I 

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. 

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

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Medicaid–SCHIP Den5 tal Benefits Improvement Act of 2009’’. 

6 SEC. 2. DENTAL BENEFITS. 

7 (a) COVERAGE.— 


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1 (1) IN GENERAL.—Section 2103 of the Social 

2 Security Act (42 U.S.C. 1397cc) is amended— 

3 (A) in subsection (a)— 

4 (i) in the matter before paragraph 

5 (1), by striking ‘‘subsection (c)(5)’’ and in6 serting ‘‘paragraphs (5) and (6) of sub7 section (c)’’ ; and 

8 (ii) in paragraph (I) , by inserting ‘‘at 

9 least’’ after ‘‘that is’’; and 

10 (B) in subsection (c)— 

11 (i) by redesignating paragraph (5) as 

12 paragraph (6); and 

13 (ii) by inserting after paragraph (4), 

14 the following: 

15 ‘‘(5) DENTAL BENEFITS.— 

16 ‘‘(A) IN GENERAL.—The child health as17 sistance provided to a targeted low-income child 

18 shall include coverage of dental services nec19 essary to prevent disease and promote oral 

20 health, restore oral structures to health and 

21 function, and treat emergency conditions. 

22 ‘‘(B) PERMITTING USE OF DENTAL

23 BENCHMARK PLANS BY CERTAIN STATES.—A 

24 State may elect to meet the requirement of sub25 paragraph (A) through dental coverage that is 


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1 equivalent to a benchmark dental benefit pack2 age described in subparagraph (C). 

3 ‘‘(C) BENCHMARK DENTAL BENEFIT PACK4 AGES.—The benchmark dental benefit packages 

5 are as follows: 

6 ‘‘(i) FEHBP CHILDREN’S DENTAL

7 COVERAGE.—A dental benefits plan under 

8 chapter 89A of title 5, United States Code, 

9 that has been selected most frequently by 

10 employees seeking dependent coverage, 

11 among such plans that provide such de12 pendent coverage, in either of the previous 

13 2 plan years. 

14 ‘‘(ii) STATE EMPLOYEE DEPENDENT

15 DENTAL COVERAGE.—A dental benefits 

16 plan that is offered and generally available 

17 to State employees in the State involved 

18 and that has been selected most frequently 

19 by employees seeking dependent coverage, 

20 among such plans that provide such de21 pendent coverage, in either of the previous 

22 2 plan years. 

23 ‘‘(iii) COVERAGE OFFERED THROUGH

24 COMMERCIAL DENTAL PLAN.—A dental 

25 benefits plan that has the largest insured 


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1 commercial, non-medicaid enrollment of 

2 dependent covered lives of such plans that 

3 is offered in the State involved.’’. 

4 (2) ASSURING ACCESS TO CARE.—Section 

5 2102(a)(7)(B) of such Act (42 U.S.C. 1397bb(c)(2)) 

6 is amended by inserting ‘‘and services described in 

7 section 2103(c)(5)’’ after ‘‘emergency services’’. 

8 (3) EFFECTIVE DATE.—The amendments made 

9 by paragraph (1) shall apply to coverage of items 

10 and services furnished on or after October 1, 2009. 

11 (b) DENTAL EDUCATION FOR PARENTS OF

12 NEWBORNS.—The Secretary of Health and Human Serv13 ices shall develop and implement, through entities that 

14 fund or provide perinatal care services to targeted low15 income children under a State child health plan under title 

16 XXI of the Social Security Act, a program to deliver oral 

17 health educational materials that inform new parents 

18 about risks for, and prevention of, early childhood caries 

19 and the need for a dental visit within their newborn’s first 

20 year of life. 

21 (c) PROVISION OF DENTAL SERVICES THROUGH

22 FQHCS.— 

23 (1) MEDICAID.—Section 1902(a) of such Act 

24 (42 U.S.C. 1396a(a)) is amended— 


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1 (A) by striking ‘‘and’’ at the end of para2 graph (70); 

3 (B) by striking the period at the end of 

4 paragraph (71) and inserting ‘‘; and’’; and 

5 (C) by inserting after paragraph (71) the 

6 following new paragraph: 

7 ‘‘(72) provide that the State will not prevent a 

8 Federally-qualified health center from entering into 

9 contractual relationships with private practice dental 

10 providers in the provision of Federally-qualified 

11 health center services.’’. 

