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[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 462 Introduced in House (IH)]

111th CONGRESS
  1st Session
                                H. R. 462

   To amend titles XIX and XXI of the Social Security Act to improve 
    dental benefits under Medicaid and the State Children's Health 
           Insurance Program (SCHIP), and for other purposes.

_______________________________________________________________________

                    IN THE HOUSE OF REPRESENTATIVES

                            January 13, 2009

 Mr. Cummings introduced the following bill; which was referred to the 
                    Committee on Energy and Commerce

_______________________________________________________________________

                                 A BILL

 
   To amend titles XIX and XXI of the Social Security Act to improve 
    dental benefits under Medicaid and the State Children's Health 
           Insurance Program (SCHIP), and for other purposes.

    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 ``Medicaid-SCHIP Dental Benefits 
Improvement Act of 2009''.

SEC. 2. DENTAL BENEFITS.

    (a) Coverage.--
            (1) In general.--Section 2103 of the Social Security Act 
        (42 U.S.C. 1397cc) is amended--
                    (A) in subsection (a)--
                            (i) in the matter before paragraph (1), by 
                        striking ``subsection (c)(5)'' and inserting 
                        ``paragraphs (5) and (6) of subsection (c)'' ; 
                        and
                            (ii) in paragraph (I) , by inserting ``at 
                        least'' after ``that is''; and
                    (B) in subsection (c)--
                            (i) by redesignating paragraph (5) as 
                        paragraph (6); and
                            (ii) by inserting after paragraph (4), the 
                        following:
            ``(5) Dental benefits.--
                    ``(A) In general.--The child health assistance 
                provided to a targeted low-income child shall include 
                coverage of dental services necessary to prevent 
                disease and promote oral health, restore oral 
                structures to health and function, and treat emergency 
                conditions.
                    ``(B) Permitting use of dental benchmark plans by 
                certain states.--A State may elect to meet the 
                requirement of subparagraph (A) through dental coverage 
                that is equivalent to a benchmark dental benefit 
                package described in subparagraph (C).
                    ``(C) Benchmark dental benefit packages.--The 
                benchmark dental benefit packages are as follows:
                            ``(i) FEHBP children's dental coverage.--A 
                        dental benefits plan under chapter 89A of title 
                        5, United States Code, that has been selected 
                        most frequently by employees seeking dependent 
                        coverage, among such plans that provide such 
                        dependent coverage, in either of the previous 2 
                        plan years.
                            ``(ii) State employee dependent dental 
                        coverage.--A dental benefits plan that is 
                        offered and generally available to State 
                        employees in the State involved and that has 
                        been selected most frequently by employees 
                        seeking dependent coverage, among such plans 
                        that provide such dependent coverage, in either 
                        of the previous 2 plan years.
                            ``(iii) Coverage offered through commercial 
                        dental plan.--A dental benefits plan that has 
                        the largest insured commercial, non-medicaid 
                        enrollment of dependent covered lives of such 
                        plans that is offered in the State involved.''.
            (2) Assuring access to care.--Section 2102(a)(7)(B) of such 
        Act (42 U.S.C. 1397bb(c)(2)) is amended by inserting ``and 
        services described in section 2103(c)(5)'' after ``emergency 
        services''.
            (3) Effective date.--The amendments made by paragraph (1) 
        shall apply to coverage of items and services furnished on or 
        after October 1, 2009.
    (b) Dental Education for Parents of Newborns.--The Secretary of 
Health and Human Services shall develop and implement, through entities 
that fund or provide perinatal care services to targeted low-income 
children under a State child health plan under title XXI of the Social 
Security Act, a program to deliver oral health educational materials 
that inform new parents about risks for, and prevention of, early 
childhood caries and the need for a dental visit within their newborn's 
first year of life.
    (c) Provision of Dental Services Through FQHCs.--
            (1) Medicaid.--Section 1902(a) of such Act (42 U.S.C. 
        1396a(a)) is amended--
                    (A) by striking ``and'' at the end of paragraph 
                (70);
                    (B) by striking the period at the end of paragraph 
                (71) and inserting ``; and''; and
                    (C) by inserting after paragraph (71) the following 
                new paragraph:
            ``(72) provide that the State will not prevent a Federally-
        qualified health center from entering into contractual 
        relationships with private practice dental providers in the 
        provision of Federally-qualified health center services.''.
            (2) Chip.--Section 2107(e)(1) of such Act (42 U.S.C. 
        1397g(e)(1)) is amended by redesignating subparagraphs (B) 
        through (D) as subparagraphs (C) through (E), respectively, and 
