I 
110TH CONGRESS 
1ST SESSION H. R. 2723 
To amend title XIX of the Social Security Act to establish programs to 
improve the quality, performance, and delivery of pediatric care. 
IN THE HOUSE OF REPRESENTATIVES 
JUNE 14, 2007 
Ms. DEGETTE (for herself and Mrs. BONO) introduced the following bill; 
which was referred to the Committee on Energy and Commerce 
A BILL 
To amend title XIX of the Social Security Act to establish 
programs to improve the quality, performance, and deliv-
ery of pediatric care. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Children’s Health Care 
Quality Act’’. 
SEC. 2. FINDINGS. 
Congress makes the following findings: 
(1) Children have unique health care needs and 
experiences, which are often not comparable to adult 
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health care needs and experience, and they require 
specialized medical expertise. 
(2) The delivery of health care is increasingly 
being transformed by the use of quality and per-
formance measures by consumers, insurers, and pro-
viders. 
(3) A majority of public and private sector in-
vestments in the development of quality and per-
formance measures have focused on the experience 
of adults, particularly the elderly. 
(4) As a result, the supply of approved and 
demonstrated quality measures for children’s health 
care, especially pediatric inpatient care, is limited. 
(5) Growing numbers of insurers, as well as the 
Medicaid program and the State Children’s Health 
Insurance Program (SCHIP), are using publicly 
available measures, which means they have only lim-
ited options for measures of pediatric care. 
(6) A 2006 national survey found that most 
State Medicaid programs and SCHIP use largely 
primary care measures for children, which have been 
developed and selected as part of the measures 
States use to fulfill requirements for evaluating 
health plan performance, not provider performance, 
under the Medicaid program. 
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(7) The Centers for Medicare & Medicaid Serv-
ices (CMS), through its administration of the Med-
icaid program and SCHIP, is the nation’s largest 
payer of health care for children, covering 1 in every 
3 children and more than half of all infants in the 
Nation. However, CMS lacks explicit authority and 
has not committed resources to invest in the devel-
opment of quality and performance measures for 
children commensurate to the magnitude of pediatric 
care the agency pays for. 
(8) Most States do not have a large enough 
population of children upon which to develop appro-
priate measures, particularly for the treatment of se-
rious and complex conditions that only small num-
bers of children in any one state may experience. 
(9) Quality and performance measures should 
be evidence-based, approved for use through a recog-
nized national consensus development process, and 
appropriate for public reporting, such as evidence- 
based hospital measures endorsed by the National 
Quality Forum and recommended for public report-
ing by the Hospital Quality Alliance on the Hospital 
Compare tool on the website of the Department of 
Health and Human Services. 
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(10) The Federal Government should have both 
the legal authority and financial resources to invest 
in the private sector’s development and demonstra-
tion of measures of quality and performance of 
health care for children, including pediatric inpatient 
care. The Federal Government should utilize such 
authority and resources to increase the availability 
of measures for children for use by public and pri-
vate health coverage programs. 
TITLE 
I—ADVANCING 
NEW 
QUALITY AND PERFORMANCE 
MEASURES FOR CHILDREN’S 
HEALTH CARE 
SEC. 101. PEDIATRIC QUALITY AND PERFORMANCE MEAS-
URES PROGRAM. 
Title XIX of the Social Security Act (42 U.S.C. 1396 
et seq.) is amended— 
(1) by redesignating section 1939 as section 
1941; and 
(2) by inserting after section 1938 the fol-
lowing: 
‘‘PEDIATRIC QUALITY AND PERFORMANCE MEASURES 
PROGRAM 
‘‘SEC. 1939. (a) ESTABLISHMENT.—The Secretary, 
acting through the Administrator of the Centers for Medi-
care & Medicaid Services and in consultation with the Di-
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rector of the Agency for Healthcare Research and Quality, 
shall establish a program to encourage and support the 
development of new and emerging quality and perform-
ance measures for providers of pediatric care through the 
activities described in subsection (c). In establishing the 
program, gaps in existing evidence-based measures and 
priority areas for advancement shall be identified. 
‘‘(b) PURPOSE.—The purpose of the program is to 
ensure that— 
‘‘(1) evidence-based pediatric quality and per-
formance measures are developed; and 
‘‘(2) such measures are available for States, 
other purchasers of pediatric health care services, 
health care providers, and consumers to use. 