12 (2) CHIP.—Section 2107(e)(1) of such Act (42 

13 U.S.C. 1397g(e)(1)) is amended by redesignating 

14 subparagraphs (B) through (D) as subparagraphs 

15 (C) through (E), respectively, and by inserting after 

16 subparagraph (A) the following new subparagraph: 

17 ‘‘(B) Section 1902(a)(72) (relating to lim18 iting FQHC contracting for provision of dental 

19 services).’’. 

20 (3) EFFECTIVE DATE.—The amendments made 

21 by this subsection shall take effect on January 1, 

22 2009. 

23 (d) REPORTING INFORMATION ON DENTAL

24 HEALTH.— 


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1 (1) MEDICAID.—Section 1902(a)(43)(D)(iii) of 

2 such Act (42 U.S.C. 1396a(a)(43)(D)(iii)) is amend3 ed by inserting ‘‘and other information relating to 

4 the provision of dental services to such children de5 scribed in section 2108(e)’’ after ‘‘receiving dental 

6 services,’’. 

7 (2) CHIP.—Section 2108 of such Act (42 

8 U.S.C. 1397hh) is amended by adding at the end 

9 the following new subsection: 

10 ‘‘(e) INFORMATION ON DENTAL CARE FOR CHIL11 DREN.— 

12 ‘‘(1) IN GENERAL.—Each annual report under 

13 subsection (a) shall include the following information 

14 with respect to care and services described in section 

15 1905(r)(3) provided to targeted low-income children 

16 enrolled in the State child health plan under this 

17 title at any time during the year involved: 

18 ‘‘(A) The number of enrolled children by 

19 age grouping used for reporting purposes under 

20 section 1902(a)(43). 

21 ‘‘(B) For children within each such age 

22 grouping, information of the type contained in 

23 questions 12(a)–(c) of CMS Form 416 (that 

24 consists of the number of enrolled targeted low 


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1 income children who receive any, preventive, or 

2 restorative dental care under the State plan). 

3 ‘‘(C) For the age grouping that includes 

4 children 8 years of age, the number of such 

5 children who have received a protective sealant 

6 on at least one permanent molar tooth. 

7 ‘‘(2) INCLUSION OF INFORMATION ON ENROLL8 EES IN MANAGED CARE PLANS.—The information 

9 under paragraph (1) shall include information on 

10 children who are enrolled in managed care plans and 

11 other private health plans and contracts with such 

12 plans under this title shall provide for the reporting 

13 of such information by such plans to the State.’’. 

14 (3) EFFECTIVE DATE.—The amendments made 

15 by this subsection shall be effective for annual re16 ports submitted for years beginning after date of en17 actment. 

18 (e) IMPROVED ACCESSIBILITY OF DENTAL PROVIDER

19 INFORMATION TO ENROLLEES UNDER MEDICAID AND

20 CHIP.—The Secretary of Health and Human Services 

21 shall— 

22 (1) work with States, pediatric dentists, and 

23 other dental providers (including providers that are, 

24 or are affiliated with, a school of dentistry) to in25 clude, not later than 6 months after the date of the 


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1 enactment of this Act, on the Insure Kids Now 

2 website (http://www.insurekidsnow.gov/) and hotline 

3 (1–877–KIDS–NOW) (or on any successor websites 

4 or hotlines) a current and accurate list of all such 

5 dentists and providers within each State that provide 

6 dental services to children enrolled in the State plan 

7 (or waiver) under Medicaid or the State child health 

8 plan (or waiver) under title XXI of the Social Secu9 rity Act, and shall ensure that such list is updated 

10 at least quarterly; and 

11 (2) work with States to include, not later than 

12 6 months after the date of the enactment of this 

13 Act, a description of the dental services provided 

14 under each State plan (or waiver) under Medicaid 

15 and each State child health plan (or waiver) under 

16 title XXI of the Social Security Act on such Insure 

17 Kids Now website, and shall ensure that such list is 

18 updated at least annually. 

