I 

111TH CONGRESS 

1ST SESSION H. R. 194 

To amend the Social Security Act to guarantee comprehensive health care 

coverage for all children born after 2009, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

JANUARY 6, 2009 

Mr. STARK introduced the following bill; which was referred to the Committee 

on Energy and Commerce, and in addition to the Committee on Ways 

and Means, for a period to be subsequently determined by the Speaker, 

in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned 

A BILL 

To amend the Social Security Act to guarantee comprehensive health care coverage for all children born after 2009, 

and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘MediKids Health Insurance Act of 2009’’. 

6 (b) TABLE OF CONTENTS.—The table of contents of 

7 this Act is as follows: 

Sec. 1. Short title; table of contents. 


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TITLE I—MEDIKIDS HEALTH INSURANCE 

Sec. 101. Findings. 

Sec. 102. Benefits for all children born after 2009. 

‘‘TITLE XXII—MEDIKIDS PROGRAM 

‘‘Sec. 2201. Eligibility. 

‘‘Sec. 2202. Benefits. 

‘‘Sec. 2203. Premiums. 

‘‘Sec. 2204. MediKids Trust Fund. 

‘‘Sec. 2205. Oversight and accountability. 

‘‘Sec. 2206. Inclusion of care coordination services. 

‘‘Sec. 2207. Administration and miscellaneous. 

Sec. 103. MediKids premium. 

Sec. 104. Refundable credit for certain cost-sharing expenses under MediKids 

program. 

Sec. 105. Report on long-term revenues. 

TITLE II—STRENGTHENING QUALITY OF CARE AND HEALTH 

OUTCOMES 

Sec. 201. Child health quality improvement activities for children enrolled in 

MediKids, Medicaid, or CHIP. 

Sec. 202. Improved availability of public information regarding enrollment of 

children in CHIP and Medicaid. 

Sec. 203. Application of certain managed care quality safeguards to CHIP. 

1 TITLE I—MEDIKIDS HEALTH 

2 INSURANCE 

3 SEC. 101. FINDINGS. 

4 (a) FINDINGS.—Congress finds the following: 

5 (1) More than 9 million American children are 

6 uninsured. 

7 (2) Children who are uninsured receive less 

8 medical care and less preventive care and have a 

9 poorer level of health, which result in lifetime costs 

10 to themselves and to the entire American economy. 

11 (3) Although SCHIP and Medicaid are success12 fully extending a health coverage safety net to a 

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1 lation of uninsured children, they alone cannot 

2 achieve 100 percent health insurance coverage for 

3 our nation’s children due to inevitable gaps during 

4 outreach and enrollment, fluctuations in eligibility, 

5 variations in access to private insurance at all in6 come levels, and variations in States’ ability to pro7 vide required matching funds. 

8 (4) As all segments of society continue to be9 come more transient, with many changes in employ10 ment over the working lifetime of parents, the need 

11 for a reliable safety net of health insurance which 

12 follows children across State lines, already a major 

13 problem for the children of migrant and seasonal 

14 farmworkers, will become a major concern for all 

15 families in the United States. 

16 (5) The medicare program has successfully 

17 evolved over the years to provide a stable, universal 

18 source of health insurance for the nation’s disabled 

19 and those over age 65, and provides a tested model 

20 for designing a program to reach out to America’s 

21 children. 

22 (6) The problem of insuring 100 percent of all 

23 American children could be gradually solved by auto24 matically enrolling all children born after December 

25 31, 2009, in a program modeled after Medicare (and 


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1 to be known as ‘‘MediKids’’), and allowing those 

2 children to be transferred into other equivalent or 

3 better insurance programs, including either private 

4 insurance, SCHIP, or Medicaid, if they are eligible 

5 to do so, but maintaining the child’s default enroll6 ment in MediKids for any times when the child’s ac7 cess to other sources of insurance is lost. 

8 (7) A family’s freedom of choice to use other in9 surers to cover children would not be interfered with 

10 in any way, and children eligible for SCHIP and 

11 Medicaid would continue to be enrolled in those pro12 grams, but the underlying safety net of MediKids 

13 would always be available to cover any gaps in insur14 ance due to changes in medical condition, employ15 ment, income, or marital status, or other changes af16 fecting a child’s access to alternate forms of insur17 ance. 

18 (8) The MediKids program can be administered 

19 without impacting the finances or status of the exist20 ing Medicare program. 

21 (9) The MediKids benefit package can be tai22 lored to the special needs of children and updated 

23 over time. 

24 (10) The financing of the program can be ad25 ministered without difficulty by a yearly payment of 


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1 affordable premiums through a family’s tax filing (or 

2 adjustment of a family’s earned income tax credit). 

3 (11) The cost of the program will gradually rise 

4 as the number of children using MediKids as the in5 surer of last resort increases, and a future Congress 

6 always can accelerate or slow down the enrollment 

7 process as desired, while the societal costs for emer8 gency room usage, lost productivity and work days, 

9 and poor health status for the next generation of 

10 Americans will decline. 

11 (12) Over time 100 percent of American chil12 dren will always have basic health insurance, and we 

13 can therefore expect a healthier, more equitable, and 

14 more productive society. 

15 SEC. 102. BENEFITS FOR ALL CHILDREN BORN AFTER 2009. 

16 (a) IN GENERAL.—The Social Security Act is amend17 ed by adding at the end the following new title: 

18 ‘‘TITLE XXII—MEDIKIDS 

19 PROGRAM 

20 ‘‘SEC. 2201. ELIGIBILITY. 

21 ‘‘(a) ELIGIBILITY OF INDIVIDUALS BORN AFTER DE22 CEMBER 31, 2009; ALL CHILDREN UNDER 23 YEARS OF

23 AGE IN FIFTH YEAR.—An individual who meets the fol24 lowing requirements with respect to a month is eligible to 

25 enroll under this title with respect to such month: 


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1 ‘‘(1) AGE.— 

2 ‘‘(A) FIRST YEAR.—As of the first day of 

3 the first year in which this title is effective, the 

4 individual has not attained 6 years of age. 

5 ‘‘(B) SECOND YEAR.—As of the first day 

6 of the second year in which this title is effec7 tive, the individual has not attained 11 years of 

8 age. 

9 ‘‘(C) THIRD YEAR.—As of the first day of 

10 the third year in which this title is effective, the 

11 individual has not attained 16 years of age. 

12 ‘‘(D) FOURTH YEAR.—As of the first day 

13 of the fourth year in which this title is effective, 

14 the individual has not attained 21 years of age. 

15 ‘‘(E) FIFTH AND SUBSEQUENT YEARS.— 

16 As of the first day of the fifth year in which 

17 this title is effective and each subsequent year, 

18 the individual has not attained 23 years of age. 

19 ‘‘(2) CITIZENSHIP.—The individual is a citizen 

20 or national of the United States or is permanently 

21 residing in the United States under color of law. 

22 ‘‘(b) ENROLLMENT PROCESS.—An individual may 

23 enroll in the program established under this title only in 

24 such manner and form as may be prescribed by regula25 tions, and only during an enrollment period prescribed by 


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1 the Secretary consistent with the provisions of this section. 

2 Such regulations shall provide a process under which— 

3 ‘‘(1) individuals who are born in the United 

4 States after December 31, 2009, are deemed to be 

5 enrolled at the time of birth and a parent or guard6 ian of such an individual is permitted to pre-enroll 

7 in the month prior to the expected month of birth; 

8 ‘‘(2) individuals who are born outside the 

9 United States after such date and who become eligi10 ble to enroll by virtue of immigration into (or an ad11 justment of immigration status in) the United 

12 States are deemed enrolled at the time of entry or 

13 adjustment of status; 

14 ‘‘(3) eligible individuals may otherwise be en15 rolled at such other times and manner as the Sec16 retary shall specify, including the use of outstationed 

17 eligibility sites as described in section 

18 1902(a)(55)(A) and the use of presumptive eligi19 bility provisions like those described in section 

20 1920A; and 

21 ‘‘(4) at the time of automatic enrollment of a 

22 child, the Secretary provides for issuance to a parent 

23 or custodian of the individual a card evidencing cov24 erage under this title and for a description of such 

25 coverage. 


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1 The provisions of section 1837(h) apply with respect to 

2 enrollment under this title in the same manner as they 

3 apply to enrollment under part B of title XVIII. An indi4 vidual who is enrolled under this title is not eligible to 

5 be enrolled under an MA or MA–PD plan under part C 

6 of title XVIII. 

7 ‘‘(c) DATE COVERAGE BEGINS.— 

8 ‘‘(1) IN GENERAL.—The period during which 

9 an individual is entitled to benefits under this title 

10 shall begin as follows, but in no case earlier than 

11 January 1, 2010: 

12 ‘‘(A) In the case of an individual who is 

13 enrolled under paragraph (1) or (2) of sub14 section (b), the date of birth or date of obtain15 ing appropriate citizenship or immigration sta16 tus, as the case may be. 

17 ‘‘(B) In the case of another individual who 

18 enrolls (including pre-enrolls) before the month 

19 in which the individual satisfies eligibility for 

20 enrollment under subsection (a), the first day of 

21 such month of eligibility. 

22 ‘‘(C) In the case of another individual who 

23 enrolls during or after the month in which the 

24 individual first satisfies eligibility for enrollment 


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1 under such subsection, the first day of the fol2 lowing month. 

3 ‘‘(2) AUTHORITY TO PROVIDE FOR PARTIAL

4 MONTHS OF COVERAGE.—Under regulations, the 

5 Secretary may, in the Secretary’s discretion, provide 

6 for coverage periods that include portions of a 

7 month in order to avoid lapses of coverage. 

8 ‘‘(3) LIMITATION ON PAYMENTS.—No payments 

9 may be made under this title with respect to the ex10 penses of an individual enrolled under this title un11 less such expenses were incurred by such individual 

12 during a period which, with respect to the individual, 

13 is a coverage period under this section. 

14 ‘‘(d) EXPIRATION OF ELIGIBILITY.—An individual’s 

15 coverage period under this section shall continue until the 

16 individual’s enrollment has been terminated because the 

17 individual no longer meets the requirements of subsection 

18 (a) (whether because of age or change in immigration sta19 tus). 

