II 

111TH CONGRESS 

1ST SESSION S. 314 

To amend title XIX of the Social Security Act to establish programs to 

improve the quality, performance, and delivery of pediatric care. 

IN THE SENATE OF THE UNITED STATES 

JANUARY 26, 2009 

Mr. HATCH introduced the following bill; which was read twice and referred 

to the Committee on Finance 

A BILL 

To amend title XIX of the Social Security Act to establish 

programs to improve the quality, performance, and delivery of pediatric care. 

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 ‘‘Children’s Health Care 

5 Quality Act’’. 

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1 TITLE I—ADVANCING NEW 

2 QUALITY AND PERFORMANCE 

3 MEASURES FOR CHILDREN’S 

4 HEALTH CARE 

5 SEC. 101. PEDIATRIC QUALITY AND PERFORMANCE MEAS6 URES PROGRAM. 

7 Title XIX of the Social Security Act (42 U.S.C. 1396 

8 et seq.) is amended by adding at the end the following: 

9 ‘‘PEDIATRIC QUALITY AND PERFORMANCE MEASURES

10 PROGRAM

11 ‘‘SEC. 1942. (a) ESTABLISHMENT.—The Secretary, 

12 acting through the Administrator of the Centers for Medi13 care & Medicaid Services and in consultation with the Di14 rector of the Agency for Healthcare Research and Quality, 

15 shall establish a program to encourage and support the 

16 development of new and emerging quality and perform17 ance measures for providers of pediatric care and the in18 corporation of such measures into systemic approaches to 

19 improve care and outcomes for children through the activi20 ties described in subsection (c). In establishing the pro21 gram, gaps in existing evidence-based measures and pri22 ority areas for advancement shall be identified. 

23 ‘‘(b) PURPOSE.—The purpose of the program is to 

24 ensure that— 

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1 ‘‘(1) evidence-based pediatric quality and per2 formance measures are developed; 

3 ‘‘(2) such measures are available for States, 

4 other purchasers of pediatric health care services, 

5 health care providers, and consumers to use; and 

6 ‘‘(3) technical assistance is provided to assist 

7 with the implementation of such measures. 

8 ‘‘(c) PROGRAM ACTIVITIES.— 

9 ‘‘(1) IDENTIFYING QUALITY AND PERFORMANCE

10 MEASURES FOR PROVIDERS OF PEDIATRIC SERVICES

11 AND OPPORTUNITIES FOR NEW MEASURES.—Not 

12 later than 3 months after the date of enactment of 

13 this section, the Secretary shall identify quality and 

14 performance measures for providers of pediatric 

15 services and opportunities for the development of 

16 new measures, taking into consideration existing evi17 dence-based measures. In conducting this review, the 

18 Secretary shall convene and consult with representa19 tives of— 

20 ‘‘(A) States; 

21 ‘‘(B) pediatric hospitals, pediatricians, and 

22 other pediatric health professionals; 

23 ‘‘(C) national organizations representing— 

24 ‘‘(i) consumers of children’s health 

25 care; and 

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1 ‘‘(ii) purchasers of children’s health 

2 care; 

3 ‘‘(D) experts in pediatric quality and per4 formance measurement; and 

5 ‘‘(E) a voluntary consensus standards set6 ting organization and other organizations in7 volved in the advancement of consensus on evi8 dence-based measures of health care. 

9 ‘‘(2) DEVELOPING, VALIDATING, AND TESTING

10 NEW MEASURES.—The Secretary shall award grants 

11 or contracts to eligible entities (as defined in sub12 section (d)(1)) for the development, validation, and 

13 testing of new and emerging quality and perform14 ance measures for providers of pediatric services. 

15 Such measures shall— 

16 ‘‘(A) provide consumers and purchasers 

17 (including States and beneficiaries under the 

18 program under this title and title XXI) with in19 formation about provider performance and qual20 ity; and 

21 ‘‘(B) assist health care providers in im22 proving the quality of the services they provide 

23 and their performance with respect to the provi24 sion of such services. 