19 (f) GAO STUDY AND REPORT.— 

20 (1) STUDY.—The Comptroller General of the 

21 United States shall provide for a study that exam22 ines— 

23 (A) access to dental services by children in 

24 underserved areas; 


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1 (B) children’s access to oral health care, 

2 including preventive and restorative services, 

3 under Medicaid and the State Children’s Health 

4 Insurance Program, including— 

5 (i) the extent to which dental pro6 viders are willing to treat children eligible 

7 for such programs; 

8 (ii) information on such children’s ac9 cess to networks of care, including such 

10 networks that serve special needs children; 

11 and 

12 (iii) geographic availability of oral 

13 health care, including preventive and re14 storative services, under such programs; 

15 and 

16 (C) the feasibility and appropriateness of 

17 using qualified mid-level dental health pro18 viders, in coordination with dentists, to improve 

19 access for children to oral health services and 

20 public health overall. 

21 (2) REPORT.—Not later than 18 months after 

22 the date of the enactment of this Act, the Comp23 troller General shall submit to Congress a report on 

24 the study conducted under paragraph (1). The re25 port shall include recommendations for such Federal 


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1 and State legislative and administrative changes as 

2 the Comptroller General determines are necessary to 

3 address any barriers to access to oral health care, 

4 including preventive and restorative services, under 

5 Medicaid and the State Children’s Health Insurance 

6 Program that may exist. 

7 SEC. 3. CHILD HEALTH QUALITY IMPROVEMENT ACTIVI8 TIES FOR CHILDREN ENROLLED IN MED9 ICAID OR CHIP. 

10 (a) DEVELOPMENT OF CHILD HEALTH QUALITY

11 MEASURES FOR CHILDREN ENROLLED IN MEDICAID OR

12 CHIP.—Title XI of the Social Security Act (42 U.S.C. 

13 1301 et seq.) is amended by inserting after section 1139 

14 the following new section: 

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

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

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

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

20 2010, the Secretary shall identify and publish for 

21 general comment an initial, recommended core set of 

22 child health quality measures for use by State pro23 grams administered under titles XIX and XXI, 

24 health insurance issuers and managed care entities 

25 that enter into contracts with such programs, and 


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1 providers of items and services under such pro2 grams. 

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

6 shall identify existing quality of care measures for 

7 children that are in use under public and privately 

8 sponsored health care coverage arrangements, or 

9 that are part of reporting systems that measure both 

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

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

15 of child health quality measures that includes (but 

16 is not limited to) the following: 

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

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

20 full range of— 

21 ‘‘(i) preventive services, treatments, 

22 and services for acute conditions, including 

23 services to promote healthy birth, prevent 

24 and treat premature birth, and detect the 

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1 ditions that could adversely affect growth 

2 and development; and 

3 ‘‘(ii) treatments to correct or amelio4 rate the effects of physical and mental con5 ditions, including chronic conditions, and, 

6 with respect to dental care, conditions re7 quiring the restoration of teeth, relief of 

8 pain and infection, and maintenance of 

9 dental health, in infants, young children, 

10 school-age children, and adolescents. 

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

12 ambulatory and inpatient health care settings 

13 in which such care is furnished. 

14 ‘‘(D) The types of measures that, taken to15 gether, can be used to estimate the overall na16 tional quality of health care for children, includ17 ing children with special needs, and to perform 

18 comparative analyses of pediatric health care 

19 quality and racial, ethnic, and socioeconomic 

20 disparities in child health and health care for 

21 children. 

22 ‘‘(4) ENCOURAGE VOLUNTARY AND STANDARD23 IZED REPORTING.—Not later than 2 years after the 

24 date of enactment of this section, the Secretary, in 

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1 ized format for reporting information and proce2 dures and approaches that encourage States to use 

3 the initial core measurement set to voluntarily report 

4 information regarding the quality of pediatric health 

5 care under titles XIX and XXI. 

6 ‘‘(5) ADOPTION OF BEST PRACTICES IN IMPLE7 MENTING QUALITY PROGRAMS.—The Secretary shall 

8 disseminate information to States regarding best 

9 practices among States with respect to measuring 

10 and reporting on the quality of health care for chil11 dren, and shall facilitate the adoption of such best 

12 practices. In developing best practices approaches, 

13 the Secretary shall give particular attention to State 

14 measurement techniques that ensure the timeliness 

15 and accuracy of provider reporting, encourage pro16 vider reporting compliance, encourage successful 

17 quality improvement strategies, and improve effi18 ciency in data collection using health information 

19 technology. 