20 ‘‘(e) ENTITLEMENT TO MEDIKIDS BENEFITS FOR

21 ENROLLED INDIVIDUALS.—An individual enrolled under 

22 this title is entitled to the benefits described in section 

23 2202. 

24 ‘‘(f) LOW-INCOME INFORMATION.— 


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1 ‘‘(1) INQUIRY OF INCOME.—At the time of en2 rollment of a child under this title, the Secretary 

3 shall make an inquiry as to whether the family in4 come (as determined for purposes of section 

5 1905(p)) of the family that includes the child is 

6 within any of the following income ranges: 

7 ‘‘(A) UP TO 150 PERCENT OF POVERTY.— 

8 The income of the family does not exceed 150 

9 percent of the poverty line for a family of the 

10 size involved. 

11 ‘‘(B) BETWEEN 150 AND 200 PERCENT OF

12 POVERTY.—The income of the family exceeds 

13 150 percent, but does not exceed 200 percent, 

14 of such poverty line. 

15 ‘‘(C) BETWEEN 200 AND 300 PERCENT OF

16 POVERTY.—The income of the family exceeds 

17 200 percent, but does not exceed 300 percent, 

18 of such poverty line. 

19 ‘‘(2) CODING.—If the family income is within a 

20 range described in paragraph (1), the Secretary 

21 shall encode in the identification card issued in con22 nection with eligibility under this title a code indi23 cating the range applicable to the family of the child 

24 involved. 


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1 ‘‘(3) PROVIDER VERIFICATION THROUGH ELEC2 TRONIC SYSTEM.—The Secretary also shall provide 

3 for an electronic system through which providers 

4 may verify which income range described in para5 graph (1), if any, is applicable to the family of the 

6 child involved. 

7 ‘‘(g) CONSTRUCTION.—Nothing in this title shall be 

8 construed as requiring (or preventing) an individual who 

9 is enrolled under this title from seeking medical assistance 

10 under a State medicaid plan under title XIX or child 

11 health assistance under a State child health plan under 

12 title XXI. 

13 ‘‘SEC. 2202. BENEFITS. 

14 ‘‘(a) SECRETARIAL SPECIFICATION OF BENEFIT

15 PACKAGE.— 

16 ‘‘(1) IN GENERAL.—The Secretary shall specify 

17 the benefits to be made available under this title 

18 consistent with the provisions of this section and in 

19 a manner designed to meet the health needs of en20 rollees. 

21 ‘‘(2) UPDATING.—The Secretary shall update 

22 the specification of benefits over time to ensure the 

23 inclusion of age-appropriate benefits to reflect the 

24 enrollee population. 


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1 ‘‘(3) ANNUAL UPDATING.—The Secretary shall 

2 establish procedures for the annual review and up3 dating of such benefits to account for changes in 

4 medical practice, new information from medical re5 search, and other relevant developments in health 

6 science. 

7 ‘‘(4) INPUT.—The Secretary shall seek the 

8 input of the pediatric community in specifying and 

9 updating such benefits. 

10 ‘‘(5) LIMITATION ON UPDATING.—In no case 

11 shall updating of benefits under this subsection re12 sult in a failure to provide benefits required under 

13 subsection (b). 

14 ‘‘(b) INCLUSION OF CERTAIN BENEFITS.— 

15 ‘‘(1) MEDICARE CORE BENEFITS.—Such bene16 fits shall include (to the extent consistent with other 

17 provisions of this section) at least the same benefits 

18 (including coverage, access, availability, duration, 

19 and beneficiary rights) that are available under 

20 parts A and B of title XVIII. 

21 ‘‘(2) ALL REQUIRED MEDICAID BENEFITS.— 

22 Such benefits shall also include all items and serv23 ices for which medical assistance is required to be 

24 provided under section 1902(a)(10)(A) to individuals 

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1 odic screening, diagnostic services, and treatment 

2 services. 

3 ‘‘(3) INCLUSION OF PRESCRIPTION DRUGS.— 

4 Such benefits also shall include (as specified by the 

5 Secretary) benefits for prescription drugs and 

6 biologicals which are not less than the benefits for 

7 such drugs and biologicals under the standard op8 tion for the service benefit plan described in section 

9 8903(1) of title 5, United States Code, offered dur10 ing 2007. 

11 ‘‘(4) COST-SHARING.— 

12 ‘‘(A) IN GENERAL.—Subject to subpara13 graph (B), such benefits also shall include the 

14 cost-sharing (in the form of deductibles, coin15 surance, and copayments) which is substantially 

16 similar to such cost-sharing under the health 

17 benefits coverage in any of the four largest 

18 health benefits plans (determined by enroll19 ment) offered under chapter 89 of title 5, 

20 United States Code, and including an out-of21 pocket limit for catastrophic expenditures for 

22 covered benefits, except that no cost-sharing 

23 shall be imposed with respect to early and peri24 odic screening and diagnostic services included 

25 under paragraph (2). 


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1 ‘‘(B) REDUCED COST-SHARING FOR LOW

2 INCOME CHILDREN.—Such benefits shall pro3 vide that— 

4 ‘‘(i) there shall be no cost-sharing for 

5 children in families the income of which is 

6 within the range described in section 

7 2201(f)(1)(A); 

8 ‘‘(ii) the cost-sharing otherwise appli9 cable shall be reduced by 75 percent for 

10 children in families the income of which is 

11 within the range described in section 

12 2201(f)(1)(B); or 

13 ‘‘(iii) the cost-sharing otherwise appli14 cable shall be reduced by 50 percent for 

15 children in families the income of which is 

16 within the range described in section 

17 2201(f)(1)(C). 

18 ‘‘(C) CATASTROPHIC LIMIT ON COST-SHAR19 ING.—For a refundable credit for cost-sharing 

20 in the case of cost-sharing in excess of a per21 centage of the individual’s adjusted gross in22 come, see section 36 of the Internal Revenue 

23 Code of 1986. 

24 ‘‘(c) PAYMENT SCHEDULE.—The Secretary, with the 

25 assistance of the Medicare Payment Advisory Commission, 


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1 shall develop and implement a payment schedule for bene2 fits covered under this title. To the extent feasible, such 

3 payment schedule shall be consistent with comparable pay4 ment schedules and reimbursement methodologies applied 

5 under parts A and B of title XVIII. 

6 ‘‘(d) INPUT.—The Secretary shall specify such bene7 fits and payment schedules only after obtaining input from 

8 appropriate child health providers and experts. 

9 ‘‘(e) ENROLLMENT IN HEALTH PLANS.—The Sec10 retary shall provide for the offering of benefits under this 

11 title through enrollment in a health benefit plan that 

12 meets the same (or similar) requirements as the require13 ments that apply to Medicare Advantage plans under part 

14 C of title XVIII (other than any such requirements that 

15 relate to part D of such title). In the case of individuals 

16 enrolled under this title in such a plan, the payment rate 

17 shall be based on payment rates provided for under section 

18 1853(c) in effect before the date of the enactment of the 

19 Medicare Prescription Drug, Modernization, and Improve20 ment Act of 2003 (Public Law 108–173), except that such 

21 payment rates shall be adjusted in an appropriate manner 

22 to reflect differences between the population served under 

23 this title and the population under title XVIII. 

24 ‘‘SEC. 2203. PREMIUMS. 

25 ‘‘(a) AMOUNT OF MONTHLY PREMIUMS.— 


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1 ‘‘(1) IN GENERAL.—The Secretary shall, during 

2 September of each year (beginning with 2009), es3 tablish a monthly MediKids premium for the fol4 lowing year. Subject to paragraph (2), the monthly 

MediKids premium for a year is equal to 1 5 ⁄12 of the 

6 annual premium rate computed under subsection 

7 (b). 

8 ‘‘(2) ELIMINATION OF MONTHLY PREMIUM FOR

9 DEMONSTRATION OF EQUIVALENT COVERAGE (IN10 CLUDING COVERAGE UNDER LOW-INCOME PRO11 GRAMS).—The amount of the monthly premium im12 posed under this section for an individual for a 

13 month shall be zero in the case of an individual who 

14 demonstrates to the satisfaction of the Secretary 

15 that the individual has basic health insurance cov16 erage for that month. For purposes of the previous 

17 sentence enrollment in a medicaid plan under title 

18 XIX, a State child health insurance plan under title 

19 XXI, or under the medicare program under title 

20 XVIII is deemed to constitute basic health insurance 

21 coverage described in such sentence. 

22 ‘‘(b) ANNUAL PREMIUM.— 

23 ‘‘(1) NATIONAL PER CAPITA AVERAGE.—The 

24 Secretary shall estimate the average, annual per 

25 capita amount that would be payable under this title 


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1 with respect to individuals residing in the United 

2 States who meet the requirement of section 

3 2201(a)(1) as if all such individuals were eligible for 

4 (and enrolled) under this title during the entire year 

5 (and assuming that section 1862(b)(2)(A)(i) did not 

6 apply). 

7 ‘‘(2) ANNUAL PREMIUM.—Subject to subsection 

8 (d), the annual premium under this subsection for 

9 months in a year is equal to 25 percent of the aver10 age, annual per capita amount estimated under 

11 paragraph (1) for the year. 

12 ‘‘(c) PAYMENT OF MONTHLY PREMIUM.— 

13 ‘‘(1) PERIOD OF PAYMENT.—In the case of an 

14 individual who participates in the program estab15 lished by this title, subject to subsection (d), the 

16 monthly premium shall be payable for the period 

17 commencing with the first month of the individual’s 

18 coverage period and ending with the month in which 

19 the individual’s coverage under this title terminates. 

20 ‘‘(2) COLLECTION THROUGH TAX RETURN.— 

21 For provisions providing for the payment of monthly 

22 premiums under this subsection, see section 59B of 

23 the Internal Revenue Code of 1986. 

24 ‘‘(3) PROTECTIONS AGAINST FRAUD AND

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1 tion with States and other health insurance issuers, 

2 administrative systems to ensure that claims which 

3 are submitted to more than one payor are coordi4 nated and duplicate payments are not made. 

5 ‘‘(d) REDUCTION IN PREMIUM FOR CERTAIN LOW6 INCOME FAMILIES.—For provisions reducing the premium 

7 under this section for certain low-income families, see sec8 tion 59B(d) of the Internal Revenue Code of 1986. 

9 ‘‘SEC. 2204. MEDIKIDS TRUST FUND. 

