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[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[S. 225 Introduced in Senate (IS)]

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.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Children's Health Care Quality 
Act''.

SEC. 2. FINDINGS.

    Congress makes the following findings:
            (1) Children have unique health care needs and experiences, 
        which are often not comparable to adult health care needs and 
        experience, and they require specialized medical expertise.
            (2) The delivery of health care is increasingly being 
        transformed by the use of quality and performance measures by 
        consumers, insurers, and providers.
            (3) A majority of public and private sector investments in 
        the development of quality and performance measures have 
        focused on the experience of adults, particularly the elderly.
            (4) As a result, the supply of approved and demonstrated 
        quality measures for children's health care, especially 
        pediatric inpatient care, is limited.
            (5) Growing numbers of insurers, as well as the Medicaid 
        program and the State Children's Health Insurance Program 
        (SCHIP), are using publicly available measures, which means 
        they have only limited options for measures of pediatric care.
            (6) A 2006 national survey found that most State Medicaid 
        programs and SCHIP use largely primary care measures for 
        children, which have been developed and selected as part of the 
        measures States use to fulfill requirements for evaluating 
        health plan performance, not provider performance, under the 
        Medicaid program.
            (7) The Centers for Medicare & Medicaid Services (CMS), 
        through its administration of the Medicaid program and SCHIP, 
        is the Nation's largest payer of health care for children, 
        covering one in every 3 children and more than half of all 
        infants in the Nation. However, CMS lacks explicit authority 
        and has not committed resources to invest in the development of 
        quality and performance measures for children commensurate to 
        the magnitude of pediatric care the agency pays for.
            (8) Most States do not have a large enough population of 
        children upon which to develop appropriate measures, 
        particularly for the treatment of serious and complex 
        conditions that only small numbers of children in any one State 
        may experience.
            (9) Quality and performance measures should be evidence-
        based, approved for use through a recognized national consensus 
        development process, and appropriate for public reporting, such 
        as evidence-based hospital measures endorsed by the National 
        Quality Forum and recommended for public reporting by the 
        Hospital Quality Alliance on the Hospital Compare tool on the 
        website of the Department of Health and Human Services.
            (10) The Federal Government should have both the legal 
        authority and financial resources to invest in the private 
        sector's development and demonstration of measures of quality 
        and performance of health care for children, including 
        pediatric inpatient care. The Federal Government should utilize 
        such authority and resources to increase the availability of 
        measures for children for use by public and private health 
        coverage programs.

TITLE I--ADVANCING NEW QUALITY AND PERFORMANCE MEASURES FOR CHILDREN'S 
                              HEALTH CARE

SEC. 101. PEDIATRIC QUALITY AND PERFORMANCE MEASURES PROGRAM.

    Title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) is 
amended by adding at the end the following:

