162 
† HR 2 EAS 
Reauthorization Act of 2009, so as to per-
mit the State to make a determination 
(under paragraph (2)(B), (3), or (10) of 
section 2105(c) of the Social Security Act or 
otherwise) concerning the cost-effectiveness 
of the State providing medical or child 
health assistance through premium assist-
ance for the purchase of coverage under such 
group health plan and in order for the 
State to provide supplemental benefits re-
quired under paragraph (10)(E) of such sec-
tion or other authority.’’. 
(B) 
CONFORMING
AMENDMENT.—Section 
102(b) of the Employee Retirement Income Secu-
rity Act of 1974 (29 U.S.C. 1022(b)) is amend-
ed— 
(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 complying with section 
701(f)(3)(B)(i), the model notice applicable 
to the State in which the participants and 
beneficiaries reside’’.
163 
† HR 2 EAS 
(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 Med-
icaid, 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 coverage coordination disclo-
sure form described in subclause (II) 
and to identify the impediments to the 
effective coordination of coverage avail-
able to families that include employees 
of employers that maintain group 
health plans and members who are eli-
gible for medical assistance under title 
XIX of the Social Security Act or child 
health assistance or other health bene-
164 
† HR 2 EAS 
fits coverage under title XXI of such 
Act. 
(II) MODEL COVERAGE COORDINA-
TION DISCLOSURE FORM DESCRIBED.— 
The model form described in this sub-
clause is a form for plan administra-
tors of group health plans to complete 
for purposes of permitting a State to 
determine the availability and cost-ef-
fectiveness 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 coverage for enrollees of such plans. 
Such form shall provide the following 
information in addition to such other 
information as the Working Group de-
termines appropriate: 
(aa) 
A 
determination 
of 
whether the employee is eligible 
for coverage under the group 
health plan.
165 
† HR 2 EAS 
(bb) The name and contract 
information of the plan adminis-
trator 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 coverage under the 
plan. 
(ii) 
MEMBERSHIP.—The 
Working 
Group shall consist of not more than 30 
members and shall be composed of rep-
resentatives of— 
(I) the Department of Labor; 
(II) the Department of Health 
and Human Services; 
(III) State directors of the Med-
icaid 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;
166 
† HR 2 EAS 
(V) employers, including owners 
of small businesses and their trade or 
industry representatives and certified 
human resource and payroll profes-
sionals; 
(VI) plan administrators and 
plan sponsors of group health plans (as 
defined in section 607(1) of the Em-
ployee Retirement Income Security Act 
of 1974); 
(VII) health insurance issuers; 
and 
(VIII) children and other bene-
ficiaries of 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. 
(iii) COMPENSATION.—The members of 
the Working Group shall serve without com-
pensation. 
(iv) ADMINISTRATIVE
SUPPORT.—The 
Department of Health and Human Services 
and the Department of Labor shall jointly 
provide appropriate administrative support
168 
† HR 2 EAS 
shall jointly submit a report to each 
House of the Congress regarding the 
recommendations contained in the re-
port 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 begin-
ning with the first plan year that begins after
169 
† HR 2 EAS 
the date on which such model coverage coordina-
tion 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 subpara-
graph, 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 information required to be disclosed under section 
701(f)(3)(B)(ii). For purposes of this subparagraph, each 
violation with respect to any single participant or bene-
ficiary shall be treated as a separate violation.’’. 
(2) AMENDMENTS TO PUBLIC HEALTH SERVICE 
ACT.—Section 2701(f) of the Public Health Service
170 
† HR 2 EAS 
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 en-
rolled, 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 COVERAGE.—The employee or depend-
ent 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 em-
ployee 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
171 
† HR 2 EAS 
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 in-
surance coverage, under such Medicaid plan 
or State child health plan (including under 
any waiver or demonstration project con-
ducted under or in relation to such a plan), 
if the employee requests coverage under the 
group health plan or health insurance cov-
erage 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
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
172 
† HR 2 EAS 
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 writ-
ten notice informing the employee of 
potential opportunities then currently 
available in the State in which the em-
ployee resides for premium assistance 
under such plans for health coverage of 
the employee or the employee’s depend-
ents. For purposes of compliance with 
this subclause, the employer may use 
any State-specific model notice devel-
oped 
in 
accordance 
with 
section 
701(f)(3)(B)(i)(II) of the Employee Re-
tirement 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
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† HR 2 EAS 
employee resides concurrent with the 
furnishing of materials notifying the 
employee of health plan eligibility, con-
current 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 de-
scription as provided in section 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 benefits 
available under the group health plan in 
sufficient specificity, as determined under 
regulations of the Secretary of Health and
174 
† HR 2 EAS 
Human Services in consultation with the 
Secretary that require use of the model cov-
erage coordination disclosure form developed 
under section 311(b)(1)(C) of the Children’s 
Health Insurance Reauthorization 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 otherwise) concerning the 
cost-effectiveness of the State providing med-
ical or child health assistance through pre-
mium assistance for the purchase of cov-
erage 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 MEDICAID 
OR CHIP. 
