H. R. 3963—63 
under the group health plan in sufficient specificity, 
as determined under regulations of the Secretary of 
Health and Human Services in consultation with the 
Secretary that require use of the model coverage 
coordination disclosure form developed under section 
311(b)(1)(C) of the Children’s Health Insurance Pro-
gram Reauthorization Act of 2007, so as to permit 
the State to make a determination (under paragraph 
(2)(B), (3), or (10) of section 2105(c) of the Social Secu-
rity Act or otherwise) concerning the cost-effectiveness 
of the State providing medical or child health assist-
ance through premium assistance for the purchase of 
coverage under such group health plan and in order 
for the State to provide supplemental benefits required 
under paragraph (10)(E) of such section or other 
authority.’’. 
(b) CONFORMING AMENDMENTS.— 
(1) AMENDMENTS TO EMPLOYEE RETIREMENT INCOME SECU-
RITY ACT.— 
(A) IN
GENERAL.—Section 701(f) of the Employee 
Retirement Income Security Act of 1974 (29 U.S.C. 1181(f)) 
is amended by adding at the end the following new para-
graph: 
‘‘(3) SPECIAL RULES FOR APPLICATION IN CASE OF MEDICAID 
AND CHIP.— 
‘‘(A) IN GENERAL.—A group health plan, and a health 
insurance issuer offering group health insurance coverage 
in connection with a group health plan, shall permit an 
employee who is eligible, but not enrolled, for coverage 
under the terms of the plan (or a dependent of such an 
employee if the dependent is eligible, but not enrolled, 
for coverage under such terms) to enroll for coverage under 
the terms of the plan if either of the following conditions 
is met: 
‘‘(i) TERMINATION
OF
MEDICAID
OR
CHIP
COV-
ERAGE.—The employee or dependent is covered under 
a Medicaid plan under title XIX of the Social Security 
Act or under a State child health plan under title 
XXI of such Act and coverage of the employee or 
dependent under such a plan is terminated as a result 
of loss of eligibility for such coverage and the employee 
requests coverage under the group health plan (or 
health insurance coverage) not later than 60 days after 
the date of termination of such coverage. 
‘‘(ii) ELIGIBILITY
FOR
EMPLOYMENT
ASSISTANCE 
UNDER MEDICAID OR CHIP.—The employee or dependent 
becomes eligible for assistance, with respect to coverage 
under the group health plan or health insurance cov-
erage, under such Medicaid plan or State child health 
plan (including under any waiver or demonstration 
project conducted under or in relation to such a plan), 
if the employee requests coverage under the group 
health plan or health insurance coverage not later 
than 60 days after the date the employee or dependent 
is determined to be eligible for such assistance. 
‘‘(B) COORDINATION WITH MEDICAID AND CHIP.—
H. R. 3963—64 
‘‘(i) OUTREACH TO EMPLOYEES REGARDING AVAIL-
ABILITY OF MEDICAID AND CHIP COVERAGE.— 
‘‘(I) IN GENERAL.—Each employer that main-
tains a group health plan in a State that provides 
medical assistance under a State Medicaid plan 
under title XIX of the Social Security Act, or child 
health assistance under a State child health plan 
under title XXI of such Act, in the form of premium 
assistance for the purchase of coverage under a 
group health plan, shall provide to each employee 
a written notice informing the employee of poten-
tial opportunities then currently available in the 
State in which the employee resides for premium 
assistance under such plans for health coverage 
of the employee or the employee’s dependents. 
‘‘(II) MODEL NOTICE.—Not later than 1 year 
after the date of enactment of the Children’s 
Health Insurance Program Reauthorization Act of 
2007, the Secretary and the Secretary of Health 
and Human Services, in consultation with Direc-
tors of State Medicaid agencies under title XIX 
of the Social Security Act and Directors of State 
CHIP agencies under title XXI of such Act, shall 
jointly develop national and State-specific model 
notices for purposes of subparagraph (A). The Sec-
retary shall provide employers with such model 
notices so as to enable employers to timely comply 
with the requirements of subparagraph (A). Such 
model notices shall include information regarding 
how an employee may contact the State in which 
the employee resides for additional information 
regarding potential opportunities for such pre-
mium assistance, including how to apply for such 
assistance. 
