US Laws - Affordable Health Care Act (HR3950F)
TITLE IV--PREVENTION OF CHRONIC DISEASE AND IMPROVING PUBLIC HEALTH
Subtitle C--Creating Healthier Communities

Subtitle C--Creating Healthier Communities (6893)(1-click HTML)

SEC. 4201. COMMUNITY TRANSFORMATION GRANTS. (6894)(1-click HTML)

(a) In General- The Secretary of Health and Human Services (referred to in this section as the "Secretary"), acting through the Director of the Centers for Disease Control and Prevention (referred to in this section as the "Director"), shall award competitive grants to State and local governmental agencies and community-based organizations for the implementation, evaluation, and dissemination of evidence-based community preventive health activities in order to reduce chronic disease rates, prevent the development of secondary conditions, address health disparities, and develop a stronger evidence-base of effective prevention programming. (6895)

(b) Eligibility- To be eligible to receive a grant under subsection (a), an entity shall-- (6896)

(1) be-- (6897)

(A) a State governmental agency; (6898)

(B) a local governmental agency; (6899)

(C) a national network of community-based organizations; (6900)

(D) a State or local non-profit organization; or (6901)

(E) an Indian tribe; and (6902)

(2) submit to the Director an application at such time, in such a manner, and containing such information as the Director may require, including a description of the program to be carried out under the grant; and (6903)

(3) demonstrate a history or capacity, if funded, to develop relationships necessary to engage key stakeholders from multiple sectors within and beyond health care and across a community, such as healthy futures corps and health care providers. (6904)

(c) Use of Funds- (6905)

(1) IN GENERAL- An eligible entity shall use amounts received under a grant under this section to carry out programs described in this subsection. (6906)

(2) COMMUNITY TRANSFORMATION PLAN- (6907)

(A) IN GENERAL- An eligible entity that receives a grant under this section shall submit to the Director (for approval) a detailed plan that includes the policy, environmental, programmatic, and as appropriate infrastructure changes needed to promote healthy living and reduce disparities. (6908)

(B) ACTIVITIES- Activities within the plan may focus on (but not be limited to)-- (6909)

(i) creating healthier school environments, including increasing healthy food options, physical activity opportunities, promotion of healthy lifestyle, emotional wellness, and prevention curricula, and activities to prevent chronic diseases; (6910)

(ii) creating the infrastructure to support active living and access to nutritious foods in a safe environment; (6911)

(iii) developing and promoting programs targeting a variety of age levels to increase access to nutrition, physical activity and smoking cessation, improve social and emotional wellness, enhance safety in a community, or address any other chronic disease priority area identified by the grantee; (6912)

(iv) assessing and implementing worksite wellness programming and incentives; (6913)

(v) working to highlight healthy options at restaurants and other food venues; (6914)

(vi) prioritizing strategies to reduce racial and ethnic disparities, including social, economic, and geographic determinants of health; and (6915)

(vii) addressing special populations needs, including all age groups and individuals with disabilities, and individuals in both urban and rural areas. (6916)

(3) COMMUNITY-BASED PREVENTION HEALTH ACTIVITIES- (6917)

(A) IN GENERAL- An eligible entity shall use amounts received under a grant under this section to implement a variety of programs, policies, and infrastructure improvements to promote healthier lifestyles. (6918)

(B) ACTIVITIES- An eligible entity shall implement activities detailed in the community transformation plan under paragraph (2). (6919)

(C) IN-KIND SUPPORT- An eligible entity may provide in-kind resources such as staff, equipment, or office space in carrying out activities under this section. (6920)

(4) EVALUATION- (6921)

(A) IN GENERAL- An eligible entity shall use amounts provided under a grant under this section to conduct activities to measure changes in the prevalence of chronic disease risk factors among community members participating in preventive health activities (6922)

(B) TYPES OF MEASURES- In carrying out subparagraph (A), the eligible entity shall, with respect to residents in the community, measure-- (6923)

(i) changes in weight; (6924)

(ii) changes in proper nutrition; (6925)

(iii) changes in physical activity; (6926)

(iv) changes in tobacco use prevalence; (6927)

(v) changes in emotional well-being and overall mental health; (6928)

