20
Part P of title III of the Public Health Service Act 21
(42 U.S.C. 280g et seq.), as amended by section 5313, is 22
further amended by adding at the end the following: 23
‘‘SEC. 399W. PRIMARY CARE EXTENSION PROGRAM.
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‘‘(a) ESTABLISHMENT, PURPOSE AND DEFINITION.—
‘‘(1) IN GENERAL.—The Secretary, acting
1
through the Director of the Agency for Healthcare Re- 2
search and Quality, shall establish a Primary Care 3
Extension Program. 4
‘‘(2) PURPOSE.—The Primary Care Extension
5
Program shall provide support and assistance to pri- 6
mary care providers to educate providers about pre- 7
ventive medicine, health promotion, chronic disease 8
management, mental and behavioral health services 9
(including substance abuse prevention and treatment 10
services), and evidence-based and evidence-informed 11
therapies and techniques, in order to enable providers 12
to incorporate such matters into their practice and to 13
improve community health by working with commu- 14
nity-based health connectors (referred to in this sec- 15
tion as ‘Health Extension Agents’). 16
‘‘(3) DEFINITIONS.—In this section:
17
‘‘(A) HEALTH EXTENSION AGENT.—The
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term ‘Health Extension Agent’ means any local, 19
community-based health worker who facilitates 20
and provides assistance to primary care prac- 21
tices by implementing quality improvement or 22
system redesign, incorporating the principles of 23
the patient-centered medical home to provide 24
high-quality, effective, efficient, and safe pri- 25
mary care and to provide guidance to patients 1
in culturally and linguistically appropriate 2
ways, and linking practices to diverse health sys- 3
tem resources. 4
‘‘(B) PRIMARY CARE PROVIDER.—The term
5
‘primary care provider’ means a clinician who 6
provides integrated, accessible health care serv- 7
ices and who is accountable for addressing a 8
large majority of personal health care needs, in- 9
cluding providing preventive and health pro- 10
motion services for men, women, and children of 11
all ages, developing a sustained partnership with 12
patients, and practicing in the context of family 13
and community, as recognized by a State licens- 14
ing or regulatory authority, unless otherwise 15
specified in this section. 16
‘‘(b) GRANTS TO ESTABLISH STATE HUBS AND LOCAL
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PRIMARY CARE EXTENSIONAGENCIES.—
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‘‘(1) GRANTS.—The Secretary shall award com-
19
petitive grants to States for the establishment of 20
State- or multistate-level primary care Primary Care 21
Extension Program State Hubs (referred to in this 22
section as ‘Hubs’). 23
‘‘(2) COMPOSITION OF HUBS.—A Hub established
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by a State pursuant to paragraph (1)— 25
‘‘(A) shall consist of, at a minimum, the 1
State health department, the entity responsible 2
for administering the State Medicaid program 3
(if other than the State health department), the 4
State-level entity administering the Medicare 5
program, and the departments of 1 or more 6
health professions schools in the State that train 7
providers in primary care; and 8
‘‘(B) may include entities such as hospital 9
associations, primary care practice-based re- 10
search networks, health professional societies, 11
State primary care associations, State licensing 12
boards, organizations with a contract with the 13
Secretary under section 1153 of the Social Secu- 14
rity Act, consumer groups, and other appro- 15
priate entities. 16
‘‘(c) STATE AND LOCALACTIVITIES.—
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‘‘(1) HUB ACTIVITIES.—Hubs established under
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a grant under subsection (b) shall— 19
‘‘(A) submit to the Secretary a plan to co- 20
ordinate functions with quality improvement or- 21
ganizations and area health education centers if 22
such entities are members of the Hub not de- 23
scribed in subsection (b)(2)(A); 24
‘‘(B) contract with a county- or local-level 1
entity that shall serve as the Primary Care Ex- 2
tension Agency to administer the services de- 3
scribed in paragraph (2); 4
‘‘(C) organize and administer grant funds 5
to county- or local-level Primary Care Extension 6
Agencies that serve a catchment area, as deter- 7
mined by the State; and 8
‘‘(D) organize State-wide or multistate net- 9
works of local-level Primary Care Extension 10
Agencies to share and disseminate information 11
and practices. 12
‘‘(2) LOCAL PRIMARY CARE EXTENSION AGENCY
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ACTIVITIES.—
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‘‘(A) REQUIRED ACTIVITIES.—Primary
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Care Extension Agencies established by a Hub 16
under paragraph (1) shall— 17
‘‘(i) assist primary care providers to 18
implement a patient-centered medical home 19
