOW-INCOME WOMEN.—The Secretary

may
not make a grant under section 1501 unless the State involved
agrees that low-income women will be given priority in the provision of services and activities pursuant to paragraphs (1) and (2)
of section 1501(a).
(b) LIMITATION ON IMPOSITION OF FEES FOR SERVICES.—The
Secretary may not make a grant under section 1501 unless the
State involved agrees that, if a charge is imposed for the provision
of services or activities under the grant, such charge—
(1) will be made according to a schedule of charges that is
made available to the public;
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(2) will be adjusted to reflect the income of the woman involved; and
(3) will not be imposed on any woman with an income of
less than 100 percent of the official poverty line, as established
by the Director of the Office of Management and Budget and
revised by the Secretary in accordance with section 673(2) of
the Omnibus Budget Reconciliation Act of 1981.
(c) STATEWIDE PROVISION OF SERVICES.—
(1) IN GENERAL.—The Secretary may not make a grant
under section 1501 unless the State involved agrees that services and activities under the grant will be made available
throughout the State, including availability to members of any
Indian tribe or tribal organization (as such terms are defined
in section 4 of the Indian Self-Determination and Education
Assistance Act).
(2) WAIVER.—The Secretary may waive the requirement
established in paragraph (1) for a State if the Secretary determines that compliance by the State with the requirement
would result in an inefficient allocation of resources with respect to carrying out the purpose described in section 1501(a).
(3) GRANTS TO TRIBES AND TRIBAL ORGANIZATIONS.—
(A) The Secretary, acting through the Director of the
Centers for Disease Control and Prevention, may make
grants to tribes and tribal organizations (as such terms are
used in paragraph (1)) for the purpose of carrying out programs described in section 1501(a). This title applies to
such a grant (in relation to the jurisdiction of the tribe or
organization) to the same extent and in the same manner
as such title applies to a grant to a State under section
1501 (in relation to the jurisdiction of the State).
(B) If a tribe or tribal organization is receiving a grant
under subparagraph (A) and the State in which the tribe
or organization is located is receiving a grant under section 1501, the requirement established in paragraph (1) for
the State regarding the tribe or organization is deemed to
have been waived under paragraph (2).
(d) RELATIONSHIP TO ITEMS AND SERVICES UNDER OTHER PROGRAMS.—The Secretary may not make a grant under section 1501
unless the State involved agrees that the grant will not be expended to make payment for any item or service to the extent that
payment has been made, or can reasonably be expected to be made,
with respect to such item or service—
(1) under any State compensation program, under an insurance policy, or under any Federal or State health benefits
program; or
(2) by an entity that provides health services on a prepaid
basis.
(e) COORDINATION WITH OTHER BREAST AND CERVICAL CANCER
PROGRAMS.—The Secretary may not make a grant under section
1501 unless the State involved agrees that the services and activities funded through the grant shall be coordinated with other Federal, State, and local breast and cervical cancer programs.
(f) LIMITATION ON ADMINISTRATIVE EXPENSES.—The Secretary
may not make a grant under section 1501 unless the State involved
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agrees that not more than 10 percent of the grant will be expended
for administrative expenses with respect to the grant.
(g) RESTRICTIONS ON USE OF GRANT.—The Secretary may not
make a grant under section 1501 unless the State involved agrees
that the grant will not be expended to provide inpatient hospital
services for any individual.
(h) RECORDS AND AUDITS.—The Secretary may not make a
grant under section 1501 unless the State involved agrees that—
(1) the State will establish such fiscal control and fund accounting procedures as may be necessary to ensure the proper
disbursal of, and accounting for, amounts received by the State
under such section; and
(2) upon request, the State will provide records maintained
pursuant to paragraph (1) to the Secretary or the Comptroller
of the United States for purposes of auditing the expenditures
by the State of the grant.
(i) REPORTS TO SECRETARY.—The Secretary may not make a
grant under section 1501 unless the State involved agrees to submit to the Secretary such reports as the Secretary may require
with respect to the grant.
SEC. 1505. ø300n–1¿ DESCRIPTION OF INTENDED USES OF GRANT.

The Secretary may not make a grant under section 1501 unless—
(1) the State involved submits to the Secretary a description of the purposes for which the State intends to expend the
grant;
(2) the description identifies the populations, areas, and localities in the State with a need for the services or activities
described in section 1501(a);
(3) the description provides information relating to the
services and activities to be provided, including a description
of the manner in which the services and activities will be coordinated with any similar services or activities of public and
private entities; and
(4) the description provides assurances that the grant
funds will be used in the most cost-effective manner.
SEC. 1506. ø300n–2¿ REQUIREMENT OF SUBMISSION OF APPLICATION.

The Secretary may not make a grant under section 1501 unless
an application for the grant is submitted to the Secretary, the application contains the description of intended uses required in section 1505, and the application is in such form, is made in such
manner, and contains such agreements, assurances, and information as the Secretary determines to be necessary to carry out this
title.
SEC. 1507. ø300n–3¿ TECHNICAL ASSISTANCE AND PROVISION OF SUPPLIES AND SERVICES IN LIEU OF GRANT FUNDS.
(a) TECHNICAL ASSISTANCE.—The Secretary may provide train-

ing and technical assistance with respect to the planning, development, and operation of any program or service carried out pursuant
to section 1501. The Secretary may provide such technical assistance directly or through grants to, or contracts with, public and
private entities.
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(b) PROVISION OF SUPPLIES AND SERVICES IN LIEU OF GRANT
FUNDS.—
(1) IN GENERAL.—Upon the request of a State receiving a
grant under section 1501, the Secretary may, subject to paragraph (2), provide supplies, equipment, and services for the
purpose of aiding the State in carrying out such section and,
for such purpose, may detail to the State any officer or employee of the Department of Health and Human Services.
(2) CORRESPONDING REDUCTION IN PAYMENTS.—With respect to a request described in paragraph (1), the Secretary
shall reduce the amount of payments under the grant under
section 1501 to the State involved by an amount equal to the
costs of detailing personnel (including pay, allowances, and
travel expenses) and the fair market value of any supplies,
equipment, or services provided by the Secretary. The Secretary shall, for the payment of expenses incurred in complying
with such request, expend the amounts withheld.
SEC. 1508. ø300n–4¿ EVALUATIONS AND REPORTS.
(a) EVALUATIONS.—The Secretary shall,

directly or through
contracts with public or private entities, provide for annual evaluations of programs carried out pursuant to section 1501. Such evaluations shall include evaluations of—
(1) the extent to which States carrying out such programs
are in compliance with section 1501(a)(2) and with section
1504(c); and
(2) the extent to which each State receiving a grant under
this title is in compliance with section 1502, including identification of—
(A) the amount of the non-Federal contributions by the
State for the preceding fiscal year, disaggregated according
to the source of the contributions; and
(B) the proportion of such amount of non-Federal contributions relative to the amount of Federal funds provided
through the grant to the State for the preceding fiscal
year.
(b) REPORT TO CONGRESS.—The Secretary shall, not later than
1 year after the date of the enactment of the National Breast and
Cervical Cancer Early Detection Program Reauthorization of 2007,
and annually thereafter, submit to the Committee on Energy and
Commerce of the House of Representatives, and to the Committee
on Labor and Human Resources of the Senate, a report summarizing evaluations carried out pursuant to subsection (a) during the
preceding fiscal year and making such recommendations for administrative and legislative initiatives with respect to this title as the
Secretary determines to be appropriate, including recommendations
regarding compliance by the States with section 1501(a)(2) and
with section 1504(c).
SEC. 1509. ø300n–4a¿ SUPPLEMENTAL GRANTS FOR ADDITIONAL PREVENTIVE HEALTH SERVICES.
(a) DEMONSTRATION PROJECTS.—In the case of States receiving

grants under section 1501, the Secretary, acting through the Director of the Centers for Disease Control and Prevention, may make
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grants to not more than 3 such States to carry out demonstration
projects for the purpose of—
(1) providing preventive health services in addition to the
services authorized in such section, including screenings regarding blood pressure and cholesterol, and including health
education;
(2) providing appropriate referrals for medical treatment of
women receiving services pursuant to paragraph (1) and ensuring, to the extent practicable, the provision of appropriate follow-up services; and
(3) evaluating activities conducted under paragraphs (1)
and (2) through appropriate surveillance or program-monitoring activities.
(b) STATUS AS PARTICIPANT IN PROGRAM REGARDING BREAST
AND CERVICAL CANCER.—The Secretary may not make a grant
under subsection (a) unless the State involved agrees that services
under the grant will be provided only through entities that are
screening women for breast or cervical cancer pursuant to a grant
under section 1501.
(c) APPLICABILITY OF PROVISIONS OF GENERAL PROGRAM.—This
title applies to a grant under subsection (a) to the same extent and
in the same manner as such title applies to a grant under section
1501.
(d) FUNDING.—
(1) IN GENERAL.—Subject to paragraph (2), for the purpose
of carrying out this section, there are authorized to be appropriated $3,000,000 for fiscal year 1994, and such sums as may
be necessary for each of the fiscal years 1995 through 2003.
(2) LIMITATION REGARDING FUNDING WITH RESPECT TO
BREAST AND CERVICAL CANCER.—The authorization of appropriations established in paragraph (1) is not effective for a fiscal year unless the amount appropriated under section 1510(a)
for the fiscal year is equal to or greater than $100,000,000.
SEC. 1510. ø300n–5¿ FUNDING FOR GENERAL PROGRAM.
(a) AUTHORIZATION OF APPROPRIATIONS.—For the

purpose of
carrying out this title, there are authorized to be appropriated
$50,000,000 for fiscal year 1991, such sums as may be necessary
for each of the fiscal years 1992 and 1993, $150,000,000 for fiscal
year 1994, such sums as may be necessary for each of the fiscal
years 1995 through 2003, $225,000,000 for fiscal year 2008,
$245,000,000 for fiscal year 2009, $250,000,000 for fiscal year 2010,
$255,000,000 for fiscal year 2011, and $275,000,000 for fiscal year
2012.
(b) SET-ASIDE FOR TECHNICAL ASSISTANCE AND PROVISION OF
SUPPLIES AND SERVICES.—Of the amounts appropriated under subsection (a) for a fiscal year, the Secretary shall reserve not more
than 20 percent for carrying out section 1507.

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TITLE XVI—HEALTH RESOURCES DEVELOPMENT
PART A—LOANS

AND

LOAN GUARANTEES

AUTHORITY FOR LOANS AND LOAN GUARANTEES

SEC. 1601. ø300q¿ (a)(1) The Secretary, during the period ending September 30, 1982, may, in accordance with this part, make
loans from the fund established under section 1602(d) to any public
or nonprofit private entity for projects for—
(A) the discontinuance of unneeded hospital services or facilities;
(B) the conversion of unneeded hospital services and facilities to needed health services and medical facilities, including
outpatient medical facilities and facilities for long-term care;
(C) the renovation and modernization of medical facilities,
particularly projects for the prevention or elimination of safety
hazards, projects to avoid noncompliance with licensure or accreditation standards, or projects to replace obsolete facilities;
(D) the construction of new outpatient medical facilities;
and
(E) the construction of new inpatient medical facilities in
areas which have experienced (as determined by the Secretary)
recent rapid population growth.
(2)(A) The Secretary, during the period ending September 30,
1982, may, in accordance with this part, guarantee to—
(i) non-Federal lenders for their loans to public and nonprofit private entities for medical facilities projects described in
paragraph (1), and
(ii) the Federal Financing Bank for its loans to public and
nonprofit private entities for such projects,
payment of principal and interest on such loans.
(B) In the case of a guarantee of any loan to a public or nonprofit private entity under subparagraph (A)(i) which is located in
an urban or rural poverty area, the Secretary may pay, to the holder of such loan and for and on behalf of the project for which the
loan was made, amounts sufficient to reduce by not more than onehalf the net effective interest rate otherwise payable on such loan
if the Secretary finds that without such assistance the project could
not be undertaken.
(b) The principal amount of a loan directly made or guaranteed
under subsection (a) for a medical facilities project, when added to
any other assistance provided such project under part B, may not
exceed 90 per centum of the cost of such project unless the project
is located in an area determined by the Secretary to be an urban
or rural poverty area, in which case the principal amount, when
added to other assistance under part B, may cover up to 100 per
centum of such costs.
1080
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PUBLIC HEALTH SERVICE ACT

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(c) The cumulative total of the principal of the loans outstanding at any time with respect to which guarantees have been
issued, or which have been directly made, may not exceed such limitations as may be specified in appropriation Acts.
(d) The Secretary, with the consent of the Secretary of Housing
and Urban Development, shall obtain from the Department of
Housing and Urban Development such assistance with respect to
the administration of this part as will promote efficiency and economy thereof.
GENERAL PROVISIONS RELATING TO LOAN GUARANTEES AND LOANS

SEC. 1602. ø300q–2¿ (a)(1) The Secretary may not approve a
loan guarantee for a project under this part unless he determines
that (A) the terms, conditions, security (if any), and schedule and
amount of repayments with respect to the loan are sufficient to
protect the financial interests of the United States and are otherwise reasonable, including a determination that the rate of interest
does not exceed such per centum per annum on the principal obligation outstanding as the Secretary determines to be reasonable,
taking into account the range of interest rates prevailing in the private market for similar loans and the risks assumed by the United
States, and (B) the loan would not be available on reasonable terms
and conditions without the guarantee under this part.
(2)(A) The United States shall be entitled to recover from the
applicant for a loan guarantee under this part the amount of any
payment made pursuant to such guarantee, unless the Secretary
for good cause waives such right of recovery; and, upon making any
such payment, the United States shall be subrogated to all of the
rights of the recipient of the payments with respect to which the
guarantee was made.
(B) To the extent permitted by subparagraph (C), any terms
and conditions applicable to a loan guarantee under this part (including terms and conditions imposed under subparagraph (D))
may be modified by the Secretary to the extent he determines it
to be consistent with the financial interest of the United States.
(C) Any loan guarantee made by the Secretary under this part
shall be incontestable (i) in the hands of an applicant on whose behalf such guarantee is made unless the applicant engaged in fraud
or misrepresentation in securing such guarantee, and (ii) as to any
person (or his successor in interest) who makes or contracts to
make a loan to such applicant in reliance thereon unless such person (or his successor in interest) engaged in fraud or misrepresentation in making or contracting to make such loan.
(D) Guarantees of loans under this part shall be subject to
such further terms and conditions as the Secretary determines to
be necessary to assure that the purposes of this title will be
achieved.
(b)(1) The Secretary may not approve a loan under this part
unless—
(A) the Secretary is reasonably satisfied that the applicant
under the project for which the loan would be made will be
able to make payments of principal and interest thereon when
due, and
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1082

(B) the applicant provides the Secretary with reasonable
assurances that there will be available to it such additional
funds as may be necessary to complete the project or undertaking with respect to which such loan is requested.
(2) Any loan made under this part shall (A) have such security,
(B) have such maturity date, (C) be repayable in such installments,
(D) bear interest at a rate comparable to the current rate of interest prevailing, on the date the loan is made, with respect to loans
guaranteed under this part, minus any interest subsidy made in
accordance with section 1601(a)(2)(B) with respect to a loan made
for a project located in an urban or rural poverty area, and (E) be
subject to such other terms and conditions (including provisions for
recovery in case of default), as the Secretary determines to be necessary to carry out the purposes of this title while adequately protecting the financial interests of the United States.
(3) The Secretary may, for good cause but with due regard to
the financial interests of the United States, waive any right of recovery which he has by reasons of the failure of a borrower to make
payments of principal of and interest on a loan made under this
part, except that if such loan is sold and guaranteed, any such
waiver shall have no effect upon the Secretary’s guarantee of timely payment of principal and interest.
(c)(1) The Secretary shall from time to time, but with due regard to the financial interests of the United States, sell loans made
under this part either on the private market or to the Federal National Mortgage Association in accordance with section 302 of the
Federal National Mortgage Association Charter Act or to the Federal Financing Bank.
(2) Any loan so sold shall be sold for an amount which is equal
(or approximately equal) to the amount of the unpaid principal of
such loans as of time of sale.
(3)(A) The Secretary is authorized to enter into an agreement
with the purchaser of any loan sold under this part under which
the Secretary agrees—
(i) to guarantee to such purchaser (and any successor in
interest to such purchaser) payments of the principal and interest payable under such loan, and
(ii) to pay as an interest subsidy to such purchaser (and
any successor in interest of such purchaser) amounts which,
when added to the amount of interest payable on such loan,
are equivalent to a reasonable rate of interest on such loan as
determined by the Secretary after taking into account the
range of prevailing interest rates in the private market on
similar loans and the risks assumed by the United States.
(B) Any agreement under subparagraph (A)—
(i) may provide that the Secretary shall act as agent of any
such purchaser, for the purpose of collecting from the entity to
which such loan was made and paying over to such purchaser
any payments of principal and interest payable by such entity
under such loan;
(ii) may provide for the repurchase by the Secretary of any
such loan on such terms and conditions as may be specified in
the agreement;
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(iii) shall provide that, in the event of any default by the
entity to which such loan was made in payment of principal or
interest due on such loan, the Secretary shall, upon notification to the purchaser (or to the successor in interest of such
purchaser), have the option to close out such loan (and any obligations of the Secretary with respect thereto) by paying to the
purchaser (or his successor in interest) the total amount of outstanding principal and interest due thereon at the time of such
notification; and
(iv) shall provide that, in the event such loan is closed out
as provided in clause (iii), or in the event of any other loss incurred by the Secretary by reason of the failure of such entity
to make payments of principal or interest on such loan, the
Secretary shall be subrogated to all rights of such purchaser
for recovery of such loss from such entity.
(4) Amounts received by the Secretary as proceeds from the
sale of loans under this subsection shall be deposited in the fund
established under subsection (d).
(5) If any loan to a public entity under this part is sold and
guaranteed by the Secretary under this subsection, interest paid on
such loan after its sale and any interest subsidy paid, under paragraph (3)(A)(ii), by the Secretary with respect to such loan which
is received by the purchaser of the loan (or the purchaser’s successor in interest) shall be included in the gross income of the purchaser or successor for the purpose of chapter 1 of the Internal
Revenue Code of 1954.
(d)(1) There is established in the Treasury a loan and loan
guarantee fund (hereinafter in this subsection referred to as the
‘‘fund’’) which shall be available to the Secretary without fiscal year
limitation, in such amounts as may be specified from time to time
in appropriation Acts—
(A) to enable him to make loans under this part,
(B) to enable him to discharge his responsibilities under
loan guarantees issued by him under this part,
(C) for payment of interest under section 1601(a)(2)(B) on
loans guaranteed under this part,
(D) for repurchase of loans under subsection (c)(3)(B),
(E) for payment of interest on loans which are sold and
guaranteed, and
(F) to enable the Secretary to take the action authorized
by subsection (f).
There are authorized to be appropriated from time to time such
amounts as may be necessary to provide the sums required for the
fund. There shall also be deposited in the fund amounts received
by the Secretary in connection with loans and loan guarantees
under this part and other property or assets derived by him from
his operations respecting such loans and loan guarantees, including
any money derived from the sale of assets.
(2) If at any time the sums in the funds are insufficient to enable the Secretary—
(A) to make payments of interest under section
1601(a)(2)(B),
(B) to otherwise comply with guarantees under this part of
loans to nonprofit private entities,
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1084

(C) in the case of a loan which was made, sold, and guaranteed under this part, to make to the purchaser of such loan
payments of principal and interest on such loan after default
by the entity to which the loan was made, or
(D) to repurchase loans under subsection (c)(3)(B),
(E) to make payments of interest on loans which are sold
and guaranteed, and
(F) to enable the Secretary to take the action authorized
by subsection (f),
he is authorized to issue to the Secretary of the Treasury notes or
other obligations in such forms and denominations bearing such
maturities, and subject to such terms and conditions, as may be
prescribed by the Secretary with the approval of the Secretary of
the Treasury. Such notes or other obligations shall bear interest at
a rate determined by the Secretary of the Treasury, taking into
consideration the current average market yield on outstanding
marketable obligations of the United States of comparable maturities during the month preceding the issuance of the notes or other
obligations. The Secretary of the Treasury shall purchase any notes
and other obligations issued under this paragraph and for that purpose he may use as a public debt transaction the proceeds from the
sale of any securities issued under the Second Liberty Bond Act,
and the purposes for which the securities may be issued under that
Act are extended to include any purchase of such notes and obligations. The Secretary of the Treasury may at any time sell any of
the notes or other obligations acquired by him under this paragraph. All redemptions, purchases, and sales by the Secretary of
the Treasury of such notes or other obligations shall be treated as
public debt transactions of the United States. Sums borrowed
under this paragraph shall be deposited in the fund and redemption of such notes and obligations shall be made by the Secretary
from the fund.
(e)(1) The assets, commitments, obligations, and outstanding
balances of the loan guarantee and loan fund established in the
Treasury by section 626 shall be transferred to the fund established by subsection (d) of this section.
(2) To provide additional capitalization for the fund established
under subsection (d) there are authorized to be appropriated to the
fund, such sums as may be necessary for the fiscal years ending
June 30, 1975, June 30, 1976, September 30, 1977, September 30,
1978, September 30, 1979, September 30, 1980, September 30,
1981, and September 30, 1982.
(f)(1) The Secretary may take such action as may be necessary
to prevent a default on a loan made or guaranteed under this part
or under title VI, including the waiver of regulatory conditions, deferral of loan payments, renegotiation of loans, and the expenditure
of funds for technical and consultative assistance, for the temporary payment of the interest and principal on such a loan, and
for other purposes. Any such expenditure made under the preceding sentence on behalf of a medical facility shall be made under
such terms and conditions as the Secretary shall prescribe, including the implementation of such organizational, operational, and financial reforms as the Secretary determines are appropriate and
the disclosure of such financial or other information as the SecMarch 13, 2013

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Sec. 1610

retary may require to determine the extent of the implementation
of such reforms.
(2) The Secretary may take such action, consistent with State
law respecting foreclosure procedures, as he deems appropriate to
protect the interest of the United States in the event of a default
on a loan made or guaranteed under this part or under title VI, including selling real property pledged as security for such a loan or
loan guarantee and for a reasonable period of time taking possession of, holding, and using real property pledged as security for
such a loan or loan guarantee.
PART B—PROJECT GRANTS
PROJECT GRANTS

SEC. 1610. ø300r¿ (a)(1)(A) The Secretary may make grants for
construction or modernization projects designed to—
(i) eliminate or prevent in medical facilities imminent safety hazards as defined by Federal, State, or local fire, building,
or life safety codes or regulations, or
(ii) avoid noncompliance by medical facilities with State or
voluntary licensure or accreditation standards.
(B) A grant under subparagraph (A) may only be made to—
(i) a State or political subdivision of a State, including any
city, town, county, borough, hospital district authority, or public or quasi-public corporation, for any medical facility owned
or operated by the State or political subdivision; and
(ii) a nonprofit private entity for any medical facility
owned or operated by the entity but only if the Secretary determines—
(I) the level of community service provided by the facility and the proportion of its patients who are unable to
pay for services rendered in the facility is similar to such
level and proportion in a medical facility of a State or political subdivision, and
(II) that without a grant under subparagraph (A)
there would be a disruption of the provision of health care
to low-income individuals.
(2) The amount of any grant under paragraph (1) may not exceed 75 per centum of the cost of the project for which the grant
is made unless the project is located in an area determined by the
Secretary to be an urban or rural poverty area, in which case the
grant may cover up to 100 per centum of such costs.
(3) There are authorized to be appropriated for grants under
paragraph (1) $40,000,000 for the fiscal year ending September 30,
1980, $50,000,000 for the fiscal year ending September 30, 1981,
and $50,000,000 for the fiscal year ending September 30, 1982.
Funds available for obligation under this subsection (as in effect
before the date of the enactment of the Health Planning and Resources Development Amendments of 1979) in the fiscal year ending September 30, 1979, shall remain available for obligation under
this subsection in the succeeding fiscal year.
(b)(1) The Secretary may make grants to public and nonprofit
private entities for projects for (A) construction or modernization of
outpatient medical facilities which are located apart from hospitals
March 13, 2013

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PUBLIC HEALTH SERVICE ACT

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and which will provide services for medically underserved populations, and (B) conversion of existing facilities into outpatient
medical facilities or facilities for long-term care to provide services
for such populations.
(2) The amount of any grant under paragraph (1) may not exceed 80 per centum of the cost of the project for which the grant
is made unless the project is located in an area determined by the
Secretary to be an urban or rural poverty area, in which case the
grant may cover up to 100 per centum of such costs.
(3) There are authorized to be appropriated for grants under
paragraph (1) $15,000,000 for the fiscal year ending September 30,
1981, and $15,000,000 for the fiscal year ending September 30,
1982.
PART C—GENERAL PROVISIONS
GENERAL REGULATIONS

SEC. 1620. ø300s¿ The Secretary shall by regulation—
(1) prescribe the manner in which he shall determine the
priority among projects for which assistance is available under
part A or B, based on the relative need of different areas for
such projects and giving special consideration—
(A) to projects for medical facilities serving areas with
relatively small financial resources and for medical facilities serving rural communities,
(B) in the case of projects for modernization of medical
facilities, to projects for facilities serving densely populated
areas,
(C) in the case of projects for construction of outpatient medical facilities, to projects that will be located
in, and provide services for residents of, areas determined
by the Secretary to be rural or urban poverty areas,
(D) to projects designed to (i) eliminate or prevent imminent safety hazards as defined by Federal, State, or
local fire, building, or life safety codes or regulations, or (ii)
avoid noncompliance with State or voluntary licensure or
accreditation standards, and
(E) to projects for medical facilities which, alone or in
conjunction with other facilities, will provide comprehensive health care, including outpatient and preventive care
as well as hospitalization;
(2) prescribe for medical facilities projects assisted under
part A or B general standards of construction, modernization,
and equipment, which standards may vary on the basis of the
class of facilities and their location; and
(3) prescribe the general manner in which easy entity
which receives financial assistance under part A or B or has
received financial assistance under part A or B or title VI shall
be required to comply with the assurances required to be made
at the time such assistance was received and the means by
which such entity shall be required to demonstrate compliance
with such assurances.
An entity subject to the requirements prescribed pursuant to paragraph (3) respecting compliance with assurances made in connecMarch 13, 2013

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PUBLIC HEALTH SERVICE ACT

Sec. 1621

tion with receipt of financial assistance shall submit periodically to
the Secretary data and information which reasonably supports the
entity’s compliance with such assurances. The Secretary may not
waive the requirement of the preceding sentence.
APPLICATIONS

SEC. 1621. ø300s–1¿ (a) No loan, loan guarantee, or grant may
be made under part A or B for a medical facilities project unless
an application for such project has been submitted to and approved
by the Secretary. If two or more entities join in a project, an application for such project may be filed by any of such entities or by
all of them.
(b)(1) An application for a medical facilities project shall be
submitted in such form and manner as the Secretary shall by regulation prescribe and shall, except as provided in paragraph (2), set
forth—
(A) in the case of a modernization project for a medical facility for continuation of existing health services, a finding by
the State Agency of a continued need for such services, and, in
the case of any other project for a medical facility, a finding by
the State Agency of the need for the new health services to be
provided through the medical facility upon completion of the
project;
(B) in the case of an application for a grant, assurances
satisfactory to the Secretary that (i) the applicant making the
application would not be able to complete the project for which
the application is submitted without the grant applied for, and
(ii) in the case of a project to construct a new medical facility,
it would be inappropriate to convert an existing medical facility
to provide the services to be provided through the new medical
facility;
(C) in the case of a project for the discontinuance of a service or facility or the conversion of a service or a facility, an
evaluation of the impact of such discontinuance or conversion
on the provision of health care in the health service area in
which such service was provided or facility located;
(D) a description of the site of such project;
(E) plans and specifications therefor which meet the requirements of the regulations prescribed under section 1620(2);
(F) reasonable assurance that title to such site is or will
be vested in one or more of the entities filing the application
or in a public or other nonprofit entity which is to operate the
facility on completion of the project;
(G) reasonable assurance that adequate financial support
will be available for the completion of the project and for its
maintenance and operation when completed, and, for the purpose of determining if the requirements of this subparagraph
are met, Federal assistance provided directly to a medical facility which is located in an area determined by the Secretary to
be an urban or rural poverty area or through benefits provided
individuals served at such facility shall be considered as financial support;
March 13, 2013

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PUBLIC HEALTH SERVICE ACT

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(H) the type of assistance being sought under part A or B
for the project;
(I) reasonable assurance that all laborers and mechanics
employed by contractors or subcontractors in the performance
of work on a project will be paid wages at rates not less than
those prevailing on similar construction in the locality as determined by the Secretary of Labor in accordance with the Act
of March 3, 1931 (40 U.S.C. 276a—276a–5, known as the
Davis-Bacon Act), and the Secretary of Labor shall have with
respect to such labor standards the authority and functions set
forth in Reorganization Plan Numbered 14 of 1950 (15 FR
3176; 5 U.S.C. Appendix) and section 2 of the Act of June 13,
1934 (40 U.S.C. 276c);
(J) in the case of a project for the construction or modernization of an outpatient facility, reasonable assurance that
the services of a general hospital will be available to patients
at such facility who are in need of hospital care; and
(K) reasonable assurance that at all times after such application is approved (i) the facility or portion thereof to be constructed, modernized, or converted will be made available to all
persons residing or employed in the area served by the facility,
and (ii) there will be made available in the facility or portion
thereof to be constructed, modernized, or converted a reasonable volume of services to persons unable to pay therefor and
the Secretary, in determining the reasonableness of the volume
of services provided, shall take into consideration the extent to
which compliance is feasible from a financial viewpoint.
(2)(A) The Secretary may waive—
(i) the requirements of subparagraph (D) of paragraph (1)
for compliance with modernization and equipment standards
prescribed pursuant to section 1620(2), and
(ii) the requirement of subparagraph (E) of paragraph (1)
respecting title to a project site,
in the case of an application for a project described in subparagraph (B) of this paragraph.
(B) A project referred to in subparagraph (A) is a project—
(i) for the modernization of an outpatient medical facility
which will provide general purpose health services, which is
not part of a hospital, and which will serve a medically underserved population as defined in section 1624 or as designated
by a health systems agency, and
(ii) for which the applicant seeks a loan under part A the
principal amount of which does not exceed $20,000.
RECOVERY

SEC. 1622. ø300s–1a¿ (a) If any facility with respect to which
funds have been paid under this title shall, at any time within 20
years after the completion of construction or modernization—
(1) be sold or transferred to any entity (A) which is not
qualified to file an application under section 1621 or 1642 or
(B) which is not approved as a transferee by the State Agency
of the State in which such facility is located, or its successor,
or
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PUBLIC HEALTH SERVICE ACT

Sec. 1622

(2) cease to be a public health center or a public or other
nonprofit hospital, outpatient facility, facility for long-term
care, or rehabilitation facility,
the United States shall be entitled to recover, whether from the
transferor or the transferee (or, in the case of a facility which has
ceased to be public or nonprofit, from the owners thereof) an
amount determined under subsection (c).
(b) The transferor of a facility which is sold or transferred as
described in subsection (a)(1), or the owner of a facility the use of
which is changed as described in subsection (a)(2), shall provide the
Secretary written notice of such sale, transfer, or change not later
than the expiration of 10 days from the date on which such sale,
transfer, or change occurs.
(c)(1) Except as provided in paragraph (2), the amount the
United States shall be entitled to recover under subsection (a) is
an amount bearing the same ratio to the then value (as determined
by the agreement of the parties or in an action brought in the district court of the United States for the district for which the facility
involved is situated) of so much of the facility as constituted an approved project or projects as the amount of the Federal participation bore to the cost of the construction or modernization of such
project or projects.
(2)(A) After the expiration of—
(i) 180 days after the date of the sale, transfer, or change
of use for which a notice is required by subsection (b) in the
case of a facility which is sold or transferred or the use of
which changes after the date of the enactment of this subsection, or
(ii) thirty days after the date of enactment of this subsection or if later 180 days after the date of the sale, transfer,
or change of use for which a notice is required by subsection
(b), in the case of a facility which was sold or transferred or
the use of which changed before the date of the enactment of
this subsection,
the amount which the United States is entitled to recover under
paragraph (1) with respect to a facility shall be the amount prescribed by paragraph (1) plus interest, during the period described
in subparagraph (B), at a rate (determined by the Secretary) based
on the average of the bond equivalent of the weekly 90-day Treasury bill auction rate.
(B) The period referred to in subparagraph (A) is the period beginning—
(i) in the case of a facility which was sold or transferred
or the use of which changed before the date of the enactment
of this subsection, thirty days after such date or if later 180
days after the date of the sale, transfer, or change of use for
which a notice is required by subsection (b),
(ii) in the case of a facility with respect to which notice is
provided in accordance with subsection (b), upon the expiration
of 180 days after the receipt of such notice, or
(iii) in the case of a facility with respect to which such notice is not provided as prescribed by subsection (b), on the date
of the sale, transfer, or changes of use for which such notice
was to be provided,
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Sec. 1623

PUBLIC HEALTH SERVICE ACT

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and ending on the date the amount the United States is entitled
to under paragraph (1) is collected.
(d)(1) The Secretary may waive the recovery rights of the
United States under subsection (a)(1) with respect to a facility in
any State if the Secretary determines, in accordance with regulations, that the entity to which the facility was sold or transferred—
(A) has established an irrevocable trust—
(i) in an amount equal to the greater of twice the cost
of the remaining obligation of the facility under clause (ii)
of section 1621(b)(1)(K) or the amount, determined under
subsection (c), that the United States is entitled to recover,
and
(ii) which will only be used by the entity to provide the
care required by clause (ii) of section 1621(b)(1)(K); and
(B) will meet the obligation of the facility under clause (i)
of section 1621(b)(1)(K).
(2) The Secretary may waive the recovery rights of the United
States under subsection (a)(2) with respect to a facility in any State
if the Secretary determines, in accordance with regulations, that
there is good cause for waiving such rights with respect to such facility.
(e) The right of recovery of the United States under subsection
(a) shall not constitute a lien on any facility with respect to which
funds have been paid under this title.
CONTROL OF OPERATIONS

SEC. 1623. ø300s–2¿ Except as otherwise specifically provided,
nothing in this title shall be construed as conferring on any Federal
officer, or employee the right to exercise any supervision or control
over the administration, personnel, maintenance, or operation of
any facility with respect to which any funds have been or may be
expended under this title.
DEFINITIONS

SEC. 1624. ø300s–3¿ Except as provided in section 1642(e), for
purposes of this title—
(1) The term ‘‘hospital’’ includes general, tuberculosis, and
other types of hospitals, and related facilities, such as laboratories, outpatient departments, nurses’ home facilities, extended care facilities, facilities related to programs for home
health services, self-care units, and central service facilities,
operated in connection with hospitals, and also includes education or training facilities for health professonal 1 personnel
operated as an integral part of a hospital, but does not include
any hospital furnishing primarily domiciliary care.
(2) The term ‘‘public health center’’ means a publicly
owned facility for the provision of public health services, including related publicly owned facilities such as laboratories,
clinics, and administrative offices operated in connection with
such a facility.
1 So

March 13, 2013

in law. Probably should be ‘‘professional’’.

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PUBLIC HEALTH SERVICE ACT

Sec. 1624

(3) The term ‘‘nonprofit’’ as applied to any facility means
a facility which is owned and operated by one or more nonprofit corporations or associations no part of the net earnings
of which inures, or may lawfully inure, to the benefit of any
private shareholder or individual.
(4) The term ‘‘outpatient medical facility’’ means a medical
facility (located in or apart from a hospital) for the diagnosis
or diagnosis and treatment of ambulatory patients (including
ambulatory inpatients)—
(A) which is operated in connection with a hospital;
(B) in which patient care is under the professional supervision of persons licensed to practice medicine or surgery in the State, or in the case of dental diagnosis or
treatment, under the professional supervision of persons licensed to practice dentistry in the State; or
(C) which offers to patients not requiring hospitalization the services of licensed physicians in various medical
specialties and which provides to its patients a reasonably
full range of diagnostic and treatment services.
(5) The term ‘‘rehabilitation facility’’ means a facility which
is operated for the primary purpose of assisting in the rehabilitation of disabled persons through an integrated program of—
(A) medical evaluation and services, and
(B) psychological, social, or vocational evaluation and
services,
under competent professional supervision, and in the case of
which the major portion of the required evaluation and services is furnished within the facility; and either the facility is
operated in connection with a hospital, or all medical and related health services are prescribed by, or are under the general direction of, persons licensed to practice medicine or surgery in the State.
(6) The term ‘‘facility for long-term care’’ means a facility
(including a skilled nursing or intermediate care facility) providing in-patient care for convalescent or chronic disease patients who required skilled nursing or intermediate care and
related medical services—
(A) which is a hospital (other than a hospital primarily
for the care and treatment of mentally ill or tuberculosis
patients) or is operated in connection with a hospital, or
(B) in which such care and medical services are prescribed by, or are performed under the general direction of,
persons licensed to practice medicine or surgery in the
State.
(7) The term ‘‘construction’’ means construction of new
buildings and initial equipment of such buildings and, in any
case in which it will help to provide a service not previously
provided in the community, equipment of any buildings; including architects’ fees, but excluding the cost of off-site improvements and, except with respect to public health centers,
the cost of the acquisition of land
(8) The term ‘‘cost’’ as applied to construction modernization, or conversion means the amount found by the Secretary
to be necessary for construction, modernization, or conversion,
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Sec. 1624

PUBLIC HEALTH SERVICE ACT

1092

respectively, under a project, except that, in the case of a modernization project or a project assisted under part D, such term
does not include any amount found by the Secretary to be attributable to expansion of the bed capacity of any facility.
(9) The term ‘‘modernization’’ includes the alteration, expansion, major repair (to the extent permitted by regulations),
remodeling, replacement, and renovation of existing buildings
(including initial equipment thereof), and the replacement of
obsolete equipment of existing buildings.
(10) The term ‘‘title,’’ 1 when used with reference to a site
for a project, means a fee simple, or such other estate or interest (including a leasehold on which the rental does not exceed
4 per centum of the value of the land) as the Secretary finds
sufficient to assure for a period of not less than twenty-five
years’ undisturbed use and possession for the purposes of construction, modernization, or conversion and operation of the
project for a period of not less than (A) twenty years in the
case of a project assisted under an allotment or grant under
this title, or (B) the term of repayment of a loan made or guaranteed under this title in the case of a project assisted by a
loan or loan guarantee.
(11) The term ‘‘medical facility’’ means a hospital, public
health center, outpatient medical facility, rehabilitation facility, facility for long-term care, or other facility (as may be designated by the Secretary) for the provision of health care to
ambulatory patients.
(12) The term ‘‘State Agency’’ means the State health planning and development agency of a State designated under title
XV.
(13) The term ‘‘urban or rural poverty area’’ means an
urban or rural geographical area (as defined by the Secretary)
in which a percentage (as defined by the Secretary in accordance with the next sentence) of the residents of the area have
incomes below the poverty level (as defined by the Secretary of
Commerce). The percentage referred to in the preceding sentence shall be defined so that the percentage of the population
of the United States residing in urban and rural poverty areas
is—
(A) not more than the percentage of the total population of the United States with incomes below the poverty
level (as so defined) plus five per centum, and
(B) not less than such percentage minus five per centum.
(14) The term ‘‘medically underserved population’’ means
the population of an urban or rural area designated by the Secretary as an area with a shortage of health facilities or a population group designated by the Secretary as having a shortage
of such facilities.
FINANCIAL STATEMENTS; RECORDS AND AUDIT

SEC. 1625. ø300s–4¿ (a) In the case of any facility for which
an allotment payment, grant, loan, or loan guarantee has been
1 So

March 13, 2013

in law. The comma probably should follow the ending quotations.

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PUBLIC HEALTH SERVICE ACT

Sec. 1627

made under this title, the applicant for such payment, grant, loan,
or loan guarantee (or, if appropriate, such other person as the Secretary may prescribe) shall file at least annually with the State
Agency for the State in which the facility is located a statement
which shall be in such form, and contain such information, as the
Secretary may require to accurately show—
(1) the financial operations of the facility, and
(2) the costs to the facility of providing health services in
the facility and the charges made by the facility for providing
such services,
during the period with respect to which the statement is filed.
(b)(1) Each entity receiving Federal assistance under this title
shall keep such records as the Secretary shall prescribe, including
records which fully disclose the amount and disposition by such entity of the proceeds of such assistance, the total cost of the project
in connection with which such assistance is given or used, the
amount of that portion of the cost of the project supplied by other
sources, and such other records as will facilitate an effective audit.
(2) The Secretary and the Comptroller General of the United
States, or any of their duly authorized representatives, shall have
access for the purpose of audit and examination to any books, documents, papers, and records of such entities which in the opinion of
the Secretary or the Comptroller General may be related or pertinent to the assistance referred to in paragraph (1).
(c) Each such entity shall file at least annually with the Secretary a statement which shall be in such form, and contain such
information, as the Secretary may require to accurately show—
(1) the financial operations of the facility constructed or
modernized with such assistance, and
(2) the costs to such facility of providing health services in
such facility, and the charges made for such services, during
the period with respect to which the statement is filed.
TECHNICAL ASSISTANCE

SEC. 1626. ø300s–5¿ The Secretary shall provide (either
through the Department of Health, Education, and Welfare or by
contract) all necessary technical and other nonfinancial assistance
to any public or other entity which is eligible to apply for assistance under this title to assist such entity in developing applications
to be submitted to the Secretary under section 1621 or 1642. The
Secretary shall make every effort to inform eligible applicants of
the availability of assistance under this title.
ENFORCEMENT OF ASSURANCES

SEC. 1627. ø300s–6¿ The Secretary shall investigate and ascertain, on a periodic basis, with respect to each entity which is receiving financial assistance under this title or which has received
financial assistance under title VI or this title, the extent of compliance by such entity with the assurances required to be made at the
time such assistance was received. If the Secretary finds that such
an entity has failed to comply with any such assurance, the Secretary shall report such noncompliance to the health systems agency for the health service area in which such entity is located and
March 13, 2013

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Sec. 1640

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1094

the State health planning and development agency of the State in
which the entity is located and shall take any action authorized by
law (including an action for specific performance brought by the Attorney General upon request of the Secretary) which will effect
compliance by the entity with such assurances. An action to effectuate compliance with any such assurance may be brought by a
person other than the Secretary only if a complaint has been filed
by such person with the Secretary and the Secretary has dismissed
such complaint or the Attorney General has not brought a civil action for compliance with such assurance within six months after
the date on which the complaint was filed with the Secretary.
PART D—AREA HEALTH SERVICES DEVELOPMENT FUNDS
DEVELOPMENT GRANTS FOR AREA HEALTH SERVICES DEVELOPMENT
FUNDS

SEC. 1640. ø300t¿ (a) The Secretary shall make in each fiscal
year a grant to each health systems agency—
(1) with which there is in effect a designation agreement
under section 1515(c),
(2) which has in effect an HSP and AIP reviewed by the
Statewide Health Coordinating Council, and
(3) which, as determined under the review made under
section 1535(c), is organized and operated in the manner prescribed by section 1512(b) and is performing its functions
under section 1513 in a manner satisfactory to the Secretary,
to enable the agency to establish and maintain an Area Health
Services Development Fund from which it may make grants and
enter into contracts in accordance with section 1513(c)(3).
(b)(1) Except as provided in paragraph (2), the amount of any
grant under subsection (a) shall be determined by the Secretary
after taking into consideration the population of the health service
area for which the health systems agency is designated, the average family income of the area, and the supply of health services in
the area.
(2) The amount of any grant under subsection (a) to a health
systems agency for any fiscal year may not exceed the product of
$1 and the population of the health service area for which such
agency is designated.
(c) No grant may be made under subsection (a) unless an application therefor has been submitted to, and approved by, the Secretary. Such an application shall be submitted in such form and
manner and contain such information as the Secretary may require.
(d) For the purpose of making payments pursuant to grants
under subsection (a), there are authorized to be appropriated
$25,000,000 for the fiscal year ending June 30, 1975, $75,000,000
for the fiscal year ending June 30, 1976, $120,000,000 each for the
fiscal years ending September 30, 1977, and September 30, 1978,
$20,000,000 for the fiscal year ending September 30, 1981, and
$30,000,000 for the fiscal year ending September 30, 1982.
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PUBLIC HEALTH SERVICE ACT

Sec. 1642

PART E—PROGRAM TO ASSIST AND ENCOURAGE THE VOLUNTARY
DISCONTINUANCE OF UNNEEDED HOSPITAL SERVICES AND THE
CONVERSION OF UNNEEDED HOSPITAL SERVICES TO OTHER
HEALTH SERVICES NEEDED BY THE COMMUNITY
ESTABLISHMENT OF PROGRAM

SEC. 1641. ø300t–11¿ The Secretary shall, by April 1, 1980, establish a program under which—
(1) grants and technical assistance may be provided to hospitals in operation on the date of the enactment of this part (A)
for the discontinuance of unneeded hospital services, and (B)
for the conversion of unneeded hospital services to other health
services needed by the community; and
(2) grants may be provided to State Agencies designated
under section 1521(b)(3) for reducing excesses in resources and
facilities of hospitals.
GRANTS FOR DISCONTINUANCE AND CONVERSION

SEC. 1642. ø300t–12¿ (a)(1) A grant to a hospital under the
program shall be subject to such terms and conditions as the Secretary may by regulation prescribe to assure that the grant is used
for the purpose for which it was made.
(2) The amount of any such grant shall be determined by the
Secretary. The recipient of such a grant may use the grant—
(A) in the case of a grantee which discontinues the provision of all hospital services or all inpatient hospital services or
an identifiable part of a hospital facility which provides inpatient hospital services, for the liquidation of the outstanding
debt on the facilities of the grantee used for the provision of
the services or for the liquidation of the outstanding debt of
the grantee on such identifiable part;
(B) in the case of a grantee which is discontinuing the provision of an inpatient hospital service converts or proposes to
convert an identifiable part of a hospital facility used in the
provision of the discontinued service to the delivery of other
health services, for the planning, development (including construction and acquisition of equipment), and delivery of the
health service;
(C) to provide reasonable termination pay for personnel of
the grantee who will lose employment because of the discontinuance of hospital services made by the grantee, retraining of such personnel, assisting such personnel in securing employment, and other costs of implementing arrangements described in subsection (c); and
(D) for such other costs which the Secretary determines
may need to be incurred by the grantee in discontinuing hospital services.
(b)(1) No grant may be made to a hospital unless an application therefor is submitted to and approved by the Secretary. Such
an application shall be in such form and submitted in such manner
as the Secretary may prescribe and shall include—
(A) a description of each service to be discontinued and, if
a part of a hospital is to be discontinued or converted to anMarch 13, 2013

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other use in connection with such discontinuance, a description
of such part;
(B) an evaluation of the impact of such discontinuance and
conversion on the provision of health care in the health service
area in which such service is provided;
(C) an estimate of the change in the applicant’s costs
which will result from such discontinuance and conversion; and
(D) reasonable assurance that all laborers and mechanics
employed by contractors or subcontractors in the performance
of work on a project will be paid wages at rates not less than
those prevailing on similar construction in the locality as determined by the Secretary of Labor in accordance with the Act
of March 3, 1931 (40 U.S.C. 276a—276a–5, known as the
Davis-Bacon Act), and the Secretary of Labor shall have with
respect to such labor standards the authority and functions set
forth in Reorganization Plan Numbered 14 of 1950 (15 FR
3176; 5 U.S.C. Appendix) and section 2 of the Act of June 13,
1934 (40 U.S.C. 276c);
(E) such other information as the Secretary may require.
(2)(A) The health systems agency for the health service area in
which is located a hospital applying for a grant under the program
shall (i) in making the review of the applicant’s application under
section 1513(e), determine the need for each service or part proposed to be discontinued by the applicant, (ii) in the case of an application for the conversion of a facility, determine the need for
each service which will be provided as a result of a conversion, and
(iii) make a recommendation to the State Agency for the State in
which the applicant is located respecting approval by the Secretary
of the applicant’s application.
(B) A State Agency which has received a recommendation from
a health systems agency under subparagraph (A) respecting an application shall, after consideration of such recommendation, make
a recommendation to the Secretary respecting the approval by the
Secretary of the application. A State Agency’s recommendation
under this subparagraph respecting the approval of an application
(i) shall be based upon (I) the need for each service or part proposed to be discontinued by the applicant, (II) in the case of an application for the conversion of a facility, the need for each service
which will be provided as a result of the conversion, and (III) such
other criteria as the Secretary may prescribe, and (ii) shall be accompanied by the health systems agency’s recommendation made
with respect to the approval of the application.
(C) In determining, under subparagraphs (A) and (B), the need
for the service (or services) or part proposed to be discontinued or
converted by an applicant for a grant, a health systems agency and
State Agency shall give special consideration to the unmet needs
and existing access patterns of urban or rural poverty populations.
(3)(A) The Secretary may not approve an application of a hospital for a grant—
(i) if a State Agency recommended that the application not
be approved, or
(ii) if the Secretary is unable to determine that the cost of
providing inpatient health services in the health service area
in which the applicant is located will be less than if the inpaMarch 13, 2013

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tient health services proposed to be discontinued were not discontinued.
(B) In considering applications of hospitals for grants the Secretary shall consider the recommendations of health systems agencies and State Agencies and shall give special consideration to applications (i) which will assist health systems agencies and State
Agencies to meet the goals in their health systems plans and State
health plans, or (ii) which will result in the greatest reduction in
hospital costs within a health service area.
(c)(1) Except as provided in paragraph (3), the Secretary may
not approve an application submitted under subsection (b) unless
the Secretary of Labor has certified that fair and equitable arrangements have been made to protect the interests of employees
affected by the discontinuance of services against a worsening of
their positions with respect to their employment, including arrangements to preserve the rights of employees under collectivebargaining agreements, continuation of collective-bargaining rights
consistent with the provisions of the National Labor Relations Act,
reassignment of affected employees to other jobs, retraining programs, protecting pension, health benefits, and other fringe benefits of affected employees, and arranging adequate severance pay,
if necessary.
(2) The Secretary of Labor shall by regulation prescribe guidelines for arrangements for the protection of the interests of employees affected by the discontinuance of hospital services. The Secretary of Labor shall consult with the Secretary of Health, Education, and Welfare in the promulgation of such guidelines. Such
guidelines shall first be promulgated not later than the promulgation of regulations by the Secretary for the administration of the
grants authorized by section 1641.
(3) The Secretary of Labor shall review each application submitted under subsection (b) to determine if the arrangements described in paragraph (1) have been made and if they are satisfactory and shall notify the Secretary respecting his determination.
Such review shall be completed within—
(A) ninety days from the date of the receipt of the application from the Secretary of Health, Education, and Welfare, or
(B) one hundred and twenty days from such date if the
Secretary of Labor has by regulation prescribed the circumstances under which the review will require at least one
hundred and twenty days.
If within the applicable period, the Secretary of Labor does not notify the Secretary of Health, Education, and Welfare respecting his
determination, the Secretary of Health, Education, and Welfare
shall review the application to determine if the applicant has made
the arrangements described in paragraph (1) and if such arrangements are satisfactory. The Secretary may not approve the application unless he determines that such arrangements have been made
and that they are satisfactory.
(d) The records and audits requirements of section 705 shall
apply with respect to grants made under subsection (a).
(e) For purposes of this part, the term ‘‘hospital’’ means, with
respect to any fiscal year, an institution (including a distinct part
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of an institution participating in the programs established under
title XVIII of the Social Security Act)—
(1) which satisfies paragraphs (1) and (7) of section 1861(e)
of such Act,
(2) imposes charges or accepts payments for services provided to patients, and
(3) the average duration of a patient’s stay in which was
thirty days or less in the preceding fiscal year,
but such term does not include a Federal hospital or a psychiatric
hospital (as described in section 1861(f)(1) of the Social Security
Act).
GRANTS TO STATES FOR REDUCTION OF EXCESS HOSPITAL CAPACITY

SEC. 1643. ø300t–13¿ (a) For the purpose of demonstrating the
effectiveness of various means for reducing excesses in resources
and facilities of hospitals (referred to in this section as ‘‘excess hospital capacity’’), the Secretary may make grants to State Agencies
designated under section 1521(b)(3) to assist such Agencies in—
(1) identifying (by geographic region or by health service)
excess hospital capacity,
(2) developing programs to inform the public of the costs
associated with excess hospital capacity,
(3) developing programs to reduce excess hospital capacity
in a manner which will produce the greatest savings in the
cost of health care delivery,
(4) developing means to overcome barriers to the reduction
of excess hospital capacity,
(5) in planning, evaluating, and carrying out programs to
decertify health care facilities providing health services that
are not appropriate, and
(6) any other activity related to the reduction of excess
hospital capacity.
(b) Grants under subsection (a) shall be made on such terms
and conditions as the Secretary may prescribe.
AUTHORIZATION OF APPROPRIATIONS

SEC. 1644. ø300t–14¿ To make payments under grants under
sections 1642 and 1643 there are authorized to be appropriated
$30,000,000 for the fiscal year ending September 30, 1980,
$50,000,000 for the fiscal year ending September 30, 1981, and
$75,000,000 for the fiscal year ending September 30, 1982, except
that in any fiscal year not more than 10 percent of the amount appropriated under this section may be obligated for grants under
section 1643.

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TITLE XVII—HEALTH INFORMATION AND HEALTH
PROMOTION
GENERAL AUTHORITY

SEC. 1701. ø300u¿ (a) The Secretary shall—
(1) formulate national goals, and a strategy to achieve
such goals, with respect to health information and health promotion, preventive health services, and education in the appropriate use of health care;
(2) analyze the necessary and available resources for implementing the goals and strategy formulated pursuant to
paragraph (1), and recommend appropriate educational and
quality assurance policies for the needed manpower resources
identified by such analysis;
(3) undertake and support necessary activities and programs to—
(A) incorporate appropriate health education components into our society, especially into all aspects of education and health care,
(B) increase the application and use of health knowledge, skills, and practices by the general population in its
patterns of daily living, and
(C) establish systematic processes for the exploration,
development, demonstration, and evaluation of innovative
health promotion concepts;
(4) undertake and support research and demonstrations respecting health information and health promotion, preventive
health services, and education in the appropriate use of health
care;
(5) undertake and support appropriate training in the operation of programs concerned with, health information and
health promotion, preventive health services, and education in
the appropriate use of health care;
(6) undertake and support, through improved planning and
implementation of tested models and evaluation of results, effective and efficient programs respecting health information
and health promotion, preventive health services, and education in the appropriate use of health care;
(7)(A) develop model programs through which employers in
the public sector, and employers that are small businesses (as
defined in section 3 of the Small Business Act), can provide for
their employees a program to promote healthy behaviors and
to discourage participation in unhealthy behaviors;
(B) provide technical assistance to public and private employers in implementing such programs (including private employers that are not small businesses and that will implement
1099
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programs other than the programs developed by the Secretary
pursuant to subparagraph (A)); and
(C) in providing such technical assistance, give preference
to small businesses;
(8) foster the exchange of information respecting, and foster cooperation in the conduct of, research, demonstration, and
training programs respecting health information and health
promotion, preventive health services, and education in the appropriate use of health care;
(9) provide technical assistance in the programs referred to
in paragraph (8);
(10) use such other authorities for programs respecting
health information and health promotion, preventive health
services, and education in the appropriate use of health care
as are available and coordinate such use with programs conducted under this title; and
(11) establish in the Office of the Assistant Secretary for
Health an Office of Disease Prevention and Health Promotion,
which shall—
(A) coordinate all activities within the Department
which relate to disease prevention, health promotion, preventive health services, and health information and education with respect to the appropriate use of health care;
(B) coordinate such activities with similar activities in
the private sector;
(C) establish a national information clearinghouse to
facilitate the exchange of information concerning matters
relating to health information and health promotion, preventive health services (which may include information
concerning models and standards for insurance coverage of
such services), and education in the appropriate use of
health care, to facilitate access to such information, and to
assist in the analysis of issues and problems relating to
such matters; and
(D) support projects, conduct research, and disseminate information relating to preventive medicine, health
promotion, and physical fitness and sports medicine.
The Secretary shall appoint a Director for the Office of Disease
Prevention and Health Promotion established pursuant to paragraph (11) of this subsection. The Secretary shall administer this
title in cooperation with health care providers, educators, voluntary
organizations, businesses, and State and local health agencies in
order to encourage the dissemination of health information and
health promotion activities.
(b) For the purpose of carrying out this section and sections
1702 through 1705, there are authorized to be appropriated
$10,000,000 for fiscal year 1992, and such sums as may be necessary for each of the fiscal years 1993 through 2002.
(c) No grant may be made or contract entered into under this
title unless an application therefor has been submitted to and approved by the Secretary. Such an application shall be submitted in
such form and manner and contain such information as the Secretary may prescribe. Contracts may be entered into under this
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title without regard to sections 3648 and 3709 of the Revised Statutes (31 U.S.C. 529; 41 U.S.C. 5).
RESEARCH PROGRAMS

SEC. 1702. ø300u–1¿ (a) The Secretary is authorized to conduct
and support by grant or contract (and encourage others to support)
research in health information and health promotion, preventive
health services, and education in the appropriate use of health
care. Applications for grants and contracts under this section shall
be subject to appropriate peer review. The Secretary shall also—
(1) provide consultation and technical assistance to persons who need help in preparing research proposals or in actually conducting research;
(2) determine the best methods of disseminating information concerning personal health behavior, preventive health
services and the appropriate use of health care and of affecting
behavior so that such information is applied to maintain and
improve health, and prevent disease, reduce its risk, or modify
its course or severity;
(3) determine and study environmental, occupational, social, and behavioral factors which affect and determine health
and ascertain those programs and areas for which educational
and preventive measures could be implemented to improve
health as it is affected by such factors;
(4) develop (A) methods by which the cost and effectiveness
of activities respecting health information and health promotion, preventive health services, and education in the appropriate use of health care, can be measured, including methods
for evaluating the effectiveness of various settings for such activities and the various types of persons engaged in such activities, (B) methods for reimbursement or payment for such activities, and (C) models and standards for the conduct of such
activities, including models and standards for the education, by
providers of institutional health services, of individuals receiving such services respecting the nature of the institutional
health services provided the individuals and the symptoms,
signs, or diagnoses which led to provision of such services;
(5) develop a method for assessing the cost and effectiveness of specific medical services and procedures under various
conditions of use, including the assessment of the sensitivity
and specificity of screening and diagnostic procedures; and
(6) enumerate and assess, using methods developed under
paragraph (5), preventive health measures and services with
respect to their cost and effectiveness under various conditions
of use (which measures and services may include blood pressure screening, cholesterol screening and control, smoking cessation programs, substance abuse programs, cancer screening,
dietary and nutritional counseling, diabetes screening and education, intraocular pressure screening, and stress management).
(b) The Secretary shall make a periodic survey of the needs, interest, attitudes, knowledge, and behavior of the American public
regarding health and health care. The Secretary shall take into
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consideration the findings of such surveys and the findings of similar surveys conducted by national and community health education
organizations, and other organizations and agencies for formulating
policy respecting health information and health promotion, preventive health services, and education in the appropriate use of health
care.
COMMUNITY PROGRAMS

SEC. 1703. ø300u–2¿ (a) The Secretary is authorized to conduct
and support by grant or contract (and encourage others to support)
new and innovative programs in health information and health
promotion, preventive health services, and education in the appropriate use of health care, and may specifically—
(1) support demonstration and training programs in such
matters which programs (A) are in hospitals, ambulatory care
settings, home care settings, schools, day care programs for
children, and other appropriate settings representative of
broad cross sections of the population, and include public education activities of voluntary health agencies, professional medical societies, and other private nonprofit health organizations,
(B) focus on objectives that are measurable, and (C) emphasize
the prevention or moderation of illness or accidents that appear controllable through individual knowledge and behavior;
(2) provide consultation and technical assistance to organizations that request help in planning, operating, or evaluating
programs in such matters;
(3) develop health information and health promotion materials and teaching programs including (A) model curriculums
for the training of educational and health professionals and
paraprofessionals in health education by medical, dental, and
nursing schools, schools of public health, and other institutions
engaged in training of educational or health professionals, (B)
model curriculums to be used in elementary and secondary
schools and institutions of higher learning, (C) materials and
programs for the continuing education of health professionals
and paraprofessionals in the health education of their patients,
(D) materials for public service use by the printed and broadcast media, and (E) materials and programs to assist providers
of health care in providing health education to their patients;
and
(4) support demonstration and evaluation programs for individual and group self-help programs designed to assist the
participant in using his individual capacities to deal with
health problems, including programs concerned with obesity,
hypertension, and diabetes.
(b) The Secretary is authorized to make grants to States and
other public and nonprofit entities to assist them in meeting the
costs of demonstrating and evaluating programs which provide information respecting the costs and quality of health care or information respecting health insurance policies and prepaid health
plans, or information respecting both. After the development of
models pursuant to sections 1704(4) and 1704(5) for such information, no grant may be made under this subsection for a program
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unless the information to be provided under the program is provided in accordance with one of such models applicable to the information.
(c) The Secretary is authorized to support by grant or contract
(and to encourage others to support) private nonprofit entities
working in health information and health promotion, preventive
health services, and education in the appropriate use of health
care. The amount of any grant or contract for a fiscal year beginning after September 30, 1978, for an entity may not exceed 25 per
centum of the expenses of entity for such fiscal year for health information and health promotion, preventive health services, and
education in the appropriate use of health care.
INFORMATION PROGRAMS

SEC. 1704. ø300u–3¿ The Secretary is authorized to conduct
and support by grant or contract (and encourage others to support)
such activities as may be required to make information respecting
health information and health promotion, preventive health services, and education in the appropriate use of health care available
to the consumers of medical care, providers of such care, schools,
and others who are or should be informed respecting such matters.
Such activities may include at least the following:
(1) The publication of information, pamphlets, and other
reports which are specially suited to interest and instruct the
health consumer, which information, pamphlets, and other reports shall be updated annually, shall pertain to the individual’s ability to improve and safeguard his own health; shall include material, accompanied by suitable illustrations, on child
care, family life and human development, disease prevention
(particularly prevention of pulmonary disease, cardiovascular
disease, and cancer), physical fitness, dental health, environmental health, nutrition, safety and accident prevention, drug
abuse and alcoholism, mental health, management of chronic
diseases (including diabetes and arthritis), and venereal diseases; and shall be designed to reach populations of different
languages and of different social and economic backgrounds.
(2) Securing the cooperation of the communication media,
providers of health care, schools, and others in activities designed to promote and encourage the use of health maintaining
information and behavior.
(3) The study of health information and promotion in advertising and the making to concerned Federal agencies and
others such recommendations respecting such advertising as
are appropriate.
(4) The development of models and standards for the publication by States, insurance carriers, prepaid health plans, and
others (except individual health practitioners) of information
for use by the public respecting the cost and quality of health
care, including information to enable the public to make comparisons of the cost and quality of health care.
(5) The development of models and standards for the publication by States, insurance carriers, prepaid health plans, and
others of information for use by the public respecting health inMarch 13, 2013

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surance policies and prepaid health plans, including information on the benefits provided by the various types of such policies and plans, the premium charges for such policies and
plans, exclusions from coverage or eligibility for coverage, cost
sharing requirements, and the ratio of the amounts paid as
benefits to the amounts received as premiums and information
to enable the public to make relevant comparisons of the costs
and benefits of such policies and plans.
REPORT AND STUDY

SEC. 1705. ø300u–4¿ (a) The Secretary shall, not later than
two years after the date of the enactment of this title and biannually thereafter, submit to the President for transmittal to Congress a report on the status of health information and health promotion, preventive health services, and education in the appropriate use of health care. Each such report shall include—
(1) a statement of the activities carried out under this title
since the last report and the extent to which each such activity
achieves the purposes of this title;
(2) an assessment of the manpower resources needed to
carry out programs relating to health information and health
promotion, preventive health services, and education in the appropriate use of health care, and a statement describing the activities currently being carried out under this title designed to
prepare teachers and other manpower for such programs;
(3) the goals and strategy formulated pursuant to section
1701(a)(1), the models and standards developed under this
title, and the results of the study required by subsection (b) of
this section; and
(4) such recommendations as the Secretary considers appropriate for legislation respecting health information and
health promotion, preventive health services, and education in
the appropriate use of health care, including recommendations
for revisions to and extension of this title.
(b) The Secretary shall conduct a study of health education
services and preventive health services to determine the coverage
of such services under public and private health insurance programs, including the extent and nature of such coverage and the
cost sharing requirements required by such programs for coverage
of such services.
CENTERS FOR RESEARCH AND DEMONSTRATION OF HEALTH
PROMOTION AND DISEASE PREVENTION

SEC. 1706. ø300u–5¿ (a) The Secretary shall make grants or
enter into contracts with academic health centers for the establishment, maintenance, and operation of centers for research and demonstration with respect to health promotion and disease prevention.
Centers established, maintained, or operated under this section
shall undertake research and demonstration projects in health promotion, disease prevention, and improved methods of appraising
health hazards and risk factors, and shall serve as demonstration
sites for the use of new and innovative research in public health
techniques to prevent chronic diseases.
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(b) Each center established, maintained, or operated under this
section shall—
(1) be located in an academic health center with—
(A) a multidisciplinary faculty with expertise in public
health and which has working relationships with relevant
groups in such fields as medicine, psychology, nursing, social work, education and business;
(B) graduate training programs relevant to disease
prevention;
(C) a core faculty in epidemiology, biostatistics, social
sciences, behavioral and environmental health sciences,
and health administration;
(D) a demonstrated curriculum in disease prevention;
(E) a capability for residency training in public health
or preventive medicine; and
(F) such other qualifications as the Secretary may prescribe;
(2) conduct—
(A) health promotion and disease prevention research,
including retrospective studies and longitudinal prospective studies in population groups and communities;
(B) demonstration projects for the delivery of services
relating to health promotion and disease prevention to defined population groups using, as appropriate, community
outreach and organization techniques and other methods
of educating and motivating communities; and
(C) evaluation studies on the efficacy of demonstration
projects conducted under subparagraph (B) of this paragraph.
The design of any evaluation study conducted under subparagraph
(C) shall be established prior to the commencement of the demonstration project under subparagraph (B) for which the evaluation
will be conducted.
(c)(1) In making grants and entering into contracts under this
section, the Secretary shall provide for an equitable geographical
distribution of centers established, maintained, and operated under
this section and for the distribution of such centers among areas
containing a wide range of population groups which exhibit
incidences of diseases which are most amenable to preventive intervention.
(2) The Secretary, through the Director of the Centers for Disease Control and Prevention and in consultation with the Director
of the National Institutes of Health, shall establish procedures for
the appropriate peer review of applications for grants and contracts
under this section by peer review groups composed principally of
non-Federal experts.
(d) For purposes of this section, the term ‘‘academic health center’’ means a school of medicine, a school of osteopathy, or a school
of public health, as such terms are defined in section 701(4).
(e) For the purpose of carrying out this section, there are authorized to be appropriated $10,000,000 for fiscal year 1992, and
such sums as may be necessary for each of the fiscal years 1993
through 2003.
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OFFICE OF MINORITY HEALTH

SEC. 1707. ø300u–6¿ (a) IN GENERAL.—There is established an
Office of Minority Health. The Office of Minority Health as existing
on the date of enactment of the Patient Protection and Affordable
Care Act shall be transferred to the Office of the Secretary in such
manner that there is established in the Office of the Secretary, the
Office of Minority Health, which shall be headed by the Deputy Assistant Secretary for Minority Health who shall report directly to
the Secretary, and shall retain and strengthen authorities (as in
existence on such date of enactment) for the purpose of improving
minority health and the quality of health care minorities receive,
and eliminating racial and ethnic disparities. In carrying out this
subsection, the Secretary, acting through the Deputy Assistant Secretary, shall award grants, contracts, enter into memoranda of understanding, cooperative, interagency, intra-agency and other
agreements with public and nonprofit private entities, agencies, as
well as Departmental and Cabinet agencies and organizations, and
with organizations that are indigenous human resource providers
in communities of color to assure improved health status of racial
and ethnic minorities, and shall develop measures to evaluate the
effectiveness of activities aimed at reducing health disparities and
supporting the local community. Such measures shall evaluate
community outreach activities, language services, workforce cultural competence, and other areas as determined by the Secretary.
(b) DUTIES.—With respect to improving the health of racial and
ethnic minority groups, the Secretary, acting through the Deputy
Assistant Secretary for Minority Health (in this section referred to
as the ‘‘Deputy Assistant Secretary’’), shall carry out the following:
(1) Establish short-range and long-range goals and objectives and coordinate all other activities within the Public
Health Service that relate to disease prevention, health promotion, service delivery, and research concerning such individuals. The heads of each of the agencies of the Service shall consult with the Deputy Assistant Secretary to ensure the coordination of such activities.
(2) Enter into interagency agreements with other agencies
of the Public Health Service.
(3) Support research, demonstrations and evaluations to
test new and innovative models.
(4) Increase knowledge and understanding of health risk
factors.
(5) Develop mechanisms that support better information
dissemination, education, prevention, and service delivery to
individuals from disadvantaged backgrounds, including individuals who are members of racial or ethnic minority groups.
(6) Ensure that the National Center for Health Statistics
collects data on the health status of each minority group.
(7) With respect to individuals who lack proficiency in
speaking the English language, enter into contracts with public
and nonprofit private providers of primary health services for
the purpose of increasing the access of the individuals to such
services by developing and carrying out programs to provide bilingual or interpretive services.
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(8) Support a national minority health resource center to
carry out the following:
(A) Facilitate the exchange of information regarding
matters relating to health information and health promotion, preventive health services, and education in the
appropriate use of health care.
(B) Facilitate access to such information.
(C) Assist in the analysis of issues and problems relating to such matters.
(D) Provide technical assistance with respect to the exchange of such information (including facilitating the development of materials for such technical assistance).
(9) Carry out programs to improve access to health care
services for individuals with limited proficiency in speaking the
English language. Activities under the preceding sentence shall
include developing and evaluating model projects.
(10) Advise in matters related to the development, implementation, and evaluation of health professions education in
decreasing disparities in health care outcomes, including cultural competency as a method of eliminating health disparities.
(c) ADVISORY COMMITTEE.—
(1) IN GENERAL.—The Secretary shall establish an advisory
committee to be known as the Advisory Committee on Minority
Health (in this subsection referred to as the ‘‘Committee’’).
(2) DUTIES.—The Committee shall provide advice to the
Deputy Assistant Secretary carrying out this section, including
advice on the development of goals and specific program activities under paragraphs (1) through (10) of subsection (b) for
each racial and ethnic minority group.
(3) CHAIR.—The chairperson of the Committee shall be selected by the Secretary from among the members of the voting
members of the Committee. The term of office of the chairperson shall be 2 years.
(4) COMPOSITION.—
(A) The Committee shall be composed of 12 voting
members appointed in accordance with subparagraph (B),
and nonvoting, ex officio members designated in subparagraph (C).
(B) The voting members of the Committee shall be appointed by the Secretary from among individuals who are
not officers or employees of the Federal Government and
who have expertise regarding issues of minority health.
The racial and ethnic minority groups shall be equally represented among such members.
(C) The nonvoting, ex officio members of the Committee shall be such officials of the Department of Health
and Human Services as the Secretary determines to be appropriate.
(5) TERMS.—Each member of the Committee shall serve for
a term of 4 years, except that the Secretary shall initially appoint a portion of the members to terms of 1 year, 2 years, and
3 years.
(6) VACANCIES.—If a vacancy occurs on the Committee, a
new member shall be appointed by the Secretary within 90
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days from the date that the vacancy occurs, and serve for the
remainder of the term for which the predecessor of such member was appointed. The vacancy shall not affect the power of
the remaining members to execute the duties of the Committee.
(7) COMPENSATION.—Members of the Committee who are
officers or employees of the United States shall serve without
compensation. Members of the Committee who are not officers
or employees of the United States shall receive compensation,
for each day (including travel time) they are engaged in the
performance of the functions of the Committee. Such compensation may not be in an amount in excess of the daily
equivalent of the annual maximum rate of basic pay payable
under the General Schedule (under title 5, United States Code)
for positions above GS–15.
(d) CERTAIN REQUIREMENTS REGARDING DUTIES.—
(1) RECOMMENDATIONS REGARDING LANGUAGE.—
(A) PROFICIENCY IN SPEAKING ENGLISH.—The Deputy
Assistant Secretary shall consult with the Director of the
Office of International and Refugee Health, the Director of
the Office of Civil Rights, and the Directors of other appropriate departmental entities regarding recommendations
for carrying out activities under subsection (b)(9).
(B) HEALTH PROFESSIONS EDUCATION REGARDING
HEALTH DISPARITIES.—The Deputy Assistant Secretary
shall carry out the duties under subsection (b)(10) in collaboration with appropriate personnel of the Department
of Health and Human Services, other Federal agencies,
and other offices, centers, and institutions, as appropriate,
that have responsibilities under the Minority Health and
Health Disparities Research and Education Act of 2000.
(2) EQUITABLE ALLOCATION REGARDING ACTIVITIES.—In carrying out subsection (b), the Secretary shall ensure that services provided under such subsection are equitably allocated
among all groups served under this section by the Secretary.
(3) CULTURAL COMPETENCY OF SERVICES.—The Secretary
shall ensure that information and services provided pursuant
to subsection (b) are provided in the language, educational, and
cultural context that is most appropriate for the individuals for
whom the information and services are intended.
(e) GRANTS AND CONTRACTS REGARDING DUTIES.—
(1) IN GENERAL.—In carrying out subsection (b), the Secretary acting through the Deputy Assistant Secretary may
make awards of grants, cooperative agreements, and contracts
to public and nonprofit private entities.
(2) PROCESS FOR MAKING AWARDS.—The Deputy Assistant
Secretary shall ensure that awards under paragraph (1) are
made, to the extent practical, only on a competitive basis, and
that a grant is awarded for a proposal only if the proposal has
been recommended for such an award through a process of
peer review.
(3) EVALUATION AND DISSEMINATION.—The Deputy Assistant Secretary, directly or through contracts with public and
private entities, shall provide for evaluations of projects carried
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1109

PUBLIC HEALTH SERVICE ACT

Sec. 1707A

out with awards made under paragraph (1) during the preceding 2 fiscal years. The report shall be included in the report
required under subsection (f) for the fiscal year involved.
(f) REPORTS.—
(1) IN GENERAL.—Not later than February 1 of fiscal year
1999 and of each second year thereafter, the Secretary shall
submit to the Committee on Energy and Commerce of the
House of Representatives, and to the Committee on Labor and
Human Resources of the Senate, a report describing the activities carried out under this section during the preceding 2 fiscal
years and evaluating the extent to which such activities have
been effective in improving the health of racial and ethnic minority groups. Each such report shall include the biennial reports submitted under sections 201(e)(3) and 201(f)(2) for such
years by the heads of the Public Health Service agencies.
(2) AGENCY REPORTS.—Not later than February 1, 1999,
and biennially thereafter, the heads of the Public Health Service agencies shall submit to the Deputy Assistant Secretary a
report summarizing the minority health activities of each of
the respective agencies.
(g) DEFINITION.—For purposes of this section:
(1) The term ‘‘racial and ethnic minority group’’ means
American Indians (including Alaska Natives, Eskimos, and
Aleuts); Asian Americans; Native Hawaiians and other Pacific
Islanders; Blacks; and Hispanics.
(2) The term ‘‘Hispanic’’ means individuals whose origin is
Mexican, Puerto Rican, Cuban, Central or South American, or
any other Spanish-speaking country.
(h) 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 2011
through 2016.
SEC. 1707A. ø300u–6a¿ INDIVIDUAL OFFICES OF MINORITY HEALTH
WITHIN THE DEPARTMENT.
(a) IN GENERAL.—The head of each agency specified in sub-

section (b)(1) shall establish within the agency an office to be
known as the Office of Minority Health. The head of each such Office shall be appointed by the head of the agency within which the
Office is established, and shall report directly to the head of the
agency. The head of such agency shall carry out this section (as
this section relates to the agency) acting through such Director.
(b) SPECIFIED AGENCIES.—The agencies referred to in subsection (a) are the Centers for Disease Control and Prevention, the
Health Resources and Services Administration, the Substance
Abuse and Mental Health Services Administration, the Agency for
Healthcare Research and Quality, the Food and Drug Administration, and the Centers for Medicare & Medicaid Services.
(c) DIRECTOR; APPOINTMENT.—Each Office of Minority Health
established in an agency listed in subsection (a) shall be headed by
a director, with documented experience and expertise in minority
health services research and health disparities elimination.
(d) REFERENCES.—Except as otherwise specified, any reference
in Federal law to an Office of Minority Health (in the Department
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Sec. 1708

PUBLIC HEALTH SERVICE ACT

1110

of Health and Human Services) is deemed to be a reference to the
Office of Minority Health in the Office of the Secretary.
(e) FUNDING.—
(1) ALLOCATIONS.—Of the amounts appropriated for a specified agency for a fiscal year, the Secretary must designate an
appropriate amount of funds for the purpose of carrying out activities under this section through the minority health office of
the agency. In reserving an amount under the preceding sentence for a minority health office for a fiscal year, the Secretary shall reduce, by substantially the same percentage, the
amount that otherwise would be available for each of the programs of the designated agency involved.
(2) AVAILABILITY OF FUNDS FOR STAFFING.—The purposes
for which amounts made available under paragraph may be expended by a minority health office include the costs of employing staff for such office.
OFFICE OF ADOLESCENT HEALTH

SEC. 1708. ø300u–7¿ (a) IN GENERAL.—There is established an
Office of Adolescent Health within the Office of the Assistant Secretary for Health, which office shall be headed by a director appointed by the Secretary. The Secretary shall carry out this section
acting through the Director of such Office.
(b) DUTIES.—With respect to adolescent health, the Secretary
shall—
(1) coordinate all activities within the Department of
Health and Human Services that relate to disease prevention,
health promotion, preventive health services, and health information and education with respect to the appropriate use of
health care, including coordinating—
(A) the design of programs, support for programs, and
the evaluation of programs;
(B) the monitoring of trends;
(C) projects of research (including multidisciplinary
projects) on adolescent health; and
(D) the training of health providers who work with
adolescents, particularly nurse practitioners, physician assistants, and social workers;
(2) coordinate the activities described in paragraph (1)
with similar activities in the private sector; and
(3) support projects, conduct research, and disseminate information relating to preventive medicine, health promotion,
and physical fitness and sports medicine.
(c) CERTAIN DEMONSTRATION PROJECTS.—
(1) IN GENERAL.—In carrying out subsection (b)(3), the Secretary may make grants to carry out demonstration projects for
the purpose of improving adolescent health, including projects
to train health care providers in providing services to adolescents and projects to reduce the incidence of violence among
adolescents, particularly among minority males.
(2) AUTHORIZATION OF APPROPRIATIONS.—For the purpose
of carrying out paragraph (1), there are authorized to be appropriated $5,000,000 for fiscal year 1993, and such sums as may
be necessary for each of the fiscal years 1994 through 1997.
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1111

PUBLIC HEALTH SERVICE ACT

Sec. 1710

(d) INFORMATION CLEARINGHOUSE.—In carrying out subsection
(b), the Secretary shall establish and maintain a National Information Clearinghouse on Adolescent Health to collect and disseminate
to health professionals and the general public information on adolescent health.
(e) NATIONAL PLAN.—In carrying out subsection (b), the Secretary shall develop a national plan for improving adolescent
health. The plan shall be consistent with the applicable objectives
established by the Secretary for the health status of the people of
the United States for the year 2000, and shall be periodically reviewed, and as appropriate, revised. The plan, and any revisions in
the plan, shall be submitted to the Committee on Energy and Commerce of the House of Representatives and the Committee on Labor
and Human Resources of the Senate.
(f) ADOLESCENT HEALTH.—For purposes of this section, the
term ‘‘adolescent health’’, with respect to adolescents of all ethnic
and racial groups, means all diseases, disorders, and conditions (including with respect to mental health)—
(1) unique to adolescents, or more serious or more prevalent in adolescents;
(2) for which the factors of medical risk or types of medical
intervention are different for adolescents, or for which it is unknown whether such factors or types are different for adolescents; or
(3) with respect to which there has been insufficient clinical research involving adolescents as subjects or insufficient
clinical data on adolescents.
BIENNIAL REPORT REGARDING NUTRITION AND HEALTH

SEC. 1709. ø300u–8¿ (a) BIENNIAL REPORT.—The Secretary
shall require the Surgeon General of the Public Health Service to
prepare biennial reports on the relationship between nutrition and
health. Such reports may, with respect to such relationship, include
any recommendations of the Secretary and the Surgeon General.
(b) SUBMISSION TO CONGRESS.—The Secretary shall ensure
that, not later than February 1 of 1995 and of every second year
thereafter, a report under subsection (a) is submitted to the Committee on Energy and Commerce of the House of Representatives
and the Committee on Labor and Human Resources of the Senate.
EDUCATION REGARDING DES

SEC. 1710. ø300u–9¿ (a) IN GENERAL.—The Secretary, acting
through the heads of the appropriate agencies of the Public Health
Service, shall carry out a national program for the education of
health professionals and the public with respect to the drug
diethylstilbestrol (commonly known as DES). To the extent appropriate, such national program shall use methodologies developed
through the education demonstration program carried out under
section 403C. In developing and carrying out the national program,
the Secretary shall consult closely with representatives of nonprofit
private entities that represent individuals who have been exposed
to DES and that have expertise in community-based information
campaigns for the public and for health care providers. The impleMarch 13, 2013

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Sec. 1710

PUBLIC HEALTH SERVICE ACT

1112

mentation of the national program shall begin during fiscal year
1999.
(b) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of
carrying out this section, there are authorized to be appropriated
such sums as may be necessary for each of the fiscal years 1999
through 2003. The authorization of appropriations established in
the preceding sentence is in addition to any other authorization of
appropriation that is available for such purpose.

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TITLE XVIII—PRESIDENT’S COMMISSION FOR THE STUDY
OF ETHICAL PROBLEMS IN MEDICINE AND BIOMEDICAL
AND BEHAVIORAL RESEARCH
ESTABLISHMENT OF COMMISSION

SEC. 1801. ø300v¿ (a) ESTABLISHMENT.—(1) There is established the President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research 1 (hereinafter in this title referred to as the ‘‘Commission’’) which shall be
composed of eleven members appointed by the President. The members of the Commission shall be appointed as follows:
(A) Three of the members shall be appointed from individuals who are distinguished in biomedical or behavioral research.
(B) Three of the members shall be appointed from individuals who are distinguished in the practice of medicine or otherwise distinguished in the provision of health care.
(C) Five of the members shall be appointed from individuals who are distinguished in one or more of the fields of ethics, theology, law, the natural sciences (other than a biomedical
or behavioral science), the social sciences, the humanities,
health administration, government, and public affairs.
(2) No individual who is a full-time officer or employee of the
United States may be appointed as a member of the Commission.
The Secretary of Health, Education, and Welfare, the Secretary of
Defense, the Director of Central Intelligence, the Director of the Office of Science and Technology Policy, the Administrator of Veterans’ Affairs, and the Director of the National Science Foundation
shall each designate an individual to provide liaison with the Commission.
(3) No individual may be appointed to serve as a member of
the Commission if the individual has served for two terms of four
years each as such a member.
(4) A vacancy in the Commission shall be filled in the manner
in which the original appointment was made.
(b) TERMS.—(1) Except as provided in paragraphs (2) and (3),
members shall be appointed for terms of four years.
(2) Of the members first appointed—
(A) four shall be appointed for terms of three years, and
(B) three shall be appointed for terms of two years,
as designated by the President at the time of appointment.
(3) Any member appointed to fill a vacancy occurring before
the expiration of the term for which his predecessor was appointed
shall be appointed only for the remainder of such term. A member
1 Such a Commission was established on December 17, 1979, by Executive Order No. 12184
(44 Fed. Reg. 75091). The Executive Order was revoked on February 25, 1986, by Executive
Order No. 12553 (51 Fed. Reg. 7237).

1113
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Sec. 1802

PUBLIC HEALTH SERVICE ACT

1114

may serve after the expiration of his term until his successor has
taken office.
(c) CHAIRMAN.—The Chairman of the Commission shall be appointed by the President, by and with the advice and consent of the
Senate, from members of the Commission.
(d) MEETINGS.—(1) Seven members of the Commission shall
constitute a quorum for business, but a lesser number may conduct
hearings.
(2) The Commission shall meet at the call of the Chairman or
at the call of a majority of its members.
(e) COMPENSATION.—(1) Members of the Commission shall each
be entitled to receive the daily equivalent of the annual rate of
basic pay in effect for grade GS–18 of the General Schedule for
each day (including travel time) during which they are engaged in
the actual performance of duties vested in the Commission.
(2) While away from their homes or regular places of business
in the performance of services for the Commission, members of the
Commission shall be allowed travel expenses, including per diem in
lieu of subsistence, in the same manner as persons employed intermittently in the Government service are allowed expenses under
section 5703 of title 5 of the United States Code.
DUTIES OF THE COMMISSION

SEC. 1802. ø300v–1¿ (a) STUDIES.—(1) The Commission shall
undertake studies of the ethical and legal implications of—
(A) the requirements for informed consent to participation
in research projects and to otherwise undergo medical procedures;
(B) the matter of defining death, including the advisability
of developing a uniform definition of death;
(C) voluntary testing, counseling, and information and
education programs with respect to genetic diseases and conditions, taking into account the essential equality of all human
beings, born and unborn;
(D) the differences in the availability of health services as
determined by the income or residence of the persons receiving
the services;
(E) current procedures and mechanisms designed (i) to
safeguard the privacy of human subjects of behavioral and biomedical research, (ii) to ensure the confidentiality of individually identifiable patient records, and (iii) to ensure appropriate access of patients to information continued 1 in such
records, 2 and
(F) such other matters relating to medicine or biomedical
or behavioral research as the President may designate for
study by the Commission.
The Commission shall determine the priority and order of the studies required under this paragraph.
(2) The Commission may undertake an investigation or study
of any other appropriate matter which relates to medicine or biomedical or behavioral research (including the protection of human
1 So
2 So

March 13, 2013

in law. Probably should be ‘‘contained’’.
in law. The comma should probably be a semicolon.

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1115

PUBLIC HEALTH SERVICE ACT

Sec. 1802

subjects of biomedical or behavioral research) and which is consistent with the purposes of this title on its own initiative or at the
request of the head of the Federal agency.
(3) In order to avoid duplication of effort, the Commission may,
in lieu of, or as part of, any study or investigation required or otherwise conducted under this subsection, use a study or investigation conducted by another entity if the Commission sets forth its
reasons for such use.
(4) Upon the completion of each investigation or study undertaken by the Commission under this subsection (including a study
or investigation which merely uses another study or investigation),
it shall report its findings (including any recommendations for legislation or administrative action) to the President and the Congress
and to each Federal agency to which a recommendation in the report applies.
(b) RECOMMENDATIONS TO AGENCIES.—(1) Within 60 days of
the date a Federal agency receives a recommendation from the
Commission that the agency take any action with respect to its
rules, policies, guidelines, or regulations, the agency shall publish
such recommendation in the Federal Register and shall provide opportunity for interested persons to submit written data, views, and
arguments with respect to adoption of the recommendation.
(2) Within the 180-day period beginning on the date of such
publication, the agency shall determine whether the action proposed by such recommendation is appropriate, and, to the extent
that it determines that—
(A) such action is not appropriate, the agency shall, within
such time period, provide the Commission with, and publish in
the Federal Register, a notice of such determination (including
an adequate statement of the reasons for the determination),
or
(B) such action is appropriate, the agency shall undertake
such action as expeditiously as feasible and shall notify the
Commission of the determination and the action undertaken.
(c) REPORT ON PROTECTION OF HUMAN SUBJECTS.—The Commission shall biennially report to the President, the Congress, and
appropriate Federal agencies on the protection of human subjects
of biomedical and behavioral research. Each such report shall include a review of the adequacy and uniformity (1) of the rules, policies, guidelines, and regulations of all Federal agencies regarding
the protection of human subjects of biomedical or behavioral research which such agencies conduct or support, and (2) of the implementation of such rules, policies, guidelines, and regulations by
such agencies, and may include such recommendations for legislation and administrative action as the Commission deems appropriate.
(d) ANNUAL REPORT.—Not later than December 15 of each year
(beginning with 1979) the Commission shall report to the President, the Congress, and appropriate Federal agencies on the activities of the Commission during the fiscal year ending in such year.
Each such report shall include a complete list of all recommendations described in subsection (b)(1) made to Federal agencies by the
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Sec. 1803

PUBLIC HEALTH SERVICE ACT

1116

Commission during the fiscal year and the actions taken, pursant 1
to subsection (b)(2), by the agencies upon such recommendations,
and may include such recommendations for legislation and administrative action as the Commission deems appropriate.
(e) PUBLICATIONS.—The Commission may at any time publish
and disseminate to the public reports respecting its activities.
(f) DEFINITIONS.—For purposes of this section:
(1) The term ‘‘Federal agency’’ means an authority of the
government of the United States, but does not include (A) the
Congress, (B) the courts of the United States, and (C) the government of the Commonwealth of Puerto Rico, the government
of the District of Columbia, or the government of any territory
or possession of the United States.
(2) The term ‘‘protection of human subjects’’ includes the
protection of the health, safety, and privacy of individuals.
ADMINISTRATIVE PROVISIONS

SEC. 1803. ø300v–2¿ (a) HEARINGS.—The Commission may for
the purpose of carrying out this title hold such hearings, sit and
act at such times and places, take such testimony, and receive such
evidence, as the Commission may deem advisable.
(b) STAFF.—(1) The Commission may appoint and fix the pay
of such staff personnel as it deems desirable. Such personnel shall
be appointed subject to the provisions of title 5, United States
Code, governing appointments in the competitive service, and shall
be paid in accordance with the provisions of chapter 51 and subchapter III of chapter 53 of such title relating to classification and
General Schedule pay rates.
(2) The Commission may procure temporary and intermittent
services to the same extent as is authorized by section 3109(b) of
title 5 of the United States Code, but at rates for individuals not
to exceed the daily equivalent of the annual rate of basis pay in
effect for grade GS–18 of the General Schedule.
(3) Upon request of the Commission, the head of any Federal
agency is authorized to detail, on a reimbursable basis, any of the
personnel of such agency to the Commission to assist it in carrying
out its duties under this title.
(c) CONTRACTS.—The Commission, in performing its duties and
functions under this title, may enter into contracts with appropriate public or nonprofit private entities. The authority of the
Commission to enter into such contracts is effective for any fiscal
year only to such extent or in such amounts as are provided in advance in appropriation Acts.
(d) INFORMATION.—(1) The Commission may secure directly
from any Federal agency information necessary to enable it to
carry out this title. Upon request of the Chairman of the Commission, the head of such agency shall furnish such information to the
Commission.
(2) The Commission shall promptly arrange for such security
clearances for its members and appropriate staff as are necessary
to obtain access to classified information needed to carry out its duties under this title.
1 So

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in law. Probably should be ‘‘pursuant’’.

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1117

PUBLIC HEALTH SERVICE ACT

Sec. 1804

(3) The Commission shall not disclose any information reported
to or otherwise obtained by the Commission which is exempt from
disclosure under subsection (a) of section 552 of title 5, United
States Code, by reason of paragraphs (4) and (6) of subsection (b)
of such section.
(e) SUPPORT SERVICES.—The Administrator of General Services
shall provide to the Commission on a reimbursable basis such administrative support services as the Commission may request.
AUTHORIZATION OF APPROPRIATIONS; TERMINATION OF COMMISSION

SEC. 1804. ø300v–3¿ (a) AUTHORIZATIONS.—To carry out this
title there are authorized to be appropriated $5,000,000 for the fiscal year ending September 30, 1979, $5,000,000 for the fiscal year
ending September 30, 1980, $5,000,000 for the fiscal year ending
September 30, 1981, and $5,000,000 for the fiscal year ending September 30, 1982.
(b) FEDERAL ADVISORY COMMITTEE ACT; TERMINATION.—The
Commission shall be subject to the Federal Advisory Committee
Act, except that, under section 14(a)(1)(B) of such Act, the Commission shall terminate on December 31, 1982.

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TITLE XIX—BLOCK GRANTS
PART A—PREVENTIVE HEALTH AND HEALTH SERVICES BLOCK
GRANT
AUTHORIZATION OF APPROPRIATIONS

SEC. 1901. ø300w¿ (a) For the purpose of allotments under section 1902, there are authorized to be appropriated $205,000,000 for
fiscal year 1993, and such sums as may be necessary for each of
the fiscal years 1994 through 1998.
(b) Of the amount appropriated for any fiscal year under subsection (a), at least $7,000,000 shall be made available for allotments under section 1902(b).
ALLOTMENTS

SEC. 1902. ø300w–1¿ (a)(1) From the amounts appropriated
under section 1901 for any fiscal year and available for allotment
under this subsection, the Secretary shall allot to each State an
amount which bears the same ratio to the available amounts for
that fiscal year as the amounts provided by the Secretary under
the provisions of law listed in paragraph (2) to the State and entities in the State for fiscal year 1981 bore to the total amount appropriated for such provisions of law for fiscal year 1981.
(2) The provisions of law referred to in paragraph (1) are the
following provisions of law as in effect on September 30, 1981:
(A) The authority for grants under section 317 for preventive health service programs for the control of rodents.
(B) The authority for grants under section 317 for establishing and maintaining community and school-based fluoridation programs.
(C) The authority for grants under section 317 for preventive health service programs for hypertension.
(D) Sections 401 and 402 of the Health Services and Centers Amendments of 1978.
(E) Section 314(d).
(F) Section 339(a).
(G) Sections 1202, 1203, and 1204.
(b) From the amount required to be made available under section 1901(b) for allotments under this subsection for any fiscal
year, the Secretary shall make allotments to each State on the
basis of the population of the State.
(c) To the extent that all the funds appropriated under section
1901 for a fiscal year and available for allotment in such fiscal year
are not otherwise allotted to States because—
(1) one or more States have not submitted an application
or description of activities in accordance with section 1905 for
the fiscal year;
1118
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1119

PUBLIC HEALTH SERVICE ACT

Sec. 1902

(2) one or more States have notified the Secretary that
they do not intend to use the full amount of their allotment;
or
(3) some State allotments are offset or repaid under section 1906(b)(3);
such excess shall be allotted among each of the remaining States
in proportion to the amount otherwise allotted to such States for
the fiscal year without regard to this subsection.
(d)(1) If the Secretary—
(A) receives a request from the governing body of an Indian tribe or tribal organization within any State that funds
under this part be provided directly by the Secretary to such
tribe or organization, and
(B) determines that the members of such tribe or tribal organization would be better served by means of grants made directly by the Secretary under this part,
the Secretary shall reserve from amounts which would otherwise
be allotted to such State under subsection (a) for the fiscal year the
amount determined under paragraph (2).
(2) The Secretary shall reserve for the purpose of paragraph (1)
from amounts that would otherwise be allotted to such State under
subsection (a) an amount equal to the amount which bears the
same ratio to the State’s allotment for the fiscal year involved as
the total amount provided or allotted for fiscal year 1981 by the
Secretary to such tribe or tribal organization under the provisions
of law referred to in subsection (a) bore to the total amount provided or allotted for such fiscal year by the Secretary to the State
and entities (including Indian tribes and tribal organizations) in
the State under such provisions of law.
(3) The amount reserved by the Secretary on the basis of a determination under this subsection shall be granted to the Indian
tribe or tribal organization serving the individuals for whom such
a determination has been made.
(4) In order for an Indian tribe or tribal organization to be eligible for a grant for a fiscal year under this subsection, it shall submit to the Secretary a plan for such fiscal year which meets such
criteria as the Secretary may prescribe.
(5) The terms ‘‘Indian tribe’’ and ‘‘tribal organization’’ have the
same meaning given such terms in section 4(b) and section 4(c) of
the Indian Self-Determination and Education Assistance Act.
(e) The Secretary shall conduct a study for the purpose of devising a formula for the equitable distribution of funds available for
allotment to the States under this section. In conducting the study,
the Secretary shall take into account—
(1) the financial resources of the various States,
(2) the populations of the States, and
(3) any other factor which the Secretary may consider appropriate.
Before June 30, 1982, the Secretary shall submit a report to the
Congress respecting the development of a formula and make such
recommendations as the Secretary may deem appropriate in order
to ensure the most equitable distribution of funds under allotments
under this section.
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Sec. 1903

PUBLIC HEALTH SERVICE ACT

1120

PAYMENTS UNDER ALLOTMENTS TO STATES

SEC. 1903. ø300w–2¿ (a)(1) For each fiscal year, the Secretary
shall make payments, as provided by section 203 of the Intergovernmental Cooperation Act of 1968 (42 U.S.C. 4213), to each State
from its allotment under section 1902 (other than any amount reserved under section 1902(d)) from amounts appropriated for that
fiscal year.
(2) Any amount paid to a State for a fiscal year and remaining
unobligated at the end of such year shall remain available for the
next fiscal year to such State for the purposes for which it was
made.
(b) The Secretary, at the request of a State, may reduce the
amount of payments under subsection (a) by—
(1) the fair market value of any supplies or equipment furnished the State, and
(2) the amount of the pay, allowances, and travel expenses
of any officer or employee of the Government when detailed to
the State and the amount of any other costs incurred in connection with the detail of such officer or employee,
when the furnishing of supplies or equipment or the detail of an
officer or employee is for the convenience of and at the request of
the State and for the purpose of conducting activities described in
section 1904. The amount by which any payment is so reduced
shall be available for payment by the Secretary of the costs incurred in furnishing the supplies or equipment or in detailing the
personnel, on which the reduction of the payment is based, and the
amount shall be deemed to be part of the payment and shall be
deemed to have been paid to the State.
USE OF ALLOTMENTS

SEC. 1904. ø300w–3¿ (a)(1) Except as provided in subsections
(b) and (c), payments made to a State under section 1903 may be
used for the following:
(A) Activities consistent with making progress toward
achieving the objectives established by the Secretary for the
health status of the population of the United States for the
year 2000 (in this part referred to as ‘‘year 2000 health objectives’’).
(B) Preventive health service programs for the control of
rodents and for community and school-based fluoridation programs.
(C) Feasibility studies and planning for emergency medical
services systems and the establishment, expansion, and improvement of such systems. Amounts for such systems may not
be used for the costs of the operation of the systems or the purchase of equipment for the systems, except that such amounts
may be used for the payment of not more than 50 percent of
the costs of purchasing communications equipment for the systems. Amounts may be expended for feasibility studies or planning for the trauma-care components of such systems only if
the studies or planning, respectively, is consistent with the requirements of section 1213(a).
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1121

PUBLIC HEALTH SERVICE ACT

Sec. 1904

(D) Providing services to victims of sex offenses and for
prevention of sex offenses.
(E) The establishment, operation, and coordination of effective and cost-efficient systems to reduce the prevalence of illness due to asthma and asthma-related illnesses, especially
among children, by reducing the level of exposure to cockroach
allergen or other known asthma triggers through the use of integrated pest management, as applied to cockroaches or other
known allergens. Amounts expended for such systems may include the costs of building maintenance and the costs of programs to promote community participation in the carrying out
at such sites of integrated pest management, as applied to
cockroaches or other known allergens. For purposes of this subparagraph, the term ‘‘integrated pest management’’ means an
approach to the management of pests in public facilities that
combines biological, cultural, physical, and chemical tools in a
way that minimizes economic, health, and environmental risks.
(F) With respect to activities described in any of subparagraphs (A) through (E), related planning, administration, and
educational activities.
(G) Monitoring and evaluation of activities carried out
under any of subparagraphs (A) through (F).
(2) Except as provided in subsection (b), amounts paid to a
State under section 1903 from its allotment under section 1902(b)
may only be used for providing services to rape victims and for
rape prevention.
(3) The Secretary may provide technical assistance to States in
planning and operating activities to be carried out under this part.
(b) A State may not use amounts paid to it under section 1903
to—
(1) provide inpatient services,
(2) make cash payments to intended recipients of health
services,
(3) purchase or improve land, purchase, construct, or permanently improve (other than minor remodeling) any building
or other facility, or purchase major medical equipment,
(4) satisfy any requirement for the expenditure of non-Federal funds as a condition for the receipt of Federal funds, or
(5) provide financial assistance to any entity other than a
public or nonprofit private entity.
Except as provided in subsection (a)(1)(E), the Secretary may waive
the limitation contained in paragraph (3) upon the request of a
State if the Secretary finds that there are extraordinary circumstances to justify the waiver and that granting the waiver will
assist in carrying out this part.
(c) A State may transfer not more than 7 percent of the
amount allotted to the State under section 1902(a) for any fiscal
year for use by the State under part B of this title and title V of
the Social Security Act in such fiscal year as follows: At any time
in the first three quarters of the fiscal year a State may transfer
not more than 3 percent of the allotment of the State for the fiscal
year for such use, and in the last quarter of a fiscal year a State
may transfer for such use not more than the remainder of the
amount of its allotment which may be transferred.
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Sec. 1905

PUBLIC HEALTH SERVICE ACT

1122

(d) Of the amount paid to any State under section 1903, not
more than 10 percent paid from each of its allotments under subsections (a) and (b) of section 1902 may be used for administering
the funds made available under section 1903. The State will pay
from non-Federal sources the remaining costs of administering
such funds.
APPLICATION FOR PAYMENTS; STATE PLAN

SEC. 1905. ø300w–4¿ (a) IN GENERAL.—The Secretary may
make payments under section 1903 to a State for a fiscal year only
if—
(1) the State submits to the Secretary an application for
the payments;
(2) the application contains a State plan in accordance
with subsection (b);
(3) the application contains the certification described in
subsection (c);
(4) the application contains such assurances as the Secretary may require regarding the compliance of the State with
the requirements of this part (including assurances regarding
compliance with the agreements described in subsection (c));
and
(5) the application is in such form and is submitted by
such date as the Secretary may require.
(b) STATE PLAN.—A State plan required in subsection (a)(2) for
a fiscal year is in accordance with this subsection if the plan meets
the following conditions:
(1) The plan is developed by the State agency with principal responsibility for public health programs, in consultation
with the advisory committee established pursuant to subsection (c)(2).
(2) The plan specifies the activities authorized in section
1904 that are to be carried out with payments made to the
State under section 1903, including a specification of the year
2000 health objectives for which the State will expend the payments.
(3) The plan specifies the populations in the State for
which such activities are to be carried out.
(4) The plan specifies any populations in the State that
have a disparate need for such activities.
(5) With respect to each population specified under paragraph (3), the plan contains a strategy for expending such payments to carry out such activities to make progress toward improving the health status of the population, which strategy includes—
(A) a description of the programs and projects to be
carried out;
(B) an estimate of the number of individuals to be
served by the programs and projects; and
(C) an estimate of the number of public health personnel needed to carry out the strategy.
(6) The plan specifies the amount of such payments to be
expended for each of such activities and, with respect to the activity involved—
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PUBLIC HEALTH SERVICE ACT

Sec. 1905

(A) the amount to be expended for each population
specified under paragraph (3); and
(B) the amount to be expended for each population
specified under paragraph (4).
(c) STATE CERTIFICATION.—The certification referred to in subsection (a)(3) for a fiscal year is a certification to the Secretary by
the chief executive officer of the State involved as follows:
(1)(A) In the development of the State plan required in
subsection (a)(2)—
(i) the chief health officer of the State held public
hearings on the plan; and
(ii) proposals for the plan were made public in a manner that facilitated comments from public and private entities (including Federal and other public agencies).
(B) The State agrees that, if any revisions are made in
such plan during the fiscal year, the State will, with respect
to the revisions, hold hearings and make proposals public in
accordance with subparagraph (A), and will submit to the Secretary a description of the revisions.
(2) The State has established an advisory committee in accordance with subsection (d).
(3) The State agrees to expend payments under section
1903 only for the activities authorized in section 1904.
(4) The State agrees to expend such payments in accordance with the State plan submitted under subsection (a)(2)
(with any revisions submitted to the Secretary under paragraph (1)(B)), including making expenditures to carry out the
strategy contained in the plan pursuant to subsection (b)(5).
(5)(A) The State agrees that, in the case of each population
for which such strategy is carried out, the State will measure
the extent of progress being made toward improving the health
status of the population.
(B) The State agrees that—
(i) the State will collect and report data in accordance
with section 1906(a); and
(ii) for purposes of subparagraph (A), progress will be
measured through use of each of the applicable uniform
data items developed by the Secretary under paragraph (2)
of such section, or if no such items are applicable, through
use of the uniform criteria developed by the Secretary
under paragraph (3) of such section.
(6) With respect to the activities authorized in section
1904, the State agrees to maintain State expenditures for such
activities at a level that is not less than the average level of
such expenditures maintained by the State for the 2-year period preceding the fiscal year for which the State is applying
to receive payments under section 1903.
(7) The State agrees to establish reasonable criteria to
evaluate the effective performance of entities that receive
funds from such payments and procedures for procedural and
substantive independent State review of the failure by the
State to provide funds for any such entity.
(8) The State agrees to permit and cooperate with Federal
investigations undertaken in accordance with section 1907.
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Sec. 1905

PUBLIC HEALTH SERVICE ACT

1124

(9) The State has in effect a system to protect from inappropriate disclosure patient and sex offense victim records
maintained by the State in connection with an activity funded
under this part or by any entity which is receiving payments
from the allotment of the State under this part.
(10) The State agrees to provide the officer of the State
government responsible for the administration of the State
highway safety program with an opportunity to—
(A) participate in the development of any plan by the
State relating to emergency medical services, as such plan
relates to highway safety; and
(B) review and comment on any proposal by any State
agency to use any Federal grant or Federal payment received by the State for the provision of emergency medical
services as such proposal relates to highway safety.
(d) STATE ADVISORY COMMITTEE.—
(1) IN GENERAL.—For purposes of subsection (c)(2), an advisory committee is in accordance with this subsection if such
committee is known as the State Preventive Health Advisory
Committee (in this subsection referred to as the ‘‘Committee’’)
and the Committee meets the conditions described in the subsequent paragraphs of this subsection.
(2) DUTIES.—A condition under paragraph (1) for a State
is that the duties of the Committee are—
(A) to hold public hearings on the State plan required
in subsection (a)(2); and
(B) to make recommendations pursuant to subsection
(b)(1) regarding the development and implementation of
such plan, including recommendations on—
(i) the conduct of assessments of the public health;
(ii) which of the activities authorized in section
1904 should be carried out in the State;
(iii) the allocation of payments made to the State
under section 1903;
(iv) the coordination of activities carried out under
such plan with relevant programs of other entities;
and
(v) the collection and reporting of data in accordance with section 1906(a).
(3) COMPOSITION.—
(A) A condition under paragraph (1) for a State is that
the Committee is composed of such members of the general
public, and such officials of the health departments of political subdivisions of the State, as may be necessary to
provide adequate representation of the general public and
of such health departments.
(B) With respect to compliance with subparagraph (A),
the membership of advisory committees established pursuant to subsection (c)(2) may include representatives of
community-based organizations (including minority community-based organizations), schools of public health, and
entities to which the State involved awards grants or contracts to carry out activities authorized in section 1904.
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PUBLIC HEALTH SERVICE ACT

Sec. 1906

(4) CHAIR; MEETINGS.—A condition under paragraph (1) for
a State is that the State public health officer serves as the
chair of the Committee, and that the Committee meets not less
than twice each fiscal year.
REPORTS, DATA, AND AUDITS

SEC. 1906. ø300w–5¿ (a)(1) For purposes of section
1905(c)(5)(B)(i), a State is collecting and reporting data for a fiscal
year in accordance with this subsection if the State submits to the
Secretary, not later than February 1 of the succeeding fiscal year,
a report that—
(A) describes the purposes for which the State expended
payments made to the State under section 1903;
(B) pursuant to section 1905(c)(5)(A), describes the extent
of progress made by the State for purposes of such section;
(C) meets the conditions described in the subsequent paragraphs of this subsection; and
(D) contains such additional information regarding activities authorized in section 1904, and is submitted in such form,
as the Secretary may require.
(2)(A) The Secretary, in consultation with the States, shall develop sets of data for uniformly defining health status for purposes
of the year 2000 health objectives (which sets are in this subsection
referred to as ‘‘uniform data sets’’). Each of such sets shall consist
of one or more categories of information (in this subsection individually referred to as a ‘‘uniform data item’’). The Secretary shall develop formats for the uniform collecting and reporting of information on such items.
(B) A condition under paragraph (1)(C) for a fiscal year is that
the State involved will, in accordance with the applicable format
under subparagraph (A), collect during such year, and include in
the report under paragraph (1), the necessary information for one
uniform data item from each of the uniform data sets, which items
are selected for the State by the Secretary.
(C) In the case of fiscal year 1995 and each subsequent fiscal
year, a condition under paragraph (1) for a State is that the State
will, in accordance with the applicable format under subparagraph
(A), collect during such year, and include in the report under paragraph (1), the necessary information for each of the uniform data
sets appropriate to the year 2000 health objectives that the State
has, in the State plan submitted under section 1905 for the fiscal
year, specified as a purpose for which payments under section 1903
are to be expended.
(3) The Secretary, in consultation with the States, shall establish criteria for the uniform collection and reporting of data on activities authorized in section 1904 with respect to which no uniform
data items exist.
(4) A condition under paragraph (1) for a fiscal year is that the
State involved will make copies of the report submitted under such
paragraph for the fiscal year available for public inspection, and
will upon request provide a copy of the report to any individual for
a charge not exceeding the cost of providing the copy.
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Sec. 1907

PUBLIC HEALTH SERVICE ACT

1126

(b)(1) Each State shall establish fiscal control and fund accounting procedures as may be necessary to assure the proper disbursal of and accounting for Federal funds paid to the State under
section 1903 and funds transferred under section 1904(c) for use
under this part.
(2) Each State shall annually audit its expenditures from payments received under section 1903. Such State audits shall be conducted by an entity independent of any agency administering a program funded under this part and, in so far as practical, in accordance with the Comptroller General’s standards for auditing governmental organizations, programs, activities, and functions. Within
30 days following the date each audit is completed, the chief executive officer of the State shall transmit a copy of that audit to the
Secretary.
(3) Each State shall, after being provided by the Secretary with
adequate notice and opportunity for a hearing within the State,
repay to the United States amounts found not to have been expended in accordance with the requirements of this part or the certification provided by the State under section 1905. If such repayment is not made, the Secretary shall, after providing the State
with adequate notice and opportunity for a hearing within the
State, offset such amounts against the amount of any allotment to
which the State is or may become entitled under this part.
(4) The State shall make copies of the reports and audits required by this section available for public inspection within the
State.
(5) The Comptroller General of the United States shall, from
time to time, evaluate the expenditures by States of grants under
this part in order to assure that expenditures are consistent with
the provisions of this part and the certification provided by the
State under section 1905.
(6) Not later than October 1, 1990, the Secretary shall report
to the Congress on the activities of the States that have received
funds under this part and may include in the report any recommendations for appropriate changes in legislation.
(c) Title XVII of the Omnibus Budget Reconciliation Act of
1981 shall not apply with respect to audits of funds allotted under
this part.
WITHHOLDING

SEC. 1907. ø300w–6¿ (a)(1) The Secretary shall, after adequate
notice and an opportunity for a hearing conducted within the affected State, withhold funds from any State which does not use its
allotment in accordance with the requirements of this part or the
certification provided under section 1905. The Secretary shall withhold such funds until the Secretary finds that the reason for the
withholding has been removed and there is reasonable assurance
that it will not recur.
(2) The Secretary may not institute proceedings to withhold
funds under paragraph (1) unless the Secretary has conducted an
investigation concerning whether the State has used its allotment
in accordance with the requirements of this part or the certification
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PUBLIC HEALTH SERVICE ACT

Sec. 1908

graph shall be conducted within the affected State by qualified investigators.
(3) The Secretary shall respond in an expeditious manner to
complaints of a substantial or serious nature that a State has
failed to use funds in accordance with the requirements of this part
or certifications provided under section 1905.
(4) The Secretary may not withhold funds under paragraph (1)
from a State for a minor failure to comply with the requirements
of this part or certifications provided under section 1905.
(b)(1) The Secretary shall conduct in several States in each fiscal year investigations of the use of funds received by the States
under this part in order to evaluate compliance with the requirements of this part and certifications provided under section 1905.
(2) The Comptroller General of the United States may conduct
investigations of the use of funds received under this part by a
State in order to insure compliance with the requirements of this
part and certifications provided under section 1905.
(c) Each State, and each entity which has received funds from
an allotment made to a State under this part, shall make appropriate books, documents, papers, and records available to the Secretary or the Comptroller General of the United States, or any of
their duly authorized representatives, for examination, copying, or
mechanical reproduction on or off the premises of the appropriate
entity upon a reasonable request therefor.
(d)(1) In conducting any investigation in a State, the Secretary
or the Comptroller General of the United States may not make a
request for any information not readily available to such State or
an entity which has received funds from an allotment made to the
State under this part or make an unreasonable request for information to be compiled, collected, or transmitted in any form not
readily available.
(2) Paragraph (1) does not apply to the collection, compilation,
or transmittal of data in the course of a judicial proceeding.
NONDISCRIMINATION

SEC. 1908. ø300w–7¿ (a)(1) For the purpose of applying the
prohibitions against discrimination on the basis of age under the
Age Discrimination Act of 1975, on the basis of handicap under section 504 of the Rehabilitation Act of 1973, on the basis of sex under
title IX of the Education Amendments of 1972, or on the basis of
race, color, or national origin under title VI of the Civil Rights Act
of 1964, programs and activities funded in whole or in part with
funds made available under this part are considered to be programs and activities receiving Federal financial assistance.
(2) No person shall on the ground of sex or religion be excluded
from participation in, be denied the benefits of, or be subjected to
discrimination under, any program or activity funded in whole or
in part with funds made available under this part.
(b) Whenever the Secretary finds that a State, or an entity
that has received a payment from an allotment to a State under
section 1902, has failed to comply with a provision of law referred
to in subsection (a)(1), with subsection (a)(2), or with an applicable
regulation (including one prescribed to carry out subsection (a)(2)),
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Sec. 1909

PUBLIC HEALTH SERVICE ACT

1128

the Secretary shall notify the chief executive officer of the State
and shall request him to secure compliance. If within a reasonable
period of time, not to exceed sixty days, the chief executive officer
fails or refuses to secure compliance, the Secretary may—
(1) refer the matter to the Attorney General with a recommendation that an appropriate civil action be instituted,
(2) exercise the powers and functions provided by title VI
of the Civil Rights Act of 1964, the Age Discrimination Act of
1975, or section 504 of the Rehabilitation Act of 1973, as may
be applicable, or
(3) take such other action as may be provided by law.
(c) When a matter is referred to the Attorney General pursuant
to subsection (b)(1), or whenever he has reason to believe that a
State or an entity is engaged in a pattern or practice in violation
of a provision of law referred to in subsection (a)(1) or in violation
of subsection (a)(2), the Attorney General may bring a civil action
in any appropriate district court of the United States for such relief
as may be appropriate, including injunctive relief.
CRIMINAL PENALTY FOR FALSE STATEMENTS

SEC. 1909. ø300w–8¿ Whoever—
(1) knowingly and willfully makes or causes to be made
any false statement or representation of a material fact in connection with the furnishing of items or services for which payment may be made by a State from funds allotted to the State
under this part, or
(2) having knowledge of the occurrence of any event affecting his initial or continued right to any such payment conceals
or fails to disclose such event with an intent fraudulently to secure such payment either in a greater amount than is due or
when no such payment is authorized,
shall be fined not more than $25,000 or imprisoned for not more
than five years, or both.
EMERGENCY MEDICAL SERVICES FOR CHILDREN

SEC. 1910. ø300w–9¿ (a) For activities in addition to the activities which may be carried out by States under section 1904(a)(1)(F),
the Secretary may make grants to States or accredited schools of
medicine in States to support a program of demonstration projects
for the expansion and improvement of emergency medical services
for children who need treatment for trauma or critical care. Any
grant made under this subsection shall be for not more than a 4year period (with an optional 5th year based on performance), subject to annual evaluation by the Secretary. Only 3 grants under
this subsection may be made in a State (to a State or to a school
of medicine in such State) in any fiscal year.
(b) The Secretary may renew a grant made under subsection
(a) for one additional one-year period only if the Secretary determines that renewal of such grant will provide significant benefits
through the collection, analysis, and dissemination of information
or data which will be useful to States in which grants under such
subsection have not been made.
(c) For purposes of this section—
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PUBLIC HEALTH SERVICE ACT

Sec. 1912

(1) the term ‘‘school of medicine’’ has the same meaning as
in section 701(4); and
(2) the term ‘‘accredited’’ has the same meaning as in section 701(5).
(d) To carry out this section, there are authorized to be appropriated $2,000,000 for fiscal year 1985 and for each of the two succeeding fiscal years, $3,000,000 for fiscal year 1989, $4,000,000 for
fiscal year 1990, $5,000,000 for each of the fiscal years 1991 and
1992, such sums as may be necessary for each of the fiscal years
1993 through 2005, $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.
PART B—BLOCK GRANTS REGARDING MENTAL HEALTH
SUBSTANCE ABUSE

AND

Subpart I—Block Grants for Community Mental
Health Services
SEC. 1911. ø300x¿ FORMULA GRANTS TO STATES.
(a) IN GENERAL.—For the purpose described

in subsection (b),
the Secretary, acting through the Director of the Center for Mental
Health Services, shall make an allotment each fiscal year for each
State in an amount determined in accordance with section 1918.
The Secretary shall make a grant to the State of the allotment
made for the State for the fiscal year if the State submits to the
Secretary an application in accordance with section 1917.
(b) PURPOSE OF GRANTS.—A funding agreement for a grant
under subsection (a) is that, subject to section 1916, the State involved will expend the grant only for the purpose of—
(1) carrying out the plan submitted under section 1912(a)
by the State for the fiscal year involved;
(2) evaluating programs and services carried out under the
plan; and
(3) planning, administration, and educational activities related to providing services under the plan.
SEC. 1912. ø300x–1¿ STATE PLAN FOR COMPREHENSIVE COMMUNITY
MENTAL HEALTH SERVICES FOR CERTAIN INDIVIDUALS.
(a) IN GENERAL.—The Secretary may make a grant under sec-

tion 1911 only if—
(1) the State involved submits to the Secretary a plan for
providing comprehensive community mental health services to
adults with a serious mental illness and to children with a serious emotional disturbance;
(2) the plan meets the criteria specified in subsection (b);
and
(3) the plan is approved by the Secretary.
(b) CRITERIA FOR PLAN.—With respect to the provision of comprehensive community mental health services to individuals who
are either adults with a serious mental illness or children with a
serious emotional disturbance, the criteria referred to in subsection
(a) regarding a plan are as follows:
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Sec. 1912

PUBLIC HEALTH SERVICE ACT

1130

(1) COMPREHENSIVE COMMUNITY-BASED MENTAL HEALTH
SYSTEMS.—The plan provides for an organized communitybased system of care for individuals with mental illness and
describes available services and resources in a comprehensive
system of care, including services for dually diagnosed individuals. The description of the system of care shall include health
and mental health services, rehabilitation services, employment services, housing services, educational services, substance abuse services, medical and dental care, and other support services to be provided to individuals with Federal, State
and local public and private resources to enable such individuals to function outside of inpatient or residential institutions
to the maximum extent of their capabilities, including services
to be provided by local school systems under the Individuals
with Disabilities Education Act. The plan shall include a separate description of case management services and provide for
activities leading to reduction of hospitalization.
(2) MENTAL HEALTH SYSTEM DATA AND EPIDEMIOLOGY.—
The plan contains an estimate of the incidence and prevalence
in the State of serious mental illness among adults and serious
emotional disturbance among children and presents quantitative targets to be achieved in the implementation of the
system described in paragraph (1).
(3) CHILDREN’S SERVICES.—In the case of children with serious emotional disturbance, the plan—
(A) subject to subparagraph (B), provides for a system
of integrated social services, educational services, juvenile
services, and substance abuse services that, together with
health and mental health services, will be provided in
order for such children to receive care appropriate for their
multiple needs (such system to include services provided
under the Individuals with Disabilities Education Act);
(B) provides that the grant under section 1911 for the
fiscal year involved will not be expended to provide any
service under such system other than comprehensive community mental health services; and
(C) provides for the establishment of a defined geographic area for the provision of the services of such system.
(4) TARGETED SERVICES TO RURAL AND HOMELESS POPULATIONS.—The plan describes the State’s outreach to and services for individuals who are homeless and how communitybased services will be provided to individuals residing in rural
areas.
(5) MANAGEMENT SYSTEMS.—The plan describes the financial resources, staffing and training for mental health providers that is necessary to implement the plan, and provides
for the training of providers of emergency health services regarding mental health. The plan further describes the manner
in which the State intends to expend the grant under section
1911 for the fiscal year involved.
Except as provided for in paragraph (3), the State plan shall contain the information required under this subsection with respect to
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1131

PUBLIC HEALTH SERVICE ACT

Sec. 1912

both adults with serious mental illness and children with serious
emotional disturbance.
(c) DEFINITIONS REGARDING MENTAL ILLNESS AND EMOTIONAL
DISTURBANCE; METHODS FOR ESTIMATE OF INCIDENCE AND PREVALENCE.—
(1) ESTABLISHMENT BY SECRETARY OF DEFINITIONS; DISSEMINATION.—For purposes of this subpart, the Secretary shall
establish definitions for the terms ‘‘adults with a serious mental illness’’ and ‘‘children with a serious emotional disturbance’’. The Secretary shall disseminate the definitions to the
States.
(2) STANDARDIZED METHODS.—The Secretary shall establish standardized methods for making the estimates required
in subsection (b)(11) with respect to a State. A funding agreement for a grant under section 1911 for the State is that the
State will utilize such methods in making the estimates.
(3) DATE CERTAIN FOR COMPLIANCE BY SECRETARY.—Not
later than 90 days after the date of the enactment of the
ADAMHA Reorganization Act 1, the Secretary shall establish
the definitions described in paragraph (1), shall begin dissemination of the definitions to the States, and shall establish the
standardized methods described in paragraph (2).
(d) REQUIREMENT OF IMPLEMENTATION OF PLAN.—
(1) COMPLETE IMPLEMENTATION.—Except as provided in
paragraph (2), in making a grant under section 1911 to a State
for a fiscal year, the Secretary shall make a determination of
the extent to which the State has implemented the plan required in subsection (a). If the Secretary determines that a
State has not completely implemented the plan, the Secretary
shall reduce the amount of the allotment under section 1911
for the State for the fiscal year involved by an amount equal
to 10 percent of the amount determined under section 1918 for
the State for the fiscal year.
(2) SUBSTANTIAL IMPLEMENTATION AND GOOD FAITH EFFORT
REGARDING FISCAL YEAR 1993.—
(A) In making a grant under section 1911 to a State
for fiscal year 1993, the Secretary shall make a determination of the extent to which the State has implemented the
plan required in subsection (a). If the Secretary determines
that the State has not substantially implemented the plan,
the Secretary shall, subject to subparagraph (B), reduce
the amount of the allotment under section 1911 for the
State for such fiscal year by an amount equal to 10 percent
of the amount determined under section 1918 for the State
for the fiscal year.
(B) In carrying out subparagraph (A), if the Secretary
determines that the State is making a good faith effort to
implement the plan required in subsection (a), the Secretary may make a reduction under such subparagraph in
an amount that is less than the amount specified in such
subparagraph, except that the reduction may not be made
in an amount that is less than 5 percent of the amount de1 Enacted

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July 10, 1992.

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Sec. 1913

PUBLIC HEALTH SERVICE ACT

1132

termined under section 1918 for the State for fiscal year
1993.
SEC. 1913. ø300x–2¿ CERTAIN AGREEMENTS.
(a) ALLOCATION FOR SYSTEMS OF INTEGRATED
CHILDREN.—
(1) IN GENERAL.—With respect to children

SERVICES

FOR

with a serious
emotional disturbance, a funding agreement for a grant under
section 1911 is that—
(A) in the case of a grant for fiscal year 1993, the
State involved will expend not less than 10 percent of the
grant to increase (relative to fiscal year 1992) funding for
the system of integrated services described in section
1912(b)(9);
(B) in the case of a grant for fiscal year 1994, the
State will expend not less than 10 percent of the grant to
increase (relative to fiscal year 1993) funding for such system; and
(C) in the case of a grant for any subsequent fiscal
year, the State will expend for such system not less than
an amount equal to the amount expended by the State for
fiscal year 1994.
(2) WAIVER.—
(A) Upon the request of a State, the Secretary may
provide to the State a waiver of all or part of the requirement established in paragraph (1) if the Secretary determines that the State is providing an adequate level of comprehensive community mental health services for children
with a serious emotional distrubance 1, as indicated by a
comparison of the number of such children for which such
services are sought with the availability in the State of the
services.
(B) The Secretary shall approve or deny a request for
a waiver under subparagraph (A) not later than 120 days
after the date on which the request is made.
(C) Any waiver provided by the Secretary under subparagraph (A) shall be applicable only to the fiscal year involved.
(b) PROVIDERS OF SERVICES.—A funding agreement for a grant
under section 1911 for a State is that, with respect to the plan submitted under section 1912(a) for the fiscal year involved—
(1) services under the plan will be provided only through
appropriate, qualified community programs (which may include
community mental health centers, child mental-health programs, psychosocial rehabilitation programs, mental health
peer-support programs, and mental-health primary consumerdirected programs); and
(2) services under the plan will be provided through community mental health centers only if the centers meet the criteria specified in subsection (c).
1 So in law. See section 201 of Public Law 102–321 (106 Stat. 381). Probably should be ‘‘disturbance’’.

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PUBLIC HEALTH SERVICE ACT

Sec. 1914

(c) CRITERIA FOR MENTAL HEALTH CENTERS.—The criteria referred to in subsection (b)(2) regarding community mental health
centers are as follows:
(1) With respect to mental health services, the centers provide services as follows:
(A) Services principally to individuals residing in a defined geographic area (hereafter in this subsection referred
to as a ‘‘service area’’).
(B) Outpatient services, including specialized outpatient services for children, the elderly, individuals with
a serious mental illness, and residents of the service areas
of the centers who have been discharged from inpatient
treatment at a mental health facility.
(C) 24-hour-a-day emergency care services.
(D) Day treatment or other partial hospitalization
services, or psychosocial rehabilitation services.
(E) Screening for patients being considered for admission to State mental health facilities to determine the appropriateness of such admission.
(2) The mental health services of the centers are provided,
within the limits of the capacities of the centers, to any individual residing or employed in the service area of the center
regardless of ability to pay for such services.
(3) The mental health services of the centers are available
and accessible promptly, as appropriate and in a manner which
preserves human dignity and assures continuity and high quality care.
SEC. 1914. ø300x–3¿ STATE MENTAL HEALTH PLANNING COUNCIL.
(a) IN GENERAL.—A funding agreement for a grant under

section 1911 is that the State involved will establish and maintain a
State mental health planning council in accordance with the conditions described in this section.
(b) DUTIES.—A condition under subsection (a) for a Council is
that the duties of the Council are—
(1) to review plans provided to the Council pursuant to
section 1915(a) by the State involved and to submit to the
State any recommendations of the Council for modifications to
the plans;
(2) to serve as an advocate for adults with a serious mental illness, children with a severe emotional disturbance, and
other individuals with mental illnesses or emotional problems;
and
(3) to monitor, review, and evaluate, not less than once
each year, the allocation and adequacy of mental health services within the State.
(c) MEMBERSHIP.—
(1) IN GENERAL.—A condition under subsection (a) for a
Council is that the Council be composed of residents of the
State, including representatives of—
(A) the principal State agencies with respect to—
(i) mental health, education, vocational rehabilitation, criminal justice, housing, and social services; and
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PUBLIC HEALTH SERVICE ACT

1134

(ii) the development of the plan submitted pursuant to title XIX of the Social Security Act;
(B) public and private entities concerned with the
need, planning, operation, funding, and use of mental
health services and related support services;
(C) adults with serious mental illnesses who are receiving (or have received) mental health services; and
(D) the families of such adults or families of children
with emotional disturbance.
(2) CERTAIN REQUIREMENTS.—A condition under subsection
(a) for a Council is that—
(A) with respect to the membership of the Council, the
ratio of parents of children with a serious emotional disturbance to other members of the Council is sufficient to
provide adequate representation of such children in the deliberations of the Council; and
(B) not less than 50 percent of the members of the
Council are individuals who are not State employees or
providers of mental health services.
(d) DEFINITION.—For purposes of this section, the term ‘‘Council’’ means a State mental health planning council.
SEC. 1915. ø300x–4¿ ADDITIONAL PROVISIONS.
(a) REVIEW OF STATE PLAN BY MENTAL HEALTH PLANNING
COUNCIL.—The Secretary may make a grant under section 1911 to

a State only if—
(1) the plan submitted under section 1912(a) with respect
to the grant and the report of the State under section 1942(a)
concerning the preceding fiscal year has been reviewed by the
State mental health planning council under section 1914; and
(2) the State submits to the Secretary any recommendations received by the State from such council for modifications
to the plan (without regard to whether the State has made the
recommended modifications) and any comments concerning the
annual report.
(b) MAINTENANCE OF EFFORT REGARDING STATE EXPENDITURES
FOR MENTAL HEALTH.—
(1) IN GENERAL.—A funding agreement for a grant under
section 1911 is that the State involved will maintain State expenditures for community mental health services at a level
that is not less than the average level of such expenditures
maintained by the State for the 2-year period preceding the fiscal year for which the State is applying for the grant.
(2) EXCLUSION OF CERTAIN FUNDS.—The Secretary may exclude from the aggregate State expenditures under subsection
(a), funds appropriated to the principle agency for authorized
activities which are of a non-recurring nature and for a specific
purpose.
(3) WAIVER.—The Secretary may, upon the request of a
State, waive the requirement established in paragraph (1) if
the Secretary determines that extraordinary economic conditions in the State justify the waiver.
(4) NONCOMPLIANCE BY STATE.—
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PUBLIC HEALTH SERVICE ACT

Sec. 1917

(A) In making a grant under section 1911 to a State
for a fiscal year, the Secretary shall make a determination
of whether, for the previous fiscal year, the State maintained material compliance with the agreement made
under paragraph (1). If the Secretary determines that a
State has failed to maintain such compliance, the Secretary shall reduce the amount of the allotment under section 1911 for the State for the fiscal year for which the
grant is being made by an amount equal to the amount
constituting such failure for the previous fiscal year.
(B) The Secretary may make a grant under section
1911 for a fiscal year only if the State involved submits to
the Secretary information sufficient for the Secretary to
make the determination required in subparagraph (A).
SEC. 1916. ø300x–5¿ RESTRICTIONS ON USE OF PAYMENTS.
(a) IN GENERAL.—A funding agreement for a grant

under section 1911 is that the State involved will not expend the grant—
(1) to provide inpatient services;
(2) to make cash payments to intended recipients of health
services;
(3) to purchase or improve land, purchase, construct, or
permanently improve (other than minor remodeling) any building or other facility, or purchase major medical equipment;
(4) to satisfy any requirement for the expenditure of nonFederal funds as a condition for the receipt of Federal funds;
or
(5) to provide financial assistance to any entity other than
a public or nonprofit private entity.
(b) LIMITATION ON ADMINISTRATIVE EXPENSES.—A funding
agreement for a grant under section 1911 is that the State involved
will not expend more than 5 percent of the grant for administrative
expenses with respect to the grant.
SEC. 1917. ø300x–6¿ APPLICATION FOR GRANT.
(a) IN GENERAL.—For purposes of section

1911, an application
for a grant under such section for a fiscal year in accordance with 1
this section if, subject to subsection (b)—
(1) the plan is received by the Secretary not later than
September 1 of the fiscal year prior to the fiscal year for which
a State is seeking funds, and the report from the previous fiscal year as required under section 1941 is received by December 1 of the fiscal year of the grant;
(2) the application contains each funding agreement that is
described in this subpart or subpart III for such a grant (other
than any such agreement that is not applicable to the State);
(3) the agreements are made through certification from the
chief executive officer of the State;
(4) with respect to such agreements, the application provides assurances of compliance satisfactory to the Secretary;
1 So in law. See section 201 of Public Law 102–321 (106 Stat. 384). Probably should be ‘‘is
in accordance with’’.

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1136

(5) the application contains the plan required in section
1912(a), the information required in section 1915(b)(3)(B), and
the report required in section 1942(a);
(6) the application contains recommendations in compliance with section 1915(a), or if no such recommendations are
received by the State, the application otherwise demonstrates
compliance with such section; and
(7) the application (including the plan under section
1912(a)) is otherwise in such form, is made in such manner,
and contains such agreements, assurances, and information as
the Secretary determines to be necessary to carry out this subpart.
(b) WAIVERS REGARDING CERTAIN TERRITORIES.—In the case of
any territory of the United States except Puerto Rico, the Secretary
may waive such provisions of this subpart and subpart III as the
Secretary determines to be appropriate, other than the provisions
of section 1916.
SEC. 1918. ø300x–7¿ DETERMINATION OF AMOUNT OF ALLOTMENT.
(a) STATES.—
(1) DETERMINATION UNDER FORMULA.—Subject to

subsection (b), the Secretary shall determine the amount of the allotment required in section 1911 for a State for a fiscal year
in accordance with the following formula:

A +

X
U

,

(2) DETERMINATION OF TERM ‘‘A’’.—For purposes of paragraph (1), the term ‘‘A’’ means the difference between—
(A) the amount appropriated under section 1920(a) for
allotments under section 1911 for the fiscal year involved;
and
(B) an amount equal to 1.5 percent of the amount referred to in subparagraph (A).
(3) DETERMINATION OF TERM ‘‘U’’.—For purposes of paragraph (1), the term ‘‘U’’ means the sum of the respective terms
‘‘X’’ determined for the States under paragraph (4).
(4) DETERMINATION OF TERM ‘‘X’’.—For purposes of paragraph (1), the term ‘‘X’’ means the product of—
(A) an amount equal to the product of—
(i) the term ‘‘P’’, as determined for the State involved under paragraph (5); and
(ii) the factor determined under paragraph (8) for
the State; and
(B) the greater of—
(i) 0.4; and
(ii) an amount equal to an amount determined for
the State in accordance with the following formula:
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PUBLIC HEALTH SERVICE ACT
1¥.35 +

R%
P%

Sec. 1918

,

(5) DETERMINATION OF TERM ‘‘P’’.—
(A) For purposes of paragraph (4), the term ‘‘P’’ means
the sum of—
(i) an amount equal to the product of 0.107 and
the number of individuals in the State who are between 18 and 24 years of age (inclusive);
(ii) an amount equal to the product of 0.166 and
the number of individuals in the State who are between 25 and 44 years of age (inclusive);
(iii) an amount equal to the product of 0.099 and
the number of individuals in the State who are between 45 and 64 years of age (inclusive); and
(iv) an amount equal to the product of 0.082 and
the number of individuals in the State who are 65
years of age or older.
(B) With respect to data on population that is necessary for purposes of making a determination under subparagraph (A), the Secretary shall use the most recent
data that is available from the Secretary of Commerce pursuant to the decennial census and pursuant to reasonable
estimates by such Secretary of changes occurring in the
data in the ensuing period.
(6) DETERMINATION OF TERM ‘‘R%’’.—
(A) For purposes of paragraph (4), the term ‘‘R%’’, except as provided in subparagraph (D), means the percentage constituted by the ratio of the amount determined
under subparagraph (B) for the State involved to the
amount determined under subparagraph (C).
(B) The amount determined under this subparagraph
for the State involved is the quotient of—
(i) the most recent 3-year arithmetic mean of the
total taxable resources of the State, as determined by
the Secretary of the Treasury; divided by
(ii) the factor determined under paragraph (8) for
the State.
(C) The amount determined under this subparagraph
is the sum of the respective amounts determined for the
States under subparagraph (B) (including the District of
Columbia).
(D)(i) In the case of the District of Columbia, for purposes of paragraph (4), the term ‘‘R%’’ means the percentage constituted by the ratio of the amount determined
under clause (ii) for such District to the amount determined under clause (iii).
(ii) The amount determined under this clause for the
District of Columbia is the quotient of—
(I) the most recent 3-year arithmetic mean of total
personal income in such District, as determined by the
Secretary of Commerce; divided by
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1138

(II) the factor determined under paragraph (8) for
the District.
(iii) The amount determined under this clause is the
sum of the respective amounts determined for the States
(including the District of Columbia) by making, for each
State, the same determination as is described in clause (ii)
for the District of Columbia.
(7) DETERMINATION OF TERM ‘‘P%’’.—For purposes of paragraph (4), the term ‘‘P%’’ means the percentage constituted by
the ratio of the term ‘‘P’’ determined under paragraph (5) for
the State involved to the sum of the respective terms ‘‘P’’ determined for the States.
(8) DETERMINATION OF CERTAIN FACTOR.—
(A) The factor determined under this paragraph for
the State involved is a factor whose purpose is to adjust
the amount determined under clause (i) of paragraph
(4)(A), and the amounts determined under each of subparagraphs (B)(i) and (D)(ii)(I) of paragraph (6), to reflect
the differences that exist between the State and other
States in the costs of providing comprehensive community
mental health services to adults with a serious mental illness and to children with a serious emotional disturbance.
(B) Subject to subparagraph (C), the factor determined
under this paragraph and in effect for the fiscal year involved shall be determined according to the methodology
described in the report entitled ‘‘Adjusting the Alcohol,
Drug Abuse and Mental Health Services Block Grant Allocations for Poverty Populations and Cost of Service’’, dated
March 30, 1990, and prepared by Health Economics Research, a corporation, pursuant to a contract with the National Institute on Drug Abuse.
(C) The factor determined under this paragraph for
the State involved may not for any fiscal year be greater
than 1.1 or less than 0.9.
(D)(i) Not later than October 1, 1992, the Secretary,
after consultation with the Comptroller General, shall in
accordance with this section make a determination for
each State of the factor that is to be in effect for the State
under this paragraph. The factor so determined shall remain in effect through fiscal year 1994, and shall be recalculated every third fiscal year thereafter.
(ii) After consultation with the Comptroller General,
the Secretary shall, through publication in the Federal
Register, periodically make such refinements in the methodology referred to in subparagraph (B) as are consistent
with the purpose described in subparagraph (A).
(b) MINIMUM ALLOTMENTS FOR STATES.—With respect to fiscal
year 2000, and subsequent fiscal years, the amount of the allotment of a State under section 1911 shall not be less than the
amount the State received under such section for fiscal year 1998.
(c) TERRITORIES.—
(1) DETERMINATION UNDER FORMULA.—Subject to paragraphs (2) and (4), the amount of an allotment under section
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PUBLIC HEALTH SERVICE ACT

Sec. 1920

1911 for a territory of the United States for a fiscal year shall
be the product of—
(A) an amount equal to the amounts reserved under
paragraph (3) for the fiscal year; and
(B) a percentage equal to the quotient of—
(i) the civilian population of the territory, as indicated by the most recently available data; divided by
(ii) the aggregate civilian population of the territories of the United States, as indicated by such data.
(2) MINIMUM ALLOTMENT FOR TERRITORIES.—The amount
of an allotment under section 1911 for a territory of the United
States for a fiscal year shall be the greater of—
(A) the amount determined under paragraph (1) for
the territory for the fiscal year;
(B) $50,000; and
(C) with respect to fiscal years 1993 and 1994, an
amount equal to 20.6 percent of the amount received by
the territory from allotments made pursuant to this part
for fiscal year 1992.
(3) RESERVATION OF AMOUNTS.—The Secretary shall each
fiscal year reserve for the territories of the United States 1.5
percent of the amounts appropriated under section 1920(a) for
allotments under section 1911 for the fiscal year.
(4) AVAILABILITY OF DATA ON POPULATION.—With respect
to data on the civilian population of the territories of the
United States, if the Secretary determines for a fiscal year that
recent such data for purposes of paragraph (1)(B) do not exist
regarding a territory, the Secretary shall for such purposes estimate the civilian population of the territory by modifying the
data on the territory to reflect the average extent of change occurring during the ensuing period in the population of all territories with respect to which recent such data do exist.
(5) APPLICABILITY OF CERTAIN PROVISIONS.—For purposes
of subsection (a), the term ‘‘State’’ does not include the territories of the United States.
SEC. 1919. ø300x–8¿ DEFINITIONS.

For purposes of this subpart:
(1) The terms ‘‘adults with a serious mental illness’’ and
‘‘children with a serious emotional disturbance’’ have the
meanings given such terms under section 1912(c)(1).
(2) The term ‘‘funding agreement’’, with respect to a grant
under section 1911 to a State, means that the Secretary may
make such a grant only if the State makes the agreement involved.
SEC. 1920. ø300x–9¿ FUNDING.
(a) AUTHORIZATION OF

APPROPRIATIONS.—For the purpose of
carrying out this subpart, and subpart III and section 505 with respect to mental health, there are authorized to be appropriated
$450,000,000 for fiscal year 2001, and such sums as may be necessary for each of the fiscal years 2002 and 2003.
(b) ALLOCATIONS FOR TECHNICAL ASSISTANCE, DATA COLLECTION, AND PROGRAM EVALUATION.—
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1140

(1) IN GENERAL.—For the purpose of carrying out section
1948(a) with respect to mental health and the purposes specified in paragraphs (2) and (3), the Secretary shall obligate 5
percent of the amounts appropriated under subsection (a) for
a fiscal year.
(2) DATA COLLECTION.—The purpose specified in this paragraph is carrying out sections 505 and 1971 with respect to
mental health.
(3) PROGRAM EVALUATION.—The purpose specified in this
paragraph is the conduct of evaluations of prevention and
treatment programs and services with respect to mental health
to determine methods for improving the availability and quality of such programs and services.

