‘‘(2) INCLUSION OF INFORMATION ON ENROLL-
EES IN MANAGED CARE PLANS.—The information 
under paragraph (1) shall include information on 
children who are enrolled in managed care plans and 
other private health plans and contracts with such 
plans under this title shall provide for the reporting 
of such information by such plans to the State.’’. 
(3) EFFECTIVE DATE.—The amendments made 
by this subsection shall be effective for annual re-
ports submitted for years beginning after date of en-
actment. 
(d) GAO STUDY AND REPORT.— 
(1) STUDY.—The Comptroller General of the 
United States shall provide for a study that exam-
ines— 
(A) access to dental services by children in 
underserved areas; and 
(B) the feasibility and appropriateness of 
using qualified mid-level dental health pro-
viders, in coordination with dentists, to improve 
access for children to oral health services and 
public health overall. 
(2) REPORT.—Not later than 1 year after the 
date of the enactment of this Act, the Comptroller 
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General shall submit to Congress a report on the 
study conducted under paragraph (1). 
SEC. 145. PROHIBITING INITIATION OF NEW HEALTH OP-
PORTUNITY ACCOUNT DEMONSTRATION PRO-
GRAMS. 
After the date of the enactment of this Act, the Sec-
retary of Health and Human Services may not approve 
any new demonstration programs under section 1938 of 
the Social Security Act (42 U.S.C. 1396u–8). 
Subtitle F—Quality and Program 
Integrity 
SEC. 151. PEDIATRIC HEALTH QUALITY MEASUREMENT 
PROGRAM. 
(a) 
QUALITY
MEASUREMENT
OF
CHILDREN’S 
HEALTH.— 
(1) ESTABLISHMENT OF PROGRAM TO DEVELOP 
QUALITY
MEASURES
FOR
CHILDREN’S
HEALTH.— 
The Secretary of Health and Human Services (in 
this section referred to as the ‘‘Secretary’’) shall es-
tablish a child health care quality measurement pro-
gram (in this subsection referred to as the ‘‘chil-
dren’s health quality measurement program’’) to de-
velop and implement— 
(A) pediatric quality measures on chil-
dren’s health care that may be used by public 
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and private health care purchasers (and a sys-
tem for reporting such measures); and 
(B) measures of overall program perform-
ance that may be used by public and private 
health care purchasers. 
The Secretary shall publish, not later than Sep-
tember 30, 2009, the recommended measures under 
the program for application under the amendments 
made by subsection (b) for years beginning with 
2010. 
(2) MEASURES.— 
(A) 
SCOPE.—The 
measures 
developed 
under the children’s health quality measure-
ment program shall— 
(i) provide comprehensive information 
with respect to the provision and outcomes 
of health care for young children, school 
age children, and older children. 
(ii) be designed to identify disparities 
by pediatric characteristics (including, at a 
minimum, those specified in subparagraph 
(C)) in child health and the provision of 
health care; 
(iii) be designed to ensure that the 
data required for such measures is col-
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lected and reported in a standard format 
that permits comparison at a State, plan, 
and provider level, and between insured 
and uninsured children; 
(iv) take into account existing meas-
ures of child health quality and be periodi-
cally updated; 
(v) include measures of clinical health 
care quality which meet the requirements 
for pediatric quality measures in para-
graph (1); 
(vi) improve and augment existing 
measures of clinical health care quality for 
children’s health care and develop new and 
emerging measures; and 
(vii) increase the portfolio of evidence- 
based pediatric quality measures available 
to public and private purchasers, providers, 
and consumers. 
(B) SPECIFIC MEASURES.—Such measures 
shall include measures relating to at least the 
following aspects of health care for children: 
(i) The proportion of insured (and un-
insured) children who receive age-appro-
priate preventive health and dental care 
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(including age appropriate immunizations) 
at each stage of child health development. 
(ii) The proportion of insured (and 
uninsured) children who receive dental care 
for restoration of teeth, relief of pain and 
infection, and maintenance of dental 
health. 
(iii) The effectiveness of early health 
care interventions for children whose as-
sessments indicate the presence or risk of 
physical or mental conditions that could 
adversely affect growth and development. 
(iv) The effectiveness of treatment to 
ameliorate the effects of diagnosed physical 
and mental health conditions, including 
chronic conditions. 
(v) The proportion of children under 
age 21 who are continuously insured for a 
period of 12 months or longer. 
(vi) The effectiveness of health care 
for children with disabilities. 
In carrying out clause (vi), the Secretary shall 
develop quality measures and best practices re-
lating to cystic fibrosis. 
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(C) REPORTING METHODOLOGY FOR ANAL-
YSIS
BY
PEDIATRIC
CHARACTERISTICS.—The 
children’s health quality measurement program 
shall describe with specificity such measures 
and the process by which such measures will be 
reported in a manner that permits analysis 
based on each of the following pediatric charac-
teristics: 
(i) Age. 
(ii) Gender. 
(iii) Race. 
(iv) Ethnicity. 
(v) Primary language of the child’s 
parents (or caretaker relative). 
(vi) Disability or chronic condition 
(including cystic fibrosis). 
(vii) Geographic location. 
(viii) Coverage status under public 
and private health insurance programs. 
(D) PEDIATRIC
QUALITY
MEASURE.—In 
this subsection, the term ‘‘pediatric quality 
measure’’ means a measurement of clinical care 
that assesses one or more aspects of pediatric 
health care quality (in various settings) includ-
ing the structure of the clinical care system, the 
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process and outcome of care, or patient experi-
ence in such care. 