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

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

22 Secretary shall report to Congress on— 

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

24 to improve— 


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1 ‘‘(i) quality related to the duration 

2 and stability of health insurance coverage 

3 for children under titles XIX and XXI; 

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

5 care under such titles, including preventive 

6 health services, dental services, health care 

7 for acute conditions, chronic health care, 

8 and health services to ameliorate the ef9 fects of physical and mental conditions and 

10 to aid in growth and development of in11 fants, young children, school-age children, 

12 and adolescents with special health care 

13 needs; and 

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

15 care under such titles across the domains 

16 of quality, including clinical quality, health 

17 care safety, family experience with health 

18 care, health care in the most integrated 

19 setting, and elimination of racial, ethnic, 

20 and socioeconomic disparities in health and 

21 health care; 

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

23 States under titles XIX and XXI, utilizing the 

24 initial core quality measurement set; and 


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1 ‘‘(C) any recommendations for legislative 

2 changes needed to improve the quality of care 

3 provided to children under titles XIX and XXI, 

4 including recommendations for quality reporting 

5 by States. 

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

7 shall provide technical assistance to States to assist 

8 them in adopting and utilizing core child health 

9 quality measures in administering the State plans 

10 under titles XIX and XXI. 

11 ‘‘(8) DEFINITION OF CORE SET.—In this sec12 tion, the term ‘core set’ means a group of valid, reli13 able, and evidence-based quality measures that, 

14 taken together— 

15 ‘‘(A) provide information regarding the 

16 quality of health coverage and health care for 

17 children; 

18 ‘‘(B) address the needs of children 

19 throughout the developmental age span; and 

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

21 care providers to understand the quality of care 

22 in relation to the preventive needs of children, 

23 treatments aimed at managing and resolving 

24 acute conditions, and diagnostic and treatment 

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1 rate physical, mental, or developmental condi2 tions that could, if untreated or poorly treated, 

3 become chronic. 

4 ‘‘(b) ADVANCING AND IMPROVING PEDIATRIC QUAL5 ITY MEASURES.— 

6 ‘‘(1) ESTABLISHMENT OF PEDIATRIC QUALITY

7 MEASURES PROGRAM.—Not later than January 1, 

8 2011, the Secretary shall establish a pediatric qual9 ity measures program to— 

10 ‘‘(A) improve and strengthen the initial 

11 core child health care quality measures estab12 lished by the Secretary under subsection (a); 

13 ‘‘(B) expand on existing pediatric quality 

14 measures used by public and private health care 

15 purchasers and advance the development of 

16 such new and emerging quality measures; and 

17 ‘‘(C) increase the portfolio of evidence18 based, consensus pediatric quality measures 

19 available to public and private purchasers of 

20 children’s health care services, providers, and 

21 consumers. 

22 ‘‘(2) EVIDENCE-BASED MEASURES.—The meas23 ures developed under the pediatric quality measures 

24 program shall, at a minimum, be— 


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1 ‘‘(A) evidence-based and, where appro2 priate, risk adjusted; 

3 ‘‘(B) designed to identify and eliminate ra4 cial and ethnic disparities in child health and 

5 the provision of health care; 

6 ‘‘(C) designed to ensure that the data re7 quired for such measures is collected and re8 ported in a standard format that permits com9 parison of quality and data at a State, plan, 

10 and provider level; 

11 ‘‘(D) periodically updated; and 

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

13 services, and domains of health care quality de14 scribed in clauses (i), (ii), and (iii) of subsection 

15 (a)(6)(A). 