‘‘(III) OPTION TO PROVIDE CONCURRENT WITH 
PROVISION OF PLAN MATERIALS TO EMPLOYEE.—An 
employer may provide the model notice applicable 
to the State in which an employee resides concur-
rent with the furnishing of materials notifying the 
employee of health plan eligibility, concurrent with 
materials provided to the employee in connection 
with an open season or election process conducted 
under the plan, or concurrent with the furnishing 
of the summary plan description as provided in 
section 104(b). 
‘‘(ii) DISCLOSURE ABOUT GROUP HEALTH PLAN BENE-
FITS
TO
STATES
FOR
MEDICAID
AND
CHIP
ELIGIBLE 
INDIVIDUALS.—In the case of a participant or bene-
ficiary of a group health plan who is covered under 
a Medicaid plan of a State under title XIX of the 
Social Security Act or under a State child health plan 
under title XXI of such Act, the plan administrator 
of the group health plan shall disclose to the State, 
upon request, information about the benefits available 
under the group health plan in sufficient specificity, 
as determined under regulations of the Secretary of 
Health and Human Services in consultation with the
H. R. 3963—65 
Secretary that require use of the model coverage 
coordination disclosure form developed under section 
311(b)(1)(C) of the Children’s Health Insurance Pro-
gram Reauthorization Act of 2007, so as to permit 
the State to make a determination (under paragraph 
(2)(B), (3), or (10) of section 2105(c) of the Social Secu-
rity Act or otherwise) concerning the cost-effectiveness 
of the State providing medical or child health assist-
ance through premium assistance for the purchase of 
coverage under such group health plan and in order 
for the State to provide supplemental benefits required 
under paragraph (10)(E) of such section or other 
authority.’’. 
(B) CONFORMING AMENDMENT.—Section 102(b) of the 
Employee Retirement Income Security Act of 1974 (29 
U.S.C. 1022(b)) is amended— 
(i) by striking ‘‘and the remedies’’ and inserting 
‘‘, the remedies’’; and 
(ii) by inserting before the period the following: 
‘‘, and if the employer so elects for purposes of com-
plying with section 701(f)(3)(B)(i), the model notice 
applicable to the State in which the participants and 
beneficiaries reside’’. 
(C) WORKING
GROUP
TO
DEVELOP
MODEL
COVERAGE 
COORDINATION DISCLOSURE FORM.— 
(i) MEDICAID, CHIP, AND
EMPLOYER-SPONSORED 
COVERAGE COORDINATION WORKING GROUP.— 
(I) IN GENERAL.—Not later than 60 days after 
the date of enactment of this Act, the Secretary 
of Health and Human Services and the Secretary 
of Labor shall jointly establish a Medicaid, CHIP, 
and Employer-Sponsored Coverage Coordination 
Working Group (in this subparagraph referred to 
as the ‘‘Working Group’’). The purpose of the 
Working Group shall be to develop the model cov-
erage coordination disclosure form described in 
subclause (II) and to identify the impediments to 
the effective coordination of coverage available to 
families that include employees of employers that 
maintain group health plans and members who 
are eligible for medical assistance under title XIX 
of the Social Security Act or child health assistance 
or other health benefits coverage under title XXI 
of such Act. 
(II) MODEL COVERAGE COORDINATION DISCLO-
SURE FORM DESCRIBED.—The model form described 
in this subclause is a form for plan administrators 
of group health plans to complete for purposes 
of permitting a State to determine the availability 
and cost-effectiveness of the coverage available 
under such plans to employees who have family 
members who are eligible for premium assistance 
offered under a State plan under title XIX or XXI 
of such Act and to allow for coordination of cov-
erage for enrollees of such plans. Such form shall 
provide the following information in addition to
H. R. 3963—66 
such other information as the Working Group 
determines appropriate: 
(aa) A determination of whether the 
employee is eligible for coverage under the 
group health plan. 