(vi) other factors using community-specific data from the Behavioral Risk Factor Surveillance Survey; and (6929)

(vii) other factors as determined by the Secretary. (6930)

(C) REPORTING- An eligible entity shall annually submit to the Director a report containing an evaluation of activities carried out under the grant. (6931)

(5) DISSEMINATION- A grantee under this section shall-- (6932)

(A) meet at least annually in regional or national meetings to discuss challenges, best practices, and lessons learned with respect to activities carried out under the grant; and (6933)

(B) develop models for the replication of successful programs and activities and the mentoring of other eligible entities. (6934)

(d) Training- (6935)

(1) IN GENERAL- The Director shall develop a program to provide training for eligible entities on effective strategies for the prevention and control of chronic disease and the link between physical, emotional, and social well-being. (6936)

(2) COMMUNITY TRANSFORMATION PLAN- The Director shall provide appropriate feedback and technical assistance to grantees to establish community transformation plans (6937)

(3) EVALUATION- The Director shall provide a literature review and framework for the evaluation of programs conducted as part of the grant program under this section, in addition to working with academic institutions or other entities with expertise in outcome evaluation. (6938)

(e) Prohibition- A grantee shall not use funds provided under a grant under this section to create video games or to carry out any other activities that may lead to higher rates of obesity or inactivity. (6939)

(f) Authorization of Appropriations- There are authorized to be appropriated to carry out this section, such sums as may be necessary for each fiscal years 2010 through 2014. (6940)

SEC. 4202. HEALTHY AGING, LIVING WELL; EVALUATION OF COMMUNITY-BASED PREVENTION AND WELLNESS PROGRAMS FOR MEDICARE BENEFICIARIES. (6941)(1-click HTML)

(a) Healthy Aging, Living Well- (6942)

(1) IN GENERAL- The Secretary of Health and Human Services (referred to in this section as the "Secretary"), acting through the Director of the Centers for Disease Control and Prevention, shall award grants to State or local health departments and Indian tribes to carry out 5-year pilot programs to provide public health community interventions, screenings, and where necessary, clinical referrals for individuals who are between 55 and 64 years of age. (6943)

(2) ELIGIBILITY- To be eligible to receive a grant under paragraph (1), an entity shall-- (6944)

(A) be-- (6945)

(i) a State health department; (6946)

(ii) a local health department; or (6947)

(iii) an Indian tribe; (6948)

(B) submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require including a description of the program to be carried out under the grant; (6949)

(C) design a strategy for improving the health of the 55-to-64 year-old population through community-based public health interventions; and (6950)

(D) demonstrate the capacity, if funded, to develop the relationships necessary with relevant health agencies, health care providers, community-based organizations, and insurers to carry out the activities described in paragraph (3), such relationships to include the identification of a community-based clinical partner, such as a community health center or rural health clinic. (6951)

(3) USE OF FUNDS- (6952)

(A) IN GENERAL- A State or local health department shall use amounts received under a grant under this subsection to carry out a program to provide the services described in this paragraph to individuals who are between 55 and 64 years of age. (6953)

(B) PUBLIC HEALTH INTERVENTIONS- (6954)

(i) IN GENERAL- In developing and implementing such activities, a grantee shall collaborate with the Centers for Disease Control and Prevention and the Administration on Aging, and relevant local agencies and organizations. (6955)

(ii) TYPES OF INTERVENTION ACTIVITIES- Intervention activities conducted under this subparagraph may include efforts to improve nutrition, increase physical activity, reduce tobacco use and substance abuse, improve mental health, and promote healthy lifestyles among the target population. (6956)

(C) COMMUNITY PREVENTIVE SCREENINGS- (6957)

(i) IN GENERAL- In addition to community-wide public health interventions, a State or local health department shall use amounts received under a grant under this subsection to conduct ongoing health screening to identify risk factors for cardiovascular disease, cancer, stroke, and diabetes among individuals in both urban and rural areas who are between 55 and 64 years of age. (6958)

(ii) TYPES OF SCREENING ACTIVITIES- Screening activities conducted under this subparagraph may include-- (6959)

(I) mental health/behavioral health and substance use disorders; (6960)

