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[Congressional Bills 105th Congress]
[From the U.S. Government Publishing Office]
[S. 1808 Introduced in Senate (IS)]

105th CONGRESS
  2d Session
                                S. 1808

  To amend title XXVII of the Public Health Service Act and part 7 of 
subtitle B of title I of the Employee Retirement Income Security Act of 
   1974 to establish standards for the health quality improvement of 
         children in managed care plans and other health plans.

_______________________________________________________________________

                   IN THE SENATE OF THE UNITED STATES

                             March 20, 1998

  Mr. Reed (for himself, Mr. Kennedy, and Mrs. Murray) introduced the 
 following bill; which was read twice and referred to the Committee on 
                       Labor and Human Resources

_______________________________________________________________________

                                 A BILL

 
  To amend title XXVII of the Public Health Service Act and part 7 of 
subtitle B of title I of the Employee Retirement Income Security Act of 
   1974 to establish standards for the health quality improvement of 
         children in managed care plans and other health plans.

    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 Insurance 
Accountability Act of 1998''.

SEC. 2. FINDINGS.

    Congress makes the following findings:
            (1) Children have health and development needs that are 
        markedly different than those for the adult population.
            (2) Children experience complex and continuing changes 
        during the continuum from birth to adulthood in which 
        appropriate health care is essential for optimal development.
            (3) The vast majority of work done on development methods 
        to assess the effectiveness of health care services and the 
        impact of medical care on patient outcomes and patient 
        satisfaction has been focused on adults.
            (4) Health outcome measures need to be age, gender, and 
        developmentally appropriate to be useful to families and 
        children.
            (5) Costly disorders of adulthood often have their origins 
        in childhood, making early access to effective health services 
        in childhood essential.
            (6) More than 200 chronic conditions, disabilities and 
        diseases affect children, including asthma, diabetes, sickle 
        cell anemia, spina bifida, epilepsy, autism, cerebral palsy, 
        congenital heart disease, mental retardation, and cystic 
        fibrosis. These children need the services of specialists who 
        have indepth knowledge about their particular condition.
            (7) Children's patterns of illness, disability and injury 
        differ dramatically from adults.

SEC. 2. AMENDMENTS TO THE PUBLIC HEALTH SERVICE ACT.

    (a) Patient Protection Standards.--Title XXVII of the Public Health 
Service Act is amended--
            (1) by redesignating part C as part D; and
            (2) by inserting after part B the following new part:

            ``Part C--Children's Health Protection Standards

``SEC. 2770. ACCESS TO CARE.