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1 ‘‘(3) ACHIEVING CONSENSUS ON EVIDENCE2 BASED MEASURES.—The Secretary shall award 

3 grants or contracts to eligible consensus entities (as 

4 defined in subsection (d)(2)) for the development of 

5 consensus on evidence-based measures for pediatric 

6 care that have broad acceptability in the health care 

7 industry. 

8 ‘‘(d) ELIGIBLE ENTITIES.— 

9 ‘‘(1) DEVELOPMENT, VALIDATION, AND TEST10 ING.—For purposes of paragraph (2) of subsection 

11 (c), the term ‘eligible entity’ means— 

12 ‘‘(A) organizations with demonstrated ex13 pertise and capacity in the development and 

14 evaluation of pediatric quality and performance 

15 measures; 

16 ‘‘(B) an organization or association of 

17 health care providers with demonstrated experi18 ence in working with accrediting organizations 

19 in developing pediatric quality and performance 

20 measures; and 

21 ‘‘(C) a collaboration of national pediatric 

22 organizations working to improve pediatric 

23 quality and performance in the delivery of chil24 dren’s health care. 

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1 ‘‘(2) ACHIEVEMENT OF CONSENSUS.—For pur2 poses of paragraph (3) of such subsection, the term 

3 ‘eligible consensus entity’ means an organization, in4 cluding a voluntary consensus standards setting or5 ganization, involved in the advancement of consensus 

6 on evidence-based measures of health care. 

7 ‘‘(e) ONGOING AUTHORITY TO UPDATE AND ADJUST

8 PEDIATRIC MEASURES.—The Secretary may update and 

9 adjust measures developed and advanced under the pro10 gram under this section in accordance with— 

11 ‘‘(1) any changes that a voluntary consensus 

12 standards setting organization determines should be 

13 made with respect to such measures; or 

14 ‘‘(2) new evidence indicating the need for 

15 changes with respect to such measures. 

16 ‘‘(f) ADDITION OF PEDIATRIC CONSUMER ASSESS17 MENT MEASURES TO CAHPS HOSPITAL SURVEY CON18 DUCTED BY AHRQ.—The Director of the Agency for 

19 Healthcare Research and Quality shall ensure that con20 sumer assessment measures for hospital services for chil21 dren are added to the Consumer Assessment of Healthcare 

22 Providers and Systems (CAHPS) Hospital survey con23 ducted by such Agency. 

24 ‘‘(g) APPROPRIATION.—There are authorized to be 

25 appropriated and there are appropriated, for the purpose 

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1 of carrying out this section, $10,000,000, for each of fiscal 

2 years 2009 through 2013, to remain available until ex3 pended.’’. 

4 TITLE II—STATE TRANSFORMA5 TION GRANTS FOR PEDIAT6 RIC CARE 

7 SEC. 201. GRANTS TO STATES FOR DEMONSTRATION 

8 PROJECTS TRANSFORMING DELIVERY OF PE9 DIATRIC CARE. 

10 Title XIX of the Social Security Act (42 U.S.C. 1396 

11 et seq.), as amended by section 101, is amended by adding 

12 at the end the following: 

13 ‘‘GRANTS TO STATE FOR DEMONSTRATION PROJECTS

14 TRANSFORMING DELIVERY OF PEDIATRIC CARE

15 ‘‘SEC. 1943. (a) ESTABLISHMENT.—The Secretary, 

16 acting through the Administrator of the Centers for Medi17 care & Medicaid Services, shall establish demonstration 

18 projects, including demonstration projects in multiple 

19 States in each of the 4 categories described in subsection 

20 (d), to award grants to States to improve the delivery of 

21 health care services provided to children under this title 

22 and title XXI. 

23 ‘‘(b) DURATION.—The demonstration projects shall 

24 be conducted for a period of 4 years. 

25 ‘‘(c) ELIGIBILITY.—A State shall not be eligible to 

26 receive a grant under this section unless the State has 

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1 demonstrated experience or commitment to the concept of 

2 transformation in the delivery of pediatric care. 

3 ‘‘(d) CATEGORIES OF PROJECTS.—The following cat4 egories of projects are described in this subsection: 

5 ‘‘(1) HEALTH INFORMATION TECHNOLOGY SYS6 TEMS.—Projects for developing health information 

7 technology systems, including technology acquisition, 

8 electronic health record development, data standards 

9 development, and software development, for pediatric 

10 hospital and physician services and other commu11 nity-based services; implementing model systems; 

12 and evaluating their impact on the quality, safety, 

13 and costs of care. 

