KIDS Health Act of 2022
Bill: S.5011 | Sponsor: Sen. Carper, Thomas R. (D-DE)
Policy area: Health

Summary:
Kickstarting Innovative Demonstrations Supporting Kids Health Act of 2022 or the KIDS Health Act of 2022
This bill requires the Centers for Medicare & Medicaid Services (CMS) to implement a demonstration program that supports a whole child health model for children under Medicaid and the Children's Health Insurance Program (CHIP).
Specifically, the CMS must award grants to up to 15 states to plan and implement a health care model that supports the physical, behavioral, social, and other needs of children who qualify for Medicaid or CHIP through care coordination and integrated supportive services. States must implement models for 4-6 years. The CMS must provide technical assistance and guidance to states for the demonstration program. The bill also provides for an 80% federal matching rate for program costs.
The Government Accountability Office must report on program outcomes.

To amend title XIX of the Social Security Act to establish a 
demonstration project testing Whole Child Health Models, and for other 
                               purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Kickstarting Innovative 
Demonstrations Supporting Kids Health Act of 2022'' or the ``KIDS 
Health Act of 2022''.

SEC. 2. ESTABLISHMENT OF WHOLE CHILD HEALTH MODELS.

    Section 1903 of the Social Security Act (42 U.S.C. 1396b) is 
amended by adding at the end the following new subsection:
    ``(cc) Whole Child Health Demonstration Project.--
            ``(1) In general.--The Secretary, acting through the Deputy 
        Administrator and Director of the Center for Medicaid and CHIP 
        Services, shall conduct a demonstration project (referred to in 
        this subsection as the `demonstration project') under which 
        participating States shall design and implement whole child 
        health models in 1 or more target communities in accordance 
        with the requirements of this subsection. The requirements of 
        section 1902(a)(1) (relating to statewideness) shall not apply 
        to the demonstration project.
            ``(2) Design phase.--
                    ``(A) Grants.--Not later than 12 months after the 
                date of the enactment of this subsection, the Secretary 
                shall award up to 15 grants to States that submit 
                complete applications for such grants which meet the 
                requirements of subparagraph (C).
                    ``(B) Selection of grantees.--In awarding grants 
                under this paragraph, the Secretary shall, to the 
                extent possible, prioritize awarding grants to a 
                geographically diverse selection of States and target 
                communities of different sizes and with varying 
                experience with value-based payment, including rural 
                and urban communities.
                    ``(C) Grant application.--A State shall include in 
                an application for a grant awarded under this paragraph 
                the following:
                            ``(i) A description of each proposed target 
                        community in which the State proposes to 
                        implement a whole child health model.
                            ``(ii) For each target community described 
                        in clause (i), a statement of the proposed 
                        objectives of the State in implementing a whole 
                        child health model in that community.
                            ``(iii) Such other information as the 
                        Secretary may require.
                    ``(D) Use of grant funds.--
                            ``(i) In general.--A State awarded a grant 
                        under this paragraph shall use the grant funds 
                        to--
                                    ``(I) conduct or use an existing 
                                needs assessment that is not more than 
                                two years old and meets the 
                                requirements of clause (ii) for each 
                                proposed target community;
                                    ``(II) not later than 12 months 
                                after being awarded the grant, design 
                                and submit for approval by the 
                                Secretary a proposed whole child health 
                                model that meets the requirements of 
                                subparagraph (E) for each target 
                                community based on the results of the 
                                needs assessment and other assessments 
                                or surveys conducted for that 
                                community; and
                                    ``(III) implement the whole child 
                                health model during the implementation 
                                phase described in paragraph (3).
                            ``(ii) Needs assessment requirements.--A 
                        needs assessment conducted for a proposed 
                        target community with grant funds awarded to a 
                        State shall include the following:
                                    ``(I) An evaluation of the physical 
                                health, mental, emotional and 
                                behavioral health, developmental, 
                                social, relational and substance use 
                                disorder service needs of eligible 
                                individuals in the target community, 
                                including needs that could be addressed 
                                through population-based or community-
                                based interventions.
                                    ``(II) A review of the resources 
                                available to meet the physical health, 
                                mental health, and substance use 
                                disorder service needs of eligible 
                                individuals in the target community.
                                    ``(III) A description of the 
                                barriers identified in the target 
                                community to eligible individuals 
                                accessing resources and services to 
                                address their physical health, mental 
                                health, and substance use disorder 
                                service needs.
                                    ``(IV) A description of health 
                                disparities identified in the target 
                                community, including input from 
                                community residents in the target 
                                community.
                    ``(E) Whole child health model requirements.--
                            ``(i) In general.--A proposed whole child 
                        health model shall include descriptions of the 
                        following:
                                    ``(I) How the State and its multi-
                                sector partners will address the 
                                physical health, mental, emotional and 
                                behavioral health, developmental, 
                                social, relational and substance use 
                                disorder service needs of eligible 
                                individuals in the target community 
                                identified in the needs assessment of 
                                that community through implementation 
                                of the whole child health model and 
                                provision of whole child health 
                                services.
                                    ``(II) How the State Medicaid, 
                                human services, and child welfare 
                                agencies will coordinate with community 
