II
112th CONGRESS
1st Session
S. 174
IN THE SENATE OF THE UNITED STATES
January 25 (legislative day, January 5), 2011
Mr. Harkin introduced the following bill; which was read twice and referred to the Committee on Finance
A BILL
To improve the health of Americans and reduce health care costs by reorienting the Nation's health care system toward prevention, wellness, and health promotion.
Short title; table of contents
Short title
This Act may be cited
as the Healthy Lifestyles and
Prevention America Act
or the HeLP America Act
.
Table of contents
The table of contents of this Act is as follows:
Sec. 1. Short title; table of contents.
TITLE I—Healthier kids and schools
Sec. 101. Nutrition and physical activity in child care quality improvement.
Sec. 102. Access to local foods and school gardens at preschools and child care.
Sec. 103. Fresh fruit and vegetable program.
Sec. 104. Equal physical activity opportunities for students with disabilities.
TITLE II—Healthier communities and workplaces
Subtitle A—Creating healthier communities
Sec. 201. Technical assistance for the development of joint use agreements.
Sec. 202. Community sports programs for individuals with disabilities.
Sec. 203. Community gardens.
Sec. 204. Physical activity guidelines for Americans.
Sec. 205. Tobacco taxes parity.
Sec. 206. Leveraging and coordinating federal resources for improved health.
Subtitle B—Incentives for a healthier workforce
Sec. 211. Tax credit to employers for costs of implementing wellness programs.
Sec. 212. Employer-provided off-premises athletic facilities.
Sec. 213. Task force for the promotion of breastfeeding in the workplace.
Sec. 214. Improving healthy eating and active living options in Federal workplaces.
TITLE III—Responsible marketing and consumer awareness
Sec. 301. Guidelines for reduction in sodium content in certain foods.
Sec. 302. Nutrition labeling for food products sold principally for use in restaurants or other retail food establishments.
Sec. 303. Front-label food guidance systems.
Sec. 304. Rulemaking authority for advertising to children.
Sec. 305. Health literacy: research, coordination and dissemination.
Sec. 306. Disallowance of deductions for advertising and marketing expenses relating to tobacco product use.
Sec. 307. Incentives to reduce tobacco use.
TITLE IV—Expanded coverage of preventive services
Sec. 401. Required coverage of preventive services under the Medicaid program.
Sec. 402. Coverage for comprehensive workplace wellness program and preventive services.
Sec. 403. Health professional education and training in healthy eating.
TITLE V—Research
Sec. 501. Grants for Body Mass Index data analysis.
Sec. 502. National assessment of mental health needs.
Healthier kids and schools
Nutrition and physical activity in child care quality improvement
Section 658G of the Child Care and Development Block Grant Act of 1990 (42 U.S.C. 9858e) is amended—
by striking
choice, and
and inserting choice,
; and
by inserting
after referral services)
the following: , and the
provision of resources to enable eligible child care providers to meet, exceed,
or sustain success in meeting or exceeding Federal or State high-quality
program standards relating to health, mental health, nutrition, physical
activity, and physical development
.
Access to local foods and school gardens at preschools and child care
Section 18(g) of the Richard B. Russell National School Lunch Act (42 U.S.C. 1769(g)) is amended—
by redesignating paragraphs (1) through (4) as paragraphs (2) through (5), respectively;
by inserting before paragraph (2) (as redesignated by paragraph (1)) the following:
Definitions
In this subsection:
Child care center
The term child care center means a child care center participating in the program under section 17 (other than a child care center that solely participates in the program under subsection (r) of that section).
Sponsoring organization
The term sponsoring organization means an institution described in subparagraphs (C), (D), or (E) of section 17(a)(2).
;
in paragraph (2) (as so redesignated)—
in the paragraph
heading, by striking In
general
and inserting Assistance
;
in the matter
preceding subparagraph (A), by inserting , child care centers,
sponsoring organizations for home-based care,
after
schools
; and
in subparagraph
(A), by inserting , child care centers, sponsoring organizations for
home-based care,
after schools
;
in paragraph (3)
(as so redesignated), by striking paragraph (1)
and inserting
paragraph (2)
; and
in paragraph (4) (as so redesignated)—
in subparagraph (A)(i)—
in
subclause (I), by striking or
;
in
subclause (II), by striking the period at the end and inserting ;
or
; and
by adding at the end the following:
a consortium of at least 2 child care centers or sponsoring organizations for home-based care with hands-on vegetable gardening and nutrition education that is incorporated into the curriculum for 1 or more age groups at 2 or more eligible centers or family child care homes supported by sponsoring organizations for home-based care.
; and
in subparagraph
(F), by striking paragraph (1)(H)
and inserting paragraph
(2)(H)
.
Fresh fruit and vegetable program
Section 19 of the Richard B. Russell National School Lunch Act (42 U.S.C. 1769a) is amended—
by striking subsections (c) and (d) and inserting the following:
School participation
In general
Each State shall carry out the program in each elementary school (as defined in section 9101 of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 7801)) in the State—
in which not less than 50 percent of the students are eligible for free or reduced price meals under this Act; and
that submits an application in accordance with paragraph (2).
Application
In general
An interested elementary school shall submit to the State an application containing—
information pertaining to the percentage of students enrolled in the school who are eligible for free or reduced price school lunches under this Act;
a certification of support for participation in the program signed by the school food manager, the school principal, and the district superintendent (or equivalent positions, as determined by the school);
a plan for implementation of the program, including efforts to integrate activities carried out under this section with other efforts to promote sound health and nutrition, reduce overweight and obesity, or promote physical activity; and
such other information as may be requested by the Secretary.
Partnerships
Each State shall encourage interested elementary schools to submit a plan for implementation of the program that includes a partnership with 1 or more entities that will provide non-Federal resources (including entities representing the fruit and vegetable industry).
;
by striking subsection (i) and inserting the following:
Funding
In general
Out of any funds in the Treasury not otherwise appropriated, the Secretary of the Treasury shall transfer to the Secretary to carry out this section such sums as are necessary, to remain available until expended.
Receipt and acceptance
The Secretary shall be entitled to receive, shall accept, and shall use to carry out this section the funds transferred under paragraph (1), without further appropriation.
; and
by redesignating subsections (e) through (i) as subsections (d) through (h), respectively.
Equal physical activity opportunities for students with disabilities
In general
Title V of the Rehabilitation Act of 1973 (29 U.S.C. 791 et seq.) is amended by adding at the end the following:
Equal physical activity opportunities for students with disabilities
In general
The Secretary shall promote equal opportunities for students with disabilities to be included and to participate in physical education and extracurricular athletics implemented in, or in conjunction with, elementary schools, secondary schools, and institutions of higher education, by ensuring the provision of appropriate technical assistance and guidance for schools and institutions described in this subsection and their personnel.
Technical assistance and guidance
The provision of technical assistance and guidance described in subsection (a) shall include—
providing technical assistance to elementary schools, secondary schools, local educational agencies, State educational agencies, and institutions of higher education, regarding—
inclusion and participation of students with disabilities, in a manner equal to that of the other students, in physical education opportunities (including classes), and extracurricular athletics opportunities, including technical assistance on providing reasonable modifications to policies, practices, and procedures, and providing supports to ensure such inclusion and participation;
provision of adaptive sports programs, in the physical education and extracurricular athletics opportunities, including programs with competitive sports leagues or competitions, for students with disabilities; and
responsibilities of the schools, institutions, and agencies involved under section 504, the Americans with Disabilities Act of 1990 (42 U.S.C. 12101 et seq.), and any other applicable Federal law to provide students with disabilities equal access to extracurricular athletics;
facilitating information sharing among the schools, institutions, and agencies, and students with disabilities, on ways to provide inclusive opportunities in physical education and extracurricular athletics for students with disabilities; and
monitoring the extent to which physical education and extracurricular athletics opportunities for students with disabilities are implemented in, or in conjunction with, elementary schools, secondary schools, and institutions of higher education.
Definitions
In this section:
Agencies
The terms local educational agency and State educational agency have the meanings given the terms in section 9101 of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 7801).
Schools
The terms elementary school, secondary school, and institution of higher education mean an elementary school, secondary school, or institution of higher education, respectively (as defined in section 9101 of the Elementary and Secondary Education Act of 1965), that receives or has 1 or more students that receive, Federal financial assistance.
Student with a disability
In general
The term student with a disability means an individual who—
attends an elementary school, secondary school, or institution of higher education; and
who—
is eligible for, and receiving, special education or related services under part B of the Individuals with Disabilities Education Act (20 U.S.C. 1411 et seq.); or
is an individual with a disability, for purposes of section 504 or the Americans with Disabilities Act of 1990.
Students with disabilities
The term students with disabilities means more than 1 student with a disability.
.
Table of contents
The table of contents in section 1(b) of the Rehabilitation Act of 1973 is amended by inserting after the item relating to section 509 the following:
Sec. 510. Establishment of standards for accessible medical diagnostic equipment.