14 ‘‘(2) DISEASE MANAGEMENT.—Projects for pro15 viding provider-based care management for children 

16 with chronic conditions (including physical, develop17 mental, behavioral, and psychological conditions), 

18 demonstrating the effectiveness of provider-based 

19 management models in promoting better care, reduc20 ing adverse health outcomes, and preventing avoid21 able hospitalizations. 

22 ‘‘(3) EVIDENCE-BASED QUALITY IMPROVE23 MENTS.—Projects for implementing evidence-based 

24 approaches to improving efficiency, safety, and effec25 tiveness in the delivery of hospital care for children 

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1 across hospital services, evaluating the translation of 

2 successful models of such evidence-based approaches 

3 to other institutions, and the impact of such changes 

4 on the quality, safety, and costs of care. 

5 ‘‘(4) QUALITY AND PERFORMANCE MEASURES

6 FOR PROVIDERS OF CHILDREN’S HEALTH CARE

7 SERVICES.—Projects to pilot test evidence-based pe8 diatric quality and performance measures for inpa9 tient hospital services, physician services, or services 

10 of other health professionals, determining the reli11 ability, feasibility, and validity of such measures, 

12 and evaluating their potential impact on improving 

13 the quality and delivery of children’s health care. To 

14 the extent feasible, such measures shall have been 

15 approved by consensus standards setting organiza16 tions. 

17 ‘‘(e) UNIFORM METRICS.—The Secretary shall estab18 lish uniform metrics (adjusted, as appropriate, for patient 

19 acuity), collect data, and conduct evaluations with respect 

20 to each demonstration project category described in sub21 section (d). In establishing such metrics, collecting such 

22 data, and conducting such evaluations, the Secretary shall 

23 consult with— 

24 ‘‘(1) experts in each such demonstration project 

25 category; 

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1 ‘‘(2) participating States; 

2 ‘‘(3) national pediatric provider organizations; 

3 ‘‘(4) health care consumers; and 

4 ‘‘(5) such other entities or individuals with rel5 evant expertise as the Secretary determines appro6 priate. 

7 ‘‘(f) EVALUATION AND REPORT.—The Secretary 

8 shall evaluate the demonstration projects conducted under 

9 this section and submit a report to Congress not later than 

10 3 months before the completion of each demonstration 

11 project that includes the findings of the evaluation and 

12 recommendations with respect to— 

13 ‘‘(1) expansion of the demonstration project to 

14 additional States and sites; and 

15 ‘‘(2) the broader implementation of approaches 

16 identified as being successful in advancing quality 

17 and performance in the delivery of medical assist18 ance provided to children under this title and title 

19 XXI. 

20 ‘‘(g) WAIVER.—The Secretary may waive the require21 ments of this title and title XXI to the extent necessary 

22 to carry out the demonstration projects under this section. 

23 ‘‘(h) AMOUNTS PAID TO A STATE.—Amounts paid to 

24 a State under this section— 

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1 ‘‘(1) shall be in addition to Federal payments 

2 made to the State under section 1903(a); 

3 ‘‘(2) shall not be used for the State share of 

4 any expenditures claimed for payment under such 

5 section; and 

6 ‘‘(3) shall be used only for expenditures of the 

7 State for participating in the demonstration 

8 projects, or for expenditures of providers in partici9 pating in the demonstration projects, including— 

10 ‘‘(A) administrative costs of States and 

11 participating providers (such as costs associated 

12 with the design and evaluation of, and data col13 lection under, the demonstration projects); and 

14 ‘‘(B) such other expenditures that are not 

15 otherwise eligible for reimbursement under this 

16 title or title XXI as the Secretary may deter17 mine appropriate. 

18 ‘‘(i) APPROPRIATION.—There are authorized to be 

19 appropriated and there are appropriated, for the purpose 

20 of carrying out this section, to remain available until ex21 pended $10,000,000 for each of fiscal years 2009 through 

22 2013.’’. 

