,,ib  ,union ,cal5d> ,no4 #bfb  #aae?   
,,congress  #a/ ,session  ,h4 ,r4 #cibb 
,report ,no4 #aae-cei1 ,"p ,i  ,,9 ,,!  
,,h\se ,,( ,,repres5tatives  ,octob] #c1
 #bjag ,mr4 ,wald5 introduc$ ! foll[+   
bill2 :i* 0 ref]r$ to ! ,committee on   
,en]gy & ,comm]ce1 & 9 addition to !    
,committee on ,ways & ,means1 = a p]iod 
to be subsequ5tly det]m9$ by ! ,speak]1 
9 ea* case = consid]ation ( su*         
provisions z fall )9 ! jurisdiction ( ! 
committee conc]n$  ,octob] #ai1 #bjag   
,report$ f ! ,committee on ,en]gy &     
,comm]ce ) an am5dm5t ,/rike out all    
aft] ! enact+ clause & ins]t ! "p pr9t$ 
9 italic  ,octob] #ai1 #bjag,!          
,committee on ,ways & ,means dis*>g$2   
committ$ to ! ,committee ( ! ,:ole ,h\se
 on ! ,/ate ( ! ,union & ord]$ to be    
printed,for text ( introduc$ bill1 see  
copy ( bill z introduc$ on ,octob] #c1  
#bjag  ,a ,,bill  ,to ext5d fund+ =     
c]ta9 public heal? programs1 & = o!r    
purposes4  #a4 ,%ort title ,?is ,act may
 be cit$ z ! ,community ,heal? ,&       

,m$ical ,pr(essionals ,improve ,our     
,nation ,act ( #bjag or ! ,,*ampion     
,act4  #b4 ,table ( cont5ts ,! table (  
cont5ts = ?is ,act is z foll[s3  ,sec4  
#a4 ,%ort title4 ,sec4 #b4 ,table (     
cont5ts4 ,title ,i--,ext5sion ( ,public 
,heal? ,programs ,sec4 #aja4 ,ext5sion =
 community heal? c5t]s & ! ,national    
,heal? ,s]vice ,corps4 ,sec4 #ajb4      
,ext5sion = special diabetes programs4  
,sec4 #ajc4 ,reau?orization ( program ( 
paym5ts to tea*+ heal? c5t]s t op]ate   
graduate m$ical education programs4     
,sec4 #ajd4 ,ext5sion = family-to-family
 heal? in=mation c5t]s4 ,sec4 #aje4 ,y\?
 emp[]m5t program2 p]sonal              
responsibility education4 ,title        
,,ii--,(fsets ,sec4 #bja4 ,provid+ =    
qualifi$ heal? plan grace p]iod         
requirem5ts = issu] receipt ( advance   
paym5ts ( co/-%>+ r$uctions & premium   
tax cr$its t are m consi/5t ) ,/ate law 
grace p]iod requirem5ts4 ,sec4 #bjb4    
,prev5tion & ,public ,heal? ,fund4  ,i  
,ext5sion ( ,public ,heal? ,programs    

#aja4 ,ext5sion = community heal? c5t]s 
& ! ,national ,heal? ,s]vice ,corps  7a7
 ,community heal? c5t]s fund+ ,section  
#ajejc7;b77#a77;,e7 ( ! ,pati5t         
,protection & ,af=dable ,c>e ,act 7#db  
,u4,s4,c4 #bed;b-#b7;b77#a77;,e77 is    
am5d$ by /rik+ #bjag & ins]t+ #bjai4    
7b7 ,o!r community heal? c5t]s          
provisions ,section #ccj ( ! ,public    
,heal? ,s]vice ,act 7#db ,u4,s4,c4      
#bed;b7 is am5d$-- 7#a7 9 subsection    
7b77#a77;,a77ii71 by /rik+ abuse &      
ins]t+ use disord]2  7#b7 9 subsection  
7b77#b77;,a71 by /rik+ abuse & ins]t+   
use disord]2  7#c7 9 subsection 7c7--   
7,a7 9 p>agraph 7#a71 by /rik+          
subp>agraphs 7,b7 ?r\gh 7,d72  7,b7 by  
/rik+ 7#a7 ,9 g5]al & all t foll[s ?r\gh
 ,! ,secret>y & ins]t+ ! foll[+3  7#a7  
,c5t]s ,! ,secret>y  2 &  7,c7 9        
p>agraph 7#a71 z am5d$1 by r$esignat+   
clauses 7i7 ?r\gh 7v7 z subp>agraphs    
7,a7 ?r\gh 7,e7 & mov+ ! m>g9 ( ea* (   
su* r$esignat$ subp>agraph #b ems to !  
left2  7#d7 by /rik+ subsection 7d7 &   

ins]t+ ! foll[+3  7d7 ,improv+ quality (
 c>e  7#a7 ,supplem5tal aw>ds ,!        
,secret>y may aw>d supplem5tal grant    
funds to heal? c5t]s fund$ "u ?is       
section to implem5t evid5ce-bas$ models 
= increas+ access to high-quality prim>y
 c>e s]vices1 :i* may include models    
relat$ to--  7,a7 improv+ ! deliv]y (   
c>e = individuals ) multiple *ronic     
conditions2  7,b7 work=ce configuration2
  7,c7 r$uc+ ! co/ ( c>e2  7,d7 enhanc+ 
c>e coord9ation2  7,e7 exp&+ ! use (    
teleheal? & te*nology-enabl$            
collaborative le>n+ & capacity build+   
models2  7,f7 c>e integration1 includ+  
integration ( behavioral heal?1 m5tal   
heal?1 or sub/ance use disord] s]vices2 
&  7,g7 address+ em]g+ public heal? or  
sub/ance use disord] issues to meet !   
heal? ne$s ( ! population s]v$ by !     
heal? c5t]4  7#b7 ,su/a9ability ,9 mak+ 
supplem5tal aw>ds "u ?is subsection1 !  
,secret>y may consid] :e!r ! heal? c5t] 
involv$ has submitt$ a plan = cont9u+ ! 
activities fund$ "u ?is subsection aft] 

