111TH CONGRESS 

1ST SESSION S. 225 

To amend title XIX of the Social Security Act to establish programs to 

improve the quality, performance, and delivery of pediatric care. 

IN THE SENATE OF THE UNITED STATES 

JANUARY 13, 2009 

Mr. BAYH (for himself, Mr. HATCH, Mrs. LINCOLN, Mr. KERRY, Mr. LUGAR, 

Mr. KENNEDY, Ms. STABENOW, Mr. BENNETT, and Mr. VOINOVICH) introduced the following bill; which was read twice and referred to the Committee on Finance 

A BILL 

To amend title XIX of the Social Security Act to establish 

programs to improve the quality, performance, and delivery of pediatric care. 

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. 

4 This Act may be cited as the ‘‘Children’s Health Care 

5 Quality Act’’. 

6 SEC. 2. FINDINGS. 

7 Congress makes the following findings: 

8 (1) Children have unique health care needs and 

9 experiences, which are often not comparable to adult 


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1 health care needs and experience, and they require 

2 specialized medical expertise. 

3 (2) The delivery of health care is increasingly 

4 being transformed by the use of quality and per5 formance measures by consumers, insurers, and pro6 viders. 

7 (3) A majority of public and private sector in8 vestments in the development of quality and per9 formance measures have focused on the experience 

10 of adults, particularly the elderly. 

11 (4) As a result, the supply of approved and 

12 demonstrated quality measures for children’s health 

13 care, especially pediatric inpatient care, is limited. 

14 (5) Growing numbers of insurers, as well as the 

15 Medicaid program and the State Children’s Health 

16 Insurance Program (SCHIP), are using publicly 

17 available measures, which means they have only lim18 ited options for measures of pediatric care. 

19 (6) A 2006 national survey found that most 

20 State Medicaid programs and SCHIP use largely 

21 primary care measures for children, which have been 

22 developed and selected as part of the measures 

23 States use to fulfill requirements for evaluating 

24 health plan performance, not provider performance, 

25 under the Medicaid program. 


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1 (7) The Centers for Medicare & Medicaid Serv2 ices (CMS), through its administration of the Med3 icaid program and SCHIP, is the Nation’s largest 

4 payer of health care for children, covering one in 

5 every 3 children and more than half of all infants in 

6 the Nation. However, CMS lacks explicit authority 

7 and has not committed resources to invest in the de8 velopment of quality and performance measures for 

9 children commensurate to the magnitude of pediatric 

10 care the agency pays for. 

11 (8) Most States do not have a large enough 

12 population of children upon which to develop appro13 priate measures, particularly for the treatment of se14 rious and complex conditions that only small num15 bers of children in any one State may experience. 

16 (9) Quality and performance measures should 

17 be evidence-based, approved for use through a recog18 nized national consensus development process, and 

19 appropriate for public reporting, such as evidence20 based hospital measures endorsed by the National 

21 Quality Forum and recommended for public report22 ing by the Hospital Quality Alliance on the Hospital 

23 Compare tool on the website of the Department of 

24 Health and Human Services. 


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1 (10) The Federal Government should have both 

2 the legal authority and financial resources to invest 

3 in the private sector’s development and demonstra4 tion of measures of quality and performance of 

5 health care for children, including pediatric inpatient 

6 care. The Federal Government should utilize such 

7 authority and resources to increase the availability 

8 of measures for children for use by public and pri9 vate health coverage programs. 