Subpart II—Block Grants for Prevention and
Treatment of Substance Abuse
SEC. 1921. ø300x–21¿ FORMULA GRANTS TO STATES.
(a) IN GENERAL.—For the purpose described

in subsection (b),
the Secretary, acting through the Center for Substance Abuse
Treatment, shall make an allotment each fiscal year for each State
in an amount determined in accordance with section 1933. The Secretary shall make a grant to the State of the allotment made for
the State for the fiscal year if the State submits to the Secretary
an application in accordance with section 1932.
(b) AUTHORIZED ACTIVITIES.—A funding agreement for a grant
under subsection (a) is that, subject to section 1931, the State involved will expend the grant only for the purpose of planning, carrying out, and evaluating activities to prevent and treat substance
abuse and for related activities authorized in section 1924.
SEC. 1922. ø300x–22¿ CERTAIN ALLOCATIONS.
(a) ALLOCATION REGARDING PRIMARY PREVENTION PROGRAMS.—A funding agreement for a grant under section 1921 is

that, in expending the grant, the State involved—
(1) will expend not less than 20 percent for programs for
individuals who do not require treatment for substance abuse,
which programs—
(A) educate and counsel the individuals on such abuse;
and
(B) provide for activities to reduce the risk of such
abuse by the individuals;
(2) will, in carrying out paragraph (1)—
(A) give priority to programs for populations that are
at risk of developing a pattern of such abuse; and
(B) ensure that programs receiving priority under subparagraph (A) develop community-based strategies for the
prevention of such abuse, including strategies to discourage the use of alcoholic beverages and tobacco products by
individuals to whom it is unlawful to sell or distribute
such beverages or products.
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PUBLIC HEALTH SERVICE ACT

Sec. 1923

(b) 1 ALLOCATIONS REGARDING WOMEN.—
(1) IN GENERAL.—Subject to paragraph (2), a funding
agreement for a grant under section 1921 for a fiscal year is
that—
(A) in the case of a grant for fiscal year 1993, the
State involved will expend not less than 5 percent of the
grant to increase (relative to fiscal year 1992) the availability of treatment services designed for pregnant women
and women with dependent children (either by establishing new programs or expanding the capacity of existing
programs);
(B) in the case of a grant for fiscal year 1994, the
State will expend not less than 5 percent of the grant to
so increase (relative to fiscal year 1993) the availability of
such services for such women; and
(C) in the case of a grant for any subsequent fiscal
year, the State will expend for such services for such
women not less than an amount equal to the amount expended by the State for fiscal year 1994.
(2) WAIVER.—
(A) Upon the request of a State, the Secretary may
provide to the State a waiver of all or part of the requirement established in paragraph (1) if the Secretary determines that the State is providing an adequate level of
treatments services for women described in such paragraph, as indicated by a comparison of the number of such
women seeking the services with the availability in the
State of the services.
(B) The Secretary shall approve or deny a request for
a waiver under subparagraph (A) not later than 120 days
after the date on which the request is made.
(C) Any waiver provided by the Secretary under subparagraph (A) shall be applicable only to the fiscal year involved.
(3) CHILDCARE AND PRENATAL CARE.—A funding agreement
for a grant under section 1921 for a State is that each entity
providing treatment services with amounts reserved under
paragraph (1) by the State will, directly or through arrangements with other public or nonprofit private entities, make
available prenatal care to women receiving such services and,
while the women are receiving the services, childcare.
SEC. 1923. ø300x–23¿ INTRAVENOUS SUBSTANCE ABUSE.
(a) CAPACITY OF TREATMENT PROGRAMS.—
1 Paragraph (2)(A) of section 3303(f) of Public Law 106–310 (114 Stat. 1211) provides as follows:

(2) CONFORMING AMENDMENTS.—Effective upon the publication of the regulations developed in accordance with section 1932(e)(1) of the Public Health Service Act (42 U.S.C. 300x–
32(d))—
(A) section 1922(c) of the Public Health Service Act (42 U.S.C. 300x–22(c)) is amended
by—
(i) striking paragraph (2); and
(ii) redesignating paragraph (3) as paragraph (2); and
The reference to section 1922(c) probably should be a reference to section 1922(b), as amended
by section 3303(a) of such Public Law.

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PUBLIC HEALTH SERVICE ACT

1142

(1) NOTIFICATION OF REACHING CAPACITY.—A funding
agreement for a grant under section 1921 is that the State involved will, in the case of programs of treatment for intravenous drug abuse, require that any such program receiving
amounts from the grant, upon reaching 90 percent of its capacity to admit individuals to the program, provide to the State
a notification of such fact.
(2) PROVISION OF TREATMENT.—A funding agreement for a
grant under section 1921 is that the State involved will, with
respect to notifications under paragraph (1), ensure that each
individual who requests and is in need of treatment for intravenous drug abuse is admitted to a program of such treatment
not later than—
(A) 14 days after making the request for admission to
such a program; or
(B) 120 days after the date of such request, if no such
program has the capacity to admit the individual on the
date of such request and if interim services are made
available to the individual not later than 48 hours after
such request.
(b) OUTREACH REGARDING INTRAVENOUS SUBSTANCE ABUSE.—
A funding agreement for a grant under section 1921 is that the
State involved, in providing amounts from the grant to any entity
for treatment services for intravenous drug abuse, will require the
entity to carry out activities to encourage individuals in need of
such treatment to undergo treatment.
SEC. 1924. ø300x–24¿ REQUIREMENTS REGARDING TUBERCULOSIS AND
HUMAN IMMUNODEFICIENCY VIRUS.
(a) TUBERCULOSIS.—
(1) IN GENERAL.—A funding agreement for a grant under

section 1921 is that the State involved will require that any
entity receiving amounts from the grant for operating a program of treatment for substance abuse—
(A) will, directly or through arrangements with other
public or nonprofit private entities, routinely make available tuberculosis services to each individual receiving
treatment for such abuse; and
(B) in the case of an individual in need of such treatment who is denied admission to the program on the basis
of the lack of the capacity of the program to admit the individual, will refer the individual to another provider of tuberculosis services.
(2) TUBERCULOSIS SERVICES.—For purposes of paragraph
(1), the term ‘‘tuberculosis services’’, with respect to an individual, means—
(A) counseling the individual with respect to tuberculosis;
(B) testing to determine whether the individual has
contracted such disease and testing to determine the form
of treatment for the disease that is appropriate for the individual; and
(C) providing such treatment to the individual.
(b) HUMAN IMMUNODEFICIENCY VIRUS.—
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Sec. 1924

(1) REQUIREMENT FOR CERTAIN STATES.—In the case of a
State described in paragraph (2), a funding agreement for a
grant under section 1921 is that—
(A) with respect to individuals undergoing treatment
for substance abuse, the State will, subject to paragraph
(3), carry out 1 or more projects to make available to the
individuals early intervention services for HIV disease at
the sites at which the individuals are undergoing such
treatment;
(B) for the purpose of providing such early intervention services through such projects, the State will make
available from the grant the percentage that is applicable
for the State under paragraph (4); and
(C) the State will, subject to paragraph (5), carry out
such projects only in geographic areas of the State that
have the greatest need for the projects.
(2) DESIGNATED STATES.—For purposes of this subsection,
a State described in this paragraph is any State whose rate of
cases of acquired immune deficiency syndrome is 10 or more
such cases per 100,000 individuals (as indicated by the number
of such cases reported to and confirmed by the Director of the
Centers for Disease Control for the most recent calendar year
for which such data are available).
(3) USE OF EXISTING PROGRAMS REGARDING SUBSTANCE
ABUSE.—With respect to programs that provide treatment services for substance abuse, a funding agreement for a grant
under section 1921 for a designated State is that each such
program participating in a project under paragraph (1) will be
a program that began operation prior to the fiscal year for
which the State is applying to receive the grant. A program
that so began operation may participate in a project under
paragraph (1) without regard to whether the program has been
providing early intervention services for HIV disease.
(4) APPLICABLE PERCENTAGE REGARDING EXPENDITURES FOR
SERVICES.—
(A)(i) For purposes of paragraph (1)(B), the percentage
that is applicable under this paragraph for a designated
State is, subject to subparagraph (B), the percentage by
which the amount of the grant under section 1921 for the
State for the fiscal year involved is an increase over the
amount specified in clause (ii).
(ii) The amount specified in this clause is the amount
that was reserved by the designated State involved from
the allotment of the State under section 1912A for fiscal
year 1991 in compliance with section 1916(c)(6)(A)(ii) (as
such sections were in effect for such fiscal year).
(B) If the percentage determined under subparagraph
(A) for a designated State for a fiscal year is less than 2
percent (including a negative percentage, in the case of a
State for which there is no increase for purposes of such
subparagraph), the percentage applicable under this paragraph for the State is 2 percent. If the percentage so determined is 2 percent or more, the percentage applicable
under this paragraph for the State is the percentage deterMarch 13, 2013

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1144

mined under subparagraph (A), subject to not exceeding 5
percent.
(5) REQUIREMENT REGARDING RURAL AREAS.—
(A) A funding agreement for a grant under section
1921 for a designated State is that, if the State will carry
out 2 or more projects under paragraph (1), the State will
carry out 1 such project in a rural area of the State, subject to subparagraph (B).
(B) The Secretary shall waive the requirement established in subparagraph (A) if the State involved certifies to
the Secretary that—
(i) there is insufficient demand in the State to
carry out a project under paragraph (1) in any rural
area of the State; or
(ii) there are no rural areas in the State.
(6) MANNER OF PROVIDING SERVICES.—With respect to the
provision of early intervention services for HIV disease to an
individual, a funding agreement for a grant under section 1921
for a designated State is that—
(A) such services will be undertaken voluntarily by,
and with the informed consent of, the individual; and
(B) undergoing such services will not be required as a
condition of receiving treatment services for substance
abuse or any other services.
(7) DEFINITIONS.—For purposes of this subsection:
(A) The term ‘‘designated State’’ means a State described in paragraph (2).
(B) The term ‘‘early intervention services’’, with respect to HIV disease, means—
(i) appropriate pretest counseling;
(ii) testing individuals with respect to such disease, including tests to confirm the presence of the disease, tests to diagnose the extent of the deficiency in
the immune system, and tests to provide information
on appropriate therapeutic measures for preventing
and treating the deterioration of the immune system
and for preventing and treating conditions arising
from the disease;
(iii) appropriate post-test counseling; and
(iv) providing the therapeutic measures described
in clause (ii).
(C) The term ‘‘HIV disease’’ means infection with the
etiologic agent for acquired immune deficiency syndrome.
(c) EXPENDITURE OF GRANT FOR COMPLIANCE WITH AGREEMENTS.—
(1) IN GENERAL.—A grant under section 1921 may be expended for purposes of compliance with the agreements required in this section, subject to paragraph (2).
(2) LIMITATION.—A funding agreement for a grant under
section 1921 for a State is that the grant will not be expended
to make payment for any service provided for purposes of compliance with this section to the extent that payment has been
made, or can reasonably be expected to be made, with respect
to such service—
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Sec. 1925

(A) under any State compensation program, under any
insurance policy, or under any Federal or State health
benefits program (including the program established in
title XVIII of the Social Security Act and the program established in title XIX of such Act); or
(B) by an entity that provides health services on a prepaid basis.
(d) MAINTENANCE OF EFFORT.—With respect to services provided for by a State for purposes of compliance with this section,
a funding agreement for a grant under section 1921 is that the
State will maintain expenditures of non-Federal amounts for such
services at a level that is not less than average level of such expenditures maintained by the State for 2-year period preceding the
first fiscal year for which the State receives such a grant.
(e) APPLICABILITY OF CERTAIN PROVISION.—Section 1931 applies to this section (and to each other provision of this subpart).
SEC. 1925. ø300x–25¿ GROUP HOMES FOR RECOVERING SUBSTANCE
ABUSERS.
(a) STATE REVOLVING FUNDS FOR ESTABLISHMENT OF HOMES.—

A State, using funds available under section 1921, may establish
and maintain the ongoing operation of a revolving fund in accordance with this section to support group homes for recovering substance abusers as follows:
(1) The purpose of the fund is to make loans for the costs
of establishing programs for the provision of housing in which
individuals recovering from alcohol or drug abuse may reside
in groups of not less than 6 individuals. The fund is established directly by the State or through the provision of a grant
or contract to a nonprofit private entity.
(2) The programs are carried out in accordance with guidelines issued under subsection (b).
(3) Not less than $100,000 is available for the fund.
(4) Loans made from the revolving fund do not exceed
$4,000 and each such loan is repaid to the revolving fund by
the residents of the housing involved not later than 2 years
after the date on which the loan is made.
(5) Each such loan is repaid by such residents through
monthly installments, and a reasonable penalty is assessed for
each failure to pay such periodic installments by the date specified in the loan agreement involved.
(6) Such loans are made only to nonprofit private entities
agreeing that, in the operation of the program established pursuant to the loan—
(A) the use of alcohol or any illegal drug in the housing provided by the program will be prohibited;
(B) any resident of the housing who violates such prohibition will be expelled from the housing;
(C) the costs of the housing, including fees for rent and
utilities, will be paid by the residents of the housing; and
(D) the residents of the housing will, through a majority vote of the residents, otherwise establish policies governing residence in the housing, including the manner in
which applications for residence in the housing are approved.
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1146

(b) ISSUANCE BY SECRETARY OF GUIDELINES.—The Secretary
shall ensure that there are in effect guidelines under this subpart
for the operation of programs described in subsection (a).
(c) APPLICABILITY TO TERRITORIES.—The requirements established in subsection (a) shall not apply to any territory of the
United States other than the Commonwealth of Puerto Rico.
SEC. 1926. ø300x–26¿ STATE LAW REGARDING SALE OF TOBACCO PRODUCTS TO INDIVIDUALS UNDER AGE OF 18.
(a) RELEVANT LAW.—
(1) IN GENERAL.—Subject to paragraph (2), for fiscal year

1994 and subsequent fiscal years, the Secretary may make a
grant under section 1921 only if the State involved has in effect a law providing that it is unlawful for any manufacturer,
retailer, or distributor of tobacco products to sell or distribute
any such product to any individual under the age of 18.
(2) DELAYED APPLICABILITY FOR CERTAIN STATES.—In the
case of a State whose legislature does not convene a regular
session in fiscal year 1993, and in the case of a State whose
legislature does not convene a regular session in fiscal year
1994, the requirement described in paragraph (1) as a condition of a receipt of a grant under section 1921 shall apply only
for fiscal year 1995 and subsequent fiscal years.
(b) ENFORCEMENT.—
(1) IN GENERAL.—For the first applicable fiscal year and
for subsequent fiscal years, a funding agreement for a grant
under section 1921 is that the State involved will enforce the
law described in subsection (a) in a manner that can reasonably be expected to reduce the extent to which tobacco products
are available to individuals under the age of 18.
(2) ACTIVITIES AND REPORTS REGARDING ENFORCEMENT.—
For the first applicable fiscal year and for subsequent fiscal
years, a funding agreement for a grant under section 1921 is
that the State involved will—
(A) annually conduct random, unannounced inspections to ensure compliance with the law described in subsection (a); and
(B) annually submit to the Secretary a report describing—
(i) the activities carried out by the State to enforce
such law during the fiscal year preceding the fiscal
year for which the State is seeking the grant;
(ii) the extent of success the State has achieved in
reducing the availability of tobacco products to individuals under the age of 18; and
(iii) the strategies to be utilized by the State for
enforcing such law during the fiscal year for which the
grant is sought.
(c) NONCOMPLIANCE OF STATE.—Before making a grant under
section 1921 to a State for the first applicable fiscal year or any
subsequent fiscal year, the Secretary shall make a determination
of whether the State has maintained compliance with subsections
(a) and (b). If, after notice to the State and an opportunity for a
hearing, the Secretary determines that the State is not in compliance with such subsections, the Secretary shall reduce the amount
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PUBLIC HEALTH SERVICE ACT

Sec. 1928

of the allotment under such section for the State for the fiscal year
involved by an amount equal to—
(1) in the case of the first applicable fiscal year, 10 percent
of the amount determined under section 1933 for the State for
the fiscal year;
(2) in the case of the first fiscal year following such applicable fiscal year, 20 percent of the amount determined under
section 1933 for the State for the fiscal year;
(3) in the case of the second such fiscal year, 30 percent
of the amount determined under section 1933 for the State for
the fiscal year; and
(4) in the case of the third such fiscal year or any subsequent fiscal year, 40 percent of the amount determined under
section 1933 for the State for the fiscal year.
(d) DEFINITION.—For purposes of this section, the term ‘‘first
applicable fiscal year’’ means—
(1) fiscal year 1995, in the case of any State described in
subsection (a)(2); and
(2) fiscal year 1994, in the case of any other State.
SEC. 1927. ø300x–27¿ TREATMENT SERVICES FOR PREGNANT WOMEN.
(a) IN GENERAL.—A funding agreement for a grant under sec-

tion 1921 is that the State involved—
(1) will ensure that each pregnant woman in the State who
seeks or is referred for and would benefit from such services
is given preference in admissions to treatment facilities receiving funds pursuant to the grant; and
(2) will, in carrying out paragraph (1), publicize the availability to such women of services from the facilities and the
fact that the women receive such preference.
(b) REFERRALS REGARDING STATES.—A funding agreement for
a grant under section 1921 is that, in carrying out subsection
(a)(1)—
(1) the State involved will require that, in the event that
a treatment facility has insufficient capacity to provide treatment services to any woman described in such subsection who
seeks the services from the facility, the facility refer the
woman to the State; and
(2) the State, in the case of each woman for whom a referral under paragraph (1) is made to the State—
(A) will refer the woman to a treatment facility that
has the capacity to provide treatment services to the
woman; or
(B) will, if no treatment facility has the capacity to
admit the woman, make interim services available to the
woman not later than 48 hours after the women 1 seeks
the treatment services.
SEC. 1928. ø300x–28¿ ADDITIONAL AGREEMENTS.
(a) IMPROVEMENT OF PROCESS FOR APPROPRIATE REFERRALS
FOR TREATMENT.—With respect to individuals seeking treatment

services, a funding agreement for a grant under section 1921 is
1 So in law. See section 202 of Public Law 102–321 (106 Stat. 396). Probably should be
‘‘woman’’.

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PUBLIC HEALTH SERVICE ACT

1148

that the State involved will improve (relative to fiscal year 1992)
the process in the State for referring the individuals to treatment
facilities that can provide to the individuals the treatment modality
that is most appropriate for the individuals.
(b) CONTINUING EDUCATION.—With respect to any facility for
treatment services or prevention actitivities 2 that is receiving
amounts from a grant under section 1921, a funding agreement for
a State for a grant under such section is that continuing education
in such services or activities (or both, as the case may be) will be
made available to employees of the facility who provide the services
or activities.
(c) COORDINATION OF VARIOUS ACTIVITIES AND SERVICES.—A
funding agreement for a grant under section 1921 is that the State
involved will coordinate prevention and treatment activities with
the provision of other appropriate services (including health, social,
correctional and criminal justice, educational, vocational rehabilitation, and employment services).
(d) 1 WAIVER OF REQUIREMENT.—
(1) IN GENERAL.—Upon the request of a State, the Secretary may provide to a State a waiver of any or all of the requirements established in this section if the Secretary determines that, with respect to services for the prevention and
treatment of substance abuse, the requirement involved is unnecessary for maintaining quality in the provision of such services in the State.
(2) DATE CERTAIN FOR ACTING UPON REQUEST.—The Secretary shall approve or deny a request for a waiver under paragraph (1) not later than 120 days after the date on which the
request is made.
(3) APPLICABILITY OF WAIVER.—Any waiver provided by the
Secretary under paragraph (1) shall be applicable only to the
fiscal year involved.
SEC. 1929. ø300x–29¿ SUBMISSION TO SECRETARY OF STATEWIDE ASSESSMENT OF NEEDS.

The Secretary may make a grant under section 1921 only if the
State submits to the Secretary an assessment of the need in the
State for authorized activities (which assessment is conducted in
accordance with criteria issued by the Secretary), both by locality
and by the State in general, which assessment includes a description of—
(1) the incidence and prevalence in the State of drug abuse
and the incidence and prevalence in the State of alcohol abuse
and alcoholism;
(2) current prevention and treatment activities in the
State;
2 So in law. See section 202 of Public Law 102–321 (106 Stat. 396). Probably should be ‘‘activities’’.
1Paragraph (2)(B) of section 3303(f) of Public Law 106–310 (114 Stat. 1211) provides as follows:

(2) CONFORMING AMENDMENTS.—Effective upon the publication of the regulations developed in accordance with section 1932(e)(1) of the Public Health Service Act (42 U.S.C. 300x–
32(d))—
(A) * * *
(B) section 1928(d) of the Public Health Service Act (42 U.S.C. 300x–28(d)) is repealed.

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Sec. 1931

(3) the need of the State for technical assistance to carry
out such activities;
(4) efforts by the State to improve such activities; and
(5) the extent to which the availability of such activities is
insufficient to meet the need for the activities, the interim
services to be made available under sections 1923(a) and
1927(b), and the manner in which such services are to be so
available.
SEC. 1930. ø300x–30¿ MAINTENANCE OF EFFORT REGARDING STATE EXPENDITURES.
(a) IN GENERAL.—With respect to the principal agency of a

State for carrying out authorized activities, a funding agreement
for a grant under section 1921 for the State for a fiscal year is that
such agency will for such year maintain aggregate State expenditures for authorized activities at a level that is not less than the
average level of such expenditures maintained by the State for the
2-year period preceding the fiscal year for which the State is applying for the grant.
(b) EXCLUSION OF CERTAIN FUNDS.—The Secretary may exclude from the aggregate State expenditures under subsection (a),
funds appropriated to the principle agency for authorized activities
which are of a non-recurring nature and for a specific purpose.
(c) WAIVER.—
(1) IN GENERAL.—Upon the request of a State, the Secretary may waive all or part of the requirement established in
subsection (a) if the Secretary determines that extraordinary
economic conditions in the State justify the waiver.
(2) DATE CERTAIN FOR ACTING UPON REQUEST.—The Secretary shall approve or deny a request for a waiver under paragraph (1) not later than 120 days after the date on which the
request is made.
(3) APPLICABILITY OF WAIVER.—Any waiver provided by the
Secretary under paragraph (1) shall be applicable only to the
fiscal year involved.
(d) NONCOMPLIANCE BY STATE.—
(1) IN GENERAL.—In making a grant under section 1921 to
a State for a fiscal year, the Secretary shall make a determination of whether, for the previous fiscal year, the State maintained material compliance with any agreement made under
subsection (a). If the Secretary determines that a State has
failed to maintain such compliance, the Secretary shall reduce
the amount of the allotment under section 1921 for the State
for the fiscal year for which the grant is being made by an
amount equal to the amount constituting such failure for the
previous fiscal year.
(2) SUBMISSION OF INFORMATION TO SECRETARY.—The Secretary may make a grant under section 1921 for a fiscal year
only if the State involved submits to the Secretary information
sufficient for the Secretary to make the determination required
in paragraph (1).
SEC. 1931. ø300x–31¿ RESTRICTIONS ON EXPENDITURE OF GRANT.
(a) IN GENERAL.—
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1150

(1) CERTAIN RESTRICTIONS.—A funding agreement for a
grant under section 1921 is that the State involved will not expend the grant—
(A) to provide inpatient hospital services, except as
provided in subsection (b);
(B) to make cash payments to intended recipients of
health services;
(C) to purchase or improve land, purchase, construct,
or permanently improve (other than minor remodeling)
any building or other facility, or purchase major medical
equipment;
(D) to satisfy any requirement for the expenditure of
non-Federal funds as a condition for the receipt of Federal
funds;
(E) to provide financial assistance to any entity other
than a public or nonprofit private entity; or
(F) to carry out any program prohibited by section
256(b) of the Health Omnibus Programs Extension of 1988
(42 U.S.C. 300ee–5).
(2) LIMITATION ON ADMINISTRATIVE EXPENSES.—A funding
agreement for a grant under section 1921 is that the State involved will not expend more than 5 percent of the grant to pay
the costs of administering the grant.
(3) LIMITATION REGARDING PENAL AND CORRECTIONAL INSTITUTIONS.—A funding agreement for a State for a grant
under section 1921 is that, in expending the grant for the purpose of providing treatment services in penal or correctional institutions of the State, the State will not expend more than an
amount equal to the amount expended for such purpose by the
State from the grant made under section 1912A to the State
for fiscal year 1991 (as section 1912A was in effect for such fiscal year).
(b) EXCEPTION REGARDING INPATIENT HOSPITAL SERVICES.—
(1) MEDICAL NECESSITY AS PRECONDITION.—With respect to
compliance with the agreement made under subsection (a), a
State may expend a grant under section 1921 to provide inpatient hospital services as treatment for substance abuse only if
it has been determined, in accordance with guidelines issued
by the Secretary, that such treatment is a medical necessity for
the individual involved, and that the individual cannot be effectively treated in a community-based, nonhospital, residential program of treatment.
(2) RATE OF PAYMENT.—In the case of an individual for
whom a grant under section 1921 is expended to provide inpatient hospital services described in paragraph (1), a funding
agreement for the grant for the State involved is that the daily
rate of payment provided to the hospital for providing the services to the individual will not exceed the comparable daily rate
provided for community-based, nonhospital, residential programs of treatment for substance abuse.
(c) WAIVER REGARDING CONSTRUCTION OF FACILITIES.—
(1) IN GENERAL.—The Secretary may provide to any State
a waiver of the restriction established in subsection (a)(1)(C)
for the purpose of authorizing the State to expend a grant
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Sec. 1932

under section 1921 for the construction of a new facility or rehabilitation of an existing facility, but not for land acquisition.
(2) STANDARD REGARDING NEED FOR WAIVER.—The Secretary may approve a waiver under paragraph (1) only if the
State demonstrates to the Secretary that adequate treatment
cannot be provided through the use of existing facilities and
that alternative facilities in existing suitable buildings are not
available.
(3) AMOUNT.—In granting a waiver under paragraph (1),
the Secretary shall allow the use of a specified amount of funds
to construct or rehabilitate a specified number of beds for residential treatment and a specified number of slots for outpatient treatment, based on reasonable estimates by the State
of the costs of construction or rehabilitation. In considering
waiver applications, the Secretary shall ensure that the State
has carefully designed a program that will minimize the costs
of additional beds.
(4) MATCHING FUNDS.—The Secretary may grant a waiver
under paragraph (1) only if the State agrees, with respect to
the costs to be incurred by the State in carrying out the purpose of the waiver, to make available non-Federal contributions in cash toward such costs in an amount equal to not less
than $1 for each $1 of Federal funds provided under section
1921.
(5) DATE CERTAIN FOR ACTING UPON REQUEST.—The Secretary shall act upon a request for a waiver under paragraph
(1) not later than 120 days after the date on which the request
is made.
SEC. 1932. ø300x–32¿ APPLICATION FOR GRANT; APPROVAL OF STATE
PLAN.
(a) IN GENERAL.—For purposes of section 1921, an application

for a grant under such section for a fiscal year is in accordance
with this section if, subject to subsections (c) and (d)(2)—
(1) the application is received by the Secretary not later
than October 1 of the fiscal year for which the State is seeking
funds;
(2) the application contains each funding agreement that is
described in this subpart or subpart III for such a grant (other
than any such agreement that is not applicable to the State);
(3) the agreements are made through certification from the
chief executive officer of the State;
(4) with respect to such agreements, the application provides assurances of compliance satisfactory to the Secretary;
(5) the application contains the information required in
section 1929, the information required in section 1930(c)(2),
and the report required in section 1942(a);
(6)(A) the application contains a plan in accordance with
subsection (b) and the plan is approved by the Secretary; and
(B) the State provides assurances satisfactory to the Secretary that the State complied with the provisions of the plan
under subparagraph (A) that was approved by the Secretary
for the most recent fiscal year for which the State received a
grant under section 1921; and
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1152

(7) the application (including the plan under paragraph
(6)) is otherwise in such form, is made in such manner, and
contains such agreements, assurances, and information as the
Secretary determines to be necessary to carry out this subpart.
(b) STATE PLAN.—
(1) IN GENERAL.—A plan submitted by a State under subsection (a)(6) is in accordance with this subsection if the plan
contains detailed provisions for complying with each funding
agreement for a grant under section 1921 that is applicable to
the State, including a description of the manner in which the
State intends to expend the grant.
(2) AUTHORITY OF SECRETARY REGARDING MODIFICATIONS.—
As a condition of making a grant under section 1921 to a State
for a fiscal year, the Secretary may require that the State modify any provision of the plan submitted by the State under subsection (a)(6) (including provisions on priorities in carrying out
authorized activities). If the Secretary approves the plan and
makes the grant to the State for the fiscal year, the Secretary
may not during such year require the State to modify the plan.
(3) AUTHORITY OF CENTER FOR SUBSTANCE ABUSE PREVENTION.—With respect to plans submitted by the States under
subsection (a)(6), the Secretary, acting through the Director of
the Center for Substance Abuse Prevention, shall review and
approve or disapprove the provisions of the plans that relate
to prevention activities.
(c) WAIVERS REGARDING CERTAIN TERRITORIES.—In the case of
any territory of the United States except Puerto Rico, the Secretary
may waive such provisions of this subpart and subpart III as the
Secretary determines to be appropriate, other than the provisions
of section 1931.
(d) ISSUANCE OF REGULATIONS; PRECONDITION TO MAKING
GRANTS.—
(1) REGULATIONS.—Not later than August 25, 1992, the
Secretary, acting as appropriate through the Director of the
Center for Treatment Improvement or the Director of the Center for Substance Abuse Prevention, shall by regulation establish standards specifying the circumstances in which the Secretary will consider an application for a grant under section
1921 to be in accordance with this section.
(2) ISSUANCE AS PRECONDITION TO MAKING GRANTS.—The
Secretary may not make payments under any grant under section 1921 for fiscal year 1993 on or after January 1, 1993, unless the Secretary has issued standards under paragraph (1).
(e) WAIVER AUTHORITY FOR CERTAIN REQUIREMENTS.—
(1) IN GENERAL.—Upon the request of a State, the Secretary may waive the requirements of all or part of the sections described in paragraph (2) using objective criteria established by the Secretary by regulation after consultation with
the States and other interested parties including consumers
and providers.
(2) SECTIONS.—The sections described in paragraph (1) are
sections 1922(c), 1923, 1924 and 1928.
(3) DATE CERTAIN FOR ACTING UPON REQUEST.—The Secretary shall approve or deny a request for a waiver under paraMarch 13, 2013

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Sec. 1933

graph (1) and inform the State of that decision not later than
120 days after the date on which the request and all the information needed to support the request are submitted.
(4) ANNUAL REPORTING REQUIREMENT.—The Secretary
shall annually report to the general public on the States that
receive a waiver under this subsection.
SEC. 1933. ø300x–33¿ DETERMINATION OF AMOUNT OF ALLOTMENT.
(a) STATES.—
(1) IN GENERAL.—Subject to subsection (b), the Secretary

shall determine the amount of the allotment required in section 1921 for a State for a fiscal year as follows:
(A) The formula established in paragraph (1) of section
1918(a) shall apply to this subsection to the same extent
and in the same manner as the formula applies for purposes of section 1918(a), except that, in the application of
such formula for purposes of this subsection, the modifications described in subparagraph (B) shall apply.
(B) For purposes of subparagraph (A), the modifications described in this subparagraph are as follows:
(i) The amount specified in paragraph (2)(A) of
section 1918(a) is deemed to be the amount appropriated under section 1935(a) for allotments under section 1921 for the fiscal year involved.
(ii) The term ‘‘P’’ is deemed to have the meaning
given in paragraph (2) of this subsection. Section
1918(a)(5)(B) applies to the data used in determining
such term for the States.
(iii) The factor determined under paragraph (8) of
section 1918(a) is deemed to have the purpose of reflecting the differences that exist between the State
involved and other States in the costs of providing authorized services.
(2) DETERMINATION OF TERM ‘‘P’’.—For purposes of this
subsection, the term ‘‘P’’ means the percentage that is the
arithmetic mean of the percentage determined under subparagraph (A) and the percentage determined under subparagraph
(B), as follows:
(A) The percentage constituted by the ratio of—
(i) an amount equal to the sum of the total number of individuals who reside in the State involved and
are between 18 and 24 years of age (inclusive) and the
number of individuals in the State who reside in urbanized areas of the State and are between such years
of age; to
(ii) an amount equal to the total of the respective
sums determined for the States under clause (i).
(B) The percentage constituted by the ratio of—
(i) the total number of individuals in the State
who are between 25 and 64 years of age (inclusive); to
(ii) an amount equal to the sum of the respective
amounts determined for the States under clause (i).
(b) MINIMUM ALLOTMENTS FOR STATES.—
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1154

(1) IN GENERAL.—With respect to fiscal year 2000, and
each subsequent fiscal year, the amount of the allotment of a
State under section 1921 shall not be less than the amount the
State received under such section for the previous fiscal year
increased by an amount equal to 30.65 percent of the percentage by which the aggregate amount allotted to all States for
such fiscal year exceeds the aggregate amount allotted to all
States for the previous fiscal year.
(2) LIMITATIONS.—
(A) IN GENERAL.—Except as provided in subparagraph
(B), a State shall not receive an allotment under section
1921 for a fiscal year in an amount that is less than an
amount equal to 0.375 percent of the amount appropriated
under section 1935(a) for such fiscal year.
(B) EXCEPTION.—In applying subparagraph (A), the
Secretary shall ensure that no State receives an increase
in its allotment under section 1921 for a fiscal year (as
compared to the amount allotted to the State in the prior
fiscal year) that is in excess of an amount equal to 300
percent of the percentage by which the amount appropriated under section 1935(a) for such fiscal year exceeds
the amount appropriated for the prior fiscal year.
(3) DECREASE IN OR EQUAL APPROPRIATIONS.—If the
amount appropriated under section 1935(a) for a fiscal year is
equal to or less than the amount appropriated under such section for the prior fiscal year, the amount of the State allotment
under section 1921 shall be equal to the amount that the State
received under section 1921 in the prior fiscal year decreased
by the percentage by which the amount appropriated for such
fiscal year is less than the amount appropriated or such section
for the prior fiscal year.
(c) TERRITORIES.—
(1) DETERMINATION UNDER FORMULA.—Subject to paragraphs (2) and (4), the amount of an allotment under section
1921 for a territory of the United States for a fiscal year shall
be the product of—
(A) an amount equal to the amounts reserved under
paragraph (3) for the fiscal year; and
(B) a percentage equal to the quotient of—
(i) the civilian population of the territory, as indicated by the most recently available data; divided by
(ii) the aggregate civilian population of the territories of the United States, as indicated by such data.
(2) MINIMUM ALLOTMENT FOR TERRITORIES.—The amount
of an allotment under section 1921 for a territory of the United
States for a fiscal year shall be the greater of—
(A) the amount determined under paragraph (1) for
the territory for the fiscal year;
(B) $50,000; and
(C) with respect to fiscal years 1993 and 1994, an
amount equal to 79.4 percent of the amount received by
the territory from allotments made pursuant to this part
for fiscal year 1992.
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Sec. 1933

(3) RESERVATION OF AMOUNTS.—The Secretary shall each
fiscal year reserve for the territories of the United States 1.5
percent of the amounts appropriated under section 1935(a) for
allotments under section 1921 for the fiscal year.
(4) AVAILABILITY OF DATA ON POPULATION.—With respect
to data on the civilian population of the territories of the
United States, if the Secretary determines for a fiscal year that
recent such data for purposes of paragraph (1)(B) do not exist
regarding a territory, the Secretary shall for such purposes estimate the civilian population of the territory by modifying the
data on the territory to reflect the average extent of change occurring during the ensuing period in the population of all territories with respect to which recent such data do exist.
(5) APPLICABILITY OF CERTAIN PROVISIONS.—For purposes
of subsections (a) and (b), the term ‘‘State’’ does not include the
territories of the United States.
(d) INDIAN TRIBES AND TRIBAL ORGANIZATIONS.—
(1) IN GENERAL.—If the Secretary—
(A) receives a request from the governing body of an
Indian tribe or tribal organization within any State that
funds under this subpart be provided directly by the Secretary to such tribe or organization; and
(B) makes a determination that the members of such
tribe or tribal organization would be better served by
means of grants made directly by the Secretary under
this; 1
the Secretary shall reserve from the allotment under section
1921 for the State for the fiscal year involved an amount that
bears the same ratio to the allotment as the amount provided
under this subpart to the tribe or tribal organization for fiscal
year 1991 for activities relating to the prevention and treatment of the abuse of alcohol and other drugs bore to the
amount of the portion of the allotment under this subpart for
the State for such fiscal year that was expended for such activities.
(2) TRIBE OR TRIBAL ORGANIZATION AS GRANTEE.—The
amount reserved by the Secretary on the basis of a determination under this paragraph 2 shall be granted to the Indian tribe
or tribal organization serving the individuals for whom such a
determination has been made.
(3) APPLICATION.—In order for an Indian tribe or tribal organization to be eligible for a grant for a fiscal year under this
paragraph, it shall submit to the Secretary a plan for such fiscal year that meets such criteria as the Secretary may prescribe.
(4) DEFINITION.—The terms ‘‘Indian tribe’’ and ‘‘tribal organization’’ have the same meaning given such terms in subsections (b) and (c) of section 4 of the Indian Self-Determination and Education Assistance Act.
1 So in law. See section 102 of Public Law 102–321 (106 Stat. 402). Probably should be ‘‘under
this subpart’’.
2 So in law. See section 102 of Public Law 102–321 (106 Stat. 402). Probably should be ‘‘subsection’’.

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SEC. 1934. ø300x–34¿ DEFINITIONS.

For purposes of this subpart:
(1) The term ‘‘authorized activities’’, subject to section
1931, means the activities described in section 1921(b).
(2) The term ‘‘funding agreement’’, with respect to a grant
under section 1921 to a State, means that the Secretary may
make such a grant only if the State makes the agreement involved.
(3) The term ‘‘prevention activities’’, subject to section
1931, means activities to prevent substance abuse.
(4) The term ‘‘substance abuse’’ means the abuse of alcohol
or other drugs.
(5) The term ‘‘treatment activities’’ means treatment services and, subject to section 1931, authorized activities that are
related to treatment services.
(6) The term ‘‘treatment facility’’ means an entity that provides treatment services.
(7) The term ‘‘treatment services’’, subject to section 1931,
means treatment for substance abuse.
SEC. 1935. ø300x–35¿ FUNDING.
(a) AUTHORIZATION OF APPROPRIATIONS.—For

the purpose of
carrying out this subpart, subpart III and section 505 with respect
to substance abuse, and section 515(d), there are authorized to be
appropriated $2,000,000,000 for fiscal year 2001, and such sums as
may be necessary for each of the fiscal years 2002 and 2003.
(b) ALLOCATIONS FOR TECHNICAL ASSISTANCE, NATIONAL DATA
BASE, DATA COLLECTION, AND PROGRAM EVALUATIONS.—
(1) IN GENERAL.—
(A) For the purpose of carrying out section 1948(a)
with respect to substance abuse, section 515(d), and the
purposes specified in subparagraphs (B) and (C), the Secretary shall obligate 5 percent of the amounts appropriated under subsection (a) each fiscal year.
(B) The purpose specified in this subparagraph is the
collection of data in this paragraph 1 is carrying out sections 505 and 1971 with respect to substance abuse.
(C) The purpose specified in this subparagraph is the
conduct of evaluations of authorized activities to determine
methods for improving the availability and quality of such
activities.
(2) ACTIVITIES OF CENTER FOR SUBSTANCE ABUSE PREVENTION.—Of the amounts reserved under paragraph (1) for a fiscal year, the Secretary, acting through the Director of the Center for Substance Abuse Prevention, shall obligate 20 percent
for carrying out paragraph (1)(C), section 1948(a) with respect
to prevention activities, and section 515(d).
(3) CORE DATA SET.—A State that receives a new grant,
contract, or cooperative agreement from amounts available to
the Secretary under paragraph (1), for the purposes of improving the data collection, analysis and reporting capabilities of
the State, shall be required, as a condition of receipt of funds,
1 So in law. See section 202 of Public Law 102–321 (106 Stat. 403). The words ‘‘the collection
of data in this paragraph’’ probably should not appear.

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Sec. 1943

to collect, analyze, and report to the Secretary for each fiscal
year subsequent to receiving such funds a core data set to be
determined by the Secretary in conjunction with the States.

Subpart III—General Provisions
SEC. 1941. ø300x–51¿ OPPORTUNITY FOR PUBLIC COMMENT ON STATE
PLANS.

A funding agreement for a grant under section 1911 or 1921
is that the State involved will make the plan required in section
1912, and the plan required in section 1932, respectively, public
within the State in such manner as to facilitate comment from any
person (including any Federal or other public agency) during the
development of the plan (including any revisions) and after the
submission of the plan to the Secretary.
SEC. 1942. ø300x–52¿ REQUIREMENT OF REPORTS AND AUDITS BY
STATES.
(a) REPORT.—A funding agreement for a grant under section

1911 or 1921 is that the State involved will submit to the Secretary
a report in such form and containing such information as the Secretary determines (after consultation with the States) to be necessary for securing a record and a description of—
(1) the purposes for which the grant received by the State
for the preceding fiscal year under the program involved were
expended and a description of the activities of the State under
the program; and
(2) the recipients of amounts provided in the grant.
(b) AUDITS.—A funding agreement for a grant under section
1911 or 1921 is that the State will, with respect to the grant, comply with chapter 75 of title 31, United States Code.
(c) AVAILABILITY TO PUBLIC.—A funding agreement for a grant
under section 1911 or 1921 is that the State involved will—
(1) make copies of the reports and audits described in this
section available for public inspection within the State; and
(2) provide copies of the report under subsection (a), upon
request, to any interested person (including any public agency).
SEC. 1943. ø300x–53¿ ADDITIONAL REQUIREMENTS.
(a) IN GENERAL.—A funding agreement for

a grant under section 1911 or 1921 is that the State involved will—
(1)(A) for the fiscal year for which the grant involved is
provided, provide for independent peer review to assess the
quality, appropriateness, and efficacy of treatment services
provided in the State to individuals under the program involved; and
(B) ensure that, in the conduct of such peer review, not
fewer than 5 percent of the entities providing services in the
State under such program are reviewed (which 5 percent is
representative of the total population of such entities);
(2) permit and cooperate with Federal investigations undertaken in accordance with section 1945; and
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1158

retary in the development of uniform criteria for the collection
of data pursuant to such section.
(b) PATIENT RECORDS.—The Secretary may make a grant under
section 1911 or 1921 only if the State involved has in effect a system to protect from inappropriate disclosure patient records maintained by the State in connection with an activity funded under the
program involved or by any entity which is receiving amounts from
the grant.
SEC. 1944. ø300x–54¿ DISPOSITION OF CERTAIN FUNDS APPROPRIATED
FOR ALLOTMENTS.
(a) IN GENERAL.—Amounts described in subsection (b) and

available for a fiscal year pursuant to section 1911 or 1921, as the
case may be, shall be allotted by the Secretary and paid to the
States receiving a grant under the program involved, other than
any State referred to in subsection (b) with respect to such program. Such amounts shall be allotted in a manner equivalent to
the manner in which the allotment under the program involved
was determined.
(b) SPECIFICATION OF AMOUNTS.—The amounts referred to in
subsection (a) are any amounts that—
(1) are not paid to States under the program involved as
a result of—
(A) the failure of any State to submit an application
in accordance with the program;
(B) the failure of any State to prepare such application
in compliance with the program; or
(C) any State informing the Secretary that the State
does not intend to expend the full amount of the allotment
made to the State under the program;
(2) are terminated, repaid, or offset under section 1945;
(3) in the case of the program established in section 1911,
are available as a result of reductions in allotments under such
section pursuant to section 1912(d) or 1915(b); or
(4) in the case of the program established in section 1921,
are available as a result of reductions in allotments under such
section pursuant to section 1926 or 1930.
SEC. 1945. ø300x–55¿ FAILURE TO COMPLY WITH AGREEMENTS.
(a) SUSPENSION OR TERMINATION OF PAYMENTS.—Subject

to
subsection (e), if the Secretary determines that a State has materially failed to comply with the agreements or other conditions required for the receipt of a grant under the program involved, the
Secretary may in whole or in part suspend payments under the
grant, terminate the grant for cause, or employ such other remedies (including the remedies provided for in subsections (b) and
(c)) as may be legally available and appropriate in the circumstances involved.
(b) REPAYMENT OF PAYMENTS.—
(1) IN GENERAL.—Subject to subsection (e), the Secretary
may require a State to repay with interest any payments received by the State under section 1911 or 1921 that the Secretary determines were not expended by the State in accordance with the agreements required under the program involved.

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PUBLIC HEALTH SERVICE ACT

Sec. 1945

(2) OFFSET AGAINST PAYMENTS.—If a State fails to make a
repayment required in paragraph (1), the Secretary may offset
the amount of the repayment against the amount of any payment due to be paid to the State under the program involved.
(c) WITHHOLDING OF PAYMENTS.—
(1) IN GENERAL.—Subject to subsections (e) and (g)(3), the
Secretary may withhold payments due under section 1911 or
1921 if the Secretary determines that the State involved is not
expending amounts received under the program involved in accordance with the agreements required under the program.
(2) TERMINATION OF WITHHOLDING.—The Secretary shall
cease withholding payments from a State under paragraph (1)
if the Secretary determines that there are reasonable assurances that the State will expend amounts received under the
program involved in accordance with the agreements required
under the program.
(d) APPLICABILITY OF REMEDIES TO CERTAIN VIOLATIONS.—
(1) IN GENERAL.—With respect to agreements or other conditions for receiving a grant under the program involved, in
the case of the failure of a State to maintain material compliance with a condition referred to in paragraph (2), the provisions for noncompliance with the condition that are provided in
the section establishing the condition shall apply in lieu of subsections (a) through (c) of this section.
(2) RELEVANT CONDITIONS.—For purposes of paragraph (1):
(A) In the case of the program established in section
1911, a condition referred to in this paragraph is the condition established in section 1912(d) and the condition established in section 1915(b).
(B) In the case of the program established in section
1921, a condition referred to in this paragraph is the condition established in section 1926 and the condition established in section 1930.
(e) OPPORTUNITY FOR HEARING.—Before taking action against
a State under any of subsections (a) through (c) (or under a section
referred to in subsection (d)(2), as the case may be), the Secretary
shall provide to the State involved adequate notice and an opportunity for a hearing.
(f) REQUIREMENT OF HEARING IN CERTAIN CIRCUMSTANCES.—
(1) IN GENERAL.—If the Secretary receives a complaint that
a State has failed to maintain material compliance with the
agreements or other conditions required for receiving a grant
under the program involved (including any condition referred
to for purposes of subsection (d)), and there appears to be reasonable evidence to support the complaint, the Secretary shall
promptly conduct a hearing with respect to the complaint.
(2) FINDING OF MATERIAL NONCOMPLIANCE.—If in a hearing
under paragraph (1) the Secretary finds that the State involved has failed to maintain material compliance with the
agreement or other condition involved, the Secretary shall take
such action under this section as may be appropriate to ensure
that material compliance is so maintained, or such action as
may be required in a section referred to in subsection (d)(2), as
the case may be.
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1160

(g) CERTAIN INVESTIGATIONS.—
(1) REQUIREMENT REGARDING SECRETARY.—The Secretary
shall in fiscal year 1994 and each subsequent fiscal year conduct in not less than 10 States investigations of the expenditure of grants received by the States under section 1911 or
1921 in order to evaluate compliance with the agreements required under the program involved.
(2) PROVISION OF RECORDS ETC. UPON REQUEST.—Each
State receiving a grant under section 1911 or 1921, and each
entity receiving funds from the grant, shall make appropriate
books, documents, papers, and records available to the Secretary or the Comptroller General, or any of their duly authorized representatives, for examination, copying, or mechanical
reproduction on or off the premises of the appropriate entity
upon a reasonable request therefor.
(3) LIMITATIONS ON AUTHORITY.—The Secretary may not
institute proceedings under subsection (c) unless the Secretary
has conducted an investigation concerning whether the State
has expended payments under the program involved in accordance with the agreements required under the program. Any
such investigation shall be conducted within the State by
qualified investigators.
SEC. 1946. ø300x–56¿ PROHIBITIONS REGARDING RECEIPT OF FUNDS.
(a) ESTABLISHMENT.—
(1) CERTAIN FALSE STATEMENTS AND REPRESENTATIONS.—A

person shall not knowingly and willfully make or cause to be
made any false statement or representation of a material fact
in connection with the furnishing of items or services for which
payments may be made by a State from a grant made to the
State under section 1911 or 1921.
(2) CONCEALING OR FAILING TO DISCLOSE CERTAIN
EVENTS.—A person with knowledge of the occurrence of any
event affecting the initial or continued right of the person to
receive any payments from a grant made to a State under section 1911 or 1921 shall not conceal or fail to disclose any such
event with an intent fraudulently to secure such payment either in a greater amount than is due or when no such amount
is due.
(b) CRIMINAL PENALTY FOR VIOLATION OF PROHIBITION.—Any
person who violates any prohibition established in subsection (a)
shall for each violation be fined in accordance with title 18, United
States Code, or imprisoned for not more than 5 years, or both.
SEC. 1947. ø300x–57¿ NONDISCRIMINATION.
(a) IN GENERAL.—
(1) RULE OF CONSTRUCTION REGARDING CERTAIN CIVIL
RIGHTS LAWS.—For the purpose of applying the prohibitions

against discrimination on the basis of age under the Age Discrimination Act of 1975, on the basis of handicap under section
504 of the Rehabilitation Act of 1973, on the basis of sex under
title IX of the Education Amendments of 1972, or on the basis
of race, color, or national origin under title VI of the Civil
Rights Act of 1964, programs and activities funded in whole or
in part with funds made available under section 1911 or 1921
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Sec. 1948

shall be considered to be programs and activities receiving Federal financial assistance.
(2) PROHIBITION.—No person shall on the ground of sex
(including, in the case of a woman, on the ground that the
woman is pregnant), or on the ground of religion, be excluded
from participation in, be denied the benefits of, or be subjected
to discrimination under, any program or activity funded in
whole or in part with funds made available under section 1911
or 1921.
(b) ENFORCEMENT.—
(1) REFERRALS TO ATTORNEY GENERAL AFTER NOTICE.—
Whenever the Secretary finds that a State, or an entity that
has received a payment pursuant to section 1911 or 1921, has
failed to comply with a provision of law referred to in subsection (a)(1), with subsection (a)(2), or with an applicable regulation (including one prescribed to carry out subsection (a)(2)),
the Secretary shall notify the chief executive officer of the
State and shall request the chief executive officer to secure
compliance. If within a reasonable period of time, not to exceed
60 days, the chief executive officer fails or refuses to secure
compliance, the Secretary may—
(A) refer the matter to the Attorney General with a
recommendation that an appropriate civil action be instituted;
(B) exercise the powers and functions provided by the
Age Discrimination Act of 1975, section 504 of the Rehabilitation Act of 1973, title IX of the Education Amendments of 1972, or title VI of the Civil Rights Act of 1964,
as may be applicable; or
(C) take such other actions as may be authorized by
law.
(2) AUTHORITY OF ATTORNEY GENERAL.—When a matter is
referred to the Attorney General pursuant to paragraph (1)(A),
or whenever the Attorney General has reason to believe that
a State or an entity is engaged in a pattern or practice in violation of a provision of law referred to in subsection (a)(1) or in
violation of subsection (a)(2), the Attorney General may bring
a civil action in any appropriate district court of the United
States for such relief as may be appropriate, including injunctive relief.
SEC. 1948. ø300x–58¿ TECHNICAL ASSISTANCE AND PROVISION OF SUPPLIES AND SERVICES IN LIEU OF GRANT FUNDS.
(a) TECHNICAL ASSISTANCE.—The Secretary shall, without

charge to a State receiving a grant under section 1911 or 1921, provide to the State (or to any public or nonprofit private entity within
the State) technical assistance with respect to the planning, development, and operation of any program or service carried out pursuant to the program involved. The Secretary may provide such technical assistance directly, through contract, or through grants.
(b) PROVISION OF SUPPLIES AND SERVICES IN LIEU OF GRANT
FUNDS.—
(1) IN GENERAL.—Upon the request of a State receiving a
grant under section 1911 or 1921, the Secretary may, subject
to paragraph (2), provide supplies, equipment, and services for
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PUBLIC HEALTH SERVICE ACT

1162

the purpose of aiding the State in carrying out the program involved and, for such purpose, may detail to the State any officer or employee of the Department of Health and Human Services.
(2) CORRESPONDING REDUCTION IN PAYMENTS.—With respect to a request described in paragraph (1), the Secretary
shall reduce the amount of payments under the program involved to the State by an amount equal to the costs of detailing
personnel and the fair market value of any supplies, equipment, or services provided by the Secretary. The Secretary
shall, for the payment of expenses incurred in complying with
such request, expend the amounts withheld.
SEC. 1949. 1 ø300x–59¿ PLANS FOR PERFORMANCE PARTNERSHIPS.
(a) DEVELOPMENT.—The Secretary in conjunction with States

and other interested groups shall develop separate plans for the
programs authorized under subparts I and II for creating more
flexibility for States and accountability based on outcome and other
performance measures. The plans shall each include—
(1) a description of the flexibility that would be given to
the States under the plan;
(2) the common set of performance measures that would be
used for accountability, including measures that would be used
for the program under subpart II for pregnant addicts, HIV
transmission, tuberculosis, and those with a co-occurring substance abuse and mental disorders, and for programs under
subpart I for children with serious emotional disturbance and
adults with serious mental illness and for individuals with cooccurring mental health and substance abuse disorders;
(3) the definitions for the data elements to be used under
the plan;
(4) the obstacles to implementation of the plan and the
manner in which such obstacles would be resolved;
(5) the resources needed to implement the performance
partnerships under the plan; and
(6) an implementation strategy complete with recommendations for any necessary legislation.
(b) SUBMISSION.—Not later than 2 years after the date of the
enactment of this Act 2, the plans developed under subsection (a)
shall be submitted to the Committee on Health, Education, Labor,
and Pensions of the Senate and the Committee on Commerce of the
House of Representatives.
(c) INFORMATION.—As the elements of the plans described in
subsection (a) are developed, States are encouraged to provide information to the Secretary on a voluntary basis.
(d) PARTICIPANTS.—The Secretary shall include among those
interested groups that participate in the development of the plan
1 Section 1949 appears according to the probable intent of the Congress. Section 3403(a) of
Public Law 106–310 (114 Stat. 1219) provides that the section ‘‘is amended as follows:’’. No
amendatory instructions were then given, but a substitute text was provided. The amendment
probably should have instructed that section 1949 ‘‘is amended to read as follows:’’.
2 The probable intent of the Congress was that the reference to ‘‘this Act’’ be a reference to
the Children’s Health Act of 2000 (Public Law 106–310), which provided a substitute text for
section 1949 (see footnote 1), including subsection (b) above. That Act was enacted October 17,
2000. (A reference to ‘‘this Act’’ is a reference to the Public Health Service Act, which was enacted July 1, 1944.)

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Sec. 1954

consumers of mental health or substance abuse services, providers,
representatives of political divisions of States, and representatives
of racial and ethnic groups including Native Americans.
SEC. 1950. ø300x–60¿ RULE OF CONSTRUCTION REGARDING DELEGATION OF AUTHORITY TO STATES.

With respect to States receiving grants under section 1911 or
1921, this part may not be construed to authorize the Secretary to
delegate to the States the primary responsibility for interpreting
the governing provisions of this part.
SEC. 1951. ø300x–61¿ SOLICITATION OF VIEWS OF CERTAIN ENTITIES.

In carrying out this part, the Secretary, as appropriate, shall
solicit the views of the States and other appropriate entities.
SEC. 1952. 1 ø300x–62¿ AVAILABILITY TO STATES OF GRANT PAYMENTS.

Any amounts paid to a State for a fiscal year under section
1911 or 1921 shall be available for obligation and expenditure until
the end of the fiscal year following the fiscal year for which the
amounts were paid.
SEC. 1953. ø300x–63¿ CONTINUATION OF CERTAIN PROGRAMS.
(a) IN GENERAL.—Of the amount allotted to the State

of Hawaii under section 1911, and the amount allotted to such State
under section 1921, an amount equal to the proportion of Native
Hawaiians residing in the State to the total population of the State
shall be available, respectively, for carrying out the program involved for Native Hawaiians.
(b) EXPENDITURE OF AMOUNTS.—The amount made available
under subsection (a) may be expended only through contracts entered into by the State of Hawaii with public and private nonprofit
organizations to enable such organizations to plan, conduct, and
administer comprehensive substance abuse and treatment programs for the benefit of Native Hawaiians. In entering into contracts under this section, the State of Hawaii shall give preference
to Native Hawaiian organizations and Native Hawaiian health centers.
(c) DEFINITIONS.—For the purposes of this subsection 2, the
terms ‘‘Native Hawaiian’’, ‘‘Native Hawaiian organization’’, and
‘‘Native Hawaiian health center’’ have the meaning given such
terms in section 2308 of subtitle D of title II of the Anti-Drug
Abuse Act of 1988.
SEC. 1954. ø300x–64¿ DEFINITIONS.
(a) DEFINITIONS FOR SUBPART

III.—For purposes of this sub-

part:
(1) The term ‘‘program involved’’ means the program of
grants established in section 1911 or 1921, or both, as indicated by whether the State involved is receiving or is applying
to receive a grant under section 1911 or 1921, or both.
1 Section 1952 appears according to the probable intent of the Congress. Section 3403(b) of
Public Law 106–310 (114 Stat. 1220) provides that the section ‘‘is amended as follows:’’. No
amendatory instructions were then given, but a substitute text was provided. The amendment
probably should have instructed that section 1952 ‘‘is amended to read as follows:’’.
2 So in law. See section 203 of Public Law 102–321 (106 Stat. 409). Probably should be ‘‘section’’.

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Sec. 1955

PUBLIC HEALTH SERVICE ACT

1164

(2)(A) The term ‘‘funding agreement’’, with respect to a
grant under section 1911, has the meaning given such term in
section 1919.
(B) The term ‘‘funding agreement’’, with respect to a grant
under section 1921, has the meaning given such term in section 1934.
(b) DEFINITIONS FOR PART B.—For purposes of this part:
(1) The term ‘‘Comptroller General’’ means the Comptroller
General of the United States.
(2) The term ‘‘State’’, except as provided in sections
1918(c)(5) and 1933(c)(5), means each of the several States, the
District of Columbia, and each of the territories of the United
States.
(3) The term ‘‘territories of the United States’’ means each
of the Commonwealth of Puerto Rico, American Samoa, Guam,
the Commonwealth of the Northern Mariana Islands, the Virgin Islands, Palau, the Marshall Islands, and Micronesia.
(4) The term ‘‘interim services’’, in the case of an individual in need of treatment for substance abuse who has been
denied admission to a program of such treatment on the basis
of the lack of the capacity of the program to admit the individual, means services for reducing the adverse health effects
of such abuse, for promoting the health of the individual, and
for reducing the risk of transmission of disease, which services
are provided until the individual is admitted to such a program.
SEC. 1955. ø300x–65¿ SERVICES PROVIDED BY NONGOVERNMENTAL ORGANIZATIONS. 1
(a) PURPOSES.—The purposes of this section are—

(1) to prohibit discrimination against nongovernmental organizations and certain individuals on the basis of religion in
the distribution of government funds to provide substance
abuse services under this title and title V, and the receipt of
services under such titles; and
(2) to allow the organizations to accept the funds to provide the services to the individuals without impairing the religious character of the organizations or the religious freedom of
the individuals.
(b) RELIGIOUS ORGANIZATIONS INCLUDED AS NONGOVERNMENTAL PROVIDERS.—
(1) IN GENERAL.—A State may administer and provide substance abuse services under any program under this title or
title V through grants, contracts, or cooperative agreements to
provide assistance to beneficiaries under such titles with nongovernmental organizations.
(2) REQUIREMENT.—A State that elects to utilize nongovernmental organizations as provided for under paragraph
(1) shall consider, on the same basis as other nongovernmental
organizations, religious organizations to provide services under
1 Part G of title V of this Act (the second part G; see page 677) also relates to religious organizations as providers of substance abuse services. That part was added by section 144 of the
Community Renewal Tax Relief Act of 2000 (as enacted into law by section 1(a)(7) of Public Law
106–554; 114 Stat. 2763A–619). Section 1955 above was added by section 3305 of Public Law
106–310 (114 Stat. 1212).

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Sec. 1955

substance abuse programs under this title or title V, so long
as the programs under such titles are implemented in a manner consistent with the Establishment Clause of the first
amendment to the Constitution. Neither the Federal Government nor a State or local government receiving funds under
such programs shall discriminate against an organization that
provides services under, or applies to provide services under,
such programs, on the basis that the organization has a religious character.
(c) RELIGIOUS CHARACTER AND INDEPENDENCE.—
(1) IN GENERAL.—A religious organization that provides
services under any substance abuse program under this title or
title V shall retain its independence from Federal, State, and
local governments, including such organization’s control over
the definition, development, practice, and expression of its religious beliefs.
(2) ADDITIONAL SAFEGUARDS.—Neither the Federal Government nor a State or local government shall require a religious
organization—
(A) to alter its form of internal governance; or
(B) to remove religious art, icons, scripture, or other
symbols,
in order to be eligible to provide services under any substance
abuse program under this title or title V.
(d) EMPLOYMENT PRACTICES.—
(1) SUBSTANCE ABUSE.—A religious organization that provides services under any substance abuse program under this
title or title V may require that its employees providing services under such program adhere to rules forbidding the use of
drugs or alcohol.
(2) TITLE VII EXEMPTION.—The exemption of a religious organization provided under section 702 or 703(e)(2) of the Civil
Rights Act of 1964 (42 U.S.C. 2000e–1, 2000e–2(e)(2)) regarding employment practices shall not be affected by the religious
organization’s provision of services under, or receipt of funds
from, any substance abuse program under this title or title V.
(e) RIGHTS OF BENEFICIARIES OF ASSISTANCE.—
(1) IN GENERAL.—If an individual described in paragraph
(3) has an objection to the religious character of the organization from which the individual receives, or would receive, services funded under any substance abuse program under this
title or title V, the appropriate Federal, State, or local governmental entity shall provide to such individual (if otherwise eligible for such services) within a reasonable period of time after
the date of such objection, services that—
(A) are from an alternative provider that is accessible
to the individual; and
(B) have a value that is not less than the value of the
services that the individual would have received from such
organization.
(2) NOTICE.—The appropriate Federal, State, or local governmental entity shall ensure that notice is provided to individuals described in paragraph (3) of the rights of such individuals under this section.
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(3) INDIVIDUAL DESCRIBED.—An individual described in
this paragraph is an individual who receives or applies for
services under any substance abuse program under this title or
title V.
(f ) NONDISCRIMINATION AGAINST BENEFICIARIES.—A religious
organization providing services through a grant, contract, or cooperative agreement under any substance abuse program under this
title or title V shall not discriminate, in carrying out such program,
against an individual described in subsection (e)(3) on the basis of
religion, a religious belief, a refusal to hold a religious belief, or a
refusal to actively participate in a religious practice.
(g) FISCAL ACCOUNTABILITY.—
(1) IN GENERAL.—Except as provided in paragraph (2), any
religious organization providing services under any substance
abuse program under this title or title V shall be subject to the
same regulations as other nongovernmental organizations to
account in accord with generally accepted accounting principles
for the use of such funds provided under such program.
(2) LIMITED AUDIT.—Such organization shall segregate government funds provided under such substance abuse program
into a separate account. Only the government funds shall be
subject to audit by the government.
(h) COMPLIANCE.—Any party that seeks to enforce such party’s
rights under this section may assert a civil action for injunctive relief exclusively in an appropriate Federal or State court against the
entity, agency or official that allegedly commits such violation.
(i) LIMITATIONS ON USE OF FUNDS FOR CERTAIN PURPOSES.—No
funds provided through a grant or contract to a religious organization to provide services under any substance abuse program under
this title or title V shall be expended for sectarian worship, instruction, or proselytization.
( j) EFFECT ON STATE AND LOCAL FUNDS.—If a State or local
government contributes State or local funds to carry out any substance abuse program under this title or title V, the State or local
government may segregate the State or local funds from the Federal funds provided to carry out the program or may commingle the
State or local funds with the Federal funds. If the State or local
government commingles the State or local funds, the provisions of
this section shall apply to the commingled funds in the same manner, and to the same extent, as the provisions apply to the Federal
funds.
(k) TREATMENT OF INTERMEDIATE CONTRACTORS.—If a nongovernmental organization (referred to in this subsection as an ‘‘intermediate organization’’), acting under a contract or other agreement with the Federal Government or a State or local government,
is given the authority under the contract or agreement to select
nongovernmental organizations to provide services under any substance abuse program under this title or title V, the intermediate
organization shall have the same duties under this section as the
government but shall retain all other rights of a nongovernmental
organization under this section.
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SEC. 1956. ø300x–66¿ SERVICES FOR INDIVIDUALS WITH CO-OCCURRING DISORDERS.

States may use funds available for treatment under sections
1911 and 1921 to treat persons with co-occurring substance abuse
and mental disorders as long as funds available under such sections are used for the purposes for which they were authorized by
law and can be tracked for accounting purposes.

PART C—CERTAIN PROGRAMS REGARDING
MENTAL HEALTH AND SUBSTANCE ABUSE
Subpart I—Data Infrastructure Development
SEC. 1971. ø300y¿ DATA INFRASTRUCTURE DEVELOPMENT.
(a) IN GENERAL.—The Secretary may make grants

to, and
enter into contracts or cooperative agreements with States for the
purpose of developing and operating mental health or substance
abuse data collection, analysis, and reporting systems with regard
to performance measures including capacity, process, and outcomes
measures.
(b) PROJECTS.—The Secretary shall establish criteria to ensure
that services will be available under this section to States that
have a fundamental basis for the collection, analysis, and reporting
of mental health and substance abuse performance measures and
States that do not have such basis. The Secretary will establish criteria for determining whether a State has a fundamental basis for
the collection, analysis, and reporting of data.
(c) CONDITION OF RECEIPT OF FUNDS.—As a condition of the receipt of an award under this section a State shall agree to collect,
analyze, and report to the Secretary within 2 years of the date of
the award on a core set of performance measures to be determined
by the Secretary in conjunction with the States.
(d) MATCHING REQUIREMENT.—
(1) IN GENERAL.—With respect to the costs of the program
to be carried out under subsection (a) by a State, the Secretary
may make an award under such subsection only if the applicant agrees to make available (directly or through donations
from public or private entities) non-Federal contributions toward such costs in an amount that is not less than 50 percent
of such costs.
(2) DETERMINATION OF AMOUNT CONTRIBUTED.—Non-Federal contributions under paragraph (1) may be in cash or in
kind, fairly evaluated, including plant, equipment, or services.
Amounts provided by the Federal Government, or services assisted or subsidized to any significant extent by the Federal
Government, may not be included in determining the amount
of such contributions.
(e) DURATION OF SUPPORT.—The period during which payments
may be made for a project under subsection (a) may be not less
than 3 years nor more than 5 years.
(f ) AUTHORIZATION OF APPROPRIATION.—
(1) IN GENERAL.—For the purpose of carrying out this section, there are authorized to be appropriated such sums as
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may be necessary for each of the fiscal years 2001, 2002 and
2003.
(2) ALLOCATION.—Of the amounts appropriated under
paragraph (1) for a fiscal year, 50 percent shall be expended
to support data infrastructure development for mental health
and 50 percent shall be expended to support data infrastructure development for substance abuse.

Subpart II—Interim Maintenance Treatment of
Narcotics Dependence
SEC. 1976. ø300y–11¿ INTERIM MAINTENANCE TREATMENT.
(a) REQUIREMENT REGARDING SECRETARY.—Subject

to the following subsections of this section, for the purpose of reducing the
incidence of the transmission of HIV disease pursuant to the intravenous abuse of heroin or other morphine-like drugs, the Secretary,
in establishing conditions for the use of methadone in public or
nonprofit private programs of treatment for dependence on such
drugs, shall authorize such programs—
(1) to dispense methadone for treatment purposes to individuals who—
(A) meet the conditions for admission to such programs that dispense methadone as part of comprehensive
treatment for such dependence; and
(B) are seeking admission to such programs that so
dispense methadone, but as a result of the limited capacity
of the programs, will not gain such admission until 14 or
more days after seeking admission to the programs; and
(2) in dispensing methadone to such individuals, to provide
only minimum ancillary services during the period in which
the individuals are waiting for admission to programs of comprehensive treatment.
(b) INAPPLICABILITY OF REQUIREMENT IN CERTAIN CIRCUMSTANCES.—
(1) IN GENERAL.—The requirement established in subsection (a) for the Secretary does not apply if any or all of the
following conditions are met:
(A) The preponderance of scientific research indicates
that the risk of the transmission of HIV disease pursuant
to the intravenous abuse of drugs is minimal.
(B) The preponderance of scientific research indicates
that the medically supervised dispensing of methadone is
not an effective method of reducing the extent of dependence on heroin and other morphine-like drugs.
(C) The preponderance of available data indicates
that, of treatment programs that dispense methadone as
part of comprehensive treatment, a substantial majority
admit all individuals seeking services to the programs not
later than 14 days after the individuals seek admission to
the programs.
(2) EVALUATION BY SECRETARY.—In evaluating whether
any or all of the conditions described in paragraph (1) have
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been met, the Secretary shall consult with the National Commission on Acquired Immune Deficiency Syndrome.
(c) CONDITIONS FOR OBTAINING AUTHORIZATION FROM SECRETARY.—
(1) IN GENERAL.—In carrying out the requirement established in subsection (a), the Secretary shall, after consultation
with the National Commission on Acquired Immune Deficiency
Syndrome, by regulation issue such conditions for treatment
programs to obtain authorization from the Secretary to provide
interim maintenance treatment as may be necessary to carry
out the purpose described in such subsection. Such conditions
shall include conditions for preventing the unauthorized use of
methadone.
(2) COUNSELING ON HIV DISEASE.—The regulations issued
under paragraph (1) shall provide that an authorization described in such paragraph may not be issued to a treatment
program unless the program provides to recipients of the treatment counseling on preventing exposure to and the transmission of HIV disease.
(3) PERMISSION OF RELEVANT STATE AS CONDITION OF AUTHORIZATION.—The regulations issued under paragraph (1)
shall provide that the Secretary may not provide an authorization described in such paragraph to any treatment program in
a State unless the chief public health officer of the State has
certified to the Secretary that—
(A) such officer does not object to the provision of such
authorizations to treatment programs in the State; and
(B) the provision of interim maintenance services in
the State will not reduce the capacity of comprehensive
treatment programs in the State to admit individuals to
the programs (relative to the date on which such officer so
certifies).
(4) DATE CERTAIN FOR ISSUANCE OF REGULATIONS; FAILURE
OF SECRETARY.—The Secretary shall issue the final rule for
purposes of the regulations required in paragraph (1), and such
rule shall be effective, not later than the expiration of the 180day period beginning on the date of the enactment of the
ADAMHA Reorganization Act 1. If the Secretary fails to meet
the requirement of the preceding sentence, the proposed rule
issued on March 2, 1989, with respect to part 291 of title 21,
Code of Federal Regulations (docket numbered 88N–0444; 54
Fed. Reg. 8973 et seq.) is deemed to take effect as a final rule
upon the expiration of such period, and the provisions of paragraph (3) of this subsection are deemed to be incorporated into
such rule.
(d) DEFINITIONS.—For purposes of this section:
(1) The term ‘‘interim maintenance services’’ means the
provision of methadone in a treatment program under the circumstances described in paragraphs (1) and (2) of subsection
(a).
(2) The term ‘‘HIV disease’’ means infection with the etiologic agent for acquired immune deficiency syndrome.
1 Enacted

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(3) The term ‘‘treatment program’’ means a public or nonprofit private program of treatment for dependence on heroin
or other morphine-like drugs.

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TITLE XX—ADOLESCENT FAMILY LIFE DEMONSTRATION
PROJECTS
FINDINGS AND PURPOSES

SEC. 2001. ø300z¿ (a) The Congress finds that—
(1) in 1978, an estimated one million one hundred thousand teenagers became pregnant, more than five hundred
thousand teenagers carried their babies to term, and over onehalf of the babies born to such teenagers were born out of wedlock;
(2) adolescents aged seventeen and younger accounted for
more than one-half of the out of wedlock births to teenagers;
(3) in a high proportion of cases, the pregnant adolescent
is herself the product of an unmarried parenthood during adolescence and is continuing the pattern in her own lifestyle;
(4) it is estimated that approximately 80 per centum of unmarried teenagers who carry their pregnancies to term live
with their families before and during their pregnancy and remain with their families after the birth of the child;
(5) pregnancy and childbirth among unmarried adolescents, particularly young adolescents, often results in severe
adverse health, social, and economic consequences including: a
higher percentage of pregnancy and childbirth complications; a
higher incidence of low birth weight babies; a higher infant
mortality and morbidity; a greater likelihood that an adolescent marriage will end in divorce; a decreased likelihood of
completing schooling; and higher risks of unemployment and
welfare dependency; and therefore, education, training, and job
research services are important for adolescent parents;
(6)(A) adoption is a positive option for unmarried pregnant
adolescents who are unwilling or unable to care for their children since adoption is a means of providing permanent families
for such children from available approved couples who are unable or have difficulty in conceiving or carrying children of
their own to term; and
(B) at present, only 4 per centum of unmarried pregnant
adolescents who carry their babies to term enter into an adoption plan or arrange for their babies to be cared for by relatives
or friends;
(7) an unmarried adolescent who becomes pregnant once is
likely to experience recurrent pregnancies and childbearing,
with increased risks;
(8)(A) the problems of adolescent premarital sexual relations, pregnancy, and parenthood are multiple and complex
and are frequently associated with or are a cause of other troublesome situations in the family; and
1171
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(B) such problems are best approached through a variety
of integrated and essential services provided to adolescents and
their families by other family members, religious and charitable organizations, voluntary associations, and other groups in
the private sector as well as services provided by publicly sponsored initiatives;
(9) a wide array of educational, health, and supportive
services are not available to adolescents with such problems or
to their families, or when available frequently are fragmented
and thus are of limited effectiveness in discouraging adolescent
premarital sexual relations and the consequences of such relations;
(10)(A) prevention of adolescent sexual activity and adolescent pregnancy depends primarily upon developing strong family values and close family ties, and since the family is the
basic social unit in which the values and attitudes of adolescents concerning sexuality and pregnancy are formed, programs designed to deal with issues of sexuality and pregnancy
will be successful to the extent that such programs encourage
and sustain the role of the family in dealing with adolescent
sexual activity and adolescent pregnancy;
(B) Federal policy therefore should encourage the development of appropriate health, educational, and social services
where such services are now lacking or inadequate, and the
better coordination of existing services where they are available; and
(C) services encouraged by the Federal Government should
promote the involvement of parents with their adolescent children, and should emphasize the provision of support by other
family members, religious and charitable organizations, voluntary associations, and other groups in the private sector in
order to help adolescents and their families deal with complex
issues of adolescent premarital sexual relations and the consequences of such relations; and
(11)(A) there has been limited research concerning the societal causes and consequences of adolescent pregnancy;
(B) there is limited knowledge concerning which means of
intervention are effective in mediating or eliminating adolescent premarital sexual relations and adolescent pregnancy; and
(C) it is necessary to expand and strengthen such knowledge in order to develop an array of approaches to solving the
problems of adolescent premarital sexual relations and adolescent pregnancy in both urban and rural settings.
(b) Therefore, the purposes of this title are—
(1) to find effective means, within the context of the family, of reaching adolescents before they become sexually active
in order to maximize the guidance and support available to
adolescents from parents and other family members, and to
promote self discipline and other prudent approaches to the
problem of adolescent premarital sexual relations, including
adolescent pregnancy;
(2) to promote adoption as an alternative for adolescent
parents;
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(3) to establish innovative, comprehensive, and integrated
approaches to the delivery of care services both for pregnant
adolescents, with primary emphasis on unmarried adolescents
who are seventeen years of age or under, and for adolescent
parents, which shall be based upon an assessment of existing
programs and, where appropriate, upon efforts to establish better coordination, integration, and linkages among such existing
programs in order to—
(A) enable pregnant adolescents to obtain proper care
and assist pregnant adolescents and adolescent parents to
become productive independent contributors to family and
community life; and
(B) assist families of adolescents to understand and resolve the societal causes which are associated with adolescent pregnancy;
(4) to encourage and support research projects and demonstration projects concerning the societal causes and consequences of adolescent premarital sexual relations, contraceptive use, pregnancy, and child rearing;
(5) to support evaluative research to identify effective services which alleviate, eliminate, or resolve any negative consequences of adolescent premarital sexual relations and adolescent childbearing for the parents, the child, and their families;
and
(6) to encourage and provide for the dissemination of results, findings, and information from programs and research
projects relating to adolescent premarital sexual relations,
pregnancy, and parenthood.
DEFINITIONS

SEC. 2002. ø300z–1¿ (a) For the purposes of this title, the
term—
(1) ‘‘Secretary’’ means the Secretary of Health and Human
Services;
(2) ‘‘eligible person’’ means—
(A) with regard to the provision of care services, a
pregnant adolescent, an adolescent parent, or the family of
a pregnant adolescent or an adolescent parent; or
(B) with regard to the provision of prevention services
and referral to such other services which may be appropriate, a nonpregnant adolescent;
(3) ‘‘eligible grant recipient’’ means a public or nonprofit
private organization or agency which demonstrates, to the satisfaction of the Secretary—
(A) in the case of an organization which will provide
care services, the capability of providing all care services
in a single setting or the capability of creating a network
through which all care services would be provided; or
(B) in the case of an organization which will provide
prevention services, the capability of providing such services;
(4) ‘‘necessary services’’ means services which may be provided by grantees which are—
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(A) pregnancy testing and maternity counseling;
(B) adoption counseling and referral services which
present adoption as an option for pregnant adolescents, including referral to licensed adoption agencies in the community if the eligible grant recipient is not a licensed
adoption agency;
(C) primary and preventive health services including
prenatal and postnatal care;
(D) nutrition information and counseling;
(E) referral for screening and treatment of venereal
disease;
(F) referral to appropriate pediatric care;
(G) educational services relating to family life and
problems associated with adolescent premarital sexual relations, including—
(i) information about adoption;
(ii) education on the responsibilities of sexuality
and parenting;
(iii) the development of material to support the
role of parents as the provider of sex education; and
(iv) assistance to parents, schools, youth agencies,
and health providers to educate adolescents and preadolescents concerning self-discipline and responsibility in human sexuality;
(H) appropriate educational and vocational services;
(I) referral to licensed residential care or maternity
home services; and
(J) mental health services and referral to mental
health services and to other appropriate physical health
services;
(K) child care sufficient to enable the adolescent parent to continue education or to enter into employment;
(L) consumer education and homemaking;
(M) counseling for the immediate and extended family
members of the eligible person;
(N) transportation;
(O) outreach services to families of adolescents to discourage sexual relations among unemancipated minors;
(P) family planning services; and
(Q) such other services consistent with the purposes of
this title as the Secretary may approve in accordance with
regulations promulgated by the Secretary;
(5) ‘‘core services’’ means those services which shall be provided by a grantee, as determined by the Secretary by regulation;
(6) ‘‘supplemental services’’ means those services which
may be provided by a grantee, as determined by the Secretary
by regulation;
(7) ‘‘care services’’ means necessary services for the provision of care to pregnant adolescents and adolescent parents
and includes all core services with respect to the provision of
such care prescribed by the Secretary by regulation;
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scribed in subparagraphs (A), (D), (E), (G), (H), (M), (N), (O),
and (Q) of paragraph (4);
(9) ‘‘adolescent’’ means an individual under the age of nineteen; and
(10) ‘‘unemancipated minor’’ means a minor who is subject
to the control, authority, and supervision of his or her parents
or guardians, as determined under State law.
(b) Until such time as the Secretary promulgates regulations
pursuant to the second sentence of this subsection, the Secretary
shall use the regulations promulgated under title VI of the Health
Services and Centers Amendments of 1978 which were in effect on
the date of enactment of this title, to determine which necessary
services are core services for purposes of this title. The Secretary
may promulgate regulations to determine which necessary services
are core services for purposes of this title based upon an evaluation
of and information concerning which necessary services are essential to carry out the purposes of this title and taking into account
(1) factors such as whether services are to be provided in urban or
rural areas, the ethnic groups to be served, and the nature of the
populations to be served, and (2) the results of the evaluations required under section 2006(b). The Secretary may from time to time
revise such regulations.
AUTHORITY TO MAKE GRANTS FOR DEMONSTRATION PROJECTS

SEC. 2003. ø300z–2¿ (a) The Secretary may make grants to further the purposes of this title to eligible grant recipients which
have submitted an application which the Secretary finds meets the
requirements of section 2006 for demonstration projects which the
Secretary determines will help communities provide appropriate
care and prevention services in easily accessible locations. Demonstration projects shall, as appropriate, provide, supplement, or
improve the quality of such services. Demonstration projects shall
use such methods as will strengthen the capacity of families to deal
with the sexual behavior, pregnancy, or parenthood of adolescents
and to make use of support systems such as other family members,
friends, religious and charitable organizations, and voluntary associations.
(b) Grants under this title for demonstration projects may be
for the provision of—
(1) care services;
(2) prevention services; or
(3) a combination of care services and prevention services.
USES OF GRANTS FOR DEMONSTRATION PROJECTS FOR SERVICES

SEC. 2004. ø300z–3¿ (a) Except as provided in subsection (b),
funds provided for demonstration projects for services under this
title may be used by grantees only to—
(1) provide to eligible persons—
(A) care services;
(B) prevention services; or
(C) care and prevention services (in the case of a
grantee who is providing a combination of care and prevention services);
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(2) coordinate, integrate, and provide linkages among providers of care, prevention, and other services for eligible persons in furtherance of the purposes of this title;
(3) provide supplemental services where such services are
not adequate or not available to eligible persons in the community and which are essential to the care of pregnant adolescents and to the prevention of adolescent premarital sexual relations and adolescent pregnancy;
(4) plan for the administration and coordination of pregnancy prevention services and programs of care for pregnant
adolescents and adolescent parents which will further the objectives of this title; and
(5) fulfill assurances required for grant approval by section
2006.
(b)(1) No funds provided for a demonstration project for services under this title may be used for the provision of family planning services (other than counseling and referral services) to adolescents unless appropriate family planning services are not otherwise available in the community.
(2) Any grantee who receives funds for a demonstration project
for services under this title and who, after determining under paragraph (1) that appropriate family planning services are not otherwise available in the community, provides family planning services
(other than counseling and referral services) to adolescents may
only use funds provided under this title for such family planning
services if all funds received by such grantee from all other sources
to support such family planning services are insufficient to support
such family planning services.
(c) Grantees who receive funds for a demonstration project for
services under this title shall charge fees for services pursuant to
a fee schedule approved by the Secretary as a part of the application described in section 2006 which bases fees charged by the
grantee on the income of the eligible person or the parents or legal
guardians of the eligible person and takes into account the difficulty adolescents face in obtaining resources to pay for services.
A grantee who receives funds for a demonstration project for services under this title may not, in any case, discriminate with regard
to the provision of services to any individual because of that individual’s inability to provide payment for such services, except that
in determining the ability of an unemancipated minor to provide
payment for services, the income of the family of an unemancipated
minor shall be considered in determining the ability of such minor
to make such payments unless the parents or guardians of the
unemancipated minor refuse to make such payments.
PRIORITIES, AMOUNTS, AND DURATION OF GRANTS FOR
DEMONSTRATION PROJECTS FOR SERVICES

SEC. 2005. ø300z–4¿ (a) In approving applications for grants
for demonstration projects for services under this title, the Secretary shall give priority to applicants who—
(1) serve an area where there is a high incidence of adolescent pregnancy;
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(2) serve an area with a high proportion of low-income
families and where the availability of programs of care for
pregnant adolescents and adolescent parents is low;
(3) show evidence—
(A) in the case of an applicant who will provide care
services, of having the ability to bring together a wide
range of needed core services and, as appropriate, supplemental services in comprehensive single-site projects, or to
establish a well-integrated network of such services (appropriate for the target population and geographic area to
be served including the special needs of rural areas) for
pregnant adolescents or adolescent parents; or
(B) in the case of an applicant who will provide prevention services, of having the ability to provide prevention services for adolescents and their families which are
appropriate for the target population and the geographic
area to be served, including the special needs of rural
areas;
(4) will utilize to the maximum extent feasible existing
available programs and facilities such as neighborhood and primary health care centers, maternity homes which provide or
can be equipped to provide services to pregnant adolescents,
agencies serving families, youth, and children with established
programs of service to pregnant adolescents and vulnerable
families, licensed adoption agencies, children and youth centers, maternal and infant health centers, regional rural health
facilities, school and other educational programs, mental
health programs, nutrition programs, recreation programs, and
other ongoing pregnancy prevention services and programs of
care for pregnant adolescents and adolescent parents;
(5) make use, to the maximum extent feasible, of other
Federal, State, and local funds, programs, contributions, and
other third-party reimbursements;
(6) can demonstrate a community commitment to the program by making available to the demonstration project nonFederal funds, personnel, and facilities;
(7) have involved the community to be served, including
public and private agencies, adolescents, and families, in the
planning and implementation of the demonstration project; and
(8) will demonstrate innovative and effective approaches in
addressing the problems of adolescent premarital sexual relations, pregnancy, or parenthood, including approaches to provide pregnant adolescents with adequate information about
adoption.
(b)(1) The amount of a grant for a demonstration project for
services under this title shall be determined by the Secretary,
based on factors such as the incidence of adolescent pregnancy in
the geographic area to be served, and the adequacy of pregnancy
prevention services and programs of care for pregnant adolescents
and adolescent parents in such area.
(2) In making grants for demonstration projects for services
under this title, the Secretary shall consider the special needs of
rural areas and, to the maximum extent practicable, shall disMarch 13, 2013

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tribute funds taking into consideration the relative number of adolescents in such areas in need of such services.
(c)(1) A grantee may not receive funds for a demonstration
project for services under this title for a period in excess of 5 years.
(2)(A) Subject to paragraph (3), a grant for a demonstration
project for services under this title may not exceed—
(i) 70 per centum of the costs of the project for the first
and second years of the project;
(ii) 60 per centum of such costs for the third year of the
project;
(iii) 50 per centum of such costs for the fourth year of the
project; and
(iv) 40 per centum of such costs for the fifth year of the
project.
(B) Non-Federal contributions required by subparagraph (A)
may be in cash or in kind, fairly evaluated, including plant, equipment, or services.
(3) The Secretary may waive the limitation specified in paragraph (2)(A) for any year in accordance with criteria established by
regulation.
REQUIREMENTS FOR APPLICATIONS

SEC. 2006. ø300z–5¿ (a) An application for a grant for a demonstration project for services under this title shall be in such form
and contain such information as the Secretary may require, and
shall include—
(1) an identification of the incidence of adolescent pregnancy and related problems;
(2) a description of the economic conditions and income
levels in the geographic area to be served;
(3) a description of existing pregnancy prevention services
and programs of care for pregnant adolescents and adolescent
parents (including adoption services), and including where,
how, by whom, and to which population groups such services
are provided, and the extent to which they are coordinated in
the geographic area to be served;
(4) a description of the major unmet needs for services for
adolescents at risk of initial or recurrent pregnancies and an
estimate of the number of adolescents not being served in the
area;
(5)(A) in the case of an applicant who will provide care
services, a description of how all core services will be provided
in the demonstration project using funds under this title or
will otherwise be provided by the grantee in the area to be
served, the population to which such services will be provided,
how such services will be coordinated, integrated, and linked
with other related programs and services and the source or
sources of funding of such core services in the public and private sectors; or
(B) in the case of an applicant who will provide prevention
services, a description of the necessary services to be provided
and how the applicant will provide such services;
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(6) a description of the manner in which adolescents needing services other than the services provided directly by the applicant will be identified and how access and appropriate referral to such other services (such as medicaid; licensed adoption
agencies; maternity home services; public assistance; employment services; child care services for adolescent parents; and
other city, county, and State programs related to adolescent
pregnancy) will be provided, including a description of a plan
to coordinate such other services with the services supported
under this title;
(7) a description of the applicant’s capacity to continue
services as Federal funds decrease and in the absence of Federal assistance;
(8) a description of the results expected from the provision
of services, and the procedures to be used for evaluating those
results;
(9) a summary of the views of public agencies, providers of
services, and the general public in the geographic area to be
served, concerning the proposed use of funds provided for a
demonstration project for services under this title and a description of procedures used to obtain those views, and, in the
case of applicants who propose to coordinate services administered by a State, the written comments of the appropriate
State officials responsible for such services;
(10) assurances that the applicant will have an ongoing
quality assurance program;
(11) assurances that, where appropriate, the applicant
shall have a system for maintaining the confidentiality of patient records in accordance with regulations promulgated by
the Secretary;
(12) assurances that the applicant will demonstrate its financial responsibility by the use of such accounting procedures
and other requirements as may be prescribed by the Secretary;
(13) assurances that the applicant (A) has or will have a
contractual or other arrangement with the agency of the State
(in which the applicant provides services) that administers or
supervises the administration of a State plan approved under
title XIX of the Social Security Act for the payment of all or
a part of the applicant’s costs in providing health services to
persons who are eligible for medical assistance under such a
State plan, or (B) has made or will make every reasonable effort to enter into such an arrangement;
(14) assurances that the applicant has made or will make
and will continue to make every reasonable effort to collect appropriate reimbursement for its costs in providing health services to persons who are entitled to benefits under title V of the
Social Security Act, to medical assistance under a State plan
approved under title XIX of such Act, or to assistance for medical expenses under any other public assistance program or private health insurance program;
(15) assurances that the applicant has or will make and
will continue to make every reasonable effort to collect appropriate reimbursement for its costs in providing services to perMarch 13, 2013

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sons entitled to services under parts B and E of title IV and
title XX of the Social Security Act;
(16)(A) a description of—
(i) the schedule of fees to be used in the provision of
services, which shall comply with section 2004(c) and
which shall be designed to cover all reasonable direct and
indirect costs incurred by the applicant in providing services; and
(ii) a corresponding schedule of discounts to be applied
to the payment of such fees, which shall comply with section 2004(c) and which shall be adjusted on the basis of
the ability of the eligible person to pay;
(B) assurances that the applicant has made and will continue to make every reasonable effort—
(i) to secure from eligible persons payment for services
in accordance with such schedules;
(ii) to collect reimbursement for health or other services provided to persons who are entitled to have payment
made on their behalf for such services under any Federal
or other government program or private insurance program; and
(iii) to seek such reimbursement on the basis of the
full amount of fees for services without application of any
discount; and
(C) assurances that the applicant has submitted or will
submit to the Secretary such reports as the Secretary may require to determine compliance with this paragraph;
(17) assurances that the applicant will make maximum
use of funds available under title X of this Act;
(18) assurances that the acceptance by any individual of
family planning services or family planning information (including educational materials) provided through financial assistance under this title shall be voluntary and shall not be a
prerequisite to eligibility for or receipt of any other service furnished by the applicant;
(19) assurances that fees collected by the applicant for
services rendered in accordance with this title shall be used by
the applicant to further the purposes of this title;
(20) assurances that the applicant, if providing both prevention and care services will not exclude or discriminate
against any adolescent who receives prevention services and
subsequently requires care services as a pregnant adolescent;
(21) a description of how the applicant will, as appropriate
in the provision of services—
(A) involve families of adolescents in a manner which
will maximize the role of the family in the solution of problems relating to the parenthood or pregnancy of the adolescent;
(B) involve religious and charitable organizations, voluntary associations, and other groups in the private sector
as well as services provided by publicly sponsored initiatives;
(22)(A) assurances that—
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(i) except as provided in subparagraph (B) and subject
to clause (ii), the applicant will notify the parents or
guardians of any unemancipated minor requesting services
from the applicant and, except as provided in subparagraph (C), will obtain the permission of such parents or
guardians with respect to the provision of such services;
and
(ii) in the case of a pregnant unemancipated minor requesting services from the applicant, the applicant will notify the parents or guardians of such minor under clause
(i) within a reasonable period of time;
(B) assurances that the applicant will not notify or request
the permission of the parents or guardian of any
unemancipated minor without the consent of the minor—
(i) who solely is requesting from the applicant pregnancy testing or testing or treatment for venereal disease;
(ii) who is the victim of incest involving a parent; or
(iii) if an adult sibling of the minor or an adult aunt,
uncle, or grandparent who is related to the minor by blood
certifies to the grantee that notification of the parents or
guardians of such minor would result in physical injury to
such minor; and
(C) assurances that the applicant will not require, with respect to the provision of services, the permission of the parents
or guardians of any pregnant unemancipated minor if such
parents or guardians are attempting to compel such minor to
have an abortion;
(23) assurances that primary emphasis for services supported under this title shall be given to adolescents seventeen
and under who are not able to obtain needed assistance
through other means;
(24) assurances that funds received under this title shall
supplement and not supplant funds received from any other
Federal, State, or local program or any private sources of
funds; and
(25) a plan for the conduct of, and assurances that the applicant will conduct, evaluations of the effectiveness of the
services supported under this title in accordance with subsection (b).
(b)(1) Each grantee which receives funds for a demonstration
project for services under this title shall expend at least 1 per centum but not in excess of 5 per centum of the amounts received
under this title for the conduct of evaluations of the services supported under this title. The Secretary may, for a particular grantee
upon good cause shown, waive the provisions of the preceding sentence with respect to the amounts to be expended on evaluations,
but may not waive the requirement that such evaluations be conducted.
(2) Evaluations required by paragraph (1) shall be conducted
by an organization or entity which is independent of the grantee
providing services supported under this title. To assist in conducting the evaluations required by paragraph (1), each grantee
shall develop a working relationship with a college or university located in the grantee’s State which will provide or assist in proMarch 13, 2013

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viding monitoring and evaluation of services supported under this
title unless no college or university in the grantee’s State is willing
or has the capacity to provide or assist in providing such monitoring and assistance.
(3) The Secretary may provide technical assistance with respect to the conduct of evaluations required under this subsection
to any grantee which is unable to develop a working relationship
with a college or university in the applicant’s State for the reasons
described in paragraph (2).
(c) Each grantee which receives funds for a demonstration
project for services under this title shall make such reports concerning its use of Federal funds as the Secretary may require. Reports shall include, at such times as are considered appropriate by
the Secretary, the results of the evaluations of the services supported under this title.
(d)(1) A grantee shall periodically notify the Secretary of the
exact number of instances in which a grantee does not notify the
parents or guardians of a pregnant unemancipated minor under
subsection (a)(22)(B)(iii).
(2) For purposes of subsection (a)(22)(B)(iii), the term ‘‘adult’’
means an adult as defined by State law.
(e) Each applicant shall provide the Governor of the State in
which the applicant is located a copy of each application submitted
to the Secretary for a grant for a demonstration project for services
under this title. The Governor shall submit to the applicant comments on any such application within the period of sixty days beginning on the day when the Governor receives such copy. The applicant shall include the comments of the Governor with such application.
(f) No application submitted for a grant for a demonstration
project for care services under this title may be approved unless
the Secretary is satisfied that core services shall be available
through the applicant within a reasonable time after such grant is
received.
COORDINATION OF FEDERAL AND STATE PROGRAMS

SEC. 2007. ø300z–6¿ (a) The Secretary shall coordinate Federal
policies and programs providing services relating to the prevention
of adolescent sexual relations and initial and recurrent adolescent
pregnancies and providing care services for pregnant adolescents.
In achieving such coordination, the Secretary shall—
(1) require grantees who receive funds for demonstration
projects for services under this title to report periodically to the
Secretary concerning Federal, State, and local policies and programs that interfere with the delivery of and coordination of
pregnancy prevention services and other programs of care for
pregnant adolescents and adolescent parents;
(2) provide technical assistance to facilitate coordination by
State and local recipients of Federal assistance;
(3) review all programs administered by the Department of
Health and Human Services which provide prevention services
or care services to determine if the policies of such programs
are consistent with the policies of this title, consult with other
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Sec. 2008

departments and agencies of the Federal Government who administer programs that provide such services, and encourage
such other departments and agencies to make recommendations, as appropriate, for legislation to modify such programs
in order to facilitate the use of all Government programs which
provide such services as a basis for delivery of more comprehensive prevention services and more comprehensive programs of care for pregnant adolescents and adolescent parents;
(4) give priority in the provision of funds, where appropriate, to applicants using single or coordinated grant applications for multiple programs; and
(5) give priority, where appropriate, to the provision of
funds under Federal programs administered by the Secretary
(other than the program established by this title) to projects
providing comprehensive prevention services and comprehensive programs of care for pregnant adolescents and adolescent
parents.
(b) Any recipient of a grant for a demonstration project for
services under this title shall coordinate its activities with any
other recipient of such a grant which is located in the same locality.
RESEARCH

SEC. 2008. ø300z–7¿ (a)(1) The Secretary may make grants
and enter into contracts with public agencies or private organizations or institutions of higher education to support the research
and dissemination activities described in paragraphs (4), (5), and
(6) of section 2001(b).
(2) The Secretary may make grants or enter into contracts
under this section for a period of one year. A grant or contract
under this section for a project may be renewed for four additional
one-year periods, which need not be consecutive.
(3) A grant or contract for any one-year period under this section may not exceed $100,000 for the direct costs of conducting research or disemination 1 activities under this section and may include such additional amounts for the indirect costs of conducting
such activities as the Secretary determines appropriate. The Secretary may waive the preceding sentence with respect to a specific
project if he determines that—
(A) exceptional circumstances warrant such waiver and
that the project will have national impact; or
(B) additional amounts are necessary for the direct costs of
conducting limited demonstration projects for the provision of
necessary services in order to provide data for research carried
out under this title.
(4) The amount of any grant or contract made under this section may remain available for obligation or expenditure after the
close of the one-year period for which such grant or contract is
made in order to assist the recipient in preparing the report required by subsection (f)(1).
(b)(1) Funds provided for research under this section may be
used for descriptive or explanatory surveys, longitudinal studies, or
1 So

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in law. Probably should be ‘‘dissemination’’.

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limited demonstration projects for services that are for the purpose
of increasing knowledge and understanding of the matters described in paragraphs (4) and (5) of section 2001(b).
(2) Funds provided under this section may not be used for the
purchase or improvement of land, or the purchase, construction, or
permanent improvement (other than minor remodeling) of any
building or facility.
(c) The Secretary may not make any grant or enter into any
contract to support research or dissemination activities under this
section unless—
(1) the Secretary has received an application for such
grant or contract which is in such form and which contains
such information as the Secretary may by regulation require;
(2) the applicant has demonstrated that the applicant is
capable of conducting one or more of the types of research or
dissemination activities described in paragraph (4), (5), or (6)
of section 2001(b); and
(3) in the case of an application for a research project, the
panel established by subsection (e)(2) has determined that the
project is of scientific merit.
(d) The Secretary shall, where appropriate, coordinate research
and dissemination activities carried out under this section with research and dissemination activities carried out by the National Institutes of Health.
(e)(1) The Secretary shall establish a system for the review of
applications for grants and contracts under this section. Such system shall be substantially similar to the system for scientific peer
review of the National Institutes of Health and shall meet the requirements of paragraphs (2) and (3).
(2) In establishing the system required by paragraph (1), the
Secretary shall establish a panel to review applications under this
section. Not more than 25 per centum of the members of the panel
shall be physicians. The panel shall meet as often as may be necessary to facilitate the expeditious review of applications under this
section, but not less than once each year. The panel shall review
each project for which an application is made under this section,
evaluate the scientific merit of the project, determine whether the
project is of scientific merit, and make recommendations to the Secretary concerning whether the application for the project should be
approved.
(3) The Secretary shall make grants under this section from
among the projects which the panel established by paragraph (2)
has determined to be of scientific merit and may only approve an
application for a project if the panel has made such determination
with respect to such a project. The Secretary shall make a determination with respect to an application within one month after receiving the determinations and recommendations of such panel
with respect to the application.
(f)(1)(A) The recipient of a grant or contract for a research
project under this section shall prepare and transmit to the Secretary a report describing the results and conclusions of such research. Except as provided in subparagraph (B), such report shall
be transmitted to the Secretary not later than eighteen months
after the end of the year for which funds are provided under this
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Sec. 2011

section. The recipient may utilize reprints of articles published or
accepted for publication in professional journals to supplement or
replace such report if the research contained in such articles was
supported under this section during the year for which the report
is required.
(B) In the case of any research project for which assistance is
provided under this section for two or more consecutive one-year
periods, the recipient of such assistance shall prepare and transmit
the report required by subparagraph (A) to the Secretary not later
than twelve months after the end of each one-year period for which
such funding is provided.
(2) Recipients of grants and contracts for dissemination under
this section shall submit to the Secretary such reports as the Secretary determines appropriate.
EVALUATION AND ADMINISTRATION

SEC. 2009. ø300z–8¿ (a) Of the funds appropriated under this
title, the Secretary shall reserve not less than 1 per centum and
not more than 3 per centum for the evaluation of activities carried
out under this title. The Secretary shall submit to the appropriate
committees of the Congress a summary of each evaluation conducted under this section.
(b) The officer or employee of the Department of Health and
Human Services designated by the Secretary to carry out the provisions of this title shall report directly to the Assistant Secretary for
Health with respect to the activities of such officer or employee in
carrying out such provisions.
AUTHORIZATION OF APPROPRIATIONS

SEC. 2010. ø300z–9¿ (a) For the purpose of carrying out this
title, there are authorized to be appropriated $30,000,000 for the
fiscal year ending September 30, 1982, $30,000,000 for the fiscal
year ending September 30, 1983, $30,000,000 for the fiscal year
ending September 30, 1984, and $30,000,000 for the fiscal year
ending September 30, 1985.
(b) At least two-thirds of the amounts appropriated to carry
out this title shall be used to make grants for demonstration
projects for services.
(c) Not more than one-third of the amounts specified under
subsection (b) for use for grants for demonstration projects for services shall be used for grants for demonstration projects for prevention services.
RESTRICTIONS

SEC. 2011. ø300z–10¿ (a) Grants or payments may be made
only to programs or projects which do not provide abortions or
abortion counseling or referral, or which do not subcontract with or
make any payment to any person who provides abortions or abortion counseling or referral, except that any such program or project
may provide referral for abortion counseling to a pregnant adolescent if such adolescent and the parents or guardians of such adolescent request such referral; and grants may be made only to projects
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or programs which do not advocate, promote, or encourage abortion.
(b) The Secretary shall ascertain whether programs or projects
comply with subsection (a) and take appropriate action if programs
or projects do not comply with such subsection, including withholding of funds.

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TITLE XXI—VACCINES
Subtitle 1—National Vaccine Program
ESTABLISHMENT

SEC. 2101. ø300aa–1¿ The Secretary shall establish in the Department of Health and Human Services a National Vaccine Program to achieve optimal prevention of human infectious diseases
through immunization and to achieve optimal prevention against
adverse reactions to vaccines. The Program shall be administered
by a Director selected by the Secretary.
PROGRAM RESPONSIBILITIES

SEC. 2102. ø300aa–2¿ (a) The Director of the Program shall
have the following responsibilities:
(1) VACCINE RESEARCH.—The Director of the Program
shall, through the plan issued under section 2103, coordinate
and provide direction for research carried out in or through the
National Institutes of Health, the Centers for Disease Control
and Prevention, the Office of Biologics Research and Review of
the Food and Drug Administration, the Department of Defense,
and the Agency for International Development on means to induce human immunity against naturally occurring infectious
diseases and to prevent adverse reactions to vaccines.
(2) VACCINE DEVELOPMENT.—The Director of the Program
shall, through the plan issued under section 2103, coordinate
and provide direction for activities carried out in or through
the National Institutes of Health, the Office of Biologics Research and Review of the Food and Drug Administration, the
Department of Defense, and the Agency for International Development to develop the techniques needed to produce safe
and effective vaccines.
(3) SAFETY AND EFFICACY TESTING OF VACCINES.—The Director of the Program shall, through the plan issued under section 2103, coordinate and provide direction for safety and efficacy testing of vaccines carried out in or through the National
Institutes of Health, the Centers for Disease Control and Prevention, the Office of Biologics Research and Review of the
Food and Drug Administration, the Department of Defense,
and the Agency for International Development.
(4) LICENSING OF VACCINE MANUFACTURERS AND VACCINES.—The Director of the Program shall, through the plan
issued under section 2103, coordinate and provide direction for
the allocation of resources in the implementation of the licensing program under section 353.
(5) PRODUCTION AND PROCUREMENT OF VACCINES.—The Director of the Program shall, through the plan issued under sec1187
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tion 2103, ensure that the governmental and non-governmental
production and procurement of safe and effective vaccines by
the Public Health Service, the Department of Defense, and the
Agency for International Development meet the needs of the
United States population and fulfill commitments of the
United States to prevent human infectious diseases in other
countries.
(6) DISTRIBUTION AND USE OF VACCINES.—The Director of
the Program shall, through the plan issued under section 2103,
coordinate and provide direction to the Centers for Disease
Control and Prevention and assistance to States, localities, and
health practitioners in the distribution and use of vaccines, including efforts to encourage public acceptance of immunizations and to make health practitioners and the public aware of
potential adverse reactions and contraindications to vaccines.
(7) EVALUATING THE NEED FOR AND THE EFFECTIVENESS
AND ADVERSE EFFECTS OF VACCINES AND IMMUNIZATION ACTIVITIES.—The Director of the Program shall, through the plan
issued under section 2103, coordinate and provide direction to
the National Institutes of Health, the Centers for Disease Control and Prevention, the Office of Biologics Research and Review of the Food and Drug Administration, the National Center for Health Statistics, the National Center for Health Services Research and Health Care Technology Assessment, and
the Centers for Medicare & Medicaid Services in monitoring
the need for and the effectiveness and adverse effects of vaccines and immunization activities.
(8) COORDINATING GOVERNMENTAL AND NON-GOVERNMENTAL ACTIVITIES.—The Director of the Program shall,
through the plan issued under section 2103, provide for the exchange of information between Federal agencies involved in
the implementation of the Program and non-governmental entities engaged in the development and production of vaccines
and in vaccine research and encourage the investment of nongovernmental resources complementary to the governmental
activities under the Program.
(9) FUNDING OF FEDERAL AGENCIES.—The Director of the
Program shall make available to Federal agencies involved in
the implementation of the plan issued under section 2103
funds appropriated under section 2106 to supplement the
funds otherwise available to such agencies for activities under
the plan.
(b) In carrying out subsection (a) and in preparing the plan
under section 2103, the Director shall consult with all Federal
agencies involved in research on and development, testing, licensing, production, procurement, distribution, and use of vaccines.
PLAN

SEC. 2103. ø300aa–3¿ The Director of the Program shall prepare and issue a plan for the implementation of the responsibilities
of the Director under section 2102. The plan shall establish priorities in research and the development, testing, licensing, production, procurement, distribution, and effective use of vaccines, describe an optimal use of resources to carry out such priorities, and
March 13, 2013

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Sec. 2110

describe how each of the various departments and agencies will
carry out their vaccine functions in consultation and coordination
with the Program and in conformity with such priorities. The first
plan under this section shall be prepared not later than January
1, 1987, and shall be revised not later than January 1 of each succeeding year.
NATIONAL VACCINE ADVISORY COMMITTEE

SEC. 2105. 1 ø300aa–5¿ (a) There is established the National
Vaccine Advisory Committee. The members of the Committee shall
be appointed by the Director of the Program, in consultation with
the National Academy of Sciences, from among individuals who are
engaged in vaccine research or the manufacture of vaccines or who
are physicians, members of parent organizations concerned with
immunizations, or representatives of State or local health agencies
or public health organizations.
(b) The Committee shall—
(1) study and recommend ways to encourage the availability of an adequate supply of safe and effective vaccination
products in the States,
(2) recommend research priorities and other measures the
Director of the Program should take to enhance the safety and
efficacy of vaccines,
(3) advise the Director of the Program in the implementation of sections 2102, 2103, and 2104 1, and
(4) identify annually for the Director of the Program the
most important areas of government and non-government cooperation that should be considered in implementing sections
2102, 2103, and 2104 1.
AUTHORIZATIONS

SEC. 2106. ø300aa–6¿ (a) To carry out this subtitle other than
section 2102(9) there are authorized to be appropriated such sums
as may be necessary for each of the fiscal years 2004 and 2005.
(b) To carry out section 2102(9) there are authorized to be appropriated such sums as may be necessary for each of the fiscal
years 2004 and 2005.
Subtitle 2—National Vaccine Injury Compensation Program
PART A—PROGRAM REQUIREMENTS
ESTABLISHMENT OF PROGRAM

SEC. 2110. ø300aa–10¿ (a) PROGRAM ESTABLISHED.—There is
established the National Vaccine Injury Compensation Program to
be administered by the Secretary under which compensation may
be paid for a vaccine-related injury or death.
(b) ATTORNEY’S OBLIGATION.—It shall be the ethical obligation
of any attorney who is consulted by an individual with respect to
a vaccine-related injury or death to advise such individual that
compensation may be available under the program for such injury
or death.
1 Section

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2104 was repealed by section 601(a)(1)(H) of Public Law 105–362.

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(c) PUBLICITY.—The Secretary shall undertake reasonable efforts to inform the public of the availability of the Program.
PETITIONS FOR COMPENSATION

SEC. 2111. ø300aa–11¿ (a) GENERAL RULE.—
(1) A proceeding for compensation under the Program for
a vaccine-related injury or death shall be initiated by service
upon the Secretary and the filing of a petition containing the
matter prescribed by subsection (c) with the United States
Claims Court. The clerk of the United States Claims Court
shall immediately forward the filed petition to the chief special
master for assignment to a special master under section
2112(d)(1).
(2)(A) No person may bring a civil action for damages in
an amount greater than $1,000 or in an unspecified amount
against a vaccine administrator or manufacturer in a State or
Federal court for damages arising from a vaccine-related injury
or death associated with the administration of a vaccine after
the effective date of this part, and no such court may award
damages in an amount greater than $1,000 in a civil action for
damages for such a vaccine-related injury or death,
unless a petition has been filed, in accordance with section
2116, for compensation under the Program for such injury or
death and—
(i)(I) the United States Claims Court has issued a
judgment under section 2112 on such petition, and
(II) such person elects under section 2121(a) to file such an
action, or
(ii) such person elects to withdraw such petition under
section 2121(b) or such petition is considered withdrawn
under such section.
(B) If a civil action which is barred under subparagraph
(A) is filed in a State or Federal court, the court shall dismiss
the action. If a petition is filed under this section with respect
to the injury or death for which such civil action was brought,
the date such dismissed action was filed shall, for purposes of
the limitations of actions prescribed by section 2116, be considered the date the petition was filed if the petition was filed
within one year of the date of the dismissal of the civil action.
(3) No vaccine administrator or manufacturer may be
made a party to a civil action (other than a civil action which
may be brought under paragraph (2)) for damages for a vaccine-related injury or death associated with the administration
of a vaccine after the effective date of this part. 1
(4) If in a civil action brought against a vaccine administrator or manufacturer before the effective date of this part 1
damages were denied for a vaccine-related injury or death or
if such civil action was dismissed with prejudice, the person
who brought such action may file a petition under subsection
(b) for such injury or death.
(5)(A) A plaintiff who on the effective date of this part 1
has pending a civil action for damages for a vaccine-related injury or death may, at any time within 2 years after the effecMarch 13, 2013

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Sec. 2111

tive date of this part 1 or before judgment, whichever occurs
first, petition to have such action dismissed without prejudice
or costs and file a petition under subsection (b) for such injury
or death.
(B) If a plaintiff has pending a civil action for damages for
a vaccine-related injury or death, such person may not file a
petition under subsection (b) for such injury or death.
(6) If a person brings a civil action after November 15,
1988 2 for damages for a vaccine-related injury or death associated with the administration of a vaccine before November 15,
1988, such person may not file a petition under subsection (b)
for such injury or death.
(7) If in a civil action brought against a vaccine administrator or manufacturer for a vaccine-related injury or death
damages are awarded under a judgment of a court or a settlement of such action, the person who brought such action may
not file a petition under subsection (b) for such injury or death.
(8) If on the effective date of this part there was pending
an appeal or rehearing with respect to a civil action brought
against a vaccine administrator or manufacturer and if the
outcome of the last appellate review of such action or the last
rehearing of such action is the denial of damages for a vaccinerelated injury or death, the person who brought such action
may file a petition under subsection (b) for such injury or
death.
(9) This subsection applies only to a person who has sustained a vaccine-related injury or death and who is qualified
to file a petition for compensation under the Program.
(10) The Clerk of the United States Claims Court is authorized to continue to receive, and forward, petitions for compensation for a vaccine-related injury or death associated with
the administration of a vaccine on or after October 1, 1992.
(b) PETITIONERS.—
(1)(A) Except as provided in subparagraph (B), any person
who has sustained a vaccine-related injury, the legal representative of such person if such person is a minor or is disabled,
or the legal representative of any person who died as the result
of the administration of a vaccine set forth in the Vaccine Injury Table may, if the person meets the requirements of subsection (c)(1), file a petition for compensation under the Program.
(B) No person may file a petition for a vaccine-related injury or death associated with a vaccine administered before the
effective date of this part if compensation has been paid under
this subtitle for 3500 petitions for such injuries or deaths.
(2) Only one petition may be filed with respect to each administration of a vaccine.
(c) PETITION CONTENT.—A petition for compensation under the
Program for a vaccine-related injury or death shall contain—
1 Effective
2 So

March 13, 2013

October 1, 1988.
in law. Probably should be followed by a comma.

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(1) except as provided in paragraph (3), an affidavit, and
supporting documentation, demonstrating that the person who
suffered such injury or who died—
(A) received a vaccine set forth in the Vaccine Injury
Table or, if such person did not receive such a vaccine, contracted polio, directly or indirectly, from another person
who received an oral polio vaccine,
(B)(i) if such person received a vaccine set forth in the
Vaccine Injury Table—
(I) received the vaccine in the United States or in
its trust territories,
(II) received the vaccine outside the United States
or a trust territory and at the time of the vaccination
such person was a citizen of the United States serving
abroad as a member of the Armed Forces or otherwise
as an employee of the United States or a dependent of
such a citizen, or
(III) received the vaccine outside the United
States or a trust territory and the vaccine was manufactured by a vaccine manufacturer located in the
United States and such person returned to the United
States not later than 6 months after the date of the
vaccination,
(ii) if such person did not receive such a vaccine but
contracted polio from another person who received an oral
polio vaccine, was a citizen of the United States or a dependent of such a citizen,
(C)(i) sustained, or had significantly aggravated, any
illness, disability, injury, or condition set forth in the Vaccine Injury Table in association with the vaccine referred
to in subparagraph (A) or died from the administration of
such vaccine, and the first symptom or manifestation of
the onset or of the significant aggravation of any such illness, disability, injury, or condition or the death occurred
within the time period after vaccine administration set
forth in the Vaccine Injury Table, or
(ii)(I) sustained, or had significantly aggravated, any
illness, disability, injury, or condition not set forth in the
Vaccine Injury Table but which was caused by a vaccine
referred to in subparagraph (A), or
(II) sustained, or had significantly aggravated, any illness, disability, injury, or condition set forth in the Vaccine Injury Table the first symptom or manifestation of the
onset or significant aggravation of which did not occur
within the time period set forth in the Table but which
was caused by a vaccine referred to in subparagraph (A),
(D)(i) suffered the residual effects or complications of
such illness, disability, injury, or condition for more than
6 months after the administration of the vaccine, or (ii)
died from the administration of the vaccine, or (iii) suffered such illness, disability, injury, or condition from the
vaccine which resulted in inpatient hospitalization and
surgical intervention, and
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PUBLIC HEALTH SERVICE ACT

Sec. 2112

(E) has not previously collected an award or settlement of a civil action for damages for such vaccine-related
injury or death,
(2) except as provided in paragraph (3), maternal prenatal
and delivery records, newborn hospital records (including all
physicians’ and nurses’ notes and test results), vaccination
records associated with the vaccine allegedly causing the injury, pre- and post-injury physician or clinic records (including
all relevant growth charts and test results), all post-injury inpatient and outpatient records (including all provider notes,
test results, and medication records), if applicable, a death certificate, and if applicable, autopsy results, and
(3) an identification of any records of the type described in
paragraph (1) or (2) which are unavailable to the petitioner
and the reasons for their unavailability.
(d) ADDITIONAL INFORMATION.—A petition may also include
other available relevant medical records relating to the person who
suffered such injury or who died from the administration of the
vaccine.
(e) SCHEDULE.—The petitioner shall submit in accordance with
a schedule set by the special master assigned to the petition assessments, evaluations, and prognoses and such other records and documents as are reasonably necessary for the determination of the
amount of compensation to be paid to, or on behalf of, the person
who suffered such injury or who died from the administration of
the vaccine.
JURISDICTION

SEC. 2112. ø300aa–12¿ (a) GENERAL RULE.—The United States
Claims Court and the United States Claims Court special masters
shall, in accordance with this section, have jurisdiction over proceedings to determine if a petitioner under section 2111 is entitled
to compensation under the Program and the amount of such compensation. The United States Claims Court may issue and enforce
such orders as the court deems necessary to assure the prompt
payment of any compensation awarded.
(b) PARTIES.—
(1) In all proceedings brought by the filing of a petition
under section 2111(b), the Secretary shall be named as the respondent, shall participate, and shall be represented in accordance with section 518(a) of title 28, United States Code.
(2) Within 30 days after the Secretary receives service of
any petition filed under section 2111 the Secretary shall publish notice of such petition in the Federal Register. The special
master designated with respect to such petition under subsection (c) shall afford all interested persons an opportunity to
submit relevant, written information—
(A) relating to the existence of the evidence described
in section 2113(a)(1)(B), or
(B) relating to any allegation in a petition with respect
to the matters described in section 2111(c)(1)(C)(ii).
(c) UNITED STATES CLAIMS COURT SPECIAL MASTERS.—
(1) There is established within the United States Claims
Court an office of special masters which shall consist of not
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more than 8 special masters. The judges of the United States
Claims Court shall appoint the special masters, 1 of whom, by
designation of the judges of the United States Claims Court,
shall serve as chief special master. The appointment and reappointment of the special masters shall be by the concurrence
of a majority of the judges of the court.
(2) The chief special master and other special masters
shall be subject to removal by the judges of the United States
Claims Court for incompetency, misconduct, or neglect of duty
or for physical or mental disability or for other good cause
shown.
(3) A special master’s office shall be terminated if the
judges of the United States Claims Court determine, upon advice of the chief special master, that the services performed by
that office are no longer needed.
(4) The appointment of any individual as a special master
shall be for a term of 4 years, subject to termination under
paragraphs (2) and (3). Individuals serving as special masters
upon the date of the enactment of this subsection shall serve
for 4 years from the date of their original appointment, subject
to termination under paragraphs (2) and (3). The chief special
master in office on the date of the enactment of this subsection
shall continue to serve as chief special master for the balance
of the master’s term, subject to termination under paragraphs
(2) and (3).
(5) The compensation of the special masters shall be determined by the judges of the United States Claims Court, upon
advice of the chief special master. The salary of the chief special master shall be the annual rate of basic pay for level IV
of the Executive Schedule, as prescribed by section 5315, title
5, United States Code. The salaries of the other special masters shall not exceed the annual rate of basic pay of level V of
the Executive Schedule, as prescribed by section 5316, title 5,
United States Code.
(6) The chief special master shall be responsible for the following:
(A) Administering the office of special masters and
their staff, providing for the efficient, expeditious, and effective handling of petitions, and performing such other
duties related to the Program as may be assigned to the
chief special master by a concurrence of a majority of the
United States Claims Courts 1 judges.
(B) Appointing and fixing the salary and duties of
such administrative staff as are necessary. Such staff shall
be subject to removal for good cause by the chief special
master.
(C) Managing and executing all aspects of budgetary
and administrative affairs affecting the special masters
and their staff, subject to the rules and regulations of the
Judicial Conference of the United States. The Conference
rules and regulations pertaining to United States magistrates shall be applied to the special masters.
1 So

March 13, 2013

in law. Probably should be ‘‘United States Court of Federal Claims’’.

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Sec. 2112

(D) Coordinating with the United States Claims Court
the use of services, equipment, personnel, information, and
facilities of the United States Claims Court without reimbursement.
(E) Reporting annually to the Congress and the judges
of the United States Claims Court on the number of petitions filed under section 2111 and their disposition, the
dates on which the vaccine-related injuries and deaths for
which the petitions were filed occurred, the types and
amounts of awards, the length of time for the disposition
of petitions, the cost of administering the Program, and
recommendations for changes in the Program.
(d) SPECIAL MASTERS.—
(1) Following the receipt and filing of a petition under section 2111, the clerk of the United States Claims Court shall
forward the petition to the chief special master who shall designate a special master to carry out the functions authorized
by paragraph (3).
(2) The special masters shall recommend rules to the
Claims Court and, taking into account such recommended
rules, the Claims Court shall promulgate rules pursuant to section 2071 of title 28, United States Code. Such rules shall—
(A) provide for a less-adversarial, expeditious, and informal proceeding for the resolution of petitions,
(B) include flexible and informal standards of admissibility of evidence,
(C) include the opportunity for summary judgment,
(D) include the opportunity for parties to submit arguments and evidence on the record without requiring routine use of oral presentations, cross examinations, or hearings, and
(E) provide for limitations on discovery and allow the
special masters to replace the usual rules of discovery in
civil actions in the United States Claims Court.
(3)(A) A special master to whom a petition has been assigned shall issue a decision on such petition with respect to
whether compensation is to be provided under the Program
and the amount of such compensation. The decision of the special master shall—
(i) include findings of fact and conclusions of law, and
(ii) be issued as expeditiously as practicable but not
later than 240 days, exclusive of suspended time under
subparagraph (C), after the date the petition was filed.
The decision of the special master may be reviewed by the
United States Claims Court in accordance with subsection (e).
(B) In conducting a proceeding on a petition a special master—
(i) may require such evidence as may be reasonable
and necessary,
(ii) may require the submission of such information as
may be reasonable and necessary,
(iii) may require the testimony of any person and the
production of any documents as may be reasonable and
necessary,
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1196

(iv) shall afford all interested persons an opportunity
to submit relevant written information—
(I) relating to the existence of the evidence described in section 2113(a)(1)(B), or
(II) relating to any allegation in a petition with respect to the matters described in section
2111(c)(1)(C)(ii), and
(v) may conduct such hearings as may be reasonable
and necessary.
There may be no discovery in a proceeding on a petition other
than the discovery required by the special master.
(C) In conducting a proceeding on a petition a special master shall suspend the proceedings one time for 30 days on the
motion of either party. After a motion for suspension is granted, further motions for suspension by either party may be
granted by the special master, if the special master determines
the suspension is reasonable and necessary, for an aggregate
period not to exceed 150 days.
(D) If, in reviewing proceedings on petitions for vaccine-related injuries or deaths associated with the administration of
vaccines before the effective date of this part, the chief special
master determines that the number of filings and resultant
workload place an undue burden on the parties or the special
master involved in such proceedings, the chief special master
may, in the interest of justice, suspend proceedings on any petition for up to 30 months (but for not more than 6 months at
a time) in addition to the suspension time under subparagraph
(C).
(4)(A) Except as provided in subparagraph (B), information
submitted to a special master or the court in a proceeding on
a petition may not be disclosed to a person who is not a party
to the proceeding without the express written consent of the
person who submitted the information.
(B) A decision of a special master or the court in a proceeding shall be disclosed, except that if the decision is to include information—
(i) which is trade secret or commercial or financial information which is privileged and confidential, or
(ii) which are medical files and similar files the disclosure of which would constitute a clearly unwarranted invasion of privacy,
and if the person who submitted such information objects to
the inclusion of such information in the decision, the decision
shall be disclosed without such information.
(e) ACTION BY THE UNITED STATES CLAIMS COURT.—
(1) Upon issuance of the special master’s decision, the parties shall have 30 days to file with the clerk of the United
States Claims Court a motion to have the court review the decision. If such a motion is filed, the other party shall file a response with the clerk of the United States Claims Court no
later than 30 days after the filing of such motion.
(2) Upon the filing of a motion under paragraph (1) with
respect to a petition, the United States Claims Court shall
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PUBLIC HEALTH SERVICE ACT

Sec. 2112

have jurisdiction to undertake a review of the record of the
proceedings and may thereafter—
(A) uphold the findings of fact and conclusions of law
of the special master and sustain the special master’s decision,
(B) set aside any findings of fact or conclusion of law
of the special master found to be arbitrary, capricious, an
abuse of discretion, or otherwise not in accordance with
law and issue its own findings of fact and conclusions of
law, or
(C) remand the petition to the special master for further action in accordance with the court’s direction.
The court shall complete its action on a petition within 120
days of the filing of a response under paragraph (1) excluding
any days the petition is before a special master as a result of
a remand under subparagraph (C). The court may allow not
more than 90 days for remands under subparagraph (C).
(3) In the absence of a motion under paragraph (1) respecting the special master’s decision or if the United States Claims
Court takes the action described in paragraph (2)(A) with respect to the special master’s decision, the clerk of the United
States Claims Court shall immediately enter judgment in accordance with the special master’s decision.
(f) APPEALS.—The findings of fact and conclusions of law of the
United States Claims Court on a petition shall be final determinations of the matters involved, except that the Secretary or any petitioner aggrieved by the findings or conclusions of the court may obtain review of the judgment of the court in the United States court
of appeals for the Federal Circuit upon petition filed within 60 days
of the date of the judgment with such court of appeals within 60
days of the date of entry of the United States Claims Court’s 1 judgment with such court of appeals.
(g) 2 NOTICE.—If—
(1) a special master fails to make a decision on a petition
within the 240 days prescribed by subsection (d)(3)(A)(ii) (excluding (A) any period of suspension under subsection (d)(3)(C)
or (d)(3)(D), and (B) any days the petition is before a special
master as a result of a remand under subsection (e)(2)(C)), or
(2) the United States Claims Court fails to enter a judgment under this section on a petition within 420 days (excluding (A) any period of suspension under subsection (d)(3)(C) or
(d)(3)(D), and (B) any days the petition is before a special master as a result of a remand under subsection (e)(2)(C)) after the
date on which the petition was filed,
the special master or court shall notify the petitioner under such
petition that the petitioner may withdraw the petition under section 2121(b) or the petitioner may choose under section 2121(b) to
1 So

in law. Probably should be a reference to the United States Court of Federal Claims.
(i)(2) of section 201 of Public Law 102–168 (105 Stat. 1104), which was enacted
on November 26, 1991, provided that the amendments made by subsections (d) and (f) of such
section ‘‘shall take effect as if the amendments had been in effect on and after October 1, 1988’’.
Such subsections (d) and (f) related to actions by petitioners, and to annuities, respectively, and
involved amendments to sections 2112(g), 2115(f)(4), 2116(c), and 2121(b).
2 Subsection

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have the petition remain before the special master or court, as the
case may be.
DETERMINATION OF ELIGIBILITY AND COMPENSATION

SEC. 2113. ø300aa–13¿ (a) GENERAL RULE.—
(1) Compensation shall be awarded under the Program to
a petitioner if the special master or court finds on the record
as a whole—
(A) that the petitioner has demonstrated by a preponderance of the evidence the matters required in the petition by section 2111(c)(1), and
(B) that there is not a preponderance of the evidence
that the illness, disability, injury, condition, or death described in the petition is due to factors unrelated to the administration of the vaccine described in the petition.
The special master or court may not make such a finding based
on the claims of a petitioner alone, unsubstantiated by medical
records or by medical opinion.
(2) For purposes of paragraph (1), the term ‘‘factors unrelated to the administration of the vaccine’’—
(A) does not include any idiopathic, unexplained, unknown, hypothetical, or undocumentable cause, factor, injury, illness, or condition, and
(B) may, as documented by the petitioner’s evidence or
other material in the record, include infection, toxins, trauma (including birth trauma and related anoxia), or metabolic disturbances which have no known relation to the
vaccine involved, but which in the particular case are
shown to have been the agent or agents principally responsible for causing the petitioner’s illness, disability, injury,
condition, or death.
(b) MATTERS TO BE CONSIDERED.—
(1) In determining whether to award compensation to a petitioner under the Program, the special master or court shall
consider, in addition to all other relevant medical and scientific
evidence contained in the record—
(A) any diagnosis, conclusion, medical judgment, or
autopsy or coroner’s report which is contained in the
record regarding the nature, causation, and aggravation of
the petitioner’s illness, disability, injury, condition, or
death, and
(B) the results of any diagnostic or evaluative test
which are contained in the record and the summaries and
conclusions.
Any such diagnosis, conclusion, judgment, test result, report,
or summary shall not be binding on the special master or
court. In evaluating the weight to be afforded to any such diagnosis, conclusion, judgment, test result, report, or summary,
the special master or court shall consider the entire record and
the course of the injury, disability, illness, or condition until
the date of the judgment of the special master or court.
(2) The special master or court may find the first symptom
or manifestation of onset or significant aggravation of an injury, disability, illness, condition, or death described in a petiMarch 13, 2013

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Sec. 2114

tion occurred within the time period described in the Vaccine
Injury Table even though the occurrence of such symptom or
manifestation was not recorded or was incorrectly recorded as
having occurred outside such period. Such a finding may be
made only upon demonstration by a preponderance of the evidence that the onset or significant aggravation of the injury,
disability, illness, condition, or death described in the petition
did in fact occur within the time period described in the Vaccine Injury Table.
(c) RECORD DEFINED.—For purposes of this section, the term
‘‘record’’ means the record established by the special masters of the
United States Claims Court in a proceeding on a petition filed
under section 2111.
VACCINE INJURY TABLE

SEC. 2114. ø300aa–14¿ (a) INITIAL TABLE.—The following is a
table of vaccines, the injuries, disabilities, illnesses, conditions, and
deaths resulting from the administration of such vaccines, and the
time period in which the first symptom or manifestation of onset
or of the significant aggravation of such injuries, disabilities, illnesses, conditions, and deaths is to occur after vaccine administration for purposes of receiving compensation under the Program:
VACCINE INJURY TABLE
I.

DTP; P; DTP/Polio Combination; or
Any Other Vaccine Containing
Whole Cell Pertussis Bacteria,
Extracted or Partial Cell Bacteria,
or Specific Pertussis Antigen(s).
Illness, disability, injury, or condition covered:
A.

II.

March 13, 2013

Anaphylaxis or anaphylactic
shock ...............................................
B. Encephalopathy (or encephalitis)
C. Shock-collapse or hypotonichyporesponsive collapse ................
D. Residual seizure disorder in accordance with subsection (b)(2) ....
E. Any acute complication or sequela (including death) of an illness, disability, injury, or condition referred to above which illness, disability, injury, or condition arose within the time period
prescribed .......................................
Measles, mumps, rubella, or any
vaccine containing any of the foregoing as a component; DT; Td; or
Tetanus Toxoid.
A. Anaphylaxis or anaphylactic
shock ...............................................
B. Encephalopathy (or encephalitis)

Time period for first symptom or
manifestation of onset or of significant aggravation after vaccine
administration:
24 hours
3 days
3 days
3 days

Not applicable

24 hours
15 days (for mumps, rubella, measles, or any vaccine containing
any of the foregoing as a component). 3 days (for DT, Td, or tetanus toxoid).

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Sec. 2114

PUBLIC HEALTH SERVICE ACT

C. Residual seizure disorder in accordance with subsection (b)(2) ....

III.

IV.

D. Any acute complication or sequela (including death) of an illness, disability, injury, or condition referred to above which illness, disability, injury, or condition arose within the time period
prescribed .......................................
Polio Vaccines (other than Inactivated Polio Vaccine).
A. Paralytic polio
—in a non-immunodeficient recipient .........................................
—in an immunodeficient recipient
—in a vaccine-associated community case ......................................
B. Any acute complication or sequela (including death) of an illness, disability, injury, or condition referred to above which illness, disability, injury, or condition arose within the time period
prescribed .......................................
Inactivated Polio Vaccine.
A. Anaphylaxis or anaphylactic
shock ...............................................
B. Any acute complication or sequela (including death) of an illness, disability, injury, or condition referred to above which illness, disability, injury, or condition arose within the time period
prescribed .......................................

1200

15 days (for mumps, rubella, measles, or any vaccine containing
any of the foregoing as a component). 3 days (for DT, Td, or tetanus toxoid).

Not applicable

30 days
6 months
Not applicable

Not applicable
24 hours

Not applicable

(b) QUALIFICATIONS AND AIDS TO INTERPRETATION.—The following qualifications and aids to interpretation shall apply to the
Vaccine Injury Table in subsection (a):
(1) A shock-collapse or a hypotonic-hyporesponsive collapse
may be evidenced by indicia or symptoms such as decrease or
loss of muscle tone, paralysis (partial or complete), hemiplegia
or hemiparesis, loss of color or turning pale white or blue, unresponsiveness to environmental stimuli, depression of consciousness, loss of consciousness, prolonged sleeping with difficulty arousing, or cardiovascular or respiratory arrest.
(2) A petitioner may be considered to have suffered a residual seizure disorder if the petitioner did not suffer a seizure or
convulsion unaccompanied by fever or accompanied by a fever
of less than 102 degrees Fahrenheit before the first seizure or
convulsion after the administration of the vaccine involved and
if—
(A) in the case of a measles, mumps, or rubella vaccine
or any combination of such vaccines, the first seizure or
convulsion occurred within 15 days after administration of
the vaccine and 2 or more seizures or convulsions occurred
within 1 year after the administration of the vaccine which
were unaccompanied by fever or accompanied by a fever of
less than 102 degrees Fahrenheit, and
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(B) in the case of any other vaccine, the first seizure
or convulsion occurred within 3 days after administration
of the vaccine and 2 or more seizures or convulsions occurred within 1 year after the administration of the vaccine which were unaccompanied by fever or accompanied
by a fever of less than 102 degrees Fahrenheit.
(3)(A) The term ‘‘encephalopathy’’ means any significant
acquired abnormality of, or injury to, or impairment of function
of the brain. Among the frequent manifestations of
encephalopathy are focal and diffuse neurologic signs, increased intracranial pressure, or changes lasting at least 6
hours in level of consciousness, with or without convulsions.
The neurological signs and symptoms of encephalopathy may
be temporary with complete recovery, or may result in various
degrees of permanent impairment. Signs and symptoms such
as high pitched and unusual screaming, persistent
unconsolable crying, and bulging fontanel are compatible with
an encephalopathy, but in and of themselves are not conclusive
evidence of encephalopathy. Encephalopathy usually can be
documented by slow wave activity on an electroencephalogram.
(B) If in a proceeding on a petition it is shown by a preponderance of the evidence that an encephalopathy was caused by
infection, toxins, trauma, or metabolic disturbances the
encephalopathy shall not be considered to be a condition set
forth in the table. If at the time a judgment is entered on a
petition filed under section 2111 for a vaccine-related injury or
death it is not possible to determine the cause, by a preponderance of the evidence, of an encephalopathy, the encephalopathy
shall be considered to be a condition set forth in the table. In
determining whether or not an encephalopathy is a condition
set forth in the table, the court shall consider the entire medical record.
(4) For purposes of paragraphs (2) and (3), the terms ‘‘seizure’’ and ‘‘convulsion’’ include grand mal, petit mal, absence,
myoclonic, tonic-clonic, and focal motor seizures and signs. If
a provision of the table to which paragraph (1), (2), (3), or (4)
applies is revised under subsection (c) or (d), such paragraph
shall not apply to such provision after the effective date of the
revision unless the revision specifies that such paragraph is to
continue to apply.
(c) ADMINISTRATIVE REVISION OF THE TABLE.—
(1) The Secretary may promulgate regulations to modify in
accordance with paragraph (3) the Vaccine Injury Table. In
promulgating such regulations, the Secretary shall provide for
notice and opportunity for a public hearing and at least 180
days of public comment.
(2) Any person (including the Advisory Commission on
Childhood Vaccines) may petition the Secretary to propose regulations to amend the Vaccine Injury Table. Unless clearly
frivolous, or initiated by the Commission, any such petition
shall be referred to the Commission for its recommendations.
Following—
(A) receipt of any recommendation of the Commission,
or
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(B) 180 days after the date of the referral to the Commission,
whichever occurs first, the Secretary shall conduct a rulemaking proceeding on the matters proposed in the petition or
publish in the Federal Register a statement of reasons for not
conducting such proceeding.
(3) A modification of the Vaccine Injury Table under paragraph (1) may add to, or delete from, the list of injuries, disabilities, illnesses, conditions, and deaths for which compensation may be provided or may change the time periods for the
first symptom or manifestation of the onset or the significant
aggravation of any such injury, disability, illness, condition, or
death.
(4) Any modification under paragraph (1) of the Vaccine
Injury Table shall apply only with respect to petitions for compensation under the Program which are filed after the effective
date of such regulation.
(d) ROLE OF COMMISSION.—Except with respect to a regulation
recommended by the Advisory Commission on Childhood Vaccines,
the Secretary may not propose a regulation under subsection (c) or
any revision thereof, unless the Secretary has first provided to the
Commission a copy of the proposed regulation or revision, requested recommendations and comments by the Commission, and
afforded the Commission at least 90 days to make such recommendations.
(e) 1 ADDITIONAL VACCINES.—
(1) VACCINES RECOMMENDED BEFORE AUGUST 1, 1993.—By
August 1, 1995, the Secretary shall revise the Vaccine Injury
Table included in subsection (a) to include—
(A) vaccines which are recommended to the Secretary
by the Centers for Disease Control and Prevention before
August 1, 1993, for routine administration to children,
(B) the injuries, disabilities, illnesses, conditions, and
deaths associated with such vaccines, and
(C) the time period in which the first symptoms or
manifestations of onset or other significant aggravation of
such injuries, disabilities, illnesses, conditions, and deaths
associated with such vaccines may occur.
(2) VACCINES RECOMMENDED AFTER AUGUST 1, 1993.—When
after August 1, 1993, the Centers for Disease Control and Prevention recommends a vaccine to the Secretary for routine administration to children, the Secretary shall, within 2 years of
such recommendation, amend the Vaccine Injury Table included in subsection (a) to include—
(A) vaccines which were recommended for routine administration to children,
(B) the injuries, disabilities, illnesses, conditions, and
deaths associated with such vaccines, and
1 Section

13632(a)(3) of Public Law 103-66 (107 Stat. 646) provides as follows:
‘‘(3) EFFECTIVE DATE.—A revision by the Secretary under section 2114(e) of the Public
Health Service Act (42 U.S.C. 300aa–14(e)) (as amended by paragraph (2)) shall take effect
upon the effective date of a tax enacted to provide funds for compensation paid with respect
to the vaccine to be added to the vaccine injury table in section 2114(a) of the Public Health
Service Act (42 U.S.C. 300aa–14(a)).’’.

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(C) the time period in which the first symptoms or
manifestations of onset or other significant aggravation of
such injuries, disabilities, illnesses, conditions, and deaths
associated with such vaccines may occur.
COMPENSATION

SEC. 2115. ø300aa–15¿ (a) GENERAL RULE.—Compensation
awarded under the Program to a petitioner under section 2111 for
a vaccine-related injury or death associated with the administration of a vaccine after the effective date of this part 1 shall include
the following:
(1)(A) Actual unreimbursable expenses incurred from the
date of the judgment awarding such expenses and reasonable
projected unreimbursable expenses which—
(i) result from the vaccine-related injury for which the
petitioner seeks compensation,
(ii) have been or will be incurred by or on behalf of the
person who suffered such injury, and
(iii)(I) have been or will be for diagnosis and medical
or other remedial care determined to be reasonably necessary, or
(II) have been or will be for rehabilitation, developmental evaluation, special education, vocational training
and placement, case management services, counseling,
emotional or behavioral therapy, residential and custodial
care and service expenses, special equipment, related travel expenses, and facilities determined to be reasonably necessary.
(B) Subject to section 2116(a)(2), actual unreimbursable expenses incurred before the date of the judgment awarding such
expenses which—
(i) resulted from the vaccine-related injury for which
the petitioner seeks compensation,
(ii) were incurred by or on behalf of the person who
suffered such injury, and
(iii) were for diagnosis, medical or other remedial care,
rehabilitation, developmental evaluation, special education, vocational training and placement, case management services, counseling, emotional or behavioral therapy,
residential and custodial care and service expenses, special
equipment, related travel expenses, and facilities determined to be reasonably necessary.
(2) In the event of a vaccine-related death, an award of
$250,000 for the estate of the deceased.
(3)(A) In the case of any person who has sustained a vaccine-related injury after attaining the age of 18 and whose
earning capacity is or has been impaired by reason of such person’s vaccine-related injury for which compensation is to be
awarded, compensation for actual and anticipated loss of earnings determined in accordance with generally recognized actuarial principles and projections.
1 Effective

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October 1, 1988.

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(B) In the case of any person who has sustained a vaccinerelated injury before attaining the age of 18 and whose earning
capacity is or has been impaired by reason of such person’s
vaccine-related injury for which compensation is to be awarded
and whose vaccine-related injury is of sufficient severity to permit reasonable anticipation that such person is likely to suffer
impaired earning capacity at age 18 and beyond, compensation
after attaining the age of 18 for loss of earnings determined on
the basis of the average gross weekly earnings of workers in
the private, non-farm sector, less appropriate taxes and the average cost of a health insurance policy, as determined by the
Secretary.
(4) For actual and projected pain and suffering and emotional distress from the vaccine-related injury, an award not to
exceed $250,000.
(b) VACCINES ADMINISTERED BEFORE THE EFFECTIVE DATE.—
Compensation awarded under the Program to a petitioner under
section 2111 for a vaccine-related injury or death associated with
the administration of a vaccine before the effective date of this
part 1 may include the compensation described in paragraphs (1)(A)
and (2) of subsection (a) and may also include an amount, not to
exceed a combined total of $30,000, for—
(1) lost earnings (as provided in paragraph (3) of subsection (a)),
(2) pain and suffering (as provided in paragraph (4) of
subsection (a)), and
(3) reasonable attorneys’ fees and costs (as provided in
subsection (e) 2.
(c) RESIDENTIAL AND CUSTODIAL CARE AND SERVICE.—The
amount of any compensation for residential and custodial care and
service expenses under subsection (a)(1) shall be sufficient to enable the compensated person to remain living at home.
(d) TYPES OF COMPENSATION PROHIBITED.—Compensation
awarded under the Program may not include the following:
(1) Punitive or exemplary damages.
(2) Except with respect to compensation payments under
paragraphs (2) and (3) of subsection (a), compensation for other
than the health, education, or welfare of the person who suffered the vaccine-related injury with respect to which the compensation is paid.
(e) ATTORNEYS’ FEES.—
(1) In awarding compensation on a petition filed under section 2111 the special master or court shall also award as part
of such compensation an amount to cover—
(A) reasonable attorneys’ fees, and
(B) other costs,
incurred in any proceeding on such petition. If the judgment of
a special master or court on such a petition does not award
compensation, the special master or court may award an
amount of compensation to cover petitioner’s reasonable attorneys’ fees and other costs incurred in any proceeding on such
1 Effective
2 So

March 13, 2013

October 1, 1988.
in law. Probably should be a closing parenthesis after ‘‘subsection (e)’’.

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PUBLIC HEALTH SERVICE ACT

Sec. 2115

petition if the special master or court determines that the petition was brought in good faith and there was a reasonable
basis for the claim for which the petition was brought.
(2) If the petitioner, before the effective date of this part, 1
filed a civil action for damages for any vaccine-related injury
or death for which compensation may be awarded under the
Program, and petitioned under section 2111(a)(5) to have such
action dismissed and to file a petition for compensation under
the Program, in awarding compensation on such petition the
special master or court may include an amount of compensation limited to the costs and expenses incurred by the petitioner and the attorney of the petitioner before the effective
date of this part 1 in preparing, filing, and prosecuting such
civil action (including the reasonable value of the attorney’s
time if the civil action was filed under contingent fee arrangements).
(3) No attorney may charge any fee for services in connection with a petition filed under section 2111 which is in addition to any amount awarded as compensation by the special
master or court under paragraph (1).
(f) PAYMENT OF COMPENSATION.—
(1) Except as provided in paragraph (2), no compensation
may be paid until an election has been made, or has been
deemed to have been made, under section 2121(a) to receive
compensation.
(2) Compensation described in subsection (a)(1)(A)(iii) shall
be paid from the date of the judgment of the United States
Claims Court under section 2112 awarding the compensation.
Such compensation may not be paid after an election under
section 2121(a) to file a civil action for damages for the vaccine-related injury or death for which such compensation was
awarded.
(3) Payments of compensation under the Program and the
costs of carrying out the Program shall be exempt from reduction under any order issued under part C of the Balanced
Budget and Emergency Deficit Control Act of 1985.
(4)(A) 1 Except as provided in subparagraph (B), payment
of compensation under the Program shall be determined on the
basis of the net present value of the elements of the compensation and shall be paid from the Vaccine Injury Compensation
Trust Fund established under section 9510 of the Internal Revenue Code of 1986 in a lump sum of which all or a portion may
be used as ordered by the special master to purchase an annuity or otherwise be used, with the consent of the petitioner, in
a manner determined by the special master to be in the best
interests of the petitioner.
(B) In the case of a payment of compensation under the
Program to a petitioner for a vaccine-related injury or death
associated with the administration of a vaccine before the effective date of this part 2 the compensation shall be determined
on the basis of the net present value of the elements of com1 See

footnote for section 2112(g).
October 1, 1988.