(a) DEVELOPMENT
OF
CHILD
HEALTH
QUALITY 
MEASURES FOR CHILDREN ENROLLED IN MEDICAID OR
175 
† HR 2 EAS 
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 gen-
eral comment an initial, recommended core set of 
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 pro-
viders of items and services under such programs. 
‘‘(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 coverage 
over time. 
‘‘(3) RECOMMENDATIONS AND DISSEMINATION.— 
Based on such existing and identified measures, the
176 
† HR 2 EAS 
Secretary shall publish an initial core set of child 
health quality measures that includes (but is not lim-
ited 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— 
‘‘(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-
177 
† HR 2 EAS 
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 
date of enactment of the Children’s Health Insurance 
Program Reauthorization Act of 2009, the Secretary, 
in consultation with States, shall develop a standard-
ized format for reporting information and procedures 
and approaches that encourage States to use the ini-
tial core measurement set to voluntarily report infor-
mation 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 children, 
and shall facilitate the adoption of such best prac-
tices. In developing best practices approaches, the Sec-
retary shall give particular attention to State meas-
urement techniques that ensure the timeliness and ac-
curacy of provider reporting, encourage provider re-
178 
† HR 2 EAS 
porting compliance, encourage successful quality im-
provement strategies, and improve efficiency 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— 
‘‘(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 condi-
tions, chronic health care, and health serv-
ices to ameliorate the effects of physical and 
mental conditions and to aid in growth and 
development of infants, young children, 
school-age children, 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 set-
179 
† HR 2 EAS 
ting, and elimination of racial, ethnic, and 
socioeconomic 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 qual-
ity 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 to-
gether— 
‘‘(A) provide information regarding the 
quality of health coverage and health care for 
children; 
‘‘(B) address the needs of children through-
out the developmental age span; and
180 
† HR 2 EAS 
‘‘(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 ameliorate 
physical, mental, or developmental conditions 
that could, if untreated or poorly treated, become 
chronic. 
‘‘(b) ADVANCING AND IMPROVING PEDIATRIC QUALITY 
MEASURES.— 
‘‘(1) ESTABLISHMENT
OF
PEDIATRIC
QUALITY 
MEASURES
PROGRAM.—Not later than January 1, 
2011, the Secretary shall establish a pediatric quality 
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
181 
† HR 2 EAS 
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— 
‘‘(A) evidence-based and, where appropriate, 
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—
182 
† HR 2 EAS 
‘‘(A) States; 
‘‘(B) pediatricians, children’s hospitals, and 
other primary and specialized pediatric health 
care professionals (including members of the al-
lied health professions) who specialize in the care 
and treatment of children, particularly children 
with special physical, mental, and developmental 
health care needs; 
‘‘(C) dental professionals, including pedi-
atric dental professionals; 
‘‘(D) health care providers that furnish pri-
mary health care to children and families who 
live in urban and rural medically underserved 
communities or who are members of distinct 
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 individ-
uals with expertise in pediatric health quality 
measurement; and
183 
† HR 2 EAS 
‘‘(H) voluntary consensus standards setting 
organizations and other organizations involved 
in the advancement of evidence-based measures of 
health care. 
‘‘(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 de-
velopment, testing, and validation of new, emerg-
ing, and innovative evidence-based measures 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
184 
† HR 2 EAS 
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 
for the development of pediatric quality measures de-
scribed in subsection paragraphs (1) through (4). 
