I
106TH CONGRESS
1ST SESSION
H. R. 1545
To amend title XXI of the Social Security Act to provide for improved
data collection and evaluations of State Children’s Health Insurance
Programs, and for other purposes.
IN THE HOUSE OF REPRESENTATIVES
APRIL 22, 1999
Mr. STUPAK introduced the following bill; which was referred to the
Committee on Commerce
A BILL
To amend title XXI of the Social Security Act to provide
for improved data collection and evaluations of State
Children’s Health Insurance Programs, and for other
purposes.
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 ‘‘CHIP Data and Eval-
uation Improvement Act of 1999’’.
SEC. 2. FUNDING FOR RELIABLE ANNUAL STATE-BY-STATE
ESTIMATES ON THE NUMBER OF CHILDREN
WHO DO NOT HAVE HEALTH INSURANCE COV-
ERAGE.
Section 2108 of the Social Security Act (42
U.S.C.1397hh) is amended by adding at the end the fol-
lowing:
‘‘(c) ADJUSTMENT TO CURRENT POPULATION SUR-
VEY TO INCLUDE STATE-BY-STATE DATA RELATING TO
CHILDREN WITHOUT HEALTH INSURANCE COVERAGE.—
‘‘(1) IN
GENERAL.—The Secretary of Com-
merce shall make appropriate adjustments to the an-
nual Current Population Survey conducted by the
Bureau of the Census in order to produce statis-
tically reliable annual State data on the number of
low-income children who do not have health insur-
ance coverage, so that real changes in the
uninsurance rates of children can reasonably be de-
tected. The Current Population Survey should
produce data under this subsection that categorizes
such children by family income, age, and race or eth-
nicity. The adjustments made to produce such data
shall include, where appropriate, expanding the sam-
ple size used in the State sampling units, expanding
the number of sampling units in a State, and an ap-
propriate verification element.
‘‘(2) APPROPRIATION.—Out of any money in
the Treasury of the United States not otherwise ap-
propriated, there are appropriated $10,000,000 for
fiscal year 2000 and each fiscal year thereafter for
the purpose of carrying out this subsection.’’.
SEC. 3. FUNDING FOR CHILDREN’S HEALTH CARE ACCESS
AND UTILIZATION STATE-BY-STATE DATA.
Section 2108 of the Social Security Act (42 U.S.C.
1397hh), as amended by section 2, is amended by adding
at the end the following:
‘‘(d) COLLECTION OF CHILDREN’S HEALTH CARE
ACCESS AND UTILIZATION STATE-LEVEL DATA.—
‘‘(1) IN
GENERAL.—The Secretary, acting
through the National Center for Health Statistics
(in this subsection referred to as the ‘Center’), shall
collect data on children’s health insurance through
the State and Local Area Integrated Telephone Sur-
vey (SLAITS) for the 50 States and the District of
Columbia. Sufficient data shall be collected so as to
provide reliable, annual, State-by-State information
on the health care access and utilization of children
in low-income households, and to allow for compari-
sons between demographic subgroups categorized
with respect to family income, age, and race or eth-
nicity.
‘‘(2) SURVEY DESIGN AND CONTENT.—
‘‘(A) IN GENERAL.—In carrying out para-
graph (1), the Secretary, acting through the
Center—
‘‘(i) shall obtain input from appro-
priate sources, including States, in design-
ing the survey and making content deci-
sions; and
‘‘(ii) at the request of a State, may
collect additional data to assist with a
State’s evaluation of the program estab-
lished under this title.
‘‘(B) REIMBURSEMENT OF COSTS OF ADDI-
TIONAL
DATA.—A State shall reimburse the
Center for services provided under subpara-
graph (A)(ii).
‘‘(3) APPROPRIATION.—Out of any money in
the Treasury of the United States not otherwise ap-
propriated, there are appropriated $9,000,000 for
fiscal year 2000 and each fiscal year thereafter for
the purpose of carrying out this subsection.’’.
SEC. 4. FEDERAL EVALUATION OF STATE CHILDREN’S
HEALTH INSURANCE PROGRAMS.
Section 2108 of the Social Security Act (42
U.S.C.1397hh), as amended by sections 2 and 3, is
amended—
(1) by redesignating subsections (c) and (d) as
subsections (d) and (e), respectively; and
(2) by inserting after subsection (b) the fol-
lowing:
‘‘(c) FEDERAL EVALUATION.—
‘‘(1) IN GENERAL.—The Secretary, directly or
through contracts or interagency agreements, shall
conduct an independent evaluation of 10 States with
approved child health plans.
‘‘(2) SELECTION
OF
STATES.—In selecting
States for the evaluation conducted under this sub-
section, the Secretary shall choose 10 States that
utilize diverse approaches to providing child health
assistance, represent various geographic areas (in-
cluding a mix of rural and urban areas), and contain
a significant portion of uncovered children.
‘‘(3) MATTERS INCLUDED.—In addition to the
elements described in subsection (b)(1), the evalua-
tion conducted under this subsection shall include,
but is not limited to, the following:
‘‘(A) Surveys of the target population (en-
rollees, disenrollees, and individuals eligible for
but not enrolled in the program under this
title).