    ``(a) Access to Appropriate Primary Care Providers.--
            ``(1) In general.--If a group health plan, or a health 
        insurance issuer, in connection with the provision of health 
        insurance coverage, requires or provides for an enrollee to 
        designate a participating primary care provider for a child of 
        such enrollee--
                    ``(A) the plan or issuer shall permit the enrollee 
                to designate a physician who specializes in pediatrics 
                as the child's primary care provider; and
                    ``(B) if such an enrollee has not designated such a 
                provider for the child, the plan or issuer shall 
                consider appropriate pediatric expertise in mandatorily 
                assigning such an enrollee to a primary care provider.
            ``(2) Construction.--Nothing in paragraph (1) shall waive 
        any requirements of coverage relating to medical necessity or 
        appropriateness with respect to coverage of services.
    ``(b) Access to Pediatric Specialty Services.--
            ``(1) Referral to speciality care for children requiring 
        treatment by specialists.--
                    ``(A) In general.--In the case of a child who is 
                covered under a group health plan, or health insurance 
                coverage offered by a health insurance issuer and who 
                has a mental or physical condition, disability, or 
                disease of sufficient seriousness and complexity to 
                require diagnosis, evaluation or treatment by a 
                specialist, the plan or issuer shall make or provide 
                for a referral to a specialist who has extensive 
                experience or training, and is available and accessible 
                to provide the treatment for such condition or disease, 
                including the choice of a nonprimary care physician 
                specialist participating in the plan or a referral to a 
                nonparticipating provider as provided for under 
                subparagraph (D) if such a provider is not available 
                within the plan.
                    ``(B) Specialist defined.--For purposes of this 
                subsection, the term `specialist' means, with respect 
                to a condition, disability, or disease, a health care 
                practitioner, facility, or center (such as a center of 
                excellence) that has extensive pediatric expertise 
                through appropriate training or experience to provide 
                high quality care in treating the condition.
                    ``(C) Referrals to participating providers.--A plan 
                or issuer is not required under subparagraph (A) to 
                provide for a referral to a specialist that is not a 
                participating provider, unless the plan or issuer does 
                not have an appropriate specialist that is available 
                and accessible to treat the enrollee's condition and 
                that is a participating provider with respect to such 
                treatment.
                    ``(D) Treatment of nonparticipating providers.--If 
                a plan or issuer refers a child enrollee to a 
                nonparticipating specialist, services provided pursuant 
                to the referral shall be provided at no additional cost 
                to the enrollee beyond what the enrollee would 
                otherwise pay for services received by such a 
                specialist that is a participating provider.
                    ``(E) Specialists as primary care providers.--A 
                plan or issuer shall have in place a procedure under 
                which a child who is covered under health insurance 
                coverage provided by the plan or issuer who has a 
                condition or disease that requires specialized medical 
                care over a prolonged period of time shall receive a 
                referral to a pediatric specialist affilated with the 
                plan, or if not available within the plan, to a 
                nonparticipating provider for such condition and such 
                specialist may be responsible for and capable of 
                providing and coordinating the child's primary and 
                specialty care.
            ``(2) Standing referrals.--
                    ``(A) In general.--A group health plan, or health 
                insurance issuer in connection with the provision of 
                health insurance coverage of a child, shall have a 
                procedure by which a child who has a condition, 
                disability, or disease that requires ongoing care from 
                a specialist may request and obtain a standing referral 
                to such specialist for treatment of such condition. If 
                the primary care provider in consultation with 
the medical director of the plan or issuer and the specialist (if any), 
determines that such a standing referral is appropriate, the plan or 
issuer shall authorize such a referral to such a specialist. Such 
standing referral shall be consistent with a treatment plan.
                    ``(B) Treatment plans.--A group health plan, or 
                health insurance issuer, with the participation of the 
                family and the health care providers of the child, 
                shall develop a treatment plan for a child who requires 
                ongoing care that covers a specified period of time 
                (but in no event less than a 6-month period). Services 