supplem5tal fund+ is exp5d$4  7#c7      
,special consid]ation ,! ,secret>y may  
give special consid]ation to            
applications = supplem5tal fund+ "u ?is 
subsection t seek to address significant
 b>ri]s to access to c>e 9 areas ) a    
great] %ortage ( heal? c>e provid]s &   
heal? s]vices relative to ! national    
av]age4  2  7#e7 9 subsection 7e77#a7-- 
7,a7 9 subp>agraph 7,b7--  7i7 by /rik+ 
#b ye>s & ins]t+ #a ye>2 &  7ii7 by add+
 at ! end ! foll[+3 ,! ,secret>y %all n 
make a grant "u ?is p>agraph unless !   
applicant provides assurances to !      
,secret>y t )9 #abj days ( receiv+ grant
 fund+ = ! op]ation ( ! heal? c5t]1 !   
applicant w submit1 = approval by !     
,secret>y1 an implem5tation plan to meet
 ! requirem5ts ( subsection 7l77#c74 ,! 
,secret>y may ext5d su* #abj-;day p]iod 
= a*iev+ compliance ^u a demon/ration ( 
good cause by ! heal? c5t]42 &  7,b7 9  
subp>agraph 7,c7-- 7i7 9 ! subp>agraph  
head+1 by /rik+ & plans2  7ii7 by /rik+ 
or plan 7z describ$ 9 subp>agraphs 7,b7 

& 7,c7 ( subsection 7c77#a772  7iii7 by 
/rik+ or plan1 includ+ ! pur*ase &      
ins]t+ ! foll[+3 8includ+--  7i7 !      
pur*ase  2  7iv7 by ins]t+ 1 :i* may    
include data & in=mation sy/ems aft] (  
equipm5t2  7v7 by /rik+ ! p]iod at ! end
 & ins]t+ a semicolon2 &  7vi7 by add+  
at ! end ! foll[+3  7ii7 ! provision (  
tra9+ & te*nical assi/ance2 &  7iii7 o!r
 activities t--  7,i7 r$uce co/s        
associat$ ) ! provision ( heal? s]vices2
  7,,ii7 improve access to1 &           
availability (1 heal? s]vices provid$ to
 individuals s]v$ by ! c5t]s2  7,,iii7  
enhance ! quality & coord9ation ( heal? 
s]vices2 or  7,,iv7 improve ! heal?     
/atus ( communities4  2  7#f7 9         
subsection 7e77#e77;,b7-- 7,a7 9 ! head+
 ( subp>agraph 7,b71 by /rik+ & plans2 &
  7,b7 by /rik+ & subp>agraphs 7,b7 &   
7,c7 ( subsection 7c77#a7 to a heal?    
c5t] or to a network or plan & ins]t+ to
 a heal? c5t] or to a network2  7#g7 by 
/rik+ subsection 7s72  7#h7 by          
r$esignat+ subsections 7g7 ?r\gh 7r7 z  

subsections 7h7 ?r\gh 7s71 respectively2
  7#i7 by ins]t+ aft] subsection 7f71 ! 
foll[+3  7g7 ,new access po9ts & exp&$  
s]vices  7#a7 ,approval ( new access    
po9ts  7,a7 ,9 g5]al ,! ,secret>y may   
approve applications = grants "u        
subp>agraph 7,a7 or 7,b7 ( subsection   
7e77#a7 to e/abli% new deliv]y sites4   
7,b7 ,special consid]ation ,9 c>ry+ out 
subp>agraph 7,a71 ! ,secret>y may give  
special consid]ation to applicants t h  
demon/rat$ ! new deliv]y site w be      
locat$ )9 a sp>sely populat$ area1 or an
 area :i* has a level ( unmet ne$ t is  
high] relative to o!r applicants4  7,c7 
,consid]ation ( applications ,9 c>ry+   
out subp>agraph 7,a71 ! ,secret>y %all  
approve applications = grants "u        
subp>agraphs 7,a7 & 7,b7 ( subsection   
7e77#a7 9 su* a mann] t ! ratio ( !     
m$ically und]s]v$ populations 9 rural   
areas :i* may be expect$ to use !       
s]vices provid$ by ! applicants involv$ 
to ! m$ically und]s]v$ populations 9    
urban areas :i* may be expect$ to use ! 

s]vices provid$ by ! applicants is n    
less ?an two to ?ree or great] ?an ?ree 
to two4  7,d7 ,s]vice area ov]lap ,if 9 
c>ry+ out subp>agraph 7,a7 ! applicant  
proposes to s]ve an area t is curr5tly  
s]v$ by ano!r heal? c5t] fund$ "u ?is   
section1 ! ,secret>y may consid] :e!r ! 
aw>d ( fund+ to an additional heal? c5t]
 9 ! area c be ju/ifi$ bas$ on ! unmet  
ne$ = additional s]vices )9 ! cat*m5t   
area4  7#b7 ,approval ( exp&$ s]vice    
applications  7,a7 ,9 g5]al ,! ,secret>y
 may approve applications = grants "u   
subp>agraph 7,a7 or 7,b7 ( subsection   
7e77#a7 to exp& ! capacity ( ! applicant
 to provide requir$ prim>y heal? s]vices
 describ$ 9 subsection 7b77#a7 or       
additional heal? s]vices describ$ 9     
subsection 7b77#b74  7,b7 ,priority     
expansion projects ,9 c>ry+ out         
subp>agraph 7,a71 ! ,secret>y may give  
special consid]ation to exp&$ s]vice    
applications t seek to address em]g+    
public heal? or behavioral heal?1 m5tal 
heal?1 or sub/ance abuse issues ?r\gh   

