203 
following the fiscal years for which they receive 
grants under this subsection; 
‘‘(E) located in communities that are medi-
cally underserved, as determined by the Sec-
retary; 
‘‘(F) located in areas in which the average 
poverty rate is at least 150 percent or higher of 
the average poverty rate in the State involved, 
as determined by the Secretary; and 
‘‘(G) that submit plans that exhibit multi-
sectoral, cooperative conduct that includes the 
involvement of a broad range of stakeholders, 
including— 
‘‘(i) community-based organizations; 
‘‘(ii) local governments; 
‘‘(iii) local educational agencies; 
‘‘(iv) the private sector; 
‘‘(v) State or local departments of 
health; 
‘‘(vi) accredited colleges, universities, 
and community colleges; 
‘‘(vii) health care providers; 
‘‘(viii) State and local departments of 
transportation and city planning; and
204 
‘‘(ix) other entities determined appro-
priate by the Secretary. 
‘‘(5) PROGRAM DESIGN.— 
‘‘(A) INITIAL DESIGN.—Not later than 1 
year after the date of enactment of the Chil-
dren’s Health Insurance Program Reauthoriza-
tion Act of 2009, the Secretary shall design the 
demonstration 
project. 
The 
demonstration 
should draw upon promising, innovative models 
and incentives to reduce behavioral risk factors. 
The Administrator of the Centers for Medicare 
& Medicaid Services shall consult with the Di-
rector of the Centers for Disease Control and 
Prevention, the Director of the Office of Minor-
ity Health, the heads of other agencies in the 
Department of Health and Human Services, 
and such professional organizations, as the Sec-
retary determines to be appropriate, on the de-
sign, conduct, and evaluation of the demonstra-
tion. 
‘‘(B) NUMBER AND PROJECT AREAS.—Not 
later than 2 years after the date of enactment 
of the Children’s Health Insurance Program 
Reauthorization Act of 2009, the Secretary 
shall award 1 grant that is specifically designed
205 
to determine whether programs similar to pro-
grams to be conducted by other grantees under 
this subsection should be implemented with re-
spect to the general population of children who 
are eligible for child health assistance under 
State child health plans under title XXI in 
order to reduce the incidence of childhood obe-
sity among such population. 
‘‘(6) REPORT TO CONGRESS.—Not later than 3 
years after the date the Secretary implements the 
demonstration project under this subsection, the 
Secretary shall submit to Congress a report that de-
scribes the project, evaluates the effectiveness and 
cost effectiveness of the project, evaluates the bene-
ficiary satisfaction under the project, and includes 
any such other information as the Secretary deter-
mines to be appropriate. 
‘‘(7) DEFINITIONS.—In this subsection: 
‘‘(A) 
FEDERALLY-QUALIFIED
HEALTH 
CENTER.—The term ‘Federally-qualified health 
center’ has the meaning given that term in sec-
tion 1905(l)(2)(B). 
‘‘(B) INDIAN
TRIBE.—The term ‘Indian 
tribe’ has the meaning given that term in sec-
206 
tion 4 of the Indian Health Care Improvement 
Act (25 U.S.C. 1603). 
‘‘(C) SELF-ASSESSMENT.—The term ‘self- 
assessment’ means a form that— 
‘‘(i) includes questions regarding— 
‘‘(I) behavioral risk factors; 
‘‘(II) 
needed 
preventive 
and 
screening services; and 
‘‘(III) target individuals’ pref-
erences for receiving follow-up infor-
mation; 
‘‘(ii) is assessed using such computer 
generated assessment programs; and 
‘‘(iii) allows for the provision of such 
ongoing support to the individual as the 
Secretary determines appropriate. 
‘‘(D) ONGOING SUPPORT.—The term ‘on-
going support’ means— 
‘‘(i) to provide any target individual 
with information, feedback, health coach-
ing, and recommendations regarding— 
‘‘(I) the results of a self-assess-
ment given to the individual; 
‘‘(II) behavior modification based 
on the self-assessment; and
207 
‘‘(III) any need for clinical pre-
ventive and screening services or 
treatment including medical nutrition 
therapy; 
‘‘(ii) to provide any target individual 
with referrals to community resources and 
programs available to assist the target in-
dividual in reducing health risks; and 
‘‘(iii) to provide the information de-
scribed in clause (i) to a health care pro-
vider, if designated by the target individual 
to receive such information. 
