H. R. 2—69 
‘‘(A) State-specific child health quality measures 
applied by the States under such plans, including measures 
described in subparagraphs (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 collected through external quality reviews of 
managed 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 INFORMA-
TION 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 dem-
onstration projects to evaluate promising ideas for improving 
the quality of 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 management for children with chronic condi-
tions and the use of evidence-based approaches to improve 
the effectiveness, safety, and efficiency of health care serv-
ices for children; or 
‘‘(D) demonstrate the impact of the model electronic 
health record format for children developed and dissemi-
nated under subsection (f) on improving pediatric health, 
including the effects of chronic childhood health conditions, 
and pediatric health care quality as well as reducing health 
care costs. 
‘‘(2) REQUIREMENTS.—In awarding grants under this sub-
section, 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 demonstra-
tion project conducted with a grant awarded under this sub-
section may be conducted 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.
H. R. 2—70 
‘‘(e) CHILDHOOD OBESITY DEMONSTRATION PROJECT.— 
‘‘(1) AUTHORITY TO CONDUCT DEMONSTRATION.—The Sec-
retary, in consultation with the Administrator of the Centers 
for Medicare & Medicaid Services, shall conduct a demonstra-
tion project to develop a comprehensive and systematic model 
for reducing childhood obesity by awarding grants to eligible 
entities to carry out such project. Such model shall— 
‘‘(A) identify, through self-assessment, behavioral risk 
factors for obesity among children; 
‘‘(B) identify, through self-assessment, needed clinical 
preventive and screening benefits among those children 
identified as target individuals on the basis of such risk 
factors; 
‘‘(C) provide ongoing support to such target individuals 
and their families to reduce risk factors and promote the 
appropriate use of preventive and screening benefits; and 
‘‘(D) be designed to improve health outcomes, satisfac-
tion, quality of life, and appropriate use of items and serv-
ices for which medical 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 following: 
‘‘(A) A city, county, or Indian tribe. 
‘‘(B) A local or tribal educational agency. 
‘‘(C) An accredited university, college, or community 
college. 
‘‘(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 appropriate by the 
Secretary, including a consortia or partnership of entities 
described in any of subparagraphs (A) through (G). 
‘‘(3) USE OF FUNDS.—An eligible entity awarded 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 entities, including 
schools and other facilities providing recreational serv-
ices, to establish programs for after school and weekend 
community activities that are designed to reduce child-
hood obesity; 
‘‘(ii) forming partnerships with daycare facilities 
to establish programs that promote healthy eating 
behaviors and physical activity; and 
‘‘(iii) developing and evaluating community edu-
cational activities targeting good nutrition and pro-
moting healthy eating behaviors; 
‘‘(B) carry out age-appropriate school-based activities 
that are designed to reduce childhood obesity, including 
by— 
‘‘(i) developing and testing educational curricula 
and intervention programs designed to promote healthy 
eating behaviors and habits in youth, which may 
include—
H. R. 2—71 
‘‘(I) after hours physical activity programs; and 
‘‘(II) science-based interventions with multiple 
components to prevent eating disorders including 
nutritional content, understanding and responding 
to hunger and satiety, positive body image develop-
ment, 
positive 
self-esteem 
development, 
and 
learning life skills (such as stress management, 
communication skills, problemsolving and decision-
making skills), as well as consideration of cultural 
and developmental issues, and the role of family, 
school, and community; 
‘‘(ii) providing education and training to edu-
cational professionals regarding how to promote a 
healthy lifestyle and a healthy school environment for 
children; 
‘‘(iii) planning and implementing a healthy lifestyle 
curriculum or program with an emphasis on healthy 
eating behaviors and physical activity; and 
‘‘(iv) planning and implementing healthy lifestyle 
classes or programs for parents or guardians, with 
an emphasis on healthy eating behaviors and physical 
activity for children; 
‘‘(C) carry out educational, counseling, promotional, 
and training activities through the local health care 
delivery systems including by— 
‘‘(i) promoting healthy eating behaviors and phys-
ical activity services to treat or prevent eating dis-
orders, being overweight, and obesity; 
‘‘(ii) providing patient education and counseling 
to increase physical activity and promote healthy 
eating behaviors; 
‘‘(iii) training health professionals on how to iden-
tify and treat obese and overweight individuals which 
may include nutrition and physical activity counseling; 
and 
‘‘(iv) providing community education by a health 
professional on good nutrition and physical activity 
to develop a better understanding of the relationship 
between diet, physical activity, and eating disorders, 
obesity, or being overweight; and 
‘‘(D) provide, through qualified health professionals, 
training and supervision for community health workers 
to— 
‘‘(i) educate families regarding the relationship 
between nutrition, eating habits, physical activity, and 
obesity; 
‘‘(ii) educate families about effective strategies to 
improve nutrition, establish healthy eating patterns, 
and establish appropriate levels of physical activity; 
and 
‘‘(iii) educate and guide parents regarding the 
ability to model and communicate positive health 
behaviors. 