‘‘(c) PROGRAM ACTIVITIES.— 
‘‘(1) IDENTIFYING QUALITY AND PERFORMANCE 
MEASURES FOR PROVIDERS OF PEDIATRIC SERVICES 
AND
OPPORTUNITIES
FOR
NEW
MEASURES.—Not 
later than 3 months after the date of enactment of 
this section, the Secretary shall identify quality and 
performance measures for providers of pediatric 
services and opportunities for the development of 
new measures, taking into consideration existing evi-
dence-based measures. In conducting this review, the 
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Secretary shall convene and consult with representa-
tives of— 
‘‘(A) States; 
‘‘(B) pediatric hospitals, pediatricians, and 
other pediatric health professionals; 
‘‘(C) national organizations representing— 
‘‘(i) consumers of children’s health 
care; and 
‘‘(ii) purchasers of children’s health 
care; 
‘‘(D) experts in pediatric quality and per-
formance measurement; and 
‘‘(E) a voluntary consensus standards set-
ting organization and other organizations in-
volved in the advancement of consensus on evi-
dence-based measures of health care. 
‘‘(2) DEVELOPING, VALIDATING, AND TESTING 
NEW MEASURES.—The Secretary shall award grants 
or contracts to eligible entities (as defined in sub-
section (d)(1)) for the development, validation, and 
testing of new and emerging quality and perform-
ance measures for providers of pediatric services. 
Such measures shall— 
‘‘(A) provide consumers and purchasers 
(including States and beneficiaries under the 
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program under this title and title XXI) with in-
formation about provider performance and qual-
ity; and 
‘‘(B) assist health care providers in im-
proving the quality of the items and services 
they provide and their performance with respect 
to the provision of such items and services. 
‘‘(3) ACHIEVING
CONSENSUS
ON
EVIDENCE- 
BASED
MEASURES.—The Secretary shall award 
grants or contracts to eligible consensus entities (as 
defined in subsection (d)(2)) for the development of 
consensus on evidence-based measures for pediatric 
care that have broad acceptability in the health care 
industry. 
‘‘(d) ELIGIBLE ENTITIES.— 
‘‘(1) DEVELOPMENT, VALIDATION, AND TEST-
ING.—For purposes of paragraph (2) of subsection 
(c), the term ‘eligible entity’ means— 
‘‘(A) organizations with demonstrated ex-
pertise and capacity in the development and 
evaluation of pediatric quality and performance 
measures; 
‘‘(B) an organization or association of 
health care providers with demonstrated experi-
ence in working with accrediting organizations 
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in developing pediatric quality and performance 
measures; and 
‘‘(C) a collaboration of national pediatric 
organizations working to improve pediatric 
quality and performance measures. 
‘‘(2) ACHIEVEMENT OF CONSENSUS.—For pur-
poses of paragraph (3) of such subsection, the term 
‘eligible consensus entity’ means an organization, in-
cluding a voluntary consensus standards setting or-
ganization, involved in the advancement of consensus 
on evidence-based measures of health care. 
‘‘(e) ONGOING AUTHORITY TO UPDATE AND ADJUST 
PEDIATRIC MEASURES.—The Secretary may update and 
adjust measures developed and advanced under the pro-
gram under this section in accordance with— 
‘‘(1) any changes that a voluntary consensus 
standards setting organization determines should be 
made with respect to such measures; or 
‘‘(2) new evidence indicating the need for 
changes with respect to such measures. 
‘‘(f) ADDITION OF PEDIATRIC CONSUMER ASSESS-
MENT MEASURES TO CAHPS HOSPITAL SURVEY CON-
DUCTED BY AHRQ.—The Director of the Agency for 
Healthcare Research and Quality shall ensure that con-
sumer assessment measures for hospital services for chil-
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dren are added to the Consumer Assessment of Healthcare 
Providers and Systems (CAHPS) Hospital survey con-
ducted by such Agency. 
‘‘(g) APPROPRIATION.—There are authorized to be 
appropriated and there are appropriated, for the purpose 
of carrying out this section, $10,000,000, for each of fiscal 
years 2008 through 2012, to remain available until ex-
pended.’’. 
TITLE 
II—STATE 
TRANS-
FORMATION GRANTS FOR PE-
DIATRIC CARE 
SEC. 201. GRANTS TO STATES FOR DEMONSTRATION 
PROJECTS TRANSFORMING DELIVERY OF PE-
DIATRIC CARE. 