                provided for under the treatment plan shall not require 
                additional approvals or referrals through a gatekeeper.
                    ``(C) Terms of referral.--The provisions of 
                subparagraph (C) and (D) of paragraph (1) shall apply 
                with respect to referrals under subparagraph (A) in the 
                same manner as they apply to referrals under paragraph 
                (1)(A).
    ``(c) Adequacy of Access.--For purposes of subsections (a) and (b), 
a group health plan or health insurance issuer in connection with 
health insurance coverage shall ensure that a sufficient number, 
distribution, and variety of qualified participating health care 
providers are available so as to ensure that all covered health care 
services, including specialty services, are available and accessible to 
all enrollees in a timely manner.
    ``(d) Coverage of Emergency Services.--
            ``(1) In general.--If a group health plan, or health 
        insurance coverage offered by a health insurance issuer, 
        provides any benefits for children with respect to emergency 
        services (as defined in paragraph (2)(A)), the plan or issuer 
        shall cover emergency services furnished under the plan or 
        coverage--
                    ``(A) without the need for any prior authorization 
                determination;
                    ``(B) whether or not the physician or provider 
                furnishing such services is a participating physician 
                or provider with respect to such services; and
                    ``(C) without regard to any other term or condition 
                of such coverage (other than exclusion of benefits, or 
                an affiliation or waiting period, permitted under 
                section 2701).
            ``(2) Definitions.--In this subsection:
                    ``(A) Emergency medical condition based on prudent 
                layperson standard.--The term `emergency medical 
                condition' means a medical condition manifesting itself 
                by acute symptoms of sufficient severity (including 
                severe pain) such that a prudent layperson, who 
                possesses an average knowledge of health and medicine, 
                could reasonably expect the absence of immediate 
                medical attention to result in a condition described in 
                clause (i), (ii), or (iii) of section 1867(e)(1)(A) of 
                the Social Security Act.
                    ``(B) Emergency services.--The term `emergency 
                services' means--
                            ``(i) a medical screening examination (as 
                        required under section 1867 of the Social 
                        Security Act) that is within the capability of 
                        the emergency department of a hospital, 
                        including ancillary services routinely 
                        available to the emergency department to 
                        evaluate an emergency medical condition (as 
                        defined in subparagraph (A)); and
                            ``(ii) within the capabilities of the staff 
                        and facilities available at the hospital, such 
                        further medical examination and treatment as 
                        are required under section 1867 of such Act to 
                        stabilize the patient.
            ``(3) Reimbursement for maintenance care and post-
        stabilization care.--A group health plan, and health insurance 
        issuer offering health insurance coverage, shall provide, in 
        covering services other than emergency services, for 
        reimbursement with respect to services which are otherwise 
        covered and which are provided to an enrollee other than 
        through the plan or issuer if the services are maintenance care 
        or post-stabilization care covered under the guidelines 
        established under section 1852(d) of the Social Security Act 
        (relating to promoting efficient and timely coordination of 
        appropriate maintenance and post-stabilization care of an 
        enrollee after an enrollee has been determined to be stable).
    ``(e) Prohibition on Financial Barriers.--A health insurance issuer 
in connection with the provision of health insurance coverage may not 
impose any cost sharing for pediatric specialty services provided under 
such coverage to enrollee children in amounts that exceed the cost-
sharing required for other specialty care under such coverage.
    ``(f) Children With Special Health Care Needs.--A health insurance 
issuer in connection with the provision of health insurance coverage 
shall ensure that such coverage provides special consideration for the 
provision of services to enrollee children with special health care 
needs. Appropriate procedures shall be implemented to provide care for 
children with special health care needs. The development of such 
procedures shall include participation by the families of such 
children.
    ``(g) Definitions.--In this part:
            ``(1) Child.--The term `child' means an individual who is 
        under 19 years of age.
            ``(2) Children with special health care needs.--The term 
        `children with special health care needs' means those children 
        who have or are at elevated risk for chronic physical, 
        developmental, behavioral or emotional conditions and who also 
        require health and related services of a type and amount not 
        usually required by children.

