House and Senate Health Reform Legislation Summary of Key by cgz15130

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                                              House and Senate Health Reform Legislation:
                                      Summary of Key Mental Health/Substance Use Disorder Provisions

                                               **Does not currently include Provisions Related to Indian Health or Indian Health Service**
                                     ***This summary will be updated as needed and may require revisions given the complexity of the legislation***


                                National Association of State Alcohol and Drug Abuse Directors (NASADAD)
                                                          Division of Public Policy

    Final House Bill (H.R. 3962): Affordable Health Care                                           Final Senate Bill (H.R. 3590) Patient Protection and
         for America Act as Passed on November 7th                                                 Affordable Care Act as Introduced on November 18th
Division A, Title II, Subtitle C, Sec. 222: Essential Benefit Package (Page                 Subtitle D, Part I, Sec. 1302: Essential Health Benefits Requirements (page
110): Includes “mental health and substance use disorder services, including                103) Includes “mental health and substance use disorder services, including
behavioral health treatments” as minimum services to be covered within the                  behavioral health treatments” as minimum services to be covered within the essential
essential benefit package that all qualified plans must provide.                            benefit package that all qualified plans must provide.

Also includes “Preventive services, including those services recommended with a             Title A, Subtitle A, Sec. 2713: Coverage of Preventive Services (Page 17)
grade A or B by the Task Force on Clinical Preventive Services…” (Page 102 and Page         requires group health plans and health insurance insurers to provide coverage, and
107 on no cost sharing)                                                                     without cost sharing requirements, for: evidence-based services that have been given a
                                                                                            grade of “A”or”B” by the United States Preventive Services Task Force; immunizations
                                                                                            that are recommended by CDC; and services to infants, children and adolescents that
                                                                                            are recommended by HRSA.


Division A, Title II, Subtitle C, Section 223, Health Benefits Advisory
Committee (Page 116): “Private-public” advisory panel “to recommend covered
benefits and essential, enhanced and premium plans.”


Division A, Title II, Subtitle E, Sec. 241, Health Choices Administration,
Health Choices Commissioner (Page 136): Establishes the Health Choices
Administration as an independent branch within the Executive, with a
Commissioner, to establish qualified health benefit plan standards and enforcement
of standards working with State Insurance Commissioners. (e.g. oversees the
exchange and affordability credits).


Title II, Protections and Standards for Qualified Health Plans, Subtitle
F, Sec. Sec. 263. Study and report on methods to increase EHR use by
small health care providers Requires the Secretary of Health and Human
Services to conduct a study of potential methods to increase the use of qualified
electronic health records by small providers including higher reimbursement rates,
training, and education.

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Division A, Title III, Subtitle A, Sec. 301, Establishment of Health                    Subtitle D, Part II, Sec. 1311: Affordable Choices of Health Benefits Plans
Insurance Exchange (Page 162): Establishes a health insurance exchange under            (Page 128) Requires the Secretary to award grants, available until 2015, to States for
the purview of the Health Choices Administration that will facilitate the offering of   planning and establishment of American Health Benefit Exchanges. By 2014, requires
health insurance choices.                                                               States to establish an American Health Benefit Exchange that facilitates the purchase
                                                                                        of qualified health plans and includes a SHOP Exchange for small businesses. This
                                                                                        section also notes that all plans must adhere to the mental health parity requirements
                                                                                        (Page 152)

                                                                                        Subtitle D, Part III, Sec. 1321: State flexibility in operation and
                                                                                        enforcement of Exchanges and related requirements (Page 164) Requires the
                                                                                        Secretary, in consultation with NAIC, to set standards for Exchanges, qualified health
                                                                                        plans, reinsurance, and risk adjustment. Requires States to implement these standards
                                                                                        by 2014. If the Secretary determines before 2013 that a State will not have an
                                                                                        Exchange operational by 2014, or will not implement the standards, requires the
                                                                                        Secretary to establish and operate an Exchange in the State and to implement the
                                                                                        standards. Presumes that a State operating an Exchange before 2010 meets the
                                                                                        standards, and establishes a process for the State to come into compliance with the
                                                                                        standards.


Division A, Title III, Subtitle B, Sec. 321, Establishment and                          Subtitle D, Part III, Sec. 1323: Community health insurance option (Page
administration of a public health insurance option as an Exchange-                      182) Requires the Secretary to offer a Community Health Insurance Option as a
qualified health benefits plan (Page 217): Requires the Secretary of Health             qualified health plan through Exchanges. Allows States to enact a law to opt out of
and Human Services to develop a public health insurance option to be offered            offering the option. Requires the option to cover only essential health benefits; States
starting in 2013 as a plan choice within the Health Insurance Exchange. It              may require additional benefits, but must defray their cost. Requires the Secretary to
participates on a level playing field with private plan choices.                        set geographically adjusted premium rates that cover expected costs. Requires the
                                                                                        Secretary to negotiate provider reimbursement rates, but they must not be higher than
                                                                                        average rates paid by private qualified health plans.


