I 
116TH CONGRESS 
1ST SESSION 
H. R. 660 
To improve the health outcomes in communities through community-relevant 
health information and new health supporting incentives and programs 
funded without further appropriations. 
IN THE HOUSE OF REPRESENTATIVES 
JANUARY 17, 2019 
Mr. FORTENBERRY (for himself and Ms. JOHNSON of Texas) introduced the 
following bill; which was referred to the Committee on Energy and Commerce 
A BILL 
To improve the health outcomes in communities through 
community-relevant health information and new health 
supporting incentives and programs funded without fur-
ther appropriations. 
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 ‘‘Community Health Im-
provement, Leadership, and Development Act of 2019’’ or 
the ‘‘CHILD Act’’. 
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SEC. 2. LOCALIZED COMMUNITY HEALTH IMPROVEMENT 
PROGRAMS. 
(a) MAKING EPIDEMIOLOGY AND CLAIMS DATA REL-
EVANT TO COMMUNITY HEALTH IMPROVEMENT.— 
(1) IN
GENERAL.—Not later than April 1, 
2020, the Secretary of Health and Human Services, 
through the Director of the Centers for Disease 
Control and Prevention in collaboration with the Ad-
ministrator of the Centers for Medicare & Medicaid 
Services, shall, subject to paragraph (2), provide for 
the maintenance of a database of de-identified epide-
miological and claims health information for the pur-
pose of making such information available in a use-
ful and informative manner to participating commu-
nities (as referenced in subsection (b)(3)(B)) in par-
ticipating States (as referenced in subsection (b)(1)) 
to support such communities in reducing rates of ill-
ness (as compared to the rate of illness within such 
community as of a period specified by the Secretary) 
and improving the management of illnesses to reduce 
the cost of health care delivery. In carrying out this 
subsection, the Director and Administrator shall, 
subject to paragraph (2), provide— 
(A) for a mechanism that enables the inte-
gration of such epidemiological and claims 
health information for such purposes; 
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(B) that such health information is avail-
able for at least the 20 health conditions and 
treatments that are associated with the highest 
expenditures under the Medicaid program 
under title XIX of the Social Security Act; 
(C) that such health information is made 
available to participating States in such a man-
ner that enables participating communities 
within such States to access such information 
that is relevant specifically to such commu-
nities; and 
(D) for a mechanism by which the Director 
and Administrator may— 
(i) update such information specific to 
each such community, to the extent prac-
ticable, in real-time or near real-time and 
as specified by the Director and Adminis-
trator; 
(ii) verify the validity of such informa-
tion and the validity of the changes in such 
information for each such community over 
such specified periods; and 
(iii) assess and measure the extent of 
such changes for each such participating 
community, including the amount of any 
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reductions in expenditures under the State 
plan under title XIX of the Social Security 
Act and the extent to which such reduc-
tions are attributable to such changes with 
respect to each such community in such 
State. 
(2) NO ADDITIONAL FUNDING.—No additional 
funds are authorized to be appropriated to carry out 
this subsection. This subsection shall be carried out 
using amounts otherwise made available to the Sec-
retary. 
(b) LOCALIZED COMMUNITY HEALTH IMPROVEMENT 
PROGRAM GRANTS.— 
(1) IN GENERAL.—The Secretary of Health and 
Human Services shall, subject to paragraph (5), 
carry out a grant program under which the Sec-
retary may award grants to States for purposes of 
carrying out localized community health improve-
ment programs described in paragraph (3). In this 
section such States awarded such grants are referred 
to as ‘‘participating States’’. 
(2) APPLICATION.—To be eligible for a grant 
under this subsection, a State shall— 
(A) submit to the Secretary an application, 
in such manner, at such time, and containing 
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such information as specified by the Secretary; 
and 
(B) enter into an arrangement with the 
Secretary under which— 
(i) the State agrees to establish and 
maintain a localized community health im-
provement program described in paragraph 
(3); 
(ii) the Secretary agrees to provide 
the State with integrated epidemiological 
and claims health information maintained 
in the database established under sub-
section (a) specific to each participating 
community within the State; and 
(iii) the State and Secretary carry out 
the community shared savings account 
agreement terms described in subsection 
(c). 