        by inserting after subparagraph (A) the following new 
        subparagraph:
                    ``(B) Section 1902(a)(72) (relating to limiting 
                FQHC contracting for provision of dental services).''.
            (3) Effective date.--The amendments made by this subsection 
        shall take effect on January 1, 2009.
    (d) Reporting Information on Dental Health.--
            (1) Medicaid.--Section 1902(a)(43)(D)(iii) of such Act (42 
        U.S.C. 1396a(a)(43)(D)(iii)) is amended by inserting ``and 
        other information relating to the provision of dental services 
        to such children described in section 2108(e)'' after 
        ``receiving dental services,''.
            (2) Chip.--Section 2108 of such Act (42 U.S.C. 1397hh) is 
        amended by adding at the end the following new subsection:
    ``(e) Information on Dental Care for Children.--
            ``(1) In general.--Each annual report under subsection (a) 
        shall include the following information with respect to care 
        and services described in section 1905(r)(3) provided to 
        targeted low-income children enrolled in the State child health 
        plan under this title at any time during the year involved:
                    ``(A) The number of enrolled children by age 
                grouping used for reporting purposes under section 
                1902(a)(43).
                    ``(B) For children within each such age grouping, 
                information of the type contained in questions 12(a)-
                (c) of CMS Form 416 (that consists of the number of 
                enrolled targeted low income children who receive any, 
                preventive, or restorative dental care under the State 
                plan).
                    ``(C) For the age grouping that includes children 8 
                years of age, the number of such children who have 
                received a protective sealant on at least one permanent 
                molar tooth.
            ``(2) Inclusion of information on enrollees in managed care 
        plans.--The information under paragraph (1) shall include 
        information on children who are enrolled in managed care plans 
        and other private health plans and contracts with such plans 
        under this title shall provide for the reporting of such 
        information by such plans to the State.''.
            (3) Effective date.--The amendments made by this subsection 
        shall be effective for annual reports submitted for years 
        beginning after date of enactment.
    (e) Improved Accessibility of Dental Provider Information to 
Enrollees Under Medicaid and Chip.--The Secretary of Health and Human 
Services shall--
            (1) work with States, pediatric dentists, and other dental 
        providers (including providers that are, or are affiliated 
        with, a school of dentistry) to include, not later than 6 
        months after the date of the enactment of this Act, on the 
        Insure Kids Now website (http://www.insurekidsnow.gov/) and 
        hotline (1-877-KIDS-NOW) (or on any successor websites or 
        hotlines) a current and accurate list of all such dentists and 
        providers within each State that provide dental services to 
        children enrolled in the State plan (or waiver) under Medicaid 
        or the State child health plan (or waiver) under title XXI of 
        the Social Security Act, and shall ensure that such list is 
        updated at least quarterly; and
            (2) work with States to include, not later than 6 months 
        after the date of the enactment of this Act, a description of 
        the dental services provided under each State plan (or waiver) 
        under Medicaid and each State child health plan (or waiver) 
        under title XXI of the Social Security Act on such Insure Kids 
        Now website, and shall ensure that such list is updated at 
        least annually.
    (f) GAO Study and Report.--
            (1) Study.--The Comptroller General of the United States 
        shall provide for a study that examines--
                    (A) access to dental services by children in 
                underserved areas;
                    (B) children's access to oral health care, 
                including preventive and restorative services, under 
                Medicaid and the State Children's Health Insurance 
                Program, including--
                            (i) the extent to which dental providers 
                        are willing to treat children eligible for such 
                        programs;
                            (ii) information on such children's access 
                        to networks of care, including such networks 
                        that serve special needs children; and
                            (iii) geographic availability of oral 
                        health care, including preventive and 
                        restorative services, under such programs; and
                    (C) the feasibility and appropriateness of using 
                qualified mid-level dental health providers, in 
                coordination with dentists, to improve access for 
                children to oral health services and public health 
                overall.
            (2) Report.--Not later than 18 months after the date of the 
        enactment of this Act, the Comptroller General shall submit to 
        Congress a report on the study conducted under paragraph (1). 
        The report shall include recommendations for such Federal and 
        State legislative and administrative changes as the Comptroller 
        General determines are necessary to address any barriers to 
        access to oral health care, including preventive and 
        restorative services, under Medicaid and the State Children's 
        Health Insurance Program that may exist.

