Patient Protection and Affordable Care Act/Title II/Subtitle L

by United States Congress

Subtitle L—Maternal and Child Health Services

SEC. 2951. MATERNAL, INFANT, AND EARLY CHILDHOOD HOME VISITING PROGRAMS.

Title V of the Social Security Act (42 U.S.C. 701 et seq.) is amended by adding at the end the following new section:

`SEC. 511. MATERNAL, INFANT, AND EARLY CHILDHOOD HOME VISITING PROGRAMS.

`(a) Purposes- The purposes of this section are--

`(1) to strengthen and improve the programs and activities carried out under this title;

`(2) to improve coordination of services for at risk communities; and

`(3) to identify and provide comprehensive services to improve outcomes for families who reside in at risk communities.

`(b) Requirement for All States To Assess Statewide Needs and Identify at Risk Communities-

`(1) IN GENERAL- Not later than 6 months after the date of enactment of this section, each State shall, as a condition of receiving payments from an allotment for the State under section 502 for fiscal year 2011, conduct a statewide needs assessment (which shall be separate from the statewide needs assessment required under section 505(a)) that identifies--

`(A) communities with concentrations of--

`(i) premature birth, low-birth weight infants, and infant mortality, including infant death due to neglect, or other indicators of at-risk prenatal, maternal, newborn, or child health;

`(ii) poverty;

`(iii) crime;

`(iv) domestic violence;

`(v) high rates of high-school drop-outs;

`(vi) substance abuse;

`(vii) unemployment; or

`(viii) child maltreatment;

`(B) the quality and capacity of existing programs or initiatives for early childhood home visitation in the State including--

`(i) the number and types of individuals and families who are receiving services under such programs or initiatives;

`(ii) the gaps in early childhood home visitation in the State; and

`(iii) the extent to which such programs or initiatives are meeting the needs of eligible families described in subsection (k)(2); and

`(C) the State's capacity for providing substance abuse treatment and counseling services to individuals and families in need of such treatment or services.

`(2) COORDINATION WITH OTHER ASSESSMENTS- In conducting the statewide needs assessment required under paragraph (1), the State shall coordinate with, and take into account, other appropriate needs assessments conducted by the State, as determined by the Secretary, including the needs assessment required under section 505(a) (both the most recently completed assessment and any such assessment in progress), the communitywide strategic planning and needs assessments conducted in accordance with section 640(g)(1)(C) of the Head Start Act, and the inventory of current unmet needs and current community-based and prevention-focused programs and activities to prevent child abuse and neglect, and other family resource services operating in the State required under section 205(3) of the Child Abuse Prevention and Treatment Act.

`(3) SUBMISSION TO THE SECRETARY- Each State shall submit to the Secretary, in such form and manner as the Secretary shall require--

`(A) the results of the statewide needs assessment required under paragraph (1); and

`(B) a description of how the State intends to address needs identified by the assessment, particularly with respect to communities identified under paragraph (1)(A), which may include applying for a grant to conduct an early childhood home visitation program in accordance with the requirements of this section.

`(c) Grants for Early Childhood Home Visitation Programs-

`(1) AUTHORITY TO MAKE GRANTS- In addition to any other payments made under this title to a State, the Secretary shall make grants to eligible entities to enable the entities to deliver services under early childhood home visitation programs that satisfy the requirements of subsection (d) to eligible families in order to promote improvements in maternal and prenatal health, infant health, child health and development, parenting related to child development outcomes, school readiness, and the socioeconomic status of such families, and reductions in child abuse, neglect, and injuries.

`(2) AUTHORITY TO USE INITIAL GRANT FUNDS FOR PLANNING OR IMPLEMENTATION- An eligible entity that receives a grant under paragraph (1) may use a portion of the funds made available to the entity during the first 6 months of the period for which the grant is made for planning or implementation activities to assist with the establishment of early childhood home visitation programs that satisfy the requirements of subsection (d).

`(3) GRANT DURATION- The Secretary shall determine the period of years for which a grant is made to an eligible entity under paragraph (1).

`(4) TECHNICAL ASSISTANCE- The Secretary shall provide an eligible entity that receives a grant under paragraph (1) with technical assistance in administering programs or activities conducted in whole or in part with grant funds.

`(d) Requirements- The requirements of this subsection for an early childhood home visitation program conducted with a grant made under this section are as follows:

`(1) QUANTIFIABLE, MEASURABLE IMPROVEMENT IN BENCHMARK AREAS-

`(A) IN GENERAL- The eligible entity establishes, subject to the approval of the Secretary, quantifiable, measurable 3- and 5-year benchmarks for demonstrating that the program results in improvements for the eligible families participating in the program in each of the following areas:

`(i) Improved maternal and newborn health.

`(ii) Prevention of child injuries, child abuse, neglect, or maltreatment, and reduction of emergency department visits.

`(iii) Improvement in school readiness and achievement.

`(iv) Reduction in crime or domestic violence.

`(v) Improvements in family economic self-sufficiency.

`(vi) Improvements in the coordination and referrals for other community resources and supports.

`(B) DEMONSTRATION OF IMPROVEMENTS AFTER 3 YEARS-

`(i) REPORT TO THE SECRETARY- Not later than 30 days after the end of the 3rd year in which the eligible entity conducts the program, the entity submits to the Secretary a report demonstrating improvement in at least 4 of the areas specified in subparagraph (A).