                                partners to ensure the successful 
                                implementation of the whole child 
                                health model in the target communities 
                                and the provision of whole child health 
                                services.
                                    ``(III) The lead agency or other 
                                entity the State proposes to designate 
                                to coordinate activities carried out to 
                                implement the whole child health model 
                                in the target communities.
                            ``(ii) Requirements.--A proposed whole 
                        child health model shall meet the following 
                        requirements:
                                    ``(I) Align with an existing or 
                                planned delivery and payment system of 
                                the State plan under this title or 
                                under a waiver of such plan, including, 
                                as applicable, a managed care delivery 
                                system.
                                    ``(II) Include partnerships with 
                                child and family serving organizations 
                                and agencies such as health care 
                                providers, payers, school districts, 
                                public health and child care.
                                    ``(III) Promote the delivery of 
                                trauma-informed and culturally 
                                competent care, including strategies to 
                                address systemic resource needs, 
                                including workforce shortages, in the 
                                target community and an assessment of 
                                the potential impact of the model on 
                                health equity, disparities, and safety 
                                net providers in the target community.
                                    ``(IV) Coordinate funding sources 
                                under the State plan under this title 
                                (or under a waiver of plan), the State 
                                plans under parts B and E of title IV, 
                                and other applicable funding sources, 
                                for the whole child health services 
                                provided under the model.
                                    ``(V) Include--
                                            ``(aa) the design and 
                                        implementation or adaptation of 
                                        a value-based payment 
                                        arrangement for providing whole 
                                        child health services under the 
                                        State plan under this title (or 
                                        under a waiver of such plan) 
                                        that promotes pediatric health; 
                                        or
                                            ``(bb) in the case of a 
                                        State that faces significant 
                                        barriers to implementing or 
                                        adapting such a value-based 
                                        payment arrangement, a proposal 
                                        for steps that the State will 
                                        take towards advancing value-
                                        based care with respect to 
                                        whole child health services 
                                        provided under the State plan 
                                        under this title (or under a 
                                        waiver of such plan).
                                    ``(VI) Include strategies to 
                                coordinate referrals to whole child 
                                health services, including using 
                                telehealth, referral networks and/or 
                                other technologies to facilitate access 
                                to whole child health services.
                                    ``(VII) Include strategies to 
                                promote the integration of primary care 
                                with whole child health services and 
                                substance use disorder services.
                                    ``(VIII) Include strategies to 
                                integrate and streamline eligibility, 
                                enrollment, and renewal processes to 
                                facilitate enrollment in health 
                                coverage and other benefit programs.
                                    ``(IX) Include strategies to 
                                promote school-based health and 
                                wellness.
                                    ``(X) Describe how the State will 
                                leverage or enhance existing health 
                                information technology infrastructure 
                                and cross-sector data-sharing 
                                capabilities to support the provision 
                                of enhanced care coordination services, 
                                including with respect to claiming 
                                administrative matching funds for the 
                                design, development, and installation 
                                of data systems to allow or enhance 
                                coordination among State agencies and 
                                other entities.
                                    ``(XI) Describe how the State will 
                                evaluate the impact of the model on 
                                child health and disparities in health 
                                outcomes, according to requirements 
                                outlined by Secretary.
                                    ``(XII) Include other such 
                                population health strategies or core 
                                services as the State determines 
                                appropriate.
                            ``(iii) Participation by indian tribes in 
                        whole child health models.--The Secretary may 
                        waive or otherwise modify the requirements for 
                        a whole child health model described in clause 
                        (ii) to the extent necessary to permit Indian 
                        tribes to participate in such a model.
            ``(3) Implementation phase.--After the design period, the 
        implementation phase of the demonstration project shall be 
        conducted for a period of not less than 48 months and not more 
        than 72 months.
            ``(4) Authorization of appropriations.--
                    ``(A) In general.--There are authorized to be 
                appropriated to the Secretary for the purpose of 
                carrying out this subsection, out of any funds in the 
                Treasury not otherwise appropriated, $125,000,000, to 
                remain available until expended.
                    ``(B) Limitation on use of funds.--From any amounts 
                appropriated pursuant to this paragraph, the Secretary 
                shall use--
                            ``(i) not more than $2,000,000 for 
                        administrative costs, staffing, and reporting 
                        requirements;
                            ``(ii) not more than $10,000,000 for 
                        learning platforms, staffing, and technical 
                        assistance related directly to the design and 
                        implementation of whole child health models, 
                        and to carry out activities under this 