‘‘(6) DEFINITION OF PEDIATRIC QUALITY MEAS-
URE.—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 devel-
oped in order to assess 1 or more aspects of pediatric 
health care quality in various institutional and am-
bulatory health care settings, including the structure 
of the clinical care system, the process of care, the out-
come of care, or patient experiences in care. 
‘‘(7) CONSTRUCTION.—Nothing in this section 
shall be construed as supporting the restriction of cov-
erage, 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
185 
† HR 2 EAS 
child health plan approved under title XXI shall an-
nually report to the Secretary on the— 
‘‘(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 qual-
ity 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 bench-
mark 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 in-
formation 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 evalu-
186 
† HR 2 EAS 
ate promising ideas for improving the quality of chil-
dren’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 improve 
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 devel-
oped and disseminated under subsection (f) on 
improving pediatric health, including the effects 
of chronic childhood health conditions, and pedi-
atric health care quality as well as reducing 
health care costs.
187 
† HR 2 EAS 
‘‘(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 conducted on 
a multistate basis, as needed. 
‘‘(4) FUNDING.—$20,000,000 of the amount ap-
propriated 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 de-
velop a comprehensive and systematic model for re-
ducing childhood obesity by awarding grants to eligi-
188 
† HR 2 EAS 
ble 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, need-
ed 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 target 
individuals and their families to reduce risk fac-
tors and promote the appropriate use of preven-
tive 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.
189 
† HR 2 EAS 
‘‘(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 entities, 
including schools and other facilities pro-
viding recreational services, to establish 
programs for after school and weekend com-
munity activities that are designed to re-
duce childhood obesity; 
‘‘(ii) 
forming 
partnerships 
with 
daycare facilities to establish programs that 
promote healthy eating behaviors and phys-
ical activity; and
190 
† HR 2 EAS 
‘‘(iii) developing and evaluating com-
munity educational activities targeting good 
nutrition and promoting healthy eating be-
haviors; 
‘‘(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 de-
signed 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 responding 
to hunger and satiety, positive body 
image development, positive self-esteem 
development, and learning life skills 
(such as stress management, commu-
nication skills, problemsolving and de-
cisionmaking skills), as well as consid-
eration of cultural and developmental
191 
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issues, and the role of family, school, 
and community; 
‘‘(ii) providing education and training 
to educational 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 behav-
iors and physical activity; and 
‘‘(iv) 
planning 
and 
implementing 
healthy lifestyle classes or programs for par-
ents or guardians, with an emphasis on 
healthy eating behaviors and physical activ-
ity for children; 
‘‘(C) carry out educational, counseling, pro-
motional, and training activities through the 
local health care delivery systems including by— 
‘‘(i) promoting healthy eating behav-
iors and physical activity services to treat 
or prevent eating disorders, being over-
weight, and obesity; 
‘‘(ii) providing patient education and 
counseling to increase physical activity and 
promote healthy eating behaviors;
192 
† HR 2 EAS 
‘‘(iii) training health professionals on 
how to identify and treat obese and over-
weight individuals which may include nu-
trition and physical activity counseling; 
and 
‘‘(iv) providing community education 
by a health professional on good nutrition 
and physical activity to develop a better un-
derstanding of the relationship between diet, 
physical activity, and eating disorders, obe-
sity, or being overweight; and 
‘‘(D) provide, through qualified health pro-
fessionals, training and supervision for commu-
nity health workers to— 
‘‘(i) educate families regarding the re-
lationship between nutrition, eating habits, 
physical activity, and obesity; 
‘‘(ii) educate families about effective 
strategies to improve nutrition, establish 
healthy eating patterns, and establish ap-
propriate levels of physical activity; and 
‘‘(iii) educate and guide parents re-
garding the ability to model and commu-
nicate positive health behaviors.
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† HR 2 EAS 
‘‘(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 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 activi-
ties 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 activi-
ties developed under grants in the years fol-
lowing the fiscal years for which they receive 
grants under this subsection;
194 
† HR 2 EAS 
‘‘(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 in-
volvement of a broad range of stakeholders, in-
cluding— 
‘‘(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 
‘‘(ix) other entities determined appro-
priate by the Secretary. 
