I 

111TH CONGRESS 

1ST SESSION H. R. 298 

To amend title XXI of the Social Security Act to require SCHIP annual 

reports to include information on the HEDIS measure relating to access 

to primary care practitioners by individuals eligible for child health 

assistance under such plans and on State efforts to avoid certain displacement of private health coverage, and to express the sense of Congress that such States should utilize Consumer Assessment of Healthcare 

Providers and Systems consumer satisfaction surveys to measure access 

by such individuals to physicians. 

IN THE HOUSE OF REPRESENTATIVES 

JANUARY 8, 2009 

Mr. BOUSTANY introduced the following bill; which was referred to the 

Committee on Energy and Commerce 

A BILL 

To amend title XXI of the Social Security Act to require 

SCHIP annual reports to include information on the 

HEDIS measure relating to access to primary care practitioners by individuals eligible for child health assistance 

under such plans and on State efforts to avoid certain 

displacement of private health coverage, and to express 

the sense of Congress that such States should utilize 

Consumer Assessment of Healthcare Providers and Systems consumer satisfaction surveys to measure access 

by such individuals to physicians. 


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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 ‘‘Improving Children’s 

5 Doctor Access Act of 2009’’. 

6 SEC. 2. STATE REQUIREMENT UNDER SCHIP TO REPORT 

7 ON HEDIS MEASURE RELATING TO ACCESS 

8 TO PCPS. 

9 (a) IN GENERAL.—Section 2108(a) of the Social Se10 curity Act (42 U.S.C. 1397hh(a)) is amended— 

11 (1) by redesignating paragraphs (1) and (2) as 

12 subparagraphs (A) and (B), respectively, with appro13 priate indentation; 

14 (2) by designating the sentence beginning with 

15 ‘‘The State shall’’ as a paragraph (1) with the hear16 ing ‘‘(1) IN GENERAL.—’’ and appropriate indenta17 tion; and 

18 (3) by adding at the end the following new 

19 paragraph: 

20 ‘‘(2) INFORMATION ON CERTAIN HEDIS MEAS21 URE REQUIRED.— 

22 ‘‘(A) IN GENERAL.—Each annual report of 

23 a State submitted under paragraph (1)(B) for 

24 a fiscal year shall include information on the 

25 access HEDIS measure described in subparaVerDate Nov 24 2008 02:34 Jan 13, 2009 Jkt 079200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H298.IH H298

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1 graph (B) for individuals eligible for child 

2 health assistance under the State child health 

3 plan during the fiscal year. 

4 ‘‘(B) ACCESS HEDIS MEASURE DE5 SCRIBED.—The access HEDIS measure de6 scribed in this subparagraph is the Health Plan 

7 Employer Data and Information Set (HEDIS) 

8 measure established by the National Committee 

9 for Quality Assurance that is the following (or, 

10 in the case of an update to such measure, such 

11 update): 

12 ‘‘(i) The percentage of each of the fol13 lowing populations of individuals described 

14 in subparagraph (A) who had a visit with 

15 a primary care practitioner during the pre16 vious 12-month period: 

17 ‘‘(I) Individuals who are at least 

18 12 months of age and who have not 

19 attained 25 months of age. 

20 ‘‘(II) Individuals who are at least 

21 25 months of age and have not at22 tained 7 years of age. 

23 ‘‘(ii) The percentage of each of the 

24 following populations of individuals de25 scribed in subparagraph (A) who had a 


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1 visit with a primary care practitioner dur2 ing the previous 24-month period: 

3 ‘‘(I) Individuals who are at least 

4 7 years of age and who have not at5 tained 12 years of age. 

6 ‘‘(II) Individuals who are at least 

7 12 years of age and who have not at8 tained 19 years of age.’’. 

9 (b) EFFECTIVE DATE.—The amendment made by 

10 subsection (a)(3) shall be effective for annual reports sub11 mitted for fiscal year 2010 and each subsequent fiscal 

12 year. 

13 SEC. 3. STATE EFFORTS UNDER SCHIP TO AVOID DIS14 PLACEMENT OF PRIVATE HEALTH COV15 ERAGE. 

16 (a) IN GENERAL.—Section 2102(c) of the Social Se17 curity Act (42 U.S.C. 1397bb(c)) is amended by adding 

18 at the end the following new paragraph: 

19 ‘‘(3) EFFORTS TO AVOID DISPLACEMENT OF

20 PRIVATE HEALTH COVERAGE.—(A) Prioritization of 

21 outreach to families with income below 200 percent 

22 of the Federal poverty level. 

23 ‘‘(B) Discouragement of the crowd out of pri24 vate health insurance coverage for families with inVerDate Nov 24 2008 03:34 Jan 12, 2009 Jkt 079200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H298.IH H298

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1 come at least 300 percent of the Federal poverty 

2 level.’’. 

3 (b) ANNUAL STATE REPORTS UNDER SCHIP ON

4 EFFORTS TO AVOID DISPLACEMENT OF PRIVATE

5 HEALTH COVERAGE.— 

6 (1) IN GENERAL.—Section 2108(a) of the So7 cial Security Act (42 U.S.C. 1397hh(a)), as amend8 ed by section 2, is further amended by adding at the 

9 end the following new paragraph: 

10 ‘‘(3) INFORMATION ON EFFORTS TO AVOID DIS11 PLACEMENT OF PRIVATE HEALTH COVERAGE.— 

12 Each annual report of a State submitted under 

13 paragraph (1)(B) shall include, with respect to the 

14 State child health plan under this title for a fiscal 

15 year, a description of the measures taken by the 

16 State, and the progress of the State, to follow the 

17 procedures described by the State pursuant to sub18 paragraphs (A) and (B) of section 2102(c)(3).’’. 

19 (2) EFFECTIVE DATE.—The amendment made 

20 by paragraph (1) shall be effective for annual re21 ports submitted for fiscal year 2010 and each subse22 quent fiscal year. 


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1 SEC. 4. SENSE OF CONGRESS REGARDING UTILIZATION OF 

2 CAHPS CONSUMER SATISFACTION SURVEYS. 

3 It is the sense of Congress that each State that has 

4 a State child health plan under title XXI of the Social 

5 Security Act should— 

6 (1) utilize consumer satisfaction surveys devel7 oped by the Consumer Assessment of Healthcare 

8 Providers and Systems (CAHPS) administered by 

9 the Agency for Healthcare Research and Quality, 

10 specifically the Getting Needed Care and Getting 

11 Care Quickly question components of the CAHPS 

12 4.0H Child Survey (or in the case of an update to 

13 such survey, of such update), to measure the extent 

14 to which individuals eligible for child health assist15 ance under the State plan have access to physicians, 

16 including primary care practitioners and specialists, 

17 and the degree of ease with which such access is at18 tainable by such individuals; and 

19 (2) include the results of such surveys for a fis20 cal year in the annual report submitted for such fis21 cal year by the State to the Secretary under section 

22 2108(a) of the Social Security Act (42 U.S.C. 

23 1397hh(a)). 

Æ 


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