Division A, Title II, Subtitle B, Sec. 214, Parity in Mental Health and                 Subtitle D, Part II, Sec. 1311: Affordable Choices of Health Benefits Plans
Substance Abuse Benefits (Page 105): Requires plans in the exchange,                    (Page 152) Requires all plans to apply the mental health and substance use disorder
individual and group plans to adhere to parity requirements.                            parity requirements.

Division A, Title I, Sec. 112: Wellness Programs (Page 69): Sec. of Labor
and Sec. of HHS shall jointly awards to small employers for wellness programs with
awareness, screenings, education, and behavioral change – substance abuse
specifically referenced under behavioral change component. The amount of the
grant shall equal 50 percent of the costs incurred by the small employer for
implementing wellness plans – with a cap of $50,000 over 8 years. Programs must
be “certified” by HHS and Labor and be “evidence-based.”

Division A, Title IV and Title V pertaining to Individual Responsibility                Subtitle F, Part I and II pertaining to Individual and Employer
and Employer Responsibility (begins on page 268): Establishes a penalty on              Responsibility (begins on page 321) Requires individuals to maintain minimum
those who do not obtain health insurance coverage at 2.5 percent of adjusted gross      essential coverage beginning in 2014. Failure to maintain coverage will result in a
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income above a certain threshold. Certain exceptions apply.                             penalty of $95 in 2014, $350 in 2015, $750 in 2016 and indexed thereafter.

Includes provisions requiring employers, by January 1, 2013, to either offer health     Includes provisions requiring employers to either offer health insurance or contribute
insurance or contribute funds for that individual’s insurance.                          funds for that individual’s insurance.

                                                                         Medicare Provisions



Division B, Title III, Sec. 1308: Coverage of marriage and family
therapist services and mental health counselor services (Page 712) Adds
State-licensed or certified marriage and family therapists and mental health
counselors as Medicare providers and pays them at the same rate as social workers.




Division B, Title IV, Subtitle A, Section 1401, Comparative Effectiveness
Research (Page 741): Creates a new Center within the Agency for Healthcare
Research and Quality (AHRQ), supported by a combination of public and private
funding that will conduct, support and synthesize Comparative Effectiveness
Research (CER). Establishes an independent stakeholder commission which
recommends to the Center research priorities, study methods, and ways to
disseminate research.

                                                                         Medicaid Provisions



Division B, Title VII, Subtitle A, Sec. 1701, Medicaid and Health Reform,               Title II, Subtitle A, Sec. 2001: Medicaid Coverage for the lowest income
Eligibility for Individuals with Incomes Below 150 percent of Federal                   populations (Page 397) requires State Medicaid programs to cover non-elderly,
Poverty level (Page 1022-1030): Requires State Medicaid programs to cover               non-pregnant individuals who are not entitled for Medicare with incomes at or below
non-disabled, childless adults under age 65 not eligible for Medicare with incomes at   133% of the Federal Poverty Level (FPL) beginning January 1, 2013.
or below 150% of FPL ($16,200 per year for an individual).
                                                                                        (b) Creates a new State option to provide Medicaid coverage through a State plan
(b) Requires State Medicaid programs to cover children, parents, and individuals        amendment beginning on January 1, 2011.
with disabilities under age 65 with income at or below 150% of FPL ($33,100 per
year for a family of 4).                                                                (c) Creates a mandatory Medicaid income eligible level for children ages six to 19 from
                                                                                        100% to 133% of FPL.
(c) Requires State Medicaid programs to cover newborns up to the first 60 days of

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life who do not otherwise have coverage upon birth. The federal government would      (d) Newly-eligible individuals would receive benchmark or benchmark equivalent
pay 100% of the costs of Medicaid coverage for these newborns.                        coverage consistent with the requirements of section 1937 of the Social Security Act.
                                                                                      Benchmark and benchmark-equivalent coverage would be required to provide at least
(d) For the new Medicaid expansion category of childless adults with incomes at or    essential benefits and prescription drugs and mental health services would be added to
below 150% of FPL, States may only enroll an individual into a managed care entity    the list of services that must be covered at actuarial equivalence.
after demonstrating to the Secretary of HHS “…that the entity, though its provider
network and other arrangements, has the capacity to meet the health, mental health,
and substance abuse needs.”



Division B, Title VII, Subtitle B (Prevention in Medicaid), Sec. 1711,
Required Coverage of Preventive Services (Page 1052): Requires State
Medicaid programs to cover, without cost-sharing,, preventive services that are
recommended by the U.S. Preventive Services Task Force and appropriate for
Medicaid beneficiaries.