Sec. 511. Equal physical activity opportunities for students with disabilities.
.
Healthier communities and workplaces
Creating healthier communities
Technical assistance for the development of joint use agreements
In general
The Secretary of Health and Human Services, acting through the Director of the Centers for Disease Control and Prevention and in coordination with the Secretary of Education and in consultation with leading national experts and organizations advancing healthy living in the school environment, shall develop and disseminate guidelines and best practices, including model documents, and provide technical assistance to elementary and secondary schools to assist such schools with the development of joint use agreements so as to address liability, operational and management, and cost issues that may otherwise impede the ability of community members to use school facilities for recreational and nutritional purposes during nonschool hours.
Definition
In this section, the term joint use agreement means a formal agreement between an elementary or secondary school and another entity relating to the use of the school's facilities, equipment, or property, including recreational and food services facilities, equipment, and property, by individuals other than the school's students or staff.
Community sports programs for individuals with disabilities
Part P of title III of the Public Health Service Act (42 U.S.C. 280g et seq.) is amended by adding at the end the following:
Community sports programs for individuals with disabilities
In general
Individual with a disability defined
For purposes of this section, the term individual with a disability means any person who has a disability as defined in section 3 of the Americans with Disabilities Act of 1990 (42 U.S.C. 12102).
Individual with a physical disability
The term individual with a physical disability means an individual with a disability that has a physical or visual disability.
Community sports grants program
The Secretary, in collaboration with the National Advisory Committee on Community Sports Programs for Individuals with Disabilities, may award grants on a competitive basis to public and nonprofit private entities to implement community-based, sports and athletic programs for individuals with disabilities, including youth with disabilities.
Application
To be eligible to receive a grant under this section, a public or nonprofit private entity shall submit to the Secretary an application at such time, in such manner, and containing such agreements, assurances, and information as the Secretary determines to be necessary to carry out this section.
Authorized activities
Amounts awarded under a grant under subsection (a) shall be used for—
community-based sports programs, leagues, or competitions in individual or team sports for individuals with physical disabilities;
regional sports programs or competitions in individual or team sports for individuals with physical disabilities;
the development of competitive team and individual sports programs for individuals with disabilities at the high school and collegiate level; or
the development of mentoring programs to encourage participation in sports programs for individuals with disabilities, including individuals with recently acquired disabilities.
Priorities
Advisory committee
The Secretary shall establish a National Advisory Committee on Community Sports Programs for Individuals with Disabilities that shall—
establish priorities for the implementation of this section;
review grant proposals;
make recommendations for distribution of the available appropriated funds to specific applicants; and
annually evaluate the progress of programs carried out under this section in implementing such priorities.
Representation
The Advisory Committee established under paragraph (1) shall include representatives of—
the Department of Health and Human Services Office on Disability;
the United States Surgeon General;
the Centers for Disease Control and Prevention;
disabled sports organizations;
organizations that represent the interests of individuals with disabilities; and
individuals with disabilities (including athletes with physical disabilities) or their family members.
Dissemination of information
The Secretary shall disseminate information about the availability of grants under this section in a manner that is designed to reach public entities and nonprofit private organizations that are dedicated to providing outreach, advocacy, or independent living services to individuals with disabilities.
Technical assistance
The Secretary, in conjunction with the United States Olympic Committee and disabled sports organizations, shall establish a technical assistance center to provide training, support, and information to grantees under this section on establishing and operating community sports programs for individuals with disabilities.
Report to congress
Not later than 180 days after the date of the enactment of this section, and annually thereafter, the Secretary shall submit to Congress a report summarizing activities, findings, outcomes, and recommendations resulting from the grant projects funded under this section during the year for which the report is being prepared.
Authorization of appropriations
In general
To carry out this section, there are authorized to be appropriated such sums as may be necessary.
Limitation
Not to exceed 10 percent of the amount appropriated in each fiscal year shall be used to carry out activities under subsection (c)(4).
.
Community gardens
Subtitle D of title X of the Food, Conservation, and Energy Act of 2008 (Public Law 110–246; 122 Stat. 2109) is amended by adding at the end the following:
Community garden grant program
Definitions
In this section:
Eligible entity
The term eligible entity means—
a nonprofit organization; or
a unit of general local government, or tribal government, located on tribal land or in a low-income community.
Low-income community
The term low-income community means—
a community in which not less than 50 percent of children are eligible for free or reduced priced meals under the Richard B. Russell National School Lunch Act (42 U.S.C. 1751 et seq.); or
any other community determined by the Secretary to be low-income for purposes of this section.
Unit of general local government
The term unit of general local
government
has the meaning given the term in section 102 of the Housing
and Community Development Act of 1974 (42 U.S.C. 5302).
Program established
Using such amounts as are appropriated to carry out this section, the Secretary shall award grants to eligible entities to expand, establish, or maintain community gardens.
Application
To be considered for a grant under this section, an eligible entity shall submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require, including—
an assurance that priority for hiring for jobs created by the expansion, establishment, or maintenance of a community garden funded with a grant received under this section will be given to individuals who reside in the community in which the garden is located; and
a demonstration that the eligible entity is committed to providing non-Federal financial or in-kind support (such as providing a water supply) for the community garden for which the entity receives funds under this section.
.
Physical activity guidelines for Americans
Report
In general
At least every 5 years, the Secretary of
Health and Human Services (in this Act referred to as the
Secretary
) shall publish a report entitled Physical
Activity Guidelines for Americans
. Each such report shall contain
physical activity information and guidelines for the general public, and shall
be promoted by each Federal agency in carrying out any Federal health
program.
Basis of guidelines
The information and guidelines contained in each report required under paragraph (1) shall be based on the preponderance of the scientific and medical knowledge which is current at the time the report is prepared, and shall include guidelines for identified population subgroups, including children, if the preponderance of scientific and medical knowledge indicates those subgroups require different levels of physical activity.
Approval by Secretary
Review
Any Federal agency that proposes to issue any physical activity guidance for the general population or identified population subgroups shall submit the text of such guidance to the Secretary for a 60-day review period.
Basis of review
In general
During the 60-day review period established
in paragraph (1), the Secretary shall review and approve or disapprove such
guidance to assure that the guidance either is consistent with the
Physical Activity Guidelines for Americans
or that the guidance
is based on medical or new scientific knowledge which is determined to be valid
by the Secretary. If after such 60-day review period the Secretary has not
notified the proposing agency that such guidance has been disapproved, then
such guidance may be issued by the agency. If the Secretary disapproves such
guidance, it shall be returned to the agency. If the Secretary finds that such
guidance is inconsistent with the Physical Activity Guidelines for
Americans
and so notifies the proposing agency, such agency shall
follow the procedures set forth in this subsection before disseminating such
proposal to the public in final form. If after such 60-day period, the
Secretary disapproves such guidance as inconsistent with the Physical
Activity Guidelines for Americans
the proposing agency shall—
publish a notice in the Federal Register of the availability of the full text of the proposal and the preamble of such proposal which shall explain the basis and purpose for the proposed physical activity guidance;
provide in such notice for a public comment period of 30 days; and
make available for public inspection and copying during normal business hours any comment received by the agency during such comment period.
Review of comments
After review of comments received during the comment period, the Secretary may approve for dissemination by the proposing agency a final version of such physical activity guidance along with an explanation of the basis and purpose for the final guidance which addresses significant and substantive comments as determined by the proposing agency.
Announcement
Any such final physical activity guidance to be disseminated under subparagraph (B) shall be announced in a notice published in the Federal Register, before public dissemination along with an address where copies may be obtained.
Notification of disapproval
If after the 30-day period for comment as provided under subparagraph (A)(ii), the Secretary disapproves a proposed physical activity guidance, the Secretary shall notify the Federal agency submitting such guidance of such disapproval, and such guidance may not be issued, except as provided in subparagraph (E).
Review of disapproval
If a proposed physical activity guidance is disapproved by the Secretary under subparagraph (D), the Federal agency proposing such guidance may, within 15 days after receiving notification of such disapproval under subparagraph (D), request the Secretary to review such disapproval. Within 15 days after receiving a request for such a review, the Secretary shall conduct such review. If, pursuant to such review, the Secretary approves such proposed physical activity guidance, such guidance may be issued by the Federal agency.
Definitions
In this subsection:
The term physical activity guidance for the general population does not include any rule or regulation issued by a Federal agency.
The term identified population subgroups shall include, but not be limited to, groups based on factors such as age, sex, race, or physical disability.
Existing authority not affected
This section does not place any limitations on—
the conduct or support of any scientific or medical research by any Federal agency; or
the presentation of any scientific or medical findings or the exchange or review of scientific or medical information by any Federal agency.
Tobacco taxes parity
Increase in excise tax on small cigarettes and small cigars
Section
5701(a)(1) of the Internal Revenue Code of 1986 is amended by striking
$50.33
and inserting $77.83
.