`(ii) CORRECTIVE ACTION PLAN- If the report submitted by the eligible entity under clause (i) fails to demonstrate improvement in at least 4 of the areas specified in subparagraph (A), the entity shall develop and implement a plan to improve outcomes in each of the areas specified in subparagraph (A), subject to approval by the Secretary. The plan shall include provisions for the Secretary to monitor implementation of the plan and conduct continued oversight of the program, including through submission by the entity of regular reports to the Secretary.

`(iii) TECHNICAL ASSISTANCE-

`(I) IN GENERAL- The Secretary shall provide an eligible entity required to develop and implement an improvement plan under clause (ii) with technical assistance to develop and implement the plan. The Secretary may provide the technical assistance directly or through grants, contracts, or cooperative agreements.

`(II) ADVISORY PANEL- The Secretary shall establish an advisory panel for purposes of obtaining recommendations regarding the technical assistance provided to entities in accordance with subclause (I).

`(iv) NO IMPROVEMENT OR FAILURE TO SUBMIT REPORT- If the Secretary determines after a period of time specified by the Secretary that an eligible entity implementing an improvement plan under clause (ii) has failed to demonstrate any improvement in the areas specified in subparagraph (A), or if the Secretary determines that an eligible entity has failed to submit the report required under clause (i), the Secretary shall terminate the entity's grant and may include any unexpended grant funds in grants made to nonprofit organizations under subsection (h)(2)(B).

`(C) FINAL REPORT- Not later than December 31, 2015, the eligible entity shall submit a report to the Secretary demonstrating improvements (if any) in each of the areas specified in subparagraph (A).

`(2) IMPROVEMENTS IN OUTCOMES FOR INDIVIDUAL FAMILIES-

`(A) IN GENERAL- The program is designed, with respect to an eligible family participating in the program, to result in the participant outcomes described in subparagraph (B) that the eligible entity identifies on the basis of an individualized assessment of the family, are relevant for that family.

`(B) PARTICIPANT OUTCOMES- The participant outcomes described in this subparagraph are the following:

`(i) Improvements in prenatal, maternal, and newborn health, including improved pregnancy outcomes

`(ii) Improvements in child health and development, including the prevention of child injuries and maltreatment and improvements in cognitive, language, social-emotional, and physical developmental indicators.

`(iii) Improvements in parenting skills.

`(iv) Improvements in school readiness and child academic achievement.

`(v) Reductions in crime or domestic violence.

`(vi) Improvements in family economic self-sufficiency.

`(vii) Improvements in the coordination of referrals for, and the provision of, other community resources and supports for eligible families, consistent with State child welfare agency training.

`(3) CORE COMPONENTS- The program includes the following core components:

`(A) SERVICE DELIVERY MODEL OR MODELS-

`(i) IN GENERAL- Subject to clause (ii), the program is conducted using 1 or more of the service delivery models described in item (aa) or (bb) of subclause (I) or in subclause (II) selected by the eligible entity:

`(I) The model conforms to a clear consistent home visitation model that has been in existence for at least 3 years and is research-based, grounded in relevant empirically-based knowledge, linked to program determined outcomes, associated with a national organization or institution of higher education that has comprehensive home visitation program standards that ensure high quality service delivery and continuous program quality improvement, and has demonstrated significant, (and in the case of the service delivery model described in item (aa), sustained) positive outcomes, as described in the benchmark areas specified in paragraph (1)(A) and the participant outcomes described in paragraph (2)(B), when evaluated using well-designed and rigorous--

`(aa) randomized controlled research designs, and the evaluation results have been published in a peer-reviewed journal; or

`(bb) quasi-experimental research designs.

`(II) The model conforms to a promising and new approach to achieving the benchmark areas specified in paragraph (1)(A) and the participant outcomes described in paragraph (2)(B), has been developed or identified by a national organization or institution of higher education, and will be evaluated through well-designed and rigorous process.

`(ii) MAJORITY OF GRANT FUNDS USED FOR EVIDENCE-BASED MODELS- An eligible entity shall use not more than 25 percent of the amount of the grant paid to the entity for a fiscal year for purposes of conducting a program using the service delivery model described in clause (i)(II).

`(iii) CRITERIA FOR EVIDENCE OF EFFECTIVENESS OF MODELS- The Secretary shall establish criteria for evidence of effectiveness of the service delivery models and shall ensure that the process for establishing the criteria is transparent and provides the opportunity for public comment.

`(B) ADDITIONAL REQUIREMENTS-

`(i) The program adheres to a clear, consistent model that satisfies the requirements of being grounded in empirically-based knowledge related to home visiting and linked to the benchmark areas specified in paragraph (1)(A) and the participant outcomes described in paragraph (2)(B) related to the purposes of the program.

`(ii) The program employs well-trained and competent staff, as demonstrated by education or training, such as nurses, social workers, educators, child development specialists, or other well-trained and competent staff, and provides ongoing and specific training on the model being delivered.

`(iii) The program maintains high quality supervision to establish home visitor competencies.

`(iv) The program demonstrates strong organizational capacity to implement the activities involved.

`(v) The program establishes appropriate linkages and referral networks to other community resources and supports for eligible families.

`(vi) The program monitors the fidelity of program implementation to ensure that services are delivered pursuant to the specified model.

`(4) PRIORITY FOR SERVING HIGH-RISK POPULATIONS- The eligible entity gives priority to providing services under the program to the following:

`(A) Eligible families who reside in communities in need of such services, as identified in the statewide needs assessment required under subsection (b)(1)(A).

`(B) Low-income eligible families.