                                                                                      Title II, Subtitle I, Sec. 2703: State Option to Provide health homes for
                                                                                      enrollees with chronic conditions (Page 528) allows States the option of
                                                                                      enrolling Medicaid beneficiaries with chronic conditions into a health home which
                                                                                      would be comprised of a team of health professionals and would provide a
                                                                                      comprehensive set of medical services including care coordination.

                                                                                      States should consult and coordinate with SAMHSA regarding the prevention and
                                                                                      treatment of mental illness and substance use disorders among eligible individuals
                                                                                      with chronic conditions.

                                                                                      To be eligible, an individual must suffer from two chronic conditions; one chronic
                                                                                      condition with the risk for a second chronic condition; or one chronic condition and a
                                                                                      persistent mental health condition.

                                                                                      For the purpose of this section, a chronic condition is defined as: a mental health
                                                                                      condition, a substance use disorder; asthma, diabetes, heart disease or being
                                                                                      overweight.


Division B, Title VII, Subtitle B (Prevention in Medicaid), Sec. 1712,
Tobacco Cessation (Page 1054): Prohibits State Medicaid programs from
excluding tobacco cessation products from coverage.

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Division B, Title VII, Subtitle C, Sec. 1727: Therapeutic Foster Care (Page
1074) Clarifies that federal Medicaid law does not prohibit State Medicaid
programs from covering therapeutic foster care for children in out-of-home
placements.



Division B, Title VII, Subtitle H, Sec. 1787, Demonstration project for                  Title II, Subtitle I, Sec. 2707: Medicaid Emergency Psychiatric
stabilization of emergency medical conditions by nonpublicly owned or                    Demonstration Project (Page 547) requires the Secretary of HHS to establish a
operated institutions for mental diseases (Page 1160): Provides $75 million              three year Medicaid demonstration project in up to eight States. Participating States
for a 3-year demonstration project to test the reimbursement of private psychiatric      would be required to reimburse certain institutions for mental diseases (IMDs) for
hospitals for the stabilization of individuals between 21 and 65 with emergency          services provided to Medicaid beneficiaries between the ages of 21 and 65 who are in
medical conditions.                                                                      need of medical assistance to stabilize an emergency psychiatric condition.

                                                  Public Health and Workforce Development Provisions



Division C—Public Health and Workforce Development, Sec. 2002,                           Title V, Subtitle B, Sec. 5101: National health care workforce commission
Pubic Health Investment Fund (Page 1225): Establishes the Public Health                  (Page 1278) establishes a national commission tasked with reviewing health care
Investment Fund and deposits a total of $34 billion for use over the next five years     workforce and projected workforce needs. The overall goal of the Commission is to
($4.6 billion in FY 2011, $5.6 billion in FY 2012, $6.9 in FY 2013, $7.8 billion in FY   provide comprehensive, unbiased information to Congress and the Administration
2014 and $9 billion in FY 2015). These funds are authorized to be appropriated by        about how to align federal health workforce resources with national needs. Mental
the Committee on Appropriations for activities in this Division (described below)        health and behavioral health care workforce capacity needs would be specifically
and are over and above the level of appropriations provided for these activities for     included in this evaluation. Behavioral and mental health workforce professionals
FY 2008.                                                                                 would include substance abuse prevention and treatment professionals.



Division C, Title I, Sec. 2101: Increased Funding for Community Health                   Title V, Subtitle B, Sec. 5102: State Health Care Workforce Development
Centers (Page 1229) Authorizes an additional $12 billion over the next five years        Grants (Page 1297) authorizes the Secretary to award competitive grants for the
(FY 2011 – FY 2015) for community health centers to be appropriated from the             purpose of enabling State partnerships to complete comprehensive planning and to
Public Health Investment Fund (under Sec. 2002).                                         carry out activities leading to coherent and comprehensive health care workforce
                                                                                         development strategies at the State and local levels.




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Division C, Title II, Subtitle C, Sec. 2231, Public Health Workforce Corps             Title V, Subtitle C, Sec. 5203: Healthcare Workforce Loan Repayment
(Page 1263): Establishes within the Health Resources and Services Administration       Programs (Page 1319) establishes a loan repayment program for pediatric
(HRSA) a Public Health Workforce Corps to address public health workforce              subspecialists and providers of adolescent mental health and behavioral health
shortages. Modeled on the National Health Service Corps, the program provides          (including substance use disorder services) services who are or will be working in a
scholarship and loan repayment support for public health professionals serving in      Health Professional Shortage area, Medically Underserved Area or with a Medically
areas of need. Director of CDC responsible for designing a methodology for placing     Underserved Population.
and assigning public health professionals, which may allow placement in State, local
and tribal health departments and FQHCs.  