Section
5701(b)(1) of the Internal Revenue Code of 1986 is amended by striking
$50.33
and inserting $77.83
Tax parity for pipe tobacco and roll-Your-Own tobacco
Section 5701(f)
of the Internal Revenue Code of 1986 is amended by striking $2.8311
cents
and inserting $38.32
.
Section 5701(g)
of the Internal Revenue Code of 1986 is amended by striking
$24.78
and inserting $38.32
.
Clarification of definition of small cigars
Paragraphs (1) and (2) of section
5701(a) of the Internal Revenue Code of 1986 are each amended by striking
three pounds per thousand
and inserting four and one-half
pounds per thousand
.
Clarification of definition of cigarette
Paragraph (2) of section 5702(b) of
the Internal Revenue Code of 1986 is amended by insert before the final period
the following: , which includes any roll for smoking containing tobacco
that weighs no more than four and a half pounds per thousand, unless it is
wrapped in whole tobacco leaf and does not have a cellulose acetate or other
cigarette-style filter
.
Tax parity for smokeless tobacco
Section 5701(e) of the Internal Revenue Code of 1986 is amended—
in paragraph (1),
by striking $1.51
and inserting $20.75
;
in paragraph (2),
by striking 50.33 cents
and inserting $8.30
;
and
by adding at the end the following:
Smokeless tobacco sold in discrete single-use units
On discrete single-use units, $77.83 per each 1,000 single-use units.
.
Section 5702(m) of the Internal Revenue Code of 1986 is amended—
in paragraph (1),
or chewing tobacco
and inserting chewing tobacco,
discrete single-use unit
;
in paragraphs (2)
and (3), by inserting that is not a discrete single-use unit
before the period in each such paragraph;
by adding at the end the following:
Discrete single-use unit
The term discrete single-use unit means any product containing tobacco that—
is intended or expected to be consumed without being combusted; and
is in the form of a lozenge, tablet, pill, pouch, dissolvable strip, or other discrete single-use or single-dose unit.
.
Clarifying other tobacco tax definitions
Tobacco product definition
Section 5702(c) of the Internal Revenue Code of 1986
is amended by inserting before the period the following: , and any other
product containing tobacco that is intended or expected to be
consumed
.
Cigarette paper definition
Section 5702(e) of the Internal Revenue Code of 1986
is amended by striking except tobacco,
and inserting or
cigar
.
Cigarette tube definition
Section 5702(f) of the Internal Revenue Code of 1986
is amended by inserting before the period or cigars
.
Importer definition
Section 5702(k) of the Internal Revenue Code of 1986
is amended by inserting or any other tobacco product
after
cigars or cigarettes
.
Floor Stocks Taxes
Imposition of tax
On tobacco products manufactured in or imported into the United States which are removed before any tax increase date and held on such date for sale by any person, there is hereby imposed a tax in an amount equal to the excess of—
the tax which would be imposed under section 5701 of the Internal Revenue Code of 1986 on the article if the article had been removed on such date, over
the prior tax (if any) imposed under section 5701 of such Code on such article.
Credit against tax
Each person shall be allowed as a credit against the taxes imposed by paragraph (1) an amount equal to $500. Such credit shall not exceed the amount of taxes imposed by paragraph (1) on such date for which such person is liable.
Liability for tax and method of payment
Liability for tax
A person holding tobacco products on any tax increase date to which any tax imposed by paragraph (1) applies shall be liable for such tax.
Method of payment
The tax imposed by paragraph (1) shall be paid in such manner as the Secretary shall prescribe by regulations.
Time for payment
The tax imposed by paragraph (1) shall be paid on or before the date that is 120 days after the effective date of the tax rate increase.
Articles in foreign trade zones
Notwithstanding the Act of June 18, 1934 (commonly known as the Foreign Trade Zone Act, 48 Stat. 998, 19 U.S.C. 81a et seq.) or any other provision of law, any article which is located in a foreign trade zone on any tax increase date shall be subject to the tax imposed by paragraph (1) if—
internal revenue taxes have been determined, or customs duties liquidated, with respect to such article before such date pursuant to a request made under the 1st proviso of section 3(a) of such Act, or
such article is held on such date under the supervision of an officer of the United States Customs and Border Protection of the Department of Homeland Security pursuant to the 2d proviso of such section 3(a).
Definitions
For purposes of this subsection—
In general
Any term used in this subsection which is also used in section 5702 of such Code shall have the same meaning as such term has in such section.
Tax increase date
The term tax increase date means the effective date of any increase in any tobacco product excise tax rate pursuant to the amendments made by this section.
Secretary
The term Secretary means the Secretary of the Treasury or the Secretary’s delegate.
Controlled groups
Rules similar to the rules of section 5061(e)(3) of such Code shall apply for purposes of this subsection.
Other laws applicable
All provisions of law, including penalties, applicable with respect to the taxes imposed by section 5701 of such Code shall, insofar as applicable and not inconsistent with the provisions of this subsection, apply to the floor stocks taxes imposed by paragraph (1), to the same extent as if such taxes were imposed by such section 5701. The Secretary may treat any person who bore the ultimate burden of the tax imposed by paragraph (1) as the person to whom a credit or refund under such provisions may be allowed or made.
Effective Date
The amendments made by this section shall apply to articles removed (as defined in section 5702(j) of the Internal Revenue Code of 1986) after December 31, 2010.
Leveraging and coordinating federal resources for improved health
Health impacts of non-Health legislation
In general
Not later than 6 months after the date of enactment of this Act, the National Prevention, Health Promotion and Public Health Council, shall enter into a contract with the Institute of Medicine of the National Academy of Sciences for the conduct of a study to assess the potential health impacts of major non-health related legislation that is likely to be considered by Congress within a year of completion of the study. Such study shall identify the ways in which such legislation involved is likely to impact the health of Americans and shall contain recommendations to Congress on ways to maximize the positive health impacts and minimize the negative health impacts.
Timing
The timing of the study under paragraph (1) shall be provide for in a manner that ensures that the results of the study will be available at least 3 months prior to the consideration of the legislation involved by Congress.
Guidelines
To the extent practicable, the Council under paragraph (1) shall ensure that the study conducted under this subsection complies with the consensus guidelines on how to carry out a health impact assessment, including stakeholder engagement guidelines, such as the HIA of the Americas Practice Guidelines and guidelines promulgated by the World Health Organization and other consensus bodies.
Report
Upon completion of the study under this subsection, the Institute of Medicine shall submit to the Council under paragraph (1), and make available to the general public, a report that—
summarizes the direct, indirect, and cumulative health impacts identified in the assessment; and
contains recommendations for how to maximize positive health impacts and minimize negative health impacts of the legislation involved.
Type of legislation
For purposes of this subsection, the term non-health related legislation shall have the meaning given such term by the Council under paragraph (1), and shall include legislation that is likely to have impacts on the health of Americans where such impacts are not likely to be considered by Congress to the extent required by their scope without the conduct of an assessment under this subsection. Examples of major non-health related legislation that could be the subject of the study include reauthorizations of the Safe, Accountable, Flexible, Efficient Transportation Equity Act: A Legacy for Users (SAFETEA–LU; Public Law 109–59), the Food, Conservation, and Energy Act of 2008 (Public Law 110–246), and the Elementary and Secondary Education Act of 1965 (20 U.S.C. 6301 et seq.).
Improving health impacts of Federal agency activities
In general
The Secretary, acting through the Director of the Centers for Disease Control and Prevention and in coordination with the National Prevention, Health Promotion and Public Health Council, shall detail employees of the Department of Health and Human Services to policy and program planning offices of other Federal departments and agencies, including the Department of Transportation, the Department of Housing and Urban Development, the Department of Agriculture, the Department of Education, and the Department of the Interior, in order to assist those departments and agencies to consider the impacts of their activities on the health of the populations served and to assist with the integration of health goals into the activities of the departments and agencies, as appropriate.
Duties
Employees detailed under paragraph (1) shall assist with assessments of the potential impacts of the programs and activities of the department or agency involved on the health and well-being of the populations served, the development of metrics and performance standards that can be incorporated, as appropriate, into the activities, performance measurements, and grant and contract standards of the department or agency, and the development of the report detailed in paragraph (3).
Reports
Not later than 1 year after the date of enactment of this Act, and annually thereafter, each department and agency with a detailee under this section shall submit to the National Prevention, Health Promotion and Public Health Council, the Committee on Health, Education, Labor, and Pensions of the Senate and the Committee on Energy and Commerce of the House of Representatives a report detailing the health impacts of the department or agency's activities and any plans to improve those impacts.
Incentives for a healthier workforce
Tax credit to employers for costs of implementing wellness programs
In general
Subpart D of part IV of subchapter A of chapter 1 of the Internal Revenue Code of 1986 is amended by adding at the end the following:
Wellness program credit
Allowance of credit
In general
For purposes of section 38, the wellness program credit determined under this section for any taxable year during the credit period with respect to an employer is an amount equal to 50 percent of the costs paid or incurred by the employer in connection with a qualified wellness program during the taxable year.
