[Congressional Bills 105th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4118 Introduced in House (IH)]
105th CONGRESS
2d Session
H. R. 4118
To amend title XXVII of the Public Health Service Act and part 7 of
subtitle B of title I of the Employee Retirement Income Security Act of
1974 to establish standards for the health quality improvement of
children in managed care plans and other health plans.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
June 23, 1998
Mrs. Morella (for herself, Ms. Eshoo, Ms. Slaughter, Mr. Hilliard, Mr.
Serrano, Mr. Kleczka, Mr. Baldacci, Mr. Romero-Barcelo, and Mr. Nadler)
introduced the following bill; which was referred to the Committee on
Commerce, and in addition to the Committee on Education and the
Workforce, for a period to be subsequently determined by the Speaker,
in each case for consideration of such provisions as fall within the
jurisdiction of the committee concerned
_______________________________________________________________________
A BILL
To amend title XXVII of the Public Health Service Act and part 7 of
subtitle B of title I of the Employee Retirement Income Security Act of
1974 to establish standards for the health quality improvement of
children in managed care plans and other health plans.
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 ``Children's Health Insurance
Accountability Act of 1998''.
SEC. 2. FINDINGS; PURPOSE.
(a) Findings.--Congress makes the following findings:
(1) Children have health and development needs that are
markedly different than those for the adult population.
(2) Children experience complex and continuing changes
during the continuum from birth to adulthood in which
appropriate health care is essential for optimal development.
Their organ systems, bones, immunologic and cognitive systems
all go through different developmental stages before reaching
maturation and therefore, depending on age and state of
development, respond differently to both illness and treatment.
(3) The vast majority of work done on development methods
to assess the effectiveness of health care services and the
impact of medical care on patient outcomes and patient
satisfaction has been focused on adults.
(4) Health outcome measures need to be age, gender, and
developmentally appropriate to be useful to families and
children.
(5) Costly disorders of adulthood often have their origins
in childhood, making early access to effective health services
in childhood essential.
(6) More than 200 chronic conditions, disabilities and
diseases affect children, including asthma, diabetes, sickle
cell anemia, spina bifida, epilepsy, autism, cerebral palsy,
congenital heart disease, mental retardation, and cystic
fibrosis. These children need the services of specialists who
have indepth knowledge about their particular condition.
(7) Children's patterns of illness, disability and injury
differ dramatically from adults.
(8) Children are dependent on adults and community
institutions to promote their health and well-being and so they
are a particularly vulnerable population.
(9) Children are smaller than adults, ranging in size from
very premature infants to adult-sized adolescents. As a result,
smaller children are vulnerable to sudden shifts in conditions,
medication must be more finely calibrated, and procedures can
be more difficult.
(10) Children are our nation's poorest population and with
that poverty often comes increased vulnerability and reduced
access to needed health care services that are characterized by
lack of continuity of care, delays in obtaining care, and
limited choices about where and from whom care may be received.
(11) Children with special health care needs are
particularly vulnerable because only a very small percentage of
children have a major illness, injury, or congenital condition,
and private managed care plans often have little experience in
serving such children.
(12) Children do not command a large amount of influence in
the health care marketplace; they account for less than 15
percent of national health care spending.
(13) Research related to child and adolescent health and
development is underrepresented in comparison to our nation's
research commitment to other national priorities.
(14) In comparison to children in other industrialized
nations, the health status of children in this country
continues to fall short in areas such as infant mortality,
death by injury or accident, and suicide.
(15) An excellent delivery health care system promoting
improved pediatric health would be child and family centered,
accessible, continuous, comprehensive, coordinated, compassionate,
offer specialized services, ensure quality assurance, and provide
relevant data and information.
(16) Assuring that children receive what they need from the
health system is a special responsibility of adults--
individually as parents and collectively as a society--and
problems found in the health care system for children should be
identified and corrected quickly so that our children grow into
healthy and productive adults.
(b) Purpose.--It is the purpose of this Act to establish and
implement quality standards for the protection of children under group
health plans and health insurance coverage that are intended to
supplement any consumer protections intended to cover all individuals
covered under such plans or coverage.
SEC. 3. AMENDMENTS TO THE PUBLIC HEALTH SERVICE ACT.
(a) In General.--Title XXVII of the Public Health Service Act is
amended--
(1) by redesignating part C as part D; and
(2) by inserting after part B the following new part:
``Part C--Children's Health Protection Standards
``SEC. 2770. ACCESS TO CARE.