Division C, Title II, Subtitle C, Sec. 2322, Enhancing the Public Health               Title V, Subtitle C, Sec. 5204: Public Health Workforce Recruitment and
Workforce (Page 1272): Provides funding through HRSA in consultation with              Retention Program (Page 1324) offers loan repayment to public health students
CDC to support public health training programs for those in the field of nursing,      and workers in exchange for working at least three years at a federal, State, local or
health administration, management or policy, preventive medicine, veterinary           tribal public health agency.
medicine or dental medicine. Eligible applicants include accredited schools, State,
local or tribal health department, public or private nonprofit entities or a
combination of the two.



Division C, Title II, Subtitle C, Sec. 2233, Public Health Training Centers            Title V, Subtitle C, Sec. 5206: Grants for State and local programs (Page
(Page 1275): Revises the goals for the public health training grant programs to        1331) awards scholarships to mid-career public and allied health professionals
comport with the Secretary’s new national prevention and wellness strategy (under      employed in public and allied health positions at the Federal, State, tribal or local level
Sec. 3121).                                                                            to receive additional training in public or allied health fields. $60 million is authorized
                                                                                       for this program.



Division C, Title II, Subtitle C, Sec. 2234, Preventive Medicine and Public            Title V, Subtitle D, Sec. 5302: Training Opportunities for Direct Care
Health Training Grant Program (Page 1276): The Secretary of HHS, Acting                Workers (Page 1346) authorizes funding over three years to establish new training
through the Administrator of HRSA and with consultation with the Director of CDC       opportunities for direct care workers providing long-term care services and supports,
shall provide funding to support training grant programs graduate medical residents    which would include facilities for those individuals with mental retardation as well as
in preventive medicine specialties. Eligible applicants include schools of public      home and community based settings. $10 million is authorized.
health, medicine or osteopathic medicine, public or private non-profit hospital or
State, local or tribal health departments.




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Division C, Title II, Part 3, Sec. 2261, Health Workforce Evaluation and            Title V, Subtitle B, Sec. 5103: Health Care Workforce Assessment (Page
Assessment (Page 1285): Creates a 15 member Advisory Committee on Health            1309) This section codifies the existing National Center for Health Workforce Analysis
Workforce Evaluation and Assessment to assess the adequacy and appropriateness      and establishes several regional centers for workforce analysis to collect, analyze and
of the nation’s health workforce, and to make recommendations to the Secretary on   report data related to primary care workforce programs.
federal workforce policies to ensure that such workforce is meeting the nation’s
needs. The definition of health workforce includes …”mental health and behavioral
health professionals.” The Assistant Secretary for Health within HHS oversees the   Title V, Subtitle D, Sec. 5306: Mental and Behavioral Health education and
work of this new Advisory Committee.                                                training grants (Page 1369) awards grants to schools for the development,
                                                                                    expansion, or enhancement of training programs in social work, graduate psychology,
                                                                                    professional training in child and adolescent mental health, and pre-service or in-
                                                                                    service training to paraprofessionals in child and adolescent mental health. Substance
                                                                                    use disorder prevention and treatment services would be included within this section.

                                                                                    $8 million is authorized for training in social work; $12 million is authorized in
                                                                                    training for psychology; $10 million is authorized in training for child and adolescent
                                                                                    mental health; and $5 million is authorized in paraprofessional adolescent and child
                                                                                    work.


                                                                                    Title V, Subtitle D, Sec. 5313: Grants to Promote the Community Health
                                                                                    Workforce (Page 1389) authorizes the Secretary, through the Director of CDC, to
                                                                                    award grants to States, public health departments, clinics, hospitals, Federally qualified
                                                                                    health centers and other nonprofits to promote positive health behaviors and outcomes
                                                                                    in medically underserved areas through the use of community health workers.

                                                                                    Community health workers offer interpretation and translation services, provide
                                                                                    culturally appropriate health education and information, offer informal counseling and
                                                                                    guidance on health behaviors, advocate for individuals and community needs and can
                                                                                    provide some direct primary care services and screenings.


                                                                                    Title V, Subtitle D, Sec. 5315: United States Public Health Sciences Track
                                                                                    (Page 1397) Directs the Surgeon General to establish a U.S. Public Health Sciences
                                                                                    Track to train physicians, dentists, nurses, physician assistants, mental and behavioral
                                                                                    health specialists, and public health professionals emphasizing team-based service,
                                                                                    public health, epidemiology, and emergency preparedness and response in affiliated
                                                                                    institutions. Students receive tuition remission and a stipend and are accepted as
                                                                                    Commission Corps officers in the U.S. Public Health Service for two years.