16 ‘‘(3) PROCESS FOR PEDIATRIC QUALITY MEAS17 URES PROGRAM.—In identifying gaps in existing pe18 diatric quality measures and establishing priorities 

19 for development and advancement of such measures, 

20 the Secretary shall consult with— 

21 ‘‘(A) States; 

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

23 and other primary and specialized pediatric 

24 health care professionals (including members of 

25 the allied health professions) who specialize in 


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1 the care and treatment of children, particularly 

2 children with special physical, mental, and de3 velopmental health care needs; 

4 ‘‘(C) dental professionals, including pedi5 atric dental professionals; 

6 ‘‘(D) health care providers that furnish 

7 primary health care to children and families 

8 who live in urban and rural medically under9 served communities or who are members of dis10 tinct population sub-groups at heightened risk 

11 for poor health outcomes; 

12 ‘‘(E) national organizations representing 

13 children, including children with disabilities and 

14 children with chronic conditions; 

15 ‘‘(F) national organizations representing 

16 consumers and purchasers of children’s health 

17 care; 

18 ‘‘(G) national organizations and individuals 

19 with expertise in pediatric health quality meas20 urement; and 

21 ‘‘(H) voluntary consensus standards set22 ting organizations and other organizations in23 volved in the advancement of evidence-based 

24 measures of health care. 


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

2 A PORTFOLIO OF PEDIATRIC QUALITY MEASURES.— 

3 As part of the program to advance pediatric quality 

4 measures, the Secretary shall— 

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

6 development, testing, and validation of new, 

7 emerging, and innovative evidence-based meas8 ures for children’s health care services across 

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

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

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

12 ‘‘(i) the development of consensus on 

13 evidence-based measures for children’s 

14 health care services; 

15 ‘‘(ii) the dissemination of such meas16 ures to public and private purchasers of 

17 health care for children; and 

18 ‘‘(iii) the updating of such measures 

19 as necessary. 

20 ‘‘(5) REVISING, STRENGTHENING, AND IMPROV21 ING INITIAL CORE MEASURES.—Beginning no later 

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

23 Secretary shall publish recommended changes to the 

24 core measures described in subsection (a) that shall 

25 reflect the testing, validation, and consensus process 


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1 for the development of pediatric quality measures 

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

3 ‘‘(6) DEFINITION OF PEDIATRIC QUALITY

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

5 quality measure’ means a measurement of clinical 

6 care that is capable of being examined through the 

7 collection and analysis of relevant information, that 

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

9 pediatric health care quality in various institutional 

10 and ambulatory health care settings, including the 

11 structure of the clinical care system, the process of 

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

13 care. 

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

15 shall be construed as supporting the restriction of 

16 coverage, under title XIX or XXI or otherwise, to 

17 only those services that are evidence-based. 

18 ‘‘(c) ANNUAL STATE REPORTS REGARDING STATE19 SPECIFIC QUALITY OF CARE MEASURES APPLIED UNDER

20 MEDICAID OR CHIP.— 

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

22 with a State plan approved under title XIX or a 

23 State child health plan approved under title XXI 

24 shall annually report to the Secretary on the— 


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

2 measures applied by the States under such 

3 plans, including measures described in subpara4 graphs (A) and (B) of subsection (a)(6); and 

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

6 quality of health care furnished to children 

7 under such plans, including information col8 lected through external quality reviews of man9 aged care organizations under section 1932 of 

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

11 and benchmark plans under sections 1937 and 

12 2103 of such Act (42 U.S.C. 1396u–7, 1397cc). 

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

14 30, 2010, and annually thereafter, the Secretary 

15 shall collect, analyze, and make publicly available the 

16 information reported by States under paragraph (1). 

17 ‘‘(d) DEMONSTRATION PROJECTS FOR IMPROVING

18 THE QUALITY OF CHILDREN’S HEALTH CARE AND THE

19 USE OF HEALTH INFORMATION TECHNOLOGY.— 

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

21 years 2009 through 2013, the Secretary shall award 

22 not more than 10 grants to States and child health 

23 providers to conduct demonstration projects to 

24 evaluate promising ideas for improving the quality of 


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1 children’s health care provided under title XIX or 

2 XXI, including projects to— 

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

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

5 health care under such titles (including testing 

6 the validity and suitability for reporting of such 

7 measures); 

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

9 technology in care delivery for children under 

10 such titles; 

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

12 improve the delivery of children’s health care 

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

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

17 health care services for children; or 

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

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

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

23 pediatric health care quality as well as reducing 

24 health care costs. 