‘‘(4) PRIORITY.—In awarding grants under paragraph (1), 
the Secretary shall give priority to awarding grants to eligible 
entities—
H. R. 2—72 
‘‘(A) that demonstrate that they have previously 
applied successfully for funds to carry out activities that 
seek to promote individual and community health and to 
prevent the incidence of chronic disease and that can cite 
published and peer-reviewed research demonstrating 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 activities 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 contributions, 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 following the fiscal years for which 
they receive grants under this subsection; 
‘‘(E) located in communities that are medically under-
served, as determined by the Secretary; 
‘‘(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 multisectoral, 
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 commu-
nity colleges; 
‘‘(vii) health care providers; 
‘‘(viii) State and local departments of transpor-
tation and city planning; and 
‘‘(ix) other entities determined appropriate by the 
Secretary. 
‘‘(5) PROGRAM DESIGN.— 
‘‘(A) INITIAL DESIGN.—Not later than 1 year after the 
date of enactment of the Children’s Health Insurance Pro-
gram Reauthorization Act of 2009, the Secretary shall 
design the demonstration project. The demonstration 
should draw upon promising, innovative models and incen-
tives to reduce behavioral risk factors. The Administrator 
of the Centers for Medicare & Medicaid Services shall 
consult with the Director of the Centers for Disease Control 
and Prevention, the Director of the Office of Minority 
Health, the heads of other agencies in the Department 
of Health and Human Services, and such professional 
organizations, as the Secretary determines to be appro-
priate, on the design, conduct, and evaluation of the dem-
onstration. 
‘‘(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 Sec-
retary shall award 1 grant that is specifically designed
H. R. 2—73 
to determine whether programs similar to programs to 
be conducted by other grantees under this subsection 
should be implemented with respect to the general popu-
lation of children who are eligible for child health assist-
ance under State child health plans under title XXI in 
order to reduce the incidence of childhood obesity 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 describes the project, evaluates the effectiveness 
and cost effectiveness of the project, evaluates the beneficiary 
satisfaction under the project, and includes any such other 
information as the Secretary determines 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 section 1905(l)(2)(B). 
‘‘(B) INDIAN TRIBE.—The term ‘Indian tribe’ has the 
meaning given that term in section 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’ 
preferences 
for 
receiving follow-up information; 
‘‘(ii) is assessed using such computer generated 
assessment programs; and 
‘‘(iii) allows for the provision of such ongoing sup-
port to the individual as the Secretary determines 
appropriate. 
‘‘(D) ONGOING SUPPORT.—The term ‘ongoing support’ 
means— 
‘‘(i) to provide any target individual with informa-
tion, feedback, health coaching, and recommendations 
regarding— 
‘‘(I) the results of a self-assessment given to 
the individual; 
‘‘(II) behavior modification based on the self- 
assessment; and 
‘‘(III) any need for clinical preventive 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 individual in reducing health risks; 
and 
‘‘(iii) to provide the information described in clause 
(i) to a health care provider, if designated by the target 
individual to receive such information. 
‘‘(8) AUTHORIZATION OF APPROPRIATIONS.—There is author-
ized to be appropriated to carry out this subsection, $25,000,000 
for the period of fiscal years 2009 through 2013.
H. R. 2—74 
‘‘(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 encourage the develop-
ment 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— 
‘‘(A) subject to State laws, accessible to parents, care-
givers, and other consumers for the sole purpose of dem-
onstrating compliance with school or leisure activity 
requirements, such as appropriate immunizations or 
physicals; 
‘‘(B) designed to allow interoperable exchanges 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 receive is clinically appropriate and 
of high quality; 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 appropriated 
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 report to Congress on the extent 
and quality of efforts to measure child health status and the 
quality of health care for children across the age span and 
in relation to preventive care, treatments for acute conditions, 
and treatments aimed at ameliorating or correcting physical, 
mental, and developmental conditions 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 require-
ments under Federal grant programs and national popu-
lation surveys and estimates conducted directly 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 cov-
ered by each system, and the extent to which the informa-
tion so generated is made widely available through publica-
tion; 
‘‘(C) identify gaps in knowledge related to children’s 
health status, health disparities among subgroups of chil-
dren, the effects of social conditions on children’s health 
status and use and effectiveness of health care, and the 
relationship between child health status and family income, 
family stability and preservation, and children’s school 
readiness and educational achievement and attainment; 
and
H. R. 2—75 
‘‘(D) make recommendations regarding improving and 
strengthening the timeliness, quality, and public trans-
parency and accessibility of information about child health 
and health care quality. 
‘‘(2) FUNDING.—Up to $1,000,000 of the amount appro-
priated under subsection (i) for a fiscal year shall be used 
to carry out this subsection. 