increas+ ! availability ( additional    
heal? s]vices describ$ 9 subsection     
7b77#b7 9 an area 9 :i* !re are         
significant b>ri]s to access+ c>e4  7,c7
 ,consid]ation ( applications ,9 c>ry+  
out subp>agraph 7,a71 ! ,secret>y %all  
approve applications = applicants 9 su* 
a mann] t ! ratio ( ! m$ically und]s]v$ 
populations 9 rural areas :i* may be    
expect$ to use ! s]vices provid$ by !   
applicants involv$ to ! m$ically        
und]s]v$ populations 9 urban areas :i*  
may be expect$ to use ! s]vices provid$ 
by su* applicants is n less ?an two to  
?ree or great] ?an ?ree to two4  2      
7#aj7 9 subsection 7i7 7z s             
r$esignat$7-- 7,a7 9 p>agraph 7#a71 by  
/rik+ & *ildr5 & y\? at risk (          
homelessness & ins]t+ 1 *ildr5 & y\? at 
risk ( homelessness1 homeless vet]ans1 &
 vet]ans at risk ( homelessness2 &  7,b7
 9 p>agraph 7#e7-- 7i7 by /rik+         
subp>agraph 7,b72  7ii7 by r$esignat+   
subp>agraph 7,c7 z subp>agraph 7,b72 &  
7iii7 9 subp>agraph 7,b7 7z s           

r$esignat$7--  7,i7 9 ! subp>agraph     
head+1 by /rik+ abuse & ins]t+ use      
disord]2 &  7,,ii7 by /rik+ abuse &     
ins]t+ use disord]2  7#aa7 9 subsection 
7l7 7z s r$esignat$7-- 7,a7 9 p>agraph  
7#b7--  7i7 9 ! p>agraph head+1 by      
ins]t+ unmet be=e ne$2  7ii7 9 ! matt]  
prec$+ subp>agraph 7,a71 by ins]t+ & an 
application = a grant "u subsection 7g7 
aft] subsection 7e77#a72  7iii7 9       
subp>agraph 7,a71 by ins]t+ unmet be=e  
ne$ = heal? s]vices2  7iv7 9 subp>agraph
 7,b71 by /rik+ & at ! end2  7v7 9      
subp>agraph 7,c71 by /rik+ ! p]iod at ! 
end & ins]t+ 2 &2 &  7vi7 by add+ aft]  
subp>agraph 7,c7 ! foll[+3  7,d7 9 !    
case ( an application = a grant pursuant
 to subsection 7g77#a71 a demon/ration t
 ! applicant has consult$ ) appropriate 
,/ate & local gov]nm5t ag5cies1 & heal? 
c>e provid]s reg>d+ ! ne$ = ! heal?     
s]vices to be provid$ at ! propos$      
deliv]y site4  2  7,b7 9 p>agraph 7#c7--
 7i7 9 ! matt] prec$+ subp>agraph 7,a71 
by ins]t+ or subsection 7g7 aft]        

subsection 7e77#a77;,b72  7ii7 9        
subp>agraph 7,b71 by /rik+ 9 ! cat*m5t  
area ( ! c5t] & ins]t+ 1 includ+ o!r    
heal? c>e provid]s t provide c>e )9 !   
cat*m5t area1 local hospitals1 &        
specialty provid]s 9 ! cat*m5t area ( ! 
c5t]1 to provide access to s]vices n    
available ?r\gh ! heal? c5t] & to r$uce 
! non-urg5t use ( hospital em]g5cy      
dep>tm5ts2  7iii7 9 subp>agraph         
7,h77ii71 by ins]t+ :o %all be directly 
employ$ by ! c5t] aft] approves !       
selection ( a director = ! c5t]2  7iv7 9
 subp>agraph 7,l71 by /rik+ & at ! end2 
7v7 9 subp>agraph 7,m71 by /rik+ ! p]iod
 & ins]t+ 2 &2 &  7vi7 by ins]t+ aft]   
subp>agraph 7,m71 ! foll[+3  7,n7 ! c5t]
 has writt5 policies & proc$ures 9 place
 to ensure ! appropriate use ( ,f$]al   
funds 9 compliance ) applicable ,f$]al  
/atutes1 regulations1 & ! t]ms &        
conditions ( ! ,f$]al aw>d4  2 &  7,c7  
by /rik+ p>agraph 7#d72  7#ab7 9        
subsection 7m7 7z s r$esignat$71 by add+
 at ! end ! foll[+3 ,funds exp5d$ to    

c>ry out activities "u ?is subsection & 
op]ational support activities "u        
subsection 7n7 %all n exce$ #c p]c5t ( !
 am\nt appropriat$ = ?is section = !    
fiscal ye> involv$42  7#ac7 9 subsection
 7q7 7z s r$esignat$71 by /rik+ grants =
 new heal? c5t]s "u subsections 7c7 &   
7e7 & ins]t+ op]at+ grants "u subsection
 7e71 applications = new access po9ts & 
exp&$ s]vice pursuant to subsection 7g72
  7#ad7 9 subsection 7r77#d7 7z s       
r$esignat$71 by add+ at ! end ! foll[+3 
,a waiv] provid$ by ! ,secret>y "u ?is  
p>agraph may n rema9 9 effect = m ?an #a
 ye> & may n be ext5d$ aft] su* p]iod4  
,an entity may n receive m ?an "o waiv] 
"u ?is p>agraph 9 consecutive ye>s42    
7#ae7 9 subsection 7s77#c7 7z s         
r$esignat$7-- 7,a7 by /rik+ appropriate 
committees ( ,congress a report conc]n+ 
! di/ribution ( funds "u ?is section &  
ins]t+ ! foll[+3 8,committee on ,heal?1 
,education1 ,labor1 & ,p5sions ( !      
,s5ate1 & ! ,committee on ,en]gy &      
,comm]ce ( ! ,h\se ( ,repres5tatives1 a 

