Authorizing Legislation

Attachment 1a. NCEH Authority

Public Health Service Act
Section 301(a) [42 USC 241]
Research and Investigation in General

As amended by the 1988 Lead Contamination Control Act:
Section 317A [42 USC 247b-1]
Screenings, Referrals, and Education Regarding Lead Poisoning
Section 317B [42 USC 247b-3]
Education, Technology Assessment, and Epidemiology Regarding Lead Poisoning

Patient Protection and Affordable Care Act
Section 4002 [42 USC 300u-11]
Prevention and Public Health Fund

2016 Water Infrastructure Improvements for the Nation Act
[Public Law No. 114-322]
Section 2204
Other Lead Programs

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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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Sec. 301

PUBLIC HEALTH SERVICE ACT

2

(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,
March 13, 2013

Public Health Service Act

As amended by the 1988 Lead Contamination Control Act:
Section 317A [42 USC 247b-1]
Screenings, Referrals, and Education Regarding Lead Poisoning
Section 317B [42 USC 247b-3]
Education, Technology Assessment, and Epidemiology Regarding Lead Poisoning

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PUBLIC HEALTH SERVICE ACT

Sec. 317A

(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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Sec. 317A

PUBLIC HEALTH SERVICE ACT

30

(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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PUBLIC HEALTH SERVICE ACT

Sec. 317A

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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Sec. 317A

PUBLIC HEALTH SERVICE ACT

32

(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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PUBLIC HEALTH SERVICE ACT

Sec. 317B

(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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Sec. 317B

PUBLIC HEALTH SERVICE ACT

34

(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

March 13, 2013

October 27, 1992.

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PUBLIC HEALTH SERVICE ACT

Sec. 317C

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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Patient Protection and Affordable Care Act

Section 4002 [42 US 300u-11]
Prevention and Public Health Fund

111TH CONGRESS
"
2d Session

LEGISLATIVE COUNSEL

!

PRINT 111–1

COMPILATION OF PATIENT PROTECTION
AND AFFORDABLE CARE ACT

[As Amended Through May 1, 2010]
INCLUDING

PATIENT PROTECTION AND AFFORDABLE CARE ACT
HEALTH-RELATED PORTIONS OF THE HEALTH CARE
EDUCATION RECONCILIATION ACT OF 2010

AND

PREPARED BY THE

Office of the Legislative Counsel
FOR THE USE OF THE

U.S. HOUSE OF REPRESENTATIVES

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MAY 2010

OFFICE OF THE LEGISLATIVE COUNSEL
SANDRA L. STROKOFF, Legislative Counsel
EDWARD G. GROSSMAN, Deputy Legislative Counsel

Prepared by
EDWARD G. GROSSMAN, Deputy Legislative Counsel
with the assistance of
CRAIG A. STERKX, Publications Coordinator
ELONDA C. BLOUNT, Staff Assistant
EMILY M. VOLBERDING, Staff Assistant

This document is of the Patient Protection and Affordable Care
Act (‘‘PPACA’’; Public Law 111–148) consolidating the amendments
made by title X of the Act and the Health Care and Education Reconciliation Act of 2010 (‘‘HCERA’’; Public Law 111–152). The text
of the Indian Health Care Improvement Reauthorization and Extension Act of 2009 (S. 1790), as enacted (in amended form) by section 10221 of PPACA, is shown in a separate, accompanying document.
Preparation of document.—This document was prepared by
the attorneys and staff of the House Office of the Legislative Counsel (HOLC) for the use of its attorneys and clients. It is not an official document of the House of Representatives or its committees
and may not be cited as ‘‘the law’’. At the request of the Leadership, it is being made available to the public through Congressional
websites and may be downloaded at http://docs.house.gov/
energycommerce/ppacacon.pdf. Errors in this document are solely
the responsibility of HOLC. Please email any corrections to
‘‘hlccomments@mail.house.gov’’. This document (originally dated
May 24, 2010) may be updated to reflect corrections of errors or
subsequent changes in law.
United States Code citations.—United States Code section
numbers assigned to sections in PPACA are specified in brackets
after the section numbers in the heading of each section, viz., 2711
ø42 U.S.C. 300gg–11¿.