`(C) Eligible families who are pregnant women who have not attained age 21.

`(D) Eligible families that have a history of child abuse or neglect or have had interactions with child welfare services.

`(E) Eligible families that have a history of substance abuse or need substance abuse treatment.

`(F) Eligible families that have users of tobacco products in the home.

`(G) Eligible families that are or have children with low student achievement.

`(H) Eligible families with children with developmental delays or disabilities.

`(I) Eligible families who, or that include individuals who, are serving or formerly served in the Armed Forces, including such families that have members of the Armed Forces who have had multiple deployments outside of the United States.

`(e) Application Requirements- An eligible entity desiring a grant under this section shall submit an application to the Secretary for approval, in such manner as the Secretary may require, that includes the following:

`(1) A description of the populations to be served by the entity, including specific information regarding how the entity will serve high risk populations described in subsection (d)(4).

`(2) An assurance that the entity will give priority to serving low-income eligible families and eligible families who reside in at risk communities identified in the statewide needs assessment required under subsection (b)(1)(A).

`(3) The service delivery model or models described in subsection (d)(3)(A) that the entity will use under the program and the basis for the selection of the model or models.

`(4) A statement identifying how the selection of the populations to be served and the service delivery model or models that the entity will use under the program for such populations is consistent with the results of the statewide needs assessment conducted under subsection (b).

`(5) The quantifiable, measurable benchmarks established by the State to demonstrate that the program contributes to improvements in the areas specified in subsection (d)(1)(A).

`(6) An assurance that the entity will obtain and submit documentation or other appropriate evidence from the organization or entity that developed the service delivery model or models used under the program to verify that the program is implemented and services are delivered according to the model specifications.

`(7) Assurances that the entity will establish procedures to ensure that--

`(A) the participation of each eligible family in the program is voluntary; and

`(B) services are provided to an eligible family in accordance with the individual assessment for that family.

`(8) Assurances that the entity will--

`(A) submit annual reports to the Secretary regarding the program and activities carried out under the program that include such information and data as the Secretary shall require; and

`(B) participate in, and cooperate with, data and information collection necessary for the evaluation required under subsection (g)(2) and other research and evaluation activities carried out under subsection (h)(3).

`(9) A description of other State programs that include home visitation services, including, if applicable to the State, other programs carried out under this title with funds made available from allotments under section 502(c), programs funded under title IV, title II of the Child Abuse Prevention and Treatment Act (relating to community-based grants for the prevention of child abuse and neglect), and section 645A of the Head Start Act (relating to Early Head Start programs).

`(10) Other information as required by the Secretary.

`(f) Maintenance of Effort- Funds provided to an eligible entity receiving a grant under this section shall supplement, and not supplant, funds from other sources for early childhood home visitation programs or initiatives.

`(g) Evaluation-

`(1) INDEPENDENT, EXPERT ADVISORY PANEL- The Secretary, in accordance with subsection (h)(1)(A), shall appoint an independent advisory panel consisting of experts in program evaluation and research, education, and early childhood development--

`(A) to review, and make recommendations on, the design and plan for the evaluation required under paragraph (2) within 1 year after the date of enactment of this section;

`(B) to maintain and advise the Secretary regarding the progress of the evaluation; and

`(C) to comment, if the panel so desires, on the report submitted under paragraph (3).

`(2) AUTHORITY TO CONDUCT EVALUATION- On the basis of the recommendations of the advisory panel under paragraph (1), the Secretary shall, by grant, contract, or interagency agreement, conduct an evaluation of the statewide needs assessments submitted under subsection (b) and the grants made under subsections (c) and (h)(3)(B). The evaluation shall include--

`(A) an analysis, on a State-by-State basis, of the results of such assessments, including indicators of maternal and prenatal health and infant health and mortality, and State actions in response to the assessments; and

`(B) an assessment of--

`(i) the effect of early childhood home visitation programs on child and parent outcomes, including with respect to each of the benchmark areas specified in subsection (d)(1)(A) and the participant outcomes described in subsection (d)(2)(B);

`(ii) the effectiveness of such programs on different populations, including the extent to which the ability of programs to improve participant outcomes varies across programs and populations; and

`(iii) the potential for the activities conducted under such programs, if scaled broadly, to improve health care practices, eliminate health disparities, and improve health care system quality, efficiencies, and reduce costs.

`(3) REPORT- Not later than March 31, 2015, the Secretary shall submit a report to Congress on the results of the evaluation conducted under paragraph (2) and shall make the report publicly available.

`(h) Other Provisions-

`(1) INTRA-AGENCY COLLABORATION- The Secretary shall ensure that the Maternal and Child Health Bureau and the Administration for Children and Families collaborate with respect to carrying out this section, including with respect to--

`(A) reviewing and analyzing the statewide needs assessments required under subsection (b), the awarding and oversight of grants awarded under this section, the establishment of the advisory panels required under subsections (d)(1)(B)(iii)(II) and (g)(1), and the evaluation and report required under subsection (g); and

`(B) consulting with other Federal agencies with responsibility for administering or evaluating programs that serve eligible families to coordinate and collaborate with respect to research related to such programs and families, including the Office of the Assistant Secretary for Planning and Evaluation of the Department of Health and Human Services, the Centers for Disease Control and Prevention, the National Institute of Child Health and Human Development of the National Institutes of Health, the Office of Juvenile Justice and Delinquency Prevention of the Department of Justice, and the Institute of Education Sciences of the Department of Education.