report includ+1 at a m9imum--  7,a7 !   
di/ribution ( funds = c>ry+ out ?is     
section  2  7,b7 by /rik+ populations4  
,su* report %all include an assessm5t & 
ins]t+ ! foll[+3 8populations2  7,b7 an 
assessm5t  2  7,c7 by /rik+ & !         
rationale = any sub/antial *anges 9 !   
di/ribution ( funds4 & ins]t+ a         
semicolon2 &  7,d7 by add+ at ! end !   
foll[+3  7,c7 ! di/ribution ( aw>ds &   
fund+ = new or exp&$ s]vices 9 ea* (    
rural areas & urban areas2  7,d7 !      
di/ribution ( aw>ds & fund+ = e/abli%+  
new access po9ts1 & ! numb] ( new access
 po9ts creat$2  7,e7 ! am\nt ( unexp5d$ 
fund+ = loan gu>antees & loan gu>antee  
au?ority "u title ,,xvi2  7,f7 !        
rationale = any sub/antial *anges 9 !   
di/ribution ( funds2  7,g7 ! rate (     
closures = heal? c5t]s & access po9ts2  
7,h7 ! numb] & reason = any grants aw>d$
 pursuant to subsection 7e77#a77;,b72 & 
7,i7 ! numb] & reason = any waiv]s      
provid$ pursuant to subsection 7r77#d74 
2 &  7#af7 9 subsection 7s7 7z s        

r$esignat$7 by add+ at ! end ! foll[+   
new p>agraph3  7#e7 ,fund+ =            
p>ticipation ( heal? c5t]s 9 ,all ( ,u  
,rese>* ,program ,9 addition to any     
am\nts made available pursuant to       
subsection 7d7 ( ?is section1 p>agraph  
7#a7 ( ?is subsection1 section #djb;,a (
 ?is ,act1 or section #ajejc ( ! ,pati5t
 ,protection & ,af=dable ,c>e ,act1 !re 
is au?oriz$ to be appropriat$1 & !re is 
appropriat$1 out ( any monies 9 !       
,treasury n o!rwise appropriat$1 to !   
,secret>y #be1jjj1jjj = fiscal ye> #bjah
 to support ! p>ticipation ( heal? c5t]s
 9 ! ,all ( ,u ,rese>* ,program "u !    
,precision ,m$ic9e ,initiative "u       
section #dih;,e ( ?is ,act4  4  7c7     
,national ,heal? ,s]vice ,corps ,section
 #ajejc7;b77#b77;,e7 ( ! ,pati5t        
,protection & ,af=dable ,c>e ,act 7#db  
,u4,s4,c4 #bed;b-#b7;b77#b77;,e77 is    
am5d$ by /rik+ #bjag & ins]t+ #bjai4    
7d7 ,application ,am\nts appropriat$    
pursuant to ?is section = fiscal ye>    
#bjah or #bjai are subject to !         

requirem5ts conta9$ 9 ,public ,law      
#aae-ca = funds = programs au?oriz$ "u  
sections #ccj ?r\gh #cdj ( ! ,public    
,heal? ,s]vice ,act 7#db ,u4,s4,c4      
#bed;b-#bef74  7e7 ,con=m+ am5dm5ts     
,section #cjad7;h7 ( title #ah1 ,unit$  
,/ates ,code1 is am5d$-- 7#a7 9 p>agraph
 7#a71 by /rik+ 1 z am5d$ by section    
#bba ( ! ,m$ic>e ,access & ,,*ip        
,reau?orization ,act ( #bjae12 &  7#b7 9
 p>agraph 7#d71 by ins]t+ & section     
#aja7;d7 ( ! ,community ,heal? ,&       
,m$ical ,pr(essionals ,improve ,our     
,nation ,act ( #bjag aft] section       
#bba7;c7 ( ! ,m$ic>e ,access & ,,*ip    
,reau?orization ,act ( #bjae4  #ajb4    
,ext5sion = special diabetes programs   
7a7 ,special diabetes program = type ,i 
diabetes ,section #ccj;,b7b77#b77;,c7 ( 
! ,public ,heal? ,s]vice ,act 7#db      
,u4,s4,c4 #bed;c-#b7;b77#b77;,c77 is    
am5d$ by /rik+ #bjag & ins]t+ #bjai4    
7b7 ,special diabetes program = ,indians
 ,section #ccj;,c7c77#b7 ( ! ,public    
,heal? ,s]vice ,act 7#db ,u4,s4,c4      

#bed;c-#c7;c77#b77 is am5d$-- 7#a7 9    
subp>agraph 7,c71 by /rik+ & at ! end2  
7#b7 9 subp>agraph 7,d71 by /rik+ !     
p]iod at ! end & ins]t+ & #aab1ejj1jjj =
 ! p]iod consi/+ ( ! second1 ?ird1 &    
f\r? qu>t]s ( fiscal ye> #bjah2 &2 &    
7#c7 by add+ at ! end ! foll[+3  7,e7   
#aej1jjj1jjj = fiscal ye> #bjai4  4     
#ajc4 ,reau?orization ( program (       
paym5ts to tea*+ heal? c5t]s t op]ate   
graduate m$ical education programs  7a7 
,paym5ts ,subsection 7a7 ( section      
#cdj;,h ( ! ,public ,heal? ,s]vice ,act 
7#db ,u4,s4,c4 #bef;h7 is am5d$ to read 
z foll[s3  7a7 ,paym5ts  7#a7 ,9 g5]al  
,subject to subsection 7h77#b71 !       
,secret>y %all make paym5ts "u ?is      
section = direct exp5ses & indirect     
exp5ses to qualifi$ tea*+ heal? c5t]s t 
are li/$ z sponsor+ in/itutions by !    
relevant accr$it+ body =--  7,a7        
ma9t5ance ( exi/+ approv$ graduate      
m$ical resid5cy tra9+ programs2  7,b7   
expansion ( exi/+ approv$ graduate      
m$ical resid5cy tra9+ programs2 &  7,c7 