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

2 under this subsection, the Secretary shall ensure 

3 that— 

4 ‘‘(A) only 1 demonstration project funded 

5 under a grant awarded under this subsection 

6 shall be conducted in a State; and 

7 ‘‘(B) demonstration projects funded under 

8 grants awarded under this subsection shall be 

9 conducted evenly between States with large 

10 urban areas and States with large rural areas. 

11 ‘‘(3) AUTHORITY FOR MULTISTATE

12 PROJECTS.—A demonstration project conducted with 

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

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

16 appropriated under subsection (i) for a fiscal year 

17 shall be used to carry out this subsection. 

18 ‘‘(e) CHILDHOOD OBESITY DEMONSTRATION

19 PROJECT.— 

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

23 Services, shall conduct a demonstration project to 

24 develop a comprehensive and systematic model for 

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1 gible entities to carry out such project. Such model 

2 shall— 

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

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

6 needed clinical preventive and screening benefits 

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

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

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

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

17 child health assistance is available under title 

18 XXI among such target individuals. 

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

20 this subsection, an eligible entity is any of the fol21 lowing: 

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

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

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

25 community college. 


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

2 ‘‘(E) A local health department. 

3 ‘‘(F) A health care provider. 

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

5 ‘‘(H) Any other entity determined appro6 priate by the Secretary, including a consortia or 

7 partnership of entities described in any of sub8 paragraphs (A) through (G). 

9 ‘‘(3) USE OF FUNDS.—An eligible entity award10 ed a grant under this subsection shall use the funds 

11 made available under the grant to— 

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

13 related to reducing childhood obesity, including 

14 by— 

15 ‘‘(i) forming partnerships with enti16 ties, including schools and other facilities 

17 providing recreational services, to establish 

18 programs for after school and weekend 

19 community activities that are designed to 

20 reduce childhood obesity; 

21 ‘‘(ii) forming partnerships with 

22 daycare facilities to establish programs 

23 that promote healthy eating behaviors and 

24 physical activity; and 


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1 ‘‘(iii) developing and evaluating com2 munity educational activities targeting 

3 good nutrition and promoting healthy eat4 ing behaviors; 

5 ‘‘(B) carry out age-appropriate school6 based activities that are designed to reduce 

7 childhood obesity, including by— 

8 ‘‘(i) developing and testing edu9 cational curricula and intervention pro10 grams designed to promote healthy eating 

11 behaviors and habits in youth, which may 

12 include— 

13 ‘‘(I) after hours physical activity 

14 programs; and 

15 ‘‘(II) science-based interventions 

16 with multiple components to prevent 

17 eating disorders including nutritional 

18 content, understanding and respond19 ing to hunger and satiety, positive 

20 body image development, positive self21 esteem development, and learning life 

22 skills (such as stress management, 

23 communication skills, problemsolving 

24 and decisionmaking skills), as well as 

25 consideration of cultural and developVerDate Nov 24 2008 01:39 Jan 16, 2009 Jkt 079200 PO 00000 Frm 00026 Fmt 6652 Sfmt 6201 E:\BILLS\H462.IH H462

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1 mental issues, and the role of family, 

2 school, and community; 

3 ‘‘(ii) providing education and training 

4 to educational professionals regarding how 

5 to promote a healthy lifestyle and a 

6 healthy school environment for children; 

7 ‘‘(iii) planning and implementing a 

8 healthy lifestyle curriculum or program 

9 with an emphasis on healthy eating behav10 iors and physical activity; and 

11 ‘‘(iv) planning and implementing 

12 healthy lifestyle classes or programs for 

13 parents or guardians, with an emphasis on 

14 healthy eating behaviors and physical ac15 tivity for children; 

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

17 promotional, and training activities through the 

18 local health care delivery systems including 

19 by— 

20 ‘‘(i) promoting healthy eating behav21 iors and physical activity services to treat 

22 or prevent eating disorders, being over23 weight, and obesity; 


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1 ‘‘(ii) providing patient education and 

2 counseling to increase physical activity and 

3 promote healthy eating behaviors; 

