II

106TH CONGRESS

1ST SESSION S. 206

To amend title XXI of the Social Security Act to provide for improved

data collection and evaluations of State Children’s Health Insurance

Programs, and for other purposes.

IN THE SENATE OF THE UNITED STATES

JANUARY 19, 1999

Mr. MOYNIHAN (for himself and Mr. CHAFEE) introduced the following bill;

which was read twice and referred to the Committee on Finance

A BILL

To amend title XXI of the Social Security Act to provide

for improved data collection and evaluations of State

Children’s Health Insurance Programs, 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 ‘‘CHIP Data and Eval5 uation Improvement Act of 1999.’’.
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1 SEC. 2. FUNDING FOR RELIABLE ANNUAL STATE-BY-STATE

2 ESTIMATES ON THE NUMBER OF CHILDREN

3 WHO DO NOT HAVE HEALTH INSURANCE COV4 ERAGE.

5 Section 2108 of the Social Security Act (42

6 U.S.C.1397hh) is amended by adding at the end the fol7 lowing:

8 ‘‘(c) ADJUSTMENT TO CURRENT POPULATION SUR9 VEY TO INCLUDE STATE-BY-STATE DATA RELATING TO

10 CHILDREN WITHOUT HEALTH INSURANCE COVERAGE.—

11 ‘‘(1) IN GENERAL.—The Secretary of Com12 merce shall make appropriate adjustments to the an13 nual Current Population Survey conducted by the

14 Bureau of the Census in order to produce statis15 tically reliable annual State data on the number of

16 low-income children who do not have health insur17 ance coverage, so that real changes in the

18 uninsurance rates of children can reasonably be de19 tected. The Current Population Survey should

20 produce data under this subsection that categorizes

21 such children by family income, age, and race or eth22 nicity. The adjustments made to produce such data

23 shall include, where appropriate, expanding the sam24 ple size used in the State sampling units, expanding

25 the number of sampling units in a State, and an ap26 propriate verification element.
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1 ‘‘(2) APPROPRIATION.—Out of any money in

2 the Treasury of the United States not otherwise ap3 propriated, there are appropriated $10,000,000 for

4 fiscal year 2000 and each fiscal year thereafter for

5 the purpose of carrying out this subsection.’’.

6 SEC. 3. FUNDING FOR CHILDREN’S HEALTH CARE ACCESS

7 AND UTILIZATION STATE-BY-STATE DATA.

8 Section 2108 of the Social Security Act (42 U.S.C.

9 1397hh), as amended by section 2, is amended by adding

10 at the end the following:

11 ‘‘(d) COLLECTION OF CHILDREN’S HEALTH CARE

12 ACCESS AND UTILIZATION STATE-LEVEL DATA.—

13 ‘‘(1) IN GENERAL.—The Secretary, acting

14 through the National Center for Health Statistics

15 (in this subsection referred to as the ‘Center’), shall

16 collect data on children’s health insurance through

17 the State and Local Area Integrated Telephone Sur18 vey (SLAITS) for the 50 States and the District of

19 Columbia. Sufficient data shall be collected so as to

20 provide reliable, annual, State-by-State information

21 on the health care access and utilization of children

22 in low-income households, and to allow for compari23 sons between demographic subgroups categorized

24 with respect to family income, age, and race or eth25 nicity.
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1 ‘‘(2) SURVEY DESIGN AND CONTENT.—

2 ‘‘(A) IN GENERAL.—In carrying out para3 graph (1), the Secretary, acting through the

4 Center—

5 ‘‘(i) shall obtain input from appro6 priate sources, including States, in design7 ing the survey and making content deci8 sions; and

9 ‘‘(ii) at the request of a State, may

10 collect additional data to assist with a

11 State’s evaluation of the program estab12 lished under this title.

13 ‘‘(B) REIMBURSEMENT OF COSTS OF ADDI14 TIONAL DATA.—A State shall reimburse the

15 Center for services provided under subpara16 graph (A)(ii).

17 ‘‘(3) APPROPRIATION.—Out of any money in

18 the Treasury of the United States not otherwise ap19 propriated, there are appropriated $9,000,000 for

20 fiscal year 2000 and each fiscal year thereafter for

21 the purpose of carrying out this subsection.’’.
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1 SEC. 4. FEDERAL EVALUATION OF STATE CHILDREN’S

2 HEALTH INSURANCE PROGRAMS.

3 Section 2108 of the Social Security Act (42

4 U.S.C.1397hh), as amended by sections 2 and 3, is

5 amended—

6 (1) by redesignating subsections (c) and (d) as

7 subsections (d) and (e), respectively; and

8 (2) by inserting after subsection (b) the follow9 ing:

10 ‘‘(c) FEDERAL EVALUATION.—

11 ‘‘(1) IN GENERAL.—The Secretary, directly or

12 through contracts or interagency agreements, shall

13 conduct an independent evaluation of 10 States with

14 approved child health plans.

15 ‘‘(2) SELECTION OF STATES.—In selecting

16 States for the evaluation conducted under this sub17 section, the Secretary shall choose 10 States that

18 utilize diverse approaches to providing child health

19 assistance, represent various geographic areas (in20 cluding a mix of rural and urban areas), and contain

21 a significant portion of uncovered children.

22 ‘‘(3) MATTERS INCLUDED.—In addition to the

23 elements described in subsection (b)(1), the evalua24 tion conducted under this subsection shall include,

25 but is not limited to, the following:
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1 ‘‘(A) Surveys of the target population (en2 rollees, disenrollees, and individuals eligible for

3 but not enrolled in the program under this

4 title).