10 TITLE I—ADVANCING NEW 

11 QUALITY AND PERFORMANCE 

12 MEASURES FOR CHILDREN’S 

13 HEALTH CARE 

14 SEC. 101. PEDIATRIC QUALITY AND PERFORMANCE MEAS15 URES PROGRAM. 

16 Title XIX of the Social Security Act (42 U.S.C. 1396 

17 et seq.) is amended by adding at the end the following: 

18 ‘‘PEDIATRIC QUALITY AND PERFORMANCE MEASURES

19 PROGRAM

20 ‘‘SEC. 1942. (a) ESTABLISHMENT.—The Secretary, 

21 acting through the Administrator of the Centers for Medi22 care & Medicaid Services and in consultation with the Di23 rector of the Agency for Healthcare Research and Quality, 

24 shall establish a program to encourage and support the 

25 development of new and emerging quality and perform26 ance measures for providers of pediatric care and the inVerDate Nov 24 2008 05:25 Jan 14, 2009 Jkt 079200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S225.IS S225

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1 corporation of such measures into systemic approaches to 

2 improve care and outcomes for children through the activi3 ties described in subsection (c). In establishing the pro4 gram, gaps in existing evidence-based measures and pri5 ority areas for advancement shall be identified. 

6 ‘‘(b) PURPOSE.—The purpose of the program is to 

7 ensure that— 

8 ‘‘(1) evidence-based pediatric quality and per9 formance measures are developed; 

10 ‘‘(2) such measures are available for States, 

11 other purchasers of pediatric health care services, 

12 health care providers, and consumers to use; and 

13 ‘‘(3) technical assistance is provided to assist 

14 with the implementation of such measures. 

15 ‘‘(c) PROGRAM ACTIVITIES.— 

16 ‘‘(1) IDENTIFYING QUALITY AND PERFORMANCE

17 MEASURES FOR PROVIDERS OF PEDIATRIC SERVICES

18 AND OPPORTUNITIES FOR NEW MEASURES.—Not 

19 later than 3 months after the date of enactment of 

20 this section, the Secretary shall identify quality and 

21 performance measures for providers of pediatric 

22 services and opportunities for the development of 

23 new measures, taking into consideration existing evi24 dence-based measures. In conducting this review, the 


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1 Secretary shall convene and consult with representa2 tives of— 

3 ‘‘(A) States; 

4 ‘‘(B) pediatric hospitals, pediatricians, and 

5 other pediatric health professionals; 

6 ‘‘(C) national organizations representing— 

7 ‘‘(i) consumers of children’s health 

8 care; and 

9 ‘‘(ii) purchasers of children’s health 

10 care; 

11 ‘‘(D) experts in pediatric quality and per12 formance measurement; and 

13 ‘‘(E) a voluntary consensus standards set14 ting organization and other organizations in15 volved in the advancement of consensus on evi16 dence-based measures of health care. 

17 ‘‘(2) DEVELOPING, VALIDATING, AND TESTING

18 NEW MEASURES.—The Secretary shall award grants 

19 or contracts to eligible entities (as defined in sub20 section (d)(1)) for the development, validation, and 

21 testing of new and emerging quality and perform22 ance measures for providers of pediatric services. 

23 Such measures shall— 

24 ‘‘(A) provide consumers and purchasers 

25 (including States and beneficiaries under the 


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1 program under this title and title XXI) with in2 formation about provider performance and qual3 ity; and 

4 ‘‘(B) assist health care providers in im5 proving the quality of the services they provide 

6 and their performance with respect to the provi7 sion of such services. 

8 ‘‘(3) ACHIEVING CONSENSUS ON EVIDENCE9 BASED MEASURES.—The Secretary shall award 

10 grants or contracts to eligible consensus entities (as 

11 defined in subsection (d)(2)) for the development of 

12 consensus on evidence-based measures for pediatric 

13 care that have broad acceptability in the health care 

14 industry. 

15 ‘‘(d) ELIGIBLE ENTITIES.— 

16 ‘‘(1) DEVELOPMENT, VALIDATION, AND TEST17 ING.—For purposes of paragraph (2) of subsection 

18 (c), the term ‘eligible entity’ means— 

19 ‘‘(A) organizations with demonstrated ex20 pertise and capacity in the development and 

21 evaluation of pediatric quality and performance 

22 measures; 

23 ‘‘(B) an organization or association of 

24 health care providers with demonstrated experi25 ence in working with accrediting organizations 


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1 in developing pediatric quality and performance 

2 measures; and 

3 ‘‘(C) a collaboration of national pediatric 

4 organizations working to improve pediatric 

5 quality and performance in the delivery of chil6 dren’s health care. 