‘‘(8) AUTHORIZATION
OF
APPROPRIATIONS.— 
There is authorized to be appropriated to carry out 
this subsection, $25,000,000 for the period of fiscal 
years 2009 through 2013. 
‘‘(f) 
DEVELOPMENT
OF
MODEL
ELECTRONIC 
HEALTH RECORD FORMAT FOR CHILDREN ENROLLED IN 
MEDICAID OR CHIP.— 
‘‘(1) IN GENERAL.—Not later than January 1, 
2010, the Secretary shall establish a program to en-
courage the development and dissemination of a 
model electronic health record format for children 
enrolled in the State plan under title XIX or the 
State child health plan under title XXI that is—
208 
‘‘(A) subject to State laws, accessible to 
parents, caregivers, and other consumers for 
the sole purpose of demonstrating compliance 
with school or leisure activity requirements, 
such as appropriate immunizations or physicals; 
‘‘(B) designed to allow interoperable ex-
changes that conform with Federal and State 
privacy and security requirements; 
‘‘(C) structured in a manner that permits 
parents and caregivers to view and understand 
the extent to which the care their children re-
ceive is clinically appropriate and of high qual-
ity; and 
‘‘(D) capable of being incorporated into, 
and otherwise compatible with, other standards 
developed for electronic health records. 
‘‘(2) FUNDING.—$5,000,000 of the amount ap-
propriated under subsection (i) for a fiscal year shall 
be used to carry out this subsection. 
‘‘(g) STUDY OF PEDIATRIC HEALTH AND HEALTH 
CARE QUALITY MEASURES.— 
‘‘(1) IN
GENERAL.—Not later than July 1, 
2010, the Institute of Medicine shall study and re-
port to Congress on the extent and quality of efforts 
to measure child health status and the quality of
209 
health care for children across the age span and in 
relation to preventive care, treatments for acute con-
ditions, and treatments aimed at ameliorating or 
correcting physical, mental, and developmental con-
ditions in children. In conducting such study and 
preparing such report, the Institute of Medicine 
shall— 
‘‘(A) consider all of the major national 
population-based reporting systems sponsored 
by the Federal Government that are currently 
in place, including reporting requirements 
under Federal grant programs and national 
population surveys and estimates conducted di-
rectly by the Federal Government; 
‘‘(B) identify the information regarding 
child health and health care quality that each 
system is designed to capture and generate, the 
study and reporting periods covered by each 
system, and the extent to which the information 
so generated is made widely available through 
publication; 
‘‘(C) identify gaps in knowledge related to 
children’s health status, health disparities 
among subgroups of children, the effects of so-
cial conditions on children’s health status and
210 
use and effectiveness of health care, and the re-
lationship between child health status and fam-
ily income, family stability and preservation, 
and children’s school readiness and educational 
achievement and attainment; and 
‘‘(D) make recommendations regarding im-
proving and strengthening the timeliness, qual-
ity, and public transparency and accessibility of 
information about child health and health care 
quality. 
‘‘(2) FUNDING.—Up to $1,000,000 of the 
amount appropriated under subsection (i) for a fis-
cal year shall be used to carry out this subsection. 
‘‘(h) RULE
OF CONSTRUCTION.—Notwithstanding 
any other provision in this section, no evidence based qual-
ity measure developed, published, or used as a basis of 
measurement or reporting under this section may be used 
to establish an irrebuttable presumption regarding either 
the medical necessity of care or the maximum permissible 
coverage for any individual child who is eligible for and 
receiving medical assistance under title XIX or child 
health assistance under title XXI. 
‘‘(i) APPROPRIATION.—Out of any funds in the 
Treasury not otherwise appropriated, there is appro-
priated for each of fiscal years 2009 through 2013,
211 
$45,000,000 for the purpose of carrying out this section 
(other than subsection (e)). Funds appropriated under 
this subsection shall remain available until expended.’’. 