`(2) GRANTS TO ELIGIBLE ENTITIES THAT ARE NOT STATES-

`(A) INDIAN TRIBES, TRIBAL ORGANIZATIONS, OR URBAN INDIAN ORGANIZATIONS- The Secretary shall specify requirements for eligible entities that are Indian Tribes (or a consortium of Indian Tribes), Tribal Organizations, or Urban Indian Organizations to apply for and conduct an early childhood home visitation program with a grant under this section. Such requirements shall, to the greatest extent practicable, be consistent with the requirements applicable to eligible entities that are States and shall require an Indian Tribe (or consortium), Tribal Organization, or Urban Indian Organization to--

`(i) conduct a needs assessment similar to the assessment required for all States under subsection (b); and

`(ii) establish quantifiable, measurable 3- and 5-year benchmarks consistent with subsection (d)(1)(A).

`(B) NONPROFIT ORGANIZATIONS- If, as of the beginning of fiscal year 2012, a State has not applied or been approved for a grant under this section, the Secretary may use amounts appropriated under paragraph (1) of subsection (j) that are available for expenditure under paragraph (3) of that subsection to make a grant to an eligible entity that is a nonprofit organization described in subsection (k)(1)(B) to conduct an early childhood home visitation program in the State. The Secretary shall specify the requirements for such an organization to apply for and conduct the program which shall, to the greatest extent practicable, be consistent with the requirements applicable to eligible entities that are States and shall require the organization to--

`(i) carry out the program based on the needs assessment conducted by the State under subsection (b); and

`(ii) establish quantifiable, measurable 3- and 5-year benchmarks consistent with subsection (d)(1)(A).

`(3) RESEARCH AND OTHER EVALUATION ACTIVITIES-

`(A) IN GENERAL- The Secretary shall carry out a continuous program of research and evaluation activities in order to increase knowledge about the implementation and effectiveness of home visiting programs, using random assignment designs to the maximum extent feasible. The Secretary may carry out such activities directly, or through grants, cooperative agreements, or contracts.

`(B) REQUIREMENTS- The Secretary shall ensure that--

`(i) evaluation of a specific program or project is conducted by persons or individuals not directly involved in the operation of such program or project; and

`(ii) the conduct of research and evaluation activities includes consultation with independent researchers, State officials, and developers and providers of home visiting programs on topics including research design and administrative data matching.

`(4) REPORT AND RECOMMENDATION- Not later than December 31, 2015, the Secretary shall submit a report to Congress regarding the programs conducted with grants under this section. The report required under this paragraph shall include--

`(A) information regarding the extent to which eligible entities receiving grants under this section demonstrated improvements in each of the areas specified in subsection (d)(1)(A);

`(B) information regarding any technical assistance provided under subsection (d)(1)(B)(iii)(I), including the type of any such assistance provided; and

`(C) recommendations for such legislative or administrative action as the Secretary determines appropriate.

`(i) Application of Other Provisions of Title-

`(1) IN GENERAL- Except as provided in paragraph (2), the other provisions of this title shall not apply to a grant made under this section.

`(2) EXCEPTIONS- The following provisions of this title shall apply to a grant made under this section to the same extent and in the same manner as such provisions apply to allotments made under section 502(c):

`(A) Section 504(b)(6) (relating to prohibition on payments to excluded individuals and entities).

`(B) Section 504(c) (relating to the use of funds for the purchase of technical assistance).

`(C) Section 504(d) (relating to a limitation on administrative expenditures).

`(D) Section 506 (relating to reports and audits), but only to the extent determined by the Secretary to be appropriate for grants made under this section.

`(E) Section 507 (relating to penalties for false statements).

`(F) Section 508 (relating to nondiscrimination).

`(G) Section 509(a) (relating to the administration of the grant program).

`(j) Appropriations-

`(1) IN GENERAL- Out of any funds in the Treasury not otherwise appropriated, there are appropriated to the Secretary to carry out this section--

`(A) $100,000,000 for fiscal year 2010;

`(B) $250,000,000 for fiscal year 2011;

`(C) $350,000,000 for fiscal year 2012;

`(D) $400,000,000 for fiscal year 2013; and

`(E) $400,000,000 for fiscal year 2014.

`(2) RESERVATIONS- Of the amount appropriated under this subsection for a fiscal year, the Secretary shall reserve--

`(A) 3 percent of such amount for purposes of making grants to eligible entities that are Indian Tribes (or a consortium of Indian Tribes), Tribal Organizations, or Urban Indian Organizations; and

`(B) 3 percent of such amount for purposes of carrying out subsections (d)(1)(B)(iii), (g), and (h)(3).

`(3) AVAILABILITY- Funds made available to an eligible entity under this section for a fiscal year shall remain available for expenditure by the eligible entity through the end of the second succeeding fiscal year after award. Any funds that are not expended by the eligible entity during the period in which the funds are available under the preceding sentence may be used for grants to nonprofit organizations under subsection (h)(2)(B).

`(k) Definitions- In this section:

`(1) ELIGIBLE ENTITY-

`(A) IN GENERAL- The term `eligible entity' means a State, an Indian Tribe, Tribal Organization, or Urban Indian Organization, Puerto Rico, Guam, the Virgin Islands, the Northern Mariana Islands, and American Samoa.

`(B) NONPROFIT ORGANIZATIONS- Only for purposes of awarding grants under subsection (h)(2)(B), such term shall include a nonprofit organization with an established record of providing early childhood home visitation programs or initiatives in a State or several States.