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                                                                                   Title V, Subtitle E, Sec. 5403: Interdisciplinary, Community-based
                                                                                   Linkages (Page 1418) authorizes funding to establish community-based training
                                                                                   and education grants for Area Health Education Centers (AHEC) and Programs. These
                                                                                   programs target individuals seeking careers in the health professions from urban and
                                                                                   rural medically underserved communities. Coordination with mental health and
                                                                                   behavioral health facilities is included in this section. $125 million is authorized.


                                                                                   Title V, Subtitle E, Sec. 5405: Primary Care Extension Program (Page 1431)
                                                                                   Acting through the Director of AHRQ, creates a Primary Care Extension Program to
                                                                                   educate and provide technical assistance to primary care providers about evidence-
                                                                                   based therapies, preventive medicine, health promotion, chronic disease management
                                                                                   and mental health (which includes substance abuse prevention and treatment
                                                                                   services).

                                                                                   AHRQ will award planning and program grants to State hubs including the State health
                                                                                   department, State level entities administering Medicare and Medicaid and at least one
                                                                                   health professions school. All appropriate Federal agencies including SAMHSA need to
                                                                                   be consulted in carrying out this program.

                                                                                   $120 million is authorized to carry out this program.


                                                                                   Title V, Subtitle G, Sec. 5601: Spending on Federally Qualified Health
                                                                                   Centers (Page 1508) authorizes the following appropriations: $2.98 billion in FY
                                                                                   2010; $3.86 billion in FY 2011; $4.99 billion in FY 2012; $6.44 billion in FY 2013;
                                                                                   $7.33 billion in FY 2014; $8.33 billion in FY 2015.


                                                                                   Title V, Subtitle G, Sec. 5604: Co-Locating Primary and Specialty Care in
                                                                                   Community-mental health settings (Page 1515) authorizes $50 million in grants
                                                                                   for coordinated and integrated services through the co-location of primary and
                                                                                   specialty care in community-based mental and behavioral health settings.

                                                          Prevention and Wellness Provisions


Division C, Title III, Subtitle A, Sec. 3111, Prevention and Wellness Trust        Title IV, Subtitle A, Sec. 4002: Prevention and Public Health Trust Fund
(Page 1297): Establishes a Prevention and Wellness Trust that authorizes           (Page 1141) Establishes a Prevention and Public Health Investment Fund. The goal of
appropriations from the Public Health Investment Fund (under Sec. 2002) of $15.4   the Investment Fund is to provide an expanded and sustained national investment in
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billion over the next five years ($2.4 billion in FY 2011, $2.8 billion in FY 2012, $3.1   the prevention and public health programs to improve health and help restrain the rate
billion in FY 2013, $3.5 billion in FY 2014 and $3.6 billion in FY 2015) to fund           of growth in private and public sector health care costs. This will involve a dedicated
activities under Subtitle C (Prevention Task Forces), Subtitle D (Prevention and           stable funding stream for prevention, wellness and public health activities authorized
Wellness Research), Subtitle E (Delivery of Community-Based Prevention and                 by the Public Health Service Act.
Wellness Services) and Subtitle F (Core Public Health Infrastructure and Activities)
of new PHSA Title XXXI.                                                                    For Fiscal Year 2010, $500,000,000 is authorized; for FY 2011, $750,000,000 is
                                                                                           authorized; for FY 2012, $1,000,000,000 is authorized; for FY 2013, $1,250,000,000
                                                                                           is authorized; for FY 2014, $1,500,000,000 is authorized; and for FY 2015 and all
                                                                                           other FYs, $2,000,000,000 is authorized.


Division C, Title III, Subtitle B, Sec. 3121, National Prevention and                      Title IV, Subtitle A, Sec. 4001: National Prevention, Health Promotion and
Wellness Strategy (Page 1299): Requires the Secretary to develop and                       Public Health Council (Page 1134) creates an interagency council dedicated to
periodically update a national strategy “…designed to improve the nation’s health          promotion healthy policies at the federal level. The Council shall consist of
through evidence-based clinical and community-based prevention and wellness                representatives of federal agencies that interact with federal health and safety policy
activities…” The first report is due one year after the bill is enacted. The Strategy      including HHS, Education, Labor, ONDCP and others. The Council will establish a
must include national goals and objectives, taking into account Health People);            national prevention and health promotion strategy and develop interagency working
establish priorities; identification of disparities in prevention and wellness; review     relationships to implement the strategy. The Council will report annually to Congress
prevention payment incentives, workforce, and prevention delivery capacity system;         on health promotion activities of the Council and progress in meeting goals of the
and a plan to address these issues. The Secretary of HHS must consult with                 national strategy. Substance use disorders are listed as one of the national priorities to
SAMHSA and other agencies on the development of the Prevention and Wellness                be included in the report to Congress and the President.
Strategy.