10 ‘‘(a) ESTABLISHMENT OF TRUST FUND.— 

11 ‘‘(1) IN GENERAL.—There is hereby created on 

12 the books of the Treasury of the United States a 

13 trust fund to be known as the ‘MediKids Trust 

14 Fund’ (in this section referred to as the ‘Trust 

15 Fund’). The Trust Fund shall consist of such gifts 

16 and bequests as may be made as provided in section 

17 201(i)(1) and such amounts as may be deposited in, 

18 or appropriated to, such fund as provided in this 

19 title. 

20 ‘‘(2) PREMIUMS.—Premiums collected under 

21 section 59B of the Internal Revenue Code of 1986 

22 shall be periodically transferred to the Trust Fund. 

23 ‘‘(3) TRANSITIONAL FUNDING BEFORE RECEIPT

24 OF PREMIUMS.—In order to provide for funds in the 

25 Trust Fund to cover expenditures from the fund in 


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1 advance of receipt of premiums under section 2203, 

2 there are transferred to the Trust Fund from the 

3 general fund of the United States Treasury such 

4 amounts as may be necessary. 

5 ‘‘(b) INCORPORATION OF PROVISIONS.— 

6 ‘‘(1) IN GENERAL.—Subject to paragraph (2), 

7 subsection (b) (other than the last sentence) and 

8 subsections (c) through (i) of section 1841 shall 

9 apply with respect to the Trust Fund and this title 

10 in the same manner as they apply with respect to 

11 the Federal Supplementary Medical Insurance Trust 

12 Fund and part B, respectively. 

13 ‘‘(2) MISCELLANEOUS REFERENCES.—In apply14 ing provisions of section 1841 under paragraph 

15 (1)— 

16 ‘‘(A) any reference in such section to ‘this 

17 part’ is construed to refer to title XXII; 

18 ‘‘(B) any reference in section 1841(h) to 

19 section 1840(d) and in section 1841(i) to sec20 tions 1840(b)(1) and 1842(g) are deemed ref21 erences to comparable authority exercised under 

22 this title; 

23 ‘‘(C) payments may be made under section 

24 1841(g) to the Trust Funds under sections 

25 1817 and 1841 as reimbursement to such funds 


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1 for payments they made for benefits provided 

2 under this title; and 

3 ‘‘(D) the Board of Trustees of the 

4 MediKids Trust Fund shall be the same as the 

5 Board of Trustees of the Federal Supple6 mentary Medical Insurance Trust Fund. 

7 ‘‘SEC. 2205. OVERSIGHT AND ACCOUNTABILITY. 

8 ‘‘(a) PERIODIC GAO REPORTS.—The Comptroller 

9 General of the United States shall periodically submit to 

10 Congress reports on the operation of the program under 

11 this title, including on the financing of coverage provided 

12 under this title. 

13 ‘‘(b) PERIODIC MEDPAC REPORTS.—The Medicare 

14 Payment Advisory Commission shall periodically report to 

15 Congress concerning the program under this title. 

16 ‘‘SEC. 2206. INCLUSION OF CARE COORDINATION SERVICES. 

17 ‘‘(a) IN GENERAL.— 

18 ‘‘(1) PROGRAM AUTHORITY.—The Secretary, 

19 beginning in 2010, may implement a care coordina20 tion services program in accordance with the provi21 sions of this section under which, in appropriate cir22 cumstances, eligible individuals under section 2201 

23 may elect to have health care services covered under 

24 this title managed and coordinated by a designated 

25 care coordinator. 


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1 ‘‘(2) ADMINISTRATION BY CONTRACT.—The 

2 Secretary may administer the program under this 

3 section through a contract with an appropriate pro4 gram administrator. 

5 ‘‘(3) COVERAGE.—Care coordination services 

6 furnished in accordance with this section shall be 

7 treated under this title as if they were included in 

8 the definition of medical and other health services 

9 under section 1861(s) and benefits shall be available 

10 under this title with respect to such services without 

11 the application of any deductible or coinsurance. 

12 ‘‘(b) ELIGIBILITY CRITERIA; IDENTIFICATION AND

13 NOTIFICATION OF ELIGIBLE INDIVIDUALS.— 

14 ‘‘(1) INDIVIDUAL ELIGIBILITY CRITERIA.—The 

15 Secretary shall specify criteria to be used in making 

16 a determination as to whether an individual may ap17 propriately be enrolled in the care coordination serv18 ices program under this section, which shall include 

19 at least a finding by the Secretary that for cohorts 

20 of individuals with characteristics identified by the 

21 Secretary, professional management and coordina22 tion of care can reasonably be expected to improve 

23 processes or outcomes of health care and to reduce 

24 aggregate costs to the programs under this title. 


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1 ‘‘(2) PROCEDURES TO FACILITATE ENROLL2 MENT.—The Secretary shall develop and implement 

3 procedures designed to facilitate enrollment of eligi4 ble individuals in the program under this section. 

5 ‘‘(c) ENROLLMENT OF INDIVIDUALS.— 

6 ‘‘(1) SECRETARY’S DETERMINATION OF ELIGI7 BILITY.—The Secretary shall determine the eligi8 bility for services under this section of individuals 

9 who are enrolled in the program under this section 

10 and who make application for such services in such 

11 form and manner as the Secretary may prescribe. 

12 ‘‘(2) ENROLLMENT PERIOD.— 

13 ‘‘(A) EFFECTIVE DATE AND DURATION.— 

14 Enrollment of an individual in the program 

15 under this section shall be effective as of the 

16 first day of the month following the month in 

17 which the Secretary approves the individual’s 

18 application under paragraph (1), shall remain 

19 in effect for one month (or such longer period 

20 as the Secretary may specify), and shall be 

21 automatically renewed for additional periods, 

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1 vidual to disenroll for cause at any time and 

2 without cause at re-enrollment intervals. 

3 ‘‘(B) LIMITATION ON REENROLLMENT.— 

4 The Secretary may establish limits on an indi5 vidual’s eligibility to reenroll in the program 

6 under this section if the individual has 

7 disenrolled from the program more than once 

8 during a specified time period. 

9 ‘‘(d) PROGRAM.—The care coordination services pro10 gram under this section shall include the following ele11 ments: 

12 ‘‘(1) BASIC CARE COORDINATION SERVICES.— 

13 ‘‘(A) IN GENERAL.—Subject to the cost-ef14 fectiveness criteria specified in subsection 

15 (b)(1), except as otherwise provided in this sec16 tion, enrolled individuals shall receive services 

17 described in section 1905(t)(1) and may receive 

18 additional items and services as described in 

19 subparagraph (B). 

20 ‘‘(B) ADDITIONAL BENEFITS.—The Sec21 retary may specify additional benefits for which 

22 payment would not otherwise be made under 

23 this title that may be available to individuals 

24 enrolled in the program under this section (sub25 ject to an assessment by the care coordinator of 


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1 an individual’s circumstance and need for such 

2 benefits) in order to encourage enrollment in, or 

3 to improve the effectiveness of, such program. 

4 ‘‘(2) CARE COORDINATION REQUIREMENT.— 

5 Notwithstanding any other provision of this title, the 

6 Secretary may provide that an individual enrolled in 

7 the program under this section may be entitled to 

8 payment under this title for any specified health 

9 care items or services only if the items or services 

10 have been furnished by the care coordinator, or co11 ordinated through the care coordination services pro12 gram. Under such provision, the Secretary shall pre13 scribe exceptions for emergency medical services as 

14 described in section 1852(d)(3), and other excep15 tions determined by the Secretary for the delivery of 

16 timely and needed care. 

17 ‘‘(e) CARE COORDINATORS.— 

18 ‘‘(1) CONDITIONS OF PARTICIPATION.—In order 

19 to be qualified to furnish care coordination services 

20 under this section, an individual or entity shall— 

21 ‘‘(A) be a health care professional or entity 

22 (which may include physicians, physician group 

23 practices, or other health care professionals or 

24 entities the Secretary may find appropriate) 


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1 meeting such conditions as the Secretary may 

2 specify; 

3 ‘‘(B) have entered into a care coordination 

4 agreement; and 

5 ‘‘(C) meet such criteria as the Secretary 

6 may establish (which may include experience in 

7 the provision of care coordination or primary 

8 care physician’s services). 

9 ‘‘(2) AGREEMENT TERM; PAYMENT.— 

10 ‘‘(A) DURATION AND RENEWAL.—A care 

11 coordination agreement under this subsection 

12 shall be for one year and may be renewed if the 

13 Secretary is satisfied that the care coordinator 

14 continues to meet the conditions of participa15 tion specified in paragraph (1). 

16 ‘‘(B) PAYMENT FOR SERVICES.—The Sec17 retary may negotiate or otherwise establish pay18 ment terms and rates for services described in 

19 subsection (d)(1). 

20 ‘‘(C) LIABILITY.—Care coordinators shall 

21 be subject to liability for actual health damages 

22 which may be suffered by recipients as a result 

23 of the care coordinator’s decisions, failure or 

24 delay in making decisions, or other actions as 

25 a care coordinator. 


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1 ‘‘(D) TERMS.—In addition to such other 

2 terms as the Secretary may require, an agree3 ment under this section shall include the terms 

4 specified in subparagraphs (A) through (C) of 

5 section 1905(t)(3). 

6 ‘‘SEC. 2207. ADMINISTRATION AND MISCELLANEOUS. 

7 ‘‘(a) IN GENERAL.—Except as otherwise provided in 

8 this title— 

9 ‘‘(1) the Secretary shall enter into appropriate 

10 contracts with providers of services, other health 

11 care providers, carriers, and fiscal intermediaries, 

12 taking into account the types of contracts used 

13 under title XVIII with respect to such entities, to 

14 administer the program under this title; 

15 ‘‘(2) beneficiary protections for individuals en16 rolled under this title shall not be less than the ben17 eficiary protections (including limits on balance bill18 ing) provided medicare beneficiaries under title 

19 XVIII; 

20 ‘‘(3) benefits described in section 2202 that are 

21 payable under this title to such individuals shall be 

22 paid in a manner specified by the Secretary (taking 

23 into account, and based to the greatest extent prac24 ticable upon, the manner in which they are provided 

25 under title XVIII); and 


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1 ‘‘(4) provider participation agreements under 

2 title XVIII shall apply to enrollees and benefits 

3 under this title in the same manner as they apply 

4 to enrollees and benefits under title XVIII. 