          ``pediatric quality and performance measures program

    ``Sec. 1942.  (a) Establishment.--The Secretary, acting through the 
Administrator of the Centers for Medicare & Medicaid Services and in 
consultation with the Director of the Agency for Healthcare Research 
and Quality, shall establish a program to encourage and support the 
development of new and emerging quality and performance measures for 
providers of pediatric care and the incorporation of such measures into 
systemic approaches to improve care and outcomes for children through 
the activities described in subsection (c). In establishing the 
program, gaps in existing evidence-based measures and priority areas 
for advancement shall be identified.
    ``(b) Purpose.--The purpose of the program is to ensure that--
            ``(1) evidence-based pediatric quality and performance 
        measures are developed;
            ``(2) such measures are available for States, other 
        purchasers of pediatric health care services, health care 
        providers, and consumers to use; and
            ``(3) technical assistance is provided to assist with the 
        implementation of such measures.
    ``(c) Program Activities.--
            ``(1) Identifying quality and performance measures for 
        providers of pediatric services and opportunities for new 
        measures.--Not later than 3 months after the date of enactment 
        of this section, the Secretary shall identify quality and 
        performance measures for providers of pediatric services and 
        opportunities for the development of new measures, taking into 
        consideration existing evidence-based measures. In conducting 
        this review, the Secretary shall convene and consult with 
        representatives of--
                    ``(A) States;
                    ``(B) pediatric hospitals, pediatricians, and other 
                pediatric health professionals;
                    ``(C) national organizations representing--
                            ``(i) consumers of children's health care; 
                        and
                            ``(ii) purchasers of children's health 
                        care;
                    ``(D) experts in pediatric quality and performance 
                measurement; and
                    ``(E) a voluntary consensus standards setting 
                organization and other organizations involved in the 
                advancement of consensus on evidence-based measures of 
                health care.
            ``(2) Developing, validating, and testing new measures.--
        The Secretary shall award grants or contracts to eligible 
        entities (as defined in subsection (d)(1)) for the development, 
        validation, and testing of new and emerging quality and 
        performance measures for providers of pediatric services. Such 
        measures shall--
                    ``(A) provide consumers and purchasers (including 
                States and beneficiaries under the program under this 
                title and title XXI) with information about provider 
                performance and quality; and
                    ``(B) assist health care providers in improving the 
                quality of the services they provide and their 
                performance with respect to the provision of such 
                services.
            ``(3) Achieving consensus on evidence-based measures.--The 
        Secretary shall award grants or contracts to eligible consensus 
        entities (as defined in subsection (d)(2)) for the development 
        of consensus on evidence-based measures for pediatric care that 
        have broad acceptability in the health care industry.
    ``(d) Eligible Entities.--
            ``(1) Development, validation, and testing.--For purposes 
        of paragraph (2) of subsection (c), the term `eligible entity' 
        means--
                    ``(A) organizations with demonstrated expertise and 
                capacity in the development and evaluation of pediatric 
                quality and performance measures;
                    ``(B) an organization or association of health care 
                providers with demonstrated experience in working with 
                accrediting organizations in developing pediatric 
                quality and performance measures; and
                    ``(C) a collaboration of national pediatric 
                organizations working to improve pediatric quality and 
                performance in the delivery of children's health care.
            ``(2) Achievement of consensus.--For purposes of paragraph 
        (3) of such subsection, the term `eligible consensus entity' 
        means an organization, including a voluntary consensus 
        standards setting organization, involved in the advancement of 
        consensus on evidence-based measures of health care.
    ``(e) Ongoing Authority To Update and Adjust Pediatric Measures.--
The Secretary may update and adjust measures developed and advanced 
under the program under this section in accordance with--
            ``(1) any changes that a voluntary consensus standards 
        setting organization determines should be made with respect to 
        such measures; or
            ``(2) new evidence indicating the need for changes with 
        respect to such measures.
    ``(f) Addition of Pediatric Consumer Assessment Measures to CAHPS 
Hospital Survey Conducted by AHRQ.--The Director of the Agency for 
Healthcare Research and Quality shall ensure that consumer assessment 
measures for hospital services for children are added to the Consumer 
Assessment of Healthcare Providers and Systems (CAHPS) Hospital survey 
conducted by such Agency.
    ``(g) Appropriation.--There are authorized to be appropriated and 
there are appropriated, for the purpose of carrying out this section, 
$10,000,000, for each of fiscal years 2009 through 2013, to remain 
available until expended.''.

        TITLE II--STATE TRANSFORMATION GRANTS FOR PEDIATRIC CARE

SEC. 201. GRANTS TO STATES FOR DEMONSTRATION PROJECTS TRANSFORMING 
              DELIVERY OF PEDIATRIC CARE.