e/abli%m5t ( new approv$ graduate m$ical
 resid5cy tra9+ programs1 z appropriate4
  7#b7 ,priority ,9 mak+ paym5ts        
pursuant to p>agraph 7#a77;,c71 !       
,secret>y %all give priority to qualifi$
 tea*+ heal? c5t]s t--  7,a7 s]ve a     
heal? pr(essional %ortage area ) a      
designation 9 effect "u section #ccb or 
a m$ically und]s]v$ community 7z def9$ 9
 section #gii;,b72 or  7,b7 are locat$ 9
 a rural area 7z def9$ 9 section        
#ahhf7;d77#b77;,d7 ( ! ,social ,security
 ,act74  4  7b7 ,fund+ ,subsection 7g7 (
 section #cdj;,h ( ! ,public ,heal?     
,s]vice ,act 7#db ,u4,s4,c4 #bef;h7 is  
am5d$--  7#a7 by /rik+ ,to c>ry out &   
ins]t+ ! foll[+3  7#a7 ,9 g5]al ,to c>ry
 out  2  7#b7 by /rik+ & #ae1jjj1jjj = !
 fir/ qu>t] ( fiscal ye> #bjah & ins]t+ 
1 #ae1jjj1jjj = ! fir/ qu>t] ( fiscal   
ye> #bjah1 #aaa1ejj1jjj = ! p]iod       
consi/+ ( ! second1 ?ird1 & f\r? qu>t]s 
( fiscal ye> #bjah1 & #abf1ejj1jjj =    
fiscal ye> #bjai1 to rema9 available    
until exp5d$2 &  7#c7 by add+ at ! end !

 foll[+3  7#b7 ,adm9i/rative exp5ses ,( 
! am\nt made available to c>ry out ?is  
section = any fiscal ye>1 ! ,secret>y   
may n use m ?an #e p]c5t ( su* am\nt = !
 exp5ses ( adm9i/]+ ?is section4  4  7c7
 ,annual report+ ,subsection 7h77#a7 (  
section #cdj;,h ( ! ,public ,heal?      
,s]vice ,act 7#db ,u4,s4,c4 #bef;h7 is  
am5d$-- 7#a7 by r$esignat+ subp>agraph  
7,d7 z subp>agraph 7,h72 &  7#b7 by     
ins]t+ aft] subp>agraph 7,c7 ! foll[+3  
7,d7 ,! numb] ( pati5ts treat$ by       
resid5ts describ$ 9 p>agraph 7#d74  7,e7
 ,! numb] ( visits by pati5ts treat$ by 
resid5ts describ$ 9 p>agraph 7#d74  7,f7
 ,( ! numb] ( resid5ts describ$ 9       
p>agraph 7#d7 :o complet$ _! resid5cy   
tra9+ at ! end ( su* resid5cy academic  
ye>1 ! numb] & p]c5tage ( su* resid5ts  
ent]+ prim>y c>e practice 7mean+ any ( !
 areas ( practice li/$ 9 ! def9ition ( a
 prim>y c>e resid5cy program 9 section  
#gdi;,a74  7,g7 ,( ! numb] ( resid5ts   
describ$ 9 p>agraph 7#d7 :o complet$ _! 
resid5cy tra9+ at ! end ( su* resid5cy  

academic ye>1 ! numb] & p]c5tage ( su*  
resid5ts :o ent]$ practice at a heal?   
c>e facility--  7i7 prim>ily s]v+ a     
heal? pr(essional %ortage area ) a      
designation 9 effect "u section #ccb or 
a m$ically und]s]v$ community 7z def9$ 9
 section #gii;,b72 or  7ii7 locat$ 9 a  
rural area 7z def9$ 9 section           
#ahhf7;d77#b77;,d7 ( ! ,social ,security
 ,act74  4  7d7 ,report on tra9+ co/s ,n
 lat] ?an ,m>* #ca1 #bjai1 ! ,secret>y (
 ,heal? & ,human ,s]vices %all submit to
 ! ,congress a report on ! direct       
graduate exp5ses ( approv$ graduate     
m$ical resid5cy tra9+ programs1 & !     
indirect exp5ses associat$ ) !          
additional co/s ( tea*+ resid5ts1 (     
qualifi$ tea*+ heal? c5t]s 7z su* t]ms  
are us$ or def9$ 9 section #cdj;,h ( !  
,public ,heal? ,s]vice ,act 7#db        
,u4,s4,c4 #bef;h774  7e7 ,def9ition     
,subsection 7j7 ( section #cdj;,h ( !   
,public ,heal? ,s]vice ,act 7#db        
,u4,s4,c4 #bef;h7 is am5d$-- 7#a7 by    
r$esignat+ p>agraphs 7#b7 & 7#c7 z      

p>agraphs 7#c7 & 7#d71 respectively2 &  
7#b7 by ins]t+ aft] p>agraph 7#a7 !     
foll[+3  7#b7 ,new approv$ graduate     
m$ical resid5cy tra9+ program ,! t]m new
 approv$ graduate m$ical resid5cy tra9+ 
program means an approv$ graduate m$ical
 resid5cy tra9+ program = :i* ! sponsor+
 qualifi$ tea*+ heal? c5t] has n receiv$
 a paym5t "u ?is section = a previ\s    
fiscal ye> 7o!r ?an pursuant to         
subsection 7a77#a77;,c774  4  7f7       
,te*nical correction ,subsection 7f7 (  
section #cdj;,h 7#db ,u4,s4,c4 #bef;h7  
is am5d$ by /rik+ hospital ea* place x  
appe>s & ins]t+ tea*+ heal? c5t]4  7g7  
,paym5ts = previ\s fiscal ye>s ,!       
provisions ( section #cdj;,h ( ! ,public
 ,heal? ,s]vice ,act 7#db ,u4,s4,c4     
#bef;h71 z 9 effect on ! day be=e ! date
 ( enactm5t ( ?is ,act1 %all cont9ue to 
apply ) respect to paym5ts "u su*       
section = fiscal ye>s be=e fiscal ye>   
#bjah4  #ajd4 ,ext5sion =               
family-to-family heal? in=mation c5t]s  
,section #eja7;c7 ( ! ,social ,security 