`(2) ELIGIBLE FAMILY- The term `eligible family' means--

`(A) a woman who is pregnant, and the father of the child if the father is available; or

`(B) a parent or primary caregiver of a child, including grandparents or other relatives of the child, and foster parents, who are serving as the child's primary caregiver from birth to kindergarten entry, and including a noncustodial parent who has an ongoing relationship with, and at times provides physical care for, the child.

`(3) INDIAN TRIBE; TRIBAL ORGANIZATION- The terms `Indian Tribe' and `Tribal Organization', and `Urban Indian Organization' have the meanings given such terms in section 4 of the Indian Health Care Improvement Act.'.

SEC. 2952. SUPPORT, EDUCATION, AND RESEARCH FOR POSTPARTUM DEPRESSION.

(a) Research on Postpartum Conditions-

(1) EXPANSION AND INTENSIFICATION OF ACTIVITIES- The Secretary of Health and Human Services (in this subsection and subsection (c) referred to as the `Secretary') is encouraged to continue activities on postpartum depression or postpartum psychosis (in this subsection and subsection (c) referred to as `postpartum conditions'), including research to expand the understanding of the causes of, and treatments for, postpartum conditions. Activities under this paragraph shall include conducting and supporting the following:

(A) Basic research concerning the etiology and causes of the conditions.

(B) Epidemiological studies to address the frequency and natural history of the conditions and the differences among racial and ethnic groups with respect to the conditions.

(C) The development of improved screening and diagnostic techniques.

(D) Clinical research for the development and evaluation of new treatments.

(E) Information and education programs for health care professionals and the public, which may include a coordinated national campaign to increase the awareness and knowledge of postpartum conditions. Activities under such a national campaign may--

(i) include public service announcements through television, radio, and other means; and

(ii) focus on--

(I) raising awareness about screening;

(II) educating new mothers and their families about postpartum conditions to promote earlier diagnosis and treatment; and

(III) ensuring that such education includes complete information concerning postpartum conditions, including its symptoms, methods of coping with the illness, and treatment resources.

(2) SENSE OF CONGRESS REGARDING LONGITUDINAL STUDY OF RELATIVE MENTAL HEALTH CONSEQUENCES FOR WOMEN OF RESOLVING A PREGNANCY-

(A) SENSE OF CONGRESS- It is the sense of Congress that the Director of the National Institute of Mental Health may conduct a nationally representative longitudinal study (during the period of fiscal years 2010 through 2019) of the relative mental health consequences for women of resolving a pregnancy (intended and unintended) in various ways, including carrying the pregnancy to term and parenting the child, carrying the pregnancy to term and placing the child for adoption, miscarriage, and having an abortion. This study may assess the incidence, timing, magnitude, and duration of the immediate and long-term mental health consequences (positive or negative) of these pregnancy outcomes.

(B) REPORT- Subject to the completion of the study under subsection (a), beginning not later than 5 years after the date of the enactment of this Act, and periodically thereafter for the duration of the study, such Director may prepare and submit to the Congress reports on the findings of the study.

(b) Grants To Provide Services to Individuals With a Postpartum Condition and Their Families- Title V of the Social Security Act (42 U.S.C. 701 et seq.), as amended by section 2951, is amended by adding at the end the following new section:

`SEC. 512. SERVICES TO INDIVIDUALS WITH A POSTPARTUM CONDITION AND THEIR FAMILIES.

`(a) In General- In addition to any other payments made under this title to a State, the Secretary may make grants to eligible entities for projects for the establishment, operation, and coordination of effective and cost-efficient systems for the delivery of essential services to individuals with or at risk for postpartum conditions and their families.

`(b) Certain Activities- To the extent practicable and appropriate, the Secretary shall ensure that projects funded under subsection (a) provide education and services with respect to the diagnosis and management of postpartum conditions for individuals with or at risk for postpartum conditions and their families. The Secretary may allow such projects to include the following:

`(1) Delivering or enhancing outpatient and home-based health and support services, including case management and comprehensive treatment services.

`(2) Delivering or enhancing inpatient care management services that ensure the well-being of the mother and family and the future development of the infant.

`(3) Improving the quality, availability, and organization of health care and support services (including transportation services, attendant care, homemaker services, day or respite care, and providing counseling on financial assistance and insurance).

`(4) Providing education about postpartum conditions to promote earlier diagnosis and treatment. Such education may include--

`(A) providing complete information on postpartum conditions, symptoms, methods of coping with the illness, and treatment resources; and

`(B) in the case of a grantee that is a State, hospital, or birthing facility--

`(i) providing education to new mothers and fathers, and other family members as appropriate, concerning postpartum conditions before new mothers leave the health facility; and

`(ii) ensuring that training programs regarding such education are carried out at the health facility.

`(c) Integration With Other Programs- To the extent practicable and appropriate, the Secretary may integrate the grant program under this section with other grant programs carried out by the Secretary, including the program under section 330 of the Public Health Service Act.

`(d) Requirements- The Secretary shall establish requirements for grants made under this section that include a limit on the amount of grants funds that may be used for administration, accounting, reporting, or program oversight functions and a requirement for each eligible entity that receives a grant to submit, for each grant period, a report to the Secretary that describes how grant funds were used during such period.

`(e) Technical Assistance- The Secretary may provide technical assistance to entities seeking a grant under this section in order to assist such entities in complying with the requirements of this section.

`(f) Application of Other Provisions of Title-

`(1) IN GENERAL- Except as provided in paragraph (2), the other provisions of this title shall not apply to a grant made under this section.