    Title XIX of the Social Security Act (42 U.S.C. 1396 et seq.), as 
amended by section 101, is amended by adding at the end the following:

 ``grants to state for demonstration projects transforming delivery of 
                             pediatric care

    ``Sec. 1943.  (a) Establishment.--The Secretary, acting through the 
Administrator of the Centers for Medicare & Medicaid Services, shall 
establish demonstration projects, including demonstration projects in 
multiple States in each of the 4 categories described in subsection 
(d), to award grants to States to improve the delivery of health care 
services provided to children under this title and title XXI.
    ``(b) Duration.--The demonstration projects shall be conducted for 
a period of 4 years.
    ``(c) Eligibility.--A State shall not be eligible to receive a 
grant under this section unless the State has demonstrated experience 
or commitment to the concept of transformation in the delivery of 
pediatric care.
    ``(d) Categories of Projects.--The following categories of projects 
are described in this subsection:
            ``(1) Health information technology systems.--Projects for 
        developing health information technology systems, including 
        technology acquisition, electronic health record development, 
        data standards development, and software development, for 
        pediatric hospital and physician services and other community-
        based services; implementing model systems; and evaluating 
        their impact on the quality, safety, and costs of care.
            ``(2) Disease management.--Projects for providing provider-
        based care management for children with chronic conditions 
        (including physical, developmental, behavioral, and 
        psychological conditions), demonstrating the effectiveness of 
        provider-based management models in promoting better care, 
        reducing adverse health outcomes, and preventing avoidable 
        hospitalizations.
            ``(3) Evidence-based quality improvements.--Projects for 
        implementing evidence-based approaches to improving efficiency, 
        safety, and effectiveness in the delivery of hospital care for 
        children across hospital services, evaluating the translation 
        of successful models of such evidence-based approaches to other 
        institutions, and the impact of such changes on the quality, 
        safety, and costs of care.
            ``(4) Quality and performance measures for providers of 
        children's health care services.--Projects to pilot test 
        evidence-based pediatric quality and performance measures for 
        inpatient hospital services, physician services, or services of 
        other health professionals, determining the reliability, 
        feasibility, and validity of such measures, and evaluating 
        their potential impact on improving the quality and delivery of 
        children's health care. To the extent feasible, such measures 
        shall have been approved by consensus standards setting 
        organizations.
    ``(e) Uniform Metrics.--The Secretary shall establish uniform 
metrics (adjusted, as appropriate, for patient acuity), collect data, 
and conduct evaluations with respect to each demonstration project 
category described in subsection (d). In establishing such metrics, 
collecting such data, and conducting such evaluations, the Secretary 
shall consult with--
            ``(1) experts in each such demonstration project category;
            ``(2) participating States;
            ``(3) national pediatric provider organizations;
            ``(4) health care consumers; and
            ``(5) such other entities or individuals with relevant 
        expertise as the Secretary determines appropriate.
    ``(f) Evaluation and Report.--The Secretary shall evaluate the 
demonstration projects conducted under this section and submit a report 
to Congress not later than 3 months before the completion of each 
demonstration project that includes the findings of the evaluation and 
recommendations with respect to--
            ``(1) expansion of the demonstration project to additional 
        States and sites; and
            ``(2) the broader implementation of approaches identified 
        as being successful in advancing quality and performance in the 
        delivery of medical assistance provided to children under this 
        title and title XXI.
    ``(g) Waiver.--The Secretary may waive the requirements of this 
title and title XXI to the extent necessary to carry out the 
demonstration projects under this section.
    ``(h) Amounts Paid to a State.--Amounts paid to a State under this 
section--
            ``(1) shall be in addition to Federal payments made to the 
        State under section 1903(a);
            ``(2) shall not be used for the State share of any 
        expenditures claimed for payment under such section; and
            ``(3) shall be used only for expenditures of the State for 
        participating in the demonstration projects, or for 
        expenditures of providers in participating in the demonstration 
        projects, including--
                    ``(A) administrative costs of States and 
                participating providers (such as costs associated with 
                the design and evaluation of, and data collection 
                under, the demonstration projects); and
                    ``(B) such other expenditures that are not 
                otherwise eligible for reimbursement under this title 
                or title XXI as the Secretary may determine 
                appropriate.
    ``(i) Appropriation.--There are authorized to be appropriated and 
there are appropriated, for the purpose of carrying out this section, 
to remain available until expended $10,000,000 for each of fiscal years 
2009 through 2013.''.