(bb) The name and contract information 
of the plan administrator of the group health 
plan. 
(cc) The benefits offered under the plan. 
(dd) The premiums and cost-sharing 
required under the plan. 
(ee) Any other information relevant to cov-
erage under the plan. 
(ii) MEMBERSHIP.—The Working Group shall con-
sist of not more than 30 members and shall be com-
posed of representatives of— 
(I) the Department of Labor; 
(II) the Department of Health and Human 
Services; 
(III) State directors of the Medicaid program 
under title XIX of the Social Security Act; 
(IV) State directors of the State Children’s 
Health Insurance Program under title XXI of the 
Social Security Act; 
(V) employers, including owners of small 
businesses and their trade or industry representa-
tives and certified human resource and payroll 
professionals; 
(VI) plan administrators and plan sponsors 
of group health plans (as defined in section 607(1) 
of the Employee Retirement Income Security Act 
of 1974); 
(VII) health insurance issuers; and 
(VIII) children and other beneficiaries of med-
ical assistance under title XIX of the Social Secu-
rity Act or child health assistance or other health 
benefits coverage under title XXI of such Act. 
(iii) COMPENSATION.—The members of the Working 
Group shall serve without compensation. 
(iv) ADMINISTRATIVE SUPPORT.—The Department of 
Health and Human Services and the Department of 
Labor shall jointly provide appropriate administrative 
support to the Working Group, including technical 
assistance. The Working Group may use the services 
and facilities of either such Department, with or with-
out reimbursement, as jointly determined by such 
Departments. 
(v) REPORT.— 
(I) REPORT BY WORKING GROUP TO THE SECRE-
TARIES.—Not later than 18 months after the date 
of the enactment of this Act, the Working Group 
shall submit to the Secretary of Labor and the 
Secretary of Health and Human Services the model 
form described in clause (i)(II) along with a report 
containing recommendations for appropriate meas-
ures to address the impediments to the effective 
coordination of coverage between group health
H. R. 3963—67 
plans and the State plans under titles XIX and 
XXI of the Social Security Act. 
(II) REPORT
BY
SECRETARIES
TO
THE
CON-
GRESS.—Not later than 2 months after receipt of 
the report pursuant to subclause (I), the Secre-
taries shall jointly submit a report to each House 
of the Congress regarding the recommendations 
contained in the report under such subclause. 
(vi) TERMINATION.—The Working Group shall 
terminate 30 days after the date of the issuance of 
its report under clause (v). 
(D) EFFECTIVE
DATES.—The Secretary of Labor and 
the Secretary of Health and Human Services shall develop 
the initial model notices under section 701(f)(3)(B)(i)(II) 
of the Employee Retirement Income Security Act of 1974, 
and the Secretary of Labor shall provide such notices to 
employers, not later than the date that is 1 year after 
the date of enactment of this Act, and each employer shall 
provide the initial annual notices to such employer’s 
employees beginning with the first plan year that begins 
after the date on which such initial model notices are 
first issued. The model coverage coordination disclosure 
form developed under subparagraph (C) shall apply with 
respect to requests made by States beginning with the 
first plan year that begins after the date on which such 
model coverage coordination disclosure form is first issued. 
(E) ENFORCEMENT.—Section 502 of the Employee 
Retirement Income Security Act of 1974 (29 U.S.C. 1132) 
is amended— 
(i) in subsection (a)(6), by striking ‘‘or (8)’’ and 
inserting ‘‘(8), or (9)’’; and 
(ii) in subsection (c), by redesignating paragraph 
(9) as paragraph (10), and by inserting after paragraph 
(8) the following: 
‘‘(9)(A) The Secretary may assess a civil penalty against any 
employer of up to $100 a day from the date of the employer’s 
failure to meet the notice requirement of section 701(f)(3)(B)(i)(I). 