``(a) Access to Appropriate Primary Care Providers.--
``(1) In general.--If a group health plan, or a health
insurance issuer, in connection with the provision of health
insurance coverage, requires or provides for an enrollee to
designate a participating primary care provider for a child of
such enrollee--
``(A) the plan or issuer shall permit the enrollee
to designate a physician who specializes in pediatrics
as the child's primary care provider; and
``(B) if such an enrollee has not designated such a
provider for the child, the plan or issuer shall
consider appropriate pediatric expertise in mandatorily
assigning such an enrollee to a primary care provider.
``(2) Construction.--Nothing in paragraph (1) shall waive
any requirements of coverage relating to medical necessity or
appropriateness with respect to coverage of services.
``(b) Access to Pediatric Specialty Services.--
``(1) Referral to speciality care for children requiring
treatment by specialists.--
``(A) In general.--In the case of a child who is
covered under a group health plan, or under health
insurance coverage offered by a health insurance
issuer, and who has a mental or physical condition,
disability, or disease of sufficient seriousness and
complexity to require diagnosis, evaluation or
treatment by a specialist, the plan or issuer shall
make or provide for a referral to a specialist who has
extensive experience or training, and is available and
accessible to provide the treatment for such condition
or disease, including the choice of a nonprimary care
physician specialist participating in the plan or a
referral to a nonparticipating provider as provided for
under subparagraph (D) if such a provider is not
available within the plan.
``(B) Specialist defined.--For purposes of this
subsection, the term `specialist' means, with respect
to a condition, disability, or disease, a health care
practitioner, facility, or center (such as a center of
excellence) that has extensive pediatric expertise
through appropriate training or experience to provide
high quality care in treating the condition,
disability, or disease.
``(C) Referrals to participating providers.--A plan
or issuer is not required under subparagraph (A) to
provide for a referral to a specialist that is not a
participating provider, unless the plan or issuer does
not have an appropriate specialist that is available
and accessible to treat the enrollee's condition and
that is a participating provider with respect to such
treatment.
``(D) Treatment of nonparticipating providers.--If
a plan or issuer refers a child enrollee to a
nonparticipating specialist, services provided pursuant
to the referral shall be provided at no additional cost
to the enrollee beyond what the enrollee would
otherwise pay for services received by such a
specialist that is a participating provider.
``(E) Specialists as primary care providers.--A
plan or issuer shall have in place a procedure under
which a child who is covered under the coverage
provided by the plan or issuer who has a condition or
disease that requires specialized medical care over a
prolonged period of time shall receive a referral to a
pediatric specialist affiliated with the plan or
issuer, or if not available within the plan or
coverage, to a nonparticipating provider for such
condition and such specialist may be responsible for
and capable of providing and coordinating the child's
primary and specialty care.
``(2) Standing referrals.--
``(A) In general.--A group health plan, or health
insurance issuer in connection with the provision of
health insurance coverage, shall have a procedure by
which a child who is a participant, beneficiary, or
enrollee under the plan or coverage and who has a
condition, disability, or disease that requires ongoing
care from a specialist may request and obtain a
standing referral to such specialist for treatment of
such condition. If the primary care provider in
consultation with the medical director of the plan or
issuer and the specialist (if any), determines that
such a standing referral is appropriate, the plan or
issuer shall authorize such a referral to such a
specialist. Such standing referral shall be consistent
with a treatment plan.
``(B) Treatment plans.--A group health plan, or
health insurance issuer, with the participation of the
family and the health care providers of the child,
shall develop a treatment plan for a child who requires
ongoing care that covers a specified period of time
(but in no event less than a 6-month period). Services
provided for under the treatment plan shall not require
additional approvals or referrals through a gatekeeper.
``(C) Terms of referral.--The provisions of
subparagraph (C) and (D) of paragraph (1) shall apply
with respect to referrals under subparagraph (A) in the
same manner as they apply to referrals under paragraph
(1)(A).
``(c) Adequacy of Access.--For purposes of subsections (a) and (b),
a group health plan or health insurance issuer in connection with
health insurance coverage shall ensure that a sufficient number,
distribution, and variety of qualified participating health care
providers are available so as to ensure that all covered health care
services, including specialty services, are available and accessible to
all enrollees who are children in a timely manner.