5 ‘‘(b) COORDINATION WITH MEDICAID AND

6 SCHIP.—Notwithstanding any other provision of law, in7 dividuals entitled to benefits for items and services under 

8 this title who also qualify for benefits under title XIX or 

9 XXI or any other Federally funded health care program 

10 that provides basic health insurance coverage described in 

11 section 2203(a)(2) may continue to qualify and obtain 

12 benefits under such other title or program, and in such 

13 case such an individual shall elect either— 

14 ‘‘(1) such other title or program to be primary 

15 payor to benefits under this title, in which case no 

16 benefits shall be payable under this title and the 

17 monthly premium under section 2203 shall be zero; 

18 or 

19 ‘‘(2) benefits under this title shall be primary 

20 payor to benefits provided under such title or pro21 gram, in which case the Secretary shall enter into 

22 agreements with States as may be appropriate to 

23 provide that, in the case of such individuals, the ben24 efits under titles XIX and XXI or such other pro25 gram (including reduction of cost-sharing) are proVerDate Nov 24 2008 23:34 Jan 11, 2009 Jkt 079200 PO 00000 Frm 00027 Fmt 6652 Sfmt 6201 E:\BILLS\H194.IH H194

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1 vided on a ‘wrap-around’ basis to the benefits under 

2 this title.’’. 

3 (b) CONFORMING AMENDMENTS TO SOCIAL SECU4 RITY ACT PROVISIONS.— 

5 (1) Section 201(i)(1) of the Social Security Act 

6 (42 U.S.C. 401(i)(1)) is amended by striking ‘‘or the 

7 Federal Supplementary Medical Insurance Trust 

8 Fund’’ and inserting ‘‘the Federal Supplementary 

9 Medical Insurance Trust Fund, and the MediKids 

10 Trust Fund’’. 

11 (2) Section 201(g)(1)(A) of such Act (42 

12 U.S.C. 401(g)(1)(A)) is amended by striking ‘‘and 

13 the Federal Supplementary Medical Insurance Trust 

14 Fund established by title XVIII’’ and inserting ‘‘, 

15 the Federal Supplementary Medical Insurance Trust 

16 Fund, and the MediKids Trust Fund established by 

17 title XVIII’’. 

18 (c) MAINTENANCE OF MEDICAID ELIGIBILITY AND

19 BENEFITS FOR CHILDREN.— 

20 (1) IN GENERAL.—In order for a State to con21 tinue to be eligible for payments under section 

22 1903(a) of the Social Security Act (42 U.S.C. 

23 1396b(a))— 

24 (A) the State may not reduce standards of 

25 eligibility, or benefits, provided under its State 


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1 medicaid plan under title XIX of the Social Se2 curity Act or under its State child health plan 

3 under title XXI of such Act for individuals 

4 under 23 years of age below such standards of 

5 eligibility, and benefits, in effect on the date of 

6 the enactment of this Act; and 

7 (B) the State shall demonstrate to the sat8 isfaction of the Secretary of Health and Human 

9 Services that any savings in State expenditures 

10 under title XIX or XXI of the Social Security 

11 Act that results from children enrolling under 

12 title XXII of such Act shall be used in a man13 ner that improves services to beneficiaries 

14 under title XIX of such Act, such as through 

15 expansion of eligibility, improved nurse and 

16 nurse aide staffing and improved inspections of 

17 nursing facilities, and coverage of additional 

18 services. 

19 (2) MEDIKIDS AS PRIMARY PAYOR.—In apply20 ing title XIX of the Social Security Act, the 

21 MediKids program under title XXII of such Act 

22 shall be treated as a primary payor in cases in which 

23 the election described in section 2207(b)(2) of such 

24 Act, as added by subsection (a), has been made. 

25 (d) EXPANSION OF MEDPAC MEMBERSHIP TO 19.— 


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1 (1) IN GENERAL.—Section 1805(c) of the So2 cial Security Act (42 U.S.C. 1395b–6(c)) is amend3 ed— 

4 (A) in paragraph (1), by striking ‘‘17’’ and 

5 inserting ‘‘19’’; and 

6 (B) in paragraph (2)(B), by inserting ‘‘ex7 perts in children’s health,’’ after ‘‘other health 

8 professionals,’’. 

9 (2) INITIAL TERMS OF ADDITIONAL MEM10 BERS.— 

11 (A) IN GENERAL.—For purposes of stag12 gering the initial terms of members of the 

13 Medicare Payment Advisory Commission under 

14 section 1805(c)(3) of the Social Security Act 

15 (42 U.S.C. 1395b–6(c)(3)), the initial terms of 

16 the 2 additional members of the Commission 

17 provided for by the amendment under sub18 section (a)(1) are as follows: 

19 (i) One member shall be appointed for 

20 1 year. 

21 (ii) One member shall be appointed 

22 for 2 years. 

23 (B) COMMENCEMENT OF TERMS.—Such 

24 terms shall begin on January 1, 2009. 


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1 (3) DUTIES.—Section 1805(b)(1)(A) of such 

2 Act (42 U.S.C. 1395b–6(b)(1)(A)) is amended by in3 serting before the semicolon at the end the following: 

4 ‘‘and payment policies under title XXII’’. 

5 SEC. 103. MEDIKIDS PREMIUM. 

6 (a) GENERAL RULE.—Subchapter A of chapter 1 of 

7 the Internal Revenue Code of 1986 (relating to determina8 tion of tax liability) is amended by adding at the end the 

9 following new part: 

10 ‘‘PART VIII—MEDIKIDS PREMIUM 

‘‘Sec. 59B. MediKids premium. 

11 ‘‘SEC. 59B. MEDIKIDS PREMIUM. 

12 ‘‘(a) IMPOSITION OF TAX.—In the case of a taxpayer 

13 to whom this section applies, there is hereby imposed (in 

14 addition to any other tax imposed by this subtitle) a 

15 MediKids premium for the taxable year. 

16 ‘‘(b) INDIVIDUALS SUBJECT TO PREMIUM.— 

17 ‘‘(1) IN GENERAL.—This section shall apply to 

18 a taxpayer if a MediKid is a dependent of the tax19 payer for the taxable year. 

20 ‘‘(2) MEDIKID.—For purposes of this section, 

21 the term ‘MediKid’ means any individual enrolled in 

22 the MediKids program under title XXII of the Social 

23 Security Act. 


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1 ‘‘(c) AMOUNT OF PREMIUM.—For purposes of this 

2 section, the MediKids premium for a taxable year is the 

3 sum of the monthly premiums (for months in the taxable 

4 year) determined under section 2203 of the Social Secu5 rity Act with respect to each MediKid who is a dependent 

6 of the taxpayer for the taxable year. 

7 ‘‘(d) EXCEPTIONS BASED ON ADJUSTED GROSS IN8 COME.— 

9 ‘‘(1) EXEMPTION FOR VERY LOW-INCOME TAX10 PAYERS.— 

11 ‘‘(A) IN GENERAL.—No premium shall be 

12 imposed by this section on any taxpayer having 

13 an adjusted gross income not in excess of the 

14 exemption amount. 

15 ‘‘(B) EXEMPTION AMOUNT.—For purposes 

16 of this paragraph, the exemption amount is— 

17 ‘‘(i) $20,535 in the case of a taxpayer 

18 having 1 MediKid, 

19 ‘‘(ii) $25,755 in the case of a tax20 payer having 2 MediKids, 

21 ‘‘(iii) $30,975 in the case of a tax22 payer having 3 MediKids, and 

23 ‘‘(iv) $35,195 in the case of a tax24 payer having 4 or more MediKids. 


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1 ‘‘(C) PHASEOUT OF EXEMPTION.—In the 

2 case of a taxpayer having an adjusted gross in3 come which exceeds the exemption amount but 

4 does not exceed twice the exemption amount, 

5 the premium shall be the amount which bears 

6 the same ratio to the premium which would 

7 (but for this subparagraph) apply to the tax8 payer as such excess bears to the exemption 

9 amount. 

10 ‘‘(D) INFLATION ADJUSTMENT OF EXEMP11 TION AMOUNTS.—In the case of any taxable 

12 year beginning in a calendar year after 2008, 

13 each dollar amount contained in subparagraph 

14 (C) shall be increased by an amount equal to 

15 the product of— 

16 ‘‘(i) such dollar amount, and 

17 ‘‘(ii) the cost-of-living adjustment de18 termined under section 1(f)(3) for the cal19 endar year in which the taxable year be20 gins, determined by substituting ‘calendar 

21 year 2007’ for ‘calendar year 1992’ in sub22 paragraph (B) thereof. 

23 If any increase determined under the preceding 

24 sentence is not a multiple of $50, such increase 

25 shall be rounded to the nearest multiple of $50. 


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1 ‘‘(2) PREMIUM LIMITED TO 5 PERCENT OF AD2 JUSTED GROSS INCOME.—In no event shall any tax3 payer be required to pay a premium under this sec4 tion in excess of an amount equal to 5 percent of the 

5 taxpayer’s adjusted gross income. 

6 ‘‘(e) COORDINATION WITH OTHER PROVISIONS.— 

7 ‘‘(1) NOT TREATED AS MEDICAL EXPENSE.— 

8 For purposes of this chapter, any premium paid 

9 under this section shall not be treated as expense for 

10 medical care. 

11 ‘‘(2) NOT TREATED AS TAX FOR CERTAIN PUR12 POSES.—The premium paid under this section shall 

13 not be treated as a tax imposed by this chapter for 

14 purposes of determining— 

15 ‘‘(A) the amount of any credit allowable 

16 under this chapter, or 

17 ‘‘(B) the amount of the minimum tax im18 posed by section 55. 

19 ‘‘(3) TREATMENT UNDER SUBTITLE F.—For 

20 purposes of subtitle F, the premium paid under this 

21 section shall be treated as if it were a tax imposed 

22 by section 1.’’. 

23 (b) TECHNICAL AMENDMENTS.— 


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1 (1) Subsection (a) of section 6012 of such Code 

2 is amended by inserting after paragraph (9) the fol3 lowing new paragraph: 

4 ‘‘(10) Every individual liable for a premium 

5 under section 59B.’’. 

6 (2) The table of parts for subchapter A of chap7 ter 1 of such Code is amended by adding at the end 

8 the following new item: 

‘‘PART VIII. MEDIKIDS PREMIUM’’. 