For purposes of this subparagraph, each violation with respect 
to any single employee shall be treated as a separate violation. 
‘‘(B) The Secretary may assess a civil penalty against any 
plan administrator of up to $100 a day from the date of the plan 
administrator’s failure to timely provide to any State the informa-
tion required to be disclosed under section 701(f)(3)(B)(ii). For pur-
poses of this subparagraph, each violation with respect to any 
single participant or beneficiary shall be treated as a separate 
violation.’’. 
(2) AMENDMENTS TO PUBLIC HEALTH SERVICE ACT.—Section 
2701(f) of the Public Health Service Act (42 U.S.C. 300gg(f)) 
is amended by adding at the end the following new paragraph: 
‘‘(3) SPECIAL RULES FOR APPLICATION IN CASE OF MEDICAID 
AND CHIP.— 
‘‘(A) IN GENERAL.—A group health plan, and a health 
insurance issuer offering group health insurance coverage 
in connection with a group health plan, shall permit an 
employee who is eligible, but not enrolled, for coverage 
under the terms of the plan (or a dependent of such an 
employee if the dependent is eligible, but not enrolled,
H. R. 3963—68 
for coverage under such terms) to enroll for coverage under 
the terms of the plan if either of the following conditions 
is met: 
‘‘(i) TERMINATION
OF
MEDICAID
OR
CHIP
COV-
ERAGE.—The employee or dependent is covered under 
a Medicaid plan under title XIX of the Social Security 
Act or under a State child health plan under title 
XXI of such Act and coverage of the employee or 
dependent under such a plan is terminated as a result 
of loss of eligibility for such coverage and the employee 
requests coverage under the group health plan (or 
health insurance coverage) not later than 60 days after 
the date of termination of such coverage. 
‘‘(ii) ELIGIBILITY
FOR
EMPLOYMENT
ASSISTANCE 
UNDER MEDICAID OR CHIP.—The employee or dependent 
becomes eligible for assistance, with respect to coverage 
under the group health plan or health insurance cov-
erage, under such Medicaid plan or State child health 
plan (including under any waiver or demonstration 
project conducted under or in relation to such a plan), 
if the employee requests coverage under the group 
health plan or health insurance coverage not later 
than 60 days after the date the employee or dependent 
is determined to be eligible for such assistance. 
‘‘(B) COORDINATION WITH MEDICAID AND CHIP.— 
‘‘(i) OUTREACH TO EMPLOYEES REGARDING AVAIL-
ABILITY OF MEDICAID AND CHIP COVERAGE.— 
‘‘(I) IN GENERAL.—Each employer that main-
tains a group health plan in a State that provides 
medical assistance under a State Medicaid plan 
under title XIX of the Social Security Act, or child 
health assistance under a State child health plan 
under title XXI of such Act, in the form of premium 
assistance for the purchase of coverage under a 
group health plan, shall provide to each employee 
a written notice informing the employee of poten-
tial opportunities then currently available in the 
State in which the employee resides for premium 
assistance under such plans for health coverage 
of the employee or the employee’s dependents. For 
purposes of compliance with this subclause, the 
employer may use any State-specific model notice 
developed 
in 
accordance 
with 
section 
701(f)(3)(B)(i)(II) of the Employee Retirement 
Income 
Security 
Act 
of 
1974 
(29 
U.S.C. 
1181(f)(3)(B)(i)(II)). 
‘‘(II) OPTION
TO
PROVIDE
CONCURRENT
WITH 
PROVISION OF PLAN MATERIALS TO EMPLOYEE.—An 
employer may provide the model notice applicable 
to the State in which an employee resides concur-
rent with the furnishing of materials notifying the 
employee of health plan eligibility, concurrent with 
materials provided to the employee in connection 
with an open season or election process conducted 
under the plan, or concurrent with the furnishing 
of the summary plan description as provided in
H. R. 3963—69 
section 104(b) of the Employee Retirement Income 
Security Act of 1974. 
