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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 em-
ployees beginning with the first plan year that 
begins after the date on which such initial 
model notices are first issued. The model cov-
erage coordination disclosure form developed 
under subparagraph (C) shall apply with re-
spect 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 sub-
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paragraph, each violation with respect to any single em-
ployee 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 information required to be disclosed under sec-
tion 701(f)(3)(B)(ii). For purposes 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, for coverage under such 
terms) to enroll for coverage under the terms of 
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the plan if either of the following conditions is 
met: 
‘‘(i) TERMINATION OF MEDICAID OR 
CHIP
COVERAGE.—The employee or de-
pendent 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 eligi-
bility 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 termi-
nation of such coverage. 
‘‘(ii) ELIGIBILITY FOR EMPLOYMENT 
ASSISTANCE UNDER MEDICAID OR CHIP.— 
The employee or dependent becomes eligi-
ble for assistance, with respect to coverage 
under the group health plan or health in-
surance coverage, 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 
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HR 2 PCS
under the group health plan or health in-
surance coverage not later than 60 days 
after the date the employee or dependent is 
determined to be eligible for such assist-
ance. 
‘‘(B) COORDINATION WITH MEDICAID AND 
CHIP.— 
‘‘(i) OUTREACH TO EMPLOYEES RE-
GARDING AVAILABILITY OF MEDICAID AND 
CHIP COVERAGE.— 
‘‘(I) IN
GENERAL.—Each em-
ployer that maintains a group health 
plan in a State that provides medical 
assistance under a State Medicaid 
plan under title XIX of the Social Se-
curity 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 potential opportunities then cur-
rently available in the State in which 
the employee resides for premium as-
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sistance under such plans for health 
coverage of the employee or the em-
ployee’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 CON-
CURRENT WITH PROVISION OF PLAN 
MATERIALS
TO
EMPLOYEE.—An em-
ployer may provide the model notice 
applicable to the State in which an 
employee resides concurrent 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 con-
ducted under the plan, or concurrent 
with the furnishing of the summary 
plan description as provided in section 
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104(b) of the Employee Retirement 
Income Security Act of 1974. 
‘‘(ii) 
DISCLOSURE
ABOUT
GROUP 
HEALTH PLAN BENEFITS TO STATES FOR 
MEDICAID
AND
CHIP
ELIGIBLE
INDIVID-
UALS.—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, information about the bene-
fits available under the group health plan 
in sufficient specificity, as determined 
under regulations of the Secretary of 
Health and Human Services in consulta-
tion 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 Reau-
thorization Act of 2009, so as to permit 
the State to make a determination (under 
paragraph (2)(B), (3), or (10) of section 
2105(c) of the Social Security Act or oth-
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erwise) concerning 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 ACTIVI-
TIES FOR CHILDREN ENROLLED IN MED-
ICAID 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 following new section: 
‘‘SEC. 1139A. CHILD HEALTH QUALITY MEASURES. 
‘‘(a) DEVELOPMENT OF AN INITIAL CORE SET OF 
HEALTH CARE QUALITY MEASURES FOR CHILDREN EN-
ROLLED IN MEDICAID OR CHIP.— 
‘‘(1) IN GENERAL.—Not later than January 1, 
2010, the Secretary shall identify and publish for 
general comment an initial, recommended core set of 
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child health quality measures for use by State pro-
grams 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 pro-
grams. 
‘‘(2) IDENTIFICATION OF INITIAL CORE MEAS-
URES.—In consultation with the individuals and en-
tities described in subsection (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 cov-
erage over time. 
‘‘(3) 
RECOMMENDATIONS
AND
DISSEMINA-
TION.—Based on such existing and identified meas-
ures, the Secretary shall publish 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 in-
surance coverage over a 12-month time period. 
‘‘(B) The availability and effectiveness of a 
full range of— 
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‘‘(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 con-
ditions that could adversely affect growth 
and development; and 
‘‘(ii) treatments to correct or amelio-
rate the effects of physical and mental con-
ditions, including chronic conditions, in in-
fants, young children, school-age children, 
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 to-
gether, can be used to estimate the overall na-
tional quality of health care for children, includ-
ing children with special needs, and to perform 
comparative analyses of pediatric health care 
quality and racial, ethnic, and socioeconomic 
disparities in child health and health care for 
children. 