9 (c) EFFECTIVE DATE.—The amendments made by 

10 this section shall apply to months beginning after Decem11 ber 2008, in taxable years ending after such date. 

12 SEC. 104. REFUNDABLE CREDIT FOR CERTAIN COST-SHAR13 ING EXPENSES UNDER MEDIKIDS PROGRAM. 

14 (a) IN GENERAL.—Subpart C of part IV of sub15 chapter A of chapter 1 of the Internal Revenue Code of 

16 1986 (relating to refundable credits) is amended by redes17 ignating section 37 as section 37A and by inserting after 

18 section 36 the following new section: 

19 ‘‘SEC. 37. CATASTROPHIC LIMIT ON COST-SHARING EX20 PENSES UNDER MEDIKIDS PROGRAM. 

21 ‘‘(a) IN GENERAL.—In the case of a taxpayer who 

22 has a MediKid (as defined in section 59B) at any time 

23 during the taxable year, there shall be allowed as a credit 

24 against the tax imposed by this subtitle an amount equal 

25 to the excess of— 


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1 ‘‘(1) the amount paid by the taxpayer during 

2 the taxable year as cost-sharing under section 

3 2202(b)(4) of the Social Security Act, over 

4 ‘‘(2) 5 percent of the taxpayer’s adjusted gross 

5 income for the taxable year. 

6 ‘‘(b) COORDINATION WITH OTHER PROVISIONS.— 

7 The excess described in subsection (a) shall not be taken 

8 into account in computing the amount allowable to the 

9 taxpayer as a deduction under section 162(l) or 213(a).’’. 

10 (b) TECHNICAL AMENDMENTS.— 

11 (1) The table of sections for subpart C of part 

12 IV of subchapter A of chapter 1 of such Code is 

13 amended by redesignating the item relating to sec14 tion 37 as an item relating to section 37A and by 

15 inserting before such item the following new item: 

‘‘Sec. 37. Catastrophic limit on cost-sharing expenses under MediKids program.’’. 

16 (2) Paragraph (2) of section 1324(b) of title 

17 31, United States Code, is amended by inserting ‘‘, 

18 37,’’ after ‘‘section 35’’. 

19 (c) EFFECTIVE DATE.—The amendments made by 

20 this section shall apply to taxable years beginning after 

21 December 31, 2009. 

22 SEC. 105. REPORT ON LONG-TERM REVENUES. 

23 Within one year after the date of the enactment of 

24 this Act, the Secretary of the Treasury shall propose a 


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1 gradual schedule of progressive tax changes to fund the 

2 program under title XXII of the Social Security Act, as 

3 the number of enrollees grows in the out-years. 

4 TITLE II—STRENGTHENING 

5 QUALITY OF CARE AND 

6 HEALTH OUTCOMES 

7 SEC. 201. CHILD HEALTH QUALITY IMPROVEMENT ACTIVI8 TIES FOR CHILDREN ENROLLED IN 

9 MEDIKIDS, MEDICAID, OR CHIP. 

10 (a) DEVELOPMENT OF CHILD HEALTH QUALITY

11 MEASURES FOR CHILDREN ENROLLED IN MEDIKIDS, 

12 MEDICAID, OR CHIP.—Title XI of the Social Security Act 

13 (42 U.S.C. 1301 et seq.) is amended by inserting after 

14 section 1139 the following new section: 

15 ‘‘SEC. 1139A. CHILD HEALTH QUALITY MEASURES. 

16 ‘‘(a) DEVELOPMENT OF AN INITIAL CORE SET OF

17 HEALTH CARE QUALITY MEASURES FOR CHILDREN EN18 ROLLED IN MEDIKIDS, MEDICAID, OR CHIP.— 

19 ‘‘(1) IN GENERAL.—Not later than January 1, 

20 2010, the Secretary shall identify and publish for 

21 general comment an initial, recommended core set of 

22 child health quality measures for use under title 

23 XXII, by State programs administered under titles 

24 XIX and XXI, health insurance issuers and man25 aged care entities that enter into contracts with such 


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1 programs, and providers of items and services under 

2 such programs. 

3 ‘‘(2) IDENTIFICATION OF INITIAL CORE MEAS4 URES.—In consultation with the individuals and en5 tities described in subsection (b)(3), the Secretary 

6 shall identify existing quality of care measures for 

7 children that are in use under public and privately 

8 sponsored health care coverage arrangements, or 

9 that are part of reporting systems that measure both 

10 the presence and duration of health insurance cov11 erage over time. 

12 ‘‘(3) RECOMMENDATIONS AND DISSEMINA13 TION.—Based on such existing and identified meas14 ures, the Secretary shall publish an initial core set 

15 of child health quality measures that includes (but 

16 is not limited to) the following: 

17 ‘‘(A) The duration of children’s health in18 surance coverage over a 12-month time period. 

19 ‘‘(B) The availability and effectiveness of a 

20 full range of— 

21 ‘‘(i) preventive services, treatments, 

22 and services for acute conditions, including 

23 services to promote healthy birth, prevent 

24 and treat premature birth, and detect the 

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1 ditions that could adversely affect growth 

2 and development; and 

3 ‘‘(ii) treatments to correct or amelio4 rate the effects of physical and mental con5 ditions, including chronic conditions, in in6 fants, young children, school-age children, 

7 and adolescents. 

8 ‘‘(C) The availability of care in a range of 

9 ambulatory and inpatient health care settings 

10 in which such care is furnished. 

11 ‘‘(D) The types of measures that, taken to12 gether, can be used to estimate the overall na13 tional quality of health care for children, includ14 ing children with special needs, and to perform 

15 comparative analyses of pediatric health care 

16 quality and racial, ethnic, and socioeconomic 

17 disparities in child health and health care for 

18 children. 

19 ‘‘(4) ENCOURAGE VOLUNTARY AND STANDARD20 IZED REPORTING.—Not later than 2 years after the 

21 date of this section, the Secretary, in consultation 

22 with States, shall develop a standardized format for 

23 reporting information and procedures and ap24 proaches that encourage States to use the initial 

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1 tion regarding the quality of pediatric health care 

2 under titles XIX and XXI and for the reporting of 

3 such standardized reporting under title XXII. 

4 ‘‘(5) ADOPTION OF BEST PRACTICES IN IMPLE5 MENTING QUALITY PROGRAMS.—The Secretary shall 

6 disseminate information to States regarding best 

7 practices among States with respect to measuring 

8 and reporting on the quality of health care for chil9 dren, and shall facilitate the adoption of such best 

10 practices. In developing best practices approaches, 

11 the Secretary shall give particular attention to State 

12 measurement techniques that ensure the timeliness 

13 and accuracy of provider reporting, encourage pro14 vider reporting compliance, encourage successful 

15 quality improvement strategies, and improve effi16 ciency in data collection using health information 

17 technology. 

18 ‘‘(6) REPORTS TO CONGRESS.—Not later than 

19 January 1, 2011, and every 3 years thereafter, the 

20 Secretary shall report to Congress on— 

21 ‘‘(A) the status of the Secretary’s efforts 

22 to improve— 

23 ‘‘(i) quality related to the duration 

24 and stability of health insurance coverage 


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1 for children under titles XIX, XXI, and 

2 XXII; 

3 ‘‘(ii) the quality of children’s health 

4 care under such titles, including preventive 

5 health services, health care for acute condi6 tions, chronic health care, and health serv7 ices to ameliorate the effects of physical 

8 and mental conditions and to aid in growth 

9 and development of infants, young chil10 dren, school-age children, and adolescents 

11 with special health care needs; and 

12 ‘‘(iii) the quality of children’s health 

13 care under such titles across the domains 

14 of quality, including clinical quality, health 

15 care safety, family experience with health 

16 care, health care in the most integrated 

17 setting, and elimination of racial, ethnic, 

18 and socioeconomic disparities in health and 

19 health care; 

20 ‘‘(B) the status of voluntary reporting by 

21 States under titles XIX and XXI, and reporting 

22 by the Secretary under title XXII, utilizing the 

23 initial core quality measurement set; and 

24 ‘‘(C) any recommendations for legislative 

25 changes needed to improve the quality of care 


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1 provided to children under titles XIX, XXI, and 

2 XXII, including recommendations for quality 

3 reporting by States. 

4 ‘‘(7) TECHNICAL ASSISTANCE.—The Secretary 

5 shall provide technical assistance to States to assist 

6 them in adopting and utilizing core child health 

7 quality measures in administering the State plans 

8 under titles XIX and XXI. 

9 ‘‘(8) DEFINITION OF CORE SET.—In this sec10 tion, the term ‘core set’ means a group of valid, reli11 able, and evidence-based quality measures that, 

12 taken together— 

13 ‘‘(A) provide information regarding the 

14 quality of health coverage and health care for 

15 children; 

16 ‘‘(B) address the needs of children 

17 throughout the developmental age span; and 

18 ‘‘(C) allow purchasers, families, and health 

19 care providers to understand the quality of care 

20 in relation to the preventive needs of children, 

21 treatments aimed at managing and resolving 

22 acute conditions, and diagnostic and treatment 

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1 tions that could, if untreated or poorly treated, 

2 become chronic. 

3 ‘‘(b) ADVANCING AND IMPROVING PEDIATRIC QUAL4 ITY MEASURES.— 

5 ‘‘(1) ESTABLISHMENT OF PEDIATRIC QUALITY

6 MEASURES PROGRAM.—Not later than January 1, 

7 2011, the Secretary shall establish a pediatric qual8 ity measures program to— 

9 ‘‘(A) improve and strengthen the initial 

10 core child health care quality measures estab11 lished by the Secretary under subsection (a); 

12 ‘‘(B) expand on existing pediatric quality 

13 measures used by public and private health care 

14 purchasers and advance the development of 

15 such new and emerging quality measures; and 

16 ‘‘(C) increase the portfolio of evidence17 based, consensus pediatric quality measures 

18 available to public and private purchasers of 

19 children’s health care services, providers, and 

20 consumers. 