Limitation
The amount of credit allowed under paragraph (1) for any taxable year shall not exceed the sum of—
the product of $200 and the number of employees of the employer not in excess of 200 employees, plus
the product of $100 and the number of employees of the employer in excess of 200 employees.
Qualified wellness program
For purposes of this section—
Qualified wellness program
The term qualified wellness program means a program which—
consists of any 3 of the wellness program components described in subsection (c), and
which is certified by the Secretary of Health and Human Services, in consultation with the Secretary of the Treasury and Secretary of Labor, as a qualified wellness program under this section.
Programs must be consistent with research and best practices
In general
The Secretary of Health and Human Services shall not certify a program as a qualified wellness program unless the program—
is consistent with evidence-based research and best practices, as identified by persons with expertise in employer health promotion and wellness programs,
includes multiple, evidence-based strategies which are based on the existing and emerging research and careful scientific reviews, including the Guide to Community Preventive Services, the Guide to Clinical Preventive Services, and the National Registry for Effective Programs, and
includes strategies which focus on employee populations with a disproportionate burden of health problems.
Periodic updating and review
The Secretary of Health and Human Services shall establish procedures for periodic review and recertifications of programs under this subsection. Such procedures shall require revisions of programs if necessary to ensure compliance with the requirements of this section and require updating of the programs to the extent the Secretary, in consultation with the Secretary of the Treasury and the Secretary of Labor, determines necessary to reflect new scientific findings.
Health literacy
The Secretary of Health and Human Services shall, as part of the certification process, encourage employers to make the programs culturally competent and to meet the health literacy needs of the employees covered by the programs.
Wellness program components
For purposes of this section, the wellness program components described in this subsection are the following:
Health awareness component
A health awareness component which provides for the following:
Health education
The dissemination of health information which addresses the specific needs and health risks of employees.
Health screenings
The opportunity for periodic screenings for health problems and referrals for appropriate follow up measures.
Employee engagement component
An employee engagement component which provides for—
the establishment of a committee to actively engage employees in worksite wellness programs through worksite assessments and program planning, delivery, evaluation, and improvement efforts, and
the tracking of employee participation.
Behavioral change component
A behavioral change component which provides for altering employee lifestyles to encourage healthy living through counseling, seminars, on-line programs, or self-help materials which provide technical assistance and problem solving skills. Such component may include programs relating to—
tobacco use,
overweight and obesity,
stress management,
physical activity,
nutrition,
substance abuse,
depression, and
mental health promotion (including anxiety).
Supportive environment component
A supportive environment component which includes the following:
On-site policies
Policies and services at the worksite which promote a healthy lifestyle, including policies relating to—
tobacco use at the worksite,
the nutrition of food available at the worksite through cafeterias and vending options,
minimizing stress and promoting positive mental health in the workplace,
where applicable, accessible and attractive stairs, and
the encouragement of physical activity before, during, and after work hours.
Participation incentives
In general
Qualified incentive benefits for each employee who participates in the health screenings described in paragraph (1)(B) or the behavioral change programs described in paragraph (3).
Qualified incentive benefit
For purposes of clause (i), the term qualified incentive benefit means any benefit which is approved by the Secretary of Health and Human Services, in consultation with the Secretary of the Treasury and the Secretary of Labor. Such benefit may include an adjustment in health insurance premiums or co-pays.
Employee input
The opportunity for employees to participate in the management of any qualified wellness program to which this section applies.
Participation requirement
In general
No credit shall be allowed under subsection (a) unless the Secretary of Health and Human Services, in consultation with the Secretary of the Treasury and Secretary of Labor, as a part of any certification described in subsection (b), that each wellness program component of the qualified wellness program applies to all qualified employees of the employer. The Secretary of Health and Human Services shall prescribe rules under which an employer shall not be treated as failing to meet the requirements of this subsection merely because the employer provides specialized programs for employees with specific health needs or unusual employment requirements or provides a pilot program to test new wellness strategies.
Qualified employee
For purposes of paragraph (1), the term qualified employee means an employee who works an average of not less than 25 hours per week during the taxable year.
Other definitions and special rules
For purposes of this section—
Employee and employer
Partners and partnerships
The term employee includes a partner and the term employer includes a partnership.
Certain rules to apply
Rules similar to the rules of section 52 shall apply.
Certain costs not included
Costs paid or incurred by an employer for food or health insurance shall not be taken into account under subsection (a).
No credit where grant awarded
No credit shall be allowable under subsection (a) with respect to any qualified wellness program of any taxpayer (other than an eligible employer described in subsection (f)(2)(A)) who receives a grant provided by the United States, a State, or a political subdivision of a State for use in connection with such program. The Secretary shall prescribe rules providing for the waiver of this paragraph with respect to any grant which does not constitute a significant portion of the funding for the qualified wellness program.
Credit period
In general
The term credit period means the period of 10 consecutive taxable years beginning with the taxable year in which the qualified wellness program is first certified under this section.
Special rule for existing programs
In the case of an employer (or predecessor)
which operates a wellness program for its employees on the date of the
enactment of this section, subparagraph (A) shall be applied by substituting
3 consecutive taxable years
for 10 consecutive taxable
years
. The Secretary shall prescribe rules under which this subsection
shall not apply if an employer is required to make substantial modifications in
the existing wellness program in order to qualify such program for
certification as a qualified wellness program.
Controlled groups
For purposes of this paragraph, all persons treated as a single employer under subsection (b), (c), (m), or (o) of section 414 shall be treated as a single employer.
Portion of credit made refundable
In general
In the case of an eligible employer of an employee, the aggregate credits allowed to a taxpayer under subpart C shall be increased by the lesser of—
the credit which would be allowed under this section without regard to this subsection and the limitation under section 38(c), or
the amount by which the aggregate amount of credits allowed by this subpart (determined without regard to this subsection) would increase if the limitation imposed by section 38(c) for any taxable year were increased by the amount of employer payroll taxes imposed on the taxpayer during the calendar year in which the taxable year begins.
Eligible employer
For purposes of this subsection, the term eligible employer means an employer which is—
a State or political subdivision thereof, the District of Columbia, a possession of the United States, or an agency or instrumentality of any of the foregoing, or
any organization described in section 501(c) of the Internal Revenue Code of 1986 which is exempt from taxation under section 501(a) of such Code.
Employer payroll taxes
For purposes of this subsection—
In general
The term employer payroll taxes means the taxes imposed by—
section 3111(b), and
sections 3211(a) and 3221(a) (determined at a rate equal to the rate under section 3111(b)).
Special rule
A rule similar to the rule of section 24(d)(2)(C) shall apply for purposes of subparagraph (A).
Termination
This section shall not apply to any amount paid or incurred after December 31, 2017.
.
Treatment as general business credit
Subsection (b) of section 38 of the
Internal Revenue Code of 1986 is amended by striking plus
at the
end of paragraph (35), by striking the period at the end of paragraph (36) and
inserting , plus
, and by adding at the end the following:
the wellness program credit determined under section 45S.
.
Denial of double benefit
Section 280C of the Internal Revenue Code of 1986 is amended by adding at the end the following new subsection:
Wellness program credit
In general
No deduction shall be allowed for that portion of the costs paid or incurred for a qualified wellness program (within the meaning of section 45S) allowable as a deduction for the taxable year which is equal to the amount of the credit allowable for the taxable year under section 45S.
Similar rule where taxpayer capitalizes rather than deducts expenses
If—
the amount of the credit determined for the taxable year under section 45S, exceeds
the amount allowable as a deduction for such taxable year for a qualified wellness program,
Controlled groups
In the case of a corporation which is a member of a controlled group of corporations (within the meaning of section 41(f)(5)) or a trade or business which is treated as being under common control with other trades or business (within the meaning of section 41(f)(1)(B)), this subsection shall be applied under rules prescribed by the Secretary similar to the rules applicable under subparagraphs (A) and (B) of section 41(f)(1).
.
Clerical amendment
The table of sections for subpart D of part IV of subchapter A of chapter 1 of the Internal Revenue Code of 1986 is amended by adding at the end the following:
Sec. 45S. Wellness program credit.
.
Effective date
The amendments made by this section shall apply to taxable years beginning after the date of enactment of this Act.
Outreach
In general
The Secretary of the Treasury, in conjunction with the Director of the Centers for Disease Control and members of the business community, shall institute an outreach program to inform businesses about the availability of the wellness program credit under section 45S of the Internal Revenue Code of 1986 as well as to educate businesses on how to develop programs according to recognized and promising practices and on how to measure the success of implemented programs.
Authorization of appropriations
There are authorized to be appropriated such sums as are necessary to carry out the outreach program described in paragraph (1).