Division C, Title III, Subtitle C, Sec. 3131, Task Force on Clinical                       Title IV, Subtitle A, Sec. 4003: Clinical and Community Preventive Services
Preventive Services (Page 1301): Converts the existing U.S. Preventive Services            (Page 1142) expands the efforts of and improves coordination between the two task
Task Force, within AHRQ, into the 30 member Task Force on Clinical Preventive              forces, the U.S. Preventive Services Task Force and the Community Preventive Services
Services. The charge to the Task Force is to conduct evidence-based systemic               Task Force, which provide recommendations for preventive interventions. This section
reviews of data and literature to determine which clinical preventive services (i.e.,      also gives the Task Forces clear duties. The two Task Forces are also expected to
preventive services delivered by traditional health care providers in clinical settings)   coordinate together on recommendations.
are scientifically proven to be effective.


Division C, Title III, Subtitle C, Sec. 3132, Task Force on Community
Preventive Services (Page 1308): Codifies the existing 30 member Task Force
on Community Preventive Services within CDC. The charge to the Task Force is to
conduct evidence-based systematic reviews of data and literature to determine
which community preventive services (i.e., preventive services that are delivered
outside traditional clinical settings and frequently implemented across targeted
groups) are scientifically proven to be effective.


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Division C, Title III, Subtitle D, Sec. 3141: Prevention and Wellness                  Title IV, Subtitle A, Sec. 4004: Education and Outreach Campaign
Research Activity Coordination (Page 1314) Directs the CDC and NIH                     Regarding Preventive Benefits (Page 1150) Directs the Secretary to convene a
directors to take into consideration the national strategy on prevention (under Sec.   national public/private partnership for the purposes of conducting a national
3121), recommendations from the Task Force on Clinical Preventive Services (under      prevention and public health promotion outreach and education campaign. The goal of
Sec. 3131), and recommendations from the Task Force on Community Preventive            the campaign is to raise awareness of activities to promote health and prevent diseases
Services (under Sec. 3132) in conducting or supporting research on prevention and      across the lifespan. The Secretary will conduct a national media campaign on health
wellness.                                                                              promotion and disease prevention focusing on nutrition, physical activity and smoking
                                                                                       cessation using science-based social research.

                                                                                       The Secretary will also provide guidance and relevant information to States and health
                                                                                       care providers regarding preventive and obesity-related services that are available to
                                                                                       Medicaid enrollees. Each State would be required to design a public awareness
                                                                                       campaign to education Medicaid enrollees regarding availability and coverage of such
                                                                                       services.


Division C, Title III, Subtitle D, Sec. 3142: Community Prevention and                 Title IV, Subtitle B, Sec. 4103: Medicare Coverage of Annual wellness Visit
Wellness Research Grants (Page 1315) Provides support for CDC research on              Providing Personalized Prevention Plan (Page 1174) provides coverage under
community preventive services.                                                         Medicare with no-co-payment or deductible for an annual wellness visit and
                                                                                       personalized prevention plan services.


Division C, Title III, Subtitle D, Sec. 3143: Research on subsidies and                Title IV, Subtitle B, Sec. 4104: Removal of Barriers to Preventive Services
rewards to encourage wellness and healthy behaviors (Page 1316)                        in Medicare (Page 1184) waives beneficiary coinsurance requirements for most
Provides support for research on incentivizing proven healthy behaviors and for the    preventive services, requiring Medicare to cover 100 percent of the costs. Services for
inclusion of effective incentive programs in the essential benefits package or in      which no coinsurance or deductible would be required are the personalized prevention
community prevention and wellness programs.                                            plan services and any covered preventive service if it is recommended with a grade of A
                                                                                       or B by the U.S. Preventive Services Task Force.


Division C, Title III, Subtitle E, Sec. 3151: Community Prevention and                 Title IV, Subtitle B, Sec. 4106: Improving Access to Preventive Services for
Wellness Services Grants (Page 1319) Establishes a grant program within the            Eligible Adults in Medicaid (Page 1190) the current Medicaid State option to
CDC to support the delivery of evidence-based, community-based prevention and          provide other diagnostic, screening, preventive, and rehabilitation services would be
wellness services across the country. Eligible entities include state and local        expanded to include: (1) any clinical preventive service recommended with a grade of A
governments, nonprofits, and consortia such as community partnerships                  or B by the U.S. Preventive Services Task Force and (2) with respect to adults,
representing Health Empowerment Zones. At least 50% of grant funds must be             immunizations recommended by the Advisory Committee on Immunization Practices
spent on implementing services whose primary purpose is to reduce health               (ACIP) and their administration.
disparities. Beginning in FY 2014, the Secretary shall award grants under this
section only to those applicants planning or implementing services recommended by


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the Task Force on Community Preventive Services under Section 3132 or deemed
effective based on comparable rigor as determined by CDC.



