---
kind: "section"
citation: "42 U.S.C. § 280g–12"
title: "42"
title_heading: "The Public Health and Welfare"
number: "280g–12"
heading: "Primary Care Extension Program"
release: "119-102"
date: "2026-07-12"
url: "https://uscodex.org/usc/42/280g-12"
units:
  - "Chapter 6A — Public Health Service"
  - "Subchapter II — General Powers and Duties"
  - "Part P — Additional Programs"
---

# §280g–12. Primary Care Extension Program

- (a) **Establishment, purpose and definition—**
  - (1) **In general—** The [Secretary](/usc/42/201.md?p=c), acting through the [Director](/usc/42/11851.md?p=5) of the [Agency](/usc/42/8262.md?p=1) for Healthcare Research and Quality, shall establish a Primary Care Extension [Program](/usc/42/274l–1.md?p=4).
  - (2) **Purpose—** The Primary Care Extension [Program](/usc/42/274l–1.md?p=4) shall provide support and assistance to primary care [providers](/usc/42/299b–21.md?p=8) to educate [providers](/usc/42/299b–21.md?p=8) about preventive medicine, health promotion, chronic disease management, mental and behavioral health [services](/usc/42/201.md?p=a) (including substance abuse prevention and [treatment](/usc/42/11851.md?p=11) [services](/usc/42/201.md?p=a)), and evidence-based and evidence-informed therapies and techniques, in order to enable [providers](/usc/42/299b–21.md?p=8) to incorporate such matters into their practice and to improve community health by working with community-based health connectors (referred to in this section as “Health Extension Agents”).
  - (3) **Definitions—** In this section:
    - (A) **Health Extension Agent—** The term “Health Extension Agent” means any local, community-based health worker who facilitates and provides assistance to primary care [practices](/usc/42/17061.md?p=19) by implementing quality improvement or system redesign, incorporating the principles of the patient-centered medical home to provide high-quality, effective, efficient, and safe primary care and to provide guidance to patients in culturally and linguistically appropriate ways, and linking [practices](/usc/42/17061.md?p=19) to diverse health system resources.
    - (B) **Primary care provider—** The term “primary care [provider](/usc/42/299b–21.md?p=8)” means a clinician who provides integrated, accessible health [care services](/usc/42/300z–1.md?p=a-7) and who is accountable for addressing a large majority of personal health care needs, including providing preventive and health promotion [services](/usc/42/201.md?p=a) for men, women, and children of all ages, developing a sustained partnership with patients, and practicing in the context of family and community, as recognized by a [State](/usc/42/201.md?p=f) licensing or regulatory authority, unless otherwise specified in this section.
- (b) **Grants to establish State Hubs and local Primary Care Extension Agencies—**
  - (1) **Grants—** The [Secretary](/usc/42/201.md?p=c) shall award competitive grants to [States](/usc/42/201.md?p=f) for the establishment of [State](/usc/42/201.md?p=f)- or multistate-level primary care Primary Care Extension [Program](/usc/42/274l–1.md?p=4) [State](/usc/42/201.md?p=f) Hubs (referred to in this section as “Hubs”).
  - (2) **Composition of Hubs—** A Hub established by a [State](/usc/42/201.md?p=f) pursuant to [paragraph (1)](#b-1)—
    - (A) shall consist of, at a minimum, the [State](/usc/42/201.md?p=f) health department, the entity responsible for administering the [State](/usc/42/201.md?p=f) Medicaid [program](/usc/42/274l–1.md?p=4) (if other than the [State](/usc/42/201.md?p=f) health department), the [State](/usc/42/201.md?p=f)-level entity administering the Medicare [program](/usc/42/274l–1.md?p=4), and the departments that train [providers](/usc/42/299b–21.md?p=8) in primary care in 1 or more health professions [schools](/usc/42/300j–21.md?p=6) in the [State](/usc/42/201.md?p=f); and
    - (B) may include entities such as [hospital](/usc/42/300s–3.md?p=1) associations, primary care practice-based research networks, health professional societies, [State](/usc/42/201.md?p=f) primary care associations, [State](/usc/42/201.md?p=f) licensing boards, organizations with a contract with the [Secretary](/usc/42/201.md?p=c) under [section 1320c–2 of this title](/usc/42/1320c–2.md), consumer groups, and other appropriate entities.
- (c) **State and local activities—**
  - (1) **Hub activities—** Hubs established under a grant under [subsection (b)](#b) shall—
    - (A) submit to the [Secretary](/usc/42/201.md?p=c) a plan to coordinate functions with quality improvement organizations and area health education centers if such entities are members of the Hub not described in [subsection (b)(2)(A)](#b-2-A);
    - (B) contract with a county- or local-level entity that shall serve as the Primary Care Extension [Agency](/usc/42/8262.md?p=1) to administer the [services](/usc/42/201.md?p=a) described in [paragraph (2)](#c-2);
    - (C) organize and administer grant funds to county- or local-level Primary Care Extension [Agencies](/usc/42/8262.md?p=1) that serve a catchment area, as determined by the [State](/usc/42/201.md?p=f); and
    - (D) organize [State](/usc/42/201.md?p=f)-wide or multistate networks of local-level Primary Care Extension [Agencies](/usc/42/8262.md?p=1) to share and disseminate information and [practices](/usc/42/17061.md?p=19).
  - (2) **Local Primary Care Extension Agency activities—**
    - (A) **Required activities—** Primary Care Extension [Agencies](/usc/42/8262.md?p=1) established by a Hub under [paragraph (1)](#c-1) shall—
      - (i) assist primary care [providers](/usc/42/299b–21.md?p=8) to implement a patient-centered medical home to improve the accessibility, quality, and efficiency of primary [care services](/usc/42/300z–1.md?p=a-7), including health homes;