2 Effective

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pensation and paid in 4 equal annual installments of which all
or a portion of the proceeds 1 may be used as ordered by the
special master to purchase an annuity or otherwise be used,
with the consent of the petitioner, in a manner determined by
the special master to be in the best interests of the petitioner.
Any reasonable attorneys’ fees and costs shall be paid in a
lump sum. If the appropriations under subsection (j) are insufficient to make a payment of an annual installment, the limitation on civil actions prescribed by section 2121(a) shall not
apply to a civil action for damages brought by the petitioner
entitled to the payment.
(C) In purchasing an annuity under subparagraph (A) or
(B), the Secretary may purchase a guarantee for the annuity,
may enter into agreements regarding the purchase price for
and rate of return of the annuity, and may take such other actions as may be necessary to safeguard the financial interests
of the United States regarding the annuity. Any payment received by the Secretary pursuant to the preceding sentence
shall be paid to the Vaccine Injury Compensation Trust Fund
established under section 9510 of the Internal Revenue Code
of 1986, or to the appropriations account from which the funds
were derived to purchase the annuity, whichever is appropriate.
(g) PROGRAM NOT PRIMARILY LIABLE.—Payment of compensation under the Program shall not be made for any item or service
to the extent that payment has been made, or can reasonably be
expected to be made, with respect to such item or service (1) under
any State compensation program, under an insurance policy, or
under any Federal or State health benefits program (other than
under title XIX of the Social Security Act), or (2) by an entity
which provides health services on a prepaid basis.
(h) LIABILITY OF HEALTH INSURANCE CARRIERS, PREPAID
HEALTH PLANS, AND BENEFIT PROVIDERS.—No policy of health insurance may make payment of benefits under the policy secondary
to the payment of compensation under the Program and—
(1) no State, and
(2) no entity which provides health services on a prepaid
basis or provides health benefits,
may make the provision of health services or health benefits secondary to the payment of compensation under the Program, except
that this subsection shall not apply to the provision of services or
benefits under title XIX of the Social Security Act.
(i) SOURCE OF COMPENSATION.—
(1) Payment of compensation under the Program to a petitioner for a vaccine-related injury or death associated with the
administration of a vaccine before the effective date of this
part 1 shall be made by the Secretary from appropriations
under subsection (j).
1 Section 201(e)(1)(B) of Public Law 102–168 (105 Stat. 1103) provided that this subparagraph
is amended by striking out ‘‘paid in 4 equal installments of which all or portion of the proceeds’’
and inserting in lieu thereof ‘‘shall be paid from appropriations made available under subsection
(j) in a lump sum of which all or a portion’’. The amendment cannot be executed because the
term to be struck does not appear in the law. (Compare ‘‘equal installments’’ with ‘‘equal annual
installments’’ and ‘‘or portion’’ with ‘‘or a portion’’.)

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PUBLIC HEALTH SERVICE ACT

Sec. 2116

(2) Payment of compensation under the Program to a petitioner for a vaccine-related injury or death associated with the
administration of a vaccine on or after the effective date of this
part 1 shall be made from the Vaccine Injury Compensation
Trust Fund established under section 9510 of the Internal Revenue Code of 1986.
(j) AUTHORIZATION.—For the payment of compensation under
the Program to a petitioner for a vaccine-related injury or death associated with the administration of a vaccine before the effective
date of this part 1 there are authorized to be appropriated to the
Department of Health and Human Services $80,000,000 for fiscal
year 1989, $80,000,000 for fiscal year 1990, $80,000,000 for fiscal
year 1991, $80,000,000 for fiscal year 1992, $110,000,000 for fiscal
year 1993, and $110,000,000 for each succeeding fiscal year in
which a payment of compensation is required under subsection
(f)(4)(B). Amounts appropriated under this subsection shall remain
available until expended.
LIMITATIONS OF ACTIONS

SEC. 2116. ø300aa–16¿ (a) GENERAL RULE.—In the case of—
(1) a vaccine set forth in the Vaccine Injury Table which
is administered before the effective date of this part, 1 if a vaccine-related injury or death occurred as a result of the administration of such vaccine, no petition may be filed for compensation under the Program for such injury or death after the
expiration of 28 months after the effective date of this part 1
and no such petition may be filed if the first symptom or manifestation of onset or of the significant aggravation of such injury occurred more than 36 months after the date of administration of the vaccine,
(2) a vaccine set forth in the Vaccine Injury Table which
is administered after the effective date of this part, 1 if a vaccine-related injury occurred as a result of the administration of
such vaccine, no petition may be filed for compensation under
the Program for such injury after the expiration of 36 months
after the date of the occurrence of the first symptom or manifestation of onset or of the significant aggravation of such injury, and
(3) a vaccine set forth in the Vaccine Injury Table which
is administered after the effective date of this part, 1 if a death
occurred as a result of the administration of such vaccine, no
petition may be filed for compensation under the Program for
such death after the expiration of 24 months from the date of
the death and no such petition may be filed more than 48
months after the date of the occurrence of the first symptom
or manifestation of onset or of the significant aggravation of
the injury from which the death resulted.
(b) EFFECT OF REVISED TABLE.—If at any time the Vaccine Injury Table is revised and the effect of such revision is to permit an
individual who was not, before such revision, eligible to seek compensation under the Program, or to significantly increase the likelihood of obtaining compensation, such person may, notwithstanding
1 Effective

March 13, 2013

October 1, 1988.

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1208

section 2111(b)(2), file a petition for such compensation not later
than 2 years after the effective date of the revision, except that no
compensation may be provided under the Program with respect to
a vaccine-related injury or death covered under the revision of the
table if—
(1) the vaccine-related death occurred more than 8 years
before the date of the revision of the table, or
(2) the vaccine-related injury occurred more than 8 years
before the date of the revision of the table.
(c) 1 STATE LIMITATIONS OF ACTIONS.—If a petition is filed
under section 2111 for a vaccine-related injury or death, limitations
of actions under State law shall be stayed with respect to a civil
action brought for such injury or death for the period beginning on
the date the petition is filed and ending on the date (1) an election
is made under section 2121(a) to file the civil action or (2) an election is made under section 2121(b) to withdraw the petition.
SUBROGRATION

SEC. 2117. ø300aa–17¿ (a) GENERAL RULE.—Upon payment of
compensation to any petitioner under the Program, the trust fund
which has been established to provide such compensation shall be
subrograted 2 to all rights of the petitioner with respect to the vaccine-related injury or death for which compensation was paid, except that the trust fund may not recover under such rights an
amount greater than the amount of compensation paid to the petitioner.
(b) DISPOSITION OF AMOUNTS RECOVERED.—Amounts recovered
under subsection (a) shall be collected on behalf of, and deposited
in, the Vaccine Injury Compensation Trust Fund established under
section 9510 of the Internal Revenue Code of 1986.
ADVISORY COMMISSION ON CHILDHOOD VACCINES

SEC. 2119. ø300aa–19¿ (a) ESTABLISHMENT.—There is established the Advisory Commission on Childhood Vaccines. The Commission shall be composed of:
(1) Nine members appointed by the Secretary as follows:
(A) Three members who are health professionals, who
are not employees of the United States, and who have expertise in the health care of children, the epidemiology, etiology, and prevention of childhood diseases, and the adverse reactions associated with vaccines, of whom at least
two shall be pediatricians.
(B) Three members from the general public, of whom
at least two shall be legal representatives of children who
have suffered a vaccine-related injury or death.
(C) Three members who are attorneys, of whom at
least one shall be an attorney whose specialty includes
representation of persons who have suffered a vaccine-related injury or death and of whom one shall be an attorney
whose specialty includes representation of vaccine manufacturers.
1 See
2 So

March 13, 2013

footnote for section 2112(g).
in law. Probably should be ‘‘subrogated’’.

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PUBLIC HEALTH SERVICE ACT

Sec. 2119

(2) The Director of the National Institutes of Health, the
Assistant Secretary for Health, the Director of the Centers for
Disease Control and Prevention, and the Commissioner of Food
and Drugs (or the designees of such officials), each of whom
shall be a nonvoting ex officio member.
The Secretary shall select members of the Commission within 90
days of the effective date of this part. 1 The members of the Commission shall select a Chair from among the members.
(b) TERM OF OFFICE.—Appointed members of the Commission
shall be appointed for a term of office of 3 years, except that of the
members first appointed, 3 shall be appointed for a term of 1 year,
3 shall be appointed for a term of 2 years, and 3 shall be appointed
for a term of 3 years, as determined by the Secretary.
(c) MEETINGS.—The Commission shall first meet within 60
days after all members of the Commission are appointed, and
thereafter shall meet not less often than four times per year and
at the call of the chair. A quorum for purposes of a meeting is 5.
A decision at a meeting is to be made by a ballot of a majority of
the voting members of the Commission present at the meeting.
(d) COMPENSATION.—Members of the Commission who are officers or employees of the Federal Government shall serve as members of the Commission without compensation in addition to that
received in their regular public employment. Members of the Commission who are not officers or employees of the Federal Government shall be compensated at a rate not to exceed the daily equivalent of the rate in effect for grade GS–18 of the General Schedule
for each day (including traveltime) they are engaged in the performance of their duties as members of the Commission. All members, while so serving away from their homes or regular places of
business, may be allowed travel expenses, including per diem in
lieu of subsistence, in the same manner as such expenses are authorized by section 5703, title 5, United States Code, for employees
serving intermittently.
(e) STAFF.—The Secretary shall provide the Commission with
such professional and clerical staff, such information, and the services of such consultants as may be necessary to assist the Commission in carrying out effectively its functions under this section.
(f) FUNCTIONS.—The Commission shall—
(1) advise the Secretary on the implementation of the Program,
(2) on its own initiative or as the result of the filing of a
petition, recommend changes in the Vaccine Injury Table,
(3) advise the Secretary in implementing the Secretary’s
responsibilities under section 2127 regarding the need for
childhood vaccination products that result in fewer or no significant adverse reactions,
(4) survey Federal, State, and local programs and activities
relating to the gathering of information on injuries associated
with the administration of childhood vaccines, including the
adverse reaction reporting requirements of section 2125(b), and
advise the Secretary on means to obtain, compile, publish, and
1 Effective

March 13, 2013

October 1, 1988.

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use credible data related to the frequency and severity of adverse reactions associated with childhood vaccines, and
(5) recommend to the Director of the National Vaccine Program research related to vaccine injuries which should be conducted to carry out this subtitle.
PART B—ADDITIONAL REMEDIES
AUTHORITY TO BRING ACTIONS

SEC. 2121. ø300aa–21¿ (a) ELECTION.—After judgment has
been entered by the United States Claims Court or, if an appeal
is taken under section 2112(f), after the appellate court’s mandate
is issued, the petitioner who filed the petition under section 2111
shall file with the clerk of the United States Claims Court—
(1) if the judgment awarded compensation, an election in
writing to receive the compensation or to file a civil action for
damages for such injury or death, or
(2) if the judgment did not award compensation, an election in writing to accept the judgment or to file a civil action
for damages for such injury or death.
An election shall be filed under this subsection not later than 90
days after the date of the court’s final judgment with respect to
which the election is to be made. If a person required to file an
election with the court under this subsection does not file the election within the time prescribed for filing the election, such person
shall be deemed to have filed an election to accept the judgment
of the court. If a person elects to receive compensation under a
judgment of the court in an action for a vaccine-related injury or
death associated with the administration of a vaccine before the effective date of this part or is deemed to have accepted the judgment of the court in such an action, such person may not bring or
maintain a civil action for damages against a vaccine administrator
or manufacturer for the vaccine-related injury or death for which
the judgment was entered. For limitations on the bringing of civil
actions for vaccine-related injuries or deaths associated with the
administration of a vaccine after the effective date of this part 1,
see section 2111(a)(2).
(b) 2 CONTINUANCE OR WITHDRAWAL OF PETITION.3—A petitioner under a petition filed under section 2111 may submit to the
United States Claims Court a notice in writing choosing to continue or to withdraw the petition if—
(1) a special master fails to make a decision on such
petition within the 240 days prescribed by section
2112(d)(3)(A)(ii) (excluding (i) any period of suspension
under section 2112(d)(3)(C) or 2112(d)(3)(D), and (ii) any
1 Effective

October 1, 1988.
footnote for section 2112(g).
amendment described in section 201(d)(3)(C) of Public Law 102–168 (105 Stat. 1103) has
been executed according to the probable intent of the Congress. After redesignating former subparagraphs (A) and (B) as paragraphs (1) and (2), the amendatory instructions of the section
provided that section 2121(b) is amended ‘‘by running the text of paragraph (1) into the subsection heading and making the margin of the text full measure’’. The instructions were applied
to portions of the matter preceding paragraph (1) as redesignated, rather than to the text of
paragraph (1). (That is, the instructions were applied to the former paragraph (1).)
2 See

3 The

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PUBLIC HEALTH SERVICE ACT

Sec. 2122

days the petition is before a special master as a result of
a remand under section 2112(e)(2)(C)), or
(2) the court fails to enter a judgment under section
2112 on the petition within 420 days (excluding (i) any period of suspension under section 2112(d)(3)(C) or
2112(d)(3)(D), and (ii) any days the petition is before a special master as a result of a remand under section
2112(e)(2)(C)) after the date on which the petition was
filed.
Such a notice shall be filed within 30 days of the provision of
the notice required by section 2112(g).
(c) LIMITATIONS OF ACTIONS.—A civil action for damages arising from a vaccine-related injury or death for which a petition was
filed under section 2111 shall, except as provided in section 2116(c),
be brought within the period prescribed by limitations of actions
under State law applicable to such civil action.
STANDARDS OF RESPONSIBILITY

SEC. 2122. ø300aa–22¿ (a) GENERAL RULE.—Except as provided in subsections (b), (c), and (e) State law shall apply to a civil
action brought for damages for a vaccine-related injury or death.
(b) UNAVOIDABLE ADVERSE SIDE EFFECTS; WARNINGS.—
(1) No vaccine manufacturer shall be liable in a civil action
for damages arising from a vaccine-related injury or death associated with the administration of a vaccine after the effective
date of this part 1 if the injury or death resulted from side effects that were unavoidable even though the vaccine was properly prepared and was accompanied by proper directions and
warnings.
(2) For purposes of paragraph (1), a vaccine shall be presumed to be accompanied by proper directions and warnings if
the vaccine manufacturer shows that it complied in all material respects with all requirements under the Federal Food,
Drug, and Cosmetic Act and section 351 of the Public Health
Service Act (including regulations issued under such provisions) applicable to the vaccine and related to vaccine-related
injury or death for which the civil action was brought unless
the plaintiff shows—
(A) that the manufacturer engaged in the conduct set
forth in subparagraph (A) or (B) of section 2123(d)(2), or
(B) by clear and convincing evidence that the manufacturer failed to exercise due care notwithstanding its compliance with such Act and section (and regulations issued
under such provisions).
(c) DIRECT WARNINGS.—No vaccine manufacturer shall be liable in a civil action for damages arising from a vaccine-related injury or death associated with the administration of a vaccine after
the effective date of this part 1 solely due to the manufacturer’s failure to provide direct warnings to the injured party (or the injured
party’s legal representative) of the potential dangers resulting from
the administration of the vaccine manufactured by the manufacturer.
(d) CONSTRUCTION.—The standards of responsibility prescribed
by this section are not to be construed as authorizing a person who
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brought a civil action for damages against a vaccine manufacturer
for a vaccine-related injury or death in which damages were denied
or which was dismissed with prejudice to bring a new civil action
against such manufacturer for such injury or death.
(e) PREEMPTION.—No State may establish or enforce a law
which prohibits an individual from bringing a civil action against
a vaccine manufacturer for damages for a vaccine-related injury or
death if such civil action is not barred by this subtitle.
TRIAL

SEC. 2123. ø300aa–23¿ (a) GENERAL RULE.—A civil action
against a vaccine manufacturer for damages for a vaccine-related
injury or death associated with the administration of a vaccine
after the effective date of this part 1 which is not barred by section
2111(a)(2) shall be tried in three stages.
(b) LIABILITY.—The first stage of such a civil action shall be
held to determine if a vaccine manufacturer is liable under section
2122.
(c) GENERAL DAMAGES.—The second stage of such a civil action
shall be held to determine the amount of damages (other than punitive damages) a vaccine manufacturer found to be liable under
section 2122 shall be required to pay.
(d) PUNITIVE DAMAGES.—
(1) If sought by the plaintiff, the third stage of such an action shall be held to determine the amount of punitive damages a vaccine manufacturer found to be liable under section
2122 shall be required to pay.
(2) If in such an action the manufacturer shows that it
complied, in all material respects, with all requirements under
the Federal Food, Drug, and Cosmetic Act and the Public
Health Service Act applicable to the vaccine and related to the
vaccine injury or death with respect to which the action was
brought, the manufacturer shall not be held liable for punitive
damages unless the manufacturer engaged in—
(A) fraud or intentional and wrongful withholding of
information from the Secretary during any phase of a proceeding for approval of the vaccine under section 351,
(B) intentional and wrongful withholding of information relating to the safety or efficacy of the vaccine after
its approval, or
(C) other criminal or illegal activity relating to the
safety and effectiveness of vaccines,
which activity related to the vaccine-related injury or death for
which the civil action was brought.
(e) EVIDENCE.—In any stage of a civil action, the Vaccine Injury Table, any finding of fact or conclusion of law of the United
States Claims Court or a special master in a proceeding on a petition filed under section 2111 and the final judgment of the United
States Claims Court and subsequent appellate review on such a petition shall not be admissible.
1 Effective

March 13, 2013

October 1, 1988.

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PUBLIC HEALTH SERVICE ACT

PART C—ASSURING

A

Sec. 2125

SAFER CHILDHOOD VACCINATION PROGRAM
THE UNITED STATES

IN

RECORDING AND REPORTING OF INFORMATION

SEC. 2125. ø300aa–25¿ (a) GENERAL RULE.—Each health care
provider who administers a vaccine set forth in the Vaccine Injury
Table to any person shall record, or ensure that there is recorded,
in such person’s permanent medical record (or in a permanent office log or file to which a legal representative shall have access
upon request) with respect to each such vaccine—
(1) the date of administration of the vaccine,
(2) the vaccine manufacturer and lot number of the vaccine,
(3) the name and address and, if appropriate, the title of
the health care provider administering the vaccine, and
(4) any other identifying information on the vaccine required pursuant to regulations promulgated by the Secretary.
(b) REPORTING.—
(1) Each health care provider and vaccine manufacturer
shall report to the Secretary—
(A) the occurrence of any event set forth in the Vaccine Injury Table, including the events set forth in section
2114(b) which occur within 7 days of the administration of
any vaccine set forth in the Table or within such longer period as is specified in the Table or section,
(B) the occurrence of any contraindicating reaction to
a vaccine which is specified in the manufacturer’s package
insert, and
(C) such other matters as the Secretary may by regulation require.
Reports of the matters referred to in subparagraphs (A) and
(B) shall be made beginning 90 days after the effective date of
this part. 1 The Secretary shall publish in the Federal Register
as soon as practicable after such date a notice of the reporting
requirement.
(2) A report under paragraph (1) respecting a vaccine shall
include the time periods after the administration of such vaccine within which vaccine-related illnesses, disabilities, injuries, or conditions, the symptoms and manifestations of such
illnesses, disabilities, injuries, or conditions, or deaths occur,
and the manufacturer and lot number of the vaccine.
(3) The Secretary shall issue the regulations referred to in
paragraph (1)(C) within 180 days of the effective date of this
part. 1
(c) RELEASE OF INFORMATION.—
(1) Information which is in the possession of the Federal
Government and State and local governments under this section and which may identify an individual shall not be made
available under section 552 of title 5, United States Code, or
otherwise, to any person except—
(A) the person who received the vaccine, or
(B) the legal representative of such person.
1 Effective

March 13, 2013

December 22, 1987.

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1214

(2) For purposes of paragraph (1), the term ‘‘information
which may identify an individual’’ shall be limited to the name,
street address, and telephone number of the person who received the vaccine and of that person’s legal representative and
the medical records of such person relating to the administration of the vaccine, and shall not include the locality and State
of vaccine administration, the name of the health care provider
who administered the vaccine, the date of the vaccination, or
information concerning any reported illness, disability, injury,
or condition resulting from the administration of the vaccine,
any symptom or manifestation of such illness, disability, injury, or condition, or death resulting from the administration
of the vaccine.
(3) Except as provided in paragraph (1), all information reported under this section shall be available to the public.
VACCINE INFORMATION

SEC. 2126. ø300aa–26¿ (a) GENERAL RULE.—Not later than 1
year after the effective date of this part, 1 the Secretary shall develop and disseminate vaccine information materials for distribution by health care providers to the legal representatives of any
child or to any other individual receiving a vaccine set forth in the
Vaccine Injury Table. Such materials shall be published in the Federal Register and may be revised.
(b) DEVELOPMENT AND REVISION OF MATERIALS.—Such materials shall be developed or revised—
(1) after notice to the public and 60 days of comment
thereon, and
(2) in consultation with the Advisory Commission on
Childhood Vaccines, appropriate health care providers and parent organizations, the Centers for Disease Control and Prevention, and the Food and Drug Administration.
(c) INFORMATION REQUIREMENTS.—The information in such materials shall be based on available data and information, shall be
presented in understandable terms and shall include—
(1) a concise description of the benefits of the vaccine,
(2) a concise description of the risks associated with the
vaccine,
(3) a statement of the availability of the National Vaccine
Injury Compensation Program, and
(4) such other relevant information as may be determined
by the Secretary.
(d) HEALTH CARE PROVIDER DUTIES.—On and after a date determined by the Secretary which is—
(1) after the Secretary develops the information materials
required by subsection (a), and
(2) not later than 6 months after the date such materials
are published in the Federal Register,
each health care provider who administers a vaccine set forth in
the Vaccine Injury Table shall provide to the legal representatives
of any child or to any other individual to whom such provider intends to administer such vaccine a copy of the information materials developed pursuant to subsection (a), supplemented with visual presentations or oral explanations, in appropriate cases. Such
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PUBLIC HEALTH SERVICE ACT

Sec. 2128

materials shall be provided prior to the administration of such vaccine.
MANDATE FOR SAFER CHILDHOOD VACCINES

SEC. 2127. ø300aa–27¿ (a) GENERAL RULE.—In the administration of this subtitle and other pertinent laws under the jurisdiction
of the Secretary, the Secretary shall—
(1) promote the development of childhood vaccines that result in fewer and less serious adverse reactions than those vaccines on the market on the effective date of this part 1 and promote the refinement of such vaccines, and
(2) make or assure improvements in, and otherwise use
the authorities of the Secretary with respect to, the licensing,
manufacturing, processing, testing, labeling, warning, use instructions, distribution, storage, administration, field surveillance, adverse reaction reporting, and recall of reactogenic lots
or batches, of vaccines, and research on vaccines, in order to
reduce the risks of adverse reactions to vaccines.
(b) TASK FORCE.—
(1) The Secretary shall establish a task force on safer
childhood vaccines which shall consist of the Director of the
National Institutes of Health, the Commissioner of the Food
and Drug Administration, and the Director of the Centers for
Disease Control.
(2) The Director of the National Institutes of Health shall
serve as chairman of the task force.
(3) In consultation with the Advisory Commission on
Childhood Vaccines, the task force shall prepare recommendations to the Secretary concerning implementation of the requirements of subsection (a).
(c) REPORT.—Within 2 years after the effective date of this
part, 1 and periodically thereafter, the Secretary shall prepare and
transmit to the Committee on Energy and Commerce of the House
of Representatives and the Committee on Labor and Human Resources of the Senate a report describing the actions taken pursuant to subsection (a) during the preceding 2-year period.
MANUFACTURER RECORDKEEPING AND REPORTING

SEC. 2128. ø300aa–28¿ (a) GENERAL RULE.—Each vaccine
manufacturer of a vaccine set forth in the Vaccine Injury Table or
any other vaccine the administration of which is mandated by the
law or regulations of any State, shall, with respect to each batch,
lot, or other quantity manufactured or licensed after the effective
date of this part— 1
(1) prepare and maintain records documenting the history
of the manufacturing, processing, testing, repooling, and reworking of each batch, lot, or other quantity of such vaccine,
including the identification of any significant problems encountered in the production, testing, or handling of such batch, lot,
or other quantity,
(2) if a safety test on such batch, lot, or other quantity indicates a potential imminent or substantial public health haz1 Effective

March 13, 2013

December 22, 1987.

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Sec. 2131

PUBLIC HEALTH SERVICE ACT

1216

ard is presented, report to the Secretary within 24 hours of
such safety test which the manufacturer (or manufacturer’s
representative) conducted, including the date of the test, the
type of vaccine tested, the identity of the batch, lot, or other
quantity tested, whether the batch, lot, or other quantity tested is the product of repooling or reworking of previous batches,
lots, or other quantities (and, if so, the identity of the previous
batches, lots, or other quantities which were repooled or reworked), the complete test results, and the name and address
of the person responsible for conducting the test,
(3) include with each such report a certification signed by
a responsible corporate official that such report is true and
complete, and
(4) prepare, maintain, and upon request submit to the Secretary product distribution records for each such vaccine by
batch, lot, or other quantity number.
(b) SANCTION.—Any vaccine manufacturer who intentionally
destroys, alters, falsifies, or conceals any record or report required
under paragraph (1) or (2) of subsection (a) shall—
(1) be subject to a civil penalty of up to $100,000 per occurrence, or
(2) be fined $50,000 or imprisoned for not more than 1
year, or both.
Such penalty shall apply to the person who intentionally destroyed,
altered, falsified, or concealed such record or report, to the person
who directed that such record or report be destroyed, altered, falsified, or concealed, and to the vaccine manufacturer for which
such person is an agent, employee, or representative. Each act of
destruction, alteration, falsification, or concealment shall be treated
as a separate occurrence.
PART D—GENERAL PROVISIONS
CITIZEN’S ACTIONS

SEC. 2131. ø300aa–31¿ (a) GENERAL RULE.—Except as provided in subsection (b), any person may commence in a district
court of the United States a civil action on such person’s own behalf against the Secretary where there is alleged a failure of the
Secretary to perform any act or duty under this subtitle.
(b) NOTICE.—No action may be commenced under subsection
(a) before the date which is 60 days after the person bringing the
action has given written notice of intent to commence such action
to the Secretary.
(c) COSTS OF LITIGATION.—The court, in issuing any final order
in any action under this section, may award costs of litigation (including reasonable attorney and expert witness fees) to any plaintiff who substantially prevails on one or more significant issues in
the action.
JUDICIAL REVIEW

SEC. 2132. ø300aa–32¿ A petition for review of a regulation
under this subtitle may be filed in a court of appeals of the United
States within 60 days from the date of the promulgation of the regMarch 13, 2013

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PUBLIC HEALTH SERVICE ACT

Sec. 2134

ulation or after such date if such petition is based solely on
grounds arising after such 60th day.
DEFINITIONS

SEC. 2133. 1 ø300aa–33¿ For purposes of this subtitle:
(1) The term ‘‘health care provider’’ means any licensed
health care professional, organization, or institution, whether
public or private (including Federal, State, and local departments, agencies, and instrumentalities) under whose authority
a vaccine set forth in the Vaccine Injury Table is administered.
(2) The term ‘‘legal representative’’ means a parent or an
individual who qualifies as a legal guardian under State law.
(3) The term ‘‘manufacturer’’ means any corporation, organization, or institution, whether public or private (including
Federal, State, and local departments, agencies, and instrumentalities), which manufactures, imports, processes, or distributes under its label any vaccine set forth in the Vaccine Injury Table, except that, for purposes of section 2128, such term
shall include the manufacturer of any other vaccine covered by
that section. The term ‘‘manufacture’’ means to manufacture,
import, process, or distribute a vaccine.
(4) The term ‘‘significant aggravation’’ means any change
for the worse in a preexisting condition which results in markedly greater disability, pain, or illness accompanied by substantial deterioration of health.
(5) The term ‘‘vaccine-related injury or death’’ means an
illness, injury, condition, or death associated with one or more
of the vaccines set forth in the Vaccine Injury Table, except
that the term does not include an illness, injury, condition, or
death associated with an adulterant or contaminant intentionally added to such a vaccine.
(6)(A) The term ‘‘Advisory Commission on Childhood Vaccines’’ means the Commission established under section 2119.
(B) The term ‘‘Vaccine Injury Table’’ means the table set
out in section 2114.
TERMINATION OF PROGRAM

SEC. 2134. ø300aa–34¿ (a) REVIEWS.—The Secretary shall review the number of awards of compensation made under the pro1 Paragraphs (3) and (5) above appear so as to reflect the probable intent of the Congress, and
former paragraph (7) has been struck to reflect such intent. Sections 1714, 1715, and 1716 of
Public Law 107–296 (116 Stat. 2320, 2321) made amendments to section 2133 with respect to
such paragraphs. Subsequently, section 102(a) of division L of Public Law 108–7 (117 Stat. 528)
was enacted, and that section indicated the intent of the Congress to nullify those amendments.
That section repealed sections 1714, 1715, and 1716 rather than directly amending paragraphs
(3), (5), and (7). (That section also repealed section 1717, which related to effective dates.)
Section 102(b) of Public Law 108–7 provided as follows: ‘‘The Public Health Service Act (42
U.S.C. 201 et seq.) shall be applied and administered as if the sections repealed by subsection
(a) had never been enacted.’’. Consistent with that provision, section 2133 is shown above to reflect the assumption that repealing a provision of law that makes a change in an Act has the
effect of amending that Act so as to undo the change.
Section 102(c) of such Public Law provides as follows: ‘‘No inference shall be drawn from the
enactment of sections 1714 through 1717 of the Homeland Security Act of 2002 (Public Law 107296), or from this repeal, regarding the law prior to enactment of sections 1714 through 1717
of the Homeland Security Act of 2002 (Public Law 107-296). Further, no inference shall be
drawn that subsection (a) or (b) affects any change in that prior law, or that Leroy v. Secretary
of Health and Human Services, Office of Special Master, No. 02-392V (October 11, 2002), was
incorrectly decided.’’.

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Sec. 2134

PUBLIC HEALTH SERVICE ACT

1218

gram to petitioners under section 2111 for vaccine-related injuries
and deaths associated with the administration of vaccines on or
after the effective date of this part 1 as follows:
(1) The Secretary shall review the number of such awards
made in the 12-month period beginning on the effective date
of this part. 1
(2) At the end of each 3-month period beginning after the
expiration of the 12-month period referred to in paragraph (1)
the Secretary shall review the number of such awards made in
the 3-month period.
(b) REPORT.—
(1) If in conducting a review under subsection (a) the Secretary determines that at the end of the period reviewed the
total number of awards made by the end of that period and accepted under section 2121(a) exceeds the number of awards
listed next to the period reviewed in the table in paragraph
(2)—
(A) the Secretary shall notify the Congress of such determination, and
(B) beginning 180 days after the receipt by Congress
of a notification under paragraph (1), no petition for a vaccine-related injury or death associated with the administration of a vaccine on or after the effective date of this
part 1 may be filed under section 2111.
Section 2111(a) and part B shall not apply to civil actions for
damages for a vaccine-related injury or death for which a petition may not be filed because of subparagraph (B).
(2) The table referred to in paragraph (1) is as follows:
Total number of awards
by the end of the period
Period reviewed:
reviewed
12 months after the effective date of part ..............................
150
13th through the 15th month after such date ........................
188
16th through the 18th month after such date ........................
225
19th through the 21st month after such date ........................
263
22nd through the 24th month after such date .......................
300
25th through the 27th month after such date ........................
338
28th through the 30th month after such date ........................
375
31st through the 33rd month after such date ........................
413
34th through the 36th month after such date ........................
450
37th through the 39th month after such date ........................
488
40th through the 42nd month after such date .......................
525
43rd through the 45th month after such date ........................
563
46th through the 48th month after such date ........................
600.

1 Effective

March 13, 2013

December 22, 1987.

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TITLE
XXII—REQUIREMENTS
FOR
CERTAIN
GROUP
HEALTH PLANS FOR CERTAIN STATE AND LOCAL EMPLOYEES
SEC. 2201. ø300bb–1¿ STATE AND LOCAL GOVERNMENTAL GROUP
HEALTH PLANS MUST PROVIDE CONTINUATION COVERAGE TO CERTAIN INDIVIDUALS.
(a) IN GENERAL.—In accordance with regulations which the

Secretary shall prescribe, each group health plan that is maintained by any State that receives funds under this Act, by any political subdivision of such a State, or by any agency or instrumentality of such a State or political subdivision, shall provide, in accordance with this title, that each qualified beneficiary who would
lose coverage under the plan as a result of a qualifying event is entitled, under the plan, to elect, within the election period, continuation coverage under the plan.
(b) EXCEPTION FOR CERTAIN PLANS.—Subsection (a) shall not
apply to—
(1) any group health plan for any calendar year if all employers maintaining such plan normally employed fewer than
20 employees on a typical business day during the preceding
calendar year, or
(2) any group health plan maintained for employees by the
government of the District of Columbia or any territory or possession of the United States or any agency or instrumentality.
SEC. 2202. ø300bb–2¿ CONTINUATION COVERAGE.

For purposes of section 2201, the term ‘‘continuation coverage’’
means coverage under the plan which meets the following requirements:
(1) TYPE OF BENEFIT COVERAGE.—The coverage must consist of coverage which, as of the time the coverage is being provided, is identical to the coverage provided under the plan to
similarly situated beneficiaries under the plan with respect to
whom a qualifying event has not occurred. If coverage is modified under the plan for any group of similarly situated beneficiaries, such coverage shall also be modified in the same manner for all individuals who are qualified beneficiaries under the
plan pursuant to this part 1 in connection with such group.
(2) PERIOD OF COVERAGE.—The coverage must extend for
at least the period beginning on the date of the qualifying
event and ending not earlier than the earliest of the following:
(A) MAXIMUM REQUIRED PERIOD.—
(i) GENERAL RULE FOR TERMINATIONS AND REDUCED HOURS.—In the case of a qualifying event described in section 2203(2), except as provided in clause
1 So

in law. This title is not divided into parts.

1219
March 13, 2013

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Sec. 2202

PUBLIC HEALTH SERVICE ACT

1220

(ii), the date which is 18 months after the date of the
qualifying event.
(ii) SPECIAL RULE FOR MULTIPLE QUALIFYING
EVENTS.—If a qualifying event occurs during the 18
months after the date of a qualifying event described
in section 2203(2), the date which is 36 months after
the date of the qualifying event described in section
2203(2).
(iii) GENERAL RULE FOR OTHER QUALIFYING
EVENTS.—In the case of a qualifying event not described in section 2203(2), the date which is 36 months
after the date of the qualifying event.
(iv) SPECIAL RULE FOR TAA-ELIGIBLE INDIVIDUALS.—In the case of a qualifying event described in
section 2203(2) with respect to a covered employee
who is (as of the date that the period of coverage
would, but for this clause or clause (v), otherwise terminate under clause (i) or (ii)) a TAA-eligible individual (as defined in section 2205(b)(4)(B)), the period
of coverage shall not terminate by reason of clause (i)
or (ii), as the case may be, before the later of the date
specified in such clause or the date on which such individual ceases to be such a TAA-eligible individual.
The preceding sentence shall not require any period of
coverage to extend beyond January 1, 2014.
(v) MEDICARE ENTITLEMENT FOLLOWED BY QUALIFYING EVENT.—In the case of a qualifying event described in section 2203(2) that occurs less than 18
months after the date the covered employee became
entitled to benefits under title XVIII of the Social Security Act, the period of coverage for qualified beneficiaries other than the covered employee shall not terminate under this subparagraph before the close of the
36-month period beginning on the date the covered
employee became so entitled.
(vi) SPECIAL RULE FOR DISABILITY.—In the case of
a qualified beneficiary who is determined, under title
II or XVI of the Social Security Act, to have been disabled at any time during the first 60 days of continuation coverage under this title, any reference in clause
(i) or (ii) to 18 months with respect to such event 1 is
deemed a reference to 29 months (with respect to all
qualified beneficiaries), but only if the qualified beneficiary has provided notice of such determination
under section 2206(3) before the end of such 18
months.
(B) END OF PLAN.—The date on which the employer
ceases to provide any group health plan to any employee.
(C) FAILURE TO PAY PREMIUM.—The date on which coverage ceases under the plan by reason of a failure to make
1 Section 421(a)(1)(A)(ii)(III) of Public Law 104–191 (110 Stat. 2087) provides that the last sentence of subparagraph (A) is amended by striking ‘‘with respect to such event,’’. The amendment
cannot be executed because the term to be struck does not appear. (Compare ‘‘with respect to
such event,’’ and ‘‘with respect to such event’’.)

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PUBLIC HEALTH SERVICE ACT

Sec. 2202

timely payment of any premium required under the plan
with respect to the qualified beneficiary. The payment of
any premium (other than any payment referred to in the
last sentence of paragraph (3)) shall be considered to be
timely if made within 30 days after the date due or within
such longer period as applies to or under the plan.
(D) GROUP HEALTH PLAN COVERAGE OR MEDICARE
ENTITLEMEMT.—The date on which the qualified beneficiary first becomes, after the date of the election—
(i) covered under any other group health plan (as
an employee or otherwise) which does not contain any
exclusion or limitation with respect to any preexisting
condition of such beneficiary (other than such an exclusion or limitation which does not apply to (or is satisfied by) such beneficiary by reason of chapter 100 of
the Internal Revenue Code of 1986, part 7 of subtitle
B of title I of the Employee Retirement Income Security Act of 1974, or title XXVII of this Act), or
(ii) entitled to benefits under title XVIII of the Social Security Act.
(E) TERMINATION OF EXTENDED COVERAGE FOR DISABILITY.—In the case of a qualified beneficiary who is disabled at any time during the first 60 days of continuation
coverage under this title, the month that begins more than
30 days after the date of the final determination under
title II or XVI of the Social Security Act that the qualified
beneficiary is no longer disabled.
(3) PREMIUM REQUIREMENTS.—The plan may require payment of a premium for any period of continuation coverage, except that such premium—
(A) shall not exceed 102 percent of the applicable premium for such period, and
(B) may, at the election of the payor, be made in
monthly installments.
In no event may the plan require the payment of any premium
before the day which is 45 days after the day on which the
qualified beneficiary made the initial election for continuation
coverage. In the case of an individual described in the last sentence of paragraph (2)(A), any reference in subparagraph (A) of
this paragraph to ‘‘102 percent’’ is deemed a reference to ‘‘150
percent’’ for any month after the 18th month of continuation
coverage described in clause (i) or (ii) of paragraph (2)(A).
(4) NO REQUIREMENT OF INSURABILITY.—The coverage may
not be conditioned upon, or discriminate on the basis of lack
of, evidence of insurability.
(5) CONVERSION OPTION.—In the case of a qualified beneficiary whose period of continuation coverage expires under
paragraph (2)(A), the plan must, during the 180-day period
ending on such expiration date, provide to the qualified beneficiary the option of enrollment under a conversion health plan
otherwise generally available under the plan.
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Sec. 2203

PUBLIC HEALTH SERVICE ACT

1222

SEC. 2203. ø300bb–3¿ QUALIFYING EVENT.

For purposes of this title, the term ‘‘qualifying event’’ means,
with respect to any covered employee, any of the following events
which, but for the continuation coverage required under this title,
would result in the loss of coverage of a qualified beneficiary:
(1) The death of the covered employee.
(2) The termination (other than by reason of such employee’s gross misconduct), or reduction of hours, of the
covered employee’s employment.
(3) The divorce or legal separation of the covered employee
from the employee’s spouse.
(4) The covered employee becoming entitled to benefits
under title XVIII of the Social Security Act.
(5) A dependent child ceasing to be a dependent child
under the generally applicable requirements of the plan.
SEC. 2204. ø300bb–4¿ APPLICABLE PREMIUM.

For purposes of this title—
(1) IN GENERAL.—The term ‘‘applicable premium’’ means,
with respect to any period of continuation coverage of qualified
beneficiaries, the cost to the plan for such period of the coverage for similarly situated beneficiaries with respect to whom
a qualifying event has not occurred (without regard to whether
such cost is paid by the employer or employee).
(2) SPECIAL RULE FOR SELF-INSURED PLANS.—To the extent
that a plan is a self-insured plan—
(A) IN GENERAL.—Except as provided in subparagraph
(B), the applicable premium for any period of continuation
coverage of qualified beneficiaries shall be equal to a reasonable estimate of the cost of providing coverage for such
period for similarly situated beneficiaries which—
(i) is determined on an actuarial basis, and
(ii) takes into account such factors as the Secretary may prescribe in regulations.
(B) DETERMINATION ON BASIS OF PAST COST.—If a plan
administrator elects to have this subparagraph apply, the
applicable premium for any period of continuation coverage of qualified beneficiaries shall be equal to—
(i) the cost to the plan for similarly situated beneficiaries for the same period occurring during the preceding determination period under paragraph (3), adjusted by
(ii) the percentage increase or decrease in the implicit price deflator of the gross national product (calculated by the Department of Commerce and published in the Survey of Current Business) for the 12month period ending on the last day of the sixth
month of such preceding determination period.
(C) SUBPARAGRAPH (B) NOT TO APPLY WHERE SIGNIFICANT CHANGE.—A plan administrator may not elect to
have subparagraph (B) apply in any case in which there is
any significant difference, between the determination period and the preceding determination period, in coverage
under, or in employees covered by, the plan. The determination under the preceding sentence for any determinaMarch 13, 2013

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1223

PUBLIC HEALTH SERVICE ACT

Sec. 2205

tion period shall be made at the same time as the determination under paragraph (3).
(3) DETERMINATION PERIOD.—The determination of any applicable premium shall be made for a period of 12 months and
shall be made before the beginning of such period.
SEC. 2205. ø300bb–5¿ ELECTION.
(a) IN GENERAL.—For purposes of this
(1) ELECTION PERIOD.—The term

title—
‘‘election period’’ means

the period which—
(A) begins not later than the date on which coverage
terminates under the plan by reason of a qualifying event,
(B) is of at least 60 days’ duration, and
(C) ends not earlier than 60 days after the later of—
(i) the date described in subparagraph (A), or
(ii) in the case of any qualified beneficiary who receives notice under section 2206(4), the date of such
notice.
(2) EFFECT OF ELECTION ON OTHER BENEFICIARIES.—Except
as otherwise specified in an election, any election of continuation coverage by a qualified beneficiary described in subparagraph (A)(i) or (B) of section 2208(3) shall be deemed to include
an election of continuation coverage on behalf of any other
qualified beneficiary who would lose coverage under the plan
by reason of the qualifying event. If there is a choice among
types of coverage under the plan, each qualified beneficiary is
entitled to make a separate selection among such types of coverage.
(b) TEMPORARY EXTENSION OF COBRA ELECTION PERIOD FOR
CERTAIN INDIVIDUALS.—
(1) IN GENERAL.—In the case of a nonelecting TAA-eligible
individual and notwithstanding subsection (a), such individual
may elect continuation coverage under this title during the 60day period that begins on the first day of the month in which
the individual becomes a TAA-eligible individual, but only if
such election is made not later than 6 months after the date
of the TAA-related loss of coverage.
(2) COMMENCEMENT OF COVERAGE; NO REACH-BACK.—Any
continuation coverage elected by a TAA-eligible individual
under paragraph (1) shall commence at the beginning of the
60-day election period described in such paragraph and shall
not include any period prior to such 60-day election period.
(3) PREEXISTING CONDITIONS.—With respect to an individual who elects continuation coverage pursuant to paragraph
(1), the period—
(A) beginning on the date of the TAA-related loss of
coverage, and
(B) ending on the first day of the 60-day election period described in paragraph (1),
shall be disregarded for purposes of determining the 63-day periods referred to in section 2701(c)(2), section 701(c)(2) of the
Employee Retirement Income Security Act of 1974, and section
9801(c)(2) of the Internal Revenue Code of 1986.
(4) DEFINITIONS.—For purposes of this subsection:
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Sec. 2206

PUBLIC HEALTH SERVICE ACT

1224

(A) NONELECTING TAA-ELIGIBLE INDIVIDUAL.—The term
‘‘nonelecting TAA-eligible individual’’ means a TAA-eligible
individual who—
(i) has a TAA-related loss of coverage; and
(ii) did not elect continuation coverage under this
part during the TAA-related election period.
(B) TAA-ELIGIBLE INDIVIDUAL.—The term ‘‘TAA-eligible individual’’ means—
(i) an eligible TAA recipient (as defined in paragraph (2) of section 35(c) of the Internal Revenue Code
of 1986), and
(ii) an eligible alternative TAA recipient (as defined in paragraph (3) of such section).
(C) TAA-RELATED ELECTION PERIOD.—The term ‘‘TAArelated election period’’ means, with respect to a TAA-related loss of coverage, the 60-day election period under this
part which is a direct consequence of such loss.
(D) TAA-RELATED LOSS OF COVERAGE.—The term
‘‘TAA-related loss of coverage’’ means, with respect to an
individual whose separation from employment gives rise to
being an TAA-eligible individual, the loss of health benefits coverage associated with such separation.
SEC. 2206. ø300bb–6¿ NOTICE REQUIREMENTS.

In accordance with regulations prescribed by the Secretary—
(1) the group health plan shall provide, at the time of commencement of coverage under the plan, written notice to each
covered employee and spouse of the employee (if any) of the
rights provided under this subsection, 1
(2) the employer of an employee under a plan must notify
the plan administrator of a qualifying event described in paragraph (1), (2), or (4) of section 2203 within 30 days of the date
of the qualifying event,
(3) each covered employee or qualified beneficiary is responsible for notifying the plan administrator of the occurrence
of any qualifying event described in paragraph (3) or (5) of section 2203 within 60 days after the date of the qualifying event
and each qualified beneficiary who is determined, under title
II or XVI of the Social Security Act, to have been disabled at
any time during the first 60 days of continuation coverage
under this title is responsible for notifying the plan administrator of such determination within 60 days after the date of
the determination and for notifying the plan administrator
within 30 days after the date of any final determination under
such title or titles that the qualified beneficiary is no longer
disabled, and
(4) the plan administrator shall notify—
(A) in the case of a qualifying event described in paragraph (1), (2), or (4) of section 2203, any qualified beneficiary with respect to such event, and
(B) in the case of a qualifying event described in paragraph (3) or (5) of section 2203 where the covered em1 So

March 13, 2013

in law. Probably should be ‘‘this title’’.

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1225

PUBLIC HEALTH SERVICE ACT

Sec. 2208

ployee notifies the plan administrator under paragraph (3),
any qualified beneficiary with respect to such event,
of such beneficiary’s rights under this subsection. 1
For purposes of paragraph (4), any notification shall be made within 14 days of the date on which the plan administrator is notified
under paragraph (2) or (3), whichever is applicable, and any such
notification to an individual who is a qualified beneficiary as the
spouse of the covered employee shall be treated as notification to
all other qualified beneficiaries residing with such spouse at the
time such notification is made.
SEC. 2207. 2 ø300bb–7¿ ENFORCEMENT.

Any individual who is aggrieved by the failure of a State, political subdivision, or agency or instrumentality thereof, to comply
with the requirements of this title may bring an action for appropriate equitable relief.
SEC. 2208. ø300bb–8¿ DEFINITIONS.

For purposes of this title—
(1) GROUP HEALTH PLAN.—The term ‘‘group health plan’’
has the meaning given such term in 5000(b) 1 of the Internal
Revenue Code of 1986. Such term shall not include any plan
substantially all of the coverage under which is for qualified
long-term care services (as defined in section 7702B(c) of such
Code).
(2) COVERED EMPLOYEE.—The term ‘‘covered employee’’
means an individual who is (or was) provided coverage under
a group health plan by virtue of the performance of services by
the individual for 1 or more persons maintaining the plan (including as an employee defined in section 401(c)(1) of the Internal Revenue Code of 1986).
(3) QUALIFIED BENEFICIARY.—
(A) IN GENERAL.—The term ‘‘qualified beneficiary’’
means, with respect to a covered employee under a group
health plan, any other individual who, on the day before
the qualifying event for that employee, is a beneficiary
under the plan—
(i) as the spouse of the covered employee, or
(ii) as the dependent child of the employee.
Such term shall also include a child who is born to or placed
for adoption with the covered employee during the period of
continuation coverage under this title. 2
(B) SPECIAL RULE FOR TERMINATIONS AND REDUCED
EMPLOYMENT.—In the case of a qualifying event described
2 Section 13631(d) of Public Law 103-66 (107 Stat. 643) provides as follows:
(d) CONTINUED COVERAGE OF COSTS OF A PEDIATRIC VACCINE UNDER CERTAIN GROUP HEALTH
PLANS.—
(1) REQUIREMENT.—The requirement of this paragraph, with respect to a group health
plan for plan years beginning after the date of the enactment of this Act, is that the group
health plan not reduce its coverage of the costs of pediatric vaccines (as defined under section 1928(h)(6) of the Social Security Act) below the coverage it provided as of May 1, 1993.
(2) ENFORCEMENT.—For purposes of section 2207 of the Public Health Service Act, the requirement of paragraph (1) is deemed a requirement of title XXII of such Act.
1 So in law. The word ‘‘section’’ does not appear. See section 102(d) of Public Law 104–191
(110 Stat. 1978).
2 Indentation is so in law. See section 401(a)(3) of Public Law 104–191 (110 Stat. 2085).

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in section 2203(2), the term ‘‘qualified beneficiary’’ includes
the covered employee.
(4) PLAN ADMINISTRATOR.—The term ‘‘plan administrator’’
has the meaning given the term ‘‘administrator’’ by section
3(16)(A) of the Employee Retirement Income Security Act of
1974.

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TITLE XXIII—RESEARCH WITH RESPECT TO ACQUIRED
IMMUNE DEFICIENCY SYNDROME 1
PART A—ADMINISTRATION

OF

RESEARCH PROGRAMS

SEC. 2302. ø300cc–1¿ REQUIREMENT OF EXPEDITING AWARDS OF
GRANTS AND CONTRACTS FOR RESEARCH.
(a) IN GENERAL.—The Secretary shall expedite the award of

grants, contracts, and cooperative agreements for research projects
relating to acquired immune deficiency syndrome (including such
research projects initiated independently of any solicitation by the
Secretary for proposals for such research projects).
(b) TIME LIMITATIONS WITH RESPECT TO CERTAIN APPLICATIONS.—
(1) With respect to programs of grants, contracts, and cooperative agreements described in subsection (a), any application submitted in response to a solicitation by the Secretary for
proposals pursuant to such a program—
(A) may not be approved if the application is submitted after the expiration of the 3-month period beginning on the date on which the solicitation is issued; and
(B) shall be awarded, or otherwise finally acted upon,
not later than the expiration of the 6-month period beginning on the expiration of the period described in subparagraph (A).
(2) If the Secretary makes a determination that it is not
practicable to administer a program referred to in paragraph
(1) in accordance with the time limitations described in such
paragraph, the Secretary may adjust the time limitations accordingly.
(c) REQUIREMENTS WITH RESPECT TO ADJUSTMENTS IN TIME
LIMITATIONS.—With respect to any program for which a determination described in subsection (b)(2) is made, the Secretary shall—
(1) if the determination is made before the Secretary
issues a solicitation for proposals pursuant to the program, ensure that the solicitation describes the time limitations as adjusted by the determination; and
(2) if the determination is made after the Secretary issues
such a solicitation for proposals, issue a statement describing
the time limitations as adjusted by the determination and individually notify, with respect to the determination, each applicant whose application is submitted before the expiration of
the 3-month period beginning on the date on which the solicitation was issued.
1 Subtitle E of title II of Public Law 100–607 (102 Stat. 3108) established various authorities
regarding acquired immune deficiency syndrome.
Section 2301 was repealed by section 104(b)(2)(C) of Public Law 109–482.

1227
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(d) ANNUAL REPORTS TO CONGRESS.—Except as provided in
subsection (e), the Secretary shall annually prepare, for inclusion
in the comprehensive report required in section 2301, a report—
(A) 1 summarizing programs for which the Secretary has
made a determination described in subsection (b)(2), including
a description of the time limitations as adjusted by the determination and including a summary of the solicitation issued by
the Secretary for proposals pursuant to the program; and
(B) summarizing applications that—
(i) were submitted pursuant to a program of grants,
contracts, or cooperative agreements referred to in paragraph (1) of subsection (b) for which a determination described in paragraph (2) of such subsection has not been
made; and
(ii) were not processed in accordance with the time
limitations described in such paragraph (1).
(e) QUARTERLY REPORTS FOR FISCAL YEAR 1989.—For fiscal
year 1989, the report required in subsection (d) shall, not less than
quarterly, be prepared and submitted to the Committee on Energy
and Commerce of the House of Representatives and the Committee
on Labor and Human Resources of the Senate.
SEC. 2303. ø300cc–2¿ REQUIREMENTS WITH RESPECT TO PROCESSING
OF REQUESTS FOR PERSONNEL AND ADMINISTRATIVE
SUPPORT.
(a) IN GENERAL.—The Director of the Office of Personnel Man-

agement or the Administrator of General Services, as the case may
be, shall respond to any priority request made by the Administrator of the Alcohol, Drug Abuse, and Mental Health Administration, the Director of the Centers for Disease Control and Prevention, the Commissioner of Food and Drugs, or the Director of the
National Institutes of Health, not later than 21 days after the date
on which such request is made. If the Director of the Office of Personnel Management or the Administrator of General Services, as
the case may be, does not disapprove a priority request during the
21-day period, the request shall be deemed to be approved.
(b) NOTICE TO SECRETARY AND TO ASSISTANT SECRETARY FOR
HEALTH.—The Administrator of the Substance Abuse and Mental
Health Services Administration, the Director of the Centers for
Disease Control and Prevention, the Commissioner of Food and
Drugs, and the Director of the National Institutes of Health, shall,
respectively, transmit to the Secretary and the Assistant Secretary
for Health a copy of each priority request made under this section
by the agency head involved. The copy shall be transmitted on the
date on which the priority request involved is made.
(c) DEFINITION OF PRIORITY REQUEST.—For purposes of this
section, the term ‘‘priority request’’ means any request that—
(1) is designated as a priority request by the Administrator
of the Substance Abuse and Mental Health Services Administration, the Director of the Centers for Disease Control and
Prevention, the Commissioner of Food and Drugs, or the Director of the National Institutes of Health; and
1 Designations are so in law. Subparagraphs (A) and (B) should probably be designated paragraphs (1) and (2), respectively. Similarly, clauses (i) and (ii) of subparagraph (B) should probably be designated subparagraphs (A) and (B), respectively.

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Sec. 2304

(2)(A) is made to the Director of the Office of Personnel
Management for the allocation of personnel to carry out activities with respect to acquired immune deficiency syndrome; or
(B) is made to the Administrator of General Services for
administrative support or space in carrying out such activities.
SEC. 2304. ø300cc–3¿ ESTABLISHMENT OF RESEARCH ADVISORY COMMITTEE.
(a) IN GENERAL.—After consultation with the Commissioner of

Food and Drugs, the Secretary, acting through the Director of the
National Institute of Allergy and Infectious Diseases, shall establish within such Institute an advisory committee to be known as
the AIDS Research Advisory Committee (hereafter in this section
referred to as the ‘‘Committee’’).
(b) COMPOSITION.—The Committee shall be composed of physicians whose clinical practice includes a significant number of patients with acquired immune deficiency syndrome.
(c) DUTIES.—The Committee shall—
(1) advise the Director of such Institute (and may provide
advice to the Directors of other agencies of the National Institutes of Health, as appropriate) on appropriate research activities to be undertaken with respect to clinical treatment of such
syndrome, including advice with respect to—
(A) research on drugs for preventing or minimizing the
development of symptoms or conditions arising from infection with the etiologic agent for such syndrome, including
recommendations on the projects of research with respect
to diagnosing immune deficiency and with respect to predicting, diagnosing, preventing, and treating opportunistic
cancers and infectious diseases; and
(B) research on the effectiveness of treating such
symptoms or conditions with drugs that—
(i) are not approved by the Commissioner of Food
and Drugs for the purpose of treating such symptoms
or conditions; and
(ii) are being utilized for such purpose by individuals infected with such etiologic agent;
(2)(A) review ongoing publicly and privately supported research on clinical treatment for acquired immune deficiency
syndrome, including research on drugs described in paragraph
(1); and
(B) periodically issue, and make available to health care
professionals, reports describing and evaluating such research;
(3) conduct studies and convene meetings for the purpose
of determining the recommendations among physicians in clinical practice on clinical treatment of acquired immune deficiency syndrome, including treatment with the drugs described
in paragraph (1); and
(4) conduct a study for the purpose of developing, with respect to individuals infected with the etiologic agent for acquired immune deficiency syndrome, a consensus among health
care professionals on clinical treatments for preventing or
minimizing the development of symptoms or conditions arising
from infection with such etiologic agent.
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Sec. 2311

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1230

PART B—RESEARCH AUTHORITY
SEC. 2311. ø300cc–11¿ CLINICAL EVALUATION UNITS AT NATIONAL INSTITUTES OF HEALTH.
(a) IN GENERAL.—The Secretary, acting through the Director of

the National Cancer Institute and the Director of the National Institute of Allergy and Infectious Diseases, shall for each such Institute establish a clinical evaluation unit at the Clinical Center at
the National Institutes of Health. Each of the clinical evaluation
units—
(1) shall conduct clinical evaluations of experimental treatments for acquired immune deficiency syndrome developed
within the preclinical drug development program, including
evaluations of methods of diagnosing immune deficiency and
evaluations of methods of predicting, diagnosing, preventing,
and treating opportunistic cancers and infectious diseases; and
(2) may conduct clinical evaluations of experimental treatments for such syndrome that are developed by any other national research institute of the National Institutes of Health or
by any other entity.
(b) PERSONNEL AND ADMINISTRATIVE SUPPORT.—
(1) For the purposes described in subsection (a), the Secretary, acting through the Director of the National Institutes
of Health, shall provide each of the clinical evaluation units required in such subsection—
(A)(i) with not less than 50 beds; or
(ii) with an outpatient clinical capacity equal to not
less than twice the outpatient clinical capacity, with respect to acquired immune deficiency syndrome, possessed
by the Clinical Center of the National Institutes of Health
on June 1, 1988; and
(B) with such personnel, such administrative support,
and such other support services as may be necessary.
(2) Facilities, personnel, administrative support, and other
support services provided pursuant to paragraph (1) shall be in
addition to the number or level of facilities, personnel, administrative support, and other support services that otherwise
would be available at the Clinical Center at the National Institutes of Health for the provision of clinical care for individuals
with diseases or disorders.
(c) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of
carrying out this section, there are authorized to be appropriated
such sums as may be necessary.
SEC. 2312. ø300cc–12¿ USE OF INVESTIGATIONAL NEW DRUGS WITH RESPECT TO ACQUIRED IMMUNE DEFICIENCY SYNDROME.
(a) ENCOURAGEMENT OF APPLICATIONS WITH RESPECT TO CLINICAL TRIALS.—

(1) If, in the determination of the Secretary, there is preliminary evidence that a new drug has effectiveness in humans
with respect to the prevention or treatment of acquired immune deficiency syndrome, the Secretary shall, through statements published in the Federal Register—
(A) announce the fact of such determination; and
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Sec. 2312

(B) with respect to the new drug involved, encourage
an application for an exemption for investigational use of
the new drug under regulations issued under section 505(i)
of the Federal Food, Drug, and Cosmetic Act.
(2)(A) The AIDS Research Advisory Committee established
pursuant to section 2304 shall make recommendations to the
Secretary with respect to new drugs appropriate for determinations described in paragraph (1).
(B) The Secretary shall, as soon as is practicable, determine the merits of recommendations received by the Secretary
pursuant to subparagraph (A).
(b) ENCOURAGEMENT OF APPLICATIONS WITH RESPECT TO
TREATMENT USE IN CIRCUMSTANCES OTHER THAN CLINICAL
TRIALS.—
(1) In the case of a new drug with respect to which the
Secretary has made a determination described in subsection (a)
and with respect to which an exemption is in effect for purposes of section 505(i) of the Federal Food, Drug, and Cosmetic
Act, the Secretary shall—
(A) as appropriate, encourage the sponsor of the investigation of the new drug to submit to the Secretary, in accordance with regulations issued under such section, an
application to use the drug in the treatment of individuals—
(i) who are infected with the etiologic agent for acquired immune deficiency syndrome; and
(ii) who are not participating in the clinical trials
conducted pursuant to such exemption; and
(B) if such an application is approved, encourage, as
appropriate, licensed medical practitioners to obtain, in accordance with such regulations, the new drug from such
sponsor for the purpose of treating such individuals.
(2) If the sponsor of the investigation of a new drug described in paragraph (1) does not submit to the Secretary an
application described in such paragraph (relating to treatment
use), the Secretary shall, through statements published in the
Federal Register, encourage, as appropriate, licensed medical
practitioners to submit to the Secretary such applications in
accordance with regulations described in such paragraph.
(c) TECHNICAL ASSISTANCE WITH RESPECT TO TREATMENT
USE.—In the case of a new drug with respect to which the Secretary has made a determination described in subsection (a), the
Secretary may, directly or through grants or contracts, provide
technical assistance with respect to the process of—
(1) submitting to the Secretary applications for exemptions
described in paragraph (1)(B) of such subsection;
(2) submitting to the Secretary applications described in
subsection (b); and
(3) with respect to sponsors of investigations of new drugs,
facilitating the transfer of new drugs from such sponsors to licensed medical practitioners.
(d) DEFINITION.—For purposes of this section, the term ‘‘new
drug’’ has the meaning given such term in section 201 of the Federal Food, Drug, and Cosmetic Act.
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Sec. 2313

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1232

SEC. 2313. ø300cc–13¿ TERRY BEIRN COMMUNITY-BASED AIDS RESEARCH INITIATIVE.
(a) IN GENERAL.—After consultation with the Commissioner of

Food and Drugs, the Director of the National Institutes of Health,
acting through the National Institute 1 of Allergy and Infectious
Diseases, may make grants to public entities and nonprofit private
entities concerned with acquired immune deficiency syndrome, and
may enter into contracts with public and private such entities, for
the purpose of planning and conducting, in the community involved, clinical trials of experimental treatments for infection with
the etiologic agent for such syndrome that are approved by the
Commissioner of Food and Drugs for investigational use under regulations issued under section 505 of the Federal Food, Drug, and
Cosmetic Act.
(b) REQUIREMENT OF CERTAIN PROJECTS.—
(1) Financial assistance under subsection (a) shall include
such assistance to community-based organizations and community health centers for the purpose of—
(A) retaining appropriate medical supervision;
(B) assisting with administration, data collection and
record management; and
(C) conducting training of community physicians,
nurse practitioners, physicians’ assistants and other health
professionals for the purpose of conducting clinical trials.
(2)(A) Financial assistance under subsection (a) shall include such assistance for demonstration projects designed to
implement and conduct community-based clinical trials in
order to provide access to the entire scope of communities affected by infections with the etiologic agent for acquired immune deficiency syndrome, including minorities, hemophiliacs
and transfusion-exposed individuals, women, children, users of
intravenous drugs, and individuals who are asymptomatic with
respect to such infection.
(B) The Director of the National Institutes of Health may
not provide financial assistance under this paragraph unless
the application for such assistance is approved—
(i) by the Commissioner of Food and Drugs;
(ii) by a duly constituted Institutional Review Board
that meets the requirements of part 56 of title 21, Code of
Federal Regulations; and
(iii) by the Director of the National Institute of Allergy
and Infectious Diseases.
(c) PARTICIPATION OF PRIVATE INDUSTRY, SCHOOLS OF MEDICINE AND PRIMARY PROVIDERS.—Programs carried out with financial assistance provided under subsection (a) shall be designed to
encourage private industry and schools of medicine, osteopathic
medicine, and existing consortia of primary care providers organized to conduct clinical research concerning acquired immune deficiency syndrome to participate in, and to support, the clinical trials
conducted pursuant to the programs.
1 So in law. Probably should be ‘‘acting through the Director of the National Institute’’. (Section 2617(b)(1) of Public Law 100–690 expressed the intent to so amend the provision; however,
the amendment cannot be executed because the amendatory instructions are to strike ‘‘through
the National Institutes of Allergy’’, and this term does not appear in subsection (a) (above).)

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Sec. 2314

(d) REQUIREMENT OF APPLICATION.—The Secretary may not
provide financial assistance under subsection (a) unless—
(1) an application for the assistance is submitted to the
Secretary;
(2) with respect to carrying out the purpose for which the
assistance is to be made, the application provides assurances
of compliance satisfactory to the Secretary; and
(3) the application otherwise is in such form, is made in
such manner, and contains such agreements, assurances, and
information as the Secretary determines to be necessary to
carry out this section.
(e) AUTHORIZATION OF APPROPRIATIONS.—
(1) For the purpose of carrying out subsection (b)(1), there
are authorized to be appropriated such sums as may be necessary for each of the fiscal years 1989 through 1996.
(2) For the purpose of carrying out subsection (b)(2), there
are authorized to be appropriated such sums as may be necessary for each of the fiscal years 1989 through 1996.
SEC. 2314. ø300cc–14¿ EVALUATION OF CERTAIN TREATMENTS.
(a) ESTABLISHMENT OF PROGRAM.—

(1) After consultation with the AIDS Research Advisory
Committee established pursuant to section 2304, the Secretary
shall establish a program for the evaluation of drugs that—
(A) are not approved by the Commissioner of Food and
Drugs for the purpose of treatments with respect to acquired immune deficiency syndrome; and
(B) are being utilized for such purpose by individuals
infected with the etiologic agent for such syndrome.
(2) The program established under paragraph (1) shall include evaluations of the effectiveness and the risks of the treatment involved, including the risks of foregoing treatments with
respect to acquired immune deficiency syndrome that are approved by the Commissioner of Food and Drugs.
(b) AUTHORITY WITH RESPECT TO GRANTS AND CONTRACTS.—
(1) For the purpose of conducting evaluations required in
subsection (a), the Secretary may make grants to, and enter
into cooperative agreements and contracts with, public and
nonprofit private entities.
(2) Nonprofit private entities under paragraph (1) may include nonprofit private organizations that—
(A) are established for the purpose of evaluating treatments with respect to acquired immune deficiency syndrome; and
(B) consist primarily of individuals infected with the
etiologic agent for such syndrome.
(c) SCIENTIFIC AND ETHICAL GUIDELINES.—
(1) The Secretary shall establish appropriate scientific and
ethical guidelines for the conduct of evaluations carried out
pursuant to this section. The Secretary may not provide financial assistance under subsection (b)(1) unless the applicant for
such assistance agrees to comply with such guidelines.
(2) The Secretary may establish the guidelines described in
paragraph (1) only after consulting with—
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Sec. 2315

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1234

(A) physicians whose clinical practice includes a significant number of individuals with acquired immune deficiency syndrome;
(B) individuals who are infected with the etiologic
agent for such syndrome; and
(C) other individuals with appropriate expertise or experience.
(d) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of
carrying out this section, there are authorized to be appropriated
such sums as may be necessary.
SEC. 2315. ø300cc–15¿ SUPPORT OF INTERNATIONAL EFFORTS.
(a) GRANTS AND CONTRACTS FOR RESEARCH.—

(1) Under section 307, the Secretary, acting through the
Director of the National Institutes of Health—
(A) shall, for the purpose described in paragraph (2),
make grants to, enter into cooperative agreements and
contracts with, and provide technical assistance to, international organizations concerned with public health; and
(B) may, for such purpose, provide technical assistance
to foreign governments.
(2) The purpose referred to in paragraph (1) is promoting
and expediting international research and training concerning
the natural history and pathogenesis of the human immunodeficiency virus and the development and evaluation of vaccines and treatments for acquired immune deficiency syndrome
and opportunistic infections.
(b) GRANTS AND CONTRACTS FOR ADDITIONAL PURPOSES.—After
consultation with the Administrator of the Agency for International
Development, the Secretary, acting through the Director of the
Centers for Disease Control and Prevention, shall under section
307 make grants to, enter into contracts with, and provide technical assistance to, international organizations concerned with public health and may provide technical assistance to foreign governments, in order to support—
(1) projects for training individuals with respect to developing skills and technical expertise for use in the prevention,
diagnosis, and treatment of acquired immune deficiency syndrome; and
(2) epidemiological research relating to acquired immune
deficiency syndrome.
(c) SPECIAL PROGRAMME OF WORLD HEALTH ORGANIZATION.—
Support provided by the Secretary pursuant to this section shall be
in furtherance of the global strategy of the World Health Organization Special Programme on Acquired Immunodeficiency Syndrome.
(d) PREFERENCES.—In providing grants, cooperative agreements, contracts, and technical assistance under subsections (a)
and (b), the Secretary shall—
(1) give preference to activities under such subsections conducted by, or in cooperation with, the World Health Organization; and
(2) with respect to activities carried out under such subsections in the Western Hemisphere, give preference to activiMarch 13, 2013

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Sec. 2316

ties conducted by, or in cooperation with, the Pan American
Health Organization or the World Health Organization.
(e) REQUIREMENT OF APPLICATION.—The Secretary may not
make a grant or enter into a cooperative agreement or contract
under this section unless—
(1) an application for such assistance is submitted to the
Secretary;
(2) with respect to carrying out the purpose for which such
assistance is to be provided, the application provides assurances of compliance satisfactory to the Secretary; and
(3) the application otherwise is in such form, is made in
such manner, and contains such agreements, assurances, and
information as the Secretary determines to be necessary to
carry out this section.
(f) 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 fiscal year.
SEC. 2316. ø300cc–16¿ RESEARCH CENTERS.
(a) IN GENERAL.—

(1) The Secretary, acting through the Director of the National Institute of Allergy and Infectious Diseases, may make
grants to, and enter into contracts with, public and nonprofit
private entities to assist such entities in planning, establishing, or strengthening, and providing basic operating support for, centers for basic and clinical research into, and training in, advanced diagnostic, prevention, and treatment methods for acquired immune deficiency syndrome.
(2) A grant or contract under paragraph (1) shall be provided in accordance with policies established by the Secretary,
acting through the Director of the National Institutes of
Health, and after consultation with the advisory council for the
National Institute of Allergy and Infectious Diseases.
(3) The Secretary shall ensure that, as appropriate, clinical
research programs carried out under paragraph (1) include as
research subjects women, children, hemophiliacs, and minorities.
(b) USE OF FINANCIAL ASSISTANCE.—
(1) Financial assistance under subsection (a) may be expended for—
(A) the renovation or leasing of space;
(B) staffing and other basic operating costs, including
such patient care costs as are required for clinical research;
(C) clinical training with respect to acquired immune
deficiency syndrome (including such training for allied
health professionals); and
(D) demonstration purposes, including projects in the
long-term monitoring and outpatient treatment of individuals infected with the etiologic agent for such syndrome.
(2) Financial assistance under subsection (a) may not be
expended to provide research training for which National Research Service Awards may be provided under section 487.
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1236

(c) DURATION OF SUPPORT.—Support of a center under subsection (a) may be for not more than five years. Such period may
be extended by the Director for additional periods of not more than
five years each if the operations of such center have been reviewed
by an appropriate technical and scientific peer review group established by the Director and if such group has recommended to the
Director that such period should be extended.
(d) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of
carrying out this section, there are authorized to be appropriated
such sums as may be necessary.
SEC. 2317. ø300cc–17¿ INFORMATION SERVICES.
(a) ESTABLISHMENT OF PROGRAM.—The

Secretary shall establish, maintain, and operate a program with respect to information
on research, treatment, and prevention activities relating to infection with the etiologic agent for acquired immune deficiency syndrome. The program shall, with respect to the agencies of the Department of Health and Human Services, be integrated and coordinated.
(b) TOLL-FREE TELEPHONE COMMUNICATIONS FOR HEALTH
CARE ENTITIES.—
(1) After consultation with the Director of the Office of
AIDS Research, the Administrator of the Health Resources and
Services Administration, and the Director of the Centers for
Disease Control and Prevention, the Secretary shall provide for
toll-free telephone communications to provide medical and
technical information with respect to acquired immune deficiency syndrome to health care professionals, allied health care
providers, and to professionals providing emergency health
services.
(2) Information provided pursuant to paragraph (1) shall
include—
(A) information on prevention of exposure to, and the
transmission of, the etiologic agent for acquired immune
deficiency syndrome; and
(B) information contained in the data banks established in subsections (c) and (d).
(c) DATA BANK ON RESEARCH INFORMATION.—
(1) After consultation with the Director of the Office of
AIDS Research, the Director of the Centers for Disease Control
and Prevention, and the National Library of Medicine, the Secretary shall establish a data bank of information on the results
of research with respect to acquired immune deficiency syndrome conducted in the United States and other countries.
(2) In carrying out paragraph (1), the Secretary shall collect, catalog, store, and disseminate the information described
in such paragraph. To the extent practicable, the Secretary
shall make such information available to researchers, physicians, and other appropriate individuals, of countries other
than the United States.
(d) DATA BANK ON CLINICAL TRIALS AND TREATMENTS.—
(1) After consultation with the Commissioner of Food and
Drugs, the AIDS Research Advisory Committee established
under section 2304, and the Director of the Office of AIDS ReMarch 13, 2013

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Sec. 2318

search, the Secretary shall, in carrying out subsection (a), establish a data bank of information on clinical trials and treatments with respect to infection with the etiologic agent for acquired immune deficiency syndrome (hereafter in this section
referred to as the ‘‘Data Bank’’).
(2) In carrying out paragraph (1), the Secretary shall collect, catalog, store, and disseminate the information described
in such paragraph. The Secretary shall disseminate such information through information systems available to individuals
infected with the etiologic agent for acquired immune deficiency syndrome, to other members of the public, to health care
providers, and to researchers.
(e) REQUIREMENTS WITH RESPECT TO DATA BANK ON CLINICAL
TRIALS AND TREATMENTS.—The Data Bank shall include the following:
(1) A registry of clinical trials of experimental treatments
for acquired immune deficiency syndrome and related illnesses
conducted under regulations promulgated pursuant to section
505 of the Federal Food, Drug and Cosmetic Act that provides
a description of the purpose of each experimental drug protocol
either with the consent of the protocol sponsor, or when a trial
to test efficacy begins. Information provided shall include eligibility criteria and the location of trial sites, and must be forwarded to the Data Bank by the sponsor of the trial not later
than 21 days after the approval by the Food and Drug Administration.
(2) Information pertaining to experimental treatments for
acquired immune deficiency syndrome that may be available
under a treatment investigational new drug application that
has been submitted to the Food and Drug Administration pursuant to part 312 of title 21, Code of Federal Regulations. The
Data Bank shall also include information pertaining to the results of clinical trials of such treatments, with the consent of
the sponsor, of such experimental treatments, including information concerning potential toxicities or adverse effects associated with the use or administration of such experimental treatment.
SEC. 2318. ø300cc–18¿ DEVELOPMENT OF MODEL PROTOCOLS FOR
CLINICAL CARE OF INFECTED INDIVIDUALS.
(a) IN GENERAL.—

(1) The Secretary, acting through the Director of the National Institutes of Health and after consultation with the Administrator for Health Care Policy and Research, may make
grants to public and nonprofit private entities for the establishment of projects to develop model protocols for the clinical care
of individuals infected with the etiologic agent for acquired immune deficiency syndrome, including treatment and prevention
of HIV infection and related conditions among women.
(2) The Secretary may not make a grant under paragraph
(1) unless—
(A) the applicant for the grant is a provider of comprehensive primary care; or
(B) the applicant for the grant agrees, with respect to
the project carried out pursuant to paragraph (1), to enter
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into a cooperative arrangement with an entity that is a
provider of comprehensive primary care.
(b) REQUIREMENT OF PROVISION OF CERTAIN SERVICES.—The
Secretary may not make a grant under subsection (a) unless the
applicant for the grant agrees that, with respect to patients participating in the project carried out with the grant, services provided
pursuant to the grant will include—
(1) monitoring, in clinical laboratories, of the condition of
such patients;
(2) clinical intervention for infection with the etiologic
agent for acquired immune deficiency syndrome, including
measures for the prevention of conditions arising from the infection;
(3) information and counseling on the availability of treatments for such infection approved by the Commissioner of Food
and Drugs, on the availability of treatments for such infection
not yet approved by the Commissioner, and on the reports
issued by the AIDS Research Advisory Committee under section 2304(c)(2)(B);
(4) support groups; and
(5) information on, and referrals to, entities providing appropriate social support services.
(c) LIMITATION ON IMPOSITION OF CHARGES FOR SERVICES.—
The Secretary may not make a grant under subsection (a) unless
the applicant for the grant agrees that, if the applicant will routinely impose a charge for providing services pursuant to the grant,
the applicant will not impose the charge on any individual seeking
such services who is unable to pay the charge.
(d) EVALUATION AND REPORTS.—
(1) The Secretary may not make a grant under subsection
(a) unless the applicant for the grant agrees, with respect to
the project carried out pursuant to subsection (a), to submit to
the Secretary—
(A) information sufficient to assist in the replication of
the model protocol developed pursuant to the project; and
(B) such reports as the Secretary may require.
(2) The Secretary shall provide for evaluations of projects
carried out pursuant to subsection (a) and shall annually submit to the Congress a report describing such projects. The report shall include the findings made as a result of such evaluations and may include any recommendations of the Secretary
for appropriate administrative and legislative initiatives with
respect to the program established in this section.
(e) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of
carrying out this section, there are authorized to be appropriated
such sums as may be necessary for each of the fiscal years 1989
through 1991, and such sums as may be necessary for each of the
fiscal years 1994 through 1996.
SEC. 2319. ø300cc–19¿ NATIONAL BLOOD RESOURCE EDUCATION PROGRAM.

After consultation with the Director of the National Heart,
Lung, and Blood Institute and the Commissioner of Food and
Drugs, the Secretary shall establish a program of research and
education regarding blood donations and transfusions to maintain
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and improve the safety of the blood supply. Education programs
shall be directed at health professionals, patients, and the community to—
(1) in the case of the public and patients undergoing treatment—
(A) increase awareness that the process of donating
blood is safe;
(B) promote the concept that blood donors are contributors to a national need to maintain an adequate and safe
blood supply;
(C) encourage blood donors to donate more than once
a year; and
(D) encourage repeat blood donors to recruit new donors;
(2) in the case of health professionals—
(A) improve knowledge, attitudes, and skills of health
professionals in the appropriate use of blood and blood
components;
(B) increase the awareness and understanding of
health professionals regarding the risks versus benefits of
blood transfusion; and
(C) encourage health professionals to consider alternatives to the administration of blood or blood components
for their patients; and
(3) in the case of the community, increase coordination,
communication, and collaboration among community, professional, industry, and government organizations regarding blood
donation and transfusion issues.
SEC. 2320. ø300cc–20¿ ADDITIONAL AUTHORITY WITH RESPECT TO RESEARCH.
(a) DATA COLLECTION WITH RESPECT TO NATIONAL PREVALENCE.—

(1) The Secretary, acting through the Director of the Centers for Disease Control and Prevention, may, through representative sampling and other appropriate methodologies, provide for the continuous collection of data on the incidence in
the United States of cases of acquired immune deficiency syndrome and of cases of infection with the etiologic agent for such
syndrome. The Secretary may carry out the program of data
collection directly or through cooperative agreements and contracts with public and nonprofit private entities.
(2) The Secretary shall encourage each State to enter into
a cooperative agreement or contract under paragraph (1) with
the Secretary in order to facilitate the prompt collection of the
most recent accurate data on the incidence of cases described
in such paragraph.
(3) The Secretary shall ensure that data collected under
paragraph (1) includes data on the demographic characteristics
of the population of individuals with cases described in paragraph (1), including data on specific subpopulations at risk of
infection with the etiologic agent for acquired immune deficiency syndrome.
(4) In carrying out this subsection, the Secretary shall, for
the purpose of assuring the utility of data collected under this
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section, request entities with expertise in the methodologies of
data collection to provide, as soon as is practicable, assistance
to the Secretary and to the States with respect to the development and utilization of uniform methodologies of data collection.
(5) The Secretary shall provide for the dissemination of
data collected pursuant to this subsection. In carrying out this
paragraph, the Secretary may publish such data as frequently
as the Secretary determines to be appropriate with respect to
the protection of the public health. The Secretary shall publish
such data not less than once each year.
(b) EPIDEMIOLOGICAL AND DEMOGRAPHIC DATA.—
(1) The Secretary, acting through the Director of the Centers for Disease Control and Prevention, shall develop an epidemiological data base and shall provide for long-term studies
for the purposes of—
(A) collecting information on the demographic characteristics of the population of individuals infected with the
etiologic agent for acquired immune deficiency syndrome
and the natural history of such infection; and
(B) developing models demonstrating the long-term domestic and international patterns of the transmission of
such etiologic agent.
(2) The Secretary may carry out paragraph (1) directly or
through grants to, or cooperative agreeements 1 or contracts
with, public and nonprofit private entities, including Federal
agencies.
(c) LONG-TERM RESEARCH.—The Secretary may make grants to
public and nonprofit private entities for the purpose of assisting
grantees in conducting long-term research into treatments for acquired immune deficiency syndrome developed from knowledge of
the genetic nature of the etiologic agent for such syndrome.
(d) SOCIAL SCIENCES RESEARCH.—The Secretary, acting
through the Director of the National Institute of Mental Health,
may make grants to public and nonprofit private entities for the
purpose of assisting grantees in conducting scientific research into
the psychological and social sciences as such sciences relate to acquired immune deficiency syndrome.
(e) AUTHORIZATION OF APPROPRIATIONS.—
(1) For the purpose of carrying out this section, there are
authorized to be appropriated such sums as may be necessary
for each fiscal year.
(2) Amounts appropriated pursuant to paragraph (1) to
carry out subsection (c) shall remain available until expended.
PART C—RESEARCH TRAINING
SEC. 2341. ø300cc–31¿ FELLOWSHIPS AND TRAINING.
(a) IN GENERAL.—The Secretary, acting through

the Director of
the Centers for Disease Control 2, shall establish fellowship and
1 So in law. Probably should be ‘‘agreements’’.
2 So in law. Section 312(d)(21) of Public Law 102–531 (106 Stat. 3505) provided that section
2341(a) is amended by striking ‘‘Centers for Disease Control’’ and inserting ‘‘Centers for Disease
Control and Prevention’’. The amendment cannot be executed because it does not specify to
which of the instances of such term the amendment applies.

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training programs to be conducted by the Centers for Disease Control 2 to train individuals to develop skills in epidemiology, surveillance, testing, counseling, education, information, and laboratory
analysis relating to acquired immune deficiency syndrome. Such
programs shall be designed to enable health professionals and
health personnel trained under such programs to work, after receiving such training, in national and international efforts toward
the prevention, diagnosis, and treatment of acquired immune deficiency syndrome.
(b) PROGRAMS CONDUCTED BY NATIONAL INSTITUTE OF MENTAL
HEALTH.—The Secretary, acting through the Director of the National Institute of Mental Health, shall conduct or support fellowship and training programs for individuals pursuing graduate or
postgraduate study in order to train such individuals to conduct
scientific research into the psychological and social sciences as such
sciences relate to acquired immune deficiency syndrome.
(c) RELATIONSHIP TO LIMITATION ON NUMBER OF EMPLOYEES.—
Any individual receiving a fellowship or receiving training under
subsection (a) or (b) shall not be included in any determination of
the number of full-time equivalent employees of the Department of
Health and Human Services for the purpose of any limitation on
the number of such employees established by law prior to, on, or
after the date of the enactment of the AIDS Amendments of 1988.
(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 fiscal year.
PART D—OFFICE

OF

AIDS RESEARCH

Subpart I—Interagency Coordination of Activities
SEC. 2351. ø300cc–40¿ ESTABLISHMENT OF OFFICE.
(a) IN GENERAL.—There is established within

the National Institutes of Health an office to be known as the Office of AIDS Research. The Office shall be headed by a director, who shall be appointed by the Secretary.
(b) DUTIES.—
(1) INTERAGENCY COORDINATION OF AIDS ACTIVITIES.—With
respect to acquired immune deficiency syndrome, the Director
of the Office shall plan, coordinate, and evaluate research and
other activities conducted or supported by the agencies of the
National Institutes of Health. In carrying out the preceding
sentence, the Director of the Office shall evaluate the AIDS activities of each of such agencies and shall provide for the periodic reevaluation of such activities.
(2) CONSULTATIONS.—The Director of the Office shall carry
out this subpart (including developing and revising the plan required in section 2353) in consultation with the heads of the
agencies of the National Institutes of Health, with the advisory
councils of the agencies, and with the advisory council established under section 2352.
(3) COORDINATION.—The Director of the Office shall act as
the primary Federal official with responsibility for overseeing
all AIDS research conducted or supported by the National Institutes of Health, and
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(A) shall serve to represent the National Institutes of
Health AIDS Research Program at all relevant Executive
branch task forces and committees; and
(B) shall maintain communications with all relevant
Public Health Service agencies and with various other departments of the Federal Government, to ensure the timely transmission of information concerning advances in
AIDS research and the clinical treatment of acquired immune deficiency syndrome and its related conditions, between these various agencies for dissemination to affected
communities and health care providers.
SEC. 2351A. ø300cc–40a¿ MICROBICIDE RESEARCH.
(a) FEDERAL STRATEGIC PLAN.—The Director

of the Office

shall—
(1) expedite the implementation of the Federal strategic
plans required by section 403(a) of the Public Health Service
Act (42 U.S.C. 283(a)(5)) regarding the conduct and support of
research on, and development of, a microbicide to prevent the
transmission of the human immunodeficiency virus; and
(2) review and, as appropriate, revise such plan to
prioritize funding and activities relative to their scientific urgency and potential market readiness.
implementing,
reviewing,
and
(b)
COORDINATION.—In
prioritizing elements of the plan described in subsection (a), the Director of the Office shall consult, as appropriate, with—
(1) representatives of other Federal agencies involved in
microbicide research, including the Coordinator of United
States Government Activities to Combat HIV/AIDS Globally,
the Director of the Centers for Disease Control and Prevention,
and the Administrator of the United States Agency for International Development;
(2) the microbicide research and development community;
and
(3) health advocates.
SEC. 2352. ø300cc–40a¿ ADVISORY COUNCIL; COORDINATING COMMITTEES.
(a) ADVISORY COUNCIL.—
(1) IN GENERAL.—The Secretary shall establish an advisory

council for the purpose of providing advice to the Director of
the Office on carrying out this part. (Such council is referred
to in this subsection as the ‘‘Advisory Council’’.)
(2) COMPOSITION, COMPENSATION, TERMS, CHAIR, ETC.—
Subsections (b) through (g) of section 406 apply to the Advisory
Council to the same extent and in the same manner as such
subsections apply to advisory councils for the national research
institutes, except that—
(A) in addition to the ex officio members specified in
section 406(b)(2), there shall serve as such members of the
Advisory Council a representative from the advisory council of each of the National Cancer Institute and the National Institute on Allergy and Infectious Diseases; and
(B) with respect to the other national research institutes, there shall serve as ex officio members of such
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Sec. 2353

Council, in addition to such members specified in subparagraph (A), a representative from the advisory council of
each of the 2 institutes that receive the greatest funding
for AIDS activities.
(b) INDIVIDUAL COORDINATING COMMITTEES REGARDING RESEARCH DISCIPLINES.—
(1) IN GENERAL.—The Director of the Office shall establish,
for each research discipline in which any activity under the
plan required in section 2353 is carried out, a committee for
the purpose of providing advice to the Director of the Office on
carrying out this part with respect to such discipline. (Each
such committee is referred to in this subsection as a ‘‘coordinating committee’’.)
(2) COMPOSITION.—Each coordinating committee shall be
composed of representatives of the agencies of the National Institutes of Health with significant responsibilities regarding
the research discipline involved.
SEC. 2353. ø300cc–40b¿ COMPREHENSIVE PLAN FOR EXPENDITURE OF
APPROPRIATIONS.
(a) IN GENERAL.—Subject to the provisions of this section and

other applicable law, the Director of the Office, in carrying out section 2351, shall—
(1) establish a comprehensive plan for the conduct and
support of all AIDS activities of the agencies of the National
Institutes of Health (which plan shall be first established
under this paragraph not later than 12 months after the date
of the enactment of the National Institutes of Health Revitalization Act of 1993); 1
(2) ensure that the Plan establishes priorities among the
AIDS activities that such agencies are authorized to carry out;
(3) ensure that the Plan establishes objectives regarding
such activities, describes the means for achieving the objectives, and designates the date by which the objectives are expected to be achieved;
(4) ensure that all amounts appropriated for such activities
are expended in accordance with the Plan;
(5) review the Plan not less than annually, and revise the
Plan as appropriate; and
(6) ensure that the Plan serves as a broad, binding statement of policies regarding AIDS activities of the agencies, but
does not remove the responsibility of the heads of the agencies
for the approval of specific programs or projects, or for other
details of the daily administration of such activities, in accordance with the Plan.
(b) CERTAIN COMPONENTS OF PLAN.—With respect to AIDS activities of the agencies of the National Institutes of Health, the Director of the Office shall ensure that the Plan—
(1) provides for basic research;
(2) provides for applied research;
(3) provides for research that is conducted by the agencies;
(4) provides for research that is supported by the agencies;
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(5) provides for proposals developed pursuant to solicitations by the agencies and for proposals developed independently of such solicitations; and
(6) provides for behavioral research and social sciences research.
(c) BUDGET ESTIMATES.—
(1) FULL-FUNDING BUDGET.—
(A) With respect to a fiscal year, the Director of the
Office shall prepare and submit directly to the President,
for review and transmittal to the Congress, a budget estimate for carrying out the Plan for the fiscal year, after
reasonable opportunity for comment (but without change)
by the Secretary, the Director of the National Institutes of
Health, and the advisory council established under section
2352. The budget estimate shall include an estimate of the
number and type of personnel needs for the Office.
(B) The budget estimate submitted under subparagraph (A) shall estimate the amounts necessary for the
agencies of the National Institutes of Health to carry out
all AIDS activities determined by the Director of the Office
to be appropriate, without regard to the probability that
such amounts will be appropriated.
(2) ALTERNATIVE BUDGETS.—
(A) With respect to a fiscal year, the Director of the
Office shall prepare and submit to the Secretary and the
Director of the National Institutes of Health the budget estimates described in subparagraph (B) for carrying out the
Plan for the fiscal year. The Secretary and such Director
shall consider each of such estimates in making recommendations to the President regarding a budget for the
Plan for such year.
(B) With respect to the fiscal year involved, the budget
estimates referred to in subparagraph (A) for the Plan are
as follows:
(i) The budget estimate submitted under paragraph (1).
(ii) A budget estimate developed on the assumption that the amounts appropriated will be sufficient
only for—
(I) continuing the conduct by the agencies of
the National Institutes of Health of existing AIDS
activities (if approved for continuation), and continuing the support of such activities by the agencies in the case of projects or programs for which
the agencies have made a commitment of continued support; and
(II) carrying out, of activities that are in addition to activities specified in subclause (I), only
such activities for which the Director determines
there is the most substantial need.
(iii) Such other budget estimates as the Director of
the Office determines to be appropriate.
(d) FUNDING.—
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(1) AUTHORIZATION OF APPROPRIATIONS.—For the purpose
of carrying out AIDS activities under the Plan, there are authorized to be appropriated such sums as may be necessary for
each of the fiscal years 1994 through 1996.
(2) RECEIPT OF FUNDS.—For the first fiscal year beginning
after the date on which the Plan first established under section
2353(a)(1) has been in effect for 12 months, and for each subsequent fiscal year, the Director of the Office shall receive directly from the President and the Director of the Office of Management and Budget all funds available for AIDS activities of
the National Institutes of Health.
(3) ALLOCATIONS FOR AGENCIES.—
(A) Each fiscal year the Director of the Office shall,
from the amounts received under paragraph (2) for the fiscal year, allocate to the agencies of the National Institutes
of Health (in accordance with the Plan) all amounts available for such year for carrying out the AIDS activities
specified in subsection (c)(2)(B)(ii)(I) for such year. Such allocation shall, to the extent practicable, be made not later
than 15 days after the date on which the Director receives
amounts under paragraph (2).
(B) Each fiscal year the Director of the Office shall,
from the amounts received under paragraph (2) for the fiscal year, allocate to the agencies of the National Institutes
of Health (in accordance with the Plan) all amounts available for such year for carrying out AIDS activities that are
not referred to in subparagraph (A). Such allocation shall,
to the extent practicable, be made not later than 30 days
after the date on which the Director receives amounts
under paragraph (2).
SEC. 2354. ø300cc–41¿ ADDITIONAL AUTHORITIES.
(a) IN GENERAL.—In carrying out AIDS research,

the Director
of the Office—
(1) shall develop and expand clinical trials of treatments
and therapies for infection with the etiologic agent for acquired
immune deficiency syndrome, including such clinical trials for
women, infants, children, hemophiliacs, and minorities;
(2) may establish or support the large-scale development
and preclinical screening, production, or distribution of specialized biological materials and other therapeutic substances for
AIDS research and set standards of safety and care for persons
using such materials;
(3) may support—
(A) AIDS research conducted outside the United
States by qualified foreign professionals if such research
can reasonably be expected to benefit the people of the
United States;
(B) collaborative research involving American and foreign participants; and
(C) the training of American scientists abroad and foreign scientists in the United States;
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(4) may encourage and coordinate AIDS research conducted by any industrial concern that evidences a particular
capability for the conduct of such research;
(5)(A) may acquire, improve, repair, operate, and maintain
laboratories, other research facilities, equipment, and such
other real or personal property as the Director of the Office determines necessary;
(B) may make grants for the construction or renovation of
facilities; and
(C) may acquire, without regard to the Act of March 3,
1877 (40 U.S.C. 34) by lease or otherwise through the Administrator of General Services, buildings or parts of buildings in
the District of Columbia or communities located adjacent to the
District of Columbia for the use of the National Institutes of
Health for a period not to exceed ten years; and
(6) subject to section 405(b)(2) and without regard to section 3324 of title 31, United States Code, and section 3709 of
the Revised Statutes (41 U.S.C. 5), may enter into such contracts and cooperative agreements with any public agency, or
with any person, firm, association, corporation, or educational
institution, as may be necessary to expedite and coordinate research relating to acquired immune deficiency syndrome.
(b) PROJECTS FOR COOPERATION AMONG PUBLIC AND PRIVATE
HEALTH ENTITIES.—In carrying out subsection (a), the Director of
the Office shall establish projects to promote cooperation among
Federal agencies, State, local, and regional public health agencies,
and private entities, in research concerning the diagnosis, prevention, and treatment of acquired immune deficiency syndrome.
Subpart II—Emergency Discretionary Fund
SEC. 2356. ø300cc–43¿ EMERGENCY DISCRETIONARY FUND.
(a) IN GENERAL.—
(1) ESTABLISHMENT.—There is established a

fund consisting of such amounts as may be appropriated under subsection (g). Subject to the provisions of this section, the Director of the Office, after consultation with the advisory council
established under section 2352, may expend amounts in the
Fund for the purpose of conducting and supporting such AIDS
activities, including projects of AIDS research, as may be authorized in this Act for the National Institutes of Health.
(2) PRECONDITIONS TO USE OF FUND.—Amounts in the
Fund may be expended only if—
(A) the Director identifies the particular set of AIDS
activities for which such amounts are to be expended;
(B) the set of activities so identified constitutes either
a new project or additional AIDS activities for an existing
project;
(C) the Director of the Office has made a determination that there is a significant need for such set of activities; and
(D) as of June 30 of the fiscal year preceding the fiscal
year in which the determination is made, such need was
not provided for in any appropriations Act passed by the

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House of Representatives to make appropriations for the
Departments of Labor, Health and Human Services (including the National Institutes of Health), Education, and
related agencies for the fiscal year in which the determination is made.
(3) TWO-YEAR USE OF FUND FOR PROJECT INVOLVED.—In
the case of an identified set of AIDS activities, obligations of
amounts in the Fund may not be made for such set of activities
after the expiration of the 2-year period beginning on the date
on which the initial obligation of such amounts is made for
such set.
(b) PEER REVIEW.—With respect to an identified set of AIDS
activities carried out with amounts in the Fund, this section may
not be construed as waiving applicable requirements for peer review.
(c) LIMITATIONS ON USE OF FUND.—
(1) CONSTRUCTION OF FACILITIES.—Amounts in the Fund
may not be used for the construction, renovation, or relocation
of facilities, or for the acquisition of land.
(2) CONGRESSIONAL DISAPPROVAL OF PROJECTS.—
(A) Amounts in the Fund may not be expended for the
fiscal year involved for an identified set of AIDS activities,
or a category of AIDS activities, for which—
(i)(I) amounts were made available in an appropriations Act for the preceding fiscal year; and
(II) amounts are not made available in any appropriations Act for the fiscal year involved; or
(ii) amounts are by law prohibited from being expended.
(B) A determination under subparagraph (A)(i) of
whether amounts have been made available in appropriations Acts for a fiscal year shall be made without regard
to whether such Acts make available amounts for the
Fund.
(3) INVESTMENT OF FUND AMOUNTS.—Amounts in the Fund
may not be invested.
(d) APPLICABILITY OF LIMITATION REGARDING NUMBER OF EMPLOYEES.—The purposes for which amounts in the Fund may be expended include the employment of individuals necessary to carry
out identified sets of AIDS activities approved under subsection (a).
Any individual employed under the preceding sentence may not be
included in any determination of the number of full-time equivalent
employees for the Department of Health and Human Services for
the purpose of any limitation on the number of such employees established by law prior to, on, or after the date of the enactment of
the National Institutes of Health Revitalization Act of 1993. 1
(e) DEFINITIONS.—For purposes of this section:
(1) The term ‘‘Fund’’ means the fund established in subsection (a).
(2) The term ‘‘identified set of AIDS activities’’ means a
particular set of AIDS activities identified under subsection
(a)(2)(A).
(f) FUNDING.—
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(1) AUTHORIZATION OF APPROPRIATIONS.—For the purpose
of providing amounts for the Fund, there is authorized to be
appropriated $100,000,000 for each of the fiscal years 1994
through 1996.
(2) AVAILABILITY.—Amounts appropriated for the Fund are
available until expended.
Subpart III—General Provisions
SEC. 2359. ø300cc–45¿ GENERAL PROVISIONS REGARDING THE OFFICE.
(a) ADMINISTRATIVE SUPPORT FOR OFFICE.—The Secretary, act-

ing through the Director of the National Institutes of Health, shall
provide administrative support and support services to the Director
of the Office and shall ensure that such support takes maximum
advantage of existing administrative structures at the agencies of
the National Institutes of Health.
(b) EVALUATION.—Not later than 5 years after the date of the
enactment of National Institutes of Health Revitalization Act of
1993, 1 the Secretary shall conduct an evaluation to—
(1) determine the effect of this section on the planning and
coordination of the AIDS research programs at the institutes,
centers and divisions of the National Institutes of Health;
(2) evaluate the extent to which this part has eliminated
the duplication of administrative resources among such Institutes, centers and divisions; and
(3) provide recommendations concerning future alterations
with respect to this part.
(c) DEFINITIONS.—For purposes of this part:
(1) The term ‘‘AIDS activities’’ means AIDS research and
other activities that relate to acquired immune deficiency syndrome.
(2) The term ‘‘AIDS research’’ means research with respect
to acquired immune deficiency syndrome.
(3) The term ‘‘Office’’ means the Office of AIDS Research.
(4) The term ‘‘Plan’’ means the plan required in section
2353(a)(1).
PART E—GENERAL PROVISIONS
SEC. 2361. ø300cc–51¿ DEFINITION.

For purposes of this title:
(1) The term ‘‘infection’’, with respect to the etiologic agent
for acquired immune deficiency syndrome, includes opportunistic cancers and infectious diseases and any other conditions
arising from infection with such etiologic agent.
(2) The term ‘‘treatment’’, with respect to the etiologic
agent for acquired immune deficiency syndrome, includes primary and secondary prophylaxis.

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TITLE XXIV—HEALTH SERVICES WITH RESPECT TO
ACQUIRED IMMUNE DEFICIENCY SYNDROME 1
PART A—FORMULA GRANTS TO STATES FOR HOME
BASED HEALTH SERVICES

AND

SEC. 2401. ø300dd¿ ESTABLISHMENT OF PROGRAM.
(a) ALLOTMENTS FOR STATES.—For the purpose

COMMUNITY-

described in
subsection (b), the Secretary shall for each of the fiscal years 1989
and 1990 make an allotment for each State in an amount determined in accordance with section 2408. The Secretary shall make
payments each such fiscal year to each State from the allotment for
the State if the Secretary approves for the fiscal year involved an
application submitted by the State pursuant to section 2407.
(b) PURPOSE OF GRANTS.—The Secretary may not make payments under subsection (a) for a fiscal year unless the State involved agrees to expend the payments only for the purpose of providing services in accordance with section 2402.
(c) ELIGIBLE INDIVIDUAL DEFINED.—For purposes of this part:
(1) The term ‘‘eligible individual’’ means an individual infected with the etiologic agent for acquired immune deficiency
syndrome who either is medically dependent or chronically dependent.
(2) The term ‘‘medically dependent’’ means, with respect to
an individual, that the individual has been certified by a physician as—
(A) requiring the routine use of appropriate medical
services (which may include home intravenous drug therapy) to prevent or compensate for the individual’s serious
deterioration, arising from infection with the etiologic
agent for acquired immune deficiency syndrome, of physical health or cognitive function, and
(B) being able to avoid long-term or repeated care as
an inpatient or resident in a hospital, nursing facility, or
other institution if home and community-based health
services are provided to the individual.
(3) The term ‘‘chronically dependent’’ means, with respect
to an individual, that the individual has been certified by a
physician as—
(A) being unable to perform, because of physical or
cognitive impairment (without substantial assistance from
another individual) arising from infection with the etiologic agent for acquired immune deficiency syndrome, at
least 2 of the following activities of daily living: bathing,
dressing, toileting, transferring, and eating, or
1 See

footnote at beginning of title XXIII.

1249
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(B) having a similar level of disability due to cognitive
impairment (as defined by the Secretary).
(d) HOME AND COMMUNITY-BASED HEALTH SERVICES DEFINED.—For purposes of this part, the term ‘‘home and communitybased health services’’—
(1) means, with respect to an eligible individual, skilled
health services furnished to the individual in the individual’s
home pursuant to a written plan of care established by a
health care professional for the provision of such services and
items and services described in paragraph (2);
(2) includes—
(A) durable medical equipment,
(B) homemaker/home health aide services and personal care services furnished in the individual’s home,
(C) day treatment or other partial hospitalization services,
(D) home intravenous drug therapy (including prescription drugs administered intravenously as part of such
therapy), and
(E) routine diagnostic tests administered in the individual’s home,
furnished pursuant to such plan of care; but
(3) does not include, except as specifically provided in
paragraph (2)—
(A) diagnostic tests,
(B) inpatient hospital services,
(C) nursing facility services, and
(D) prescription drugs.
SEC. 2402. ø300dd–1¿ PROVISIONS WITH RESPECT TO CARRYING OUT
PURPOSE OF GRANTS.
(a) REQUIRED USES OF FUNDS.—The Secretary may not make

payments under section 2401(a) unless the State involved agrees
that the State will—
(1) provide for home and community-based health services
for eligible individuals pursuant to written plans of care established by health care professionals for providing such services
to such individuals;
(2) provide for the identification, location, and provision of
outreach to eligible individuals;
(3) provide for coordinating the provision of services under
this part with the provision of similar or related services by
public and private entities; and
(4) give priority to the provision of outreach and home and
community-based services to eligible individuals with low incomes.
(b) AUTHORITY FOR GRANTS AND CONTRACTS.—A State may
make payment for services under subsection (a) through grants to
public and nonprofit private entities and through contracts with
public and private entities. In providing such financial assistance,
a State shall give priority to public and nonprofit private entities
that have demonstrated experience in delivering home and community-based health services to individuals infected with the etiologic
agent for acquired immune deficiency syndrome.
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PUBLIC HEALTH SERVICE ACT

Sec. 2405

SEC. 2403. ø300dd–2¿ REQUIREMENT OF SUBMISSION OF DESCRIPTION OF INTENDED USES OF GRANT.

The Secretary may not make payments under section 2401(a)
to a State for a fiscal year unless—
(1) the State submits to the Secretary a description of the
purposes for which the State intends to expend such payments
for the fiscal year;
(2) such description provides information relating to the
services and activities to be provided, including a description
of the manner in which such services and activities will be coordinated with any similar services and activities of public and
private entities; and
(3) such description includes information relating to (A)
the process for determining which eligible individuals are
medically dependent or chronically dependent and (B) the process for establishing written plans of care for the provision of
home and community-based health services under this part.
SEC. 2404. ø300dd–3¿ RESTRICTIONS ON USE OF GRANT.
(a) IN GENERAL.—The Secretary may not make

payments
under section 2401(a) for a fiscal year to a State unless the State
agrees that the payments will not be expended—
(1) to provide for items or services described in section
2401(d)(3);
(2) to make cash payments to intended recipients of services;
(3) to purchase or improve real property (other than minor
remodeling of existing improvements to real property) or to
purchase major medical equipment; or
(4) to satisfy any requirement for the expenditure of nonFederal funds as a condition for the receipt of Federal funds.
(b) LIMITATION ON ADMINISTRATIVE EXPENSES.—The Secretary
may not make payments under section 2401(a) for a fiscal year unless the State involved agrees that the State will not expend more
than 5 percent of the payments made to the State under such section for administrative expenses with respect to carrying out the
purpose of this part.
(c) LIMITATION ON TOTAL PAYMENTS.—
(1) Before March 1, 1989, for fiscal year 1989 and before
September 1, 1989, for fiscal year 1990, the Secretary shall determine and publish the national average monthly payments,
for extended care services under part A of title XVIII of the Social Security Act, for each resident of a skilled nursing facility
the Secretary estimates will be paid in the fiscal year.
(2) The Secretary may not make payments under section
2401(a) for a fiscal year to a State to the extent that the average monthly payments for eligible individuals provided home
and community-based health services under this part in the
State exceeds 65 percent of the national average monthly payments determined and published for the fiscal year under
paragraph (1).
SEC. 2405. ø300dd–4¿ REQUIREMENT OF REPORTS AND AUDITS BY
STATES.
(a) REPORTS.—
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(1) The Secretary may not make payments under section
2401(a) for a fiscal year unless the State involved agrees to
prepare and submit to the Secretary, by not later than January
1 following the fiscal year, an annual report in such form and
containing such information as the Secretary determines (after
consultation with the States and the Comptroller General of
the United States) to be necessary for—
(A) securing a record and a description of the purposes
for which payments received by the State pursuant to section 2401(a) were expended and of the recipients of such
payments;
(B) determining whether the payments were expended
in accordance with the purpose of this part; and
(C) determining the percentage of payments received
pursuant to section 2401(a) that were expended by the
State for administrative expenses during the fiscal year involved.
(2) Each report by a State under paragraph (1) for a fiscal
year also shall include—
(A) information on the number and type of eligible individuals provided home and community-based health
services by the State under this part for the fiscal year;
(B) information on the types of home and communitybased health services so provided;
(C) information on the average monthly costs of such
services and a comparison of such costs with costs of providing services in hospitals, nursing facilities, and similar
institutions; and
(D) such other information as the Secretary may require to provide for an evaluation of the program under
this part and its cost-effectiveness.
(b) AUDITS.—
(1) The Secretary may not make payments under section
2401(a) for a fiscal year unless the State involved agrees to establish such fiscal control and fund accounting procedures as
may be necessary to ensure the proper disbursal of, and accounting for, amounts received by the State under such section.
(2) The Secretary may not make payments under section
2401(a) for a fiscal year unless the State involved agrees that—
(A) the State will provide for—
(i) a financial and compliance audit of such payments; or
(ii) a single financial and compliance audit of each
entity administering such payments;
(B) the audit will be performed biennially and will
cover expenditures in each fiscal year; and
(C) the audit will be conducted in accordance with
standards established by the Comptroller General of the
United States for the audit of governmental organizations,
programs, activities, and functions.
(3) The Secretary may not make payments under section
2401(a) for a fiscal year unless the State involved agrees that,
not later than 30 days after the completion of an audit under
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Sec. 2406

paragraph (2), the State will provide a copy of the audit report
to the State legislature.
(4) For purposes of paragraph (2), the term ‘‘financial and
compliance audit’’ means an audit to determine whether the financial statements of an audited entity present fairly the financial position, and the results of financial operations, of the
entity in accordance with generally accepted accounting principles, and whether the entity has complied with laws and regulations that may have a material effect upon the financial
statements.
(c) AVAILABILITY TO PUBLIC.—The Secretary may not make
payments under section 2401(a) unless the State involved agrees to
make copies of the reports and audits described in this section
available for public inspection.
(d) EVALUATIONS BY COMPTROLLER GENERAL.—The Comptroller General of the United States shall, from time to time, evaluate the expenditures by the States of payments under section
2401(a) in order to assure that expenditures are consistent with the
provisions of this part.
SEC. 2406. ø300dd–5¿ ADDITIONAL REQUIRED AGREEMENTS.
(a) 1 IN GENERAL.—The Secretary may not make

payments
under section 2401(a) for a fiscal year unless the State involved
agrees that—
(1) the legislature of the State will conduct public hearings
on the proposed use and distribution of the payments to be received from the allotments for each such fiscal year;
(2)(A) the State will, to the maximum extent practicable,
ensure that services provided to an individual pursuant to the
program involved will be provided without regard to the ability
of the individual to pay for such services and without regard
to the current or past health condition of the individual;
(B) if any charges are imposed for the provision of home
and community-based health services for which assistance is
provided under this part, such charges (i) will be pursuant to
a public schedule of charges, (ii) will not be imposed on any eligible individual with an income that does not exceed 100 percent of the official poverty line, and (iii) for an eligible individual with an income that exceeds 100 percent of the official
poverty line, will be adjusted to reflect the income of the individual;
(3) the State will provide for periodic independent peer review to assess the quality and appropriateness of home and
community-based health services provided by entities that receive funds from the State pursuant to section 2401(a);
(4) the State will permit and cooperate with Federal investigations undertaken under section 2409(e);
(5) the State will maintain State expenditures for home
and community-based health services for individuals infected
with the etiologic agent for acquired immune deficiency syndrome at a level equal to not less than the average level of
such expenditures maintained by the State for the 2-year pe1 So

March 13, 2013

in law. This section does not contain a subsection (b).

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Sec. 2407

PUBLIC HEALTH SERVICE ACT

1254

riod preceding the fiscal year for which the State is applying
to receive payments; and
(6) the State will not make payments from allotments
made under section 2401(a) for any item or service to the extent that payment has been made, or can reasonably be expected to be made, with respect to that item or service (i)
under any State compensation program, under an insurance
policy, under any Federal or State health benefits program, or
(ii) by an entity that provides health services on a prepaid
basis.
SEC. 2407. ø300dd–6¿ REQUIREMENT OF SUBMISSION OF APPLICATION
CONTAINING CERTAIN AGREEMENTS AND ASSURANCES.

The Secretary may not make payments under section 2401(a)
to a State for a fiscal year unless—
(1) the State submits to the Secretary an application for
the payments containing agreements in accordance with sections 2401 through 2406;
(2) the agreements are made through certification from the
chief executive officer of the State;
(3) with respect to such agreements, the application provides assurances of compliance satisfactory to the Secretary;
(4) the application contains the description of intended expenditures required in section 2403; and
(5) the application otherwise is in such form, is made in
such manner, and contains such agreements, assurances, and
information as the Secretary determines to be necessary to
carry out this part.
SEC. 2408. ø300dd–7¿ DETERMINATION OF AMOUNT OF ALLOTMENTS
FOR STATES.
(a) MINIMUM ALLOTMENT.—Subject to the extent of amounts

made available in appropriations Acts, the amount of an allotment
under section 2401(a) for—
(1) each of the several States, the District of Columbia,
and the Commonwealth of Puerto Rico, for a fiscal year shall
be the greater of—
(A) $100,000, and
(B) an amount determined under subsection (b); and
(2) each territory of the United States (as defined in section 2413(5)) shall be $25,000.
(b) DETERMINATION UNDER FORMULA.—
(1) The amount referred to in subsection (a)(1)(B) for a
State is the product of—
(A) an amount equal to the amount appropriated pursuant to section 2414(a) for the fiscal year involved; and
(B) the ratio of the distribution factor for the State to
the sum of the distribution factors for all the States.
(2) In paragraph (1)(B), the term ‘‘distribution factor’’
means, for a State, the product of—
(A) the number in the State of additional cases of acquired immune deficiency syndrome, as indicated by the
number of such cases reported to and confirmed by the
Secretary for the most recent fiscal year for which such
data are available, and
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PUBLIC HEALTH SERVICE ACT

Sec. 2408

(B) the ratio (based on the most recent available data)
of (i) the average per capita income of individuals in the
United States to (ii) the average per capita income of individuals in the State;
except that the distribution factors for all the States and territories shall be proportionally reduced to the extent necessary
to assure that the total of the allotments under subsection (a)
for all the States and territories for each fiscal year does not
exceed the amount appropriated pursuant to section 2414(a)
for the fiscal year.
(c) INDIAN TRIBES.—
(1) Upon the request of the governing body of an Indian
tribe or tribal organization within a State to the Secretary, the
Secretary shall—
(A) reserve from the amount that otherwise would be
allotted for the fiscal year to the State under subsection (a)
an amount determined in accordance with paragraph (2);
and
(B) grant the amount reserved under subparagraph
(A) to the Indian tribe or tribal organization serving eligible individuals who are members of the Indian tribe or
tribal organization.
(2) The amount reserved under paragraph (1)(A) shall be
an amount equal to the product of—
(A) the amount that otherwise would be allotted to the
State under subsection (a) for the fiscal year; and
(B) the Secretary’s estimate of the proportion of the
number of additional cases described in subsection
(b)(2)(A) that are attributable to members of the Indian
tribe or tribal organization.
(3) The Secretary may not make a grant under paragraph
(1)(B) to an Indian tribe or tribal organization unless the Indian tribe or tribal organization submits to the Secretary an
application meeting the requirements of such an application
under section 2407.
(d) DISPOSITION OF CERTAIN FUNDS APPROPRIATED FOR ALLOTMENTS.—
(1) Amounts described in paragraph (2) shall, in accordance with paragraph (3), be allotted by the Secretary to States
receiving payments under section 2401(a) for the fiscal year
(other than any State referred to in paragraph (2)(B)).
(2) The amounts referred to in paragraph (1) are any
amounts that are not paid to States or territories under section
2401(a) as a result of—
(A) the failure of any State or territory to submit an
application under section 2407 within a reasonable time
period established by the Secretary; or
(B) any State or territory informing the Secretary that
the State or territory does not intend to expend the full
amount of the allotment made to the State or territory.
(3) The amount of an allotment under paragraph (1) for a
State for a fiscal year shall be an amount equal to the product
of—
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Sec. 2409

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1256

(A) an amount equal to the amount described in paragraph (2) for the fiscal year involved; and
(B) the ratio determined under subsection (b)(1)(B) for
the State.
SEC. 2409. ø300dd–8¿ FAILURE TO COMPLY WITH AGREEMENTS.
(a) REPAYMENT OF PAYMENTS.—

(1) The Secretary may, subject to subsection (c), require a
State to repay any payments received by the State under section 2401(a) that the Secretary determines were not expended
by the State in accordance with the agreements required to be
contained in the application submitted by the State pursuant
to section 2407.
(2) If a State fails to make a repayment required in paragraph (1), the Secretary may offset the amount of the repayment against the amount of any payment due to be paid to the
State under section 2401(a).
(b) WITHHOLDING OF PAYMENTS.—
(1) The Secretary may, subject to subsection (c), withhold
payments due under section 2401(a) if the Secretary determines that the State involved is not expending amounts received under such section in accordance with the agreements
required to be contained in the application submitted by the
State pursuant to section 2407.
(2) The Secretary shall cease withholding payments from
a State under paragraph (1) if the Secretary determines that
there are reasonable assurances that the State will expend
amounts received under section 2401(a) in accordance with the
agreements referred to in such paragraph.
(c) OPPORTUNITY FOR HEARING.—Before requiring repayment of
payments under subsection (a)(1), or withholding payments under
subsection (b)(1), the Secretary shall provide to the State an opportunity for a hearing conducted within the State.
(d) TECHNICAL VIOLATIONS.—The Secretary may not require repayment under subsection (a)(1), or withhold payments under subsection (b)(1), for a technical violation, as determined by the Secretary, of any agreement required to be contained in the application submitted by the State pursuant to section 2407.
(e) INVESTIGATIONS.—
(1) The Secretary shall conduct in several States in each
fiscal year investigations of the expenditure of payments received by the States under section 2401(a) in order to evaluate
compliance with the agreements required to be contained in
the applications submitted to the Secretary pursuant to section
2407.
(2) Each State, and each entity receiving funds from payments made to a State under section 2401(a), shall make appropriate books, documents, papers, and records available to
the Secretary and the Comptroller General of the United
States, or any of their duly authorized representatives, for examination, copying, or mechanical reproduction on or off the
premises of the appropriate entity upon a reasonable request
therefor.
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PUBLIC HEALTH SERVICE ACT

Sec. 2412

(3)(A) In conducting any investigation in a State, the Secretary and the Comptroller General of the United States may
not make a request for any information not readily available
to the State, or to an entity receiving funds from payments
made to the State under section 2401(a), or make an unreasonable request for information to be compiled, collected, or transmitted in any form not readily available.
(B) Subparagraph (A) shall not apply to the collection,
compilation, or transmittal of data in the course of a judicial
proceeding.
SEC. 2410. ø300dd–9¿ PROHIBITION AGAINST CERTAIN FALSE STATEMENTS.
(a) IN GENERAL.—A person may not knowingly make or cause

to be made any false statement or representation of a material fact
in connection with the furnishing of items or services for which
amounts may be paid by a State from payments received by the
State under section 2401(a).
(b) CRIMINAL PENALTY FOR VIOLATION OF PROHIBITION.—Any
person who violates a prohibition established in subsection (a) may
for each violation be fined in accordance with title 18, United
States Code, or imprisoned for not more than 5 years, or both.
SEC. 2411. ø300dd–10¿ TECHNICAL ASSISTANCE AND PROVISION BY
SECRETARY OF SUPPLIES AND SERVICES IN LIEU OF
GRANT FUNDS.
(a) TECHNICAL ASSISTANCE.—Upon the request of a State re-

ceiving payments under section 2401(a), the Secretary may, without charge to the State, provide to the State (or to any public or
private entity designated by the State) technical assistance with respect to the planning, development, and operation of any program
or service carried out pursuant to this part. The Secretary may provide such technical assistance directly, through contract, or
through grants.
(b) PROVISION BY SECRETARY OF SUPPLIES AND SERVICES IN
LIEU OF GRANT FUNDS.—
(1) Upon the request of a State receiving payments under
section 2401(a), the Secretary may, subject to paragraph (2),
provide supplies, equipment, and services for the purpose of
aiding the State in carrying out this part and, for such purpose, may detail to the State any officer or employee of the Department of Health and Human Services.
(2) With respect to a request described in paragraph (1),
the Secretary shall reduce the amount of payments under section 2401(a) to the State by an amount equal to the costs of
detailing personnel and the fair market value of any supplies,
equipment, or services provided by the Secretary. The Secretary shall, for the payment of expenses incurred in complying
with such request, expend the amounts withheld.
SEC. 2412. ø300dd–11¿ REPORT BY SECRETARY.

Not later than March 1, 1990, the Secretary shall report to the
Congress on the activities of the States under this part. Such report shall include a recommendation as to whether or not the program under this part should be extended beyond fiscal year 1990
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Sec. 2413

PUBLIC HEALTH SERVICE ACT

1258

and may include any recommendations of the Secretary for appropriate administrative and legislative initiatives.
SEC. 2413. ø300dd–12¿ DEFINITIONS.

For purposes of this part:
(1) The terms ‘‘Indian tribe’’ and ‘‘tribal organization’’ have
the same meaning given such terms in sections 4(b) and 4(c)
of the Indian Self-Determination and Education Assistance
Act.
(2) The term ‘‘infected with the etiologic agent for acquired
immune deficiency syndrome’’ includes any condition arising
from infection with such etiologic agent.
(3)(A) An individual is considered to have low income if the
individual’s income does not exceed 200 percent of the official
poverty line.
(B) The term ‘‘official poverty line’’ refers, with respect to
an individual, to the official poverty line defined by the Office
of Management and Budget, and revised annually in accordance with section 673(2) of the Omnibus Budget Reconciliation
Act of 1981, applicable to a family of the size involved.
(4)(A) The term ‘‘State’’ means, except as provided in subparagraph (B), each of the several States, the District of Columbia, the Commonwealth of Puerto Rico, and each territory
of the United States.
(B) For purposes of subsections (b) and (d) of section 2408,
the term ‘‘State’’ means each of the several States, the District
of Columbia, and the Commonwealth of Puerto Rico.
(5) The term ‘‘territory of the United States’’ means each
of the following: the Virgin Islands, Guam, American Samoa,
and the Commonwealth of the Northern Mariana Islands.
SEC. 2414. ø300dd–13¿ FUNDING.
(a) AUTHORIZATION OF APPROPRIATIONS.—For

the purpose of
making allotments under section 2401(a), there are authorized to
be appropriated $100,000,000 for each of the fiscal years 1989 and
1990.
(b) AVAILABILITY TO STATES.—Any amounts paid to a State or
territory under section 2401(a) shall remain available to the State
or territory until the expiration of the 1-year period beginning on
the date on which the State or territory receives such amounts.
SEC. 2415. ø300dd–14¿ SUNSET.

Effective with respect to appropriations made for any period
after fiscal year 1990, this part is repealed.
PART B—SUBACUTE CARE
SEC. 2421. ø300dd–21¿ DEMONSTRATION PROJECTS.

(a) As used in this section:
(1) The term ‘‘individuals infected with the etiologic agent
for acquired immune deficiency syndrome’’ means individuals
who have a disease, or are recovering from a disease, attributable to the infection of such individuals with such etiologic
agent, and as a result of the effects of such disease, are in need
of subacute-care services.
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PUBLIC HEALTH SERVICE ACT

Sec. 2421

(2) The term ‘‘subacute care’’ means medical and health
care services that are required for individuals recovering from
acute care episodes that are less intensive than the level of
care provided in acute-care hospitals, and includes skilled
nursing care, hospice care, and other types of health services
provided in other long-term-care facilities.
(b) The Secretary shall conduct three demonstration projects to
determine the effectiveness and cost of providing the subacute-care
services described in subsection (b) to individuals infected with the
etiologic agent for acquired immune deficiency syndrome, and the
impact of such services on the health status of such individuals.
(c)(1) The services provided under each demonstration project
shall be designed to meet the specific needs of individuals infected
with the etiologic agent for acquired immune deficiency syndrome,
and shall include—
(A) the care and treatment of such individuals by providing—
(i) subacute care;
(ii) emergency medical care and specialized diagnostic
and therapeutic services as needed and where appropriate,
either directly or through affiliation with a hospital that
has experience in treating individuals with acquired immune deficiency syndrome; and
(iii) case management services to ensure, through existing services and programs whenever possible, appropriate discharge planning for such individuals; and
(B) technical assistance, to other facilities in the region
served by such facility, that is directed toward education and
training of physicians, nurses, and other health-care professionals in the subacute care and treatment of individuals infected with the etiologic agent for acquired immune deficiency
syndrome.
(2) Services provided under each demonstration project may
also include—
(A) hospice services;
(B) outpatient care; and
(C) outreach activities in the surrounding community to
hospitals and other health-care facilities that serve individuals
infected with the etiologic agent for acquired immune deficiency syndrome.
(d) The demonstration projects shall be conducted—
(1) during a 4-year period beginning not later than 9
months after the date of enactment of this section; 1 and
(2) at sites that—
(A) are geographically diverse and located in areas
that are appropriate for the provision of the required and
authorized services; and
(B) have the highest incidence of cases of acquired immune deficiency syndrome and the greatest need for
subacute-care services.
(e) The Secretary shall evaluate the operations of the demonstration projects and shall submit to the Committee on Energy
1 Enacted

March 13, 2013

on November 4, 1988.

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Sec. 2431

PUBLIC HEALTH SERVICE ACT

1260

and Commerce of the House of Representatives and the Committee
on Labor and Human Resources of the Senate—
(1) not later than 18 months after the beginning of the
first project, a preliminary report that contains—
(A) a description of the sites at which the projects are
being conducted and of the services being provided in each
project; and
(B) a preliminary evaluation of the experience of the
projects in the first 12 months of operation; and
(2) not later than 6 months after the completion of the last
project, a final report that contains—
(A) an assessment of the costs of subacute care for individuals infected with the etiologic agent for acquired immune deficiency syndrome, including a breakdown of all
other sources of funding for the care provided to cover
subacute care; and
(B) recommendations for appropriate legislative
changes.
(f) Each demonstration project shall provide for other research
to be carried out at the site of such demonstration project including—
(1) clinical research on acquired immune deficiency syndrome, concentrating on research on the neurological manifestations resulting from infection with the etiologic agent for
such syndrome; and
(2) the study of the psychological and mental health issues
related to such syndrome.
(g)(1) To carry out this section, there are authorized to be appropriated $10,000,000 for fiscal year 1989 and such sums as are
necessary for each of the fiscal years 1990 through 1992.
(2) Amounts appropriated pursuant to paragraph (1) shall remain available until September 10, 1992.
(h) The Secretary shall enter into an agreement with the Administrator of the Veterans’ Administration to ensure that appropriate provision will be made for the furnishing, through demonstration projects, of services to eligible veterans, under contract
with the Veterans’ Administration pursuant to section 620 of title
38, United States Code.
PART C—OTHER HEALTH SERVICES
SEC. 2431. ø300dd–31¿ GRANTS FOR ANONYMOUS TESTING.

The Secretary may make grants to the States for the purpose
of providing opportunities for individuals—
(1) to undergo counseling and testing with respect to the
etiologic agent for acquired immune deficiency syndrome without being required to provide any information relating to the
identity of the individuals; and
(2) to undergo such counseling and testing through the use
of a pseudonym.
SEC. 2432. ø300dd–32¿ REQUIREMENT OF PROVISION OF CERTAIN
COUNSELING SERVICES.
(a) COUNSELING BEFORE TESTING.—The Secretary may not

make a grant under section 2431 to a State unless the State agrees
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Sec. 2432

that, before testing an individual pursuant to such section, the
State will provide to the individual appropriate counseling with respect to acquired immune deficiency syndrome (based on the most
recent scientific data relating to such syndrome), including—
(1) measures for the prevention of exposure to, and the
transmission of, the etiologic agent for such syndrome;
(2) the accuracy and reliability of the results of such testing;
(3) the significance of the results of such testing, including
the potential for developing acquired immune deficiency syndrome; and
(4) encouraging individuals, as appropriate, to undergo
testing for such etiologic agent and providing information on
the benefits of such testing.
(b) COUNSELING OF INDIVIDUALS WITH NEGATIVE TEST RESULTS.—The Secretary may not make a grant under section 2431
to a State unless the State agrees that, if the results of testing conducted pursuant to such section indicate that an individual is not
infected with the etiologic agent for acquired immune deficiency
syndrome, the State will review for the individual the information
provided pursuant to subsection (a) with respect to such syndrome,
including—
(1) the information described in paragraphs (1) through (3)
of such subsection; and
(2) the appropriateness of further counseling, testing, and
education of the individual with respect to acquired immune
deficiency syndrome.
(c) COUNSELING OF INDIVIDUALS WITH POSITIVE TEST RESULTS.—The Secretary may not make a grant under section 2431
to a State unless the State agrees that, if the results of testing conducted pursuant to such section indicate that an individual is infected with the etiologic agent for acquired immune deficiency syndrome, the State will provide to the individual appropriate counseling with respect to such syndrome, including—
(1) reviewing the information described in paragraphs (1)
through (3) of subsection (a);
(2) reviewing the appropriateness of further counseling,
testing, and education of the individual with respect to acquired immune deficiency syndrome;
(3) the importance of not exposing others to the etiologic
agent for acquired immune deficiency syndrome;
(4) the availability in the geographic area of any appropriate services with respect to health care, including mental
health care and social and support services;
(5) the benefits of locating and counseling any individual
by whom the infected individual may have been exposed to the
etiologic agent for acquired immune deficiency syndrome and
any individual whom the infected individual may have exposed
to such etiologic agent; and
(6) the availability, if any, of the services of public health
authorities with respect to locating and counseling any individual described in paragraph (5).
(d) RULE OF CONSTRUCTION WITH RESPECT TO COUNSELING
WITHOUT TESTING.—Agreements entered into pursuant to subMarch 13, 2013

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Sec. 2432

PUBLIC HEALTH SERVICE ACT

1262

sections (a) through (c) may not be construed to prohibit any grantee under section 2431 from expending the grant for the purpose of
providing counseling services described in such subsections to an
individual who will not undergo testing described in such section
as a result of the grantee or the individual determining that such
testing of the individual is not appropriate.
(e) USE OF FUNDS.—
(1) The purpose of this subpart 1 is to provide for counseling and testing services to prevent and reduce exposure to,
and transmission of, the etiologic agent for acquired immune
deficiency syndrome.
(2) All individuals receiving counseling pursuant to this
subpart 1 are to be counseled about the harmful effects of promiscuous sexual activity and intravenous substance abuse, and
the benefits of abstaining from such activities.
(3) None of the fund appropriated to carry out this subpart 1 may be used to provide counseling that is designed to
promote or encourage, directly, homosexual or heterosexual
sexual activity or intravenous drug abuse.
(4) Paragraph (3) may not be construed to prohibit a counselor who has already performed the counseling of an individual required by paragraph (2), to provide accurate information about means to reduce an individual’s risk of exposure to,
or the transmission of, the etiologic agent for acquired immune
deficiency syndrome, provided that any informational materials
used are not obscene.
SEC. 2433. ø300dd–33¿ FUNDING.

For the purpose of grants under section 2431, there are authorized to be appropriated $100,000,000 for each of the fiscal years
1989 and 1990.

1 Probably

March 13, 2013

should be ‘‘part’’. See section 118(b)(1)(B) of Public Law 102–321 (106 Stat. 348).

\\143.231.149.13\DATA\COMP\PHSA\PHSA.025

TITLE XXV—PREVENTION OF ACQUIRED IMMUNE
DEFICIENCY SYNDROME 1
SEC. 2500. ø300ee¿ USE OF FUNDS.
(a) IN GENERAL.—The purpose

of this title is to provide for the
establishment of education and information programs to prevent
and reduce exposure to, and the transmission of, the etiologic agent
for acquired immune deficiency syndrome.
(b) CONTENTS OF PROGRAMS.—All programs of education and
information receiving funds under this title shall include information about the harmful effects of promiscuous sexual activity and
intravenous substance abuse, and the benefits of abstaining from
such activities.
(c) LIMITATION.—None of the funds appropriated to carry out
this title may be used to provide education or information designed
to promote or encourage, directly, homosexual or heterosexual sexual activity or intravenous substance abuse.
(d) CONSTRUCTION.—Subsection (c) may not be construed to restrict the ability of an education program that includes the information required in subsection (b) to provide accurate information
about various means to reduce an individual’s risk of exposure to,
or the transmission of, the etiologic agent for acquired immune deficiency syndrome, provided that any informational materials used
are not obscene.
PART A—FORMULA GRANTS

TO

STATES

SEC. 2501. ø300ee–11¿ ESTABLISHMENT OF PROGRAM.
(a) ALLOTMENTS FOR STATES.—For the purpose

described in
subsection (b), the Secretary shall for each of the fiscal years 1989
through 1991 make an allotment for each State in an amount determined in accordance with section 2507. The Secretary shall
make payments each such fiscal year to each State from the allotment for the State if the Secretary approves for the fiscal year involved an application submitted by the State pursuant to section
2503.
(b) PURPOSE OF GRANTS.—The Secretary may not make payments under subsection (a) for a fiscal year unless the State involved agrees to expend the payments only for the purpose of carrying out, in accordance with section 2502, public information activities with respect to acquired immune deficiency syndrome.
SEC. 2502. ø300ee–12¿ PROVISIONS WITH RESPECT TO CARRYING OUT
PURPOSE OF GRANTS.

A State
2501(a)—
1 See

expend

footnote at beginning of title XXIII.

1263
March 13, 2013

may

payments

received

under

section

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Sec. 2503

PUBLIC HEALTH SERVICE ACT

1264

(1) to develop, establish, and conduct public information
activities relating to the prevention and diagnosis of acquired
immune deficiency syndrome for those populations or communities in the State in which there are a significant number of
individuals at risk of infection with the etiologic agent for such
syndrome;
(2) to develop, establish, and conduct such public information activities for the general public relating to the prevention
and diagnosis of such syndrome;
(3) to develop, establish, and conduct activities to reduce
risks relating to such syndrome, including research into the
prevention of such syndrome;
(4) to conduct demonstration projects for the prevention of
such syndrome;
(5) to provide technical assistance to public entities, to
nonprofit private entities concerned with such syndrome, to
schools, and to employers, for the purpose of developing information programs relating to such syndrome;
(6) with respect to education and training programs for the
prevention of such syndrome, to conduct such programs for
health professionals (including allied health professionals),
public safety workers (including emergency response employees), teachers, school administrators, and other appropriate
education personnel;
(7) to conduct appropriate programs for educating schoolaged children with respect to such syndrome, after consulting
with local school boards;
(8) to make available to physicians and dentists in the
State information with respect to acquired immune deficiency
syndrome, including measures for the prevention of exposure
to, and the transmission of, the etiologic agent for such syndrome (which information is updated not less than annually
with the most recently available scientific date 1 relating to
such syndrome);
(9) to carry out the initial implementation of recommendations contained in the guidelines and the model curriculum developed under section 253 of the AIDS Amendments of 1988;
and
(10) to make grants to public entities, and to nonprofit private entities concerned with acquired immune deficiency syndrome, for the purpose of the development, establishment, and
expansion of programs for education directed toward individuals at increased risk of infection with the etiologic agent for
such syndrome and activities to reduce the risks of exposure to
such etiologic agent, with preference to programs directed toward populations in which there is significant evidence of such
infection.
SEC. 2503. ø300ee–13¿ REQUIREMENT OF SUBMISSION OF APPLICATION CONTAINING CERTAIN AGREEMENTS AND ASSURANCES.
(a) IN GENERAL.—The Secretary may not make payments

under section 2501(a) for a fiscal year unless—
1 So

March 13, 2013

in law. Probably should be ‘‘data’’.

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1265

PUBLIC HEALTH SERVICE ACT

Sec. 2505

(1) the State involved submits to the Secretary a description of the purposes for which the State intends to expend the
payments for the fiscal year;
(2) the description identifies the populations, areas, and localities in the State with a need for the services for which
amounts may be provided by the State under this part;
(3) the description provides information relating to the programs and activities to be supported and services to be provided, including a description of the manner in which such programs and activities will be coordinated with any similar programs and activities of public and private entities;
(4) the State submits to the Secretary an application for
the payments containing agreements in accordance with this
part;
(5) the agreements are made through certification from the
chief executive officer of the State;
(6) with respect to such agreements, the application provides assurances of compliance satisfactory to the Secretary;
and
(7) the application otherwise is in such form, is made in
such manner, and contains such agreements, assurances, and
information as the Secretary determines to be necessary to
carry out this part.
(b) OPPORTUNITY FOR PUBLIC COMMENT.—The Secretary may
not make payments under section 2501(a) for a fiscal year unless
the State involved agrees that, in developing and carrying out the
description required in subsection (a), the State will provide public
notice with respect to the description (including any revisions) and
will facilitate comments from interested persons.
SEC. 2504. ø300ee–14¿ RESTRICTIONS ON USE OF GRANT.
(a) IN GENERAL.—The Secretary may not make

payments
under section 2501(a) for a fiscal year unless the State involved
agrees that the payments will not be expended—
(1) to provide inpatient services;
(2) to make cash payments to intended recipients of services;
(3) to purchase or improve real property (other than minor
remodeling of existing improvements to real property) or to
purchase major medical equipment; or
(4) to satisfy any requirement for the expenditure of nonFederal funds as a condition for the receipt of Federal funds.
(b) LIMITATION ON ADMINISTRATIVE EXPENSES.—The Secretary
may not make payments under section 2501(a) for a fiscal year unless the State involved agrees that the State will not expend more
than 5 percent of the payments for administrative expenses with
respect to carrying out the purpose described in section 2501(b).
SEC. 2505. ø300ee–15¿ REQUIREMENT OF REPORTS AND AUDITS BY
STATES.
(a) REPORTS.—The Secretary may not make payments under

section 2501(a) for a fiscal year unless the State involved agrees to
prepare and submit to the Secretary an annual report in such form
and containing such information as the Secretary determines to be
necessary for—
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Sec. 2505

PUBLIC HEALTH SERVICE ACT

1266

(1) securing a record and a description of the purposes for
which payments received by the State pursuant to such section
were expended and of the recipients of such payments;
(2) determining whether the payments were expended in
accordance with the needs within the State required to be
identified pursuant to section 2503(a)(2);
(3) determining whether the payments were expended in
accordance with the purpose described in section 2501(b); and
(4) determining the percentage of payments received pursuant to such section that were expended by the State for administrative expenses during the preceding fiscal year.
(b) AUDITS.—
(1) The Secretary may not make payments under section
2501(a) for a fiscal year unless the State involved agrees to establish such fiscal control and fund accounting procedures as
may be necessary to ensure the proper disbursal of, and accounting for, amounts received by the State under such section.
(2) The Secretary may not make payments under section
2501(a) for a fiscal year unless the State involved agrees that—
(A) the State will provide for—
(i) a financial and compliance audit of such payments; or
(ii) a single financial and compliance audit of each
entity administering such payments;
(B) the audit will be performed biennially and will
cover expenditures in each fiscal year; and
(C) the audit will be conducted in accordance with
standards established by the Comptroller General of the
United States for the audit of governmental organizations,
programs, activities, and functions.
(3) The Secretary may not make payments under section
2501(a) for a fiscal year unless the State involved agrees that,
not later than 30 days after the completion of an audit under
paragraph (2), the State will provide a copy of the audit report
to the State legislature.
(4) For purposes of paragraph (2), the term ‘‘financial and
compliance audit’’ means an audit to determine whether the financial statements of an audited entity present fairly the financial position, and the results of financial operations, of the
entity in accordance with generally accepted accounting principles, and whether the entity has complied with laws and regulations that may have a material effect upon the financial
statements.
(c) AVAILABILITY TO PUBLIC.—The Secretary may not make
payments under section 2501(a) for a fiscal year unless the State
involved agrees to make copies of the reports and audits described
in this section available for public inspection.
(d) EVALUATIONS BY COMPTROLLER GENERAL.—The Comptroller General of the United States shall, from time to time, evaluate the expenditures by States of payments received under section
2501(a) in order to ensure that expenditures are consistent with
the provisions of this part.
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1267

PUBLIC HEALTH SERVICE ACT

Sec. 2506

SEC. 2506. ø300ee–16¿ ADDITIONAL REQUIRED AGREEMENTS.
(a) IN GENERAL.—The Secretary may not, except as provided

in
subsection (b), make payments under section 2501(a) for a fiscal
year unless the State involved agrees that—
(1) all programs conducted or supported by the State with
such payments will establish objectives for the program and
will determine the extent to which the objectives are met;
(2) information provided under this part will be scientifically accurate and factually correct;
(3) in carrying out section 2501(b), the State will give priority to programs described in section 2502(10) for individuals
described in such section;
(4) with respect to a State in which there is a substantial
number of individuals who are intravenous substance abusers,
the State will place priority on activities under this part directed at such substance abusers;
(5) with respect to a State in which there is a significant
incidence of reported cases of acquired immune deficiency syndrome, the State will—
(A) for the purpose described in subsection (b) of section 2501, expend not less than 50 percent of payments received under subsection (a) of such section for a fiscal
year—
(i) to make grants to public entities, to migrant
health centers (as defined in section 329(a)), to community health centers (as defined in section 330(a)) 1,
and to nonprofit private entities concerned with acquired immune deficiency syndrome; or
(ii) to enter into contracts with public and private
entities; and
(B) of the amounts reserved for a fiscal year by the
State for expenditures required in subparagraph (A), expend not less than 50 percent to carry out section 2502(10)
through grants to nonprofit private entities, including minority entities, concerned with acquired immune deficiency
syndrome located in and representative of communities
and subpopulations reflecting the local incidence of such
syndrome;
(6) with respect to programs carried out pursuant to section 2502(10), the State will ensure that any applicant for a
grant under such section agrees—
(A) that any educational or informational materials
developed with a grant pursuant to such section will contain material, and be presented in a manner, that is specifically directed toward the group for which such materials are intended;
(B) to provide a description of the manner in which
the applicant has planned the program in consultation
with, and of the manner in which such applicant will consult during the conduct of the program with—
(i) appropriate local officials and community
groups for the area to be served by the program;
1 See

March 13, 2013

footnote for section 217(a).