‘‘(4) ENCOURAGE VOLUNTARY AND STANDARD-
IZED REPORTING.—Not later than 2 years after the 
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date of enactment of the Children’s Health Insur-
ance Program Reauthorization Act of 2009, the Sec-
retary, 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 IMPLE-
MENTING QUALITY PROGRAMS.—The Secretary shall 
disseminate information to States regarding best 
practices among States with respect to measuring 
and reporting on the quality of health care for chil-
dren, 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 pro-
vider 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, 2011, and every 3 years thereafter, the 
Secretary shall report to Congress on— 
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‘‘(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 sec-
tion, the term ‘core set’ means a group of valid, reli-
able, 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 providers to understand the quality of care 
in relation to the preventive needs of children, 
treatments aimed at managing and resolving 
acute conditions, and diagnostic and treatment 
services whose purpose is to correct or amelio-
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rate physical, mental, or developmental condi-
tions that could, if untreated or poorly treated, 
become chronic. 
‘‘(b) ADVANCING AND IMPROVING PEDIATRIC QUAL-
ITY MEASURES.— 
‘‘(1) ESTABLISHMENT OF PEDIATRIC QUALITY 
MEASURES PROGRAM.—Not later than January 1, 
2011, the Secretary shall establish a pediatric qual-
ity measures program to— 
‘‘(A) improve and strengthen the initial 
core child health care quality measures estab-
lished 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 meas-
ures developed under the pediatric quality measures 
program shall, at a minimum, be— 
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‘‘(A) evidence-based and, where appro-
priate, risk adjusted; 
‘‘(B) designed to identify and eliminate ra-
cial and ethnic disparities in child health and 
the provision of health care; 
‘‘(C) designed to ensure that the data re-
quired for such measures is collected and re-
ported in a standard format that permits com-
parison of quality and data at a State, plan, 
and provider level; 
‘‘(D) periodically updated; and 
‘‘(E) responsive to the child health needs, 
services, and domains of health care quality de-
scribed in clauses (i), (ii), and (iii) of subsection 
(a)(6)(A). 
‘‘(3) PROCESS FOR PEDIATRIC QUALITY MEAS-
URES PROGRAM.—In identifying gaps in existing pe-
diatric quality measures and establishing priorities 
for development and advancement of such measures, 
the Secretary shall consult with— 
‘‘(A) States; 
‘‘(B) pediatricians, children’s hospitals, 
and other primary and specialized pediatric 
health care professionals (including members of 
the allied health professions) who specialize in 
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the care and treatment of children, particularly 
children with special physical, mental, and de-
velopmental health care needs; 
‘‘(C) dental professionals, including pedi-
atric dental professionals; 
‘‘(D) health care providers that furnish 
primary health care to children and families 
who live in urban and rural medically under-
served communities or who are members of dis-
tinct population sub-groups at heightened risk 
for poor health outcomes; 
‘‘(E) national organizations representing 
children, including children with disabilities and 
children with chronic conditions; 
‘‘(F) national organizations representing 
consumers and purchasers of children’s health 
care; 
‘‘(G) national organizations and individuals 
with expertise in pediatric health quality meas-
urement; and 
‘‘(H) voluntary consensus standards set-
ting organizations and other organizations in-
volved in the advancement of evidence-based 
measures of health care. 
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‘‘(4) DEVELOPING, VALIDATING, AND TESTING 
A PORTFOLIO OF PEDIATRIC QUALITY MEASURES.— 
As part of the program to advance pediatric quality 
measures, the Secretary shall— 
‘‘(A) award grants and contracts for the 
development, testing, and validation of new, 
emerging, and innovative evidence-based meas-
ures for children’s health care services across 
the domains of quality described in clauses (i), 
(ii), and (iii) of subsection (a)(6)(A); and 
‘‘(B) award grants and contracts for— 
‘‘(i) the development of consensus on 
evidence-based measures for children’s 
health care services; 
‘‘(ii) the dissemination of such meas-
ures to public and private purchasers of 
health care for children; and 
‘‘(iii) the updating of such measures 
as necessary. 
‘‘(5) REVISING, STRENGTHENING, AND IMPROV-
ING INITIAL CORE MEASURES.—Beginning no later 
than January 1, 2013, and annually thereafter, the 
Secretary shall publish recommended changes to the 
core measures described in subsection (a) that shall 
reflect the testing, validation, and consensus process 
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for the development of pediatric quality measures 
described in subsection paragraphs (1) through (4). 