(II) physical activity, smoking, and nutrition; and (6961)

(III) any other measures deemed appropriate by the Secretary. (6962)

(iii) MONITORING- Grantees under this section shall maintain records of screening results under this subparagraph to establish the baseline data for monitoring the targeted population (6963)

(D) CLINICAL REFERRAL/TREATMENT FOR CHRONIC DISEASES- (6964)

(i) IN GENERAL- A State or local health department shall use amounts received under a grant under this subsection to ensure that individuals between 55 and 64 years of age who are found to have chronic disease risk factors through the screening activities described in subparagraph (C)(ii), receive clinical referral/treatment for follow-up services to reduce such risk. (6965)

(ii) MECHANISM- (6966)

(I) IDENTIFICATION AND DETERMINATION OF STATUS- With respect to each individual with risk factors for or having heart disease, stroke, diabetes, or any other condition for which such individual was screened under subparagraph (C), a grantee under this section shall determine whether or not such individual is covered under any public or private health insurance program. (6967)

(II) INSURED INDIVIDUALS- An individual determined to be covered under a health insurance program under subclause (I) shall be referred by the grantee to the existing providers under such program or, if such individual does not have a current provider, to a provider who is in-network with respect to the program involved. (6968)

(III) UNINSURED INDIVIDUALS- With respect to an individual determined to be uninsured under subclause (I), the grantee"s community-based clinical partner described in paragraph (4)(D) shall assist the individual in determining eligibility for available public coverage options and identify other appropriate community health care resources and assistance programs. (6969)

(iii) PUBLIC HEALTH INTERVENTION PROGRAM- A State or local health department shall use amounts received under a grant under this subsection to enter into contracts with community health centers or rural health clinics and mental health and substance use disorder service providers to assist in the referral/treatment of at risk patients to community resources for clinical follow-up and help determine eligibility for other public programs. (6970)

(E) GRANTEE EVALUATION- An eligible entity shall use amounts provided under a grant under this subsection to conduct activities to measure changes in the prevalence of chronic disease risk factors among participants. (6971)

(4) PILOT PROGRAM EVALUATION- The Secretary shall conduct an annual evaluation of the effectiveness of the pilot program under this subsection. In determining such effectiveness, the Secretary shall consider changes in the prevalence of uncontrolled chronic disease risk factors among new Medicare enrollees (or individuals nearing enrollment, including those who are 63 and 64 years of age) who reside in States or localities receiving grants under this section as compared with national and historical data for those States and localities for the same population. (6972)

(5) AUTHORIZATION OF APPROPRIATIONS- There are authorized to be appropriated to carry out this subsection, such sums as may be necessary for each of fiscal years 2010 through 2014. (6973)

(b) Evaluation and Plan for Community-based Prevention and Wellness Programs for Medicare Beneficiaries- (6974)

(1) IN GENERAL- The Secretary shall conduct an evaluation of community-based prevention and wellness programs and develop a plan for promoting healthy lifestyles and chronic disease self-management for Medicare beneficiaries. (6975)

(2) MEDICARE EVALUATION OF PREVENTION AND WELLNESS PROGRAMS- (6976)

(A) IN GENERAL- The Secretary shall evaluate community prevention and wellness programs including those that are sponsored by the Administration on Aging, are evidence-based, and have demonstrated potential to help Medicare beneficiaries (particularly beneficiaries that have attained 65 years of age) reduce their risk of disease, disability, and injury by making healthy lifestyle choices, including exercise, diet, and self-management of chronic diseases. (6977)

(B) EVALUATION- The evaluation under subparagraph (A) shall consist of the following: (6978)

(i) EVIDENCE REVIEW- The Secretary shall review available evidence, literature, best practices, and resources that are relevant to programs that promote healthy lifestyles and reduce risk factors for the Medicare population. The Secretary may determine the scope of the evidence review and such issues to be considered, which shall include, at a minimum-- (6979)

(I) physical activity, nutrition, and obesity; (6980)

(II) falls; (6981)

(III) chronic disease self-management; and (6982)

(IV) mental health. (6983)