Title XIX of the Social Security Act (42 U.S.C. 1396 
et seq.), as amended by section 101, is amended by insert-
ing after section 1939 the following: 
‘‘GRANTS TO STATE FOR DEMONSTRATION PROJECTS 
TRANSFORMING DELIVERY OF PEDIATRIC CARE 
‘‘SEC. 1940. (a) ESTABLISHMENT.—The Secretary, 
acting through the Administrator of the Centers for Medi-
care & Medicaid Services, shall establish demonstration 
projects, including demonstration projects in each of the 
4 categories described in subsection (d), to award grants 
to States to improve the delivery of health care services 
provided to children under this title and title XXI. 
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‘‘(b) DURATION.—The demonstration projects shall 
be conducted for a period of 4 years. 
‘‘(c) ELIGIBILITY.—A State shall not be eligible to 
receive a grant under this section unless the State has 
demonstrated experience or commitment to the concept of 
transformation in the delivery of pediatric care. 
‘‘(d) CATEGORIES OF PROJECTS.—The following cat-
egories of projects are described in this subsection: 
‘‘(1) HEALTH INFORMATION TECHNOLOGY SYS-
TEMS.—Projects for developing health information 
technology systems, including technology acquisition, 
electronic health record development, data standards 
development, and software development, for pediatric 
hospital and physician services and other commu-
nity-based services; implementing model systems; 
and evaluating their impact on the quality, safety, 
and costs of care. 
‘‘(2) DISEASE MANAGEMENT.—Projects for pro-
viding provider-based care disease management for 
children with chronic conditions (including physical, 
developmental, behavioral, and psychological condi-
tions), demonstrating the effectiveness of provider- 
based management models in promoting better care, 
reducing adverse health outcomes, and preventing 
avoidable hospitalizations. 
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‘‘(3) 
EVIDENCE-BASED
QUALITY
IMPROVE-
MENTS.—Projects for implementing evidence-based 
approaches to improving efficiency, safety, and effec-
tiveness in the delivery of hospital care for children 
across hospital services, evaluating the translation of 
successful models of such evidence-based approaches 
to other institutions, and the impact of such changes 
on the quality, safety, and costs of care. 
‘‘(4) QUALITY AND PERFORMANCE MEASURES 
FOR
PROVIDERS
OF
CHILDREN’S
HEALTH
CARE 
SERVICES.—Projects to pilot test evidence-based pe-
diatric quality and performance measures for inpa-
tient hospital services, physician services, or services 
of other health professionals, determining the reli-
ability, feasibility, and validity of such measures, 
and evaluating their potential impact on improving 
the quality and delivery of children’s health care. To 
the extent feasible, such measures shall have been 
approved by consensus standards setting organiza-
tions. 
‘‘(e) UNIFORM METRICS.—The Secretary shall estab-
lish uniform metrics (adjusted, as appropriate, for patient 
acuity), collect data, and conduct evaluations with respect 
to each demonstration project category described in sub-
section (d). In establishing such metrics, collecting such 
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data, and conducting such evaluations, the Secretary shall 
consult with— 
‘‘(1) experts in each such demonstration project 
category; 
‘‘(2) participating States; 
‘‘(3) national pediatric provider organizations; 
‘‘(4) health care consumers; and 
‘‘(5) such other entities or individuals with rel-
evant expertise as the Secretary determines appro-
priate. 
‘‘(f) EVALUATION
AND REPORT.—The Secretary 
shall evaluate the demonstration projects conducted under 
this section and submit a report to Congress not later than 
3 months before the completion of each demonstration 
project that includes the findings of the evaluation and 
recommendations with respect to— 
‘‘(1) expansion of the demonstration project to 
additional States and sites; and 
‘‘(2) the broader implementation of approaches 
identified as being successful in advancing quality 
and performance in the delivery of medical assist-
ance provided to children under this title and title 
XXI. 
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‘‘(g) WAIVER.—The Secretary may waive the require-
ments of this title and title XXI to the extent necessary 
to carry out the demonstration projects under this section. 
‘‘(h) AMOUNTS PAID TO A STATE.—Amounts paid to 
a State under this section— 
‘‘(1) shall be in addition to Federal payments 
made to the State under section 1903(a); 
‘‘(2) shall not be used for the State share of 
any expenditures claimed for payment under such 
section; and 
‘‘(3) shall be used only for expenditures of the 
State 
for 
participating 
in 
the 
demonstration 
projects, or for expenditures of providers in partici-
pating in the demonstration projects, including— 
‘‘(A) administrative costs of States and 
participating providers (such as costs associated 
with the design and evaluation of, and data col-
lection under, the demonstration projects); and 
‘‘(B) such other expenditures that are not 
otherwise eligible for reimbursement under this 
title or title XXI as the Secretary may deter-
mine appropriate. 