5 ‘‘(B) Evaluation of effective and ineffective

6 outreach and enrollment practices with respect

7 to children (for both the program under this

8 title and the medicaid program under title

9 XIX), and identification of enrollment barriers

10 and key elements of effective outreach and en11 rollment practices, including practices that have

12 successfully enrolled hard-to-reach populations

13 such as children who are eligible for medical as14 sistance under title XIX but have not been en15 rolled previously in the medicaid program under

16 that title.

17 ‘‘(C) Evaluation of the extent to which

18 State medicaid eligibility practices and proce19 dures under the medicaid program under title

20 XIX are a barrier to the enrollment of children

21 under that program, and the extent to which

22 coordination (or lack of coordination) between

23 that program and the program under this title

24 affects the enrollment of children under both

25 programs.
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1 ‘‘(D) An assessment of the effect of cost2 sharing on utilization, enrollment, and coverage

3 retention.

4 ‘‘(E) Evaluation of disenrollment or other

5 retention issues, such as switching to private

6 coverage, failure to pay premiums, or barriers

7 in the recertification process.

8 ‘‘(4) SUBMISSION TO CONGRESS.—Not later

9 than December 31, 2001, the Secretary shall submit

10 to Congress the results of the evaluation conducted

11 under this subsection.

12 ‘‘(5) FUNDING.—Out of any money in the

13 Treasury of the United States not otherwise appro14 priated, there are appropriated $10,000,000 for fis15 cal year 2000 for the purpose of conducting the eval16 uation authorized under this subsection. Amounts

17 appropriated under this paragraph shall remain

18 available without fiscal year limitation.’’.

19 SEC. 5. STANDARDIZED REPORTING REQUIREMENTS FOR

20 ANNUAL REPORTS.

21 Section 2108(a) of the Social Security Act (42 U.S.C.

22 1397hh(a)) is amended by—

23 (1) redesignating paragraphs (1) and (2) as

24 subparagraphs (A) and (B), respectively and indent25 ing appropriately;
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1 (2) by striking ‘‘The State shall—’’ and insert2 ing the following

3 ‘‘(1) IN GENERAL.—The State shall—’’; and

4 (3) by adding at the end the following:

5 ‘‘(2) STANDARDIZED REPORTING REQUIRE6 MENTS.—Each annual report submitted under this

7 subsection shall, in addition to expenditure and

8 other reporting requirements specified by the Sec9 retary, include the following:

10 ‘‘(A) Enrollee counts categorized by income

11 (that at least identifies enrollees with income

12 below the poverty line), age, and race or eth13 nicity, and, if income levels used in State re14 porting differ from that prescribed by the Sec15 retary, a detailed description of the eligibility

16 methodologies used by the State, including all

17 relevant income disregards, exempted income,

18 and eligibility family units.

19 ‘‘(B) The annual percentages of those indi20 viduals who sought coverage (as determined by

21 the Secretary) through the screening and enroll22 ment process established under the State pro23 gram under this title who were—

24 ‘‘(i) enrolled in the program under

25 this title;
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1 ‘‘(ii) enrolled in the medicaid program

2 under title XIX; or

3 ‘‘(iii) determined eligible for, but not

4 enrolled in, the program under this title or

5 the medicaid program under title XIX.’’.

6 SEC. 6. INSPECTOR GENERAL AUDIT AND GAO REPORT ON

7 ENROLLEES ELIGIBLE FOR MEDICAID.

8 Section 2108 of the Social Security Act (42

9 U.S.C.1397hh), as amended by section 4, is amended by

10 adding at the end the following:

11 ‘‘(f) INSPECTOR GENERAL AUDIT AND GAO RE12 PORT.—

13 ‘‘(1) AUDIT.—Beginning with fiscal year 2000,

14 and every third fiscal year thereafter, the Secretary,

15 through the Inspector General of the Department of

16 Health and Human Services, shall audit a sample

17 from among the States described in paragraph (2)

18 in order to—

19 ‘‘(A) determine the number, if any,

20 of enrollees under the plan under this title who

21 are eligible for medical assistance under title

22 XIX (other than as an optional targeted

23 low-income children under section

24 1902(a)(10)(A)(ii)(XIV)); and
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1 ‘‘(B) assess the progress made in reducing

2 the number of targeted uncovered low-income

3 children relative to the goals established in the

4 State child health plan, as reported to the Sec5 retary in accordance with subsection (a)(2).

6 ‘‘(2) STATE DESCRIBED.—A State described in

7 this paragraph is a State with an approved State

8 child health plan under this title that does not, as

9 part of such plan, provide health benefits coverage

10 under the State’s medicaid program under title XIX.

11 ‘‘(3) MONITORING AND REPORT FROM GAO.—

12 The Comptroller General of the United States shall

13 monitor the audits conducted under this subsection

14 and, not later than March 1 of each fiscal year after

15 a fiscal year in which an audit is conducted under

16 this subsection, shall submit a report to Congress on

17 the results of the audit conducted during the prior

18 fiscal year.’’.

19 SEC. 7. COORDINATION OF DATA COLLECTION WITH DATA

20 REQUIREMENTS UNDER THE MATERNAL AND

21 CHILD HEALTH SERVICES BLOCK GRANT.

22 Subparagraphs (C)(ii) and (D)(ii) of section

23 506(a)(2) of the Social Security Act (42 U.S.C. 706(a)(2))

24 are each amended by inserting ‘‘or the State plan under

25 title XXI’’ after ‘‘title XIX’’.
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1 SEC. 8. COORDINATION OF DATA SURVEYS AND REPORTS.

2 The Secretary of Health and Human Services,

3 through the Assistant Secretary for Planning and Evalua4 tion, shall establish a clearinghouse for the consolidation

5 and coordination of all Federal data bases and reports re6 garding children’s health.

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