SEC. 3. CHILD HEALTH QUALITY IMPROVEMENT ACTIVITIES FOR CHILDREN 
              ENROLLED IN MEDICAID OR CHIP.

    (a) Development of Child Health Quality Measures for Children 
Enrolled in Medicaid or Chip.--Title XI of the Social Security Act (42 
U.S.C. 1301 et seq.) is amended by inserting after section 1139 the 
following new section:

``SEC. 1139A. CHILD HEALTH QUALITY MEASURES.

    ``(a) Development of an Initial Core Set of Health Care Quality 
Measures for Children Enrolled in Medicaid or Chip.--
            ``(1) In general.--Not later than January 1, 2010, the 
        Secretary shall identify and publish for general comment an 
        initial, recommended core set of child health quality measures 
        for use by State programs administered under titles XIX and 
        XXI, health insurance issuers and managed care entities that 
        enter into contracts with such programs, and providers of items 
        and services under such programs.
            ``(2) Identification of initial core measures.--In 
        consultation with the individuals and entities described in 
        subsection (b)(3), the Secretary shall identify existing 
        quality of care measures for children that are in use under 
        public and privately sponsored health care coverage 
        arrangements, or that are part of reporting systems that 
        measure both the presence and duration of health insurance 
        coverage over time.
            ``(3) Recommendations and dissemination.--Based on such 
        existing and identified measures, the Secretary shall publish 
        an initial core set of child health quality measures that 
        includes (but is not limited to) the following:
                    ``(A) The duration of children's health insurance 
                coverage over a 12-month time period.
                    ``(B) The availability and effectiveness of a full 
                range of--
                            ``(i) preventive services, treatments, and 
                        services for acute conditions, including 
                        services to promote healthy birth, prevent and 
                        treat premature birth, and detect the presence 
                        or risk of physical or mental conditions that 
                        could adversely affect growth and development; 
                        and
                            ``(ii) treatments to correct or ameliorate 
                        the effects of physical and mental conditions, 
                        including chronic conditions, and, with respect 
                        to dental care, conditions requiring the 
                        restoration of teeth, relief of pain and 
                        infection, and maintenance of dental health, in 
                        infants, young children, school-age children, 
                        and adolescents.
                    ``(C) The availability of care in a range of 
                ambulatory and inpatient health care settings in which 
                such care is furnished.
                    ``(D) The types of measures that, taken together, 
                can be used to estimate the overall national quality of 
                health care for children, including children with 
                special needs, and to perform comparative analyses of 
                pediatric health care quality and racial, ethnic, and 
                socioeconomic disparities in child health and health 
                care for children.
            ``(4) Encourage voluntary and standardized reporting.--Not 
        later than 2 years after the date of enactment of this section, 
        the Secretary, in consultation with States, shall develop a 
        standardized format for reporting information and procedures 
        and approaches that encourage States to use the initial core 
        measurement set to voluntarily report information regarding the 
        quality of pediatric health care under titles XIX and XXI.
            ``(5) Adoption of best practices in implementing quality 
        programs.--The Secretary shall disseminate information to 
        States regarding best practices among States with respect to 
        measuring and reporting on the quality of health care for 
        children, and shall facilitate the adoption of such best 
        practices. In developing best practices approaches, the 
        Secretary shall give particular attention to State measurement 
        techniques that ensure the timeliness and accuracy of provider 
        reporting, encourage provider reporting compliance, encourage 
        successful quality improvement strategies, and improve 
        efficiency in data collection using health information 
        technology.
            ``(6) Reports to congress.--Not later than January 1, 2011, 
        and every 3 years thereafter, the Secretary shall report to 
        Congress on--
                    ``(A) the status of the Secretary's efforts to 
                improve--
                            ``(i) quality related to the duration and 
                        stability of health insurance coverage for 
                        children under titles XIX and XXI;
                            ``(ii) the quality of children's health 
                        care under such titles, including preventive 
                        health services, dental services, health care 
                        for acute conditions, chronic health care, and 
                        health services to ameliorate the effects of 
                        physical and mental conditions and to aid in 
                        growth and development of infants, young 
                        children, school-age children, and adolescents 
                        with special health care needs; and
                            ``(iii) the quality of children's health 
                        care under such titles across the domains of 
                        quality, including clinical quality, health 
                        care safety, family experience with health 
                        care, health care in the most integrated 
                        setting, and elimination of racial, ethnic, and 
                        socioeconomic disparities in health and health 
                        care;
                    ``(B) the status of voluntary reporting by States 
                under titles XIX and XXI, utilizing the initial core 