,act 7#db ,u4,s4,c4 #gja7;c77 is am5d$--
 7#a7 9 p>agraph 7#a77;,a7--  7,a7 9    
clause 7v71 by /rik+ & at ! end2  7,b7 9
 clause 7vi71 by /rik+ ! p]iod at ! end 
& ins]t+ 2 &2 &  7,c7 by add+ at ! end !
 foll[+ new clause3  7vii7 #f1jjj1jjj = 
ea* ( fiscal ye>s #bjah & #bjai4  2     
7#b7 9 p>agraph 7#c77;,c71 by ins]t+    
be=e ! p]iod ! foll[+3 1 & ) respect to 
fiscal ye>s #bjah & #bjai1 su* c5t]s    
%all also be develop$ 9 all t]ritories &
 at lea/ "o su* c5t] %all be develop$ = 
,indian tribes2 &  7#c7 by am5d+        
p>agraph 7#e7 to read z foll[s3  7#e7 ,=
 purposes ( ?is subsection--  7,a7 ! t]m
 ,indian tribe has ! mean+ giv5 su* t]m 
9 section #d ( ! ,indian ,heal? ,c>e    
,improvem5t ,act 7#be ,u4,s4,c4 #afjc72 
7,b7 ! t]m ,/ate means ea* ( ! #ej      
,/ates & ! ,di/rict ( ,columbia2 &  7,c7
 ! t]m t]ritory means ,pu]to ,rico1     
,guam1 ,am]ican ,samoa1 ! ,virg9 ,isl&s1
 & ! ,nor!rn ,m>iana ,isl&s4  4  #aje4  
,y\? emp[]m5t program2 p]sonal          
responsibility education  7a7 ,y\?      

emp[]m5t program  7#a7 ,9 g5]al ,section
 #eaj ( ! ,social ,security ,act 7#db   
,u4,s4,c4 #gaj7 is am5d$ to read z      
foll[s3  #eaj4 ,y\? emp[]m5t program    
7a7 ,9 g5]al  7#a7 ,allotm5ts to ,/ates 
,= ! purpose describ$ 9 subsection 7b71 
! ,secret>y %all1 = ea* ( fiscal ye>s   
#bjah & #bjai1 allot to ea* ,/ate :i*   
has transmitt$ an application = ! fiscal
 ye> "u section #eje7;a7 an am\nt equal 
to ! product (--  7,a7 ! am\nt          
appropriat$ pursuant to subsection      
7e77#a7 = ! fiscal ye>1 m9us ! am\nt    
res]v$ "u subsection 7e77#b7 = ! fiscal 
ye>2 &  7,b7 ! proportion t ! numb] (   
l[-income *ildr5 9 ! ,/ate be>s to !    
total ( su* numb]s ( *ildr5 = all !     
,/ates4  7#b7 ,o!r allotm5ts  7,a7 ,o!r 
entities ,= ! purpose describ$ 9        
subsection 7b71 ! ,secret>y %all1 = ea* 
( fiscal ye>s #bjah & #bjai1 = any ,/ate
 :i* has n transmitt$ an application = !
 fiscal ye> "u section #eje7;a71 allot  
to "o or m entities 9 ! ,/ate ! am\nt t 
w\ld h be5 allott$ to ! ,/ate "u        

p>agraph 7#a7 if ! ,/ate _h submitt$ su*
 an application4  7,b7 ,process ,!      
,secret>y %all select ! recipi5ts (     
allotm5ts "u subp>agraph 7,a7 by means (
 a competitive grant process "u :i*--   
7i7 n lat] ?an #cj days aft] ! deadl9e =
 ! ,/ate involv$ to submit an           
application = ! fiscal ye> "u section   
#eje7;a71 ! ,secret>y publi%es a notice 
solicit+ grant applications2 &  7ii7 n  
lat] ?an #abj days aft] su* deadl9e1 all
 su* applications mu/ be submitt$4  7b7 
,purpose  7#a7 ,9 g5]al ,except = rese>*
 "u p>agraph 7#e7 & in=mation collection
 & report+ "u p>agraph 7#f71 ! purpose (
 an allotm5t "u subsection 7a7 to a     
,/ate 7or to ano!r entity 9 ! ,/ate     
pursuant to subsection 7a77#b77 is to   
enable ! ,/ate or o!r entity to implem5t
 education exclusively on sexual risk   
avoidance 7mean+ volunt>ily refra9+ f   
sexual activity74  7#b7 ,requir$        
compon5ts ,education on sexual risk     
avoidance pursuant to an allotm5t "u ?is
 section %all-- 7,a7 ensure t !         