‘‘(i) APPROPRIATION.—There are authorized to be 
appropriated and there are appropriated, for the purpose 
of carrying out this section, to remain available until ex-
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pended $10,000,000 for each of fiscal years 2008 through 
2012.’’. 
SEC. 202. REPORT BY THE COMPTROLLER GENERAL ON DE-
SIGN AND IMPLEMENTATION OF A DEM-
ONSTRATION PROJECT EVALUATING EXIST-
ING QUALITY AND PERFORMANCE MEASURES 
FOR 
CHILDREN’S 
INPATIENT 
HOSPITAL 
SERVICES. 
(a) IN GENERAL.—Not later than 12 months after 
the date of enactment of this Act, the Comptroller General 
of the United States (in this section referred to as the 
‘‘Comptroller General’’) shall submit a report to Congress 
containing recommendations for the design and implemen-
tation of a demonstration project to evaluate the suit-
ability of existing quality and performance measures for 
children’s inpatient hospital services for public reporting, 
differentiating quality, identifying best practices, and pro-
viding a basis for payment rewards. 
(b) DEVELOPMENT OF RECOMMENDATIONS.—In de-
veloping the recommendations submitted under subsection 
(a), the Comptroller General shall accomplish the fol-
lowing: 
(1) Consider which agency within the Depart-
ment of Health and Human Services should have 
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primary responsibility and oversight for such a dem-
onstration project. 
(2) Determine a sufficient number of partici-
pating hospitals and volume of children’s cases, 
given existing measures that might be chosen for 
evaluation under such a demonstration project. 
(3) Determine the number of States and variety 
of geographic locations that may be required to con-
duct such a demonstration project. 
(4) Describe alternatives for administering and 
directing funding for such a demonstration project, 
taking into consideration the potential involvement 
of multiple States, State plans under title XIX of 
the Social Security Act (42 U.S.C. 1396 et seq.), 
and State child health plans under title XXI of such 
Act (42 U.S.C. 1397aa et seq.). Such description 
shall be included in the recommendations submitted 
under subsection (a). 
(5) Determine requirements for consistency in 
measures, metrics, and risk adjustment for such a 
demonstration project, across hospitals and across 
State lines. 
(6) Consider the infrastructure requirements in-
volved in public reporting of quality and perform-
ance measures for children’s inpatient hospital serv-
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ices at the national and State levels, including the 
requirements involved with respect to maintaining 
such measures and data. 
(7) Estimate the cost of undertaking such a 
demonstration project. 
(c) SUGGESTION OF EXISTING MEASURES FOR EVAL-
UATION UNDER THE DEMONSTRATION PROJECT.— 
(1) IN GENERAL.—The report submitted under 
subsection (a) shall include suggestions for existing 
measures to be evaluated under the demonstration 
project recommended in such report, including, to 
the extent feasible, measures with respect to— 
(A) high volume pediatric inpatient condi-
tions; 
(B) high cost pediatric inpatient services; 
(C) pediatric conditions with predicted 
high morbidities; and 
(D) pediatric cases at high risk of patient 
safety failures. 
(2) SUGGESTED
MEASURES.—The measures 
suggested under paragraph (1) shall be measures 
representing process, structure, patient outcomes, or 
patient and family experience— 
(A) that are evidence-based; 
(B) that are feasible to collect and report; 
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(C) that include a mechanism for risk ad-
justment when necessary; and 
(D) for which there is a consensus within 
the pediatric hospital community or a consensus 
determined by a voluntary consensus standards 
setting organization involved in the advance-
ment of evidence-based measures of health care. 
(3) CONSULTATION.—In determining the exist-
ing measures suggested under paragraph (1), the 
Comptroller General shall consult with representa-
tives of the following: 
(A) National associations of pediatric hos-
pitals and pediatric health professionals. 
(B) Experts in pediatric quality and per-
formance measurement. 
(C) Voluntary consensus standards setting 
organizations and other organizations involved 
in the advancement of consensus on evidence- 
based measures. 
(D) The Department of Health and 
Human Services, States, and other purchasers 
of health care items and services. 
Æ 
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