                quality measurement set; and
                    ``(C) any recommendations for legislative changes 
                needed to improve the quality of care provided to 
                children under titles XIX and XXI, including 
                recommendations for quality reporting by States.
            ``(7) Technical assistance.--The Secretary shall provide 
        technical assistance to States to assist them in adopting and 
        utilizing core child health quality measures in administering 
        the State plans under titles XIX and XXI.
            ``(8) Definition of core set.--In this section, the term 
        `core set' means a group of valid, reliable, and evidence-based 
        quality measures that, taken together--
                    ``(A) provide information regarding the quality of 
                health coverage and health care for children;
                    ``(B) address the needs of children throughout the 
                developmental age span; and
                    ``(C) allow purchasers, families, and health care 
                providers to understand the quality of care in relation 
                to the preventive needs of children, treatments aimed 
                at managing and resolving acute conditions, and 
                diagnostic and treatment services whose purpose is to 
                correct or ameliorate physical, mental, or 
                developmental conditions that could, if untreated or 
                poorly treated, become chronic.
    ``(b) Advancing and Improving Pediatric Quality Measures.--
            ``(1) Establishment of pediatric quality measures 
        program.--Not later than January 1, 2011, the Secretary shall 
        establish a pediatric quality measures program to--
                    ``(A) improve and strengthen the initial core child 
                health care quality measures established by the 
                Secretary under subsection (a);
                    ``(B) expand on existing pediatric quality measures 
                used by public and private health care purchasers and 
                advance the development of such new and emerging 
                quality measures; and
                    ``(C) increase the portfolio of evidence-based, 
                consensus pediatric quality measures available to 
                public and private purchasers of children's health care 
                services, providers, and consumers.
            ``(2) Evidence-based measures.--The measures developed 
        under the pediatric quality measures program shall, at a 
        minimum, be--
                    ``(A) evidence-based and, where appropriate, risk 
                adjusted;
                    ``(B) designed to identify and eliminate racial and 
                ethnic disparities in child health and the provision of 
                health care;
                    ``(C) designed to ensure that the data required for 
                such measures is collected and reported in a standard 
                format that permits comparison of quality and data at a 
                State, plan, and provider level;
                    ``(D) periodically updated; and
                    ``(E) responsive to the child health needs, 
                services, and domains of health care quality described 
                in clauses (i), (ii), and (iii) of subsection 
                (a)(6)(A).
            ``(3) Process for pediatric quality measures program.--In 
        identifying gaps in existing pediatric quality measures and 
        establishing priorities for development and advancement of such 
        measures, the Secretary shall consult with--
                    ``(A) States;
                    ``(B) pediatricians, children's hospitals, and 
                other primary and specialized pediatric health care 
                professionals (including members of the allied health 
                professions) who specialize in the care and treatment 
                of children, particularly children with special 
                physical, mental, and developmental health care needs;
                    ``(C) dental professionals, including pediatric 
                dental professionals;
                    ``(D) health care providers that furnish primary 
                health care to children and families who live in urban 
                and rural medically underserved communities or who are 
                members of distinct population sub-groups at heightened 
                risk for poor health outcomes;
                    ``(E) national organizations representing children, 
                including children with disabilities and children with 
                chronic conditions;
                    ``(F) national organizations representing consumers 
                and purchasers of children's health care;
                    ``(G) national organizations and individuals with 
                expertise in pediatric health quality measurement; and
                    ``(H) voluntary consensus standards setting 
                organizations and other organizations involved in the 
                advancement of evidence-based measures of health care.
            ``(4) Developing, validating, and testing a portfolio of 
        pediatric quality measures.--As part of the program to advance 
        pediatric quality measures, the Secretary shall--
                    ``(A) award grants and contracts for the 
                development, testing, and validation of new, emerging, 
                and innovative evidence-based measures for children's 
                health care services across the domains of quality 
                described in clauses (i), (ii), and (iii) of subsection 
                (a)(6)(A); and
                    ``(B) award grants and contracts for--
                            ``(i) the development of consensus on 
                        evidence-based measures for children's health 
                        care services;
                            ``(ii) the dissemination of such measures 
                        to public and private purchasers of health care 
                        for children; and
                            ``(iii) the updating of such measures as 
                        necessary.
            ``(5) Revising, strengthening, and improving initial core 
        measures.--Beginning no later than January 1, 2013, and 
        annually thereafter, the Secretary shall publish recommended 