(ii) INDEPENDENT EVALUATION OF EVIDENCE-BASED COMMUNITY PREVENTION AND WELLNESS PROGRAMS- The Administrator of the Centers for Medicare & Medicaid Services, in consultation with the Assistant Secretary for Aging, shall, to the extent feasible and practicable, conduct an evaluation of existing community prevention and wellness programs that are sponsored by the Administration on Aging to assess the extent to which Medicare beneficiaries who participate in such programs-- (6984)

(I) reduce their health risks, improve their health outcomes, and adopt and maintain healthy behaviors; (6985)

(II) improve their ability to manage their chronic conditions; and (6986)

(III) reduce their utilization of health services and associated costs under the Medicare program for conditions that are amenable to improvement under such programs. (6987)

(3) REPORT- Not later than September 30, 2013, the Secretary shall submit to Congress a report that includes-- (6988)

(A) recommendations for such legislation and administrative action as the Secretary determines appropriate to promote healthy lifestyles and chronic disease self-management for Medicare beneficiaries; (6989)

(B) any relevant findings relating to the evidence review under paragraph (2)(B)(i); and (6990)

(C) the results of the evaluation under paragraph (2)(B)(ii). (6991)

(4) FUNDING- For purposes of carrying out this subsection, the Secretary shall provide for the transfer, from the Federal Hospital Insurance Trust Fund under section 1817 of the Social Security Act (42 U.S.C. 1395i) and the Federal Supplemental Medical Insurance Trust Fund under section 1841 of such Act (42 U.S.C. 1395t), in such proportion as the Secretary determines appropriate, of $50,000,000 to the Centers for Medicare & Medicaid Services Program Management Account. Amounts transferred under the preceding sentence shall remain available until expended. (6992)

(5) ADMINISTRATION- Chapter 35 of title 44, United States Code shall not apply to the this subsection. (6993)

(6) MEDICARE BENEFICIARY- In this subsection, the term "Medicare beneficiary" means an individual who is entitled to benefits under part A of title XVIII of the Social Security Act and enrolled under part B of such title. (6994)

SEC. 4203. REMOVING BARRIERS AND IMPROVING ACCESS TO WELLNESS FOR INDIVIDUALS WITH DISABILITIES. (6995)(1-click HTML)

Title V of the Rehabilitation Act of 1973 (29 U.S.C. 791 et seq.) is amended by adding at the end of the following: (6996)

SEC. 510. ESTABLISHMENT OF STANDARDS FOR ACCESSIBLE MEDICAL DIAGNOSTIC EQUIPMENT. (6997)

"(a) Standards- Not later than 24 months after the date of enactment of the Affordable Health Choices Act, the Architectural and Transportation Barriers Compliance Board shall, in consultation with the Commissioner of the Food and Drug Administration, promulgate regulatory standards in accordance with the Administrative Procedure Act (2 U.S.C. 551 et seq.) setting forth the minimum technical criteria for medical diagnostic equipment used in (or in conjunction with) physician"s offices, clinics, emergency rooms, hospitals, and other medical settings. The standards shall ensure that such equipment is accessible to, and usable by, individuals with accessibility needs, and shall allow independent entry to, use of, and exit from the equipment by such individuals to the maximum extent possible. (6998)

"(b) Medical Diagnostic Equipment Covered- The standards issued under subsection (a) for medical diagnostic equipment shall apply to equipment that includes examination tables, examination chairs (including chairs used for eye examinations or procedures, and dental examinations or procedures), weight scales, mammography equipment, x-ray machines, and other radiological equipment commonly used for diagnostic purposes by health professionals. (6999)

"(c) Review and Amendment- The Architectural and Transportation Barriers Compliance Board, in consultation with the Commissioner of the Food and Drug Administration, shall periodically review and, as appropriate, amend the standards in accordance with the Administrative Procedure Act (2 U.S.C. 551 et seq.).". (7000)

SEC. 4204. IMMUNIZATIONS. (7001)(1-click HTML)

(a) State Authority To Purchase Recommended Vaccines for Adults- Section 317 of the Public Health Service Act (42 U.S.C. 247b) is amended by adding at the end the following: (7002)

"(l) Authority to Purchase Recommended Vaccines for Adults- (7003)