‘‘(5) PROGRAM DESIGN.—
195 
† HR 2 EAS 
‘‘(A) INITIAL
DESIGN.—Not later than 1 
year after the date of enactment of the Children’s 
Health Insurance Program Reauthorization Act 
of 2009, the Secretary shall design the dem-
onstration project. The demonstration should 
draw upon promising, innovative models and in-
centives 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 Preven-
tion, the Director of the Office of Minority 
Health, the heads of other agencies in the De-
partment of Health and Human Services, and 
such professional organizations, as the Secretary 
determines to be appropriate, on the design, con-
duct, and evaluation of the demonstration. 
‘‘(B) NUMBER AND PROJECT AREAS.—Not 
later than 2 years after the date of enactment of 
the Children’s Health Insurance Program Reau-
thorization Act of 2009, the Secretary shall 
award 1 grant that is specifically designed to de-
termine whether programs similar to programs 
to be conducted by other grantees under this sub-
section should be implemented with respect to the 
general population of children who are eligible
196 
† HR 2 EAS 
for child health assistance 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 Sec-
retary shall submit to Congress a report that describes 
the project, evaluates the effectiveness and cost effec-
tiveness of the project, evaluates the beneficiary satis-
faction under the project, and includes any such other 
information as the Secretary determines to be appro-
priate. 
‘‘(7) DEFINITIONS.—In this subsection: 
‘‘(A) FEDERALLY-QUALIFIED HEALTH CEN-
TER.—The term ‘Federally-qualified health cen-
ter’ 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-as-
sessment’ means a form that— 
‘‘(i) includes questions regarding—
197 
† HR 2 EAS 
‘‘(I) behavioral risk factors; 
‘‘(II) 
needed 
preventive 
and 
screening services; and 
‘‘(III) target individuals’ pref-
erences for receiving follow-up informa-
tion; 
‘‘(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 ‘ongo-
ing support’ means— 
‘‘(i) to provide any target individual 
with information, 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 pre-
ventive and screening services or treat-
ment including medical nutrition ther-
apy;
198 
† HR 2 EAS 
‘‘(ii) to provide any target individual 
with referrals to community resources and 
programs available to assist the target indi-
vidual 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 en-
rolled 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 par-
ents, caregivers, and other consumers for the sole 
purpose of demonstrating compliance with school
199 
† HR 2 EAS 
or leisure activity requirements, such as appro-
priate 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 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 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 report to 
Congress on the extent and quality of efforts to meas-
ure 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 phys-
201 
† HR 2 EAS 
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 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 developed, published, or used as a basis of measure-
ment or reporting under this section may be used to estab-
lish an irrebuttable presumption regarding either the med-
ical 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 assist-
ance under title XXI. 
‘‘(i) APPROPRIATION.—Out of any funds in the Treas-
ury 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.’’.
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† HR 2 EAS 
(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 med-
ical assistance percentage (as defined in section 
1905(b)) of so much of the sums expended during 
such quarter (as found necessary by the Sec-
retary for the proper and efficient administra-
tion 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 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—
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† HR 2 EAS 
(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 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 eli-
gibility. 
‘‘(3) Data regarding denials of eligibility and re-
determinations of eligibility. 
‘‘(4) Data regarding access to primary and spe-
cialty services, access to networks of care, and care co-
ordination provided under the State child health 
plan, using quality care and consumer satisfaction
204 
† HR 2 EAS 
measures included in the Consumer Assessment 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 assistance, including the extent 
to which employer-sponsored health insurance cov-
erage is available for children eligible for child health 
assistance under the State child health plan, the 
range of the monthly amount of such assistance pro-
vided 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 pre-
mium assistance, the effective strategies the State en-
gages 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 em-
ployer-sponsored health insurance offered in the State. 
‘‘(6) To the extent applicable, a description of 
any State activities that are designed to reduce the
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† HR 2 EAS 
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 re-
porting 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 informa-
tion in accordance with the standardized format spec-
ified by the Secretary under paragraph (1). 
(c) ADDITIONAL FUNDING FOR THE SECRETARY TO 
IMPROVE TIMELINESS OF DATA REPORTING AND ANALYSIS 
FOR PURPOSES OF DETERMINING ENROLLMENT INCREASES 
UNDER MEDICAID AND CHIP.— 
(1) APPROPRIATION.—There is appropriated, out 
of any money in the Treasury not otherwise appro-
206 
† HR 2 EAS 
priated, $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 eli-
gibility of children under Medicaid and CHIP and to 
provide guidance to States with respect to any new 
reporting requirements related to such improvements. 