        changes to the core measures described in subsection (a) that 
        shall reflect the testing, validation, and consensus process 
        for the development of pediatric quality measures described in 
        subsection paragraphs (1) through (4).
            ``(6) Definition of pediatric quality measure.--In this 
        subsection, the term `pediatric quality measure' means a 
        measurement of clinical care that is capable of being examined 
        through the collection and analysis of relevant information, 
        that is developed in order to assess 1 or more aspects of 
        pediatric health care quality in various institutional and 
        ambulatory health care settings, including the structure of the 
        clinical care system, the process of care, the outcome of care, 
        or patient experiences in care.
            ``(7) Construction.--Nothing in this section shall be 
        construed as supporting the restriction of coverage, under 
        title XIX or XXI or otherwise, to only those services that are 
        evidence-based.
    ``(c) Annual State Reports Regarding State-Specific Quality of Care 
Measures Applied Under Medicaid or Chip.--
            ``(1) Annual state reports.--Each State with a State plan 
        approved under title XIX or a State child health plan approved 
        under title XXI shall annually report to the Secretary on the--
                    ``(A) State-specific child health quality measures 
                applied by the States under such plans, including 
                measures described in subparagraphs (A) and (B) of 
                subsection (a)(6); and
                    ``(B) State-specific information on the quality of 
                health care furnished to children under such plans, 
                including information collected through external 
                quality reviews of managed care organizations under 
                section 1932 of the Social Security Act (42 U.S.C. 
                1396u-4) and benchmark plans under sections 1937 and 
                2103 of such Act (42 U.S.C. 1396u-7, 1397cc).
            ``(2) Publication.--Not later than September 30, 2010, and 
        annually thereafter, the Secretary shall collect, analyze, and 
        make publicly available the information reported by States 
        under paragraph (1).
    ``(d) Demonstration Projects for Improving the Quality of 
Children's Health Care and the Use of Health Information Technology.--
            ``(1) In general.--During the period of fiscal years 2009 
        through 2013, the Secretary shall award not more than 10 grants 
        to States and child health providers to conduct demonstration 
        projects to evaluate promising ideas for improving the quality 
        of children's health care provided under title XIX or XXI, 
        including projects to--
                    ``(A) experiment with, and evaluate the use of, new 
                measures of the quality of children's health care under 
                such titles (including testing the validity and 
                suitability for reporting of such measures);
                    ``(B) promote the use of health information 
                technology in care delivery for children under such 
                titles;
                    ``(C) evaluate provider-based models which improve 
                the delivery of children's health care services under 
                such titles, including care management for children 
                with chronic conditions and the use of evidence-based 
                approaches to improve the effectiveness, safety, and 
                efficiency of health care services for children; or
                    ``(D) demonstrate the impact of the model 
                electronic health record format for children developed 
                and disseminated under subsection (f) on improving 
                pediatric health, including the effects of chronic 
                childhood health conditions, and pediatric health care 
                quality as well as reducing health care costs.
            ``(2) Requirements.--In awarding grants under this 
        subsection, the Secretary shall ensure that--
                    ``(A) only 1 demonstration project funded under a 
                grant awarded under this subsection shall be conducted 
                in a State; and
                    ``(B) demonstration projects funded under grants 
                awarded under this subsection shall be conducted evenly 
                between States with large urban areas and States with 
                large rural areas.
            ``(3) Authority for multistate projects.--A demonstration 
        project conducted with a grant awarded under this subsection 
        may be conducted on a multistate basis, as needed.
            ``(4) Funding.--$20,000,000 of the amount appropriated 
        under subsection (i) for a fiscal year shall be used to carry 
        out this subsection.
    ``(e) Childhood Obesity Demonstration Project.--
            ``(1) Authority to conduct demonstration.--The Secretary, 
        in consultation with the Administrator of the Centers for 
        Medicare & Medicaid Services, shall conduct a demonstration 
        project to develop a comprehensive and systematic model for 
        reducing childhood obesity by awarding grants to eligible 
        entities to carry out such project. Such model shall--
                    ``(A) identify, through self-assessment, behavioral 
                risk factors for obesity among children;
                    ``(B) identify, through self-assessment, needed 
                clinical preventive and screening benefits among those 
                children identified as target individuals on the basis 
                of such risk factors;
                    ``(C) provide ongoing support to such target 
                individuals and their families to reduce risk factors 
                and promote the appropriate use of preventive and 
                screening benefits; and
                    ``(D) be designed to improve health outcomes, 
                satisfaction, quality of life, and appropriate use of 
                items and services for which medical assistance is 
                available under title XIX or child health assistance is 
                available under title XXI among such target 
                individuals.
            ``(2) Eligibility entities.--For purposes of this 