Employer-provided off-premises athletic facilities
Treatment as fringe benefit
Subparagraph (A) of section 132(j)(4) of the Internal Revenue Code of 1986 is amended to read as follows:
In general
Gross income shall not include—
the value of any on-premises athletic facility provided by an employer to its employees, and
so much of the fees, dues, or membership expenses paid by an employer to an athletic or fitness facility described in subparagraph (C) on behalf of its employees as does not exceed $900 per employee per year.
.
Athletic facilities described
Paragraph (4) of section 132(j) of the Internal Revenue Code of 1986 is amended by adding at the end the following new subparagraph:
Certain athletic or fitness facilities described
For purposes of subparagraph (A)(ii), an athletic or fitness facility described in this subparagraph is a facility—
which provides instruction in a program of physical exercise, offers facilities for the preservation, maintenance, encouragement, or development of physical fitness, or is the site of such a program of a State or local government,
which is not a private club owned and operated by its members,
which does not offer golf, hunting, sailing, or riding facilities,
whose health or fitness facility is not incidental to its overall function and purpose, and
which is fully compliant with the State of jurisdiction and Federal anti-discrimination laws.
.
Exclusion applies to highly compensated employees only If no discrimination
Section 132(j)(1) of the Internal Revenue Code of 1986 is amended—
by striking
Paragraphs (1) and (2) of subsection (a)
and inserting
Subsections (a)(1), (a)(2), and (j)(4)
, and
by striking the
heading thereof through apply
and inserting
Certain exclusions
apply
.
Employer deduction for dues to certain athletic facilities
In general
Paragraph (3) of section 274(a) of the Internal Revenue
Code of 1986 is amended by adding at the end the following new sentence:
The preceding sentence shall not apply to so much of the fees, dues, or
membership expenses paid to athletic or fitness facilities (within the meaning
of section 132(j)(4)(C)) as does not exceed $900 per employee per
year.
.
Conforming amendment
The last sentence of section 274(e)(4) of such Code is
amended by inserting the first sentence of
before
subsection (a)(3)
.
Effective date
The amendments made by this section shall apply to taxable years beginning after the date of the enactment of this Act.
Task force for the promotion of breastfeeding in the workplace
Establishment
The
Secretary of Health and Human Services and the Secretary of Labor, or their
designees, shall convene a task force for the purpose of promoting
breastfeeding among working mothers (referred to in this section as the
Task Force
).
Membership
The Task Force shall be composed of members who are—
expert staff from the Department of Labor with expertise in workforce issues;
expert staff from the Department of Health and Human Services with expertise in the areas of breastfeeding and breastfeeding promotion;
members of the United States Breastfeeding Committee;
expert staff from the Department of Agriculture; and
appointed by the Secretary of Health and Human Services and the Secretary of Labor, including—
working mothers who have experience in working and breastfeeding; and
representatives of the human resource departments of both large and small employers that have successfully promoted breastfeeding and breastmilk pumping support at work.
Period of appointment; vacancies
Members shall be appointed for the life of the Task Force. Any vacancy in the Task Force shall not affects its powers, but shall be filled in the same manner as the original appointment.
Chair
The Task Force shall be chaired jointly by the Secretary of Health and Human Services and the Secretary of Labor, or their designees.
Duties of the task force
Examination
Consistent with the Department of Health and Human Services Blueprint for Action on Breastfeeding (2000), the Task Force shall examine the following issues:
The challenges that mothers face with continuing breastfeeding when the mothers return to work after giving birth.
The challenges that employers face in accommodating mothers who seek to continue to breastfeed or to express milk when the mothers re-enter the workforce, including different challenges that mothers of varying socio-economic status and in different professions may face.
The benefits that accrue to mothers, babies, and to employers when mothers are able to continue to breastfeed or to express breastmilk at work after the mothers have re-entered the workforce.
Federal and State statutes that may have the effect of reducing breastfeeding and breastfeeding retention rates among working mothers.
Reports
In general
Not later than 1 year after the date of enactment of this section, the Task Force shall issue a public report with recommendations on the following:
Steps that can be taken to promote breastfeeding among working mothers and to remove barriers to breastfeeding among working mothers.
Potential ways in which the Federal Government can work with employers to promote breastfeeding among working mothers.
Areas in which changes to existing Federal, State, or local laws would likely have the effect of making it easier for working mothers to breastfeed or would remove impediments to breastfeeding that currently exist in such laws.
Whether or not increased rates of breastfeeding among working mothers would likely have the result of reducing health care costs among such mothers and their children, and, in particular, whether increased rates of breastfeeding would be likely to result in lower Federal expenditures on health care for such mothers and their children.
Areas in which the Federal Government, through increased efforts by Federal agencies, or changes to existing Federal law, can and should increase the Federal Government's efforts to promote breastfeeding among working mothers.
Copy to congress
Upon completion of the report described in subparagraph (A), the Task Force shall submit a copy of the report to the Committee on Health, Education, Labor, and Pensions of the Senate, the Committee on Appropriations of the Senate, the Committee on Education and the Workforce of the House of Representatives, and the Committee on Appropriations of the House of Representatives.
Powers of the task force
Hearings
The Task Force may hold such hearings, sit and act at such times and places, take such testimony, and receive such evidence as the Task Force considers advisable to carry out this section.
Information from federal agencies
The Task Force may secure directly from any Federal department or agency such information as the Task Force considers necessary to carry out this section. Upon request of the Chair of the Task Force, the head of such department or agency shall furnish such information to the Task Force.
Postal services
The Task Force may use the United States mails in the same manner and under the same conditions as other departments and agencies of the Federal Government.
Donations
The Task Force may accept, use, and dispose of donations of services or property.
Operating expenses
The operating expenses of the Task Force, including travel expenses for members of the Task Force, shall be paid for from the general operating expenses funds of the Secretary of Health and Human Services and the Secretary of Labor.
Improving healthy eating and active living options in Federal workplaces
Menu labeling in Federal food establishments
In general
Executive and Judicial buildings
Section 403(q) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 343(q)) is amended by adding at the end the following:
The requirements of subparagraph (5)(H) shall apply—
to a restaurant or similar retail food establishment located in a Federal building in the same manner as such subparagraph applies to a restaurant or similar retail food establishment that is part of a chain with 20 or more locations, as described in subparagraph (5)(H)(i); and
to a person that operates a vending machine located in a Federal building in the same manner as such subparagraph applies to a person who is engaged in the business of owning or operating 20 or more vending machines, as described in subparagraph (5)(H)(viii).
In this subparagraph, the term Federal building means a building that is—
under the control of the Federal agency (as defined in section 102 of title 40, United States Code);
owned by the Federal Government; and
located in a State, the District of Columbia, Puerto Rico, or a territory or possession of the United States.
.
Applicability
The requirement in the amendment made by paragraph (1) shall apply to restaurants or similar retail food establishments and vending machines located in a Federal building beginning 12 months after the date of enactment of this Act.
Congressional buildings
The Architect of the Capitol, in coordination with the Committee on Rules and Administration of the Senate and the Committee on House Administration of the House of Representatives, shall establish a program to apply the requirements of section 403(q)(5)(H) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 343(q)(5)(H)) (as amended by paragraph (1)) to—
food that is served in restaurants or other similar retail food establishments that are located in Congressional buildings and installations;
food that is sold through vending machines that are operated in Congressional buildings and installations; and
food that is served to individuals within Congressional buildings and installations pursuant to a contract with a private entity.
Nutritional standards for food in Federal buildings
Executive and Judicial buildings
Subchapter V of chapter 5 of subtitle I of title 40, United States Code, is amended by adding at the end the following:
Nutritional standards for food in Federal buildings
In general
The Administrator of General Services, in consultation with the Secretary of Health and Human Services, shall establish, by regulation, nutritional standards for all food products provided at Federal buildings and installations (including food products provided by contractors or vending machines).
Use of amounts
Amounts appropriated to an executive agency for installation, repair, and maintenance, generally, may be used to achieve compliance with the regulations promulgated pursuant to this section.
Liability
Nothing in this section increases or enlarges the tort liability of the Federal Government for any injury to an individual or damage to property.
.
Congressional buildings
The Architect of the Capitol, in coordination with the Committee on Rules and Administration of the Senate and the Committee on House Administration of the House of Representatives shall establish nutritional standards for all food products provided at Congressional buildings and installations (including food products provided by contractors or vending machines).
Encouragement of use of stairs
Executive and Judicial buildings
Subchapter V of chapter 5 of subtitle I of title 40, United States Code, as amended by subsection (b), is further amended by adding at the end the following:
Encouragement of use of stairs
In general
Each Federal agency shall install point-of-decision prompts encouraging individuals to use stairs wherever practicable at each relevant building and installation that is—
under the control of the Federal agency;
owned by the Federal Government; and
located in a State, the District of Columbia, Puerto Rico, or a territory or possession of the United States.
Reimbursement
Subsection (a) may be carried out by—
reimbursement to a State or political subdivision of a State, the District of Columbia, Puerto Rico, or a territory or possession of the United States; or
a means other than reimbursement.