\\143.231.149.13\DATA\COMP\PHSA\PHSA.025
Sec. 2507

PUBLIC HEALTH SERVICE ACT

1268

(ii) organizations comprised of, and representing,
the specific population to which the education or prevention effort is to be directed; and
(iii) individuals having expertise in health education and in the needs of the population to be served;
(C) to provide information demonstrating that the applicant has continuing relationships, or will establish continuing relationships, with a portion of the population in
the service area that is at risk of infection with the etiologic agent for acquired immune deficiency syndrome and
with public and private entities in such area that provide
health or other support services to individuals with such
infection;
(D) to provide a description of—
(i) the objectives established by the applicant for
the conduct of the program; and
(ii) the methods the applicant will use to evaluate
the activities conducted under the program to determine if such objectives are met; and
(E) such other information as the Secretary may prescribe;
(7) with respect to programs carried out pursuant to section 2502(10), the State will give preference to any applicant
for a grant pursuant to such section that is located in, has a
history of service in, and will serve under the program, any geographic area in which—
(A) there is a significant incidence of acquired immune
deficiency syndrome;
(B) there has been a significant increase in the incidence of such syndrome; or
(C) there is a significant risk of becoming infected with
the etiologic agent for such syndrome;
(8) the State will establish reasonable criteria to evaluate
the effective performance of entities that receive funds from
payments made to the State under section 2501(a) and will establish procedures for procedural and substantive independent
State review of the failure by the State to provide funds for
any such entity;
(9) the State will permit and cooperate with Federal investigations undertaken in accordance with section 2508(e);
(10) the State will maintain State expenditures for services
provided pursuant to section 2501 at a level equal to not less
than the average level of such expenditures maintained by the
State for the 2-year period preceding the fiscal year for which
the State is applying to receive payments.
(b) DEFINITION.—For purposes of subsection (a)(5), the term
‘‘significant percentage’’ means at least a percentage of 1 percent
of the number of reported cases of acquired immune deficiency syndrome in the United States.
SEC. 2507. ø300ee–17¿ DETERMINATION OF AMOUNT OF ALLOTMENTS
FOR STATES.
(a) MINIMUM ALLOTMENT.—Subject to the extent of amounts

made available in appropriation Acts, the allotment for a State
under section 2501(a) for a fiscal year shall be the greater of—
March 13, 2013

\\143.231.149.13\DATA\COMP\PHSA\PHSA.025
1269

PUBLIC HEALTH SERVICE ACT

Sec. 2507

(1) the applicable amount specified in subsection (b); or
(2) the amount determined in accordance with subsection
(c).
(b) DETERMINATION OF MINIMUM ALLOTMENT.—
(1) If the total amount appropriated under section 2514(a)
for a fiscal year exceeds $100,000,000, the amount referred to
in subsection (a)(1) shall be $300,000 for the fiscal year.
(2) If the total amount appropriated under section 2514(a)
for a fiscal year equals or exceeds $50,000,000, but is less than
$100,000,000, the amount referred to in subsection (a)(1) shall
be $200,000 for the fiscal year.
(3) If the total amount appropriated under section 2514(a)
for a fiscal year is less than $50,000,000, the amount referred
to in subsection (a)(1) shall be $100,000 for the fiscal year.
(c) DETERMINATION UNDER FORMULA.—
(1) The amount referred to in subsection (a)(2) is the sum
of—
(A) the amount determined under paragraph (2); and
(B) the amount determined under paragraph (3).
(2) The amount referred to in paragraph (1)(A) is the product of—
(A) an amount equal to 50 percent of the amounts appropriated pursuant to section 2514(a); and
(B) a percentage equal to the quotient of—
(i) the population of the State involved; divided by
(ii) the population of the United States.
(3) The amount referred to in paragraph (1)(B) is the product of—
(A) an amount equal to 50 percent of the amounts appropriated pursuant to section 2514(a); and
(B) a percentage equal to the quotient of—
(i) the number of additional cases of acquired immune deficiency syndrome reported to and confirmed
by the Secretary for the State involved for the most recent fiscal year for which such data is available; divided by
(ii) the number of additional cases of such syndrome reported to and confirmed by the Secretary for
the United States for such fiscal year.
(d) DISPOSITION OF CERTAIN FUNDS APPROPRIATED FOR ALLOTMENTS.—
(1) Amounts described in paragraph (2) shall be allotted by
the Secretary to States receiving payments under section
2501(a) for the fiscal year (other than any State referred to in
paragraph (2)(C)). Such amounts shall be allotted according to
a formula established by the Secretary. The formula shall be
equivalent to the formula described in this section under which
the allotment under section 2501(a) for the State for the fiscal
year involved was determined.
(2) The amounts referred to in paragraph (1) are any
amounts that are not paid to States under section 2501(a) as
a result of—
(A) the failure of any State to submit an application
under section 2503;
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\\143.231.149.13\DATA\COMP\PHSA\PHSA.025
Sec. 2508

PUBLIC HEALTH SERVICE ACT

1270

(B) the failure, in the determination of the Secretary,
of any State to prepare within a reasonable period of time
such application in compliance with such section; or
(C) any State informing the Secretary that the State
does not intend to expend the full amount of the allotment
made to the State.
SEC. 2508. ø300ee–18¿ FAILURE TO COMPLY WITH AGREEMENTS.
(a) REPAYMENT OF PAYMENTS.—

(1) The Secretary may, subject to subsection (c), require a
State to repay any payments received by the State under section 2501(a) that the Secretary determines were not expended
by the State in accordance with the agreements required to be
contained in the application submitted by the State pursuant
to section 2503.
(2) If a State fails to make a repayment required in paragraph (1), the Secretary may offset the amount of the repayment against the amount of any payment due to be paid to the
State under section 2501(a).
(b) WITHHOLDING OF PAYMENTS.—
(1) The Secretary may, subject to subsection (c), withhold
payments due under section 2501(a) if the Secretary determines that the State involved is not expending amounts received under such section in accordance with the agreements
required to be contained in the application submitted by the
State pursuant to section 2503.
(2) The Secretary shall cease withholding payments from
a State under paragraph (1) if the Secretary determines that
there are reasonable assurances that the State will expend
amounts received under section 2501(a) in accordance with the
agreements referred to in such paragraph.
(3) The Secretary may not withhold funds under paragraph (1) from a State for a minor failure to comply with the
agreements referred to in such paragraph.
(c) OPPORTUNITY FOR HEARING.—Before requiring repayment of
payments under subsection (a)(1), or withholding payments under
subsection (b)(1), the Secretary shall provide to the State an opportunity for a hearing conducted within the State.
(d) PROMPT RESPONSE TO SERIOUS ALLEGATIONS.—The Secretary shall promptly respond to any complaint of a substantial or
serious nature that a State has failed to expend amounts received
under section 2501(a) in accordance with the agreements required
to be contained in the application submitted by the State pursuant
to section 2503.
(e) INVESTIGATIONS.—
(1) The Secretary shall conduct in several States in each
fiscal year investigations of the expenditure of payments received by the States under section 2501(a) in order to evaluate
compliance with the agreements required to be contained in
the applications submitted to the Secretary pursuant to section
2503.
(2) The Comptroller General of the United States may conduct investigations of the expenditure of funds received under
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1271

PUBLIC HEALTH SERVICE ACT

Sec. 2510

section 2501(a) by a State in order to ensure compliance with
the agreements referred to in paragraph (1).
(3) Each State, and each entity receiving funds from payments made to a State under section 2501(a), shall make appropriate books, documents, papers, and records available to
the Secretary and the Comptroller General of the United
States, or any of their duly authorized representatives, for examination, copying, or mechanical reproduction on or off the
premises of the appropriate entity upon a reasonable request
therefor.
(4)(A) In conducting any investigation in a State, the Secretary and the Comptroller General of the United States may
not make a request for any information not readily available
to the State, or to an entity receiving funds from payments
made to the State under section 2501(a), or make an unreasonable request for information to be compiled, collected, or transmitted in any form not readily available.
(B) Subparagraph (A) shall not apply to the collection,
compilation, or transmittal of data in the course of a judicial
proceeding.
SEC. 2509. ø300ee–19¿ PROHIBITION AGAINST CERTAIN FALSE STATEMENTS.
(a) IN GENERAL.—

(1) A person may not knowingly make or cause to be made
any false statement or representation of a material fact in connection with the furnishing of items or services for which
amounts may be paid by a State from payments received by
the State under section 2501(a).
(2) A person with knowledge of the occurrence of any event
affecting the right of the person to receive any amounts from
payments made to the State under section 2501(a) may not
conceal or fail to disclose any such event with the intent of
fraudulently securing such amounts.
(b) CRIMINAL PENALTY FOR VIOLATION OF PROHIBITION.—Any
person who violates a prohibition established in subsection (a) may
for each violation be fined in accordance with title 18, United
States Code, or imprisoned for not more than 5 years, or both.
SEC. 2510. ø300ee–20¿ TECHNICAL ASSISTANCE AND PROVISION BY
SECRETARY OF SUPPLIES AND SERVICES IN LIEU OF
GRANT FUNDS.
(a) TECHNICAL ASSISTANCE.—The Secretary may provide train-

ing and technical assistance to States with respect to the planning,
development, and operation of any program or service carried out
pursuant to this part. The Secretary may provide such technical assistance directly or through grants or contracts.
(b) PROVISION BY SECRETARY OF SUPPLIES AND SERVICES IN
LIEU OF GRANT FUNDS.—
(1) Upon the request of a State receiving payments under
this part, the Secretary may, subject to paragraph (2), provide
supplies, equipment, and services for the purpose of aiding the
State in carrying out such part and, for such purpose, may detail to the State any officer or employee of the Department of
Health and Human Services.
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Sec. 2511

PUBLIC HEALTH SERVICE ACT

1272

(2) With respect to a request described in paragraph (1),
the Secretary shall reduce the amount of payments under section 2501(a) to the State by an amount equal to the costs of
detailing personnel and the fair market value of any supplies,
equipment, or services provided by the Secretary. The Secretary shall, for the payment of expenses incurred in complying
with such request, expend the amounts withheld.
SEC. 2511. ø300ee–21¿ EVALUATIONS.

The Secretary shall, directly or through grants or contracts,
evaluate the services provided and activities carried out with payments to States under this part.
SEC. 2512. ø300ee–22¿ REPORT BY SECRETARY.

The Secretary shall annually prepare a report on the activities
of the States carried out pursuant to this part. Such report may include any recommendations of the Secretary for appropriate administrative and legislative initiatives. The report shall be submitted
to the Congress through inclusion in the comprehensive report required in section 2301(a).
SEC. 2513. ø300ee–23¿ DEFINITION.

For purposes of this part, the term ‘‘infection with the etiologic
agent for acquired immune deficiency syndrome’’ includes any condition arising from such etiologic agent.
SEC. 2514. ø300ee–24¿ FUNDING.
(a) AUTHORIZATION OF APPROPRIATIONS.—For

the purpose of
making allotments under section 2501(a), there are authorized to
be appropriated $165,000,000 for fiscal year 1989 and such sums
as may be necessary for each of the fiscal years 1990 and 1991.
(b) AVAILABILITY TO STATES.—Any amounts paid to a State
under section 2501(a) shall remain available to the State until the
expiration of the 1-year period beginning on the date on which the
State receives such amounts.
PART B—NATIONAL INFORMATION PROGRAMS
SEC. 2521. ø300ee–31¿ AVAILABILITY OF INFORMATION TO GENERAL
PUBLIC.
(a) COMPREHENSIVE INFORMATION PLAN.—The Secretary, act-

ing through the Director of the Centers for Disease Control and
Prevention, shall annually prepare a comprehensive plan, including
a budget, for a National Acquired Immune Deficiency Syndrome Information Program. The plan shall contain provisions to implement
the provisions of this title. The Director shall submit such plan to
the Secretary. The authority established in this subsection may not
be construed to be the exclusive authority for the Director to carry
out information activities with respect to acquired immune deficiency syndrome.
(b) CLEARINGHOUSE.—
(1) The Secretary, acting through the Director of the Centers for Disease Control and Prevention, may establish a clearinghouse to make information concerning acquired immune deficiency syndrome available to Federal agencies, States, public
and private entities, and the general public.
(2) The clearinghouse may conduct or support programs—
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1273

PUBLIC HEALTH SERVICE ACT

Sec. 2523

(A) to develop and obtain educational materials, model
curricula, and methods directed toward reducing the transmission of the etiologic agent for acquired immune deficiency syndrome;
(B) to provide instruction and support for individuals
who provide instruction in methods and techniques of education relating to the prevention of acquired immune deficiency syndrome and instruction in the use of the materials and curricula described in subparagraph (A); and
(C) to conduct, or to provide for the conduct of, the materials, curricula, and methods described in paragraph (1)
and the efficacy of such materials, curricula, and methods
in preventing infection with the the 1 etiologic agent for acquired immune deficiency syndrome.
(c) TOLL-FREE TELEPHONE COMMUNICATIONS.—The Secretary
shall provide for the establishment and maintenance of toll-free
telephone communications to provide information to, and respond
to queries from, the public concerning acquired immune deficiency
syndrome. Such communications shall be available on a 24-hour
basis.
SEC. 2522. ø300ee–32¿ PUBLIC INFORMATION CAMPAIGNS.
(a) IN GENERAL.—The Secretary, acting through the

Director of
the Centers for Disease Control and Prevention, may make grants
to public entities, and to nonprofit private entities concerned with
acquired immune deficiency syndrome, and shall enter into contracts with public and private entities, for the development and delivery of public service announcements and paid advertising messages that warn individuals about activities which place them at
risk of infection with the etiologic agent for such syndrome.
(b) REQUIREMENT OF APPLICATION.—The Secretary may not
provide financial assistance under subsection (a) unless—
(1) an application for such assistance is submitted to the
Secretary;
(2) with respect to carrying out the purpose for which the
assistance is to be provided, the application provides assurances of compliance satisfactory to the Secretary; and
(3) the application otherwise is in such form, is made in
such manner, and contains such agreements, assurances, and
information as the Secretary determines to be necessary to
carry out this section.
SEC. 2523. ø300ee–33¿ PROVISION OF INFORMATION TO UNDERSERVED POPULATIONS.
(a) IN GENERAL.—The Secretary may make grants to public en-

tities, to migrant health centers (as defined in section 329(a) 2), to
community health centers (as defined in section 330(a)) 2, and to
nonprofit private entities concerned with acquired immune deficiency syndrome, for the purpose of assisting grantees in providing
services to populations of individuals that are underserved with respect to programs providing information on the prevention of expo1 So

in law. The word ‘‘the’’ appears twice.
footnote for section 217(a).

2 See

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sure to, and the transmission of, the etiologic agent for acquired
immune deficiency syndrome.
(b) PREFERENCES IN MAKING GRANTS.—In making grants
under subsection (a), the Secretary shall give preference to any applicant for such a grant that has the ability to disseminate rapidly
the information described in subsection (a) (including any national
organization with such ability).
SEC. 2524. ø300ee–34¿ AUTHORIZATION OF APPROPRIATIONS.
(a) IN GENERAL.—For the purpose of carrying out sections

2521
through 2523, there are authorized to be appropriated
$105,000,000 for fiscal year 1989 and such sums as may be necessary for each of the fiscal years 1990 and 1991.
(b) ALLOCATIONS.—
(1) Of the amounts appropriated pursuant to subsection
(a), the Secretary shall make available $45,000,000 to carry out
section 2522 and $30,000,000 to carry out this part through financial assistance to minority entities for the provision of services to minority populations.
(2) After consultation with the Director of the Office of Minority Health and with the Indian Health Service, the Secretary, acting through the Director of the Centers for Disease
Control and Prevention, shall, not later than 90 days after the
date of the enactment of the AIDS Amendments of 1988, 1 publish guidelines to provide procedures for applications for funding pursuant to paragraph (1) and for public comment.

1 Enacted

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on November 4, 1988.

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TITLE XXVI—HIV HEALTH CARE
SERVICES PROGRAM 1, 2
PART A—EMERGENCY RELIEF
FOR

FOR AREAS WITH
SERVICES 3

SUBSTANTIAL NEED

Subpart I—General Grant Provisions
SEC. 2601. ø300ff–11¿ ESTABLISHMENT OF PROGRAM OF GRANTS.
(a) ELIGIBLE AREAS.—The Secretary, acting through the

Administrator of the Health Resources and Services Administration,
shall, subject to subsections (b) through (c), make grants in accordance with section 2603 for the purpose of assisting in the provision
of the services specified in section 2604 in any metropolitan area
for which there has been reported to and confirmed by the Director
of the Centers for Disease Control and Prevention a cumulative
total of more than 2,000 cases of AIDS during the most recent period of 5 calendar years for which such data are available.
(b) CONTINUED STATUS AS ELIGIBLE AREA.—Notwithstanding
any other provision of this section, a metropolitan area that is an
eligible area for a fiscal year continues to be an eligible area until
the metropolitan area fails, for three consecutive fiscal years—
(1) to meet the requirements of subsection (a); and
(2) to have a cumulative total of 3,000 or more living cases
of AIDS (reported to and confirmed by the Director of the Centers for Disease Control and Prevention) as of December 31 of
the most recent calendar year for which such data is available.
(c) BOUNDARIES.—For purposes of determining eligibility under
this subpart—
(1) with respect to a metropolitan area that received funding under this subpart in fiscal year 2006, the boundaries of
such metropolitan area shall be the boundaries that were in effect for such area for fiscal year 1994; or
(2) with respect to a metropolitan area that becomes eligible to receive funding under this subpart in any fiscal year
1 This title was added by Public Law 101–381. Section 2 of that Public Law provides as follows: ‘‘It is the purpose of this Act to provide emergency assistance to localities that are disproportionately affected by the Human Immunodeficiency Virus epidemic and to make financial
assistance available to States and other public or private nonprofit entities to provide for the
development, organization, coordination and operation of more effective and cost efficient systems for the delivery of essential services to individuals and families with HIV disease.’’.
2 Section 502 of Public Law 106–345 (114 Stat. 1353) relates to the development of reliable
and affordable tests for HIV disease that can rapidly be administered and whose results can
rapidly be obtained.
3 With respect to information for determining formula grants under parts A and B, section
501(a) of Public Law 106–345 (114 Stat. 1352) provides for a study of State surveillance systems
regarding cases of infection with the human immunodeficiency virus. Section 501(d)(1) of such
Law requires that a report of the findings of the study be submitted not later than 3 years after
the date of the enactment of the Law, which was enacted October 20, 2000.

1275
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after fiscal year 2006, the boundaries of such metropolitan area
shall be the boundaries that are in effect for such area when
such area initially receives funding under this subpart.
SEC. 2602. ø300ff–12¿ ADMINISTRATION AND PLANNING COUNCIL.
(a) ADMINISTRATION.—
(1) IN GENERAL.—Assistance made available under grants

awarded under this subpart shall be directed to the chief elected official of the city or urban county that administers the public health agency that provides outpatient and ambulatory
services to the greatest number of individuals with AIDS, as
reported to and confirmed by the Centers for Disease Control
and Prevention, in the eligible area that is awarded such a
grant.
(2) REQUIREMENTS.—
(A) IN GENERAL.—To receive assistance under section
2601(a), the chief elected official of the eligible area involved shall—
(i) establish, through intergovernmental agreements with the chief elected officials of the political
subdivisions described in subparagraph (B), an administrative mechanism to allocate funds and services
based on—
(I) the number of AIDS cases in such subdivisions;
(II) the severity of need for outpatient and
ambulatory care services in such subdivisions; and
(III) the health and support services personnel needs of such subdivisions; and
(ii) establish an HIV health services planning
council in accordance with subsection (b).
(B) LOCAL POLITICAL SUBDIVISION.—The political subdivisions referred to in subparagraph (A) are those political subdivisions in the eligible area—
(i) that provide HIV-related health services; and
(ii) for which the number of cases reported for
purposes of section 2601(a) constitutes not less than
10 percent of the number of such cases reported for
the eligible area.
(b) HIV HEALTH SERVICES PLANNING COUNCIL.—
(1) ESTABLISHMENT.—To be eligible for assistance under
this subpart, the chief elected official described in subsection
(a)(1) shall establish or designate an HIV health services planning council that shall reflect in its composition the demographics of the population of individuals with HIV/AIDS in the
eligible area involved, with particular consideration given to
disproportionately affected and historically underserved groups
and subpopulations. Nominations for membership on the council shall be identified through an open process and candidates
shall be selected based on locally delineated and publicized criteria. Such criteria shall include a conflict-of-interest standard
that is in accordance with paragraph (5).
(2) REPRESENTATION.—The HIV health services planning
council shall include representatives of—
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(A) health care providers, including federally qualified
health centers;
(B) community-based organizations serving affected
populations and AIDS service organizations;
(C) social service providers, including providers of
housing and homeless services;
(D) mental health and substance abuse providers;
(E) local public health agencies;
(F) hospital planning agencies or health care planning
agencies;
(G) affected communities, including people with HIV/
AIDS, members of a Federally recognized Indian tribe as
represented in the population, individuals co-infected with
hepatitis B or C and historically underserved groups and
subpopulations;
(H) nonelected community leaders;
(I) State government (including the State medicaid
agency and the agency administering the program under
part B);
(J) grantees under subpart II of part C;
(K) grantees under section 2671, or, if none are operating in the area, representatives of organizations with a
history of serving children, youth, women, and families living with HIV and operating in the area;
(L) grantees under other Federal HIV programs, including but not limited to providers of HIV prevention
services; and
(M) representatives of individuals who formerly were
Federal, State, or local prisoners, were released from the
custody of the penal system during the preceding 3 years,
and had HIV/AIDS as of the date on which the individuals
were so released.
(3) METHOD OF PROVIDING FOR COUNCIL.—
(A) IN GENERAL.—In providing for a council for purposes of paragraph (1), a chief elected official receiving a
grant under section 2601(a) may establish the council directly or designate an existing entity to serve as the council, subject to subparagraph (B).
(B) CONSIDERATION REGARDING DESIGNATION OF COUNCIL.—In making a determination of whether to establish or
designate a council under subparagraph (A), a chief elected
official receiving a grant under section 2601(a) shall give
priority to the designation of an existing entity that has
demonstrated experience in planning for the HIV health
care service needs within the eligible area and in the implementation of such plans in addressing those needs. Any
existing entity so designated shall be expanded to include
a broad representation of the full range of entities that
provide such services within the geographic area to be
served.
(4) DUTIES.—The planning council established or designated under paragraph (1) shall—
(A) determine the size and demographics of the population of individuals with HIV/AIDS, as well as the size
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and demographics of the estimated population of individuals with HIV/AIDS who are unaware of their HIV status;
(B) determine the needs of such population, with particular attention to—
(i) individuals with HIV/AIDS who know their
HIV status and are not receiving HIV-related services;
(ii) disparities in access and services among affected subpopulations and historically underserved
communities; and
(iii) individuals with HIV/AIDS who do not know
their HIV status;
(C) establish priorities for the allocation of funds within the eligible area, including how best to meet each such
priority and additional factors that a grantee should consider in allocating funds under a grant based on the—
(i) size and demographics of the population of individuals with HIV/AIDS (as determined under subparagraph (A)) and the needs of such population (as determined under subparagraph (B));
(ii) demonstrated (or probable) cost effectiveness
and outcome effectiveness of proposed strategies and
interventions, to the extent that data are reasonably
available;
(iii) priorities of the communities with HIV/AIDS
for whom the services are intended;
(iv) coordination in the provision of services to
such individuals with programs for HIV prevention
and for the prevention and treatment of substance
abuse, including programs that provide comprehensive
treatment for such abuse;
(v) availability of other governmental and nongovernmental resources, including the State medicaid
plan under title XIX of the Social Security Act and the
State Children’s Health Insurance Program under title
XXI of such Act to cover health care costs of eligible
individuals and families with HIV/AIDS; and
(vi) capacity development needs resulting from
disparities in the availability of HIV-related services
in historically underserved communities;
(D) develop a comprehensive plan for the organization
and delivery of health and support services described in
section 2604 that—
(i) includes a strategy for identifying individuals
who know their HIV status and are not receiving such
services and for informing the individuals of and enabling the individuals to utilize the services, giving particular attention to eliminating disparities in access
and services among affected subpopulations and historically underserved communities, and including discrete goals, a timetable, and an appropriate allocation
of funds;
(ii) includes a strategy to coordinate the provision
of such services with programs for HIV prevention (including outreach and early intervention) and for the
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Sec. 2602

prevention and treatment of substance abuse (including programs that provide comprehensive treatment
services for such abuse);
(iii) is compatible with any State or local plan for
the provision of services to individuals with HIV/AIDS;
and
(iv) includes a strategy, coordinated as appropriate with other community strategies and efforts, including discrete goals, a timetable, and appropriate
funding, for identifying individuals with HIV/AIDS
who do not know their HIV status, making such individuals aware of such status, and enabling such individuals to use the health and support services described in section 2604, with particular attention to reducing barriers to routine testing and disparities in
access and services among affected subpopulations and
historically underserved communities;
(E) assess the efficiency of the administrative mechanism in rapidly allocating funds to the areas of greatest
need within the eligible area, and at the discretion of the
planning council, assess the effectiveness, either directly or
through contractual arrangements, of the services offered
in meeting the identified needs;
(F) participate in the development of the statewide coordinated statement of need initiated by the State public
health agency responsible for administering grants under
part B;
(G) establish methods for obtaining input on community needs and priorities which may include public meetings (in accordance with paragraph (7)), conducting focus
groups, and convening ad-hoc panels; and
(H) coordinate with Federal grantees that provide
HIV-related services within the eligible area.
(5) CONFLICTS OF INTEREST.—
(A) IN GENERAL.—The planning council under paragraph (1) may not be directly involved in the administration of a grant under section 2601(a). With respect to compliance with the preceding sentence, the planning council
may not designate (or otherwise be involved in the selection of) particular entities as recipients of any of the
amounts provided in the grant.
(B) REQUIRED AGREEMENTS.—An individual may serve
on the planning council under paragraph (1) only if the individual agrees that if the individual has a financial interest in an entity, if the individual is an employee of a public
or private entity, or if the individual is a member of a public or private organization, and such entity or organization
is seeking amounts from a grant under section 2601(a), the
individual will not, with respect to the purpose for which
the entity seeks such amounts, participate (directly or in
an advisory capacity) in the process of selecting entities to
receive such amounts for such purpose.
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(C) COMPOSITION OF COUNCIL.—The following applies
regarding the membership of a planning council under
paragraph (1):
(i) Not less than 33 percent of the council shall be
individuals who are receiving HIV-related services
pursuant to a grant under section 2601(a), are not officers, employees, or consultants to any entity that receives amounts from such a grant, and do not represent any such entity, and reflect the demographics of
the population of individuals with HIV/AIDS as determined under paragraph (4)(A). For purposes of the
preceding sentence, an individual shall be considered
to be receiving such services if the individual is a parent of, or a caregiver for, a minor child who is receiving such services.
(ii) With respect to membership on the planning
council, clause (i) may not be construed as having any
effect on entities that receive funds from grants under
any of parts B through F but do not receive funds
from grants under section 2601(a), on officers or employees of such entities, or on individuals who represent such entities.
(6) GRIEVANCE PROCEDURES.—A planning council under
paragraph (1) shall develop procedures for addressing grievances with respect to funding under this subpart, including
procedures for submitting grievances that cannot be resolved to
binding arbitration. Such procedures shall be described in the
by-laws of the planning council and be consistent with the requirements of subsection (c).
(7) PUBLIC DELIBERATIONS.—With respect to a planning
council under paragraph (1), the following applies:
(A) The council may not be chaired solely by an employee of the grantee under section 2601(a).
(B) In accordance with criteria established by the Secretary:
(i) The meetings of the council shall be open to the
public and shall be held only after adequate notice to
the public.
(ii) The records, reports, transcripts, minutes,
agenda, or other documents which were made available to or prepared for or by the council shall be available for public inspection and copying at a single location.
(iii) Detailed minutes of each meeting of the council shall be kept. The accuracy of all minutes shall be
certified to by the chair of the council.
(iv) This subparagraph does not apply to any disclosure of information of a personal nature that would
constitute a clearly unwarranted invasion of personal
privacy, including any disclosure of medical information or personnel matters.
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Sec. 2603

(c) 1 GRIEVANCE PROCEDURES.—
(1) FEDERAL RESPONSIBILITY.—
(A) MODELS.—The Secretary shall, through a process
that includes consultations with grantees under this subpart and public and private experts in grievance procedures, arbitration, and mediation, develop model grievance
procedures that may be implemented by the planning
council under subsection (b)(1) and grantees under this
subpart. Such model procedures shall describe the elements that must be addressed in establishing local grievance procedures and provide grantees with flexibility in
the design of such local procedures.
(B) REVIEW.—The Secretary shall review grievance
procedures established by the planning council and grantees under this subpart to determine if such procedures are
adequate. In making such a determination, the Secretary
shall assess whether such procedures permit legitimate
grievances to be filed, evaluated, and resolved at the local
level.
(2) GRANTEES.—To be eligible to receive funds under this
subpart, a grantee shall develop grievance procedures that are
determined by the Secretary to be consistent with the model
procedures developed under paragraph (1)(A). Such procedures
shall include a process for submitting grievances to binding arbitration.
(d) PROCESS FOR ESTABLISHING ALLOCATION PRIORITIES.—
Promptly after the date of the submission of the report required in
section 501(b) of the Ryan White CARE Act Amendments of 2000 1
(relating to the relationship between epidemiological measures and
health care for certain individuals with HIV/AIDS), the Secretary,
in consultation with planning councils and entities that receive
amounts from grants under section 2601(a) or 2611, shall develop
epidemiologic measures—
(1) for establishing the number of individuals living with
HIV/AIDS who are not receiving HIV-related health services;
and
(2) for carrying out the duties under subsection (b)(4) and
section 2617(b).
(e) TRAINING GUIDANCE AND MATERIALS.—The Secretary shall
provide to each chief elected official receiving a grant under section
2601(a) guidelines and materials for training members of the planning council under paragraph (1) regarding the duties of the council.
SEC. 2603. ø300ff–13¿ TYPE AND DISTRIBUTION OF GRANTS.
(a) GRANTS BASED ON RELATIVE NEED OF AREA.—
(1) IN GENERAL.—In carrying out section 2601(a),

the Secretary shall make a grant for each eligible area for which an
application under section 2605(a) has been approved. Each

1 Subsection (c) was added by an amendment to subsection (b). Section 3(b)(1)(F) of Public Law
104–146 (110 Stat. 1348) provided that subsection (b) of section 2602 is amended ‘‘by adding
at the end thereof the following:’’, and then added paragraphs (5) and (6) and subsection (c).
1 Public Law 106–345 (114 Stat. 1352). Section 501(d)(2) of such Law requires that the report
be submitted not later than 2 years after the date of the enactment of the Law, which was enacted October 20, 2000.

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such grant shall be made in an amount determined in accordance with paragraph (3).
(2) EXPEDITED DISTRIBUTION.—Not later than 60 days after
an appropriation becomes available to carry out this subpart
for a fiscal year, the Secretary shall, except in the case of waivers granted under section 2605(c), disburse 662⁄3 percent of the
amount made available under section 2610(b) for carrying out
this subpart for such fiscal year through grants to eligible
areas under section 2601(a), in accordance with paragraphs (3)
and (4).
(3) AMOUNT OF GRANT.—
(A) IN GENERAL.—Subject to the extent of amounts
made available in appropriations Acts, a grant made for
purposes of this paragraph to an eligible area shall be
made in an amount equal to the product of—
(i) an amount equal to the amount available for
distribution under paragraph (2) for the fiscal year involved; and
(ii) the percentage constituted by the ratio of the
distribution factor for the eligible area to the sum of
the respective distribution factors for all eligible areas;
which product shall then, as applicable, be increased under
paragraph (4).
(B) DISTRIBUTION FACTOR.—For purposes of subparagraph (A)(ii), the term ‘‘distribution factor’’ means an
amount equal to the estimated number of living cases of
AIDS 1 in the eligible area involved, as determined under
subparagraph (C).
(C) LIVING CASES OF HIV/AIDS.—
(i) REQUIREMENT OF NAMES-BASED REPORTING.—
Except as provided in clause (ii), the number determined under this subparagraph for an eligible area for
a fiscal year for purposes of subparagraph (B) is the
number of living names-based cases of HIV/AIDS that,
as of December 31 of the most recent calendar year for
which such data is available, have been reported to
and confirmed by the Director of the Centers for Disease Control and Prevention.
(ii) TRANSITION PERIOD; EXEMPTION REGARDING
NON-AIDS CASES.—For each of the fiscal years 2007
through 2012, an eligible area is, subject to clauses
(iii) through (v), exempt from the requirement under
clause (i) that living names-based non-AIDS cases of
HIV be reported unless—
(I) a system was in operation as of December
31, 2005, that provides sufficiently accurate and
reliable names-based reporting of such cases
1 Section

102(b)(1) of Public Law 109–415 provides as follows:
(1) in subparagraph (B), by striking ‘‘estimated living cases of acquired immune deficiency
syndrome’’ and inserting ‘‘living cases of HIV/AIDS (reported to and confirmed by the Director of the Centers for Disease Control and Prevention)’’; and
Such amendment could not be executed because the words ‘‘number of’’ probably should appear before ‘‘living cases’’ in the matter purported to be struck.

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throughout the State in which the area is located,
subject to clause (viii); or
(II) no later than the beginning of fiscal year
2008 or a subsequent fiscal year through fiscal
year 2012, the Secretary, in consultation with the
chief executive of the State in which the area is located, determines that a system has become operational in the State that provides sufficiently accurate and reliable names-based reporting of such
cases throughout the State.
(iii) REQUIREMENTS FOR EXEMPTION FOR FISCAL
YEAR 2007.—For fiscal year 2007, an exemption under
clause (ii) for an eligible area applies only if, by October 1, 2006—
(I)(aa) the State in which the area is located
had submitted to the Secretary a plan for making
the transition to sufficiently accurate and reliable
names-based reporting of living non-AIDS cases of
HIV; or
(bb) all statutory changes necessary to provide
for sufficiently accurate and reliable reporting of
such cases had been made; and
(II) the State had agreed that, by April 1,
2008, the State will begin accurate and reliable
names-based reporting of such cases, except that
such agreement is not required to provide that, as
of such date, the system for such reporting be
fully sufficient with respect to accuracy and reliability throughout the area.
(iv) REQUIREMENT FOR EXEMPTION AS OF FISCAL
YEAR 2008.—For each of the fiscal years 2008 through
2012, an exemption under clause (ii) for an eligible
area applies only if, as of April 1, 2008, the State in
which the area is located is substantially in compliance with the agreement under clause (iii)(II).
(v) PROGRESS TOWARD NAMES-BASED REPORTING.—
For fiscal year 2009 or a subsequent fiscal year, the
Secretary may terminate an exemption under clause
(ii) for an eligible area if the State in which the area
is located submitted a plan under clause (iii)(I)(aa)
and the Secretary determines that the State is not
substantially following the plan.
(vi) COUNTING OF CASES IN AREAS WITH EXEMPTIONS.—
(I) IN GENERAL.—With respect to an eligible
area that is under a reporting system for living
non-AIDS cases of HIV that is not names-based
(referred to in this subparagraph as ‘‘code-based
reporting’’), the Secretary shall, for purposes of
this subparagraph, modify the number of such
cases reported for the eligible area in order to adjust for duplicative reporting in and among systems that use code-based reporting.
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(II) ADJUSTMENT RATE.—The adjustment rate
under subclause (I) for an eligible area shall be a
reduction of 5 percent for fiscal years before fiscal
year 2012 (and 6 percent for fiscal year 2012) in
the number of living non-AIDS cases of HIV reported for the area.
(III) INCREASED ADJUSTMENT FOR CERTAIN
AREAS PREVIOUSLY USING CODE-BASED REPORTING.—For purposes of this subparagraph for each
of fiscal years 2010 through 2012, the Secretary
shall deem the applicable number of living cases
of HIV/AIDS in an area that were reported to and
confirmed by the Centers for Disease Control and
Prevention to be 3 percent higher than the actual
number if—
(aa) for fiscal year 2007, such area was a
transitional area;
(bb) fiscal year 2007 was the first year in
which the count of living non-AIDS cases of
HIV in such area, for purposes of this section,
was based on a names-based reporting system; and
(cc) the amount of funding that such area
received under this part for fiscal year 2007
was less than 70 percent of the amount of
funding (exclusive of funds that were identified as being for purposes of the Minority
AIDS Initiative) that such area received
under such part for fiscal year 2006.
(vii) MULTIPLE POLITICAL JURISDICTIONS.—With
respect to living non-AIDS cases of HIV, if an eligible
area is not entirely within one political jurisdiction
and as a result is subject to more than one reporting
system for purposes of this subparagraph:
(I) Names-based reporting under clause (i) applies in a jurisdictional portion of the area, or an
exemption under clause (ii) applies in such portion
(subject to applicable provisions of this subparagraph), according to whether names-based reporting or code-based reporting is used in such portion.
(II) If under subclause (I) both names-based
reporting and code-based reporting apply in the
area, the number of code-based cases shall be reduced under clause (vi).
(viii) LIST OF ELIGIBLE AREAS MEETING STANDARD
REGARDING DECEMBER 31, 2005.—
(I) IN GENERAL.—If an eligible area or portion
thereof is in a State specified in subclause (II), the
eligible area or portion shall be considered to meet
the standard described in clause (ii)(I). No other
eligible area or portion thereof may be considered
to meet such standard.
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(II) RELEVANT STATES.—For purposes of subclause (I), the States specified in this subclause
are the following: Alaska, Alabama, Arkansas, Arizona, Colorado, Florida, Indiana, Iowa, Idaho,
Kansas, Louisiana, Michigan, Minnesota, Missouri, Mississippi, North Carolina, North Dakota,
Nebraska, New Jersey, New Mexico, New York,
Nevada, Ohio, Oklahoma, South Carolina, South
Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, West Virginia, Wyoming, Guam, and the
Virgin Islands.
(ix) RULES OF CONSTRUCTION REGARDING ACCEPTANCE OF REPORTS.—
(I) CASES OF AIDS.—With respect to an eligible
area that is subject to the requirement under
clause (i) and is not in compliance with the requirement for names-based reporting of living
non-AIDS cases of HIV, the Secretary shall, notwithstanding such noncompliance, accept reports
of living cases of AIDS that are in accordance with
such clause.
(II) APPLICABILITY OF EXEMPTION REQUIREMENTS.—The provisions of clauses (ii) through
(viii) may not be construed as having any legal effect for fiscal year 2013 or any subsequent fiscal
year, and accordingly, the status of a State for
purposes of such clauses may not be considered
after fiscal year 2012.
(x) PROGRAM FOR DETECTING INACCURATE OR
FRAUDULENT COUNTING.—The Secretary shall carry
out a program to monitor the reporting of namesbased cases for purposes of this subparagraph and to
detect instances of inaccurate reporting, including
fraudulent reporting.
(xi) FUTURE FISCAL YEARS.—For fiscal years beginning with fiscal year 2013, determinations under this
paragraph shall be based only on living names-based
cases of HIV/AIDS with respect to the area involved.
(D) CODE-BASED AREAS; LIMITATION ON INCREASE IN
GRANT .—
(i) IN GENERAL.—For each of the fiscal years 2007
through 2012, if code-based reporting (within the
meaning of subparagraph (C)(vi)) applies in an eligible
area or any portion thereof as of the beginning of the
fiscal year involved, then notwithstanding any other
provision of this paragraph, the amount of the grant
pursuant to this paragraph for such area for such fiscal year may not—
(I) for fiscal year 2007, exceed by more than
5 percent the amount of the grant for the area
that would have been made pursuant to this paragraph and paragraph (4) for fiscal year 2006 (as
such paragraphs were in effect for such fiscal
year) if paragraph (2) (as so in effect) had been
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applied by substituting ‘‘662⁄3 percent’’ for ‘‘50 percent’’; and
(II) for each of the fiscal years 2008 through
2012, exceed by more than 5 percent the amount
of the grant pursuant to this paragraph and paragraph (4) for the area for the preceding fiscal year.
(ii) USE OF AMOUNTS INVOLVED.—For each of the
fiscal years 2007 through 2012, amounts available as
a result of the limitation under clause (i) shall be
made available by the Secretary as additional
amounts for grants pursuant to subsection (b) for the
fiscal year involved, subject to paragraph (4) and section 2610(d)(2).
(4) INCREASES IN GRANT.—
(A) IN GENERAL.—For each eligible area that received
a grant pursuant to this subsection for fiscal year 2009,
the Secretary shall, for each of the fiscal years 2010
through 2013, increase the amount of the grant made pursuant to paragraph (3) for the area to ensure that the
amount of the grant for the fiscal year involved is not less
than the following amount, as applicable to such fiscal
year:
(i) For fiscal year 2010, an amount equal to 95
percent of the sum of the amount of the grant made
pursuant to paragraph (3) and this paragraph for fiscal year 2009.
(ii) For each of the fiscal years 2011 and 2012, an
amount equal to 100 percent of the amount of the
grant made pursuant to paragraph (3) and this paragraph for fiscal year 2010.
(iii) For fiscal year 2013, an amount equal to 92.5
percent of the amount of the grant made pursuant to
paragraph (3) and this paragraph for fiscal year 2012.
(B) SOURCE OF FUNDS FOR INCREASE.—
(i) IN GENERAL.—From the amounts available for
carrying out the single program referred to in section
2609(d)(2)(C) for a fiscal year (relating to supplemental grants), the Secretary shall make available
such amounts as may be necessary to comply with
subparagraph (A), subject to section 2610(d)(2).
(ii) PRO RATA REDUCTION.—If the amounts referred to in clause (i) for a fiscal year are insufficient
to fully comply with subparagraph (A) for the year, the
Secretary, in order to provide the additional funds necessary for such compliance, shall reduce on a pro rata
basis the amount of each grant pursuant to this subsection for the fiscal year, other than grants for eligible areas for which increases under subparagraph (A)
apply. A reduction under the preceding sentence may
not be made in an amount that would result in the eligible area involved becoming eligible for such an increase.
(C) LIMITATION.—This paragraph may not be construed as having any applicability after fiscal year 2013.
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(b) SUPPLEMENTAL GRANTS.—
(1) IN GENERAL.—Subject to subsection (a)(4)(B)(i) and section 2610(d), the Secretary shall disburse the remainder of
amounts not disbursed under section 2603(a)(2) for such fiscal
year for the purpose of making grants under section 2601(a) to
eligible areas whose application under section 2605(b)—
(A) contains a report concerning the dissemination of
emergency relief funds under subsection (a) and the plan
for utilization of such funds;
(B) demonstrates the need in such area, on an objective and quantified basis, for supplemental financial assistance to combat the HIV epidemic;
(C) demonstrates the existing commitment of local resources of the area, both financial and in-kind, to combating the HIV epidemic;
(D) demonstrates the ability of the area to utilize such
supplemental financial resources in a manner that is immediately responsive and cost effective;
(E) demonstrates that resources will be allocated in
accordance with the local demographic incidence of AIDS
including appropriate allocations for services for infants,
children, youth, women, and families with HIV/AIDS;
(F) demonstrates the inclusiveness of affected communities and individuals with HIV/AIDS;
(G) demonstrates the manner in which the proposed
services are consistent with the local needs assessment
and the statewide coordinated statement of need;
(H) demonstrates the ability of the applicant to expend
funds efficiently by not having had, for the most recent
grant year under subsection (a) for which data is available,
more than 5 percent of grant funds under such subsection
canceled, offset under subsection (c)(4), or covered by any
waivers under subsection (c)(3); and
(I) demonstrates success in identifying individuals
with HIV/AIDS as described in clauses (i) through (iii) of
paragraph (2)(A).
(2) AMOUNT OF GRANT.—
(A) IN GENERAL.—The amount of each grant made for
purposes of this subsection shall be determined by the Secretary based on a weighting of factors under paragraph (1),
with demonstrated need under subparagraph (B) of such
paragraph counting one-third, and demonstrated success
in identifying individuals with HIV/AIDS who do not know
their HIV status and making them aware of such status
counting one-third. In making such determination, the
Secretary shall consider—
(i) the number of individuals who have been tested for HIV/AIDS;
(ii) of those individuals described in clause (i), the
number of individuals who tested for HIV/AIDS who
are made aware of their status, including the number
who test positive; and
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(iii) of those individuals described in clause (ii),
the number who have been referred to appropriate
treatment and care.
(B) DEMONSTRATED NEED.—The factors considered by
the Secretary in determining whether an eligible area has
a demonstrated need for purposes of paragraph (1)(B) may
include any or all of the following:
(i) The unmet need for such services, as determined under section 2602(b)(4) or other community
input process as defined under section 2609(d)(1)(A).
(ii) An increasing need for HIV/AIDS-related services, including relative rates of increase in the number
of cases of HIV/AIDS.
(iii) The relative rates of increase in the number
of cases of HIV/AIDS within new or emerging subpopulations.
(iv) The current prevalence of HIV/AIDS.
(v) Relevant factors related to the cost and complexity of delivering health care to individuals with
HIV/AIDS in the eligible area.
(vi) The impact of co-morbid factors, including cooccurring conditions, determined relevant by the Secretary.
(vii) The prevalence of homelessness.
(viii) The prevalence of individuals described
under section 2602(b)(2)(M).
(ix) The relevant factors that limit access to
health care, including geographic variation, adequacy
of health insurance coverage, and language barriers.
(x) The impact of a decline in the amount received
pursuant to subsection (a) on services available to all
individuals with HIV/AIDS identified and eligible
under this title.
(C) PRIORITY IN MAKING GRANTS.—The Secretary shall
provide funds under this subsection to an eligible area to
address the decline or disruption of all EMA-provided services related to the decline in the amounts received pursuant to subsection (a) consistent with the grant award for
the eligible area for fiscal year 2006, to the extent that the
factor under subparagraph (B)(x) (relating to a decline in
funding) applies to the eligible area.
(D) INCREASED ADJUSTMENT FOR CERTAIN AREAS PREVIOUSLY USING CODE-BASED REPORTING.—For purposes of
this subsection for each of fiscal years 2010 through 2012,
the Secretary shall deem the applicable number of living
cases of HIV/AIDS in an area that were reported to and
confirmed by the Centers for Disease Control and Prevention to be 3 percent higher than the actual number if the
conditions described in items (aa) through (cc) of subsection (a)(3)(C)(vi)(III) are all satisfied.
(3) REMAINDER OF AMOUNTS.—In determining the amount
of funds to be obligated under paragraph (1), the Secretary
shall include amounts that are not paid to the eligible areas
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under expedited procedures under section 2603(a)(2) as a result of—
(A) the failure of any eligible area to submit an application under section 2605(c); or
(B) any eligible area informing the Secretary that such
eligible area does not intend to expend the full amount of
its grant under such section.
(4) FAILURE TO SUBMIT.—
(A) IN GENERAL.—The failure of an eligible area to
submit an application for an expedited grant under section
2603(a)(2) shall not result in such area being ineligible for
a grant under this subsection.
(B) APPLICATION.—The application of an eligible area
submitted under section 2605(b) shall contain the assurances required under subsection (a) of such section if such
eligible area fails to submit an application for an expedited
grant under section 2603(a)(2).
(c) TIMEFRAME FOR OBLIGATION AND EXPENDITURE OF GRANT
FUNDS.—
(1) OBLIGATION BY END OF GRANT YEAR.—Effective for fiscal year 2007 and subsequent fiscal years, funds from a grant
award made pursuant to subsection (a) or (b) for a fiscal year
are available for obligation by the eligible area involved
through the end of the one-year period beginning on the date
in such fiscal year on which funds from the award first become
available to the area (referred to in this subsection as the
‘‘grant year for the award’’), except as provided in paragraph
(3)(A).
(2) SUPPLEMENTAL GRANTS; CANCELLATION OF UNOBLIGATED BALANCE OF GRANT AWARD.—Effective for fiscal year
2007 and subsequent fiscal years, if a grant award made pursuant to subsection (b) for an eligible area for a fiscal year has
an unobligated balance as of the end of the grant year for the
award—
(A) the Secretary shall cancel that unobligated balance
of the award, and shall require the eligible area to return
any amounts from such balance that have been disbursed
to the area; and
(B) the funds involved shall be made available by the
Secretary as additional amounts for grants pursuant to
subsection (b) for the first fiscal year beginning after the
fiscal year in which the Secretary obtains the information
necessary for determining that the balance is required
under subparagraph (A) to be canceled, except that the
availability of the funds for such grants is subject to subsection (a)(4) and section 2610(d)(2) as applied for such
year.
(3) FORMULA GRANTS; CANCELLATION OF UNOBLIGATED BALANCE OF GRANT AWARD; WAIVER PERMITTING CARRYOVER.—
(A) IN GENERAL.—Effective for fiscal year 2007 and
subsequent fiscal years, if a grant award made pursuant
to subsection (a) for an eligible area for a fiscal year has
an unobligated balance as of the end of the grant year for
the award, the Secretary shall cancel that unobligated balMarch 13, 2013

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ance of the award, and shall require the eligible area to return any amounts from such balance that have been disbursed to the area, unless—
(i) before the end of the grant year, the chief elected official of the area submits to the Secretary a written application for a waiver of the cancellation, which
application includes a description of the purposes for
which the area intends to expend the funds involved;
and
(ii) the Secretary approves the waiver.
(B) EXPENDITURE BY END OF CARRYOVER YEAR.—With
respect to a waiver under subparagraph (A) that is approved for a balance that is unobligated as of the end of
a grant year for an award:
(i) The unobligated funds are available for expenditure by the eligible area involved for the one-year period beginning upon the expiration of the grant year
(referred to in this subsection as the ‘‘carryover year’’).
(ii) If the funds are not expended by the end of the
carryover year, the Secretary shall cancel that unexpended balance of the award, and shall require the eligible area to return any amounts from such balance
that have been disbursed to the area.
(C) USE OF CANCELLED BALANCES.—In the case of any
balance of a grant award that is cancelled under subparagraph (A) or (B)(ii), the grant funds involved shall be made
available by the Secretary as additional amounts for
grants pursuant to subsection (b) for the first fiscal year
beginning after the fiscal year in which the Secretary obtains the information necessary for determining that the
balance is required under such subparagraph to be canceled, except that the availability of the funds for such
grants is subject to subsection (a)(4) and section 2610(d)(2)
as applied for such year.
(D) CORRESPONDING REDUCTION IN FUTURE GRANT.—
(i) IN GENERAL.—In the case of an eligible area for
which a balance from a grant award under subsection
(a) is unobligated as of the end of the grant year for
the award—
(I) the Secretary shall reduce, by the same
amount as such unobligated balance (less any
amount of such balance that is the subject of a
waiver of cancellation under subparagraph (A)),
the amount of the grant under such subsection for
the first fiscal year beginning after the fiscal year
in which the Secretary obtains the information
necessary for determining that such balance was
unobligated as of the end of the grant year (which
requirement for a reduction applies without regard to whether a waiver under subparagraph (A)
has been approved with respect to such balance);
and
(II) the grant funds involved in such reduction
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tional funds for grants pursuant to subsection (b)
for such first fiscal year, subject to subsection
(a)(4) and section 2610(d)(2);
except that this clause does not apply to the eligible
area if the amount of the unobligated balance was 5
percent or less.
(ii) RELATION TO INCREASES IN GRANT.—A reduction under clause (i) for an eligible area for a fiscal
year may not be taken into account in applying subsection (a)(4) with respect to the area for the subsequent fiscal year.
(4) AUTHORITY REGARDING ADMINISTRATION OF PROVISIONS.—In administering paragraphs (2) and (3) with respect
to the unobligated balance of an eligible area, the Secretary
may elect to reduce the amount of future grants to the area
under subsection (a) or (b), as applicable, by the amount of any
such unobligated balance in lieu of cancelling such amount as
provided for in paragraph (2) or (3)(A). In such case, the Secretary may permit the area to use such unobligated balance for
purposes of any such future grant. An amount equal to such
reduction shall be available for use as additional amounts for
grants pursuant to subsection (b), subject to subsection (a)(4)
and section 2610(d)(2). Nothing in this paragraph shall be construed to affect the authority of the Secretary under paragraphs (2) and (3), including the authority to grant waivers
under paragraph (3)(A). The reduction in future grants authorized under this paragraph shall be notwithstanding the penalty required under paragraph (3)(D) with respect to unobligated funds.
(d) COMPLIANCE WITH PRIORITIES OF HIV PLANNING COUNCIL.—Notwithstanding any other provision of this subpart, the Secretary, in carrying out section 2601(a), may not make any grant
under subsection (a) or (b) to an eligible area unless the application
submitted by such area under section 2605 for the grant involved
demonstrates that the grants made under subsections (a) and (b)
to the area for the preceding fiscal year (if any) were expended in
accordance with the priorities applicable to such year that were established, pursuant to section 2602(b)(4)(C), by the planning council serving the area.
(e) REPORT ON THE AWARDING OF SUPPLEMENTAL FUNDS.—Not
later than 45 days after the awarding of supplemental funds under
this section, the Secretary shall submit to Congress a report concerning such funds. Such report shall include information detailing—
(1) the total amount of supplemental funds available under
this section for the year involved;
(2) the amount of supplemental funds used in accordance
with the hold harmless provisions of subsection (a)(4);
(3) the amount of supplemental funds disbursed pursuant
to subsection (b)(2)(C);
(4) the disbursement of the remainder of the supplemental
funds after taking into account the uses described in paragraphs (2) and (3); and
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(5) the rationale used for the amount of funds disbursed as
described under paragraphs (2), (3), and (4).
SEC. 2604. ø300ff–14¿ USE OF AMOUNTS.
(a) REQUIREMENTS.—The Secretary

may not make a grant
under section 2601(a) to the chief elected official of an eligible area
unless such political subdivision agrees that—
(1) subject to paragraph (2), the allocation of funds and
services within the eligible area will be made in accordance
with the priorities established, pursuant to section
2602(b)(4)(C), by the HIV health services planning council that
serves such eligible area;
(2) funds provided under section 2601 will be expended
only for—
(A) core medical services described in subsection (c);
(B) support services described in subsection (d); and
(C) administrative expenses described in subsection
(h); and
(3) the use of such funds will comply with the requirements of this section.
(b) DIRECT FINANCIAL ASSISTANCE TO APPROPRIATE ENTITIES.—
(1) IN GENERAL.—The chief elected official of an eligible
area shall use amounts from a grant under section 2601 to provide direct financial assistance to entities described in paragraph (2) for the purpose of providing core medical services
and support services.
(2) APPROPRIATE ENTITIES.—Direct financial assistance
may be provided under paragraph (1) to public or nonprofit private entities, or private for-profit entities if such entities are
the only available provider of quality HIV care in the area.
(c) REQUIRED FUNDING FOR CORE MEDICAL SERVICES.—
(1) IN GENERAL.—With respect to a grant under section
2601 for an eligible area for a grant year, the chief elected official of the area shall, of the portion of the grant remaining
after reserving amounts for purposes of paragraphs (1) and
(5)(B)(i) of subsection (h), use not less than 75 percent to provide core medical services that are needed in the eligible area
for individuals with HIV/AIDS who are identified and eligible
under this title (including services regarding the co-occurring
conditions of the individuals).
(2) WAIVER.—
(A) IN GENERAL.—The Secretary shall waive the application of paragraph (1) with respect to a chief elected official for a grant year if the Secretary determines that, within the eligible area involved—
(i) there are no waiting lists for AIDS Drug Assistance Program services under section 2616; and
(ii) core medical services are available to all individuals with HIV/AIDS identified and eligible under
this title.
(B) NOTIFICATION OF WAIVER STATUS.—When informing the chief elected official of an eligible area that a grant
under section 2601 is being made for the area for a grant
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year, the Secretary shall inform the official whether a
waiver under subparagraph (A) is in effect for such year.
(3) CORE MEDICAL SERVICES.—For purposes of this subsection, the term ‘‘core medical services’’, with respect to an individual with HIV/AIDS (including the co-occurring conditions
of the individual), means the following services:
(A) Outpatient and ambulatory health services.
(B) AIDS Drug Assistance Program treatments in accordance with section 2616.
(C) AIDS pharmaceutical assistance.
(D) Oral health care.
(E) Early intervention services described in subsection
(e).
(F) Health insurance premium and cost sharing assistance for low-income individuals in accordance with section
2615.
(G) Home health care.
(H) Medical nutrition therapy.
(I) Hospice services.
(J) Home and community-based health services as defined under section 2614(c).
(K) Mental health services.
(L) Substance abuse outpatient care.
(M) Medical case management, including treatment
adherence services.
(d) SUPPORT SERVICES.—
(1) IN GENERAL.—For purposes of this section, the term
‘‘support services’’ means services, subject to the approval of
the Secretary, that are needed for individuals with HIV/AIDS
to achieve their medical outcomes (such as respite care for persons caring for individuals with HIV/AIDS, outreach services,
medical transportation, linguistic services, and referrals for
health care and support services).
(2) MEDICAL OUTCOMES.—In this subsection, the term
‘‘medical outcomes’’ means those outcomes affecting the HIVrelated clinical status of an individual with HIV/AIDS.
(e) EARLY INTERVENTION SERVICES.—
(1) IN GENERAL.—For purposes of this section, the term
‘‘early intervention services’’ means HIV/AIDS early intervention services described in section 2651(e), with follow-up referral provided for the purpose of facilitating the access of individuals receiving the services to HIV-related health services. The
entities through which such services may be provided under
the grant include public health departments, emergency rooms,
substance abuse and mental health treatment programs, detoxification centers, detention facilities, clinics regarding sexually transmitted diseases, homeless shelters, HIV/AIDS counseling and testing sites, health care points of entry specified by
eligible areas, federally qualified health centers, and entities
described in section 2652(a) that constitute a point of access to
services by maintaining referral relationships.
(2) CONDITIONS.—With respect to an entity that proposes
to provide early intervention services under paragraph (1),
such paragraph shall apply only if the entity demonstrates to
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the satisfaction of the chief elected official for the eligible area
involved that—
(A) Federal, State, or local funds are otherwise inadequate for the early intervention services the entity proposes to provide; and
(B) the entity will expend funds pursuant to such
paragraph to supplement and not supplant other funds
available to the entity for the provision of early intervention services for the fiscal year involved.
(f) PRIORITY FOR WOMEN, INFANTS, CHILDREN, AND YOUTH.—
(1) IN GENERAL.—For the purpose of providing health and
support services to infants, children, youth, and women with
HIV/AIDS, including treatment measures to prevent the
perinatal transmission of HIV, the chief elected official of an
eligible area, in accordance with the established priorities of
the planning council, shall for each of such populations in the
eligible area use, from the grants made for the area under section 2601(a) for a fiscal year, not less than the percentage constituted by the ratio of the population involved (infants, children, youth, or women in such area) with HIV/AIDS to the
general population in such area of individuals with HIV/AIDS.
(2) WAIVER.—With respect to the population involved, the
Secretary may provide to the chief elected official of an eligible
area a waiver of the requirement of paragraph (1) if such official demonstrates to the satisfaction of the Secretary that the
population is receiving HIV-related health services through the
State medicaid program under title XIX of the Social Security
Act, the State children’s health insurance program under title
XXI of such Act, or other Federal or State programs.
(g) REQUIREMENT OF STATUS AS MEDICAID PROVIDER.—
(1) PROVISION OF SERVICE.—Subject to paragraph (2), the
Secretary may not make a grant under section 2601(a) for the
provision of services under this section in a State unless, in the
case of any such service that is available pursuant to the State
plan approved under title XIX of the Social Security Act for the
State—
(A) the political subdivision involved will provide the
service directly, and the political subdivision has entered
into a participation agreement under the State plan and is
qualified to receive payments under such plan; or
(B) the political subdivision will enter into an agreement with a public or nonprofit private entity under which
the entity will provide the service, and the entity has entered into such a participation agreement and is qualified
to receive such payments.
(2) WAIVER.—
(A) IN GENERAL.—In the case of an entity making an
agreement pursuant to paragraph (1)(B) regarding the provision of services, the requirement established in such
paragraph shall be waived by the HIV health services
planning council for the eligible area if the entity does not,
in providing health care services, impose a charge or accept reimbursement available from any third-party payor,
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including reimbursement under any insurance policy or
under any Federal or State health benefits program.
(B) DETERMINATION.—A determination by the HIV
health services planning council of whether an entity referred to in subparagraph (A) meets the criteria for a waiver under such subparagraph shall be made without regard
to whether the entity accepts voluntary donations for the
purpose of providing services to the public.
(h) ADMINISTRATION.—
(1) LIMITATION.—The chief elected official of an eligible
area shall not use in excess of 10 percent of amounts received
under a grant under this subpart for administrative expenses.
(2) ALLOCATIONS BY CHIEF ELECTED OFFICIAL.—In the case
of entities and subcontractors to which the chief elected official
of an eligible area allocates amounts received by the official
under a grant under this subpart, the official shall ensure that,
of the aggregate amount so allocated, the total of the expenditures by such entities for administrative expenses does not exceed 10 percent (without regard to whether particular entities
expend more than 10 percent for such expenses).
(3) ADMINISTRATIVE ACTIVITIES.—For purposes of paragraph (1), amounts may be used for administrative activities
that include—
(A) routine grant administration and monitoring activities, including the development of applications for part
A funds, the receipt and disbursal of program funds, the
development and establishment of reimbursement and accounting systems, the development of a clinical quality
management program as described in paragraph (5), the
preparation of routine programmatic and financial reports,
and compliance with grant conditions and audit requirements; and
(B) all activities associated with the grantee’s contract
award procedures, including the activities carried out by
the HIV health services planning council as established
under section 2602(b), the development of requests for proposals, contract proposal review activities, negotiation and
awarding of contracts, monitoring of contracts through
telephone consultation, written documentation or onsite
visits, reporting on contracts, and funding reallocation activities.
(4) SUBCONTRACTOR ADMINISTRATIVE ACTIVITIES.—For the
purposes of this subsection, subcontractor administrative activities include—
(A) usual and recognized overhead activities, including
established indirect rates for agencies;
(B) management oversight of specific programs funded
under this title; and
(C) other types of program support such as quality assurance, quality control, and related activities.
(5) CLINICAL QUALITY MANAGEMENT.—
(A) REQUIREMENT.—The chief elected official of an eligible area that receives a grant under this subpart shall
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ment program to assess the extent to which HIV health
services provided to patients under the grant are consistent with the most recent Public Health Service guidelines for the treatment of HIV/AIDS and related opportunistic infection, and as applicable, to develop strategies for
ensuring that such services are consistent with the guidelines for improvement in the access to and quality of HIV
health services.
(B) USE OF FUNDS.—
(i) IN GENERAL.—From amounts received under a
grant awarded under this subpart for a fiscal year, the
chief elected official of an eligible area may use for activities associated with the clinical quality management program required in subparagraph (A) not to exceed the lesser of—
(I) 5 percent of amounts received under the
grant; or
(II) $3,000,000.
(ii) RELATION TO LIMITATION ON ADMINISTRATIVE
EXPENSES.—The costs of a clinical quality management program under subparagraph (A) may not be
considered administrative expenses for purposes of the
limitation established in paragraph (1).
(i) CONSTRUCTION.—A chief elected official may not use
amounts received under a grant awarded under this subpart to
purchase or improve land, or to purchase, construct, or permanently improve (other than minor remodeling) any building or
other facility, or to make cash payments to intended recipients of
services.
SEC. 2605. ø300ff–15¿ APPLICATION.
(a) IN GENERAL.—To be eligible

to receive a grant under section 2601, an eligible area shall prepare and submit to the Secretary an application, in accordance with subsection (c) regarding
a single application and grant award, at such time, in such form,
and containing such information as the Secretary shall require, including assurances adequate to ensure—
(1)(A) that funds received under a grant awarded under
this subpart will be utilized to supplement not supplant State
funds made available in the year for which the grant is awarded to provide HIV-related services as described in section
2604(b)(1);
(B) that the political subdivisions within the eligible area
will maintain the level of expenditures by such political subdivisions for HIV-related services as described in section
2604(b)(1) at a level that is equal to the level of such expenditures by such political subdivisions for the preceding fiscal
year; and
(C) that political subdivisions within the eligible area will
not use funds received under a grant awarded under this subpart in maintaining the level of expenditures for HIV-related
services as required in subparagraph (B);
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ments pursuant to section 2602, and has developed or will develop the comprehensive plan in accordance with section
2602(b)(3)(B);
(3) that entities within the eligible area that receive funds
under a grant under this subpart will maintain appropriate relationships with entities in the eligible area served that constitute key points of access to the health care system for individuals with HIV/AIDS (including emergency rooms, substance
abuse treatment programs, detoxification centers, adult and juvenile detention facilities, sexually transmitted disease clinics,
HIV counseling and testing sites, mental health programs, and
homeless shelters), and other entities under section 2604(b)(3)
and 2652(a), for the purpose of facilitating early intervention
for individuals newly diagnosed with HIV/AIDS and individuals knowledgeable of their HIV status but not in care;
(4) that the chief elected official of the eligible area will
satisfy all requirements under section 2604(c);
(5) that entities within the eligible area that will receive
funds under a grant provided under section 2601(a) shall participate in an established HIV community-based continuum of
care if such continuum exists within the eligible area;
(6) that funds received under a grant awarded under this
subpart will not be utilized to make payments for any item or
service to the extent that payment has been made, or can reasonably be expected to be made, with respect to that item or
service—
(A) under any State compensation program, under an
insurance policy, or under any Federal or State health
benefits program (except for a program administered by or
providing the services of the Indian Health Service); or
(B) by an entity that provides health services on a prepaid basis;
(7) to the maximum extent practicable, that—
(A) HIV health care and support services provided
with assistance made available under this subpart will be
provided without regard—
(i) to the ability of the individual to pay for such
services; and
(ii) to the current or past health condition of the
individual to be served;
(B) such services will be provided in a setting that is
accessible to low-income individuals with HIV-disease; and
(C) a program of outreach will be provided to low-income individuals with HIV-disease to inform such individuals of such services;
(8) that the applicant has participated, or will agree to
participate, in the statewide coordinated statement of need
process where it has been initiated by the State public health
agency responsible for administering grants under part B, and
ensure that the services provided under the comprehensive
plan are consistent with the statewide coordinated statement
of need;
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(9) that the eligible area has procedures in place to ensure
that services provided with funds received under this subpart
meet the criteria specified in section 2604(b)(1); and
(10) that the chief elected official will submit to the lead
State agency under section 2617(b)(4), audits, consistent with
Office of Management and Budget circular A133, regarding
funds expended in accordance with this subpart every 2 years
and shall include necessary client-based data to compile unmet
need calculations and Statewide coordinated statements of
need process.
(b) APPLICATION.—An eligible area that desires to receive a
grant under section 2603(b) shall prepare and submit to the Secretary an application, in accordance with subsection (c) regarding
a single application and grant award, at such time, in such form,
and containing such information as the Secretary shall require, including the information required under such subsection and information concerning—
(1) the number of individuals to be served within the eligible area with assistance provided under the grant, including
the identification of individuals with HIV/AIDS as described in
clauses (i) through (iii) of section 2603(b)(2)(A);
(2) demographic data on the population of such individuals;
(3) the average cost of providing each category of HIV-related health services and the extent to which such cost is paid
by third-party payors;
(4) the aggregate amounts expended for each such category
of services;
(5) the manner in which the expected expenditures are related to the planning process for States that receive funding
under part B (including the planning process described in section 2617(b)); and
(6) the expected expenditures and how those expenditures
will improve overall client outcomes, as described under the
State plan under section 2617(b), and through additional outcomes measures as identified by the HIV health services planning council under section 2602(b).
(c) SINGLE APPLICATION AND GRANT AWARD.—
(1) APPLICATION.—The Secretary may phase in the use of
a single application that meets the requirements of subsections
(a) and (b) of section 2603 with respect to an eligible area that
desires to receive grants under section 2603 for a fiscal year.
(2) GRANT AWARD.—The Secretary may phase in the
awarding of a single grant to an eligible area that submits an
approved application under paragraph (1) for a fiscal year.
(d) DATE CERTAIN FOR SUBMISSION.—
(1) REQUIREMENT.—Except as provided in paragraph (2), to
be eligible to receive a grant under section 2601(a) for a fiscal
year, an application under subsection (a) shall be submitted
not later than 45 days after the date on which appropriations
are made under section 2677 for the fiscal year.
(2) EXCEPTION.—The Secretary may extend the time for
the submission of an application under paragraph (1) for a period of not to exceed 60 days if the Secretary determines that
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the eligible area has made a good faith effort to comply with
the requirement of such paragraph but has otherwise been unable to submit its application.
(3) DISTRIBUTION BY SECRETARY.—Not later than 45 days
after receiving an application that meets the requirements of
subsection (a) from an eligible area, the Secretary shall distribute to such eligible area the amounts awarded under the
grant for which the application was submitted.
(4) REDISTRIBUTION.—Any amounts appropriated in any
fiscal year under this subpart and not obligated to an eligible
entity as a result of the failure of such entity to submit an application shall be redistributed by the Secretary to other eligible entities in proportion to the original grants made to such
eligible areas under section 2601(a).
(e) REQUIREMENTS REGARDING IMPOSITION OF CHARGES FOR
SERVICES.—
(1) IN GENERAL.—The Secretary may not make a grant
under section 2601 to an eligible area unless the eligible area
provides assurances that in the provision of services with assistance provided under the grant—
(A) in the case of individuals with an income less than
or equal to 100 percent of the official poverty line, the provider will not impose charges on any such individual for
the provision of services under the grant;
(B) in the case of individuals with an income greater
than 100 percent of the official poverty line, the provider—
(i) will impose a charge on each such individual
for the provision of such services; and
(ii) will impose the charge according to a schedule
of charges that is made available to the public;
(C) in the case of individuals with an income greater
than 100 percent of the official poverty line and not exceeding 200 percent of such poverty line, the provider will
not, for any calendar year, impose charges in an amount
exceeding 5 percent of the annual gross income of the individual involved;
(D) in the case of individuals with an income greater
than 200 percent of the official poverty line and not exceeding 300 percent of such poverty line, the provider will
not, for any calendar year, impose charges in an amount
exceeding 7 percent of the annual gross income of the individual involved; and
(E) in the case of individuals with an income greater
than 300 percent of the official poverty line, the provider
will not, for any calendar year, impose charges in an
amount exceeding 10 percent of the annual gross income
of the individual involved.
(2) ASSESSMENT OF CHARGE.—With respect to compliance
with the assurance made under paragraph (1), a grantee or entity receiving assistance under this subpart may, in the case of
individuals subject to a charge for purposes of such paragraph—
(A) assess the amount of the charge in the discretion
of the grantee, including imposing only a nominal charge
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for the provision of services, subject to the provisions of
such paragraph regarding public schedules and regarding
limitations on the maximum amount of charges; and
(B) take into consideration the medical expenses of individuals in assessing the amount of the charge, subject to
such provisions.
(3) APPLICABILITY OF LIMITATION ON AMOUNT OF CHARGE.—
The Secretary may not make a grant under section 2601 to an
eligible area unless the eligible area agrees that the limitations
established in subparagraphs (C), (D) and (E) of paragraph (1)
regarding the imposition of charges for services applies to the
annual aggregate of charges imposed for such services, without
regard to whether they are characterized as enrollment fees,
premiums, deductibles, cost sharing, copayments, coinsurance,
or other charges.
(4) WAIVER REGARDING SECONDARY AGREEMENTS.—The requirements established in paragraphs (1) through (3) shall be
waived in accordance with section 2604(d)(2).
SEC. 2606. ø300ff–16¿ TECHNICAL ASSISTANCE.

The Administrator of the Health Resources and Services Administration shall, beginning on the date of enactment of this title,
provide technical assistance, including assistance from other grantees, contractors or subcontractors under this title to assist newly
eligible metropolitan areas in the establishment of HIV health
services planning councils and, to assist entities in complying with
the requirements of this subpart in order to make such entities eligible to receive a grant under this subpart. The Administrator may
make planning grants available to metropolitan areas, in an
amount not to exceed $75,000 for any metropolitan area, projected
to be eligible for funding under section 2601 in the following fiscal
year. Such grant amounts shall be deducted from the first year formula award to eligible areas accepting such grants. Not to exceed
1 percent of the amount appropriated for a fiscal year under section
2677 for grants under part A may be used to carry out this section.
SEC. 2607. ø300ff–17¿ DEFINITIONS.

For purposes of this subpart:
(1) ELIGIBLE AREA.—The term ‘‘eligible area’’ means a metropolitan area meeting the requirements of section 2601 that
are applicable to the area.
(2) METROPOLITAN AREA.—The term ‘‘metropolitan area’’
means an area that is referred to in the HIV/AIDS Surveillance Report of the Centers for Disease Control and Prevention
as a metropolitan area, and that has a population of 50,000 or
more individuals.

Subpart II—Transitional Grants
SEC. 2609. ø300ff–19¿ ESTABLISHMENT OF PROGRAM.
(a) IN GENERAL.—The Secretary, acting through

the Administrator of the Health Resources and Services Administration, shall
make grants for the purpose of providing services described in section 2604 in transitional areas, subject to the same provisions reMarch 13, 2013

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garding the allocation of grant funds as apply under subsection (c)
of such section.
(b) TRANSITIONAL AREAS.—For purposes of this section, the
term ‘‘transitional area’’ means, subject to subsection (c), a metropolitan area for which there has been reported to and confirmed by
the Director of the Centers for Disease Control and Prevention a
cumulative total of at least 1,000, but fewer than 2,000, cases of
AIDS during the most recent period of 5 calendar years for which
such data are available.
(c) CERTAIN ELIGIBILITY RULES.—
(1) FISCAL YEAR 2011.—With respect to grants under subsection (a) for fiscal year 2011, a metropolitan area that received funding under subpart I for fiscal year 2010 but does
not for fiscal year 2011 qualify under such subpart as an eligible area and does not qualify under subsection (b) as a transitional area shall, notwithstanding subsection (b), be considered
a transitional area.
(2) CONTINUED STATUS AS TRANSITIONAL AREA.—
(A) IN GENERAL.—Notwithstanding subsection (b), a
metropolitan area that is a transitional area for a fiscal
year continues, except as provided in subparagraph (B), to
be a transitional area until the metropolitan area fails, for
three consecutive fiscal years—
(i) to qualify under such subsection as a transitional area; and
(ii) subject to subparagraphs (B) and (C), to have
a cumulative total of 1,500 or more living cases of
AIDS (reported to and confirmed by the Director of the
Centers for Disease Control and Prevention) as of December 31 of the most recent calendar year for which
such data is available.
(B) PERMITTING MARGIN OF ERROR APPLICABLE TO CERTAIN METROPOLITAN AREAS.—In applying subparagraph
(A)(ii) for a fiscal year after fiscal year 2008, in the case
of a metropolitan area that has a cumulative total of at
least 1,400 (and fewer than 1,500) living cases of AIDS as
of December 31 of the most recent calendar year for which
such data is available, such area shall be treated as having
met the criteria of such subparagraph if not more than 5
percent of the total from grants awarded to such area
under this part is unobligated as of the end of the most recent fiscal year for which such data is available.
(C) EXCEPTION REGARDING STATUS AS ELIGIBLE AREA.—
Subparagraphs (A) and (B) do not apply for a fiscal year
if the metropolitan area involved qualifies under subpart
I as an eligible area.
(d) APPLICATION OF CERTAIN PROVISIONS OF SUBPART I.—
(1) ADMINISTRATION; PLANNING COUNCIL.—
(A) IN GENERAL.—The provisions of section 2602 apply
with respect to a grant under subsection (a) for a transitional area to the same extent and in the same manner as
such provisions apply with respect to a grant under subpart I for an eligible area, except that, subject to subparagraph (B), the chief elected official of the transitional area
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may elect not to comply with the provisions of section
2602(b) if the official provides documentation to the Secretary that details the process used to obtain community
input (particularly from those with HIV) in the transitional area for formulating the overall plan for priority setting and allocating funds from the grant under subsection
(a).
(B) EXCEPTION.—For each of the fiscal years 2007
through 2013, the exception described in subparagraph (A)
does not apply if the transitional area involved received
funding under subpart I for fiscal year 2006.
(2) TYPE AND DISTRIBUTION OF GRANTS; TIMEFRAME FOR OBLIGATION AND EXPENDITURE OF GRANT FUNDS.—
(A) FORMULA GRANTS; SUPPLEMENTAL GRANTS.—The
provisions of section 2603 apply with respect to grants
under subsection (a) to the same extent and in the same
manner as such provisions apply with respect to grants
under subpart I, subject to subparagraphs (B) and (C).
(B) FORMULA GRANTS; INCREASE IN GRANT.—For purposes of subparagraph (A), section 2603(a)(4) does not
apply.
(C) SUPPLEMENTAL GRANTS; SINGLE PROGRAM WITH
SUBPART I PROGRAM.—With respect to section 2603(b) as
applied for purposes of subparagraph (A):
(i) The Secretary shall combine amounts available
pursuant to such subparagraph with amounts available for carrying out section 2603(b) and shall administer the two programs as a single program.
(ii) In the single program, the Secretary has discretion in allocating amounts between eligible areas
under subpart I and transitional areas under this section, subject to the eligibility criteria that apply under
such section, and subject to section 2603(b)(2)(C) (relating to priority in making grants).
(iii) Pursuant to section 2603(b)(1), amounts for
the single program are subject to use under sections
2603(a)(4) and 2610(d)(1).
(3) APPLICATION; TECHNICAL ASSISTANCE; DEFINITIONS.—
The provisions of sections 2605, 2606, and 2607 apply with respect to grants under subsection (a) to the same extent and in
the same manner as such provisions apply with respect to
grants under subpart I.

Subpart III—General Provisions
SEC. 2610. ø300ff–20¿ AUTHORIZATION OF APPROPRIATIONS.
(a) IN GENERAL.—For the purpose of carrying out

this part,
there are authorized to be appropriated $604,000,000 for fiscal year
2007, $626,300,000 for fiscal year 2008, $649,500,000 for fiscal year
2009, $681,975,000 for fiscal year 2010, $716,074,000 for fiscal year
2011, $751,877,000 for fiscal year 2012, and $789,471,000 for fiscal
year 2013. Amounts appropriated under the preceding sentence for
a fiscal year are available for obligation by the Secretary until the
end of the second succeeding fiscal year.
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(b) RESERVATION OF AMOUNTS.—
(1) FISCAL YEAR 2007.—Of the amount appropriated under
subsection (a) for fiscal year 2007, the Secretary shall reserve—
(A) $458,310,000 for grants under subpart I; and
(B) $145,690,000 for grants under section 2609.
(2) SUBSEQUENT FISCAL YEARS.—Of the amount appropriated under subsection (a) for fiscal year 2008 and each subsequent fiscal year—
(A) the Secretary shall reserve an amount for grants
under subpart I; and
(B) the Secretary shall reserve an amount for grants
under section 2609.
(c) TRANSFER OF CERTAIN AMOUNTS; CHANGE IN STATUS AS ELIGIBLE AREA OR TRANSITIONAL AREA.—Notwithstanding subsection
(b):
(1) If a metropolitan area is an eligible area under subpart
I for a fiscal year, but for a subsequent fiscal year ceases to
be an eligible area by reason of section 2601(b)—
(A)(i) the amount reserved under paragraph (1)(A) or
(2)(A) of subsection (b) of this section for the first such subsequent year of not being an eligible area is deemed to be
reduced by an amount equal to the amount of the grant
made pursuant to section 2603(a) for the metropolitan area
for the preceding fiscal year; and
(ii)(I) if the metropolitan area qualifies for such first
subsequent fiscal year as a transitional area under 2609,
the amount reserved under paragraph (1)(B) or (2)(B) of
subsection (b) for such fiscal year is deemed to be increased by an amount equal to the amount of the reduction
under subparagraph (A) for such year; or
(II) if the metropolitan area does not qualify for such
first subsequent fiscal year as a transitional area under
2609, an amount equal to the amount of such reduction is,
notwithstanding subsection (a), transferred and made
available for grants pursuant to section 2618(a)(1), in addition to amounts available for such grants under section
2623; and
(B) if a transfer under subparagraph (A)(ii)(II) is made
with respect to the metropolitan area for such first subsequent fiscal year, then—
(i) the amount reserved under paragraph (1)(A) or
(2)(A) of subsection (b) of this section for such year is
deemed to be reduced by an additional $500,000; and
(ii) an amount equal to the amount of such additional reduction is, notwithstanding subsection (a),
transferred and made available for grants pursuant to
section 2618(a)(1), in addition to amounts available for
such grants under section 2623.
(2) If a metropolitan area is a transitional area under section 2609 for a fiscal year, but for a subsequent fiscal year
ceases to be a transitional area by reason of section 2609(c)(2)
(and does not qualify for such subsequent fiscal year as an eligible area under subpart I)—
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(A) the amount reserved under subsection (b)(2)(B) of
this section for the first such subsequent fiscal year of not
being a transitional area is deemed to be reduced by an
amount equal to the total of—
(i) the amount of the grant that, pursuant to section 2603(a), was made under section 2609(d)(2)(A) for
the metropolitan area for the preceding fiscal year;
and
(ii) $500,000; and
(B)(i) subject to clause (ii), an amount equal to the
amount of the reduction under subparagraph (A) for such
year is, notwithstanding subsection (a), transferred and
made available for grants pursuant to section 2618(a)(1),
in addition to amounts available for such grants under section 2623; and
(ii) for each of fiscal years 2010 through 2013, notwithstanding subsection (a)—
(I) there shall be transferred to the State containing the metropolitan area, for purposes described
in section 2612(a), an amount (which shall not be
taken into account in applying section 2618(a)(2)(H))
equal to—
(aa) for the first fiscal year of the metropolitan area not being a transitional area, 75 percent
of the amount described in subparagraph (A)(i) for
such area;
(bb) for the second fiscal year of the metropolitan area not being a transitional area, 50 percent of such amount; and
(cc) for the third fiscal year of the metropolitan area not being a transitional area, 25 percent
of such amount; and
(II) there shall be transferred and made available
for grants pursuant to section 2618(a)(1) for the fiscal
year, in addition to amounts available for such grants
under section 2623, an amount equal to the total
amount of the reduction for such fiscal year under
subparagraph (A), less the amount transferred for
such fiscal year under subclause (I).
(3) If a metropolitan area is a transitional area under section 2609 for a fiscal year, but for a subsequent fiscal year
qualifies as an eligible area under subpart I—
(A) the amount reserved under subsection (b)(2)(B) of
this section for the first such subsequent fiscal year of becoming an eligible area is deemed to be reduced by an
amount equal to the amount of the grant that, pursuant
to section 2603(a), was made under section 2609(d)(2)(A)
for the metropolitan area for the preceding fiscal year; and
(B) the amount reserved under subsection (b)(2)(A) for
such fiscal year is deemed to be increased by an amount
equal to the amount of the reduction under subparagraph
(A) for such year.
(d) CERTAIN TRANSFERS; ALLOCATIONS BETWEEN PROGRAMS
UNDER SUBPART I.—With respect to paragraphs (1)(B)(i) and
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(2)(A)(ii) of subsection (c), the Secretary shall administer any reductions under such paragraphs for a fiscal year in accordance with
the following:
(1) The reductions shall be made from amounts available
for the single program referred to in section 2609(d)(2)(C) (relating to supplemental grants).
(2) The reductions shall be made before the amounts referred to in paragraph (1) are used for purposes of section
2603(a)(4).
(3) If the amounts referred to in paragraph (1) are not sufficient for making all the reductions, the reductions shall be reduced until the total amount of the reductions equals the total
of the amounts referred to in such paragraph.
(e) RULES OF CONSTRUCTION REGARDING FIRST SUBSEQUENT
FISCAL YEAR.—Paragraphs (1) and (2) of subsection (c) apply with
respect to each series of fiscal years during which a metropolitan
area is an eligible area under subpart I or a transitional area
under section 2609 for a fiscal year and then for a subsequent fiscal year ceases to be such an area by reason of section 2601(b) or
2609(c)(2), respectively, rather than applying to a single such series. Paragraph (3) of subsection (c) applies with respect to each series of fiscal years during which a metropolitan area is a transitional area under section 2609 for a fiscal year and then for a subsequent fiscal year becomes an eligible area under subpart I, rather
than applying to a single such series.
PART B—CARE GRANT PROGRAM 1,

2

Subpart I—General Grant Provisions
SEC. 2611. ø300ff–21¿ GRANTS.

The Secretary shall, subject to the availability of appropriations, make grants to States to enable such States to improve the
quality, availability and organization of health care and support
services for individuals and families with HIV/AIDS. The authority
of the Secretary to provide grants under part B is subject to section
2626(e)(2) (relating to the decrease in perinatal transmission of
HIV/AIDS).
SEC. 2612. ø300ff–22¿ GENERAL USE OF GRANTS.
(a) IN GENERAL.—A State may use amounts

provided under
grants made under section 2611 for—
(1) core medical services described in subsection (b);
(2) support services described in subsection (c); and
(3) administrative expenses described in section 2618(b)(3).
(b) REQUIRED FUNDING FOR CORE MEDICAL SERVICES.—
(1) IN GENERAL.—With respect to a grant under section
2611 for a State for a grant year, the State shall, of the portion
of the grant remaining after reserving amounts for purposes of
subparagraphs (A) and (E)(ii)(I) of section 2618(b)(3), use not
less than 75 percent to provide core medical services that are
1 Section 8(a) of Public Law 104–146 (110 Stat. 1372) establishes a condition for the receipt
of grants under part B. The condition relates to notification of spouses of HIV-infected patients.
2 See footnote at the beginning of part A.

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needed in the State for individuals with HIV/AIDS who are
identified and eligible under this title (including services regarding the co-occurring conditions of the individuals).
(2) WAIVER.—
(A) IN GENERAL.—The Secretary shall waive the application of paragraph (1) with respect to a State for a grant
year if the Secretary determines that, within the State—
(i) there are no waiting lists for AIDS Drug Assistance Program services under section 2616; and
(ii) core medical services are available to all individuals with HIV/AIDS identified and eligible under
this title.
(B) NOTIFICATION OF WAIVER STATUS.—When informing a State that a grant under section 2611 is being made
to the State for a fiscal year, the Secretary shall inform
the State whether a waiver under subparagraph (A) is in
effect for the fiscal year.
(3) CORE MEDICAL SERVICES.—For purposes of this subsection, the term ‘‘core medical services’’, with respect to an individual infected with HIV/AIDS (including the co-occurring
conditions of the individual) means the following services:
(A) Outpatient and ambulatory health services.
(B) AIDS Drug Assistance Program treatments in accordance with section 2616.
(C) AIDS pharmaceutical assistance.
(D) Oral health care.
(E) Early intervention services described in subsection
(d).
(F) Health insurance premium and cost sharing assistance for low-income individuals in accordance with section
2615.
(G) Home health care.
(H) Medical nutrition therapy.
(I) Hospice services.
(J) Home and community-based health services as defined under section 2614(c).
(K) Mental health services.
(L) Substance abuse outpatient care.
(M) Medical case management, including treatment
adherence services.
(c) SUPPORT SERVICES.—
(1) IN GENERAL.—For purposes of this subsection, the term
‘‘support services’’ means services, subject to the approval of
the Secretary, that are needed for individuals with HIV/AIDS
to achieve their medical outcomes (such as respite care for persons caring for individuals with HIV/AIDS, outreach services,
medical transportation, linguistic services, and referrals for
health care and support services).
(2) DEFINITION OF MEDICAL OUTCOMES.—In this subsection,
the term ‘‘medical outcomes’’ means those outcomes affecting
the HIV-related clinical status of an individual with HIV/AIDS.
(d) EARLY INTERVENTION SERVICES.—
(1) IN GENERAL.—For purposes of this section, the term
‘‘early intervention services’’ means HIV/AIDS early intervenMarch 13, 2013

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tion services described in section 2651(e), with follow-up referral provided for the purpose of facilitating the access of individuals receiving the services to HIV-related health services. The
entities through which such services may be provided under
the grant include public health departments, emergency rooms,
substance abuse and mental health treatment programs, detoxification centers, detention facilities, clinics regarding sexually transmitted diseases, homeless shelters, HIV/AIDS counseling and testing sites, health care points of entry specified by
States, federally qualified health centers, and entities described in section 2652(a) that constitute a point of access to
services by maintaining referral relationships.
(2) CONDITIONS.—With respect to an entity that proposes
to provide early intervention services under paragraph (1),
such paragraph shall apply only if the entity demonstrates to
the satisfaction of the chief elected official for the State involved that—
(A) Federal, State, or local funds are otherwise inadequate for the early intervention services the entity proposes to provide; and
(B) the entity will expend funds pursuant to such subparagraph to supplement and not supplant other funds
available to the entity for the provision of early intervention services for the fiscal year involved.
(e) PRIORITY FOR WOMEN, INFANTS, CHILDREN, AND YOUTH.—
(1) IN GENERAL.—For the purpose of providing health and
support services to infants, children, youth, and women with
HIV/AIDS, including treatment measures to prevent the
perinatal transmission of HIV, a State shall for each of such
populations in the eligible area use, from the grants made for
the area under section 2601(a) for a fiscal year, not less than
the percentage constituted by the ratio of the population involved (infants, children, youth, or women in such area) with
HIV/AIDS to the general population in such area of individuals
with HIV/AIDS.
(2) WAIVER.—With respect to the population involved, the
Secretary may provide to a State a waiver of the requirement
of paragraph (1) if such State demonstrates to the satisfaction
of the Secretary that the population is receiving HIV-related
health services through the State medicaid program under title
XIX of the Social Security Act, the State children’s health insurance program under title XXI of such Act, or other Federal
or State programs.
(f) CONSTRUCTION.—A State may not use amounts received
under a grant awarded under section 2611 to purchase or improve
land, or to purchase, construct, or permanently improve (other than
minor remodeling) any building or other facility, or to make cash
payments to intended recipients of services.
SEC. 2613. ø300ff–23¿ GRANTS TO ESTABLISH HIV CARE CONSORTIA.
(a) CONSORTIA.—A State may, subject to subsection (f), use

amounts provided under a grant awarded under section 2611 to
provide assistance under section 2612(a) to an entity that—
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(1) is an association of one or more public, and one or more
nonprofit private, (or private for-profit providers or organizations if such entities are the only available providers of quality
HIV care in the area) health care and support service providers
and community based organizations operating within areas determined by the State to be most affected by HIV/AIDS; and
(2) agrees to use such assistance for the planning, development and delivery, through the direct provision of services or
through entering into agreements with other entities for the
provision of such services, of comprehensive outpatient health
and support services for individuals with HIV disease, that
may include—
(A) essential health services such as case management
services, medical, nursing, substance abuse treatment,
mental health treatment, and dental care, diagnostics,
monitoring, prophylactic treatment for opportunistic infections, treatment education to take place in the context of
health care delivery, and medical follow-up services, mental health, developmental, and rehabilitation services,
home health and hospice care; and
(B) essential support services such as transportation
services, attendant care, homemaker services, day or respite care, benefits advocacy, advocacy services provided
through public and nonprofit private entities, and services
that are incidental to the provision of health care services
for individuals with HIV/AIDS including nutrition services,
housing referral services, and child welfare and family
services (including foster care and adoption services).
An entity or entities of the type described in this subsection shall
hereinafter be referred to in this title as a ‘‘consortium’’ or ‘‘consortia’’.
(b) ASSURANCES.—
(1) REQUIREMENT.—To receive assistance from a State
under subsection (a), an applicant consortium shall provide the
State with assurances that—
(A) within any locality in which such consortium is to
operate, the populations and subpopulations of individuals
and families with HIV/AIDS have been identified by the
consortium, particularly those experiencing disparities in
access and services and those who reside in historically
underserved communities;
(B) the service plan established under subsection (c)(2)
by such consortium is consistent with the comprehensive
plan under section 2617(b)(4) and addresses the special
care and service needs of the populations and subpopulations identified under subparagraph (A); and
(C) except as provided in paragraph (2), the consortium will be a single coordinating entity that will integrate
the delivery of services among the populations and subpopulations identified under subparagraph (A).
(2) EXCEPTION.—Subparagraph (C) of paragraph (1) shall
not apply to any applicant consortium that the State determines will operate in a community or locality in which it has
been demonstrated by the applicant consortium that—
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(A) subpopulations exist within the community to be
served that have unique service requirements; and
(B) such unique service requirements cannot be adequately and efficiently addressed by a single consortium
serving the entire community or locality.
(c) APPLICATION.—
(1) IN GENERAL.—To receive assistance from the State
under subsection (a), a consortium shall prepare and submit to
the State, an application that—
(A) demonstrates that the consortium includes agencies and community-based organizations—
(i) with a record of service to populations and subpopulations with HIV/AIDS requiring care within the
community to be served; and
(ii) that are representative of populations and subpopulations reflecting the local incidence of HIV and
that are located in areas in which such populations reside;
(B) demonstrates that the consortium has carried out
an assessment of service needs within the geographic area
to be served and, after consultation with the entities described in paragraph (2), has established a plan to ensure
the delivery of services to meet such identified needs that
shall include—
(i) assurances that service needs will be addressed
through the coordination and expansion of existing
programs before new programs are created;
(ii) assurances that, in metropolitan areas, the geographic area to be served by the consortium corresponds to the geographic boundaries of local health
and support services delivery systems to the extent
practicable;
(iii) assurances that, in the case of services for individuals residing in rural areas, the applicant consortium shall deliver case management services that link
available community support services to appropriate
specialized medical services; and
(iv) assurances that the assessment of service
needs and the planning of the delivery of services will
include participation by individuals with HIV/AIDS;
(C) demonstrates that adequate planning has occurred
to meet the special needs of families with HIV/AIDS, including family centered and youth centered care;
(D) demonstrates that the consortium has created a
mechanism to evaluate periodically—
(i) the success of the consortium in responding to
identified needs; and
(ii) the cost-effectiveness of the mechanisms employed by the consortium to deliver comprehensive
care;
(E) demonstrates that the consortium will report to
the State the results of the evaluations described in subparagraph (D) and shall make available to the State or the
Secretary, on request, such data and information on the
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program methodology that may be required to perform an
independent evaluation; and
(F) demonstrates that adequate planning occurred to
address disparities in access and services and historically
underserved communities.
(2) CONSULTATION.—In establishing the plan required
under paragraph (1)(B), the consortium shall consult with—
(A)(i) the public health agency that provides or supports ambulatory and outpatient HIV-related health care
services within the geographic area to be served; or
(ii) in the case of a public health agency that does not
directly provide such HIV-related health care services such
agency shall consult with an entity or entities that directly
provide ambulatory and outpatient HIV-related health
care services within the geographic area to be served;
(B) not less than one community-based organization
that is organized solely for the purpose of providing HIVrelated support services to individuals with HIV/AIDS;
(C) grantees under section 2671, or, if none are operating in the area, representatives in the area of organizations with a history of serving children, youth, women, and
families living with HIV; and
(D) the types of entities described in section
2602(b)(2).
The organization to be consulted under subparagraph (B) shall
be at the discretion of the applicant consortium.
(d) DEFINITION.—As used in section 2611, the term ‘‘family centered care’’ means the system of services described in this section
that is targeted specifically to the special needs of infants, children,
women, and families. Family centered care shall be based on a
partnership between parents, professionals, and the community designed to ensure an integrated, coordinated, culturally sensitive,
and community-based continuum of care for children, women, and
families with HIV/AIDS.
(e) PRIORITY.—In providing assistance under subsection (a), the
State shall, among applicants that meet the requirements of this
section, give priority—
(1) first to consortia that are receiving assistance from the
Health Resources and Services Administration for adult and
pediatric HIV-related care demonstration projects; and then
(2) to any other existing HIV care consortia.
(f) ALLOCATION OF FUNDS; TREATMENT AS SUPPORT SERVICES.—
For purposes of the requirement of section 2612(b)(1), expenditures
of grants under section 2611 for or through consortia under this
section are deemed to be support services, not core medical services. The preceding sentence may not be construed as having any
legal effect on the provisions of subsection (a) that relate to authorized expenditures of the grant.
SEC. 2614. ø300ff–24¿ GRANTS FOR HOME- AND COMMUNITY-BASED
CARE.
(a) USES.—A State may use amounts provided under a grant

awarded under section 2611 to make grants under section
2612(b)(3)(J) to entities to—
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(1) provide home- and community-based health services for
individuals with HIV/AIDS pursuant to written plans of care
prepared by a case management team, that shall include appropriate health care professionals, in such State for providing
such services to such individuals;
(2) provide outreach services to individuals with HIV/
AIDS, including those individuals in rural areas; and
(3) provide for the coordination of the provision of services
under this section with the provision of HIV-related health
services, including specialty care and vaccinations for hepatitis
co-infection, provided by public and private entities.
(b) PRIORITY.—In awarding grants under subsection (a), a
State shall give priority to entities that provide assurances to the
State that—
(1) such entities will participate in HIV care consortia if
such consortia exist within the State; and
(2) such entities will utilize amounts provided under such
grants for the provision of home- and community-based services to low-income individuals with HIV/AIDS.
(c) DEFINITION.—As used in section 2611, the term ‘‘home- and
community-based health services’’—
(1) means, with respect to an individual with HIV/AIDS,
skilled health services furnished to the individual in the individual’s home pursuant to a written plan of care established by
a case management team, that shall include appropriate health
care professionals, for the provision of such services and items
described in paragraph (2);
(2) includes—
(A) durable medical equipment;
(B) home health aide services and personal care services furnished in the home of the individual;
(C) day treatment or other partial hospitalization services;
(D) home intravenous and aerosolized drug therapy
(including prescription drugs administered as part of such
therapy);
(E) routine diagnostic testing administered in the
home of the individual; and
(F) appropriate mental health, developmental, and rehabilitation services; and
(3) does not include—
(A) inpatient hospital services; and
(B) nursing home and other long term care facilities.
SEC. 2615. ø300ff–25¿ CONTINUUM OF HEALTH INSURANCE COVERAGE.
(a) IN GENERAL.—A State may use amounts received under a

grant awarded under section 2611 to establish a program of financial assistance under section 2612(b)(3)(F) to assist eligible low-income individuals with HIV/AIDS in—
(1) maintaining a continuity of health insurance; or
(2) receiving medical benefits under a health insurance
program, including risk-pools.
(b) LIMITATIONS.—Assistance shall not be utilized under subsection (a)—
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(1) to pay any costs associated with the creation, capitalization, or administration of a liability risk pool (other than
those costs paid on behalf of individuals as part of premium
contributions to existing liability risk pools); and
(2) to pay any amount expended by a State under title XIX
of the Social Security Act.
SEC. 2616. ø300ff–26¿ PROVISION OF TREATMENTS.
(a) IN GENERAL.—A State shall use a portion

of the amounts
provided under a grant awarded under section 2611 to establish a
program under section 2612(b)(3)(B) to provide therapeutics to
treat HIV/AIDS or prevent the serious deterioration of health arising from HIV/AIDS in eligible individuals, including measures for
the prevention and treatment of opportunistic infections.
(b) ELIGIBLE INDIVIDUAL.—To be eligible to receive assistance
from a State under this section an individual shall—
(1) have a medical diagnosis of HIV/AIDS; and
(2) be a low-income individual, as defined by the State.
(c) STATE DUTIES.—In carrying out this section the State
shall—
(1) ensure that the therapeutics included on the list of
classes of core antiretroviral therapeutics established by the
Secretary under subsection (e) are, at a minimum, the treatments provided by the State pursuant to this section;
(2) provide assistance for the purchase of treatments determined to be eligible under paragraph (1), and the provision of
such ancillary devices that are essential to administer such
treatments;
(3) provide outreach to individuals with HIV/AIDS, and as
appropriate to the families of such individuals;
(4) facilitate access to treatments for such individuals;
(5) document the progress made in making therapeutics
described in subsection (a) available to individuals eligible for
assistance under this section; and
(6) encourage, support, and enhance adherence to and compliance with treatment regimens, including related medical
monitoring.
Of the amount reserved by a State for a fiscal year for use under
this section, the State may not use more than 5 percent to carry
out services under paragraph (6), except that the percentage applicable with respect to such paragraph is 10 percent if the State
demonstrates to the Secretary that such additional services are essential and in no way diminish access to the therapeutics described
in subsection (a).
(d) DUTIES OF THE SECRETARY.—In carrying out this section,
the Secretary shall review the current status of State drug reimbursement programs established under section 2612(2) and assess
barriers to the expanded availability of the treatments described in
subsection (a). The Secretary shall also examine the extent to
which States coordinate with other grantees under this title to reduce barriers to the expanded availability of the treatments described in subsection (a).
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velop and maintain a list of classes of core antiretroviral therapeutics, which list shall be based on the therapeutics included in
the guidelines of the Secretary known as the Clinical Practice
Guidelines for Use of HIV/AIDS Drugs, relating to drugs needed to
manage symptoms associated with HIV. The preceding sentence
does not affect the authority of the Secretary to modify such Guidelines.
(f) USE OF HEALTH INSURANCE AND PLANS.—
(1) IN GENERAL.—In carrying out subsection (a), a State
may expend a grant under section 2611 to provide the therapeutics described in such subsection by paying on behalf of individuals with HIV/AIDS the costs of purchasing or maintaining health insurance or plans whose coverage includes a full
range of such therapeutics and appropriate primary care services.
(2) LIMITATION.—The authority established in paragraph
(1) applies only to the extent that, for the fiscal year involved,
the costs of the health insurance or plans to be purchased or
maintained under such paragraph do not exceed the costs of
otherwise providing therapeutics described in subsection (a).
(g) DRUG REBATE PROGRAM.—A State shall ensure that any
drug rebates received on drugs purchased from funds provided pursuant to this section are applied to activities supported under this
subpart, with priority given to activities described under this section.
SEC. 2617. ø300ff–27¿ STATE APPLICATION.
(a) IN GENERAL.—The Secretary shall

not make a grant to a
State under section 2611 for a fiscal year unless the State prepares
and submits, to the Secretary, an application at such time, in such
form, and containing such agreements, assurances, and information
as the Secretary determines to be necessary to carry out section
2611.
(b) DESCRIPTION OF INTENDED USES AND AGREEMENTS.—The
application submitted under subsection (a) shall contain—
(1) a detailed description of the HIV-related services provided in the State to individuals and families with HIV/AIDS
during the year preceding the year for which the grant is requested, and the number of individuals and families receiving
such services, that shall include—
(A) a description of the types of programs operated or
funded by the State for the provision of HIV-related services during the year preceding the year for which the grant
is requested and the methods utilized by the State to finance such programs;
(B) an accounting of the amount of funds that the
State has expended for such services and programs during
the year preceding the year for which the grant is requested; and
(C) information concerning—
(i) the number of individuals to be served with assistance provided under the grant;
(ii) demographic data on the population of the individuals to be served;
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(iii) the average cost of providing each category of
HIV-related health services and the extent to which
such cost is paid by third-party payors; and
(iv) the aggregate amounts expended for each such
category of services;
(2) a determination of the size and demographics of the
population of individuals with HIV/AIDS in the State;
(3) a determination of the needs of such population, with
particular attention to—
(A) individuals with HIV/AIDS who know their HIV
status and are not receiving HIV-related services; and
(B) disparities in access and services among affected
subpopulations and historically underserved communities;
(4) the designation of a lead State agency that shall—
(A) administer all assistance received under section
2611;
(B) conduct the needs assessment and prepare the
State plan under paragraph (3);
(C) prepare all applications for assistance under section 2611;
(D) receive notices with respect to programs under this
title;
(E) every 2 years, collect and submit to the Secretary
all audits, consistent with Office of Management and
Budget circular A133, from grantees within the State, including audits regarding funds expended in accordance
with section 2611; and
(F) carry out any other duties determined appropriate
by the Secretary to facilitate the coordination of programs
under this title.
(5) a comprehensive plan that describes the organization
and delivery of HIV health care and support services to be
funded with assistance received under section 2611 that shall
include a description of the purposes for which the State intends to use such assistance, and that—
(A) 1 establishes priorities for the allocation of funds
within the State based on—
(i) size and demographics of the population of individuals with HIV/AIDS (as determined under paragraph (2)) and the needs of such population (as determined under paragraph (3));
(ii) availability of other governmental and nongovernmental resources, including the State medicaid
plan under title XIX of the Social Security Act and the
State Children’s Health Insurance Program under title
XXI of such Act to cover health care costs of eligible
individuals and families with HIV/AIDS;
1The placement of subparagraphs (A) through (C) is according to the probable intent of the
Congress. Section 205(a)(3) of Public Law 106–345 (114 Stat. 1332, 1333) amended paragraph
(4) by redesignating subparagraphs (A) through (C) as subparagraphs (D) through (F), and then
instructed that new subparagraphs (A) through (C) be inserted before ‘‘subparagraph (C)’’. The
amendment probably should have instructed that the new subparagraphs be inserted before subparagraph (D), as redesignated.

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(iii) capacity development needs resulting from
disparities in the availability of HIV-related services
in historically underserved communities and rural
communities; and
(iv) the efficiency of the administrative mechanism
of the State for rapidly allocating funds to the areas
of greatest need within the State;
(B) includes a strategy for identifying individuals who
know their HIV status and are not receiving such services
and for informing the individuals of and enabling the individuals to utilize the services, giving particular attention
to eliminating disparities in access and services among affected subpopulations and historically underserved communities, and including discrete goals, a timetable, and an appropriate allocation of funds;
(C) includes a strategy to coordinate the provision of
such services with programs for HIV prevention (including
outreach and early intervention) and for the prevention
and treatment of substance abuse (including programs
that provide comprehensive treatment services for such
abuse);
(D) describes the services and activities to be provided
and an explanation of the manner in which the elements
of the program to be implemented by the State with such
assistance will maximize the quality of health and support
services available to individuals with HIV/AIDS throughout the State;
(E) provides a description of the manner in which
services funded with assistance provided under section
2611 will be coordinated with other available related services for individuals with HIV/AIDS;
(F) provides a description of how the allocation and
utilization of resources are consistent with the statewide
coordinated statement of need (including traditionally underserved populations and subpopulations) developed in
partnership with other grantees in the State that receive
funding under this title; and
(G) includes key outcomes to be measured by all entities in the State receiving assistance under this title; and
(6) an assurance that the public health agency administering the grant for the State will periodically convene a
meeting of individuals with HIV/AIDS, members of a Federally
recognized Indian tribe as represented in the State, representatives of grantees under each part under this title, providers,
and public agency representatives for the purpose of developing
a statewide coordinated statement of need;
(7) an assurance by the State that—
(A) the public health agency that is administering the
grant for the State engages in a public advisory planning
process, including public hearings, that includes the participants under paragraph (6), and the types of entities described in section 2602(b)(2), in developing the comprehensive plan under paragraph (5) and commenting on the implementation of such plan;
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(B) the State will—
(i) to the maximum extent practicable, ensure that
HIV-related health care and support services delivered
pursuant to a program established with assistance
provided under section 2611 will be provided without
regard to the ability of the individual to pay for such
services and without regard to the current or past
health condition of the individual with HIV/AIDS;
(ii) ensure that such services will be provided in
a setting that is accessible to low-income individuals
with HIV/AIDS;
(iii) provide outreach to low-income individuals
with HIV/AIDS to inform such individuals of the services available under section 2611; and
(iv) in the case of a State that intends to use
amounts provided under the grant for purposes described in 2615 1, submit a plan to the Secretary that
demonstrates that the State has established a program that assures that—
(I) such amounts will be targeted to individuals who would not otherwise be able to afford
health insurance coverage; and
(II) income, asset, and medical expense criteria will be established and applied by the State
to identify those individuals who qualify for assistance under such program, and information concerning such criteria shall be made available to
the public;
(C) the State will provide for periodic independent
peer review to assess the quality and appropriateness of
health and support services provided by entities that receive funds from the State under section 2611;
(D) the State will permit and cooperate with any Federal investigations undertaken regarding programs conducted under section 2611;
(E) the State will maintain HIV-related activities at a
level that is equal to not less than the level of such expenditures by the State for the 1-year period preceding the
fiscal year for which the State is applying to receive a
grant under section 2611;
(F) the State will ensure that grant funds are not utilized to make payments for any item or service to the extent that payment has been made, or can reasonably be expected to be made, with respect to that item or service—
(i) under any State compensation program, under
an insurance policy, or under any Federal or State
health benefits program; or
(ii) by an entity that provides health services on
a prepaid basis (except for a program administered by
1 The word ‘‘section’’ probably should appear before ‘‘2615’’. Section 12(c)(3) of Public Law 104–
146 (110 Stat. 1373) provides that subsection (b)(3)(B)(iv) is amended by inserting ‘‘section’’ before ‘‘2615’’, but the amendment cannot be executed because the term ‘‘2615’’ does not appear
in paragraph (3)(B)(iv). The term formerly did appear in such paragraph, but former paragraph
(3) was redesignated as paragraph (4) by section 3(c)(4)(B) of such Public Law (110 Stat. 1355).

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or providing the services of the Indian Health Service);
and
(G) entities within areas in which activities under the
grant are carried out will maintain appropriate relationships with entities in the area served that constitute key
points of access to the health care system for individuals
with HIV/AIDS (including emergency rooms, substance
abuse treatment programs, detoxification centers, adult
and juvenile detention facilities, sexually transmitted disease clinics, HIV counseling and testing sites, mental
health programs, and homeless shelters), and other entities under section 2612(c) and 2652(a), for the purpose of
facilitating early intervention for individuals newly diagnosed with HIV/AIDS and individuals knowledgeable of
their HIV status but not in care; and
(8) a comprehensive plan—
(A) containing an identification of individuals with
HIV/AIDS as described in clauses (i) through (iii) of section
2603(b)(2)(A) and the strategy required under section
2602(b)(4)(D)(iv);
(B) describing the estimated number of individuals
within the State with HIV/AIDS who do not know their
status;
(C) describing activities undertaken by the State to
find the individuals described in subparagraph (A) and to
make such individuals aware of their status;
(D) describing the manner in which the State will provide undiagnosed individuals who are made aware of their
status with access to medical treatment for their HIV/
AIDS; and
(E) describing efforts to remove legal barriers, including State laws and regulations, to routine testing.
(c) REQUIREMENTS REGARDING IMPOSITION OF CHARGES FOR
SERVICES.—
(1) IN GENERAL.—The Secretary may not make a grant
under section 2611 to a State unless the State provides assurances that in the provision of services with assistance provided
under the grant—
(A) in the case of individuals with an income less than
or equal to 100 percent of the official poverty line, the provider will not impose charges on any such individual for
the provision of services under the grant;
(B) in the case of individuals with an income greater
than 100 percent of the official poverty line, the provider—
(i) will impose charges on each such individual for
the provision of such services; and
(ii) will impose charges according to a schedule of
charges that is made available to the public;
(C) in the case of individuals with an income greater
than 100 percent of the official poverty line and not exceeding 200 percent of such poverty line, the provider will
not, for any calendar year, impose charges in an amount
exceeding 5 percent of the annual gross income of the individual involved;
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(D) in the case of individuals with an income greater
than 200 percent of the official poverty line and not exceeding 300 percent of such poverty line, the provider will
not, for any calendar year, impose charges in an amount
exceeding 7 percent of the annual gross income of the individual involved; and
(E) in the case of individuals with an income greater
than 300 percent of the official poverty line, the provider
will not, for any calendar year, impose charges in an
amount exceeding 10 percent of the annual gross income
of the individual involved.
(2) ASSESSMENT OF CHARGE.—With respect to compliance
with the assurance made under paragraph (1), a grantee under
section 2611 may, in the case of individuals subject to a charge
for purposes of such paragraph—
(A) assess the amount of the charge in the discretion
of the grantee, including imposing only a nominal charge
for the provision of services, subject to the provisions of
such paragraph regarding public schedules regarding limitation on the maximum amount of charges; and
(B) take into consideration the medical expenses of individuals in assessing the amount of the charge, subject
to such provisions.
(3) APPLICABILITY OF LIMITATION ON AMOUNT OF CHARGE.—
The Secretary may not make a grant under section 2611 unless
the applicant of the grant agrees that the limitations established in subparagraphs (C), (D), and (E) of paragraph (1) regarding the imposition of charges for services applies to the annual aggregate of charges imposed for such services, without
regard to whether they are characterized as enrollment fees,
premiums, deductibles, cost sharing, copayments, coinsurance,
or other charges.
(4) WAIVER.—
(A) IN GENERAL.—The State shall waive the requirements established in paragraphs (1) through (3) in the
case of an entity that does not, in providing health care
services, impose a charge or accept reimbursement from
any third-party payor, including reimbursement under any
insurance policy or under any Federal or State health benefits program.
(B) DETERMINATION.—A determination by the State of
whether an entity referred to in subparagraph (A) meets
the criteria for a waiver under such subparagraph shall be
made without regard to whether the entity accepts voluntary donations regarding the provision of services to the
public.
(d) REQUIREMENT OF MATCHING FUNDS REGARDING STATE ALLOTMENTS.—
(1) IN GENERAL.—In the case of any State to which the criterion described in paragraph (3) applies, the Secretary may
not make a grant under section 2611 unless the State agrees
that, with respect to the costs to be incurred by the State in
carrying out the program for which the grant was awarded, the
State will, subject to subsection (b)(2), make available (directly
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or through donations from public or private entities) non-Federal contributions toward such costs in an amount equal to—
(A) for the first fiscal year of payments under the
grant, not less than 162⁄3 percent of such costs ($1 for each
$5 of Federal funds provided in the grant);
(B) for any second fiscal year of such payments, not
less than 20 percent of such costs ($1 for each $4 of Federal funds provided in the grant);
(C) for any third fiscal year of such payments, not less
than 25 percent of such costs ($1 for each $3 of Federal
funds provided in the grant);
(D) for any fourth fiscal year of such payments, not
less than 331⁄3 percent of such costs ($1 for each $2 of Federal funds provided in the grant); and
(E) for any subsequent fiscal year of such payments,
not less than 331⁄3 percent of such costs ($1 for each $2 of
Federal funds provided in the grant).
(2) DETERMINATION OF AMOUNT OF NON-FEDERAL CONTRIBUTION.—
(A) IN GENERAL.—Non-Federal contributions required
in paragraph (1) may be in cash or in kind, fairly evaluated, including plant, equipment, or services. Amounts
provided by the Federal Government, and any portion of
any service subsidized by the Federal Government, may
not be included in determining the amount of such nonFederal contributions.
(B) INCLUSION OF CERTAIN AMOUNTS.—
(i) In making a determination of the amount of
non-Federal contributions made by a State for purposes of paragraph (1), the Secretary shall, subject to
clause (ii), include any non-Federal contributions provided by the State for HIV-related services, without
regard to whether the contributions are made for programs established pursuant to this title;
(ii) In making a determination for purposes of
clause (i), the Secretary may not include any non-Federal contributions provided by the State as a condition
of receiving Federal funds under any program under
this title (except for the program established in section
2611) or under other provisions of law.
(3) APPLICABILITY OF REQUIREMENT.—
(A) NUMBER OF CASES.—A State referred to in paragraph (1) is any State for which the number of cases of
HIV/AIDS reported to and confirmed by the Director of the
Centers for Disease Control and Prevention for the period
described in subparagraph (B) constitutes in excess of 1
percent of the aggregate number of such cases reported to
and confirmed by the Director for such period for the
United States.
(B) PERIOD OF TIME.—The period referred to in subparagraph (A) is the 2-year period preceding the fiscal year
for which the State involved is applying to receive a grant
under subsection (a).
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(C) PUERTO RICO.—For purposes of paragraph (1), the
number of cases of HIV/AIDS reported and confirmed for
the Commonwealth of Puerto Rico for any fiscal year shall
be deemed to be less than 1 percent.
(4) DIMINISHED STATE CONTRIBUTION.—With respect to a
State that does not make available the entire amount of the
non-Federal contribution referred to in paragraph (1), the
State shall continue to be eligible to receive Federal funds
under a grant under section 2611, except that the Secretary in
providing Federal funds under the grant shall provide such
funds (in accordance with the ratios prescribed in paragraph
(1)) only with respect to the amount of funds contributed by
such State.
SEC. 2618. ø300ff–28¿ DISTRIBUTION OF FUNDS.
(a) AMOUNT OF GRANT TO STATE.—
(1) MINIMUM ALLOTMENT.—Subject

to the extent of
amounts made available under section 2623, the amount of a
grant to be made under section 2611 for—
(A) each of the 50 States, the District of Columbia,
Guam, and the Virgin Islands (referred to in this paragraph as a ‘‘covered State’’) for a fiscal year shall be the
greater of—
(i)(I) with respect to a covered State that has less
than 90 living cases of AIDS, as determined under
paragraph (2)(D), $200,000; or
(II) with respect to a covered State that has 90 or
more living cases of AIDS, as determined under paragraph (2)(D), $500,000; and
(ii) an amount determined under paragraph (2)
and then, as applicable, increased under paragraph
(2)(H); and
(B) each territory other than Guam and the Virgin Islands shall be the greater of $50,000 or an amount determined under paragraph (2).
(2) DETERMINATION.—
(A) FORMULA.—For purposes of paragraph (1), the
amount referred to in this paragraph for a State (including
a territory) for a fiscal year is, subject to subparagraphs
(E) and (F)—
(i) an amount equal to the amount made available
under section 2623 for the fiscal year involved for
grants pursuant to paragraph (1), subject to subparagraph (F); and
(ii) the percentage constituted by the sum of—
(I) the product of 0.75 and the ratio of the
State distribution factor for the State or territory
(as determined under subsection (B)) to the sum of
the respective State distribution factors for all
States or territories;
(II) the product of .20 and the ratio of the
non-EMA distribution factor for the State or territory (as determined under subparagraph (C)) to

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the sum of the respective non-EMA distribution
factors for all States or territories; and
(III) if the State does not for such fiscal year
contain any area that is an eligible area under
subpart I of part A or any area that is a transitional area under section 2609 (referred to in this
subclause as a ‘‘no-EMA State’’), the product of
0.05 and the ratio of the number of cases that applies for the State under subparagraph (D) to the
sum of the respective numbers of cases that so
apply for all no-EMA States.
(B) STATE DISTRIBUTION FACTOR.—For purposes of subparagraph (A)(ii)(I), the term ‘‘State distribution factor’’
means an amount equal to the number of living cases of
HIV/AIDS in the State involved, as determined under subparagraph (D).
(C) NON-EMA DISTRIBUTION FACTOR.—For purposes of
subparagraph (A)(ii)(II), the term ‘‘non-ema distribution
factor’’ means an amount equal to the sum of—
(i) the number of living cases of HIV/AIDS in the
State involved, as determined under subparagraph
(D); less
(ii) a number equal to the sum of—
(I) the total number of living cases of HIV/
AIDS that are within areas in such State that are
eligible areas under subpart I of part A for the fiscal year involved, which individual number for an
area is the number that applies under section
2601 for the area for such fiscal year; and
(II) the total number of such cases that are
within areas in such State that are transitional
areas under section 2609 for such fiscal year,
which individual number for an area is the number that applies under such section for the fiscal
year.
(D) LIVING CASES OF HIV/AIDS.—
(i) REQUIREMENT OF NAMES-BASED REPORTING.—
Except as provided in clause (ii), the number determined under this subparagraph for a State for a fiscal
year for purposes of subparagraph (B) is the number
of living names-based cases of HIV/AIDS in the State
that, as of December 31 of the most recent calendar
year for which such data is available, have been reported to and confirmed by the Director of the Centers
for Disease Control and Prevention.
(ii) TRANSITION PERIOD; EXEMPTION REGARDING
NON-AIDS CASES.—For each of the fiscal years 2007
through 2012, a State is, subject to clauses (iii)
through (v), exempt from the requirement under
clause (i) that living non-AIDS names-based cases of
HIV be reported unless—
(I) a system was in operation as of December
31, 2005, that provides sufficiently accurate and
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reliable names-based reporting of such cases
throughout the State, subject to clause (vii); or
(II) no later than the beginning of fiscal year
2008 or a subsequent fiscal year through fiscal
year 2012, the Secretary, after consultation with
the chief executive of the State, determines that a
system has become operational in the State that
provides sufficiently accurate and reliable namesbased reporting of such cases throughout the
State.
(iii) REQUIREMENTS FOR EXEMPTION FOR FISCAL
YEAR 2007.—For fiscal year 2007, an exemption under
clause (ii) for a State applies only if, by October 1,
2006—
(I)(aa) the State had submitted to the Secretary a plan for making the transition to sufficiently accurate and reliable names-based reporting of living non-AIDS cases of HIV; or
(bb) all statutory changes necessary to provide
for sufficiently accurate and reliable reporting of
such cases had been made; and
(II) the State had agreed that, by April 1,
2008, the State will begin accurate and reliable
names-based reporting of such cases, except that
such agreement is not required to provide that, as
of such date, the system for such reporting be
fully sufficient with respect to accuracy and reliability throughout the area.
(iv) REQUIREMENT FOR EXEMPTION AS OF FISCAL
YEAR 2008.—For each of the fiscal years 2008 through
2012, an exemption under clause (ii) for a State applies only if, as of April 1, 2008, the State is substantially in compliance with the agreement under clause
(iii)(II).
(v) PROGRESS TOWARD NAMES-BASED REPORTING.—
For fiscal year 2009 or a subsequent fiscal year, the
Secretary may terminate an exemption under clause
(ii) for a State if the State submitted a plan under
clause (iii)(I)(aa) and the Secretary determines that
the State is not substantially following the plan.
(vi) COUNTING OF CASES IN AREAS WITH EXEMPTIONS.—
(I) IN GENERAL.—With respect to a State that
is under a reporting system for living non-AIDS
cases of HIV that is not names-based (referred to
in this subparagraph as ‘‘code-based reporting’’),
the Secretary shall, for purposes of this subparagraph, modify the number of such cases reported
for the State in order to adjust for duplicative reporting in and among systems that use code-based
reporting.
(II) ADJUSTMENT RATE.—The adjustment rate
under subclause (I) for a State shall be a reduction of 5 percent for fiscal years before fiscal year
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2012 (and 6 percent for fiscal year 2012) in the
number of living non-AIDS cases of HIV reported
for the State.
(III) INCREASED ADJUSTMENT FOR CERTAIN
STATES PREVIOUSLY USING CODE-BASED REPORTING.—For purposes of this subparagraph for each
of fiscal years 2010 through 2012, the Secretary
shall deem the applicable number of living cases
of HIV/AIDS in a State that were reported to and
confirmed by the Centers for Disease Control and
Prevention to be 3 percent higher than the actual
number if—
(aa) there is an area in such State that
satisfies all of the conditions described in
items
(aa)
through
(cc)
of
section
2603(a)(3)(C)(vi)(III); or
(bb)(AA) fiscal year 2007 was the first
year in which the count of living non-AIDS
cases of HIV in such area, for purposes of this
part, was based on a names-based reporting
system; and
(BB) the amount of funding that such
State received under this part for fiscal year
2007 was less than 70 percent of the amount
of funding that such State received under
such part for fiscal year 2006.
(vii) LIST OF STATES MEETING STANDARD REGARDING DECEMBER 31, 2005.—
(I) IN GENERAL.—If a State is specified in subclause (II), the State shall be considered to meet
the standard described in clause (ii)(I). No other
State may be considered to meet such standard.
(II) RELEVANT STATES.—For purposes of subclause (I), the States specified in this subclause
are the following: Alaska, Alabama, Arkansas, Arizona, Colorado, Florida, Indiana, Iowa, Idaho,
Kansas, Louisiana, Michigan, Minnesota, Missouri, Mississippi, North Carolina, North Dakota,
Nebraska, New Jersey, New Mexico, New York,
Nevada, Ohio, Oklahoma, South Carolina, South
Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, West Virginia, Wyoming, Guam, and the
Virgin Islands.
(viii) RULES OF CONSTRUCTION REGARDING ACCEPTANCE OF REPORTS.—
(I) CASES OF AIDS.—With respect to a State
that is subject to the requirement under clause (i)
and is not in compliance with the requirement for
names-based reporting of living non-AIDS cases of
HIV, the Secretary shall, notwithstanding such
noncompliance, accept reports of living cases of
AIDS that are in accordance with such clause.
(II) APPLICABILITY OF EXEMPTION REQUIREMENTS.—The provisions of clauses (ii) through (vii)
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may not be construed as having any legal effect
for fiscal year 2013 or any subsequent fiscal year,
and accordingly, the status of a State for purposes
of such clauses may not be considered after fiscal
year 2012.
(ix) PROGRAM FOR DETECTING INACCURATE OR
FRAUDULENT COUNTING.—The Secretary shall carry
out a program to monitor the reporting of namesbased cases for purposes of this subparagraph and to
detect instances of inaccurate reporting, including
fraudulent reporting.
(x) FUTURE FISCAL YEARS.—For fiscal years beginning with fiscal year 2013, determinations under this
paragraph shall be based only on living names-based
cases of HIV/AIDS with respect to the State involved.
(E) CODE-BASED STATES; LIMITATION ON INCREASE IN
GRANT.—
(i) IN GENERAL.—For each of the fiscal years 2007
through 2012, if code-based reporting (within the
meaning of subparagraph (D)(vi)) applies in a State as
of the beginning of the fiscal year involved, then notwithstanding any other provision of this paragraph,
the amount of the grant pursuant to paragraph (1) for
the State may not for the fiscal year involved exceed
by more than 5 percent the amount of the grant pursuant to this paragraph for the State for the preceding
fiscal year, except that the limitation under this clause
may not result in a grant pursuant to paragraph (1)
for a fiscal year that is less than the minimum amount
that applies to the State under such paragraph for
such fiscal year.
(ii) USE OF AMOUNTS INVOLVED.—For each of the
fiscal years 2007 through 2012, amounts available as
a result of the limitation under clause (i) shall be
made available by the Secretary as additional
amounts for grants pursuant to section 2620, subject
to subparagraph (H).
(F) 1 APPROPRIATIONS FOR TREATMENT DRUG PROGRAM.—
(i) FORMULA GRANTS.—With respect to the fiscal
year involved, if under section 2623 an appropriations
Act provides an amount exclusively for carrying out
section 2616, the portion of such amount allocated to
a State shall be the product of—
(I) 2 100 percent of such amount, less the percentage reserved under clause (ii)(V); and
(II) 2 the percentage constituted by the ratio of the
State distribution factor for the State (as determined
1 The amendments made by section 203(c) of Public Law 109–415 to section 2618(a)(2)(G) have
been carried out to subparagraph (F), as redesignated by subsection (b)(4) of such Public Law,
in order to reflect the probable intent of Congress.
2 Indentation of subclauses (I) and (II) are so in law. See section 206(e)(1) of Public Law 106–
345 (114 Stat. 1336).

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under subparagraph (B)) to the sum of the State distribution factors for all States;
which product shall then, as applicable, be increased
under subparagraph (H).
(ii) SUPPLEMENTAL TREATMENT DRUG GRANTS.—
(I) IN GENERAL.—From amounts made available under subclause (V), the Secretary shall
award supplemental grants to States described in
subclause (II) to enable such States to purchase
and distribute to eligible individuals under section
2616(b) pharmaceutical therapeutics described
under subsections (c)(2) and (e) of such section.
(II) ELIGIBLE STATES.—For purposes of subclause (I), a State shall be an eligible State if the
State did not have unobligated funds subject to reallocation under section 2618(d) in the previous
fiscal year and, in accordance with criteria established by the Secretary, demonstrates a severe
need for a grant under this clause. For purposes
of determining severe need, the Secretary shall
consider eligibility standards, formulary composition, the number of eligible individuals to whom a
State is unable to provide therapeutics described
in section 2616(a), and an unanticipated increase
of eligible individuals with HIV/AIDS.
(III) STATE REQUIREMENTS.—The Secretary
may not make a grant to a State under this clause
unless the State agrees that the State will make
available (directly or through donations of public
or private entities) non-Federal contributions toward the activities to be carried out under the
grant in an amount equal to $1 for each $4 of Federal funds provided in the grant, except that the
Secretary may waive this subclause if the State
has otherwise fully complied with section 2617(d)
with respect to the grant year involved. The provisions of this subclause shall apply to States that
are not required to comply with such section
2617(d).
(IV) USE AND COORDINATION.—Amounts made
available under a grant under this clause shall
only be used by the State to provide HIV/AIDS-related medications. The State shall coordinate the
use of such amounts with the amounts otherwise
provided under section 2616(a) in order to maximize drug coverage.
(V) FUNDING.—For the purpose of making
grants under this clause, the Secretary shall each
fiscal year reserve 5 percent of the amount referred to in clause (i) with respect to section 2616.
(iii) CODE-BASED STATES; LIMITATION ON INCREASE
IN FORMULA GRANT.—The limitation under subparagraph (E)(i) applies to grants pursuant to clause (i) of
this subparagraph to the same extent and in the same
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manner as such limitation applies to grants pursuant
to paragraph (1), except that the reference to minimum grants does not apply for purposes of this
clause. Amounts available as a result of the limitation
under the preceding sentence shall be made available
by the Secretary as additional amounts for grants
under clause (ii) of this subparagraph.
(H) 1 INCREASE IN FORMULA GRANTS.—
(i) ASSURANCE OF AMOUNT.—
(I) GENERAL RULE.—For fiscal year 2010, the
Secretary shall ensure, subject to clauses (ii)
through (iv), that the total for a State of the grant
pursuant to paragraph (1) and the grant pursuant
to subparagraph (F) is not less than 95 percent of
such total for the State for fiscal year 2009.
(II) RULE OF CONSTRUCTION.—With respect to
the application of subclause (I), the 95 percent requirement under such subclause shall apply with
respect to each grant awarded under paragraph
(1) and with respect to each grant awarded under
subparagraph (F).
(ii) FISCAL YEARS 2011 AND 2012.—For each of the
fiscal years 2011 and 2012, the Secretary shall ensure
that the total for a State of the grant pursuant to
paragraph (1) and the grant pursuant to subparagraph
(F) is not less than 100 percent of such total for the
State for fiscal year 2010.
(iii) FISCAL YEAR 2013.—For fiscal year 2013, the
Secretary shall ensure that the total for a State of the
grant pursuant to paragraph (1) and the grant pursuant to subparagraph (F) is not less than 92.5 percent
of such total for the State for fiscal year 2012.
(iv) SOURCE OF FUNDS FOR INCREASE.—
(I) IN GENERAL.—From the amount reserved
under section 2623(b)(2) for a fiscal year, and from
amounts available for such section pursuant to
subsection (d) of this section, the Secretary shall
make available such amounts as may be necessary
to comply with clause (i).
(II) PRO RATA REDUCTION.—If the amounts referred to in subclause (I) for a fiscal year are insufficient to fully comply with clause (i) for the
year, the Secretary, in order to provide the additional funds necessary for such compliance, shall
reduce on a pro rata basis the amount of each
grant pursuant to paragraph (1) for the fiscal
year, other than grants for States for which increases under clause (i) apply and other than
States described in paragraph (1)(A)(i)(I). A reduction under the preceding sentence may not be
made in an amount that would result in the State
involved becoming eligible for such an increase.
1 So

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in law. There is no subparagraph (G).

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(v) APPLICABILITY.—This paragraph may not be
construed as having any applicability after fiscal year
2013.
(b) ALLOCATION OF ASSISTANCE BY STATES.—
(1) ALLOWANCES.—Prior to allocating assistance under this
subsection, a State shall consider the unmet needs of those
areas that have not received financial assistance under part A.
(2) PLANNING AND EVALUATIONS.—Subject to paragraph (4)
and except as provided in paragraph (5), a State may not use
more than 10 percent of amounts received under a grant
awarded under section 2611 for planning and evaluation activities.
(3) ADMINISTRATION.—
(A) IN GENERAL.—Subject to paragraph (4), and except
as provided in paragraph (5), a State may not use more
than 10 percent of amounts received under a grant awarded under section 2611 for administration.
(B) ALLOCATIONS.—In the case of entities and subcontractors to which a State allocates amounts received by
the State under a grant under section 2611, the State shall
ensure that, of the aggregate amount so allocated, the total
of the expenditures by such entities for administrative expenses does not exceed 10 percent (without regard to
whether particular entities expend more than 10 percent
for such expenses).
(C) ADMINISTRATIVE ACTIVITIES.—For the purposes of
subparagraph (A), amounts may be used for administrative
activities that include routine grant administration and
monitoring activities, including a clinical quality management program under subparagraph (E).
(D) SUBCONTRACTOR ADMINISTRATIVE COSTS.—For the
purposes of this paragraph, subcontractor administrative
activities include—
(i) usual and recognized overhead, including established indirect rates for agencies;
(ii) management oversight of specific programs
funded under this title; and
(iii) other types of program support such as quality assurance, quality control, and related activities.
(E) CLINICAL QUALITY MANAGEMENT.—
(i) REQUIREMENT.—Each State that receives a
grant under section 2611 shall provide for the establishment of a clinical quality management program to
assess the extent to which HIV health services provided to patients under the grant are consistent with
the most recent Public Health Service guidelines for
the treatment of HIV/AIDS and related opportunistic
infection, and as applicable, to develop strategies for
ensuring that such services are consistent with the
guidelines for improvement in the access to and quality of HIV health services.
(ii) USE OF FUNDS.—
(I) IN GENERAL.—From amounts received
under a grant awarded under section 2611 for a
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fiscal year, a State may use for activities associated with the clinical quality management program required in clause (i) not to exceed the lesser
of—
(aa) 5 percent of amounts received under
the grant; or
(bb) $3,000,000.
(II) RELATION TO LIMITATION ON ADMINISTRATIVE EXPENSES.—The costs of a clinical quality
management program under clause (i) may not be
considered administrative expenses for purposes
of the limitation established in subparagraph (A).
(4) LIMITATION ON USE OF FUNDS.—Except as provided in
paragraph (5), a State may not use more than a total of 15 percent of amounts received under a grant awarded under section
2611 for the purposes described in paragraphs (2) and (3).
(5) EXCEPTION.—With respect to a State that receives the
minimum allotment under subsection (a)(1) for a fiscal year,
such State, from the amounts received under a grant awarded
under section 2611 for such fiscal year for the activities described in paragraphs (2) and (3), may, notwithstanding paragraphs (2) through (4) 1, use not more than that amount required to support one full-time-equivalent employee.
(6) CONSTRUCTION.—A State may not use amounts received under a grant awarded under section 2611 to purchase
or improve land, or to purchase, construct, or permanently improve (other than minor remodeling) any building or other facility, or to make cash payments to intended recipients of
services.
(c) EXPEDITED DISTRIBUTION.—
(1) IN GENERAL.—Not less than 75 percent of the amounts
received under a grant awarded to a State under section 2611
shall be obligated to specific programs and projects and made
available for expenditure not later than—
(A) in the case of the first fiscal year for which
amounts are received, 150 days after the receipt of such
amounts by the State; and
(B) in the case of succeeding fiscal years, 120 days
after the receipt of such amounts by the State.
(2) PUBLIC COMMENT.—Within the time periods referred to
in paragraph (1), the State shall invite and receive public comment concerning methods for the utilization of such amounts.
(d) REALLOCATION.—Any portion of a grant made to a State
under section 2611 for a fiscal year that has not been obligated as
described in subsection (c) ceases to be available to the State and
shall be made available by the Secretary for grants under section
2620, in addition to amounts made available for such grants under
section 2623(b)(2).
1 Section 203(e)(5) of Public Law 109–415 (120 Stat. 2795) struck ‘‘paragraphs (3)’’ and all that
follows through ‘‘(5),’’ and inserted revised text. There were two references to ‘‘paragraphs (3)’’.
The amendment was executed to the first such reference to reflect the probable intent of Congress.

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Sec. 2620

SEC. 2619. ø300ff–29¿ TECHNICAL ASSISTANCE.

The Secretary shall provide technical assistance in administering and coordinating the activities authorized under section
2612, including technical assistance for the development and implementation of statewide coordinated statements of need.
SEC. 2620. ø300ff–29a¿ SUPPLEMENTAL GRANTS.
(a) IN GENERAL.—For the purpose of providing

services described in section 2612(a), the Secretary shall make grants to
States—
(1) whose applications under section 2617 have demonstrated the need in the State, on an objective and quantified
basis, for supplemental financial assistance to provide such
services; and
(2) that did not, for the most recent grant year pursuant
to section 2618(a)(1) or 2618(a)(2)(F)(i) for which data is available, have more than 5 percent of grant funds under such sections canceled, offset under section 2622(e), or covered by any
waivers under section 2622(c).
(b) DEMONSTRATED NEED.—The factors considered by the Secretary in determining whether an eligible area has a demonstrated
need for purposes of subsection (a)(1) may include any or all of the
following:
(1) The unmet need for such services, as determined under
section 2617(b).
(2) An increasing need for HIV/AIDS-related services, including relative rates of increase in the number of cases of
HIV/AIDS.
(3) The relative rates of increase in the number of cases
of HIV/AIDS within new or emerging subpopulations.
(4) The current prevalence of HIV/AIDS.
(5) Relevant factors related to the cost and complexity of
delivering health care to individuals with HIV/AIDS in the eligible area.
(6) The impact of co-morbid factors, including co-occurring
conditions, determined relevant by the Secretary.
(7) The prevalence of homelessness.
(8) The prevalence of individuals described under section
2602(b)(2)(M).
(9) The relevant factors that limit access to health care, including geographic variation, adequacy of health insurance coverage, and language barriers.
(10) The impact of a decline in the amount received pursuant to section 2618 on services available to all individuals with
HIV/AIDS identified and eligible under this title.
(c) PRIORITY IN MAKING GRANTS.—The Secretary shall provide
funds under this section to a State to address the decline in services related to the decline in the amounts received pursuant to section 2618 consistent with the grant award to the State for fiscal
year 2006, to the extent that the factor under subsection (b)(10) (relating to a decline in funding) applies to the State.
(d) REPORT ON THE AWARDING OF SUPPLEMENTAL FUNDS.—Not
later than 45 days after the awarding of supplemental funds under
this section, the Secretary shall submit to Congress a report conMarch 13, 2013

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cerning such funds. Such report shall include information detailing—
(1) the total amount of supplemental funds available under
this section for the year involved;
(2) the amount of supplemental funds used in accordance
with the hold harmless provisions of section 2618(a)(2);
(3) the amount of supplemental funds disbursed pursuant
to subsection (c);
(4) the disbursement of the remainder of the supplemental
funds after taking into account the uses described in paragraphs (2) and (3); and
(5) the rationale used for the amount of funds disbursed as
described under paragraphs (2), (3), and (4).
(e) CORE MEDICAL SERVICES.—The provisions of section 2612(b)
apply with respect to a grant under this section to the same extent
and in the same manner as such provisions apply with respect to
a grant made pursuant to section 2618(a)(1).
(f) APPLICABILITY OF GRANT AUTHORITY.—The authority to
make grants under this section applies beginning with the first fiscal year for which amounts are made available for such grants
under section 2623(b)(1).
SEC. 2621. ø300ff–30¿ EMERGING COMMUNITIES.
(a) IN GENERAL.—The Secretary shall

award supplemental
grants to States determined to be eligible under subsection (b) to
enable such States to provide comprehensive services of the type
described in section 2612(a) to supplement the services otherwise
provided by the State under a grant under this subpart in emerging communities within the State that are not eligible to receive
grants under part A.
(b) ELIGIBILITY.—To be eligible to receive a supplemental grant
under subsection (a), a State shall—
(1) be eligible to receive a grant under this subpart;
(2) demonstrate the existence in the State of an emerging
community as defined in subsection (d)(1);
(3) agree that the grant will be used to provide funds directly to emerging communities in the State, separately from
other funds under this title that are provided by the State to
such communities; and
(4) submit the information described in subsection (c).
(c) REPORTING REQUIREMENTS.—A State that desires a grant
under this section shall, as part of the State application submitted
under section 2617, submit a detailed description of the manner in
which the State will use amounts received under the grant and of
the severity of need. Such description shall include—
(1) a report concerning the dissemination of supplemental
funds under this section and the plan for the utilization of such
funds in the emerging community;
(2) a demonstration of the existing commitment of local resources, both financial and in-kind;
(3) a demonstration that the State will maintain HIV-related activities at a level that is equal to not less than the level
of such activities in the State for the 1-year period preceding
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Sec. 2622

the fiscal year for which the State is applying to receive a
grant under section 2611;
(4) a demonstration of the ability of the State to utilize
such supplemental financial resources in a manner that is immediately responsive and cost effective;
(5) a demonstration that the resources will be allocated in
accordance with the local demographic incidence of AIDS including appropriate allocations for services for infants, children, women, and families with HIV/AIDS;
(6) a demonstration of the inclusiveness of the planning
process, with particular emphasis on affected communities and
individuals with HIV/AIDS; and
(7) a demonstration of the manner in which the proposed
services are consistent with local needs assessments and the
statewide coordinated statement of need.
(d) DEFINITIONS OF EMERGING COMMUNITY.—For purposes of
this section, the term ‘‘emerging community’’ means a metropolitan
area (as defined in section 2607) for which there has been reported
to and confirmed by the Director of the Centers for Disease Control
and Prevention a cumulative total of at least 500, but fewer than
1,000, cases of AIDS during the most recent period of 5 calendar
years for which such data are available.
(e) CONTINUED STATUS AS EMERGING COMMUNITY.—Notwithstanding any other provision of this section, a metropolitan area
that is an emerging community for a fiscal year continues to be an
emerging community until the metropolitan area fails, for three
consecutive fiscal years—
(1) to meet the requirements of subsection (d); and
(2) to have a cumulative total of 750 or more living cases
of AIDS (reported to and confirmed by the Director of the Centers for Disease Control and Prevention) as of December 31 of
the most recent calendar year for which such data is available.
(f) DISTRIBUTION.—The amount of a grant under subsection (a)
for a State for a fiscal year shall be an amount equal to the product
of—
(1) the amount available under section 2623(b)(1) for the
fiscal year; and
(2) a percentage equal to the ratio constituted by the number of living cases of HIV/AIDS in emerging communities in
the State to the sum of the respective numbers of such cases
in such communities for all States.
SEC. 2622. ø300ff–31a¿ TIMEFRAME FOR OBLIGATION AND EXPENDITURE OF GRANT FUNDS.
(a) OBLIGATION BY END OF GRANT YEAR.—Effective for fiscal

year 2007 and subsequent fiscal years, funds from a grant award
made to a State for a fiscal year pursuant to section 2618(a)(1) or
2618(a)(2)(F), or under section 2620 or 2621, are available for obligation by the State through the end of the one-year period beginning on the date in such fiscal year on which funds from the award
first become available to the State (referred to in this section as the
‘‘grant year for the award’’), except as provided in subsection (c)(1).
(b) SUPPLEMENTAL GRANTS; CANCELLATION OF UNOBLIGATED
BALANCE OF GRANT AWARD.—Effective for fiscal year 2007 and subsequent fiscal years, if a grant award made to a State for a fiscal
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year pursuant to section 2618(a)(2)(F)(ii), or under section 2620 or
2621, has an unobligated balance as of the end of the grant year
for the award—
(1) the Secretary shall cancel that unobligated balance of
the award, and shall require the State to return any amounts
from such balance that have been disbursed to the State; and
(2) the funds involved shall be made available by the Secretary as additional amounts for grants pursuant to section
2620 for the first fiscal year beginning after the fiscal year in
which the Secretary obtains the information necessary for determining that the balance is required under paragraph (1) to
be canceled, except that the availability of the funds for such
grants is subject to section 2618(a)(2)(H) as applied for such
year.
(c) FORMULA GRANTS; CANCELLATION OF UNOBLIGATED BALANCE OF GRANT AWARD; WAIVER PERMITTING CARRYOVER.—
(1) IN GENERAL.—Effective for fiscal year 2007 and subsequent fiscal years, if a grant award made to a State for a fiscal
year pursuant to section 2618(a)(1) or 2618(a)(2)(F)(i) has an
unobligated balance as of the end of the grant year for the
award, the Secretary shall cancel that unobligated balance of
the award, and shall require the State to return any amounts
from such balance that have been disbursed to the State, unless—
(A) before the end of the grant year, the State submits
to the Secretary a written application for a waiver of the
cancellation, which application includes a description of
the purposes for which the State intends to expend the
funds involved; and
(B) the Secretary approves the waiver.
(2) EXPENDITURE BY END OF CARRYOVER YEAR.—With respect to a waiver under paragraph (1) that is approved for a
balance that is unobligated as of the end of a grant year for
an award:
(A) The unobligated funds are available for expenditure by the State involved for the one-year period beginning upon the expiration of the grant year (referred to in
this section as the ‘‘carryover year’’).
(B) If the funds are not expended by the end of the
carryover year, the Secretary shall cancel that unexpended
balance of the award, and shall require the State to return
any amounts from such balance that have been disbursed
to the State.
(3) USE OF CANCELLED BALANCES.—In the case of any balance of a grant award that is cancelled under paragraph (1) or
(2)(B), the grant funds involved shall be made available by the
Secretary as additional amounts for grants under section 2620
for the first fiscal year beginning after the fiscal year in which
the Secretary obtains the information necessary for determining that the balance is required under such paragraph to
be canceled, except that the availability of the funds for such
grants is subject to section 2618(a)(2)(H) as applied for such
year.
(4) CORRESPONDING REDUCTION IN FUTURE GRANT.—
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(A) IN GENERAL.—In the case of a State for which a
balance from a grant award made pursuant to section
2618(a)(1) or 2618(a)(2)(F)(i) is unobligated as of the end
of the grant year for the award—
(i) the Secretary shall reduce, by the same amount
as such unobligated balance (less any amount of such
balance that is the subject of a waiver of cancellation
under paragraph (1)), the amount of the grant under
such section for the first fiscal year beginning after
the fiscal year in which the Secretary obtains the information necessary for determining that such balance
was unobligated as of the end of the grant year (which
requirement for a reduction applies without regard to
whether a waiver under paragraph (1) has been approved with respect to such balance); and
(ii) the grant funds involved in such reduction
shall be made available by the Secretary as additional
funds for grants under section 2620 for such first fiscal
year, subject to section 2618(a)(2)(H);
except that this subparagraph does not apply to the State
if the amount of the unobligated balance was 5 percent or
less.
(B) RELATION TO INCREASES IN GRANT.—A reduction
under subparagraph (A) for a State for a fiscal year may
not be taken into account in applying section 2618(a)(2)(H)
with respect to the State for the subsequent fiscal year.
(d) TREATMENT OF DRUG REBATES.—For purposes of this section, funds that are drug rebates referred to in section 2616(g) may
not be considered part of any grant award referred to in subsection
(a). If an expenditure of ADAP rebate funds would trigger a penalty under this section or a higher penalty than would otherwise
have applied, the State may request that for purposes of this section, the Secretary deem the State’s unobligated balance to be reduced by the amount of rebate funds in the proposed expenditure.
Notwithstanding 2618(a)(2)(F), any unobligated amount under section 2618(a)(2)(F)(ii)(V) that is returned to the Secretary for reallocation shall be used by the Secretary for—
(1) the ADAP supplemental program if the Secretary determines appropriate; or
(2) for additional amounts for grants pursuant to section
2620.
(e) AUTHORITY REGARDING ADMINISTRATION OF PROVISIONS.—
In administering subsections (b) and (c) with respect to the unobligated balance of a State, the Secretary may elect to reduce the
amount of future grants to the State under section 2618, 2620, or
2621, as applicable, by the amount of any such unobligated balance
in lieu of cancelling such amount as provided for in subsection (b)
or (c)(1). In such case, the Secretary may permit the State to use
such unobligated balance for purposes of any such future grant. An
amount equal to such reduction shall be available for use as additional amounts for grants pursuant to section 2620, subject to section 2618(a)(2)(H). Nothing in this paragraph shall be construed to
affect the authority of the Secretary under subsections (b) and (c),
including the authority to grant waivers under subsection (c)(1).
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The reduction in future grants authorized under this subsection
shall be notwithstanding the penalty required under subsection
(c)(4) with respect to unobligated funds.
SEC. 2623. AUTHORIZATION OF APPROPRIATIONS.
(a) IN GENERAL.—For the purpose of carrying

out this subpart,
there are authorized to be appropriated $1,195,500,000 for fiscal
year 2007, $1,239,500,000 for fiscal year 2008, $1,285,200,000 for
fiscal year 2009, $1,349,460,000 for fiscal year 2010, $1,416,933,000
for fiscal year 2011, $1,487,780,000 for fiscal year 2012, and
$1,562,169,000 for fiscal year 2013. Amounts appropriated under
the preceding sentence for a fiscal year are available for obligation
by the Secretary until the end of the second succeeding fiscal year.
(b) RESERVATION OF AMOUNTS.—
(1) EMERGING COMMUNITIES.—Of the amount appropriated
under subsection (a) for a fiscal year, the Secretary shall reserve $5,000,000 for grants under section 2621.
(2) SUPPLEMENTAL GRANTS.—
(A) IN GENERAL.—Of the amount appropriated under
subsection (a) for a fiscal year in excess of the 2006 adjusted amount, the Secretary shall reserve 1⁄3 for grants
under section 2620, except that the availability of the reserved funds for such grants is subject to section
2618(a)(2)(H) as applied for such year, and except that any
amount appropriated exclusively for carrying out section
2616 (and, accordingly, distributed under section
2618(a)(2)(F)) is not subject to this subparagraph.
(B) 2006 ADJUSTED AMOUNT.—For purposes of subparagraph (A), the term ‘‘2006 adjusted amount’’ means
the amount appropriated for fiscal year 2006 under section
2677(b) (as such section was in effect for such fiscal year),
excluding any amount appropriated for such year exclusively for carrying out section 2616 (and, accordingly, distributed under section 2618(a)(2)(I), as so in effect).