21 ‘‘(2) EVIDENCE-BASED MEASURES.—The meas22 ures developed under the pediatric quality measures 

23 program shall, at a minimum, be— 

24 ‘‘(A) evidence-based and, where appro25 priate, risk adjusted; 


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1 ‘‘(B) designed to identify and eliminate ra2 cial and ethnic disparities in child health and 

3 the provision of health care; 

4 ‘‘(C) designed to ensure that the data re5 quired for such measures is collected and re6 ported in a standard format that permits com7 parison of quality and data at a State, plan, 

8 and provider level; 

9 ‘‘(D) periodically updated; and 

10 ‘‘(E) responsive to the child health needs, 

11 services, and domains of health care quality de12 scribed in clauses (i), (ii), and (iii) of subsection 

13 (a)(6)(A). 

14 ‘‘(3) PROCESS FOR PEDIATRIC QUALITY MEAS15 URES PROGRAM.—In identifying gaps in existing pe16 diatric quality measures and establishing priorities 

17 for development and advancement of such measures, 

18 the Secretary shall consult with— 

19 ‘‘(A) States; 

20 ‘‘(B) pediatricians, children’s hospitals, 

21 and other primary and specialized pediatric 

22 health care professionals (including members of 

23 the allied health professions) who specialize in 

24 the care and treatment of children, particularly 


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1 children with special physical, mental, and de2 velopmental health care needs; 

3 ‘‘(C) dental professionals, including pedi4 atric dental professionals; 

5 ‘‘(D) health care providers that furnish 

6 primary health care to children and families 

7 who live in urban and rural medically under8 served communities or who are members of dis9 tinct population sub-groups at heightened risk 

10 for poor health outcomes; 

11 ‘‘(E) national organizations representing 

12 children, including children with disabilities and 

13 children with chronic conditions; 

14 ‘‘(F) national organizations representing 

15 consumers and purchasers of children’s health 

16 care; 

17 ‘‘(G) national organizations and individuals 

18 with expertise in pediatric health quality meas19 urement; and 

20 ‘‘(H) voluntary consensus standards set21 ting organizations and other organizations in22 volved in the advancement of evidence-based 

23 measures of health care. 

24 ‘‘(4) DEVELOPING, VALIDATING, AND TESTING

25 A PORTFOLIO OF PEDIATRIC QUALITY MEASURES.— 


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1 As part of the program to advance pediatric quality 

2 measures, the Secretary shall— 

3 ‘‘(A) award grants and contracts for the 

4 development, testing, and validation of new, 

5 emerging, and innovative evidence-based meas6 ures for children’s health care services across 

7 the domains of quality described in clauses (i), 

8 (ii), and (iii) of subsection (a)(6)(A); and 

9 ‘‘(B) award grants and contracts for— 

10 ‘‘(i) the development of consensus on 

11 evidence-based measures for children’s 

12 health care services; 

13 ‘‘(ii) the dissemination of such meas14 ures to public and private purchasers of 

15 health care for children; and 

16 ‘‘(iii) the updating of such measures 

17 as necessary. 

18 ‘‘(5) REVISING, STRENGTHENING, AND IMPROV19 ING INITIAL CORE MEASURES.—Beginning no later 

20 than January 1, 2013, and annually thereafter, the 

21 Secretary shall publish recommended changes to the 

22 core measures described in subsection (a) that shall 

23 reflect the testing, validation, and consensus process 

24 for the development of pediatric quality measures 

25 described in subsection paragraphs (1) through (4). 


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1 ‘‘(6) DEFINITION OF PEDIATRIC QUALITY

2 MEASURE.—In this subsection, the term ‘pediatric 

3 quality measure’ means a measurement of clinical 

4 care that is capable of being examined through the 

5 collection and analysis of relevant information, that 

6 is developed in order to assess 1 or more aspects of 

7 pediatric health care quality in various institutional 

8 and ambulatory health care settings, including the 

9 structure of the clinical care system, the process of 

10 care, the outcome of care, or patient experiences in 

11 care. 

12 ‘‘(7) CONSTRUCTION.—Nothing in this section 

13 shall be construed as supporting the restriction of 

14 coverage, under title XIX, XXI, or XXII or other15 wise, to only those services that are evidence-based. 

16 ‘‘(c) ANNUAL STATE REPORTS REGARDING STATE17 SPECIFIC QUALITY OF CARE MEASURES APPLIED UNDER

18 MEDICAID OR CHIP.— 

19 ‘‘(1) ANNUAL STATE REPORTS.—Each State 

20 with a State plan approved under title XIX or a 

21 State child health plan approved under title XXI 

22 shall annually report to the Secretary on the— 

23 ‘‘(A) State-specific child health quality 

24 measures applied by the States under such 


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1 plans, including measures described in subpara2 graphs (A) and (B) of subsection (a)(6); and 

3 ‘‘(B) State-specific information on the 

4 quality of health care furnished to children 

5 under such plans, including information col6 lected through external quality reviews of man7 aged care organizations under section 1932 of 

8 the Social Security Act (42 U.S.C. 1396u–4) 

9 and benchmark plans under sections 1937 and 

10 2103 of such Act (42 U.S.C. 1396u–7, 1397cc). 

11 The Secretary shall collect such information with re12 spect to children under title XXII. 

13 ‘‘(2) PUBLICATION.—Not later than September 

14 30, 2010, and annually thereafter, the Secretary 

15 shall collect, analyze, and make publicly available the 

16 information reported by States under paragraph (1) 

17 or collected by the Secretary under such paragraph. 

18 ‘‘(d) DEMONSTRATION PROJECTS FOR IMPROVING

19 THE QUALITY OF CHILDREN’S HEALTH CARE AND THE

20 USE OF HEALTH INFORMATION TECHNOLOGY.— 

21 ‘‘(1) IN GENERAL.—During the period of fiscal 

22 years 2009 through 2013, the Secretary shall award 

23 not more than 10 grants to States and child health 

24 providers to conduct demonstration projects to 

25 evaluate promising ideas for improving the quality of 


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1 children’s health care provided under title XIX, 

2 XXI, or XXII, including projects to— 

3 ‘‘(A) experiment with, and evaluate the use 

4 of, new measures of the quality of children’s 

5 health care under such titles (including testing 

6 the validity and suitability for reporting of such 

7 measures); 

8 ‘‘(B) promote the use of health information 

9 technology in care delivery for children under 

10 such titles; 

11 ‘‘(C) evaluate provider-based models which 

12 improve the delivery of children’s health care 

13 services under such titles, including care man14 agement for children with chronic conditions 

15 and the use of evidence-based approaches to im16 prove the effectiveness, safety, and efficiency of 

17 health care services for children; or 

18 ‘‘(D) demonstrate the impact of the model 

19 electronic health record format for children de20 veloped and disseminated under subsection (f) 

21 on improving pediatric health, including the ef22 fects of chronic childhood health conditions, and 

23 pediatric health care quality as well as reducing 

24 health care costs. 


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1 ‘‘(2) REQUIREMENTS.—In awarding grants 

2 under this subsection, the Secretary shall ensure 

3 that— 

4 ‘‘(A) only 1 demonstration project funded 

5 under a grant awarded under this subsection 

6 shall be conducted in a State; and 

7 ‘‘(B) demonstration projects funded under 

8 grants awarded under this subsection shall be 

9 conducted evenly between States with large 

10 urban areas and States with large rural areas. 

11 ‘‘(3) AUTHORITY FOR MULTISTATE

12 PROJECTS.—A demonstration project conducted with 

13 a grant awarded under this subsection may be con14 ducted on a multistate basis, as needed. 

15 ‘‘(4) FUNDING.—$20,000,000 of the amount 

16 appropriated under subsection (i) for a fiscal year 

17 shall be used to carry out this subsection. 

18 ‘‘(e) CHILDHOOD OBESITY DEMONSTRATION

19 PROJECT.— 

20 ‘‘(1) AUTHORITY TO CONDUCT DEMONSTRA21 TION.—The Secretary, in consultation with the Ad22 ministrator of the Centers for Medicare & Medicaid 

23 Services, shall conduct a demonstration project to 

24 develop a comprehensive and systematic model for 

25 reducing childhood obesity by awarding grants to eliVerDate Nov 24 2008 23:34 Jan 11, 2009 Jkt 079200 PO 00000 Frm 00050 Fmt 6652 Sfmt 6201 E:\BILLS\H194.IH H194

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1 gible entities to carry out such project. Such model 

2 shall— 

3 ‘‘(A) identify, through self-assessment, be4 havioral risk factors for obesity among children; 

5 ‘‘(B) identify, through self-assessment, 

6 needed clinical preventive and screening benefits 

7 among those children identified as target indi8 viduals on the basis of such risk factors; 

9 ‘‘(C) provide ongoing support to such tar10 get individuals and their families to reduce risk 

11 factors and promote the appropriate use of pre12 ventive and screening benefits; and 

13 ‘‘(D) be designed to improve health out14 comes, satisfaction, quality of life, and appro15 priate use of items and services for which med16 ical assistance is available under title XIX, 

17 child health assistance is available under title 

18 XXI, or benefits are available under title XXII 

19 among such target individuals. 

20 ‘‘(2) ELIGIBILITY ENTITIES.—For purposes of 

21 this subsection, an eligible entity is any of the fol22 lowing: 

23 ‘‘(A) A city, county, or Indian tribe. 

24 ‘‘(B) A local or tribal educational agency. 


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1 ‘‘(C) An accredited university, college, or 

2 community college. 

3 ‘‘(D) A Federally-qualified health center. 

4 ‘‘(E) A local health department. 

5 ‘‘(F) A health care provider. 

6 ‘‘(G) A community-based organization. 

7 ‘‘(H) Any other entity determined appro8 priate by the Secretary, including a consortia or 

9 partnership of entities described in any of sub10 paragraphs (A) through (G). 