to improve the accessibility, quality, and ef- 20
ficiency of primary care services, including 21
health homes; 22
‘‘(ii) develop and support primary 23
care learning communities to enhance the 24
dissemination of research findings for evi- 25
dence-based practice, assess implementation 1
of practice improvement, share best prac- 2
tices, and involve community clinicians in 3
the generation of new knowledge and identi- 4
fication of important questions for research; 5
‘‘(iii) participate in a national net- 6
work of Primary Care Extension Hubs and 7
propose how the Primary Care Extension 8
Agency will share and disseminate lessons 9
learned and best practices; and 10
‘‘(iv) develop a plan for financial sus- 11
tainability involving State, local, and pri- 12
vate contributions, to provide for the reduc- 13
tion in Federal funds that is expected after 14
an initial 6-year period of program estab- 15
lishment, infrastructure development, and 16
planning. 17
‘‘(B) DISCRETIONARY ACTIVITIES.—Pri-
18
mary Care Extension Agencies established by a 19
Hub under paragraph (1) may— 20
‘‘(i) provide technical assistance, train- 21
ing, and organizational support for commu- 22
nity health teams established under section 23
3602 of the Patient Protection and Afford- 24
able Care Act; 25
‘‘(ii) collect data and provision of pri- 1
mary care provider feedback from standard- 2
ized measurements of processes and out- 3
comes to aid in continuous performance im- 4
provement; 5
‘‘(iii) collaborate with local health de- 6
partments, community health centers, tribes 7
and tribal entities, and other community 8
agencies to identify community health pri- 9
orities and local health workforce needs, and 10
participate in community-based efforts to 11
address the social and primary deter- 12
minants of health, strengthen the local pri- 13
mary care workforce, and eliminate health 14
disparities; 15
‘‘(iv) develop measures to monitor the 16
impact of the proposed program on the 17
health of practice enrollees and of the wider 18
community served; and 19
‘‘(v) participate in other activities, as 20
determined appropriate by the Secretary. 21
‘‘(d) FEDERAL PROGRAM ADMINISTRATION.—
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‘‘(1) GRANTS; TYPES.—Grants awarded under
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subsection (b) shall be— 24
‘‘(A) program grants, that are awarded to 1
State or multistate entities that submit fully-de- 2
veloped plans for the implementation of a Hub, 3
for a period of 6 years; or 4
‘‘(B) planning grants, that are awarded to 5
State or multistate entities with the goal of de- 6
veloping a plan for a Hub, for a period of 2 7
years. 8
‘‘(2) APPLICATIONS.—To be eligible for a grant
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under subsection (b), a State or multistate entity 10
shall submit to the Secretary an application, at such 11
time, in such manner, and containing such informa- 12
tion as the Secretary may require. 13
‘‘(3) EVALUATION.—A State that receives a grant
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under subsection (b) shall be evaluated at the end of 15
the grant period by an evaluation panel appointed by 16
the Secretary. 17
‘‘(4) CONTINUING SUPPORT.—After the sixth
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year in which assistance is provided to a State under 19
a grant awarded under subsection (b), the State may 20
receive additional support under this section if the 21
State program has received satisfactory evaluations 22
with respect to program performance and the merits 23
of the State sustainability plan, as determined by the 24
Secretary. 25
‘‘(5) LIMITATION.—A State shall not use in ex-
1
cess of 10 percent of the amount received under a 2
grant to carry out administrative activities under 3
this section. Funds awarded pursuant to this section 4
shall not be used for funding direct patient care. 5
‘‘(e) REQUIREMENTS ON THE SECRETARY.—In car-
6
rying out this section, the Secretary shall consult with the 7
heads of other Federal agencies with demonstrated experi- 8
ence and expertise in health care and preventive medicine, 9
such as the Centers for Disease Control and Prevention, the 10
Substance Abuse and Mental Health Administration, the 11
Health Resources and Services Administration, the Na- 12
tional Institutes of Health, the Office of the National Coor- 13
dinator for Health Information Technology, the Indian 14
Health Service, the Agricultural Cooperative Extension 15
Service of the Department of Agriculture, and other entities, 16
as the Secretary determines appropriate. 17
‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—To
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awards grants as provided in subsection (d), there are au- 19
thorized to be appropriated $120,000,000 for each of fiscal 20
years 2011 and 2012, and such sums as may be necessary 21
to carry out this section for each of fiscal years 2013 22
through 2014.’’. 23