"(1) IN GENERAL- The Secretary may negotiate and enter into contracts with manufacturers of vaccines for the purchase and delivery of vaccines for adults as provided for under subsection (e). (7004)

"(2) STATE PURCHASE- A State may obtain additional quantities of such adult vaccines (subject to amounts specified to the Secretary by the State in advance of negotiations) through the purchase of vaccines from manufacturers at the applicable price negotiated by the Secretary under this subsection.". (7005)

(b) Demonstration Program to Improve Immunization Coverage- Section 317 of the Public Health Service Act (42 U.S.C. 247b), as amended by subsection (a), is further amended by adding at the end the following: (7006)

"(m) Demonstration Program To Improve Immunization Coverage- (7007)

"(1) IN GENERAL- The Secretary, acting through the Director of the Centers for Disease Control and Prevention, shall establish a demonstration program to award grants to States to improve the provision of recommended immunizations for children, adolescents, and adults through the use of evidence-based, population-based interventions for high-risk populations. (7008)

"(2) STATE PLAN- To be eligible for a grant under paragraph (1), a State shall submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require, including a State plan that describes the interventions to be implemented under the grant and how such interventions match with local needs and capabilities, as determined through consultation with local authorities. (7009)

"(3) USE OF FUNDS- Funds received under a grant under this subsection shall be used to implement interventions that are recommended by the Task Force on Community Preventive Services (as established by the Secretary, acting through the Director of the Centers for Disease Control and Prevention) or other evidence-based interventions, including-- (7010)

"(A) providing immunization reminders or recalls for target populations of clients, patients, and consumers; (7011)

"(B) educating targeted populations and health care providers concerning immunizations in combination with one or more other interventions; (7012)

"(C) reducing out-of-pocket costs for families for vaccines and their administration; (7013)

"(D) carrying out immunization-promoting strategies for participants or clients of public programs, including assessments of immunization status, referrals to health care providers, education, provision of on-site immunizations, or incentives for immunization; (7014)

"(E) providing for home visits that promote immunization through education, assessments of need, referrals, provision of immunizations, or other services; (7015)

"(F) providing reminders or recalls for immunization providers; (7016)

"(G) conducting assessments of, and providing feedback to, immunization providers; (7017)

"(H) any combination of one or more interventions described in this paragraph; or (7018)

"(I) immunization information systems to allow all States to have electronic databases for immunization records. (7019)

"(4) CONSIDERATION- In awarding grants under this subsection, the Secretary shall consider any reviews or recommendations of the Task Force on Community Preventive Services. (7020)

"(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 high-risk populations within the State. (7021)

"(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. (7022)

"(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.". (7023)

(c) Reauthorization of Immunization Program- Section 317(j) of the Public Health Service Act (42 U.S.C. 247b(j)) is amended-- (7024)

(1) in paragraph (1), by striking "for each of the fiscal years 1998 through 2005"; and (7025)

(2) in paragraph (2), by striking "after October 1, 1997,". (7026)

(d) Rule of Construction Regarding Access to Immunizations- Nothing in this section (including the amendments made by this section), or any other provision of this Act (including any amendments made by this Act) shall be construed to decrease children"s access to immunizations. (7027)

(e) GAO Study and Report on Medicare Beneficiary Access to Vaccines- (7028)

(1) STUDY- The Comptroller General of the United States (in this section referred to as the "Comptroller General") shall conduct a study on the ability of Medicare beneficiaries who were 65 years of age or older to access routinely recommended vaccines covered under the prescription drug program under part D of title XVIII of the Social Security Act over the period since the establishment of such program. Such study shall include the following: (7029)

(A) An analysis and determination of-- (7030)

(i) the number of Medicare beneficiaries who were 65 years of age or older and were eligible for a routinely recommended vaccination that was covered under part D; (7031)

(ii) the number of such beneficiaries who actually received a routinely recommended vaccination that was covered under part D; and (7032)

(iii) any barriers to access by such beneficiaries to routinely recommended vaccinations that were covered under part D. (7033)

(B) A summary of the findings and recommendations by government agencies, departments, and advisory bodies (as well as relevant professional organizations) on the impact of coverage under part D of routinely recommended adult immunizations for access to such immunizations by Medicare beneficiaries. (7034)