‘‘(h) RULE
OF
CONSTRUCTION.—Notwithstanding any other 
provision in this section, no evidence based quality measure devel-
oped, 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 appropriated for each of fiscal 
years 2009 through 2013, $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.—Section 1903(a)(3)(A) 
(42 U.S.C. 1396b(a)(3)(A)), is amended— 
(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 medical assistance 
percentage (as defined in section 1905(b)) of so much of 
the sums expended during such quarter (as found necessary 
by the Secretary for the proper and efficient administration 
of the State plan) as are attributable to such developments 
or modifications of systems of the type described in clause 
(i) as are necessary for the efficient collection and reporting 
on child health measures; and’’. 
SEC. 
402. 
IMPROVED 
AVAILABILITY 
OF 
PUBLIC 
INFORMATION 
REGARDING ENROLLMENT OF CHILDREN 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 inserting ‘‘Subject to subsection 
(e), the State’’; and 
(2) by adding at the end the following new subsection: 
‘‘(e) INFORMATION REQUIRED FOR INCLUSION IN STATE ANNUAL 
REPORT.—The State shall include the following information in the 
annual report required under subsection (a): 
‘‘(1) Eligibility criteria, enrollment, and retention data 
(including data with respect to continuity of coverage or dura-
tion of benefits). 
‘‘(2) Data regarding the extent to which the State uses 
process measures with respect to determining the eligibility 
of children under the State child health plan, including meas-
ures such as 12-month continuous eligibility, self-declaration 
of income for applications or renewals, or presumptive eligi-
bility. 
‘‘(3) Data regarding denials of eligibility and redetermina-
tions of eligibility.
H. R. 2—76 
‘‘(4) Data regarding access to primary and specialty serv-
ices, access to networks of care, and care coordination provided 
under the State child health plan, using quality care and con-
sumer satisfaction measures included in the Consumer Assess-
ment of Healthcare Providers and Systems (CAHPS) survey. 
‘‘(5) If the State provides child health assistance in the 
form of premium assistance for the purchase of coverage under 
a group health plan, data regarding the provision of such assist-
ance, including the extent to which employer-sponsored health 
insurance coverage is available for children eligible for child 
health assistance under the State child health plan, the range 
of the monthly amount of such assistance provided on behalf 
of a child or family, the number of children or families provided 
such assistance 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 purchased with such premium 
assistance, the effective strategies the State engages in to 
reduce any administrative barriers to the provision of such 
assistance, and, the effects, if any, of the provision of such 
assistance on preventing the coverage provided under the State 
child health plan from substituting for coverage provided under 
employer-sponsored health insurance 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 insur-
ance connector program or support for innovative private health 
coverage initiatives.’’. 
(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 standard-
ized format for States to use for reporting the information 
required under section 2108(e) of the Social Security Act, as 
added by subsection (a)(2). 
(2) TRANSITION PERIOD FOR STATES.—Each State that is 
required to submit a report under subsection (a) of section 
2108 of the Social Security Act that includes the information 
required under subsection (e) of such section may use up to 
3 reporting periods to transition to the reporting of such 
information in accordance with the standardized format speci-
fied by the Secretary under paragraph (1). 
(c) ADDITIONAL FUNDING FOR THE SECRETARY TO IMPROVE TIME-
LINESS OF DATA REPORTING AND ANALYSIS FOR PURPOSES OF DETER-
MINING ENROLLMENT INCREASES UNDER MEDICAID
AND CHIP.— 
(1) APPROPRIATION.—There is appropriated, out of any 
money in the Treasury not otherwise appropriated, $5,000,000 
to the Secretary for fiscal year 2009 for the purpose of 
improving the timeliness of the data reported and analyzed 
from the Medicaid Statistical Information System (MSIS) for 
purposes of providing more timely data on enrollment and 
eligibility of children under Medicaid and CHIP and to provide 
guidance to States with respect to any new reporting require-
ments related to such improvements. Amounts appropriated 
under this paragraph shall remain available until expended. 
(2) REQUIREMENTS.—The improvements made by the Sec-
retary under paragraph (1) shall be designed and implemented 
(including with respect to any necessary guidance for States
H. R. 2—77 
to report such information in a complete and expeditious 
manner) so that, beginning no later than October 1, 2009, 
data regarding the enrollment of low-income children (as 
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 PRIMARY AND SPE-
CIALITY 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 Medicaid and CHIP, including— 
(A) the extent to which providers are willing 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 degree of avail-
ability of services for children under such programs. 
(2) REPORT.—Not later than 2 years after the date of enact-
ment of this Act, the Comptroller General shall submit a report 
to the Committee on Finance of the Senate and the Committee 
on Energy and Commerce of the House of Representatives 
on the study conducted under paragraph (1) that includes rec-
ommendations for such Federal and State legislative and 
administrative changes as the Comptroller General determines 
are necessary to address any barriers to access to children’s 
care under Medicaid and CHIP that may exist. 
SEC. 403. APPLICATION OF CERTAIN MANAGED CARE QUALITY SAFE-
GUARDS 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 REQUIREMENTS.— 
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 man-
aged care organizations under this title in the same manner 
as such subsections apply 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.—