unambigu\s & prim>y emphasis & context =
 ea* topic describ$ 9 p>agraph 7#c7 is a
 message to y\? t normalizes ! optimal  
heal? behavior ( avoid+ nonm>ital sexual
 activity2  7,b7 be m$ically accurate & 
complete2  7,c7 be age-appropriate2 &   
7,d7 be bas$ on adolesc5t le>n+ &       
developm5tal !ories = ! age gr\p receiv+
 ! education4  7#c7 ,topics ,education  
on sexual risk avoidance pursuant to an 
allotm5t "u ?is section %all address ea*
 ( ! foll[+ topics3  7,a7 ,! holi/ic    
individual & societal b5efits associat$ 
) p]sonal responsibility1               
self-regulation1 goal sett+1 heal?y     
decisionmak+1 & a focus on ! future4    
7,b7 ,! advantage ( refra9+ f nonm>ital 
sexual activity 9 ord] to improve !     
future prospects & physical & emotional 
heal? ( y\?4  7,c7 ,! increas$          
likelihood ( avoid+ pov]ty :5 y\? atta9 
self-suffici5cy & emotional maturity    
be=e engag+ 9 sexual activity4  7,d7 ,! 
f\ndational compon5ts ( heal?y          
relation%ips & _! impact on ! =mation ( 

heal?y m>riages & safe & /able families4
  7,e7 ,h[ o!r y\? risk behaviors1 su* z
 drug & alcohol usage1 increase ! risk =
 te5 sex4  7,f7 ,h[ to resi/ & avoid1 & 
receive help reg>d+1 sexual co]cion &   
dat+ viol5ce1 recogniz+ t ev5 ) cons5t  
te5 sex rema9s a y\? risk behavior4     
7#d7 ,contraception ,education on sexual
 risk avoidance pursuant to an allotm5t 
"u ?is section %all ensure t-- 7,a7 any 
in=mation provid$ on contraception is   
m$ically accurate & ensures t /ud5ts    
und]/& t contraception (f]s physical    
risk r$uction1 b n risk elim9ation2 &   
7,b7 ! education does n include         
demon/rations1 simulations1 or          
di/ribution ( contraceptive devices4    
7#e7 ,rese>*  7,a7 ,9 g5]al ,a ,/ate or 
o!r entity receiv+ an allotm5t pursuant 
to subsection 7a7 may use up to #bj     
p]c5t ( su* allotm5t to build ! evid5ce 
base = sexual risk avoidance education  
by conduct+ or support+ rese>*4  7,b7   
,requirem5ts ,any rese>* conduct$ or    
support$ pursuant to subp>agraph 7,a7   

%all be-- 7i7 rigor\s2  7ii7            
evid5ce-bas$2 &  7iii7 design$ &        
conduct$ by indep5d5t rese>*]s :o h     
exp]i5ce 9 conduct+ & publi%+ rese>* 9  
pe]-review$ outlets4  7#f7 ,in=mation   
collection & report+ ,a ,/ate or o!r    
entity receiv+ an allotm5t pursuant to  
subsection 7a7 %all1 z specifi$ by !    
,secret>y--  7,a7 collect in=mation on !
 programs & activities fund$ ?r\gh !    
allotm5t2 &  7,b7 submit reports to !   
,secret>y on ! data f su* programs &    
activities4  7c7 ,national evaluation   
7#a7 ,9 g5]al ,! ,secret>y %all-- 7,a7 9
 consultation ) appropriate ,/ate &     
local ag5cies1 conduct "o or m rigor\s  
evaluations ( ! education fund$ ?r\gh   
?is section & associat$ data2 &  7,b7   
submit a report to ! ,congress on !     
results ( su* evaluations1 toge!r ) a   
summ>y ( ! in=mation collect$ pursuant  
to subsection 7b77#f74  7#b7            
,consultation ,9 conduct+ ! evaluations 
requir$ by p>agraph 7#a71 includ+ !     
e/abli%m5t ( evaluation me?odologies1 ! 

,secret>y %all consult ) relevant       
/akehold]s4  7d7 ,applicability ( c]ta9 
provisions  7#a7 ,sections #ejc1 #ejg1 &
 #ejh apply to allotm5ts "u subsection  
7a7 to ! same ext5t & 9 ! same mann] z  
su* sections apply to allotm5ts "u      
section #ejb7;c74  7#b7 ,sections #eje &
 #ejf apply to allotm5ts "u subsection  
7a7 to ! ext5t det]m9$ by ! ,secret>y to
 be appropriate4  7e7 ,fund+  7#a7 ,9   
g5]al ,to c>ry out ?is section1 !re is  
appropriat$1 out ( any money 9 !        
,treasury n o!rwise appropriat$1        
#ge1jjj1jjj = ea* ( fiscal ye>s #bjah & 
#bjai4  7#b7 ,res]vation ,! ,secret>y   
%all res]ve1 = ea* ( fiscal ye>s #bjah &
 #bjai1 n m ?an #bj p]c5t ( ! am\nt     
appropriat$ pursuant to p>agraph 7#a7 = 
adm9i/]+ ! program "u ?is section1      
includ+ ! conduct+ ( national           
evaluations & ! provision ( te*nical    
assi/ance to ! recipi5ts ( allotm5ts4  4
  7#b7 ,effective date ,! am5dm5t made  
by ?is section takes effect on ,octob]  
#a1 #bjag4  7b7 ,p]sonal responsibility 

education  7#a7 ,9 g5]al ,section #eac (
 ! ,social ,security ,act 7#db ,u4,s4,c4
 #gac7 is am5d$--  7,a7 9 subsection    
7a77#a77;,a71 by /rik+ #bjag & ins]t+   
#bjai2 &  7,b7 9 subsection 7a77#d7--   
7i7 9 subp>agraph 7,a71 by /rik+ #bjag  
ea* place x appe>s & ins]t+ #bjai2 &    
7ii7 9 subp>agraph 7,b7--  7,i7 9 !     
subp>agraph head+1 by /rik+ #c-ye>      
grants & ins]t+ ,competitive ,,prep     
grants2 &  7,,ii7 9 clause 7i71 by /rik+
 solicit applications to aw>d #c-ye>    
grants 9 ea* ( fiscal ye>s #bjab ?r\gh  
#bjag & ins]t+ cont9ue ?r\gh fiscal ye> 
#bjai grants aw>d$ = any ( fiscal ye>s  
#bjae ?r\gh #bjag2  7,c7 9 subsection   
7c77#a71 by ins]t+ aft] y\? )           
,,hiv_/,,aids1 ! foll[+3 victims ( human
 traffick+12 &  7,d7 9 subsection 7f71  
by /rik+ #bjag & ins]t+ #bjai4  7#b7    
,effective date ,! am5dm5ts made by ?is 
subsection take effect on ,octob] #a1   
#bjag4  ,,ii ,(fsets  #bja4 ,provid+ =  
qualifi$ heal? plan grace p]iod         
requirem5ts = issu] receipt ( advance   