`(2) EXCEPTIONS- The following provisions of this title shall apply to a grant made under this section to the same extent and in the same manner as such provisions apply to allotments made under section 502(c):

`(A) Section 504(b)(6) (relating to prohibition on payments to excluded individuals and entities).

`(B) Section 504(c) (relating to the use of funds for the purchase of technical assistance).

`(C) Section 504(d) (relating to a limitation on administrative expenditures).

`(D) Section 506 (relating to reports and audits), but only to the extent determined by the Secretary to be appropriate for grants made under this section.

`(E) Section 507 (relating to penalties for false statements).

`(F) Section 508 (relating to nondiscrimination).

`(G) Section 509(a) (relating to the administration of the grant program).

`(g) Definitions- In this section:

`(1) The term `eligible entity'--

`(A) means a public or nonprofit private entity; and

`(B) includes a State or local government, public-private partnership, recipient of a grant under section 330H of the Public Health Service Act (relating to the Healthy Start Initiative), public or nonprofit private hospital, community-based organization, hospice, ambulatory care facility, community health center, migrant health center, public housing primary care center, or homeless health center.

`(2) The term `postpartum condition' means postpartum depression or postpartum psychosis.'.

(c) General Provisions-

(1) AUTHORIZATION OF APPROPRIATIONS- To carry out this section and the amendment made by subsection (b), there are authorized to be appropriated, in addition to such other sums as may be available for such purpose--

(A) $3,000,000 for fiscal year 2010; and

(B) such sums as may be necessary for fiscal years 2011 and 2012.

(2) REPORT BY THE SECRETARY-

(A) STUDY- The Secretary shall conduct a study on the benefits of screening for postpartum conditions.

(B) REPORT- Not later than 2 years after the date of the enactment of this Act, the Secretary shall complete the study required by subparagraph (A) and submit a report to the Congress on the results of such study.

SEC. 2953. PERSONAL RESPONSIBILITY EDUCATION.

Title V of the Social Security Act (42 U.S.C. 701 et seq.), as amended by sections 2951 and 2952(c), is amended by adding at the end the following:

`SEC. 513. PERSONAL RESPONSIBILITY EDUCATION.

`(a) Allotments to States-

`(1) AMOUNT-

`(A) IN GENERAL- For the purpose described in subsection (b), subject to the succeeding provisions of this section, for each of fiscal years 2010 through 2014, the Secretary shall allot to each State an amount equal to the product of--

`(i) the amount appropriated under subsection (f) for the fiscal year and available for allotments to States after the application of subsection (c); and

`(ii) the State youth population percentage determined under paragraph (2).

`(B) MINIMUM ALLOTMENT-

`(i) IN GENERAL- Each State allotment under this paragraph for a fiscal year shall be at least $250,000.

`(ii) PRO RATA ADJUSTMENTS- The Secretary shall adjust on a pro rata basis the amount of the State allotments determined under this paragraph for a fiscal year to the extent necessary to comply with clause (i).

`(C) APPLICATION REQUIRED TO ACCESS ALLOTMENTS-

`(i) IN GENERAL- A State shall not be paid from its allotment for a fiscal year unless the State submits an application to the Secretary for the fiscal year and the Secretary approves the application (or requires changes to the application that the State satisfies) and meets such additional requirements as the Secretary may specify.

`(ii) REQUIREMENTS- The State application shall contain an assurance that the State has complied with the requirements of this section in preparing and submitting the application and shall include the following as well as such additional information as the Secretary may require:

`(I) Based on data from the Centers for Disease Control and Prevention National Center for Health Statistics, the most recent pregnancy rates for the State for youth ages 10 to 14 and youth ages 15 to 19 for which data are available, the most recent birth rates for such youth populations in the State for which data are available, and trends in those rates for the most recently preceding 5-year period for which such data are available.

`(II) State-established goals for reducing the pregnancy rates and birth rates for such youth populations.

`(III) A description of the State's plan for using the State allotments provided under this section to achieve such goals, especially among youth populations that are the most high-risk or vulnerable for pregnancies or otherwise have special circumstances, including youth in foster care, homeless youth, youth with HIV/AIDS, pregnant youth who are under 21 years of age, mothers who are under 21 years of age, and youth residing in areas with high birth rates for youth.

`(2) STATE YOUTH POPULATION PERCENTAGE-

`(A) IN GENERAL- For purposes of paragraph (1)(A)(ii), the State youth population percentage is, with respect to a State, the proportion (expressed as a percentage) of--

`(i) the number of individuals who have attained age 10 but not attained age 20 in the State; to

`(ii) the number of such individuals in all States.

`(B) DETERMINATION OF NUMBER OF YOUTH- The number of individuals described in clauses (i) and (ii) of subparagraph (A) in a State shall be determined on the basis of the most recent Bureau of the Census data.

`(3) AVAILABILITY OF STATE ALLOTMENTS- Subject to paragraph (4)(A), amounts allotted to a State pursuant to this subsection for a fiscal year shall remain available for expenditure by the State through the end of the second succeeding fiscal year.

`(4) AUTHORITY TO AWARD GRANTS FROM STATE ALLOTMENTS TO LOCAL ORGANIZATIONS AND ENTITIES IN NONPARTICIPATING STATES-

`(A) GRANTS FROM UNEXPENDED ALLOTMENTS- If a State does not submit an application under this section for fiscal year 2010 or 2011, the State shall no longer be eligible to submit an application to receive funds from the amounts allotted for the State for each of fiscal years 2010 through 2014 and such amounts shall be used by the Secretary to award grants under this paragraph for each of fiscal years 2012 through 2014. The Secretary also shall use any amounts from the allotments of States that submit applications under this section for a fiscal year that remain unexpended as of the end of the period in which the allotments are available for expenditure under paragraph (3) for awarding grants under this paragraph.