‘‘(6) DEFINITION
OF
PEDIATRIC
QUALITY 
MEASURE.—In this subsection, the term ‘pediatric 
quality measure’ means a measurement of clinical 
care that is capable of being examined through the 
collection and analysis of relevant information, that 
is developed in order to assess 1 or more aspects of 
pediatric health care quality in various institutional 
and ambulatory health care settings, including the 
structure of the clinical care system, the process of 
care, the outcome of care, or patient experiences in 
care. 
‘‘(7) CONSTRUCTION.—Nothing in this section 
shall be construed as supporting the restriction of 
coverage, under title XIX or XXI or otherwise, to 
only those services that are evidence-based. 
‘‘(c) ANNUAL STATE REPORTS REGARDING STATE- 
SPECIFIC QUALITY OF CARE MEASURES APPLIED UNDER 
MEDICAID OR CHIP.— 
‘‘(1) ANNUAL
STATE
REPORTS.—Each State 
with a State plan approved under title XIX or a 
State child health plan approved under title XXI 
shall annually report to the Secretary on the— 
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‘‘(A) State-specific child health quality 
measures applied by the States under such 
plans, including measures described in subpara-
graphs (A) and (B) of subsection (a)(6); and 
‘‘(B) State-specific information on the 
quality of health care furnished to children 
under such plans, including information col-
lected through external quality reviews of man-
aged care organizations under section 1932 of 
the Social Security Act (42 U.S.C. 1396u–4) 
and benchmark plans under sections 1937 and 
2103 of such Act (42 U.S.C. 1396u–7, 1397cc). 
‘‘(2) PUBLICATION.—Not later than September 
30, 2010, and annually thereafter, the Secretary 
shall collect, analyze, and make publicly available the 
information reported by States under paragraph (1). 
‘‘(d) DEMONSTRATION PROJECTS
FOR IMPROVING 
THE QUALITY OF CHILDREN’S HEALTH CARE AND THE 
USE OF HEALTH INFORMATION TECHNOLOGY.— 
‘‘(1) IN GENERAL.—During the period of fiscal 
years 2009 through 2013, the Secretary shall award 
not more than 10 grants to States and child health 
providers to conduct demonstration projects to 
evaluate promising ideas for improving the quality of 
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children’s health care provided under title XIX or 
XXI, including projects to— 
‘‘(A) experiment with, and evaluate the use 
of, new measures of the quality of children’s 
health care under such titles (including testing 
the validity and suitability for reporting of such 
measures); 
‘‘(B) promote the use of health information 
technology in care delivery for children under 
such titles; 
‘‘(C) evaluate provider-based models which 
improve the delivery of children’s health care 
services under such titles, including care man-
agement for children with chronic conditions 
and the use of evidence-based approaches to im-
prove the effectiveness, safety, and efficiency of 
health care services for children; or 
‘‘(D) demonstrate the impact of the model 
electronic health record format for children de-
veloped and disseminated under subsection (f) 
on improving pediatric health, including the ef-
fects of chronic childhood health conditions, and 
pediatric health care quality as well as reducing 
health care costs. 
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‘‘(2) REQUIREMENTS.—In awarding grants 
under this subsection, the Secretary shall ensure 
that— 
‘‘(A) only 1 demonstration project funded 
under a grant awarded under this subsection 
shall be conducted in a State; and 
‘‘(B) demonstration projects funded under 
grants awarded under this subsection shall be 
conducted evenly between States with large 
urban areas and States with large rural areas. 
‘‘(3) 
AUTHORITY
FOR
MULTISTATE 
PROJECTS.—A demonstration project conducted with 
a grant awarded under this subsection may be con-
ducted on a multistate basis, as needed. 
‘‘(4) FUNDING.—$20,000,000 of the amount 
appropriated under subsection (i) for a fiscal year 
shall be used to carry out this subsection. 
‘‘(e) 
CHILDHOOD
OBESITY
DEMONSTRATION 
PROJECT.— 
‘‘(1) AUTHORITY
TO
CONDUCT
DEMONSTRA-
TION.—The Secretary, in consultation with the Ad-
ministrator of the Centers for Medicare & Medicaid 
Services, shall conduct a demonstration project to 
develop a comprehensive and systematic model for 
reducing childhood obesity by awarding grants to eli-
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gible entities to carry out such project. Such model 
shall— 
‘‘(A) identify, through self-assessment, be-
havioral risk factors for obesity among children; 
‘‘(B) identify, through self-assessment, 
needed clinical preventive and screening benefits 
among those children identified as target indi-
viduals on the basis of such risk factors; 
‘‘(C) provide ongoing support to such tar-
get individuals and their families to reduce risk 
factors and promote the appropriate use of pre-
ventive and screening benefits; and 
‘‘(D) be designed to improve health out-
comes, satisfaction, quality of life, and appro-
priate use of items and services for which med-
ical assistance is available under title XIX or 
child health assistance is available under title 
XXI among such target individuals. 