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Page

Sec.
Sec.
Sec.
Sec.

3509.
3510.
3511.
3512.

Improving women’s health ...........................................................
Patient navigator program ...........................................................
Authorization of appropriations ...................................................
GAO study and report on causes of action .................................

454
460
461
461

Subtitle G—Protecting and Improving Guaranteed Medicare Benefits
Sec. 3601. Protecting and improving guaranteed Medicare benefits ..........
Sec. 3602. No cuts in guaranteed benefits ....................................................

462
462

TITLE IV—PREVENTION OF CHRONIC DISEASE AND IMPROVING PUBLIC
HEALTH
Subtitle A—Modernizing Disease Prevention and Public Health Systems
Sec. 4001. National Prevention, Health Promotion and Public Health
Council ...........................................................................................................
Sec. 4002. Prevention and Public Health Fund ............................................
Sec. 4003. Clinical and community Preventive Services .............................
Sec. 4004. Education and outreach campaign regarding preventive benefits ..................................................................................................................

463
466
466
469

Subtitle B—Increasing Access to Clinical Preventive Services
Sec. 4101. School-based health centers .........................................................
Sec. 4102. Oral healthcare prevention activities ..........................................
Sec. 4103. Medicare coverage of annual wellness visit providing a personalized prevention plan .............................................................................
Sec. 4104. Removal of barriers to preventive services in Medicare ............
Sec. 4105. Evidence-based coverage of preventive services in Medicare ....
Sec. 4106. Improving access to preventive services for eligible adults
in Medicaid ....................................................................................................
Sec. 4107. Coverage of comprehensive tobacco cessation services for pregnant women in Medicaid ..............................................................................
Sec. 4108. Incentives for prevention of chronic diseases in medicaid ........

471
476
478
482
483
484
485
486

Subtitle C—Creating Healthier Communities
Sec. 4201. Community transformation grants ..............................................
Sec. 4202. Healthy aging, living well; evaluation of community-based
prevention and wellness programs for Medicare beneficiaries .................
Sec. 4203. Removing barriers and improving access to wellness for individuals with disabilities ...............................................................................
Sec. 4204. Immunizations ..............................................................................
Sec. 4205. Nutrition labeling of standard menu items at Chain Restaurants .........................................................................................................
Sec. 4206. Demonstration project concerning individualized wellness
plan ................................................................................................................
Sec. 4207. Reasonable break time for nursing mothers ...............................

489
492
496
496
499
502
503

Subtitle D—Support for Prevention and Public Health Innovation
Sec. 4301. Research on optimizing the delivery of public health services .
Sec. 4302. Understanding health disparities: data collection and analysis .................................................................................................................
Sec. 4303. CDC and employer-based wellness programs .............................
Sec. 4304. Epidemiology-Laboratory Capacity Grants .................................
Sec. 4305. Advancing research and treatment for pain care management
Sec. 4306. Funding for Childhood Obesity Demonstration Project .............

504
504
509
510
511
513

Subtitle E—Miscellaneous Provisions
Sec. 4401. Sense of the Senate concerning CBO scoring .............................

514

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463

PPACA (Consolidated)

Sec. 4001

TITLE IV—PREVENTION OF CHRONIC
DISEASE AND IMPROVING PUBLIC
HEALTH
Subtitle A—Modernizing Disease
Prevention and Public Health Systems
SEC. 4001 ø42 U.S.C. 300u–10¿. NATIONAL PREVENTION, HEALTH PROMOTION AND PUBLIC HEALTH COUNCIL.
(a) ESTABLISHMENT.—The President shall establish, within the