Subpart II—Provisions Concerning Pregnancy
and Perinatal Transmission of HIV
SEC. 2625. ø300ff–33¿ EARLY DIAGNOSIS GRANT PROGRAM.
(a) IN GENERAL.—In the case of States whose laws

or regulations are in accordance with subsection (b), the Secretary, acting
through the Centers for Disease Control and Prevention, shall
make grants to such States for the purposes described in subsection (c).
(b) DESCRIPTION OF COMPLIANT STATES.—For purposes of subsection (a), the laws or regulations of a State are in accordance
with this subsection if, under such laws or regulations (including
programs carried out pursuant to the discretion of State officials),
both of the policies described in paragraph (1) are in effect, or both
of the policies described in paragraph (2) are in effect, as follows:
(1)(A) Voluntary opt-out testing of pregnant women.
(B) Universal testing of newborns.
(2)(A) Voluntary opt-out testing of clients at sexually
transmitted disease clinics.
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(B) Voluntary opt-out testing of clients at substance abuse
treatment centers.
The Secretary shall periodically ensure that the applicable policies
are being carried out and recertify compliance.
(c) USE OF FUNDS.—A State may use funds provided under
subsection (a) for HIV/AIDS testing (including rapid testing), prevention counseling, treatment of newborns exposed to HIV/AIDS,
treatment of mothers infected with HIV/AIDS, and costs associated
with linking those diagnosed with HIV/AIDS to care and treatment
for HIV/AIDS.
(d) APPLICATION.—A State that is eligible for the grant under
subsection (a) shall submit an application to the Secretary, in such
form, in such manner, and containing such information as the Secretary may require.
(e) LIMITATION ON AMOUNT OF GRANT.—A grant under subsection (a) to a State for a fiscal year may not be made in an
amount exceeding $10,000,000.
(f) RULE OF CONSTRUCTION.—Nothing in this section shall be
construed to pre-empt State laws regarding HIV/AIDS counseling
and testing.
(g) DEFINITIONS.—In this section:
(1) The term ‘‘voluntary opt-out testing’’ means HIV/AIDS
testing—
(A) that is administered to an individual seeking other
health care services; and
(B) in which—
(i) pre-test counseling is not required but the individual is informed that the individual will receive an
HIV/AIDS test and the individual may opt out of such
testing; and
(ii) for those individuals with a positive test result, post-test counseling (including referrals for care)
is provided and confidentiality is protected.
(2) The term ‘‘universal testing of newborns’’ means HIV/
AIDS testing that is administered within 48 hours of delivery
to—
(A) all infants born in the State; or
(B) all infants born in the State whose mother’s HIV/
AIDS status is unknown at the time of delivery.
(h) AUTHORIZATION OF APPROPRIATIONS.—Of the funds appropriated annually to the Centers for Disease Control and Prevention
for HIV/AIDS prevention activities, $30,000,000 shall be made
available for each of the fiscal years 2007 through 2009 for grants
under subsection (a), of which $20,000,000 shall be made available
for grants to States with the policies described in subsection (b)(1),
and $10,000,000 shall be made available for grants to States with
the policies described in subsection (b)(2). Funds provided under
this section are available until expended.
SEC. 2626.

ø300ff–34¿ PERINATAL TRANSMISSION OF HIV DISEASE;
CONTINGENT REQUIREMENT REGARDING STATE GRANTS
UNDER THIS PART.
ANNUAL DETERMINATION OF REPORTED CASES.—A State

(a)
shall annually determine the rate of reported cases of AIDS as a
result of perinatal transmission among residents of the State.
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(b) CAUSES OF PERINATAL TRANSMISSION.—In determining the
rate under subsection (a), a State shall also determine the possible
causes of perinatal transmission. Such causes may include—
(1) the inadequate provision within the State of prenatal
counseling and testing in accordance with the guidelines issued
by the Centers for Disease Control and Prevention;
(2) the inadequate provision or utilization within the State
of appropriate therapy or failure of such therapy to reduce
perinatal transmission of HIV, including—
(A) that therapy is not available, accessible or offered
to mothers; or
(B) that available therapy is offered but not accepted
by mothers; or
(3) other factors (which may include the lack of prenatal
care) determined relevant by the State.
(c) CDC REPORTING SYSTEM.—Not later than 4 months after
the date of enactment of this subpart, the Director of the Centers
for Disease Control and Prevention shall develop and implement a
system to be used by States to comply with the requirements of
subsections (a) and (b). The Director shall issue guidelines to ensure that the data collected is statistically valid.
SEC. 2627. ø300ff–37¿ STATE HIV TESTING PROGRAMS ESTABLISHED
PRIOR TO OR AFTER ENACTMENT.

Nothing in this subpart shall be construed to disqualify a State
from receiving grants under this title if such State has established
at any time prior to or after the date of enactment of this subpart
a program of mandatory HIV testing.
SEC. 2628. ø300ff–37a¿ RECOMMENDATIONS FOR REDUCING INCIDENCE OF PERINATAL TRANSMISSION.
(a) STUDY BY INSTITUTE OF MEDICINE.—
(1) IN GENERAL.—The Secretary shall request the Institute

of Medicine to enter into an agreement with the Secretary
under which such Institute conducts a study to provide the following:
(A) For the most recent fiscal year for which the information is available, a determination of the number of newborn infants with HIV born in the United States with respect to whom the attending obstetrician for the birth did
not know the HIV status of the mother.
(B) A determination for each State of any barriers, including legal barriers, that prevent or discourage an obstetrician from making it a routine practice to offer pregnant
women an HIV test and a routine practice to test newborn
infants for HIV/AIDS in circumstances in which the obstetrician does not know the HIV status of the mother of the
infant.
(C) Recommendations for each State for reducing the
incidence of cases of the perinatal transmission of HIV, including recommendations on removing the barriers identified under subparagraph (B).
If such Institute declines to conduct the study, the Secretary
shall enter into an agreement with another appropriate public
or nonprofit private entity to conduct the study.
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Sec. 2631

(2) REPORT.—The Secretary shall ensure that, not later
than 18 months after the effective date of this section, the
study required in paragraph (1) is completed and a report describing the findings made in the study is submitted to the appropriate committees of the Congress, the Secretary, and the
chief public health official of each of the States.
(b) PROGRESS TOWARD RECOMMENDATIONS.—In fiscal year
2004, the Secretary shall collect information from the States describing the actions taken by the States toward meeting the recommendations specified for the States under subsection (a)(1)(C).
(c) SUBMISSION OF REPORTS TO CONGRESS.—The Secretary
shall submit to the appropriate committees of the Congress reports
describing the information collected under subsection (b).

Subpart III—Certain Partner Notification
Programs
SEC. 2631. ø300ff–38¿ GRANTS FOR PARTNER NOTIFICATION PROGRAMS.
(a) IN GENERAL.—In the case of States whose laws or regula-

tions are in accordance with subsection (b), the Secretary, subject
to subsection (c)(2), may make grants to the States for carrying out
programs to provide partner counseling and referral services.
(b) DESCRIPTION OF COMPLIANT STATE PROGRAMS.—For purposes of subsection (a), the laws or regulations of a State are in accordance with this subsection if under such laws or regulations (including programs carried out pursuant to the discretion of State officials) the following policies are in effect:
(1) The State requires that the public health officer of the
State carry out a program of partner notification to inform
partners of individuals with HIV/AIDS that the partners may
have been exposed to the disease.
(2)(A) In the case of a health entity that provides for the
performance on an individual of a test for HIV/AIDS, or that
treats the individual for the disease, the State requires, subject
to subparagraph (B), that the entity confidentially report the
positive test results to the State public health officer in a manner recommended and approved by the Director of the Centers
for Disease Control and Prevention, together with such additional information as may be necessary for carrying out such
program.
(B) The State may provide that the requirement of subparagraph (A) does not apply to the testing of an individual for
HIV/AIDS if the individual underwent the testing through a
program designed to perform the test and provide the results
to the individual without the individual disclosing his or her
identity to the program. This subparagraph may not be construed as affecting the requirement of subparagraph (A) with
respect to a health entity that treats an individual for HIV/
AIDS.
(3) The program under paragraph (1) is carried out in accordance with the following:
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(A) Partners are provided with an appropriate opportunity to learn that the partners have been exposed to
HIV/AIDS, subject to subparagraph (B).
(B) The State does not inform partners of the identity
of the infected individuals involved.
(C) Counseling and testing for HIV/AIDS are made
available to the partners and to infected individuals, and
such counseling includes information on modes of transmission for the disease, including information on prenatal
and perinatal transmission and preventing transmission.
(D) Counseling of infected individuals and their partners includes the provision of information regarding therapeutic measures for preventing and treating the deterioration of the immune system and conditions arising from the
disease, and the provision of other prevention-related information.
(E) Referrals for appropriate services are provided to
partners and infected individuals, including referrals for
support services and legal aid.
(F) Notifications under subparagraph (A) are provided
in person, unless doing so is an unreasonable burden on
the State.
(G) There is no criminal or civil penalty on, or civil liability for, an infected individual if the individual chooses
not to identify the partners of the individual, or the individual does not otherwise cooperate with such program.
(H) The failure of the State to notify partners is not
a basis for the civil liability of any health entity who under
the program reported to the State the identity of the infected individual involved.
(I) The State provides that the provisions of the program may not be construed as prohibiting the State from
providing a notification under subparagraph (A) without
the consent of the infected individual involved.
(4) The State annually reports to the Director of the Centers for Disease Control and Prevention the number of individuals from whom the names of partners have been sought under
the program under paragraph (1), the number of such individuals who provided the names of partners, and the number of
partners so named who were notified under the program.
(5) The State cooperates with such Director in carrying out
a national program of partner notification, including the sharing of information between the public health officers of the
States.
(c) REPORTING SYSTEM FOR CASES OF HIV DISEASE; PREFERENCE IN MAKING GRANTS.—In making grants under subsection
(a), the Secretary shall give preference to States whose reporting
systems for cases of HIV/AIDS produce data on such cases that is
sufficiently accurate and reliable for use for purposes of section
2618(a)(2)(D)(i).
(d) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of
carrying out this section, there is authorized to be appropriated
$10,000,000 for each of the fiscal years 2007 through 2009.
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Sec. 2651

PART C—EARLY INTERVENTION SERVICES
Subpart I—Categorical Grants
SEC. 2651. ø300ff–51¿ ESTABLISHMENT OF A PROGRAM.
(a) IN GENERAL.—For the purposes described in

subsection (b),
the Secretary, acting through the Administrator of the Health Resources and Services Administration, may make grants to public
and nonprofit private entities specified in section 2652(a).
(b) REQUIREMENTS.—
(1) IN GENERAL.—The Secretary may not make a grant
under subsection (a) unless the applicant for the grant agrees
to expend the grant only for—
(A) core medical services described in subsection (c);
(B) support services described in subsection (d); and
(C) administrative expenses as described in section
2664(g)(3).
(2) EARLY INTERVENTION SERVICES.—An applicant for a
grant under subsection (a) shall expend not less than 50 percent of the amount received under the grant for the services
described in subparagraphs (B) through (E) of subsection (e)(1)
for individuals with HIV/AIDS.
(c) REQUIRED FUNDING FOR CORE MEDICAL SERVICES.—
(1) IN GENERAL.—With respect to a grant under subsection
(a) to an applicant for a fiscal year, the applicant shall, of the
portion of the grant remaining after reserving amounts for purposes of paragraphs (3) and (5) of section 2664(g), use not less
than 75 percent to provide core medical services that are needed in the area involved for individuals with HIV/AIDS who are
identified and eligible under this title (including services regarding the co-occurring conditions of the individuals).
(2) WAIVER.—
(A) The Secretary shall waive the application of paragraph (1) with respect to an applicant for a grant if the
Secretary determines that, within the service area of the
applicant—
(i) there are no waiting lists for AIDS Drug Assistance Program services under section 2616; and
(ii) core medical services are available to all individuals with HIV/AIDS identified and eligible under
this title.
(B) NOTIFICATION OF WAIVER STATUS.—When informing an applicant that a grant under subsection (a) is being
made for a fiscal year, the Secretary shall inform the applicant whether a waiver under subparagraph (A) is in effect for the fiscal year.
(3) CORE MEDICAL SERVICES.—For purposes of this subsection, the term ‘‘core medical services’’, with respect to an individual with HIV/AIDS (including the co-occurring conditions
of the individual) means the following services:
(A) Outpatient and ambulatory health services.
(B) AIDS Drug Assistance Program treatments under
section 2616.
(C) AIDS pharmaceutical assistance.
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(D) Oral health care.
(E) Early intervention services described in subsection
(e).
(F) Health insurance premium and cost sharing assistance for low-income individuals in accordance with section
2615.
(G) Home health care.
(H) Medical nutrition therapy.
(I) Hospice services.
(J) Home and community-based health services as defined under section 2614(c).
(K) Mental health services.
(L) Substance abuse outpatient care.
(M) Medical case management, including treatment
adherence services.
(d) SUPPORT SERVICES.—
(1) IN GENERAL.—For purposes of this section, the term
‘‘support services’’ means services, subject to the approval of
the Secretary, that are needed for individuals with HIV/AIDS
to achieve their medical outcomes (such as respite care for persons caring for individuals with HIV/AIDS, outreach services,
medical transportation, linguistic services, and referrals for
health care and support services).
(2) DEFINITION OF MEDICAL OUTCOMES.—In this section,
the term ‘‘medical outcomes’’ means those outcomes affecting
the HIV-related clinical status of an individual with HIV/AIDS.
(e) SPECIFICATION OF EARLY INTERVENTION SERVICES.—
(1) IN GENERAL.—The early intervention services referred
to in this section are—
(A) counseling individuals with respect to HIV/AIDS in
accordance with section 2662;
(B) testing individuals with respect to HIV/AIDS, including tests to confirm the presence of the disease, tests
to diagnose the extent of the deficiency in the immune system, and tests to provide information on appropriate
therapeutic measures for preventing and treating the deterioration of the immune system and for preventing and
treating conditions arising from HIV/AIDS;
(C) referrals described in paragraph (2);
(D) other clinical and diagnostic services regarding
HIV/AIDS, and periodic medical evaluations of individuals
with HIV/AIDS; and
(E) providing the therapeutic measures described in
subparagraph (B).
(2) REFERRALS.—The services referred to in paragraph
(1)(C) are referrals of individuals with HIV/AIDS to appropriate providers of health and support services, including, as
appropriate—
(A) to entities receiving amounts under part A or B for
the provision of such services;
(B) to biomedical research facilities of institutions of
higher education that offer experimental treatment for
such disease, or to community-based organizations or other
entities that provide such treatment; or
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Sec. 2652

(C) to grantees under section 2671, in the case of a
pregnant woman.
(3) REQUIREMENT OF AVAILABILITY OF ALL EARLY INTERVENTION SERVICES THROUGH EACH GRANTEE.—
(A) IN GENERAL.—The Secretary may not make a
grant under subsection (a) unless the applicant for the
grant agrees that each of the early intervention services
specified in paragraph (2) will be available through the
grantee. With respect to compliance with such agreement,
such a grantee may expend the grant to provide the early
intervention services directly, and may expend the grant to
enter into agreements with public or nonprofit private entities, or private for-profit entities if such entities are the
only available provider of quality HIV care in the area,
under which the entities provide the services.
(B) OTHER REQUIREMENTS.—Grantees described in—
(i) subparagraphs (A), (D), (E), and (F) of section
2652(a)(1) shall use not less than 50 percent of the
amount of such a grant to provide the services described in subparagraphs (A), (B), (D), and (E) of paragraph (1) directly and on-site or at sites where other
primary care services are rendered; and
(ii) subparagraphs (B) and (C) of section 2652(a)(1)
shall ensure the availability of early intervention services through a system of linkages to community-based
primary care providers, and to establish mechanisms
for the referrals described in paragraph (1)(C), and for
follow-up concerning such referrals.
SEC. 2652. ø300ff–52¿ MINIMUM QUALIFICATIONS OF GRANTEES.
(a) ELIGIBLE ENTITIES.—
(1) IN GENERAL.—The entities referred to in section 2651(a)

are public entities and nonprofit private entities that are—
(A) federally-qualified health centers under section
1905(l)(2)(B) of the Social Security Act;
(B) grantees under section 1001 (regarding family
planning) other than States;
(C) comprehensive hemophilia diagnostic and treatment centers;
(D) rural health clinics;
(E) health facilities operated by or pursuant to a contract with the Indian Health Service;
(F) community-based organizations, clinics, hospitals
and other health facilities that provide early intervention
services to those persons infected with HIV/AIDS through
intravenous drug use; or
(G) nonprofit private entities that provide comprehensive primary care services to populations at risk of HIV/
AIDS, including faith-based and community-based organizations.
(2) UNDERSERVED POPULATIONS.—Entities described in
paragraph (1) shall serve underserved populations which may
include minority populations and Native American populations,
ex-offenders, individuals with comorbidities including hepatitis
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B or C, mental illness, or substance abuse, low-income populations, inner city populations, and rural populations. 1;
(b) STATUS AS MEDICAID PROVIDER.—
(1) IN GENERAL.—Subject to paragraph (2), the Secretary
may not make a grant under section 2651 for the provision of
services described in subsection (b) of such section in a State
unless, in the case of any such service that is available pursuant to the State plan approved under title XIX of the Social Security Act for the State—
(A) the applicant for the grant will provide the service
directly, and the applicant has entered into a participation
agreement under the State plan and is qualified to receive
payments under such plan; or
(B) the applicant for the grant will enter into an
agreement with a public or nonprofit private entity, or a
private for-profit entity if such entity is the only available
provider of quality HIV care in the area, under which the
entity will provide the service, and the entity has entered
into such a participation agreement and is qualified to receive such payments.
(2) WAIVER REGARDING CERTAIN SECONDARY AGREEMENTS.—
(A) In the case of an entity making an agreement pursuant to paragraph (1)(B) regarding the provision of services, the requirement established in such paragraph regarding a participation agreement shall be waived by the
Secretary if the entity does not, in providing health care
services, impose a charge or accept reimbursement available from any third-party payor, including reimbursement
under any insurance policy or under any Federal or State
health benefits program.
(B) A determination by the Secretary of whether an
entity referred to in subparagraph (A) meets the criteria
for a waiver under such subparagraph shall be made without regard to whether the entity accepts voluntary donations regarding the provision of services to the public.
SEC. 2653. ø300ff–53¿ PREFERENCES IN MAKING GRANTS.
(a) IN GENERAL.—In making grants under section

2651, the
Secretary shall give preference to any qualified applicant experiencing an increase in the burden of providing services regarding
HIV/AIDS, as indicated by the factors specified in subsection (b).
(b) SPECIFICATION OF FACTORS.—
(1) IN GENERAL.—In the case of the geographic area with
respect to which the entity involved is applying for a grant
under section 2651, the factors referred to in subsection (a), as
determined for the period specified in paragraph (2), are—
(A) the number of cases of HIV/AIDS;
(B) the rate of increase in such cases;
(C) the lack of availability of early intervention services;
(D) the number of other cases of sexually transmitted
diseases, and the number of cases of tuberculosis and of
1 See

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footnote for section 217(a).

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drug abuse and the number of cases of individuals co-infected with HIV/AIDS and hepatitis B or C;
(E) the rate of increase in each of the cases specified
in subparagraph (D);
(F) the lack of availability of primary health services
from providers other than such applicant; and
(G) the distance between such area and the nearest
community that has an adequate level of availability of appropriate HIV-related services, and the length of time required to travel such distance.
(2) RELEVANT PERIOD OF TIME.—The period referred to in
paragraph (1) is the 2-year period preceding the fiscal year for
which the entity involved is applying to receive a grant under
section 2651.
(c) EQUITABLE ALLOCATIONS.—In providing preferences for purposes of subsection (b), the Secretary shall equitably allocate the
preferences among urban and rural areas.
(d) CERTAIN AREAS.—Of the applicants who qualify for preference under this section—
(1) the Secretary shall give preference to applicants that
will expend the grant under section 2651 to provide early
intervention under such section in rural areas; and
(2) the Secretary shall give preference to areas that are
underserved with respect to such services.
SEC. 2654. ø300ff–54¿ MISCELLANEOUS PROVISIONS.
(a) SERVICES FOR INDIVIDUALS WITH HEMOPHILIA.—In

making
grants under section 2651, the Secretary shall ensure that any
such grants made regarding the provision of early intervention
services to individuals with hemophilia are made through the network of comprehensive hemophilia diagnostic and treatment centers.
(b) TECHNICAL ASSISTANCE.—The Secretary may, directly or
through grants or contracts, provide technical assistance to nonprofit private entities regarding the process of submitting to the
Secretary applications for grants under section 2651, and may provide technical assistance with respect to the planning, development, and operation of any program or service carried out pursuant
to such section.
(c) PLANNING AND DEVELOPMENT GRANTS.—
(1) IN GENERAL.—The Secretary may provide planning
grants to public and nonprofit private entities for purposes of—
(A) enabling such entities to provide early intervention
services; and
(B) assisting the entities in expanding their capacity
to provide HIV/AIDS-related health services, including
early intervention services, in low-income communities and
affected subpopulations that are underserved with respect
to such services (subject to the condition that a grant pursuant to this subparagraph may not be expended to purchase or improve land, or to purchase, construct, or permanently improve, other than minor remodeling, any building
or other facility).
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(2) REQUIREMENT.—The Secretary may only award a grant
to an entity under paragraph (1) if the Secretary determines
that the entity will use such grant to assist the entity in qualifying for a grant under section 2651.
(3) PREFERENCE.—In awarding grants under paragraph
(1), the Secretary shall give preference to entities that provide
primary care services in rural areas or to underserved populations.
(4) AMOUNT AND DURATION OF GRANTS.—
(A) EARLY INTERVENTION SERVICES.—A grant under
paragraph (1)(A) may be made in an amount not to exceed
$50,000.
(B) CAPACITY DEVELOPMENT.—
(i) AMOUNT.—A grant under paragraph (1)(B) may
be made in an amount not to exceed $150,000.
(ii) DURATION.—The total duration of a grant
under paragraph (1)(B), including any renewal, may
not exceed 3 years.
(5) LIMITATION.—Not to exceed 5 percent of the amount
appropriated for a fiscal year under section 2655 may be used
to carry out this section.
SEC. 2655. ø300ff–55¿ AUTHORIZATION OF APPROPRIATIONS.

For the purpose of making grants under section 2651, there
are authorized to be appropriated, $218,600,000 for fiscal year
2007, $226,700,000 for fiscal year 2008, $235,100,000 for fiscal year
2009, $246,855,000 for fiscal year 2010, $259,198,000 for fiscal year
2011, $272,158,000 for fiscal year 2012, and $285,766,000 for fiscal
year 2013.
Subpart II—General Provisions
SEC. 2661. ø300ff–61¿ CONFIDENTIALITY AND INFORMED CONSENT.
(a) CONFIDENTIALITY.—The Secretary may not make a grant

under this part unless, in the case of any entity applying for a
grant under section 2651, the entity agrees to ensure that information regarding the receipt of early intervention services pursuant to
the grant is maintained confidentially in a manner not inconsistent
with applicable law.
(b) INFORMED CONSENT.—The Secretary may not make a grant
under this part unless the applicant for the grant agrees that, in
testing an individual for HIV/AIDS, the applicant will test an individual only after the individual confirms that the decision of the individual with respect to undergoing such testing is voluntarily
made.
SEC. 2662. ø300ff–62¿ PROVISION OF CERTAIN COUNSELING SERVICES.
(a) COUNSELING OF INDIVIDUALS WITH NEGATIVE TEST RESULTS.—The Secretary may not make a grant under this part un-

less the applicant for the grant agrees that, if the results of testing
conducted for HIV/AIDS indicate that an individual does not have
such condition, the applicant will provide the individual information, including—
(1) measures for prevention of, exposure to, and transmission of HIV/AIDS, hepatitis B, hepatitis C, and other sexually transmitted diseases;
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(2) the accuracy and reliability of results of testing for
HIV/AIDS, hepatitis B, and hepatitis C;
(3) the significance of the results of such testing, including
the potential for developing AIDS, hepatitis B, or hepatitis C;
(4) the appropriateness of further counseling, testing, and
education of the individual regarding HIV/AIDS and other sexually transmitted diseases;
(5) if diagnosed with chronic hepatitis B or hepatitis C coinfection, the potential of developing hepatitis-related liver disease and its impact on HIV/AIDS; and
(6) information regarding the availability of hepatitis B
vaccine and information about hepatitis treatments.
(b) COUNSELING OF INDIVIDUALS WITH POSITIVE TEST RESULTS.—The Secretary may not make a grant under this part unless the applicant for the grant agrees that, if the results of testing
for HIV/AIDS indicate that the individual has such condition, the
applicant will provide to the individual appropriate counseling regarding the condition, including—
(1) information regarding—
(A) measures for prevention of, exposure to, and transmission of HIV/AIDS, hepatitis B, and hepatitis C;
(B) the accuracy and reliability of results of testing for
HIV/AIDS, hepatitis B, and hepatitis C; and
(C) the significance of the results of such testing, including the potential for developing AIDS, hepatitis B, or
hepatitis C;
(2) reviewing the appropriateness of further counseling,
testing, and education of the individual regarding HIV/AIDS
and other sexually transmitted diseases; and
(3) providing counseling—
(A) on the availability, through the applicant, of early
intervention services;
(B) on the availability in the geographic area of appropriate health care, mental health care, and social and support services, including providing referrals for such services, as appropriate;
(C)(i) that explains the benefits of locating and counseling any individual by whom the infected individual may
have been exposed to HIV/AIDS, hepatitis B, or hepatitis
C and any individual whom the infected individual may
have exposed to HIV/AIDS, hepatitis B, or hepatitis C; and
(ii) that emphasizes it is the duty of infected individuals to disclose their infected status to their sexual partners and their partners in the sharing of hypodermic needles; that provides advice to infected individuals on the
manner in which such disclosures can be made; and that
emphasizes that it is the continuing duty of the individuals to avoid any behaviors that will expose others to HIV/
AIDS, hepatitis B, or hepatitis C; and
(D) on the availability of the services of public health
authorities with respect to locating and counseling any individual described in subparagraph (C);
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(4) if diagnosed with chronic hepatitis B or hepatitis C coinfection, the potential of developing hepatitis-related liver disease and its impact on HIV/AIDS; and
(5) information regarding the availability of hepatitis B
vaccine.
(c) ADDITIONAL REQUIREMENTS REGARDING APPROPRIATE COUNSELING.—The Secretary may not make a grant under this part unless the applicant for the grant agrees that, in counseling individuals with respect to HIV/AIDS, the applicant will ensure that the
counseling is provided under conditions appropriate to the needs of
the individuals.
(d) COUNSELING OF EMERGENCY RESPONSE EMPLOYEES.—The
Secretary may not make a grant under this part to a State unless
the State agrees that, in counseling individuals with respect to
HIV/AIDS, the State will ensure that, in the case of emergency response employees, the counseling is provided to such employees
under conditions appropriate to the needs of the employees regarding the counseling.
(e) RULE OF CONSTRUCTION REGARDING COUNSELING WITHOUT
TESTING.—Agreements made pursuant to this section may not be
construed to prohibit any grantee under this part from expending
the grant for the purpose of providing counseling services described
in this section to an individual who does not undergo testing for
HIV/AIDS as a result of the grantee or the individual determining
that such testing of the individual is not appropriate.
SEC. 2663. ø300ff–63¿ APPLICABILITY OF REQUIREMENTS REGARDING
CONFIDENTIALITY, INFORMED CONSENT, AND COUNSELING.

The Secretary may not make a grant under this part unless
the applicant for the grant agrees that, with respect to testing for
HIV/AIDS, any such testing carried out by the applicant with funds
appropriated through this Act will be carried out in accordance
with conditions described in sections 2661 and 2662.
SEC. 2664. ø300ff–64¿ ADDITIONAL REQUIRED AGREEMENTS.
(a) REPORTS TO SECRETARY.—The Secretary may not

make a
grant under this part unless—
(1) the applicant submits to the Secretary—
(A) a specification of the expenditures made by the applicant for early intervention services for the fiscal year
preceding the fiscal year for which the applicant is applying to receive the grant;
(B) an estimate of the number of individuals to whom
the applicant has provided such services for such fiscal
year;
(C) information regarding how the expected expenditures of the grant are related to the planning process for
localities funded under part A (including the planning
process described in section 2602) and for States funded
under part B (including the planning process described in
section 2617(b)); and
(D) a specification of the expected expenditures and
how those expenditures will improve overall client outMarch 13, 2013

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comes, as described in the State plan under section
2617(b);
(2) the applicant agrees to submit to the Secretary a report
providing—
(A) the number of individuals to whom the applicant
provides early intervention services pursuant to the grant;
(B) epidemiological and demographic data on the population of such individuals;
(C) the extent to which the costs of HIV-related health
care for such individuals are paid by third-party payors;
(D) the average costs of providing each category of
early intervention service; and
(E) the aggregate amounts expended for each such category;
(3) the applicant agrees to provide additional documentation to the Secretary regarding the process used to obtain community input into the design and implementation of activities
related to such grant; and
(4) the applicant agrees to submit, every 2 years, to the
lead State agency under section 2617(b)(4) audits, consistent
with Office of Management and Budget circular A133, regarding funds expended in accordance with this title and shall include necessary client level data to complete unmet need calculations and Statewide coordinated statements of need process.
(b) PROVISION OF OPPORTUNITIES FOR ANONYMOUS COUNSELING
AND TESTING.—The Secretary may not make a grant under this
part unless the applicant for the grant agrees that, to the extent
permitted under State law, regulation or rule, the applicant will
offer substantial opportunities for an individual—
(1) to undergo counseling and testing regarding HIV/AIDS
without being required to provide any information relating to
the identity of the individual; and
(2) to undergo such counseling and testing through the use
of a pseudonym.
(c) PROHIBITION AGAINST REQUIRING TESTING AS CONDITION OF
RECEIVING OTHER HEALTH SERVICES.—The Secretary may not
make a grant under this part unless the applicant for the grant
agrees that, with respect to an individual seeking health services
from the applicant, the applicant will not require the individual to
undergo testing for HIV as a condition of receiving any health services unless such testing is medically indicated in the provision of
the health services sought by the individual.
(d) MAINTENANCE OF SUPPORT.—The Secretary may not make
a grant under this part unless the applicant for the grant agrees
to maintain the expenditures of the applicant for early intervention
services at a level equal to not less than the level of such expenditures maintained by the State for the fiscal year preceding the fiscal year for which the applicant is applying to receive the grant.
(e) REQUIREMENTS REGARDING IMPOSITION OF CHARGES FOR
SERVICES.—
(1) IN GENERAL.—The Secretary may not make a grant
under this part unless, subject to paragraph (5), the applicant
for the grant agrees that—
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(A) in the case of individuals with an income less than
or equal to 100 percent of the official poverty line, the applicant will not impose a charge on any such individual for
the provision of early intervention services under the
grant;
(B) in the case of individuals with an income greater
than 100 percent of the official poverty line, the applicant—
(i) will impose a charge on each such individual
for the provision of such services; and
(ii) will impose the charge according to a schedule
of charges that is made available to the public.
(2) LIMITATION ON CHARGES REGARDING INDIVIDUALS SUBJECT TO CHARGES.—With respect to the imposition of a charge
for purposes of paragraph (1)(B)(ii), the Secretary may not
make a grant under this part unless, subject to paragraph (5),
the applicant for the grant agrees that—
(A) in the case of individuals with an income greater
than 100 percent of the official poverty line and not exceeding 200 percent of such poverty line, the applicant will
not, for any calendar year, impose charges in an amount
exceeding 5 percent of the annual gross income of the individual involved;
(B) in the case of individuals with an income greater
than 200 percent of the official poverty line and not exceeding 300 percent of such poverty line, the applicant will
not, for any calendar year, impose charges in an amount
exceeding 7 percent of the annual gross income of the individual involved; and
(C) in the case of individuals with an income greater
than 300 percent of the official poverty line, the applicant
will not, for any calendar year, impose charges in an
amount exceeding 10 percent of the annual gross income
of the individual involved.
(3) ASSESSMENT OF CHARGE.—With respect to compliance
with the agreement made under paragraph (1), a grantee
under this part may, in the case of individuals subject to a
charge for purposes of such paragraph—
(A) assess the amount of the charge in the discretion
of the grantee, including imposing only a nominal charge
for the provision of services, subject to the provisions of
such paragraph regarding public schedules and of paragraph (2) regarding limitations on the maximum amount
of charges; and
(B) take into consideration the medical expenses of individuals in assessing the amount of the charge, subject to
such provisions.
(4) APPLICABILITY OF LIMITATION ON AMOUNT OF CHARGE.—
The Secretary may not make a grant under this part unless
the applicant for the grant agrees that the limitations established in paragraph (2) regarding the imposition of charges for
services applies to the annual aggregate of charges imposed for
such services, without regard to whether they are characterMarch 13, 2013

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ized as enrollment fees, premiums, deductibles, cost sharing,
copayments, coinsurance, or similar charges.
(5) WAIVER REGARDING CERTAIN SECONDARY AGREEMENTS.—The requirement established in paragraph (1)(B)(i)
shall be waived by the Secretary in the case of any entity for
whom the Secretary has granted a waiver under section
2652(b)(2).
(f) RELATIONSHIP TO ITEMS AND SERVICES UNDER OTHER PROGRAMS.—
(1) IN GENERAL.—The Secretary may not make a grant
under this part unless the applicant for the grant agrees that,
subject to paragraph (2), the grant will not be expended by the
applicant, or by any entity receiving amounts from the applicant for the provision of early intervention services, to make
payment for any such service to the extent that payment has
been made, or can reasonably be expected to be made, with respect to such service—
(A) under any State compensation program, under an
insurance policy, or under any Federal or State health
benefits program (except for a program administered by or
providing the services of the Indian Health Service); or
(B) by an entity that provides health services on a prepaid basis.
(2) APPLICABILITY TO CERTAIN SECONDARY AGREEMENTS
FOR PROVISION OF SERVICES.—An agreement made under paragraph (1) shall not apply in the case of an entity through
which a grantee under this part provides early intervention
services if the Secretary has provided a waiver under section
2652(b)(2) regarding the entity.
(g) ADMINISTRATION OF GRANT.—The Secretary may not make
a grant under this part unless the applicant for the grant agrees
that—
(1) the applicant will not expend amounts received pursuant to this part for any purpose other than the purposes described in the subpart under which the grant involved is made;
(2) the applicant will establish such procedures for fiscal
control and fund accounting as may be necessary to ensure
proper disbursement and accounting with respect to the grant;
(3) the applicant will not expend more than 10 percent of
the grant for administrative expenses with respect to the
grant, including planning and evaluation, except that the costs
of a clinical quality management program under paragraph (5)
may not be considered administrative expenses for purposes of
such limitation;
(4) the applicant will submit evidence that the proposed
program is consistent with the statewide coordinated statement of need and agree to participate in the ongoing revision
of such statement of need; and
(5) the applicant will provide for the establishment of a
clinical quality management program—
(A) to assess the extent to which medical services
funded under this title that are provided to patients are
consistent with the most recent Public Health Service
guidelines for the treatment of HIV/AIDS and related opMarch 13, 2013

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portunistic infections, and as applicable, to develop strategies for ensuring that such services are consistent with the
guidelines; and
(B) to ensure that improvements in the access to and
quality of HIV health services are addressed.
SEC. 2665. ø300ff–65¿ REQUIREMENT OF SUBMISSION OF APPLICATION
CONTAINING CERTAIN AGREEMENTS AND ASSURANCES.

The Secretary may not make a grant under this part unless—
(1) an application for the grant is submitted to the Secretary containing agreements and assurances in accordance
with this part and containing the information specified in section 2664(a)(1);
(2) with respect to such agreements, the application provides assurances of compliance satisfactory to the Secretary;
and
(3) the application otherwise is in such form, is made in
such manner, and contains such agreements, assurances, and
information as the Secretary determines to be necessary to
carry out this part.
SEC. 2666. ø300ff–66¿ PROVISION BY SECRETARY OF SUPPLIES AND
SERVICES IN LIEU OF GRANT FUNDS.
(a) IN GENERAL.—Upon the request of a grantee under this

part, the Secretary may, subject to subsection (b), provide supplies,
equipment, and services for the purpose of aiding the grantee in
providing early intervention services and, for such purpose, may
detail to the State any officer or employee of the Department of
Health and Human Services.
(b) LIMITATION.—With respect to a request described in subsection (a), the Secretary shall reduce the amount of payments
under the grant involved by an amount equal to the costs of detailing personnel and the fair market value of any supplies, equipment, or services provided by the Secretary. The Secretary shall,
for the payment of expenses incurred in complying with such request, expend the amounts withheld.
SEC. 2667. ø300ff–67¿ USE OF FUNDS.

Counseling programs carried out under this part—
(1) shall not be designed to promote or encourage, directly,
intravenous drug abuse or sexual activity, homosexual or heterosexual;
(2) shall be designed to reduce exposure to and transmission of HIV/AIDS by providing accurate information;
(3) shall provide information on the health risks of promiscuous sexual activity and intravenous drug abuse; amd
(4) shall provide information on the transmission and prevention of hepatitis A, B, and C, including education about the
availability of hepatitis A and B vaccines and assisting patients in identifying vaccination sites.

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PART D—WOMEN, INFANTS, CHILDREN, AND
YOUTH
SEC. 2671. ø300ff–71¿ GRANTS FOR COORDINATED SERVICES AND ACCESS TO RESEARCH FOR WOMEN, INFANTS, CHILDREN,
AND YOUTH.
(a) IN GENERAL.—The Secretary, acting through the Adminis-

trator of the Health Resources and Services Administration, shall
award grants to public and nonprofit private entities (including a
health facility operated by or pursuant to a contract with the Indian Health Service) for the purpose of providing family-centered
care involving outpatient or ambulatory care (directly or through
contracts or memoranda of understanding) for women, infants, children, and youth with HIV/AIDS.
(b) ADDITIONAL SERVICES FOR PATIENTS AND FAMILIES.—Funds
provided under grants awarded under subsection (a) may be used
for the following support services:
(1) Family-centered care including case management.
(2) Referrals for additional services including—
(A) referrals for inpatient hospital services, treatment
for substance abuse, and mental health services; and
(B) referrals for other social and support services, as
appropriate.
(3) Additional services necessary to enable the patient and
the family to participate in the program established by the applicant pursuant to such subsection including services designed
to recruit and retain youth with HIV.
(4) The provision of information and education on opportunities to participate in HIV/AIDS-related clinical research.
(c) COORDINATION WITH OTHER ENTITIES.—A grant awarded
under subsection (a) may be made only if the applicant provides an
agreement that includes the following:
(1) The applicant will coordinate activities under the grant
with other providers of health care services under this Act, and
under title V of the Social Security Act, including programs
promoting the reduction and elimination of risk of HIV/AIDS
for youth.
(2) The applicant will participate in the statewide coordinated statement of need under part B (where it has been initiated by the public health agency responsible for administering
grants under part B) and in revisions of such statement.
(3) The applicant will every 2 years submit to the lead
State agency under section 2617(b)(4) audits regarding funds
expended in accordance with this title and shall include necessary client-level data to complete unmet need calculations
and Statewide coordinated statements of need process.
(d) ADMINISTRATION; APPLICATION.—A grant may only be
awarded to an entity under subsection (a) if an application for the
grant is submitted to the Secretary and the application is in such
form, is made in such manner, and contains such agreements, assurances, and information as the Secretary determines to be necessary to carry out this section. Such application shall include the
following:
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1352

(1) Information regarding how the expected expenditures
of the grant are related to the planning process for localities
funded under part A (including the planning process outlined
in section 2602) and for States funded under part B (including
the planning process outlined in section 2617(b)).
(2) A specification of the expected expenditures and how
those expenditures will improve overall patient outcomes, as
outlined as part of the State plan (under section 2617(b)) or
through additional outcome measures.
(e) ANNUAL REVIEW OF PROGRAMS; EVALUATIONS.—
(1) REVIEW REGARDING ACCESS TO AND PARTICIPATION IN
PROGRAMS.—With respect to a grant under subsection (a) for
an entity for a fiscal year, the Secretary shall, not later than
180 days after the end of the fiscal year, provide for the conduct and completion of a review of the operation during the
year of the program carried out under such subsection by the
entity. The purpose of such review shall be the development of
recommendations, as appropriate, for improvements in the following:
(A) Procedures used by the entity to allocate opportunities and services under subsection (a) among patients of
the entity who are women, infants, children, or youth.
(B) Other procedures or policies of the entity regarding
the participation of such individuals in such program.
(2) EVALUATIONS.—— 1The Secretary shall, directly or
through contracts with public and private entities, provide for
evaluations of programs carried out pursuant to subsection (a).
(f) ADMINISTRATIVE EXPENSES.—
(1) LIMITATION.—A grantee may not use more than 10 percent of amounts received under a grant awarded under this
section for administrative expenses.
(2) CLINICAL QUALITY MANAGEMENT PROGRAM.—A grantee
under this section shall implement a clinical quality management program to assess the extent to which HIV health services provided to patients under the grant are consistent with
the most recent Public Health Service guidelines for the treatment of HIV/AIDS and related opportunistic infection, and as
applicable, to develop strategies for ensuring that such services
are consistent with the guidelines for improvement in the access to and quality of HIV health services.
(g) TRAINING AND TECHNICAL ASSISTANCE.—From the amounts
appropriated under subsection (j) for a fiscal year, the Secretary
may use not more than 5 percent to provide, directly or through
contracts with public and private entities (which may include
grantees under subsection (a)), training and technical assistance to
assist applicants and grantees under subsection (a) in complying
with the requirements of this section.
(h) DEFINITIONS.—In this section:
(1) ADMINISTRATIVE EXPENSES.—The term ‘‘administrative
expenses’’ means funds that are to be used by grantees for
grant management and monitoring activities, including costs
1 Dash

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related to any staff or activity unrelated to services or indirect
costs.
(2) INDIRECT COSTS.—The term ‘‘indirect costs’’ means costs
included in a Federally negotiated indirect rate.
(3) SERVICES.—The term ‘‘services’’ means—
(A) services that are provided to clients to meet the
goals and objectives of the program under this section, including the provision of professional, diagnostic, and therapeutic services by a primary care provider or a referral to
and provision of specialty care; and
(B) services that sustain program activity and contribute to or help improve services under subparagraph
(A).
(i) APPLICATION TO PRIMARY CARE SERVICES.—Nothing in this
part shall be construed as requiring funds under this part to be
used for primary care services when payments are available for
such services from other sources (including under titles XVIII, XIX,
and XXI of the Social Security Act).
(j) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of
carrying out this section, there are authorized to be appropriated,
$71,800,000 for each of the fiscal years 2007 through 2009,
$75,390,000 for fiscal year 2010, $79,160,000 for fiscal year 2011,
$83,117,000 for fiscal year 2012, and $87,273,000 for fiscal year
2013.

PART E—GENERAL PROVISIONS
SEC. 2681. ø300ff–81¿ COORDINATION.
(a) REQUIREMENT.—The Secretary

shall ensure that the Health
Resources and Services Administration, the Centers for Disease
Control and Prevention, the Substance Abuse and Mental Health
Services Administration, and the Centers for Medicare & Medicaid
Services coordinate the planning, funding, and implementation of
Federal HIV programs (including all minority AIDS initiatives of
the Public Health Service, including under section 2693) to enhance
the continuity of care and prevention services for individuals with
HIV/AIDS or those at risk of such disease. The Secretary shall consult with other Federal agencies, including the Department of Veterans Affairs, as needed and utilize planning information submitted to such agencies by the States and entities eligible for assistance under this title.
(b) REPORT.—The Secretary shall biennially prepare and submit to the appropriate committees of the Congress a report concerning the coordination efforts at the Federal, State, and local levels described in this section, including a description of Federal barriers to HIV program integration and a strategy for eliminating
such barriers and enhancing the continuity of care and prevention
services for individuals with HIV/AIDS or those at risk of such disease.
(c) INTEGRATION BY STATE.—As a condition of receipt of funds
under this title, a State shall provide assurances to the Secretary
that health support services funded under this title will be integrated with other such services, that programs will be coordinated
with other available programs (including Medicaid), and that the
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continuity of care and prevention services of individuals with HIV/
AIDS is enhanced.
(d) INTEGRATION BY LOCAL OR PRIVATE ENTITIES.—As a condition of receipt of funds under this title, a local government or private nonprofit entity shall provide assurances to the Secretary that
services funded under this title will be integrated with other such
services, that programs will be coordinated with other available
programs (including Medicaid), and that the continuity of care and
prevention services of individuals with HIV is enhanced.
SEC. 2682. ø300ff–82¿ AUDITS.
(a) IN GENERAL.—For

fiscal year 2009, and each subsequent
fiscal year, the Secretary may reduce the amounts of grants under
this title to a State or political subdivision of a State for a fiscal
year if, with respect to such grants for the second preceding fiscal
year, the State or subdivision fails to prepare audits in accordance
with the procedures of section 7502 of title 31, United States Code.
The Secretary shall annually select representative samples of such
audits, prepare summaries of the selected audits, and submit the
summaries to the Congress.
(b) POSTING ON THE INTERNET.—All audits that the Secretary
receives from the State lead agency under section 2617(b)(4) shall
be posted, in their entirety, on the Internet website of the Health
Resources and Services Administration.
SEC. 2683. ø300ff–83¿ PUBLIC HEALTH EMERGENCY.
(a) IN GENERAL.—In an emergency area and

during an emergency period, the Secretary shall have the authority to waive such
requirements of this title to improve the health and safety of those
receiving care under this title and the general public, except that
the Secretary may not expend more than 5 percent of the funds allocated under this title for sections 2620 and section 2603(b).
(b) EMERGENCY AREA AND EMERGENCY PERIOD.—In this section:
(1) EMERGENCY AREA.—The term ‘‘emergency area’’ means
a geographic area in which there exists—
(A) an emergency or disaster declared by the President
pursuant to the National Emergencies Act or the Robert T.
Stafford Disaster Relief and Emergency Assistance Act; or
(B) a public health emergency declared by the Secretary pursuant to section 319.
(2) EMERGENCY PERIOD.—The term ‘‘emergency period’’
means the period in which there exists—
(A) an emergency or disaster declared by the President
pursuant to the National Emergencies Act or the Robert T.
Stafford Disaster Relief and Emergency Assistance Act; or
(B) a public health emergency declared by the Secretary pursuant to section 319.
(c) UNOBLIGATED FUNDS.—If funds under a grant under this
section are not expended for an emergency in the fiscal year in
which the emergency is declared, such funds shall be returned to
the Secretary for reallocation under sections 2603(b) and 2620.
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SEC. 2684. ø300ff–84¿ PROHIBITION ON PROMOTION OF CERTAIN ACTIVITIES.

None of the funds appropriated under this title shall be used
to fund AIDS programs, or to develop materials, designed to promote or encourage, directly, intravenous drug use or sexual activity, whether homosexual or heterosexual. Funds authorized under
this title may be used to provide medical treatment and support
services for individuals with HIV.
SEC. 2685. ø300ff–85¿ PRIVACY PROTECTIONS.
(a) IN GENERAL.—The Secretary shall ensure

that any information submitted to, or collected by, the Secretary under this title excludes any personally identifiable information.
(b) DEFINITION.—In this section, the term ‘‘personally identifiable information’’ has the meaning given such term under the regulations promulgated under section 264(c) of the Health Insurance
Portability and Accountability Act of 1996.
SEC. 2686. ø300ff–86¿ GAO REPORT.

The Comptroller General of the Government Accountability Office shall, not less than 1 year after the date of enactment of the
Ryan White HIV/AIDS Treatment Extension Act of 2009, submit to
the appropriate committees of Congress a report describing Minority AIDS Initiative activities across the Department of Health and
Human Services, including programs under this title and programs
at the Centers for Disease Control and Prevention, the Substance
Abuse and Mental Health Services Administration, and other departmental agencies. Such report shall include a history of program
activities within each relevant agency and a description of activities conducted, people served and types of grantees funded, and
shall collect and describe best practices in community outreach and
capacity-building of community based organizations serving the
communities that are disproportionately affected by HIV/AIDS.
SEC. 2687. ø300ff–87¿ SEVERITY OF NEED INDEX.
(a) DEVELOPMENT OF INDEX.—Not later

than September 30,
2008, the Secretary shall develop and submit to the appropriate
committees of Congress a severity of need index in accordance with
subsection (c).
(b) DEFINITION OF SEVERITY OF NEED INDEX.—In this section,
the term ‘‘severity of need index’’ means the index of the relative
needs of individuals within a State or area, as identified by a number of different factors, and is a factor or set of factors that is multiplied by the number of living HIV/AIDS cases in a State or area,
providing different weights to those cases based on needs. Such factors or set of factors may be different for different components of
the provisions under this title.
(c) REQUIREMENTS FOR SECRETARIAL SUBMISSION.—When the
Secretary submits to the appropriate committees of Congress the
severity of need index under subsection (a), the Secretary shall provide the following:
(1) Methodology for and rationale behind developing the
severity of need index, including information related to the
field testing of the severity of need index.
(2) An independent contractor analysis of activities carried
out under paragraph (1).
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(3) Information regarding the process by which the Secretary received community input regarding the application and
development of the severity of need index.
(d) ANNUAL REPORTS.—If the Secretary fails to submit the severity of need index under subsection (a) in either of fiscal years
2007 or 2008, the Secretary shall prepare and submit to the appropriate committees of Congress a report for such fiscal year—
(1) that updates progress toward having client level data;
(2) that updates the progress toward having a severity of
need index, including information related to the methodology
and process for obtaining community input; and
(3) that, as applicable, states whether the Secretary could
develop a severity of need index before fiscal year 2009.
SEC. 2688. ø300ff–87a¿ NATIONAL HIV/AIDS TESTING GOAL.
(a) IN GENERAL.—Not later than January 1, 2010,

the Secretary shall establish a national HIV/AIDS testing goal of
5,000,000 tests for HIV/AIDS annually through federally-supported
HIV/AIDS prevention, treatment, and care programs, including
programs under this title and other programs administered by the
Centers for Disease Control and Prevention.
(b) ANNUAL REPORT.—Not later than January 1, 2011, and annually thereafter, the Secretary, acting through the Director of the
Centers for Disease Control and Prevention, shall submit to Congress a report describing, with regard to the preceding 12-month
reporting period—
(1) whether the testing goal described in subsection (a) has
been met;
(2) the total number of individuals tested through federally-supported and other HIV/AIDS prevention, treatment, and
care programs in each State;
(3) the number of individuals who—
(A) prior to such 12-month period, were unaware of
their HIV status; and
(B) through federally-supported and other HIV/AIDS
prevention, treatment, and care programs, were diagnosed
and referred into treatment and care during such period;
(4) any barriers, including State laws and regulations, that
the Secretary determines to be a barrier to meeting the testing
goal described in subsection (a);
(5) the amount of funding the Secretary determines necessary to meet the annual testing goal in the following 12
months and the amount of Federal funding expended to meet
the testing goal in the prior 12-month period; and
(6) the most cost-effective strategies for identifying and diagnosing individuals who were unaware of their HIV status,
including voluntary testing with pre-test counseling, routine
screening including opt-out testing, partner counseling and referral services, and mass media campaigns.
(c) REVIEW OF PROGRAM EFFECTIVENESS.—Not later than 1
year after the date of enactment of this section, the Secretary, in
consultation with the Director of the Centers for Disease Control
and Prevention, shall submit a report to Congress based on a comprehensive review of each of the programs and activities conducted
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by the Centers for Disease Control and Prevention as part of the
Domestic HIV/AIDS Prevention Activities, including the following:
(1) The amount of funding provided for each program or
activity.
(2) The primary purpose of each program or activity.
(3) The annual goals for each program or activity.
(4) The relative effectiveness of each program or activity
with relation to the other programs and activities conducted by
the Centers for Disease Control and Prevention, based on the—
(A) number of previously undiagnosed individuals with
HIV/AIDS made aware of their status and referred into
the appropriate treatment;
(B) amount of funding provided for each program or
activity compared to the number of undiagnosed individuals with HIV/AIDS made aware of their status;
(C) program’s contribution to the National HIV/AIDS
testing goal; and
(D) progress made toward the goals described in paragraph (3).
(5) Recommendations if any to Congress on ways to allocate funding for domestic HIV/AIDS prevention activities and
programs in order to achieve the National HIV/AIDS testing
goal.
(d) COORDINATION WITH OTHER FEDERAL ACTIVITIES.—In pursuing the National HIV/AIDS testing goal, the Secretary, where appropriate, shall consider and coordinate with other national strategies conducted by the Federal Government to address HIV/AIDS.
SEC. 2689. ø300ff–88¿ DEFINITIONS.

For purposes of this title:
(1) AIDS.—The term ‘‘AIDS’’ means acquired immune deficiency syndrome.
(2) CO-OCCURRING CONDITIONS.—The term ‘‘co-occurring
conditions’’ means one or more adverse health conditions in an
individual with HIV/AIDS, without regard to whether the individual has AIDS and without regard to whether the conditions
arise from HIV.
(3) COUNSELING.—The term ‘‘counseling’’ means such counseling provided by an individual trained to provide such counseling.
(4) FAMILY-CENTERED CARE.—The term ‘‘family-centered
care’’ means the system of services described in this title that
is targeted specifically to the special needs of infants, children,
women and families. Family-centered care shall be based on a
partnership between parents, professionals, and the community designed to ensure an integrated, coordinated, culturally
sensitive, and community-based continuum of care for children,
women, and families with HIV/AIDS.
(5) FAMILIES WITH HIV/AIDS.—The term ‘‘families with HIV/
AIDS’’ means families in which one or more members have
HIV/AIDS.
(6) HIV.—The term ‘‘HIV’’ means infection with the human
immunodeficiency virus.
(7) HIV/AIDS.—
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(A) IN GENERAL.—The term ‘‘HIV/AIDS’’ means HIV,
and includes AIDS and any condition arising from AIDS.
(B) COUNTING OF CASES.—The term ‘‘living cases of
HIV/AIDS’’, with respect to the counting of cases in a geographic area during a period of time, means the sum of—
(i) the number of living non-AIDS cases of HIV in
the area; and
(ii) the number of living cases of AIDS in the area.
(C) NON-AIDS CASES.—The term ‘‘non-AIDS’’, with respect to a case of HIV, means that the individual involved
has HIV but does not have AIDS.
(8) HUMAN IMMUNODEFICIENCY VIRUS.—The term ‘‘human
immunodeficiency virus’’ means the etiologic agent for AIDS.
(9) OFFICIAL POVERTY LINE.—The term ‘‘official poverty
line’’ means the poverty line established by the Director of the
Office of Management and Budget and revised by the Secretary
in accordance with section 673(2) of the Omnibus Budget Reconciliation Act of 1981.
(10) PERSON.—The term ‘‘person’’ includes one or more individuals, governments (including the Federal Government and
the governments of the States), governmental agencies, political subdivisions, labor unions, partnerships, associations, corporations, legal representatives, mutual companies, joint-stock
companies, trusts, unincorporated organizations, receivers,
trustees, and trustees in cases under title 11, United States
Code.
(11) STATE.—
(A) IN GENERAL.—The term ‘‘State’’ means each of the
50 States, the District of Columbia, and each of the territories.
(B) TERRITORIES.—The term ‘‘territory’’ means each of
American Samoa, Guam, the Commonwealth of Puerto
Rico, the Commonwealth of the Northern Mariana Islands,
the Virgin Islands, the Republic of the Marshall Islands,
the Federated States of Micronesia, and Palau.
(12) YOUTH WITH HIV.—The term ‘‘youth with HIV’’ means
individuals who are 13 through 24 years old and who have
HIV/AIDS.

PART F—DEMONSTRATION AND TRAINING
Subpart I—Special Projects of National
Significance
SEC. 2691. ø300ff–101¿ SPECIAL PROJECTS OF NATIONAL SIGNIFICANCE.
(a) IN GENERAL.—Of the amount appropriated under each of

parts A, B, C, and D for each fiscal year, the Secretary shall use
the greater of $20,000,000 or an amount equal to 3 percent of such
amount appropriated under each such part, but not to exceed
$25,000,000, to administer special projects of national significance
to—
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Sec. 2692

(1) quickly respond to emerging needs of individuals receiving assistance under this title; and
(2) to fund special programs to develop a standard electronic client information data system to improve the ability of
grantees under this title to report client-level data to the Secretary.
(b) GRANTS.—The Secretary shall award grants under subsection (a) to entities eligible for funding under parts A, B, C, and
D based on—
(1) whether the funding will promote obtaining client level
data as it relates to the creation of a severity of need index,
including funds to facilitate the purchase and enhance the utilization of qualified health information technology systems;
(2) demonstrated ability to create and maintain a qualified
health information technology system;
(3) the potential replicability of the proposed activity in
other similar localities or nationally;
(4) the demonstrated reliability of the proposed qualified
health information technology system across a variety of providers, geographic regions, and clients; and
(5) the demonstrated ability to maintain a safe and secure
qualified health information system; or
(6) newly emerging needs of individuals receiving assistance under this title.
(c) COORDINATION.—The Secretary may not make a grant
under this section unless the applicant submits evidence that the
proposed program is consistent with the statewide coordinated
statement of need, and the applicant agrees to participate in the
ongoing revision process of such statement of need.
(d) PRIVACY PROTECTION.—The Secretary may not make a
grant under this section for the development of a qualified health
information technology system unless the applicant provides assurances to the Secretary that the system will, at a minimum, comply
with the privacy regulations promulgated under section 264(c) of
the Health Insurance Portability and Accountability Act of 1996.
(e) REPLICATION.—The Secretary shall make information concerning successful models or programs developed under this part
available to grantees under this title for the purpose of coordination, replication, and integration. To facilitate efforts under this
subsection, the Secretary may provide for peer-based technical assistance for grantees funded under this part.

Subpart II—AIDS Education and Training Centers
SEC. 2692. ø300ff–111¿ HIV/AIDS COMMUNITIES, SCHOOLS, AND CENTERS.
(a) SCHOOLS; CENTERS.—
(1) IN GENERAL.—The Secretary may make grants and

enter into contracts to assist public and nonprofit private entities and schools and academic health science centers in meeting the costs of projects—
(A) to train health personnel, including practitioners
in programs under this title and other community providers, in the diagnosis, treatment, and prevention of HIV/
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Sec. 2692

PUBLIC HEALTH SERVICE ACT

1360

AIDS, including the prevention of the perinatal transmission of the disease, including measures for the prevention and treatment of opportunistic infections, and including (as applicable to the type of health professional involved), prenatal and other gynecological care for women
with HIV/AIDS;
(B) to train the faculty of schools of, and graduate departments or programs of, medicine, nursing, osteopathic
medicine, dentistry, public health, allied health, and mental health practice to teach health professions students to
provide for the health care needs of individuals with HIV/
AIDS;
(C) to develop and disseminate curricula and resource
materials relating to the care and treatment of individuals
with such disease and the prevention of the disease among
individuals who are at risk of contracting the disease; and
(D) to develop protocols for the medical care of women
with HIV/AIDS, including prenatal and other gynecological
care for such women.
(2) PREFERENCE IN MAKING GRANTS.—In making grants
under paragraph (1), the Secretary shall give preference to
qualified projects which will—
(A) train, or result in the training of, health professionals who will provide treatment for minority individuals
and Native Americans with HIV/AIDS and other individuals who are at high risk of contracting such disease;
(B) train, or result in the training of, minority health
professionals and minority allied health professionals to
provide treatment for individuals with such disease; and
(C) train or result in the training of health professionals and allied health professionals to provide treatment for hepatitis B or C co-infected individuals.
(3) APPLICATION.—No grant or contract may be made
under paragraph (1) unless an application is submitted to the
Secretary in such form, at such time, and containing such information, as the Secretary may prescribe.
(b) DENTAL SCHOOLS.—
(1) IN GENERAL.—
(A) GRANTS.—The Secretary may make grants to dental schools and programs described in subparagraph (B) to
assist such schools and programs with respect to oral
health care to patients with HIV/AIDS.
(B) ELIGIBLE APPLICANTS.—For purposes of this subsection, the dental schools and programs referred to in this
subparagraph are dental schools and programs that were
described in section 777(b)(4)(B) as such section was in effect on the day before the date of the enactment of the
Health Professions Education Partnerships Act of 1998
(Public Law 105–392) and in addition dental hygiene programs that are accredited by the Commission on Dental
Accreditation.
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(2) APPLICATION.—Each dental school or program described
in section 1 the section referred to in paragraph (1)(B) may annually submit an application documenting the unreimbursed
costs of oral health care provided to patients with HIV/AIDS
by that school or hospital during the prior year.
(3) DISTRIBUTION.—The Secretary shall distribute the
available funds among all eligible applicants, taking into account the number of patients with HIV/AIDS served and the
unreimbursed oral health care costs incurred by each institution as compared with the total number of patients served and
costs incurred by all eligible applicants.
(4) MAINTENANCE OF EFFORT.—The Secretary shall not
make a grant under this subsection if doing so would result in
any reduction in State funding allotted for such purposes.
(5) COMMUNITY-BASED CARE.—The Secretary may make
grants to dental schools and programs described in paragraph
(1)(B) that partner with community-based dentists to provide
oral health care to patients with HIV/AIDS in unserved areas.
Such partnerships shall permit the training of dental students
and residents and the participation of community dentists as
adjunct faculty.
(c) AUTHORIZATION OF APPROPRIATIONS.—
(1) SCHOOLS; CENTERS.—For the purpose of awarding
grants under subsection (a), there are authorized to be appropriated $34,700,000 for each of the fiscal years 2007 through
2009, $36,535,000 for fiscal year 2010, $38,257,000 for fiscal
year 2011, $40,170,000 for fiscal year 2012, and $42,178,000
for fiscal year 2013.
(2) DENTAL SCHOOLS.—For the purpose of awarding grants
under subsection (b), there are authorized to be appropriated
$13,000,000 for each of the fiscal years 2007 through 2009,
$13,650,000 for fiscal year 2010, $14,333,000 for fiscal year
2011, $15,049,000 for fiscal year 2012, and $15,802,000 for fiscal year 2013.

Subpart III—Minority AIDS Initiative
SEC. 2693. ø300ff–121¿ MINORITY AIDS INITIATIVE.
(a) IN GENERAL.—For the purpose of carrying

out activities
under this section to evaluate and address the disproportionate impact of HIV/AIDS on, and the disparities in access, treatment, care,
and outcomes for, racial and ethnic minorities (including African
Americans, Alaska Natives, Latinos, American Indians, Asian
Americans, Native Hawaiians, and Pacific Islanders), there are authorized to be appropriated $131,200,000 for fiscal year 2007,
$135,100,000 for fiscal year 2008, $139,100,000 for fiscal year 2009,
$146,055,000 for fiscal year 2010, $153,358,000 for fiscal year 2011,
$161,026,000 for fiscal year 2012, and $169,077,000 for fiscal year
2013. The Secretary shall develop a formula for the awarding of
grants under subsections (b)(1)(A) and (b)(1)(B) that ensures that
funding is provided based on the distribution of populations disproportionately impacted by HIV/AIDS.
1 So

March 13, 2013

in law. See section 402(b)(2) of Public Law 106–345 (114 Stat. 1349).

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(b) CERTAIN ACTIVITIES.—
(1) IN GENERAL.—In carrying out the purpose described in
subsection (a), the Secretary shall provide for—
(A) emergency assistance under part A;
(B) care grants under part B;
(C) early intervention services under part C;
(D) services through projects for HIV-related care
under part D; and
(E) activities through education and training centers
under section 2692.
(2) ALLOCATIONS AMONG ACTIVITIES.—Activities under
paragraph (1) shall be carried out by the Secretary in accordance with the following:
(A) For supplemental grants to improve HIV-related
health outcomes to reduce existing racial and ethnic health
disparities, the Secretary shall, of the amount appropriated under subsection (a) for a fiscal year, reserve the
following, as applicable:
(i) For fiscal year 2007, $43,800,000.
(ii) For fiscal year 2008, $45,400,000.
(iii) For fiscal year 2009, $47,100,000.
(iv) For fiscal year 2010, $46,738,000.
(v) For fiscal year 2011, $49,075,000.
(vi) For fiscal year 2012, $51,528,000.
(vii) For fiscal year 2013, $54,105,000.
(B) For grants used for supplemental support education and outreach services to increase the number of eligible racial and ethnic minorities who have access to treatment through the program under section 2616 for therapeutics, the Secretary shall, of the amount appropriated
for a fiscal year under subsection (a), reserve the following,
as applicable:
(i) For fiscal year 2007, $7,000,000.
(ii) For fiscal year 2008, $7,300,000.
(iii) For fiscal year 2009, $7,500,000.
(iv) For fiscal year 2010, $8,763,000.
(v) For fiscal year 2011, $9,202,000.
(vi) For fiscal year 2012, $9,662,000.
(vii) For fiscal year 2013, $10,145,000.
(C) For planning grants, capacity-building grants, and
services grants to health care providers who have a history
of providing culturally and linguistically appropriate care
and services to racial and ethnic minorities, the Secretary
shall, of the amount appropriated for a fiscal year under
subsection (a), reserve the following, as applicable:
(i) For fiscal year 2007, $53,400,000.
(ii) For fiscal year 2008, $55,400,000.
(iii) For fiscal year 2009, $57,400,000.
(iv) For fiscal year 2010, $61,343,000.
(v) For fiscal year 2011, $64,410,000.
(vi) For fiscal year 2012, $67,631,000.
(vii) For fiscal year 2013, $71,012,000.
(D) For eliminating racial and ethnic disparities in the
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propriate care services for HIV disease for women, infants,
children, and youth, the Secretary shall, of the amount appropriated under subsection (a), reserve the following, as
applicable:
(i) For fiscal year 2010, $20,448,000.
(ii) For fiscal year 2011, $21,470,000.
(iii) For fiscal year 2012, $22,543,000.
(iv) For fiscal year 2013, $23,671,000.
(E) For increasing the training capacity of centers to
expand the number of health care professionals with treatment expertise and knowledge about the most appropriate
standards of HIV disease-related treatments and medical
care for racial and ethnic minority adults, adolescents, and
children with HIV disease, the Secretary shall, of the
amount appropriated under subsection (a), reserve the following, as applicable:
(i) For fiscal year 2010, $8,763,000.
(ii) For fiscal year 2011, $9,201,000.
(iii) For fiscal year 2012, $9,662,000.
(iv) For fiscal year 2013, $10,144,000.
(c) CONSISTENCY WITH PRIOR PROGRAM.—With respect to the
purpose described in subsection (a), the Secretary shall carry out
this section consistent with the activities carried out under this
title by the Secretary pursuant to the Departments of Labor,
Health and Human Services, and Education, and Related Agencies
Appropriations Act, 2002 (Public Law 107–116).
(d) SYNCHRONIZATION OF MINORITY AIDS INITIATIVE.—For fiscal year 2010 and each subsequent fiscal year, the Secretary shall
incorporate and synchronize the schedule of application submissions and funding availability under this section with the schedule
of application submissions and funding availability under the corresponding provisions of this title XXVI as follows:
(1) The schedule for carrying out subsection (b)(1)(A) shall
be the same as the schedule applicable to emergency assistance
under part A.
(2) The schedule for carrying out subsection (b)(1)(B) shall
be the same as the schedule applicable to care grants under
part B.
(3) The schedule for carrying out subsection (b)(1)(C) shall
be the same as the schedule applicable to grants for early
intervention services under part C.
(4) The schedule for carrying out subsection (b)(1)(D) shall
be the same as the schedule applicable to grants for services
through projects for HIV-related care under part D.
(5) The schedule for carrying out subsection (b)(1)(E) shall
be the same as the schedule applicable to grants and contracts
for activities through education and training centers under section 2692.

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PUBLIC HEALTH SERVICE ACT

1364

PART G—NOTIFICATION OF POSSIBLE
EXPOSURE TO INFECTIOUS DISEASES
SEC. 2695. ø300ff–131¿ INFECTIOUS DISEASES AND CIRCUMSTANCES
RELEVANT TO NOTIFICATION REQUIREMENTS.
(a) IN GENERAL.—Not later than 180 days after the date of the

enactment of this part, the Secretary shall complete the development of—
(1) a list of potentially life-threatening infectious diseases,
including emerging infectious diseases, to which emergency response employees may be exposed in responding to emergencies;
(2) guidelines describing the circumstances in which such
employees may be exposed to such diseases, taking into account the conditions under which emergency response is provided; and
(3) guidelines describing the manner in which medical facilities should make determinations for purposes of section
2695B(d).
(b) SPECIFICATION OF AIRBORNE INFECTIOUS DISEASES.—The
list developed by the Secretary under subsection (a)(1) shall include
a specification of those infectious diseases on the list that are routinely transmitted through airborne or aerosolized means.
(c) DISSEMINATION.—The Secretary shall—
(1) transmit to State public health officers copies of the list
and guidelines developed by the Secretary under subsection (a)
with the request that the officers disseminate such copies as
appropriate throughout the States; and
(2) make such copies available to the public.
SEC. 2695A. ø300ff–132¿ ROUTINE NOTIFICATIONS WITH RESPECT TO
AIRBORNE INFECTIOUS DISEASES IN VICTIMS ASSISTED.
(a) ROUTINE NOTIFICATION OF DESIGNATED OFFICER.—
(1) DETERMINATION BY TREATING FACILITY.—If a victim of

an emergency is transported by emergency response employees
to a medical facility and the medical facility makes a determination that the victim has an airborne infectious disease,
the medical facility shall notify the designated officer of the
emergency response employees who transported the victim to
the medical facility of the determination.
(2) DETERMINATION BY FACILITY ASCERTAINING CAUSE OF
DEATH.—If a victim of an emergency is transported by emergency response employees to a medical facility and the victim
dies at or before reaching the medical facility, the medical facility ascertaining the cause of death shall notify the designated officer of the emergency response employees who transported the victim to the initial medical facility of any determination by the medical facility that the victim had an airborne infectious disease.
(b) REQUIREMENT OF PROMPT NOTIFICATION.—With respect to
a determination described in paragraph (1) or (2) of subsection (a),
the notification required in each of such paragraphs shall be made
as soon as is practicable, but not later than 48 hours after the determination is made.
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SEC. 2695B. ø300ff–133¿ REQUEST FOR NOTIFICATION WITH RESPECT
TO VICTIMS ASSISTED.
(a) INITIATION OF PROCESS BY EMPLOYEE.—If an emergency re-

sponse employee believes that the employee may have been exposed to an infectious disease by a victim of an emergency who was
transported to a medical facility as a result of the emergency, and
if the employee attended, treated, assisted, or transported the victim pursuant to the emergency, then the designated officer of the
employee shall, upon the request of the employee, carry out the duties described in subsection (b) regarding a determination of whether the employee may have been exposed to an infectious disease by
the victim.
(b) INITIAL DETERMINATION BY DESIGNATED OFFICER.—The duties referred to in subsection (a) are that—
(1) the designated officer involved collect the facts relating
to the circumstances under which, for purposes of subsection
(a), the employee involved may have been exposed to an infectious disease; and
(2) the designated officer evaluate such facts and make a
determination of whether, if the victim involved had any infectious disease included on the list issued under paragraph (1)
of section 2695(a), the employee would have been exposed to
the disease under such facts, as indicated by the guidelines
issued under paragraph (2) of such section.
(c) SUBMISSION OF REQUEST TO MEDICAL FACILITY.—
(1) IN GENERAL.—If a designated officer makes a determination under subsection (b)(2) that an emergency response
employee may have been exposed to an infectious disease, the
designated officer shall submit to the medical facility to which
the victim involved was transported a request for a response
under subsection (d) regarding the victim of the emergency involved.
(2) FORM OF REQUEST.—A request under paragraph (1)
shall be in writing and be signed by the designated officer involved, and shall contain a statement of the facts collected pursuant to subsection (b)(1).
(d) EVALUATION AND RESPONSE REGARDING REQUEST TO MEDICAL FACILITY.—
(1) IN GENERAL.—If a medical facility receives a request
under subsection (c), the medical facility shall evaluate the
facts submitted in the request and make a determination of
whether, on the basis of the medical information possessed by
the facility regarding the victim involved, the emergency response employee was exposed to an infectious disease included
on the list issued under paragraph (1) of section 2695(a), as indicated by the guidelines issued under paragraph (2) of such
section.
(2) NOTIFICATION OF EXPOSURE.—If a medical facility
makes a determination under paragraph (1) that the emergency response employee involved has been exposed to an infectious disease, the medical facility shall, in writing, notify the
designated officer who submitted the request under subsection
(c) of the determination.
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(3) FINDING OF NO EXPOSURE.—If a medical facility makes
a determination under paragraph (1) that the emergency response employee involved has not been exposed to an infectious
disease, the medical facility shall, in writing, inform the designated officer who submitted the request under subsection (c)
of the determination.
(4) INSUFFICIENT INFORMATION.—
(A) If a medical facility finds in evaluating facts for
purposes of paragraph (1) that the facts are insufficient to
make the determination described in such paragraph, the
medical facility shall, in writing, inform the designated officer who submitted the request under subsection (c) of the
insufficiency of the facts.
(B)(i) If a medical facility finds in making a determination under paragraph (1) that the facility possesses no
information on whether the victim involved has an infectious disease included on the list under section 2695(a),
the medical facility shall, in writing, inform the designated
officer who submitted the request under subsection (c) of
the insufficiency of such medical information.
(ii) If after making a response under clause (i) a medical facility determines that the victim involved has an infectious disease, the medical facility shall make the determination described in paragraph (1) and provide the applicable response specified in this subsection.
(e) TIME FOR MAKING RESPONSE.—After receiving a request
under subsection (c) (including any such request resubmitted under
subsection (g)(2)), a medical facility shall make the applicable response specified in subsection (d) as soon as is practicable, but not
later than 48 hours after receiving the request.
(f) DEATH OF VICTIM OF EMERGENCY.—
(1) FACILITY ASCERTAINING CAUSE OF DEATH.—If a victim
described in subsection (a) dies at or before reaching the medical facility involved, and the medical facility receives a request
under subsection (c), the medical facility shall provide a copy
of the request to the medical facility ascertaining the cause of
death of the victim, if such facility is a different medical facility than the facility that received the original request.
(2) RESPONSIBILITY OF FACILITY.—Upon the receipt of a
copy of a request for purposes of paragraph (1), the duties otherwise established in this part regarding medical facilities
shall apply to the medical facility ascertaining the cause of
death of the victim in the same manner and to the same extent
as such duties apply to the medical facility originally receiving
the request.
(g) ASSISTANCE OF PUBLIC HEALTH OFFICER.—
(1) EVALUATION OF RESPONSE OF MEDICAL FACILITY REGARDING INSUFFICIENT FACTS.—
(A) In the case of a request under subsection (c) to
which a medical facility has made the response specified in
subsection (d)(4)(A) regarding the insufficiency of facts, the
public health officer for the community in which the medical facility is located shall evaluate the request and the
response, if the designated officer involved submits such
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documents to the officer with the request that the officer
make such an evaluation.
(B) As soon as is practicable after a public health officer receives a request under subparagraph (A), but not
later than 48 hours after receipt of the request, the public
health officer shall complete the evaluation required in
such paragraph and inform the designated officer of the results of the evaluation.
(2) FINDINGS OF EVALUATION.—
(A) If an evaluation under paragraph (1)(A) indicates
that the facts provided to the medical facility pursuant to
subsection (c) were sufficient for purposes of determinations under subsection (d)(1)—
(i) the public health officer shall, on behalf of the
designated officer involved, resubmit the request to
the medical facility; and
(ii) the medical facility shall provide to the designated officer the applicable response specified in
subsection (d).
(B) If an evaluation under paragraph (1)(A) indicates
that the facts provided in the request to the medical facility were insufficient for purposes of determinations specified in subsection (c)—
(i) the public health officer shall provide advice to
the designated officer regarding the collection and description of appropriate facts; and
(ii) if sufficient facts are obtained by the designated officer—
(I) the public health officer shall, on behalf of
the designated officer involved, resubmit the request to the medical facility; and
(II) the medical facility shall provide to the
designated officer the appropriate response under
subsection (c).
SEC. 2695C. ø300ff–134¿ PROCEDURES FOR NOTIFICATION OF EXPOSURE.
(a) CONTENTS OF NOTIFICATION TO OFFICER.—In making a no-

tification required under section 2695A or section 2695B(d)(2), a
medical facility shall provide—
(1) the name of the infectious disease involved; and
(2) the date on which the victim of the emergency involved
was transported by emergency response employees to the medical facility involved.
(b) MANNER OF NOTIFICATION.—If a notification under section
2695A or section 2695B(d)(2) is mailed or otherwise indirectly
made—
(1) the medical facility sending the notification shall, upon
sending the notification, inform the designated officer to whom
the notification is sent of the fact that the notification has been
sent; and
(2) such designated officer shall, not later than 10 days
after being informed by the medical facility that the notification has been sent, inform such medical facility whether the
designated officer has received the notification.
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SEC. 2695D. ø300ff–135¿ NOTIFICATION OF EMPLOYEE.
(a) IN GENERAL.—After receiving a notification

for purposes of
section 2695A or 2695B(d)(2), a designated officer of emergency response employees shall, to the extent practicable, immediately notify each of such employees who—
(1) responded to the emergency involved; and
(2) as indicated by guidelines developed by the Secretary,
may have been exposed to an infectious disease.
(b) CERTAIN CONTENTS OF NOTIFICATION TO EMPLOYEE.—A notification under this subsection to an emergency response employee
shall inform the employee of—
(1) the fact that the employee may have been exposed to
an infectious disease and the name of the disease involved;
(2) any action by the employee that, as indicated by guidelines developed by the Secretary, is medically appropriate; and
(3) if medically appropriate under such criteria, the date of
such emergency.
(c) RESPONSES OTHER THAN NOTIFICATION OF EXPOSURE.—
After receiving a response under paragraph (3) or (4) of subsection
(d) of section 2695B, or a response under subsection (g)(1) of such
section, the designated officer for the employee shall, to the extent
practicable, immediately inform the employee of the response.
SEC. 2695E. ø300ff–136¿ SELECTION OF DESIGNATED OFFICERS.
(a) IN GENERAL.—For the purposes of receiving notifications

and responses and making requests under this part on behalf of
emergency response employees, the public health officer of each
State shall designate 1 official or officer of each employer of emergency response employees in the State.
(b) PREFERENCE IN MAKING DESIGNATIONS.—In making the
designations required in subsection (a), a public health officer shall
give preference to individuals who are trained in the provision of
health care or in the control of infectious diseases.
SEC. 2695F. ø300ff–137¿ LIMITATION WITH RESPECT TO DUTIES OF
MEDICAL FACILITIES.

The duties established in this part for a medical facility—
(1) shall apply only to medical information possessed by
the facility during the period in which the facility is treating
the victim for conditions arising from the emergency, or during
the 60-day period beginning on the date on which the victim
is transported by emergency response employees to the facility,
whichever period expires first; and
(2) shall not apply to any extent after the expiration of the
30-day period beginning on the expiration of the applicable period referred to in paragraph (1), except that such duties shall
apply with respect to any request under section 2695B(c) received by a medical facility before the expiration of such 30-day
period.
SEC. 2695G. ø300ff–138¿ MISCELLANEOUS PROVISIONS.
(a) LIABILITY OF MEDICAL FACILITIES, DESIGNATED OFFICERS,
PUBLIC HEALTH OFFICERS, AND GOVERNING ENTITIES.—This part

may not be construed to authorize any cause of action for damages
or any civil penalty against any medical facility, any designated officer, any other public health officer, or any governing entity of
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such facility or officer for failure to comply with the duties established in this part.
(b) TESTING.—This part may not, with respect to victims of
emergencies, be construed to authorize or require a medical facility
to test any such victim for any infectious disease.
(c) CONFIDENTIALITY.—This part may not be construed to authorize or require any medical facility, any designated officer of
emergency response employees, or any such employee, to disclose
identifying information with respect to a victim of an emergency or
with respect to an emergency response employee.
(d) FAILURE TO PROVIDE EMERGENCY SERVICES.—This part
may not be construed to authorize any emergency response employee to fail to respond, or to deny services, to any victim of an
emergency.
(e) NOTIFICATION AND REPORTING DEADLINES.—In any case in
which the Secretary determines that, wholly or partially as a result
of a public health emergency that has been determined pursuant
to section 319(a), individuals or public or private entities are unable to comply with the requirements of this part, the Secretary
may, notwithstanding any other provision of law, temporarily suspend, in whole or in part, the requirements of this part as the circumstances reasonably require. Before or promptly after such a
suspension, the Secretary shall notify the Congress of such action
and publish in the Federal Register a notice of the suspension.
(f) CONTINUED APPLICATION OF STATE AND LOCAL LAW.—Nothing in this part shall be construed to limit the application of State
or local laws that require the provision of data to public health authorities.
SEC. 2695H. ø300ff–139¿ INJUNCTIONS REGARDING VIOLATION OF PROHIBITION.
(a) IN GENERAL.—The Secretary may, in any court of com-

petent jurisdiction, commence a civil action for the purpose of obtaining temporary or permanent injunctive relief with respect to
any violation of this part.
(b) FACILITATION OF INFORMATION ON VIOLATIONS.—The Secretary shall establish an administrative process for encouraging
emergency response employees to provide information to the Secretary regarding violations of this part. As appropriate, the Secretary shall investigate alleged such violations and seek appropriate injunctive relief.
SEC. 2695I. ø300ff–140¿ APPLICABILITY OF PART.

This part shall not apply in a State if the chief executive officer
of the State certifies to the Secretary that the law of the State is
substantially consistent with this part.

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TITLE XXVII—REQUIREMENTS RELATING TO HEALTH
INSURANCE COVERAGE

PART A—INDIVIDUAL AND GROUP MARKET
REFORMS
[Note: For a version of law of part A, as amended by 1001,
1201, and 1563 (relating to conforming amendments--originally
designated as section 1562 and redesignated as section 1563 by section 10107(b)(1)) of Public Law 111–148, see note set out in italic
typeface that appears after section 2737 below.]
Subpart 1—Portability, Access, and Renewability Requirements
SEC. 2701. ø300gg¿ INCREASED PORTABILITY THROUGH LIMITATION
ON PREEXISTING CONDITION EXCLUSIONS.
(a) LIMITATION ON PREEXISTING CONDITION EXCLUSION PERIOD;
CREDITING FOR PERIODS OF PREVIOUS COVERAGE.—Subject to sub-

section (d), a group health plan, and a health insurance issuer offering group health insurance coverage, may, with respect to a participant or beneficiary, impose a preexisting condition exclusion
only if—
(1) such exclusion relates to a condition (whether physical
or mental), regardless of the cause of the condition, for which
medical advice, diagnosis, care, or treatment was recommended
or received within the 6-month period ending on the enrollment date;
(2) such exclusion extends for a period of not more than 12
months (or 18 months in the case of a late enrollee) after the
enrollment date; and
(3) the period of any such preexisting condition exclusion
is reduced by the aggregate of the periods of creditable coverage (if any, as defined in subsection (c)(1)) applicable to the
participant or beneficiary as of the enrollment date.
(b) DEFINITIONS.—For purposes of this part—
(1) PREEXISTING CONDITION EXCLUSION.—
(A) IN GENERAL.—The term ‘‘preexisting condition exclusion’’ means, with respect to coverage, a limitation or
exclusion of benefits relating to a condition based on the
fact that the condition was present before the date of enrollment for such coverage, whether or not any medical advice, diagnosis, care, or treatment was recommended or received before such date.
(B) TREATMENT OF GENETIC INFORMATION.—Genetic information shall not be treated as a condition described in
subsection (a)(1) in the absence of a diagnosis of the condition related to such information.
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(2) ENROLLMENT DATE.—The term ‘‘enrollment date’’
means, with respect to an individual covered under a group
health plan or health insurance coverage, the date of enrollment of the individual in the plan or coverage or, if earlier, the
first day of the waiting period for such enrollment.
(3) LATE ENROLLEE.—The term ‘‘late enrollee’’ means, with
respect to coverage under a group health plan, a participant or
beneficiary who enrolls under the plan other than during—
(A) the first period in which the individual is eligible
to enroll under the plan, or
(B) a special enrollment period under subsection (f).
(4) WAITING PERIOD.—The term ‘‘waiting period’’ means,
with respect to a group health plan and an individual who is
a potential participant or beneficiary in the plan, the period
that must pass with respect to the individual before the individual is eligible to be covered for benefits under the terms of
the plan.
(c) RULES RELATING TO CREDITING PREVIOUS COVERAGE.—
(1) CREDITABLE COVERAGE DEFINED.—For purposes of this
title, the term ‘‘creditable coverage’’ means, with respect to an
individual, coverage of the individual under any of the following:
(A) A group health plan.
(B) Health insurance coverage.
(C) Part A or part B of title XVIII of the Social Security Act.
(D) Title XIX of the Social Security Act, other than
coverage consisting solely of benefits under section 1928.
(E) Chapter 55 of title 10, United States Code.
(F) A medical care program of the Indian Health Service or of a tribal organization.
(G) A State health benefits risk pool.
(H) A health plan offered under chapter 89 of
title 5, United States Code.
(I) A public health plan (as defined in regulations).
(J) A health benefit plan under section 5(e) of the
Peace Corps Act (22 U.S.C. 2504(e)).
Such term does not include coverage consisting solely of coverage of excepted benefits (as defined in section 2791(c)).
(2) NOT COUNTING PERIODS BEFORE SIGNIFICANT BREAKS IN
COVERAGE.—
(A) IN GENERAL.—A period of creditable coverage shall
not be counted, with respect to enrollment of an individual
under a group health plan, if, after such period and before
the enrollment date, there was a 63-day period during all
of which the individual was not covered under any creditable coverage.
(B) WAITING PERIOD NOT TREATED AS A BREAK IN COVERAGE.—For purposes of subparagraph (A) and subsection
(d)(4), any period that an individual is in a waiting period
for any coverage under a group health plan (or for group
health insurance coverage) or is in an affiliation period (as
defined in subsection (g)(2)) shall not be taken into account
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in determining the continuous period under subparagraph
(A).
(C) TAA-ELIGIBLE INDIVIDUALS.—In the case of plan
years beginning before January 1, 2014—
(i) TAA PRE-CERTIFICATION PERIOD RULE.—In the
case of a TAA-eligible individual, the period beginning
on the date the individual has a TAA-related loss of
coverage and ending on the date that is 7 days after
the date of the issuance by the Secretary (or by any
person or entity designated by the Secretary) of a
qualified health insurance costs credit eligibility certificate for such individual for purposes of section 7527
of the Internal Revenue Code of 1986 shall not be
taken into account in determining the continuous period under subparagraph (A).
(ii) DEFINITIONS.—The terms ‘‘TAA-eligible individual’’ and ‘‘TAA-related loss of coverage’’ have the
meanings given such terms in section 2205(b)(4).
(3) METHOD OF CREDITING COVERAGE.—
(A) STANDARD METHOD.—Except as otherwise provided
under subparagraph (B), for purposes of applying subsection (a)(3), a group health plan, and a health insurance
issuer offering group health insurance coverage, shall
count a period of creditable coverage without regard to the
specific benefits covered during the period.
(B) ELECTION OF ALTERNATIVE METHOD.—A group
health plan, or a health insurance issuer offering group
health insurance, may elect to apply subsection (a)(3)
based on coverage of benefits within each of several classes
or categories of benefits specified in regulations rather
than as provided under subparagraph (A). Such election
shall be made on a uniform basis for all participants and
beneficiaries. Under such election a group health plan or
issuer shall count a period of creditable coverage with respect to any class or category of benefits if any level of
benefits is covered within such class or category.
(C) PLAN NOTICE.—In the case of an election with respect to a group health plan under subparagraph (B)
(whether or not health insurance coverage is provided in
connection with such plan), the plan shall—
(i) prominently state in any disclosure statements
concerning the plan, and state to each enrollee at the
time of enrollment under the plan, that the plan has
made such election, and
(ii) include in such statements a description of the
effect of this election.
(D) ISSUER NOTICE.—In the case of an election under
subparagraph (B) with respect to health insurance coverage offered by an issuer in the small or large group market, the issuer—
(i) shall prominently state in any disclosure statements concerning the coverage, and to each employer
at the time of the offer or sale of the coverage, that the
issuer has made such election, and
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(ii) shall include in such statements a description
of the effect of such election.
(4) ESTABLISHMENT OF PERIOD.—Periods of creditable coverage with respect to an individual shall be established
through presentation of certifications described in subsection
(e) or in such other manner as may be specified in regulations.
(d) EXCEPTIONS.—
(1) EXCLUSION NOT APPLICABLE TO CERTAIN NEWBORNS.—
Subject to paragraph (4), a group health plan, and a health insurance issuer offering group health insurance coverage, may
not impose any preexisting condition exclusion in the case of
an individual who, as of the last day of the 30-day period beginning with the date of birth, is covered under creditable coverage.
(2) EXCLUSION NOT APPLICABLE TO CERTAIN ADOPTED CHILDREN.—Subject to paragraph (4), a group health plan, and a
health insurance issuer offering group health insurance coverage, may not impose any preexisting condition exclusion in
the case of a child who is adopted or placed for adoption before
attaining 18 years of age and who, as of the last day of the 30day period beginning on the date of the adoption or placement
for adoption, is covered under creditable coverage. The previous sentence shall not apply to coverage before the date of
such adoption or placement for adoption.
(3) EXCLUSION NOT APPLICABLE TO PREGNANCY.—A group
health plan, and health insurance issuer offering group health
insurance coverage, may not impose any preexisting condition
exclusion relating to pregnancy as a preexisting condition.
(4) LOSS IF BREAK IN COVERAGE.—Paragraphs (1) and (2)
shall no longer apply to an individual after the end of the first
63-day period during all of which the individual was not covered under any creditable coverage.
(e) CERTIFICATIONS AND DISCLOSURE OF COVERAGE.—
(1) REQUIREMENT FOR CERTIFICATION OF PERIOD OF CREDITABLE COVERAGE.—
(A) IN GENERAL.—A group health plan, and a health
insurance issuer offering group health insurance coverage,
shall provide the certification described in subparagraph
(B)—
(i) at the time an individual ceases to be covered
under the plan or otherwise becomes covered under a
COBRA continuation provision,
(ii) in the case of an individual becoming covered
under such a provision, at the time the individual
ceases to be covered under such provision, and
(iii) on the request on behalf of an individual
made not later than 24 months after the date of cessation of the coverage described in clause (i) or (ii),
whichever is later.
The certification under clause (i) may be provided, to the
extent practicable, at a time consistent with notices required under any applicable COBRA continuation provision.
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(B) CERTIFICATION.—The certification described in this
subparagraph is a written certification of—
(i) the period of creditable coverage of the individual under such plan and the coverage (if any)
under such COBRA continuation provision, and
(ii) the waiting period (if any) (and affiliation period, if applicable) imposed with respect to the individual for any coverage under such plan.
(C) ISSUER COMPLIANCE.—To the extent that medical
care under a group health plan consists of group health insurance coverage, the plan is deemed to have satisfied the
certification requirement under this paragraph if the
health insurance issuer offering the coverage provides for
such certification in accordance with this paragraph.
(2) DISCLOSURE OF INFORMATION ON PREVIOUS BENEFITS.—
In the case of an election described in subsection (c)(3)(B) by
a group health plan or health insurance issuer, if the plan or
issuer enrolls an individual for coverage under the plan and
the individual provides a certification of coverage of the individual under paragraph (1)—
(A) upon request of such plan or issuer, the entity
which issued the certification provided by the individual
shall promptly disclose to such requesting plan or issuer
information on coverage of classes and categories of health
benefits available under such entity’s plan or coverage,
and
(B) such entity may charge the requesting plan or
issuer for the reasonable cost of disclosing such information.
(3) REGULATIONS.—The Secretary shall establish rules to
prevent an entity’s failure to provide information under paragraph (1) or (2) with respect to previous coverage of an individual from adversely affecting any subsequent coverage of the
individual under another group health plan or health insurance coverage.
(f) SPECIAL ENROLLMENT PERIODS.—
(1) INDIVIDUALS LOSING OTHER COVERAGE.—A group health
plan, and a health insurance issuer offering group health insurance coverage in connection with a group health plan, shall
permit an employee who is eligible, but not enrolled, for coverage under the terms of the plan (or a dependent of such an
employee if the dependent is eligible, but not enrolled, for coverage under such terms) to enroll for coverage under the terms
of the plan if each of the following conditions is met:
(A) The employee or dependent was covered under a
group health plan or had health insurance coverage at the
time coverage was previously offered to the employee or
dependent.
(B) The employee stated in writing at such time that
coverage under a group health plan or health insurance
coverage was the reason for declining enrollment, but only
if the plan sponsor or issuer (if applicable) required such
a statement at such time and provided the employee with
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notice of such requirement (and the consequences of such
requirement) at such time.
(C) The employee’s or dependent’s coverage described
in subparagraph (A)—
(i) was under a COBRA continuation provision
and the coverage under such provision was
exhausted; or
(ii) was not under such a provision and either the
coverage was terminated as a result of loss of eligibility for the coverage (including as a result of legal
separation, divorce, death, termination of employment,
or reduction in the number of hours of employment) or
employer contributions toward such coverage were terminated.
(D) Under the terms of the plan, the employee requests such enrollment not later than 30 days after the
date of exhaustion of coverage described in subparagraph
(C)(i) or termination of coverage or employer contribution
described in subparagraph (C)(ii).
(2) FOR DEPENDENT BENEFICIARIES.—
(A) IN GENERAL.—If—
(i) a group health plan makes coverage available
with respect to a dependent of an individual,
(ii) the individual is a participant under the plan
(or has met any waiting period applicable to becoming
a participant under the plan and is eligible to be enrolled under the plan but for a failure to enroll during
a previous enrollment period), and
(iii) a person becomes such a dependent of the individual through marriage, birth, or adoption or placement for adoption,
the group health plan shall provide for a dependent special
enrollment period described in subparagraph (B) during
which the person (or, if not otherwise enrolled, the individual) may be enrolled under the plan as a dependent of
the individual, and in the case of the birth or adoption of
a child, the spouse of the individual may be enrolled as a
dependent of the individual if such spouse is otherwise eligible for coverage.
(B) DEPENDENT SPECIAL ENROLLMENT PERIOD.—A dependent special enrollment period under this subparagraph shall be a period of not less than 30 days and shall
begin on the later of—
(i) the date dependent coverage is made
available, or
(ii) the date of the marriage, birth, or adoption or
placement for adoption (as the case may be) described
in subparagraph (A)(iii).
(C) NO WAITING PERIOD.—If an individual seeks to enroll a dependent during the first 30 days of such a dependent special enrollment period, the coverage of the dependent shall become effective—
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(i) in the case of marriage, not later than the first
day of the first month beginning after the date the
completed request for enrollment is received;
(ii) in the case of a dependent’s birth, as of the
date of such birth; or
(iii) in the case of a dependent’s adoption or placement for adoption, the date of such adoption or placement for adoption.
(3) SPECIAL RULES FOR APPLICATION IN CASE OF MEDICAID
AND CHIP.—
(A) IN GENERAL.—A group health plan, and a health
insurance issuer offering group health insurance coverage
in connection with a group health plan, shall permit an
employee who is eligible, but not enrolled, for coverage
under the terms of the plan (or a dependent of such an employee if the dependent is eligible, but not enrolled, for coverage under such terms) to enroll for coverage under the
terms of the plan if either of the following conditions is
met:
(i) TERMINATION OF MEDICAID OR CHIP COVERAGE.—The employee or dependent is covered under
a Medicaid plan under title XIX of the Social Security
Act or under a State child health plan under title XXI
of such Act and coverage of the employee or dependent
under such a plan is terminated as a result of loss of
eligibility for such coverage and the employee requests
coverage under the group health plan (or health insurance coverage) not later than 60 days after the date of
termination of such coverage.
(ii) ELIGIBILITY FOR EMPLOYMENT ASSISTANCE
UNDER MEDICAID OR CHIP.—The employee or dependent becomes eligible for assistance, with respect to coverage under the group health plan or health insurance
coverage, under such Medicaid plan or State child
health plan (including under any waiver or demonstration project conducted under or in relation to such a
plan), if the employee requests coverage under the
group health plan or health insurance coverage not
later than 60 days after the date the employee or dependent is determined to be eligible for such assistance.
(B) COORDINATION WITH MEDICAID AND CHIP.—
(i) OUTREACH TO EMPLOYEES REGARDING AVAILABILITY OF MEDICAID AND CHIP COVERAGE.—
(I) IN GENERAL.—Each employer that maintains a group health plan in a State that provides
medical assistance under a State Medicaid plan
under title XIX of the Social Security Act, or child
health assistance under a State child health plan
under title XXI of such Act, in the form of premium assistance for the purchase of coverage
under a group health plan, shall provide to each
employee a written notice informing the employee
of potential opportunities then currently available
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in the State in which the employee resides for premium assistance under such plans for health coverage of the employee or the employee’s dependents. For purposes of compliance with this subclause, the employer may use any State-specific
model notice developed in accordance with section
701(f)(3)(B)(i)(II) of the Employee Retirement Income Security Act of 1974 (29 U.S.C.
1181(f)(3)(B)(i)(II)).
(II) OPTION TO PROVIDE CONCURRENT WITH
PROVISION OF PLAN MATERIALS TO EMPLOYEE.—An
employer may provide the model notice applicable
to the State in which an employee resides concurrent with the furnishing of materials notifying the
employee of health plan eligibility, concurrent
with materials provided to the employee in connection with an open season or election process
conducted under the plan, or concurrent with the
furnishing of the summary plan description as
provided in section 104(b) of the Employee Retirement Income Security Act of 1974.
(ii) DISCLOSURE ABOUT GROUP HEALTH PLAN BENEFITS TO STATES FOR MEDICAID AND CHIP ELIGIBLE INDIVIDUALS.—In the case of an enrollee in a group health
plan who is covered under a Medicaid plan of a State
under title XIX of the Social Security Act or under a
State child health plan under title XXI of such Act,
the plan administrator of the group health plan shall
disclose to the State, upon request, information about
the benefits available under the group health plan in
sufficient specificity, as determined under regulations
of the Secretary of Health and Human Services in consultation with the Secretary that require use of the
model coverage coordination disclosure form developed
under section 311(b)(1)(C) of the Children’s Health Insurance Reauthorization Act of 2009, so as to permit
the State to make a determination (under paragraph
(2)(B), (3), or (10) of section 2105(c) of the Social Security Act or otherwise) concerning the cost-effectiveness
of the State providing medical or child health assistance through premium assistance for the purchase of
coverage under such group health plan and in order
for the State to provide supplemental benefits required
under paragraph (10)(E) of such section or other authority.
(g) USE OF AFFILIATION PERIOD BY HMOS AS ALTERNATIVE TO
PREEXISTING CONDITION EXCLUSION.—
(1) IN GENERAL.—A health maintenance organization
which offers health insurance coverage in connection with a
group health plan and which does not impose any preexisting
condition exclusion allowed under subsection (a) with respect
to any particular coverage option may impose an affiliation period for such coverage option, but only if—
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(A) such period is applied uniformly without regard to
any health status-related factors; and
(B) such period does not exceed 2 months (or 3 months
in the case of a late enrollee).
(2) AFFILIATION PERIOD.—
(A) DEFINED.—For purposes of this title, the term ‘‘affiliation period’’ means a period which, under the terms of
the health insurance coverage offered by the health maintenance organization, must expire before the health insurance coverage becomes effective. The organization is not
required to provide health care services or benefits during
such period and no premium shall be charged to the participant or beneficiary for any coverage during the period.
(B) BEGINNING.—Such period shall begin on the enrollment date.
(C) RUNS CONCURRENTLY WITH WAITING PERIODS.—An
affiliation period under a plan shall run concurrently with
any waiting period under the plan.
(3) ALTERNATIVE METHODS.—A health maintenance organization described in paragraph (1) may use alternative methods,
from those described in such paragraph, to address adverse selection as approved by the State insurance commissioner or official or officials designated by the State to enforce the requirements of this part for the State involved with respect to such
issuer.
SEC. 2702. ø300gg–1¿ PROHIBITING DISCRIMINATION AGAINST INDIVIDUAL PARTICIPANTS AND BENEFICIARIES BASED ON
HEALTH STATUS.
(a) IN ELIGIBILITY TO ENROLL.—
(1) IN GENERAL.—Subject to paragraph (2), a group health

plan, and a health insurance issuer offering group health insurance coverage in connection with a group health plan, may
not establish rules for eligibility (including continued eligibility) of any individual to enroll under the terms of the plan
based on any of the following health status-related factors in
relation to the individual or a dependent of the individual:
(A) Health status.
(B) Medical condition (including both physical and
mental illnesses).
(C) Claims experience.
(D) Receipt of health care.
(E) Medical history.
(F) Genetic information.
(G) Evidence of insurability (including conditions arising out of acts of domestic violence).
(H) Disability.
(2) NO APPLICATION TO BENEFITS OR EXCLUSIONS.—To the
extent consistent with section 701, paragraph (1) shall not be
construed—
(A) to require a group health plan, or group health insurance coverage, to provide particular benefits other than
those provided under the terms of such plan or coverage,
or
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(B) to prevent such a plan or coverage from establishing limitations or restrictions on the amount, level, extent, or nature of the benefits or coverage for similarly situated individuals enrolled in the plan or coverage.
(3) CONSTRUCTION.—For purposes of paragraph (1), rules
for eligibility to enroll under a plan include rules defining any
applicable waiting periods for such enrollment.
(b) IN PREMIUM CONTRIBUTIONS.—
(1) IN GENERAL.—A group health plan, and a health insurance issuer offering health insurance coverage in connection
with a group health plan, may not require any individual (as
a condition of enrollment or continued enrollment under the
plan) to pay a premium or contribution which is greater than
such premium or contribution for a similarly situated individual enrolled in the plan on the basis of any health statusrelated factor in relation to the individual or to an individual
enrolled under the plan as a dependent of the individual.
(2) CONSTRUCTION.—Nothing in paragraph (1) shall be construed—
(A) to restrict the amount that an employer may be
charged for coverage under a group health plan except as
provided in paragraph (3); or
(B) to prevent a group health plan, and a health insurance issuer offering group health insurance coverage, from
establishing premium discounts or rebates or modifying
otherwise applicable copayments or deductibles in return
for adherence to programs of health promotion and disease
prevention.
(3) NO GROUP-BASED DISCRIMINATION ON BASIS OF GENETIC
INFORMATION.—
(A) IN GENERAL.—For purposes of this section, a group
health plan, and health insurance issuer offering group
health insurance coverage in connection with a group
health plan, may not adjust premium or contribution
amounts for the group covered under such plan on the
basis of genetic information.
(B) RULE OF CONSTRUCTION.—Nothing in subparagraph (A) or in paragraphs (1) and (2) of subsection (d)
shall be construed to limit the ability of a health insurance
issuer offering health insurance coverage in connection
with a group health plan to increase the premium for an
employer based on the manifestation of a disease or disorder of an individual who is enrolled in the plan. In such
case, the manifestation of a disease or disorder in one individual cannot also be used as genetic information about
other group members and to further increase the premium
for the employer.
(c) GENETIC TESTING.—
(1) LIMITATION ON REQUESTING OR REQUIRING GENETIC
TESTING.—A group health plan, and a health insurance issuer
offering health insurance coverage in connection with a group
health plan, shall not request or require an individual or a
family member of such individual to undergo a genetic test.
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(2) RULE OF CONSTRUCTION.—Paragraph (1) shall not be
construed to limit the authority of a health care professional
who is providing health care services to an individual to request that such individual undergo a genetic test.
(3) RULE OF CONSTRUCTION REGARDING PAYMENT.—
(A) IN GENERAL.—Nothing in paragraph (1) shall be
construed to preclude a group health plan, or a health insurance issuer offering health insurance coverage in connection with a group health plan, from obtaining and
using the results of a genetic test in making a determination regarding payment (as such term is defined for the
purposes of applying the regulations promulgated by the
Secretary under part C of title XI of the Social Security
Act and section 264 of the Health Insurance Portability
and Accountability Act of 1996, as may be revised from
time to time) consistent with subsection (a).
(B) LIMITATION.—For purposes of subparagraph (A), a
group health plan, or a health insurance issuer offering
health insurance coverage in connection with a group
health plan, may request only the minimum amount of information necessary to accomplish the intended purpose.
(4) RESEARCH EXCEPTION.—Notwithstanding paragraph (1),
a group health plan, or a health insurance issuer offering
health insurance coverage in connection with a group health
plan, may request, but not require, that a participant or beneficiary undergo a genetic test if each of the following conditions
is met:
(A) The request is made pursuant to research that
complies with part 46 of title 45, Code of Federal Regulations, or equivalent Federal regulations, and any applicable State or local law or regulations for the protection of
human subjects in research.
(B) The plan or issuer clearly indicates to each participant or beneficiary, or in the case of a minor child, to the
legal guardian of such beneficiary, to whom the request is
made that—
(i) compliance with the request is voluntary; and
(ii) non-compliance will have no effect on enrollment status or premium or contribution amounts.
(C) No genetic information collected or acquired under
this paragraph shall be used for underwriting purposes.
(D) The plan or issuer notifies the Secretary in writing
that the plan or issuer is conducting activities pursuant to
the exception provided for under this paragraph, including
a description of the activities conducted.
(E) The plan or issuer complies with such other conditions as the Secretary may by regulation require for activities conducted under this paragraph.
(d) PROHIBITION ON COLLECTION OF GENETIC INFORMATION.—
(1) IN GENERAL.—A group health plan, and a health insurance issuer offering health insurance coverage in connection
with a group health plan, shall not request, require, or purchase genetic information for underwriting purposes (as defined in section 2791).
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(2) PROHIBITION ON COLLECTION OF GENETIC INFORMATION
PRIOR TO ENROLLMENT.—A group health plan, and a health insurance issuer offering health insurance coverage in connection
with a group health plan, shall not request, require, or purchase genetic information with respect to any individual prior
to such individual’s enrollment under the plan or coverage in
connection with such enrollment.
(3) INCIDENTAL COLLECTION.—If a group health plan, or a
health insurance issuer offering health insurance coverage in
connection with a group health plan, obtains genetic information incidental to the requesting, requiring, or purchasing of
other information concerning any individual, such request, requirement, or purchase shall not be considered a violation of
paragraph (2) if such request, requirement, or purchase is not
in violation of paragraph (1).
(e) APPLICATION TO ALL PLANS.—The provisions of subsections
(a)(1)(F), (b)(3), (c) , and (d) and subsection (b)(1) and section 2701
with respect to genetic information, shall apply to group health
plans and health insurance issuers without regard to section
2721(a).
(f) GENETIC INFORMATION OF A FETUS OR EMBRYO.—Any reference in this part to genetic information concerning an individual
or family member of an individual shall—
(1) with respect to such an individual or family member of
an individual who is a pregnant woman, include genetic information of any fetus carried by such pregnant woman; and
(2) with respect to an individual or family member utilizing an assisted reproductive technology, include genetic information of any embryo legally held by the individual or family member.

Subpart II—Improving Coverage
SEC. 2711. ø300gg–11¿ NO LIFETIME OR ANNUAL LIMITS.
(a) PROHIBITION.—
(1) IN GENERAL.—A group health plan and a

health insurance issuer offering group or individual health insurance coverage may not establish—
(A) lifetime limits on the dollar value of benefits for
any participant or beneficiary; or
(B) except as provided in paragraph (2), annual limits
on the dollar value of benefits for any participant or beneficiary.
(2) ANNUAL LIMITS PRIOR TO 2014.—With respect to plan
years beginning prior to January 1, 2014, a group health plan
and a health insurance issuer offering group or individual
health insurance coverage may only establish a restricted annual limit on the dollar value of benefits for any participant or
beneficiary with respect to the scope of benefits that are essential health benefits under section 1302(b) of the Patient Protection and Affordable Care Act, as determined by the Secretary.
In defining the term ‘‘restricted annual limit’’ for purposes of
the preceding sentence, the Secretary shall ensure that access

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to needed services is made available with a minimal impact on
premiums.
(b) PER BENEFICIARY LIMITS.—Subsection (a) shall not be construed to prevent a group health plan or health insurance coverage
from placing annual or lifetime per beneficiary limits on specific
covered benefits that are not essential health benefits under section
1302(b) of the Patient Protection and Affordable Care Act, to the
extent that such limits are otherwise permitted under Federal or
State law.
SEC. 2712. ø300gg–12¿ PROHIBITION ON RESCISSIONS.

A group health plan and a health insurance issuer offering
group or individual health insurance coverage shall not rescind
such plan or coverage with respect to an enrollee once the enrollee
is covered under such plan or coverage involved, except that this
section shall not apply to a covered individual who has performed
an act or practice that constitutes fraud or makes an intentional
misrepresentation of material fact as prohibited by the terms of the
plan or coverage. Such plan or coverage may not be cancelled except with prior notice to the enrollee, and only as permitted under
section 2702(c) or 2742(b).
SEC. 2713. ø300gg–13¿ COVERAGE OF PREVENTIVE HEALTH SERVICES.
(a) IN GENERAL.—A group health plan and a health insurance

issuer offering group or individual health insurance coverage shall,
at a minimum provide coverage for and shall not impose any cost
sharing requirements for—
(1) evidence-based items or services that have in effect a
rating of ‘‘A’’ or ‘‘B’’ in the current recommendations of the
United States Preventive Services Task Force;
(2) immunizations that have in effect a recommendation
from the Advisory Committee on Immunization Practices of the
Centers for Disease Control and Prevention with respect to the
individual involved; and
(3) with respect to infants, children, and adolescents, evidence-informed preventive care and screenings provided for in
the comprehensive guidelines supported by the Health Resources and Services Administration.
(4) with respect to women, such additional preventive care
and screenings not described in paragraph (1) as provided for
in comprehensive guidelines supported by the Health Resources and Services Administration for purposes of this paragraph.
(5) for the purposes of this Act, and for the purposes of any
other provision of law, the current recommendations of the
United States Preventive Service Task Force regarding breast
cancer screening, mammography, and prevention shall be considered the most current other than those issued in or around
November 2009.
Nothing in this subsection shall be construed to prohibit a plan or
issuer from providing coverage for services in addition to those recommended by United States Preventive Services Task Force or to
deny coverage for services that are not recommended by such Task
Force.
(b) INTERVAL.—
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(1) IN GENERAL.—The Secretary shall establish a minimum
interval between the date on which a recommendation described in subsection (a)(1) or (a)(2) or a guideline under subsection (a)(3) is issued and the plan year with respect to which
the requirement described in subsection (a) is effective with respect to the service described in such recommendation or
guideline.
(2) MINIMUM.—The interval described in paragraph (1)
shall not be less than 1 year.
(c) VALUE-BASED INSURANCE DESIGN.—The Secretary may develop guidelines to permit a group health plan and a health insurance issuer offering group or individual health insurance coverage
to utilize value-based insurance designs.
SEC. 2714. ø300gg–14¿ EXTENSION OF DEPENDENT COVERAGE.
(a) IN GENERAL.—A group health plan and a health insurance

issuer offering group or individual health insurance coverage that
provides dependent coverage of children shall continue to make
such coverage available for an adult child until the child turns 26
years of age. Nothing in this section shall require a health plan or
a health insurance issuer described in the preceding sentence to
make coverage available for a child of a child receiving dependent
coverage.
(b) REGULATIONS.—The Secretary shall promulgate regulations
to define the dependents to which coverage shall be made available
under subsection (a).
(c) RULE OF CONSTRUCTION.—Nothing in this section shall be
construed to modify the definition of ‘‘dependent’’ as used in the Internal Revenue Code of 1986 with respect to the tax treatment of
the cost of coverage.
SEC. 2715. ø300gg–15¿ DEVELOPMENT AND UTILIZATION OF UNIFORM
EXPLANATION OF COVERAGE DOCUMENTS AND STANDARDIZED DEFINITIONS.
(a) IN GENERAL.—Not later than 12 months after the date of

enactment of the Patient Protection and Affordable Care Act, the
Secretary shall develop standards for use by a group health plan
and a health insurance issuer offering group or individual health
insurance coverage, in compiling and providing to applicants, enrollees, and policyholders or certificate holders a summary of benefits and coverage explanation that accurately describes the benefits
and coverage under the applicable plan or coverage. In developing
such standards, the Secretary shall consult with the National Association of Insurance Commissioners (referred to in this section as
the ‘‘NAIC’’), a working group composed of representatives of
health insurance-related consumer advocacy organizations, health
insurance issuers, health care professionals, patient advocates including those representing individuals with limited English proficiency, and other qualified individuals.
(b) REQUIREMENTS.—The standards for the summary of benefits and coverage developed under subsection (a) shall provide for
the following:
(1) APPEARANCE.—The standards shall ensure that the
summary of benefits and coverage is presented in a uniform
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format that does not exceed 4 pages in length and does not include print smaller than 12-point font.
(2) LANGUAGE.—The standards shall ensure that the summary is presented in a culturally and linguistically appropriate
manner and utilizes terminology understandable by the average plan enrollee.
(3) CONTENTS.—The standards shall ensure that the summary of benefits and coverage includes—
(A) uniform definitions of standard insurance terms
and medical terms (consistent with subsection (g)) so that
consumers may compare health insurance coverage and
understand the terms of coverage (or exception to such
coverage);
(B) a description of the coverage, including cost sharing for—
(i) each of the categories of the essential health
benefits described in subparagraphs (A) through (J) of
section 1302(b)(1) of the Patient Protection and Affordable Care Act; and
(ii) other benefits, as identified by the Secretary;
(C) the exceptions, reductions, and limitations on coverage;
(D) the cost-sharing provisions, including deductible,
coinsurance, and co-payment obligations;
(E) the renewability and continuation of coverage provisions;
(F) a coverage facts label that includes examples to illustrate common benefits scenarios, including pregnancy
and serious or chronic medical conditions and related cost
sharing, such scenarios to be based on recognized clinical
practice guidelines;
(G) a statement of whether the plan or coverage—
(i) provides minimum essential coverage (as defined under section 5000A(f) of the Internal Revenue
Code 1986); and
(ii) ensures that the plan or coverage share of the
total allowed costs of benefits provided under the plan
or coverage is not less than 60 percent of such costs;
(H) a statement that the outline is a summary of the
policy or certificate and that the coverage document itself
should be consulted to determine the governing contractual provisions; and
(I) a contact number for the consumer to call with additional questions and an Internet web address where a
copy of the actual individual coverage policy or group certificate of coverage can be reviewed and obtained.
(c) PERIODIC REVIEW AND UPDATING.—The Secretary shall periodically review and update, as appropriate, the standards developed under this section.
(d) REQUIREMENT TO PROVIDE.—
(1) IN GENERAL.—Not later than 24 months after the date
of enactment of the Patient Protection and Affordable Care
Act, each entity described in paragraph (3) shall provide, prior
to any enrollment restriction, a summary of benefits and covMarch 13, 2013

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erage explanation pursuant to the standards developed by the
Secretary under subsection (a) to—
(A) an applicant at the time of application;
(B) an enrollee prior to the time of enrollment or reenrollment, as applicable; and
(C) a policyholder or certificate holder at the time of
issuance of the policy or delivery of the certificate.
(2) COMPLIANCE.—An entity described in paragraph (3) is
deemed to be in compliance with this section if the summary
of benefits and coverage described in subsection (a) is provided
in paper or electronic form.
(3) ENTITIES IN GENERAL.—An entity described in this
paragraph is—
(A) a health insurance issuer (including a group health
plan that is not a self-insured plan) offering health insurance coverage within the United States; or
(B) in the case of a self-insured group health plan, the
plan sponsor or designated administrator of the plan (as
such terms are defined in section 3(16) of the Employee
Retirement Income Security Act of 1974).
(4) NOTICE OF MODIFICATIONS.—If a group health plan or
health insurance issuer makes any material modification in
any of the terms of the plan or coverage involved (as defined
for purposes of section 102 of the Employee Retirement Income
Security Act of 1974) that is not reflected in the most recently
provided summary of benefits and coverage, the plan or issuer
shall provide notice of such modification to enrollees not later
than 60 days prior to the date on which such modification will
become effective.
(e) PREEMPTION.—The standards developed under subsection
(a) shall preempt any related State standards that require a summary of benefits and coverage that provides less information to
consumers than that required to be provided under this section, as
determined by the Secretary.
(f) FAILURE TO PROVIDE.—An entity described in subsection
(d)(3) that willfully fails to provide the information required under
this section shall be subject to a fine of not more than $1,000 for
each such failure. Such failure with respect to each enrollee shall
constitute a separate offense for purposes of this subsection.
(g) DEVELOPMENT OF STANDARD DEFINITIONS.—
(1) IN GENERAL.—The Secretary shall, by regulation, provide for the development of standards for the definitions of
terms used in health insurance coverage, including the insurance-related terms described in paragraph (2) and the medical
terms described in paragraph (3).
(2) INSURANCE-RELATED TERMS.—The insurance-related
terms described in this paragraph are premium, deductible, coinsurance, co-payment, out-of-pocket limit, preferred provider,
non-preferred provider, out-of-network co-payments, UCR
(usual, customary and reasonable) fees, excluded services,
grievance and appeals, and such other terms as the Secretary
determines are important to define so that consumers may
compare health insurance coverage and understand the terms
of their coverage.
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(3) MEDICAL TERMS.—The medical terms described in this
paragraph are hospitalization, hospital outpatient care, emergency room care, physician services, prescription drug coverage, durable medical equipment, home health care, skilled
nursing care, rehabilitation services, hospice services, emergency medical transportation, and such other terms as the Secretary determines are important to define so that consumers
may compare the medical benefits offered by health insurance
and understand the extent of those medical benefits (or exceptions to those benefits).
SEC. 2715A. ø300gg–15a¿ PROVISION OF ADDITIONAL INFORMATION.

A group health plan and a health insurance issuer offering
group or individual health insurance coverage shall comply with
the provisions of section 1311(e)(3) of the Patient Protection and
Affordable Care Act, except that a plan or coverage that is not offered through an Exchange shall only be required to submit the information required to the Secretary and the State insurance commissioner, and make such information available to the public.
SEC. 2716. ø300gg–16¿ PROHIBITION ON DISCRIMINATION IN FAVOR OF
HIGHLY COMPENSATED INDIVIDUALS.
(a) IN GENERAL.—A group health plan (other than a self-in-

sured plan) shall satisfy the requirements of section 105(h)(2) of
the Internal Revenue Code of 1986 (relating to prohibition on discrimination in favor of highly compensated individuals).
(b) RULES AND DEFINITIONS.—For purposes of this section—
(1) CERTAIN RULES TO APPLY.—Rules similar to the rules
contained in paragraphs (3), (4), and (8) of section 105(h) of
such Code shall apply.
(2) HIGHLY COMPENSATED INDIVIDUAL.—The term ‘‘highly
compensated individual’’ has the meaning given such term by
section 105(h)(5) of such Code.
SEC. 2717. ø300gg–17¿ ENSURING THE QUALITY OF CARE.
(a) QUALITY REPORTING.—
(1) IN GENERAL.—Not later than 2 years after

the date of
enactment of the Patient Protection and Affordable Care Act,
the Secretary, in consultation with experts in health care quality and stakeholders, shall develop reporting requirements for
use by a group health plan, and a health insurance issuer offering group or individual health insurance coverage, with respect to plan or coverage benefits and health care provider reimbursement structures that—
(A) improve health outcomes through the implementation of activities such as quality reporting, effective case
management, care coordination, chronic disease management, and medication and care compliance initiatives, including through the use of the medical homes model as defined for purposes of section 3602 of the Patient Protection
and Affordable Care Act, for treatment or services under
the plan or coverage;
(B) implement activities to prevent hospital readmissions through a comprehensive program for hospital discharge that includes patient-centered education and counseling, comprehensive discharge planning, and post dis-

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charge reinforcement by an appropriate health care professional;
(C) implement activities to improve patient safety and
reduce medical errors through the appropriate use of best
clinical practices, evidence based medicine, and health information technology under the plan or coverage; and
(D) implement wellness and health promotion activities.
(2) REPORTING REQUIREMENTS.—
(A) IN GENERAL.—A group health plan and a health insurance issuer offering group or individual health insurance coverage shall annually submit to the Secretary, and
to enrollees under the plan or coverage, a report on whether the benefits under the plan or coverage satisfy the elements described in subparagraphs (A) through (D) of paragraph (1).
(B) TIMING OF REPORTS.—A report under subparagraph (A) shall be made available to an enrollee under the
plan or coverage during each open enrollment period.
(C) AVAILABILITY OF REPORTS.—The Secretary shall
make reports submitted under subparagraph (A) available
to the public through an Internet website.
(D) PENALTIES.—In developing the reporting requirements under paragraph (1), the Secretary may develop and
impose appropriate penalties for non-compliance with such
requirements.
(E) EXCEPTIONS.—In developing the reporting requirements under paragraph (1), the Secretary may provide for
exceptions to such requirements for group health plans
and health insurance issuers that substantially meet the
goals of this section.
(b) WELLNESS AND PREVENTION PROGRAMS.—For purposes of
subsection (a)(1)(D), wellness and health promotion activities may
include personalized wellness and prevention services, which are
coordinated, maintained or delivered by a health care provider, a
wellness and prevention plan manager, or a health, wellness or
prevention services organization that conducts health risk assessments or offers ongoing face-to-face, telephonic or web-based intervention efforts for each of the program’s participants, and which
may include the following wellness and prevention efforts:
(1) Smoking cessation.
(2) Weight management.
(3) Stress management.
(4) Physical fitness.
(5) Nutrition.
(6) Heart disease prevention.
(7) Healthy lifestyle support.
(8) Diabetes prevention.
(c) PROTECTION OF SECOND AMENDMENT GUN RIGHTS.—
(1) WELLNESS AND PREVENTION PROGRAMS.—A wellness
and health promotion activity implemented under subsection
(a)(1)(D) may not require the disclosure or collection of any information relating to—
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(A) the presence or storage of a lawfully-possessed firearm or ammunition in the residence or on the property of
an individual; or
(B) the lawful use, possession, or storage of a firearm
or ammunition by an individual.
(2) LIMITATION ON DATA COLLECTION.—None of the authorities provided to the Secretary under the Patient Protection and
Affordable Care Act or an amendment made by that Act shall
be construed to authorize or may be used for the collection of
any information relating to—
(A) the lawful ownership or possession of a firearm or
ammunition;
(B) the lawful use of a firearm or ammunition; or
(C) the lawful storage of a firearm or ammunition.
(3) LIMITATION ON DATABASES OR DATA BANKS.—None of
the authorities provided to the Secretary under the Patient
Protection and Affordable Care Act or an amendment made by
that Act shall be construed to authorize or may be used to
maintain records of individual ownership or possession of a
firearm or ammunition.
(4) LIMITATION ON DETERMINATION OF PREMIUM RATES OR
ELIGIBILITY FOR HEALTH INSURANCE.—A premium rate may not
be increased, health insurance coverage may not be denied,
and a discount, rebate, or reward offered for participation in a
wellness program may not be reduced or withheld under any
health benefit plan issued pursuant to or in accordance with
the Patient Protection and Affordable Care Act or an amendment made by that Act on the basis of, or on reliance upon—
(A) the lawful ownership or possession of a firearm or
ammunition; or
(B) the lawful use or storage of a firearm or ammunition.
(5) LIMITATION ON DATA COLLECTION REQUIREMENTS FOR
INDIVIDUALS.—No individual shall be required to disclose any
information under any data collection activity authorized
under the Patient Protection and Affordable Care Act or an
amendment made by that Act relating to—
(A) the lawful ownership or possession of a firearm or
ammunition; or
(B) the lawful use, possession, or storage of a firearm
or ammunition.
(d) REGULATIONS.—Not later than 2 years after the date of enactment of the Patient Protection and Affordable Care Act, the Secretary shall promulgate regulations that provide criteria for determining whether a reimbursement structure is described in subsection (a).
(e) STUDY AND REPORT.—Not later than 180 days after the date
on which regulations are promulgated under subsection (c), the
Government Accountability Office shall review such regulations
and conduct a study and submit to the Committee on Health, Education, Labor, and Pensions of the Senate and the Committee on
Energy and Commerce of the House of Representatives a report regarding the impact the activities under this section have had on
the quality and cost of health care.
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SEC. 2718. ø300gg–18¿ BRINGING DOWN THE COST OF HEALTH CARE
COVERAGE.
(a) CLEAR ACCOUNTING FOR COSTS.—A health insurance issuer

offering group or individual health insurance coverage (including a
grandfathered health plan) shall, with respect to each plan year,
submit to the Secretary a report concerning the ratio of the incurred loss (or incurred claims) plus the loss adjustment expense
(or change in contract reserves) to earned premiums. Such report
shall include the percentage of total premium revenue, after accounting for collections or receipts for risk adjustment and risk corridors and payments of reinsurance, that such coverage expends—
(1) on reimbursement for clinical services provided to enrollees under such coverage;
(2) for activities that improve health care quality; and
(3) on all other non-claims costs, including an explanation
of the nature of such costs, and excluding Federal and State
taxes and licensing or regulatory fees.
The Secretary shall make reports received under this section available to the public on the Internet website of the Department of
Health and Human Services.
(b) ENSURING THAT CONSUMERS RECEIVE VALUE FOR THEIR
PREMIUM PAYMENTS.—
(1) REQUIREMENT TO PROVIDE VALUE FOR PREMIUM PAYMENTS.—
(A) REQUIREMENT.—Beginning not later than January
1, 2011, a health insurance issuer offering group or individual health insurance coverage (including a grandfathered health plan) shall, with respect to each plan year,
provide an annual rebate to each enrollee under such coverage, on a pro rata basis, if the ratio of the amount of premium revenue expended by the issuer on costs described
in paragraphs (1) and (2) of subsection (a) to the total
amount of premium revenue (excluding Federal and State
taxes and licensing or regulatory fees and after accounting
for payments or receipts for risk adjustment, risk corridors, and reinsurance under sections 1341, 1342, and
1343 of the Patient Protection and Affordable Care Act) for
the plan year (except as provided in subparagraph (B)(ii)),
is less than—
(i) with respect to a health insurance issuer offering coverage in the large group market, 85 percent, or
such higher percentage as a State may by regulation
determine; or
(ii) with respect to a health insurance issuer offering coverage in the small group market or in the individual market, 80 percent, or such higher percentage
as a State may by regulation determine, except that
the Secretary may adjust such percentage with respect
to a State if the Secretary determines that the application of such 80 percent may destabilize the individual
market in such State.
(B) REBATE AMOUNT.—
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(i) CALCULATION OF AMOUNT.—The total amount
of an annual rebate required under this paragraph
shall be in an amount equal to the product of—
(I) the amount by which the percentage described in clause (i) or (ii) of subparagraph (A) exceeds the ratio described in such subparagraph;
and
(II) the total amount of premium revenue (excluding Federal and State taxes and licensing or
regulatory fees and after accounting for payments
or receipts for risk adjustment, risk corridors, and
reinsurance under sections 1341, 1342, and 1343
of the Patient Protection and Affordable Care Act)
for such plan year.
(ii) CALCULATION BASED ON AVERAGE RATIO.—Beginning on January 1, 2014, the determination made
under subparagraph (A) for the year involved shall be
based on the averages of the premiums expended on
the costs described in such subparagraph and total
premium revenue for each of the previous 3 years for
the plan.
(2) CONSIDERATION IN SETTING PERCENTAGES.—In determining the percentages under paragraph (1), a State shall seek
to ensure adequate participation by health insurance issuers,
competition in the health insurance market in the State, and
value for consumers so that premiums are used for clinical
services and quality improvements.
(3) ENFORCEMENT.—The Secretary shall promulgate regulations for enforcing the provisions of this section and may provide for appropriate penalties.
(c) DEFINITIONS.—Not later than December 31, 2010, and subject to the certification of the Secretary, the National Association
of Insurance Commissioners shall establish uniform definitions of
the activities reported under subsection (a) and standardized methodologies for calculating measures of such activities, including definitions of which activities, and in what regard such activities, constitute activities described in subsection (a)(2). Such methodologies
shall be designed to take into account the special circumstances of
smaller plans, different types of plans, and newer plans.
(d) ADJUSTMENTS.—The Secretary may adjust the rates described in subsection (b) if the Secretary determines appropriate on
account of the volatility of the individual market due to the establishment of State Exchanges.
(e) STANDARD HOSPITAL CHARGES.—Each hospital operating
within the United States shall for each year establish (and update)
and make public (in accordance with guidelines developed by the
Secretary) a list of the hospital’s standard charges for items and
services provided by the hospital, including for diagnosis-related
groups established under section 1886(d)(4) of the Social Security
Act.
SEC. 2719. ø300gg–19¿ APPEALS PROCESS.
(a) INTERNAL CLAIMS APPEALS.—
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(1) IN GENERAL.—A group health plan and a health insurance issuer offering group or individual health insurance coverage shall implement an effective appeals process for appeals
of coverage determinations and claims, under which the plan
or issuer shall, at a minimum—
(A) have in effect an internal claims appeal process;
(B) provide notice to enrollees, in a culturally and linguistically appropriate manner, of available internal and
external appeals processes, and the availability of any applicable office of health insurance consumer assistance or
ombudsman established under section 2793 to assist such
enrollees with the appeals processes; and
(C) allow an enrollee to review their file, to present
evidence and testimony as part of the appeals process, and
to receive continued coverage pending the outcome of the
appeals process.
(2) ESTABLISHED PROCESSES.—To comply with paragraph
(1)—
(A) a group health plan and a health insurance issuer
offering group health coverage shall provide an internal
claims and appeals process that initially incorporates the
claims and appeals procedures (including urgent claims)
set forth at section 2560.503–1 of title 29, Code of Federal
Regulations, as published on November 21, 2000 (65 Fed.
Reg. 70256), and shall update such process in accordance
with any standards established by the Secretary of Labor
for such plans and issuers; and
(B) a health insurance issuer offering individual
health coverage, and any other issuer not subject to subparagraph (A), shall provide an internal claims and appeals process that initially incorporates the claims and appeals procedures set forth under applicable law (as in existence on the date of enactment of this section), and shall
update such process in accordance with any standards established by the Secretary of Health and Human Services
for such issuers.
(b) EXTERNAL REVIEW.—A group health plan and a health insurance issuer offering group or individual health insurance coverage—
(1) shall comply with the applicable State external review
process for such plans and issuers that, at a minimum, includes the consumer protections set forth in the Uniform External Review Model Act promulgated by the National Association of Insurance Commissioners and is binding on such plans;
or
(2) shall implement an effective external review process
that meets minimum standards established by the Secretary
through guidance and that is similar to the process described
under paragraph (1)—
(A) if the applicable State has not established an external review process that meets the requirements of paragraph (1); or
(B) if the plan is a self-insured plan that is not subject
to State insurance regulation (including a State law that
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establishes an external review process described in paragraph (1)).
(c) SECRETARY AUTHORITY.—The Secretary may deem the external review process of a group health plan or health insurance
issuer, in operation as of the date of enactment of this section, to
be in compliance with the applicable process established under subsection (b), as determined appropriate by the Secretary.
SEC. 2719A. ø300gg–19a¿ PATIENT PROTECTIONS.
(a) CHOICE OF HEALTH CARE PROFESSIONAL.—If

a group health
plan, or a health insurance issuer offering group or individual
health insurance coverage, requires or provides for designation by
a participant, beneficiary, or enrollee of a participating primary
care provider, then the plan or issuer shall permit each participant,
beneficiary, and enrollee to designate any participating primary
care provider who is available to accept such individual.
(b) COVERAGE OF EMERGENCY SERVICES.—
(1) IN GENERAL.—If a group health plan, or a health insurance issuer offering group or individual health insurance
issuer, provides or covers any benefits with respect to services
in an emergency department of a hospital, the plan or issuer
shall cover emergency services (as defined in paragraph
(2)(B))—
(A) without the need for any prior authorization determination;
(B) whether the health care provider furnishing such
services is a participating provider with respect to such
services;
(C) in a manner so that, if such services are provided
to a participant, beneficiary, or enrollee—
(i) by a nonparticipating health care provider with
or without prior authorization; or
(ii)(I) such services will be provided without imposing any requirement under the plan for prior authorization of services or any limitation on coverage
where the provider of services does not have a contractual relationship with the plan for the providing of
services that is more restrictive than the requirements
or limitations that apply to emergency department
services received from providers who do have such a
contractual relationship with the plan; and
(II) if such services are provided out-of-network,
the cost-sharing requirement (expressed as a copayment amount or coinsurance rate) is the same requirement that would apply if such services were provided
in-network;
(D) without regard to any other term or condition of
such coverage (other than exclusion or coordination of benefits, or an affiliation or waiting period, permitted under
section 2701 of this Act, section 701 of the Employee Retirement Income Security Act of 1974, or section 9801 of
the Internal Revenue Code of 1986, and other than applicable cost-sharing).
(2) DEFINITIONS.—In this subsection:
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(A) EMERGENCY MEDICAL CONDITION.—The term
‘‘emergency medical condition’’ means a medical condition
manifesting itself by acute symptoms of sufficient severity
(including severe pain) such that a prudent layperson, who
possesses an average knowledge of health and medicine,
could reasonably expect the absence of immediate medical
attention to result in a condition described in clause (i),
(ii), or (iii) of section 1867(e)(1)(A) of the Social Security
Act.
(B) EMERGENCY SERVICES.—The term ‘‘emergency
services’’ means, with respect to an emergency medical
condition—
(i) a medical screening examination (as required
under section 1867 of the Social Security Act) that is
within the capability of the emergency department of
a hospital, including ancillary services routinely available to the emergency department to evaluate such
emergency medical condition, and
(ii) within the capabilities of the staff and facilities available at the hospital, such further medical examination and treatment as are required under section 1867 of such Act to stabilize the patient.
(C) STABILIZE.—The term ‘‘to stabilize’’, with respect to
an emergency medical condition (as defined in subparagraph (A)), has the meaning give in section 1867(e)(3) of
the Social Security Act (42 U.S.C. 1395dd(e)(3)).
(c) ACCESS TO PEDIATRIC CARE.—
(1) PEDIATRIC CARE.—In the case of a person who has a
child who is a participant, beneficiary, or enrollee under a
group health plan, or health insurance coverage offered by a
health insurance issuer in the group or individual market, if
the plan or issuer requires or provides for the designation of
a participating primary care provider for the child, the plan or
issuer shall permit such person to designate a physician
(allopathic or osteopathic) who specializes in pediatrics as the
child’s primary care provider if such provider participates in
the network of the plan or issuer.
(2) CONSTRUCTION.—Nothing in paragraph (1) shall be construed to waive any exclusions of coverage under the terms
and conditions of the plan or health insurance coverage with
respect to coverage of pediatric care.
(d) PATIENT ACCESS TO OBSTETRICAL AND GYNECOLOGICAL
CARE.—
(1) GENERAL RIGHTS.—
(A) DIRECT ACCESS.—A group health plan, or health
insurance issuer offering group or individual health insurance coverage, described in paragraph (2) may not require
authorization or referral by the plan, issuer, or any person
(including a primary care provider described in paragraph
(2)(B)) in the case of a female participant, beneficiary, or
enrollee who seeks coverage for obstetrical or gynecological
care provided by a participating health care professional
who specializes in obstetrics or gynecology. Such professional shall agree to otherwise adhere to such plan’s or
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issuer’s policies and procedures, including procedures regarding referrals and obtaining prior authorization and
providing services pursuant to a treatment plan (if any)
approved by the plan or issuer.
(B) OBSTETRICAL AND GYNECOLOGICAL CARE.—A group
health plan or health insurance issuer described in paragraph (2) shall treat the provision of obstetrical and gynecological care, and the ordering of related obstetrical and
gynecological items and services, pursuant to the direct access described under subparagraph (A), by a participating
health care professional who specializes in obstetrics or
gynecology as the authorization of the primary care provider.
(2) APPLICATION OF PARAGRAPH.—A group health plan, or
health insurance issuer offering group or individual health insurance coverage, described in this paragraph is a group
health plan or coverage that—
(A) provides coverage for obstetric or gynecologic care;
and
(B) requires the designation by a participant, beneficiary, or enrollee of a participating primary care provider.
(3) CONSTRUCTION.—Nothing in paragraph (1) shall be construed to—
(A) waive any exclusions of coverage under the terms
and conditions of the plan or health insurance coverage
with respect to coverage of obstetrical or gynecological
care; or
(B) preclude the group health plan or health insurance
issuer involved from requiring that the obstetrical or gynecological provider notify the primary care health care professional or the plan or issuer of treatment decisions.
Subpart 2—Other Requirements 1
SEC. 2725. ø300gg–4¿ STANDARDS RELATING TO BENEFITS FOR MOTHERS AND NEWBORNS.
(a) REQUIREMENTS FOR MINIMUM HOSPITAL STAY FOLLOWING
BIRTH.—
(1) IN GENERAL.—A group health plan, and a health insur-

ance issuer offering group health insurance coverage, may
not—
(A) except as provided in paragraph (2)—
(i) restrict benefits for any hospital length of stay
in connection with childbirth for the mother or newborn child, following a normal vaginal delivery, to less
than 48 hours, or
(ii) restrict benefits for any hospital length of stay
in connection with childbirth for the mother or newborn child, following a cesarean section, to less than
96 hours, or
1 Effective January 1, 2014, the probable intent of Congress is to strike both the subpart designation and heading, but the amendment by section 1563 (relating to conforming amendments-originally designated as section 1562 and redesignated as section 1563 by section 10107(b)(1))
of Public Law 111–148, strikes only the ‘‘second heading’’.