``SEC. 2771. CONTINUITY OF CARE.

    ``(a) In General.--If a contract between a health insurance issuer, 
in connection with the provision of health insurance coverage, and a 
health care provider is terminated (other than by the issuer for 
failure to meet applicable quality standards or for fraud) and an 
enrollee is undergoing a course of treatment from the provider at the 
time of such termination, the issuer shall--
            ``(1) notify the enrollee of such termination, and
            ``(2) subject to subsection (c), permit the enrollee to 
        continue the course of treatment with the provider during a 
        transitional period (provided under subsection (b)).
    ``(b) Transitional Period.--
            ``(1) In general.--Except as provided in paragraphs (2) 
        through (4), the transitional period under this subsection 
        shall extend for at least--
                    ``(A) 60 days from the date of the notice to the 
                enrollee of the provider's termination in the case of a 
                primary care provider, or
                    ``(B) 120 days from such date in the case of 
                another provider.
            ``(2) Institutional care.--The transitional period under 
        this subsection for institutional or inpatient care from a 
        provider shall extend until the discharge or termination of the 
        period of institutionalization and shall include reasonable 
        follow-up care related to the institutionalization and shall 
        also include institutional care scheduled prior to the date of 
        termination of the provider status.
            ``(3) Pregnancy.--If--
                    ``(A) an enrollee has entered the second trimester 
                of pregnancy at the time of a provider's termination of 
                participation, and
                    ``(B) the provider was treating the pregnancy 
                before date of the termination,
        the transitional period under this subsection with respect to 
        provider's treatment of the pregnancy shall extend through the 
        provision of post-partum care directly related to the delivery.
            ``(4) Terminal illness.--
                    ``(A) In general.--If--
                            ``(i) an enrollee was determined to be 
                        terminally ill (as defined in subparagraph (B)) 
                        at the time of a provider's termination of 
                        participation, and
                            ``(ii) the provider was treating the 
                        terminal illness before the date of 
                        termination,
                the transitional period under this subsection shall 
                extend for the remainder of the enrollee's life for 
                care directly related to the treatment of the terminal 
                illness.
                    ``(B) Definition.--In subparagraph (A), an enrollee 
                is considered to be `terminally ill' if the enrollee 
                has a medical prognosis that the enrollee's life 
                expectancy is 6 months or less.
    ``(c) Permissible Terms and Conditions.--An issuer may condition 
coverage of continued treatment by a provider under subsection (a)(2) 
upon the provider agreeing to the following terms and conditions:
            ``(1) The provider agrees to continue to accept 
        reimbursement from the issuer at the rates applicable prior to 
        the start of the transitional period as payment in full.
            ``(2) The provider agrees to adhere to the issuer's quality 
        assurance standards and to provide to the issuer necessary 
        medical information related to the care provided.
            ``(3) The provider agrees otherwise to adhere to the 
        issuer's policies and procedures, including procedures 
        regarding referrals and obtaining prior authorization and 
        providing services pursuant to a treatment plan approved by the 
        issuer.

``SEC. 2772. CONTINUOUS QUALITY IMPROVEMENT.

    ``(a) In General.--A health insurance issuer that offers health 
insurance coverage for children shall establish and maintain an 
ongoing, internal quality assurance program that at a minimum meets the 
requirements of subsection (b).
    ``(b) Requirements.--The internal quality assurance program of an 
issuer under subsection (a) shall--
            ``(1) establish and measure a set of health care, 
        functional assessments, structure, processes and outcomes, and 
        quality indicators that are unique to children and based on 
        nationally accepted standards or guidelines of care;
            ``(2) maintain written protocols consistent with recognized 
        clinical guidelines or current consensus on the pediatric 
        field, to be used for purposes of internal utilization review, 
        with periodic updating and evaluation by pediatric specialists 
        to determine effectiveness in controlling utilization;
            ``(3) provide for peer review by health care professionals 
        of the structure, processes, and outcomes related to the 
        provision of health services, including pediatric review of 
        pediatric cases;
            ``(4) include in member satisfaction surveys, questions on 
        child and family satisfaction and experience of care, including 
        care to children with special needs;
            ``(5) monitor and evaluate the continuity of care with 
        respect to children;
            ``(6) include pediatric measures that are directed at 
        meeting the needs of at-risk children and children with chronic 
        conditions, disabilities and severe illnesses;
            ``(7) maintain written guidelines to ensure the 
        availability of medications appropriate to children;
            ``(8) use focused studies of care received by children with 
        certain types of chronic conditions and disabilities and 
        focused studies of specialized services used by children with 
        chronic conditions and disabilities;
            ``(9) monitor access to pediatric specialty services; and
            ``(10) monitor child health care professional satisfaction.
    ``(c) Utilization Review Activities.--
            ``(1) Compliance with requirements.--
                    ``(A) In general.--A health insurance issuer that 
                offers health insurance coverage for children shall 
                conduct utilization review activities in connection 
                with the provision of such coverage only in accordance 
                with a utilization review program that meets at a 
                minimum the requirements of this subsection.
                    ``(B) Definitions.--In this subsection:
                            ``(i) Clinical peers.--The term `clinical 
                        peer' means, with respect to a review, a 
                        physician or other health care professional who 
                        holds a non-restricted license in a State and 
                        in the same or similar specialty as typically 
                        manages the pediatric medical condition, 
                        procedure, or treatment under review.
                            ``(ii) Health care professional.--The term 
                        `health care professional' means a physician or 
                        other health care practitioner licensed or 
                        certified under State law to provide health 
                        care services and who is operating within the 
                        scope of such licensure or certification.
                            ``(iii) Utilization review.--The terms 
                        `utilization review' and `utilization review 
                        activities' mean procedures used to monitor or 
                        evaluate the clinical necessity, 
                        appropriateness, efficacy, or efficiency of 
                        health care services, procedures or settings 
                        for children, and includes prospective review, 
                        concurrent review, second opinions, case 
                        management, discharge planning, or 
                        retrospective review specific to children.
            ``(2) Written policies and criteria.--
                    ``(A) Written policies.--A utilization review 
                program shall be conducted consistent with written 
                policies and procedures that govern all aspects of the 
                program.
                    ``(B) Use of written criteria.--A utilization 
                review program shall utilize written clinical review 
                criteria specific to children and developed pursuant to 
                the program with the input of appropriate physicians, 
                including pediatricians, nonprimary care pediatric 
                specialists, and other child health professionals.
                    ``(C) Administration by health care 
                professionals.--A utilization review program shall be 
                administered by qualified health care professionals, 
                including health care professionals with pediatric 
                expertise who shall oversee review decisions.
            ``(3) Use of qualified, independent personnel.--
                    ``(A) In general.--A utilization review program 
                shall provide for the conduct of utilization review 
                activities only through personnel who are qualified 
                and, to the extent required, who have received 
                appropriate pediatric or child health training in the 
                conduct of such activities under the program.
                    ``(B) Peer review of adverse clinical 
                determinations.--A utilization review program shall 
                provide that clinical peers shall evaluate the clinical 
                appropriateness of adverse clinical determinations and 
                divergent clinical options.