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1 SEC. 202. REPORT BY THE COMPTROLLER GENERAL ON DE2 SIGN AND IMPLEMENTATION OF A DEM3 ONSTRATION PROJECT EVALUATING EXIST4 ING QUALITY AND PERFORMANCE MEASURES 

5 FOR CHILDREN’S INPATIENT HOSPITAL 

6 SERVICES. 

7 (a) IN GENERAL.—Not later than 12 months after 

8 the date of enactment of this Act, the Comptroller General 

9 of the United States (in this section referred to as the 

10 ‘‘Comptroller General’’) shall submit a report to Congress 

11 containing recommendations for the design and implemen12 tation of a demonstration project to evaluate the suit13 ability of existing quality and performance measures for 

14 children’s inpatient hospital services for public reporting, 

15 differentiating quality, identifying best practices, and pro16 viding a basis for payment rewards. 

17 (b) DEVELOPMENT OF RECOMMENDATIONS.—In de18 veloping the recommendations submitted under subsection 

19 (a), the Comptroller General shall accomplish the fol20 lowing: 

21 (1) Consider which agency within the Depart22 ment of Health and Human Services should have 

23 primary responsibility and oversight for such a dem24 onstration project. 

25 (2) Determine a sufficient number of partici26 pating hospitals and volume of children’s cases, 

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1 given existing measures that might be chosen for 

2 evaluation under such a demonstration project. 

3 (3) Determine the number of States and variety 

4 of geographic locations that may be required to con5 duct such a demonstration project. 

6 (4) Describe alternatives for administering and 

7 directing funding for such a demonstration project, 

8 taking into consideration the potential involvement 

9 of multiple States, State plans under title XIX of 

10 the Social Security Act (42 U.S.C. 1396 et seq.), 

11 and State child health plans under title XXI of such 

12 Act (42 U.S.C. 1397aa et seq.). Such description 

13 shall be included in the recommendations submitted 

14 under subsection (a). 

15 (5) Determine requirements for consistency in 

16 measures, metrics, and risk adjustment for such a 

17 demonstration project, across hospitals and across 

18 State lines. 

19 (6) Consider the infrastructure requirements in20 volved in public reporting of quality and perform21 ance measures for children’s inpatient hospital serv22 ices at the national and State levels, including the 

23 requirements involved with respect to maintaining 

24 such measures and data. 

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1 (7) Estimate the cost of undertaking such a 

2 demonstration project. 

3 (c) SUGGESTION OF EXISTING MEASURES FOR EVAL4 UATION UNDER THE DEMONSTRATION PROJECT.— 

5 (1) IN GENERAL.—The report submitted under 

6 subsection (a) shall include suggestions for existing 

7 measures to be evaluated under the demonstration 

8 project recommended in such report, including, to 

9 the extent feasible, measures with respect to— 

10 (A) high volume pediatric inpatient condi11 tions; 

12 (B) high cost pediatric inpatient services; 

13 (C) pediatric conditions with predicted 

14 high morbidities; and 

15 (D) pediatric cases at high risk of patient 

16 safety failures. 

17 (2) SUGGESTED MEASURES.—The measures 

18 suggested under paragraph (1) shall be measures 

19 representing process, structure, patient outcomes, or 

20 patient and family experience— 

21 (A) that are evidence-based; 

22 (B) that are feasible to collect and report; 

23 (C) that include a mechanism for risk ad24 justment when necessary; and 

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1 (D) for which there is a consensus within 

2 the pediatric hospital community or a consensus 

3 determined by a voluntary consensus standards 

4 setting organization involved in the advance5 ment of evidence-based measures of health care. 

6 (3) CONSULTATION.—In determining the exist7 ing measures suggested under paragraph (1), the 

8 Comptroller General shall consult with representa9 tives of the following: 

10 (A) National associations of pediatric hos11 pitals and pediatric health professionals. 

12 (B) Experts in pediatric quality and per13 formance measurement. 

14 (C) Voluntary consensus standards setting 

15 organizations and other organizations involved 

16 in the advancement of consensus on evidence17 based measures. 

18 (D) The Department of Health and 

19 Human Services, States, and other purchasers 

20 of health care items and services. 

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