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Sec. 2725

(B) require that a provider obtain authorization from
the plan or the issuer for prescribing any length of stay required under subparagraph (A) (without regard to paragraph (2)).
(2) EXCEPTION.—Paragraph (1)(A) shall not apply in connection with any group health plan or health insurance issuer
in any case in which the decision to discharge the mother or
her newborn child prior to the expiration of the minimum
length of stay otherwise required under paragraph (1)(A) is
made by an attending provider in consultation with the mother.
(b) PROHIBITIONS.—A group health plan, and a health insurance issuer offering group health insurance coverage in connection
with a group health plan, may not—
(1) deny to the mother or her newborn child eligibility, or
continued eligibility, to enroll or to renew coverage under the
terms of the plan, solely for the purpose of avoiding the requirements of this section;
(2) provide monetary payments or rebates to mothers to
encourage such mothers to accept less than the minimum protections available under this section;
(3) penalize or otherwise reduce or limit the reimbursement of an attending provider because such provider provided
care to an individual participant or beneficiary in accordance
with this section;
(4) provide incentives (monetary or otherwise) to an attending provider to induce such provider to provide care to an
individual participant or beneficiary in a manner inconsistent
with this section; or
(5) subject to subsection (c)(3), restrict benefits for any portion of a period within a hospital length of stay required under
subsection (a) in a manner which is less favorable than the
benefits provided for any preceding portion of such stay.
(c) RULES OF CONSTRUCTION.—
(1) Nothing in this section shall be construed to require a
mother who is a participant or beneficiary—
(A) to give birth in a hospital; or
(B) to stay in the hospital for a fixed period of time following the birth of her child.
(2) This section shall not apply with respect to any group
health plan, or any group health insurance coverage offered by
a health insurance issuer, which does not provide benefits for
hospital lengths of stay in connection with childbirth for a
mother or her newborn child.
(3) Nothing in this section shall be construed as preventing
a group health plan or issuer from imposing deductibles, coinsurance, or other cost-sharing in relation to benefits for hospital lengths of stay in connection with childbirth for a mother
or newborn child under the plan (or under health insurance
coverage offered in connection with a group health plan), except that such coinsurance or other cost-sharing for any portion of a period within a hospital length of stay required under
subsection (a) may not be greater than such coinsurance or
cost-sharing for any preceding portion of such stay.
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(d) NOTICE.—A group health plan under this part shall comply
with the notice requirement under section 711(d) of the Employee
Retirement Income Security Act of 1974 with respect to the requirements of this section as if such section applied to such plan.
(e) LEVEL AND TYPE OF REIMBURSEMENTS.—Nothing in this
section shall be construed to prevent a group health plan or a
health insurance issuer offering group health insurance coverage
from negotiating the level and type of reimbursement with a provider for care provided in accordance with this section.
(f) PREEMPTION; EXCEPTION FOR HEALTH INSURANCE COVERAGE
IN CERTAIN STATES.—
(1) IN GENERAL.—The requirements of this section shall
not apply with respect to health insurance coverage if there is
a State law (as defined in section 2723(d)(1)) for a State that
regulates such coverage that is described in any of the following subparagraphs:
(A) Such State law requires such coverage to provide
for at least a 48-hour hospital length of stay following a
normal vaginal delivery and at least a 96-hour hospital
length of stay following a cesarean section.
(B) Such State law requires such coverage to provide
for maternity and pediatric care in accordance with guidelines established by the American College of Obstetricians
and Gynecologists, the American Academy of Pediatrics, or
other established professional medical associations.
(C) Such State law requires, in connection with such
coverage for maternity care, that the hospital length of
stay for such care is left to the decision of (or required to
be made by) the attending provider in consultation with
the mother.
(2) CONSTRUCTION.—Section 2723(a)(1) shall not be construed as superseding a State law described in paragraph (1).
SEC. 2726. ø300gg–5¿ PARITY IN MENTAL HEALTH AND SUBSTANCE USE
DISORDER BENEFITS.
(a) IN GENERAL.—
(1) AGGREGATE LIFETIME LIMITS.—In the case of a group

health plan (or health insurance coverage offered in connection
with such a plan) that provides both medical and surgical benefits and mental health or substance use disorder benefits—
(A) NO LIFETIME LIMIT.—If the plan or coverage does
not include an aggregate lifetime limit on substantially all
medical and surgical benefits, the plan or coverage may
not impose any aggregate lifetime limit on mental health
or substance use disorder benefits.
(B) LIFETIME LIMIT.—If the plan or coverage includes
an aggregate lifetime limit on substantially all medical
and surgical benefits (in this paragraph referred to as the
‘‘applicable lifetime limit’’), the plan or coverage shall either—
(i) apply the applicable lifetime limit both to the
medical and surgical benefits to which it otherwise
would apply and to mental health and substance use
disorder benefits and not distinguish in the application of such limit between such medical and surgical
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benefits and mental health and substance use disorder
benefits; or
(ii) not include any aggregate lifetime limit on
mental health or substance use disorder benefits that
is less than the applicable lifetime limit.
(C) RULE IN CASE OF DIFFERENT LIMITS.—In the case
of a plan or coverage that is not described in subparagraph
(A) or (B) and that includes no or different aggregate lifetime limits on different categories of medical and surgical
benefits, the Secretary shall establish rules under which
subparagraph (B) is applied to such plan or coverage with
respect to mental health and substance use disorder benefits by substituting for the applicable lifetime limit an average
aggregate
lifetime
limit that is computed taking into account the weighted
average of the aggregate lifetime limits applicable to such
categories.
(2) ANNUAL LIMITS.—In the case of a group health plan (or
health insurance coverage offered in connection with such a
plan) that provides both medical and surgical benefits and
mental health or substance use disorder benefits—
(A) NO ANNUAL LIMIT.—If the plan or coverage does
not include an annual limit on substantially all medical
and surgical benefits, the plan or coverage may not impose
any annual limit on mental health or substance use disorder benefits.
(B) ANNUAL LIMIT.—If the plan or coverage includes
an annual limit on substantially all medical and surgical
benefits (in this paragraph referred to as the ‘‘applicable
annual limit’’), the plan or coverage shall either—
(i) apply the applicable annual limit both to medical and surgical benefits to which it otherwise would
apply and to mental health and substance use disorder
benefits and not distinguish in the application of such
limit between such medical and surgical benefits and
mental health and substance use disorder benefits; or
(ii) not include any annual limit on mental health
or substance use disorder benefits that is less than the
applicable annual limit.
(C) RULE IN CASE OF DIFFERENT LIMITS.—In the case
of a plan or coverage that is not described in subparagraph
(A) or (B) and that includes no or different annual limits
on different categories of medical and surgical benefits, the
Secretary shall establish rules under which subparagraph
(B) is applied to such plan or coverage with respect to
mental health and substance use disorder benefits by substituting for the applicable annual limit an average annual
limit that is computed taking into account the weighted
average of the annual limits applicable to such categories.
(3) FINANCIAL REQUIREMENTS AND TREATMENT LIMITATIONS.—
(A) IN GENERAL.—In the case of a group health plan
(or health insurance coverage offered in connection with
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fits and mental health or substance use disorder benefits,
such plan or coverage shall ensure that—
(i) the financial requirements applicable to such
mental health or substance use disorder benefits are
no more restrictive than the predominant financial requirements applied to substantially all medical and
surgical benefits covered by the plan (or coverage), and
there are no separate cost sharing requirements that
are applicable only with respect to mental health or
substance use disorder benefits; and
(ii) the treatment limitations applicable to such
mental health or substance use disorder benefits are
no more restrictive than the predominant treatment
limitations applied to substantially all medical and
surgical benefits covered by the plan (or coverage) and
there are no separate treatment limitations that are
applicable only with respect to mental health or substance use disorder benefits.
(B) DEFINITIONS.—In this paragraph:
(i) FINANCIAL REQUIREMENT.—The term ‘‘financial
requirement’’ includes deductibles, copayments, coinsurance, and out-of-pocket expenses, but excludes an
aggregate lifetime limit and an annual limit subject to
paragraphs (1) and (2).
(ii) PREDOMINANT.—A financial requirement or
treatment limit is considered to be predominant if it
is the most common or frequent of such type of limit
or requirement.
(iii) TREATMENT LIMITATION.—The term ‘‘treatment limitation’’ includes limits on the frequency of
treatment, number of visits, days of coverage, or other
similar limits on the scope or duration of treatment.
(4) AVAILABILITY OF PLAN INFORMATION.—The criteria for
medical necessity determinations made under the plan with respect to mental health or substance use disorder benefits (or
the health insurance coverage offered in connection with the
plan with respect to such benefits) shall be made available by
the plan administrator (or the health insurance issuer offering
such coverage) in accordance with regulations to any current or
potential participant, beneficiary, or contracting provider upon
request. The reason for any denial under the plan (or coverage)
of reimbursement or payment for services with respect to mental health or substance use disorder benefits in the case of any
participant or beneficiary shall, on request or as otherwise required, be made available by the plan administrator (or the
health insurance issuer offering such coverage) to the participant or beneficiary in accordance with regulations.
(5) OUT-OF-NETWORK PROVIDERS.—In the case of a plan or
coverage that provides both medical and surgical benefits and
mental health or substance use disorder benefits, if the plan or
coverage provides coverage for medical or surgical benefits provided by out-of-network providers, the plan or coverage shall
provide coverage for mental health or substance use disorder
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benefits provided by out-of-network providers in a manner that
is consistent with the requirements of this section.
(b) CONSTRUCTION.—Nothing in this section shall be
construed—
(1) as requiring a group health plan (or health insurance
coverage offered in connection with such a plan) to provide any
mental health or substance use disorder benefits; or
(2) in the case of a group health plan (or health insurance
coverage offered in connection with such a plan) that provides
mental health or substance use disorder benefits, as affecting
the terms and conditions of the plan or coverage relating to
such benefits under the plan or coverage, except as provided in
subsection (a).
(c) EXEMPTIONS.—
(1) SMALL EMPLOYER EXEMPTION.—This section shall not
apply to any group health plan (and group health insurance
coverage offered in connection with a group health plan) for
any plan year of a small employer (as defined in section
2791(e)(4), except that for purposes of this paragraph such
term shall include employers with 1 employee in the case of an
employer residing in a State that permits small groups to include a single individual).
(2) COST EXEMPTION.—
(A) IN GENERAL.—With respect to a group health plan
(or health insurance coverage offered in connection with
such a plan), if the application of this section to such plan
(or coverage) results in an increase for the plan year involved of the actual total costs of coverage with respect to
medical and surgical benefits and mental health and substance use disorder benefits under the plan (as determined
and certified under subparagraph (C)) by an amount that
exceeds the applicable percentage described in subparagraph (B) of the actual total plan costs, the provisions of
this section shall not apply to such plan (or coverage) during the following plan year, and such exemption shall
apply to the plan (or coverage) for 1 plan year. An employer may elect to continue to apply mental health and
substance use disorder parity pursuant to this section with
respect to the group health plan (or coverage) involved regardless of any increase in total costs.
(B) APPLICABLE PERCENTAGE.—With respect to a plan
(or coverage), the applicable percentage described in this
subparagraph shall be—
(i) 2 percent in the case of the first plan year in
which this section is applied; and
(ii) 1 percent in the case of each subsequent plan
year.
(C) DETERMINATIONS BY ACTUARIES.—Determinations
as to increases in actual costs under a plan (or coverage)
for purposes of this section shall be made and certified by
a qualified and licensed actuary who is a member in good
standing of the American Academy of Actuaries. All such
determinations shall be in a written report prepared by
the actuary. The report, and all underlying documentation
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relied upon by the actuary, shall be maintained by the
group health plan or health insurance issuer for a period
of 6 years following the notification made under subparagraph (E).
(D) 6-MONTH DETERMINATIONS.—If a group health plan
(or a health insurance issuer offering coverage in connection with a group health plan) seeks an exemption under
this paragraph, determinations under subparagraph (A)
shall be made after such plan (or coverage) has complied
with this section for the first 6 months of the plan year involved.
(E) NOTIFICATION.—
(i) IN GENERAL.—A group health plan (or a health
insurance issuer offering coverage in connection with
a group health plan) that, based upon a certification
described under subparagraph (C), qualifies for an exemption under this paragraph, and elects to implement the exemption, shall promptly notify the Secretary, the appropriate State agencies, and participants and beneficiaries in the plan of such election.
(ii) REQUIREMENT.—A notification to the Secretary
under clause (i) shall include—
(I) a description of the number of covered lives
under the plan (or coverage) involved at the time
of the notification, and as applicable, at the time
of any prior election of the cost-exemption under
this paragraph by such plan (or coverage);
(II) for both the plan year upon which a cost
exemption is sought and the year prior, a description of the actual total costs of coverage with respect to medical and surgical benefits and mental
health and substance use disorder benefits under
the plan; and
(III) for both the plan year upon which a cost
exemption is sought and the year prior, the actual
total costs of coverage with respect to mental
health and substance use disorder benefits under
the plan.
(iii) CONFIDENTIALITY.—A notification to the Secretary under clause (i) shall be confidential. The Secretary shall make available, upon request and on not
more than an annual basis, an anonymous itemization
of such notifications, that includes—
(I) a breakdown of States by the size and type
of employers submitting such notification; and
(II) a summary of the data received under
clause (ii).
(F) AUDITS BY APPROPRIATE AGENCIES.—To determine
compliance with this paragraph, the Secretary may audit
the books and records of a group health plan or health insurance issuer relating to an exemption, including any actuarial reports prepared pursuant to subparagraph (C),
during the 6 year period following the notification of such
exemption under subparagraph (E). A State agency receivMarch 13, 2013

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Sec. 2727

ing a notification under subparagraph (E) may also conduct such an audit with respect to an exemption covered
by such notification.
(d) SEPARATE APPLICATION TO EACH OPTION OFFERED.—In the
case of a group health plan that offers a participant or beneficiary
two or more benefit package options under the plan, the requirements of this section shall be applied separately with respect to
each such option.
(e) DEFINITIONS.—For purposes of this section—
(1) AGGREGATE LIFETIME LIMIT.—The term ‘‘aggregate lifetime limit’’ means, with respect to benefits under a group
health plan or health insurance coverage, a dollar limitation on
the total amount that may be paid with respect to such benefits under the plan or health insurance coverage with respect
to an individual or other coverage unit.
(2) ANNUAL LIMIT.—The term ‘‘annual limit’’ means, with
respect to benefits under a group health plan or health
insurance coverage, a dollar limitation on the total amount of
benefits that may be paid with respect to such benefits in a 12month period under the plan or health insurance coverage with
respect to an individual or other coverage unit.
(3) MEDICAL OR SURGICAL BENEFITS.—The term ‘‘medical or
surgical
benefits’’
means
benefits
with
respect
to
medical or surgical services, as defined under the terms of the
plan or coverage (as the case may be), but does not include
mental health or substance use disorder benefits.
(4) MENTAL HEALTH BENEFITS.—The term ‘‘mental health
benefits’’ means benefits with respect to services for mental
health conditions, as defined under the terms of the plan and
in accordance with applicable Federal and State law.
(5) SUBSTANCE USE DISORDER BENEFITS.—The term ‘‘substance use disorder benefits’’ means benefits with respect to
services for substance use disorders, as defined under the
terms of the plan and in accordance with applicable Federal
and State law.
SEC. 2727. ø300gg–6¿ REQUIRED COVERAGE FOR RECONSTRUCTIVE
SURGERY FOLLOWING MASTECTOMIES.

The provisions of section 713 of the Employee Retirement Income Security Act of 1974 shall apply to group health plans, and
health insurance issuers providing health insurance coverage in
connection with group health plans, as if included in this subpart. 2
2 Section 2706 was added by subsection (a) of section 903 of the Departments of Labor, Health
and Human Services, and Education, and Related Agencies Appropriations Act, 1999 (as contained in section 101(f) of division A of Public Law 105–277; 112 Stat. 2681–438). Subsection
(c) of such section 903 concerns effective dates, and paragraph (1) of the subsection provides as
follows:
‘‘(1) GROUP PLANS.—
‘‘(A) IN GENERAL.—The amendment made by subsection (a) shall apply to group
health plans for plan years beginning on or after the date of enactment of this Act.
‘‘(B) SPECIAL RULE FOR COLLECTIVE BARGAINING AGREEMENTS.—In the case of a group
health plan maintained pursuant to 1 or more collective bargaining agreements between employee representatives and 1 or more employers, any plan amendment made
pursuant to a collective bargaining agreement relating to the plan which amends the
plan solely to conform to any requirement added by the amendment made by subsection
(a) shall not be treated as a termination of such collective bargaining agreement.’’.
The Public Law was enacted October 21, 1998.

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SEC. 2728. ø300gg–7¿ COVERAGE OF DEPENDENT STUDENTS ON MEDICALLY NECESSARY LEAVE OF ABSENCE.
(a) MEDICALLY NECESSARY LEAVE OF ABSENCE.—In this sec-

tion, the term ‘‘medically necessary leave of absence’’ means, with
respect to a dependent child described in subsection (b)(2) in connection with a group health plan or health insurance coverage offered in connection with such plan, a leave of absence of such child
from a postsecondary educational institution (including an institution of higher education as defined in section 102 of the Higher
Education Act of 1965), or any other change in enrollment of such
child at such an institution, that—
(1) commences while such child is suffering from a serious
illness or injury;
(2) is medically necessary; and
(3) causes such child to lose student status for purposes of
coverage under the terms of the plan or coverage.
(b) REQUIREMENT TO CONTINUE COVERAGE.—
(1) IN GENERAL.—In the case of a dependent child described in paragraph (2), a group health plan, or a health insurance issuer that provides health insurance coverage in connection with a group health plan, shall not terminate coverage
of such child under such plan or health insurance coverage due
to a medically necessary leave of absence before the date that
is the earlier of—
(A) the date that is 1 year after the first day of the
medically necessary leave of absence; or
(B) the date on which such coverage would otherwise
terminate under the terms of the plan or health insurance
coverage.
(2) DEPENDENT CHILD DESCRIBED.—A dependent child described in this paragraph is, with respect to a group health
plan or health insurance coverage offered in connection with
the plan, a beneficiary under the plan who—
(A) is a dependent child, under the terms of the plan
or coverage, of a participant or beneficiary under the plan
or coverage; and
(B) was enrolled in the plan or coverage, on the basis
of being a student at a postsecondary educational institution (as described in subsection (a)), immediately before
the first day of the medically necessary leave of absence
involved.
(3) CERTIFICATION BY PHYSICIAN.—Paragraph (1) shall
apply to a group health plan or health insurance coverage offered by an issuer in connection with such plan only if the plan
or issuer of the coverage has received written certification by
a treating physician of the dependent child which states that
the child is suffering from a serious illness or injury and that
the leave of absence (or other change of enrollment) described
in subsection (a) is medically necessary.
(c) NOTICE.—A group health plan, and a health insurance
issuer providing health insurance coverage in connection with a
group health plan, shall include, with any notice regarding a requirement for certification of student status for coverage under the
plan or coverage, a description of the terms of this section for conMarch 13, 2013

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Sec. 2731

tinued coverage during medically necessary leaves of absence. Such
description shall be in language which is understandable to the
typical plan participant.
(d) NO CHANGE IN BENEFITS.—A dependent child whose benefits are continued under this section shall be entitled to the same
benefits as if (during the medically necessary leave of absence) the
child continued to be a covered student at the institution of higher
education and was not on a medically necessary leave of absence.
(e) CONTINUED APPLICATION IN CASE OF CHANGED COVERAGE.—If—
(1) a dependent child of a participant or beneficiary is in
a period of coverage under a group health plan or health insurance coverage offered in connection with such a plan, pursuant
to a medically necessary leave of absence of the child described
in subsection (b);
(2) the manner in which the participant or beneficiary is
covered under the plan changes, whether through a change in
health insurance coverage or health insurance issuer, a change
between health insurance coverage and self-insured coverage,
or otherwise; and
(3) the coverage as so changed continues to provide coverage of beneficiaries as dependent children,
this section shall apply to coverage of the child under the changed
coverage for the remainder of the period of the medically necessary
leave of absence of the dependent child under the plan in the same
manner as it would have applied if the changed coverage had been
the previous coverage.
Subpart 3—Provisions Applicable Only to Health Insurance Issuers
SEC. 2731. ø300gg–11¿ GUARANTEED AVAILABILITY OF COVERAGE
FOR EMPLOYERS IN THE GROUP MARKET.
(a) ISSUANCE OF COVERAGE IN THE SMALL GROUP MARKET.—
(1) IN GENERAL.—Subject to subsections (c) through (f),

each health insurance issuer that offers health insurance coverage in the small group market in a State—
(A) must accept every small employer (as defined in
section 2791(e)(4)) in the State that applies for such coverage; and
(B) must accept for enrollment under such coverage
every eligible individual (as defined in paragraph (2)) who
applies for enrollment during the period in which the individual first becomes eligible to enroll under the terms of
the group health plan and may not place any restriction
which is inconsistent with section 2702 on an eligible individual being a participant or beneficiary.
(2) ELIGIBLE INDIVIDUAL DEFINED.—For purposes of this
section, the term ‘‘eligible individual’’ means, with respect to a
health insurance issuer that offers health insurance coverage
to a small employer in connection with a group health plan in
the small group market, such an individual in relation to the
employer as shall be determined—
(A) in accordance with the terms of such plan,
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Sec. 2731

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(B) as provided by the issuer under rules of the issuer
which are uniformly applicable in a State to small employers in the small group market, and
(C) in accordance with all applicable State laws governing such issuer and such market.
(b) ASSURING ACCESS IN THE LARGE GROUP MARKET.—
(1) REPORTS TO HHS.—The Secretary shall request that the
chief executive officer of each State submit to the Secretary, by
not later December 31, 2000, and every 3 years thereafter a report on—
(A) the access of large employers to health insurance
coverage in the State, and
(B) the circumstances for lack of access (if any) of
large employers (or one or more classes of such employers)
in the State to such coverage.
(2) TRIENNIAL REPORTS TO CONGRESS.—The Secretary,
based on the reports submitted under paragraph (1) and such
other information as the Secretary may use, shall prepare and
submit to Congress, every 3 years, a report describing the extent to which large employers (and classes of such employers)
that seek health insurance coverage in the different States are
able to obtain access to such coverage. Such report shall include such recommendations as the Secretary determines to be
appropriate.
(3) GAO REPORT ON LARGE EMPLOYER ACCESS TO HEALTH
INSURANCE COVERAGE.—The Comptroller General shall provide
for a study of the extent to which classes of large employers
in the different States are able to obtain access to health insurance coverage and the circumstances for lack of access (if any)
to such coverage. The Comptroller General shall submit to
Congress a report on such study not later than 18 months after
the date of the enactment of this title.
(c) SPECIAL RULES FOR NETWORK PLANS.—
(1) IN GENERAL.—In the case of a health insurance issuer
that offers health insurance coverage in the small group market through a network plan, the issuer may—
(A) limit the employers that may apply for such coverage to those with eligible individuals who live, work, or
reside in the service area for such network plan; and
(B) within the service area of such plan, deny such
coverage to such employers if the issuer has demonstrated,
if required, to the applicable State authority that—
(i) it will not have the capacity to deliver services
adequately to enrollees of any additional groups because of its obligations to existing group contract holders and enrollees, and
(ii) it is applying this paragraph uniformly to all
employers without regard to the claims experience of
those employers and their employees (and their dependents) or any health status-related factor relating
to such employees and dependents.
(2) 180-DAY SUSPENSION UPON DENIAL OF COVERAGE.—An
issuer, upon denying health insurance coverage in any service
area in accordance with paragraph (1)(B), may not offer covMarch 13, 2013

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PUBLIC HEALTH SERVICE ACT

Sec. 2731

erage in the small group market within such service area for
a period of 180 days after the date such coverage is denied.
(d) APPLICATION OF FINANCIAL CAPACITY LIMITS.—
(1) IN GENERAL.—A health insurance issuer may deny
health insurance coverage in the small group market if the
issuer has demonstrated, if required, to the applicable State
authority that—
(A) it does not have the financial reserves necessary to
underwrite additional coverage; and
(B) it is applying this paragraph uniformly to all employers in the small group market in the State consistent
with applicable State law and without regard to the claims
experience of those employers and their employees (and
their dependents) or any health status-related factor relating to such employees and dependents.
(2) 180-DAY SUSPENSION UPON DENIAL OF COVERAGE.—A
health insurance issuer upon denying health insurance coverage in connection with group health plans in accordance with
paragraph (1) in a State may not offer coverage in connection
with group health plans in the small group market in the State
for a period of 180 days after the date such coverage is denied
or until the issuer has demonstrated to the applicable State
authority, if required under applicable State law, that the
issuer has sufficient financial reserves to underwrite additional
coverage, whichever is later. An applicable State authority may
provide for the application of this subsection on a service-areaspecific basis.
(e) EXCEPTION TO REQUIREMENT FOR FAILURE TO MEET CERTAIN MINIMUM PARTICIPATION OR CONTRIBUTION RULES.—
(1) IN GENERAL.—Subsection (a) shall not be construed to
preclude a health insurance issuer from establishing employer
contribution rules or group participation rules for the offering
of health insurance coverage in connection with a group health
plan in the small group market, as allowed under applicable
State law.
(2) RULES DEFINED.—For purposes of paragraph (1)—
(A) the term ‘‘employer contribution rule’’ means a requirement relating to the minimum level or amount of employer contribution toward the premium for enrollment of
participants and beneficiaries; and
(B) the term ‘‘group participation rule’’ means a requirement relating to the minimum number of participants
or beneficiaries that must be enrolled in relation to a specified percentage or number of eligible individuals or employees of an employer.
(f) EXCEPTION FOR COVERAGE OFFERED ONLY TO BONA FIDE
ASSOCIATION MEMBERS.—Subsection (a) shall not apply to health
insurance coverage offered by a health insurance issuer if such coverage is made available in the small group market only through
one or more bona fide associations (as defined in section
2791(d)(3)).
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Sec. 2732

PUBLIC HEALTH SERVICE ACT

1406

SEC. 2732. ø300gg–12¿ GUARANTEED RENEWABILITY OF COVERAGE
FOR EMPLOYERS IN THE GROUP MARKET.
(a) IN GENERAL.—Except as provided in this section, if a health

insurance issuer offers health insurance coverage in the small or
large group market in connection with a group health plan, the
issuer must renew or continue in force such coverage at the option
of the plan sponsor of the plan.
(b) GENERAL EXCEPTIONS.—A health insurance issuer may
nonrenew or discontinue health insurance coverage offered in connection with a group health plan in the small or large group market based only on one or more of the following:
(1) NONPAYMENT OF PREMIUMS.—The plan sponsor has
failed to pay premiums or contributions in accordance with the
terms of the health insurance coverage or the issuer has not
received timely premium payments.
(2) FRAUD.—The plan sponsor has performed an act or
practice that constitutes fraud or made an intentional misrepresentation of material fact under the terms of the coverage.
(3) VIOLATION OF PARTICIPATION OR CONTRIBUTION
RULES.—The plan sponsor has failed to comply with a material
plan provision relating to employer contribution or group participation rules, as permitted under section 2711(e) in the case
of the small group market or pursuant to applicable State law
in the case of the large group market.
(4) TERMINATION OF COVERAGE.—The issuer is ceasing to
offer coverage in such market in accordance with subsection (c)
and applicable State law.
(5) MOVEMENT OUTSIDE SERVICE AREA.—In the case of a
health insurance issuer that offers health insurance coverage
in the market through a network plan, there is no longer any
enrollee in connection with such plan who lives, resides, or
works in the service area of the issuer (or in the area for which
the issuer is authorized to do business) and, in the case of the
small group market, the issuer would deny enrollment with respect to such plan under section 2711(c)(1)(A).
(6) ASSOCIATION MEMBERSHIP CEASES.—In the case of
health insurance coverage that is made available in the small
or large group market (as the case may be) only through one
or more bona fide associations, the membership of an employer
in the association (on the basis of which the coverage is provided) ceases but only if such coverage is terminated under
this paragraph uniformly without regard to any health statusrelated factor relating to any covered individual.
(c) REQUIREMENTS FOR UNIFORM TERMINATION OF COVERAGE.—
(1) PARTICULAR TYPE OF COVERAGE NOT OFFERED.—In any
case in which an issuer decides to discontinue offering a particular type of group health insurance coverage offered in the
small or large group market, coverage of such type may be discontinued by the issuer in accordance with applicable State
law in such market only if—
(A) the issuer provides notice to each plan sponsor provided coverage of this type in such market (and participants and beneficiaries covered under such coverage) of
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Sec. 2732

such discontinuation at least 90 days prior to the date of
the discontinuation of such coverage;
(B) the issuer offers to each plan sponsor provided coverage of this type in such market, the option to purchase
all (or, in the case of the large group market, any) other
health insurance coverage currently being offered by the
issuer to a group health plan in such market; and
(C) in exercising the option to discontinue coverage of
this type and in offering the option of coverage under subparagraph (B), the issuer acts uniformly without regard to
the claims experience of those sponsors or any health status-related factor relating to any participants or beneficiaries covered or new participants or beneficiaries who
may become eligible for such coverage.
(2) DISCONTINUANCE OF ALL COVERAGE.—
(A) IN GENERAL.—In any case in which a health insurance issuer elects to discontinue offering all health insurance coverage in the small group market or the large
group market, or both markets, in a State, health insurance coverage may be discontinued by the issuer only in
accordance with applicable State law and if—
(i) the issuer provides notice to the applicable
State authority and to each plan sponsor (and participants and beneficiaries covered under such coverage)
of such discontinuation at least 180 days prior to the
date of the discontinuation of such coverage; and
(ii) all health insurance issued or delivered for
issuance in the State in such market (or markets) are
discontinued and coverage under such health insurance coverage in such market (or markets) is not renewed.
(B) PROHIBITION ON MARKET REENTRY.—In the case of
a discontinuation under subparagraph (A) in a market, the
issuer may not provide for the issuance of any health insurance coverage in the market and State involved during
the 5-year period beginning on the date of the discontinuation of the last health insurance coverage not so renewed.
(d) EXCEPTION FOR UNIFORM MODIFICATION OF COVERAGE.—At
the time of coverage renewal, a health insurance issuer may modify
the health insurance coverage for a product offered to a group
health plan—
(1) in the large group market; or
(2) in the small group market if, for coverage that is available in such market other than only through one or more bona
fide associations, such modification is consistent with State law
and effective on a uniform basis among group health plans
with that product.
(e) APPLICATION TO COVERAGE OFFERED ONLY THROUGH ASSOCIATIONS.—In applying this section in the case of health insurance
coverage that is made available by a health insurance issuer in the
small or large group market to employers only through one or more
associations, a reference to ‘‘plan sponsor’’ is deemed, with respect
to coverage provided to an employer member of the association, to
include a reference to such employer.
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Sec. 2733

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SEC. 2733. ø300gg–13¿ DISCLOSURE OF INFORMATION.
(a) DISCLOSURE OF INFORMATION BY HEALTH PLAN

ISSUERS.—
In connection with the offering of any health insurance coverage to
a small employer, a health insurance issuer—
(1) shall make a reasonable disclosure to such employer, as
part of its solicitation and sales materials, of the availability
of information described in subsection (b), and
(2) upon request of such a small employer, provide such information.
(b) INFORMATION DESCRIBED.—
(1) IN GENERAL.—Subject to paragraph (3), with respect to
a health insurance issuer offering health insurance coverage to
a small employer, information described in this subsection is
information concerning—
(A) the provisions of such coverage concerning issuer’s
right to change premium rates and the factors that may
affect changes in premium rates;
(B) the provisions of such coverage relating to renewability of coverage;
(C) the provisions of such coverage relating to any preexisting condition exclusion; and
(D) the benefits and premiums available under all
health insurance coverage for which the employer is qualified.
(2) FORM OF INFORMATION.—Information under this subsection shall be provided to small employers in a manner determined to be understandable by the average small employer,
and shall be sufficient to reasonably inform small employers of
their rights and obligations under the health insurance coverage.
(3) EXCEPTION.—An issuer is not required under this section to disclose any information that is proprietary and trade
secret information under applicable law.
Subpart 4—Exclusion of Plans; Enforcement; Preemption

SEC. 2735. ø300gg–21¿ EXCLUSION OF CERTAIN PLANS.
(a) EXCEPTION FOR CERTAIN SMALL GROUP HEALTH

PLANS.—
The requirements of subparts 1 and 3 1 shall not apply to any
group health plan (and health insurance coverage offered in connection with a group health plan) for any plan year if, on the first
day of such plan year, such plan has less than 2 participants who
are current employees.
(b) LIMITATION ON APPLICATION OF PROVISIONS RELATING TO
GROUP HEALTH PLANS.—
(1) IN GENERAL.—The requirements of subparts 1 through
3 shall apply with respect to group health plans only—
(A) subject to paragraph (2), in the case of a plan that
is a nonfederal governmental plan, and
(B) with respect to health insurance coverage offered
in connection with a group health plan (including such a
plan that is a church plan or a governmental plan).
(2) TREATMENT OF NONFEDERAL GOVERNMENTAL PLANS.—
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PUBLIC HEALTH SERVICE ACT

Sec. 2735

(A) ELECTION TO BE EXCLUDED.—Except as provided in
subparagraph (D), if the plan sponsor of a nonfederal governmental plan which is a group health plan to which the
provisions of subparts 1 through 3 otherwise apply makes
an election under this subparagraph (in such form and
manner as the Secretary may by regulations prescribe),
then the requirements of such subparts insofar as they
apply directly to group health plans (and not merely to
group health insurance coverage) shall not apply to such
governmental plans for such period except as provided in
this paragraph.
(B) PERIOD OF ELECTION.—An election under subparagraph (A) shall apply—
(i) for a single specified plan year, or
(ii) in the case of a plan provided pursuant to a
collective bargaining agreement, for the term of such
agreement.
An election under clause (i) may be extended through subsequent elections under this paragraph.
(C) NOTICE TO ENROLLEES.—Under such an election,
the plan shall provide for—
(i) notice to enrollees (on an annual basis and at
the time of enrollment under the plan) of the fact and
consequences of such election, and
(ii) certification and disclosure of creditable coverage under the plan with respect to enrollees in accordance with section 2701(e).
(D) ELECTION NOT APPLICABLE TO REQUIREMENTS CONCERNING GENETIC INFORMATION.—The election described in
subparagraph (A) shall not be available with respect to the
provisions of subsections (a)(1)(F), (b)(3), (c), and (d) of section 2702 and the provisions of sections 2701 and 2702(b)
to the extent that such provisions apply to genetic information.
(c) EXCEPTION FOR CERTAIN BENEFITS.—The requirements of
subparts 1 through 3 shall not apply to any group health plan (or
group health insurance coverage) in relation to its provision of excepted benefits described in section 2791(c)(1).
(d) EXCEPTION FOR CERTAIN BENEFITS IF CERTAIN CONDITIONS
MET.—
(1) LIMITED, EXCEPTED BENEFITS.—The requirements of
subparts 1 through 3 shall not apply to any group health plan
(and group health insurance coverage offered in connection
with a group health plan) in relation to its provision of excepted benefits described in section 2791(c)(2) if the benefits—
(A) are provided under a separate policy, certificate, or
contract of insurance; or
(B) are otherwise not an integral part of the plan.
(2) NONCOORDINATED, EXCEPTED BENEFITS.—The requirements of subparts 1 through 3 shall not apply to any group
health plan (and group health insurance coverage offered in
connection with a group health plan) in relation to its provision
of excepted benefits described in section 2791(c)(3) if all of the
following conditions are met:
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Sec. 2736

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(A) The benefits are provided under a separate policy,
certificate, or contract of insurance.
(B) There is no coordination between the provision of
such benefits and any exclusion of benefits under any
group health plan maintained by the same plan sponsor.
(C) Such benefits are paid with respect to an event
without regard to whether benefits are provided with respect to such an event under any group health plan maintained by the same plan sponsor.
(3) SUPPLEMENTAL EXCEPTED BENEFITS.—The requirements
of this part shall not apply to any group health plan (and
group health insurance coverage) in relation to its provision of
excepted benefits described in section 27971(c)(4) if the benefits
are provided under a separate policy, certificate, or contract of
insurance.
(e) TREATMENT OF PARTNERSHIPS.—For purposes of this part—
(1) TREATMENT AS A GROUP HEALTH PLAN.—Any plan, fund,
or program which would not be (but for this subsection) an employee welfare benefit plan and which is established or maintained by a partnership, to the extent that such plan, fund, or
program provides medical care (including items and services
paid for as medical care) to present or former partners in the
partnership or to their dependents (as defined under the terms
of the plan, fund, or program), directly or through insurance,
reimbursement, or otherwise, shall be treated (subject to paragraph (2)) as an employee welfare benefit plan which is a
group health plan.
(2) EMPLOYER.—In the case of a group health plan, the
term ‘‘employer’’ also includes the partnership in relation to
any partner.
(3) PARTICIPANTS OF GROUP HEALTH PLANS.—In the case of
a group health plan, the term ‘‘participant’’ also includes—
(A) in connection with a group health plan maintained
by a partnership, an individual who is a partner in relation to the partnership, or
(B) in connection with a group health plan maintained
by a self-employed individual (under which one or more
employees are participants), the self-employed individual,
if such individual is, or may become, eligible to receive a benefit under the plan or such individual’s beneficiaries may be eligible to receive any such benefit.
SEC. 2736. ø300gg–22¿ ENFORCEMENT.
(a) STATE ENFORCEMENT.—
(1) STATE AUTHORITY.—Subject

to section 2723, each State
may require that health insurance issuers that issue, sell,
renew, or offer health insurance coverage in the State in the
small or large group markets meet the requirements of this
part with respect to such issuers.
(2) FAILURE TO IMPLEMENT PROVISIONS.—In the case of a
determination by the Secretary that a State has failed to substantially enforce a provision (or provisions) in this part with
respect to health insurance issuers in the State, the Secretary
shall enforce such provision (or provisions) under subsection (b)

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PUBLIC HEALTH SERVICE ACT

Sec. 2736

insofar as they relate to the issuance, sale, renewal, and offering of health insurance coverage in connection with group
health plans in such State.
(b) SECRETARIAL ENFORCEMENT AUTHORITY.—
(1) LIMITATION.—The provisions of this subsection shall
apply to enforcement of a provision (or provisions) of this part
only—
(A) as provided under subsection (a)(2); and
(B) with respect to group health plans that are nonFederal governmental plans.
(2) IMPOSITION OF PENALTIES.—In the cases described in
paragraph (1)—
(A) IN GENERAL.—Subject to the succeeding provisions
of this subsection, any non-Federal governmental plan that
is a group health plan and any health insurance issuer
that fails to meet a provision of this part applicable to
such plan or issuer is subject to a civil money penalty
under this subsection.
(B) LIABILITY FOR PENALTY.—In the case of a
failure by—
(i) a health insurance issuer, the issuer is liable
for such penalty, or
(ii) a group health plan that is a non-Federal governmental plan which is—
(I) sponsored by 2 or more employers, the
plan is liable for such penalty, or
(II) not so sponsored, the employer is liable
for such penalty.
(C) AMOUNT OF PENALTY.—
(i) IN GENERAL.—The maximum amount of penalty
imposed under this paragraph is $100 for each day for
each individual with respect to which such a failure
occurs.
(ii) CONSIDERATIONS IN IMPOSITION.—In determining the amount of any penalty to be assessed
under this paragraph, the Secretary shall take into account the previous record of compliance of the entity
being assessed with the applicable provisions of this
part and the gravity of the violation.
(iii) LIMITATIONS.—
(I) PENALTY NOT TO APPLY WHERE FAILURE
NOT DISCOVERED EXERCISING REASONABLE DILIGENCE.—No civil money penalty shall be imposed
under this paragraph on any failure during any
period for which it is established to the satisfaction of the Secretary that none of the entities
against whom the penalty would be imposed
knew, or exercising reasonable diligence would
have known, that such failure existed.
(II) PENALTY NOT TO APPLY TO FAILURES CORRECTED WITHIN 30 DAYS.—No civil money penalty
shall be imposed under this paragraph on any
failure if such failure was due to reasonable cause
and not to willful neglect, and such failure is corMarch 13, 2013

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rected during the 30-day period beginning on the
first day any of the entities against whom the
penalty would be imposed knew, or exercising reasonable diligence would have known, that such
failure existed.
(D) ADMINISTRATIVE REVIEW.—
(i) OPPORTUNITY FOR HEARING.—The entity assessed shall be afforded an opportunity for hearing by
the Secretary upon request made within 30 days after
the date of the issuance of a notice of assessment. In
such hearing the decision shall be made on the record
pursuant to section 554 of title 5, United States Code.
If no hearing is requested, the assessment shall constitute a final and unappealable order.
(ii) HEARING PROCEDURE.—If a hearing is requested, the initial agency decision shall be made by
an administrative law judge, and such decision shall
become the final order unless the Secretary modifies
or vacates the decision. Notice of intent to modify or
vacate the decision of the administrative law judge
shall be issued to the parties within 30 days after the
date of the decision of the judge. A final order which
takes effect under this paragraph shall be
subject to review only as provided under subparagraph
(E).
(E) JUDICIAL REVIEW.—
(i) FILING OF ACTION FOR REVIEW.—Any entity
against whom an order imposing a civil money penalty
has been entered after an agency hearing under this
paragraph may obtain review by the United States
district court for any district in which such entity is
located or the United States District Court for the District of Columbia by filing a notice of appeal in such
court within 30 days from the date of such order, and
simultaneously sending a copy of such notice by registered mail to the Secretary.
(ii) CERTIFICATION OF ADMINISTRATIVE RECORD.—
The Secretary shall promptly certify and file in such
court the record upon which the penalty was imposed.
(iii) STANDARD FOR REVIEW.—The findings of the
Secretary shall be set aside only if found to be unsupported by substantial evidence as provided by section
706(2)(E) of title 5, United States Code.
(iv) APPEAL.—Any final decision, order, or judgment of the district court concerning such review shall
be subject to appeal as provided in chapter 83 of title
28 of such Code.
(F) FAILURE TO PAY ASSESSMENT; MAINTENANCE OF ACTION.—
(i) FAILURE TO PAY ASSESSMENT.—If any entity
fails to pay an assessment after it has become a final
and unappealable order, or after the court has entered
final judgment in favor of the Secretary, the Secretary
shall refer the matter to the Attorney General who
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shall recover the amount assessed by action in the appropriate United States district court.
(ii) NONREVIEWABILITY.—In such action the validity and appropriateness of the final order imposing the
penalty shall not be subject to review.
(G) PAYMENT OF PENALTIES.—Except as otherwise provided, penalties collected under this paragraph shall be
paid to the Secretary (or other officer) imposing the penalty and shall be available without appropriation and until
expended for the purpose of enforcing the provisions with
respect to which the penalty was imposed.
(3) ENFORCEMENT AUTHORITY RELATING TO GENETIC DISCRIMINATION.—
(A) GENERAL RULE.—In the cases described in paragraph (1), notwithstanding the provisions of paragraph
(2)(C), the succeeding subparagraphs of this paragraph
shall apply with respect to an action under this subsection
by the Secretary with respect to any failure of a health insurance issuer in connection with a group health plan, to
meet the requirements of subsection (a)(1)(F), (b)(3), (c), or
(d) of section 2702 or section 2701 or 2702(b)(1) with respect to genetic information in connection with the plan.
(B) AMOUNT.—
(i) IN GENERAL.—The amount of the penalty imposed under this paragraph shall be $100 for each day
in the noncompliance period with respect to each participant or beneficiary to whom such failure relates.
(ii) NONCOMPLIANCE PERIOD.—For purposes of this
paragraph, the term ‘‘noncompliance period’’ means,
with respect to any failure, the period—
(I) beginning on the date such failure first occurs; and
(II) ending on the date the failure is corrected.
(C) MINIMUM PENALTIES WHERE FAILURE DISCOVERED.—Notwithstanding clauses (i) and (ii) of subparagraph (D):
(i) IN GENERAL.—In the case of 1 or more failures
with respect to an individual—
(I) which are not corrected before the date on
which the plan receives a notice from the Secretary of such violation; and
(II) which occurred or continued during the
period involved;
the amount of penalty imposed by subparagraph (A)
by reason of such failures with respect to such individual shall not be less than $2,500.
(ii) HIGHER MINIMUM PENALTY WHERE VIOLATIONS
ARE MORE THAN DE MINIMIS.—To the extent violations
for which any person is liable under this paragraph for
any year are more than de minimis, clause (i) shall be
applied by substituting ‘‘$15,000’’ for ‘‘$2,500’’ with respect to such person.
(D) LIMITATIONS.—
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(i) PENALTY NOT TO APPLY WHERE FAILURE NOT
DISCOVERED EXERCISING REASONABLE DILIGENCE.—No
penalty shall be imposed by subparagraph (A) on any
failure during any period for which it is established to
the satisfaction of the Secretary that the person otherwise liable for such penalty did not know, and exercising reasonable diligence would not have known,
that such failure existed.
(ii) PENALTY NOT TO APPLY TO FAILURES CORRECTED WITHIN CERTAIN PERIODS.—No penalty shall be
imposed by subparagraph (A) on any failure if—
(I) such failure was due to reasonable cause
and not to willful neglect; and
(II) such failure is corrected during the 30-day
period beginning on the first date the person otherwise liable for such penalty knew, or exercising
reasonable diligence would have known, that such
failure existed.
(iii) OVERALL LIMITATION FOR UNINTENTIONAL
FAILURES.—In the case of failures which are due to
reasonable cause and not to willful neglect, the penalty imposed by subparagraph (A) for failures shall not
exceed the amount equal to the lesser of—
(I) 10 percent of the aggregate amount paid or
incurred by the employer (or predecessor employer) during the preceding taxable year for
group health plans; or
(II) $500,000.
(E) WAIVER BY SECRETARY.—In the case of a failure
which is due to reasonable cause and not to willful neglect,
the Secretary may waive part or all of the penalty imposed
by subparagraph (A) to the extent that the payment of
such penalty would be excessive relative to the failure involved.
SEC. 2737. ø300gg–23¿ PREEMPTION; STATE FLEXIBILITY; CONSTRUCTION.
(a) CONTINUED APPLICABILITY OF STATE LAW WITH RESPECT TO
HEALTH INSURANCE ISSUERS.—
(1) IN GENERAL.—Subject to paragraph (2) and except as

provided in subsection (b), this part and part C insofar as it
relates to this part shall not be construed to supersede any
provision of State law which establishes, implements, or continues in effect any standard or requirement solely relating to
health insurance issuers in connection with group health insurance coverage except to the extent that such standard or requirement prevents the application of a requirement of this
part.
(2) CONTINUED PREEMPTION WITH RESPECT TO GROUP
HEALTH PLANS.—Nothing in this part shall be construed to affect or modify the provisions of section 514 of the Employee Retirement Income Security Act of 1974 with respect to group
health plans.
(b) SPECIAL RULES IN CASE OF PORTABILITY REQUIREMENTS.—
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Sec. 2737

(1) IN GENERAL.—Subject to paragraph (2), the provisions
of this part relating to health insurance coverage offered by a
health insurance issuer supersede any provision of State law
which establishes, implements, or continues in effect a standard or requirement applicable to imposition of a preexisting
condition exclusion specifically governed by section 701 which
differs from the standards or requirements specified in such
section.
(2) EXCEPTIONS.—Only in relation to health insurance coverage offered by a health insurance issuer, the provisions of
this part do not supersede any provision of State law to the extent that such provision—
(i) 1 substitutes for the reference to ‘‘6-month period’’
in section 2701(a)(1) a reference to any shorter period of
time;
(ii) 1 substitutes for the reference to ‘‘12 months’’ and
‘‘18 months’’ in section 2701(a)(2) a reference to any shorter period of time;
(iii) 1 substitutes for the references to ‘‘63’’ days in sections 2701(c)(2)(A) and 2701(d)(4)(A) a reference to any
greater number of days;
(iv) 1 substitutes for the reference to ‘‘30-day period’’ in
sections 2701(b)(2) and 2701(d)(1) a reference to any greater period;
(v) 1 prohibits the imposition of any preexisting condition exclusion in cases not described in section 2701(d) or
expands the exceptions described in such section;
(vi) 1 requires special enrollment periods in addition to
those required under section 2701(f); or
(vii) 1 reduces the maximum period permitted in an affiliation period under section 2701(g)(1)(B).
(c) RULES OF CONSTRUCTION.—Nothing in this part (other than
section 2704) shall be construed as requiring a group health plan
or health insurance coverage to provide specific benefits under the
terms of such plan or coverage.
(d) DEFINITIONS.—For purposes of this section—
(1) STATE LAW.—The term ‘‘State law’’ includes all laws,
decisions, rules, regulations, or other State action having the
effect of law, of any State. A law of the United States applicable only to the District of Columbia shall be treated as a State
law rather than a law of the United States.
(2) STATE.—The term ‘‘State’’ includes a State (including
the Northern Mariana Islands), any political subdivisions of a
State or such Islands, or any agency or instrumentality of either.

[Note: Effective on January 1, 2014, sections 1001, 1201, and
1563 (relating to conforming amendments--originally designated as
section 1562 and redesignated as section 1563 by section
1 Clauses (i) through (vii) probably should be redesignated as subparagraphs (A) through (G).
See section 102(a) of Public Law 104–191 (110 Stat. 1971).

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10107(b)(1)) of Public Law 111–148 provides for amendments to
provisions in part A. The conforming amendments made by section
1563 (as so redesignated) of such Public Law to part A take effect
on date of enactment (March 23, 2010) but have been carried to
this version to reflect to probable intent of Congress. Upon such
date, part A of title XXVII reads as follows:]

PART A—INDIVIDUAL AND GROUP MARKET
REFORMS
Subpart I—General Reform
SEC. 2701. ƒ300gg≈ FAIR HEALTH INSURANCE PREMIUMS.
(a) 1 PROHIBITING DISCRIMINATORY PREMIUM RATES.—
(1) IN GENERAL.—With respect to the premium rate

charged
by a health insurance issuer for health insurance coverage offered in the individual or small group market—
(A) such rate shall vary with respect to the particular
plan or coverage involved only by—
(i) whether such plan or coverage covers an individual or family;
(ii) rating area, as established in accordance with
paragraph (2);
(iii) age, except that such rate shall not vary by
more than 3 to 1 for adults (consistent with section
2707(c)); and
(iv) tobacco use, except that such rate shall not
vary by more than 1.5 to 1; and
(B) such rate shall not vary with respect to the particular plan or coverage involved by any other factor not described in subparagraph (A).
(2) RATING AREA.—
(A) IN GENERAL.—Each State shall establish 1 or more
rating areas within that State for purposes of applying the
requirements of this title.
(B) SECRETARIAL REVIEW.—The Secretary shall review
the rating areas established by each State under subparagraph (A) to ensure the adequacy of such areas for purposes
of carrying out the requirements of this title. If the Secretary determines a State’s rating areas are not adequate,
or that a State does not establish such areas, the Secretary
may establish rating areas for that State.
(3) PERMISSIBLE AGE BANDS.—The Secretary, in consultation with the National Association of Insurance Commissioners,
shall define the permissible age bands for rating purposes
under paragraph (1)(A)(iii).
(4) APPLICATION OF VARIATIONS BASED ON AGE OR TOBACCO
USE.—With respect to family coverage under a group health
plan or health insurance coverage, the rating variations permitted under clauses (iii) and (iv) of paragraph (1)(A) shall be

1 There

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PUBLIC HEALTH SERVICE ACT

Sec. 2702

applied based on the portion of the premium that is attributable
to each family member covered under the plan or coverage.
(5) SPECIAL RULE FOR LARGE GROUP MARKET.—If a State
permits health insurance issuers that offer coverage in the large
group market in the State to offer such coverage through the
State Exchange (as provided for under section 1312(f)(2)(B) of
the Patient Protection and Affordable Care Act), the provisions
of this subsection shall apply to all coverage offered in such
market (other than self-insured group health plans offered in
such market) in the State.
SEC. 2702. ƒ300gg–1≈ GUARANTEED AVAILABILITY OF COVERAGE.
(a) GUARANTEED ISSUANCE OF COVERAGE IN THE INDIVIDUAL
AND GROUP MARKET.—Subject to subsections (b) through (e), each

health insurance issuer that offers health insurance coverage in the
individual or group market in a State must accept every employer
and individual in the State that applies for such coverage.
(b) ENROLLMENT.—
(1) RESTRICTION.—A health insurance issuer described in
subsection (a) may restrict enrollment in coverage described in
such subsection to open or special enrollment periods.
(2) ESTABLISHMENT.—A health insurance issuer described
in subsection (a) shall, in accordance with the regulations promulgated under paragraph (3), establish special enrollment periods for qualifying events (under section 603 of the Employee
Retirement Income Security Act of 1974).
(3) REGULATIONS.—The Secretary shall promulgate regulations with respect to enrollment periods under paragraphs (1)
and (2).
(c) SPECIAL RULES FOR NETWORK PLANS.—
(1) IN GENERAL.—In the case of a health insurance issuer
that offers health insurance coverage in the group and individual market through a network plan, the issuer may—
(A) limit the employers that may apply for such coverage to those with eligible individuals who live, work, or
reside in the service area for such network plan; and
(B) within the service area of such plan, deny such coverage to such employers and individuals if the issuer has
demonstrated, if required, to the applicable State authority
that—
(i) it will not have the capacity to deliver services
adequately to enrollees of any additional groups or any
additional individuals because of its obligations to existing group contract holders and enrollees, and
(ii) it is applying this paragraph uniformly to all
employers and individuals without regard to the
claims experience of those individuals, employers and
their employees (and their dependents) or any health
status-related factor relating to such individuals employees and dependents.
(2) 180-DAY SUSPENSION UPON DENIAL OF COVERAGE.—An
issuer, upon denying health insurance coverage in any service
area in accordance with paragraph (1)(B), may not offer coverage in the group or individual market within such service
March 13, 2013

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1418

area for a period of 180 days after the date such coverage is denied.
(d) APPLICATION OF FINANCIAL CAPACITY LIMITS.—
(1) IN GENERAL.—A health insurance issuer may deny
health insurance coverage in the group or individual market if
the issuer has demonstrated, if required, to the applicable State
authority that—
(A) it does not have the financial reserves necessary to
underwrite additional coverage; and
(B) it is applying this paragraph uniformly to all employers and individuals in the group or individual market
in the State consistent with applicable State law and without regard to the claims experience of those individuals,
employers and their employees (and their dependents) or
any health status-related factor relating to such individuals, employees and dependents.
(2) 180-DAY SUSPENSION UPON DENIAL OF COVERAGE.—A
health insurance issuer upon denying health insurance coverage
in connection with group health plans in accordance with paragraph (1) in a State may not offer coverage in connection with
group health plans in the group or individual market in the
State for a period of 180 days after the date such coverage is
denied or until the issuer has demonstrated to the applicable
State authority, if required under applicable State law, that the
issuer has sufficient financial reserves to underwrite additional
coverage, whichever is later. An applicable State authority may
provide for the application of this subsection on a service-areaspecific basis.
SEC. 2703. ƒ300gg–2≈ GUARANTEED RENEWABILITY OF COVERAGE.
(a) IN GENERAL.—Except as provided in this section, if a health

insurance issuer offers health insurance coverage in the individual
or group market, the issuer must renew or continue in force such
coverage at the option of the plan sponsor or the individual, as applicable.
(b) GENERAL EXCEPTIONS.—A health insurance issuer may
nonrenew or discontinue health insurance coverage offered in connection with a health insurance coverage offered in the group or individual market based only on one or more of the following:
(1) NONPAYMENT OF PREMIUMS.—The plan sponsor, or individual, as applicable, has failed to pay premiums or contributions in accordance with the terms of the health insurance coverage or the issuer has not received timely premium payments.
(2) FRAUD.—The plan sponsor, or individual, as applicable,
has performed an act or practice that constitutes fraud or made
an intentional misrepresentation of material fact under the
terms of the coverage.
(3) VIOLATION OF PARTICIPATION OR CONTRIBUTION
RATES.—In the case of a group health plan, the plan sponsor
has failed to comply with a material plan provision relating to
employer contribution or group participation rules, pursuant to
applicable State law.
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Sec. 2703

(4) TERMINATION OF COVERAGE.—The issuer is ceasing to
offer coverage in such market in accordance with subsection (c)
and applicable State law.
(5) MOVEMENT OUTSIDE SERVICE AREA.—In the case of a
health insurance issuer that offers health insurance coverage in
the market through a network plan, there is no longer any enrollee in connection with such plan who lives, resides, or works
in the service area of the issuer (or in the area for which the
issuer is authorized to do business) and, in the case of the small
group market, the issuer would deny enrollment with respect to
such plan under section 2711(c)(1)(A).
(6) ASSOCIATION MEMBERSHIP CEASES.—In the case of
health insurance coverage that is made available in the small
or large group market (as the case may be) only through one or
more bona fide associations, the membership of an employer in
the association (on the basis of which the coverage is provided)
ceases but only if such coverage is terminated under this paragraph uniformly without regard to any health status-related
factor relating to any covered individual.
(c) REQUIREMENTS FOR UNIFORM TERMINATION OF COVERAGE.—
(1) PARTICULAR TYPE OF COVERAGE NOT OFFERED.—In any
case in which an issuer decides to discontinue offering a particular type of group or individual health insurance coverage,
coverage of such type may be discontinued by the issuer in accordance with applicable State law in such market only if—
(A) the issuer provides notice to each plan sponsor or
individual, as applicable, provided coverage of this type in
such market (and participants and beneficiaries covered
under such coverage) of such discontinuation at least 90
days prior to the date of the discontinuation of such coverage;
(B) the issuer offers to each plan sponsor or individual,
as applicable, provided coverage of this type in such market, the option to purchase all (or, in the case of the large
group market, any) other health insurance coverage currently being offered by the issuer to a group health plan or
individual health insurance coverage 1 in such market; and
(C) in exercising the option to discontinue coverage of
this type and in offering the option of coverage under subparagraph (B), the issuer acts uniformly without regard to
the claims experience of those sponsors or individuals, as
applicable, or any health status-related factor relating to
any participants or beneficiaries covered or new participants or beneficiaries who may become eligible for such
coverage.
(2) DISCONTINUANCE OF ALL COVERAGE.—
(A) IN GENERAL.—In any case in which a health insurance issuer elects to discontinue offering all health insur1 Section 1563(c)(9)(C)(i)(III)(bb) (relating to conforming amendments--originally designated as
section 1562 and redesignated as section 1563 by section 10107(b)(1)) of Public Law 111–148 provides for an amendment to insert ‘‘or individual health insurance coverage’’. Such amendment
did not specify where to insert this new language, however, it was carried out by inserting such
language after ‘‘group health plan’’ to reflect the probable intent of Congress.

March 13, 2013

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PUBLIC HEALTH SERVICE ACT

1420

ance coverage in the individual or group market, or all
markets, in a State, health insurance coverage may be discontinued by the issuer only in accordance with applicable
State law and if—
(i) the issuer provides notice to the applicable State
authority and to each plan sponsor or individual, as
applicable, (and participants and beneficiaries covered
under such coverage) of such discontinuation at least
180 days prior to the date of the discontinuation of
such coverage; and
(ii) all health insurance issued or delivered for
issuance in the State in such market (or markets) are
discontinued and coverage under such health insurance coverage in such market (or markets) is not renewed.
(B) PROHIBITION ON MARKET REENTRY.—In the case of
a discontinuation under subparagraph (A) in a market, the
issuer may not provide for the issuance of any health insurance coverage in the market and State involved during the
5-year period beginning on the date of the discontinuation
of the last health insurance coverage not so renewed.
(d) EXCEPTION FOR UNIFORM MODIFICATION OF COVERAGE.—At
the time of coverage renewal, a health insurance issuer may modify
the health insurance coverage for a product offered to a group
health plan—
(1) in the large group market; or
(2) in the small group market if, for coverage that is available in such market other than only through one or more bona
fide associations, such modification is consistent with State law
and effective on a uniform basis among group health plans
with that product.
(e) APPLICATION TO COVERAGE OFFERED ONLY THROUGH ASSOCIATIONS.—In applying this section in the case of health insurance
coverage that is made available by a health insurance issuer in the
small or large group market to employers only through one or more
associations, a reference to ‘‘plan sponsor’’ is deemed, with respect
to coverage provided to an employer member of the association, to
include a reference to such employer.
SEC. 2704. ƒ300gg–3≈ PROHIBITION OF PREEXISTING CONDITION EXCLUSIONS OR OTHER DISCRIMINATION BASED ON
HEALTH STATUS.
(a) IN GENERAL.—A group health plan and a health insurance

issuer offering group or individual health insurance coverage may
not impose any preexisting condition exclusion with respect to such
plan or coverage.
(b) DEFINITIONS.—For purposes of this part—
(1) PREEXISTING CONDITION EXCLUSION.—
(A) IN GENERAL.—The term ‘‘preexisting condition exclusion’’ means, with respect to coverage, a limitation or exclusion of benefits relating to a condition based on the fact
that the condition was present before the date of enrollment
for such coverage, whether or not any medical advice, diagnosis, care, or treatment was recommended or received before such date.
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PUBLIC HEALTH SERVICE ACT

Sec. 2704

(B) TREATMENT OF GENETIC INFORMATION.—Genetic information shall not be treated as a condition described in
subsection (a)(1) in the absence of a diagnosis of the condition related to such information.
(2) ENROLLMENT DATE.—The term ‘‘enrollment date’’
means, with respect to an individual covered under a group
health plan or health insurance coverage, the date of enrollment
of the individual in the plan or coverage or, if earlier, the first
day of the waiting period for such enrollment.
(3) LATE ENROLLEE.—The term ‘‘late enrollee’’ means, with
respect to coverage under a group health plan, a participant or
beneficiary who enrolls under the plan other than during—
(A) the first period in which the individual is eligible
to enroll under the plan, or
(B) a special enrollment period under subsection (f).
(4) WAITING PERIOD.—The term ‘‘waiting period’’ means,
with respect to a group health plan and an individual who is
a potential participant or beneficiary in the plan, the period
that must pass with respect to the individual before the individual is eligible to be covered for benefits under the terms of
the plan.
(c) RULES RELATING TO CREDITING PREVIOUS COVERAGE.—
(1) CREDITABLE COVERAGE DEFINED.—For purposes of this
title, the term ‘‘creditable coverage’’ means, with respect to an
individual, coverage of the individual under any of the following:
(A) A group health plan.
(B) Health insurance coverage.
(C) Part A or part B of title XVIII of the Social Security Act.
(D) Title XIX of the Social Security Act, other than coverage consisting solely of benefits under section 1928.
(E) Chapter 55 of title 10, United States Code.
(F) A medical care program of the Indian Health Service or of a tribal organization.
(G) A State health benefits risk pool.
(H) A health plan offered under chapter 89 of
title 5, United States Code.
(I) A public health plan (as defined in regulations).
(J) A health benefit plan under section 5(e) of the Peace
Corps Act (22 U.S.C. 2504(e)).
Such term does not include coverage consisting solely of coverage of excepted benefits (as defined in section 2791(c)).
(2) NOT COUNTING PERIODS BEFORE SIGNIFICANT BREAKS IN
COVERAGE.—
(A) IN GENERAL.—A period of creditable coverage shall
not be counted, with respect to enrollment of an individual
under a group or individual health plan, if, after such period and before the enrollment date, there was a 63-day period during all of which the individual was not covered
under any creditable coverage.
(B) WAITING PERIOD NOT TREATED AS A BREAK IN COVERAGE.—For purposes of subparagraph (A) and subsection
(d)(4), any period that an individual is in a waiting period
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Sec. 2704

PUBLIC HEALTH SERVICE ACT

1422

for any coverage under a group or individual health plan
(or for group health insurance coverage) or is in an affiliation period (as defined in subsection (g)(2)) shall not be
taken into account in determining the continuous period
under subparagraph (A).
(C) TAA-ELIGIBLE INDIVIDUALS.—In the case of plan
years beginning before January 1, 2014 1—
(i) TAA PRE-CERTIFICATION PERIOD RULE.—In the
case of a TAA-eligible individual, the period beginning
on the date the individual has a TAA-related loss of
coverage and ending on the date that is 7 days after
the date of the issuance by the Secretary (or by any person or entity designated by the Secretary) of a qualified
health insurance costs credit eligibility certificate for
such individual for purposes of section 7527 of the Internal Revenue Code of 1986 shall not be taken into account in determining the continuous period under subparagraph (A).
(ii) DEFINITIONS.—The terms ‘‘TAA-eligible individual’’ and ‘‘TAA-related loss of coverage’’ have the
meanings given such terms in section 2205(b)(4).
(3) METHOD OF CREDITING COVERAGE.—
(A) STANDARD METHOD.—Except as otherwise provided
under subparagraph (B), for purposes of applying subsection (a)(3), a group health plan, and a health insurance
issuer offering group or individual health insurance coverage, shall count a period of creditable coverage without
regard to the specific benefits covered during the period.
(B) ELECTION OF ALTERNATIVE METHOD.—A group
health plan, or a health insurance issuer offering group or
individual health insurance, may elect to apply subsection
(a)(3) based on coverage of benefits within each of several
classes or categories of benefits specified in regulations
rather than as provided under subparagraph (A). Such
election shall be made on a uniform basis for all participants and beneficiaries. Under such election a group or individual health plan or issuer shall count a period of creditable coverage with respect to any class or category of benefits if any level of benefits is covered within such class or
category.
(C) PLAN NOTICE.—In the case of an election with respect to a group health plan under subparagraph (B)
(whether or not health insurance coverage is provided in
connection with such plan), the plan shall—
(i) prominently state in any disclosure statements
concerning the plan, and state to each enrollee at the
1 The date specified in subparagraph (C) reflects the probable intent of Congress. Section
242(a)(4) of Public Law 112–40 provides for an amendment to section 2704(c)(2)(C) of the Public
Health Service Act (as in effect for plan years beginning on or after January 1, 2014), by striking
‘‘February 13, 2011’’ and inserting ‘‘January 1, 2014’’.

The amendment made by Public Law 112–40 to section 2704(c)(2)(C), as transferred, redesignated, and amended by Public Law 111–148 (effective beginning on January 14, 2014), was carried after executing the amendment made by section 114(c) of Public Law 111–344.

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time of enrollment under the plan, that the plan has
made such election, and
(ii) include in such statements a description of the
effect of this election.
(D) ISSUER NOTICE.—In the case of an election under
subparagraph (B) with respect to health insurance coverage
offered by an issuer in the individual or group group 1 market, the issuer—
(i) shall prominently state in any disclosure statements concerning the coverage, and to each employer at
the time of the offer or sale of the coverage, that the
issuer has made such election, and
(ii) shall include in such statements a description
of the effect of such election.
(4) ESTABLISHMENT OF PERIOD.—Periods of creditable coverage with respect to an individual shall be established through
presentation of certifications described in subsection (e) or in
such other manner as may be specified in regulations.
(d) EXCEPTIONS.—
(1) EXCLUSION NOT APPLICABLE TO CERTAIN NEWBORNS.—
Subject to paragraph (4), a group health plan, and a health insurance issuer offering group or individual health insurance
coverage, may not impose any preexisting condition exclusion in
the case of an individual who, as of the last day of the 30-day
period beginning with the date of birth, is covered under creditable coverage.
(2) EXCLUSION NOT APPLICABLE TO CERTAIN ADOPTED CHILDREN.—Subject to paragraph (4), a group health plan, and a
health insurance issuer offering group or individual health insurance coverage, may not impose any preexisting condition exclusion in the case of a child who is adopted or placed for adoption before attaining 18 years of age and who, as of the last day
of the 30-day period beginning on the date of the adoption or
placement for adoption, is covered under creditable coverage.
The previous sentence shall not apply to coverage before the
date of such adoption or placement for adoption.
(3) EXCLUSION NOT APPLICABLE TO PREGNANCY.—A group
health plan, and health insurance issuer offering group or individual health insurance coverage, may not impose any preexisting condition exclusion relating to pregnancy as a preexisting condition.
(4) LOSS IF BREAK IN COVERAGE.—Paragraphs (1) and (2)
shall no longer apply to an individual after the end of the first
63-day period during all of which the individual was not covered under any creditable coverage.
(e) CERTIFICATIONS AND DISCLOSURE OF COVERAGE.—
(1) REQUIREMENT FOR CERTIFICATION OF PERIOD OF CREDITABLE COVERAGE.—
(A) IN GENERAL.—A group health plan, and a health
insurance issuer offering group or individual health insur1 So in law. See amendment made by section 1563(c)(1)(A)(ii)(II) (relating to conforming
amendments--originally designated as section 1562 and redesignated as section 1563 by section
10107(b)(1)) of Public Law 111–148.

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ance coverage, shall provide the certification described in
subparagraph (B)—
(i) at the time an individual ceases to be covered
under the plan or otherwise becomes covered under a
COBRA continuation provision,
(ii) in the case of an individual becoming covered
under such a provision, at the time the individual
ceases to be covered under such provision, and
(iii) on the request on behalf of an individual
made not later than 24 months after the date of cessation of the coverage described in clause (i) or (ii),
whichever is later.
The certification under clause (i) may be provided, to the
extent practicable, at a time consistent with notices required under any applicable COBRA continuation provision.
(B) CERTIFICATION.—The certification described in this
subparagraph is a written certification of—
(i) the period of creditable coverage of the individual under such plan and the coverage (if any) under
such COBRA continuation provision, and
(ii) the waiting period (if any) (and affiliation period, if applicable) imposed with respect to the individual for any coverage under such plan.
(C) ISSUER COMPLIANCE.—To the extent that medical
care under a group health plan consists of group health insurance coverage, the plan is deemed to have satisfied the
certification requirement under this paragraph if the health
insurance issuer offering the coverage provides for such certification in accordance with this paragraph.
(2) DISCLOSURE OF INFORMATION ON PREVIOUS BENEFITS.—
In the case of an election described in subsection (c)(3)(B) by a
group health plan or health insurance issuer, if the plan or
issuer enrolls an individual for coverage under the plan and the
individual provides a certification of coverage of the individual
under paragraph (1)—
(A) upon request of such plan or issuer, the entity
which issued the certification provided by the individual
shall promptly disclose to such requesting plan or issuer information on coverage of classes and categories of health
benefits available under such entity’s plan or coverage, and
(B) such entity may charge the requesting plan or
issuer for the reasonable cost of disclosing such information.
(3) REGULATIONS.—The Secretary shall establish rules to
prevent an entity’s failure to provide information under paragraph (1) or (2) with respect to previous coverage of an individual from adversely affecting any subsequent coverage of the
individual under another group health plan or health insurance coverage.
(f) SPECIAL ENROLLMENT PERIODS.—
(1) INDIVIDUALS LOSING OTHER COVERAGE.—A group health
plan, and a health insurance issuer offering group health insurance coverage in connection with a group health plan, shall perMarch 13, 2013

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mit an employee who is eligible, but not enrolled, for coverage
under the terms of the plan (or a dependent of such an employee
if the dependent is eligible, but not enrolled, for coverage under
such terms) to enroll for coverage under the terms of the plan
if each of the following conditions is met:
(A) The employee or dependent was covered under a
group health plan or had health insurance coverage at the
time coverage was previously offered to the employee or dependent.
(B) The employee stated in writing at such time that
coverage under a group health plan or health insurance
coverage was the reason for declining enrollment, but only
if the plan sponsor or issuer (if applicable) required such
a statement at such time and provided the employee with
notice of such requirement (and the consequences of such
requirement) at such time.
(C) The employee’s or dependent’s coverage described in
subparagraph (A)—
(i) was under a COBRA continuation provision
and the coverage under such provision was
exhausted; or
(ii) was not under such a provision and either the
coverage was terminated as a result of loss of eligibility
for the coverage (including as a result of legal separation, divorce, death, termination of employment, or reduction in the number of hours of employment) or employer contributions toward such coverage were terminated.
(D) Under the terms of the plan, the employee requests
such enrollment not later than 30 days after the date of exhaustion of coverage described in subparagraph (C)(i) or
termination of coverage or employer contribution described
in subparagraph (C)(ii).
(2) FOR DEPENDENT BENEFICIARIES.—
(A) IN GENERAL.—If—
(i) a group health plan makes coverage available
with respect to a dependent of an individual,
(ii) the individual is a participant under the plan
(or has met any waiting period applicable to becoming
a participant under the plan and is eligible to be enrolled under the plan but for a failure to enroll during
a previous enrollment period), and
(iii) a person becomes such a dependent of the individual through marriage, birth, or adoption or placement for adoption,
the group health plan shall provide for a dependent special
enrollment period described in subparagraph (B) during
which the person (or, if not otherwise enrolled, the individual) may be enrolled under the plan as a dependent of
the individual, and in the case of the birth or adoption of
a child, the spouse of the individual may be enrolled as a
dependent of the individual if such spouse is otherwise eligible for coverage.
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(B) DEPENDENT SPECIAL ENROLLMENT PERIOD.—A dependent special enrollment period under this subparagraph
shall be a period of not less than 30 days and shall begin
on the later of—
(i) the date dependent coverage is made
available, or
(ii) the date of the marriage, birth, or adoption or
placement for adoption (as the case may be) described
in subparagraph (A)(iii).
(C) NO WAITING PERIOD.—If an individual seeks to enroll a dependent during the first 30 days of such a dependent special enrollment period, the coverage of the dependent
shall become effective—
(i) in the case of marriage, not later than the first
day of the first month beginning after the date the completed request for enrollment is received;
(ii) in the case of a dependent’s birth, as of the date
of such birth; or
(iii) in the case of a dependent’s adoption or placement for adoption, the date of such adoption or placement for adoption.
(3) SPECIAL RULES FOR APPLICATION IN CASE OF MEDICAID
AND CHIP.—
(A) IN GENERAL.—A group health plan, and a health
insurance issuer offering group health insurance coverage
in connection with a group health plan, shall permit an
employee who is eligible, but not enrolled, for coverage
under the terms of the plan (or a dependent of such an employee if the dependent is eligible, but not enrolled, for coverage under such terms) to enroll for coverage under the
terms of the plan if either of the following conditions is met:
(i) TERMINATION OF MEDICAID OR CHIP COVERAGE.—The employee or dependent is covered under a
Medicaid plan under title XIX of the Social Security
Act or under a State child health plan under title XXI
of such Act and coverage of the employee or dependent
under such a plan is terminated as a result of loss of
eligibility for such coverage and the employee requests
coverage under the group health plan (or health insurance coverage) not later than 60 days after the date of
termination of such coverage.
(ii) ELIGIBILITY FOR EMPLOYMENT ASSISTANCE
UNDER MEDICAID OR CHIP.—The employee or dependent
becomes eligible for assistance, with respect to coverage
under the group health plan or health insurance coverage, under such Medicaid plan or State child health
plan (including under any waiver or demonstration
project conducted under or in relation to such a plan),
if the employee requests coverage under the group
health plan or health insurance coverage not later than
60 days after the date the employee or dependent is determined to be eligible for such assistance.
(B) COORDINATION WITH MEDICAID AND CHIP.—
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(i) OUTREACH TO EMPLOYEES REGARDING AVAILABILITY OF MEDICAID AND CHIP COVERAGE.—
(I) IN GENERAL.—Each employer that maintains a group health plan in a State that provides
medical assistance under a State Medicaid plan
under title XIX of the Social Security Act, or child
health assistance under a State child health plan
under title XXI of such Act, in the form of premium assistance for the purchase of coverage
under a group health plan, shall provide to each
employee a written notice informing the employee
of potential opportunities then currently available
in the State in which the employee resides for premium assistance under such plans for health coverage of the employee or the employee’s dependents.
For purposes of compliance with this subclause,
the employer may use any State-specific model notice developed in accordance with section
701(f)(3)(B)(i)(II) of the Employee Retirement Income Security Act of 1974 (29 U.S.C.
1181(f)(3)(B)(i)(II)).
(II) OPTION TO PROVIDE CONCURRENT WITH
PROVISION OF PLAN MATERIALS TO EMPLOYEE.—An
employer may provide the model notice applicable
to the State in which an employee resides concurrent with the furnishing of materials notifying the
employee of health plan eligibility, concurrent with
materials provided to the employee in connection
with an open season or election process conducted
under the plan, or concurrent with the furnishing
of the summary plan description as provided in
section 104(b) of the Employee Retirement Income
Security Act of 1974.
(ii) DISCLOSURE ABOUT GROUP HEALTH PLAN BENEFITS TO STATES FOR MEDICAID AND CHIP ELIGIBLE INDIVIDUALS.—In the case of an enrollee in a group health
plan who is covered under a Medicaid plan of a State
under title XIX of the Social Security Act or under a
State child health plan under title XXI of such Act, the
plan administrator of the group health plan shall disclose to the State, upon request, information about the
benefits available under the group health plan in sufficient specificity, as determined under regulations of the
Secretary of Health and Human Services in consultation with the Secretary that require use of the model
coverage coordination disclosure form developed under
section 311(b)(1)(C) of the Children’s Health Insurance
Reauthorization Act of 2009, so as to permit the State
to make a determination (under paragraph (2)(B), (3),
or (10) of section 2105(c) of the Social Security Act or
otherwise) concerning the cost-effectiveness of the State
providing medical or child health assistance through
premium assistance for the purchase of coverage under
such group health plan and in order for the State to
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provide supplemental benefits required under paragraph (10)(E) of such section or other authority.
(g) USE OF AFFILIATION PERIOD BY HMOS AS ALTERNATIVE TO
PREEXISTING CONDITION EXCLUSION.—
(1) IN GENERAL.—A health maintenance organization which
offers health insurance coverage in connection with a group
health plan and which does not impose any preexisting condition exclusion allowed under subsection (a) with respect to any
particular coverage option may impose an affiliation period for
such coverage option, but only if—
(A) such period is applied uniformly without regard to
any health status-related factors; and
(B) such period does not exceed 2 months (or 3 months
in the case of a late enrollee).
(2) AFFILIATION PERIOD.—
(A) DEFINED.—For purposes of this title, the term ‘‘affiliation period’’ means a period which, under the terms of
the health insurance coverage offered by the health maintenance organization, must expire before the health insurance
coverage becomes effective. The organization is not required
to provide health care services or benefits during such period and no premium shall be charged to the participant
or beneficiary for any coverage during the period.
(B) BEGINNING.—Such period shall begin on the enrollment date.
(C) RUNS CONCURRENTLY WITH WAITING PERIODS.—An
affiliation period under a plan shall run concurrently with
any waiting period under the plan.
(3) ALTERNATIVE METHODS.—A health maintenance organization described in paragraph (1) may use alternative methods,
from those described in such paragraph, to address adverse selection as approved by the State insurance commissioner or official or officials designated by the State to enforce the requirements of this part for the State involved with respect to such
issuer.
SEC. 2705. ƒ300gg–4≈ PROHIBITING DISCRIMINATION AGAINST INDIVIDUAL PARTICIPANTS AND BENEFICIARIES BASED ON
HEALTH STATUS.
(a) IN GENERAL.—A group health plan and a health insurance

issuer offering group or individual health insurance coverage may
not establish rules for eligibility (including continued eligibility) of
any individual to enroll under the terms of the plan or coverage
based on any of the following health status-related factors in relation to the individual or a dependent of the individual:
(1) Health status.
(2) Medical condition (including both physical and mental
illnesses).
(3) Claims experience.
(4) Receipt of health care.
(5) Medical history.
(6) Genetic information.
(7) Evidence of insurability (including conditions arising
out of acts of domestic violence).
(8) Disability.
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(9) Any other health status-related factor determined appropriate by the Secretary.
(b) IN PREMIUM CONTRIBUTIONS.—
(1) IN GENERAL.—A group health plan, and a health insurance issuer offering group or individual health insurance coverage, may not require any individual (as a condition of enrollment or continued enrollment under the plan) to pay a premium or contribution which is greater than such premium or
contribution for a similarly situated individual enrolled in the
plan on the basis of any health status-related factor in relation
to the individual or to an individual enrolled under the plan
as a dependent of the individual.
(2) CONSTRUCTION.—Nothing in paragraph (1) shall be
construed—
(A) to restrict the amount that an employer or individual may be charged for coverage under a group health
plan except as provided in paragraph (3) or individual
health coverage, as the case may be; or
(B) to prevent a group health plan, and a health insurance issuer offering group health insurance coverage, from
establishing premium discounts or rebates or modifying
otherwise applicable copayments or deductibles in return
for adherence to programs of health promotion and disease
prevention.
(3) NO GROUP-BASED DISCRIMINATION ON BASIS OF GENETIC
INFORMATION.—
(A) IN GENERAL.—For purposes of this section, a group
health plan, and health insurance issuer offering group or
individual health insurance coverage, may not adjust premium or contribution amounts for the group covered under
such plan on the basis of genetic information.
(B) RULE OF CONSTRUCTION.—Nothing in subparagraph (A) or in paragraphs (1) and (2) of subsection (d)
shall be construed to limit the ability of a health insurance
issuer offering group or individual health insurance coverage to increase the premium for an employer based on the
manifestation of a disease or disorder of an individual who
is enrolled in the plan. In such case, the manifestation of
a disease or disorder in one individual cannot also be used
as genetic information about other group members and to
further increase the premium for the employer.
(c) GENETIC TESTING.—
(1) LIMITATION ON REQUESTING OR REQUIRING GENETIC
TESTING.—A group health plan, and a health insurance issuer
offering health insurance coverage in connection with a group
health plan, shall not request or require an individual or a
family member of such individual to undergo a genetic test.
(2) RULE OF CONSTRUCTION.—Paragraph (1) shall not be
construed to limit the authority of a health care professional
who is providing health care services to an individual to request that such individual undergo a genetic test.
(3) RULE OF CONSTRUCTION REGARDING PAYMENT.—
(A) IN GENERAL.—Nothing in paragraph (1) shall be
construed to preclude a group health plan, or a health inMarch 13, 2013

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surance issuer offering health insurance coverage in connection with a group health plan, from obtaining and using
the results of a genetic test in making a determination regarding payment (as such term is defined for the purposes
of applying the regulations promulgated by the Secretary
under part C of title XI of the Social Security Act and section 264 of the Health Insurance Portability and Accountability Act of 1996, as may be revised from time to time)
consistent with subsection (a).
(B) LIMITATION.—For purposes of subparagraph (A), a
group health plan, or a health insurance issuer offering
health insurance coverage in connection with a group
health plan, may request only the minimum amount of information necessary to accomplish the intended purpose.
(4) RESEARCH EXCEPTION.—Notwithstanding paragraph
(1), a group health plan, or a health insurance issuer offering
health insurance coverage in connection with a group health
plan, may request, but not require, that a participant or beneficiary undergo a genetic test if each of the following conditions
is met:
(A) The request is made pursuant to research that complies with part 46 of title 45, Code of Federal Regulations,
or equivalent Federal regulations, and any applicable State
or local law or regulations for the protection of human subjects in research.
(B) The plan or issuer clearly indicates to each participant or beneficiary, or in the case of a minor child, to the
legal guardian of such beneficiary, to whom the request is
made that—
(i) compliance with the request is voluntary; and
(ii) non-compliance will have no effect on enrollment status or premium or contribution amounts.
(C) No genetic information collected or acquired under
this paragraph shall be used for underwriting purposes.
(D) The plan or issuer notifies the Secretary in writing
that the plan or issuer is conducting activities pursuant to
the exception provided for under this paragraph, including
a description of the activities conducted.
(E) The plan or issuer complies with such other conditions as the Secretary may by regulation require for activities conducted under this paragraph.
(d) PROHIBITION ON COLLECTION OF GENETIC INFORMATION.—
(1) IN GENERAL.—A group health plan, and a health insurance issuer offering health insurance coverage in connection
with a group health plan, shall not request, require, or purchase genetic information for underwriting purposes (as defined
in section 2791).
(2) PROHIBITION ON COLLECTION OF GENETIC INFORMATION
PRIOR TO ENROLLMENT.—A group health plan, and a health insurance issuer offering health insurance coverage in connection
with a group health plan, shall not request, require, or purchase genetic information with respect to any individual prior
to such individual’s enrollment under the plan or coverage in
connection with such enrollment.
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(3) INCIDENTAL COLLECTION.—If a group health plan, or a
health insurance issuer offering health insurance coverage in
connection with a group health plan, obtains genetic information incidental to the requesting, requiring, or purchasing of
other information concerning any individual, such request, requirement, or purchase shall not be considered a violation of
paragraph (2) if such request, requirement, or purchase is not
in violation of paragraph (1).
(e) APPLICATION TO ALL PLANS.—The provisions of subsections
(a)(6), (b)(3), (c), and (d) and subsection (b)(1) and section 2704 with
respect to genetic information, shall apply to group health plans
and health insurance issuers without regard to section 2735(a).
(f) GENETIC INFORMATION OF A FETUS OR EMBRYO.—Any reference in this part to genetic information concerning an individual
or family member of an individual shall—
(1) with respect to such an individual or family member of
an individual who is a pregnant woman, include genetic information of any fetus carried by such pregnant woman; and
(2) with respect to an individual or family member utilizing
an assisted reproductive technology, include genetic information
of any embryo legally held by the individual or family member.
(j) 1 PROGRAMS OF HEALTH PROMOTION OR DISEASE PREVENTION.—
(1) GENERAL PROVISIONS.—
(A) GENERAL RULE.—For purposes of subsection
(b)(2)(B), a program of health promotion or disease prevention (referred to in this subsection as a ‘‘wellness program’’)
shall be a program offered by an employer that is designed
to promote health or prevent disease that meets the applicable requirements of this subsection.
(B) NO CONDITIONS BASED ON HEALTH STATUS FACTOR.—If none of the conditions for obtaining a premium
discount or rebate or other reward for participation in a
wellness program is based on an individual satisfying a
standard that is related to a health status factor, such
wellness program shall not violate this section if participation in the program is made available to all similarly situated individuals and the requirements of paragraph (2) are
complied with.
(C) CONDITIONS BASED ON HEALTH STATUS FACTOR.—If
any of the conditions for obtaining a premium discount or
rebate or other reward for participation in a wellness program is based on an individual satisfying a standard that
is related to a health status factor, such wellness program
shall not violate this section if the requirements of paragraph (3) are complied with.
(2) WELLNESS PROGRAMS NOT SUBJECT TO REQUIREMENTS.—If none of the conditions for obtaining a premium discount or rebate or other reward under a wellness program as
described in paragraph (1)(B) are based on an individual satisfying a standard that is related to a health status factor (or if
such a wellness program does not provide such a reward), the
1 So

March 13, 2013

in law. There are no subsections (g)–(i).

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wellness program shall not violate this section if participation
in the program is made available to all similarly situated individuals. The following programs shall not have to comply with
the requirements of paragraph (3) if participation in the program is made available to all similarly situated individuals:
(A) A program that reimburses all or part of the cost
for memberships in a fitness center.
(B) A diagnostic testing program that provides a reward for participation and does not base any part of the reward on outcomes.
(C) A program that encourages preventive care related
to a health condition through the waiver of the copayment
or deductible requirement under group health plan for the
costs of certain items or services related to a health condition (such as prenatal care or well-baby visits).
(D) A program that reimburses individuals for the
costs of smoking cessation programs without regard to
whether the individual quits smoking.
(E) A program that provides a reward to individuals
for attending a periodic health education seminar.
(3) WELLNESS PROGRAMS SUBJECT TO REQUIREMENTS.—If
any of the conditions for obtaining a premium discount, rebate,
or reward under a wellness program as described in paragraph
(1)(C) is based on an individual satisfying a standard that is
related to a health status factor, the wellness program shall not
violate this section if the following requirements are complied
with:
(A) The reward for the wellness program, together with
the reward for other wellness programs with respect to the
plan that requires satisfaction of a standard related to a
health status factor, shall not exceed 30 percent of the cost
of employee-only coverage under the plan. If, in addition to
employees or individuals, any class of dependents (such as
spouses or spouses and dependent children) may participate
fully in the wellness program, such reward shall not exceed
30 percent of the cost of the coverage in which an employee
or individual and any dependents are enrolled. For purposes of this paragraph, the cost of coverage shall be determined based on the total amount of employer and employee
contributions for the benefit package under which the employee is (or the employee and any dependents are) receiving coverage. A reward may be in the form of a discount
or rebate of a premium or contribution, a waiver of all or
part of a cost-sharing mechanism (such as deductibles, copayments, or coinsurance), the absence of a surcharge, or
the value of a benefit that would otherwise not be provided
under the plan. The Secretaries of Labor, Health and
Human Services, and the Treasury may increase the reward available under this subparagraph to up to 50 percent of the cost of coverage if the Secretaries determine that
such an increase is appropriate.
(B) The wellness program shall be reasonably designed
to promote health or prevent disease. A program complies
with the preceding sentence if the program has a reasonMarch 13, 2013

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able chance of improving the health of, or preventing disease in, participating individuals and it is not overly burdensome, is not a subterfuge for discriminating based on a
health status factor, and is not highly suspect in the method chosen to promote health or prevent disease.
(C) The plan shall give individuals eligible for the program the opportunity to qualify for the reward under the
program at least once each year.
(D) The full reward under the wellness program shall
be made available to all similarly situated individuals. For
such purpose, among other things:
(i) The reward is not available to all similarly situated individuals for a period unless the wellness program allows—
(I) for a reasonable alternative standard (or
waiver of the otherwise applicable standard) for
obtaining the reward for any individual for whom,
for that period, it is unreasonably difficult due to
a medical condition to satisfy the otherwise applicable standard; and
(II) for a reasonable alternative standard (or
waiver of the otherwise applicable standard) for
obtaining the reward for any individual for whom,
for that period, it is medically inadvisable to attempt to satisfy the otherwise applicable standard.
(ii) If reasonable under the circumstances, the plan
or issuer may seek verification, such as a statement
from an individual’s physician, that a health status
factor makes it unreasonably difficult or medically inadvisable for the individual to satisfy or attempt to satisfy the otherwise applicable standard.
(E) The plan or issuer involved shall disclose in all
plan materials describing the terms of the wellness program the availability of a reasonable alternative standard
(or the possibility of waiver of the otherwise applicable
standard) required under subparagraph (D). If plan materials disclose that such a program is available, without describing its terms, the disclosure under this subparagraph
shall not be required.
(k) EXISTING PROGRAMS.—Nothing in this section shall prohibit
a program of health promotion or disease prevention that was established prior to the date of enactment of this section and applied
with all applicable regulations, and that is operating on such date,
from continuing to be carried out for as long as such regulations remain in effect.
(l) WELLNESS PROGRAM DEMONSTRATION PROJECT.—
(1) IN GENERAL.—Not later than July 1, 2014, the Secretary, in consultation with the Secretary of the Treasury and
the Secretary of Labor, shall establish a 10-State demonstration
project under which participating States shall apply the provisions of subsection (j) to programs of health promotion offered
by a health insurance issuer that offers health insurance coverage in the individual market in such State.
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(2) EXPANSION OF DEMONSTRATION PROJECT.—If the Secretary, in consultation with the Secretary of the Treasury and
the Secretary of Labor, determines that the demonstration
project described in paragraph (1) is effective, such Secretaries
may, beginning on July 1, 2017 expand such demonstration
project to include additional participating States.
(3) REQUIREMENTS.—
(A) MAINTENANCE OF COVERAGE.—The Secretary, in
consultation with the Secretary of the Treasury and the
Secretary of Labor, shall not approve the participation of a
State in the demonstration project under this section unless
the Secretaries determine that the State’s project is designed in a manner that—
(i) will not result in any decrease in coverage; and
(ii) will not increase the cost to the Federal Government in providing credits under section 36B of the
Internal Revenue Code of 1986 or cost-sharing assistance under section 1402 of the Patient Protection and
Affordable Care Act.
(B) OTHER REQUIREMENTS.—States that participate in
the demonstration project under this subsection—
(i) may permit premium discounts or rebates or the
modification of otherwise applicable copayments or
deductibles for adherence to, or participation in, a reasonably designed program of health promotion and disease prevention;
(ii) shall ensure that requirements of consumer
protection are met in programs of health promotion in
the individual market;
(iii) shall require verification from health insurance issuers that offer health insurance coverage in the
individual market of such State that premium discounts—
(I) do not create undue burdens for individuals insured in the individual market;
(II) do not lead to cost shifting; and
(III) are not a subterfuge for discrimination;
(iv) shall ensure that consumer data is protected in
accordance with the requirements of section 264(c) of
the Health Insurance Portability and Accountability
Act of 1996 (42 U.S.C. 1320d–2 note); and
(v) shall ensure and demonstrate to the satisfaction
of the Secretary that the discounts or other rewards
provided under the project reflect the expected level of
participation in the wellness program involved and the
anticipated effect the program will have on utilization
or medical claim costs.
(m) REPORT.—
(1) IN GENERAL.—Not later than 3 years after the date of
enactment of the Patient Protection and Affordable Care Act,
the Secretary, in consultation with the Secretary of the Treasury
and the Secretary of Labor, shall submit a report to the appropriate committees of Congress concerning—
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(A) the effectiveness of wellness programs (as defined in
subsection (j)) in promoting health and preventing disease;
(B) the impact of such wellness programs on the access
to care and affordability of coverage for participants and
non-participants of such programs;
(C) the impact of premium-based and cost-sharing incentives on participant behavior and the role of such programs in changing behavior; and
(D) the effectiveness of different types of rewards.
(2) DATA COLLECTION.—In preparing the report described
in paragraph (1), the Secretaries shall gather relevant information from employers who provide employees with access to
wellness programs, including State and Federal agencies.
(n) REGULATIONS.—Nothing in this section shall be construed
as prohibiting the Secretaries of Labor, Health and Human Services, or the Treasury from promulgating regulations in connection
with this section.
SEC. 2706. ƒ300gg–5≈ NON-DISCRIMINATION IN HEALTH CARE.
(a) PROVIDERS.—A group health plan and a health insurance

issuer offering group or individual health insurance coverage shall
not discriminate with respect to participation under the plan or coverage against any health care provider who is acting within the
scope of that provider’s license or certification under applicable
State law. This section shall not require that a group health plan
or health insurance issuer contract with any health care provider
willing to abide by the terms and conditions for participation established by the plan or issuer. Nothing in this section shall be construed as preventing a group health plan, a health insurance issuer,
or the Secretary from establishing varying reimbursement rates
based on quality or performance measures.
(b) INDIVIDUALS.—The provisions of section 1558 of the Patient
Protection and Affordable Care Act (relating to non-discrimination)
shall apply with respect to a group health plan or health insurance
issuer offering group or individual health insurance coverage.
SEC. 2707. ƒ300gg–6≈ COMPREHENSIVE HEALTH INSURANCE COVERAGE.
(a) COVERAGE FOR ESSENTIAL HEALTH BENEFITS PACKAGE.—A

health insurance issuer that offers health insurance coverage in the
individual or small group market shall ensure that such coverage
includes the essential health benefits package required under section
1302(a) of the Patient Protection and Affordable Care Act.
(b) COST-SHARING UNDER GROUP HEALTH PLANS.—A group
health plan shall ensure that any annual cost-sharing imposed
under the plan does not exceed the limitations provided for under
paragraphs (1) and (2) of section 1302(c).
(c) CHILD-ONLY PLANS.—If a health insurance issuer offers
health insurance coverage in any level of coverage specified under
section 1302(d) of the Patient Protection and Affordable Care Act,
the issuer shall also offer such coverage in that level as a plan in
which the only enrollees are individuals who, as of the beginning
of a plan year, have not attained the age of 21.
(d) DENTAL ONLY.—This section shall not apply to a plan described in section 1302(d)(2)(B)(ii)(I).
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SEC. 2708. ƒ300gg–7≈ PROHIBITION ON EXCESSIVE WAITING PERIODS.

A group health plan and a health insurance issuer offering
group health insurance coverage shall not apply any waiting period
(as defined in section 2704(b)(4)) that exceeds 90 days.
SEC. 2709. ƒ300gg–8≈ COVERAGE FOR INDIVIDUALS PARTICIPATING IN
APPROVED CLINICAL TRIALS. 1
(a) COVERAGE.—
(1) IN GENERAL.—If a group health plan or a health insur-

ance issuer offering group or individual health insurance coverage provides coverage to a qualified individual, then such
plan or issuer—
(A) may not deny the individual participation in the
clinical trial referred to in subsection (b)(2);
(B) subject to subsection (c), may not deny (or limit or
impose additional conditions on) the coverage of routine patient costs for items and services furnished in connection
with participation in the trial; and
(C) may not discriminate against the individual on the
basis of the individual’s participation in such trial.
(2) ROUTINE PATIENT COSTS.—
(A) INCLUSION.—For purposes of paragraph (1)(B), subject to subparagraph (B), routine patient costs include all
items and services consistent with the coverage provided in
the plan (or coverage) that is typically covered for a qualified individual who is not enrolled in a clinical trial.
(B) EXCLUSION.—For purposes of paragraph (1)(B),
routine patient costs does not include—
(i) the investigational item, device, or service, itself;
(ii) items and services that are provided solely to
satisfy data collection and analysis needs and that are
not used in the direct clinical management of the patient; or
(iii) a service that is clearly inconsistent with widely accepted and established standards of care for a
particular diagnosis.
(3) USE OF IN-NETWORK PROVIDERS.—If one or more participating providers is participating in a clinical trial, nothing in
paragraph (1) shall be construed as preventing a plan or issuer
from requiring that a qualified individual participate in the
trial through such a participating provider if the provider will
accept the individual as a participant in the trial.
(4) USE OF OUT-OF-NETWORK.—Notwithstanding paragraph
(3), paragraph (1) shall apply to a qualified individual participating in an approved clinical trial that is conducted outside
the State in which the qualified individual resides.
(b) QUALIFIED INDIVIDUAL DEFINED.—For purposes of subsection (a), the term ‘‘qualified individual’’ means an individual
who is a participant or beneficiary in a health plan or with coverage
1 So in law. There are two section 2709’s. The first section 2709 (relating Disclosure of Information), was former section 2713, which was then redesignated as 2733 (by section 1001(3) of Public
Law 111–148), then redesignated again to section 2709 and transfered to appear after section
2708 (by section 1563(c)(10)(C) (relating to conforming amendments--originally designated as section 1562 and redesignated as section 1563 by section 10107(b)(1)) of such Public Law).

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described in subsection (a)(1) and who meets the following conditions:
(1) The individual is eligible to participate in an approved
clinical trial according to the trial protocol with respect to treatment of cancer or other life-threatening disease or condition.
(2) Either—
(A) the referring health care professional is a participating health care provider and has concluded that the individual’s participation in such trial would be appropriate
based upon the individual meeting the conditions described
in paragraph (1); or
(B) the participant or beneficiary provides medical and
scientific information establishing that the individual’s
participation in such trial would be appropriate based
upon the individual meeting the conditions described in
paragraph (1).
(c) LIMITATIONS ON COVERAGE.—This section shall not be construed to require a group health plan, or a health insurance issuer
offering group or individual health insurance coverage, to provide
benefits for routine patient care services provided outside of the
plan’s (or coverage’s) health care provider network unless out-of-network benefits are otherwise provided under the plan (or coverage).
(d) APPROVED CLINICAL TRIAL DEFINED.—
(1) IN GENERAL.—In this section, the term ‘‘approved clinical trial’’ means a phase I, phase II, phase III, or phase IV
clinical trial that is conducted in relation to the prevention, detection, or treatment of cancer or other life-threatening disease
or condition and is described in any of the following subparagraphs:
(A) FEDERALLY FUNDED TRIALS.—The study or investigation is approved or funded (which may include funding
through in-kind contributions) by one or more of the following:
(i) The National Institutes of Health.
(ii) The Centers for Disease Control and Prevention.
(iii) The Agency for Health Care Research and
Quality.
(iv) The Centers for Medicare & Medicaid Services.
(v) cooperative group or center of any of the entities
described in clauses (i) through (iv) or the Department
of Defense or the Department of Veterans Affairs.
(vi) A qualified non-governmental research entity
identified in the guidelines issued by the National Institutes of Health for center support grants.
(vii) Any of the following if the conditions described in paragraph (2) are met:
(I) The Department of Veterans Affairs.
(II) The Department of Defense.
(III) The Department of Energy.
(B) The study or investigation is conducted under an
investigational new drug application reviewed by the Food
and Drug Administration.
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(C) The study or investigation is a drug trial that is exempt from having such an investigational new drug application.
(2) CONDITIONS FOR DEPARTMENTS.—The conditions described in this paragraph, for a study or investigation conducted by a Department, are that the study or investigation has
been reviewed and approved through a system of peer review
that the Secretary determines—
(A) to be comparable to the system of peer review of
studies and investigations used by the National Institutes
of Health, and
(B) assures unbiased review of the highest scientific
standards by qualified individuals who have no interest in
the outcome of the review.
(e) LIFE-THREATENING CONDITION DEFINED.—In this section,
the term ‘‘life-threatening condition’’ means any disease or condition
from which the likelihood of death is probable unless the course of
the disease or condition is interrupted.
(f) CONSTRUCTION.—Nothing in this section shall be construed
to limit a plan’s or issuer’s coverage with respect to clinical trials.
(g) APPLICATION TO FEHBP.—Notwithstanding any provision of
chapter 89 of title 5, United States Code, this section shall apply to
health plans offered under the program under such chapter.
(h) PREEMPTION.—Notwithstanding any other provision of this
Act, nothing in this section shall preempt State laws that require a
clinical trials policy for State regulated health insurance plans that
is in addition to the policy required under this section.
SEC. 2709. ƒ300gg–9≈ DISCLOSURE OF INFORMATION.
(a) DISCLOSURE OF INFORMATION BY HEALTH

PLAN ISSUERS.—
In connection with the offering of any health insurance coverage to
a small employer or an individual, a health insurance issuer—
(1) shall make a reasonable disclosure to such employer,, 1
or individual, as applicable, as part of its solicitation and sales
materials, of the availability of information described in subsection (b), and
(2) upon request of such a employer, or individual, as applicable,, 1 or individual, as applicable, provide such information.
(b) INFORMATION DESCRIBED.—
(1) IN GENERAL.—Subject to paragraph (3), with respect to
a health insurance issuer offering health insurance coverage to
a employer, or individual, as applicable,, 1 information described in this subsection is information concerning—
(A) the provisions of such coverage concerning issuer’s
right to change premium rates and the factors that may affect changes in premium rates; and
(B) the benefits and premiums available under all
health insurance coverage for which the employer, or individual, as applicable, is qualified.
(2) FORM OF INFORMATION.—Information under this subsection shall be provided to employers, or individuals, as applicable, in a manner determined to be understandable by the av1 So

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PUBLIC HEALTH SERVICE ACT

Sec. 2712

erage employer, or individual, as applicable,, 1 and shall be sufficient to reasonably inform employers, or individuals, as applicable, of their rights and obligations under the health insurance
coverage.
(3) EXCEPTION.—An issuer is not required under this section to disclose any information that is proprietary and trade
secret information under applicable law.

Subpart II—Improving Coverage 1
SEC. 2711. ƒ300gg–11≈ NO LIFETIME OR ANNUAL LIMITS.
(a) PROHIBITION.—
(1) IN GENERAL.—A group health plan and a

health insurance issuer offering group or individual health insurance coverage may not establish—
(A) lifetime limits on the dollar value of benefits for
any participant or beneficiary; or
(B) except as provided in paragraph (2), annual limits
on the dollar value of benefits for any participant or beneficiary.
(2) ANNUAL LIMITS PRIOR TO 2014.—With respect to plan
years beginning prior to January 1, 2014, a group health plan
and a health insurance issuer offering group or individual
health insurance coverage may only establish a restricted annual limit on the dollar value of benefits for any participant or
beneficiary with respect to the scope of benefits that are essential health benefits under section 1302(b) of the Patient Protection and Affordable Care Act, as determined by the Secretary.
In defining the term ‘‘restricted annual limit’’ for purposes of
the preceding sentence, the Secretary shall ensure that access to
needed services is made available with a minimal impact on
premiums.
(b) PER BENEFICIARY LIMITS.—Subsection (a) shall not be construed to prevent a group health plan or health insurance coverage
from placing annual or lifetime per beneficiary limits on specific
covered benefits that are not essential health benefits under section
1302(b) of the Patient Protection and Affordable Care Act, to the extent that such limits are otherwise permitted under Federal or State
law.

SEC. 2712. ƒ300gg–12≈ PROHIBITION ON RESCISSIONS.

A group health plan and a health insurance issuer offering
group or individual health insurance coverage shall not rescind
such plan or coverage with respect to an enrollee once the enrollee
is covered under such plan or coverage involved, except that this section shall not apply to a covered individual who has performed an
act or practice that constitutes fraud or makes an intentional misrepresentation of material fact as prohibited by the terms of the
plan or coverage. Such plan or coverage may not be cancelled except
with prior notice to the enrollee, and only as permitted under section 2702(c) or 2742(b).
1 So

in law.
is a subpart 2 (arabic 2) beginning with section 2722.

1 There

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PUBLIC HEALTH SERVICE ACT

1440

SEC. 2713. ƒ300gg–13≈ COVERAGE OF PREVENTIVE HEALTH SERVICES.
(a) IN GENERAL.—A group health plan and a health insurance

issuer offering group or individual health insurance coverage shall,
at a minimum provide coverage for and shall not impose any cost
sharing requirements for—
(1) evidence-based items or services that have in effect a
rating of ‘‘A’’ or ‘‘B’’ in the current recommendations of the
United States Preventive Services Task Force;
(2) immunizations that have in effect a recommendation
from the Advisory Committee on Immunization Practices of the
Centers for Disease Control and Prevention with respect to the
individual involved; and
(3) with respect to infants, children, and adolescents, evidence-informed preventive care and screenings provided for in
the comprehensive guidelines supported by the Health Resources
and Services Administration.
(4) with respect to women, such additional preventive care
and screenings not described in paragraph (1) as provided for
in comprehensive guidelines supported by the Health Resources
and Services Administration for purposes of this paragraph.
(5) for the purposes of this Act, and for the purposes of any
other provision of law, the current recommendations of the
United States Preventive Service Task Force regarding breast
cancer screening, mammography, and prevention shall be considered the most current other than those issued in or around
November 2009.
Nothing in this subsection shall be construed to prohibit a plan or
issuer from providing coverage for services in addition to those recommended by United States Preventive Services Task Force or to
deny coverage for services that are not recommended by such Task
Force.
(b) INTERVAL.—
(1) IN GENERAL.—The Secretary shall establish a minimum
interval between the date on which a recommendation described
in subsection (a)(1) or (a)(2) or a guideline under subsection
(a)(3) is issued and the plan year with respect to which the requirement described in subsection (a) is effective with respect to
the service described in such recommendation or guideline.
(2) MINIMUM.—The interval described in paragraph (1)
shall not be less than 1 year.
(c) VALUE-BASED INSURANCE DESIGN.—The Secretary may develop guidelines to permit a group health plan and a health insurance issuer offering group or individual health insurance coverage
to utilize value-based insurance designs.
SEC. 2714. ƒ300gg–14≈ EXTENSION OF DEPENDENT COVERAGE.
(a) IN GENERAL.—A group health plan and a health insurance

issuer offering group or individual health insurance coverage that
provides dependent coverage of children shall continue to make such
coverage available for an adult child until the child turns 26 years
of age. Nothing in this section shall require a health plan or a
health insurance issuer described in the preceding sentence to make
coverage available for a child of a child receiving dependent coverage.
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(b) REGULATIONS.—The Secretary shall promulgate regulations
to define the dependents to which coverage shall be made available
under subsection (a).
(c) RULE OF CONSTRUCTION.—Nothing in this section shall be
construed to modify the definition of ‘‘dependent’’ as used in the Internal Revenue Code of 1986 with respect to the tax treatment of the
cost of coverage.
SEC. 2715. ƒ300gg–15≈ DEVELOPMENT AND UTILIZATION OF UNIFORM
EXPLANATION OF COVERAGE DOCUMENTS AND STANDARDIZED DEFINITIONS.
(a) IN GENERAL.—Not later than 12 months after the date of en-

actment of the Patient Protection and Affordable Care Act, the Secretary shall develop standards for use by a group health plan and
a health insurance issuer offering group or individual health insurance coverage, in compiling and providing to applicants, enrollees,
and policyholders or certificate holders a summary of benefits and
coverage explanation that accurately describes the benefits and coverage under the applicable plan or coverage. In developing such
standards, the Secretary shall consult with the National Association
of Insurance Commissioners (referred to in this section as the
‘‘NAIC’’), a working group composed of representatives of health insurance-related consumer advocacy organizations, health insurance
issuers, health care professionals, patient advocates including those
representing individuals with limited English proficiency, and other
qualified individuals.
(b) REQUIREMENTS.—The standards for the summary of benefits
and coverage developed under subsection (a) shall provide for the
following:
(1) APPEARANCE.—The standards shall ensure that the
summary of benefits and coverage is presented in a uniform format that does not exceed 4 pages in length and does not include
print smaller than 12-point font.
(2) LANGUAGE.—The standards shall ensure that the summary is presented in a culturally and linguistically appropriate
manner and utilizes terminology understandable by the average
plan enrollee.
(3) CONTENTS.—The standards shall ensure that the summary of benefits and coverage includes—
(A) uniform definitions of standard insurance terms
and medical terms (consistent with subsection (g)) so that
consumers may compare health insurance coverage and understand the terms of coverage (or exception to such coverage);
(B) a description of the coverage, including cost sharing for—
(i) each of the categories of the essential health
benefits described in subparagraphs (A) through (J) of
section 1302(b)(1) of the Patient Protection and Affordable Care Act; and
(ii) other benefits, as identified by the Secretary;
(C) the exceptions, reductions, and limitations on coverage;
(D) the cost-sharing provisions, including deductible,
coinsurance, and co-payment obligations;
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(E) the renewability and continuation of coverage provisions;
(F) a coverage facts label that includes examples to illustrate common benefits scenarios, including pregnancy
and serious or chronic medical conditions and related cost
sharing, such scenarios to be based on recognized clinical
practice guidelines;
(G) a statement of whether the plan or coverage—
(i) provides minimum essential coverage (as defined under section 5000A(f) of the Internal Revenue
Code 1986); and
(ii) ensures that the plan or coverage share of the
total allowed costs of benefits provided under the plan
or coverage is not less than 60 percent of such costs;
(H) a statement that the outline is a summary of the
policy or certificate and that the coverage document itself
should be consulted to determine the governing contractual
provisions; and
(I) a contact number for the consumer to call with additional questions and an Internet web address where a
copy of the actual individual coverage policy or group certificate of coverage can be reviewed and obtained.
(c) PERIODIC REVIEW AND UPDATING.—The Secretary shall periodically review and update, as appropriate, the standards developed
under this section.
(d) REQUIREMENT TO PROVIDE.—
(1) IN GENERAL.—Not later than 24 months after the date
of enactment of the Patient Protection and Affordable Care Act,
each entity described in paragraph (3) shall provide, prior to
any enrollment restriction, a summary of benefits and coverage
explanation pursuant to the standards developed by the Secretary under subsection (a) to—
(A) an applicant at the time of application;
(B) an enrollee prior to the time of enrollment or reenrollment, as applicable; and
(C) a policyholder or certificate holder at the time of
issuance of the policy or delivery of the certificate.
(2) COMPLIANCE.—An entity described in paragraph (3) is
deemed to be in compliance with this section if the summary of
benefits and coverage described in subsection (a) is provided in
paper or electronic form.
(3) ENTITIES IN GENERAL.—An entity described in this
paragraph is—
(A) a health insurance issuer (including a group health
plan that is not a self-insured plan) offering health insurance coverage within the United States; or
(B) in the case of a self-insured group health plan, the
plan sponsor or designated administrator of the plan (as
such terms are defined in section 3(16) of the Employee Retirement Income Security Act of 1974).
(4) NOTICE OF MODIFICATIONS.—If a group health plan or
health insurance issuer makes any material modification in any
of the terms of the plan or coverage involved (as defined for purposes of section 102 of the Employee Retirement Income Security
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Sec. 2716

Act of 1974) that is not reflected in the most recently provided
summary of benefits and coverage, the plan or issuer shall provide notice of such modification to enrollees not later than 60
days prior to the date on which such modification will become
effective.
(e) PREEMPTION.—The standards developed under subsection
(a) shall preempt any related State standards that require a summary of benefits and coverage that provides less information to consumers than that required to be provided under this section, as determined by the Secretary.
(f) FAILURE TO PROVIDE.—An entity described in subsection
(d)(3) that willfully fails to provide the information required under
this section shall be subject to a fine of not more than $1,000 for
each such failure. Such failure with respect to each enrollee shall
constitute a separate offense for purposes of this subsection.
(g) DEVELOPMENT OF STANDARD DEFINITIONS.—
(1) IN GENERAL.—The Secretary shall, by regulation, provide for the development of standards for the definitions of
terms used in health insurance coverage, including the insurance-related terms described in paragraph (2) and the medical
terms described in paragraph (3).
(2) INSURANCE-RELATED TERMS.—The insurance-related
terms described in this paragraph are premium, deductible, coinsurance, co-payment, out-of-pocket limit, preferred provider,
non-preferred provider, out-of-network co-payments, UCR
(usual, customary and reasonable) fees, excluded services, grievance and appeals, and such other terms as the Secretary determines are important to define so that consumers may compare
health insurance coverage and understand the terms of their
coverage.
(3) MEDICAL TERMS.—The medical terms described in this
paragraph are hospitalization, hospital outpatient care, emergency room care, physician services, prescription drug coverage,
durable medical equipment, home health care, skilled nursing
care, rehabilitation services, hospice services, emergency medical transportation, and such other terms as the Secretary determines are important to define so that consumers may compare
the medical benefits offered by health insurance and understand the extent of those medical benefits (or exceptions to those
benefits).
SEC. 2715A. ƒ300gg–15a≈ PROVISION OF ADDITIONAL INFORMATION.

A group health plan and a health insurance issuer offering
group or individual health insurance coverage shall comply with
the provisions of section 1311(e)(3) of the Patient Protection and Affordable Care Act, except that a plan or coverage that is not offered
through an Exchange shall only be required to submit the information required to the Secretary and the State insurance commissioner, and make such information available to the public.
SEC. 2716. ƒ300gg–16≈ PROHIBITION ON DISCRIMINATION IN FAVOR OF
HIGHLY COMPENSATED INDIVIDUALS.
(a) IN GENERAL.—A group health plan (other than a self-in-

sured plan) shall satisfy the requirements of section 105(h)(2) of the
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Internal Revenue Code of 1986 (relating to prohibition on discrimination in favor of highly compensated individuals).
(b) RULES AND DEFINITIONS.—For purposes of this section—
(1) CERTAIN RULES TO APPLY.—Rules similar to the rules
contained in paragraphs (3), (4), and (8) of section 105(h) of
such Code shall apply.
(2) HIGHLY COMPENSATED INDIVIDUAL.—The term ‘‘highly
compensated individual’’ has the meaning given such term by
section 105(h)(5) of such Code.
SEC. 2717. ƒ300gg–17≈ ENSURING THE QUALITY OF CARE.
(a) QUALITY REPORTING.—
(1) IN GENERAL.—Not later than 2 years after

the date of
enactment of the Patient Protection and Affordable Care Act,
the Secretary, in consultation with experts in health care quality and stakeholders, shall develop reporting requirements for
use by a group health plan, and a health insurance issuer offering group or individual health insurance coverage, with respect
to plan or coverage benefits and health care provider reimbursement structures that—
(A) improve health outcomes through the implementation of activities such as quality reporting, effective case
management, care coordination, chronic disease management, and medication and care compliance initiatives, including through the use of the medical homes model as defined for purposes of section 3602 of the Patient Protection
and Affordable Care Act, for treatment or services under
the plan or coverage;
(B) implement activities to prevent hospital readmissions through a comprehensive program for hospital discharge that includes patient-centered education and counseling, comprehensive discharge planning, and post discharge reinforcement by an appropriate health care professional;
(C) implement activities to improve patient safety and
reduce medical errors through the appropriate use of best
clinical practices, evidence based medicine, and health information technology under the plan or coverage; and
(D) implement wellness and health promotion activities.
(2) REPORTING REQUIREMENTS.—
(A) IN GENERAL.—A group health plan and a health insurance issuer offering group or individual health insurance coverage shall annually submit to the Secretary, and
to enrollees under the plan or coverage, a report on whether
the benefits under the plan or coverage satisfy the elements
described in subparagraphs (A) through (D) of paragraph
(1).
(B) TIMING OF REPORTS.—A report under subparagraph (A) shall be made available to an enrollee under the
plan or coverage during each open enrollment period.
(C) AVAILABILITY OF REPORTS.—The Secretary shall
make reports submitted under subparagraph (A) available
to the public through an Internet website.

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(D) PENALTIES.—In developing the reporting requirements under paragraph (1), the Secretary may develop and
impose appropriate penalties for non-compliance with such
requirements.
(E) EXCEPTIONS.—In developing the reporting requirements under paragraph (1), the Secretary may provide for
exceptions to such requirements for group health plans and
health insurance issuers that substantially meet the goals
of this section.
(b) WELLNESS AND PREVENTION PROGRAMS.—For purposes of
subsection (a)(1)(D), wellness and health promotion activities may
include personalized wellness and prevention services, which are coordinated, maintained or delivered by a health care provider, a
wellness and prevention plan manager, or a health, wellness or prevention services organization that conducts health risk assessments
or offers ongoing face-to-face, telephonic or web-based intervention
efforts for each of the program’s participants, and which may include the following wellness and prevention efforts:
(1) Smoking cessation.
(2) Weight management.
(3) Stress management.
(4) Physical fitness.
(5) Nutrition.
(6) Heart disease prevention.
(7) Healthy lifestyle support.
(8) Diabetes prevention.
(c) PROTECTION OF SECOND AMENDMENT GUN RIGHTS.—
(1) WELLNESS AND PREVENTION PROGRAMS.—A wellness
and health promotion activity implemented under subsection
(a)(1)(D) may not require the disclosure or collection of any information relating to—
(A) the presence or storage of a lawfully-possessed firearm or ammunition in the residence or on the property of
an individual; or
(B) the lawful use, possession, or storage of a firearm
or ammunition by an individual.
(2) LIMITATION ON DATA COLLECTION.—None of the authorities provided to the Secretary under the Patient Protection and
Affordable Care Act or an amendment made by that Act shall
be construed to authorize or may be used for the collection of
any information relating to—
(A) the lawful ownership or possession of a firearm or
ammunition;
(B) the lawful use of a firearm or ammunition; or
(C) the lawful storage of a firearm or ammunition.
(3) LIMITATION ON DATABASES OR DATA BANKS.—None of
the authorities provided to the Secretary under the Patient Protection and Affordable Care Act or an amendment made by that
Act shall be construed to authorize or may be used to maintain
records of individual ownership or possession of a firearm or
ammunition.
(4) LIMITATION ON DETERMINATION OF PREMIUM RATES OR
ELIGIBILITY FOR HEALTH INSURANCE.—A premium rate may not
be increased, health insurance coverage may not be denied, and
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a discount, rebate, or reward offered for participation in a
wellness program may not be reduced or withheld under any
health benefit plan issued pursuant to or in accordance with
the Patient Protection and Affordable Care Act or an amendment made by that Act on the basis of, or on reliance upon—
(A) the lawful ownership or possession of a firearm or
ammunition; or
(B) the lawful use or storage of a firearm or ammunition.
(5) LIMITATION ON DATA COLLECTION REQUIREMENTS FOR
INDIVIDUALS.—No individual shall be required to disclose any
information under any data collection activity authorized under
the Patient Protection and Affordable Care Act or an amendment made by that Act relating to—
(A) the lawful ownership or possession of a firearm or
ammunition; or
(B) the lawful use, possession, or storage of a firearm
or ammunition.
(d) REGULATIONS.—Not later than 2 years after the date of enactment of the Patient Protection and Affordable Care Act, the Secretary shall promulgate regulations that provide criteria for determining whether a reimbursement structure is described in subsection (a).
(e) STUDY AND REPORT.—Not later than 180 days after the date
on which regulations are promulgated under subsection (c), the Government Accountability Office shall review such regulations and
conduct a study and submit to the Committee on Health, Education,
Labor, and Pensions of the Senate and the Committee on Energy
and Commerce of the House of Representatives a report regarding
the impact the activities under this section have had on the quality
and cost of health care.
SEC. 2718. ƒ300gg–18≈ BRINGING DOWN THE COST OF HEALTH CARE
COVERAGE.
(a) CLEAR ACCOUNTING FOR COSTS.—A health insurance issuer

offering group or individual health insurance coverage (including a
grandfathered health plan) shall, with respect to each plan year,
submit to the Secretary a report concerning the ratio of the incurred
loss (or incurred claims) plus the loss adjustment expense (or
change in contract reserves) to earned premiums. Such report shall
include the percentage of total premium revenue, after accounting
for collections or receipts for risk adjustment and risk corridors and
payments of reinsurance, that such coverage expends—
(1) on reimbursement for clinical services provided to enrollees under such coverage;
(2) for activities that improve health care quality; and
(3) on all other non-claims costs, including an explanation
of the nature of such costs, and excluding Federal and State
taxes and licensing or regulatory fees.
The Secretary shall make reports received under this section available to the public on the Internet website of the Department of
Health and Human Services.
(b) ENSURING THAT CONSUMERS RECEIVE VALUE FOR THEIR
PREMIUM PAYMENTS.—
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(1) REQUIREMENT

Sec. 2718

TO PROVIDE VALUE FOR PREMIUM PAY-

MENTS.—

(A) REQUIREMENT.—Beginning not later than January
1, 2011, a health insurance issuer offering group or individual health insurance coverage (including a grandfathered health plan) shall, with respect to each plan year,
provide an annual rebate to each enrollee under such coverage, on a pro rata basis, if the ratio of the amount of premium revenue expended by the issuer on costs described in
paragraphs (1) and (2) of subsection (a) to the total amount
of premium revenue (excluding Federal and State taxes and
licensing or regulatory fees and after accounting for payments or receipts for risk adjustment, risk corridors, and
reinsurance under sections 1341, 1342, and 1343 of the Patient Protection and Affordable Care Act) for the plan year
(except as provided in subparagraph (B)(ii)), is less than—
(i) with respect to a health insurance issuer offering coverage in the large group market, 85 percent, or
such higher percentage as a State may by regulation
determine; or
(ii) with respect to a health insurance issuer offering coverage in the small group market or in the individual market, 80 percent, or such higher percentage as
a State may by regulation determine, except that the
Secretary may adjust such percentage with respect to a
State if the Secretary determines that the application of
such 80 percent may destabilize the individual market
in such State.
(B) REBATE AMOUNT.—
(i) CALCULATION OF AMOUNT.—The total amount of
an annual rebate required under this paragraph shall
be in an amount equal to the product of—
(I) the amount by which the percentage described in clause (i) or (ii) of subparagraph (A) exceeds the ratio described in such subparagraph;
and
(II) the total amount of premium revenue (excluding Federal and State taxes and licensing or
regulatory fees and after accounting for payments
or receipts for risk adjustment, risk corridors, and
reinsurance under sections 1341, 1342, and 1343
of the Patient Protection and Affordable Care Act)
for such plan year.
(ii) CALCULATION BASED ON AVERAGE RATIO.—Beginning on January 1, 2014, the determination made
under subparagraph (A) for the year involved shall be
based on the averages of the premiums expended on the
costs described in such subparagraph and total premium revenue for each of the previous 3 years for the
plan.
(2) CONSIDERATION IN SETTING PERCENTAGES.—In determining the percentages under paragraph (1), a State shall seek
to ensure adequate participation by health insurance issuers,
competition in the health insurance market in the State, and
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value for consumers so that premiums are used for clinical services and quality improvements.
(3) ENFORCEMENT.—The Secretary shall promulgate regulations for enforcing the provisions of this section and may provide for appropriate penalties.
(c) DEFINITIONS.—Not later than December 31, 2010, and subject to the certification of the Secretary, the National Association of
Insurance Commissioners shall establish uniform definitions of the
activities reported under subsection (a) and standardized methodologies for calculating measures of such activities, including definitions of which activities, and in what regard such activities, constitute activities described in subsection (a)(2). Such methodologies
shall be designed to take into account the special circumstances of
smaller plans, different types of plans, and newer plans.
(d) ADJUSTMENTS.—The Secretary may adjust the rates described in subsection (b) if the Secretary determines appropriate on
account of the volatility of the individual market due to the establishment of State Exchanges.
(e) STANDARD HOSPITAL CHARGES.—Each hospital operating
within the United States shall for each year establish (and update)
and make public (in accordance with guidelines developed by the
Secretary) a list of the hospital’s standard charges for items and
services provided by the hospital, including for diagnosis-related
groups established under section 1886(d)(4) of the Social Security
Act.
SEC. 2719. ƒ300gg–19≈ APPEALS PROCESS.
(a) INTERNAL CLAIMS APPEALS.—
(1) IN GENERAL.—A group health

plan and a health insurance issuer offering group or individual health insurance coverage shall implement an effective appeals process for appeals
of coverage determinations and claims, under which the plan or
issuer shall, at a minimum—
(A) have in effect an internal claims appeal process;
(B) provide notice to enrollees, in a culturally and linguistically appropriate manner, of available internal and
external appeals processes, and the availability of any applicable office of health insurance consumer assistance or
ombudsman established under section 2793 to assist such
enrollees with the appeals processes; and
(C) allow an enrollee to review their file, to present evidence and testimony as part of the appeals process, and to
receive continued coverage pending the outcome of the appeals process.
(2) ESTABLISHED PROCESSES.—To comply with paragraph
(1)—
(A) a group health plan and a health insurance issuer
offering group health coverage shall provide an internal
claims and appeals process that initially incorporates the
claims and appeals procedures (including urgent claims)
set forth at section 2560.503–1 of title 29, Code of Federal
Regulations, as published on November 21, 2000 (65 Fed.
Reg. 70256), and shall update such process in accordance

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PUBLIC HEALTH SERVICE ACT

Sec. 2719A

with any standards established by the Secretary of Labor
for such plans and issuers; and
(B) a health insurance issuer offering individual health
coverage, and any other issuer not subject to subparagraph
(A), shall provide an internal claims and appeals process
that initially incorporates the claims and appeals procedures set forth under applicable law (as in existence on the
date of enactment of this section), and shall update such
process in accordance with any standards established by
the Secretary of Health and Human Services for such
issuers.
(b) EXTERNAL REVIEW.—A group health plan and a health insurance issuer offering group or individual health insurance coverage—
(1) shall comply with the applicable State external review
process for such plans and issuers that, at a minimum, includes the consumer protections set forth in the Uniform External Review Model Act promulgated by the National Association
of Insurance Commissioners and is binding on such plans; or
(2) shall implement an effective external review process that
meets minimum standards established by the Secretary through
guidance and that is similar to the process described under
paragraph (1)—
(A) if the applicable State has not established an external review process that meets the requirements of paragraph (1); or
(B) if the plan is a self-insured plan that is not subject
to State insurance regulation (including a State law that
establishes an external review process described in paragraph (1)).
(c) SECRETARY AUTHORITY.—The Secretary may deem the external review process of a group health plan or health insurance
issuer, in operation as of the date of enactment of this section, to
be in compliance with the applicable process established under subsection (b), as determined appropriate by the Secretary.
SEC. 2719A. ƒ300gg–19a≈ PATIENT PROTECTIONS.
(a) CHOICE OF HEALTH CARE PROFESSIONAL.—If

a group health
plan, or a health insurance issuer offering group or individual
health insurance coverage, requires or provides for designation by a
participant, beneficiary, or enrollee of a participating primary care
provider, then the plan or issuer shall permit each participant, beneficiary, and enrollee to designate any participating primary care
provider who is available to accept such individual.
(b) COVERAGE OF EMERGENCY SERVICES.—
(1) IN GENERAL.—If a group health plan, or a health insurance issuer offering group or individual health insurance
issuer, provides or covers any benefits with respect to services
in an emergency department of a hospital, the plan or issuer
shall cover emergency services (as defined in paragraph
(2)(B))—
(A) without the need for any prior authorization determination;
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(B) whether the health care provider furnishing such
services is a participating provider with respect to such
services;
(C) in a manner so that, if such services are provided
to a participant, beneficiary, or enrollee—
(i) by a nonparticipating health care provider with
or without prior authorization; or
(ii)(I) such services will be provided without imposing any requirement under the plan for prior authorization of services or any limitation on coverage where
the provider of services does not have a contractual relationship with the plan for the providing of services
that is more restrictive than the requirements or limitations that apply to emergency department services received from providers who do have such a contractual
relationship with the plan; and
(II) if such services are provided out-of-network,
the cost-sharing requirement (expressed as a copayment
amount or coinsurance rate) is the same requirement
that would apply if such services were provided in-network; 1
(D) without regard to any other term or condition of
such coverage (other than exclusion or coordination of benefits, or an affiliation or waiting period, permitted under
section 2701 of this Act, section 701 of the Employee Retirement Income Security Act of 1974, or section 9801 of the Internal Revenue Code of 1986, and other than applicable
cost-sharing).
(2) DEFINITIONS.—In this subsection:
(A) EMERGENCY MEDICAL CONDITION.—The term ‘‘emergency medical condition’’ means a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that a prudent layperson, who
possesses an average knowledge of health and medicine,
could reasonably expect the absence of immediate medical
attention to result in a condition described in clause (i), (ii),
or (iii) of section 1867(e)(1)(A) of the Social Security Act.
(B) EMERGENCY SERVICES.—The term ‘‘emergency services’’ means, with respect to an emergency medical condition—
(i) a medical screening examination (as required
under section 1867 of the Social Security Act) that is
within the capability of the emergency department of a
hospital, including ancillary services routinely available to the emergency department to evaluate such
emergency medical condition, and
(ii) within the capabilities of the staff and facilities
available at the hospital, such further medical examination and treatment as are required under section
1867 of such Act to stabilize the patient.
(C) STABILIZE.—The term ‘‘to stabilize’’, with respect to
an emergency medical condition (as defined in subpara1 Probably

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should read ‘‘; and’’.

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PUBLIC HEALTH SERVICE ACT

Sec. 2719A

graph (A)), has the meaning give in section 1867(e)(3) of the
Social Security Act (42 U.S.C. 1395dd(e)(3)).
(c) ACCESS TO PEDIATRIC CARE.—
(1) PEDIATRIC CARE.—In the case of a person who has a
child who is a participant, beneficiary, or enrollee under a
group health plan, or health insurance coverage offered by a
health insurance issuer in the group or individual market, if
the plan or issuer requires or provides for the designation of a
participating primary care provider for the child, the plan or
issuer shall permit such person to designate a physician
(allopathic or osteopathic) who specializes in pediatrics as the
child’s primary care provider if such provider participates in
the network of the plan or issuer.
(2) CONSTRUCTION.—Nothing in paragraph (1) shall be
construed to waive any exclusions of coverage under the terms
and conditions of the plan or health insurance coverage with respect to coverage of pediatric care.
(d) PATIENT ACCESS TO OBSTETRICAL AND GYNECOLOGICAL
CARE.—
(1) GENERAL RIGHTS.—
(A) DIRECT ACCESS.—A group health plan, or health
insurance issuer offering group or individual health insurance coverage, described in paragraph (2) may not require
authorization or referral by the plan, issuer, or any person
(including a primary care provider described in paragraph
(2)(B)) in the case of a female participant, beneficiary, or
enrollee who seeks coverage for obstetrical or gynecological
care provided by a participating health care professional
who specializes in obstetrics or gynecology. Such professional shall agree to otherwise adhere to such plan’s or
issuer’s policies and procedures, including procedures regarding referrals and obtaining prior authorization and
providing services pursuant to a treatment plan (if any) approved by the plan or issuer.
(B) OBSTETRICAL AND GYNECOLOGICAL CARE.—A group
health plan or health insurance issuer described in paragraph (2) shall treat the provision of obstetrical and gynecological care, and the ordering of related obstetrical and
gynecological items and services, pursuant to the direct access described under subparagraph (A), by a participating
health care professional who specializes in obstetrics or
gynecology as the authorization of the primary care provider.
(2) APPLICATION OF PARAGRAPH.—A group health plan, or
health insurance issuer offering group or individual health insurance coverage, described in this paragraph is a group health
plan or coverage that—
(A) provides coverage for obstetric or gynecologic care;
and
(B) requires the designation by a participant, beneficiary, or enrollee of a participating primary care provider.
(3) CONSTRUCTION.—Nothing in paragraph (1) shall be
construed to—
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Sec. 2725

PUBLIC HEALTH SERVICE ACT

1452

(A) waive any exclusions of coverage under the terms
and conditions of the plan or health insurance coverage
with respect to coverage of obstetrical or gynecological care;
or
(B) preclude the group health plan or health insurance
issuer involved from requiring that the obstetrical or gynecological provider notify the primary care health care professional or the plan or issuer of treatment decisions.
SEC. 2725. 1 ƒ300gg–25≈ STANDARDS RELATING TO BENEFITS FOR
MOTHERS AND NEWBORNS.
(a) REQUIREMENTS FOR MINIMUM HOSPITAL STAY FOLLOWING
BIRTH.—
(1) IN GENERAL.—A group health plan, and a health insur-

ance issuer offering group or individual health insurance coverage, may not—
(A) except as provided in paragraph (2)—
(i) restrict benefits for any hospital length of stay
in connection with childbirth for the mother or newborn child, following a normal vaginal delivery, to less
than 48 hours, or
(ii) restrict benefits for any hospital length of stay
in connection with childbirth for the mother or newborn child, following a cesarean section, to less than 96
hours, or
(B) require that a provider obtain authorization from
the plan or the issuer for prescribing any length of stay required under subparagraph (A) (without regard to paragraph (2)).
(2) EXCEPTION.—Paragraph (1)(A) shall not apply in connection with any group health plan or health insurance issuer
in any case in which the decision to discharge the mother or her
newborn child prior to the expiration of the minimum length of
stay otherwise required under paragraph (1)(A) is made by an
attending provider in consultation with the mother.
(b) PROHIBITIONS.—A group health plan, and a health insurance issuer offering group or individual health insurance coverage,
may not—
(1) deny to the mother or her newborn child eligibility, or
continued eligibility, to enroll or to renew coverage under the
terms of the plan or coverage, solely for the purpose of avoiding
the requirements of this section;
(2) provide monetary payments or rebates to mothers to encourage such mothers to accept less than the minimum protections available under this section;
(3) penalize or otherwise reduce or limit the reimbursement
of an attending provider because such provider provided care to
an individual participant or beneficiary in accordance with this
section;
(4) provide incentives (monetary or otherwise) to an attending provider to induce such provider to provide care to an indi1 The placement of this section and succeeding sections 2726, 2727, and 2728 here, versus after
section 2724, is ambiguous insofar as these sections at the time of their redesignation from sections 2704–2708 were not explicitly moved to follow section 2724, yet the failure to place them
after section 2724 results in these sections not following ordinary sequential numbering.

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PUBLIC HEALTH SERVICE ACT

Sec. 2725

vidual participant or beneficiary in a manner inconsistent with
this section; or
(5) subject to subsection (c)(3), restrict benefits for any portion of a period within a hospital length of stay required under
subsection (a) in a manner which is less favorable than the benefits provided for any preceding portion of such stay.
(c) RULES OF CONSTRUCTION.—
(1) Nothing in this section shall be construed to require a
mother who is a participant or beneficiary—
(A) to give birth in a hospital; or
(B) to stay in the hospital for a fixed period of time following the birth of her child.
(2) This section shall not apply with respect to any group
health plan, or any health insurance issuer offering group or
individual health insurance coverage, which does not provide
benefits for hospital lengths of stay in connection with childbirth for a mother or her newborn child.
(3) Nothing in this section shall be construed as preventing
a group health plan or health insurance issuer from imposing
deductibles, coinsurance, or other cost-sharing in relation to
benefits for hospital lengths of stay in connection with childbirth for a mother or newborn child under the plan (or under
health insurance coverage offered in connection with a group
health plan), except that such coinsurance or other cost-sharing
for any portion of a period within a hospital length of stay required under subsection (a) may not be greater than such coinsurance or cost-sharing for any preceding portion of such stay.
(d) NOTICE.—A group health plan under this part shall comply
with the notice requirement under section 711(d) of the Employee
Retirement Income Security Act of 1974 with respect to the requirements of this section as if such section applied to such plan.
(e) LEVEL AND TYPE OF REIMBURSEMENTS.—Nothing in this section shall be construed to prevent a group health plan or a health
insurance issuer offering group or individual health insurance coverage from negotiating the level and type of reimbursement with a
provider for care provided in accordance with this section.
(f) PREEMPTION; EXCEPTION FOR HEALTH INSURANCE COVERAGE
IN CERTAIN STATES.—
(1) IN GENERAL.—The requirements of this section shall not
apply with respect to health insurance coverage if there is a
State law (as defined in section 2723(d)(1)) for a State that regulates such coverage that is described in any of the following
subparagraphs:
(A) Such State law requires such coverage to provide
for at least a 48-hour hospital length of stay following a
normal vaginal delivery and at least a 96-hour hospital
length of stay following a cesarean section.
(B) Such State law requires such coverage to provide
for maternity and pediatric care in accordance with guidelines established by the American College of Obstetricians
and Gynecologists, the American Academy of Pediatrics, or
other established professional medical associations.
(C) Such State law requires, in connection with such
coverage for maternity care, that the hospital length of stay
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Sec. 2726

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1454

for such care is left to the decision of (or required to be
made by) the attending provider in consultation with the
mother.
(2) CONSTRUCTION.—Section 2723(a)(1) shall not be construed as superseding a State law described in paragraph (1).
SEC. 2726. ƒ300gg–26≈ PARITY IN MENTAL HEALTH AND SUBSTANCE
USE DISORDER BENEFITS.
(a) IN GENERAL.—
(1) AGGREGATE LIFETIME LIMITS.—In the case of a group

health plan or a health insurance issuer offering group or individual health insurance coverage that provides both medical
and surgical benefits and mental health or substance use disorder benefits—
(A) NO LIFETIME LIMIT.—If the plan or coverage does
not include an aggregate lifetime limit on substantially all
medical and surgical benefits, the plan or coverage may not
impose any aggregate lifetime limit on mental health or
substance use disorder benefits.
(B) LIFETIME LIMIT.—If the plan or coverage includes
an aggregate lifetime limit on substantially all medical and
surgical benefits (in this paragraph referred to as the ‘‘applicable lifetime limit’’), the plan or coverage shall either—
(i) apply the applicable lifetime limit both to the
medical and surgical benefits to which it otherwise
would apply and to mental health and substance use
disorder benefits and not distinguish in the application
of such limit between such medical and surgical benefits and mental health and substance use disorder benefits; or
(ii) not include any aggregate lifetime limit on
mental health or substance use disorder benefits that is
less than the applicable lifetime limit.
(C) RULE IN CASE OF DIFFERENT LIMITS.—In the case
of a plan or coverage that is not described in subparagraph
(A) or (B) and that includes no or different aggregate lifetime limits on different categories of medical and surgical
benefits, the Secretary shall establish rules under which
subparagraph (B) is applied to such plan or coverage with
respect to mental health and substance use disorder benefits by substituting for the applicable lifetime limit an average
aggregate
lifetime
limit that is computed taking into account the weighted average of the aggregate lifetime limits applicable to such categories.
(2) ANNUAL LIMITS.—In the case of a group health plan or
a health insurance issuer offering group or individual health
insurance coverage that provides both medical and surgical
benefits and mental health or substance use disorder benefits—
(A) NO ANNUAL LIMIT.—If the plan or coverage does not
include an annual limit on substantially all medical and
surgical benefits, the plan or coverage may not impose any
annual limit on mental health or substance use disorder
benefits.
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Sec. 2726

(B) ANNUAL LIMIT.—If the plan or coverage includes an
annual limit on substantially all medical and surgical benefits (in this paragraph referred to as the ‘‘applicable annual limit’’), the plan or coverage shall either—
(i) apply the applicable annual limit both to medical and surgical benefits to which it otherwise would
apply and to mental health and substance use disorder
benefits and not distinguish in the application of such
limit between such medical and surgical benefits and
mental health and substance use disorder benefits; or
(ii) not include any annual limit on mental health
or substance use disorder benefits that is less than the
applicable annual limit.
(C) RULE IN CASE OF DIFFERENT LIMITS.—In the case
of a plan or coverage that is not described in subparagraph
(A) or (B) and that includes no or different annual limits
on different categories of medical and surgical benefits, the
Secretary shall establish rules under which subparagraph
(B) is applied to such plan or coverage with respect to mental health and substance use disorder benefits by substituting for the applicable annual limit an average annual
limit that is computed taking into account the weighted average of the annual limits applicable to such categories.
(3) FINANCIAL REQUIREMENTS AND TREATMENT LIMITATIONS.—
(A) IN GENERAL.—In the case of a group health plan or
a health insurance issuer offering group or individual
health insurance coverage that provides both medical and
surgical benefits and mental health or substance use disorder benefits, such plan or coverage shall ensure that—
(i) the financial requirements applicable to such
mental health or substance use disorder benefits are no
more restrictive than the predominant financial requirements applied to substantially all medical and
surgical benefits covered by the plan (or coverage), and
there are no separate cost sharing requirements that
are applicable only with respect to mental health or
substance use disorder benefits; and
(ii) the treatment limitations applicable to such
mental health or substance use disorder benefits are no
more restrictive than the predominant treatment limitations applied to substantially all medical and surgical benefits covered by the plan (or coverage) and
there are no separate treatment limitations that are applicable only with respect to mental health or substance
use disorder benefits.
(B) DEFINITIONS.—In this paragraph:
(i) FINANCIAL REQUIREMENT.—The term ‘‘financial
requirement’’ includes deductibles, copayments, coinsurance, and out-of-pocket expenses, but excludes an
aggregate lifetime limit and an annual limit subject to
paragraphs (1) and (2).
(ii) PREDOMINANT.—A financial requirement or
treatment limit is considered to be predominant if it is
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the most common or frequent of such type of limit or
requirement.
(iii) TREATMENT LIMITATION.—The term ‘‘treatment
limitation’’ includes limits on the frequency of treatment, number of visits, days of coverage, or other similar limits on the scope or duration of treatment.
(4) AVAILABILITY OF PLAN INFORMATION.—The criteria for
medical necessity determinations made under the plan with respect to mental health or substance use disorder benefits (or the
health insurance coverage offered in connection with the plan
with respect to such benefits) shall be made available by the
plan administrator (or the health insurance issuer offering such
coverage) in accordance with regulations to any current or potential participant, beneficiary, or contracting provider upon request. The reason for any denial under the plan (or coverage)
of reimbursement or payment for services with respect to mental
health or substance use disorder benefits in the case of any participant or beneficiary shall, on request or as otherwise required, be made available by the plan administrator (or the
health insurance issuer offering such coverage) to the participant or beneficiary in accordance with regulations.
(5) OUT-OF-NETWORK PROVIDERS.—In the case of a plan or
coverage that provides both medical and surgical benefits and
mental health or substance use disorder benefits, if the plan or
coverage provides coverage for medical or surgical benefits provided by out-of-network providers, the plan or coverage shall
provide coverage for mental health or substance use disorder
benefits provided by out-of-network providers in a manner that
is consistent with the requirements of this section.
(b) CONSTRUCTION.—Nothing in this section shall be
construed—
(1) as requiring a group health plan or a health insurance
issuer offering group or individual health insurance coverage to
provide any mental health or substance use disorder benefits; or
(2) in the case of a group health plan or a health insurance
issuer offering group or individual health insurance coverage
that provides mental health or substance use disorder benefits,
as affecting the terms and conditions of the plan or coverage relating to such benefits under the plan or coverage, except as
provided in subsection (a).
(c) EXEMPTIONS.—
(1) SMALL EMPLOYER EXEMPTION.—This section shall not
apply to any group health plan and a health insurance issuer
offering group or individual health insurance coverage for any
plan year of a small employer (as defined in section 2791(e)(4),
except that for purposes of this paragraph such term shall include employers with 1 employee in the case of an employer residing in a State that permits small groups to include a single
individual).
(2) COST EXEMPTION.—
(A) IN GENERAL.—With respect to a group health plan
or a health insurance issuer offering group or individual
health insurance coverage, if the application of this section
to such plan (or coverage) results in an increase for the
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Sec. 2726

plan year involved of the actual total costs of coverage with
respect to medical and surgical benefits and mental health
and substance use disorder benefits under the plan (as determined and certified under subparagraph (C)) by an
amount that exceeds the applicable percentage described in
subparagraph (B) of the actual total plan costs, the provisions of this section shall not apply to such plan (or coverage) during the following plan year, and such exemption
shall apply to the plan (or coverage) for 1 plan year. An
employer may elect to continue to apply mental health and
substance use disorder parity pursuant to this section with
respect to the group health plan (or coverage) involved regardless of any increase in total costs.
(B) APPLICABLE PERCENTAGE.—With respect to a plan
(or coverage), the applicable percentage described in this
subparagraph shall be—
(i) 2 percent in the case of the first plan year in
which this section is applied; and
(ii) 1 percent in the case of each subsequent plan
year.
(C) DETERMINATIONS BY ACTUARIES.—Determinations
as to increases in actual costs under a plan (or coverage)
for purposes of this section shall be made and certified by
a qualified and licensed actuary who is a member in good
standing of the American Academy of Actuaries. All such
determinations shall be in a written report prepared by the
actuary. The report, and all underlying documentation relied upon by the actuary, shall be maintained by the group
health plan or health insurance issuer for a period of 6
years following the notification made under subparagraph
(E).
(D) 6-MONTH DETERMINATIONS.—If a group health plan
(or a health insurance issuer offering coverage in connection with a group health plan) 1 seeks an exemption under
this paragraph, determinations under subparagraph (A)
shall be made after such plan (or coverage) has complied
with this section for the first 6 months of the plan year involved.
(E) NOTIFICATION.—
(i) IN GENERAL.—A group health plan (or a health
insurance issuer offering coverage in connection with a
group health plan) 1 that, based upon a certification described under subparagraph (C), qualifies for an exemption under this paragraph, and elects to implement
the exemption, shall promptly notify the Secretary, the
appropriate State agencies, and participants and beneficiaries in the plan of such election.
(ii) REQUIREMENT.—A notification to the Secretary
under clause (i) shall include—
1 In section 1563 (relating to conforming amendments--originally designated as section 1562
and redesignated as section 1563 by section 10107(b)(1)) of Public Law 111–148, Congress may
have intended to replace the parenthetical with a reference to both group and individual health
insurance. The Congression intent is unclear.