Amounts appropriated under this paragraph shall re-
main 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 
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 SPECIALITY SERVICES.—
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† HR 2 EAS 
(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. 
(2) REPORT.—Not later than 2 years after the 
date of enactment of this Act, the Comptroller General 
shall submit a report to the Committee on Finance of 
the Senate and the Committee on Energy and Com-
merce 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 Gen-
eral determines are necessary to address any barriers
208 
† HR 2 EAS 
to access to children’s care under Medicaid and CHIP 
that may exist. 
SEC. 403. APPLICATION OF CERTAIN MANAGED CARE QUAL-
ITY 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 pro-
vide for the application of subsections (a)(4), (a)(5), 
(b), (c), (d), and (e) of section 1932 (relating to re-
quirements for managed care) to coverage, State agen-
cies, enrollment brokers, managed care entities, and 
managed 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 sub-
section (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.—
209 
† HR 2 EAS 
(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 insert-
ing ‘‘paragraphs (5) and (7) of subsection 
(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.— 
‘‘(A) IN GENERAL.—The child health assist-
ance provided to a targeted low-income child 
shall include coverage of dental services necessary 
to prevent disease and promote oral health, re-
store oral structures to health and function, and 
treat emergency conditions. 
‘‘(B) PERMITTING USE OF DENTAL BENCH-
MARK PLANS BY CERTAIN STATES.—A State may 
elect to meet the requirement of subparagraph 
(A) through dental coverage that is equivalent to
210 
† HR 2 EAS 
a benchmark dental benefit package described in 
subparagraph (C). 
‘‘(C) BENCHMARK DENTAL BENEFIT PACK-
AGES.—The benchmark dental benefit packages 
are as follows: 
‘‘(i) FEHBP CHILDREN’S DENTAL COV-
ERAGE.—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 depend-
ent coverage, in either of the previous 2 
plan years. 
‘‘(ii) STATE
EMPLOYEE
DEPENDENT 
DENTAL COVERAGE.—A dental benefits 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 depend-
ent coverage, in either of the previous 2 
plan years. 
‘‘(iii) COVERAGE OFFERED THROUGH 
COMMERCIAL DENTAL PLAN.—A dental ben-
efits plan that has the largest insured com-
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† HR 2 EAS 
mercial, non-medicaid enrollment of de-
pendent 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 paragraphs (1) and (2) shall apply to coverage of 
items and services furnished on or after October 1, 
2009. 
(b) STATE OPTION TO PROVIDE DENTAL-ONLY SUP-
PLEMENTAL COVERAGE.— 
(1) IN GENERAL.—Section 2110(b) (42 U.S.C. 
1397jj(b)) is amended— 
(A) in paragraph (1)(C), by inserting ‘‘, 
subject to paragraph (5),’’ after ‘‘under title XIX 
or’’; and 
(B) by adding at the end the following new 
paragraph: 
‘‘(5) OPTION
FOR
STATES
WITH
A
SEPARATE 
CHIP PROGRAM TO PROVIDE DENTAL-ONLY SUPPLE-
MENTAL COVERAGE.— 
‘‘(A) IN
GENERAL.—Subject to subpara-
graphs (B) and (C), in the case of any child who
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† HR 2 EAS 
is enrolled in a group health plan or health in-
surance coverage offered through an employer 
who would, but for the application of paragraph 
(1)(C), satisfy the requirements for being a tar-
geted low-income child under a State child health 
plan that is implemented under this title, a 
State may waive the application of such para-
graph to the child in order to provide— 
‘‘(i) dental coverage consistent with the 
requirements of subsection (c)(5) of section 
2103; or 
‘‘(ii) cost-sharing protection for dental 
coverage consistent with such requirements 
and the requirements of subsection (e)(3)(B) 
of such section. 
‘‘(B) LIMITATION.—A State may limit the 
application of a waiver of paragraph (1)(C) to 
children whose family income does not exceed a 
level specified by the State, so long as the level 
so specified does not exceed the maximum income 
level otherwise established for other children 
under the State child health plan. 
‘‘(C) CONDITIONS.—A State may not offer 
dental-only supplemental coverage under this