7 ‘‘(2) ACHIEVEMENT OF CONSENSUS.—For pur8 poses of paragraph (3) of such subsection, the term 

9 ‘eligible consensus entity’ means an organization, in10 cluding a voluntary consensus standards setting or11 ganization, involved in the advancement of consensus 

12 on evidence-based measures of health care. 

13 ‘‘(e) ONGOING AUTHORITY TO UPDATE AND ADJUST

14 PEDIATRIC MEASURES.—The Secretary may update and 

15 adjust measures developed and advanced under the pro16 gram under this section in accordance with— 

17 ‘‘(1) any changes that a voluntary consensus 

18 standards setting organization determines should be 

19 made with respect to such measures; or 

20 ‘‘(2) new evidence indicating the need for 

21 changes with respect to such measures. 

22 ‘‘(f) ADDITION OF PEDIATRIC CONSUMER ASSESS23 MENT MEASURES TO CAHPS HOSPITAL SURVEY CON24 DUCTED BY AHRQ.—The Director of the Agency for 

25 Healthcare Research and Quality shall ensure that conVerDate Nov 24 2008 05:25 Jan 14, 2009 Jkt 079200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S225.IS S225

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1 sumer assessment measures for hospital services for chil2 dren are added to the Consumer Assessment of Healthcare 

3 Providers and Systems (CAHPS) Hospital survey con4 ducted by such Agency. 

5 ‘‘(g) APPROPRIATION.—There are authorized to be 

6 appropriated and there are appropriated, for the purpose 

7 of carrying out this section, $10,000,000, for each of fiscal 

8 years 2009 through 2013, to remain available until ex9 pended.’’. 

10 TITLE II—STATE TRANS11 FORMATION GRANTS FOR PE12 DIATRIC CARE 

13 SEC. 201. GRANTS TO STATES FOR DEMONSTRATION 

14 PROJECTS TRANSFORMING DELIVERY OF PE15 DIATRIC CARE. 

16 Title XIX of the Social Security Act (42 U.S.C. 1396 

17 et seq.), as amended by section 101, is amended by adding 

18 at the end the following: 

19 ‘‘GRANTS TO STATE FOR DEMONSTRATION PROJECTS

20 TRANSFORMING DELIVERY OF PEDIATRIC CARE

21 ‘‘SEC. 1943. (a) ESTABLISHMENT.—The Secretary, 

22 acting through the Administrator of the Centers for Medi23 care & Medicaid Services, shall establish demonstration 

24 projects, including demonstration projects in multiple 

25 States in each of the 4 categories described in subsection 

26 (d), to award grants to States to improve the delivery of 


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1 health care services provided to children under this title 

2 and title XXI. 

3 ‘‘(b) DURATION.—The demonstration projects shall 

4 be conducted for a period of 4 years. 

5 ‘‘(c) ELIGIBILITY.—A State shall not be eligible to 

6 receive a grant under this section unless the State has 

7 demonstrated experience or commitment to the concept of 

8 transformation in the delivery of pediatric care. 

9 ‘‘(d) CATEGORIES OF PROJECTS.—The following cat10 egories of projects are described in this subsection: 

11 ‘‘(1) HEALTH INFORMATION TECHNOLOGY SYS12 TEMS.—Projects for developing health information 

13 technology systems, including technology acquisition, 

14 electronic health record development, data standards 

15 development, and software development, for pediatric 

16 hospital and physician services and other commu17 nity-based services; implementing model systems; 

18 and evaluating their impact on the quality, safety, 

19 and costs of care. 