`(B) 3-year GRANTS-

`(i) IN GENERAL- The Secretary shall solicit applications to award 3-year grants in each of fiscal years 2012, 2013, and 2014 to local organizations and entities to conduct, consistent with subsection (b), programs and activities in States that do not submit an application for an allotment under this section for fiscal year 2010 or 2011.

`(ii) FAITH-BASED ORGANIZATIONS OR CONSORTIA- The Secretary may solicit and award grants under this paragraph to faith-based organizations or consortia.

`(C) EVALUATION- An organization or entity awarded a grant under this paragraph shall agree to participate in a rigorous Federal evaluation.

`(5) MAINTENANCE OF EFFORT- No payment shall be made to a State from the allotment determined for the State under this subsection or to a local organization or entity awarded a grant under paragraph (4), if the expenditure of non-federal funds by the State, organization, or entity for activities, programs, or initiatives for which amounts from allotments and grants under this subsection may be expended is less than the amount expended by the State, organization, or entity for such programs or initiatives for fiscal year 2009.

`(6) DATA COLLECTION AND REPORTING- A State or local organization or entity receiving funds under this section shall cooperate with such requirements relating to the collection of data and information and reporting on outcomes regarding the programs and activities carried out with such funds, as the Secretary shall specify.

`(b) Purpose-

`(1) IN GENERAL- The purpose of an allotment under subsection (a)(1) to a State is to enable the State (or, in the case of grants made under subsection (a)(4)(B), to enable a local organization or entity) to carry out personal responsibility education programs consistent with this subsection.

`(2) PERSONAL RESPONSIBILITY EDUCATION PROGRAMS-

`(A) IN GENERAL- In this section, the term `personal responsibility education program' means a program that is designed to educate adolescents on--

`(i) both abstinence and contraception for the prevention of pregnancy and sexually transmitted infections, including HIV/AIDS, consistent with the requirements of subparagraph (B); and

`(ii) at least 3 of the adulthood preparation subjects described in subparagraph (C).

`(B) REQUIREMENTS- The requirements of this subparagraph are the following:

`(i) The program replicates evidence-based effective programs or substantially incorporates elements of effective programs that have been proven on the basis of rigorous scientific research to change behavior, which means delaying sexual activity, increasing condom or contraceptive use for sexually active youth, or reducing pregnancy among youth.

`(ii) The program is medically-accurate and complete.

`(iii) The program includes activities to educate youth who are sexually active regarding responsible sexual behavior with respect to both abstinence and the use of contraception.

`(iv) The program places substantial emphasis on both abstinence and contraception for the prevention of pregnancy among youth and sexually transmitted infections.

`(v) The program provides age-appropriate information and activities.

`(vi) The information and activities carried out under the program are provided in the cultural context that is most appropriate for individuals in the particular population group to which they are directed.

`(C) ADULTHOOD PREPARATION SUBJECTS- The adulthood preparation subjects described in this subparagraph are the following:

`(i) Healthy relationships, such as positive self-esteem and relationship dynamics, friendships, dating, romantic involvement, marriage, and family interactions.

`(ii) Adolescent development, such as the development of healthy attitudes and values about adolescent growth and development, body image, racial and ethnic diversity, and other related subjects.

`(iii) Financial literacy.

`(iv) Parent-child communication.

`(v) Educational and career success, such as developing skills for employment preparation, job seeking, independent living, financial self-sufficiency, and workplace productivity.

`(vi) Healthy life skills, such as goal-setting, decision making, negotiation, communication and interpersonal skills, and stress management.

`(c) Reservations of Funds-

`(1) GRANTS TO IMPLEMENT INNOVATIVE STRATEGIES- From the amount appropriated under subsection (f) for the fiscal year, the Secretary shall reserve $10,000,000 of such amount for purposes of awarding grants to entities to implement innovative youth pregnancy prevention strategies and target services to high-risk, vulnerable, and culturally under-represented youth populations, including youth in foster care, homeless youth, youth with HIV/AIDS, pregnant women who are under 21 years of age and their partners, mothers who are under 21 years of age and their partners, and youth residing in areas with high birth rates for youth. An entity awarded a grant under this paragraph shall agree to participate in a rigorous Federal evaluation of the activities carried out with grant funds.

`(2) OTHER RESERVATIONS- From the amount appropriated under subsection (f) for the fiscal year that remains after the application of paragraph (1), the Secretary shall reserve the following amounts:

`(A) GRANTS FOR INDIAN TRIBES OR TRIBAL ORGANIZATIONS- The Secretary shall reserve 5 percent of such remainder for purposes of awarding grants to Indian tribes and tribal organizations in such manner, and subject to such requirements, as the Secretary, in consultation with Indian tribes and tribal organizations, determines appropriate.

`(B) SECRETARIAL RESPONSIBILITIES-

`(i) RESERVATION OF FUNDS- The Secretary shall reserve 10 percent of such remainder for expenditures by the Secretary for the activities described in clauses (ii) and (iii).