4 ‘‘(iii) training health professionals on 

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

8 and 

9 ‘‘(iv) providing community education 

10 by a health professional on good nutrition 

11 and physical activity to develop a better 

12 understanding of the relationship between 

13 diet, physical activity, and eating disorders, 

14 obesity, or being overweight; and 

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

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

20 physical activity, and obesity; 

21 ‘‘(ii) educate families about effective 

22 strategies to improve nutrition, establish 

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


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

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

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

6 awarding grants to eligible entities— 

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

9 out activities that seek to promote individual 

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

14 propose to carry out with funds made available 

15 under the grant are effective; 

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

18 set by the State in the Healthy People 2010 

19 plan of the State; 

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

22 funding activities under the grants; 

23 ‘‘(D) that develop comprehensive plans 

24 that include a strategy for extending program 

25 activities developed under grants in the years 


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1 following the fiscal years for which they receive 

2 grants under this subsection; 

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

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

7 poverty rate is at least 150 percent or higher of 

8 the average poverty rate in the State involved, 

9 as determined by the Secretary; and 

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

12 involvement of a broad range of stakeholders, 

13 including— 

14 ‘‘(i) community-based organizations; 

15 ‘‘(ii) local governments; 

16 ‘‘(iii) local educational agencies; 

17 ‘‘(iv) the private sector; 

18 ‘‘(v) State or local departments of 

19 health; 

20 ‘‘(vi) accredited colleges, universities, 

21 and community colleges; 

22 ‘‘(vii) health care providers; 

23 ‘‘(viii) State and local departments of 

24 transportation and city planning; and 


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

3 ‘‘(5) PROGRAM DESIGN.— 

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

5 year after the date of enactment of this section, 

6 the Secretary shall design the demonstration 

7 project. The demonstration should draw upon 

8 promising, innovative models and incentives to 

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

11 Services shall consult with the Director of the 

12 Centers for Disease Control and Prevention, the 

13 Director of the Office of Minority Health, the 

14 heads of other agencies in the Department of 

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

18 and evaluation of the demonstration. 

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

20 later than 2 years after the date of enactment 

21 of this section, the Secretary shall award 1 

22 grant that is specifically designed to determine 

23 whether programs similar to programs to be 

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


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

3 health plans under title XXI in order to reduce 

4 the incidence of childhood obesity among such 

5 population. 

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

7 years after the date the Secretary implements the 

8 demonstration project under this subsection, the 

9 Secretary shall submit to Congress a report that de10 scribes the project, evaluates the effectiveness and 

11 cost effectiveness of the project, evaluates the bene12 ficiary satisfaction under the project, and includes 

13 any such other information as the Secretary deter14 mines to be appropriate. 

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

16 ‘‘(A) FEDERALLY-QUALIFIED HEALTH

17 CENTER.—The term ‘Federally-qualified health 

18 center’ has the meaning given that term in sec19 tion 1905(l)(2)(B). 

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

21 tribe’ has the meaning given that term in sec22 tion 4 of the Indian Health Care Improvement 

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

24 ‘‘(C) SELF-ASSESSMENT.—The term ‘self25 assessment’ means a form that— 


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1 ‘‘(i) includes questions regarding— 

2 ‘‘(I) behavioral risk factors; 

3 ‘‘(II) needed preventive and 

4 screening services; and 

5 ‘‘(III) target individuals’ pref6 erences for receiving follow-up infor7 mation; 

8 ‘‘(ii) is assessed using such computer 

9 generated assessment programs; and 

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

11 ongoing support to the individual as the 

12 Secretary determines appropriate. 

13 ‘‘(D) ONGOING SUPPORT.—The term ‘on14 going support’ means— 

15 ‘‘(i) to provide any target individual 

16 with information, feedback, health coach17 ing, and recommendations regarding— 

18 ‘‘(I) the results of a self-assess19 ment given to the individual; 

20 ‘‘(II) behavior modification based 

21 on the self-assessment; and 

22 ‘‘(III) any need for clinical pre23 ventive and screening services or 

24 treatment including medical nutrition 

25 therapy; 


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1 ‘‘(ii) to provide any target individual 

2 with referrals to community resources and 

3 programs available to assist the target in4 dividual in reducing health risks; and 

5 ‘‘(iii) to provide the information de6 scribed in clause (i) to a health care pro7 vider, if designated by the target individual 

8 to receive such information. 