20 ‘‘(2) DISEASE MANAGEMENT.—Projects for pro21 viding provider-based care management for children 

22 with chronic conditions (including physical, develop23 mental, behavioral, and psychological conditions), 

24 demonstrating the effectiveness of provider-based 

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1 ing adverse health outcomes, and preventing avoid2 able hospitalizations. 

3 ‘‘(3) EVIDENCE-BASED QUALITY IMPROVE4 MENTS.—Projects for implementing evidence-based 

5 approaches to improving efficiency, safety, and effec6 tiveness in the delivery of hospital care for children 

7 across hospital services, evaluating the translation of 

8 successful models of such evidence-based approaches 

9 to other institutions, and the impact of such changes 

10 on the quality, safety, and costs of care. 

11 ‘‘(4) QUALITY AND PERFORMANCE MEASURES

12 FOR PROVIDERS OF CHILDREN’S HEALTH CARE

13 SERVICES.—Projects to pilot test evidence-based pe14 diatric quality and performance measures for inpa15 tient hospital services, physician services, or services 

16 of other health professionals, determining the reli17 ability, feasibility, and validity of such measures, 

18 and evaluating their potential impact on improving 

19 the quality and delivery of children’s health care. To 

20 the extent feasible, such measures shall have been 

21 approved by consensus standards setting organiza22 tions. 

23 ‘‘(e) UNIFORM METRICS.—The Secretary shall estab24 lish uniform metrics (adjusted, as appropriate, for patient 

25 acuity), collect data, and conduct evaluations with respect 


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1 to each demonstration project category described in sub2 section (d). In establishing such metrics, collecting such 

3 data, and conducting such evaluations, the Secretary shall 

4 consult with— 

5 ‘‘(1) experts in each such demonstration project 

6 category; 

7 ‘‘(2) participating States; 

8 ‘‘(3) national pediatric provider organizations; 

9 ‘‘(4) health care consumers; and 

10 ‘‘(5) such other entities or individuals with rel11 evant expertise as the Secretary determines appro12 priate. 

13 ‘‘(f) EVALUATION AND REPORT.—The Secretary 

14 shall evaluate the demonstration projects conducted under 

15 this section and submit a report to Congress not later than 

16 3 months before the completion of each demonstration 

17 project that includes the findings of the evaluation and 

18 recommendations with respect to— 

19 ‘‘(1) expansion of the demonstration project to 

20 additional States and sites; and 

21 ‘‘(2) the broader implementation of approaches 

22 identified as being successful in advancing quality 

23 and performance in the delivery of medical assist24 ance provided to children under this title and title 

25 XXI. 


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1 ‘‘(g) WAIVER.—The Secretary may waive the require2 ments of this title and title XXI to the extent necessary 

3 to carry out the demonstration projects under this section. 

4 ‘‘(h) AMOUNTS PAID TO A STATE.—Amounts paid to 

5 a State under this section— 

6 ‘‘(1) shall be in addition to Federal payments 

7 made to the State under section 1903(a); 

8 ‘‘(2) shall not be used for the State share of 

9 any expenditures claimed for payment under such 

10 section; and 

11 ‘‘(3) shall be used only for expenditures of the 

12 State for participating in the demonstration 

13 projects, or for expenditures of providers in partici14 pating in the demonstration projects, including— 

15 ‘‘(A) administrative costs of States and 

16 participating providers (such as costs associated 

17 with the design and evaluation of, and data col18 lection under, the demonstration projects); and 

19 ‘‘(B) such other expenditures that are not 

20 otherwise eligible for reimbursement under this 

21 title or title XXI as the Secretary may deter22 mine appropriate. 

23 ‘‘(i) APPROPRIATION.—There are authorized to be 

24 appropriated and there are appropriated, for the purpose 

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1 pended $10,000,000 for each of fiscal years 2009 through 

2 2013.’’. 