      - (ii) develop and support primary care learning communities to enhance the dissemination of research findings for evidence-based practice, assess implementation of practice improvement, share best [practices](/usc/42/17061.md?p=19), and involve community clinicians in the generation of new knowledge and identification of important questions for research;
      - (iii) participate in a national network of Primary Care Extension Hubs and propose how the Primary Care Extension [Agency](/usc/42/8262.md?p=1) will share and disseminate lessons learned and best [practices](/usc/42/17061.md?p=19); and
      - (iv) develop a plan for financial sustainability involving [State](/usc/42/201.md?p=f), local, and private contributions, to provide for the reduction in Federal funds that is expected after an initial 6-year period of [program](/usc/42/274l–1.md?p=4) establishment, infrastructure development, and planning.
    - (B) **Discretionary activities—** Primary Care Extension [Agencies](/usc/42/8262.md?p=1) established by a Hub under [paragraph (1)](#c-1) may—
      - (i) provide technical assistance, training, and organizational support for community health teams established under [section 256a–1](/usc/42/256a–1.md)[^1] of this title;
      - (ii) collect data and provision of primary care [provider](/usc/42/299b–21.md?p=8) feedback from standardized measurements of processes and outcomes to aid in continuous performance improvement;
      - (iii) collaborate with local health departments, community health centers, tribes and tribal entities, and other community [agencies](/usc/42/8262.md?p=1) to identify community health priorities and local health workforce needs, and participate in community-based efforts to address the social and primary determinants of health, strengthen the local primary care workforce, and eliminate health disparities;
      - (iv) develop measures to monitor the impact of the proposed [program](/usc/42/274l–1.md?p=4) on the health of practice enrollees and of the wider community served; and
      - (v) participate in other activities, as determined appropriate by the [Secretary](/usc/42/201.md?p=c).
- (d) **Federal program administration—**
  - (1) **Grants; types—** Grants awarded under [subsection (b)](#b) shall be—
    - (A) [program](/usc/42/274l–1.md?p=4) grants, that are awarded to [State](/usc/42/201.md?p=f) or multistate entities that submit fully-developed plans for the implementation of a Hub, for a period of 6 years; or
    - (B) planning grants, that are awarded to [State](/usc/42/201.md?p=f) or multistate entities with the goal of developing a plan for a Hub, for a period of 2 years.
  - (2) **Applications—** To be eligible for a grant under [subsection (b)](#b), a [State](/usc/42/201.md?p=f) or multistate entity shall submit to the [Secretary](/usc/42/201.md?p=c) an application, at such time, in such manner, and containing such information as the [Secretary](/usc/42/201.md?p=c) may require.
  - (3) **Evaluation—** A [State](/usc/42/201.md?p=f) that receives a grant under [subsection (b)](#b) shall be evaluated at the end of the grant period by an evaluation panel appointed by the [Secretary](/usc/42/201.md?p=c).
  - (4) **Continuing support—** After the sixth year in which assistance is provided to a [State](/usc/42/201.md?p=f) under a grant awarded under [subsection (b)](#b), the [State](/usc/42/201.md?p=f) may receive additional support under this section if the [State](/usc/42/201.md?p=f) [program](/usc/42/274l–1.md?p=4) has received satisfactory evaluations with respect to [program](/usc/42/274l–1.md?p=4) performance and the merits of the [State](/usc/42/201.md?p=f) sustainability plan, as determined by the [Secretary](/usc/42/201.md?p=c).
  - (5) **Limitation—** A [State](/usc/42/201.md?p=f) shall not use in excess of 10 percent of the amount received under a grant to carry out administrative activities under this section. Funds awarded pursuant to this section shall not be used for funding direct patient care.
- (e) **Requirements on the Secretary—** In carrying out this section, the [Secretary](/usc/42/201.md?p=c) shall consult with the heads of other Federal [agencies](/usc/42/8262.md?p=1) with demonstrated experience and expertise in health care and preventive medicine, such as the Centers for Disease Control and Prevention, the Substance Abuse and Mental Health Administration, the Health Resources and [Services](/usc/42/201.md?p=a) Administration, the National Institutes of Health, the Office of the National Coordinator for Health Information Technology, the Indian Health [Service](/usc/42/201.md?p=a), the Agricultural Cooperative Extension [Service](/usc/42/201.md?p=a) of the Department of Agriculture, and other entities, as the [Secretary](/usc/42/201.md?p=c) determines appropriate.
- (f) **Authorization of appropriations—** To awards grants as provided in [subsection (d)](#d), there are authorized to be appropriated $120,000,000 for each of fiscal years 2011 and 2012, and such sums as may be necessary to carry out this section for each of fiscal years 2013 through 2014.

## Footnotes

[^1]: See References in Text note below.

## Source credit

(July 1, 1944, ch. 373, title III, § 399V–1, formerly § 399W, as added, amended, and renumbered § 399V–1, Pub. L. 111–148, title V, § 5405, title X, § 10501(f)(1), (2), Mar. 23, 2010, 124 Stat. 649, 996.)

## Notes

### Editorial Notes

### References in Text

Section 256a–1 of this title, referred to in subsec. (c)(2)(B)(i), was in the original “section 3602 of the Patient Protection and Affordable Care Act”, and was translated as meaning section 3502 of the Patient Protection and Affordable Care Act, Pub. L. 111–148, to reflect the probable intent of Congress.

### Amendments

2010—Subsec. (b)(2)(A). Pub. L. 111–148, § 10501(f)(2), substituted “and the departments that train providers in primary care in 1 or more health professions schools in the State” for “and the departments of 1 or more health professions schools in the State that train providers in primary care”.