‘‘(B) Evaluation of effective and ineffective
outreach and enrollment practices with respect
to children (for both the program under this
title and the medicaid program under title
XIX), and identification of enrollment barriers
and key elements of effective outreach and en-
rollment practices, including practices that have
successfully enrolled hard-to-reach populations
such as children who are eligible for medical as-
sistance under title XIX but have not been en-
rolled previously in the medicaid program under
that title.
‘‘(C) Evaluation of the extent to which
State medicaid eligibility practices and proce-
dures under the medicaid program under title
XIX are a barrier to the enrollment of children
under that program, and the extent to which
coordination (or lack of coordination) between
that program and the program under this title
affects the enrollment of children under both
programs.
‘‘(D) An assessment of the effect of cost-
sharing on utilization, enrollment, and coverage
retention.
‘‘(E) Evaluation of disenrollment or other
retention issues, such as switching to private
coverage, failure to pay premiums, or barriers
in the recertification process.
‘‘(4) SUBMISSION
TO
CONGRESS.—Not later
than December 31, 2001, the Secretary shall submit
to Congress the results of the evaluation conducted
under this subsection.
‘‘(5) FUNDING.—Out of any money in the
Treasury of the United States not otherwise appro-
priated, there are appropriated $10,000,000 for fis-
cal year 2000 for the purpose of conducting the eval-
uation authorized under this subsection. Amounts
appropriated under this paragraph shall remain
available without fiscal year limitation.’’.
SEC. 5. STANDARDIZED REPORTING REQUIREMENTS FOR
ANNUAL REPORTS.
Section 2108(a) of the Social Security Act (42 U.S.C.
1397hh(a)) is amended by—
(1) redesignating paragraphs (1) and (2) as
subparagraphs (A) and (B), respectively and indent-
ing appropriately;
(2) by striking ‘‘The State shall—’’ and insert-
ing the following
‘‘(1) IN GENERAL.—The State shall—’’; and
(3) by adding at the end the following:
‘‘(2) STANDARDIZED
REPORTING
REQUIRE-
MENTS.—Each annual report submitted under this
subsection shall, in addition to expenditure and
other reporting requirements specified by the Sec-
retary, include the following:
‘‘(A) Enrollee counts categorized by income
(that at least identifies enrollees with income
below the poverty line), age, and race or eth-
nicity, and, if income levels used in State re-
porting differ from that prescribed by the Sec-
retary, a detailed description of the eligibility
methodologies used by the State, including all
relevant income disregards, exempted income,
and eligibility family units.
‘‘(B) The annual percentages of those indi-
viduals who sought coverage (as determined by
the Secretary) through the screening and enroll-
ment process established under the State pro-
gram under this title who were—
‘‘(i) enrolled in the program under
this title;
‘‘(ii) enrolled in the medicaid program
under title XIX; or
‘‘(iii) determined eligible for, but not
enrolled in, the program under this title or
the medicaid program under title XIX.’’.
SEC. 6. INSPECTOR GENERAL AUDIT AND GAO REPORT ON
ENROLLEES ELIGIBLE FOR MEDICAID.
Section 2108 of the Social Security Act (42 U.S.C.
1397hh), as amended by section 4, is amended by adding
at the end the following:
‘‘(f) INSPECTOR GENERAL AUDIT
AND GAO RE-
PORT.—
‘‘(1) AUDIT.—Beginning with fiscal year 2000,
and every third fiscal year thereafter, the Secretary,
through the Inspector General of the Department of
Health and Human Services, shall audit a sample
from among the States described in paragraph (2)
in order to—
‘‘(A) determine the number, if any,
of enrollees under the plan under this title who
are eligible for medical assistance under title
XIX (other than as an optional targeted
low-income 
children 
under 
section
1902(a)(10)(A)(ii)(XIV)); and
‘‘(B) assess the progress made in reducing
the number of targeted uncovered low-income
children relative to the goals established in the
State child health plan, as reported to the Sec-
retary in accordance with subsection (a)(2).
‘‘(2) STATE DESCRIBED.—A State described in
this paragraph is a State with an approved State
child health plan under this title that does not, as
part of such plan, provide health benefits coverage
under the State’s medicaid program under title XIX.
‘‘(3) MONITORING AND REPORT FROM GAO.—
The Comptroller General of the United States shall
monitor the audits conducted under this subsection
and, not later than March 1 of each fiscal year after
a fiscal year in which an audit is conducted under
this subsection, shall submit a report to Congress on
the results of the audit conducted during the prior
fiscal year.’’.
SEC. 7. COORDINATION OF DATA COLLECTION WITH DATA
REQUIREMENTS UNDER THE MATERNAL AND
CHILD HEALTH SERVICES BLOCK GRANT.
Subparagraphs 
(C)(ii) 
and 
(D)(ii) 
of 
section
506(a)(2) of the Social Security Act (42 U.S.C. 706(a)(2))
are each amended by inserting ‘‘or the State plan under
title XXI’’ after ‘‘title XIX’’.
SEC. 8. COORDINATION OF DATA SURVEYS AND REPORTS.
The Secretary of Health and Human Services,
through the Assistant Secretary for Planning and Evalua-
tion, shall establish a clearinghouse for the consolidation
and coordination of all Federal data bases and reports re-
garding children’s health.
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