‘‘(ii) DISCLOSURE ABOUT GROUP HEALTH PLAN BENE-
FITS
TO
STATES
FOR
MEDICAID
AND
CHIP
ELIGIBLE 
INDIVIDUALS.—In the case of an enrollee in a group 
health plan who is covered under a Medicaid plan 
of a State under title XIX of the Social Security Act 
or under a State child health plan under title XXI 
of such Act, the plan administrator of the group health 
plan shall disclose to the State, upon request, informa-
tion about the benefits available under the group 
health plan in sufficient specificity, as determined 
under regulations of the Secretary of Health and 
Human Services in consultation with the Secretary 
that require use of the model coverage coordination 
disclosure form developed under section 311(b)(1)(C) 
of the Children’s Health Insurance Reauthorization Act 
of 2007, so as to permit the State to make a determina-
tion (under paragraph (2)(B), (3), or (10) of section 
2105(c) of the Social Security Act or otherwise) con-
cerning the cost-effectiveness of the State providing 
medical or child health assistance through premium 
assistance for the purchase of coverage under such 
group health plan and in order for the State to provide 
supplemental benefits required under paragraph 
(10)(E) of such section or other authority.’’. 
TITLE IV—STRENGTHENING QUALITY 
OF CARE AND HEALTH OUTCOMES 
SEC. 401. CHILD HEALTH QUALITY IMPROVEMENT ACTIVITIES FOR 
CHILDREN ENROLLED IN MEDICAID OR CHIP. 
(a) DEVELOPMENT OF CHILD HEALTH QUALITY MEASURES FOR 
CHILDREN ENROLLED IN MEDICAID OR CHIP.—Title XI (42 U.S.C. 
1301 et seq.) is amended by inserting after section 1139 the fol-
lowing new section: 
‘‘SEC. 1139A. CHILD HEALTH QUALITY MEASURES. 
‘‘(a) DEVELOPMENT OF AN INITIAL CORE SET OF HEALTH CARE 
QUALITY MEASURES
FOR CHILDREN ENROLLED
IN MEDICAID
OR 
CHIP.— 
‘‘(1) IN GENERAL.—Not later than January 1, 2009, the 
Secretary shall identify and publish for general comment an 
initial, recommended core set of child health quality measures 
for use by State programs administered under titles XIX and 
XXI, health insurance issuers and managed care entities that 
enter into contracts with such programs, and providers of items 
and services under such programs. 
‘‘(2) IDENTIFICATION OF INITIAL CORE MEASURES.—In con-
sultation with the individuals and entities described in sub-
section (b)(3), the Secretary shall identify existing quality of 
care measures for children that are in use under public and 
privately sponsored health care coverage arrangements, or that 
are part of reporting systems that measure both the presence 
and duration of health insurance coverage over time.
H. R. 3963—70 
‘‘(3) RECOMMENDATIONS
AND
DISSEMINATION.—Based on 
such existing and identified measures, the Secretary shall pub-
lish an initial core set of child health quality measures that 
includes (but is not limited to) the following: 
‘‘(A) The duration of children’s health insurance cov-
erage over a 12-month time period. 
‘‘(B) The availability and effectiveness of a full range 
of— 
‘‘(i) preventive services, treatments, and services 
for acute conditions, including services to promote 
healthy birth, prevent and treat premature birth, and 
detect the presence or risk of physical or mental condi-
tions that could adversely affect growth and develop-
ment; and 
‘‘(ii) treatments to correct or ameliorate the effects 
of physical and mental conditions, including chronic 
conditions, in infants, young children, school-age chil-
dren, and adolescents. 
‘‘(C) The availability of care in a range of ambulatory 
and inpatient health care settings in which such care is 
furnished. 
‘‘(D) The types of measures that, taken together, can 
be used to estimate the overall national quality of health 
care for children, including children with special needs, 
and to perform comparative analyses of pediatric health 
care quality and racial, ethnic, and socioeconomic dispari-
ties in child health and health care for children. 