(3) CONSULTATION
IN
DEVELOPING
QUALITY 
MEASURES FOR CHILDREN’S HEALTH SERVICES.—In 
developing and implementing the children’s health 
quality measurement program, the Secretary shall 
consult with— 
(A) States; 
(B) pediatric hospitals, pediatricians, and 
other primary and specialized pediatric health 
care professionals (including members of the al-
lied health professions) who specialize in the 
care and treatment of children, particularly 
children with special physical, mental, and de-
velopmental health care needs; 
(C) dental professionals; 
(D) health care providers that furnish pri-
mary health care to children and families who 
live in urban and rural medically underserved 
communities or who are members of distinct 
population sub-groups at heightened risk for 
poor health outcomes; 
(E) national organizations representing 
children, including children with disabilities and 
children with chronic conditions; 
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(F) national organizations and individuals 
with expertise in pediatric health quality per-
formance measurement; and 
(G) voluntary consensus standards setting 
organizations and other organizations involved 
in the advancement of evidence based measures 
of health care. 
(4) USE OF GRANTS AND CONTRACTS.—In car-
rying out the children’s health quality measurement 
program, the Secretary may award grants and con-
tracts to develop, test, validate, update, and dissemi-
nate quality measures under the program. 
(5) TECHNICAL
ASSISTANCE.—The Secretary 
shall provide technical assistance to States to estab-
lish for the reporting of quality measures under ti-
tles XIX and XXI of the Social Security Act in ac-
cordance with the children’s health quality measure-
ment program. 
(b) DISSEMINATION OF INFORMATION ON THE QUAL-
ITY OF PROGRAM PERFORMANCE.—Not later than Janu-
ary 1, 2009, and annually thereafter, the Secretary shall 
collect, analyze, and make publicly available on a public 
website of the Department of Health and Human Services 
in an online format— 
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(1) a complete list of all measures in use by 
States as of such date and used to measure the 
quality of medical and dental health services fur-
nished to children enrolled under title XIX of XXI 
of the Social Security Act by participating providers, 
managed care entities, and plan issuers; and 
(2) information on health care quality for chil-
dren contained in external quality review reports re-
quired under section 1932(c)(2) of such Act (42 
U.S.C. 1396u–2) or produced by States that admin-
ister separate plans under title XXI of such Act. 
(c) REPORTS TO CONGRESS ON PROGRAM PERFORM-
ANCE.—Not later than January 1, 2010, and every 2 
years thereafter, the Secretary shall report to Congress 
on— 
(1) the quality of health care for children en-
rolled under title XIX and XXI of the Social Secu-
rity Act under the children’s health quality measure-
ment program; and 
(2) patterns of health care utilization with re-
spect to the measures specified in subsection 
(a)(2)(B) among children by the pediatric character-
istics listed in subsection (a)(2)(C). 
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SEC. 152. APPLICATION OF CERTAIN MANAGED CARE 
QUALITY SAFEGUARDS TO CHIP. 
(a) IN GENERAL.—Section 2103(f) of Social Security 
Act (42 U.S.C. 1397bb(f)) is amended by adding at the 
end the following new paragraph: 
‘‘(3) COMPLIANCE WITH MANAGED CARE RE-
QUIREMENTS.—The State child health plan shall 
provide for the application of subsections (a)(4), 
(a)(5), (b), (c), (d), and (e) of section 1932 (relating 
to requirements for managed care) to coverage, 
State agencies, enrollment brokers, managed care 
entities, and managed care organizations under this 
title in the same manner as such subsections apply 
to coverage and such entities and organizations 
under title XIX.’’. 
(b) EFFECTIVE DATE.—The amendment made by 
subsection (a) shall apply to contract years for health 
plans beginning on or after July 1, 2008. 
SEC. 153. UPDATED FEDERAL EVALUATION OF CHIP. 
Section 2108(c) of the Social Security Act (42 U.S.C. 
1397hh(c)) is amended by striking paragraph (5) and in-
serting the following: 
‘‘(5) SUBSEQUENT
EVALUATION
USING
UP-
DATED INFORMATION.— 
‘‘(A) IN
GENERAL.—The Secretary, di-
rectly or through contracts or interagency 
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agreements, shall conduct an independent sub-
sequent evaluation of 10 States with approved 
child health plans. 
‘‘(B) SELECTION
OF
STATES
AND
MAT-
TERS INCLUDED.—Paragraphs (2) and (3) shall 
apply to such subsequent evaluation in the 
same manner as such provisions apply to the 
evaluation conducted under paragraph (1). 
‘‘(C) SUBMISSION
TO
CONGRESS.—Not 
later than December 31, 2010, the Secretary 
shall submit to Congress the results of the eval-
uation conducted under this paragraph. 
‘‘(D) FUNDING.—Out of any money in the 
Treasury of the United States not otherwise ap-
propriated, there are appropriated $10,000,000 
for fiscal year 2009 for the purpose of con-
ducting the evaluation authorized under this 
paragraph. Amounts appropriated under this 
subparagraph shall remain available for expend-
iture through fiscal year 2011.’’. 
SEC. 154. ACCESS TO RECORDS FOR IG AND GAO AUDITS 
AND EVALUATIONS. 
Section 2108(d) of the Social Security Act (42 U.S.C. 
1397hh(d)) is amended to read as follows: 
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