`(ii) PROGRAM SUPPORT- The Secretary shall provide, directly or through a competitive grant process, research, training and technical assistance, including dissemination of research and information regarding effective and promising practices, providing consultation and resources on a broad array of teen pregnancy prevention strategies, including abstinence and contraception, and developing resources and materials to support the activities of recipients of grants and other State, tribal, and community organizations working to reduce teen pregnancy. In carrying out such functions, the Secretary shall collaborate with a variety of entities that have expertise in the prevention of teen pregnancy, HIV and sexually transmitted infections, healthy relationships, financial literacy, and other topics addressed through the personal responsibility education programs.

`(iii) EVALUATION- The Secretary shall evaluate the programs and activities carried out with funds made available through allotments or grants under this section.

`(d) Administration-

`(1) IN GENERAL- The Secretary shall administer this section through the Assistant Secretary for the Administration for Children and Families within the Department of Health and Human Services.

`(2) APPLICATION OF OTHER PROVISIONS OF TITLE-

`(A) IN GENERAL- Except as provided in subparagraph (B), the other provisions of this title shall not apply to allotments or grants made under this section.

`(B) EXCEPTIONS- The following provisions of this title shall apply to allotments and grants made under this section to the same extent and in the same manner as such provisions apply to allotments made under section 502(c):

`(i) Section 504(b)(6) (relating to prohibition on payments to excluded individuals and entities).

`(ii) Section 504(c) (relating to the use of funds for the purchase of technical assistance).

`(iii) Section 504(d) (relating to a limitation on administrative expenditures).

`(iv) Section 506 (relating to reports and audits), but only to the extent determined by the Secretary to be appropriate for grants made under this section.

`(v) Section 507 (relating to penalties for false statements).

`(vi) Section 508 (relating to nondiscrimination).

`(e) Definitions- In this section:

`(1) AGE-APPROPRIATE- The term `age-appropriate', with respect to the information in pregnancy prevention, means topics, messages, and teaching methods suitable to particular ages or age groups of children and adolescents, based on developing cognitive, emotional, and behavioral capacity typical for the age or age group.

`(2) MEDICALLY ACCURATE AND COMPLETE- The term `medically accurate and complete' means verified or supported by the weight of research conducted in compliance with accepted scientific methods and--

`(A) published in peer-reviewed journals, where applicable; or

`(B) comprising information that leading professional organizations and agencies with relevant expertise in the field recognize as accurate, objective, and complete.

`(3) INDIAN TRIBES; TRIBAL ORGANIZATIONS- The terms `Indian tribe' and `Tribal organization' have the meanings given such terms in section 4 of the Indian Health Care Improvement Act (25 U.S.C. 1603)).

`(4) YOUTH- The term `youth' means an individual who has attained age 10 but has not attained age 20.

`(f) Appropriation- For the purpose of carrying out this section, there is appropriated, out of any money in the Treasury not otherwise appropriated, $75,000,000 for each of fiscal years 2010 through 2014. Amounts appropriated under this subsection shall remain available until expended.'.

SEC. 2954. RESTORATION OF FUNDING FOR ABSTINENCE EDUCATION.

Section 510 of the Social Security Act (42 U.S.C. 710) is amended--

(1) in subsection (a), by striking `fiscal year 1998 and each subsequent fiscal year' and inserting `each of fiscal years 2010 through 2014'; and

(2) in subsection (d)--

(A) in the first sentence, by striking `1998 through 2003' and inserting `2010 through 2014'; and

(B) in the second sentence, by inserting `(except that such appropriation shall be made on the date of enactment of the Patient Protection and Affordable Care Act in the case of fiscal year 2010)' before the period.

SEC. 2955. INCLUSION OF INFORMATION ABOUT THE IMPORTANCE OF HAVING A HEALTH CARE POWER OF ATTORNEY IN TRANSITION PLANNING FOR CHILDREN AGING OUT OF FOSTER CARE AND INDEPENDENT LIVING PROGRAMS.

(a) Transition Planning- Section 475(5)(H) of the Social Security Act (42 U.S.C. 675(5)(H)) is amended by inserting `includes information about the importance of designating another individual to make health care treatment decisions on behalf of the child if the child becomes unable to participate in such decisions and the child does not have, or does not want, a relative who would otherwise be authorized under State law to make such decisions, and provides the child with the option to execute a health care power of attorney, health care proxy, or other similar document recognized under State law,' after `employment services,'.

(b) Independent Living Education- Section 477(b)(3) of such Act (42 U.S.C. 677(b)(3)) is amended by adding at the end the following:

`(K) A certification by the chief executive officer of the State that the State will ensure that an adolescent participating in the program under this section are provided with education about the importance of designating another individual to make health care treatment decisions on behalf of the adolescent if the adolescent becomes unable to participate in such decisions and the adolescent does not have, or does not want, a relative who would otherwise be authorized under State law to make such decisions, whether a health care power of attorney, health care proxy, or other similar document is recognized under State law, and how to execute such a document if the adolescent wants to do so.'.

(c) Health Oversight and Coordination Plan- Section 422(b)(15)(A) of such Act (42 U.S.C. 622(b)(15)(A)) is amended--

(1) in clause (v), by striking `and' at the end; and

(2) by adding at the end the following:

`(vii) steps to ensure that the components of the transition plan development process required under section 475(5)(H) that relate to the health care needs of children aging out of foster care, including the requirements to include options for health insurance, information about a health care power of attorney, health care proxy, or other similar document recognized under State law, and to provide the child with the option to execute such a document, are met; and'.

(d) Effective Date- The amendments made by this section take effect on October 1, 2010.