‘‘(2) ELIGIBILITY ENTITIES.—For purposes of 
this subsection, an eligible entity is any of the fol-
lowing: 
‘‘(A) A city, county, or Indian tribe. 
‘‘(B) A local or tribal educational agency. 
‘‘(C) An accredited university, college, or 
community college. 
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‘‘(D) A Federally-qualified health center. 
‘‘(E) A local health department. 
‘‘(F) A health care provider. 
‘‘(G) A community-based organization. 
‘‘(H) Any other entity determined appro-
priate by the Secretary, including a consortia or 
partnership of entities described in any of sub-
paragraphs (A) through (G). 
‘‘(3) USE OF FUNDS.—An eligible entity award-
ed a grant under this subsection shall use the funds 
made available under the grant to— 
‘‘(A) carry out community-based activities 
related to reducing childhood obesity, including 
by— 
‘‘(i) forming partnerships with enti-
ties, including schools and other facilities 
providing recreational services, to establish 
programs for after school and weekend 
community activities that are designed to 
reduce childhood obesity; 
‘‘(ii) 
forming 
partnerships 
with 
daycare facilities to establish programs 
that promote healthy eating behaviors and 
physical activity; and 
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‘‘(iii) developing and evaluating com-
munity educational activities targeting 
good nutrition and promoting healthy eat-
ing behaviors; 
‘‘(B) carry out age-appropriate school- 
based activities that are designed to reduce 
childhood obesity, including by— 
‘‘(i) developing and testing edu-
cational curricula and intervention pro-
grams designed to promote healthy eating 
behaviors and habits in youth, which may 
include— 
‘‘(I) after hours physical activity 
programs; and 
‘‘(II) science-based interventions 
with multiple components to prevent 
eating disorders including nutritional 
content, understanding and respond-
ing to hunger and satiety, positive 
body image development, positive self- 
esteem development, and learning life 
skills (such as stress management, 
communication skills, problemsolving 
and decisionmaking skills), as well as 
consideration of cultural and develop-
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‘‘(iii) educate and guide parents re-
garding the ability to model and commu-
nicate positive health behaviors. 
‘‘(4) PRIORITY.—In awarding grants under 
paragraph (1), the Secretary shall give priority to 
awarding grants to eligible entities— 
‘‘(A) that demonstrate that they have pre-
viously applied successfully for funds to carry 
out activities that seek to promote individual 
and community health and to prevent the inci-
dence of chronic disease and that can cite pub-
lished 
and 
peer-reviewed 
research 
dem-
onstrating that the activities that the entities 
propose to carry out with funds made available 
under the grant are effective; 
‘‘(B) that will carry out programs or ac-
tivities that seek to accomplish a goal or goals 
set by the State in the Healthy People 2010 
plan of the State; 
‘‘(C) that provide non-Federal contribu-
tions, either in cash or in-kind, to the costs of 
funding activities under the grants; 
‘‘(D) that develop comprehensive plans 
that include a strategy for extending program 
activities developed under grants in the years 
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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 
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‘‘(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 
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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-
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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 
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‘‘(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— 
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‘‘(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 
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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 
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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, 
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$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’’. 
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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. 
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‘‘(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, 
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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-
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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 
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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. 
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(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 
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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.— 
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‘‘(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 
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plan that is offered and generally available 
to State employees in the State involved 
and 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. 
‘‘(iii) COVERAGE OFFERED THROUGH 
COMMERCIAL
DENTAL
PLAN.—A dental 
benefits plan that has the largest insured 
commercial, non-medicaid enrollment of 
dependent covered lives of such plans that 
is offered in the State involved.’’. 
(2) ASSURING
ACCESS
TO
CARE.—Section 
2102(a)(7)(B) (42 U.S.C. 1397bb(c)(2)) is amended 
by inserting ‘‘and services described in section 
2103(c)(5)’’ after ‘‘emergency services’’. 