Regulations
Subsection (a) shall be carried out in accordance with such regulations as the Administrator of General Services may promulgate, with the approval of the Director of the Office of Management and Budget.
Use of amounts
Amounts appropriated to a Federal agency for installation, repair, and maintenance, generally, shall be available to carry out this section.
Liability
Nothing in this section increases or enlarges the tort liability of the Federal Government for any injury to an individual or damage to property.
.
Congressional buildings
The Architect of the Capitol shall implement a program to install point-of-decision prompts encouraging individuals to use stairs wherever practicable in Congressional buildings and installations in the same manner as established under section 595 of title 40, United States Code (as added by paragraph (1)).
Accommodations for bicycle commuters
Executive and Judicial Federal buildings
Subchapter V of chapter 5 of subtitle I of title 40, United States Code, as amended by subsection (c), is further amended by adding at the end the following:
Accommodations for bicycle commuters
In general
Each Federal agency shall install and maintain a bicycle storage area and equipment (such as a bicycle rack) and a shower for bicycle commuters at each relevant parking structure that is—
under the control of the Federal agency;
owned by the Federal Government; and
located in a State, the District of Columbia, Puerto Rico, or a territory or possession of the United States.
Reimbursement
Subsection (a) may be carried out by—
reimbursement to a State or political subdivision of a State, the District of Columbia, Puerto Rico, or a territory or possession of the United States; or
a means other than reimbursement.
Regulations
Subsection (a) shall be carried out in accordance with such regulations as the Administrator of General Services may promulgate, with the approval of the Director of the Office of Management and Budget.
Use of amounts
Amounts appropriated to a Federal agency for installation, repair, and maintenance, generally, shall be available to carry out this section.
Liability
Nothing in this section increases or enlarges the tort liability of the Federal Government for any injury to an individual or damage to property.
.
Congressional buildings
The Architect of the Capitol, in coordination with the Sergeant at Arms and Doorkeeper of the Senate, the Sergeant at Arms of the House of Representatives, and the United States Capitol Police, shall implement, within their respective jurisdictions, a program to make accommodations for bicycle commuters on the United States Capitol complex in the same manner as established under section 596 of title 40, United States Code (as added by paragraph (1)).
Responsible marketing and consumer awareness
Guidelines for reduction in sodium content in certain foods
In general
Not later than 180 days after the date of enactment of this Act, the Secretary of Health and Human Services shall promulgate regulations establishing guidelines for the reduction, over a 2 year period, in the sodium content of processed food and restaurant food following, as appropriate, the recommendations made by the Institute of Medicine report entitled “Strategies to Reduce Sodium Intake in the United States”.
Definitions
For purposes of this section—
the term processed food has the meaning given such term in section 201(gg) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 321(gg)); and
the term restaurant food means food subject to the requirements of section 403(q)(5)(H) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 343(q)(5)(H)).
Nutrition labeling for food products sold principally for use in restaurants or other retail food establishments
Section 403(q)(5) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 343(q)(5)) is amended by striking clause (G).
Front-label food guidance systems
In general
Not later than 6
months after the date of enactment of this Act, the Secretary of Health and
Human Services (referred to in this section as the Secretary
)
shall begin soliciting public comments regarding—
the use of retail front-label food guidance systems to convey nutrition information to the public using logos, symbols, signs, emblems, insignia, or other graphic representations on the labeling of food intended for human consumption that are intended to provide simple, standardized, and understandable nutrition information to the public in graphic form;
appropriate nutrition standards by which a retail front-label food guidance system may convey the relative nutritional value of different foods in simple graphic form; and
whether American consumers would be better served by establishing a single, standardized retail front-label food guidance system regulated by the Food and Drug Administration, or by allowing individual food companies, trade associations, nonprofit organizations, and others to continue to develop their own retail front-label food guidance systems.
Effect on nutrition facts panel
In soliciting public comments under subsection (a), the Secretary shall inform the public that any retail front-label food guidance system is intended to supplement, not replace, the Nutrition Facts Panel that appears on food labels pursuant to section 403(q) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 343(q)).
Proposed regulation
Not later than 12 months following the closure of the public comment solicitation period under subsection (a), the Secretary shall—
publish a notice in the Federal Register that summarizes the public comments and describes the suggested retail front-label food guidance systems received through such solicitation; and
publish proposed regulations that—
establish a single, standardized retail front-label food guidance system; or
establish the conditions under which individual food companies, trade associations, nonprofit organizations, and other entities may continue to develop their own retail front-label food guidance systems.
Rulemaking authority for advertising to children
Purpose
The purpose of this section is to restore the authority of the Federal Trade Commission to issue regulations that restrict the marketing or advertising of foods and beverages to children under the age of 18 years if the Federal Trade Commission determines that there is evidence that consumption of certain foods and beverages is detrimental to the health of children.
Authority
Section 18 of the Federal Trade Commission Act (15 U.S.C. 57a) is amended—
in subsection
(a), by striking Except as provided in subsection (h), the
and
inserting The
;
by amending subsection (b) to read as follows:
Procedure applicable
When prescribing a rule under subsection (a)(1)(B) of this section, the Commission shall proceed in accordance with section 553 of title 5 (without regard to any reference in such section to sections 556 and 557 of such title).
;
by striking subsections (c), (f), (h), (i), and (j);
by striking subsection (d) and inserting the following:
When any rule under subsection (a)(1)(B) takes effect a subsequent violation thereof shall constitute an unfair or deceptive act or practice in violation of section 5(a)(1) of this Act, unless the Commission otherwise expressly provides in such rule.
;
by redesignating subsections (e) and (g) as subsections (d) and (e), respectively; and
in subsection (d), as redesignated—
in paragraph
(1)(B), by striking the transcript required by subsection
(c)(5),
;
in paragraph (3),
by striking error)
and all that follows through the period at
the end and inserting error).
; and
in paragraph (5), by striking subparagraph (C).
Health literacy: research, coordination and dissemination
In general
Part A of title IX of the Public Health Service Act (42 U.S.C. 299 et seq.) is amended by adding at the end the following:
Health literacy: research, coordination and dissemination
Definition
In this section, the term health literacy means a consumer’s ability to obtain, process, and understand basic health information and services needed to make appropriate health care decisions and the adaptation of services to enhance a consumer’s understanding and navigation of applicable health care services.
Health literacy program
Establishment
The
Director shall establish within the Agency a program (referred to in this
section as the program
) to strengthen health literacy by
improving measurement, research, development, and information
dissemination.
Duties
In carrying out the program, the Director shall—
gather health literacy resources from public and private sources and make such resources available to researchers, health care providers, and the general public;
identify and fill research gaps relating to health literacy that have direct applicability to—
prevention;
self-management of chronic disease;
quality improvement;
the barriers to health literacy;
relationships between health literacy and health disparities, particularly with respect to language and cultural competency; and
the utilization of information on comparative effectiveness of health treatments;
sponsor demonstration and evaluation projects with respect to interventions and tools designed to strengthen health literacy, including projects focused on—
the provision of simplified, patient-centered written materials;
technology-based communication techniques;
consumer navigation services; and
the training of health professional providers;
give preference to health literacy initiatives that—
focus on the particular needs of vulnerable populations such as the elderly, racial and ethnic minorities, children, individuals with limited English proficiency, and individuals with disabilities; and
partner with institutions in the community such as schools, libraries, senior centers, literacy groups, recreation centers, early childhood education centers, area health education centers, and public assistance programs;
assist appropriate Federal agencies in establishing specific objectives and strategies for carrying out the program, in monitoring the programs of such agencies, and incorporating health literacy into research design, human subjects protections, and informed consent in clinical research;
seek to enter into implementation partnerships with organizations and agencies, including other agencies within the Department of Health and Human Services, such as the Centers for Medicare & Medicaid Services and the Health Resources and Services Administration, the Office of the Surgeon General, the Joint Commission on the Accreditation of Healthcare Organizations, the Office of the National Coordinator for Health Information Technology, and the National Committee for Quality Assurance, to promote the adoption of interventions and tools developed under this section, particularly in the training of health professionals; and
coordinate with other agencies within the Department of Health and Human Services to collect data that monitors national trends in health literacy by including relevant items in surveys such as the Medical Expenditure Panel Survey, the National Health Interview Survey, and the National Hospital Discharge Survey.
Report
The Agency for Healthcare Research and Quality shall annually submit to Congress a report that includes—
a comprehensive and detailed description of the operations, activities, financial condition, and accomplishments of the Agency in the field of health literacy; and
a description of how plans for the operation of the program for the succeeding fiscal year will facilitate achievement of the goals of the program.
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 2012 through 2016.
State health literacy grants
Grants
The Director of the Agency shall award grants to eligible entities to facilitate State and community efforts to strengthen health literacy.