                        subsection; and
                            ``(iii) not more than $3,000,0000 may be 
                        used for carrying out evaluations described in 
                        paragraph (5).
                    ``(C) Payment for whole child health services.--
                            ``(i) In general.--For each fiscal quarter 
                        occurring during the implementation phase of 
                        the demonstration project, subject to clause 
                        (ii), the Secretary shall pay each State 
                        selected to participate in that phase of the 
                        project, an amount equal to 80 percent of the 
                        amounts expended by the State during such 
                        quarter for providing whole child health 
                        services to eligible individuals in the target 
                        communities net of any Federal payments made to 
                        the State for such expenditures, under this 
                        title or otherwise.
                            ``(ii) Requirement.--The additional Federal 
                        funds paid to a State under this subparagraph 
                        shall be used to supplement, not supplant, the 
                        level of State funds expended for services that 
                        are treated as whole child health services 
                        under the demonstration project.
            ``(5) Reports and evaluation.--
                    ``(A) In general.--A State that is selected to 
                participate in the demonstration project shall report 
                on the outcomes under the entity's whole child health 
                model pursuant to periodic reporting requirements 
                established by the Secretary.
                    ``(B) State reports.--Each State awarded a grant 
                under this subsection shall submit the following 
                reports to the Secretary:
                            ``(i) Interim report.--An interim report at 
                        the end of the first 24 months of the 
                        implementation phase of the project that 
                        describes--
                                    ``(I) the progress of the State's 
                                implementation of the whole child 
                                health model in the target communities;
                                    ``(II) the organizations and 
                                providers that are participating in the 
                                implementation of the model in the 
                                target communities;
                                    ``(III) the number of eligible 
                                individuals in the target communities 
                                receiving enhanced care coordination 
                                services; and
                                    ``(IV) such other information as 
                                the Secretary may require.
                            ``(ii) Final report.--A final report not 
                        later than 1 year after the end of the 
                        implementation phase of the demonstration 
                        project that describes--
                                    ``(I) best practices and challenges 
                                in implementing the whole child health 
                                model in the target communities;
                                    ``(II) the impact of the model on 
                                child well-being, health care outcomes 
                                and health disparities in the target 
                                communities; and
                                    ``(III) such other information as 
                                the Secretary may require.
                    ``(C) GAO report.--Not later than 3 years after the 
                first grant is awarded under this subsection, the 
                Comptroller General of the United States shall submit a 
                report to Congress evaluating the individual, 
                financial, and systems-level impacts associated with 
                whole child health models implemented under the 
                demonstration project.
            ``(6) Consultation.--A State awarded a grant under 
        paragraph (2) shall consult with stakeholders, such as eligible 
        individuals and their primary caregivers, schools, health care, 
        mental health, and substance use disorder treatment 
        organizations, pediatric providers, public health departments, 
        child care providers, juvenile justice programs, child welfare 
        programs, and community-based organizations, in designing and 
        carrying out the activities required under paragraph (2), and 
        with respect to the implementation and evaluation of the whole 
        child health models implemented by the State. Such consultation 
        may include establishment of a Community Advisory Board as 
        defined by the Secretary.
            ``(7) Responsibilities of the secretary.--
                    ``(A) Technical assistance.--
                            ``(i) In general.--The Secretary shall 
                        provide States awarded a grant under paragraph 
                        (2) with technical assistance with respect to 
                        the design of whole child health models. Such 
                        assistance may include assisting States with 
                        moving along a whole child health model and 
                        utilizing innovative financing strategies, such 
                        as braiding public and private funds. As 
                        feasible, the Secretary may partner with other 
                        Federal agencies, including the Office of 
                        Management and Budget, when providing technical 
                        assistance to promote a whole child health 
                        approach. The Secretary shall also provide such 
                        States with technical assistance with respect 
                        to implementation of such models.
                            ``(ii) Shared learning.--The Secretary 
                        shall facilitate shared learning, such as a 
                        learning collaborative, among the States 
                        participating in the demonstration project.
                            ``(iii) Reports to congress.--The Secretary 
                        shall submit to the Committee on Finance of the 
                        Senate and the Committee on Energy and Commerce 
                        of the House of Representatives the following 
                        reports:
                                    ``(I) Design phase.--Not later than 
                                36 months after the date on which 
                                design grant funds are first awarded 
                                under paragraph (2), a report that 
                                describes the whole child health models 
                                proposed by States.
                                    ``(II) Implementation phase.--
                                            ``(aa) Interim report.--Not 
                                        later than 3 years after the 
                                        date on which the 
                                        implementation phase of the 
                                        demonstration project begins, 
                                        an interim report.
                                            ``(bb) Final report.--Not 
                                        later than 2 years after the 
                                        date on which the demonstration 
                                        project ends, a final report.
                                            ``(cc) Content.--The 
                                        interim and final reports 
                                        required under this clause 
                                        shall include the following:

                                                    ``(AA) A summary of 
                                                the whole child health 
                                                models being 
                                                implemented under the 
                                                demonstration project.

                                                    ``(BB) An 
                                                assessment of the 
                                                impacts of such models 
                                                on the physical and 
                                                mental health and well-
                                                being of eligible 
                                                individuals in the 
                                                target communities.

                                                    ``(CC) A 
                                                description of the most 
                                                effective strategies of 
                                                such models in 
                                                promoting the physical 
                                                and mental health of 
                                                eligible individuals, 
                                                including the 
                                                effectiveness of such 
                                                strategies in reducing 
                                                health disparities and 
                                                improving health 
                                                equity.

                                                    ``(DD) A summary of 
                                                the information 
                                                reported to the 
                                                Secretary by States.

                                            ``(dd) Legislative 
                                        recommendations.--In addition 
                                        to the information required 
                                        under item (cc), the final 
                                        report submitted under item 
                                        (bb) shall include 
                                        recommendations for such 
                                        Federal legislative changes, if 
                                        any, as the Secretary 
                                        recommends to implement 
                                        positive outcomes identified by 
                                        the use of whole child health 
                                        models under the demonstration 
                                        project.
            ``(8) Definitions.--In this subsection:
                    ``(A) Eligible individual.--The term `eligible 
                individual' means an individual who has not attained 
                age 21 and who is eligible for medical assistance under 
                a State plan under this title or under a waiver of such 
                plan, or for assistance under a State child health plan 
                under title XXI or under a waiver of such plan.
                    ``(B) Indian tribe.--The term `Indian Tribe' has 
                the meaning given that term in section 4(e) of the 
                Indian Self-Determination and Education Assistance Act 
                (25 U.S.C. 5304(e)).
                    ``(C) Target community.--The term `target 
                community' means, with respect to a State, the 
                boundaries of a geographic area within the State in 
                which the State proposes to implement a whole child 
                health model.
                    ``(D) Whole child health services.--The term `whole 
                child health services' means the following:
                            ``(i) Comprehensive care management.
                            ``(ii) Enhanced care coordination services 
                        and referrals to health, developmental and 
                        social supports that include strategies to--
                                    ``(I) identify and address the 
                                physical, mental, emotional, and 
                                behavioral health, developmental, 
                                relational and social needs of eligible 
                                individuals;
                                    ``(II) coordinate referrals, as 
                                needed, to health care, mental, 
                                emotional, and behavioral health, 
                                substance use disorder treatment, child 
                                development, and social service 
                                providers;
                                    ``(III) ensure that eligible 
                                individuals follow up with service 
                                providers to whom they are referred; 
                                and
                                    ``(IV) facilitate the ability of 
                                eligible individuals to access needed 
                                services by centralizing, coordinating 
                                with, or co-locating resources.
            ``(9) Requirement to issue guidance on combining federal 
        and non-federal funds to address social determinants of health 
        in low-income populations.--Not later than 365 days after the 
        selection of eligible entities under this subsection, the 
        Secretary shall issue and disseminate guidance and technical 
        assistance to grant awardees to clarify strategies and best 
        practices to combine funds, including Medicaid, in the context 
        of a child health and wellness fund, consistent with Federal 
        law, and shall make such guidance publicly available.''.
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