(3) EFFECTIVE DATE.—The amendments made 
by paragraph (1) shall apply to coverage of items 
and services furnished on or after October 1, 2009. 
(b) 
DENTAL
EDUCATION
FOR
PARENTS
OF 
NEWBORNS.—The Secretary shall develop and implement, 
through entities that fund or provide perinatal care serv-
ices to targeted low-income children under a State child 
health plan under title XXI of the Social Security Act, 
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a program to deliver oral health educational materials that 
inform new parents about risks for, and prevention of, 
early childhood caries and the need for a dental visit with-
in their newborn’s first year of life. 
(c) PROVISION
OF DENTAL SERVICES THROUGH 
FQHCS.— 
(1) MEDICAID.—Section 1902(a) (42 U.S.C. 
1396a(a)) is amended— 
(A) by striking ‘‘and’’ at the end of para-
graph (70); 
(B) by striking the period at the end of 
paragraph (71) and inserting ‘‘; and’’; and 
(C) by inserting after paragraph (71) the 
following new paragraph: 
‘‘(72) provide that the State will not prevent a 
Federally-qualified health center from entering into 
contractual relationships with private practice dental 
providers in the provision of Federally-qualified 
health center services.’’. 
(2) CHIP.—Section 2107(e)(1) (42 U.S.C. 
1397g(e)(1)), as amended by subsections (a)(2) and 
(d)(2) of section 203, is amended by inserting after 
subparagraph (B) the following new subparagraph 
(and redesignating the succeeding subparagraphs ac-
cordingly): 
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‘‘(C) Section 1902(a)(72) (relating to lim-
iting FQHC contracting for provision of dental 
services).’’. 
(3) EFFECTIVE DATE.—The amendments made 
by this subsection shall take effect on January 1, 
2009. 
(d) 
REPORTING
INFORMATION
ON
DENTAL 
HEALTH.— 
(1) 
MEDICAID.—Section 
1902(a)(43)(D)(iii) 
(42 U.S.C. 1396a(a)(43)(D)(iii)) is amended by in-
serting ‘‘and other information relating to the provi-
sion of dental services to such children described in 
section 2108(e)’’ after ‘‘receiving dental services,’’. 
(2) CHIP.—Section 2108 (42 U.S.C. 1397hh) 
is amended by adding at the end the following new 
subsection: 
‘‘(e) INFORMATION ON DENTAL CARE FOR CHIL-
DREN.— 
‘‘(1) IN GENERAL.—Each annual report under 
subsection (a) shall include the following information 
with respect to care and services described in section 
1905(r)(3) provided to targeted low-income children 
enrolled in the State child health plan under this 
title at any time during the year involved: 
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‘‘(A) The number of enrolled children by 
age grouping used for reporting purposes under 
section 1902(a)(43). 
‘‘(B) For children within each such age 
grouping, information of the type contained in 
questions 12(a)–(c) of CMS Form 416 (that 
consists of the number of enrolled targeted low 
income children who receive any, preventive, or 
restorative dental care under the State plan). 
‘‘(C) For the age grouping that includes 
children 8 years of age, the number of such 
children who have received a protective sealant 
on at least one permanent molar tooth. 
‘‘(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. 
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HR 2 PCS
(e) IMPROVED ACCESSIBILITY OF DENTAL PROVIDER 
INFORMATION TO ENROLLEES UNDER MEDICAID AND 
CHIP.—The Secretary shall— 
(1) work with States, pediatric dentists, and 
other dental providers (including providers that are, 
or are affiliated with, a school of dentistry) to in-
clude, not later than 6 months after the date of the 
enactment of this Act, on the Insure Kids Now 
website (http://www.insurekidsnow.gov/) and hotline 
(1–877–KIDS–NOW) (or on any successor websites 
or hotlines) a current and accurate list of all such 
dentists and providers within each State that provide 
dental services to children enrolled in the State plan 
(or waiver) under Medicaid or the State child health 
plan (or waiver) under CHIP, and shall ensure that 
such list is updated at least quarterly; and 
(2) work with States to include, not later than 
6 months after the date of the enactment of this 
Act, a description of the dental services provided 
under each State plan (or waiver) under Medicaid 
and each State child health plan (or waiver) under 
CHIP on such Insure Kids Now website, and shall 
ensure that such list is updated at least annually. 