        subsection, an eligible entity is any of the following:
                    ``(A) A city, county, or Indian tribe.
                    ``(B) A local or tribal educational agency.
                    ``(C) An accredited university, college, or 
                community college.
                    ``(D) A Federally-qualified health center.
                    ``(E) A local health department.
                    ``(F) A health care provider.
                    ``(G) A community-based organization.
                    ``(H) Any other entity determined appropriate by 
                the Secretary, including a consortia or partnership of 
                entities described in any of subparagraphs (A) through 
                (G).
            ``(3) Use of funds.--An eligible entity awarded a grant 
        under this subsection shall use the funds made available under 
        the grant to--
                    ``(A) carry out community-based activities related 
                to reducing childhood obesity, including by--
                            ``(i) forming partnerships with entities, 
                        including schools and other facilities 
                        providing recreational services, to establish 
                        programs for after school and weekend community 
                        activities that are designed to reduce 
                        childhood obesity;
                            ``(ii) forming partnerships with daycare 
                        facilities to establish programs that promote 
                        healthy eating behaviors and physical activity; 
                        and
                            ``(iii) developing and evaluating community 
                        educational activities targeting good nutrition 
                        and promoting healthy eating behaviors;
                    ``(B) carry out age-appropriate school-based 
                activities that are designed to reduce childhood 
                obesity, including by--
                            ``(i) developing and testing educational 
                        curricula and intervention programs designed to 
                        promote healthy eating behaviors and habits in 
                        youth, which may include--
                                    ``(I) after hours physical activity 
                                programs; and
                                    ``(II) science-based interventions 
                                with multiple components to prevent 
                                eating disorders including nutritional 
                                content, understanding and responding 
                                to hunger and satiety, positive body 
                                image development, positive self-esteem 
                                development, and learning life skills 
                                (such as stress management, 
                                communication skills, problemsolving 
                                and decisionmaking skills), as well as 
                                consideration of cultural and 
                                developmental issues, and the role of 
                                family, school, and community;
                            ``(ii) providing education and training to 
                        educational professionals regarding how to 
                        promote a healthy lifestyle and a healthy 
                        school environment for children;
                            ``(iii) planning and implementing a healthy 
                        lifestyle curriculum or program with an 
                        emphasis on healthy eating behaviors and 
                        physical activity; and
                            ``(iv) planning and implementing healthy 
                        lifestyle classes or programs for parents or 
                        guardians, with an emphasis on healthy eating 
                        behaviors and physical activity for children;
                    ``(C) carry out educational, counseling, 
                promotional, and training activities through the local 
                health care delivery systems including by--
                            ``(i) promoting healthy eating behaviors 
                        and physical activity services to treat or 
                        prevent eating disorders, being overweight, and 
                        obesity;
                            ``(ii) providing patient education and 
                        counseling to increase physical activity and 
                        promote healthy eating behaviors;
                            ``(iii) training health professionals on 
                        how to identify and treat obese and overweight 
                        individuals which may include nutrition and 
                        physical activity counseling; and
                            ``(iv) providing community education by a 
                        health professional on good nutrition and 
                        physical activity to develop a better 
                        understanding of the relationship between diet, 
                        physical activity, and eating disorders, 
                        obesity, or being overweight; and
                    ``(D) provide, through qualified health 
                professionals, training and supervision for community 
                health workers to--
                            ``(i) educate families regarding the 
                        relationship between nutrition, eating habits, 
                        physical activity, and obesity;
                            ``(ii) educate families about effective 
                        strategies to improve nutrition, establish 
                        healthy eating patterns, and establish 
                        appropriate levels of physical activity; and
                            ``(iii) educate and guide parents regarding 
                        the ability to model and communicate positive 
                        health behaviors.
            ``(4) Priority.--In awarding grants under paragraph (1), 
        the Secretary shall give priority to awarding grants to 
        eligible entities--
                    ``(A) that demonstrate that they have previously 
                applied successfully for funds to carry out activities 