``SEC. 2773. APPEALS AND GRIEVANCE MECHANISMS FOR CHILDREN.

    ``(a) Internal Appeals Process.--A health insurance issuer in 
connection with the provision of health insurance coverage for children 
shall establish and maintain a system to provide for the resolution of 
complaints and appeals regarding all aspects of such coverage. Such a 
system shall include an expedited procedure for appeals on behalf of a 
child enrollee in situations in which the time frame of a standard 
appeal would jeopardize the life, health, or development of the child.
    ``(b) External Appeals Process.--A health insurance issuer in 
connection with the provision of health insurance coverage for children 
shall provide for an independent external review process that meets the 
following requirements:
            ``(1) External appeal activities shall be conducted through 
        clinical peers, a physician or other health care professional 
        who is appropriately credentialed in pediatrics with the same 
        or similar specialty and typically manages the condition, 
        procedure, or treatment under review or appeal.
            ``(2) External appeal activities shall be conducted through 
        an entity that has sufficient pediatric expertise, including 
        subspeciality expertise, and staffing to conduct external 
        appeal activities on a timely basis.
            ``(3) Such a review process shall include an expedited 
        procedure for appeals on behalf of a child enrollee in which 
        the time frame of a standard appeal would jeopardize the life, 
        health, or development of the child.

``SEC. 2774. ACCOUNTABILITY THROUGH DISTRIBUTION OF INFORMATION.

    ``(a) In General.--A health insurance issuer in connection with the 
provision of health insurance coverage for children shall submit to 
enrollees (and prospective enrollees), and make available to the 
public, in writing the health-related information described in 
subsection (b).
    ``(b) Information.--The information to be provided under subsection 
(a) shall include a report of measures of structures, processes, and 
outcomes regarding each health insurance product offered to 
participants and dependents in a manner that is separate for both the 
adult and child enrollees, using measures that are specific to each 
group.''.
    (b) Application to Group Health Insurance Coverage.--
            (1) In general.--Subpart 2 of part A of title XXVII of the 
        Public Health Service Act is amended by adding at the end the 
        following new section:

``SEC. 2706. CHILDREN'S HEALTH ACCOUNTABILITY STANDARDS.