Division C, Title III, Subtitle F, Sec. 3161: Core Public Health                       Title IV, Subtitle C, Sec. 4201: Community Transformation Grants (Page
Infrastructure for State, local and tribal health departments (Page 1323)              1203) authorizes the Secretary, through the Director of CDC, to award competitive
Establishes a grant program at CDC to improve “core public health infrastructure” at
                                                                                       grants to eligible entities, which would include State and local governmental agencies,
the State, local, and tribal level. Includes formula grants to State health
departments and competitive grants for State, local or tribal health departments.      for programs that promote individual and community health and prevent the incidence
Establishes a public health accreditation program for public health departments and    of chronic disease. Communities can carry out programs to prevent and reduce the
laboratories. Core infrastructure includes “…workforce capacity and competency;        incidence of chronic diseases associated with overweight and obesity, tobacco use, or
lab systems; health information, health information systems, and health                mental illness or other activities that are consistent with the goals of promoting healthy
information analysis; communications; financing; other relevant components of          communities. Such sums are authorized for this program.
organizational capacity; and other related activities.”

Division C, Title III, Subtitle F, Sec. 3162: Core Public Health                       Title IV, Subtitle C, Sec. 4202: Healthy Aging, living well, evaluation of
Infrastructure and Activities for CDC (Page 1327) Provides support for CDC             community-based prevention and wellness programs for Medicare
to address unmet and emerging public health needs.                                     beneficiaries (Page 1209) Authorizes the Secretary, acting through the Director of
                                                                                       CDC, to provide grants to States or large local health departments to conduct pilot
                                                                                       programs in the 55 to 64 year old population. Pilot programs would evaluate chronic
                                                                                       disease risk factors, conduct evidence-based public health interventions (which would
                                                                                       include improving mental health) and ensure that individuals identified with chronic
                                                                                       disease or at risk for chronic disease receive clinical treatment to reduce risk. Mental
                                                                                       health and substance use disorder screenings would be included within this program
                                                                                       and would allow State and local health departments to enter into agreements with
                                                                                       community health centers or rural health clinics and mental health and substance use
                                                                                       disorder service providers.

                                                                                       This section also authorizes CMS to conduct a comprehensive assessment of
                                                                                       community-based disease self-management programs that help control chronic
                                                                                       diseases. The Secretary would then develop a plan for improving access to services for
                                                                                       Medicare beneficiaries.

                                                                                       Title IV, Subtitle C, Sec. 4206: Demonstration Project Concerning
                                                                                       Individualized Wellness Plans (Page 1237) authorizes a pilot program that
                                                                                       provides at-risk populations who utilize community health centers with a
                                                                                       comprehensive risk-factor assessment and an individualized wellness plan designed to
                                                                                       reduce risk factors for preventable conditions. Alcohol and tobacco cessation
                                                                                       counseling and services are included. Such sums are authorized to carry out this
                                                                                       program.


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                                                                             Other Provisions


Title IV, Quality and Surveillance, Sec. 2401: Implementation of Best                    Title III, Part II, National Strategy to Improve Health Care Quality, Sec.
Practices in the Delivery of Health Care (Page 1333) establishes a Center for            3011: National Strategy (Page 692) requires the Secretary to establish and update
Quality Improvement to be headed by a Director that shall prioritize areas for the       annually a national strategy to improve the delivery of health care services, patient
identification, development, evaluation and implementation of best practices             health outcomes, and population health. Establishes, no later than January 1, 2011, a
including innovative methodologies and strategies for quality improvement                federal health care quality internet website.
activities in the delivery of health care services. The Director may award grants to
eligible entities which include nonprofit entities who agree to work with a variety of   Title III, Part II, Sec. 3012: Interagency Working Group on Health Care
institutional health care providers, physicians, nurses and other healthcare             Quality (Page 699) requires the President to convene an Interagency Working
professionals to help identify existing best practices and help in the development of    Group on Health Care Quality comprised of Federal agencies to collaborate on the
new best practices.                                                                      development and dissemination of quality initiatives consistent with the national
                                                                                         strategy.

Title IV, Sec. 2402: Sec. 2402. Assistant Secretary for health
information: Establishes the position of Assistant Secretary for Health
Information to provide health information on key health indicators; to facilitate
better data sharing; and to develop standards for the collection of data to study and
address health disparities.



Division C, Title V, Subtitle A, Sec. 2501: Expanded Participation in 340B               Title VII, Subtitle B, Sec. 7101: Expanded Participation in 340B Program
program (Page 1349) Extends the section 340B pharmaceutical pricing discount             (Page 1906) extends the 340B discounts to inpatient drugs and also extends
program to certain critical access hospitals, children’s hospitals, cancer hospitals,    participation to certain children’s hospitals, cancer hospitals, critical access and sole
and MH/SUD block grant treatment providers receiving SAPT Block Grant funds.             community hospitals and rural referral centers.