Department of Health and Human Services, a council to be known
as the ‘‘National Prevention, Health Promotion and Public Health
Council’’ (referred to in this section as the ‘‘Council’’).
(b) CHAIRPERSON.—The President shall appoint the Surgeon
General to serve as the chairperson of the Council.
(c) COMPOSITION.—The Council shall be composed of—
(1) the Secretary of Health and Human Services;
(2) the Secretary of Agriculture;
(3) the Secretary of Education;
(4) the Chairman of the Federal Trade Commission;
(5) the Secretary of Transportation;
(6) the Secretary of Labor;
(7) the Secretary of Homeland Security;
(8) the Administrator of the Environmental Protection
Agency;
(9) the Director of the Office of National Drug Control Policy;
(10) the Director of the Domestic Policy Council;
(11) the Assistant Secretary for Indian Affairs;
(12) the Chairman of the Corporation for National and
Community Service; and
(13) the head of any other Federal agency that the chairperson determines is appropriate.
(d) PURPOSES AND DUTIES.—The Council shall—
(1) provide coordination and leadership at the Federal
level, and among all Federal departments and agencies, with
respect to prevention, wellness and health promotion practices,
the public health system, and integrative health care in the
United States;
(2) after obtaining input from relevant stakeholders, develop a national prevention, health promotion, public health,
and integrative health care strategy that incorporates the most
effective and achievable means of improving the health status
of Americans and reducing the incidence of preventable illness
and disability in the United States;
(3) provide recommendations to the President and Congress concerning the most pressing health issues confronting
the United States and changes in Federal policy to achieve national wellness, health promotion, and public health goals, including the reduction of tobacco use, sedentary behavior, and
poor nutrition;
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Sec. 4001

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464

(4) consider and propose evidence-based models, policies,
and innovative approaches for the promotion of transformative
models of prevention, integrative health, and public health on
individual and community levels across the United States;
(5) establish processes for continual public input, including
input from State, regional, and local leadership communities
and other relevant stakeholders, including Indian tribes and
tribal organizations;
(6) submit the reports required under subsection (g); and
(7) carry out other activities determined appropriate by the
President.
(e) MEETINGS.—The Council shall meet at the call of the Chairperson.
(f) ADVISORY GROUP.—
(1) IN GENERAL.—The President shall establish an Advisory Group to the Council to be known as the ‘‘Advisory Group
on Prevention, Health Promotion, and Integrative and Public
Health’’ (hereafter referred to in this section as the ‘‘Advisory
Group’’). The Advisory Group shall be within the Department
of Health and Human Services and report to the Surgeon General.
(2) COMPOSITION.—
(A) IN GENERAL.—The Advisory Group shall be composed of not more than 25 non-Federal members to be appointed by the President.
(B) REPRESENTATION.—In appointing members under
subparagraph (A), the President shall ensure that the Advisory Group includes a diverse group of licensed health
professionals, including integrative health practitioners
who have expertise in—
(i) worksite health promotion;
(ii) community services, including community
health centers;
(iii) preventive medicine;
(iv) health coaching;
(v) public health education;
(vi) geriatrics; and
(vii) rehabilitation medicine.
(3) PURPOSES AND DUTIES.—The Advisory Group shall develop policy and program recommendations and advise the
Council on lifestyle-based chronic disease prevention and management, integrative health care practices, and health promotion.
(g) NATIONAL PREVENTION AND HEALTH PROMOTION STRATEGY.—Not later than 1 year after the date of enactment of this Act,
the Chairperson, in consultation with the Council, shall develop
and make public a national prevention, health promotion and public health strategy, and shall review and revise such strategy periodically. Such strategy shall—
(1) set specific goals and objectives for improving the
health of the United States through federally-supported prevention, health promotion, and public health programs, consistent with ongoing goal setting efforts conducted by specific
agencies;
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465

PPACA (Consolidated)