(2) REPORT- Not later than June 1, 2011, the Comptroller General shall submit to the appropriate committees of jurisdiction of the House of Representatives and the Senate a report containing the results of the study conducted under paragraph (1), together with recommendations for such legislation and administrative action as the Comptroller General determines appropriate. (7035)

(3) FUNDING- Out of any funds in the Treasury not otherwise appropriated, there are appropriated $1,000,000 for fiscal year 2010 to carry out this subsection. (7036)

SEC. 4205. NUTRITION LABELING OF STANDARD MENU ITEMS AT CHAIN RESTAURANTS. (7037)(1-click HTML)

(a) Technical Amendments- Section 403(q)(5)(A) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 343(q)(5)(A)) is amended-- (7038)

(1) in subitem (i), by inserting at the beginning "except as provided in clause (H)(ii)(III),"; and (7039)

(2) in subitem (ii), by inserting at the beginning "except as provided in clause (H)(ii)(III),". (7040)

(b) Labeling Requirements- Section 403(q)(5) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 343(q)(5)) is amended by adding at the end the following: (7041)

"(H) Restaurants, Retail Food Establishments, and Vending Machines- (7042)

"(i) GENERAL REQUIREMENTS FOR RESTAURANTS AND SIMILAR RETAIL FOOD ESTABLISHMENTS- Except for food described in subclause (vii), in the case of food that is a standard menu item that is offered for sale in a restaurant or similar retail food establishment that is part of a chain with 20 or more locations doing business under the same name (regardless of the type of ownership of the locations) and offering for sale substantially the same menu items, the restaurant or similar retail food establishment shall disclose the information described in subclauses (ii) and (iii). (7043)

"(ii) INFORMATION REQUIRED TO BE DISCLOSED BY RESTAURANTS AND RETAIL FOOD ESTABLISHMENTS- Except as provided in subclause (vii), the restaurant or similar retail food establishment shall disclose in a clear and conspicuous manner-- (7044)

"(I)(aa) in a nutrient content disclosure statement adjacent to the name of the standard menu item, so as to be clearly associated with the standard menu item, on the menu listing the item for sale, the number of calories contained in the standard menu item, as usually prepared and offered for sale; and (7045)

"(bb) a succinct statement concerning suggested daily caloric intake, as specified by the Secretary by regulation and posted prominently on the menu and designed to enable the public to understand, in the context of a total daily diet, the significance of the caloric information that is provided on the menu; (7046)

"(II)(aa) in a nutrient content disclosure statement adjacent to the name of the standard menu item, so as to be clearly associated with the standard menu item, on the menu board, including a drive-through menu board, the number of calories contained in the standard menu item, as usually prepared and offered for sale; and (7047)

"(bb) a succinct statement concerning suggested daily caloric intake, as specified by the Secretary by regulation and posted prominently on the menu board, designed to enable the public to understand, in the context of a total daily diet, the significance of the nutrition information that is provided on the menu board; (7048)

"(III) in a written form, available on the premises of the restaurant or similar retail establishment and to the consumer upon request, the nutrition information required under clauses (C) and (D) of subparagraph (1); and (7049)

"(IV) on the menu or menu board, a prominent, clear, and conspicuous statement regarding the availability of the information described in item (III). (7050)

"(iii) SELF-SERVICE FOOD AND FOOD ON DISPLAY- Except as provided in subclause (vii), in the case of food sold at a salad bar, buffet line, cafeteria line, or similar self-service facility, and for self-service beverages or food that is on display and that is visible to customers, a restaurant or similar retail food establishment shall place adjacent to each food offered a sign that lists calories per displayed food item or per serving. (7051)

"(iv) REASONABLE BASIS- For the purposes of this clause, a restaurant or similar retail food establishment shall have a reasonable basis for its nutrient content disclosures, including nutrient databases, cookbooks, laboratory analyses, and other reasonable means, as described in section 101.10 of title 21, Code of Federal Regulations (or any successor regulation) or in a related guidance of the Food and Drug Administration. (7052)