SEC. 202. REPORT BY THE COMPTROLLER GENERAL ON DESIGN AND 
              IMPLEMENTATION OF A DEMONSTRATION PROJECT EVALUATING 
              EXISTING QUALITY AND PERFORMANCE MEASURES FOR CHILDREN'S 
              INPATIENT HOSPITAL SERVICES.

    (a) In General.--Not later than 12 months after the date of 
enactment of this Act, the Comptroller General of the United States (in 
this section referred to as the ``Comptroller General'') shall submit a 
report to Congress containing recommendations for the design and 
implementation of a demonstration project to evaluate the suitability 
of existing quality and performance measures for children's inpatient 
hospital services for public reporting, differentiating quality, 
identifying best practices, and providing a basis for payment rewards.
    (b) Development of Recommendations.--In developing the 
recommendations submitted under subsection (a), the Comptroller General 
shall accomplish the following:
            (1) Consider which agency within the Department of Health 
        and Human Services should have primary responsibility and 
        oversight for such a demonstration project.
            (2) Determine a sufficient number of participating 
        hospitals and volume of children's cases, given existing 
        measures that might be chosen for evaluation under such a 
        demonstration project.
            (3) Determine the number of States and variety of 
        geographic locations that may be required to conduct such a 
        demonstration project.
            (4) Describe alternatives for administering and directing 
        funding for such a demonstration project, taking into 
        consideration the potential involvement of multiple States, 
        State plans under title XIX of the Social Security Act (42 
        U.S.C. 1396 et seq.), and State child health plans under title 
        XXI of such Act (42 U.S.C. 1397aa et seq.). Such description 
        shall be included in the recommendations submitted under 
        subsection (a).
            (5) Determine requirements for consistency in measures, 
        metrics, and risk adjustment for such a demonstration project, 
        across hospitals and across State lines.
            (6) Consider the infrastructure requirements involved in 
        public reporting of quality and performance measures for 
        children's inpatient hospital services at the national and 
        State levels, including the requirements involved with respect 
        to maintaining such measures and data.
            (7) Estimate the cost of undertaking such a demonstration 
        project.
    (c) Suggestion of Existing Measures for Evaluation Under the 
Demonstration Project.--
            (1) In general.--The report submitted under subsection (a) 
        shall include suggestions for existing measures to be evaluated 
        under the demonstration project recommended in such report, 
        including, to the extent feasible, measures with respect to--
                    (A) high volume pediatric inpatient conditions;
                    (B) high cost pediatric inpatient services;
                    (C) pediatric conditions with predicted high 
                morbidities; and
                    (D) pediatric cases at high risk of patient safety 
                failures.
            (2) Suggested measures.--The measures suggested under 
        paragraph (1) shall be measures representing process, 
        structure, patient outcomes, or patient and family experience--
                    (A) that are evidence-based;
                    (B) that are feasible to collect and report;
                    (C) that include a mechanism for risk adjustment 
                when necessary; and
                    (D) for which there is a consensus within the 
                pediatric hospital community or a consensus determined 
                by a voluntary consensus standards setting organization 
                involved in the advancement of evidence-based measures 
                of health care.
            (3) Consultation.--In determining the existing measures 
        suggested under paragraph (1), the Comptroller General shall 
        consult with representatives of the following:
                    (A) National associations of pediatric hospitals 
                and pediatric health professionals.
                    (B) Experts in pediatric quality and performance 
                measurement.
                    (C) Voluntary consensus standards setting 
                organizations and other organizations involved in the 
                advancement of consensus on evidence-based measures.
                    (D) The Department of Health and Human Services, 
                States, and other purchasers of health care items and 
                services.
                                 <all>
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