11 ‘‘(3) USE OF FUNDS.—An eligible entity award12 ed a grant under this subsection shall use the funds 

13 made available under the grant to— 

14 ‘‘(A) carry out community-based activities 

15 related to reducing childhood obesity, including 

16 by— 

17 ‘‘(i) forming partnerships with enti18 ties, including schools and other facilities 

19 providing recreational services, to establish 

20 programs for after school and weekend 

21 community activities that are designed to 

22 reduce childhood obesity; 

23 ‘‘(ii) forming partnerships with 

24 daycare facilities to establish programs 


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1 that promote healthy eating behaviors and 

2 physical activity; and 

3 ‘‘(iii) developing and evaluating com4 munity educational activities targeting 

5 good nutrition and promoting healthy eat6 ing behaviors; 

7 ‘‘(B) carry out age-appropriate school8 based activities that are designed to reduce 

9 childhood obesity, including by— 

10 ‘‘(i) developing and testing edu11 cational curricula and intervention pro12 grams designed to promote healthy eating 

13 behaviors and habits in youth, which may 

14 include— 

15 ‘‘(I) after hours physical activity 

16 programs; and 

17 ‘‘(II) science-based interventions 

18 with multiple components to prevent 

19 eating disorders including nutritional 

20 content, understanding and respond21 ing to hunger and satiety, positive 

22 body image development, positive self23 esteem development, and learning life 

24 skills (such as stress management, 

25 communication skills, problemsolving 


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1 and decisionmaking skills), as well as 

2 consideration of cultural and develop3 mental issues, and the role of family, 

4 school, and community; 

5 ‘‘(ii) providing education and training 

6 to educational professionals regarding how 

7 to promote a healthy lifestyle and a 

8 healthy school environment for children; 

9 ‘‘(iii) planning and implementing a 

10 healthy lifestyle curriculum or program 

11 with an emphasis on healthy eating behav12 iors and physical activity; and 

13 ‘‘(iv) planning and implementing 

14 healthy lifestyle classes or programs for 

15 parents or guardians, with an emphasis on 

16 healthy eating behaviors and physical ac17 tivity for children; 

18 ‘‘(C) carry out educational, counseling, 

19 promotional, and training activities through the 

20 local health care delivery systems including 

21 by— 

22 ‘‘(i) promoting healthy eating behav23 iors and physical activity services to treat 

24 or prevent eating disorders, being over25 weight, and obesity; 


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1 ‘‘(ii) providing patient education and 

2 counseling to increase physical activity and 

3 promote healthy eating behaviors; 

4 ‘‘(iii) training health professionals on 

5 how to identify and treat obese and over6 weight individuals which may include nu7 trition and physical activity counseling; 

8 and 

9 ‘‘(iv) providing community education 

10 by a health professional on good nutrition 

11 and physical activity to develop a better 

12 understanding of the relationship between 

13 diet, physical activity, and eating disorders, 

14 obesity, or being overweight; and 

15 ‘‘(D) provide, through qualified health pro16 fessionals, training and supervision for commu17 nity health workers to— 

18 ‘‘(i) educate families regarding the re19 lationship between nutrition, eating habits, 

20 physical activity, and obesity; 

21 ‘‘(ii) educate families about effective 

22 strategies to improve nutrition, establish 

23 healthy eating patterns, and establish ap24 propriate levels of physical activity; and 


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1 ‘‘(iii) educate and guide parents re2 garding the ability to model and commu3 nicate positive health behaviors. 

4 ‘‘(4) PRIORITY.—In awarding grants under 

5 paragraph (1), the Secretary shall give priority to 

6 awarding grants to eligible entities— 

7 ‘‘(A) that demonstrate that they have pre8 viously applied successfully for funds to carry 

9 out activities that seek to promote individual 

10 and community health and to prevent the inci11 dence of chronic disease and that can cite pub12 lished and peer-reviewed research dem13 onstrating that the activities that the entities 

14 propose to carry out with funds made available 

15 under the grant are effective; 

16 ‘‘(B) that will carry out programs or ac17 tivities that seek to accomplish a goal or goals 

18 set by the State in the Healthy People 2010 

19 plan of the State; 

20 ‘‘(C) that provide non-Federal contribu21 tions, either in cash or in-kind, to the costs of 

22 funding activities under the grants; 

23 ‘‘(D) that develop comprehensive plans 

24 that include a strategy for extending program 

25 activities developed under grants in the years 


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1 following the fiscal years for which they receive 

2 grants under this subsection; 

3 ‘‘(E) located in communities that are medi4 cally underserved, as determined by the Sec5 retary; 

6 ‘‘(F) located in areas in which the average 

7 poverty rate is at least 150 percent or higher of 

8 the average poverty rate in the State involved, 

9 as determined by the Secretary; and 

10 ‘‘(G) that submit plans that exhibit multi11 sectoral, cooperative conduct that includes the 

12 involvement of a broad range of stakeholders, 

13 including— 

14 ‘‘(i) community-based organizations; 

15 ‘‘(ii) local governments; 

16 ‘‘(iii) local educational agencies; 

17 ‘‘(iv) the private sector; 

18 ‘‘(v) State or local departments of 

19 health; 

20 ‘‘(vi) accredited colleges, universities, 

21 and community colleges; 

22 ‘‘(vii) health care providers; 

23 ‘‘(viii) State and local departments of 

24 transportation and city planning; and 


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1 ‘‘(ix) other entities determined appro2 priate by the Secretary. 

3 ‘‘(5) PROGRAM DESIGN.— 

4 ‘‘(A) INITIAL DESIGN.—Not later than 1 

5 year after the date of enactment of this section, 

6 the Secretary shall design the demonstration 

7 project. The demonstration should draw upon 

8 promising, innovative models and incentives to 

9 reduce behavioral risk factors. The Adminis10 trator of the Centers for Medicare & Medicaid 

11 Services shall consult with the Director of the 

12 Centers for Disease Control and Prevention, the 

13 Director of the Office of Minority Health, the 

14 heads of other agencies in the Department of 

15 Health and Human Services, and such profes16 sional organizations, as the Secretary deter17 mines to be appropriate, on the design, conduct, 

18 and evaluation of the demonstration. 

19 ‘‘(B) NUMBER AND PROJECT AREAS.—Not 

20 later than 2 years after the date of enactment 

21 of this section, the Secretary shall award 1 

22 grant that is specifically designed to determine 

23 whether programs similar to programs to be 

24 conducted by other grantees under this sub25 section should be implemented with respect to 


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1 the general population of children who are eligi2 ble for child health assistance under State child 

3 health plans under title XXI or for benefits 

4 under title XXII in order to reduce the inci5 dence of childhood obesity among such popu6 lation. 

7 ‘‘(6) REPORT TO CONGRESS.—Not later than 3 

8 years after the date the Secretary implements the 

9 demonstration project under this subsection, the 

10 Secretary shall submit to Congress a report that de11 scribes the project, evaluates the effectiveness and 

12 cost effectiveness of the project, evaluates the bene13 ficiary satisfaction under the project, and includes 

14 any such other information as the Secretary deter15 mines to be appropriate. 

16 ‘‘(7) DEFINITIONS.—In this subsection: 

17 ‘‘(A) FEDERALLY-QUALIFIED HEALTH

18 CENTER.—The term ‘Federally-qualified health 

19 center’ has the meaning given that term in sec20 tion 1905(l)(2)(B). 

21 ‘‘(B) INDIAN TRIBE.—The term ‘Indian 

22 tribe’ has the meaning given that term in sec23 tion 4 of the Indian Health Care Improvement 

24 Act (25 U.S.C. 1603). 


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1 ‘‘(C) SELF-ASSESSMENT.—The term ‘self2 assessment’ means a form that— 

3 ‘‘(i) includes questions regarding— 

4 ‘‘(I) behavioral risk factors; 

5 ‘‘(II) needed preventive and 

6 screening services; and 

7 ‘‘(III) target individuals’ pref8 erences for receiving follow-up infor9 mation; 

10 ‘‘(ii) is assessed using such computer 

11 generated assessment programs; and 

12 ‘‘(iii) allows for the provision of such 

13 ongoing support to the individual as the 

14 Secretary determines appropriate. 

15 ‘‘(D) ONGOING SUPPORT.—The term ‘on16 going support’ means— 

17 ‘‘(i) to provide any target individual 

18 with information, feedback, health coach19 ing, and recommendations regarding— 

20 ‘‘(I) the results of a self-assess21 ment given to the individual; 

22 ‘‘(II) behavior modification based 

23 on the self-assessment; and 

24 ‘‘(III) any need for clinical pre25 ventive and screening services or 


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1 treatment including medical nutrition 

2 therapy; 

3 ‘‘(ii) to provide any target individual 

4 with referrals to community resources and 

5 programs available to assist the target in6 dividual in reducing health risks; and 

7 ‘‘(iii) to provide the information de8 scribed in clause (i) to a health care pro9 vider, if designated by the target individual 

10 to receive such information. 

11 ‘‘(8) AUTHORIZATION OF APPROPRIATIONS.— 

12 There is authorized to be appropriated to carry out 

13 this subsection, $25,000,000 for the period of fiscal 

14 years 2009 through 2013. 

15 ‘‘(f) DEVELOPMENT OF MODEL ELECTRONIC

16 HEALTH RECORD FORMAT FOR CHILDREN ENROLLED IN

17 MEDICAID OR CHIP.— 

18 ‘‘(1) IN GENERAL.—Not later than January 1, 

19 2010, the Secretary shall establish a program to en20 courage the development and dissemination of a 

21 model electronic health record format for children 

22 enrolled in the State plan under title XIX, the State 

23 child health plan under title XXI, or the MediKids 

24 program under title XXII that is— 


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1 ‘‘(A) subject to State laws, accessible to 

2 parents, caregivers, and other consumers for 

3 the sole purpose of demonstrating compliance 

4 with school or leisure activity requirements, 

5 such as appropriate immunizations or physicals; 

6 ‘‘(B) designed to allow interoperable ex7 changes that conform with Federal and State 

8 privacy and security requirements; 

9 ‘‘(C) structured in a manner that permits 

10 parents and caregivers to view and understand 

11 the extent to which the care their children re12 ceive is clinically appropriate and of high qual13 ity; and 

14 ‘‘(D) capable of being incorporated into, 

15 and otherwise compatible with, other standards 

16 developed for electronic health records. 

17 ‘‘(2) FUNDING.—$5,000,000 of the amount ap18 propriated under subsection (i) for a fiscal year shall 

19 be used to carry out this subsection. 