"(v) MENU VARIABILITY AND COMBINATION MEALS- The Secretary shall establish by regulation standards for determining and disclosing the nutrient content for standard menu items that come in different flavors, varieties, or combinations, but which are listed as a single menu item, such as soft drinks, ice cream, pizza, doughnuts, or children"s combination meals, through means determined by the Secretary, including ranges, averages, or other methods. (7053)

"(vi) ADDITIONAL INFORMATION- If the Secretary determines that a nutrient, other than a nutrient required under subclause (ii)(III), should be disclosed for the purpose of providing information to assist consumers in maintaining healthy dietary practices, the Secretary may require, by regulation, disclosure of such nutrient in the written form required under subclause (ii)(III). (7054)

"(vii) NONAPPLICABILITY TO CERTAIN FOOD- (7055)

"(I) IN GENERAL- Subclauses (i) through (vi) do not apply to-- (7056)

"(aa) items that are not listed on a menu or menu board (such as condiments and other items placed on the table or counter for general use); (7057)

"(bb) daily specials, temporary menu items appearing on the menu for less than 60 days per calendar year, or custom orders; or (7058)

"(cc) such other food that is part of a customary market test appearing on the menu for less than 90 days, under terms and conditions established by the Secretary. (7059)

"(II) WRITTEN FORMS- Subparagraph (5)(C) shall apply to any regulations promulgated under subclauses (ii)(III) and (vi). (7060)

"(viii) VENDING MACHINES- (7061)

"(I) IN GENERAL- In the case of an article of food sold from a vending machine that-- (7062)

"(aa) does not permit a prospective purchaser to examine the Nutrition Facts Panel before purchasing the article or does not otherwise provide visible nutrition information at the point of purchase; and (7063)

"(bb) is operated by a person who is engaged in the business of owning or operating 20 or more vending machines, (7064)

the vending machine operator shall provide a sign in close proximity to each article of food or the selection button that includes a clear and conspicuous statement disclosing the number of calories contained in the article. (7065)

"(ix) VOLUNTARY PROVISION OF NUTRITION INFORMATION- (7066)

"(I) IN GENERAL- An authorized official of any restaurant or similar retail food establishment or vending machine operator not subject to the requirements of this clause may elect to be subject to the requirements of such clause, by registering biannually the name and address of such restaurant or similar retail food establishment or vending machine operator with the Secretary, as specified by the Secretary by regulation. (7067)

"(II) REGISTRATION- Within 120 days of enactment of this clause, the Secretary shall publish a notice in the Federal Register specifying the terms and conditions for implementation of item (I), pending promulgation of regulations. (7068)

"(III) RULE OF CONSTRUCTION- Nothing in this subclause shall be construed to authorize the Secretary to require an application, review, or licensing process for any entity to register with the Secretary, as described in such item. (7069)

"(x) REGULATIONS- (7070)

"(I) PROPOSED REGULATION- Not later than 1 year after the date of enactment of this clause, the Secretary shall promulgate proposed regulations to carry out this clause. (7071)

"(II) CONTENTS- In promulgating regulations, the Secretary shall-- (7072)

"(aa) consider standardization of recipes and methods of preparation, reasonable variation in serving size and formulation of menu items, space on menus and menu boards, inadvertent human error, training of food service workers, variations in ingredients, and other factors, as the Secretary determines; and (7073)

"(bb) specify the format and manner of the nutrient content disclosure requirements under this subclause. (7074)

"(III) REPORTING- The Secretary shall submit to the Committee on Health, Education, Labor, and Pensions of the Senate and the Committee on Energy and Commerce of the House of Representatives a quarterly report that describes the Secretary"s progress toward promulgating final regulations under this subparagraph. (7075)

"(xi) DEFINITION- In this clause, the term "menu" or "menu board" means the primary writing of the restaurant or other similar retail food establishment from which a consumer makes an order selection." (7076)

(c) National Uniformity- Section 403A(a)(4) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 343-1(a)(4)) is amended by striking "except a requirement for nutrition labeling of food which is exempt under subclause (i) or (ii) of section 403(q)(5)(A)" and inserting "except that this paragraph does not apply to food that is offered for sale in a restaurant or similar retail food establishment that is not part of a chain with 20 or more locations doing business under the same name (regardless of the type of ownership of the locations) and offering for sale substantially the same menu items unless such restaurant or similar retail food establishment complies with the voluntary provision of nutrition information requirements under section 403(q)(5)(H)(ix)". (7077)