``(d) Coverage of Emergency Services.--
``(1) In general.--If a group health plan, or health
insurance coverage offered by a health insurance issuer,
provides any benefits for children with respect to emergency
services (as defined in paragraph (2)(A)), the plan or issuer
shall cover emergency services furnished under the plan or
coverage to such enrollees--
``(A) without the need for any prior authorization
determination;
``(B) whether or not the physician or provider
furnishing such services is a participating physician
or provider with respect to such services; and
``(C) without regard to any other term or condition
of such coverage (other than exclusion of benefits, or
an affiliation or waiting period, permitted under
section 2701).
``(2) Definitions.--In this subsection:
``(A) Emergency medical condition based on prudent
layperson standard.--The term `emergency medical
condition' means a medical condition manifesting itself
by acute symptoms of sufficient severity (including
severe pain) such that a prudent layperson, who
possesses an average knowledge of health and medicine,
could reasonably expect the absence of immediate
medical attention to result in a condition described in
clause (i), (ii), or (iii) of section 1867(e)(1)(A) of
the Social Security Act.
``(B) Emergency services.--The term `emergency
services' means--
``(i) a medical screening examination (as
required under section 1867 of the Social
Security Act) that is within the capability of
the emergency department of a hospital,
including ancillary services routinely
available to the emergency department to
evaluate an emergency medical condition (as
defined in subparagraph (A)); and
``(ii) within the capabilities of the staff
and facilities available at the hospital, such
further medical examination and treatment as
are required under section 1867 of such Act to
stabilize the patient.
``(3) Reimbursement for maintenance care and post-
stabilization care.--A group health plan, and health insurance
issuer offering health insurance coverage, shall provide, in
covering services other than emergency services for enrollees
who are children, for reimbursement with respect to services
which are otherwise covered and which are provided to an
enrollee other than through the plan or issuer if the services
are maintenance care or post-stabilization care covered under
the guidelines established under section 1852(d) of the Social
Security Act (relating to promoting efficient and timely
coordination of appropriate maintenance and post-stabilization
care of an enrollee after an enrollee has been determined to be
stable).
``(e) Prohibition on Financial Barriers.--A health insurance issuer
in connection with the provision of health insurance coverage may not
impose any cost sharing for pediatric specialty services provided under
such coverage to children who are enrollees in amounts that exceed the
cost-sharing required for other specialty care under such coverage.
``(f) Children With Special Health Care Needs.--A health insurance
issuer in connection with the provision of health insurance coverage
shall ensure that such coverage provides special consideration for the
provision of services to children with special health care needs who
are enrolled under the coverage. Appropriate procedures shall be
implemented to provide care for children with special health care
needs. The development of such procedures shall include participation
by the families of such children.
``(g) Definitions.--In this part:
``(1) Child.--The term `child' means an individual who is
under 19 years of age.
``(2) Children with special health care needs.--The term
`children with special health care needs' means those children
who have or are at elevated risk for chronic physical,
developmental, behavioral or emotional conditions and who also
require health and related services of a type and amount not
usually required by other children.
``SEC. 2771. CONTINUITY OF CARE.
``(a) In General.--If a contract between a health insurance issuer,
in connection with the provision of health insurance coverage, and a
health care provider is terminated (other than by the issuer for
failure to meet applicable quality standards or for fraud) and an
enrollee who is a child is undergoing a course of treatment from the
provider at the time of such termination, the issuer shall--
``(1) notify the parent or guardian of the enrollee of such
termination, and
``(2) subject to subsection (c), permit the enrollee to
continue the course of treatment with the provider during a
transitional period (provided under subsection (b)).
``(b) Transitional Period.--
``(1) In general.--Except as provided in paragraphs (2)
through (4), the transitional period under this subsection
shall extend for at least--
``(A) 60 days from the date of the notice to the
enrollee's parent or guardian of the provider's
termination in the case of a primary care provider, or
``(B) 120 days from such date in the case of
another provider.
``(2) Institutional care.--The transitional period under
this subsection for institutional or inpatient care from a
provider shall extend until the discharge or termination of the
period of institutionalization and shall include reasonable
follow-up care related to the institutionalization and shall
also include institutional care scheduled prior to the date of
termination of the provider status.
``(3) Pregnancy.--If--
``(A) an enrollee has entered the second trimester
of pregnancy at the time of a provider's termination of
participation, and
``(B) the provider was treating the pregnancy
before date of the termination,
the transitional period under this subsection with respect to
provider's treatment of the pregnancy shall extend through the
provision of post-partum care directly related to the delivery.
``(4) Terminal illness.--
``(A) In general.--If--
``(i) an enrollee was determined to be
terminally ill (as defined in subparagraph (B))
at the time of a provider's termination of
participation, and
``(ii) the provider was treating the
terminal illness before the date of
termination,
the transitional period under this subsection shall
extend for the remainder of the enrollee's life for
care directly related to the treatment of the terminal
illness.