‘‘(4) 
ENCOURAGE
VOLUNTARY
AND
STANDARDIZED 
REPORTING.—Not later than 2 years after the date of enactment 
of the Children’s Health Insurance Program Reauthorization 
Act of 2007, the Secretary, in consultation with States, shall 
develop a standardized format for reporting information and 
procedures and approaches that encourage States to use the 
initial core measurement set to voluntarily report information 
regarding the quality of pediatric health care under titles XIX 
and XXI. 
‘‘(5) ADOPTION
OF
BEST
PRACTICES
IN
IMPLEMENTING 
QUALITY PROGRAMS.—The Secretary shall disseminate informa-
tion to States regarding best practices among States with 
respect to measuring and reporting on the quality of health 
care for children, and shall facilitate the adoption of such 
best practices. In developing best practices approaches, the 
Secretary shall give particular attention to State measurement 
techniques that ensure the timeliness and accuracy of provider 
reporting, encourage provider reporting compliance, encourage 
successful quality improvement strategies, and improve effi-
ciency in data collection using health information technology. 
‘‘(6) REPORTS TO CONGRESS.—Not later than January 1, 
2010, and every 3 years thereafter, the Secretary shall report 
to Congress on— 
‘‘(A) the status of the Secretary’s efforts to improve— 
‘‘(i) quality related to the duration and stability 
of health insurance coverage for children under titles 
XIX and XXI; 
‘‘(ii) the quality of children’s health care under 
such titles, including preventive health services, health 
care for acute conditions, chronic health care, and
H. R. 3963—71 
health services to ameliorate the effects of physical 
and mental conditions and to aid in growth and 
development of infants, young children, school-age chil-
dren, and adolescents with special health care needs; 
and 
‘‘(iii) the quality of children’s health care under 
such titles across the domains of quality, including 
clinical quality, health care safety, family experience 
with health care, health care in the most integrated 
setting, and elimination of racial, ethnic, and socio-
economic disparities in health and health care; 
‘‘(B) the status of voluntary reporting by States under 
titles XIX and XXI, utilizing the initial core quality 
measurement set; and 
‘‘(C) any recommendations for legislative changes 
needed to improve the quality of care provided to children 
under titles XIX and XXI, including recommendations for 
quality reporting by States. 
‘‘(7) TECHNICAL ASSISTANCE.—The Secretary shall provide 
technical assistance to States to assist them in adopting and 
utilizing core child health quality measures in administering 
the State plans under titles XIX and XXI. 
‘‘(8) DEFINITION OF CORE SET.—In this section, the term 
‘core set’ means a group of valid, reliable, and evidence-based 
quality measures that, taken together— 
‘‘(A) provide information regarding the quality of health 
coverage and health care for children; 
‘‘(B) address the needs of children throughout the 
developmental age span; and 
‘‘(C) allow purchasers, families, and health care pro-
viders to understand the quality of care in relation to 
the preventive needs of children, treatments aimed at man-
aging and resolving acute conditions, and diagnostic and 
treatment services whose purpose is to correct or ameliorate 
physical, mental, or developmental conditions that could, 
if untreated or poorly treated, become chronic. 
‘‘(b) ADVANCING
AND IMPROVING PEDIATRIC QUALITY MEAS-
URES.— 
‘‘(1) ESTABLISHMENT OF PEDIATRIC QUALITY MEASURES PRO-
GRAM.—Not later than January 1, 2010, the Secretary shall 
establish a pediatric quality measures program to— 
‘‘(A) improve and strengthen the initial core child 
health care quality measures established by the Secretary 
under subsection (a); 
‘‘(B) expand on existing pediatric quality measures 
used by public and private health care purchasers and 
advance the development of such new and emerging quality 
measures; and 
‘‘(C) increase the portfolio of evidence-based, consensus 
pediatric quality measures available to public and private 
purchasers of children’s health care services, providers, 
and consumers. 
‘‘(2) EVIDENCE-BASED MEASURES.—The measures developed 
under the pediatric quality measures program shall, at a min-
imum, be— 
‘‘(A) evidence-based and, where appropriate, risk 
adjusted;