(d) Rule of Construction- Nothing in the amendments made by this section shall be construed-- (7078)

(1) to preempt any provision of State or local law, unless such provision establishes or continues into effect nutrient content disclosures of the type required under section 403(q)(5)(H) of the Federal Food, Drug, and Cosmetic Act (as added by subsection (b)) and is expressly preempted under subsection (a)(4) of such section; (7079)

(2) to apply to any State or local requirement respecting a statement in the labeling of food that provides for a warning concerning the safety of the food or component of the food; or (7080)

(3) except as provided in section 403(q)(5)(H)(ix) of the Federal Food, Drug, and Cosmetic Act (as added by subsection (b)), to apply to any restaurant or similar retail food establishment other than a restaurant or similar retail food establishment described in section 403(q)(5)(H)(i) of such Act. (7081)

SEC. 4206. DEMONSTRATION PROJECT CONCERNING INDIVIDUALIZED WELLNESS PLAN. (7082)(1-click HTML)

Section 330 of the Public Health Service Act (42 U.S.C. 245b) is amended by adding at the end the following: (7083)

"(s) Demonstration Program for Individualized Wellness Plans- (7084)

"(1) IN GENERAL- The Secretary shall establish a pilot program to test the impact of providing at-risk populations who utilize community health centers funded under this section an individualized wellness plan that is designed to reduce risk factors for preventable conditions as identified by a comprehensive risk-factor assessment. (7085)

"(2) AGREEMENTS- The Secretary shall enter into agreements with not more than 10 community health centers funded under this section to conduct activities under the pilot program under paragraph (1). (7086)

"(3) WELLNESS PLANS- (7087)

"(A) IN GENERAL- An individualized wellness plan prepared under the pilot program under this subsection may include one or more of the following as appropriate to the individual"s identified risk factors: (7088)

"(i) Nutritional counseling. (7089)

"(ii) A physical activity plan. (7090)

"(iii) Alcohol and smoking cessation counseling and services. (7091)

"(iv) Stress management. (7092)

"(v) Dietary supplements that have health claims approved by the Secretary. (7093)

"(vi) Compliance assistance provided by a community health center employee. (7094)

"(B) RISK FACTORS- Wellness plan risk factors shall include-- (7095)

"(i) weight; (7096)

"(ii) tobacco and alcohol use; (7097)

"(iii) exercise rates; (7098)

"(iv) nutritional status; and (7099)

"(v) blood pressure. (7100)

"(C) COMPARISONS- Individualized wellness plans shall make comparisons between the individual involved and a control group of individuals with respect to the risk factors described in subparagraph (B). (7101)

"(4) AUTHORIZATION OF APPROPRIATIONS- There is authorized to be appropriated to carry out this subsection, such sums as may be necessary.". (7102)

SEC. 4207. REASONABLE BREAK TIME FOR NURSING MOTHERS. (7103)(1-click HTML)

Section 7 of the Fair Labor Standards Act of 1938 (29 U.S.C. 207) is amended by adding at the end the following: (7104)

"(r)(1) An employer shall provide-- (7105)

"(A) a reasonable break time for an employee to express breast milk for her nursing child for 1 year after the child"s birth each time such employee has need to express the milk; and (7106)

"(B) a place, other than a bathroom, that is shielded from view and free from intrusion from coworkers and the public, which may be used by an employee to express breast milk. (7107)

"(2) An employer shall not be required to compensate an employee receiving reasonable break time under paragraph (1) for any work time spent for such purpose. (7108)

"(3) An employer that employs less than 50 employees shall not be subject to the requirements of this subsection, if such requirements would impose an undue hardship by causing the employer significant difficulty or expense when considered in relation to the size, financial resources, nature, or structure of the employer"s business. (7109)

"(4) Nothing in this subsection shall preempt a State law that provides greater protections to employees than the protections provided for under this subsection.". (7110)

  

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