                that seek to promote individual and community health 
                and to prevent the incidence of chronic disease and 
                that can cite published and peer-reviewed research 
                demonstrating that the activities that the entities 
                propose to carry out with funds made available under 
                the grant are effective;
                    ``(B) that will carry out programs or activities 
                that seek to accomplish a goal or goals set by the 
                State in the Healthy People 2010 plan of the State;
                    ``(C) that provide non-Federal contributions, 
                either in cash or in-kind, to the costs of funding 
                activities under the grants;
                    ``(D) that develop comprehensive plans that include 
                a strategy for extending program activities developed 
                under grants in the years following the fiscal years 
                for which they receive grants under this subsection;
                    ``(E) located in communities that are medically 
                underserved, as determined by the Secretary;
                    ``(F) located in areas in which the average poverty 
                rate is at least 150 percent or higher of the average 
                poverty rate in the State involved, as determined by 
                the Secretary; and
                    ``(G) that submit plans that exhibit multisectoral, 
                cooperative conduct that includes the involvement of a 
                broad range of stakeholders, including--
                            ``(i) community-based organizations;
                            ``(ii) local governments;
                            ``(iii) local educational agencies;
                            ``(iv) the private sector;
                            ``(v) State or local departments of health;
                            ``(vi) accredited colleges, universities, 
                        and community colleges;
                            ``(vii) health care providers;
                            ``(viii) State and local departments of 
                        transportation and city planning; and
                            ``(ix) other entities determined 
                        appropriate by the Secretary.
            ``(5) Program design.--
                    ``(A) Initial design.--Not later than 1 year after 
                the date of enactment of this section, the Secretary 
                shall design the demonstration project. The 
                demonstration should draw upon promising, innovative 
                models and incentives to reduce behavioral risk 
                factors. The Administrator of the Centers for Medicare 
                & Medicaid Services shall consult with the Director of 
                the Centers for Disease Control and Prevention, the 
                Director of the Office of Minority Health, the heads of 
                other agencies in the Department of Health and Human 
                Services, and such professional organizations, as the 
                Secretary determines to be appropriate, on the design, 
                conduct, and evaluation of the demonstration.
                    ``(B) Number and project areas.--Not later than 2 
                years after the date of enactment of this section, the 
                Secretary shall award 1 grant that is specifically 
                designed to determine whether programs similar to 
                programs to be conducted by other grantees under this 
                subsection should be implemented with respect to the 
                general population of children who are eligible for 
                child health assistance under State child health plans 
                under title XXI in order to reduce the incidence of 
                childhood obesity among such population.
            ``(6) Report to congress.--Not later than 3 years after the 
        date the Secretary implements the demonstration project under 
        this subsection, the Secretary shall submit to Congress a 
        report that describes the project, evaluates the effectiveness 
        and cost effectiveness of the project, evaluates the 
        beneficiary satisfaction under the project, and includes any 
        such other information as the Secretary determines to be 
        appropriate.
            ``(7) Definitions.--In this subsection:
                    ``(A) Federally-qualified health center.--The term 
                `Federally-qualified health center' has the meaning 
                given that term in section 1905(l)(2)(B).
                    ``(B) Indian tribe.--The term `Indian tribe' has 
                the meaning given that term in section 4 of the Indian 
                Health Care Improvement Act (25 U.S.C. 1603).
                    ``(C) Self-assessment.--The term `self-assessment' 
                means a form that--
                            ``(i) includes questions regarding--
                                    ``(I) behavioral risk factors;
                                    ``(II) needed preventive and 
                                screening services; and
                                    ``(III) target individuals' 
                                preferences for receiving follow-up 
                                information;
                            ``(ii) is assessed using such computer 
                        generated assessment programs; and
                            ``(iii) allows for the provision of such 
                        ongoing support to the individual as the 
                        Secretary determines appropriate.
                    ``(D) Ongoing support.--The term `ongoing support' 
                means--
                            ``(i) to provide any target individual with 
                        information, feedback, health coaching, and 
                        recommendations regarding--
                                    ``(I) the results of a self-
                                assessment given to the individual;
                                    ``(II) behavior modification based 
                                on the self-assessment; and
                                    ``(III) any need for clinical 
                                preventive and screening services or 
                                treatment including medical nutrition 