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(I) a description of the number of covered lives
under the plan (or coverage) involved at the time
of the notification, and as applicable, at the time
of any prior election of the cost-exemption under
this paragraph by such plan (or coverage);
(II) for both the plan year upon which a cost
exemption is sought and the year prior, a description of the actual total costs of coverage with respect to medical and surgical benefits and mental
health and substance use disorder benefits under
the plan; and
(III) for both the plan year upon which a cost
exemption is sought and the year prior, the actual
total costs of coverage with respect to mental
health and substance use disorder benefits under
the plan.
(iii) CONFIDENTIALITY.—A notification to the Secretary under clause (i) shall be confidential. The Secretary shall make available, upon request and on not
more than an annual basis, an anonymous itemization
of such notifications, that includes—
(I) a breakdown of States by the size and type
of employers submitting such notification; and
(II) a summary of the data received under
clause (ii).
(F) AUDITS BY APPROPRIATE AGENCIES.—To determine
compliance with this paragraph, the Secretary may audit
the books and records of a group health plan or health insurance issuer relating to an exemption, including any actuarial reports prepared pursuant to subparagraph (C),
during the 6 year period following the notification of such
exemption under subparagraph (E). A State agency receiving a notification under subparagraph (E) may also conduct such an audit with respect to an exemption covered by
such notification.
(d) SEPARATE APPLICATION TO EACH OPTION OFFERED.—In the
case of a group health plan that offers a participant or beneficiary
two or more benefit package options under the plan, the requirements of this section shall be applied separately with respect to each
such option.
(e) DEFINITIONS.—For purposes of this section—
(1) AGGREGATE LIFETIME LIMIT.—The term ‘‘aggregate lifetime limit’’ means, with respect to benefits under a group health
plan or health insurance coverage, a dollar limitation on the
total amount that may be paid with respect to such benefits
under the plan or health insurance coverage with respect to an
individual or other coverage unit.
(2) ANNUAL LIMIT.—The term ‘‘annual limit’’ means, with
respect to benefits under a group health plan or health
insurance coverage, a dollar limitation on the total amount of
benefits that may be paid with respect to such benefits in a 12month period under the plan or health insurance coverage with
respect to an individual or other coverage unit.
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Sec. 2728

(3) MEDICAL OR SURGICAL BENEFITS.—The term ‘‘medical or
surgical
benefits’’
means
benefits
with
respect
to
medical or surgical services, as defined under the terms of the
plan or coverage (as the case may be), but does not include mental health or substance use disorder benefits.
(4) MENTAL HEALTH BENEFITS.—The term ‘‘mental health
benefits’’ means benefits with respect to services for mental
health conditions, as defined under the terms of the plan and
in accordance with applicable Federal and State law.
(5) SUBSTANCE USE DISORDER BENEFITS.—The term ‘‘substance use disorder benefits’’ means benefits with respect to
services for substance use disorders, as defined under the terms
of the plan and in accordance with applicable Federal and
State law.
SEC. 2727. ƒ300gg–27≈ REQUIRED COVERAGE FOR RECONSTRUCTIVE
SURGERY FOLLOWING MASTECTOMIES. 1

The provisions of section 713 of the Employee Retirement Income Security Act of 1974 shall apply to group health plans, and
and 2 health insurance issuers offering group or individual health
insurance coverage, as if included in this subpart.
SEC. 2728. ƒ300gg–28≈ COVERAGE OF DEPENDENT STUDENTS ON MEDICALLY NECESSARY LEAVE OF ABSENCE.
(a) MEDICALLY NECESSARY LEAVE OF ABSENCE.—In this sec-

tion, the term ‘‘medically necessary leave of absence’’ means, with respect to a dependent child described in subsection (b)(2) in connection with a group health plan or individual health insurance coverage, a leave of absence of such child from a postsecondary educational institution (including an institution of higher education as
defined in section 102 of the Higher Education Act of 1965), or any
other change in enrollment of such child at such an institution,
that—
(1) commences while such child is suffering from a serious
illness or injury;
(2) is medically necessary; and
(3) causes such child to lose student status for purposes of
coverage under the terms of the plan or coverage.
(b) REQUIREMENT TO CONTINUE COVERAGE.—
(1) IN GENERAL.—In the case of a dependent child described
in paragraph (2), a group health plan, or a health insurance
issuer that offers group or individual health insurance coverage, shall not terminate coverage of such child under such
1 Section 2706 (prior to its redesignation as 2727 by Public Law 111–148) was added by subsection (a) of section 903 of the Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 1999 (as contained in section 101(f) of division
A of Public Law 105–277; 112 Stat. 2681–438). Subsection (c) of such section 903 concerns effective dates, and paragraph (1) of the subsection provides as follows:
‘‘(1) GROUP PLANS.—
‘‘(A) IN GENERAL.—The amendment made by subsection (a) shall apply to group
health plans for plan years beginning on or after the date of enactment of this Act.
‘‘(B) SPECIAL RULE FOR COLLECTIVE BARGAINING AGREEMENTS.—In the case of a group
health plan maintained pursuant to 1 or more collective bargaining agreements between employee representatives and 1 or more employers, any plan amendment made
pursuant to a collective bargaining agreement relating to the plan which amends the
plan solely to conform to any requirement added by the amendment made by subsection
(a) shall not be treated as a termination of such collective bargaining agreement.’’.
The Public Law was enacted October 21, 1998.
2 So in law.

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Sec. 2728

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plan or health insurance coverage due to a medically necessary
leave of absence before the date that is the earlier of—
(A) the date that is 1 year after the first day of the
medically necessary leave of absence; or
(B) the date on which such coverage would otherwise
terminate under the terms of the plan or health insurance
coverage.
(2) DEPENDENT CHILD DESCRIBED.—A dependent child described in this paragraph is, with respect to a group health
plan or individual health insurance coverage, a beneficiary
under the plan who—
(A) is a dependent child, under the terms of the plan
or coverage, of a participant or beneficiary under the plan
or coverage; and
(B) was enrolled in the plan or coverage, on the basis
of being a student at a postsecondary educational institution (as described in subsection (a)), immediately before the
first day of the medically necessary leave of absence involved.
(3) CERTIFICATION BY PHYSICIAN.—Paragraph (1) shall
apply to a group health plan or individual health insurance
coverage only if the plan or issuer of the coverage has received
written certification by a treating physician of the dependent
child which states that the child is suffering from a serious illness or injury and that the leave of absence (or other change of
enrollment) described in subsection (a) is medically necessary.
(c) NOTICE.—A group health plan, and a health insurance
issuer that offers group or individual health insurance coverage,
shall include, with any notice regarding a requirement for certification of student status for coverage under the plan or coverage, a
description of the terms of this section for continued coverage during
medically necessary leaves of absence. Such description shall be in
language which is understandable to the typical plan participant.
(d) NO CHANGE IN BENEFITS.—A dependent child whose benefits are continued under this section shall be entitled to the same
benefits as if (during the medically necessary leave of absence) the
child continued to be a covered student at the institution of higher
education and was not on a medically necessary leave of absence.
(e) CONTINUED APPLICATION IN CASE OF CHANGED COVERAGE.—
If—
(1) a dependent child of a participant or beneficiary is in
a period of coverage under a group health plan or individual
health insurance coverage, pursuant to a medically necessary
leave of absence of the child described in subsection (b);
(2) the manner in which the participant or beneficiary is
covered under the plan changes, whether through a change in
health insurance coverage or health insurance issuer, a change
between health insurance coverage and self-insured coverage, or
otherwise; and
(3) the coverage as so changed continues to provide coverage of beneficiaries as dependent children,
this section shall apply to coverage of the child under the changed
coverage for the remainder of the period of the medically necessary
leave of absence of the dependent child under the plan in the same
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PUBLIC HEALTH SERVICE ACT

Sec. 2722

manner as it would have applied if the changed coverage had been
the previous coverage.
Subpart 2—Exclusion of Plans; Enforcement; Preemption 1
SEC. 2722. 2 ƒ300gg–21≈ EXCLUSION OF CERTAIN PLANS.
(a) LIMITATION ON APPLICATION OF PROVISIONS RELATING TO
GROUP HEALTH PLANS.—
(1) IN GENERAL.—The requirements of subparts 1 and 2 3

shall apply with respect to group health plans only—
(A) subject to paragraph (2), in the case of a plan that
is a nonfederal governmental plan, and
(B) with respect to health insurance coverage offered in
connection with a group health plan (including such a plan
that is a church plan or a governmental plan).
(2) TREATMENT OF NONFEDERAL GOVERNMENTAL PLANS.—
(A) ELECTION TO BE EXCLUDED.—Except as provided in
subparagraph (D) or (E), if the plan sponsor of a nonfederal governmental plan which is a group health plan to
which the provisions of subparts 1 and 2 3 otherwise apply
makes an election under this subparagraph (in such form
and manner as the Secretary may by regulations prescribe),
then the requirements of such subparts insofar as they
apply directly to group health plans (and not merely to
group health insurance coverage) shall not apply to such
governmental plans for such period except as provided in
this paragraph.
(B) PERIOD OF ELECTION.—An election under subparagraph (A) shall apply—
(i) for a single specified plan year, or
(ii) in the case of a plan provided pursuant to a
collective bargaining agreement, for the term of such
agreement.
An election under clause (i) may be extended through subsequent elections under this paragraph.
(C) NOTICE TO ENROLLEES.—Under such an election,
the plan shall provide for—
(i) notice to enrollees (on an annual basis and at
the time of enrollment under the plan) of the fact and
consequences of such election, and
(ii) certification and disclosure of creditable coverage under the plan with respect to enrollees in accordance with section 2701(e).
(D) ELECTION NOT APPLICABLE TO REQUIREMENTS CONCERNING GENETIC INFORMATION.—The election described in
1 There

is a subpart II (roman II) beginning with section 2711.
numerical sequence of section enumerators beginning in subpart 2 so in law. See section
enumerators at the end of subpart 1 of this part and amendments redesignating section enumerators in subpart 2 by section 1001(4) and section 1563(c)(12) of Public Law 111–148. See
footnote accompanying section 2725 regarding ambiguity in placement of sections 2725–2728.
2 The

There are conflicting amendments made to provisions of this section by section 1563(a) and
section 1563(c)(12)(B) (relating to conforming amendments—originally designated as section
1562 and redesignated as section 1563 by section 10107(b)(1)) of Public Law 111–148). The
amendments reflected here are from section 1563(a) of such Public Law and thereby renders
the global amendment made by subsection (c)(12)(B) unexecutable.
3 The references to ‘‘subparts 1 and 2’’ probably should read ‘‘subparts I and II’’.

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subparagraph (A) shall not be available with respect to the
provisions of subsections (a)(1)(F), (b)(3), (c), and (d) of section 2702 and the provisions of sections 2701 and 2702(b)
to the extent that such provisions apply to genetic information.
(E) ELECTION NOT APPLICABLE.—The election described
in subparagraph (A) shall not be available with respect to
the provisions of subparts I and II.
(b) EXCEPTION FOR CERTAIN BENEFITS.—The requirements of
subparts 1 and 2 1 shall not apply to any individual coverage or any
group health plan (or group health insurance coverage) in relation
to its provision of excepted benefits described in section 2791(c)(1).
(c) EXCEPTION FOR CERTAIN BENEFITS IF CERTAIN CONDITIONS
MET.—
(1) LIMITED, EXCEPTED BENEFITS.—The requirements of
subparts 1 and 2 1 shall not apply to any individual coverage
or any group health plan (and group health insurance coverage
offered in connection with a group health plan) in relation to
its provision of excepted benefits described in section 2791(c)(2)
if the benefits—
(A) are provided under a separate policy, certificate, or
contract of insurance; or
(B) are otherwise not an integral part of the plan.
(2) NONCOORDINATED, EXCEPTED BENEFITS.—The requirements of subparts 1 and 2 1 shall not apply to any individual
coverage or any group health plan (and group health insurance
coverage offered in connection with a group health plan) in relation to its provision of excepted benefits described in section
2791(c)(3) if all of the following conditions are met:
(A) The benefits are provided under a separate policy,
certificate, or contract of insurance.
(B) There is no coordination between the provision of
such benefits and any exclusion of benefits under any group
health plan maintained by the same plan sponsor.
(C) Such benefits are paid with respect to an event
without regard to whether benefits are provided with respect to such an event under any group health plan maintained by the same plan sponsor or, with respect to individual coverage, under any health insurance coverage
maintained by the same health insurance issuer 2.
(3) SUPPLEMENTAL EXCEPTED BENEFITS.—The requirements
of this part shall not apply to any individual coverage or any
group health plan (and group health insurance coverage) in relation to its provision of excepted benefits described in section
27971(c)(4) if the benefits are provided under a separate policy,
certificate, or contract of insurance.
(d) TREATMENT OF PARTNERSHIPS.—For purposes of this part—
1 The

references to ‘‘subparts 1 and 2’’ probably should read ‘‘subparts I and II’’.
1563 (relating to conforming amendments--originally designated as section 1562 and
redesignated as section 1563 by section 10107(b)(1)) of Public Law 111–148 provides for an
amendment to insert ‘‘or, with respect to individual coverage, under any health insurance coverage maintained by the same health insurance issuer’’. Such amendment did not specify where
to insert this new language, however, it was carried out by inserting this new language before
the period at the end in order to reflect the probable intent of Congress.
2 Section

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1463

PUBLIC HEALTH SERVICE ACT

Sec. 2723

(1) TREATMENT AS A GROUP HEALTH PLAN.—Any plan, fund,
or program which would not be (but for this subsection) an employee welfare benefit plan and which is established or maintained by a partnership, to the extent that such plan, fund, or
program provides medical care (including items and services
paid for as medical care) to present or former partners in the
partnership or to their dependents (as defined under the terms
of the plan, fund, or program), directly or through insurance,
reimbursement, or otherwise, shall be treated (subject to paragraph (2)) as an employee welfare benefit plan which is a group
health plan.
(2) EMPLOYER.—In the case of a group health plan, the
term ‘‘employer’’ also includes the partnership in relation to any
partner.
(3) PARTICIPANTS OF GROUP HEALTH PLANS.—In the case of
a group health plan, the term ‘‘participant’’ also includes—
(A) in connection with a group health plan maintained
by a partnership, an individual who is a partner in relation to the partnership, or
(B) in connection with a group health plan maintained
by a self-employed individual (under which one or more
employees are participants), the self-employed individual,
if such individual is, or may become, eligible to receive a benefit
under the plan or such individual’s beneficiaries may be eligible
to receive any such benefit.
SEC. 2723. ƒ300gg–22≈ ENFORCEMENT.
(a) STATE ENFORCEMENT.—
(1) STATE AUTHORITY.—Subject

to section 2723, each State
may require that health insurance issuers that issue, sell,
renew, or offer health insurance coverage in the State in the individual or group market meet the requirements of this part
with respect to such issuers.
(2) FAILURE TO IMPLEMENT PROVISIONS.—In the case of a
determination by the Secretary that a State has failed to substantially enforce a provision (or provisions) in this part with
respect to health insurance issuers in the State, the Secretary
shall enforce such provision (or provisions) under subsection (b)
insofar as they relate to the issuance, sale, renewal, and offering
of health insurance coverage in connection with group health
plans or individual health insurance coverage in such State.
(b) SECRETARIAL ENFORCEMENT AUTHORITY.—
(1) LIMITATION.—The provisions of this subsection shall
apply to enforcement of a provision (or provisions) of this part
only—
(A) as provided under subsection (a)(2); and
(B) with respect to individual health insurance coverage or group health plans that are non-Federal governmental plans.
(2) IMPOSITION OF PENALTIES.—In the cases described in
paragraph (1)—
(A) IN GENERAL.—Subject to the succeeding provisions
of this subsection, any non-Federal governmental plan that
is a group health plan and any health insurance issuer

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1464

that fails to meet a provision of this part applicable to such
plan or issuer is subject to a civil money penalty under this
subsection.
(B) LIABILITY FOR PENALTY.—In the case of a
failure by—
(i) a health insurance issuer, the issuer is liable for
such penalty, or
(ii) a group health plan that is a non-Federal governmental plan which is—
(I) sponsored by 2 or more employers, the plan
is liable for such penalty, or
(II) not so sponsored, the employer is liable for
such penalty.
(C) AMOUNT OF PENALTY.—
(i) IN GENERAL.—The maximum amount of penalty
imposed under this paragraph is $100 for each day for
each individual with respect to which such a failure occurs.
(ii) CONSIDERATIONS IN IMPOSITION.—In determining the amount of any penalty to be assessed under
this paragraph, the Secretary shall take into account
the previous record of compliance of the entity being assessed with the applicable provisions of this part and
the gravity of the violation.
(iii) LIMITATIONS.—
(I) PENALTY NOT TO APPLY WHERE FAILURE
NOT DISCOVERED EXERCISING REASONABLE DILIGENCE.—No civil money penalty shall be imposed
under this paragraph on any failure during any
period for which it is established to the satisfaction
of the Secretary that none of the entities against
whom the penalty would be imposed knew, or exercising reasonable diligence would have known,
that such failure existed.
(II) PENALTY NOT TO APPLY TO FAILURES CORRECTED WITHIN 30 DAYS.—No civil money penalty
shall be imposed under this paragraph on any failure if such failure was due to reasonable cause
and not to willful neglect, and such failure is corrected during the 30-day period beginning on the
first day any of the entities against whom the penalty would be imposed knew, or exercising reasonable diligence would have known, that such failure
existed.
(D) ADMINISTRATIVE REVIEW.—
(i) OPPORTUNITY FOR HEARING.—The entity assessed shall be afforded an opportunity for hearing by
the Secretary upon request made within 30 days after
the date of the issuance of a notice of assessment. In
such hearing the decision shall be made on the record
pursuant to section 554 of title 5, United States Code.
If no hearing is requested, the assessment shall constitute a final and unappealable order.
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Sec. 2723

(ii) HEARING PROCEDURE.—If a hearing is requested, the initial agency decision shall be made by
an administrative law judge, and such decision shall
become the final order unless the Secretary modifies or
vacates the decision. Notice of intent to modify or vacate the decision of the administrative law judge shall
be issued to the parties within 30 days after the date
of the decision of the judge. A final order which takes
effect
under
this
paragraph
shall
be
subject to review only as provided under subparagraph
(E).
(E) JUDICIAL REVIEW.—
(i) FILING OF ACTION FOR REVIEW.—Any entity
against whom an order imposing a civil money penalty
has been entered after an agency hearing under this
paragraph may obtain review by the United States district court for any district in which such entity is located or the United States District Court for the District of Columbia by filing a notice of appeal in such
court within 30 days from the date of such order, and
simultaneously sending a copy of such notice by registered mail to the Secretary.
(ii) CERTIFICATION OF ADMINISTRATIVE RECORD.—
The Secretary shall promptly certify and file in such
court the record upon which the penalty was imposed.
(iii) STANDARD FOR REVIEW.—The findings of the
Secretary shall be set aside only if found to be unsupported by substantial evidence as provided by section
706(2)(E) of title 5, United States Code.
(iv) APPEAL.—Any final decision, order, or judgment of the district court concerning such review shall
be subject to appeal as provided in chapter 83 of title
28 of such Code.
(F) FAILURE TO PAY ASSESSMENT; MAINTENANCE OF ACTION.—
(i) FAILURE TO PAY ASSESSMENT.—If any entity
fails to pay an assessment after it has become a final
and unappealable order, or after the court has entered
final judgment in favor of the Secretary, the Secretary
shall refer the matter to the Attorney General who
shall recover the amount assessed by action in the appropriate United States district court.
(ii) NONREVIEWABILITY.—In such action the validity and appropriateness of the final order imposing the
penalty shall not be subject to review.
(G) PAYMENT OF PENALTIES.—Except as otherwise provided, penalties collected under this paragraph shall be
paid to the Secretary (or other officer) imposing the penalty
and shall be available without appropriation and until expended for the purpose of enforcing the provisions with respect to which the penalty was imposed.
(3) ENFORCEMENT AUTHORITY RELATING TO GENETIC DISCRIMINATION.—
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(A) GENERAL RULE.—In the cases described in paragraph (1), notwithstanding the provisions of paragraph
(2)(C), the succeeding subparagraphs of this paragraph
shall apply with respect to an action under this subsection
by the Secretary with respect to any failure of a health insurance issuer in connection with a group health plan, to
meet the requirements of subsection (a)(1)(F), (b)(3), (c), or
(d) of section 2702 or section 2701 or 2702(b)(1) with respect to genetic information in connection with the plan.
(B) AMOUNT.—
(i) IN GENERAL.—The amount of the penalty imposed under this paragraph shall be $100 for each day
in the noncompliance period with respect to each participant or beneficiary to whom such failure relates.
(ii) NONCOMPLIANCE PERIOD.—For purposes of this
paragraph, the term ‘‘noncompliance period’’ means,
with respect to any failure, the period—
(I) beginning on the date such failure first occurs; and
(II) ending on the date the failure is corrected.
(C) MINIMUM PENALTIES WHERE FAILURE DISCOVERED.—Notwithstanding clauses (i) and (ii) of subparagraph (D):
(i) IN GENERAL.—In the case of 1 or more failures
with respect to an individual—
(I) which are not corrected before the date on
which the plan receives a notice from the Secretary
of such violation; and
(II) which occurred or continued during the
period involved;
the amount of penalty imposed by subparagraph (A) by
reason of such failures with respect to such individual
shall not be less than $2,500.
(ii) HIGHER MINIMUM PENALTY WHERE VIOLATIONS
ARE MORE THAN DE MINIMIS.—To the extent violations
for which any person is liable under this paragraph for
any year are more than de minimis, clause (i) shall be
applied by substituting ‘‘$15,000’’ for ‘‘$2,500’’ with respect to such person.
(D) LIMITATIONS.—
(i) PENALTY NOT TO APPLY WHERE FAILURE NOT
DISCOVERED EXERCISING REASONABLE DILIGENCE.—No
penalty shall be imposed by subparagraph (A) on any
failure during any period for which it is established to
the satisfaction of the Secretary that the person otherwise liable for such penalty did not know, and exercising reasonable diligence would not have known, that
such failure existed.
(ii) PENALTY NOT TO APPLY TO FAILURES CORRECTED WITHIN CERTAIN PERIODS.—No penalty shall be
imposed by subparagraph (A) on any failure if—
(I) such failure was due to reasonable cause
and not to willful neglect; and
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PUBLIC HEALTH SERVICE ACT

Sec. 2724

(II) such failure is corrected during the 30-day
period beginning on the first date the person otherwise liable for such penalty knew, or exercising
reasonable diligence would have known, that such
failure existed.
(iii) OVERALL LIMITATION FOR UNINTENTIONAL
FAILURES.—In the case of failures which are due to reasonable cause and not to willful neglect, the penalty
imposed by subparagraph (A) for failures shall not exceed the amount equal to the lesser of—
(I) 10 percent of the aggregate amount paid or
incurred by the employer (or predecessor employer)
during the preceding taxable year for group health
plans; or
(II) $500,000.
(E) WAIVER BY SECRETARY.—In the case of a failure
which is due to reasonable cause and not to willful neglect,
the Secretary may waive part or all of the penalty imposed
by subparagraph (A) to the extent that the payment of such
penalty would be excessive relative to the failure involved.
SEC. 2724. ƒ300gg–23≈ PREEMPTION; STATE FLEXIBILITY; CONSTRUCTION.
(a) CONTINUED APPLICABILITY OF STATE LAW WITH RESPECT TO
HEALTH INSURANCE ISSUERS.—
(1) IN GENERAL.—Subject to paragraph (2) and except as

provided in subsection (b), this part and part C insofar as it relates to this part shall not be construed to supersede any provision of State law which establishes, implements, or continues in
effect any standard or requirement solely relating to health insurance issuers in connection with individual or group health
insurance coverage except to the extent that such standard or
requirement prevents the application of a requirement of this
part.
(2) CONTINUED PREEMPTION WITH RESPECT TO GROUP
HEALTH PLANS.—Nothing in this part shall be construed to affect or modify the provisions of section 514 of the Employee Retirement Income Security Act of 1974 with respect to group
health plans.
(b) SPECIAL RULES IN CASE OF PORTABILITY REQUIREMENTS.—
(1) IN GENERAL.—Subject to paragraph (2), the provisions
of this part relating to health insurance coverage offered by a
health insurance issuer supersede any provision of State law
which establishes, implements, or continues in effect a standard
or requirement applicable to imposition of a preexisting condition exclusion specifically governed by section 701 which differs
from the standards or requirements specified in such section.
(2) EXCEPTIONS.—Only in relation to health insurance coverage offered by a health insurance issuer, the provisions of this
part do not supersede any provision of State law to the extent
that such provision—
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(i) 1 substitutes for the reference to ‘‘6-month period’’ in
section 2701(a)(1) a reference to any shorter period of time;
(ii) 1 substitutes for the reference to ‘‘12 months’’ and
‘‘18 months’’ in section 2701(a)(2) a reference to any shorter
period of time;
(iii) 1 substitutes for the references to ‘‘63’’ days in sections 2701(c)(2)(A) and 2701(d)(4)(A) a reference to any
greater number of days;
(iv) 1 substitutes for the reference to ‘‘30-day period’’ in
sections 2701(b)(2) and 2701(d)(1) a reference to any greater
period;
(v) 1 prohibits the imposition of any preexisting condition exclusion in cases not described in section 2701(d) or
expands the exceptions described in such section;
(vi) 1 requires special enrollment periods in addition to
those required under section 2701(f); or
(vii) 1 reduces the maximum period permitted in an affiliation period under section 2701(g)(1)(B).
(c) RULES OF CONSTRUCTION.—Nothing in this part (other than
section 2704) shall be construed as requiring a group health plan
or health insurance coverage to provide specific benefits under the
terms of such plan or coverage.
(d) DEFINITIONS.—For purposes of this section—
(1) STATE LAW.—The term ‘‘State law’’ includes all laws,
decisions, rules, regulations, or other State action having the effect of law, of any State. A law of the United States applicable
only to the District of Columbia shall be treated as a State law
rather than a law of the United States.
(2) STATE.—The term ‘‘State’’ includes a State (including
the Northern Mariana Islands), any political subdivisions of a
State or such Islands, or any agency or instrumentality of either. 2
PART B—INDIVIDUAL MARKET RULES 3
Subpart 1—Portability, Access, and Renewability Requirements
SEC. 2741. ø300gg–41¿ GUARANTEED AVAILABILITY OF INDIVIDUAL
HEALTH INSURANCE COVERAGE TO CERTAIN INDIVIDUALS WITH PRIOR GROUP COVERAGE.
(a) GUARANTEED AVAILABILITY.—
(1) IN GENERAL.—Subject to the succeeding subsections of

this section and section 2744, each health insurance issuer
that offers health insurance coverage (as defined in section
1 Clauses (i) through (vii) probably should be redesignated as subparagraphs (A) through (G).
See section 102(a) of Public Law 104–191 (110 Stat. 1971).
1 See footnote on previous page.
2 See footnote accompanying section 2725 regarding ambiguity in placement of sections 2725–
2728.
3 Section 111(b) of Public Law 104–191 (110 Stat. 1987) provides as follows:
‘‘(b) EFFECTIVE DATE.—
‘‘(1) IN GENERAL.—Except as provided in this subsection, part B of title XXVII of the Public Health Service Act (as inserted by subsection (a)) shall apply with respect to health insurance coverage offered, sold, issued, renewed, in effect, or operated in the individual market after June 30, 1997, regardless of when a period of creditable coverage occurs.

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2791(b)(1)) in the individual market in a State may not, with
respect to an eligible individual (as defined in subsection (b))
desiring to enroll in individual health insurance coverage—
(A) decline to offer such coverage to, or deny enrollment of, such individual; or
(B) impose any preexisting condition exclusion (as defined in section 2701(b)(1)(A)) with respect to such coverage.
(2) SUBSTITUTION BY STATE OF ACCEPTABLE ALTERNATIVE
MECHANISM.—The requirement of paragraph (1) shall not apply
to health insurance coverage offered in the individual market
in a State in which the State is implementing an acceptable alternative mechanism under section 2744.
(b) ELIGIBLE INDIVIDUAL DEFINED.—In this part, the term ‘‘eligible individual’’ means an individual—
(1)(A) for whom, as of the date on which the individual
seeks coverage under this section, the aggregate of the periods
of creditable coverage (as defined in section 2701(c)) is 18 or
more months and (B) whose most recent prior creditable coverage was under a group health plan, governmental plan, or
church plan (or health insurance coverage offered in connection
with any such plan);
(2) who is not eligible for coverage under (A) a group
health plan, (B) part A or part B of title XVIII of the Social
Security Act, or (C) a State plan under title XIX of such Act
(or any successor program), and does not have other health insurance coverage;
(3) with respect to whom the most recent coverage within
the coverage period described in paragraph (1)(A) was not terminated based on a factor described in paragraph (1) or (2) of
section 2712(b) (relating to nonpayment of premiums or fraud);
(4) if the individual had been offered the option of continuation coverage under a COBRA continuation provision or under
a similar State program, who elected such coverage; and
(5) who, if the individual elected such continuation coverage, has exhausted such continuation coverage under such
provision or program.
(c) ALTERNATIVE COVERAGE PERMITTED WHERE NO STATE
MECHANISM.—
(1) IN GENERAL.—In the case of health insurance coverage
offered in the individual market in a State in which the State
is not implementing an acceptable alternative mechanism
under section 2744, the health insurance issuer may elect to
limit the coverage offered under subsection (a) so long as it offers at least two different policy forms of health insurance coverage both of which—
‘‘(2) APPLICATION OF CERTIFICATION RULES.—The provisions of section 102(d)(2) of this Act
shall apply to section 2743 of the the Public Health Service Act in the same manner as it
applies to section 2701(e) [redesignated as section 2704(e) by P.L. 111–148] of such Act.’’.
With respect to paragraph (2) of such section 111(b), subsection (d) of section 102 of Public
Law 104–191 is not divided into paragraphs (1) and (2) (and the subsection relates to a technical
correction). Subsection (c)(2) of such section 102 does relate to certifications.

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(A) are designed for, made generally available to, and
actively marketed to, and enroll both eligible and other individuals by the issuer; and
(B) meet the requirement of paragraph (2) or (3), as
elected by the issuer.
For purposes of this subsection, policy forms which have different cost-sharing arrangements or different riders shall be
considered to be different policy forms.
(2) CHOICE OF MOST POPULAR POLICY FORMS.—The requirement of this paragraph is met, for health insurance coverage
policy forms offered by an issuer in the individual market, if
the issuer offers the policy forms for individual health insurance coverage with the largest, and next to largest, premium
volume of all such policy forms offered by the issuer in the
State or applicable marketing or service area (as may be prescribed in regulation) by the issuer in the individual market in
the period involved.
(3) CHOICE OF 2 POLICY FORMS WITH REPRESENTATIVE
COVERAGE.—
(A) IN GENERAL.—The requirement of this paragraph
is met, for health insurance coverage policy forms offered
by an issuer in the individual market, if the issuer offers
a lower-level coverage policy form (as defined in subparagraph (B)) and a higher-level coverage policy form (as defined in subparagraph (C)) each of which includes benefits
substantially similar to other individual health insurance
coverage offered by the issuer in that State and each of
which is covered under a method described in section
2744(c)(3)(A) (relating to risk adjustment, risk spreading,
or financial subsidization).
(B) LOWER-LEVEL OF COVERAGE DESCRIBED.—A policy
form is described in this subparagraph if the actuarial
value of the benefits under the coverage is at least 85 percent but not greater than 100 percent of a weighted average (described in subparagraph (D)).
(C) HIGHER-LEVEL OF COVERAGE DESCRIBED.—A policy
form is described in this subparagraph if—
(i) the actuarial value of the benefits under the
coverage is at least 15 percent greater than the actuarial value of the coverage described in subparagraph
(B) offered by the issuer in the area involved; and
(ii) the actuarial value of the benefits under the
coverage is at least 100 percent but not greater than
120 percent of a weighted average (described in subparagraph (D)).
(D) WEIGHTED AVERAGE.—For purposes of this
paragraph, the weighted average described in this subparagraph is the average actuarial value of the benefits
provided by all the health insurance coverage issued (as
elected by the issuer) either by that issuer or by all issuers
in the State in the individual market during the previous
year (not including coverage issued under this section),
weighted by enrollment for the different coverage.
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(4) ELECTION.—The issuer elections under this subsection
shall apply uniformly to all eligible individuals in the State for
that issuer. Such an election shall be effective for policies offered during a period of not shorter than 2 years.
(5) ASSUMPTIONS.—For purposes of paragraph (3), the actuarial value of benefits provided under individual health insurance coverage shall be calculated based on a standardized
population and a set of standardized utilization and cost factors.
(d) SPECIAL RULES FOR NETWORK PLANS.—
(1) IN GENERAL.—In the case of a health insurance issuer
that offers health insurance coverage in the individual market
through a network plan, the issuer may—
(A) limit the individuals who may be enrolled under
such coverage to those who live, reside, or work within the
service area for such network plan; and
(B) within the service area of such plan, deny such
coverage to such individuals if the issuer has demonstrated, if required, to the applicable State authority
that—
(i) it will not have the capacity to deliver services
adequately to additional individual enrollees because
of its obligations to existing group contract holders
and enrollees and individual enrollees, and
(ii) it is applying this paragraph uniformly to individuals without regard to any health status-related
factor of such individuals and without regard to
whether the individuals are eligible individuals.
(2) 180-DAY SUSPENSION UPON DENIAL OF COVERAGE.—An
issuer, upon denying health insurance coverage in any service
area in accordance with paragraph (1)(B), may not offer coverage in the individual market within such service area for a
period of 180 days after such coverage is denied.
(e) APPLICATION OF FINANCIAL CAPACITY LIMITS.—
(1) IN GENERAL.—A health insurance issuer may deny
health insurance coverage in the individual market to an eligible individual if the issuer has demonstrated, if required, to
the applicable State authority that—
(A) it does not have the financial reserves necessary to
underwrite additional coverage; and
(B) it is applying this paragraph uniformly to all individuals in the individual market in the State consistent
with applicable State law and without regard to any
health status-related factor of such individuals and without regard to whether the individuals are eligible individuals.
(2) 180-DAY SUSPENSION UPON DENIAL OF COVERAGE.—An
issuer upon denying individual health insurance coverage in
any service area in accordance with paragraph (1) may not
offer such coverage in the individual market within such service area for a period of 180 days after the date such coverage
is denied or until the issuer has demonstrated, if required
under applicable State law, to the applicable State authority
that the issuer has sufficient financial reserves to underwrite
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additional coverage, whichever is later. A State may provide
for the application of this paragraph on a service-area-specific
basis.
(e) 1 MARKET REQUIREMENTS.—
(1) IN GENERAL.—The provisions of subsection (a) shall not
be construed to require that a health insurance issuer offering
health insurance coverage only in connection with group health
plans or through one or more bona fide associations, or both,
offer such health insurance coverage in the individual market.
(2) CONVERSION POLICIES.—A health insurance issuer offering health insurance coverage in connection with group
health plans under this title shall not be deemed to be a health
insurance issuer offering individual health insurance coverage
solely because such issuer offers a conversion policy.
(f) 1 CONSTRUCTION.—Nothing in this section shall be
construed—
(1) to restrict the amount of the premium rates that an
issuer may charge an individual for health insurance coverage
provided in the individual market under applicable State law;
or
(2) to prevent a health insurance issuer offering health insurance coverage in the individual market from establishing
premium discounts or rebates or modifying otherwise applicable copayments or deductibles in return for adherence to programs of health promotion and disease prevention.
SEC. 2742. ø300gg–42¿ GUARANTEED RENEWABILITY OF INDIVIDUAL
HEALTH INSURANCE COVERAGE.
(a) IN GENERAL.—Except as provided in this section, a health

insurance issuer that provides individual health insurance coverage
to an individual shall renew or continue in force such coverage at
the option of the individual.
(b) GENERAL EXCEPTIONS.—A health insurance issuer may
nonrenew or discontinue health insurance coverage of an individual
in the individual market based only on one or more of the following:
(1) NONPAYMENT OF PREMIUMS.—The individual has failed
to pay premiums or contributions in accordance with the terms
of the health insurance coverage or the issuer has not received
timely premium payments.
(2) FRAUD.—The individual has performed an act or practice that constitutes fraud or made an intentional misrepresentation of material fact under the terms of the coverage.
(3) TERMINATION OF PLAN.—The issuer is ceasing to offer
coverage in the individual market in accordance with subsection (c) and applicable State law.
(4) MOVEMENT OUTSIDE SERVICE AREA.—In the case of a
health insurance issuer that offers health insurance coverage
in the market through a network plan, the individual no longer
resides, lives, or works in the service area (or in an area for
which the issuer is authorized to do business) but only if such
coverage is terminated under this paragraph uniformly without
1 So in law. Probably should redesignate the second subsection (e) and subsection (f) as subsections (f) and (g), respectively. See section 111(a) of Pub. L. 104–191 (110 Stat. 1978).

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regard to any health status-related factor of covered individuals.
(5) ASSOCIATION MEMBERSHIP CEASES.—In the case of
health insurance coverage that is made available in the individual market only through one or more bona fide associations,
the membership of the individual in the association (on the
basis of which the coverage is provided) ceases but only if such
coverage is terminated under this paragraph uniformly without
regard to any health status-related factor of covered individuals.
(c) REQUIREMENTS FOR UNIFORM TERMINATION OF COVERAGE.—
(1) PARTICULAR TYPE OF COVERAGE NOT OFFERED.—In any
case in which an issuer decides to discontinue offering a particular type of health insurance coverage offered in the individual market, coverage of such type may be discontinued by
the issuer only if—
(A) the issuer provides notice to each covered individual provided coverage of this type in such market of
such discontinuation at least 90 days prior to the date of
the discontinuation of such coverage;
(B) the issuer offers to each individual in the individual market provided coverage of this type, the option to
purchase any other individual health insurance coverage
currently being offered by the issuer for individuals in
such market; and
(C) in exercising the option to discontinue coverage of
this type and in offering the option of coverage under subparagraph (B), the issuer acts uniformly without regard to
any health status-related factor of enrolled individuals or
individuals who may become eligible for such coverage.
(2) DISCONTINUANCE OF ALL COVERAGE.—
(A) IN GENERAL.—Subject to subparagraph (C), in any
case in which a health insurance issuer elects to discontinue offering all health insurance coverage in the individual market in a State, health insurance coverage may
be discontinued by the issuer only if—
(i) the issuer provides notice to the applicable
State authority and to each individual of such discontinuation at least 180 days prior to the date of the
expiration of such coverage, and
(ii) all health insurance issued or delivered for
issuance in the State in such market are discontinued
and coverage under such health insurance coverage in
such market is not renewed.
(B) PROHIBITION ON MARKET REENTRY.—In the case of
a discontinuation under subparagraph (A) in the individual market, the issuer may not provide for the issuance
of any health insurance coverage in the market and State
involved during the 5-year period beginning on the date of
the discontinuation of the last health insurance coverage
not so renewed.
(d) EXCEPTION FOR UNIFORM MODIFICATION OF COVERAGE.—At
the time of coverage renewal, a health insurance issuer may modify
the health insurance coverage for a policy form offered to individMarch 13, 2013

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uals in the individual market so long as such modification is consistent with State law and effective on a uniform basis among all
individuals with that policy form.
(e) APPLICATION TO COVERAGE OFFERED ONLY THROUGH ASSOCIATIONS.—In applying this section in the case of health insurance
coverage that is made available by a health insurance issuer in the
individual market to individuals only through one or more associations, a reference to an ‘‘individual’’ is deemed to include a reference to such an association (of which the individual is a member).
SEC. 2743. ø300gg–43¿ CERTIFICATION OF COVERAGE.

The provisions of section 2701(e) shall apply to health insurance coverage offered by a health insurance issuer in the individual
market in the same manner as it applies to health insurance coverage offered by a health insurance issuer in connection with a
group health plan in the small or large group market.
SEC. 2744. ø300gg–44¿ STATE FLEXIBILITY IN INDIVIDUAL MARKET REFORMS.
(a) WAIVER OF REQUIREMENTS WHERE IMPLEMENTATION OF ACCEPTABLE ALTERNATIVE MECHANISM.—
(1) IN GENERAL.—The requirements of section 2741 shall

not apply with respect to health insurance coverage offered in
the individual market in the State so long as a State is found
to be implementing, in accordance with this section and consistent with section 2762(b), an alternative mechanism (in this
section referred to as an ‘‘acceptable alternative mechanism’’)—
(A) under which all eligible individuals are provided a
choice of health insurance coverage;
(B) under which such coverage does not impose any
preexisting condition exclusion with respect to such coverage;
(C) under which such choice of coverage includes at
least one policy form of coverage that is comparable to
comprehensive health insurance coverage offered in the individual market in such State or that is comparable to a
standard option of coverage available under the group or
individual health insurance laws of such State; and
(D) in a State which is implementing—
(i) a model act described in subsection (c)(1),
(ii) a qualified high risk pool described in subsection (c)(2), or
(iii) a mechanism described in subsection (c)(3).
(2) PERMISSIBLE FORMS OF MECHANISMS.—A private or
public individual health insurance mechanism (such as a
health insurance coverage pool or programs, mandatory group
conversion policies, guaranteed issue of one or more plans of
individual health insurance coverage, or open enrollment by
one or more health insurance issuers), or combination of such
mechanisms, that is designed to provide access to health benefits for individuals in the individual market in the State in accordance with this section may constitute an acceptable alternative mechanism.
(b) APPLICATION OF ACCEPTABLE ALTERNATIVE MECHANISMS.—
(1) PRESUMPTION.—
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(A) IN GENERAL.—Subject to the succeeding provisions
of this subsection, a State is presumed to be implementing
an acceptable alternative mechanism in accordance with
this section as of July 1, 1997, if, by not later than April
1, 1997, the chief executive officer of a State—
(i) notifies the Secretary that the State has enacted or intends to enact (by not later than January
1, 1998, or July 1, 1998, in the case of a State described in subparagraph (B)(ii)) any necessary legislation to provide for the implementation of a mechanism
reasonably designed to be an acceptable alternative
mechanism as of January 1, 1998, (or, in the case of
a State described in subparagraph (B)(ii), July 1,
1998); and
(ii) provides the Secretary with such information
as the Secretary may require to review the mechanism
and its implementation (or proposed implementation)
under this subsection.
(B) DELAY PERMITTED FOR CERTAIN STATES.—
(i) EFFECT OF DELAY.—In the case of a State described in clause (ii) that provides notice under subparagraph (A)(i), for the presumption to continue on
and after July 1, 1998, the chief executive officer of
the State by April 1, 1998—
(I) must notify the Secretary that the State
has enacted any necessary legislation to provide
for the implementation of a mechanism reasonably designed to be an acceptable alternative
mechanism as of July 1, 1998; and
(II) must provide the Secretary with such information as the Secretary may require to review
the mechanism and its implementation (or proposed implementation) under this subsection.
(ii) STATES DESCRIBED.—A State described in this
clause is a State that has a legislature that does not
meet within the 12-month period beginning on the
date of enactment of this Act.
(C) CONTINUED APPLICATION.—In order for a mechanism to continue to be presumed to be an acceptable alternative mechanism, the State shall provide the Secretary
every 3 years with information described in subparagraph
(A)(ii) or (B)(i)(II) (as the case may be).
(2) NOTICE.—If the Secretary finds, after review of information provided under paragraph (1) and in consultation with
the chief executive officer of the State and the insurance commissioner or chief insurance regulatory official of the State,
that such a mechanism is not an acceptable alternative mechanism or is not (or no longer) being implemented, the Secretary—
(A) shall notify the State of—
(i) such preliminary determination, and
(ii) the consequences under paragraph (3) of a failure to implement such a mechanism; and
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(B) shall permit the State a reasonable opportunity in
which to modify the mechanism (or to adopt another mechanism) in a manner so that may be an acceptable alternative mechanism or to provide for implementation of such
a mechanism.
(3) FINAL DETERMINATION.—If, after providing notice and
opportunity under paragraph (2), the Secretary finds that the
mechanism is not an acceptable alternative mechanism or the
State is not implementing such a mechanism, the Secretary
shall notify the State that the State is no longer considered to
be implementing an acceptable alternative mechanism and
that the requirements of section 2741 shall apply to health insurance coverage offered in the individual market in the State,
effective as of a date specified in the notice.
(4) LIMITATION ON SECRETARIAL AUTHORITY.—The Secretary shall not make a determination under paragraph (2) or
(3) on any basis other than the basis that a mechanism is not
an acceptable alternative mechanism or is not being implemented.
(5) FUTURE ADOPTION OF MECHANISMS.—If a State, after
January 1, 1997, submits the notice and information described
in paragraph (1), unless the Secretary makes a finding described in paragraph (3) within the 90-day period beginning on
the date of submission of the notice and information, the mechanism shall be considered to be an acceptable alternative
mechanism for purposes of this section, effective 90 days after
the end of such period, subject to the second sentence of paragraph (1).
(c) PROVISION RELATED TO RISK.—
(1) ADOPTION OF NAIC MODELS.—The model act referred to
in subsection (a)(1)(D)(i) is the Small Employer and Individual
Health Insurance Availability Model Act (adopted by the National Association of Insurance Commissioners on June 3,
1996) insofar as it applies to individual health insurance coverage or the Individual Health Insurance Portability Model Act
(also adopted by such Association on such date).
(2) QUALIFIED HIGH RISK POOL.—For purposes of subsection
(a)(1)(D)(ii), a ‘‘qualified high risk pool’’ described in this paragraph is a high risk pool that—
(A) provides to all eligible individuals health insurance
coverage (or comparable coverage) that does not impose
any preexisting condition exclusion with respect to such
coverage for all eligible individuals, and
(B) provides for premium rates and covered benefits
for such coverage consistent with standards included in
the NAIC Model Health Plan for Uninsurable Individuals
Act (as in effect as of the date of the enactment of this
title).
(3) OTHER MECHANISMS.—For purposes of subsection
(a)(1)(D)(iii), a mechanism described in this paragraph—
(A) provides for risk adjustment, risk spreading, or a
risk spreading mechanism (among issuers or policies of an
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tion for eligible individuals, including through assistance
to participating issuers; or
(B) is a mechanism under which each eligible individual is provided a choice of all individual health insurance coverage otherwise available.
SEC. 2745. ø300gg–45¿ RELIEF FOR HIGH RISK POOLS.
(a) SEED GRANTS TO STATES.—The Secretary shall

provide from
the funds appropriated under subsection (d)(1)(A) a grant of up to
$1,000,000 to each State that has not created a qualified high risk
pool as of the date of enactment of the State High Risk Pool Funding Extension Act of 2006 for the State’s costs of creation and initial operation of such a pool.
(b) GRANTS FOR OPERATIONAL LOSSES.—
(1) IN GENERAL.—In the case of a State that has established a qualified high risk pool that—
(A) restricts premiums charged under the pool to no
more than 200 percent of the premium for applicable
standard risk rates;
(B) offers a choice of two or more coverage options
through the pool; and
(C) has in effect a mechanism reasonably designed to
ensure continued funding of losses incurred by the State in
connection with operation of the pool after the end of the
last fiscal year for which a grant is provided under this
paragraph;
the Secretary shall provide, from the funds appropriated under
paragraphs (1)(B)(i) and (2)(A) of subsection (d) and allotted to
the State under paragraph (2), a grant for the losses incurred
by the State in connection with the operation of the pool.
(2) ALLOTMENT.—Subject to paragraph (4), the amounts
appropriated under paragraphs (1)(B)(i) and (2)(A) of subsection (d) for a fiscal year shall be allotted and made available
to the States (or the entities that operate the high risk pool
under applicable State law) that qualify for a grant under
paragraph (1) as follows:
(A) An amount equal to 40 percent of such appropriated amount for the fiscal year shall be allotted in equal
amounts to each qualifying State that is one of the 50
States or the District of Columbia and that applies for a
grant under this subsection.
(B) An amount equal to 30 percent of such appropriated amount for the fiscal year shall be allotted among
qualifying States that apply for such a grant so that the
amount allotted to such a State bears the same ratio to
such appropriated amount as the number of uninsured individuals in the State bears to the total number of uninsured individuals (as determined by the Secretary) in all
qualifying States that so apply.
(C) An amount equal to 30 percent of such appropriated amount for the fiscal year shall be allotted among
qualifying States that apply for such a grant so that the
amount allotted to a State bears the same ratio to such appropriated amount as the number of individuals enrolled
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in health care coverage through the qualified high risk
pool of the State bears to the total number of individuals
so enrolled through qualified high risk pools (as determined by the Secretary) in all qualifying States that so
apply.
(3) SPECIAL RULE FOR POOLS CHARGING HIGHER PREMIUMS.—In the case of a qualified high risk pool of a State
which charges premiums that exceed 150 percent of the premium for applicable standard risks, the State shall use at least
50 percent of the amount of the grant provided to the State to
carry out this subsection to reduce premiums for enrollees.
(4) LIMITATION FOR TERRITORIES.—In no case shall the aggregate amount allotted and made available under paragraph
(2) for a fiscal year to States that are not the 50 States or the
District of Columbia exceed $1,000,000.
(c) BONUS GRANTS FOR SUPPLEMENTAL CONSUMER BENEFITS.—
(1) IN GENERAL.—In the case of a State that is one of the
50 States or the District of Columbia, that has established a
qualified high risk pool, and that is receiving a grant under
subsection (b)(1), the Secretary shall provide, from the funds
appropriated under paragraphs (1)(B)(ii) and (2)(B) of subsection (d) and allotted to the State under paragraph (3), a
grant to be used to provide supplemental consumer benefits to
enrollees or potential enrollees (or defined subsets of such enrollees or potential enrollees) in qualified high risk pools.
(2) BENEFITS.—A State shall use amounts received under
a grant under this subsection to provide one or more of the following benefits:
(A) Low-income premium subsidies.
(B) A reduction in premium trends, actual premiums,
or other cost-sharing requirements.
(C) An expansion or broadening of the pool of individuals eligible for coverage, such as through eliminating
waiting lists, increasing enrollment caps, or providing
flexibility in enrollment rules.
(D) Less stringent rules, or additional waiver authority, with respect to coverage of pre-existing conditions.
(E) Increased benefits.
(F) The establishment of disease management programs.
(3) ALLOTMENT; LIMITATION.—The Secretary shall allot
funds appropriated under paragraphs (1)(B)(ii) and (2)(B) of
subsection (d) among States qualifying for a grant under paragraph (1) in a manner specified by the Secretary, but in no
case shall the amount so allotted to a State for a fiscal year
exceed 10 percent of the funds so appropriated for the fiscal
year.
(4) RULE OF CONSTRUCTION.—Nothing in this subsection
shall be construed to prohibit a State that, on the date of the
enactment of the State High Risk Pool Funding Extension Act
of 2006, is in the process of implementing a program to provide
benefits of the type described in paragraph (2), from being eligible for a grant under this subsection.
(d) FUNDING.—
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(1) APPROPRIATION FOR FISCAL YEAR 2006.—There are authorized to be appropriated for fiscal year 2006—
(A) $15,000,000 to carry out subsection (a); and
(B) $75,000,000, of which, subject to paragraph (4)—
(i) two-thirds of the amount appropriated shall be
made available for allotments under subsection (b)(2);
and
(ii) one-third of the amount appropriated shall be
made available for allotments under subsection (c)(3).
(2) AUTHORIZATION OF APPROPRIATIONS FOR FISCAL YEARS
2007 THROUGH 2010.—There are authorized to be appropriated
$75,000,000 for each of fiscal years 2007 through 2010, of
which, subject to paragraph (4)—
(A) two-thirds of the amount appropriated for a fiscal
year shall be made available for allotments under subsection (b)(2); and
(B) one-third of the amount appropriated for a fiscal
year shall be made available for allotments under subsection (c)(3).
(3) AVAILABILITY.—Funds appropriated for purposes of carrying out this section for a fiscal year shall remain available
for obligation through the end of the following fiscal year.
(4) REALLOTMENT.—If, on June 30 of each fiscal year for
which funds are appropriated under paragraph (1)(B) or (2),
the Secretary determines that all the amounts so appropriated
are not allotted or otherwise made available to States, such remaining amounts shall be allotted and made available under
subsection (b) among States receiving grants under subsection
(b) for the fiscal year based upon the allotment formula specified in such subsection.
(5) NO ENTITLEMENT.—Nothing in this section shall be construed as providing a State with an entitlement to a grant
under this section.
(e) APPLICATIONS.—To be eligible for a grant under this section, a State shall submit to the Secretary an application at such
time, in such manner, and containing such information as the Secretary may require.
(f) ANNUAL REPORT.—The Secretary shall submit to Congress
an annual report on grants provided under this section. Each such
report shall include information on the distribution of such grants
among States and the use of grant funds by States.
(g) DEFINITIONS.—In this section:
(1) QUALIFIED HIGH RISK POOL.—
(A) IN GENERAL.—The term ‘‘qualified high risk pool’’
has the meaning given such term in section 2744(c)(2), except that a State may elect to meet the requirement of
subparagraph (A) of such section (insofar as it requires the
provision of coverage to all eligible individuals) through
providing for the enrollment of eligible individuals through
an acceptable alternative mechanism (as defined for purposes of section 2744) that includes a high risk pool as a
component.
(2) STANDARD RISK RATE.—The term ‘‘standard risk rate’’
means a rate—
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(A) determined under the State high risk pool by considering the premium rates charged by other health insurers offering health insurance coverage to individuals in the
insurance market served;
(B) that is established using reasonable actuarial techniques; and
(C) that reflects anticipated claims experience and expenses for the coverage involved.
(3) STATE.—The term ‘‘State’’ means any of the 50 States
and the District of Columbia and includes Puerto Rico, the Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands.
Subpart 2—Other Requirements
SEC. 2751. ø300gg–51¿ STANDARDS RELATING TO BENEFITS FOR MOTHERS AND NEWBORNS.
(a) IN GENERAL.—The provisions of section 2704 (other than

subsections (d) and (f)) shall apply to health insurance coverage offered by a health insurance issuer in the individual market in the
same manner as it applies to health insurance coverage offered by
a health insurance issuer in connection with a group health plan
in the small or large group market.
(b) NOTICE REQUIREMENT.—A health insurance issuer under
this part shall comply with the notice requirement under section
711(d) of the Employee Retirement Income Security Act of 1974
with respect to the requirements referred to in subsection (a) as if
such section applied to such issuer and such issuer were a group
health plan.
(c) PREEMPTION; EXCEPTION FOR HEALTH INSURANCE
COVERAGE IN CERTAIN STATES.—
(1) IN GENERAL.—The requirements of this section shall
not apply with respect to health insurance coverage if there is
a State law (as defined in section 2723(d)(1)) for a State that
regulates such coverage that is described in any of the following subparagraphs:
(A) Such State law requires such coverage to provide
for at least a 48-hour hospital length of stay following a
normal vaginal delivery and at least a 96-hour hospital
length of stay following a cesarean section.
(B) Such State law requires such coverage to provide
for maternity and pediatric care in accordance with guidelines established by the American College of Obstetricians
and Gynecologists, the American Academy of Pediatrics, or
other established professional medical associations.
(C) Such State law requires, in connection with such
coverage for maternity care, that the hospital length of
stay for such care is left to the decision of (or required to
be made by) the attending provider in consultation with
the mother.
(2) CONSTRUCTION.—Section 2762(a) shall not be construed
as superseding a State law described in paragraph (1).
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SEC. 2752. ø300gg–52¿ REQUIRED COVERAGE FOR RECONSTRUCTIVE
SURGERY FOLLOWING MASTECTOMIES. 1

The provisions of section 2706 shall apply to health insurance
coverage offered by a health insurance issuer in the individual
market in the same manner as they apply to health insurance coverage offered by a health insurance issuer in connection with a
group health plan in the small or large group market.
SEC. 2753. 2 ø300gg–53¿ PROHIBITION OF HEALTH DISCRIMINATION ON
THE BASIS OF GENETIC INFORMATION.
(a) PROHIBITION ON GENETIC INFORMATION AS A CONDITION OF
ELIGIBILITY.—
(1) IN GENERAL.—A health insurance issuer offering health

insurance coverage in the individual market may not establish
rules for the eligibility (including continued eligibility) of any
individual to enroll in individual health insurance coverage
based on genetic information.
(2) RULE OF CONSTRUCTION.—Nothing in paragraph (1) or
in paragraphs (1) and (2) of subsection (e) shall be construed
to preclude a health insurance issuer from establishing rules
for eligibility for an individual to enroll in individual health insurance coverage based on the manifestation of a disease or
disorder in that individual, or in a family member of such individual where such family member is covered under the policy
that covers such individual.
(b) PROHIBITION ON GENETIC INFORMATION IN SETTING PREMIUM RATES.—
(1) IN GENERAL.—A health insurance issuer offering health
insurance coverage in the individual market shall not adjust
premium or contribution amounts for an individual on the
basis of genetic information concerning the individual or a family member of the individual.
(2) RULE OF CONSTRUCTION.—Nothing in paragraph (1) or
in paragraphs (1) and (2) of subsection (e) shall be construed
to preclude a health insurance issuer from adjusting premium
or contribution amounts for an individual on the basis of a
manifestation of a disease or disorder in that individual, or in
a family member of such individual where such family member
is covered under the policy that covers such individual. In such
case, the manifestation of a disease or disorder in one individual cannot also be used as genetic information about other
individuals covered under the policy issued to such individual
and to further increase premiums or contribution amounts.
(c) PROHIBITION ON GENETIC INFORMATION AS PREEXISTING
CONDITION.—
1 Section 2752 was added by subsection (b) of section 903 of the Departments of Labor, Health
and Human Services, and Education, and Related Agencies Appropriations Act, 1999 (as contained in section 101(f) of division A of Public Law 105–277 (112 Stat. 2681–438)). Subsection
(c) of such section 903 concerns effective dates, and paragraph (2) of the subsection provides as
follows:
‘‘(2) INDIVIDUAL PLANS.—The amendment made by subsection (b) shall apply with respect
to health insurance coverage offered, sold, issued, renewed, in effect, or operated in the individual market on or after the date of enactment of this Act.’’.
The Public Law was enacted October 21, 1998.
2 Another section designated as section 2753 appears at the end of part B. There are details
in a footnote regarding its placement at the end.

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(1) IN GENERAL.—A health insurance issuer offering health
insurance coverage in the individual market may not, on the
basis of genetic information, impose any preexisting condition
exclusion (as defined in section 2701(b)(1)(A)) with respect to
such coverage.
(2) RULE OF CONSTRUCTION.—Nothing in paragraph (1) or
in paragraphs (1) and (2) of subsection (e) shall be construed
to preclude a health insurance issuer from imposing any preexisting condition exclusion for an individual with respect to
health insurance coverage on the basis of a manifestation of a
disease or disorder in that individual.
(d) GENETIC TESTING.—
(1) LIMITATION ON REQUESTING OR REQUIRING GENETIC
TESTING.—A health insurance issuer offering health insurance
coverage in the individual market shall not request or require
an individual or a family member of such individual to undergo
a genetic test.
(2) RULE OF CONSTRUCTION.—Paragraph (1) shall not be
construed to limit the authority of a health care professional
who is providing health care services to an individual to request that such individual undergo a genetic test.
(3) RULE OF CONSTRUCTION REGARDING PAYMENT.—
(A) IN GENERAL.—Nothing in paragraph (1) shall be
construed to preclude a health insurance issuer offering
health insurance coverage in the individual market from
obtaining and using the results of a genetic test in making
a determination regarding payment (as such term is defined for the purposes of applying the regulations promulgated by the Secretary under part C of title XI of the Social Security Act and section 264 of the Health Insurance
Portability and Accountability Act of 1996, as may be revised from time to time) consistent with subsection (a) and
(c).
(B) LIMITATION.—For purposes of subparagraph (A), a
health insurance issuer offering health insurance coverage
in the individual market may request only the minimum
amount of information necessary to accomplish the intended purpose.
(4) RESEARCH EXCEPTION.—Notwithstanding paragraph (1),
a health insurance issuer offering health insurance coverage in
the individual market may request, but not require, that an individual or a family member of such individual undergo a genetic test if each of the following conditions is met:
(A) The request is made pursuant to research that
complies with part 46 of title 45, Code of Federal Regulations, or equivalent Federal regulations, and any applicable State or local law or regulations for the protection of
human subjects in research.
(B) The issuer clearly indicates to each individual, or
in the case of a minor child, to the legal guardian of such
child, to whom the request is made that—
(i) compliance with the request is voluntary; and
(ii) non-compliance will have no effect on enrollment status or premium or contribution amounts.
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(C) No genetic information collected or acquired under
this paragraph shall be used for underwriting purposes.
(D) The issuer notifies the Secretary in writing that
the issuer is conducting activities pursuant to the exception provided for under this paragraph, including a description of the activities conducted.
(E) The issuer complies with such other conditions as
the Secretary may by regulation require for activities conducted under this paragraph.
(e) PROHIBITION ON COLLECTION OF GENETIC INFORMATION.—
(1) IN GENERAL.—A health insurance issuer offering health
insurance coverage in the individual market shall not request,
require, or purchase genetic information for underwriting purposes (as defined in section 2791).
(2) PROHIBITION ON COLLECTION OF GENETIC INFORMATION
PRIOR TO ENROLLMENT.—A health insurance issuer offering
health insurance coverage in the individual market shall not
request, require, or purchase genetic information with respect
to any individual prior to such individual’s enrollment under
the plan in connection with such enrollment.
(3) INCIDENTAL COLLECTION.—If a health insurance issuer
offering health insurance coverage in the individual market obtains genetic information incidental to the requesting, requiring, or purchasing of other information concerning any individual, such request, requirement, or purchase shall not be
considered a violation of paragraph (2) if such request, requirement, or purchase is not in violation of paragraph (1).
(f) GENETIC INFORMATION OF A FETUS OR EMBRYO.—Any reference in this part to genetic information concerning an individual
or family member of an individual shall—
(1) with respect to such an individual or family member of
an individual who is a pregnant woman, include genetic information of any fetus carried by such pregnant woman; and
(2) with respect to an individual or family member utilizing an assisted reproductive technology, include genetic information of any embryo legally held by the individual or family member.
Subpart 3—General Provisions 1
SEC. 2761. ø300gg–61¿ ENFORCEMENT.
(a) STATE ENFORCEMENT.—
(1) STATE AUTHORITY.—Subject

to section 2762, each State
may require that health insurance issuers that issue, sell,
renew, or offer health insurance coverage in the State in the
individual market meet the requirements established under
this part with respect to such issuers.
(2) FAILURE TO IMPLEMENT REQUIREMENTS.—In the case of
a State that fails to substantially enforce the requirements set
forth in this part with respect to health insurance issuers in
the State, the Secretary shall enforce the requirements of this
part under subsection (b) insofar as they relate to the issuance,

1 Section 605(a)(3) of Public Law 104–204 (110 Stat. 2941) adds this subpart designation and
heading to part B.

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sale, renewal, and offering of health insurance coverage in the
individual market in such State.
(b) SECRETARIAL ENFORCEMENT AUTHORITY.—The Secretary
shall have the same authority in relation to enforcement of the provisions of this part with respect to issuers of health insurance coverage in the individual market in a State as the Secretary has
under section 2722(b)(2), and section 2722(b)(3) with respect to violations of genetic nondiscrimination provisions, in relation to the
enforcement of the provisions of part A with respect to issuers of
health insurance coverage in the small group market in the State.
SEC. 2762. ø300gg–62¿ PREEMPTION. 1
(a) IN GENERAL.—Subject to subsection

(b), nothing in this part
(or part C insofar as it applies to this part) shall be construed to
prevent a State from establishing, implementing, or continuing in
effect standards and requirements unless such standards and requirements prevent the application of a requirement of this part.
(b) RULES OF CONSTRUCTION.—(1) Nothing in this part (or part
C insofar as it applies to this part) shall be construed to affect or
modify the provisions of section 514 of the Employee Retirement
Income Security Act of 1974 (29 U.S.C. 1144).
(2) Nothing in this part (other than section 2751) shall be construed as requiring health insurance coverage offered in the individual market to provide specific benefits under the terms of such
coverage.
[Note: Section 1563(c)(15)(B) (relating to conforming amendments--originally designated as section 1562 and redesignated as
section 1563 by section 10107(b)(1)) of Public Law 111–148 provides for an amendment to add a new subsection (c) at the end of
section 2762. Such amendment takes effect on date of enactment
of Public Law 111–148 (March 23, 2010); however, they’re being
treated here as if they take effect on January 1, 2014 to reflect the
probable intent of Congress and in order to be consistent with the
execution of different amendments made by such section 1563 to
part A of this title (see details regarding the effective date in a note
to a second version of part A). Upon such date, the following new
subsection (c) reads as follows :]
(c) APPLICATION OF PART A PROVISIONS.—
(1) IN GENERAL.—The provisions of part A shall apply to
health insurance issuers providing health insurance coverage in
the individual market in a State as provided for in such part.
1 Section 1563(c)(15)(A) (relating to conforming amendments--originally designated as section
1562 and redesignated as section 1563 by section 10107(b)(1)) of Public Law 111–148 provides
for an amendment in the section heading by inserting ‘‘AND APPLICATION’’ before the period.
Section 1563(c)(15)(B) (as so redesignated) of such Public Law provides for an amendment to
add at the end a new subsection (c). See note set out in italic typeface that appears after subsection (b) below.

The amendments to section 2762 made by section 1563(c)(15), as so redesignated, takes effect
on date of enactment of Public Law 111–148 (March 23, 2010); however, they’re being treated
here as if they take effect on January 1, 2014 to reflect the probable intent of Congress and
in order to be consistent with the execution of different amendments made by such section 1563
to part A of this title (see details regarding the effective date in a note to a second version of
part A).

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(2) CLARIFICATION.—To the extent that any provision of this
part conflicts with a provision of part A with respect to health
insurance issuers providing health insurance coverage in the individual market in a State, the provisions of such part A shall
apply.

SEC. 2763. ø300gg–63¿ GENERAL EXCEPTIONS.
(a) EXCEPTION FOR CERTAIN BENEFITS.—The

requirements of
this part shall not apply to any health insurance coverage in relation to its provision of excepted benefits described in section
2791(c)(1).
(b) EXCEPTION FOR CERTAIN BENEFITS IF CERTAIN CONDITIONS
MET.—The requirements of this part shall not apply to any health
insurance coverage in relation to its provision of excepted benefits
described in paragraph (2), (3), or (4) of section 2791(c) if the benefits are provided under a separate policy, certificate, or contract of
insurance.
SEC. 2753. ø300gg–54¿ COVERAGE OF DEPENDENT STUDENTS ON MEDICALLY NECESSARY LEAVE OF ABSENCE. 1

The provisions of section 2707 shall apply to health insurance
coverage offered by a health insurance issuer in the individual
market in the same manner as they apply to health insurance coverage offered by a health insurance issuer in connection with a
group health plan in the small or large group market.
PART C—DEFINITIONS; MISCELLANEOUS PROVISIONS
SEC. 2791. ø300gg–91¿ DEFINITIONS.
(a) GROUP HEALTH PLAN.—
(1) DEFINITION.—The term

‘‘group health plan’’ means an
employee welfare benefit plan (as defined in section 3(1) of the
Employee Retirement Income Security Act of 1974) to the extent that the plan provides medical care (as defined in paragraph (2)) and including items and services paid for as medical
care) to employees or their dependents (as defined under the
terms of the plan) directly or through insurance, reimbursement, or otherwise.
(2) MEDICAL CARE.—The term ‘‘medical care’’ means
amounts paid for—
(A) the diagnosis, cure, mitigation, treatment, or prevention of disease, or amounts paid for the purpose of affecting any structure or function of the body,
(B) amounts paid for transportation primarily for and
essential to medical care referred to in subparagraph (A),
and
(C) amounts paid for insurance covering medical care
referred to in subparagraphs (A) and (B).

1 The placement of section 2753 at the end of subpart 3 is so in law. See amendment made
by section 2(b)(2) of Public Law 110–381 122 Stat. 4084). Section 102(b)(1)(A) of Public Law
110–233 redesignated subpart 3 of part B as subpart 2. Also, another section designated as section 2753 was added by section 102(b)(1)(B) of such Public Law (122 Stat. 893).

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(3) TREATMENT OF CERTAIN PLANS AS GROUP HEALTH PLAN
FOR NOTICE PROVISION.—A program under which creditable
coverage described in subparagraph (C), (D), (E), or (F) of section 2701(c)(1) is provided shall be treated as a group health
plan for purposes of applying section 2701(e).
(b) DEFINITIONS RELATING TO HEALTH INSURANCE.—
(1) HEALTH INSURANCE COVERAGE.—The term ‘‘health insurance coverage’’ means benefits consisting of medical care
(provided directly, through insurance or reimbursement, or
otherwise and including items and services paid for as medical
care) under any hospital or medical service policy or certificate,
hospital or medical service plan contract, or health maintenance organization contract offered by a health insurance
issuer.
(2) HEALTH INSURANCE ISSUER.—The term ‘‘health insurance issuer’’ means an insurance company, insurance service,
or insurance organization (including a health maintenance organization, as defined in paragraph (3)) which is licensed to engage in the business of insurance in a State and which is subject to State law which regulates insurance (within the meaning of section 514(b)(2) of the Employee Retirement Income Security Act of 1974). Such term does not include a group health
plan.
(3) HEALTH MAINTENANCE ORGANIZATION.—The term
‘‘health maintenance organization’’ means—
(A) a Federally qualified health maintenance organization (as defined in section 1301(a)),
(B) an organization recognized under State law as a
health maintenance organization, or
(C) a similar organization regulated under State law
for solvency in the same manner and to the same extent
as such a health maintenance organization.
(4) GROUP HEALTH INSURANCE COVERAGE.—The term
‘‘group health insurance coverage’’ means, in connection with a
group health plan, health insurance coverage offered in connection with such plan.
(5) INDIVIDUAL HEALTH INSURANCE COVERAGE.—The term
‘‘individual health insurance coverage’’ means health insurance
coverage offered to individuals in the individual market, but
does not include short-term limited duration insurance.
(c) EXCEPTED BENEFITS.—For purposes of this title, the term
‘‘excepted benefits’’ means benefits under one or more (or any combination thereof) of the following:
(1) BENEFITS NOT SUBJECT TO REQUIREMENTS.—
(A) Coverage only for accident, or disability income insurance, or any combination thereof.
(B) Coverage issued as a supplement to liability
insurance.
(C) Liability insurance, including general liability insurance and automobile liability insurance.
(D) Workers’ compensation or similar insurance.
(E) Automobile medical payment insurance.
(F) Credit-only insurance.
(G) Coverage for on-site medical clinics.
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(H) Other similar insurance coverage, specified in regulations, under which benefits for medical care are secondary or incidental to other insurance benefits.
(2) BENEFITS NOT SUBJECT TO REQUIREMENTS IF OFFERED
SEPARATELY.—
(A) Limited scope dental or vision benefits.
(B) Benefits for long-term care, nursing home care,
home health care, community-based care, or any combination thereof.
(C) Such other similar, limited benefits as are specified in regulations.
(3) BENEFITS NOT SUBJECT TO REQUIREMENTS IF OFFERED
AS INDEPENDENT, NONCOORDINATED BENEFITS.—
(A) Coverage only for a specified disease or illness.
(B)
Hospital
indemnity
or
other
fixed
indemnity insurance.
(4) BENEFITS NOT SUBJECT TO REQUIREMENTS IF OFFERED
AS SEPARATE INSURANCE POLICY.—Medicare supplemental
health insurance (as defined under section 1882(g)(1) of the Social Security Act), coverage supplemental to the coverage provided under chapter 55 of title 10, United States Code, and
similar supplemental coverage provided to coverage under a
group health plan.
(d) 1 OTHER DEFINITIONS.—
(1) APPLICABLE STATE AUTHORITY.—The term ‘‘applicable
State authority’’ means, with respect to a health insurance
issuer in a State, the State insurance commissioner or official
or officials designated by the State to enforce the requirements
of this title for the State involved with respect to such issuer.
(2) BENEFICIARY.—The term ‘‘beneficiary’’ has the meaning
given such term under section 3(8) of the Employee Retirement
Income Security Act of 1974.
(3) BONA FIDE ASSOCIATION.—The term ‘‘bona fide association’’ means, with respect to health insurance coverage offered
in a State, an association which—
(A) has been actively in existence for at least 5 years;
(B) has been formed and maintained in good faith for
purposes other than obtaining insurance;
(C) does not condition membership in the association
on any health status-related factor relating to an individual (including an employee of an employer or a dependent of an employee);
(D) makes health insurance coverage offered through
the association available to all members regardless of any
health status-related factor relating to such members (or
individuals eligible for coverage through a member);
(E) does not make health insurance coverage offered
through the association available other than in connection
with a member of the association; and
1 For version of law for section 2791(d)(20)–(21) (as amended by section 1563(b) (relating to
conforming amendments--originally designated as section 1562 and redesignated as section 1563
by section 10107(b)(1)) of Public Law 111–148) see note set out in italic typeface that appears
after paragraph (19).

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(F) meets such additional requirements as may be imposed under State law.
(4) COBRA CONTINUATION PROVISION.—The term ‘‘COBRA
continuation provision’’ means any of the following:
(A) Section 4980B of the Internal Revenue Code of
1986, other than subsection (f)(1) of such section insofar as
it relates to pediatric vaccines.
(B) Part 6 of subtitle B of title I of the Employee Retirement Income Security Act of 1974, other than section
609 of such Act.
(C) Title XXII of this Act.
(5) EMPLOYEE.—The term ‘‘employee’’ has the meaning
given such term under section 3(6) of the Employee Retirement
Income Security Act of 1974.
(6) EMPLOYER.—The term ‘‘employer’’ has the meaning
given such term under section 3(5) of the Employee Retirement
Income Security Act of 1974, except that such term shall include only employers of two or more employees.
(7) CHURCH PLAN.—The term ‘‘church plan’’ has the meaning given such term under section 3(33) of the Employee Retirement Income Security Act of 1974.
(8) GOVERNMENTAL PLAN.—(A) The term ‘‘governmental
plan’’ has the meaning given such term under section 3(32) of
the Employee Retirement Income Security Act of 1974 and any
Federal governmental plan.
(B) FEDERAL GOVERNMENTAL PLAN.—The term ‘‘Federal
governmental plan’’ means a governmental plan established or
maintained for its employees by the Government of the United
States or by any agency or instrumentality of such Government.
(C) NON-FEDERAL GOVERNMENTAL PLAN.—The term ‘‘nonFederal governmental plan’’ means a governmental plan that
is not a Federal governmental plan.
(9) HEALTH STATUS-RELATED FACTOR.—The term ‘‘health
status-related factor’’ means any of the factors described in section 2702(a)(1).
(10) NETWORK PLAN.—The term ‘‘network plan’’ means
health insurance coverage of a health insurance issuer under
which the financing and delivery of medical care (including
items and services paid for as medical care) are provided, in
whole or in part, through a defined set of providers under contract with the issuer.
(11) PARTICIPANT.—The term ‘‘participant’’ has the meaning given such term under section 3(7) of the Employee Retirement Income Security Act of 1974.
(12) PLACED FOR ADOPTION DEFINED.—The term ‘‘placement’’, or being ‘‘placed’’, for adoption, in connection with any
placement for adoption of a child with any person, means the
assumption and retention by such person of a legal obligation
for total or partial support of such child in anticipation of adoption of such child. The child’s placement with such person terminates upon the termination of such legal obligation.
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(13) PLAN SPONSOR.—The term ‘‘plan sponsor’’ has the
meaning given such term under section 3(16)(B) of the Employee Retirement Income Security Act of 1974.
(14) STATE.—The term ‘‘State’’ means each of the several
States, the District of Columbia, Puerto Rico, the Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands.
(15) FAMILY MEMBER.—The term ‘‘family member’’ means,
with respect to any individual—
(A) a dependent (as such term is used for purposes of
section 2701(f)(2)) of such individual; and
(B) any other individual who is a first-degree, seconddegree, third-degree, or fourth-degree relative of such individual or of an individual described in subparagraph (A).
(16) GENETIC INFORMATION.—
(A) IN GENERAL.—The term ‘‘genetic information’’
means, with respect to any individual, information about—
(i) such individual’s genetic tests,
(ii) the genetic tests of family members of such individual, and
(iii) the manifestation of a disease or disorder in
family members of such individual.
(B) INCLUSION OF GENETIC SERVICES AND PARTICIPATION IN GENETIC RESEARCH.—Such term includes, with respect to any individual, any request for, or receipt of, genetic services, or participation in clinical research which
includes genetic services, by such individual or any family
member of such individual.
(C) EXCLUSIONS.—The term ‘‘genetic information’’
shall not include information about the sex or age of any
individual.
(17) GENETIC TEST.—
(A) IN GENERAL.—The term ‘‘genetic test’’ means an
analysis of human DNA, RNA, chromosomes, proteins, or
metabolites, that detects genotypes, mutations, or chromosomal changes.
(B) EXCEPTIONS.—The term ‘‘genetic test’’ does not
mean—
(i) an analysis of proteins or metabolites that does
not detect genotypes, mutations, or chromosomal
changes; or
(ii) an analysis of proteins or metabolites that is
directly related to a manifested disease, disorder, or
pathological condition that could reasonably be detected by a health care professional with appropriate
training and expertise in the field of medicine involved.
(18) GENETIC SERVICES.—The term ‘‘genetic services’’
means—
(A) a genetic test;
(B) genetic counseling (including obtaining, interpreting, or assessing genetic information); or
(C) genetic education.
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(19) UNDERWRITING PURPOSES.—The term ‘‘underwriting
purposes’’ means, with respect to any group health plan, or
health insurance coverage offered in connection with a group
health plan—
(A) rules for, or determination of, eligibility (including
enrollment and continued eligibility) for benefits under the
plan or coverage;
(B) the computation of premium or contribution
amounts under the plan or coverage;
(C) the application of any pre-existing condition exclusion under the plan or coverage; and
(D) other activities related to the creation, renewal, or
replacement of a contract of health insurance or health
benefits.
[Note: Section 1563(b) (relating to conforming amendments-originally designated as section 1562 and redesignated as section
1563 by section 10107(b)(1)) of Public Law 111–148 provides for an
amendment to add new paragraphs (20)–(21) at the end of section
2791(d). Such amendment takes effect on date of enactment of Public Law 111–148 (March 23, 2010); however, they’re being treated
here as if they take effect on January 1, 2014 to reflect the probable intent of Congress and in order to be consistent with the execution of different amendments made by such section 1563 to part
A of this title (see details regarding the effective date in a note to
a second version of part A). Upon such date, paragraphs (20)–(21)
read as follows:]
(20) QUALIFIED HEALTH PLAN.—The term ‘‘qualified health
plan’’ has the meaning given such term in section 1301(a) of the
Patient Protection and Affordable Care Act.
(21) EXCHANGE.—The term ‘‘Exchange’’ means an American
Health Benefit Exchange established under section 1311 of the
Patient Protection and Affordable Care Act.

(e) DEFINITIONS RELATING TO MARKETS AND SMALL EMPLOYERS.—For purposes of this title:
(1) INDIVIDUAL MARKET.—
(A) IN GENERAL.—The term ‘‘individual market’’ means
the market for health insurance coverage offered to individuals other than in connection with a group health plan.
(B) TREATMENT OF VERY SMALL GROUPS.—
(i) IN GENERAL.—Subject to clause (ii), such terms
includes coverage offered in connection with a group
health plan that has fewer than two participants as
current employees on the first day of the plan year.
(ii) STATE EXCEPTION.—Clause (i) shall not apply
in the case of a State that elects to regulate the coverage described in such clause as coverage in the
small group market.
(2) LARGE EMPLOYER.—The term ‘‘large employer’’ means,
in connection with a group health plan with respect to a calMarch 13, 2013

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endar year and a plan year, an employer who employed an average of at least 51 1 employees on business days during the
preceding calendar year and who employs at least 2 employees
on the first day of the plan year.
(3) LARGE GROUP MARKET.—The term ‘‘large group market’’
means the health insurance market under which individuals
obtain health insurance coverage (directly or through any arrangement) on behalf of themselves (and their dependents)
through a group health plan maintained by a large employer.
(4) 2 SMALL EMPLOYER.—The term ‘‘small employer’’ means,
in connection with a group health plan with respect to a calendar year and a plan year, an employer who employed an average of at least 2 but not more than 50 employees on business
days during the preceding calendar year and who employs at
least 2 employees on the first day of the plan year.

[Note: Section 1563(c)(16)(B) (relating to conforming amendments--originally designated as section 1562 and redesignated as
section 1563 by section 10107(b)(1)) of Public Law 111–148 provides for amendments to paragraph (4) of section 2791(e). Such
amendments take effect on date of enactment of Public Law 111–
148 (March 23, 2010); however, they’re being treated here as if
they take effect on January 1, 2014 to reflect the probable intent
of Congress and in order to be consistent with the execution of different amendments made by such section 1563 to part A of this
title (see details regarding the effective date in a note to a second
version of part A). Upon such date, paragraph (4) reads as follows:]
(4) SMALL EMPLOYER.—The term ‘‘small employer’’ means,
in connection with a group health plan with respect to a calendar year and a plan year, an employer who employed an average of at least 1 but not more than 100 employees on business
days during the preceding calendar year and who employs at
least 1 employees on the first day of the plan year.

(5) SMALL GROUP MARKET.—The term ‘‘small group market’’ means the health insurance market under which individuals obtain health insurance coverage (directly or through any
1 Section 1563(c)(16)(A) (relating to conforming amendments--originally designated as section
1562 and redesignated as section 1563 by section 10107(b)(1)) of Public Law 111–148 provides
for an amendment to section 2791(e)(2) by striking ‘‘51’’ and inserting ‘‘101’’.

The amendment to section 2791(e) made by section 1563(c)(16)(A), as so redesignated, takes
effect on date of enactment of Public Law 111–148 (March 23, 2010); however, they’re being
treated here as if they take effect on January 1, 2014 to reflect the probable intent of Congress
and in order to be consistent with the execution of different amendments made by such section
1563 to part A of this title (see details regarding the effective date in a note to a second version
of part A).
2 For version of law of paragraph (4) (as amended by section 1563(c)(16)(B) (relating to conforming amendments--originally designated as section 1562 and redesignated as section 1563 by
section 10107(b)(1)) of Public Law 111–148) see note set out in italic typeface that appears after
this paragraph.

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arrangement) on behalf of themselves (and their dependents)
through a group health plan maintained by a small employer.
(6) APPLICATION OF CERTAIN RULES IN DETERMINATION OF
EMPLOYER SIZE.—For purposes of this subsection—
(A) APPLICATION OF AGGREGATION RULE FOR EMPLOYERS.—all persons treated as a single employer under subsection (b), (c), (m), or (o) of section 414 of the Internal
Revenue Code of 1986 shall be treated as 1 employer.
(B) EMPLOYERS NOT IN EXISTENCE IN PRECEDING
YEAR.—In the case of an employer which was not in existence throughout the preceding calendar year, the determination of whether such employer is a small or large employer shall be based on the average number of employees
that it is reasonably expected such employer will employ
on business days in the current calendar year.
(C) PREDECESSORS.—Any reference in this subsection
to an employer shall include a reference to any predecessor
of such employer.
SEC. 2792. ø300gg–92¿ REGULATIONS.

The Secretary, consistent with section 104 of the Health Care
Portability and Accountability Act of 1996, may promulgate such
regulations as may be necessary or appropriate to carry out the
provisions of this title. The Secretary may promulgate any interim
final rules as the Secretary determines are appropriate to carry out
this title.
SEC. 2793. ø300gg–93¿ HEALTH INSURANCE CONSUMER INFORMATION.
(a) IN GENERAL.—The Secretary shall award grants to States

to enable such States (or the Exchanges operating in such States)
to establish, expand, or provide support for—
(1) offices of health insurance consumer assistance; or
(2) health insurance ombudsman programs.
(b) ELIGIBILITY.—
(1) IN GENERAL.—To be eligible to receive a grant, a State
shall designate an independent office of health insurance consumer assistance, or an ombudsman, that, directly or in coordination with State health insurance regulators and consumer
assistance organizations, receives and responds to inquiries
and complaints concerning health insurance coverage with respect to Federal health insurance requirements and under
State law.
(2) CRITERIA.—A State that receives a grant under this
section shall comply with criteria established by the Secretary
for carrying out activities under such grant.
(c) DUTIES.—The office of health insurance consumer assistance or health insurance ombudsman shall—
(1) assist with the filing of complaints and appeals, including filing appeals with the internal appeal or grievance process
of the group health plan or health insurance issuer involved
and providing information about the external appeal process;
(2) collect, track, and quantify problems and inquiries encountered by consumers;
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(3) educate consumers on their rights and responsibilities
with respect to group health plans and health insurance coverage;
(4) assist consumers with enrollment in a group health
plan or health insurance coverage by providing information, referral, and assistance; and
(5) resolve problems with obtaining premium tax credits
under section 36B of the Internal Revenue Code of 1986.
(d) DATA COLLECTION.—As a condition of receiving a grant
under subsection (a), an office of health insurance consumer assistance or ombudsman program shall be required to collect and report
data to the Secretary on the types of problems and inquiries encountered by consumers. The Secretary shall utilize such data to
identify areas where more enforcement action is necessary and
shall share such information with State insurance regulators, the
Secretary of Labor, and the Secretary of the Treasury for use in the
enforcement activities of such agencies.
(e) FUNDING.—
(1) INITIAL FUNDING.—There is hereby appropriated to the
Secretary, out of any funds in the Treasury not otherwise appropriated, $30,000,000 for the first fiscal year for which this
section applies to carry out this section. Such amount shall remain available without fiscal year limitation.
(2) AUTHORIZATION FOR SUBSEQUENT YEARS.—There is authorized to be appropriated to the Secretary for each fiscal year
following the fiscal year described in paragraph (1), such sums
as may be necessary to carry out this section.
SEC. 2794. ø300gg–94¿ ENSURING THAT CONSUMERS GET VALUE FOR
THEIR DOLLARS.
(a) INITIAL PREMIUM REVIEW PROCESS.—
(1) IN GENERAL.—The Secretary, in conjunction with

States, shall establish a process for the annual review, beginning with the 2010 plan year and subject to subsection
(b)(2)(A), of unreasonable increases in premiums for health insurance coverage.
(2) JUSTIFICATION AND DISCLOSURE.—The process established under paragraph (1) shall require health insurance
issuers to submit to the Secretary and the relevant State a justification for an unreasonable premium increase prior to the
implementation of the increase. Such issuers shall prominently
post such information on their Internet websites. The Secretary shall ensure the public disclosure of information on such
increases and justifications for all health insurance issuers.
(b) CONTINUING PREMIUM REVIEW PROCESS.—
(1) INFORMING SECRETARY OF PREMIUM INCREASE PATTERNS.—As a condition of receiving a grant under subsection
(c)(1), a State, through its Commissioner of Insurance, shall—
(A) provide the Secretary with information about
trends in premium increases in health insurance coverage
in premium rating areas in the State; and
(B) make recommendations, as appropriate, to the
State Exchange about whether particular health insurance
issuers should be excluded from participation in the ExMarch 13, 2013

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change based on a pattern or practice of excessive or unjustified premium increases.
(2) MONITORING BY SECRETARY OF PREMIUM INCREASES.—
(A) IN GENERAL.—Beginning with plan years beginning in 2014, the Secretary, in conjunction with the States
and consistent with the provisions of subsection (a)(2),
shall monitor premium increases of health insurance coverage offered through an Exchange and outside of an Exchange.
(B) CONSIDERATION IN OPENING EXCHANGE.—In determining under section 1312(f)(2)(B) of the Patient Protection and Affordable Care Act whether to offer qualified
health plans in the large group market through an Exchange, the State shall take into account any excess of premium growth outside of the Exchange as compared to the
rate of such growth inside the Exchange.
(c) GRANTS IN SUPPORT OF PROCESS.—
(1) PREMIUM REVIEW GRANTS DURING 2010 THROUGH 2014.—
The Secretary shall carry out a program to award grants to
States during the 5-year period beginning with fiscal year 2010
to assist such States in carrying out subsection (a), including—
(A) in reviewing and, if appropriate under State law,
approving premium increases for health insurance coverage;
(B) in providing information and recommendations to
the Secretary under subsection (b)(1); and
(C) in establishing centers (consistent with subsection
(d)) at academic or other nonprofit institutions to collect
medical reimbursement information from health insurance
issuers, to analyze and organize such information, and to
make such information available to such issuers, health
care providers, health researchers, health care policy makers, and the general public.
(2) FUNDING.—
(A) IN GENERAL.—Out of all funds in the Treasury not
otherwise appropriated, there are appropriated to the Secretary $250,000,000, to be available for expenditure for
grants under paragraph (1) and subparagraph (B).
(B) FURTHER AVAILABILITY FOR INSURANCE REFORM
AND CONSUMER PROTECTION.—If the amounts appropriated
under subparagraph (A) are not fully obligated under
grants under paragraph (1) by the end of fiscal year 2014,
any remaining funds shall remain available to the Secretary for grants to States for planning and implementing
the insurance reforms and consumer protections under
part A.
(C) ALLOCATION.—The Secretary shall establish a formula for determining the amount of any grant to a State
under this subsection. Under such formula—
(i) the Secretary shall consider the number of
plans of health insurance coverage offered in each
State and the population of the State; and
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(ii) no State qualifying for a grant under paragraph (1) shall receive less than $1,000,000, or more
than $5,000,000 for a grant year.
(d) MEDICAL REIMBURSEMENT DATA CENTERS.—
(1) FUNCTIONS.—A center established under subsection
(c)(1)(C) shall—
(A) develop fee schedules and other database tools that
fairly and accurately reflect market rates for medical services and the geographic differences in those rates;
(B) use the best available statistical methods and data
processing technology to develop such fee schedules and
other database tools;
(C) regularly update such fee schedules and other
database tools to reflect changes in charges for medical
services;
(D) make health care cost information readily available to the public through an Internet website that allows
consumers to understand the amounts that health care
providers in their area charge for particular medical services; and
(E) regularly publish information concerning the statistical methodologies used by the center to analyze health
charge data and make such data available to researchers
and policy makers.
(2) CONFLICTS OF INTEREST.—A center established under
subsection (c)(1)(C) shall adopt by-laws that ensures that the
center (and all members of the governing board of the center)
is independent and free from all conflicts of interest. Such bylaws shall ensure that the center is not controlled or influenced
by, and does not have any corporate relation to, any individual
or entity that may make or receive payments for health care
services based on the center’s analysis of health care costs.
(3) RULE OF CONSTRUCTION.—Nothing in this subsection
shall be construed to permit a center established under subsection (c)(1)(C) to compel health insurance issuers to provide
data to the center.
SEC. 2794. ø300gg–95¿ UNIFORM FRAUD AND ABUSE REFERRAL FORMAT. 1

The Secretary shall request the National Association of Insurance Commissioners to develop a model uniform report form for
private health insurance issuer seeking to refer suspected fraud
and abuse to State insurance departments or other responsible
State agencies for investigation. The Secretary shall request that
the National Association of Insurance Commissioners develop recommendations for uniform reporting standards for such referrals.

1 So in law. There are two sections 2794s’. Sections 1003 and 6603 of Public Law 111–148 add
new section 2794s’ to the end of part C of title XXVII.

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TITLE XXVIII—NATIONAL ALL-HAZARDS
PREPAREDNESS FOR PUBLIC HEALTH
EMERGENCIES
Subtitle A—National All-Hazards Preparedness and Response Planning, Coordinating, and Reporting
SEC. 2801. ø300hh¿ PUBLIC HEALTH AND MEDICAL PREPAREDNESS
AND RESPONSE FUNCTIONS.
(a) IN GENERAL.—The Secretary of Health and Human Serv-

ices shall lead all Federal public health and medical response to
public health emergencies and incidents covered by the National
Response Plan developed pursuant to section 502(6) of the Homeland Security Act of 2002, or any successor plan.
(b) INTERAGENCY AGREEMENT.—The Secretary, in collaboration
with the Secretary of Veterans Affairs, the Secretary of Transportation, the Secretary of Defense, the Secretary of Homeland Security, and the head of any other relevant Federal agency, shall establish an interagency agreement, consistent with the National Response Plan or any successor plan, under which agreement the Secretary of Health and Human Services shall assume operational
control of emergency public health and medical response assets, as
necessary, in the event of a public health emergency, except that
members of the armed forces under the authority of the Secretary
of Defense shall remain under the command and control of the Secretary of Defense, as shall any associated assets of the Department
of Defense.
SEC. 2802. ø300hh–1¿ NATIONAL HEALTH SECURITY STRATEGY.
(a) IN GENERAL.—
(1) PREPAREDNESS AND RESPONSE REGARDING PUBLIC
HEALTH EMERGENCIES.—Beginning in 2009 and every four

years thereafter, the Secretary shall prepare and submit to the
relevant committees of Congress a coordinated strategy (to be
known as the National Health Security Strategy) and any revisions thereof, and an accompanying implementation plan for
public health emergency preparedness and response. Such National Health Security Strategy shall identify the process for
achieving the preparedness goals described in subsection (b)
and shall be consistent with the National Preparedness Goal,
the National Incident Management System, and the National
Response Plan developed pursuant to section 502(6) of the
Homeland Security Act of 2002, or any successor plan.
(2) EVALUATION OF PROGRESS.—The National Health Security Strategy shall include an evaluation of the progress made
1496
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by Federal, State, local, and tribal entities, based on the evidence-based benchmarks and objective standards that measure
levels of preparedness established pursuant to section 319C–
1(g). Such evaluation shall include aggregate and State-specific
breakdowns of obligated funding spent by major category (as
defined by the Secretary) for activities funded through awards
pursuant to sections 319C–1 and 319C–2.
(3) PUBLIC HEALTH WORKFORCE.—In 2009, the National
Health Security Strategy shall include a national strategy for
establishing an effective and prepared public health workforce,
including defining the functions, capabilities, and gaps in such
workforce, and identifying strategies to recruit, retain, and protect such workforce from workplace exposures during public
health emergencies.
(b) PREPAREDNESS GOALS.—The National Health Security
Strategy shall include provisions in furtherance of the following:
(1) INTEGRATION.—Integrating public health and public
and private medical capabilities with other first responder systems, including through—
(A) the periodic evaluation of Federal, State, local, and
tribal preparedness and response capabilities through
drills and exercises; and
(B) integrating public and private sector public health
and medical donations and volunteers.
(2) PUBLIC HEALTH.—Developing and sustaining Federal,
State, local, and tribal essential public health security capabilities, including the following:
(A) Disease situational awareness domestically and
abroad, including detection, identification, and investigation.
(B) Disease containment including capabilities for isolation, quarantine, social distancing, and decontamination.
(C) Risk communication and public preparedness.
(D) Rapid distribution and administration of medical
countermeasures.
(3) MEDICAL.—Increasing the preparedness, response capabilities, and surge capacity of hospitals, other health care facilities (including mental health facilities), and trauma care and
emergency medical service systems, with respect to public
health emergencies, which shall include developing plans for
the following:
(A) Strengthening public health emergency medical
management and treatment capabilities.
(B) Medical evacuation and fatality management.
(C) Rapid distribution and administration of medical
countermeasures.
(D) Effective utilization of any available public and
private mobile medical assets and integration of other Federal assets.
(E) Protecting health care workers and health care
first responders from workplace exposures during a public
health emergency.
(4) AT-RISK INDIVIDUALS.—
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(A) Taking into account the public health and medical
needs of at-risk individuals in the event of a public health
emergency.
(B) For purpose of this section and sections 319C–1,
319F, and 319L, the term ‘‘at-risk individuals’’ means children, pregnant women, senior citizens and other individuals who have special needs in the event of a public health
emergency, as determined by the Secretary.
(5) COORDINATION.—Minimizing duplication of, and ensuring coordination between, Federal, State, local, and tribal planning, preparedness, and response activities (including the State
Emergency Management Assistance Compact). Such planning
shall be consistent with the National Response Plan, or any
successor plan, and National Incident Management System
and the National Preparedness Goal.
(6) CONTINUITY OF OPERATIONS.—Maintaining vital public
health and medical services to allow for optimal Federal, State,
local, and tribal operations in the event of a public health
emergency.
SEC. 2803. ø300hh–2¿ ENHANCING MEDICAL SURGE CAPACITY.
(a) STUDY OF ENHANCING MEDICAL SURGE CAPACITY.—As

part
of the joint review described in section 2812(b), the Secretary shall
evaluate the benefits and feasibility of improving the capacity of
the Department of Health and Human Services to provide additional medical surge capacity to local communities in the event of
a public health emergency. Such study shall include an assessment
of the need for and feasibility of improving surge capacity
through—
(1) acquisition and operation of mobile medical assets by
the Secretary to be deployed, on a contingency basis, to a community in the event of a public health emergency;
(2) integrating the practice of telemedicine within the National Disaster Medical System; and
(3) other strategies to improve such capacity as determined
appropriate by the Secretary.
(b) AUTHORITY TO ACQUIRE AND OPERATE MOBILE MEDICAL ASSETS.—In addition to any other authority to acquire, deploy, and
operate mobile medical assets, the Secretary may acquire, deploy,
and operate mobile medical assets if, taking into consideration the
evaluation conducted under subsection (a), such acquisition, deployment, and operation is determined to be beneficial and feasible in
improving the capacity of the Department of Health and Human
Services to provide additional medical surge capacity to local communities in the event of a public health emergency.
(c) USING FEDERAL FACILITIES TO ENHANCE MEDICAL SURGE
CAPACITY.—
(1) ANALYSIS.—The Secretary shall conduct an analysis of
whether there are Federal facilities which, in the event of a
public health emergency, could practicably be used as facilities
in which to provide health care.
(2) MEMORANDA OF UNDERSTANDING.—If, based on the
analysis conducted under paragraph (1), the Secretary determines that there are Federal facilities which, in the event of
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a public health emergency, could be used as facilities in which
to provide health care, the Secretary shall, with respect to each
such facility, seek to conclude a memorandum of understanding with the head of the Department or agency that operates such facility that permits the use of such facility to provide health care in the event of a public health emergency.

Subtitle B—All-Hazards Emergency
Preparedness and Response
SEC. 2811. ø300hh–10¿ COORDINATION OF PREPAREDNESS FOR AND
RESPONSE TO ALL-HAZARDS PUBLIC HEALTH EMERGENCIES.
(a) IN GENERAL.—There is established within the Department

of Health and Human Services the position of the Assistant Secretary for Preparedness and Response. The President, with the advice and consent of the Senate, shall appoint an individual to serve
in such position. Such Assistant Secretary shall report to the Secretary.
(b) DUTIES.—Subject to the authority of the Secretary, the Assistant Secretary for Preparedness and Response shall carry out
the following functions:
(1) LEADERSHIP.—Serve as the principal advisor to the Secretary on all matters related to Federal public health and medical preparedness and response for public health emergencies.
(2) PERSONNEL.—Register, credential, organize, train,
equip, and have the authority to deploy Federal public health
and medical personnel under the authority of the Secretary, including the National Disaster Medical System, and coordinate
such personnel with the Medical Reserve Corps and the Emergency System for Advance Registration of Volunteer Health
Professionals.
(3) COUNTERMEASURES.—Oversee advanced research, development, and procurement of qualified countermeasures (as
defined in section 319F–1) and qualified pandemic or epidemic
products (as defined in section 319F–3).
(4) COORDINATION.—
(A) FEDERAL INTEGRATION.—Coordinate with relevant
Federal officials to ensure integration of Federal preparedness and response activities for public health emergencies.
(B) STATE, LOCAL, AND TRIBAL INTEGRATION.—Coordinate with State, local, and tribal public health officials, the
Emergency Management Assistance Compact, health care
systems, and emergency medical service systems to ensure
effective integration of Federal public health and medical
assets during a public health emergency.
(C) EMERGENCY MEDICAL SERVICES.—Promote improved emergency medical services medical direction, system integration, research, and uniformity of data collection, treatment protocols, and policies with regard to public health emergencies.
(5) LOGISTICS.—In coordination with the Secretary of Veterans Affairs, the Secretary of Homeland Security, the General
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1500

Services Administration, and other public and private entities,
provide logistical support for medical and public health aspects
of Federal responses to public health emergencies.
(6) LEADERSHIP.—Provide leadership in international programs, initiatives, and policies that deal with public health and
medical emergency preparedness and response.
(c) FUNCTIONS.—The Assistant Secretary for Preparedness and
Response shall—
(1) have authority over and responsibility for—
(A) the National Disaster Medical System (in accordance with section 301 of the Pandemic and All-Hazards
Preparedness Act); and
(B) the Hospital Preparedness Cooperative Agreement
Program pursuant to section 319C–2;
(2) exercise the responsibilities and authorities of the Secretary with respect to the coordination of—
(A) the Medical Reserve Corps pursuant to section
2813;
(B) the Emergency System for Advance Registration of
Volunteer Health Professionals pursuant to section 319I;
(C) the Strategic National Stockpile; and
(D) the Cities Readiness Initiative; and
(3) assume other duties as determined appropriate by the
Secretary.
SEC. 2812. ø300hh–11¿ NATIONAL DISASTER MEDICAL SYSTEM.
(a) NATIONAL DISASTER MEDICAL SYSTEM.—
(1) IN GENERAL.—The Secretary shall provide for the

operation in accordance with this section of a system to be known
as the National Disaster Medical System. The Secretary shall
designate the Assistant Secretary for Preparedness and Response as the head of the National Disaster Medical System,
subject to the authority of the Secretary.
(2) FEDERAL AND STATE COLLABORATIVE SYSTEM.—
(A) IN GENERAL.—The National Disaster Medical System shall be a coordinated effort by the Federal agencies
specified in subparagraph (B), working in collaboration
with the States and other appropriate public or private entities, to carry out the purposes described in paragraph (3).
(B) PARTICIPATING FEDERAL AGENCIES.—The Federal
agencies referred to in subparagraph (A) are the Department of Health and Human Services, the Department of
Homeland Security, the Department of Defense, and the
Department of Veterans Affairs.
(3) PURPOSE OF SYSTEM.—
(A) IN GENERAL.—The Secretary may activate the National Disaster Medical System to—
(i) provide health services, health-related social
services, other appropriate human services, and appropriate auxiliary services to respond to the needs of victims of a public health emergency (whether or not determined to be a public health emergency under section 319); or

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(ii) be present at locations, and for limited periods
of time, specified by the Secretary on the basis that
the Secretary has determined that a location is at risk
of a public health emergency during the time specified.
(B) ONGOING ACTIVITIES.—The National Disaster Medical System shall carry out such ongoing activities as may
be necessary to prepare for the provision of services described in subparagraph (A) in the event that the Secretary activates the National Disaster Medical System for
such purposes.
(C) TEST FOR MOBILIZATION OF SYSTEM.—During the
one-year period beginning on the date of the enactment of
the Pandemic and All-Hazards Preparedness Act, the Secretary shall conduct an exercise to test the capability and
timeliness of the National Disaster Medical System to mobilize and otherwise respond effectively to a bioterrorist attack or other public health emergency that affects two or
more geographic locations concurrently. Thereafter, the
Secretary may periodically conduct such exercises regarding the National Disaster Medical System as the Secretary
determines to be appropriate.
(b) MODIFICATIONS.—
(1) IN GENERAL.—Taking into account the findings from
the joint review described under paragraph (2), the Secretary
shall modify the policies of the National Disaster Medical System as necessary.
(2) JOINT REVIEW AND MEDICAL SURGE CAPACITY STRATEGIC
PLAN.—Not later than 180 days after the date of enactment of
the Pandemic and All-Hazards Preparedness Act, the Secretary, in coordination with the Secretary of Homeland Security, the Secretary of Defense, and the Secretary of Veterans
Affairs, shall conduct a joint review of the National Disaster
Medical System. Such review shall include an evaluation of
medical surge capacity, as described by section 2803(a). As part
of the National Health Security Strategy under section 2802,
the Secretary shall update the findings from such review and
further modify the policies of the National Disaster Medical
System as necessary.
(3) PARTICIPATION AGREEMENTS FOR NON-FEDERAL ENTITIES.—In carrying out paragraph (1), the Secretary shall establish criteria regarding the participation of States and private
entities in the National Disaster Medical System, including criteria regarding agreements for such participation. The criteria
shall include the following:
(A) Provisions relating to the custody and use of Federal personal property by such entities, which may in the
discretion of the Secretary include authorizing the custody
and use of such property to respond to emergency situations for which the National Disaster Medical System has
not been activated by the Secretary pursuant to subsection
(a)(3)(A). Any such custody and use of Federal personal
property shall be on a reimbursable basis.
(B) Provisions relating to circumstances in which an
individual or entity has agreements with both the National
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Disaster Medical System and another entity regarding the
provision of emergency services by the individual. Such
provisions shall address the issue of priorities among the
agreements involved.
(c) INTERMITTENT DISASTER-RESPONSE PERSONNEL.—
(1) IN GENERAL.—For the purpose of assisting the National
Disaster Medical System in carrying out duties under this section, the Secretary may appoint individuals to serve as intermittent personnel of such System in accordance with applicable civil service laws and regulations.
(2) LIABILITY.—For purposes of section 224(a) and the remedies described in such section, an individual appointed under
paragraph (1) shall, while acting within the scope of such appointment, be considered to be an employee of the Public
Health Service performing medical, surgical, dental, or related
functions. With respect to the participation of individuals appointed under paragraph (1) in training programs authorized
by the Assistant Secretary for Preparedness and Response or
a comparable official of any Federal agency specified in subsection (a)(2)(B), acts of individuals so appointed that are within the scope of such participation shall be considered within
the scope of the appointment under paragraph (1) (regardless
of whether the individuals receive compensation for such participation).
(d) CERTAIN EMPLOYMENT ISSUES REGARDING INTERMITTENT
APPOINTMENTS.—
(1) INTERMITTENT DISASTER-RESPONSE APPOINTEE.—For
purposes of this subsection, the term ‘‘intermittent disaster-response appointee’’ means an individual appointed by the Secretary under subsection (c).
(2) COMPENSATION FOR WORK INJURIES.—An intermittent
disaster-response appointee shall, while acting in the scope of
such appointment, be considered to be an employee of the Public Health Service performing medical, surgical, dental, or related functions, and an injury sustained by such an individual
shall be deemed ‘‘in the performance of duty’’, for purposes of
chapter 81 of title 5, United States Code, pertaining to compensation for work injuries. With respect to the participation
of individuals appointed under subsection (c) in training programs authorized by the Assistant Secretary for Preparedness
and Response or a comparable official of any Federal agency
specified in subsection (a)(2)(B), injuries sustained by such an
individual, while acting within the scope of such participation,
also shall be deemed ‘‘in the performance of duty’’ for purposes
of chapter 81 of title 5, United States Code (regardless of
whether the individuals receive compensation for such participation). In the event of an injury to such an intermittent disaster-response appointee, the Secretary of Labor shall be responsible for making determinations as to whether the claimant is entitled to compensation or other benefits in accordance
with chapter 81 of title 5, United States Code.
(3) EMPLOYMENT AND REEMPLOYMENT RIGHTS.—
(A) IN GENERAL.—Service as an intermittent disasterresponse appointee when the Secretary activates the NaMarch 13, 2013

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Sec. 2813

tional Disaster Medical System or when the individual
participates in a training program authorized by the Assistant Secretary for Preparedness and Response or a comparable official of any Federal agency specified in subsection (a)(2)(B) shall be deemed ‘‘service in the uniformed
services’’ for purposes of chapter 43 of title 38, United
States Code, pertaining to employment and reemployment
rights of individuals who have performed service in the
uniformed services (regardless of whether the individual
receives compensation for such participation). All rights
and obligations of such persons and procedures for assistance, enforcement, and investigation shall be as provided
for in chapter 43 of title 38, United States Code.
(B) NOTICE OF ABSENCE FROM POSITION OF EMPLOYMENT.—Preclusion of giving notice of service by necessity
of Service as an intermittent disaster-response appointee
when the Secretary activates the National Disaster Medical System shall be deemed preclusion by ‘‘military necessity’’ for purposes of section 4312(b) of title 38, United
States Code, pertaining to giving notice of absence from a
position of employment. A determination of such necessity
shall be made by the Secretary, in consultation with the
Secretary of Defense, and shall not be subject to judicial
review.
(4) LIMITATION.—An intermittent disaster-response appointee shall not be deemed an employee of the Department of
Health and Human Services for purposes other than those specifically set forth in this section.
(e) RULE OF CONSTRUCTION REGARDING USE OF COMMISSIONED
CORPS.—If the Secretary assigns commissioned officers of the Regular or Reserve Corps to serve with the National Disaster Medical
System, such assignments do not affect the terms and conditions
of their appointments as commissioned officers of the Regular or
Reserve Corps, respectively (including with respect to pay and allowances, retirement, benefits, rights, privileges, and immunities).
(f) DEFINITION.—For purposes of this section, the term ‘‘auxiliary services’’ includes mortuary services, veterinary services, and
other services that are determined by the Secretary to be appropriate with respect to the needs referred to in subsection (a)(3)(A).
(g) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of
providing for the Assistant Secretary for Preparedness and Response and the operations of the National Disaster Medical System, other than purposes for which amounts in the Public Health
Emergency Fund under section 319 are available, there are authorized to be appropriated such sums as may be necessary for each of
the fiscal years 2007 through 2011.
SEC. 2813. ø300hh–15¿ VOLUNTEER MEDICAL RESERVE CORPS.
(a) IN GENERAL.—Not later than 180 days after the date

of enactment of the Pandemic and All-Hazards Preparedness Act, the
Secretary, in collaboration with State, local, and tribal officials,
shall build on State, local, and tribal programs in existence on the
date of enactment of such Act to establish and maintain a Medical
Reserve Corps (referred to in this section as the ‘‘Corps’’) to provide
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for an adequate supply of volunteers in the case of a Federal, State,
local, or tribal public health emergency. The Corps shall be headed
by a Director who shall be appointed by the Secretary and shall
oversee the activities of the Corps chapters that exist at the State,
local, and tribal levels.
(b) STATE, LOCAL, AND TRIBAL COORDINATION.—The Corps
shall be established using existing State, local, and tribal teams
and shall not alter such teams.
(c) COMPOSITION.—The Corps shall be composed of individuals
who—
(1)(A) are health professionals who have appropriate professional training and expertise as determined appropriate by
the Director of the Corps; or
(B) are non-health professionals who have an interest in
serving in an auxiliary or support capacity to facilitate access
to health care services in a public health emergency;
(2) are certified in accordance with the certification program developed under subsection (d);
(3) are geographically diverse in residence;
(4) have registered and carry out training exercises with a
local chapter of the Medical Reserve Corps; and
(5) indicate whether they are willing to be deployed outside the area in which they reside in the event of a public
health emergency.
(d) CERTIFICATION; DRILLS.—
(1) CERTIFICATION.—The Director, in collaboration with
State, local, and tribal officials, shall establish a process for the
periodic certification of individuals who volunteer for the
Corps, as determined by the Secretary, which shall include the
completion by each individual of the core training programs developed under section 319F, as required by the Director. Such
certification shall not supercede State licensing or
credentialing requirements.
(2) DRILLS.—In conjunction with the core training programs referred to in paragraph (1), and in order to facilitate
the integration of trained volunteers into the health care system at the local level, Corps members shall engage in periodic
training exercises to be carried out at the local level.
(e) DEPLOYMENT.—During a public health emergency, the Secretary shall have the authority to activate and deploy willing members of the Corps to areas of need, taking into consideration the
public health and medical expertise required, with the concurrence
of the State, local, or tribal officials from the area where the members reside.
(f) EXPENSES AND TRANSPORTATION.—While engaged in performing duties as a member of the Corps pursuant to an assignment by the Secretary (including periods of travel to facilitate such
assignment), members of the Corps who are not otherwise employed by the Federal Government shall be allowed travel or transportation expenses, including per diem in lieu of subsistence.
(g) IDENTIFICATION.—The Secretary, in cooperation and consultation with the States, shall develop a Medical Reserve Corps
Identification Card that describes the licensure and certification inMarch 13, 2013

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Sec. 2814

formation of Corps members, as well as other identifying information determined necessary by the Secretary.
(h) INTERMITTENT DISASTER-RESPONSE PERSONNEL.—
(1) IN GENERAL.—For the purpose of assisting the Corps in
carrying out duties under this section, during a public health
emergency, the Secretary may appoint selected individuals to
serve as intermittent personnel of such Corps in accordance
with applicable civil service laws and regulations. In all other
cases, members of the Corps are subject to the laws of the
State in which the activities of the Corps are undertaken.
(2) APPLICABLE PROTECTIONS.—Subsections (c)(2), (d), and
(e) of section 2812 shall apply to an individual appointed under
paragraph (1) in the same manner as such subsections apply
to an individual appointed under section 2812(c).
(3) LIMITATION.—State, local, and tribal officials shall have
no authority to designate a member of the Corps as Federal
intermittent disaster-response personnel, but may request the
services of such members.
(i) AUTHORIZATION OF APPROPRIATIONS.—There is authorized to
be appropriated to carry out this section, $22,000,000 for fiscal year
2007, and such sums as may be necessary for each of fiscal years
2008 through 2011.
SEC. 2814. ø300hh–16¿ AT-RISK INDIVIDUALS.

The Secretary, acting through such employee of the Department of Health and Human Services as determined by the Secretary and designated publicly (which may, at the discretion of the
Secretary, involve the appointment or designation of an individual
as the Director of At-Risk Individuals), shall—
(1) oversee the implementation of the National Preparedness goal of taking into account the public health and medical
needs of at-risk individuals in the event of a public health
emergency, as described in section 2802(b)(4);
(2) assist other Federal agencies responsible for planning
for, responding to, and recovering from public health emergencies in addressing the needs of at-risk individuals;
(3) provide guidance to and ensure that recipients of State
and local public health grants include preparedness and response strategies and capabilities that take into account the
medical and public health needs of at-risk individuals in the
event of a public health emergency, as described in section
319C–1(b)(2)(A)(iii);
(4) ensure that the contents of the strategic national stockpile take into account at-risk populations as described in section 2811(b)(3)(B);
(5) oversee the progress of the Advisory Committee on AtRisk Individuals and Public Health Emergencies established
under section 319F(b)(2) and make recommendations with a
focus on opportunities for action based on the work of the Committee;
(6) oversee curriculum development for the public health
and medical response training program on medical management of casualties, as it concerns at-risk individuals as described in subparagraphs (A) through (C) of section 319F(a)(2);
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(7) disseminate novel and best practices of outreach to and
care of at-risk individuals before, during, and following public
health emergencies; and
(8) not later than one year after the date of enactment of
the Pandemic and All-Hazards Preparedness Act, prepare and
submit to Congress a report describing the progress made on
implementing the duties described in this section.
SEC. 2815. ø42 U.S.C. 300hh–17¿ EMERGENCY RESPONSE COORDINATION
OF PRIMARY CARE PROVIDERS.

The Secretary, acting through Administrator 1 of the Health
Resources and Services Administration, and in coordination with
the Assistant Secretary for Preparedness and Response, shall
(1) provide guidance and technical assistance to health
centers funded under section 330 and to State and local health
departments and emergency managers to integrate health centers into State and local emergency response plans and to better meet the primary care needs of populations served by
health centers during public health emergencies; and
(2) encourage employees at health centers funded under
section 330 to participate in emergency medical response programs including the National Disaster Medical System authorized in section 2812, the Volunteer Medical Reserve Corps authorized in section 2813, and the Emergency System for Advance Registration of Health Professions Volunteers authorized
in section 319I.

Subtitle C—Strengthening Public Health
Surveillance Systems
SEC.

2821.

ø300hh–31¿ EPIDEMIOLOGY-LABORATORY
CAPACITY
GRANTS.
IN GENERAL.—Subject to the availability of appropriations,

(a)
the Secretary, acting through the Director of the Centers for Disease Control and Prevention, shall establish an Epidemiology and
Laboratory Capacity Grant Program to award grants to State
health departments as well as local health departments and tribal
jurisdictions that meet such criteria as the Director determines appropriate. Academic centers that assist State and eligible local and
tribal health departments may also be eligible for funding under
this section as the Director determines appropriate. Grants shall be
awarded under this section to assist public health agencies in improving surveillance for, and response to, infectious diseases and
other conditions of public health importance by—
(1) strengthening epidemiologic capacity to identify and
monitor the occurrence of infectious diseases and other conditions of public health importance;
(2) enhancing laboratory practice as well as systems to report test orders and results electronically;
(3) improving information systems including developing
and maintaining an information exchange using national
guidelines and complying with capacities and functions deter1 So

March 13, 2013

in law. Probably should read ‘‘the Administrator’’.

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PUBLIC HEALTH SERVICE ACT

Sec. 2821

mined by an advisory council established and appointed by the
Director; and
(4) developing and implementing prevention and control
strategies.
(b) AUTHORIZATION OF APPROPRIATIONS.—There are authorized
to be appropriated to carry out this section $190,000,000 for each
of fiscal years 2010 through 2013, of which—
(1) not less than $95,000,000 shall be made available each
such fiscal year for activities under paragraphs (1) and (4) of
subsection (a);
(2) not less than $60,000,000 shall be made available each
such fiscal year for activities under subsection (a)(3); and
(3) not less than $32,000,000 shall be made available each
such fiscal year for activities under subsection (a)(2).

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TITLE XXIX—LIFESPAN RESPITE CARE
SEC. 2901. ø300ii¿ DEFINITIONS.

In this title:
(1) ADULT WITH A SPECIAL NEED.—The term ‘‘adult with a
special need’’ means a person 18 years of age or older who requires care or supervision to—
(A) meet the person’s basic needs;
(B) prevent physical self-injury or injury to others; or
(C) avoid placement in an institutional facility.
(2) AGING AND DISABILITY RESOURCE CENTER.—The term
‘‘aging and disability resource center’’ means an entity administering a program established by the State, as part of the
State’s system of long-term care, to provide a coordinated system for providing—
(A) comprehensive information on available public and
private long-term care programs, options, and resources;
(B) personal counseling to assist individuals in assessing their existing or anticipated long-term care needs, and
developing and implementing a plan for long-term care designed to meet their specific needs and circumstances; and
(C) consumer access to the range of publicly supported
long-term care programs for which consumers may be eligible, by serving as a convenient point of entry for such
programs.
(3) CHILD WITH A SPECIAL NEED.—The term ‘‘child with a
special need’’ means an individual less than 18 years of age
who requires care or supervision beyond that required of children generally to—
(A) meet the child’s basic needs; or
(B) prevent physical injury, self-injury, or injury to
others.
(4) ELIGIBLE STATE AGENCY.—The term ‘‘eligible State
agency’’ means a State agency that—
(A) administers the State’s program under the Older
Americans Act of 1965, administers the State’s program
under title XIX of the Social Security Act, or is designated
by the Governor of such State to administer the State’s
programs under this title;
(B) is an aging and disability resource center;
(C) works in collaboration with a public or private
nonprofit statewide respite care coalition or organization;
and
(D) demonstrates—
(i) an ability to work with other State and community-based agencies;
1508
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PUBLIC HEALTH SERVICE ACT

Sec. 2902

(ii) an understanding of respite care and family
caregiver issues across all age groups, disabilities, and
chronic conditions; and
(iii) the capacity to ensure meaningful involvement of family members, family caregivers, and care
recipients.
(5) FAMILY CAREGIVER.—The term ‘‘family caregiver’’
means an unpaid family member, a foster parent, or another
unpaid adult, who provides in-home monitoring, management,
supervision, or treatment of a child or adult with a special
need.
(6) LIFESPAN RESPITE CARE.—The term ‘‘lifespan respite
care’’ means a coordinated system of accessible, communitybased respite care services for family caregivers of children or
adults with special needs.
(7) RESPITE CARE.—The term ‘‘respite care’’ means planned
or emergency care provided to a child or adult with a special
need in order to provide temporary relief to the family caregiver of that child or adult.
(8) STATE.—The term ‘‘State’’ means any of the several
States, the District of Columbia, the Virgin Islands of the
United States, the Commonwealth of Puerto Rico, Guam,
American Samoa, and the Commonwealth of the Northern
Mariana Islands.
SEC. 2902. ø300ii–1¿ LIFESPAN RESPITE CARE GRANTS AND COOPERATIVE AGREEMENTS.
(a) PURPOSES.—The purposes of this section are—

(1) to expand and enhance respite care services to family
caregivers;
(2) to improve the statewide dissemination and coordination of respite care; and
(3) to provide, supplement, or improve access and quality
of respite care services to family caregivers, thereby reducing
family caregiver strain.
(b) AUTHORIZATION.—Subject to subsection (e), the Secretary is
authorized to award grants or cooperative agreements for the purposes described in subsection (a) to eligible State agencies for
which an application is submitted pursuant to subsection (d).
(c) FEDERAL LIFESPAN APPROACH.—In carrying out this section,
the Secretary shall work in cooperation with the National Family
Caregiver Support Program of the Administration on Aging and
other respite care programs within the Department of Health and
Human Services to ensure coordination of respite care services for
family caregivers of children and adults with special needs.
(d) APPLICATION.—
(1) SUBMISSION.—Each Governor desiring the eligible State
agency of his or her State to receive a grant or cooperative
agreement under this section shall submit an application on
behalf of such agency to the Secretary at such time, in such
manner, and containing such information as the Secretary
shall require.
(2) CONTENTS.—Each application submitted under this section shall include—
(A) a description of the eligible State agency’s—
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(i) ability to work with other State and community-based agencies;
(ii) understanding of respite care and family caregiver issues across all age groups, disabilities, and
chronic conditions; and
(iii) capacity to ensure meaningful involvement of
family members, family caregivers, and care recipients;
(B) with respect to the population of family caregivers
to whom respite care information or services will be provided or for whom respite care workers and volunteers will
be recruited and trained, a description of—
(i) the population of family caregivers;
(ii) the extent and nature of the respite care needs
of that population;
(iii) existing respite care services for that population, including numbers of family caregivers being
served and extent of unmet need;
(iv) existing methods or systems to coordinate respite care information and services to the population at
the State and local level and extent of unmet need;
(v) how respite care information dissemination
and coordination, respite care services, respite care
worker and volunteer recruitment and training programs, or training programs for family caregivers that
assist such family caregivers in making informed decisions about respite care services will be provided using
grant or cooperative agreement funds;
(vi) a plan for administration, collaboration, and
coordination of the proposed respite care activities
with other related services or programs offered by
public or private, nonprofit entities, including area
agencies on aging;
(vii) how the population, including family caregivers, care recipients, and relevant public or private
agencies, will participate in the planning and implementation of the proposed respite care activities;
(viii) how the proposed respite care activities will
make use, to the maximum extent feasible, of other
Federal, State, and local funds, programs, contributions, other forms of reimbursements, personnel, and
facilities;
(ix) respite care services available to family caregivers in the eligible State agency’s State or locality,
including unmet needs and how the eligible State
agency’s plan for use of funds will improve the coordination and distribution of respite care services for
family caregivers of children and adults with special
needs;
(x) the criteria used to identify family caregivers
eligible for respite care services;
(xi) how the quality and safety of any respite care
services provided will be monitored, including methods
to ensure that respite care workers and volunteers are
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appropriately screened and possess the necessary
skills to care for the needs of the care recipient in the
absence of the family caregiver; and
(xii) the results expected from proposed respite
care activities and the procedures to be used for evaluating those results;
(C) assurances that, where appropriate, the eligible
State agency will have a system for maintaining the confidentiality of care recipient and family caregiver records;
and
(D) a memorandum of agreement regarding the joint
responsibility for the eligible State agency’s lifespan respite program between—
(i) the eligible State agency; and
(ii) a public or private nonprofit statewide respite
coalition or organization.
(e) PRIORITY; CONSIDERATIONS.—When awarding grants or cooperative agreements under this section, the Secretary shall—
(1) give priority to eligible State agencies that the Secretary determines show the greatest likelihood of implementing or enhancing lifespan respite care statewide; and
(2) give consideration to eligible State agencies that are
building or enhancing the capacity of their long-term care systems to respond to the comprehensive needs, including respite
care needs, of their residents.
(f) USE OF GRANT OR COOPERATIVE AGREEMENT FUNDS.—
(1) IN GENERAL.—
(A) REQUIRED USES OF FUNDS.—Each eligible State
agency awarded a grant or cooperative agreement under
this section shall use all or part of the funds—
(i) to develop or enhance lifespan respite care at
the State and local levels;
(ii) to provide respite care services for family caregivers caring for children or adults;
(iii) to train and recruit respite care workers and
volunteers;
(iv) to provide information to caregivers about
available respite and support services; and
(v) to assist caregivers in gaining access to such
services.
(B) OPTIONAL USES OF FUNDS.—Each eligible State
agency awarded a grant or cooperative agreement under
this section may use part of the funds for—
(i) training programs for family caregivers to assist such family caregivers in making informed decisions about respite care services;
(ii) other services essential to the provision of respite care as the Secretary may specify; or
(iii) training and education for new caregivers.
(2) SUBCONTRACTS.—Each eligible State agency awarded a
grant or cooperative agreement under this section may carry
out the activities described in paragraph (1) directly or by
grant to, or contract with, public or private entities.
(3) MATCHING FUNDS.—
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(A) IN GENERAL.—With respect to the costs of the activities to be carried out under paragraph (1), a condition
for the receipt of a grant or cooperative agreement under
this section is that the eligible State agency agrees to
make available (directly or through donations from public
or private entities) non-Federal contributions toward such
costs in an amount that is not less than 25 percent of such
costs.
(B) DETERMINATION OF AMOUNT CONTRIBUTED.—NonFederal contributions required by subparagraph (A) may
be in cash or in kind, fairly evaluated, including plant,
equipment, or services. Amounts provided by the Federal
Government, or services assisted or subsidized to any significant extent by the Federal Government, may not be included in determining the amount of such non-Federal contributions.
(g) TERM OF GRANTS OR COOPERATIVE AGREEMENTS.—
(1) IN GENERAL.—The Secretary shall award grants or cooperative agreements under this section for terms that do not
exceed 5 years.
(2) RENEWAL.—The Secretary may renew a grant or cooperative agreement under this section at the end of the term of
the grant or cooperative agreement determined under paragraph (1).
(h) MAINTENANCE OF EFFORT.—Funds made available under
this section shall be used to supplement and not supplant other
Federal, State, and local funds available for respite care services.
SEC. 2903. ø300ii–2¿ NATIONAL LIFESPAN RESPITE RESOURCE CENTER.
(a) ESTABLISHMENT.—The Secretary may award a grant or co-

operative agreement to a public or private nonprofit entity to establish a National Resource Center on Lifespan Respite Care (referred
to in this section as the ‘‘center’’).
(b) PURPOSES OF THE CENTER.—The center shall—
(1) maintain a national database on lifespan respite care;
(2) provide training and technical assistance to State, community, and nonprofit respite care programs; and
(3) provide information, referral, and educational programs
to the public on lifespan respite care.
SEC. 2904. ø300ii–3¿ REPORT.

Not later than January 1, 2009, the Secretary shall report to
the Congress on the activities undertaken under this title. Such report shall evaluate—
(1) the number of States that have lifespan respite care
programs;
(2) the demographics of the caregivers receiving respite
care services through grants or cooperative agreements under
this title; and
(3) the effectiveness of entities receiving grants or cooperative agreements under this title.
SEC. 2905. ø300ii–4¿ AUTHORIZATION OF APPROPRIATIONS.

There are authorized to be appropriated to carry out this
title—
(1) $30,000,000 for fiscal year 2007;
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PUBLIC HEALTH SERVICE ACT
(2)
(3)
(4)
(5)

March 13, 2013

$40,000,000
$53,330,000
$71,110,000
$94,810,000

for
for
for
for

fiscal
fiscal
fiscal
fiscal

year
year
year
year

2008;
2009;
2010; and
2011.

Sec. 2905

\\143.231.149.13\DATA\COMP\PHSA\PHSA.030

TITLE XXX—HEALTH INFORMATION
TECHNOLOGY AND QUALITY
SEC. 3000. ø300jj¿ DEFINITIONS.

In this title:
(1) CERTIFIED EHR TECHNOLOGY.—The term ‘‘certified EHR
technology’’ means a qualified electronic health record that is
certified pursuant to section 3001(c)(5) as meeting standards
adopted under section 3004 that are applicable to the type of
record involved (as determined by the Secretary, such as an
ambulatory electronic health record for office-based physicians
or an inpatient hospital electronic health record for hospitals).
(2) ENTERPRISE INTEGRATION.—The term ‘‘enterprise integration’’ means the electronic linkage of health care providers,
health plans, the government, and other interested parties, to
enable the electronic exchange and use of health information
among all the components in the health care infrastructure in
accordance with applicable law, and such term includes related
application protocols and other related standards.
(3) HEALTH CARE PROVIDER.—The term ‘‘health care provider’’ includes a hospital, skilled nursing facility, nursing facility, home health entity or other long term care facility,
health care clinic, community mental health center (as defined
in section 1913(b)(1)), renal dialysis facility, blood center, ambulatory surgical center described in section 1833(i) of the Social Security Act, emergency medical services provider, Federally qualified health center, group practice, a pharmacist, a
pharmacy, a laboratory, a physician (as defined in section
1861(r) of the Social Security Act), a practitioner (as described
in section 1842(b)(18)(C) of the Social Security Act), a provider
operated by, or under contract with, the Indian Health Service
or by an Indian tribe (as defined in the Indian Self-Determination and Education Assistance Act), tribal organization, or
urban Indian organization (as defined in section 4 of the Indian Health Care Improvement Act), a rural health clinic, a
covered entity under section 340B, an ambulatory surgical center described in section 1833(i) of the Social Security Act, a
therapist (as defined in section 1848(k)(3)(B)(iii) of the Social
Security Act), and any other category of health care facility,
entity, practitioner, or clinician determined appropriate by the
Secretary.
(4) HEALTH INFORMATION.—The term ‘‘health information’’
has the meaning given such term in section 1171(4) of the Social Security Act.
(5) HEALTH INFORMATION TECHNOLOGY.—The term ‘‘health
information technology’’ means hardware, software, integrated
1514
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technologies or related licenses, intellectual property, upgrades, or packaged solutions sold as services that are designed for or support the use by health care entities or patients
for the electronic creation, maintenance, access, or exchange of
health information
(6) HEALTH PLAN.—The term ‘‘health plan’’ has the meaning given such term in section 1171(5) of the Social Security
Act.
(7) HIT POLICY COMMITTEE.—The term ‘‘HIT Policy Committee’’ means such Committee established under section
3002(a).
(8) HIT STANDARDS COMMITTEE.—The term ‘‘HIT Standards Committee’’ means such Committee established under
section 3003(a).
(9) INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION.—
The term ‘‘individually identifiable health information’’ has the
meaning given such term in section 1171(6) of the Social Security Act.
(10) LABORATORY.—The term ‘‘laboratory’’ has the meaning
given such term in section 353(a).
(11) NATIONAL COORDINATOR.—The term ‘‘National Coordinator’’ means the head of the Office of the National Coordinator for Health Information Technology established under section 3001(a).
(12) PHARMACIST.—The term ‘‘pharmacist’’ has the meaning given such term in section 804(2) of the Federal Food,
Drug, and Cosmetic Act.
(13) QUALIFIED ELECTRONIC HEALTH RECORD.—The term
‘‘qualified electronic health record’’ means an electronic record
of health-related information on an individual that—
(A) includes patient demographic and clinical health
information, such as medical history and problem lists;
and
(B) has the capacity—
(i) to provide clinical decision support;
(ii) to support physician order entry;
(iii) to capture and query information relevant to
health care quality; and
(iv) to exchange electronic health information
with, and integrate such information from other
sources.
(14) STATE.—The term ‘‘State’’ means each of the several
States, the District of Columbia, Puerto Rico, the Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands.