Use of funds
An entity receiving a grant under this subsection shall use amounts received under such grant to—
support efforts to monitor and strengthen health literacy within a State or community;
assist public and private efforts in the State or community in coordinating and delivering health literacy services;
encourage partnerships among State and local governments, community organizations, non-profit entities, academic institutions, and businesses to coordinate efforts to strengthen health literacy;
provide technical and policy assistance to State and local governments and service providers; and
monitor and evaluate programs conducted under this grant.
Report
Not later than September 30 of each fiscal year for which a grant is received by an entity under this section, the entity shall submit to the Director a report that describes the programs supported by the grant and the results of monitoring and evaluation of those programs.
Authorization of appropriations
There are authorized to be appropriated such sums as may be necessary to carry out this subsection for each of fiscal years 2012 through 2016.
.
Institute of Medicine study and report
Study
The Secretary of Health and Human Services shall seek to enter into a contract with the Institute of Medicine to conduct a study identifying opportunities within the Department of Health and Human Services to strengthen the health literacy of health care providers and health care consumers in accordance with the Patient Protection and Affordable Care Act (Public Law 111–148).
Report
A contract entered into under paragraph (1) shall include a provision requiring the Institute of Medicine, not later than 1 year after the date of enactment of this Act, to submit a report concerning the results of the study conducted under paragraph (1) to the Secretary of Health and Human Services and the appropriate committees of Congress.”.
Disallowance of deductions for advertising and marketing expenses relating to tobacco product use
In general
Part IX of subchapter B of chapter 1 of subtitle A of the Internal Revenue Code of 1986 (relating to items not deductible) is amended by adding at the end the following new section:
Disallowance of deduction for advertising and marketing expenses relating to tobacco product use
No deduction shall be allowed under this chapter for expenses relating to advertising or marketing cigars, cigarettes, smokeless tobacco, pipe tobacco, or any other tobacco product. For purposes of this section, any term used in this section which is also used in section 5702 shall have the same meaning given such term by section 5702.
.
Conforming amendment
The table of sections for such part IX is amended by adding after the item relating to section 280H the following new item:
Sec. 280I. Disallowance of deduction for tobacco advertising and marketing expenses.
.
Effective date
The amendments made by this section shall apply to taxable years beginning after the date of the enactment of this Act.
Incentives to reduce tobacco use
Child tobacco use surveys
Annual performance survey
In general
Not later than August 31, 2012, and annually thereafter,
the Secretary of Health and Human Services (referred to in this section as the
Secretary
) shall publish the results of an annual tobacco use
survey, to be carried out not later than 18 months after the date of enactment
of this Act and completed on an annual basis thereafter, to determine—
the percentage of all young individuals who used tobacco products within the 30-day period prior to the conduct of the survey involved; and
the percentage of young individuals who identify each brand of each type of tobacco product as the usual brand used within such 30-day period.
Young individuals
For the purposes of this section, the term young individuals means individuals who are under 18 years of age.
Size and methodology
In general
The survey referred to in paragraph (1) may be the National Survey on Drug Use and Health or shall at least be comparable in size and methodology to the NSDUH that was completed in 2009 to measure the use of cigarettes (by brand) by youths under 18 years of age within the 30-day period prior to the conduct of the study.
Conclusive accurateness
A survey using the methodology described in subparagraph (A) shall be deemed conclusively proper, correct, and accurate for purposes of this section.
Definition
In this section, the term National Survey on Drug Use and Health or NSDUH means the annual nationwide survey of randomly selected individuals, aged 12 and older, conducted by the Substance Abuse and Mental Health Services Administration.
Reduction
The Secretary, based on a comparison of the results of the first annual tobacco product survey referred to in paragraph (1) and the most recent NSDUH referred to in paragraph (2)(A) completed prior to the date of enactment of this Act, shall determine the percentage reduction (if any) in youth tobacco use for each manufacturer of tobacco products.
Participation in survey
Notwithstanding any other provision of law, the Secretary may conduct a survey under this subsection involving minors if the results of such survey with respect to such minors are kept confidential and not disclosed.
Nonapplicability
Chapter 35 of title 44, United States Code, shall not apply to information required for the purposes of carrying out this section.
Tobacco use reduction goal and noncompliance
Goal
It shall be the tobacco use reduction goal that youth tobacco use be reduced by at least 5 percent or a level determined significantly sufficient by the Secretary between the most recent NSDUH referred to in subsection (a)(2)(A) and the completion of the first annual cigarette survey (and such subsequent surveys as compared to the previous year's survey) referred to in subsection (a)(1).
Noncompliance
Industry-wide penalty
If the Secretary determines that the tobacco use reduction goal under paragraph (1) has not been achieved, the Secretary shall, not later than September 10, 2012, and September 10 of each year thereafter, impose an industry-wide penalty on the manufacturers of cigarettes in an amount that is in the aggregate equal to $3,000,000,000.
Payment
The industry-wide penalty imposed under this subsection shall be paid by each manufacturer based on the brand share among youth ages 12–17 (as determined by the survey described in subsection (a)(1)) as such percentage relates to the total amount to be paid by all manufacturers.
Final determination
The determination of the Secretary as to the amount and allocation of a surcharge under this section shall be final and the manufacturer shall pay such surcharge within 10 days of the date on which the manufacturer is assessed. Such payment shall be retained by the Secretary pending final judicial review of what, if any, change in the surcharge is appropriate.
Limitation
With respect to cigarettes, a manufacturer with a market share of 1 percent or less of youth tobacco use shall not be liable for the payment of a surcharge under this paragraph.
Use of amounts
Amounts collected under subparagraph (A) shall be deposited into the Prevention and Public Health Fund established under section 4002 of the Patient Protection and Affordable Care Act (42 U.S.C. 300u–11). Such funds shall remain available for transfer through September 30th of the fifth fiscal year following their collection, subject to the terms and conditions of such section 4002.
Penalties nondeductible
The payment of penalties under this section shall not be considered to be an ordinary and necessary expense in carrying on a trade or business for purposes of the Internal Revenue Code of 1986 and shall not be deductible.
Judicial review
After payment
A manufacturer of cigarettes may seek judicial review of any action under this section only after the assessment involved has been paid by the manufacturer to the Department of the Treasury and only in the United States District Court for the District of Columbia.
Review by attorney general
Prior to the filing of an action by a manufacturer seeking judicial review of an action under this section, the manufacturer shall notify the Attorney General of such intent to file and the Attorney General shall have 30 days in which to respond to the action.
Review
The amount of any surcharge paid under this section shall be subject to judicial review by the United States Court of Appeals for the District of Columbia Circuit, based on the arbitrary and capricious standard of section 706 of title 5, United States Code. Notwithstanding any other provision of law, no court shall have the authority to stay any surcharge payment due to the Secretary under this section pending judicial review until the Secretary has made or failed to make a compliance determination, as described under this section, that has adversely affected the person seeking the review.
Enforcement
Initial penalty
There is hereby imposed an initial penalty on the failure of any manufacturer to make any payment required under this section not later than a period determined sufficient by the Secretary after the date on which such payment is due.
Amount of penalty
The amount of the penalty imposed by paragraph (1) on any failure with respect to a manufacturer shall be an amount equal to 2 percent of the penalty owed under subsection (b) for each day during the noncompliance period.
Noncompliance period
For purposes of this subsection, the term noncompliance period means, with respect to any failure to make the surcharge payment required under this section, the period—
beginning on the due date for such payment; and
ending on the date on which such payment is paid in fall.
Limitations
No penalty shall be imposed by paragraph (1) on—
any failure to make a surcharge payment under this section during any period for which it is established to the satisfaction of the Secretary that none of the persons responsible for such failure knew or, exercising reasonable diligence, would have known, that such failure existed; or
any manufacturer that produces less than 1 percent of cigarettes used by youth in that year (as determined by the annual survey).
Expanded coverage of preventive services
Required coverage of preventive services under the Medicaid program
Mandatory coverage
Section 1905 of the Social Security Act (42 U.S.C. 1396d), as amended by section 4107(a)(1) of the Patient Protection and Affordable Care Act (Public Law 111–148), is amended—
in subsection (a)(4)—
by striking
and
before (D)
; and
by inserting
before the semicolon at the end the following new subparagraph: ; and
(E) preventive services described in subsection (ee);
; and
by adding at the end the following new subsection:
Preventive Services
For purposes of subsection (a)(4)(E), the preventives services described in this subsection are diagnostic, screening, preventive, and rehabilitative services not otherwise described in subsection (a) or (r) that the Secretary determines are appropriate for individuals entitled to medical assistance under this title, including—
evidence-based services that are assigned a grade of A or B by the United States Preventive Services Task Force; and
with respect to an adult individual, approved vaccines recommended for routine use by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention.
.
Elimination of cost-Sharing
Subsections
(a)(2)(D) and (b)(2)(D) of section 1916 of the Social Security Act (42 U.S.C.
1396o) are each amended by inserting preventive services described in
section 1905(ee),
after emergency services (as defined by the
Secretary),
.