                                therapy;
                            ``(ii) to provide any target individual 
                        with referrals to community resources and 
                        programs available to assist the target 
                        individual in reducing health risks; and
                            ``(iii) to provide the information 
                        described in clause (i) to a health care 
                        provider, if designated by the target 
                        individual to receive such information.
            ``(8) Authorization of appropriations.--There is authorized 
        to be appropriated to carry out this subsection, $25,000,000 
        for the period of fiscal years 2009 through 2013.
    ``(f) Development of Model Electronic Health Record Format for 
Children Enrolled in Medicaid or CHIP.--
            ``(1) In general.--Not later than January 1, 2010, the 
        Secretary shall establish a program to encourage the 
        development and dissemination of a model electronic health 
        record format for children enrolled in the State plan under 
        title XIX or the State child health plan under title XXI that 
        is--
                    ``(A) subject to State laws, accessible to parents, 
                caregivers, and other consumers for the sole purpose of 
                demonstrating compliance with school or leisure 
                activity requirements, such as appropriate 
                immunizations or physicals;
                    ``(B) designed to allow interoperable exchanges 
                that conform with Federal and State privacy and 
                security requirements;
                    ``(C) structured in a manner that permits parents 
                and caregivers to view and understand the extent to 
                which the care their children receive is clinically 
                appropriate and of high quality; and
                    ``(D) capable of being incorporated into, and 
                otherwise compatible with, other standards developed 
                for electronic health records.
            ``(2) Funding.--$5,000,000 of the amount appropriated under 
        subsection (i) for a fiscal year shall be used to carry out 
        this subsection.
    ``(g) Study of Pediatric Health and Health Care Quality Measures.--
            ``(1) In general.--Not later than July 1, 2010, the 
        Institute of Medicine shall study and report to Congress on the 
        extent and quality of efforts to measure child health status 
        and the quality of health care for children across the age span 
        and in relation to preventive care, treatments for acute 
        conditions, and treatments aimed at ameliorating or correcting 
        physical, mental, and developmental conditions in children. In 
        conducting such study and preparing such report, the Institute 
        of Medicine shall--
                    ``(A) consider all of the major national 
                population-based reporting systems sponsored by the 
                Federal Government that are currently in place, 
                including reporting requirements under Federal grant 
                programs and national population surveys and estimates 
                conducted directly by the Federal Government;
                    ``(B) identify the information regarding child 
                health and health care quality that each system is 
                designed to capture and generate, the study and 
                reporting periods covered by each system, and the 
                extent to which the information so generated is made 
                widely available through publication;
                    ``(C) identify gaps in knowledge related to 
                children's health status, health disparities among 
                subgroups of children, the effects of social conditions 
                on children's health status and use and effectiveness 
                of health care, and the relationship between child 
                health status and family income, family stability and 
                preservation, and children's school readiness and 
                educational achievement and attainment; and
                    ``(D) make recommendations regarding improving and 
                strengthening the timeliness, quality, and public 
                transparency and accessibility of information about 
                child health and health care quality.
            ``(2) Funding.--Up to $1,000,000 of the amount appropriated 
        under subsection (i) for a fiscal year shall be used to carry 
        out this subsection.
    ``(h) Rule of Construction.--Notwithstanding any other provision in 
this section, no evidence based quality measure developed, published, 
or used as a basis of measurement or reporting under this section may 
be used to establish an irrebuttable presumption regarding either the 
medical necessity of care or the maximum permissible coverage for any 
individual child who is eligible for and receiving medical assistance 
under title XIX or child health assistance under title XXI.
    ``(i) Appropriation.--Out of any funds in the Treasury not 
otherwise appropriated, there is appropriated for each of fiscal years 
2009 through 2013, $45,000,000 for the purpose of carrying out this 
section (other than subsection (e)). Funds appropriated under this 
subsection shall remain available until expended.''.
    (b) Increased Matching Rate for Collecting and Reporting on Child 
Health Measures.--Section 1903(a)(3)(A) of such Act (42 U.S.C. 
1396b(a)(3)(A)), is amended--
            (1) by striking ``and'' at the end of clause (i); and
            (2) by adding at the end the following new clause:
                    ``(iii) an amount equal to the Federal medical 
                assistance percentage (as defined in section 1905(b)) 
                of so much of the sums expended during such quarter (as 
                found necessary by the Secretary for the proper and 
                efficient administration of the State plan) as are 
                attributable to such developments or modifications of 
                systems of the type described in clause (i) as are 
                necessary for the efficient collection and reporting on 
                child health measures; and''.
                                 <all>
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