20 ‘‘(g) STUDY OF PEDIATRIC HEALTH AND HEALTH

21 CARE QUALITY MEASURES.— 

22 ‘‘(1) IN GENERAL.—Not later than July 1, 

23 2010, the Institute of Medicine shall study and re24 port to Congress on the extent and quality of efforts 

25 to measure child health status and the quality of 


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1 health care for children across the age span and in 

2 relation to preventive care, treatments for acute con3 ditions, and treatments aimed at ameliorating or 

4 correcting physical, mental, and developmental con5 ditions in children. In conducting such study and 

6 preparing such report, the Institute of Medicine 

7 shall— 

8 ‘‘(A) consider all of the major national 

9 population-based reporting systems sponsored 

10 by the Federal Government that are currently 

11 in place, including reporting requirements 

12 under Federal grant programs and national 

13 population surveys and estimates conducted di14 rectly by the Federal Government; 

15 ‘‘(B) identify the information regarding 

16 child health and health care quality that each 

17 system is designed to capture and generate, the 

18 study and reporting periods covered by each 

19 system, and the extent to which the information 

20 so generated is made widely available through 

21 publication; 

22 ‘‘(C) identify gaps in knowledge related to 

23 children’s health status, health disparities 

24 among subgroups of children, the effects of so25 cial conditions on children’s health status and 


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1 use and effectiveness of health care, and the re2 lationship between child health status and fam3 ily income, family stability and preservation, 

4 and children’s school readiness and educational 

5 achievement and attainment; and 

6 ‘‘(D) make recommendations regarding im7 proving and strengthening the timeliness, qual8 ity, and public transparency and accessibility of 

9 information about child health and health care 

10 quality. 

11 ‘‘(2) FUNDING.—Up to $1,000,000 of the 

12 amount appropriated under subsection (i) for a fis13 cal year shall be used to carry out this subsection. 

14 ‘‘(h) RULE OF CONSTRUCTION.—Notwithstanding 

15 any other provision in this section, no evidence based qual16 ity measure developed, published, or used as a basis of 

17 measurement or reporting under this section may be used 

18 to establish an irrebuttable presumption regarding either 

19 the medical necessity of care or the maximum permissible 

20 coverage for any individual child who is eligible for and 

21 receiving medical assistance under title XIX, child health 

22 assistance under title XXI, or benefits under title XXII. 

23 ‘‘(i) APPROPRIATION.—Out of any funds in the 

24 Treasury not otherwise appropriated, there is appro25 priated for each of fiscal years 2009 through 2013, 


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1 $45,000,000 for the purpose of carrying out this section 

2 (other than subsection (e)). Funds appropriated under 

3 this subsection shall remain available until expended.’’. 

4 (b) INCREASED MATCHING RATE FOR COLLECTING

5 AND REPORTING ON CHILD HEALTH MEASURES.—Sec6 tion 1903(a)(3)(A) of the Social Security Act (42 U.S.C. 

7 1396b(a)(3)(A)) is amended— 

8 (1) by striking ‘‘and’’ at the end of clause (i); 

9 and 

10 (2) by adding at the end the following new 

11 clause: 

12 ‘‘(iii) an amount equal to the Federal med13 ical assistance percentage (as defined in section 

14 1905(b)) of so much of the sums expended dur15 ing such quarter (as found necessary by the 

16 Secretary for the proper and efficient adminis17 tration of the State plan) as are attributable to 

18 such developments or modifications of systems 

19 of the type described in clause (i) as are nec20 essary for the efficient collection and reporting 

21 on child health measures; and’’. 


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1 SEC. 202. IMPROVED AVAILABILITY OF PUBLIC INFORMA2 TION REGARDING ENROLLMENT OF CHIL3 DREN IN CHIP AND MEDICAID. 

4 (a) INCLUSION OF PROCESS AND ACCESS MEASURES

5 IN ANNUAL STATE REPORTS.—Section 2108 of the Social 

6 Security Act (42 U.S.C. 1397hh) is amended— 

7 (1) in subsection (a), in the matter preceding 

8 paragraph (1), by striking ‘‘The State’’ and insert9 ing ‘‘Subject to subsection (e), the State’’; and 

10 (2) by adding at the end the following new sub11 section: 

12 ‘‘(e) INFORMATION REQUIRED FOR INCLUSION IN

13 STATE ANNUAL REPORT.—The State shall include the fol14 lowing information in the annual report required under 

15 subsection (a): 

16 ‘‘(1) Eligibility criteria, enrollment, and reten17 tion data (including data with respect to continuity 

18 of coverage or duration of benefits). 

19 ‘‘(2) Data regarding the extent to which the 

20 State uses process measures with respect to deter21 mining the eligibility of children under the State 

22 child health plan, including measures such as 12- 

23 month continuous eligibility, self-declaration of in24 come for applications or renewals, or presumptive 

25 eligibility. 


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1 ‘‘(3) Data regarding denials of eligibility and 

2 redeterminations of eligibility. 

3 ‘‘(4) Data regarding access to primary and spe4 cialty services, access to networks of care, and care 

5 coordination provided under the State child health 

6 plan, using quality care and consumer satisfaction 

7 measures included in the Consumer Assessment of 

8 Healthcare Providers and Systems (CAHPS) survey. 

9 ‘‘(5) If the State provides child health assist10 ance in the form of premium assistance for the pur11 chase of coverage under a group health plan, data 

12 regarding the provision of such assistance, including 

13 the extent to which employer-sponsored health insur14 ance coverage is available for children eligible for 

15 child health assistance under the State child health 

16 plan, the range of the monthly amount of such as17 sistance provided on behalf of a child or family, the 

18 number of children or families provided such assist19 ance on a monthly basis, the income of the children 

20 or families provided such assistance, the benefits 

21 and cost-sharing protection provided under the State 

22 child health plan to supplement the coverage pur23 chased with such premium assistance, the effective 

24 strategies the State engages in to reduce any admin25 istrative barriers to the provision of such assistance, 


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1 and, the effects, if any, of the provision of such as2 sistance on preventing the coverage provided under 

3 the State child health plan from substituting for cov4 erage provided under employer-sponsored health in5 surance offered in the State. 

6 ‘‘(6) To the extent applicable, a description of 

7 any State activities that are designed to reduce the 

8 number of uncovered children in the State, including 

9 through a State health insurance connector program 

10 or support for innovative private health coverage ini11 tiatives.’’. 

12 (b) STANDARDIZED REPORTING FORMAT.— 

13 (1) IN GENERAL.—Not later than 1 year after 

14 the date of enactment of this Act, the Secretary 

15 shall specify a standardized format for States to use 

16 for reporting the information required under section 

17 2108(e) of the Social Security Act, as added by sub18 section (a)(2). 

19 (2) TRANSITION PERIOD FOR STATES.—Each 

20 State that is required to submit a report under sub21 section (a) of section 2108 of the Social Security Act 

22 that includes the information required under sub23 section (e) of such section may use up to 3 reporting 

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1 mation in accordance with the standardized format 

2 specified by the Secretary under paragraph (1). 

3 (c) ADDITIONAL FUNDING FOR THE SECRETARY TO

4 IMPROVE TIMELINESS OF DATA REPORTING AND ANAL5 YSIS FOR PURPOSES OF DETERMINING ENROLLMENT IN6 CREASES UNDER MEDICAID AND CHIP.— 

7 (1) APPROPRIATION.—There is appropriated, 

8 out of any money in the Treasury not otherwise ap9 propriated, $5,000,000 to the Secretary for fiscal 

10 year 2009 for the purpose of improving the timeli11 ness of the data reported and analyzed from the 

12 Medicaid Statistical Information System (MSIS) for 

13 purposes of providing more timely data on enroll14 ment and eligibility of children under Medicaid and 

15 CHIP and to provide guidance to States with re16 spect to any new reporting requirements related to 

17 such improvements. Amounts appropriated under 

18 this paragraph shall remain available until expended. 

19 (2) REQUIREMENTS.—The improvements made 

20 by the Secretary under paragraph (1) shall be de21 signed and implemented (including with respect to 

22 any necessary guidance for States to report such in23 formation in a complete and expeditious manner) so 

24 that, beginning no later than October 1, 2009, data 

25 regarding the enrollment of low-income children (as 


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1 defined in section 2110(c)(4) of the Social Security 

2 Act (42 U.S.C. 1397jj(c)(4)) of a State enrolled in 

3 the State plan under Medicaid or the State child 

4 health plan under CHIP with respect to a fiscal year 

5 shall be collected and analyzed by the Secretary 

6 within 6 months of submission. 

7 (d) GAO STUDY AND REPORT ON ACCESS TO PRI8 MARY AND SPECIALTY SERVICES.— 

9 (1) IN GENERAL.—The Comptroller General of 

10 the United States shall conduct a study of children’s 

11 access to primary and specialty services under Med12 icaid, CHIP, and MediKids, including— 

13 (A) the extent to which providers are will14 ing to treat children eligible for such programs; 

15 (B) information on such children’s access 

16 to networks of care; 

17 (C) geographic availability of primary and 

18 specialty services under such programs; 

19 (D) the extent to which care coordination 

20 is provided for children’s care under Medicaid, 

21 CHIP, and MediKids; and 

22 (E) as appropriate, information on the de23 gree of availability of services for children under 

24 such programs. 


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1 (2) REPORT.—Not later than 2 years after the 

2 date of enactment of this Act, the Comptroller Gen3 eral shall submit a report to the Committee on Fi4 nance of the Senate and the Committee on Energy 

5 and Commerce of the House of Representatives on 

6 the study conducted under paragraph (1) that in7 cludes recommendations for such Federal and State 

8 legislative and administrative changes as the Comp9 troller General determines are necessary to address 

10 any barriers to access to children’s care under Med11 icaid, CHIP, and MediKids that may exist. 

12 SEC. 203. APPLICATION OF CERTAIN MANAGED CARE 

13 QUALITY SAFEGUARDS TO CHIP. 

14 (a) IN GENERAL.—Section 2103(f) of Social Security 

15 Act (42 U.S.C. 1397bb(f)) is amended by adding at the 

16 end the following new paragraph: 

17 ‘‘(3) COMPLIANCE WITH MANAGED CARE RE18 QUIREMENTS.—The State child health plan shall 

19 provide for the application of subsections (a)(4), 

20 (a)(5), (b), (c), (d), and (e) of section 1932 (relating 

21 to requirements for managed care) to coverage, 

22 State agencies, enrollment brokers, managed care 

23 entities, and managed care organizations under this 

24 title in the same manner as such subsections apply 


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1 to coverage and such entities and organizations 

2 under title XIX.’’. 

3 (b) EFFECTIVE DATE.—The amendment made by 

4 subsection (a) shall apply to contract years for health 

5 plans beginning on or after July 1, 2009. 

Æ 


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