Division C, Title V, Subtitle B, Sec. 2511: School-Based Health Clinics                  Title IV, Subtitle B, Sec. 4101: School-based Health Clinics (Page 1156)
(Page 1363) Establishes a new program to support school-based health clinics that        Establishes a new program to support school-based health clinics that provide health
provide health services, which could include mental health services and                  services, which could include mental health services (meant to include substance use
assessments, to children and adolescents. Authorizes $50 million for FY 2011 and         disorder services) and assessments, to children and adolescents. Authorizes $50
such sums as may be necessary for each of FY 2012 through FY 2015 to carry out this      million for FY 2010 to FY 2013
program.


Division C, Title V, Subtitle B, Sec. 2513, Federally Qualified Behavioral
Health Centers (Page 1377): Establishes criteria for certifying federally qualified
behavioral health centers. SAMHSA is given the responsibility to determine whether
programs meet the requirements of a FQBHC.




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Division C, Title V, Subtitle B, Sec. 2522: Mental Health and Behavioral
Health Training (Page 1392) Authorizes the Secretary of HHS, acting through
the Administrator of HRSA, in consultation with SAMHSA, to establish a new
training program for mental and behavioral health professionals (including those
specializing in substance abuse counseling and addiction medicine) to promote
interdisciplinary training and coordination of the delivery of health care. Authorizes
$60 million for each of FY 2011 through FY 2015 to carry out this program.
Requires that no less than 15% of funds be used for training programs in psychology.


Division C, Title V, Subtitle B, Sec. 2529: Postpartum Depression (Page
1429) Encourages the Secretary to expand and intensify activities on postpartum
conditions, including research, epidemiological studies, the development of
improved screening and diagnostic techniques, and information and education
programs. Requires the Secretary to conduct a study on the benefits of screening for
postpartum conditions. Expresses the sense of Congress that the Director of the
National Institute of Mental Health may conduct a nationally representative
longitudinal study on the relative mental health consequences for women of
resolving a pregnancy (intended and unintended) in various ways. Authorizes such
sums as may be necessary for each of FY 2011 through FY 2013 to carry out these
activities.


Division C, Title V, Subtitle B, Sec. 2530: Grants to Promote Positive
Health Behaviors and Outcomes (Page 1432) The Secretary, in collaboration
with CDC and others as deemed appropriate by the Secretary, is authorized to award
grants for a new training program for community health workers to promote
positive health behaviors (e.g., improved nutrition, decreased tobacco use;
decreased alcohol and substance use; decrease untreated mental health problems)
among populations in medically underserved areas. Authorizes $30 million for each
of FY 2011 through FY 2015 to carry out this program.


Division C, Title V, Subtitle B, Sec. 2534: Community-based
Collaborative Care Networks (Page 1451). Establishes a new program to
support community-based collaborative care networks, a consortium of health care
providers offering coordinated and integrated health care services for low-income
patient populations or medically-underserved communities. Each network shall
include a safety net hospital and FQHCs. Additional partners may include a critical

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access care hospital, a county or municipal department of health; a rural health
clinical or rural health network, a community clinic, including a mental health clinic,
substance abuse clinic, or reproductive health clinic, a health center controlled
network, a private practice physician or group practice, a nurse or physician’s
assistant group practice, an adult day care provider, a home health care provider,
others as authorized by the Secretary. Authorizes such sums as may be necessary for
each of FY 2011 through FY 2015 to carry out this program.


Division C, Title V, Subtitle B, Sec 2538: Screening, Brief Intervention,
Referral and Treatment for Mental Health and Substance Abuse
Disorders (Page 1478): Authorizes $30 million for the Sec. of HHS to engage in
grants, contracts or cooperative agreements to public or private nonprofit entity to
provide mental health and substance abuse SBIRT services. Grantees must
‘…maintain communication with appropriate State mental health and substance
abuse agencies.” Preference given to applicants that (1) provide services in rural and
frontier areas, (2) provide services t0 special needs populations, including American
Indian or Alaska Native populations, or (3) provide services in school-based health
clinics or on university and college campuses.


Division C, Title V, Subtitle B, Sec. 2563: Public Awareness Campaign on
Pain Management (Page 1514) Requires the Secretary to establish and
implement a national education outreach and awareness campaign on pain
management. Authorizes $2 million for FY 2011 and $4 million for each of FY 2012
through FY 2015 to carry out the campaign.


Manager’s Amendment, Section 2593, Duplicative Grant Programs
(Page 37): The Secretary of HHS shall conduct a study to determine if any new
program in Division C of the bill is duplicative of any existing program within HHS.
If the Secretary determines that a program is duplicative, action will be taken either
to attempt to integrate the new Division C program into existing programming or if
this integration is not possible or appropriate, the Secretary shall promulgate a rule
terminating one or more programs to address the duplication.




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