3 SEC. 202. REPORT BY THE COMPTROLLER GENERAL ON DE4 SIGN AND IMPLEMENTATION OF A DEM5 ONSTRATION PROJECT EVALUATING EXIST6 ING QUALITY AND PERFORMANCE MEASURES 

7 FOR CHILDREN’S INPATIENT HOSPITAL 

8 SERVICES. 

9 (a) IN GENERAL.—Not later than 12 months after 

10 the date of enactment of this Act, the Comptroller General 

11 of the United States (in this section referred to as the 

12 ‘‘Comptroller General’’) shall submit a report to Congress 

13 containing recommendations for the design and implemen14 tation of a demonstration project to evaluate the suit15 ability of existing quality and performance measures for 

16 children’s inpatient hospital services for public reporting, 

17 differentiating quality, identifying best practices, and pro18 viding a basis for payment rewards. 

19 (b) DEVELOPMENT OF RECOMMENDATIONS.—In de20 veloping the recommendations submitted under subsection 

21 (a), the Comptroller General shall accomplish the fol22 lowing: 

23 (1) Consider which agency within the Depart24 ment of Health and Human Services should have 


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1 primary responsibility and oversight for such a dem2 onstration project. 

3 (2) Determine a sufficient number of partici4 pating hospitals and volume of children’s cases, 

5 given existing measures that might be chosen for 

6 evaluation under such a demonstration project. 

7 (3) Determine the number of States and variety 

8 of geographic locations that may be required to con9 duct such a demonstration project. 

10 (4) Describe alternatives for administering and 

11 directing funding for such a demonstration project, 

12 taking into consideration the potential involvement 

13 of multiple States, State plans under title XIX of 

14 the Social Security Act (42 U.S.C. 1396 et seq.), 

15 and State child health plans under title XXI of such 

16 Act (42 U.S.C. 1397aa et seq.). Such description 

17 shall be included in the recommendations submitted 

18 under subsection (a). 

19 (5) Determine requirements for consistency in 

20 measures, metrics, and risk adjustment for such a 

21 demonstration project, across hospitals and across 

22 State lines. 

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1 ices at the national and State levels, including the 

2 requirements involved with respect to maintaining 

3 such measures and data. 

4 (7) Estimate the cost of undertaking such a 

5 demonstration project. 

6 (c) SUGGESTION OF EXISTING MEASURES FOR EVAL7 UATION UNDER THE DEMONSTRATION PROJECT.— 

8 (1) IN GENERAL.—The report submitted under 

9 subsection (a) shall include suggestions for existing 

10 measures to be evaluated under the demonstration 

11 project recommended in such report, including, to 

12 the extent feasible, measures with respect to— 

13 (A) high volume pediatric inpatient condi14 tions; 

15 (B) high cost pediatric inpatient services; 

16 (C) pediatric conditions with predicted 

17 high morbidities; and 

18 (D) pediatric cases at high risk of patient 

19 safety failures. 

20 (2) SUGGESTED MEASURES.—The measures 

21 suggested under paragraph (1) shall be measures 

22 representing process, structure, patient outcomes, or 

23 patient and family experience— 

24 (A) that are evidence-based; 

25 (B) that are feasible to collect and report; 


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1 (C) that include a mechanism for risk ad2 justment when necessary; and 

3 (D) for which there is a consensus within 

4 the pediatric hospital community or a consensus 

5 determined by a voluntary consensus standards 

6 setting organization involved in the advance7 ment of evidence-based measures of health care. 

8 (3) CONSULTATION.—In determining the exist9 ing measures suggested under paragraph (1), the 

10 Comptroller General shall consult with representa11 tives of the following: 

12 (A) National associations of pediatric hos13 pitals and pediatric health professionals. 

14 (B) Experts in pediatric quality and per15 formance measurement. 

16 (C) Voluntary consensus standards setting 

17 organizations and other organizations involved 

18 in the advancement of consensus on evidence19 based measures. 

20 (D) The Department of Health and 

21 Human Services, States, and other purchasers 

22 of health care items and services. 

Æ 


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