(f) INCLUSION OF STATUS OF EFFORTS TO IMPROVE 
DENTAL CARE IN REPORTS ON THE QUALITY OF CHIL-
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DREN’S HEALTH CARE UNDER MEDICAID AND CHIP.— 
Section 1139A(a), as added by section 401(a), is amend-
ed— 
(1) in paragraph (3)(B)(ii), by inserting ‘‘and, 
with respect to dental care, conditions requiring the 
restoration of teeth, relief of pain and infection, and 
maintenance of dental health’’ after ‘‘chronic condi-
tions’’; and 
(2) in paragraph (6)(A)(ii), by inserting ‘‘dental 
care,’’ after ‘‘preventive health services,’’. 
(g) 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; 
(B) children’s access to oral health care, 
including preventive and restorative services, 
under Medicaid and CHIP, including— 
(i) the extent to which dental pro-
viders are willing to treat children eligible 
for such programs; 
(ii) information on such children’s ac-
cess to networks of care, including such 
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HR 2 PCS
networks that serve special needs children; 
and 
(iii) geographic availability of oral 
health care, including preventive and re-
storative services, under such programs; 
and 
(C) 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 18 months year 
after the date of the enactment of this Act, the 
Comptroller General shall submit to Congress a re-
port on the study conducted under paragraph (1). 
The report shall include recommendations for such 
Federal and State legislative and administrative 
changes as the Comptroller General determines are 
necessary to address any barriers to access to oral 
health care, including preventive and restorative 
services, under Medicaid and CHIP that may exist. 
SEC. 502. MENTAL HEALTH PARITY IN CHIP PLANS. 
(a) ASSURANCE OF PARITY.—Section 2103(c) (42 
U.S.C. 1397cc(c)), as amended by section 501(a)(1)(B), 
is amended by inserting after paragraph (5), the following: 
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‘‘(6) MENTAL HEALTH SERVICES PARITY.— 
‘‘(A) IN GENERAL.—In the case of a State 
child health plan that provides both medical 
and surgical benefits and mental health or sub-
stance use disorder benefits, such plan shall en-
sure that the financial requirements and treat-
ment limitations applicable to such mental 
health or substance use disorder benefits com-
ply with the requirements of section 2705(a) of 
the Public Health Service Act in the same man-
ner as such requirements apply to a group 
health plan. 
‘‘(B) DEEMED COMPLIANCE.—To the ex-
tent that a State child health plan includes cov-
erage with respect to an individual described in 
section 1905(a)(4)(B) and covered under the 
State plan under section 1902(a)(10)(A) of the 
services described in section 1905(a)(4)(B) (re-
lating to early and periodic screening, diag-
nostic, and treatment services defined in section 
1905(r)) and provided in accordance with sec-
tion 1902(a)(43), such plan shall be deemed to 
satisfy the requirements of subparagraph (A).’’. 
(b) CONFORMING AMENDMENTS.—Section 2103 (42 
U.S.C. 1397cc) is amended— 
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(1) in subsection (a), as amended by section 
501(a)(1)(A)(i), in the matter preceding paragraph 
(1), by inserting ‘‘, (6),’’ after ‘‘(5)’’; and 
(2) in subsection (c)(2), by striking subpara-
graph (B) and redesignating subparagraphs (C) and 
(D) as subparagraphs (B) and (C), respectively. 
SEC. 503. APPLICATION OF PROSPECTIVE PAYMENT SYS-
TEM FOR SERVICES PROVIDED BY FEDER-
ALLY-QUALIFIED 
HEALTH 
CENTERS 
AND 
RURAL HEALTH CLINICS. 
(a) APPLICATION OF PROSPECTIVE PAYMENT SYS-
TEM.— 
(1) IN
GENERAL.—Section 2107(e)(1) (42 
U.S.C. 1397gg(e)(1)), as amended by section 
501(c)(2) is amended by inserting after subpara-
graph (C) the following new subparagraph (and re-
designating the succeeding subparagraphs accord-
ingly): 
‘‘(D) Section 1902(bb) (relating to pay-
ment for services provided by Federally-quali-
fied health centers and rural health clinics).’’. 
(2) EFFECTIVE DATE.—The amendment made 
by paragraph (1) shall apply to services provided on 
or after October 1, 2009. 