    ``(a) In General.--Each health insurance issuer shall comply with 
children's health accountability requirement under part C with respect 
to group health insurance coverage it offers.
    ``(b) Assuring Coordination.--The Secretary of Health and Human 
Services and the Secretary of Labor shall ensure, through the execution 
of an interagency memorandum of understanding between such Secretaries, 
that--
            ``(1) regulations, rulings, and interpretations issued by 
        such Secretaries relating to the same matter over which such 
        Secretaries have responsibility under part C (and this section) 
        and section 713 of the Employee Retirement Income Security Act 
        of 1974 are administered so as to have the same effect at all 
        times; and
            ``(2) coordination of policies relating to enforcing the 
        same requirements through such Secretaries in order to have a 
        coordinated enforcement strategy that avoids duplication of 
        enforcement efforts and assigns priorities in enforcement.''.
            (2) Conforming amendment.--Section 2792 of the Public 
        Health Service Act (42 U.S.C. 300gg-92) is amended by inserting 
        ``and section 2706(b)'' after ``of 1996''.
    (c) Application to Individual Health Insurance Coverage.--Part B of 
title XXVII of the Public Health Service Act is amended by inserting 
after section 2751 the following new section:

``SEC. 2752. CHILDREN'S HEALTH ACCOUNTABILITY STANDARDS.

    ``Each health insurance issuer shall comply with children's health 
accountability requirements under part C with respect to individual 
health insurance coverage it offers.''.
    (d) Modification of Preemption Standards.--
            (1) Group health insurance coverage.--Section 2723 of the 
        Public Health Service Act (42 U.S.C. 300gg-23) is amended--
                    (A) in subsection (a)(1), by striking ``subsection 
                (b)'' and inserting ``subsection (b) and (c)'';
                    (B) by redesignating subsections (c) and (d) as 
                subsections (d) and (e), respectively; and
                    (C) by inserting after subsection (b) the following 
                new subsection:
    ``(c) Special Rules in Case of Children's Health Accountability 
Requirements.--Subject to subsection (a)(2), the provisions of section 
2706 and part C, and part D insofar as it applies to section 2706 or 
part C, shall not prevent a State from establishing requirements 
relating to the subject matter of such provisions so long as such 
requirements are at least as stringent on health insurance issuers as 
the requirements imposed under such provisions.''.
            (2) Individual health insurance coverage.--Section 2762 of 
        the Public Health Service Act (42 U.S.C. 300gg-62), as added by 
        section 605(b)(3)(B) of Public Law 104-204, is amended--
                    (A) in subsection (a), by striking ``subsection 
                (b), nothing in this part'' and inserting ``subsections 
                (b) and (c)'', and
                    (B) by adding at the end the following new 
                subsection:
    ``(c) Special Rules in Case of Children's Health Accountability 
Requirements.--Subject to subsection (b), the provisions of section 
2752 and part C, and part D insofar as it applies to section 2752 or 
part C, shall not prevent a State from establishing requirements 
relating to the subject matter of such provisions so long as such 
requirements are at least as stringent on health insurance issuers as 
the requirements imposed under such section.''.

SEC. 3. AMENDMENTS TO THE EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 
              1974.

    (a) In General.--Subpart B of part 7 of subtitle B of title I of 
the Employee Retirement Income Security Act of 1974 is amended by 
adding at the end the following:

``SEC. 713. CHILDREN'S HEALTH ACCOUNTABILITY STANDARDS.