(3) LOCALIZED COMMUNITY HEALTH IMPROVE-
MENT PROGRAM.—For purposes of this subsection, a 
localized community health improvement program of 
a State is a program under which the State— 
(A) maintains the integrated health infor-
mation provided to the State by the Secretary 
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pursuant to the arrangement described in para-
graph (2)(B); 
(B) makes such information available to 
qualifying communities (as defined in para-
graph (4)) within such State which request 
such information and agree to the terms de-
scribed in subparagraph (D) and subsection (c) 
(in this section referred to as ‘‘participating 
communities’’) in a secure manner and format 
that is most informative to such communities in 
assisting such communities in analyzing and 
applying such data to the specific needs of such 
communities to reduce the rates of illness and 
reduce the costs of health care within such com-
munities; 
(C) submits such data as is required by 
the Secretary to assess the extent to which the 
health care interventions implemented to ad-
dress needs of such communities identified 
through the program are affecting the rates of 
illness and costs of health care within the State 
and communities within the State; and 
(D) requires that in order for communities 
to participate in such program, the communities 
agree— 
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(i) to provide for a secure method to 
make such information available to health 
care and other relevant community work-
ers, including through an interactive dash-
board system; and 
(ii) to submit such data as is required 
by the State or Secretary to assess the ex-
tent to which health care interventions im-
plemented to address needs of such com-
munities identified through the program 
are affecting the rates of illness and costs 
of health care within the communities. 
(4) QUALIFYING
COMMUNITY
DEFINED.—For 
purposes of this section, the term ‘‘qualifying com-
munity’’ means a local community determined by 
census block or census track level (based on geo-
graphic information system data) with a defined ju-
risdictional boundary (such as a local community es-
tablished by a high school feeder pattern or by the 
boundaries of a town if such town has a population 
of fewer than 25,000 residents) or a county. 
(5) NO ADDITIONAL FUNDING.—No additional 
funds are authorized to be appropriated to carry out 
this subsection. This subsection shall be carried out 
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using amounts otherwise made available to the Sec-
retary. 
(c) COMMUNITY SHARED SAVINGS ACCOUNT AGREE-
MENT TERMS.—For purposes of subsection (b)(2)(B)(iii), 
community shared savings account terms described in this 
subsection, with respect to the Secretary, a participating 
State, and participating communities within such State, 
are the following: 
(1) In the case that the database established 
under subsection (a), through the mechanism pro-
vided for under subsection (a)(4), demonstrates for 
any specified period (as determined by the Sec-
retary) that there are verified reductions in expendi-
tures under the State plan under title XIX of the 
Social Security Act, which results in reductions in 
expenditures by the Federal Government under such 
title, and attributes such reductions to one or more 
of the participating communities within such State, 
the Secretary shall transfer to the community shared 
savings account established by the State under sub-
section (e) an amount equal to 70 percent of the 
amount of such reduction so demonstrated for such 
specified period. 
(2) The State establishes such a community 
shared savings account in accordance with sub-
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section (e) and agrees to transfer to each partici-
pating community within such State 100 percent of 
such amounts transferred under paragraph (1) that 
are verified by the Secretary as attributable to such 
community. 
(3) Each participating community in such 
State— 
(A) establishes a community shared sav-
ings board described in subsection (d) that de-
termines how funds transferred to such commu-
nity under paragraph (2) are to be used for 
purposes of promoting the health and wellness 
of residents of such community; and 
(B) uses such funds only for such purposes 
and in accordance with the uses determined by 
such board. 
(d) COMMUNITY SHARED SAVINGS BOARD.—For 
purposes of this section, a community shared savings 
board, with respect to a participating community (which 
may be a county) within a participating State, is a 
board— 
(1) consisting of at least 7 members, appointed 
by the governing officials of the community through 
such a process that is specified by the community 
(and approved by the State), including— 
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(A) at least 1 member with public health 
experience; and 
(B) members with business, civic, edu-
cational, or faith-based experience; 
(2) that is representative of the geographic 
components that are included in the community; and 
(3) that hires a fiduciary agent to manage a 
community shared savings account on behalf of the 
board. 
(e) COMMUNITY SHARED SAVINGS ACCOUNT.—For 
purposes of this section, the term ‘‘community shared sav-
ings account’’ means, with respect to a participating com-
munity within a participating State, a trust created or or-
ganized in the United States for the exclusive benefit of 
the community, as defined by the community shared sav-
ings board under subsection (d) for such participating 
community, but only if the written governing instrument 
creating the trust meets the following requirements: 
(1) The trustee is a bank (as defined in section 
408(n) of the Internal Revenue Code of 1986) or 
such other person who demonstrates to the satisfac-
tion of the Director that the manner in which such 
other person will administer the trust will be con-
sistent with the requirements of this section. 
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(2) No contribution will be accepted unless it is 
in cash. 
(3) Withdrawals may only be made by the fidu-
ciary agent described in subsection (d)(3) hired by 
such board pursuant to a plan developed by the com-
munity and approved by the State and local govern-
ment. 
Æ 
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