(b) INCREASED MATCHING RATE FOR COLLECTING 
AND REPORTING ON CHILD HEALTH MEASURES.—Sec-
tion 1903(a)(3)(A) (42 U.S.C. 1396b(a)(3)(A)), is amend-
ed— 
(1) by striking ‘‘and’’ at the end of clause (i); 
and 
(2) by adding at the end the following new 
clause: 
‘‘(iii) an amount equal to the Federal med-
ical assistance percentage (as defined in section 
1905(b)) of so much of the sums expended dur-
ing such quarter (as found necessary by the 
Secretary for the proper and efficient adminis-
tration of the State plan) as are attributable to 
such developments or modifications of systems 
of the type described in clause (i) as are nec-
essary for the efficient collection and reporting 
on child health measures; and’’.
212 
SEC. 402. IMPROVED AVAILABILITY OF PUBLIC INFORMA-
TION REGARDING ENROLLMENT OF CHIL-
DREN IN CHIP AND MEDICAID. 
(a) INCLUSION OF PROCESS AND ACCESS MEASURES 
IN ANNUAL STATE REPORTS.—Section 2108 (42 U.S.C. 
1397hh) is amended— 
(1) in subsection (a), in the matter preceding 
paragraph (1), by striking ‘‘The State’’ and insert-
ing ‘‘Subject to subsection (e), the State’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(e) INFORMATION REQUIRED FOR INCLUSION IN 
STATE ANNUAL REPORT.—The State shall include the fol-
lowing information in the annual report required under 
subsection (a): 
‘‘(1) Eligibility criteria, enrollment, and reten-
tion data (including data with respect to continuity 
of coverage or duration of benefits). 
‘‘(2) Data regarding the extent to which the 
State uses process measures with respect to deter-
mining the eligibility of children under the State 
child health plan, including measures such as 12- 
month continuous eligibility, self-declaration of in-
come for applications or renewals, or presumptive 
eligibility.
213 
‘‘(3) Data regarding denials of eligibility and 
redeterminations of eligibility. 
‘‘(4) Data regarding access to primary and spe-
cialty services, access to networks of care, and care 
coordination provided under the State child health 
plan, using quality care and consumer satisfaction 
measures included in the Consumer Assessment of 
Healthcare Providers and Systems (CAHPS) survey. 
‘‘(5) If the State provides child health assist-
ance in the form of premium assistance for the pur-
chase of coverage under a group health plan, data 
regarding the provision of such assistance, including 
the extent to which employer-sponsored health insur-
ance coverage is available for children eligible for 
child health assistance under the State child health 
plan, the range of the monthly amount of such as-
sistance provided on behalf of a child or family, the 
number of children or families provided such assist-
ance on a monthly basis, the income of the children 
or families provided such assistance, the benefits 
and cost-sharing protection provided under the State 
child health plan to supplement the coverage pur-
chased with such premium assistance, the effective 
strategies the State engages in to reduce any admin-
istrative barriers to the provision of such assistance,
214 
and, the effects, if any, of the provision of such as-
sistance on preventing the coverage provided under 
the State child health plan from substituting for cov-
erage provided under employer-sponsored health in-
surance offered in the State. 
‘‘(6) To the extent applicable, a description of 
any State activities that are designed to reduce the 
number of uncovered children in the State, including 
through a State health insurance connector program 
or support for innovative private health coverage ini-
tiatives.’’. 
(b) STANDARDIZED REPORTING FORMAT.— 
(1) IN GENERAL.—Not later than 1 year after 
the date of enactment of this Act, the Secretary 
shall specify a standardized format for States to use 
for reporting the information required under section 
2108(e) of the Social Security Act, as added by sub-
section (a)(2). 
(2) TRANSITION
PERIOD
FOR
STATES.—Each 
State that is required to submit a report under sub-
section (a) of section 2108 of the Social Security Act 
that includes the information required under sub-
section (e) of such section may use up to 3 reporting 
periods to transition to the reporting of such infor-
215 
mation in accordance with the standardized format 
specified by the Secretary under paragraph (1). 