(b) TRANSITION GRANTS.— 
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(1) APPROPRIATION.—Out of any funds in the 
Treasury not otherwise appropriated, there is appro-
priated to the Secretary for fiscal year 2009, 
$5,000,000, to remain available until expended, for 
the purpose of awarding grants to States with State 
child health plans under CHIP that are operated 
separately from the State Medicaid plan under title 
XIX of the Social Security Act (including any waiver 
of such plan), or in combination with the State Med-
icaid plan, for expenditures related to transitioning 
to compliance with the requirement of section 
2107(e)(1)(D) of the Social Security Act (as added 
by subsection (a)) to apply the prospective payment 
system established under section 1902(bb) of the 
such Act (42 U.S.C. 1396a(bb)) to services provided 
by Federally-qualified health centers and rural 
health clinics. 
(2) MONITORING AND REPORT.—The Secretary 
shall monitor the impact of the application of such 
prospective payment system on the States described 
in paragraph (1) and, not later than October 1, 
2011, shall report to Congress on any effect on ac-
cess to benefits, provider payment rates, or scope of 
benefits offered by such States as a result of the ap-
plication of such payment system. 
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HR 2 PCS
(4) the term ‘‘Service Corps of Retired Execu-
tives’’ means the Service Corps of Retired Execu-
tives authorized by section 8(b)(1) of the Small 
Business Act (15 U.S.C. 637(b)(1)); 
(5) the term ‘‘small business concern’’ has the 
meaning given that term in section 3 of the Small 
Business Act (15 U.S.C. 632); 
(6) the term ‘‘small business development cen-
ter’’ means a small business development center de-
scribed in section 21 of the Small Business Act (15 
U.S.C. 648); 
(7) the term ‘‘State’’ has the meaning given 
that term for purposes of title XXI of the Social Se-
curity Act (42 U.S.C. 1397aa et seq.); 
(8) the term ‘‘State Children’s Health Insur-
ance Program’’ means the State Children’s Health 
Insurance Program established under title XXI of 
the Social Security Act (42 U.S.C. 1397aa et seq.); 
(9) the term ‘‘task force’’ means the task force 
established under subsection (b)(1); and 
(10) the term ‘‘women’s business center’’ means 
a women’s business center described in section 29 of 
the Small Business Act (15 U.S.C. 656). 
(b) ESTABLISHMENT OF TASK FORCE.— 
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ating rooms, procedure rooms, and beds of 
the applicable hospital. 
‘‘(iii) BASELINE
NUMBER
OF
OPER-
ATING
ROOMS, PROCEDURE
ROOMS, AND 
BEDS.—In this paragraph, the term ‘base-
line number of operating rooms, procedure 
rooms, and beds’ means the number of op-
erating rooms, procedure rooms, and beds 
of the applicable hospital as of the date of 
enactment of this subsection. 
‘‘(D) INCREASE
LIMITED
TO
FACILITIES 
ON THE MAIN CAMPUS OF THE HOSPITAL.— 
Any increase in the number of operating rooms, 
procedure rooms, and beds of an applicable hos-
pital pursuant to this paragraph may only occur 
in facilities on the main campus of the applica-
ble hospital. 
‘‘(E) APPLICABLE
HOSPITAL.—In this 
paragraph, the term ‘applicable hospital’ means 
a hospital— 
‘‘(i) that is located in a county in 
which the percentage increase in the popu-
lation during the most recent 5-year period 
(as of the date of the application under 
subparagraph (A)) is at least 150 percent 
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of the percentage increase in the popu-
lation growth of the State in which the 
hospital is located during that period, as 
estimated by Bureau of the Census and 
available to the Secretary; 
‘‘(ii) whose annual percent of total in-
patient admissions that represent inpatient 
admissions under the program under title 
XIX is equal to or greater than the aver-
age percent with respect to such admis-
sions for all hospitals located in the county 
in which the hospital is located; 
‘‘(iii) that does not discriminate 
against beneficiaries of Federal health care 
programs and does not permit physicians 
practicing at the hospital to discriminate 
against such beneficiaries; 
‘‘(iv) that is located in a State in 
which the average bed capacity in the 
State is less than the national average bed 
capacity; and 
‘‘(v) that has an average bed occu-
pancy rate that is greater than the average 
bed occupancy rate in the State in which 
the hospital is located. 
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Calendar No. 18 
111TH CONGRESS 
1ST SESSION 
H. R. 2 
AN ACT 
To amend title XXI of the Social Security Act to 
extend and improve the Children’s Health Insur-
ance Program, and for other purposes. 
JANUARY 16, 2009 
Read twice and placed on the calendar 
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