Subtitle A—Promotion of Health
Information Technology
SEC. 3001. ø300jj–11¿ OFFICE OF THE NATIONAL COORDINATOR FOR
HEALTH INFORMATION TECHNOLOGY.
(a) ESTABLISHMENT.—There is established within the Depart-

ment of Health and Human Services an Office of the National CoMarch 13, 2013

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ordinator for Health Information Technology (referred to in this
section as the ‘‘Office’’). The Office shall be headed by a National
Coordinator who shall be appointed by the Secretary and shall report directly to the Secretary.
(b) PURPOSE.—The National Coordinator shall perform the duties under subsection (c) in a manner consistent with the development of a nationwide health information technology infrastructure
that allows for the electronic use and exchange of information and
that—
(1) ensures that each patient’s health information is secure
and protected, in accordance with applicable law;
(2) improves health care quality, reduces medical errors,
reduces health disparities, and advances the delivery of patient-centered medical care;
(3) reduces health care costs resulting from inefficiency,
medical errors, inappropriate care, duplicative care, and incomplete information;
(4) provides appropriate information to help guide medical
decisions at the time and place of care;
(5) ensures the inclusion of meaningful public input in
such development of such infrastructure;
(6) improves the coordination of care and information
among hospitals, laboratories, physician offices, and other entities through an effective infrastructure for the secure and authorized exchange of health care information;
(7) improves public health activities and facilitates the
early identification and rapid response to public health threats
and emergencies, including bioterror events and infectious disease outbreaks;
(8) facilitates health and clinical research and health care
quality;
(9) promotes early detection, prevention, and management
of chronic diseases;
(10) promotes a more effective marketplace, greater competition, greater systems analysis, increased consumer choice,
and improved outcomes in health care services; and
(11) improves efforts to reduce health disparities.
(c) DUTIES OF THE NATIONAL COORDINATOR.—
(1) STANDARDS.—The National Coordinator shall—
(A) review and determine whether to endorse each
standard, implementation specification, and certification
criterion for the electronic exchange and use of health information that is recommended by the HIT Standards
Committee under section 3003 for purposes of adoption
under section 3004;
(B) make such determinations under subparagraph
(A), and report to the Secretary such determinations, not
later than 45 days after the date the recommendation is
received by the Coordinator; and
(C) review Federal health information technology investments to ensure that Federal health information technology programs are meeting the objectives of the strategic
plan published under paragraph (3).
(2) HIT POLICY COORDINATION.—
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(A) IN GENERAL.—The National Coordinator shall coordinate health information technology policy and programs of the Department with those of other relevant executive branch agencies with a goal of avoiding duplication
of efforts and of helping to ensure that each agency undertakes health information technology activities primarily
within the areas of its greatest expertise and technical capability and in a manner towards a coordinated national
goal.
(B) HIT POLICY AND STANDARDS COMMITTEES.—The
National Coordinator shall be a leading member in the establishment and operations of the HIT Policy Committee
and the HIT Standards Committee and shall serve as a liaison among those two Committees and the Federal Government.
(3) STRATEGIC PLAN.—
(A) IN GENERAL.—The National Coordinator shall, in
consultation with other appropriate Federal agencies (including the National Institute of Standards and Technology), update the Federal Health IT Strategic Plan (developed as of June 3, 2008) to include specific objectives,
milestones, and metrics with respect to the following:
(i) The electronic exchange and use of health information and the enterprise integration of such information.
(ii) The utilization of an electronic health record
for each person in the United States by 2014.
(iii) The incorporation of privacy and security protections for the electronic exchange of an individual’s
individually identifiable health information.
(iv) Ensuring security methods to ensure appropriate authorization and electronic authentication of
health information and specifying technologies or
methodologies for rendering health information unusable, unreadable, or indecipherable.
(v) Specifying a framework for coordination and
flow of recommendations and policies under this subtitle among the Secretary, the National Coordinator,
the HIT Policy Committee, the HIT Standards Committee, and other health information exchanges and
other relevant entities.
(vi) Methods to foster the public understanding of
health information technology.
(vii) Strategies to enhance the use of health information technology in improving the quality of health
care, reducing medical errors, reducing health disparities, improving public health, increasing prevention
and coordination with community resources, and improving the continuity of care among health care settings.
(viii) Specific plans for ensuring that populations
with unique needs, such as children, are appropriately
addressed in the technology design, as appropriate,
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which may include technology that automates enrollment and retention for eligible individuals.
(B) COLLABORATION.—The strategic plan shall be updated through collaboration of public and private entities.
(C) MEASURABLE OUTCOME GOALS.—The strategic plan
update shall include measurable outcome goals.
(D) PUBLICATION.—The National Coordinator shall republish the strategic plan, including all updates.
(4) WEBSITE.—The National Coordinator shall maintain
and frequently update an Internet website on which there is
posted information on the work, schedules, reports, recommendations, and other information to ensure transparency
in promotion of a nationwide health information technology infrastructure.
(5) CERTIFICATION.—
(A) IN GENERAL.—The National Coordinator, in consultation with the Director of the National Institute of
Standards and Technology, shall keep or recognize a program or programs for the voluntary certification of health
information technology as being in compliance with applicable certification criteria adopted under this subtitle.
Such program shall include, as appropriate, testing of the
technology in accordance with section 13201(b) of the
Health Information Technology for Economic and Clinical
Health Act.
(B) CERTIFICATION CRITERIA DESCRIBED.—In this title,
the term ‘‘certification criteria’’ means, with respect to
standards and implementation specifications for health information technology, criteria to establish that the technology meets such standards and implementation specifications.
(6) REPORTS AND PUBLICATIONS.—
(A) REPORT ON ADDITIONAL FUNDING OR AUTHORITY
NEEDED.—Not later than 12 months after the date of the
enactment of this title, the National Coordinator shall submit to the appropriate committees of jurisdiction of the
House of Representatives and the Senate a report on any
additional funding or authority the Coordinator or the HIT
Policy Committee or HIT Standards Committee requires to
evaluate and develop standards, implementation specifications, and certification criteria, or to achieve full participation of stakeholders in the adoption of a nationwide health
information technology infrastructure that allows for the
electronic use and exchange of health information.
(B) IMPLEMENTATION REPORT.—The National Coordinator shall prepare a report that identifies lessons learned
from major public and private health care systems in their
implementation of health information technology, including information on whether the technologies and practices
developed by such systems may be applicable to and usable in whole or in part by other health care providers.
(C) ASSESSMENT OF IMPACT OF HIT ON COMMUNITIES
WITH HEALTH DISPARITIES AND UNINSURED, UNDERINSURED,
AND MEDICALLY UNDERSERVED AREAS.—The National CoorMarch 13, 2013

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dinator shall assess and publish the impact of health information technology in communities with health disparities
and in areas with a high proportion of individuals who are
uninsured, underinsured, and medically underserved individuals (including urban and rural areas) and identify
practices to increase the adoption of such technology by
health care providers in such communities, and the use of
health information technology to reduce and better manage chronic diseases.
(D) EVALUATION OF BENEFITS AND COSTS OF THE ELECTRONIC USE AND EXCHANGE OF HEALTH INFORMATION.—The
National Coordinator shall evaluate and publish evidence
on the benefits and costs of the electronic use and exchange of health information and assess to whom these
benefits and costs accrue.
(E) RESOURCE REQUIREMENTS.—The National Coordinator shall estimate and publish resources required annually to reach the goal of utilization of an electronic health
record for each person in the United States by 2014, including—
(i) the required level of Federal funding;
(ii) expectations for regional, State, and private investment;
(iii) the expected contributions by volunteers to activities for the utilization of such records; and
(iv) the resources needed to establish a health information technology workforce sufficient to support
this effort (including education programs in medical
informatics and health information management).
(7) ASSISTANCE.—The National Coordinator may provide financial assistance to consumer advocacy groups and not-forprofit entities that work in the public interest for purposes of
defraying the cost to such groups and entities to participate
under, whether in whole or in part, the National Technology
Transfer Act of 1995 (15 U.S.C. 272 note).
(8) GOVERNANCE FOR NATIONWIDE HEALTH INFORMATION
NETWORK.—The National Coordinator shall establish a governance mechanism for the nationwide health information network.
(d) DETAIL OF FEDERAL EMPLOYEES.—
(1) IN GENERAL.—Upon the request of the National Coordinator, the head of any Federal agency is authorized to detail,
with or without reimbursement from the Office, any of the personnel of such agency to the Office to assist it in carrying out
its duties under this section.
(2) EFFECT OF DETAIL.—Any detail of personnel under
paragraph (1) shall—
(A) not interrupt or otherwise affect the civil service
status or privileges of the Federal employee; and
(B) be in addition to any other staff of the Department
employed by the National Coordinator.
(3) ACCEPTANCE OF DETAILEES.—Notwithstanding any
other provision of law, the Office may accept detailed personnel
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from other Federal agencies without regard to whether the
agency described under paragraph (1) is reimbursed.
(e) CHIEF PRIVACY OFFICER OF THE OFFICE OF THE NATIONAL
COORDINATOR.—Not later than 12 months after the date of the enactment of this title, the Secretary shall appoint a Chief Privacy
Officer of the Office of the National Coordinator, whose duty it
shall be to advise the National Coordinator on privacy, security,
and data stewardship of electronic health information and to coordinate with other Federal agencies (and similar privacy officers
in such agencies), with State and regional efforts, and with foreign
countries with regard to the privacy, security, and data stewardship of electronic individually identifiable health information.
SEC. 3002. ø300jj–12¿ HIT POLICY COMMITTEE.
(a) ESTABLISHMENT.—There is established

a HIT Policy Committee to make policy recommendations to the National Coordinator relating to the implementation of a nationwide health information technology infrastructure, including implementation of the
strategic plan described in section 3001(c)(3).
(b) DUTIES.—
(1) RECOMMENDATIONS ON HEALTH INFORMATION TECHNOLOGY INFRASTRUCTURE.—The HIT Policy Committee shall
recommend a policy framework for the development and adoption of a nationwide health information technology infrastructure that permits the electronic exchange and use of health information as is consistent with the strategic plan under section
3001(c)(3) and that includes the recommendations under paragraph (2). The Committee shall update such recommendations
and make new recommendations as appropriate.
(2) SPECIFIC AREAS OF STANDARD DEVELOPMENT.—
(A) IN GENERAL.—The HIT Policy Committee shall recommend the areas in which standards, implementation
specifications, and certification criteria are needed for the
electronic exchange and use of health information for purposes of adoption under section 3004 and shall recommend
an order of priority for the development, harmonization,
and recognition of such standards, specifications, and certification criteria among the areas so recommended. Such
standards and implementation specifications shall include
named standards, architectures, and software schemes for
the authentication and security of individually identifiable
health information and other information as needed to ensure the reproducible development of common solutions
across disparate entities.
(B) AREAS REQUIRED FOR CONSIDERATION.—For purposes of subparagraph (A), the HIT Policy Committee shall
make recommendations for at least the following areas:
(i) Technologies that protect the privacy of health
information and promote security in a qualified electronic health record, including for the segmentation
and protection from disclosure of specific and sensitive
individually identifiable health information with the
goal of minimizing the reluctance of patients to seek
care (or disclose information about a condition) beMarch 13, 2013

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cause of privacy concerns, in accordance with applicable law, and for the use and disclosure of limited data
sets of such information.
(ii) A nationwide health information technology infrastructure that allows for the electronic use and accurate exchange of health information.
(iii) The utilization of a certified electronic health
record for each person in the United States by 2014.
(iv) Technologies that as a part of a qualified electronic health record allow for an accounting of disclosures made by a covered entity (as defined for purposes of regulations promulgated under section 264(c)
of the Health Insurance Portability and Accountability
Act of 1996) for purposes of treatment, payment, and
health care operations (as such terms are defined for
purposes of such regulations).
(v) The use of certified electronic health records to
improve the quality of health care, such as by promoting the coordination of health care and improving
continuity of health care among health care providers,
by reducing medical errors, by improving population
health, by reducing health disparities, by reducing
chronic disease, and by advancing research and education.
(vi) Technologies that allow individually identifiable health information to be rendered unusable,
unreadable, or indecipherable to unauthorized individuals when such information is transmitted in the nationwide health information network or physically
transported outside of the secured, physical perimeter
of a health care provider, health plan, or health care
clearinghouse.
(vii) The use of electronic systems to ensure the
comprehensive collection of patient demographic data,
including, at a minimum, race, ethnicity, primary language, and gender information.
(viii) Technologies that address the needs of children and other vulnerable populations.
(C) OTHER AREAS FOR CONSIDERATION.—In making recommendations under subparagraph (A), the HIT Policy
Committee may consider the following additional areas:
(i) The appropriate uses of a nationwide health information infrastructure, including for purposes of—
(I) the collection of quality data and public reporting;
(II) biosurveillance and public health;
(III) medical and clinical research; and
(IV) drug safety.
(ii) Self-service technologies that facilitate the use
and exchange of patient information and reduce wait
times.
(iii) Telemedicine technologies, in order to reduce
travel requirements for patients in remote areas.
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(iv) Technologies that facilitate home health care
and the monitoring of patients recuperating at home.
(v) Technologies that help reduce medical errors.
(vi) Technologies that facilitate the continuity of
care among health settings.
(vii) Technologies that meet the needs of diverse
populations.
(viii) Methods to facilitate secure access by an individual to such individual’s protected health information.
(ix) Methods, guidelines, and safeguards to facilitate secure access to patient information by a family
member, caregiver, or guardian acting on behalf of a
patient due to age-related and other disability, cognitive impairment, or dementia.
(x) Any other technology that the HIT Policy Committee finds to be among the technologies with the
greatest potential to improve the quality and efficiency
of health care.
(3) FORUM.—The HIT Policy Committee shall serve as a
forum for broad stakeholder input with specific expertise in
policies relating to the matters described in paragraphs (1) and
(2).
(4) CONSISTENCY WITH EVALUATION CONDUCTED UNDER
MIPPA.—
(A) REQUIREMENT FOR CONSISTENCY.—The HIT Policy
Committee shall ensure that recommendations made
under paragraph (2)(B)(vi) are consistent with the evaluation conducted under section 1809(a) of the Social Security
Act.
(B) SCOPE.—Nothing in subparagraph (A) shall be construed to limit the recommendations under paragraph
(2)(B)(vi) to the elements described in section 1809(a)(3) of
the Social Security Act.
(C) TIMING.—The requirement under subparagraph
(A) shall be applicable to the extent that evaluations have
been conducted under section 1809(a) of the Social Security Act, regardless of whether the report described in subsection (b) of such section has been submitted.
(c) MEMBERSHIP AND OPERATIONS.—
(1) IN GENERAL.—The National Coordinator shall take a
leading position in the establishment and operations of the
HIT Policy Committee.
(2) MEMBERSHIP.—The HIT Policy Committee shall be
composed of members to be appointed as follows:
(A) 3 members shall be appointed by the Secretary, 1
of whom shall be appointed to represent the Department
of Health and Human Services and 1 of whom shall be a
public health official.
(B) 1 member shall be appointed by the majority leader of the Senate.
(C) 1 member shall be appointed by the minority leader of the Senate.
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(D) 1 member shall be appointed by the Speaker of the
House of Representatives.
(E) 1 member shall be appointed by the minority leader of the House of Representatives.
(F) Such other members as shall be appointed by the
President as representatives of other relevant Federal
agencies.
(G) 13 members shall be appointed by the Comptroller
General of the United States of whom—
(i) 3 members shall advocates for patients or consumers;
(ii) 2 members shall represent health care providers, one of which shall be a physician;
(iii) 1 member shall be from a labor organization
representing health care workers;
(iv) 1 member shall have expertise in health information privacy and security;
(v) 1 member shall have expertise in improving
the health of vulnerable populations;
(vi) 1 member shall be from the research community;
(vii) 1 member shall represent health plans or
other third-party payers;
(viii) 1 member shall represent information technology vendors;
(ix) 1 member shall represent purchasers or employers; and
(x) 1 member shall have expertise in health care
quality measurement and reporting.
(3) PARTICIPATION.—The members of the HIT Policy Committee appointed under paragraph (2) shall represent a balance among various sectors of the health care system so that
no single sector unduly influences the recommendations of the
Policy Committee.
(4) TERMS.—
(A) IN GENERAL.—The terms of the members of the
HIT Policy Committee 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 in the membership of the HIT Policy Committee that
occurs prior to 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 been appointed. A vacancy in the HIT Policy
Committee shall be filled in the manner in which the original appointment was made.
(5) OUTSIDE INVOLVEMENT.—The HIT Policy Committee
shall ensure an opportunity for the participation in activities
of the Committee of outside advisors, including individuals
with expertise in the development of policies for the electronic
exchange and use of health information, including in the areas
of health information privacy and security.
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(6) QUORUM.—A majority of the member of the HIT Policy
Committee shall constitute a quorum for purposes of voting,
but a lesser number of members may meet and hold hearings.
(7) FAILURE OF INITIAL APPOINTMENT.—If, on the date that
is 45 days after the date of enactment of this title, an official
authorized under paragraph (2) to appoint one or more members of the HIT Policy Committee has not appointed the full
number of members that such paragraph authorizes such official to appoint, the Secretary is authorized to appoint such
members.
(8) CONSIDERATION.—The National Coordinator shall ensure that the relevant and available recommendations and
comments from the National Committee on Vital and Health
Statistics are considered in the development of policies.
(d) APPLICATION OF FACA.—The Federal Advisory Committee
Act (5 U.S.C. App.), other than section 14 of such Act, shall apply
to the HIT Policy Committee.
(e) PUBLICATION.—The Secretary shall provide for publication
in the Federal Register and the posting on the Internet website of
the Office of the National Coordinator for Health Information Technology of all policy recommendations made by the HIT Policy Committee under this section.
SEC. 3003. ø300jj–13¿ HIT STANDARDS COMMITTEE.
(a) ESTABLISHMENT.—There is established

a committee to be
known as the HIT Standards Committee to recommend to the National Coordinator standards, implementation specifications, and
certification criteria for the electronic exchange and use of health
information for purposes of adoption under section 3004, consistent
with the implementation of the strategic plan described in section
3001(c)(3) and beginning with the areas listed in section
3002(b)(2)(B) in accordance with policies developed by the HIT Policy Committee.
(b) DUTIES.—
(1) STANDARDS DEVELOPMENT.—
(A) IN GENERAL.—The HIT Standards Committee shall
recommend to the National Coordinator standards, implementation specifications, and certification criteria described in subsection (a) that have been developed, harmonized, or recognized by the HIT Standards Committee.
The HIT Standards Committee shall update such recommendations and make new recommendations as appropriate, including in response to a notification sent under
section 3004(a)(2)(B). Such recommendations shall be consistent with the latest recommendations made by the HIT
Policy Committee.
(B) HARMONIZATION.—The HIT Standards Committee
recognize harmonized or updated standards from an entity
or entities for the purpose of harmonizing or updating
standards and implementation specifications in order to
achieve uniform and consistent implementation of the
standards and implementation specifications.
(C) PILOT TESTING OF STANDARDS AND IMPLEMENTATION SPECIFICATIONS.—In the development, harmonization,
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or recognition of standards and implementation specifications, the HIT Standards Committee shall, as appropriate,
provide for the testing of such standards and specifications
by the National Institute for Standards and Technology
under section 13201(a) of the Health Information Technology for Economic and Clinical Health Act.
(D) CONSISTENCY.—The standards, implementation
specifications, and certification criteria recommended
under this subsection shall be consistent with the standards for information transactions and data elements adopted pursuant to section 1173 of the Social Security Act.
(2) FORUM.—The HIT Standards Committee shall serve as
a forum for the participation of a broad range of stakeholders
to provide input on the development, harmonization, and recognition of standards, implementation specifications, and certification criteria necessary for the development and adoption
of a nationwide health information technology infrastructure
that allows for the electronic use and exchange of health information.
(3) SCHEDULE.—Not later than 90 days after the date of
the enactment of this title, the HIT Standards Committee shall
develop a schedule for the assessment of policy recommendations developed by the HIT Policy Committee under section
3002. The HIT Standards Committee shall update such schedule annually. The Secretary shall publish such schedule in the
Federal Register.
(4) PUBLIC INPUT.—The HIT Standards Committee shall
conduct open public meetings and develop a process to allow
for public comment on the schedule described in paragraph (3)
and recommendations described in this subsection. Under such
process comments shall be submitted in a timely manner after
the date of publication of a recommendation under this subsection.
(5) CONSIDERATION.—The National Coordinator shall ensure that the relevant and available recommendations and
comments from the National Committee on Vital and Health
Statistics are considered in the development of standards.
(c) MEMBERSHIP AND OPERATIONS.—
(1) IN GENERAL.—The National Coordinator shall take a
leading position in the establishment and operations of the
HIT Standards Committee.
(2) MEMBERSHIP.—The membership of the HIT Standards
Committee shall at least reflect providers, ancillary healthcare
workers, consumers, purchasers, health plans, technology vendors, researchers, relevant Federal agencies, and individuals
with technical expertise on health care quality, privacy and security, and on the electronic exchange and use of health information.
(3) PARTICIPATION.—The members of the HIT Standards
Committee appointed under this subsection shall represent a
balance among various sectors of the health care system so
that no single sector unduly influences the recommendations of
such Committee.
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(4) OUTSIDE INVOLVEMENT.—The HIT Policy Committee
shall ensure an opportunity for the participation in activities
of the Committee of outside advisors, including individuals
with expertise in the development of standards for the electronic exchange and use of health information, including in the
areas of health information privacy and security.
(5) BALANCE AMONG SECTORS.—In developing the procedures for conducting the activities of the HIT Standards Committee, the HIT Standards Committee shall act to ensure a
balance among various sectors of the health care system so
that no single sector unduly influences the actions of the HIT
Standards Committee.
(6) ASSISTANCE.—For the purposes of carrying out this section, the Secretary may provide or ensure that financial assistance is provided by the HIT Standards Committee to defray in
whole or in part any membership fees or dues charged by such
Committee to those consumer advocacy groups and not for
profit entities that work in the public interest as a part of their
mission.
(d) APPLICATION OF FACA.—The Federal Advisory Committee
Act (5 U.S.C. App.), other than section 14, shall apply to the HIT
Standards Committee.
(e) PUBLICATION.—The Secretary shall provide for publication
in the Federal Register and the posting on the Internet website of
the Office of the National Coordinator for Health Information Technology of all recommendations made by the HIT Standards Committee under this section.
SEC. 3004. ø300jj–14¿ PROCESS FOR ADOPTION OF ENDORSED RECOMMENDATIONS; ADOPTION OF INITIAL SET OF STANDARDS, IMPLEMENTATION SPECIFICATIONS, AND CERTIFICATION CRITERIA.
(a) PROCESS FOR ADOPTION OF ENDORSED RECOMMENDATIONS.—
(1) REVIEW OF ENDORSED STANDARDS, IMPLEMENTATION
SPECIFICATIONS, AND CERTIFICATION CRITERIA.—Not later than

90 days after the date of receipt of standards, implementation
specifications, or certification criteria endorsed under section
3001(c), the Secretary, in consultation with representatives of
other relevant Federal agencies, shall jointly review such
standards, implementation specifications, or certification criteria and shall determine whether or not to propose adoption
of such standards, implementation specifications, or certification criteria.
(2) DETERMINATION TO ADOPT STANDARDS, IMPLEMENTATION SPECIFICATIONS, AND CERTIFICATION CRITERIA.—If the Secretary determines—
(A) to propose adoption of any grouping of such standards, implementation specifications, or certification criteria, the Secretary shall, by regulation under section 553
of title 5, United States Code, determine whether or not to
adopt such grouping of standards, implementation specifications, or certification criteria; or
(B) not to propose adoption of any grouping of standards, implementation specifications, or certification criMarch 13, 2013

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teria, the Secretary shall notify the National Coordinator
and the HIT Standards Committee in writing of such determination and the reasons for not proposing the adoption
of such recommendation.
(3) PUBLICATION.—The Secretary shall provide for publication in the Federal Register of all determinations made by the
Secretary under paragraph (1).
(b) ADOPTION OF STANDARDS, IMPLEMENTATION SPECIFICATIONS, AND CERTIFICATION CRITERIA.—
(1) IN GENERAL.—Not later than December 31, 2009, the
Secretary shall, through the rulemaking process consistent
with subsection (a)(2)(A), adopt an initial set of standards, implementation specifications, and certification criteria for the
areas required for consideration under section 3002(b)(2)(B).
The rulemaking for the initial set of standards, implementation specifications, and certification criteria may be issued on
an interim, final basis.
(2) APPLICATION OF CURRENT STANDARDS, IMPLEMENTATION
SPECIFICATIONS, AND CERTIFICATION CRITERIA.—The standards,
implementation specifications, and certification criteria adopted before the date of the enactment of this title through the
process existing through the Office of the National Coordinator
for Health Information Technology may be applied towards
meeting the requirement of paragraph (1).
(3) SUBSEQUENT STANDARDS ACTIVITY.—The Secretary shall
adopt additional standards, implementation specifications, and
certification criteria as necessary and consistent with the
schedule published under section 3003(b)(2).
SEC. 3005. ø300jj–15¿ APPLICATION AND USE OF ADOPTED STANDARDS
AND IMPLEMENTATION SPECIFICATIONS BY FEDERAL
AGENCIES.

For requirements relating to the application and use by Federal agencies of the standards and implementation specifications
adopted under section 3004, see section 13111 of the Health Information Technology for Economic and Clinical Health Act.
SEC. 3006. ø300jj–16¿ VOLUNTARY APPLICATION AND USE OF ADOPTED
STANDARDS AND IMPLEMENTATION SPECIFICATIONS BY
PRIVATE ENTITIES.
(a) IN GENERAL.—Except as provided under section 13112 of

the HITECH Act, nothing in such Act or in the amendments made
by such Act shall be construed—
(1) to require a private entity to adopt or comply with a
standard or implementation specification adopted under section 3004; or
(2) to provide a Federal agency authority, other than the
authority such agency may have under other provisions of law,
to require a private entity to comply with such a standard or
implementation specification.
(b) RULE OF CONSTRUCTION.—Nothing in this subtitle shall be
construed to require that a private entity that enters into a contract with the Federal Government apply or use the standards and
implementation specifications adopted under section 3004 with respect to activities not related to the contract.
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SEC. 3007. ø300jj–17¿ FEDERAL HEALTH INFORMATION TECHNOLOGY.
(a) IN GENERAL.—The National Coordinator shall support the

development and routine updating of qualified electronic health
record technology (as defined in section 3000) consistent with subsections (b) and (c) and make available such qualified electronic
health record technology unless the Secretary determines through
an assessment that the needs and demands of providers are being
substantially and adequately met through the marketplace.
(b) CERTIFICATION.—In making such electronic health record
technology publicly available, the National Coordinator shall ensure that the qualified electronic health record technology described in subsection (a) is certified under the program developed
under section 3001(c)(3) to be in compliance with applicable standards adopted under section 3003(a).
(c) AUTHORIZATION TO CHARGE A NOMINAL FEE.—The National
Coordinator may impose a nominal fee for the adoption by a health
care provider of the health information technology system developed or approved under subsection (a) and (b). Such fee shall take
into account the financial circumstances of smaller providers, low
income providers, and providers located in rural or other medically
underserved areas.
(d) RULE OF CONSTRUCTION.—Nothing in this section shall be
construed to require that a private or government entity adopt or
use the technology provided under this section.
SEC. 3008. ø300jj–18¿ TRANSITIONS.

(a) ONCHIT.—To the extent consistent with section 3001, all
functions, personnel, assets, liabilities, and administrative actions
applicable to the National Coordinator for Health Information
Technology appointed under Executive Order No. 13335 or the Office of such National Coordinator on the date before the date of the
enactment of this title shall be transferred to the National Coordinator appointed under section 3001(a) and the Office of such National Coordinator as of the date of the enactment of this title.
(b) NATIONAL EHEALTH COLLABORATIVE.—Nothing in sections
3002 or 3003 or this subsection shall be construed as prohibiting
the AHIC Successor, Inc. doing business as the National eHealth
Collaborative from modifying its charter, duties, membership, and
any other structure or function required to be consistent with section 3002 and 3003 so as to allow the Secretary to recognize such
AHIC Successor, Inc. as the HIT Policy Committee or the HIT
Standards Committee.
(c) CONSISTENCY OF RECOMMENDATIONS.—In carrying out section 3003(b)(1)(A), until recommendations are made by the HIT
Policy Committee, recommendations of the HIT Standards Committee shall be consistent with the most recent recommendations
made by such AHIC Successor, Inc.
SEC. 3009. ø300jj–19¿ MISCELLANEOUS PROVISIONS.
(a) RELATION TO HIPAA PRIVACY AND SECURITY LAW.—
(1) IN GENERAL.—With respect to the relation of this

title
to HIPAA privacy and security law:
(A) This title may not be construed as having any effect on the authorities of the Secretary under HIPAA privacy and security law.

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(B) The purposes of this title include ensuring that the
health information technology standards and implementation specifications adopted under section 3004 take into account the requirements of HIPAA privacy and security
law.
(2) DEFINITION.—For purposes of this section, the term
‘‘HIPAA privacy and security law’’ means—
(A) the provisions of part C of title XI of the Social Security Act, section 264 of the Health Insurance Portability
and Accountability Act of 1996, and subtitle D of title IV
of the Health Information Technology for Economic and
Clinical Health Act; and
(B) regulations under such provisions.
(b) FLEXIBILITY.—In administering the provisions of this title,
the Secretary shall have flexibility in applying the definition of
health care provider under section 3000(3), including the authority
to omit certain entities listed in such definition when applying such
definition under this title, where appropriate.

Subtitle B—Incentives for the Use of
Health Information Technology
SEC. 3011. ø300jj–31¿ IMMEDIATE FUNDING TO STRENGTHEN THE
HEALTH INFORMATION TECHNOLOGY INFRASTRUCTURE.
(a) IN GENERAL.—The Secretary shall, using amounts appro-

priated under section 3018, invest in the infrastructure necessary
to allow for and promote the electronic exchange and use of health
information for each individual in the United States consistent
with the goals outlined in the strategic plan developed by the National Coordinator (and as available) under section 3001. The Secretary shall invest funds through the different agencies with expertise in such goals, such as the Office of the National Coordinator
for Health Information Technology, the Health Resources and Services Administration, the Agency for Healthcare Research and Quality, the Centers of Medicare & Medicaid Services, the Centers for
Disease Control and Prevention, and the Indian Health Service to
support the following:
(1) Health information technology architecture that will
support the nationwide electronic exchange and use of health
information in a secure, private, and accurate manner, including connecting health information exchanges, and which may
include updating and implementing the infrastructure necessary within different agencies of the Department of Health
and Human Services to support the electronic use and exchange of health information.
(2) Development and adoption of appropriate certified electronic health records for categories of health care providers not
eligible for support under title XVIII or XIX of the Social Security Act for the adoption of such records.
(3) Training on and dissemination of information on best
practices to integrate health information technology, including
electronic health records, into a provider’s delivery of care, consistent with best practices learned from the Health InformaMarch 13, 2013

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tion Technology Research Center developed under section
3012(b), including community health centers receiving assistance under section 330, covered entities under section 340B,
and providers participating in one or more of the programs
under titles XVIII, XIX, and XXI of the Social Security Act (relating to Medicare, Medicaid, and the State Children’s Health
Insurance Program).
(4) Infrastructure and tools for the promotion of telemedicine, including coordination among Federal agencies in the promotion of telemedicine.
(5) Promotion of the interoperability of clinical data repositories or registries.
(6) Promotion of technologies and best practices that enhance the protection of health information by all holders of individually identifiable health information.
(7) Improvement and expansion of the use of health information technology by public health departments.
(b) COORDINATION.—The Secretary shall ensure funds under
this section are used in a coordinated manner with other health information promotion activities.
(c) ADDITIONAL USE OF FUNDS.—In addition to using funds as
provided in subsection (a), the Secretary may use amounts appropriated under section 3018 to carry out health information technology activities that are provided for under laws in effect on the
date of the enactment of this title.
(d) STANDARDS FOR ACQUISITION OF HEALTH INFORMATION
TECHNOLOGY.—To the greatest extent practicable, the Secretary
shall ensure that where funds are expended under this section for
the acquisition of health information technology, such funds shall
be used to acquire health information technology that meets applicable standards adopted under section 3004. Where it is not practicable to expend funds on health information technology that
meets such applicable standards, the Secretary shall ensure that
such health information technology meets applicable standards otherwise adopted by the Secretary.
SEC. 3012. ø300jj–32¿ HEALTH INFORMATION TECHNOLOGY IMPLEMENTATION ASSISTANCE.
(a) HEALTH INFORMATION TECHNOLOGY EXTENSION PROGRAM.—

To assist health care providers to adopt, implement, and effectively
use certified EHR technology that allows for the electronic exchange and use of health information, the Secretary, acting
through the Office of the National Coordinator, shall establish a
health information technology extension program to provide health
information technology assistance services to be carried out
through the Department of Health and Human Services. The National Coordinator shall consult with other Federal agencies with
demonstrated experience and expertise in information technology
services, such as the National Institute of Standards and Technology, in developing and implementing this program.
(b) HEALTH INFORMATION TECHNOLOGY RESEARCH CENTER.—
(1) IN GENERAL.—The Secretary shall create a Health Information Technology Research Center (in this section referred
to as the ‘‘Center’’) to provide technical assistance and develop
or recognize best practices to support and accelerate efforts to
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adopt, implement, and effectively utilize health information
technology that allows for the electronic exchange and use of
information in compliance with standards, implementation
specifications, and certification criteria adopted under section
3004.
(2) INPUT.—The Center shall incorporate input from—
(A) other Federal agencies with demonstrated experience and expertise in information technology services such
as the National Institute of Standards and Technology;
(B) users of health information technology, such as
providers and their support and clerical staff and others
involved in the care and care coordination of patients, from
the health care and health information technology industry; and
(C) others as appropriate.
(3) PURPOSES.—The purposes of the Center are to—
(A) provide a forum for the exchange of knowledge and
experience;
(B) accelerate the transfer of lessons learned from existing public and private sector initiatives, including those
currently receiving Federal financial support;
(C) assemble, analyze, and widely disseminate evidence and experience related to the adoption, implementation, and effective use of health information technology
that allows for the electronic exchange and use of information including through the regional centers described in
subsection (c);
(D) provide technical assistance for the establishment
and evaluation of regional and local health information
networks to facilitate the electronic exchange of information across health care settings and improve the quality of
health care;
(E) provide technical assistance for the development
and dissemination of solutions to barriers to the exchange
of electronic health information; and
(F) learn about effective strategies to adopt and utilize
health information technology in medically underserved
communities.
(c) HEALTH INFORMATION TECHNOLOGY REGIONAL EXTENSION
CENTERS.—
(1) IN GENERAL.—The Secretary shall provide assistance
for the creation and support of regional centers (in this subsection referred to as ‘‘regional centers’’) to provide technical
assistance and disseminate best practices and other information learned from the Center to support and accelerate efforts
to adopt, implement, and effectively utilize health information
technology that allows for the electronic exchange and use of
information in compliance with standards, implementation
specifications, and certification criteria adopted under section
3004. Activities conducted under this subsection shall be consistent with the strategic plan developed by the National Coordinator, (and, as available) under section 3001.
(2) AFFILIATION.—Regional centers shall be affiliated with
any United States-based nonprofit institution or organization,
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or group thereof, that applies and is awarded financial assistance under this section. Individual awards shall be decided on
the basis of merit.
(3) OBJECTIVE.—The objective of the regional centers is to
enhance and promote the adoption of health information technology through—
(A) assistance with the implementation, effective use,
upgrading, and ongoing maintenance of health information
technology, including electronic health records, to
healthcare providers nationwide;
(B) broad participation of individuals from industry,
universities, and State governments;
(C) active dissemination of best practices and research
on the implementation, effective use, upgrading, and ongoing maintenance of health information technology, including electronic health records, to health care providers in
order to improve the quality of healthcare and protect the
privacy and security of health information;
(D) participation, to the extent practicable, in health
information exchanges;
(E) utilization, when appropriate, of the expertise and
capability that exists in Federal agencies other than the
Department; and
(F) integration of health information technology, including electronic health records, into the initial and ongoing training of health professionals and others in the
healthcare industry that would be instrumental to improving the quality of healthcare through the smooth and accurate electronic use and exchange of health information.
(4) REGIONAL ASSISTANCE.—Each regional center shall aim
to provide assistance and education to all providers in a region,
but shall prioritize any direct assistance first to the following:
(A) Public or not-for-profit hospitals or critical access
hospitals.
(B) Federally qualified health centers (as defined in
section 1861(aa)(4) of the Social Security Act).
(C) Entities that are located in rural and other areas
that serve uninsured, underinsured, and medically underserved individuals (regardless of whether such area is
urban or rural).
(D) Individual or small group practices (or a consortium thereof) that are primarily focused on primary care.
(5) FINANCIAL SUPPORT.—The Secretary may provide financial support to any regional center created under this subsection for a period not to exceed four years. The Secretary
may not provide more than 50 percent of the capital and annual operating and maintenance funds required to create and
maintain such a center, except in an instance of national economic conditions which would render this cost-share requirement detrimental to the program and upon notification to Congress as to the justification to waive the cost-share requirement.
(6) NOTICE OF PROGRAM DESCRIPTION AND AVAILABILITY OF
FUNDS.—The Secretary shall publish in the Federal Register,
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not later than 90 days after the date of the enactment of this
title, a draft description of the program for establishing regional centers under this subsection. Such description shall include the following:
(A) A detailed explanation of the program and the programs goals.
(B) Procedures to be followed by the applicants.
(C) Criteria for determining qualified applicants.
(D) Maximum support levels expected to be available
to centers under the program.
(7) APPLICATION REVIEW.—The Secretary shall subject each
application under this subsection to merit review. In making a
decision whether to approve such application and provide financial support, the Secretary shall consider at a minimum the
merits of the application, including those portions of the application regarding—
(A) the ability of the applicant to provide assistance
under this subsection and utilization of health information
technology appropriate to the needs of particular categories of health care providers;
(B) the types of service to be provided to health care
providers;
(C) geographical diversity and extent of service area;
and
(D) the percentage of funding and amount of in-kind
commitment from other sources.
(8) BIENNIAL EVALUATION.—Each regional center which receives financial assistance under this subsection shall be evaluated biennially by an evaluation panel appointed by the Secretary. Each evaluation panel shall be composed of private experts, none of whom shall be connected with the center involved, and of Federal officials. Each evaluation panel shall
measure the involved center’s performance against the objective specified in paragraph (3). The Secretary shall not continue to provide funding to a regional center unless its evaluation is overall positive.
(9) CONTINUING SUPPORT.—After the second year of assistance under this subsection, a regional center may receive additional support under this subsection if it has received positive
evaluations and a finding by the Secretary that continuation of
Federal funding to the center was in the best interest of provision of health information technology extension services.
SEC. 3013. ø300jj–33¿ STATE GRANTS TO PROMOTE HEALTH INFORMATION TECHNOLOGY.
(a) IN GENERAL.—The Secretary, acting through the National

Coordinator, shall establish a program in accordance with this section to facilitate and expand the electronic movement and use of
health information among organizations according to nationally
recognized standards.
(b) PLANNING GRANTS.—The Secretary may award a grant to
a State or qualified State-designated entity (as described in subsection (f)) that submits an application to the Secretary at such
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retary may specify, for the purpose of planning activities described
in subsection (d).
(c) IMPLEMENTATION GRANTS.—The Secretary may award a
grant to a State or qualified State designated entity that—
(1) has submitted, and the Secretary has approved, a plan
described in subsection (e) (regardless of whether such plan
was prepared using amounts awarded under subsection (b);
and
(2) submits an application at such time, in such manner,
and containing such information as the Secretary may specify.
(d) USE OF FUNDS.—Amounts received under a grant under
subsection (c) shall be used to conduct activities to facilitate and
expand the electronic movement and use of health information
among organizations according to nationally recognized standards
through activities that include—
(1) enhancing broad and varied participation in the authorized and secure nationwide electronic use and exchange of
health information;
(2) identifying State or local resources available towards a
nationwide effort to promote health information technology;
(3) complementing other Federal grants, programs, and efforts towards the promotion of health information technology;
(4) providing technical assistance for the development and
dissemination of solutions to barriers to the exchange of electronic health information;
(5) promoting effective strategies to adopt and utilize
health information technology in medically underserved communities;
(6) assisting patients in utilizing health information technology;
(7) encouraging clinicians to work with Health Information
Technology Regional Extension Centers as described in section
3012, to the extent they are available and valuable;
(8) supporting public health agencies’ authorized use of
and access to electronic health information;
(9) promoting the use of electronic health records for quality improvement including through quality measures reporting;
and
(10) such other activities as the Secretary may specify.
(e) PLAN.—
(1) IN GENERAL.—A plan described in this subsection is a
plan that describes the activities to be carried out by a State
or by the qualified State-designated entity within such State to
facilitate and expand the electronic movement and use of
health information among organizations according to nationally recognized standards and implementation specifications.
(2) REQUIRED ELEMENTS.—A plan described in paragraph
(1) shall—
(A) be pursued in the public interest;
(B) be consistent with the strategic plan developed by
the National Coordinator, (and, as available) under section
3001;
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(C) include a description of the ways the State or
qualified State-designated entity will carry out the activities described in subsection (b); and
(D) contain such elements as the Secretary may require.
(f) QUALIFIED STATE-DESIGNATED ENTITY.—For purposes of
this section, to be a qualified State-designated entity, with respect
to a State, an entity shall—
(1) be designated by the State as eligible to receive awards
under this section;
(2) be a not-for-profit entity with broad stakeholder representation on its governing board;
(3) demonstrate that one of its principal goals is to use information technology to improve health care quality and efficiency through the authorized and secure electronic exchange
and use of health information;
(4) adopt nondiscrimination and conflict of interest policies
that demonstrate a commitment to open, fair, and nondiscriminatory participation by stakeholders; and
(5) conform to such other requirements as the Secretary
may establish.
(g) REQUIRED CONSULTATION.—In carrying out activities described in subsections (b) and (c), a State or qualified State-designated entity shall consult with and consider the recommendations of—
(1) health care providers (including providers that provide
services to low income and underserved populations);
(2) health plans;
(3) patient or consumer organizations that represent the
population to be served;
(4) health information technology vendors;
(5) health care purchasers and employers;
(6) public health agencies;
(7) health professions schools, universities and colleges;
(8) clinical researchers;
(9) other users of health information technology such as
the support and clerical staff of providers and others involved
in the care and care coordination of patients; and
(10) such other entities, as may be determined appropriate
by the Secretary.
(h) CONTINUOUS IMPROVEMENT.—The Secretary shall annually
evaluate the activities conducted under this section and shall, in
awarding grants under this section, implement the lessons learned
from such evaluation in a manner so that awards made subsequent
to each such evaluation are made in a manner that, in the determination of the Secretary, will lead towards the greatest improvement in quality of care, decrease in costs, and the most effective
authorized and secure electronic exchange of health information.
(i) REQUIRED MATCH.—
(1) IN GENERAL.—For a fiscal year (beginning with fiscal
year 2011), the Secretary may not make a grant under this
section to a State unless the State agrees to make available
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tions) toward the costs of a grant awarded under subsection (c)
in an amount equal to—
(A) for fiscal year 2011, not less than $1 for each $10
of Federal funds provided under the grant;
(B) for fiscal year 2012, not less than $1 for each $7
of Federal funds provided under the grant; and
(C) for fiscal year 2013 and each subsequent fiscal
year, not less than $1 for each $3 of Federal funds provided under the grant.
(2) AUTHORITY TO REQUIRE STATE MATCH FOR FISCAL YEARS
BEFORE FISCAL YEAR 2011.—For any fiscal year during the grant
program under this section before fiscal year 2011, the Secretary may determine the extent to which there shall be required a non-Federal contribution from a State receiving a
grant under this section.
SEC. 3014. ø300jj–34¿ COMPETITIVE GRANTS TO STATES AND INDIAN
TRIBES FOR THE DEVELOPMENT OF LOAN PROGRAMS TO
FACILITATE THE WIDESPREAD ADOPTION OF CERTIFIED
EHR TECHNOLOGY.
(a) IN GENERAL.—The National Coordinator may award com-

petitive grants to eligible entities for the establishment of programs
for loans to health care providers to conduct the activities described
in subsection (e).
(b) ELIGIBLE ENTITY DEFINED.—For purposes of this subsection, the term ‘‘eligible entity’’ means a State or Indian tribe (as
defined in the Indian Self-Determination and Education Assistance
Act) that—
(1) submits to the National Coordinator an application at
such time, in such manner, and containing such information as
the National Coordinator may require;
(2) submits to the National Coordinator a strategic plan in
accordance with subsection (d) and provides to the National
Coordinator assurances that the entity will update such plan
annually in accordance with such subsection;
(3) provides assurances to the National Coordinator that
the entity will establish a Loan Fund in accordance with subsection (c);
(4) provides assurances to the National Coordinator that
the entity will not provide a loan from the Loan Fund to a
health care provider unless the provider agrees to—
(A) submit reports on quality measures adopted by the
Federal Government (by not later than 90 days after the
date on which such measures are adopted), to—
(i) the Administrator of the Centers for Medicare
& Medicaid Services (or his or her designee), in the
case of an entity participating in the Medicare program under title XVIII of the Social Security Act or
the Medicaid program under title XIX of such Act; or
(ii) the Secretary in the case of other entities;
(B) demonstrate to the satisfaction of the Secretary
(through criteria established by the Secretary) that any
certified EHR technology purchased, improved, or otherwise financially supported under a loan under this section
is used to exchange health information in a manner that,
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in accordance with law and standards (as adopted under
section 3004) applicable to the exchange of information,
improves the quality of health care, such as promoting
care coordination; and
(C) comply with such other requirements as the entity
or the Secretary may require;
(D) include a plan on how health care providers involved intend to maintain and support the certified EHR
technology over time;
(E) include a plan on how the health care providers involved intend to maintain and support the certified EHR
technology that would be purchased with such loan, including the type of resources expected to be involved and
any such other information as the State or Indian Tribe,
respectively, may require; and
(5) agrees to provide matching funds in accordance with
subsection (h).
(c) ESTABLISHMENT OF FUND.—For purposes of subsection
(b)(3), an eligible entity shall establish a certified EHR technology
loan fund (referred to in this subsection as a ‘‘Loan Fund’’) and
comply with the other requirements contained in this section. A
grant to an eligible entity under this section shall be deposited in
the Loan Fund established by the eligible entity. No funds authorized by other provisions of this title to be used for other purposes
specified in this title shall be deposited in any Loan Fund.
(d) STRATEGIC PLAN.—
(1) IN GENERAL.—For purposes of subsection (b)(2), a strategic plan of an eligible entity under this subsection shall identify the intended uses of amounts available to the Loan Fund
of such entity.
(2) CONTENTS.—A strategic plan under paragraph (1), with
respect to a Loan Fund of an eligible entity, shall include for
a year the following:
(A) A list of the projects to be assisted through the
Loan Fund during such year.
(B) A description of the criteria and methods established for the distribution of funds from the Loan Fund
during the year.
(C) A description of the financial status of the Loan
Fund as of the date of submission of the plan.
(D) The short-term and long-term goals of the Loan
Fund.
(e) USE OF FUNDS.—Amounts deposited in a Loan Fund, including loan repayments and interest earned on such amounts,
shall be used only for awarding loans or loan guarantees, making
reimbursements described in subsection (g)(4)(A), or as a source of
reserve and security for leveraged loans, the proceeds of which are
deposited in the Loan Fund established under subsection (c). Loans
under this section may be used by a health care provider to—
(1) facilitate the purchase of certified EHR technology;
(2) enhance the utilization of certified EHR technology
(which may include costs associated with upgrading health information technology so that it meets criteria necessary to be
a certified EHR technology);
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(3) train personnel in the use of such technology; or
(4) improve the secure electronic exchange of health information.
(f) TYPES OF ASSISTANCE.—Except as otherwise limited by applicable State law, amounts deposited into a Loan Fund under this
section may only be used for the following:
(1) To award loans that comply with the following:
(A) The interest rate for each loan shall not exceed the
market interest rate.
(B) The principal and interest payments on each loan
shall commence not later than 1 year after the date the
loan was awarded, and each loan shall be fully amortized
not later than 10 years after the date of the loan.
(C) The Loan Fund shall be credited with all payments
of principal and interest on each loan awarded from the
Loan Fund.
(2) To guarantee, or purchase insurance for, a local obligation (all of the proceeds of which finance a project eligible for
assistance under this subsection) if the guarantee or purchase
would improve credit market access or reduce the interest rate
applicable to the obligation involved.
(3) As a source of revenue or security for the payment of
principal and interest on revenue or general obligation bonds
issued by the eligible entity if the proceeds of the sale of the
bonds will be deposited into the Loan Fund.
(4) To earn interest on the amounts deposited into the
Loan Fund.
(5) To make reimbursements described in subsection
(g)(4)(A).
(g) ADMINISTRATION OF LOAN FUNDS.—
(1) COMBINED FINANCIAL ADMINISTRATION.—An eligible entity may (as a convenience and to avoid unnecessary administrative costs) combine, in accordance with applicable State law,
the financial administration of a Loan Fund established under
this subsection with the financial administration of any other
revolving fund established by the entity if otherwise not prohibited by the law under which the Loan Fund was established.
(2) COST OF ADMINISTERING FUND.—Each eligible entity
may annually use not to exceed 4 percent of the funds provided
to the entity under a grant under this section to pay the reasonable costs of the administration of the programs under this
section, including the recovery of reasonable costs expended to
establish a Loan Fund which are incurred after the date of the
enactment of this title.
(3) GUIDANCE AND REGULATIONS.—The National Coordinator shall publish guidance and promulgate regulations as
may be necessary to carry out the provisions of this section, including—
(A) provisions to ensure that each eligible entity commits and expends funds allotted to the entity under this
section as efficiently as possible in accordance with this
title and applicable State laws; and
(B) guidance to prevent waste, fraud, and abuse.
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(4) PRIVATE SECTOR CONTRIBUTIONS.—
(A) IN GENERAL.—A Loan Fund established under this
section may accept contributions from private sector entities, except that such entities may not specify the recipient
or recipients of any loan issued under this subsection. An
eligible entity may agree to reimburse a private sector entity for any contribution made under this subparagraph,
except that the amount of such reimbursement may not be
greater than the principal amount of the contribution
made.
(B) AVAILABILITY OF INFORMATION.—An eligible entity
shall make publicly available the identity of, and amount
contributed by, any private sector entity under subparagraph (A) and may issue letters of commendation or make
other awards (that have no financial value) to any such entity.
(h) MATCHING REQUIREMENTS.—
(1) IN GENERAL.—The National Coordinator may not make
a grant under subsection (a) to an eligible entity unless the entity agrees to make available (directly or through donations
from public or private entities) non-Federal contributions in
cash to the costs of carrying out the activities for which the
grant is awarded in an amount equal to not less than $1 for
each $5 of Federal funds provided under the grant.
(2) DETERMINATION OF AMOUNT OF NON-FEDERAL CONTRIBUTION.—In determining the amount of non-Federal contributions that an eligible entity has provided pursuant to subparagraph (A), the National Coordinator may not include any
amounts provided to the entity by the Federal Government.
(i) EFFECTIVE DATE.—The Secretary may not make an award
under this section prior to January 1, 2010.
SEC. 3015. ø300jj–35¿ DEMONSTRATION PROGRAM TO INTEGRATE INFORMATION TECHNOLOGY INTO CLINICAL EDUCATION.
(a) IN GENERAL.—The Secretary may award grants under this

section to carry out demonstration projects to develop academic
curricula integrating certified EHR technology in the clinical education of health professionals. Such awards shall be made on a
competitive basis and pursuant to peer review.
(b) ELIGIBILITY.—To be eligible to receive a grant under subsection (a), an entity shall—
(1) submit to the Secretary an application at such time, in
such manner, and containing such information as the Secretary may require;
(2) submit to the Secretary a strategic plan for integrating
certified EHR technology in the clinical education of health
professionals to reduce medical errors, increase access to prevention, reduce chronic diseases, and enhance health care quality;
(3) be—
(A) a school of medicine, osteopathic medicine, dentistry, or pharmacy, a graduate program in behavioral or
mental health, or any other graduate health professions
school;
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(B) a graduate school of nursing or physician assistant
studies;
(C) a consortium of two or more schools described in
subparagraph (A) or (B); or
(D) an institution with a graduate medical education
program in medicine, osteopathic medicine, dentistry,
pharmacy, nursing, or physician assistance studies;
(4) provide for the collection of data regarding the effectiveness of the demonstration project to be funded under the
grant in improving the safety of patients, the efficiency of
health care delivery, and in increasing the likelihood that graduates of the grantee will adopt and incorporate certified EHR
technology, in the delivery of health care services; and
(5) provide matching funds in accordance with subsection
(d).
(c) USE OF FUNDS.—
(1) IN GENERAL.—With respect to a grant under subsection
(a), an eligible entity shall—
(A) use grant funds in collaboration with 2 or more
disciplines; and
(B) use grant funds to integrate certified EHR technology into community-based clinical education.
(2) LIMITATION.—An eligible entity shall not use amounts
received under a grant under subsection (a) to purchase hardware, software, or services.
(d) FINANCIAL SUPPORT.—The Secretary may not provide more
than 50 percent of the costs of any activity for which assistance is
provided under subsection (a), except in an instance of national economic conditions which would render the cost-share requirement
under this subsection detrimental to the program and upon notification to Congress as to the justification to waive the cost-share requirement.
(e) EVALUATION.—The Secretary shall take such action as may
be necessary to evaluate the projects funded under this section and
publish, make available, and disseminate the results of such evaluations on as wide a basis as is practicable.
(f) REPORTS.—Not later than 1 year after the date of enactment
of this title, and annually thereafter, the Secretary shall submit to
the Committee on Health, Education, Labor, and Pensions and the
Committee on Finance of the Senate, and the Committee on Energy
and Commerce of the House of Representatives a report that—
(1) describes the specific projects established under this
section; and
(2) contains recommendations for Congress based on the
evaluation conducted under subsection (e).
SEC. 3016. ø300jj–36¿ INFORMATION TECHNOLOGY PROFESSIONALS IN
HEALTH CARE.
(a) IN GENERAL.—The Secretary, in consultation with the Di-

rector of the National Science Foundation, shall provide assistance
to institutions of higher education (or consortia thereof) to establish
or expand medical health informatics education programs, including certification, undergraduate, and masters degree programs, for
both health care and information technology students to ensure the
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rapid and effective utilization and development of health information technologies (in the United States health care infrastructure).
(b) ACTIVITIES.—Activities for which assistance may be provided under subsection (a) may include the following:
(1) Developing and revising curricula in medical health
informatics and related disciplines.
(2) Recruiting and retaining students to the program involved.
(3) Acquiring equipment necessary for student instruction
in these programs, including the installation of testbed networks for student use.
(4) Establishing or enhancing bridge programs in the
health informatics fields between community colleges and universities.
(c) PRIORITY.—In providing assistance under subsection (a), the
Secretary shall give preference to the following:
(1) Existing education and training programs.
(2) Programs designed to be completed in less than six
months.
SEC. 3017. ø300jj–37¿ GENERAL GRANT AND LOAN PROVISIONS.
(a) REPORTS.—The Secretary may require that an entity

receiving assistance under this subtitle shall submit to the Secretary, not
later than the date that is 1 year after the date of receipt of such
assistance, a report that includes—
(1) an analysis of the effectiveness of the activities for
which the entity receives such assistance, as compared to the
goals for such activities; and
(2) an analysis of the impact of the project on health care
quality and safety.
(b) REQUIREMENT TO IMPROVE QUALITY OF CARE AND DECREASE IN COSTS.—The National Coordinator shall annually evaluate the activities conducted under this subtitle and shall, in awarding grants, implement the lessons learned from such evaluation in
a manner so that awards made subsequent to each such evaluation
are made in a manner that, in the determination of the National
Coordinator, will result in the greatest improvement in the quality
and efficiency of health care.
SEC. 3018. ø300jj–38¿ AUTHORIZATION FOR APPROPRIATIONS.

For the purposes of carrying out this subtitle, there is authorized to be appropriated such sums as may be necessary for each of
the fiscal years 2009 through 2013.

Subtitle C—Other Provisions
SEC. 3021. ø300jj–51¿ HEALTH INFORMATION TECHNOLOGY ENROLLMENT STANDARDS AND PROTOCOLS.
(a) IN GENERAL.—
(1) STANDARDS AND PROTOCOLS.—Not later than 180 days

after the date of enactment of this title, the Secretary, in consultation with the HIT Policy Committee and the HIT Standards Committee, shall develop interoperable and secure standards and protocols that facilitate enrollment of individuals in
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Federal and State health and human services programs, as determined by the Secretary.
(2) METHODS.—The Secretary shall facilitate enrollment in
such programs through methods determined appropriate by the
Secretary, which shall include providing individuals and third
parties authorized by such individuals and their designees notification of eligibility and verification of eligibility required
under such programs.
(b) CONTENT.—The standards and protocols for electronic enrollment in the Federal and State programs described in subsection
(a) shall allow for the following:
(1) Electronic matching against existing Federal and State
data, including vital records, employment history, enrollment
systems, tax records, and other data determined appropriate
by the Secretary to serve as evidence of eligibility and in lieu
of paper-based documentation.
(2) Simplification and submission of electronic documentation, digitization of documents, and systems verification of eligibility.
(3) Reuse of stored eligibility information (including documentation) to assist with retention of eligible individuals.
(4) Capability for individuals to apply, recertify and manage their eligibility information online, including at home, at
points of service, and other community-based locations.
(5) Ability to expand the enrollment system to integrate
new programs, rules, and functionalities, to operate at increased volume, and to apply streamlined verification and eligibility processes to other Federal and State programs, as appropriate.
(6) Notification of eligibility, recertification, and other
needed communication regarding eligibility, which may include
communication via email and cellular phones.
(7) Other functionalities necessary to provide eligibles with
streamlined enrollment process.
(c) APPROVAL AND NOTIFICATION.—With respect to any standard or protocol developed under subsection (a) that has been approved by the HIT Policy Committee and the HIT Standards Committee, the Secretary—
(1) shall notify States of such standards or protocols; and
(2) may require, as a condition of receiving Federal funds
for the health information technology investments, that States
or other entities incorporate such standards and protocols into
such investments.
(d) GRANTS FOR IMPLEMENTATION OF APPROPRIATE ENROLLMENT HIT.—
(1) IN GENERAL.—The Secretary shall award grant to eligible entities to develop new, and adapt existing, technology systems to implement the HIT enrollment standards and protocols
developed under subsection (a) (referred to in this subsection
as ‘‘appropriate HIT technology’’).
(2) ELIGIBLE ENTITIES.—To be eligible for a grant under
this subsection, an entity shall—
(A) be a State, political subdivision of a State, or a
local governmental entity; and
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(B) submit to the Secretary an application at such
time, in such manner, and containing—
(i) a plan to adopt and implement appropriate enrollment technology that includes—
(I) proposed reduction in maintenance costs of
technology systems;
(II) elimination or updating of legacy systems;
and
(III) demonstrated collaboration with other
entities that may receive a grant under this section that are located in the same State, political
subdivision, or locality;
(ii) an assurance that the entity will share such
appropriate enrollment technology in accordance with
paragraph (4); and
(iii) such other information as the Secretary may
require.
(3) SHARING.—
(A) IN GENERAL.—The Secretary shall ensure that appropriate enrollment HIT adopted under grants under this
subsection is made available to other qualified State,
qualified political subdivisions of a State, or other appropriate qualified entities (as described in subparagraph (B))
at no cost.
(B) QUALIFIED ENTITIES.—The Secretary shall determine what entities are qualified to receive enrollment HIT
under subparagraph (A), taking into consideration the recommendations of the HIT Policy Committee and the HIT
Standards Committee.

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TITLE XXXI—DATA COLLECTION,
ANALYSIS, AND QUALITY
SEC. 3101. ø300kk¿ DATA COLLECTION, ANALYSIS, AND QUALITY.
(a) DATA COLLECTION.—
(1) IN GENERAL.—The Secretary shall ensure that, by

not
later than 2 years after the date of enactment of this title, any
federally conducted or supported health care or public health
program, activity or survey (including Current Population Surveys and American Community Surveys conducted by the Bureau of Labor Statistics and the Bureau of the Census) collects
and reports, to the extent practicable—
(A) data on race, ethnicity, sex, primary language, and
disability status for applicants, recipients, or participants;
(B) data at the smallest geographic level such as
State, local, or institutional levels if such data can be aggregated;
(C) sufficient data to generate statistically reliable estimates by racial, ethnic, sex, primary language, and disability status subgroups for applicants, recipients or participants using, if needed, statistical oversamples of these
subpopulations; and
(D) any other demographic data as deemed appropriate by the Secretary regarding health disparities.
(2) COLLECTION STANDARDS.—In collecting data described
in paragraph (1), the Secretary or designee shall—
(A) use Office of Management and Budget standards,
at a minimum, for race and ethnicity measures;
(B) develop standards for the measurement of sex, primary language, and disability status;
(C) develop standards for the collection of data described in paragraph (1) that, at a minimum—
(i) collects self-reported data by the applicant, recipient, or participant; and
(ii) collects data from a parent or legal guardian
if the applicant, recipient, or participant is a minor or
legally incapacitated;
(D) survey health care providers and establish other
procedures in order to assess access to care and treatment
for individuals with disabilities and to identify—
(i) locations where individuals with disabilities access primary, acute (including intensive), and longterm care;
(ii) the number of providers with accessible facilities and equipment to meet the needs of the individuals with disabilities, including medical diagnostic
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equipment that meets the minimum technical criteria
set forth in section 510 of the Rehabilitation Act of
1973; and
(iii) the number of employees of health care providers trained in disability awareness and patient care
of individuals with disabilities; and
(E) require that any reporting requirement imposed
for purposes of measuring quality under any ongoing or
federally conducted or supported health care or public
health program, activity, or survey includes requirements
for the collection of data on individuals receiving health
care items or services under such programs activities by
race, ethnicity, sex, primary language, and disability status.
(3) DATA MANAGEMENT.—In collecting data described in
paragraph (1), the Secretary, acting through the National Coordinator for Health Information Technology shall—
(A) develop national standards for the management of
data collected; and
(B) develop interoperability and security systems for
data management.
(b) 1 DATA ANALYSIS.—
(1) IN GENERAL.—For each federally conducted or supported health care or public health program or activity, the
Secretary shall analyze data collected under paragraph (a) to
detect and monitor trends in health disparities (as defined for
purposes of section 485E) at the Federal and State levels.
(c) DATA REPORTING AND DISSEMINATION.—
(1) IN GENERAL.—The Secretary shall make the analyses
described in (b) available to—
(A) the Office of Minority Health;
(B) the National Center on Minority Health and
Health Disparities;
(C) the Agency for Healthcare Research and Quality;
(D) the Centers for Disease Control and Prevention;
(E) the Centers for Medicare & Medicaid Services;
(F) the Indian Health Service and epidemiology centers funded under the Indian Health Care Improvement
Act;
(G) the Office of Rural health;
(H) other agencies within the Department of Health
and Human Services; and
(I) other entities as determined appropriate by the
Secretary.
(2) REPORTING OF DATA.—The Secretary shall report data
and analyses described in (a) and (b) through—
(A) public postings on the Internet websites of the Department of Health and Human Services; and
(B) any other reporting or dissemination mechanisms
determined appropriate by the Secretary.
(3) AVAILABILITY OF DATA.—The Secretary may make data
described in (a) and (b) available for additional research, anal1 So

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yses, and dissemination to other Federal agencies, non-governmental entities, and the public, in accordance with any Federal
agency’s data user agreements.
(d) LIMITATIONS ON USE OF DATA.—Nothing in this section
shall be construed to permit the use of information collected under
this section in a manner that would adversely affect any individual.
(e) PROTECTION AND SHARING OF DATA.—
(1) PRIVACY AND OTHER SAFEGUARDS.—The Secretary shall
ensure (through the promulgation of regulations or otherwise)
that—
(A) all data collected pursuant to subsection (a) is protected—
(i) under privacy protections that are at least as
broad as those that the Secretary applies to other
health data under the regulations promulgated under
section 264(c) of the Health Insurance Portability and
Accountability Act of 1996 (Public Law 104–191; 110
Stat. 2033); and
(ii) from all inappropriate internal use by any entity that collects, stores, or receives the data, including
use of such data in determinations of eligibility (or
continued eligibility) in health plans, and from other
inappropriate uses, as defined by the Secretary; and
(B) all appropriate information security safeguards are
used in the collection, analysis, and sharing of data collected pursuant to subsection (a).
(2) DATA SHARING.—The Secretary shall establish procedures for sharing data collected pursuant to subsection (a),
measures relating to such data, and analyses of such data,
with other relevant Federal and State agencies including the
agencies, centers, and entities within the Department of
Health and Human Services specified in subsection (c)(1)..
(f) DATA ON RURAL UNDERSERVED POPULATIONS.—The Secretary shall ensure that any data collected in accordance with this
section regarding racial and ethnic minority groups are also collected regarding underserved rural and frontier populations.
(g) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of
carrying out this section, there are authorized to be appropriated
such sums as may be necessary for each of fiscal years 2010
through 2014.
(h) REQUIREMENT FOR IMPLEMENTATION.—Notwithstanding any
other provision of this section, data may not be collected under this
section unless funds are directly appropriated for such purpose in
an appropriations Act.
(i) CONSULTATION.—The Secretary shall consult with the Director of the Office of Personnel Management, the Secretary of Defense, the Secretary of Veterans Affairs, the Director of the Bureau
of the Census, the Commissioner of Social Security, and the head
of other appropriate Federal agencies in carrying out this section.

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TITLE XXXII—[REPEALED.]
[Title XXXII of Public Health Service Act was repealed by section 642(a) of Public Law 112–240.]

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TITLE XXXIII—WORLD TRADE CENTER
HEALTH PROGRAM
Subtitle A—Establishment of Program;
Advisory Committee
SEC. 3301. ø42 U.S.C. 300mm¿ ESTABLISHMENT OF WORLD TRADE CENTER HEALTH PROGRAM.
(a) IN GENERAL.—There is hereby established within the De-

partment of Health and Human Services a program to be known
as the World Trade Center Health Program, which shall be administered by the WTC Program Administrator, to provide beginning
on July 1, 2011—
(1) medical monitoring and treatment benefits to eligible
emergency responders and recovery and cleanup workers (including those who are Federal employees) who responded to
the September 11, 2001, terrorist attacks; and
(2) initial health evaluation, monitoring, and treatment
benefits to residents and other building occupants and area
workers in New York City who were directly impacted and adversely affected by such attacks.
(b) COMPONENTS OF PROGRAM.—The WTC Program includes
the following components:
(1) MEDICAL MONITORING FOR RESPONDERS.—Medical monitoring under section 3311, including clinical examinations and
long-term health monitoring and analysis for enrolled WTC responders who were likely to have been exposed to airborne toxins that were released, or to other hazards, as a result of the
September 11, 2001, terrorist attacks.
(2) INITIAL HEALTH EVALUATION FOR SURVIVORS.—An initial health evaluation under section 3321, including an evaluation to determine eligibility for followup monitoring and treatment.
(3) FOLLOWUP MONITORING AND TREATMENT FOR WTC-RELATED HEALTH CONDITIONS FOR RESPONDERS AND SURVIVORS.—
Provision under sections 3312, 3322, and 3323 of followup
monitoring and treatment and payment, subject to the provisions of subsection (d), for all medically necessary health and
mental health care expenses of an individual with respect to a
WTC-related health condition (including necessary prescription
drugs).
(4) OUTREACH.—Establishment under section 3303 of an
education and outreach program to potentially eligible individuals concerning the benefits under this title.
(5) CLINICAL DATA COLLECTION AND ANALYSIS.—Collection
and analysis under section 3304 of health and mental health
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data relating to individuals receiving monitoring or treatment
benefits in a uniform manner in collaboration with the collection of epidemiological data under section 3342.
(6) RESEARCH ON HEALTH CONDITIONS.—Establishment
under subtitle C of a research program on health conditions resulting from the September 11, 2001, terrorist attacks.
(c) NO COST SHARING.—Monitoring and treatment benefits and
initial health evaluation benefits are provided under subtitle B
without any deductibles, copayments, or other cost sharing to an
enrolled WTC responder or certified-eligible WTC survivor. Initial
health evaluation benefits are provided under subtitle B without
any deductibles, copayments, or other cost sharing to a screeningeligible WTC survivor.
(d) PREVENTING FRAUD AND UNREASONABLE ADMINISTRATIVE
COSTS.—
(1) FRAUD.—The Inspector General of the Department of
Health and Human Services shall develop and implement a
program to review the WTC Program’s health care expenditures to detect fraudulent or duplicate billing and payment for
inappropriate services. This title is a Federal health care program (as defined in section 1128B(f) of the Social Security Act)
and is a health plan (as defined in section 1128C(c) of such
Act) for purposes of applying sections 1128 through 1128E of
such Act.
(2) UNREASONABLE ADMINISTRATIVE COSTS.—The Inspector
General of the Department of Health and Human Services
shall develop and implement a program to review the WTC
Program for unreasonable administrative costs, including with
respect to infrastructure, administration, and claims processing.
(e) QUALITY ASSURANCE.—The WTC Program Administrator
working with the Clinical Centers of Excellence shall develop and
implement a quality assurance program for the monitoring and
treatment delivered by such Centers of Excellence and any other
participating health care providers. Such program shall include—
(1) adherence to monitoring and treatment protocols;
(2) appropriate diagnostic and treatment referrals for participants;
(3) prompt communication of test results to participants;
and
(4) such other elements as the Administrator specifies in
consultation with the Clinical Centers of Excellence.
(f) ANNUAL PROGRAM REPORT.—
(1) IN GENERAL.—Not later than 6 months after the end of
each fiscal year in which the WTC Program is in operation, the
WTC Program Administrator shall submit an annual report to
the Congress on the operations of this title for such fiscal year
and for the entire period of operation of the program.
(2) CONTENTS INCLUDED IN REPORT.—Each annual report
under paragraph (1) shall include at least the following:
(A) ELIGIBLE INDIVIDUALS.—Information for each clinical program described in paragraph (3)—
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(i) on the number of individuals who applied for
certification under subtitle B and the number of such
individuals who were so certified;
(ii) of the individuals who were certified, on the
number who received monitoring under the program
and the number of such individuals who received medical treatment under the program;
(iii) with respect to individuals so certified who received such treatment, on the WTC-related health conditions for which they were treated; and
(iv) on the projected number of individuals who
will be certified under subtitle B in the succeeding fiscal year and the succeeding 10-year period.
(B) MONITORING, INITIAL HEALTH EVALUATION, AND
TREATMENT COSTS.—For each clinical program so described—
(i) information on the costs of monitoring and initial health evaluation and the costs of treatment and
on the estimated costs of such monitoring, evaluation,
and treatment in the succeeding fiscal year; and
(ii) an estimate of the cost of medical treatment
for WTC-related health conditions that have been paid
for or reimbursed by workers’ compensation, by public
or private health plans, or by New York City under
section 3331.
(C) ADMINISTRATIVE COSTS.—Information on the cost of
administering the program, including costs of program
support, data collection and analysis, and research conducted under the program.
(D) ADMINISTRATIVE EXPERIENCE.—Information on the
administrative performance of the program, including—
(i) the performance of the program in providing
timely evaluation of and treatment to eligible individuals; and
(ii) a list of the Clinical Centers of Excellence and
other providers that are participating in the program.
(E) SCIENTIFIC REPORTS.—A summary of the findings
of any new scientific reports or studies on the health effects associated with exposure described in section 3306(1),
including the findings of research conducted under section
3341(a).
(F) ADVISORY COMMITTEE RECOMMENDATIONS.—A list
of recommendations by the WTC Scientific/Technical Advisory Committee on additional WTC Program eligibility criteria and on additional WTC-related health conditions and
the action of the WTC Program Administrator concerning
each such recommendation.
(3) SEPARATE CLINICAL PROGRAMS DESCRIBED.—In paragraph (2), each of the following shall be treated as a separate
clinical program of the WTC Program:
(A) FIREFIGHTERS AND RELATED PERSONNEL.—The benefits provided for enrolled WTC responders described in
section 3311(a)(2)(A).
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(B) OTHER WTC RESPONDERS.—The benefits provided
for enrolled WTC responders not described in subparagraph (A).
(C) WTC SURVIVORS.—The benefits provided for
screening-eligible WTC survivors and certified-eligible
WTC survivors in section 3321(a).
(g) NOTIFICATION TO CONGRESS UPON REACHING 80 PERCENT
OF ELIGIBILITY NUMERICAL LIMITS.—The Secretary shall promptly
notify the Congress of each of the following:
(1) When the number of enrollments of WTC responders
subject to the limit established under section 3311(a)(4) has
reached 80 percent of such limit.
(2) When the number of certifications for certified-eligible
WTC survivors subject to the limit established under section
3321(a)(3) has reached 80 percent of such limit.
(h) CONSULTATION.—The WTC Program Administrator shall
engage in ongoing outreach and consultation with relevant stakeholders, including the WTC Health Program Steering Committees
and the Advisory Committee under section 3302, regarding the implementation and improvement of programs under this title.
SEC. 3302. ø42 U.S.C. 300mm–1¿ WTC HEALTH PROGRAM SCIENTIFIC/
TECHNICAL ADVISORY COMMITTEE; WTC HEALTH PROGRAM STEERING COMMITTEES.
(a) ADVISORY COMMITTEE.—
(1) ESTABLISHMENT.—The WTC Program Administrator

shall establish an advisory committee to be known as the WTC
Health Program Scientific/Technical Advisory Committee (in
this subsection referred to as the ‘‘Advisory Committee’’) to review scientific and medical evidence and to make recommendations to the Administrator on additional WTC Program eligibility criteria and on additional WTC-related health conditions.
(2) COMPOSITION.—The WTC Program Administrator shall
appoint the members of the Advisory Committee and shall include at least—
(A) 4 occupational physicians, at least 2 of whom have
experience treating WTC rescue and recovery workers;
(B) 1 physician with expertise in pulmonary medicine;
(C) 2 environmental medicine or environmental health
specialists;
(D) 2 representatives of WTC responders;
(E) 2 representatives of certified-eligible WTC survivors;
(F) an industrial hygienist;
(G) a toxicologist;
(H) an epidemiologist; and
(I) a mental health professional.
(3) MEETINGS.—The Advisory Committee shall meet at
such frequency as may be required to carry out its duties.
(4) REPORTS.—The WTC Program Administrator shall provide for publication of recommendations of the Advisory Committee on the public Web site established for the WTC Program.
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(5) DURATION.—Notwithstanding any other provision of
law, the Advisory Committee shall continue in operation during the period in which the WTC Program is in operation.
(6) APPLICATION OF FACA.—Except as otherwise specifically
provided, the Advisory Committee shall be subject to the Federal Advisory Committee Act.
(b) WTC HEALTH PROGRAM STEERING COMMITTEES.—
(1) CONSULTATION.—The WTC Program Administrator
shall consult with 2 steering committees (each in this section
referred to as a ‘‘Steering Committee’’) that are established as
follows:
(A) WTC RESPONDERS STEERING COMMITTEE.—One
Steering Committee, to be known as the WTC Responders
Steering Committee, for the purpose of receiving input
from affected stakeholders and facilitating the coordination
of monitoring and treatment programs for the enrolled
WTC responders under part 1 of subtitle B.
(B) WTC SURVIVORS STEERING COMMITTEE.—One
Steering Committee, to be known as the WTC Survivors
Steering Committee, for the purpose of receiving input
from affected stakeholders and facilitating the coordination
of initial health evaluations, monitoring, and treatment
programs for screening-eligible and certified-eligible WTC
survivors under part 2 of subtitle B.
(2) MEMBERSHIP.—
(A) WTC RESPONDERS STEERING COMMITTEE.—
(i) REPRESENTATION.—The WTC Responders
Steering Committee shall include—
(I) representatives of the Centers of Excellence providing services to WTC responders;
(II) representatives of labor organizations representing firefighters, police, other New York City
employees, and recovery and cleanup workers who
responded to the September 11, 2001, terrorist attacks; and
(III) 3 representatives of New York City, 1 of
whom will be selected by the police commissioner
of New York City, 1 by the health commissioner
of New York City, and 1 by the mayor of New
York City.
(ii) INITIAL MEMBERSHIP.—The WTC Responders
Steering Committee shall initially be composed of
members of the WTC Monitoring and Treatment Program Steering Committee (as in existence on the day
before the date of the enactment of this title).
(B) WTC SURVIVORS STEERING COMMITTEE.—
(i) REPRESENTATION.—The WTC Survivors Steering Committee shall include representatives of—
(I) the Centers of Excellence providing services to screening-eligible and certified-eligible
WTC survivors;
(II) the population of residents, students, and
area and other workers affected by the September
11, 2001, terrorist attacks;
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Sec. 3304

(III) screening-eligible and certified-eligible
survivors receiving initial health evaluations,
monitoring, or treatment under part 2 of subtitle
B and organizations advocating on their behalf;
and
(IV) New York City.
(ii) INITIAL MEMBERSHIP.—The WTC Survivors
Steering Committee shall initially be composed of
members of the WTC Environmental Health Center
Survivor Advisory Committee (as in existence on the
day before the date of the enactment of this title).
(C) ADDITIONAL APPOINTMENTS.—Each Steering Committee may recommend, if approved by a majority of voting
members of the Committee, additional members to the
Committee.
(D) VACANCIES.—A vacancy in a Steering Committee
shall be filled by an individual recommended by the Steering Committee.
SEC. 3303. ø42 U.S.C. 300mm–2¿ EDUCATION AND OUTREACH.

The WTC Program Administrator shall institute a program
that provides education and outreach on the existence and availability of services under the WTC Program. The outreach and education program—
(1) shall include—
(A) the establishment of a public Web site with information about the WTC Program;
(B) meetings with potentially eligible populations;
(C) development and dissemination of outreach materials informing people about the program; and
(D) the establishment of phone information services;
and
(2) shall be conducted in a manner intended—
(A) to reach all affected populations; and
(B) to include materials for culturally and linguistically diverse populations.
SEC. 3304. ø42 U.S.C. 300mm–3¿ UNIFORM DATA COLLECTION AND
ANALYSIS.
(a) IN GENERAL.—The WTC Program Administrator shall pro-

vide for the uniform collection of data, including claims data (and
analysis of data and regular reports to the Administrator) on the
prevalence of WTC-related health conditions and the identification
of new WTC-related health conditions. Such data shall be collected
for all individuals provided monitoring or treatment benefits under
subtitle B and regardless of their place of residence or Clinical Center of Excellence through which the benefits are provided. The
WTC Program Administrator shall provide, through the Data Centers or otherwise, for the integration of such data into the monitoring and treatment program activities under this title.
(b) COORDINATING THROUGH CENTERS OF EXCELLENCE.—Each
Clinical Center of Excellence shall collect data described in subsection (a) and report such data to the corresponding Data Center
for analysis by such Data Center.
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(c) COLLABORATION WITH WTC HEALTH REGISTRY.—The WTC
Program Administrator shall provide for collaboration between the
Data Centers and the World Trade Center Health Registry described in section 3342.
(d) PRIVACY.—The data collection and analysis under this section shall be conducted and maintained in a manner that protects
the confidentiality of individually identifiable health information
consistent with applicable statutes and regulations, including, as
applicable, HIPAA privacy and security law (as defined in section
3009(a)(2)) and section 552a of title 5, United States Code.
SEC. 3305. ø42 U.S.C. 300mm–4¿ CLINICAL CENTERS OF EXCELLENCE
AND DATA CENTERS.
(a) IN GENERAL.—
(1) CONTRACTS WITH CLINICAL CENTERS OF EXCELLENCE.—

The WTC Program Administrator shall, subject to subsection
(b)(1)(B), enter into contracts with Clinical Centers of Excellence (as defined in subsection (b)(1)(A))—
(A) for the provision of monitoring and treatment benefits and initial health evaluation benefits under subtitle
B;
(B) for the provision of outreach activities to individuals eligible for such monitoring and treatment benefits,
for initial health evaluation benefits, and for followup to
individuals who are enrolled in the monitoring program;
(C) for the provision of counseling for benefits under
subtitle B, with respect to WTC-related health conditions,
for individuals eligible for such benefits;
(D) for the provision of counseling for benefits for
WTC-related health conditions that may be available
under workers’ compensation or other benefit programs for
work-related injuries or illnesses, health insurance, disability insurance, or other insurance plans or through public or private social service agencies and assisting eligible
individuals in applying for such benefits;
(E) for the provision of translational and interpretive
services for program participants who are not English language proficient; and
(F) for the collection and reporting of data, including
claims data, in accordance with section 3304.
(2) CONTRACTS WITH DATA CENTERS.—
(A) IN GENERAL.—The WTC Program Administrator
shall enter into contracts with one or more Data Centers
(as defined in subsection (b)(2))—
(i) for receiving, analyzing, and reporting to the
WTC Program Administrator on data, in accordance
with section 3304, that have been collected and reported to such Data Centers by the corresponding
Clinical Centers of Excellence under subsection
(b)(1)(B)(iii);
(ii) for the development of monitoring, initial
health evaluation, and treatment protocols, with respect to WTC-related health conditions;
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(iii) for coordinating the outreach activities conducted under paragraph (1)(B) by each corresponding
Clinical Center of Excellence;
(iv) for establishing criteria for the credentialing
of medical providers participating in the nationwide
network under section 3313;
(v) for coordinating and administering the activities of the WTC Health Program Steering Committees
established under section 3002(b); and
(vi) for meeting periodically with the corresponding Clinical Centers of Excellence to obtain
input on the analysis and reporting of data collected
under clause (i) and on the development of monitoring,
initial health evaluation, and treatment protocols
under clause (ii).
(B) MEDICAL PROVIDER SELECTION.—The medical providers under subparagraph (A)(iv) shall be selected by the
WTC Program Administrator on the basis of their experience treating or diagnosing the health conditions included
in the list of WTC-related health conditions.
(C) CLINICAL DISCUSSIONS.—In carrying out subparagraph (A)(ii), a Data Center shall engage in clinical discussions across the WTC Program to guide treatment approaches for individuals with a WTC-related health condition.
(D) TRANSPARENCY OF DATA.—A contract entered into
under this subsection with a Data Center shall require the
Data Center to make any data collected and reported to
such Center under subsection (b)(1)(B)(iii) available to
health researchers and others as provided in the CDC/
ATSDR Policy on Releasing and Sharing Data.
(3) AUTHORITY FOR CONTRACTS TO BE CLASS SPECIFIC.—A
contract entered into under this subsection with a Clinical
Center of Excellence or a Data Center may be with respect to
one or more class of enrolled WTC responders, screening-eligible WTC survivors, or certified-eligible WTC survivors.
(4) USE OF COOPERATIVE AGREEMENTS.—Any contract
under this title between the WTC Program Administrator and
a Data Center or a Clinical Center of Excellence may be in the
form of a cooperative agreement.
(5) REVIEW ON FEASIBILITY OF CONSOLIDATING DATA CENTERS.—Not later than July 1, 2011, the Comptroller General of
the United States shall submit to the Committee on Energy
and Commerce of the House of Representatives and the Committee on Health, Education, Labor, and Pensions of the Senate a report on the feasibility of consolidating Data Centers
into a single Data Center.
(b) CENTERS OF EXCELLENCE.—
(1) CLINICAL CENTERS OF EXCELLENCE.—
(A) DEFINITION.—For purposes of this title, the term
‘‘Clinical Center of Excellence’’ means a Center that demonstrates to the satisfaction of the Administrator that the
Center—
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(i) uses an integrated, centralized health care provider approach to create a comprehensive suite of
health services under this title that are accessible to
enrolled WTC responders, screening-eligible WTC survivors, or certified-eligible WTC survivors;
(ii) has experience in caring for WTC responders
and screening-eligible WTC survivors or includes
health care providers who have been trained pursuant
to section 3313(c);
(iii) employs health care provider staff with expertise that includes, at a minimum, occupational medicine, environmental medicine, trauma-related psychiatry and psychology, and social services counseling;
and
(iv) meets such other requirements as specified by
the Administrator.
(B) CONTRACT REQUIREMENTS.—The WTC Program
Administrator shall not enter into a contract with a Clinical Center of Excellence under subsection (a)(1) unless the
Center agrees to do each of the following:
(i) Establish a formal mechanism for consulting
with and receiving input from representatives of eligible populations receiving monitoring and treatment
benefits under subtitle B from such Center.
(ii) Coordinate monitoring and treatment benefits
under subtitle B with routine medical care provided
for the treatment of conditions other than WTC-related health conditions.
(iii) Collect and report to the corresponding Data
Center data, including claims data, in accordance with
section 3304(b).
(iv) Have in place safeguards against fraud that
are satisfactory to the Administrator, in consultation
with the Inspector General of the Department of
Health and Human Services.
(v) Treat or refer for treatment all individuals who
are enrolled WTC responders or certified-eligible WTC
survivors with respect to such Center who present
themselves for treatment of a WTC-related health condition.
(vi) Have in place safeguards, consistent with section 3304(c), to ensure the confidentiality of an individual’s individually identifiable health information,
including requiring that such information not be disclosed to the individual’s employer without the authorization of the individual.
(vii) Use amounts paid under subsection (c)(1)
only for costs incurred in carrying out the activities
described in subsection (a), other than those described
in subsection (a)(1)(A).
(viii) Utilize health care providers with occupational and environmental medicine expertise to conduct physical and mental health assessments, in acMarch 13, 2013

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cordance with protocols developed under subsection
(a)(2)(A)(ii).
(ix) Communicate with WTC responders and
screening-eligible and certified-eligible WTC survivors
in appropriate languages and conduct outreach activities with relevant stakeholder worker or community
associations.
(x) Meet all the other applicable requirements of
this title, including regulations implementing such requirements.
(C) TRANSITION RULE TO ENSURE CONTINUITY OF
CARE.—The WTC Program Administrator shall to the maximum extent feasible ensure continuity of care in any period of transition from monitoring and treatment of an enrolled WTC responder or certified-eligible WTC survivor by
a provider to a Clinical Center of Excellence or a health
care provider participating in the nationwide network
under section 3313.
(2) DATA CENTERS.—For purposes of this title, the term
‘‘Data Center’’ means a Center that the WTC Program Administrator determines has the capacity to carry out the responsibilities for a Data Center under subsection (a)(2).
(3) CORRESPONDING CENTERS.—For purposes of this title, a
Clinical Center of Excellence and a Data Center shall be treated as ‘‘corresponding’’ to the extent that such Clinical Center
and Data Center serve the same population group.
(c) PAYMENT FOR INFRASTRUCTURE COSTS.—
(1) IN GENERAL.—The WTC Program Administrator shall
reimburse a Clinical Center of Excellence for the fixed infrastructure costs of such Center in carrying out the activities described in subtitle B at a rate negotiated by the Administrator
and such Centers. Such negotiated rate shall be fair and appropriate and take into account the number of enrolled WTC
responders receiving services from such Center under this title.
(2) FIXED INFRASTRUCTURE COSTS.—For purposes of paragraph (1), the term ‘‘fixed infrastructure costs’’ means, with respect to a Clinical Center of Excellence, the costs incurred by
such Center that are not otherwise reimbursable by the WTC
Program Administrator under section 3312(c) for patient evaluation, monitoring, or treatment but which are needed to operate the WTC program such as the costs involved in outreach
to participants or recruiting participants, data collection and
analysis, social services for counseling patients on other available assistance outside the WTC program, and the development of treatment protocols. Such term does not include costs
for new construction or other capital costs.
(d) GAO ANALYSIS.—Not later than July 1, 2011, the Comptroller General shall submit to the Committee on Energy and Commerce of the House of Representatives and the Committee on
Health, Education, Labor, and Pensions of the Senate an analysis
on whether Clinical Centers of Excellence with which the WTC
Program Administrator enters into a contract under this section
have financial systems that will allow for the timely submission of
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claims data for purposes of section 3304 and subsections (a)(1)(F)
and (b)(1)(B)(iii).
SEC. 3306. ø42 U.S.C. 300mm–5¿ DEFINITIONS.

In this title:
(1) The term ‘‘aggravating’’ means, with respect to a health
condition, a health condition that existed on September 11,
2001, and that, as a result of exposure to airborne toxins, any
other hazard, or any other adverse condition resulting from the
September 11, 2001, terrorist attacks, requires medical treatment that is (or will be) in addition to, more frequent than, or
of longer duration than the medical treatment that would have
been required for such condition in the absence of such exposure.
(2) The term ‘‘certified-eligible WTC survivor’’ has the
meaning given such term in section 3321(a)(2).
(3) The terms ‘‘Clinical Center of Excellence’’ and ‘‘Data
Center’’ have the meanings given such terms in section 3305.
(4) The term ‘‘enrolled WTC responder’’ means a WTC responder enrolled under section 3311(a)(3).
(5) The term ‘‘initial health evaluation’’ includes, with respect to an individual, a medical and exposure history, a physical examination, and additional medical testing as needed to
evaluate whether the individual has a WTC-related health condition and is eligible for treatment under the WTC Program.
(6) The term ‘‘list of WTC-related health conditions’’
means—
(A) for WTC responders, the health conditions listed in
section 3312(a)(3); and
(B) for screening-eligible and certified-eligible WTC
survivors, the health conditions listed in section 3322(b).
(7) The term ‘‘New York City disaster area’’ means the
area within New York City that is—
(A) the area of Manhattan that is south of Houston
Street; and
(B) any block in Brooklyn that is wholly or partially
contained within a 1.5-mile radius of the former World
Trade Center site.
(8) The term ‘‘New York metropolitan area’’ means an
area, specified by the WTC Program Administrator, within
which WTC responders and eligible WTC screening-eligible
survivors who reside in such area are reasonably able to access
monitoring and treatment benefits and initial health evaluation benefits under this title through a Clinical Center of Excellence described in subparagraphs (A), (B), or (C) of section
3305(b)(1).
(9) The term ‘‘screening-eligible WTC survivor’’ has the
meaning given such term in section 3321(a)(1).
(10) Any reference to ‘‘September 11, 2001’’ shall be
deemed a reference to the period on such date subsequent to
the terrorist attacks at the World Trade Center, Shanksville,
Pennsylvania, or the Pentagon, as applicable, on such date.
(11) The term ‘‘September 11, 2001, terrorist attacks’’
means the terrorist attacks that occurred on September 11,
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2001, in New York City, in Shanksville, Pennsylvania, and at
the Pentagon, and includes the aftermath of such attacks.
(12) The term ‘‘WTC Health Program Steering Committee’’
means such a Steering Committee established under section
3302(b).
(13) The term ‘‘WTC Program’’ means the Word Trade
Center Health Program established under section 3301(a).
(14)(A) The term ‘‘WTC Program Administrator’’ means—
(i) subject to subparagraph (B), with respect to paragraphs (3) and (4) of section 3311(a) (relating to enrollment
of WTC responders), section 3312(c) and the corresponding
provisions of section 3322 (relating to payment for initial
health evaluation, monitoring, and treatment, paragraphs
(1)(C), (2)(B), and (3) of section 3321(a) (relating to determination or certification of screening-eligible or certifiedeligible WTC responders), and part 3 of subtitle B (relating
to payor provisions), an official in the Department of
Health and Human Services, to be designated by the Secretary; and
(ii) with respect to any other provision of this title, the
Director of the National Institute for Occupational Safety
and Health, or a designee of such Director.
(B) In no case may the Secretary designate under subparagraph (A)(i) the Director of the National Institute for Occupational Safety and Health or a designee of such Director with
respect to section 3322 (relating to payment for initial health
evaluation, monitoring, and treatment).
(15) The term ‘‘WTC-related health condition’’ is defined in
section 3312(a).
(16) The term ‘‘WTC responder’’ is defined in section
3311(a).
(17) The term ‘‘WTC Scientific/Technical Advisory Committee’’ means such Committee established under section
3302(a).

Subtitle B—Program of Monitoring, Initial
Health Evaluations, and Treatment
PART 1—WTC RESPONDERS
SEC. 3311. ø42 U.S.C. 300mm–21¿ IDENTIFICATION OF WTC RESPONDERS
AND PROVISION OF WTC-RELATED MONITORING SERVICES.
(a) WTC RESPONDER DEFINED.—
(1) IN GENERAL.—For purposes of this title, the term ‘‘WTC

responder’’ means any of the following individuals, subject to
paragraph (4):
(A) CURRENTLY IDENTIFIED RESPONDER.—An individual
who has been identified as eligible for monitoring under
the arrangements as in effect on the date of the enactment
of this title between the National Institute for Occupational Safety and Health and—
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(i) the consortium coordinated by Mt. Sinai Hospital in New York City that coordinates the monitoring and treatment for enrolled WTC responders
other than with respect to those covered under the arrangement with the Fire Department of New York
City; or
(ii) the Fire Department of New York City.
(B) RESPONDER WHO MEETS CURRENT ELIGIBILITY CRITERIA.—An individual who meets the current eligibility criteria described in paragraph (2).
(C) RESPONDER WHO MEETS MODIFIED ELIGIBILITY CRITERIA.—An individual who—
(i) performed rescue, recovery, demolition, debris
cleanup, or other related services in the New York
City disaster area in response to the September 11,
2001, terrorist attacks, regardless of whether such
services were performed by a State or Federal employee or member of the National Guard or otherwise;
and
(ii) meets such eligibility criteria relating to exposure to airborne toxins, other hazards, or adverse conditions resulting from the September 11, 2001, terrorist attacks as the WTC Program Administrator,
after consultation with the WTC Scientific/Technical
Advisory Committee, determines appropriate.
The WTC Program Administrator shall not modify such
eligibility criteria on or after the date that the number of
enrollments of WTC responders has reached 80 percent of
the limit described in paragraph (4) or on or after the date
that the number of certifications for certified-eligible WTC
survivors under section 3321(a)(2)(B) has reached 80 percent of the limit described in section 3321(a)(3).
(2) CURRENT ELIGIBILITY CRITERIA.—The eligibility criteria
described in this paragraph for an individual is that the individual is described in any of the following categories:
(A) FIREFIGHTERS AND RELATED PERSONNEL.—The individual—
(i) was a member of the Fire Department of New
York City (whether fire or emergency personnel, active
or retired) who participated at least one day in the
rescue and recovery effort at any of the former World
Trade Center sites (including Ground Zero, Staten Island Landfill, and the New York City Chief Medical
Examiner’s Office) for any time during the period beginning on September 11, 2001, and ending on July
31, 2002; or
(ii)(I) is a surviving immediate family member of
an individual who was a member of the Fire Department of New York City (whether fire or emergency
personnel, active or retired) and was killed at the
World Trade site on September 11, 2001; and
(II) received any treatment for a WTC-related
health condition described in section 3312(a)(1)(A)(ii)
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(relating to mental health conditions) on or before September 1, 2008.
(B) LAW ENFORCEMENT OFFICERS AND WTC RESCUE, RECOVERY, AND CLEANUP WORKERS.—The individual—
(i) worked or volunteered onsite in rescue, recovery, debris cleanup, or related support services in
lower Manhattan (south of Canal St.), the Staten Island Landfill, or the barge loading piers, for at least
4 hours during the period beginning on September 11,
2001, and ending on September 14, 2001, for at least
24 hours during the period beginning on September
11, 2001, and ending on September 30, 2001, or for at
least 80 hours during the period beginning on September 11, 2001, and ending on July 31, 2002;
(ii)(I) was a member of the Police Department of
New York City (whether active or retired) or a member of the Port Authority Police of the Port Authority
of New York and New Jersey (whether active or retired) who participated onsite in rescue, recovery, debris cleanup, or related services in lower Manhattan
(south of Canal St.), including Ground Zero, the Staten Island Landfill, or the barge loading piers, for at
least 4 hours during the period beginning September
11, 2001, and ending on September 14, 2001;
(II) participated onsite in rescue, recovery, debris
cleanup, or related services at Ground Zero, the Staten
Island Landfill, or the barge loading piers, for at least
one day during the period beginning on September 11,
2001, and ending on July 31, 2002;
(III) participated onsite in rescue, recovery, debris
cleanup, or related services in lower Manhattan (south
of Canal St.) for at least 24 hours during the period
beginning on September 11, 2001, and ending on September 30, 2001; or
(IV) participated onsite in rescue, recovery, debris
cleanup, or related services in lower Manhattan (south
of Canal St.) for at least 80 hours during the period
beginning on September 11, 2001, and ending on July
31, 2002;
(iii) was an employee of the Office of the Chief
Medical Examiner of New York City involved in the
examination and handling of human remains from the
World Trade Center attacks, or other morgue worker
who performed similar post-September 11 functions
for such Office staff, during the period beginning on
September 11, 2001, and ending on July 31, 2002;
(iv) was a worker in the Port Authority TransHudson Corporation Tunnel for at least 24 hours during the period beginning on February 1, 2002, and
ending on July 1, 2002; or
(v) was a vehicle-maintenance worker who was exposed to debris from the former World Trade Center
while retrieving, driving, cleaning, repairing, and
maintaining vehicles contaminated by airborne toxins
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from the September 11, 2001, terrorist attacks during
a duration and period described in subparagraph (A).
(C) RESPONDERS TO THE SEPTEMBER 11 ATTACKS AT THE
PENTAGON AND SHANKSVILLE, PENNSYLVANIA.—The individual—
(i)(I) was a member of a fire or police department
(whether fire or emergency personnel, active or retired), worked for a recovery or cleanup contractor, or
was a volunteer; and performed rescue, recovery, demolition, debris cleanup, or other related services at the
Pentagon site of the terrorist-related aircraft crash of
September 11, 2001, during the period beginning on
September 11, 2001, and ending on the date on which
the cleanup of the site was concluded, as determined
by the WTC Program Administrator; or
(II) was a member of a fire or police department
(whether fire or emergency personnel, active or retired), worked for a recovery or cleanup contractor, or
was a volunteer; and performed rescue, recovery, demolition, debris cleanup, or other related services at the
Shanksville, Pennsylvania, site of the terrorist-related
aircraft crash of September 11, 2001, during the period beginning on September 11, 2001, and ending on
the date on which the cleanup of the site was concluded, as determined by the WTC Program Administrator; and
(ii) is determined by the WTC Program Administrator to be at an increased risk of developing a WTCrelated health condition as a result of exposure to airborne toxins, other hazards, or adverse conditions resulting from the September 11, 2001, terrorist attacks,
and meets such eligibility criteria related to such exposures, as the WTC Program Administrator determines
are appropriate, after consultation with the WTC Scientific/Technical Advisory Committee.
(3) ENROLLMENT PROCESS.—
(A) IN GENERAL.—The WTC Program Administrator
shall establish a process for enrolling WTC responders in
the WTC Program. Under such process—
(i) WTC responders described in paragraph (1)(A)
shall be deemed to be enrolled in such Program;
(ii) subject to clause (iii), the Administrator shall
enroll in such program individuals who are determined to be WTC responders;
(iii) the Administrator shall deny such enrollment
to an individual if the Administrator determines that
the numerical limitation in paragraph (4) on enrollment of WTC responders has been met;
(iv) there shall be no fee charged to the applicant
for making an application for such enrollment;
(v) the Administrator shall make a determination
on such an application not later than 60 days after the
date of filing the application; and
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(vi) an individual who is denied enrollment in
such Program shall have an opportunity to appeal
such determination in a manner established under
such process.
(B) TIMING.—
(i) CURRENTLY IDENTIFIED RESPONDERS.—In accordance with subparagraph (A)(i), the WTC Program
Administrator shall enroll an individual described in
paragraph (1)(A) in the WTC Program not later than
July 1, 2011.
(ii) OTHER RESPONDERS.—In accordance with subparagraph (A)(ii) and consistent with paragraph (4),
the WTC Program Administrator shall enroll any
other individual who is determined to be a WTC responder in the WTC Program at the time of such determination.
(4) NUMERICAL LIMITATION ON ELIGIBLE WTC RESPONDERS.—
(A) IN GENERAL.—The total number of individuals not
described in paragraph (1)(A) or (2)(A)(ii) who may be enrolled under paragraph (3)(A)(ii) shall not exceed 25,000 at
any time, of which no more than 2,500 may be individuals
enrolled based on modified eligibility criteria established
under paragraph (1)(C).
(B) PROCESS.—In implementing subparagraph (A), the
WTC Program Administrator shall—
(i) limit the number of enrollments made under
paragraph (3)—
(I) in accordance with such subparagraph; and
(II) to such number, as determined by the Administrator based on the best available information and subject to amounts available under section 3351, that will ensure sufficient funds will be
available to provide treatment and monitoring
benefits under this title, with respect to all individuals who are enrolled through the end of fiscal
year 2020; and
(ii) provide priority (subject to paragraph (3)(A)(i))
in such enrollments in the order in which individuals
apply for enrollment under paragraph (3).
(5) DISQUALIFICATION OF INDIVIDUALS ON TERRORIST WATCH
LIST.—No individual who is on the terrorist watch list maintained by the Department of Homeland Security shall qualify
as an eligible WTC responder. Before enrolling any individual
as a WTC responder in the WTC Program under paragraph (3),
the Administrator, in consultation with the Secretary of Homeland Security, shall determine whether the individual is on
such list.
(b) MONITORING BENEFITS.—
(1) IN GENERAL.—In the case of an enrolled WTC responder (other than one described in subsection (a)(2)(A)(ii)),
the WTC Program shall provide for monitoring benefits that
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tions and long-term health monitoring and analysis. In the
case of an enrolled WTC responder who is an active member
of the Fire Department of New York City, the responder shall
receive such benefits as part of the individual’s periodic company medical exams.
(2) PROVISION OF MONITORING BENEFITS.—The monitoring
benefits under paragraph (1) shall be provided through the
Clinical Center of Excellence for the type of individual involved
or, in the case of an individual residing outside the New York
metropolitan area, under an arrangement under section 3313.
SEC. 3312. ø42 U.S.C. 300mm–22¿ TREATMENT OF ENROLLED WTC RESPONDERS FOR WTC-RELATED HEALTH CONDITIONS.
(a) WTC-RELATED HEALTH CONDITION DEFINED.—
(1) IN GENERAL.—For purposes of this title, the term

‘‘WTC-related health condition’’ means a condition that—
(A)(i) is an illness or health condition for which exposure to airborne toxins, any other hazard, or any other adverse condition resulting from the September 11, 2001, terrorist attacks, based on an examination by a medical professional with experience in treating or diagnosing the
health conditions included in the applicable list of WTC-related health conditions, is substantially likely to be a significant factor in aggravating, contributing to, or causing
the illness or health condition, as determined under paragraph (2); or
(ii) is a mental health condition for which such attacks, based on an examination by a medical professional
with experience in treating or diagnosing the health conditions included in the applicable list of WTC-related health
conditions, is substantially likely to be a significant factor
in aggravating, contributing to, or causing the condition,
as determined under paragraph (2); and
(B) is included in the applicable list of WTC-related
health conditions or—
(i) with respect to a WTC responder, is provided
certification of coverage under subsection (b)(2)(B)(iii);
or
(ii) with respect to a screening-eligible WTC survivor or certified-eligible WTC survivor, is provided
certification of coverage under subsection (b)(2)(B)(iii),
as applied under section 3322(a).
In the case of a WTC responder described in section
3311(a)(2)(A)(ii) (relating to a surviving immediate family
member of a firefighter), such term does not include an illness
or health condition described in subparagraph (A)(i).
(2) DETERMINATION.—The determination under paragraph
(1) or subsection (b) of whether the September 11, 2001, terrorist attacks were substantially likely to be a significant factor in aggravating, contributing to, or causing an individual’s
illness or health condition shall be made based on an assessment of the following:
(A) The individual’s exposure to airborne toxins, any
other hazard, or any other adverse condition resulting
from the terrorist attacks. Such exposure shall be—
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(i) evaluated and characterized through the use of
a standardized, population-appropriate questionnaire
approved by the Director of the National Institute for
Occupational Safety and Health; and
(ii) assessed and documented by a medical professional with experience in treating or diagnosing health
conditions included on the list of WTC-related health
conditions.
(B) The type of symptoms and temporal sequence of
symptoms. Such symptoms shall be—
(i) assessed through the use of a standardized,
population-appropriate medical questionnaire approved by the Director of the National Institute for Occupational Safety and Health and a medical examination; and
(ii) diagnosed and documented by a medical professional described in subparagraph (A)(ii).
(3) LIST OF HEALTH CONDITIONS FOR WTC RESPONDERS.—
The list of health conditions for WTC responders consists of the
following:
(A) AERODIGESTIVE DISORDERS.—
(i) Interstitial lung diseases.
(ii) Chronic respiratory disorder—fumes/vapors.
(iii) Asthma.
(iv) Reactive airways dysfunction syndrome
(RADS).
(v) WTC-exacerbated chronic obstructive pulmonary disease (COPD).
(vi) Chronic cough syndrome.
(vii) Upper airway hyperreactivity.
(viii) Chronic rhinosinusitis.
(ix) Chronic nasopharyngitis.
(x) Chronic laryngitis.
(xi) Gastroesophageal reflux disorder (GERD).
(xii) Sleep apnea exacerbated by or related to a
condition described in a previous clause.
(B) MENTAL HEALTH CONDITIONS.—
(i) Posttraumatic stress disorder (PTSD).
(ii) Major depressive disorder.
(iii) Panic disorder.
(iv) Generalized anxiety disorder.
(v) Anxiety disorder (not otherwise specified).
(vi) Depression (not otherwise specified).
(vii) Acute stress disorder.
(viii) Dysthymic disorder.
(ix) Adjustment disorder.
(x) Substance abuse.
(C) MUSCULOSKELETAL DISORDERS FOR CERTAIN WTC
RESPONDERS.—In the case of a WTC responder described
in paragraph (4), a condition described in such paragraph.
(D) ADDITIONAL CONDITIONS.—Any cancer (or type of
cancer) or other condition added, pursuant to paragraph
(5) or (6), to the list under this paragraph.
(4) MUSCULOSKELETAL DISORDERS.—
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(A) IN GENERAL.—For purposes of this title, in the case
of a WTC responder who received any treatment for a
WTC-related musculoskeletal disorder on or before September 11, 2003, the list of health conditions in paragraph
(3) shall include:
(i) Low back pain.
(ii) Carpal tunnel syndrome (CTS).
(iii) Other musculoskeletal disorders.
(B) DEFINITION.—The term ‘‘WTC-related musculoskeletal disorder’’ means a chronic or recurrent disorder of
the musculoskeletal system caused by heavy lifting or repetitive strain on the joints or musculoskeletal system occurring during rescue or recovery efforts in the New York
City disaster area in the aftermath of the September 11,
2001, terrorist attacks.
(5) CANCER.—
(A) IN GENERAL.—The WTC Program Administrator
shall periodically conduct a review of all available scientific and medical evidence, including findings and recommendations of Clinical Centers of Excellence, published
in peer-reviewed journals to determine if, based on such
evidence, cancer or a certain type of cancer should be
added to the applicable list of WTC-related health conditions. The WTC Program Administrator shall conduct the
first review under this subparagraph not later than 180
days after the date of the enactment of this title.
(B) PROPOSED REGULATIONS AND RULEMAKING.—Based
on the periodic reviews under subparagraph (A), if the
WTC Program Administrator determines that cancer or a
certain type of cancer should be added to such list of WTCrelated health conditions, the WTC Program Administrator
shall propose regulations, through rulemaking, to add cancer or the certain type of cancer to such list.
(C) FINAL REGULATIONS.—Based on all the available
evidence in the rulemaking record, the WTC Program Administrator shall make a final determination of whether
cancer or a certain type of cancer should be added to such
list of WTC-related health conditions. If such a determination is made to make such an addition, the WTC Program
Administrator shall by regulation add cancer or the certain
type of cancer to such list.
(D) DETERMINATIONS NOT TO ADD CANCER OR CERTAIN
TYPES OF CANCER.—In the case that the WTC Program Administrator determines under subparagraph (B) or (C) that
cancer or a certain type of cancer should not be added to
such list of WTC-related health conditions, the WTC Program Administrator shall publish an explanation for such
determination in the Federal Register. Any such determination to not make such an addition shall not preclude
the addition of cancer or the certain type of cancer to such
list at a later date.
(6) ADDITION OF HEALTH CONDITIONS TO LIST FOR WTC RESPONDERS.—
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(A) IN GENERAL.—Whenever the WTC Program Administrator determines that a proposed rule should be promulgated to add a health condition to the list of health
conditions in paragraph (3), the Administrator may request a recommendation of the Advisory Committee or
may publish such a proposed rule in the Federal Register
in accordance with subparagraph (D).
(B) ADMINISTRATOR’S OPTIONS AFTER RECEIPT OF PETITION.—In the case that the WTC Program Administrator
receives a written petition by an interested party to add a
health condition to the list of health conditions in paragraph (3), not later than 60 days after the date of receipt
of such petition the Administrator shall—
(i) request a recommendation of the Advisory
Committee;
(ii) publish a proposed rule in the Federal Register
to add such health condition, in accordance with subparagraph (D);
(iii) publish in the Federal Register the Administrator’s determination not to publish such a proposed
rule and the basis for such determination; or
(iv) publish in the Federal Register a determination that insufficient evidence exists to take action
under clauses (i) through (iii).
(C) ACTION BY ADVISORY COMMITTEE.—In the case that
the Administrator requests a recommendation of the Advisory Committee under this paragraph, with respect to adding a health condition to the list in paragraph (3), the Advisory Committee shall submit to the Administrator such
recommendation not later than 60 days after the date of
such request or by such date (not to exceed 180 days after
such date of request) as specified by the Administrator.
Not later than 60 days after the date of receipt of such recommendation, the Administrator shall, in accordance with
subparagraph (D), publish in the Federal Register a proposed rule with respect to such recommendation or a determination not to propose such a proposed rule and the
basis for such determination.
(D) PUBLICATION.—The WTC Program Administrator
shall, with respect to any proposed rule under this paragraph—
(i) publish such proposed rule in accordance with
section 553 of title 5, United States Code; and
(ii) provide interested parties a period of 30 days
after such publication to submit written comments on
the proposed rule.
The WTC Program Administrator may extend the period
described in clause (ii) upon a finding of good cause. In the
case of such an extension, the Administrator shall publish
such extension in the Federal Register.
(E) INTERESTED PARTY DEFINED.—For purposes of this
paragraph, the term ‘‘interested party’’ includes a representative of any organization representing WTC responders, a nationally recognized medical association, a Clinical
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or Data Center, a State or political subdivision, or any
other interested person.
(b) COVERAGE OF TREATMENT FOR WTC-RELATED HEALTH CONDITIONS.—
(1) DETERMINATION FOR ENROLLED WTC RESPONDERS BASED
ON A WTC-RELATED HEALTH CONDITION.—
(A) IN GENERAL.—If a physician at a Clinical Center of
Excellence that is providing monitoring benefits under section 3311 for an enrolled WTC responder makes a determination that the responder has a WTC-related health
condition that is in the list in subsection (a)(3) and that exposure to airborne toxins, other hazards, or adverse conditions resulting from the September 1, 2001, terrorist attacks is substantially likely to be a significant factor in aggravating, contributing to, or causing the condition—
(i) the physician shall promptly transmit such determination to the WTC Program Administrator and
provide the Administrator with the medical facts supporting such determination; and
(ii) on and after the date of such transmittal and
subject to subparagraph (B), the WTC Program shall
provide for payment under subsection (c) for medically
necessary treatment for such condition.
(B) REVIEW; CERTIFICATION; APPEALS.—
(i) REVIEW.—A Federal employee designated by
the WTC Program Administrator shall review determinations made under subparagraph (A).
(ii) CERTIFICATION.—The Administrator shall provide a certification of such condition based upon reviews conducted under clause (i). Such a certification
shall be provided unless the Administrator determines
that the responder’s condition is not a WTC-related
health condition in the list in subsection (a)(3) or that
exposure to airborne toxins, other hazards, or adverse
conditions resulting from the September 1, 2001, terrorist attacks is not substantially likely to be a significant factor in aggravating, contributing to, or causing
the condition.
(iii) APPEAL PROCESS.—The Administrator shall
establish, by rule, a process for the appeal of determinations under clause (ii).
(2) DETERMINATION BASED ON MEDICALLY ASSOCIATED WTCRELATED HEALTH CONDITIONS.—
(A) IN GENERAL.—If a physician at a Clinical Center of
Excellence determines pursuant to subsection (a) that the
enrolled WTC responder has a health condition described
in subsection (a)(1)(A) that is not in the list in subsection
(a)(3) but which is medically associated with a WTC-related health condition—
(i) the physician shall promptly transmit such determination to the WTC Program Administrator and
provide the Administrator with the facts supporting
such determination; and
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(ii) the Administrator shall make a determination
under subparagraph (B) with respect to such physician’s determination.
(B) PROCEDURES FOR REVIEW, CERTIFICATION, AND APPEAL.—The WTC Program Administrator shall, by rule, establish procedures for the review and certification of physician determinations under subparagraph (A). Such rule
shall provide for—
(i) the timely review of such a determination by a
physician panel with appropriate expertise for the condition and recommendations to the WTC Program Administrator;
(ii) not later than 60 days after the date of the
transmittal under subparagraph (A)(i), a determination by the WTC Program Administrator on whether
or not the condition involved is described in subsection
(a)(1)(A) and is medically associated with a WTC-related health condition;
(iii) certification in accordance with paragraph
(1)(B)(ii) of coverage of such condition if determined to
be described in subsection (a)(1)(A) and medically associated with a WTC-related health condition; and
(iv) a process for appeals of determinations relating to such conditions.
(C) INCLUSION IN LIST OF HEALTH CONDITIONS.—If the
WTC Program Administrator provides certification under
subparagraph (B)(iii) for coverage of a condition, the Administrator may, pursuant to subsection (a)(6), add the
condition to the list in subsection (a)(3).
(D) CONDITIONS ALREADY DECLINED FOR INCLUSION IN
LIST.—If the WTC Program Administrator publishes a determination under subsection (a)(6)(B) not to include a condition in the list in subsection (a)(3), the WTC Program
Administrator shall not provide certification under subparagraph (B)(iii) for coverage of the condition. In the case
of an individual who is certified under subparagraph
(B)(iii) with respect to such condition before the date of the
publication of such determination the previous sentence
shall not apply.
(3) REQUIREMENT OF MEDICAL NECESSITY.—
(A) IN GENERAL.—In providing treatment for a WTCrelated health condition, a physician or other provider
shall provide treatment that is medically necessary and in
accordance with medical treatment protocols established
under subsection (d).
(B) REGULATIONS RELATING TO MEDICAL NECESSITY.—
For the purpose of this title, the WTC Program Administrator shall issue regulations specifying a standard for determining medical necessity with respect to health care
services and prescription pharmaceuticals, a process for
determining whether treatment furnished and pharmaceuticals prescribed under this title meet such standard
(including any prior authorization requirement), and a
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process for appeal of a determination under subsection
(c)(3).
(4) SCOPE OF TREATMENT COVERED.—
(A) IN GENERAL.—The scope of treatment covered
under this subsection includes services of physicians and
other health care providers, diagnostic and laboratory
tests, prescription drugs, inpatient and outpatient hospital
services, and other medically necessary treatment.
(B) PHARMACEUTICAL COVERAGE.—With respect to ensuring coverage of medically necessary outpatient prescription drugs, such drugs shall be provided, under arrangements made by the WTC Program Administrator, directly
through participating Clinical Centers of Excellence or
through one or more outside vendors.
(C) TRANSPORTATION EXPENSES FOR NATIONWIDE NETWORK.—The WTC Program Administrator may provide for
necessary and reasonable transportation and expenses incident to the securing of medically necessary treatment
through the nationwide network under section 3313 involving travel of more than 250 miles and for which payment is made under this section in the same manner in
which individuals may be furnished necessary and reasonable transportation and expenses incident to services involving travel of more than 250 miles under regulations
implementing section 3629(c) of the Energy Employees Occupational Illness Compensation Program Act of 2000 (title
XXXVI of Public Law 106–398; 42 U.S.C. 7384t(c)).
(5) PROVISION OF TREATMENT PENDING CERTIFICATION.—
With respect to an enrolled WTC responder for whom a determination is made by an examining physician under paragraph
(1) or (2), but for whom the WTC Program Administrator has
not yet determined whether to certify the determination, the
WTC Program Administrator may establish by rule a process
through which the Administrator may approve the provision of
medical treatment under this subsection (and payment under
subsection (c)) with respect to such responder and such responder’s WTC-related health condition (under such terms and
conditions as the Administrator may provide) until the Administrator makes a decision on whether to certify the determination.
(c) PAYMENT FOR INITIAL HEALTH EVALUATION, MONITORING,
AND TREATMENT OF WTC-RELATED HEALTH CONDITIONS.—
(1) MEDICAL TREATMENT.—
(A) USE OF FECA PAYMENT RATES.—
(i) IN GENERAL.—Subject to clause (ii):
(I) Subject to subparagraphs (B) and (C), the
WTC Program Administrator shall reimburse
costs for medically necessary treatment under this
title for WTC-related health conditions according
to the payment rates that would apply to the provision of such treatment and services by the facility under the Federal Employees Compensation
Act.
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(II) For treatment not covered under subclause (i) or subparagraph (B), the WTC Program
Administrator shall establish by regulation a reimbursement rate for such treatment.
(ii) EXCEPTION.—In no case shall payments for
products or services under clause (i) be made at a rate
higher than the Office of Worker’s Compensation Programs in the Department Labor would pay for such
products or services rendered at the time such products or services were provided.
(B) PHARMACEUTICALS.—
(i) IN GENERAL.—The WTC Program Administrator shall establish a program for paying for the
medically necessary outpatient prescription pharmaceuticals prescribed under this title for WTC-related
health conditions through one or more contracts with
outside vendors.
(ii) COMPETITIVE BIDDING.—Under such program
the Administrator shall—
(I) select one or more appropriate vendors
through a Federal competitive bid process; and
(II) select the lowest bidder (or bidders) meeting the requirements for providing pharmaceutical
benefits for participants in the WTC Program.
(iii) TREATMENT OF FDNY PARTICIPANTS.—Under
such program the Administrator may enter into an
agreement with a separate vendor to provide pharmaceutical benefits to enrolled WTC responders for whom
the Clinical Center of Excellence is described in section 3305 if such an arrangement is deemed necessary
and beneficial to the program by the WTC Program
Administrator.
(iv) PHARMACEUTICALS.—Not later than July 1,
2011, the Comptroller General of the United States
shall submit to the Committee on Energy and Commerce of the House of Representatives and the Committee on Health, Education, Labor, and Pensions of
the Senate a report on whether existing Federal pharmaceutical purchasing programs can provide pharmaceutical benefits more efficiently and effectively than
through the WTC program.
(C) IMPROVING QUALITY AND EFFICIENCY THROUGH
MODIFICATION OF PAYMENT AMOUNTS AND METHODOLOGIES.—The WTC Program Administrator may modify the
amounts and methodologies for making payments for initial health evaluations, monitoring, or treatment, if, taking
into account utilization and quality data furnished by the
Clinical
Centers
of
Excellence
under
section
3305(b)(1)(B)(iii), the Administrator determines that a
bundling, capitation, pay for performance, or other payment methodology would better ensure high quality and
efficient delivery of initial health evaluations, monitoring,
or treatment to an enrolled WTC responder, screening-eligible WTC survivor, or certified-eligible WTC survivor.
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(2) MONITORING AND INITIAL HEALTH EVALUATION.—The
WTC Program Administrator shall reimburse the costs of monitoring and the costs of an initial health evaluation provided
under this title at a rate set by the Administrator by regulation.
(3) DETERMINATION OF MEDICAL NECESSITY.—
(A) REVIEW OF MEDICAL NECESSITY AND PROTOCOLS.—
As part of the process for reimbursement or payment
under this subsection, the WTC Program Administrator
shall provide for the review of claims for reimbursement or
payment for the provision of medical treatment to determine if such treatment is medically necessary and in accordance with medical treatment protocols established
under subsection (d).
(B) WITHHOLDING OF PAYMENT FOR MEDICALLY UNNECESSARY TREATMENT.—The Administrator shall withhold
such reimbursement or payment for treatment that the
Administrator determines is not medically necessary or is
not in accordance with such medical treatment protocols.
(d) MEDICAL TREATMENT PROTOCOLS.—
(1) DEVELOPMENT.—The Data Centers shall develop medical treatment protocols for the treatment of enrolled WTC responders and certified-eligible WTC survivors for health conditions included in the applicable list of WTC-related health conditions.
(2) APPROVAL.—The medical treatment protocols developed
under paragraph (1) shall be subject to approval by the WTC
Program Administrator.
SEC. 3313. ø42 U.S.C. 300mm–23¿ NATIONAL ARRANGEMENT FOR BENEFITS FOR ELIGIBLE INDIVIDUALS OUTSIDE NEW YORK.
(a) IN GENERAL.—In order to ensure reasonable access to bene-

fits under this subtitle for individuals who are enrolled WTC responders, screening-eligible WTC survivors, or certified-eligible
WTC survivors and who reside in any State, as defined in section
2(f), outside the New York metropolitan area, the WTC Program
Administrator shall establish a nationwide network of health care
providers to provide monitoring and treatment benefits and initial
health evaluations near such individuals’ areas of residence in such
States. Nothing in this subsection shall be construed as preventing
such individuals from being provided such monitoring and treatment benefits or initial health evaluation through any Clinical
Center of Excellence.
(b) NETWORK REQUIREMENTS.—Any health care provider participating in the network under subsection (a) shall—
(1) meet criteria for credentialing established by the Data
Centers;
(2) follow the monitoring, initial health evaluation, and
treatment protocols developed under section 3305(a)(2)(A)(ii);
(3) collect and report data in accordance with section 3304;
and
(4) meet such fraud, quality assurance, and other requirements as the WTC Program Administrator establishes, including sections 1128 through 1128E of the Social Security Act, as
applied by section 3301(d).
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(c) TRAINING AND TECHNICAL ASSISTANCE.—The WTC Program
Administer may provide, including through contract, for the provision of training and technical assistance to health care providers
participating in the network under subsection (a).
(d) PROVISION OF SERVICES THROUGH THE VA.—
(1) IN GENERAL.—The WTC Program Administrator may
enter into an agreement with the Secretary of Veterans Affairs
for the Secretary to provide services under this section through
facilities of the Department of Veterans Affairs.
(2) NATIONAL PROGRAM.—Not later than July 1, 2011, the
Comptroller General of the United States shall submit to the
Committee on Energy and Commerce of the House of Representatives and the Committee on Health, Education, Labor,
and Pensions of the Senate a report on whether the Department of Veterans Affairs can provide monitoring and treatment
services to individuals under this section more efficiently and
effectively than through the nationwide network to be established under subsection (a).

PART 2—WTC SURVIVORS
SEC. 3321. ø42 U.S.C. 300mm–31¿ IDENTIFICATION AND INITIAL HEALTH
EVALUATION OF SCREENING-ELIGIBLE AND CERTIFIEDELIGIBLE WTC SURVIVORS.
(a) IDENTIFICATION OF SCREENING-ELIGIBLE WTC SURVIVORS
AND CERTIFIED-ELIGIBLE WTC SURVIVORS.—
(1) SCREENING-ELIGIBLE WTC SURVIVORS.—
(A) DEFINITION.—In this title, the term ‘‘screening-eli-

gible WTC survivor’’ means, subject to subparagraph (C)
and paragraph (3), an individual who is described in any
of the following clauses:
(i) CURRENTLY IDENTIFIED SURVIVOR.—An individual, including a WTC responder, who has been
identified as eligible for medical treatment and monitoring by the WTC Environmental Health Center as of
the date of enactment of this title.
(ii) SURVIVOR WHO MEETS CURRENT ELIGIBILITY
CRITERIA.—An individual who is not a WTC responder,
for purposes of the initial health evaluation under subsection (b), claims symptoms of a WTC-related health
condition and meets any of the current eligibility criteria described in subparagraph (B).
(iii) SURVIVOR WHO MEETS MODIFIED ELIGIBILITY
CRITERIA.—An individual who is not a WTC responder,
for purposes of the initial health evaluation under subsection (b), claims symptoms of a WTC-related health
condition and meets such eligibility criteria relating to
exposure to airborne toxins, other hazards, or adverse
conditions resulting from the September 11, 2001, terrorist attacks as the WTC Administrator determines,
after consultation with the Data Centers described in
section 3305 and the WTC Scientific/Technical Advisory Committee and WTC Health Program Steering
Committees under section 3302.
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The Administrator shall not modify such criteria under
clause (iii) on or after the date that the number of certifications for certified-eligible WTC survivors under paragraph (2)(B) has reached 80 percent of the limit described
in paragraph (3) or on or after the date that the number
of enrollments of WTC responders has reached 80 percent
of the limit described in section 3311(a)(4).
(B) CURRENT ELIGIBILITY CRITERIA.—The eligibility criteria described in this subparagraph for an individual are
that the individual is described in any of the following
clauses:
(i) A person who was present in the New York
City disaster area in the dust or dust cloud on September 11, 2001.
(ii) A person who worked, resided, or attended
school, childcare, or adult daycare in the New York
City disaster area for—
(I) at least 4 days during the 4-month period
beginning on September 11, 2001, and ending on
January 10, 2002; or
(II) at least 30 days during the period beginning on September 11, 2001, and ending on July
31, 2002.
(iii) Any person who worked as a cleanup worker
or performed maintenance work in the New York City
disaster area during the 4-month period described in
subparagraph (B)(i) and had extensive exposure to
WTC dust as a result of such work.
(iv) A person who was deemed eligible to receive
a grant from the Lower Manhattan Development Corporation Residential Grant Program, who possessed a
lease for a residence or purchased a residence in the
New York City disaster area, and who resided in such
residence during the period beginning on September
11, 2001, and ending on May 31, 2003.
(v) A person whose place of employment—
(I) at any time during the period beginning on
September 11, 2001, and ending on May 31, 2003,
was in the New York City disaster area; and
(II) was deemed eligible to receive a grant
from the Lower Manhattan Development Corporation WTC Small Firms Attraction and Retention
Act program or other government incentive program designed to revitalize the lower Manhattan
economy after the September 11, 2001, terrorist
attacks.
(C) APPLICATION AND DETERMINATION PROCESS FOR
SCREENING ELIGIBILITY.—
(i) IN GENERAL.—The WTC Program Administrator in consultation with the Data Centers shall establish a process for individuals, other than individuals described in subparagraph (A)(i), to be determined to be screening-eligible WTC survivors. Under
such process—
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(I) there shall be no fee charged to the applicant for making an application for such determination;
(II) the Administrator shall make a determination on such an application not later than 60
days after the date of filing the application;
(III) the Administrator shall make such a determination relating to an applicant’s compliance
with this title and shall not determine that an individual is not so eligible or deny written documentation under clause (ii) to such individual unless the Administrator determines that—
(aa) based on the application submitted,
the individual does not meet the eligibility criteria; or
(bb) the numerical limitation on certifications of certified-eligible WTC survivors set
forth in paragraph (3) has been met; and
(IV) an individual who is determined not to be
a screening-eligible WTC survivor shall have an
opportunity to appeal such determination in a
manner established under such process.
(ii) WRITTEN DOCUMENTATION OF SCREENING-ELIGIBILITY.—
(I) IN GENERAL.—In the case of an individual
who is described in subparagraph (A)(i) or who is
determined under clause (i) (consistent with paragraph (3)) to be a screening-eligible WTC survivor,
the WTC Program Administrator shall provide an
appropriate written documentation of such fact.
(II) TIMING.—
(aa) CURRENTLY IDENTIFIED SURVIVORS.—
In the case of an individual who is described
in subparagraph (A)(i), the WTC Program Administrator shall provide the written documentation under subclause (I) not later than
July 1, 2011.
(bb) OTHER MEMBERS.—In the case of another individual who is determined under
clause (i) and consistent with paragraph (3) to
be a screening-eligible WTC survivor, the
WTC Program Administrator shall provide
the written documentation under subclause (I)
at the time of such determination.
(2) CERTIFIED-ELIGIBLE WTC SURVIVORS.—
(A) DEFINITION.—The term ‘‘certified-eligible WTC survivor’’ means, subject to paragraph (3), a screening-eligible
WTC survivor who the WTC Program Administrator certifies under subparagraph (B) to be eligible for followup
monitoring and treatment under this part.
(B) CERTIFICATION OF ELIGIBILITY FOR MONITORING
AND TREATMENT.—
(i) IN GENERAL.—The WTC Program Administrator shall establish a certification process under
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which the Administrator shall provide appropriate certification to screening-eligible WTC survivors who,
pursuant to the initial health evaluation under subsection (b), are determined to be eligible for followup
monitoring and treatment under this part.
(ii) TIMING.—
(I) CURRENTLY IDENTIFIED SURVIVORS.—In the
case of an individual who is described in paragraph (1)(A)(i), the WTC Program Administrator
shall provide the certification under clause (i) not
later than July 1, 2011.
(II) OTHER MEMBERS.—In the case of another
individual who is determined under clause (i) to
be eligible for followup monitoring and treatment,
the WTC Program Administrator shall provide the
certification under such clause at the time of such
determination.
(3) NUMERICAL LIMITATION ON CERTIFIED-ELIGIBLE WTC
SURVIVORS.—
(A) IN GENERAL.—The total number of individuals not
described in paragraph (1)(A)(i) who may be certified as
certified-eligible WTC survivors under paragraph (2)(B)
shall not exceed 25,000 at any time.
(B) PROCESS.—In implementing subparagraph (A), the
WTC Program Administrator shall—
(i) limit the number of certifications provided
under paragraph (2)(B)—
(I) in accordance with such subparagraph; and
(II) to such number, as determined by the Administrator based on the best available information and subject to amounts made available under
section 3351, that will ensure sufficient funds will
be available to provide treatment and monitoring
benefits under this title, with respect to all individuals receiving such certifications through the
end of fiscal year 2020; and
(ii) provide priority in such certifications in the
order in which individuals apply for a determination
under paragraph (2)(B).
(4) DISQUALIFICATION OF INDIVIDUALS ON TERRORIST WATCH
LIST.—No individual who is on the terrorist watch list maintained by the Department of Homeland Security shall qualify
as a screening-eligible WTC survivor or a certified-eligible
WTC survivor. Before determining any individual to be a
screening-eligible WTC survivor under paragraph (1) or certifying any individual as a certified eligible WTC survivor under
paragraph (2), the Administrator, in consultation with the Secretary of Homeland Security, shall determine whether the individual is on such list.
(b) INITIAL HEALTH EVALUATION TO DETERMINE ELIGIBILITY
FOR FOLLOWUP MONITORING OR TREATMENT.—
(1) IN GENERAL.—In the case of a screening-eligible WTC
survivor, the WTC Program shall provide for an initial health
evaluation to determine if the survivor has a WTC-related
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health condition and is eligible for followup monitoring and
treatment benefits under the WTC Program. Initial health
evaluation protocols under section 3305(a)(2)(A)(ii) shall be
subject to approval by the WTC Program Administrator.
(2) INITIAL HEALTH EVALUATION PROVIDERS.—The initial
health evaluation described in paragraph (1) shall be provided
through a Clinical Center of Excellence with respect to the individual involved.
(3) LIMITATION ON INITIAL HEALTH EVALUATION BENEFITS.—Benefits for an initial health evaluation under this part
for a screening-eligible WTC survivor shall consist only of a
single medical initial health evaluation consistent with initial
health evaluation protocols described in paragraph (1). Nothing
in this paragraph shall be construed as preventing such an individual from seeking additional medical initial health evaluations at the expense of the individual.
SEC. 3322. ø42 U.S.C. 300mm–32¿ FOLLOWUP MONITORING AND TREATMENT OF CERTIFIED-ELIGIBLE WTC SURVIVORS FOR
WTC-RELATED HEALTH CONDITIONS.
(a) IN GENERAL.—Subject to subsection (b), the provisions of

sections 3311 and 3312 shall apply to followup monitoring and
treatment of WTC-related health conditions for certified-eligible
WTC survivors in the same manner as such provisions apply to the
monitoring and treatment of WTC-related health conditions for enrolled WTC responders.
(b) LIST OF WTC-RELATED HEALTH CONDITIONS FOR SURVIVORS.—The list of health conditions for screening-eligible WTC
survivors and certified-eligible WTC survivors consists of the following:
(1) AERODIGESTIVE DISORDERS.—
(A) Interstitial lung diseases.
(B) Chronic respiratory disorder—fumes/vapors.
(C) Asthma.
(D) Reactive airways dysfunction syndrome (RADS).
(E) WTC-exacerbated chronic obstructive pulmonary
disease (COPD).
(F) Chronic cough syndrome.
(G) Upper airway hyperreactivity.
(H) Chronic rhinosinusitis.
(I) Chronic nasopharyngitis.
(J) Chronic laryngitis.
(K) Gastroesophageal reflux disorder (GERD).
(L) Sleep apnea exacerbated by or related to a condition described in a previous clause.
(2) MENTAL HEALTH CONDITIONS.—
(A) Posttraumatic stress disorder (PTSD).
(B) Major depressive disorder.
(C) Panic disorder.
(D) Generalized anxiety disorder.
(E) Anxiety disorder (not otherwise specified).
(F) Depression (not otherwise specified).
(G) Acute stress disorder.
(H) Dysthymic disorder.
(I) Adjustment disorder.
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(J) Substance abuse.
(3) ADDITIONAL CONDITIONS.—Any cancer (or type of cancer) or other condition added to the list in section 3312(a)(3)
pursuant to paragraph (5) or (6) of section 3312(a), as such provisions are applied under subsection (a) with respect to certified-eligible WTC survivors.
SEC. 3323. ø42 U.S.C. 300mm–33¿ FOLLOWUP MONITORING AND TREATMENT OF OTHER INDIVIDUALS WITH WTC-RELATED
HEALTH CONDITIONS.
(a) IN GENERAL.—Subject to subsection (c), the provisions of

section 3322 shall apply to the followup monitoring and treatment
of WTC-related health conditions in the case of individuals described in subsection (b) in the same manner as such provisions
apply to the followup monitoring and treatment of WTC-related
health conditions for certified-eligible WTC survivors.
(b) INDIVIDUALS DESCRIBED.—An individual described in this
subsection is an individual who, regardless of location of residence—
(1) is not an enrolled WTC responder or a certified-eligible
WTC survivor; and
(2) is diagnosed at a Clinical Center of Excellence with a
WTC-related health condition for certified-eligible WTC survivors.
(c) LIMITATION.—
(1) IN GENERAL.—The WTC Program Administrator shall
limit benefits for any fiscal year under subsection (a) in a manner so that payments under this section for such fiscal year do
not exceed the amount specified in paragraph (2) for such fiscal
year.
(2) LIMITATION.—The amount specified in this paragraph
for—
(A) the last calendar quarter of fiscal year 2011 is
$5,000,000;
(B) fiscal year 2012 is $20,000,000; or
(C) a succeeding fiscal year is the amount specified in
this paragraph for the previous fiscal year increased by the
annual percentage increase in the medical care component
of the consumer price index for all urban consumers.

PART 3—PAYOR PROVISIONS
SEC. 3331. ø42 U.S.C. 300mm–41¿ PAYMENT OF CLAIMS.
(a) IN GENERAL.—Except as provided in subsections

(b) and (c),
the cost of monitoring and treatment benefits and initial health
evaluation benefits provided under parts 1 and 2 of this subtitle
shall be paid for by the WTC Program from the World Trade Center Health Program Fund.
(b) WORKERS’ COMPENSATION PAYMENT.—
(1) IN GENERAL.—Subject to paragraph (2), payment for
treatment under parts 1 and 2 of this subtitle of a WTC-related health condition of an individual that is work-related
shall be reduced or recouped to the extent that the WTC Program Administrator determines that payment has been made,
or can reasonably be expected to be made, under a workers’
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Sec. 3331

compensation law or plan of the United States, a State, or a
locality, or other work-related injury or illness benefit plan of
the employer of such individual, for such treatment. The provisions of clauses (iii), (iv), (v), and (vi) of paragraph (2)(B) of section 1862(b) of the Social Security Act and paragraphs (3) and
(4) of such section shall apply to the recoupment under this
subsection of a payment to the WTC Program (with respect to
a workers’ compensation law or plan, or other work-related injury or illness plan of the employer involved, and such individual) in the same manner as such provisions apply to the reimbursement of a payment under section 1862(b)(2) of such Act
to the Secretary (with respect to such a law or plan and an individual entitled to benefits under title XVIII of such Act) except that any reference in such paragraph (4) to payment rates
under title XVIII of the Social Security Act shall be deemed a
reference to payment rates under this title.
(2) EXCEPTION.—Paragraph (1) shall not apply for any
quarter, with respect to any workers’ compensation law or
plan, including line of duty compensation, to which New York
City is obligated to make payments, if, in accordance with
terms specified under the contract under subsection (d)(1)(A),
New York City has made the full payment required under such
contract for such quarter.
(3) RULES OF CONSTRUCTION.—Nothing in this title shall
be construed to affect, modify, or relieve any obligations under
a worker’s compensation law or plan, other work-related injury
or illness benefit plan of an employer, or any health insurance
plan.
(c) HEALTH INSURANCE COVERAGE.—
(1) IN GENERAL.—In the case of an individual who has a
WTC-related health condition that is not work-related and has
health coverage for such condition through any public or private health plan (including health benefits under title XVIII,
XIX, or XXI of the Social Security Act) the provisions of section
1862(b) of the Social Security Act shall apply to such a health
plan and such individual in the same manner as they apply to
group health plan and an individual entitled to benefits under
title XVIII of such Act pursuant to section 226(a) of such Act.
Any costs for items and services covered under such plan that
are not reimbursed by such health plan, due to the application
of deductibles, copayments, coinsurance, other cost sharing, or
otherwise, are reimbursable under this title to the extent that
they are covered under the WTC Program. The program under
this title shall not be treated as a legally liable party for purposes of applying section 1902(a)(25) of the Social Security Act.
(2) RECOVERY BY INDIVIDUAL PROVIDERS.—Nothing in paragraph (1) shall be construed as requiring an entity providing
monitoring and treatment under this title to seek reimbursement under a health plan with which the entity has no contract for reimbursement.
(3) MAINTENANCE OF REQUIRED MINIMUM ESSENTIAL COVERAGE.—No payment may be made for monitoring and treatment under this title for an individual for a month (beginning
with July 2014) if with respect to such month the individual—
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(A) is an applicable individual (as defined in subsection (d) of section 5000A of Internal Revenue Code of
1986) for whom the exemption under subsection (e) of such
section does not apply; and
(B) is not covered under minimum essential coverage,
as required under subsection (a) of such section.
(d) REQUIRED CONTRIBUTION BY NEW YORK CITY IN PROGRAM
COSTS.—
(1) CONTRACT REQUIREMENT.—
(A) IN GENERAL.—No funds may be disbursed from the
World Trade Center Health Program Fund under section
3351 unless New York City has entered into a contract
with the WTC Program Administrator under which New
York City agrees, in a form and manner specified by the
Administrator, to pay the full contribution described in
subparagraph (B) in accordance with this subsection on a
timely basis, plus any interest owed pursuant to subparagraph (E)(i). Such contract shall specify the terms under
which New York City shall be considered to have made the
full payment required for a quarter for purposes of subsection (b)(2).
(B) FULL CONTRIBUTION AMOUNT.—Under such contract, with respect to the last calendar quarter of fiscal
year 2011 and each calendar quarter in fiscal years 2012
through 2015 the full contribution amount under this subparagraph shall be equal to 10 percent of the expenditures
in carrying out this title for the respective quarter and
with respect to calendar quarters in fiscal year 2016, such
full contribution amount shall be equal to 1⁄9 of the Federal
expenditures in carrying out this title for the respective
quarter.
(C) SATISFACTION OF PAYMENT OBLIGATION.—The payment obligation under such contract may not be satisfied
through any of the following:
(i) An amount derived from Federal sources.
(ii) An amount paid before the date of the enactment of this title.
(iii) An amount paid to satisfy a judgment or as
part of a settlement related to injuries or illnesses
arising out of the September 11, 2001, terrorist attacks.
(D) TIMING OF CONTRIBUTION.—The payment obligation under such contract for a calendar quarter in a fiscal
year shall be paid not later than the last day of the second
succeeding calendar quarter.
(E) COMPLIANCE.—
(i) INTEREST FOR LATE PAYMENT.—If New York
City fails to pay to the WTC Program Administrator
pursuant to such contract the amount required for any
calendar quarter by the day specified in subparagraph
(D), interest shall accrue on the amount not so paid at
the rate (determined by the Administrator) based on
the average yield to maturity, plus 1 percentage point,
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Sec. 3332

on outstanding municipal bonds issued by New York
City with a remaining maturity of at least 1 year.
(ii) RECOVERY OF AMOUNTS OWED.—The amounts
owed to the WTC Program Administrator under such
contract shall be recoverable by the United States in
an action in the same manner as payments made
under title XVIII of the Social Security Act may be recoverable in an action brought under section
1862(b)(2)(B)(iii) of such Act.
(F) DEPOSIT IN FUND.—The WTC Program Administer
shall deposit amounts paid under such contract into the
World Trade Center Health Program Fund under section
3351.
(2) PAYMENT OF NEW YORK CITY SHARE OF MONITORING AND
TREATMENT COSTS.—With respect to each calendar quarter for
which a contribution is required by New York City under the
contract under paragraph (1), the WTC Program Administrator
shall—
(A) provide New York City with an estimate of such
amount of the required contribution at the beginning of
such quarter and with an updated estimate of such
amount at the beginning of each of the subsequent 2 quarters;
(B) bill such amount directly to New York City; and
(C) certify periodically, for purposes of this subsection,
whether or not New York City has paid the amount so
billed.
Such amount shall initially be estimated by the WTC Program
Administrator and shall be subject to adjustment and reconciliation based upon actual expenditures in carrying out this title.
(3) RULE OF CONSTRUCTION.—Nothing in this subsection
shall be construed as authorizing the WTC Administrator, with
respect to a fiscal year, to reduce the numerical limitation
under section 3311(a)(4) or 3321(a)(3) for such fiscal year if
New York City fails to comply with paragraph (1) for a calendar quarter in such fiscal year.
(e) WORK-RELATED DESCRIBED.—For the purposes of this section, a WTC-related health condition shall be treated as a condition
that is work-related if—
(1) the condition is diagnosed in an enrolled WTC responder, or in an individual who qualifies as a certified-eligible
WTC survivor on the basis of being a rescue, recovery, or
cleanup worker; or
(2) with respect to the condition the individual has filed
and had established a claim under a workers’ compensation
law or plan of the United States or a State, or other work-related injury or illness benefit plan of the employer of such individual.
SEC. 3332. ø42 U.S.C. 300mm–42¿ ADMINISTRATIVE ARRANGEMENT AUTHORITY.

The WTC Program Administrator may enter into arrangements with other government agencies, insurance companies, or
other third-party administrators to provide for timely and accurate
processing of claims under sections 3312, 3313, 3322, and 3323.
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Subtitle C—Research Into Conditions
SEC. 3341. ø42 U.S.C. 300mm–51¿ RESEARCH REGARDING CERTAIN
HEALTH CONDITIONS RELATED TO SEPTEMBER 11 TERRORIST ATTACKS.
(a) IN GENERAL.—With respect to individuals, including en-

rolled WTC responders and certified-eligible WTC survivors, receiving monitoring or treatment under subtitle B, the WTC Program
Administrator shall conduct or support—
(1) research on physical and mental health conditions that
may be related to the September 11, 2001, terrorist attacks;
(2) research on diagnosing WTC-related health conditions
of such individuals, in the case of conditions for which there
has been diagnostic uncertainty; and
(3) research on treating WTC-related health conditions of
such individuals, in the case of conditions for which there has
been treatment uncertainty.
The Administrator may provide such support through continuation
and expansion of research that was initiated before the date of the
enactment of this title and through the World Trade Center Health
Registry (referred to in section 3342), through a Clinical Center of
Excellence, or through a Data Center.
(b) TYPES OF RESEARCH.—The research under subsection (a)(1)
shall include epidemiologic and other research studies on WTC-related health conditions or emerging conditions—
(1) among enrolled WTC responders and certified-eligible
WTC survivors under treatment; and
(2) in sampled populations outside the New York City disaster area in Manhattan as far north as 14th Street and in
Brooklyn, along with control populations, to identify potential
for long-term adverse health effects in less exposed populations.
(c) CONSULTATION.—The WTC Program Administrator shall
carry out this section in consultation with the WTC Scientific/Technical Advisory Committee.
(d) APPLICATION OF PRIVACY AND HUMAN SUBJECT PROTECTIONS.—The privacy and human subject protections applicable to
research conducted under this section shall not be less than such
protections applicable to research conducted or funded by the Department of Health and Human Services.
SEC. 3342. ø42 U.S.C. 300mm–52¿ WORLD TRADE CENTER HEALTH REGISTRY.

For the purpose of ensuring ongoing data collection relating to
victims of the September 11, 2001, terrorist attacks, the WTC Program Administrator shall ensure that a registry of such victims is
maintained that is at least as comprehensive as the World Trade
Center Health Registry maintained under the arrangements in effect as of April 20, 2009, with the New York City Department of
Health and Mental Hygiene.

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Sec. 3351

Subtitle D—Funding
SEC. 3351. ø42 U.S.C. 300mm–61¿ WORLD TRADE CENTER HEALTH PROGRAM FUND.
(a) ESTABLISHMENT OF FUND.—
(1) IN GENERAL.—There is established a fund to be known

as the World Trade Center Health Program Fund (referred to
in this section as the ‘‘Fund’’).
(2) FUNDING.—Out of any money in the Treasury not otherwise appropriated, there shall be deposited into the Fund for
each of fiscal years 2012 through 2016 (and the last calendar
quarter of fiscal year 2011)—
(A) the Federal share, consisting of an amount equal
to the lesser of—
(i) 90 percent of the expenditures in carrying out
this title for the respective fiscal year (initially based
on estimates, subject to subsequent reconciliation
based on actual expenditures); or
(ii)(I) $71,000,000 for the last calendar quarter of
fiscal year 2011, $318,000,000 for fiscal year 2012,
$354,000,000 for fiscal year 2013, $382,000,000 for fiscal year 2014, and $431,000,000 for fiscal year 2015;
and
(II) subject to paragraph (4), an additional amount
for fiscal year 2016 from unexpended amounts for previous fiscal years; plus
(B) the New York City share, consisting of the amount
contributed under the contract under section 3331(d).
(3) CONTRACT REQUIREMENT.—
(A) IN GENERAL.—No funds may be disbursed from the
Fund unless New York City has entered into a contract
with the WTC Program Administrator under section
3331(d)(1).
(B) BREACH OF CONTRACT.—In the case of a failure to
pay the amount so required under the contract—
(i) the amount is recoverable under subparagraph
(E)(ii) of such section;
(ii) such failure shall not affect the disbursement
of amounts from the Fund; and
(iii) the Federal share described in paragraph
(2)(A) shall not be increased by the amount so unpaid.
(4) AGGREGATE LIMITATION ON FUNDING BEGINNING WITH
FISCAL YEAR 2016.—Beginning with fiscal year 2016, in no case
shall the share of Federal funds deposited into the Fund under
paragraph (2) for such fiscal year and previous fiscal years and
quarters exceed the sum of the amounts specified in paragraph
(2)(A)(ii)(I).
(b) MANDATORY FUNDS FOR MONITORING, INITIAL HEALTH
EVALUATIONS, TREATMENT, AND CLAIMS PROCESSING.—
(1) IN GENERAL.—The amounts deposited into the Fund
under subsection (a)(2) shall be available, without further appropriation, consistent with paragraph (2) and subsection (c),
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to carry out subtitle B and sections 3302(a), 3303, 3304,
3305(a)(2), 3305(c), 3341, and 3342.
(2) LIMITATION ON MANDATORY FUNDING.—This title does
not establish any Federal obligation for payment of amounts in
excess of the amounts available from the Fund for such purpose.
(3) LIMITATION ON AUTHORIZATION FOR FURTHER APPROPRIATIONS.—This title does not establish any authorization for
appropriation of amounts in excess of the amounts available
from the Fund under paragraph (1).
(c) LIMITS ON SPENDING FOR CERTAIN PURPOSES.—Of the
amounts made available under subsection (b)(1), not more than
each of the following amounts may be available for each of the following purposes:
(1) SURVIVING IMMEDIATE FAMILY MEMBERS OF FIREFIGHTERS.—For the purposes of carrying out subtitle B with respect
to
WTC
responders
described
in
section
3311(a)(2)(A)(ii)—
(A) for the last calendar quarter of fiscal year 2011,
$100,000;
(B) for fiscal year 2012, $400,000; and
(C) for each subsequent fiscal year, the amount specified under this paragraph for the previous fiscal year increased by the percentage increase in the consumer price
index for all urban consumers (all items; United States
city average) as estimated by the Secretary for the 12month period ending with March of the previous year.
(2) WTC HEALTH PROGRAM SCIENTIFIC/TECHNICAL ADVISORY
COMMITTEE.—For the purpose of carrying out section 3302(a)—
(A) for the last calendar quarter of fiscal year 2011,
$25,000;
(B) for fiscal year 2012, $100,000; and
(C) for each subsequent fiscal year, the amount specified under this paragraph for the previous fiscal year increased by the percentage increase in the consumer price
index for all urban consumers (all items; United States
city average) as estimated by the Secretary for the 12month period ending with March of the previous year.
(3) EDUCATION AND OUTREACH.—For the purpose of carrying out section 3303—
(A) for the last calendar quarter of fiscal year 2011,
$500,000;
(B) for fiscal year 2012, $2,000,000; and
(C) for each subsequent fiscal year, the amount specified under this paragraph for the previous fiscal year increased by the percentage increase in the consumer price
index for all urban consumers (all items; United States
city average) as estimated by the Secretary for the 12month period ending with March of the previous year.
(4) UNIFORM DATA COLLECTION.—For the purpose of carrying out section 3304 and for reimbursing Data Centers (as
defined in section 3305(b)(2)) for the costs incurred by such
Centers in carrying out activities under contracts entered into
under section 3305(a)(2)—
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(A) for the last calendar quarter of fiscal year 2011,
$2,500,000;
(B) for fiscal year 2012, $10,000,000; and
(C) for each subsequent fiscal year, the amount specified under this paragraph for the previous fiscal year increased by the percentage increase in the consumer price
index for all urban consumers (all items; United States
city average) as estimated by the Secretary for the 12month period ending with March of the previous year.
(5) RESEARCH REGARDING CERTAIN HEALTH CONDITIONS.—
For the purpose of carrying out section 3341—
(A) for the last calendar quarter of fiscal year 2011,
$3,750,000;
(B) for fiscal year 2012, $15,000,000; and
(C) for each subsequent fiscal year, the amount specified under this paragraph for the previous fiscal year increased by the percentage increase in the consumer price
index for all urban consumers (all items; United States
city average) as estimated by the Secretary for the 12month period ending with March of the previous year.
(6) WORLD TRADE CENTER HEALTH REGISTRY.—For the purpose of carrying out section 3342—
(A) for the last calendar quarter of fiscal year 2011,
$1,750,000;
(B) for fiscal year 2012, $7,000,000; and
(C) for each subsequent fiscal year, the amount specified under this paragraph for the previous fiscal year increased by the percentage increase in the consumer price
index for all urban consumers (all items; United States
city average) as estimated by the Secretary for the 12month period ending with March of the previous year.

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