Section
1916A(a)(1) of such Act (42 U.S.C. 1396o–1(a)(1)) is amended by inserting
, preventive services described in section 1905(ee),
after
subsection (c)
.
Conforming amendment
Effective as if included in the enactment of the Patient Protection and Affordable Care Act (Public Law 111–148), the provisions of, and amendments made by, section 4106 of such Act are repealed.
Interval period for inclusion of new recommendations in State plans
With respect to a recommendation issued on or after the date of enactment of this Act by an organization described in subsection (ee) of section 1905 of the Social Security Act for a preventive service included under such subsection, the Secretary of Health and Human Services shall establish a minimum interval period, which shall be not less than 12 months, between the date on which the recommendation is issued and the plan year for which a State plan for medical assistance under title XIX of the Social Security Act shall be required to include such preventive service.
Effective date
In general
Except as provided in paragraph (2), the amendments made by subsections (a) and (b) take effect on the date of enactment of this Act.
Extension of effective date for state law amendment
In the case of a State plan under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) which the Secretary of Health and Human Services determines requires State legislation or State regulation in order for the plan to meet the additional requirements imposed by the amendments made by subsections (a) and (b), the State plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet these additional requirements before the first day of the first calendar quarter beginning after the close of the first regular session of the State legislature that begins after the date of enactment of this Act. For purposes of the previous sentence, in the case of a State that has a 2-year legislative session, each year of the session is considered to be a separate regular session of the State legislature.
Coverage for comprehensive workplace wellness program and preventive services
Section 8904(a) of title 5, United States Code, is amended—
in paragraph (1), by adding at the end the following:
Comprehensive workplace wellness program benefits that meet the requirements of section 10408 of the Patient Protection and Affordable Care Act (Public Law 111–148).
Preventive
services benefits deemed an A
or B
service by the
United States Preventive Services Taskforce.
Immunizations that have in effect a recommendation from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention with respect to the individuals involved.
With respect to infants, children, and adolescents, evidence-informed preventive care and screenings provided for in the comprehensive guidelines supported by the Health Resources and Services Administration of the Department of Health and Human Services.
; and
in paragraph (2), by adding at the end the following:
Comprehensive workplace wellness program benefits that meet the requirements of section 10408 of the Patient Protection and Affordable Care Act (Public Law 111–148).
Preventive
services benefits deemed an A
or B
service by the
United States Preventive Services Taskforce.
Immunizations that have in effect a recommendation from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention with respect to the individuals involved.
With respect to infants, children, and adolescents, evidence-informed preventive care and screenings provided for in the comprehensive guidelines supported by the Health Resources and Services Administration of the Department of Health and Human Services.
.
Health professional education and training in healthy eating
Part Q of title III of the Public Health Service Act (42 U.S.C. 280h et seq.) is amended by striking section 399Z and inserting the following:
Health professional education and training in healthy eating
In general
The Secretary, acting through the Director of the Centers for Disease Control and Prevention, in collaboration with the Administrator of the Health Resources and Services Administration and the heads of other agencies, and in consultation with appropriate health professional associations, shall develop and carry out a program to educate and train health professionals in effective strategies to—
better identify patients at-risk of becoming overweight or obese or developing an eating disorder;
detect overweight or obesity or eating disorders among a diverse patient population;
counsel, refer, or treat patients with overweight or obesity or an eating disorder;
educate patients and the families of patients about effective strategies to establish healthy eating habits and appropriate levels of physical activity; and
assist in the creation and administration of community-based overweight and obesity and eating disorder prevention efforts.
Eating disorder
In this section, the term eating disorder includes anorexia nervosa, bulimia nervosa, binge eating disorder, and eating disorders not otherwise specified, as defined in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders or any subsequent edition.
Authorization of appropriations
There are authorized to be appropriated to carry out this section such sums as may be necessary for each of the fiscal years 2012 through 2016.
.
Research
Grants for Body Mass Index data analysis
Establishment
The Secretary of Health and Human Services
may make grants to not more than 20 eligible entities to analyze body mass
index (hereinafter in this section referred to as BMI
)
measurements of children, ages 2 through 18.
Eligibility
An eligible entity for purposes of this section is a State (including the District of Columbia, the Commonwealth of Puerto Rico, and each territory of the United States) that has a statewide immunization information system that—
has the capacity to store basic demographic information (including date of birth, gender, and geographic area of residence), height, weight, and immunization data for each resident of the State;
is accessible to doctors, nurses, other licensed medical professionals, and officials of the relevant department in the State charged with maintaining health and immunization records; and
has the capacity to integrate large amounts of data for the analysis of BMI measurements.
Use of funds
A State that receives a grant under this section shall use the grant for the following purposes:
Analyzing the effectiveness of obesity prevention programs and wellness policies carried out in the State.
Purchasing new computers, computer equipment, and software to upgrade computers to be used for a statewide immunization information system.
The hiring and employment of personnel to maintain and analyze BMI data.
The development and implementation of training programs for medical professionals to aid such professionals in taking BMI measurements and discussing such measurements with patients.
Providing information to parents and legal guardians in accordance with subsection (e)(2).
Selection Criteria
In selecting recipients of grants under this section, the Secretary shall give priority to States in which a high percentage of public and private health care providers submit data to a statewide immunization information system that—
contains immunization data for not less than 20 percent of the population of such State that is under the age of 18; and
includes data collected from men and women who are of a wide variety of ages and who reside in a wide variety of geographic areas in a State (as determined by the Secretary).
Conditions
As a condition of receiving a grant under this section, a State shall—
ensure that BMI measurements will be recorded for children ages 2 through 18—
on an annual basis by a licensed physician, nurse, nurse practitioner, or physicians assistant during an annual physical examination, wellness visit, or similar visit with a physician; and
in accordance with data collection protocols published by the American Academy of Pediatrics in the 2007 Expert Committee Recommendations; and
for each child in the State for whom such measurements indicate a BMI greater than the 95th percentile for such child’s age and gender, provide to the parents or legal guardians of such child information on how to lower BMI and information on State and local obesity prevention programs.
Reports
Reports to the Secretary
Not later than 5 years after the receipt of a grant under this section, the State receiving such grant shall submit to the Secretary the following reports:
A report containing an analysis of BMI data collected using the grant, including—
the differences in obesity trends by gender, disability, geographic area (as determined by the State), and socioeconomic status within such State; and
the demographic groups and geographic areas most affected by obesity within such State.
A report containing an analysis of the effectiveness of obesity prevention programs and State wellness policies, including—
an analysis of the success of such programs and policies prior to the receipt of the grant; and
a discussion of the means to determine the most effective strategies to combat obesity in the geographic areas identified under subparagraph (A).
Report to Congress and Certain Executive Agencies
Not later than 1 year after the Secretary receives all the reports required pursuant to paragraph (1), the Secretary shall submit to the Secretary of Education, the Secretary of Agriculture, and to Congress a report that contains the following:
An analysis of trends in childhood obesity, including how such trends vary across regions of the United States, and how such trends vary by gender and socioeconomic status.
A description of any programs that—
the Secretary has determined significantly lower childhood obesity rates for certain geographic areas in the United States, including urban, rural, and suburban areas; and
the Secretary recommends to be implemented by the States (including States that did not receive a grant under this section).
Authorization of Appropriations
There is authorized to be appropriated to the Secretary such sums as may be necessary to carry out this section for each of fiscal years 2012 through 2016.
National assessment of mental health needs
Title V of the Public Health Service Act (42 U.S.C. 290aa et seq.) is amended by inserting after section 506B (42 U.S.C. 290aa–5b) the following:
National assessment of mental health needs
In general
The Secretary, acting through the Administrator, and in consultation with the Centers for Disease Control and Prevention and the Director of the National Institutes of Health, shall establish and implement public health monitoring measures to address the mental and behavioral health status of the population of the United States and other populations served by the Administration, that include—
monitoring the mental health status of the population, including the incidence and prevalence of mental and behavioral health conditions across the lifespan;
monitoring access to appropriate diagnostic and treatment services for mental and behavioral health conditions, including trends in unmet need for services;
monitoring mental and behavioral health conditions as risk factors for obesity and chronic diseases to the extent practicable;
enhancing existing public health monitoring systems by including measures assessing mental and behavioral health status and associated risk factors; and
to the extent practicable, monitoring the immediate and long-term impact of disasters or catastrophic events, whether natural or man-made on the mental and behavioral health of affected populations.
Distinguishing among age groups
In designing and implementing the measures described in subsection (a) the Secretary shall ensure that data collection and reporting standards stratify data by age groups, in particular, to the extent practicable, children under the age of 5 years.
Report
Not later than 1 year after the date of enactment of this section, the Secretary shall submit a report to Congress that describes the progress on the implementation of the monitoring measures described in subsection (a).
Authorization of appropriations
There is authorized to be appropriated to carry out this section such sums as may be necessary to carry out this section for each of fiscal years 2012 through 2016.
.