paym5ts ( co/-%>+ r$uctions & premium   
tax cr$its t are m consi/5t ) ,/ate law 
grace p]iod requirem5ts  7a7 ,9 g5]al   
,section #adab7;c7 ( ! ,pati5t          
,protection & ,af=dable ,c>e ,act 7#db  
,u4,s4,c4 #ahjhb7;c77 is am5d$--  7#a7 9
 p>agraph 7#b7-- 7,a7 9 subp>agraph     
7,b77iv77,,ii71 by /rik+ a #c-mon? grace
 p]iod & ins]t+ a grace p]iod specifi$ 9
 subp>agraph 7,c72 &  7,b7 by add+ at ! 
end ! foll[+ new subp>agraphs3  7,c7    
,grace p]iod specifi$ ,= purposes (     
subp>agraph 7,b77iv77,,ii71 ! grace     
p]iod specifi$ 9 ?is subp>agraph is--   
7i7 = plan ye>s beg9n+ be=e ,janu>y #a1 
#bjah1 a #c-mon? grace p]iod2 &  7ii7 = 
plan ye>s beg9n+ on or aft] ,janu>y #a1 
#bjah--  7,i7 9 ! case ( an ,ex*ange    
op]at+ 9 a ,/ate t has a ,/ate law grace
 p]iod 9 place1 su* ,/ate law grace     
p]iod2 &  7,,ii7 9 ! case ( an ,ex*ange 
op]at+ 9 a ,/ate t does n h a ,/ate law 
grace p]iod 9 place1 a #a-mon? grace    
p]iod4  7,d7 ,/ate law grace p]iod ,=   
purposes ( subp>agraph 7,c71 ! t]m ,/ate

 law grace p]iod means1 ) respect to a  
,/ate1 a grace p]iod = nonpaym5t (      
premiums be=e discont9u+ cov]age t is   
applicable "u ! ,/ate law to heal?      
insurance cov]age (f]$ 9 ! individual   
m>ket ( ! ,/ate4  2 &  7#b7 9 p>agraph  
7#c71 by add+ at ! end ! foll[+ new     
s5t5ce3 ,! requirem5ts ( p>agraph       
7#b77;,b77iv7 apply to an issu] ( a     
qualifi$ heal? plan receiv+ an advanc$  
paym5t "u ?is p>agraph 9 ! same mann] & 
to ! same ext5t t su* requirem5ts apply 
to an issu] ( a qualifi$ heal? plan     
receiv+ an advanc$ paym5t "u p>agraph   
7#b77;,a744  7b7 ,report on align+ grace
 p]iods = ,m$icaid1 ,m$ic>e1 & ,ex*ange 
plans ,n lat] ?an two ye>s aft] ! date (
 full implem5tation ( subsection 7a71 ! 
,comptroll] ,g5]al ( ! ,unit$ ,/ates    
%all submit to ,congress a report on--  
7#a7 ! effects on consum]s ( align+     
grace p]iods appli$ "u ! ,m$icaid       
program "u title ,,xix ( ! ,social      
,security ,act1 "u ! ,m$ic>e program "u 
p>ts ,c & ,d ( title ,,xviii ( su* ,act1

 & "u qualifi$ heal? plans (f]$ on an   
,ex*ange e/abli%$ "u title ,i ( !       
,pati5t ,protection & ,af=dable ,c>e    
,act1 includ+ ! ext5t to :i* su* an     
alignm5t ( grace p]iods may help to     
avoid enrollm5t /atus confusion =       
individuals "u su* ,m$icaid program1    
,m$ic>e program1 & qualifi$ heal? plans2
 &  7#b7 ! ext5t to :i* su* an alignm5t 
( grace p]iods may r$uce fraud1 wa/e1 & 
abuse "u ! ,m$icaid program4  #bjb4     
,prev5tion & ,public ,heal? ,fund       
,section #djjb7;b7 ( ! ,pati5t          
,protection & ,af=dable ,c>e ,act 7#db  
,u4,s4,c4 #cjju-#aa7;b77 is am5d$ by    
/rik+ p>agraphs 7#c7 ?r\gh 7#h7 & ins]t+
 ! foll[+ new p>agraphs3  7#c7 = fiscal 
ye> #bjah1 #ijj1jjj1jjj2  7#d7 = fiscal 
ye> #bjai1 #ejj1jjj1jjj2  7#e7 = fiscal 
ye> #bjbj1 #ejj1jjj1jjj2  7#f7 = fiscal 
ye> #bjba1 #ejj1jjj1jjj2  7#g7 = fiscal 
ye> #bjbb1 #ejj1jjj1jjj2  7#h7 = fiscal 
ye> #bjbc1 #ejj1jjj1jjj2  7#i7 = fiscal 
ye> #bjbd1 #ejj1jjj1jjj2  7#aj7 = fiscal
 ye> #bjbe1 #gej1jjj1jjj2  7#aa7 =      

fiscal ye> #bjbf1 #a1jjj1jjj1jjj2 &     
7#ab7 = fiscal ye> #bjbg & ea* fiscal   
ye> !reaft]1 #b1jjj1jjj1jjj4  4  ,octob]
 #ai1 #bjag ,report$ f ! ,committee on  
,en]gy & ,comm]ce ) an amendment,october
 #ai1 #bjag,! ,committee on ,ways &     
,means dis*>g$2 committ$ to ! ,committee
 ( ! ,:ole ,h\se on ! ,/ate ( ! ,union &
 ord]$ to be pr9t$