(c) ADDITIONAL FUNDING FOR THE SECRETARY TO 
IMPROVE TIMELINESS OF DATA REPORTING AND ANAL-
YSIS FOR PURPOSES OF DETERMINING ENROLLMENT IN-
CREASES UNDER MEDICAID AND CHIP.— 
(1) APPROPRIATION.—There is appropriated, 
out of any money in the Treasury not otherwise ap-
propriated, $5,000,000 to the Secretary for fiscal 
year 2009 for the purpose of improving the timeli-
ness of the data reported and analyzed from the 
Medicaid Statistical Information System (MSIS) for 
purposes of providing more timely data on enroll-
ment and eligibility of children under Medicaid and 
CHIP and to provide guidance to States with re-
spect to any new reporting requirements related to 
such improvements. Amounts appropriated under 
this paragraph shall remain available until expended. 
(2) REQUIREMENTS.—The improvements made 
by the Secretary under paragraph (1) shall be de-
signed and implemented (including with respect to 
any necessary guidance for States to report such in-
formation in a complete and expeditious manner) so 
that, beginning no later than October 1, 2009, data 
regarding the enrollment of low-income children (as
216 
defined in section 2110(c)(4) of the Social Security 
Act (42 U.S.C. 1397jj(c)(4)) of a State enrolled in 
the State plan under Medicaid or the State child 
health plan under CHIP with respect to a fiscal year 
shall be collected and analyzed by the Secretary 
within 6 months of submission. 
(d) GAO STUDY AND REPORT ON ACCESS TO PRI-
MARY AND SPECIALITY SERVICES.— 
(1) IN GENERAL.—The Comptroller General of 
the United States shall conduct a study of children’s 
access to primary and specialty services under Med-
icaid and CHIP, including— 
(A) the extent to which providers are will-
ing to treat children eligible for such programs; 
(B) information on such children’s access 
to networks of care; 
(C) geographic availability of primary and 
specialty services under such programs; 
(D) the extent to which care coordination 
is provided for children’s care under Medicaid 
and CHIP; and 
(E) as appropriate, information on the de-
gree of availability of services for children under 
such programs.
217 
(2) REPORT.—Not later than 2 years after the 
date of enactment of this Act, the Comptroller Gen-
eral shall submit a report to the Committee on Fi-
nance of the Senate and the Committee on Energy 
and Commerce of the House of Representatives on 
the study conducted under paragraph (1) that in-
cludes recommendations for such Federal and State 
legislative and administrative changes as the Comp-
troller General determines are necessary to address 
any barriers to access to children’s care under Med-
icaid and CHIP that may exist. 
SEC. 403. 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
218 
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, 2009. 
TITLE V—IMPROVING ACCESS 
TO BENEFITS 
SEC. 501. DENTAL BENEFITS. 
(a) COVERAGE.— 
(1) IN
GENERAL.—Section 2103 (42 U.S.C. 
1397cc) is amended— 
(A) in subsection (a)— 
(i) in the matter before paragraph 
(1), by striking ‘‘subsection (c)(5)’’ and in-
serting ‘‘paragraphs (5) and (7) of sub-
section (c)’’; and 
(ii) in paragraph (1), by inserting ‘‘at 
least’’ after ‘‘that is’’; and 
(B) in subsection (c)— 
(i) by redesignating paragraph (5) as 
paragraph (7); and 
(ii) by inserting after paragraph (4), 
the following: 
‘‘(5) DENTAL BENEFITS.—
219 
‘‘(A) IN GENERAL.—The child health as-
sistance provided to a targeted low-income child 
shall include coverage of dental services nec-
essary to prevent disease and promote oral 
health, restore oral structures to health and 
function, and treat emergency conditions. 
‘‘(B) 
PERMITTING
USE
OF
DENTAL 
BENCHMARK
PLANS
BY
CERTAIN
STATES.—A 
State may elect to meet the requirement of sub-
paragraph (A) through dental coverage that is 
equivalent to a benchmark dental benefit pack-
age described in subparagraph (C). 
‘‘(C) BENCHMARK DENTAL BENEFIT PACK-
AGES.—The benchmark dental benefit packages 
are as follows: 
‘‘(i) FEHBP CHILDREN’S
DENTAL 
COVERAGE.—A dental benefits plan under 
chapter 89A of title 5, United States Code, 
that has been selected most frequently by 
employees seeking dependent coverage, 
among such plans that provide such de-
pendent coverage, in either of the previous 
2 plan years. 
‘‘(ii) STATE
EMPLOYEE
DEPENDENT 
DENTAL
COVERAGE.—A dental benefits