Sec. 4001

(2) establish specific and measurable actions and timelines
to carry out the strategy, and determine accountability for
meeting those timelines, within and across Federal departments and agencies; and
(3) make recommendations to improve Federal efforts relating to prevention, health promotion, public health, and integrative health care practices to ensure Federal efforts are consistent with available standards and evidence.
(h) REPORT.—Not later than July 1, 2010, and annually thereafter through January 1, 2015, the Council shall submit to the
President and the relevant committees of Congress, a report that—
(1) describes the activities and efforts on prevention,
health promotion, and public health and activities to develop
a national strategy conducted by the Council during the period
for which the report is prepared;
(2) describes the national progress in meeting specific prevention, health promotion, and public health goals defined in
the strategy and further describes corrective actions recommended by the Council and taken by relevant agencies and
organizations to meet these goals;
(3) contains a list of national priorities on health promotion and disease prevention to address lifestyle behavior
modification (smoking cessation, proper nutrition, appropriate
exercise, mental health, behavioral health, substance use disorder, and domestic violence screenings) and the prevention
measures for the 5 leading disease killers in the United States;
(4) contains specific science-based initiatives to achieve the
measurable goals of Healthy People 2020 regarding nutrition,
exercise, and smoking cessation, and targeting the 5 leading
disease killers in the United States; øAs revised by section
10401(a)¿
(5) contains specific plans for consolidating Federal health
programs and Centers that exist to promote healthy behavior
and reduce disease risk (including eliminating programs and
offices determined to be ineffective in meeting the priority
goals of Healthy People 2020); øAs revised by section 10401(a)¿
(6) contains specific plans to ensure that all Federal health
care programs are fully coordinated with science-based prevention recommendations by the Director of the Centers for Disease Control and Prevention; and
(7) contains specific plans to ensure that all non-Department of Health and Human Services prevention programs are
based on the science-based guidelines developed by the Centers
for Disease Control and Prevention under paragraph (4).
(i) PERIODIC REVIEWS.—The Secretary and the Comptroller
General of the United States shall jointly conduct periodic reviews,
not less than every 5 years, and evaluations of every Federal disease prevention and health promotion initiative, program, and
agency. Such reviews shall be evaluated based on effectiveness in
meeting metrics-based goals with an analysis posted on such agencies’ public Internet websites.
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Sec. 4002

PPACA (Consolidated)

466

SEC. 4002 ø42 U.S.C. 300u–11¿. PREVENTION AND PUBLIC HEALTH
FUND.
(a) PURPOSE.—It is the purpose of this section to establish a

Prevention and Public Health Fund (referred to in this section as
the ‘‘Fund’’), to be administered through the Department of Health
and Human Services, Office of the Secretary, to provide for expanded and sustained national investment in prevention and public
health programs to improve health and help restrain the rate of
growth in private and public sector health care costs.
(b) FUNDING.—There are hereby authorized to be appropriated,
and appropriated, to the Fund, out of any monies in the Treasury
not otherwise appropriated—
(1) for fiscal year 2010, $500,000,000;
(2) for fiscal year 2011, $750,000,000;
(3) for fiscal year 2012, $1,000,000,000;
(4) for fiscal year 2013, $1,250,000,000;
(5) for fiscal year 2014, $1,500,000,000; and
(6) for fiscal year 2015, and each fiscal year thereafter,
$2,000,000,000.
(c) USE OF FUND.—The Secretary shall transfer amounts in the
Fund to accounts within the Department of Health and Human
Services to increase funding, over the fiscal year 2008 level, for programs authorized by the Public Health Service Act, for prevention,
wellness, and public health activities including prevention research, health screenings, and initiatives, such as the Community
Transformation grant program, the Education and Outreach Campaign Regarding Preventive Benefits, and immunization programs.
øAs revised by section 10401(b)¿
(d) TRANSFER AUTHORITY.—The Committee on Appropriations
of the Senate and the Committee on Appropriations of the House
of Representatives may provide for the transfer of funds in the
Fund to eligible activities under this section, subject to subsection
(c).
SEC. 4003. CLINICAL AND COMMUNITY PREVENTIVE SERVICES.
(a) PREVENTIVE SERVICES TASK FORCE.—Section 915

of the
Public Health Service Act (42 U.S.C. 299b–4) is amended by striking subsection (a) and inserting the following:
‘‘(a) PREVENTIVE SERVICES TASK FORCE.—
‘‘(1) ESTABLISHMENT AND PURPOSE.—The Director shall
convene 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 recommendations, 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, nonprofit organizations, Congress and other policy-makers, governmental public health agencies, health care quality organizations, and organizations developing national health objectives.

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