    ``(a) In General.--Subject to subsection (b), the provisions of 
part C of title XXVII of the Public Health Service Act shall apply 
under this subpart and part to a group health plan (and group health 
insurance coverage offered in connection with a group health plan) as 
if such part were incorporated in this section.
    ``(b) Application.--In applying subsection (a) under this subpart 
and part, and reference in such part C--
            ``(1) to health insurance coverage is deemed to be a 
        reference only to group health insurance coverage offered in 
        connection with a group health plan and to also be a reference 
        to coverage under a group health plan;
            ``(2) to a health insurance issuer is deemed to be a 
        reference only to such an issuer in relation to group health 
        insurance coverage or, with respect to a group health plan, to 
        the plan;
            ``(3) to the Secretary is deemed to be a reference to the 
        Secretary of Labor;
            ``(4) to an applicable State authority is deemed to be a 
        reference to the Secretary of Labor; and
            ``(5) to an enrollee with respect to health insurance 
        coverage is deemed to include a reference to a participant or 
        beneficiary with respect to a group health plan.''.
    (b) Modification of Preemption Standards.--Section 731 of such Act 
(42 U.S.C. 1191) is amended--
            (1) in subsection (a)(1), by striking ``subsection (b)'' 
        and inserting ``subsections (b) and (c)'';
            (2) by redesignating subsections (c) and (d) as subsections 
        (d) and (e), respectively; and
            (3) by inserting after subsection (b) the following new 
        subsection:
    ``(c) Special Rules in Case of Patient Accountability 
Requirements.--Subject to subsection (a)(2), the provisions of section 
713, shall not prevent a State from establishing requirements relating 
to the subject matter of such provisions so long as such requirements 
are at least as stringent on group health plans and health insurance 
issuers in connection with group health insurance coverage as the 
requirements imposed under such provisions.''.
    (c) Conforming Amendments.--
            (1) Section 732(a) of such Act (29 U.S.C. 1185(a)) is 
        amended by striking ``section 711'' and inserting ``sections 
        711 and 713''.
            (2) The table of contents in section 1 of such Act is 
        amended by inserting after the item relating to section 712 the 
        following new item:

``Sec. 713. Children's health accountability standards.''.

SEC. 4. STUDIES.

    (a) By Secretary.--Not later than 1 year after the date of 
enactment of this Act, the Secretary of Health and Human Services shall 
conduct a study, and prepare and submit to Congress a report, 
concerning--
            (1) the unique characteristics of patterns of illness, 
        disability, and injury in children;
            (2) the development of measures of quality of care and 
        outcomes related to the health care of children; and
            (3) the access of children to primary mental health 
        services and the coordination of managed behavioral health 
        services.
    (b) By GAO.--
            (1) Managed care.--Not later than 1 year after the date of 
        enactment of this Act, the General Accounting Office shall 
        conduct a study, and prepare and submit to the Committee on 
        Labor and Human Resources of the Senate and the Committee on 
        Commerce of the House of Representatives a report, concerning--
                    (A) an assessment of the structure and performance 
                of non-governmental health plans, medicaid managed care 
                organizations, plans under title XIX of the Social 
                Security Act (42 U.S.C. 1396 et seq.), and the program 
                under title XXI of the Social Security Act (42 U.S.C. 
                1397aa et seq.) serving the needs of children with 
                special health care needs;
                    (B) an assessment of the structure and performance 
                of non-governmental plans in serving the needs of 
                children as compared to medicaid managed care 
                organizations under title XIX of the Social Security 
                Act (42 U.S.C. 1396 et seq.); and
                    (C) the emphasis that private managed care health 
                plans place on primary care and the control of services 
                as it relates to care and services provided to children 
                with special health care needs.
            (2) Plan survey.--Not later than 1 year after the date of 
        enactment of this Act, the General Accounting Office shall 
        prepare and submit to the Committee on Labor and Human 
        Resources of the Senate and the Committee on Commerce of the 
        House of Representatives a report that contains a survey of 
        health plan activities that address the unique health needs of 
        adolescents, including quality measures for adolescents and 
        innovative practice arrangement.
                                 <all>
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