9 ‘‘(8) AUTHORIZATION OF APPROPRIATIONS.— 

10 There is authorized to be appropriated to carry out 

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

12 years 2009 through 2013. 

13 ‘‘(f) DEVELOPMENT OF MODEL ELECTRONIC

14 HEALTH RECORD FORMAT FOR CHILDREN ENROLLED IN

15 MEDICAID OR CHIP.— 

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

17 2010, the Secretary shall establish a program to en18 courage the development and dissemination of a 

19 model electronic health record format for children 

20 enrolled in the State plan under title XIX or the 

21 State child health plan under title XXI that is— 

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

23 parents, caregivers, and other consumers for 

24 the sole purpose of demonstrating compliance 


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1 with school or leisure activity requirements, 

2 such as appropriate immunizations or physicals; 

3 ‘‘(B) designed to allow interoperable ex4 changes that conform with Federal and State 

5 privacy and security requirements; 

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

7 parents and caregivers to view and understand 

8 the extent to which the care their children re9 ceive is clinically appropriate and of high qual10 ity; and 

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

12 and otherwise compatible with, other standards 

13 developed for electronic health records. 

14 ‘‘(2) FUNDING.—$5,000,000 of the amount ap15 propriated under subsection (i) for a fiscal year shall 

16 be used to carry out this subsection. 

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

18 CARE QUALITY MEASURES.— 

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

20 2010, the Institute of Medicine shall study and re21 port to Congress on the extent and quality of efforts 

22 to measure child health status and the quality of 

23 health care for children across the age span and in 

24 relation to preventive care, treatments for acute con25 ditions, and treatments aimed at ameliorating or 


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1 correcting physical, mental, and developmental con2 ditions in children. In conducting such study and 

3 preparing such report, the Institute of Medicine 

4 shall— 

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

6 population-based reporting systems sponsored 

7 by the Federal Government that are currently 

8 in place, including reporting requirements 

9 under Federal grant programs and national 

10 population surveys and estimates conducted di11 rectly by the Federal Government; 

12 ‘‘(B) identify the information regarding 

13 child health and health care quality that each 

14 system is designed to capture and generate, the 

15 study and reporting periods covered by each 

16 system, and the extent to which the information 

17 so generated is made widely available through 

18 publication; 

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

20 children’s health status, health disparities 

21 among subgroups of children, the effects of so22 cial conditions on children’s health status and 

23 use and effectiveness of health care, and the re24 lationship between child health status and fam25 ily income, family stability and preservation, 


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1 and children’s school readiness and educational 

2 achievement and attainment; and 

3 ‘‘(D) make recommendations regarding im4 proving and strengthening the timeliness, qual5 ity, and public transparency and accessibility of 

6 information about child health and health care 

7 quality. 

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

9 amount appropriated under subsection (i) for a fis10 cal year shall be used to carry out this subsection. 

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

12 any other provision in this section, no evidence based qual13 ity measure developed, published, or used as a basis of 

14 measurement or reporting under this section may be used 

15 to establish an irrebuttable presumption regarding either 

16 the medical necessity of care or the maximum permissible 

17 coverage for any individual child who is eligible for and 

18 receiving medical assistance under title XIX or child 

19 health assistance under title XXI. 

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

21 Treasury not otherwise appropriated, there is appro22 priated for each of fiscal years 2009 through 2013, 

23 $45,000,000 for the purpose of carrying out this section 

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

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


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1 (b) INCREASED MATCHING RATE FOR COLLECTING

2 AND REPORTING ON CHILD HEALTH MEASURES.—Sec3 tion 1903(a)(3)(A) of such Act (42 U.S.C. 

4 1396b(a)(3)(A)), is amended— 

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

6 and 

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

8 clause: 

9 ‘‘(iii) an amount equal to the Federal med10 ical assistance percentage (as defined in section 

11 1905(b)) of so much of the sums expended dur12 ing such quarter (as found necessary by the 

13 Secretary for the proper and efficient adminis14 tration of the State plan) as are attributable to 

15 such developments or modifications of systems 

16 of the type described in clause (i) as are nec17 essary for the efficient collection and reporting 

18 on child health measures; and’’. 

Æ 


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