``(B) Definition.--In subparagraph (A), an enrollee
is considered to be `terminally ill' if the enrollee
has a medical prognosis that the enrollee's life
expectancy is 6 months or less.
``(c) Permissible Terms and Conditions.--An issuer may condition
coverage of continued treatment by a provider under subsection (a)(2)
upon the provider agreeing to the following terms and conditions:
``(1) The provider agrees to continue to accept
reimbursement from the issuer at the rates applicable prior to
the start of the transitional period as payment in full.
``(2) The provider agrees to adhere to the issuer's quality
assurance standards and to provide to the issuer necessary
medical information related to the care provided.
``(3) The provider agrees otherwise to adhere to the
issuer's policies and procedures, including procedures
regarding referrals and obtaining prior authorization and
providing services pursuant to a treatment plan approved by the
issuer.
``SEC. 2772. CONTINUOUS QUALITY IMPROVEMENT.
``(a) In General.--A group health plan that covers children, and a
health insurance issuer that offers health insurance coverage for
children, shall establish and maintain an ongoing, internal quality
assurance program that at a minimum meets the requirements of
subsection (b) with respect to the coverage of children.
``(b) Requirements.--The internal quality assurance program of a
plan or issuer under subsection (a) shall--
``(1) establish and measure a set of health care,
functional assessments, structure, processes and outcomes, and
quality indicators that are unique to children and based on
nationally accepted standards or guidelines of care;
``(2) maintain written protocols consistent with recognized
clinical guidelines or current consensus on the pediatric
field, to be used for purposes of internal utilization review,
with periodic updating and evaluation by pediatric specialists
to determine effectiveness in controlling utilization;
``(3) provide for peer review by health care professionals
of the structure, processes, and outcomes related to the
provision of health services, including pediatric review of
pediatric cases;
``(4) include in member satisfaction surveys, questions on
child and family satisfaction and experience of care, including
care to children with special needs;
``(5) monitor and evaluate the continuity of care with
respect to children;
``(6) include pediatric measures that are directed at
meeting the needs of children with special health care needs,
including at-risk children and children with chronic
conditions, disabilities and severe illnesses;
``(7) maintain written guidelines to ensure the
availability of medications appropriate to children;
``(8) use focused studies of care received by children with
certain types of chronic conditions and disabilities and
focused studies of specialized services used by children with
chronic conditions and disabilities;
``(9) monitor access to pediatric specialty services; and
``(10) monitor child health care professional satisfaction.
``(c) Utilization Review Activities.--
``(1) Compliance with requirements.--
``(A) In general.--A group health plan that covers
children, and a health insurance issuer that offers
health insurance coverage for children, shall conduct
utilization review activities in connection with the
provision of such coverage only in accordance with a
utilization review program that meets at a minimum the
requirements of this subsection.
``(B) Definitions.--In this subsection:
``(i) Clinical peers.--The term `clinical
peer' means, with respect to a review, a
physician or other health care professional who
holds a non-restricted license in a State and
in the same or similar specialty as typically
manages the pediatric medical condition,
procedure, or treatment under review.
``(ii) Health care professional.--The term
`health care professional' means a physician or
other health care practitioner licensed or
certified under State law to provide health
care services and who is operating within the
scope of such licensure or certification.
``(iii) Utilization review.--The terms
`utilization review' and `utilization review
activities' mean procedures used to monitor or
evaluate the clinical necessity,
appropriateness, efficacy, or efficiency of
health care services, procedures or settings
for children, and includes prospective review,
concurrent review, second opinions, case
management, discharge planning, or
retrospective review specific to children.
``(2) Written policies and criteria.--
``(A) Written policies.--A utilization review
program shall be conducted consistent with written
policies and procedures that govern all aspects of the
program.
``(B) Use of written criteria.--A utilization
review program shall utilize written clinical review
criteria specific to children and developed pursuant to
the program with the input of appropriate physicians,
including pediatricians, nonprimary care pediatric
specialists, and other child health professionals.
``(C) Administration by health care
professionals.--A utilization review program shall be
administered by qualified health care professionals,
including health care professionals with pediatric
expertise who shall oversee review decisions.
``(3) Use of qualified, independent personnel.--
``(A) In general.--A utilization review program
shall provide for the conduct of utilization review
activities only through personnel who are qualified
and, to the extent required, who have received
appropriate pediatric or child health training in the
conduct of such activities under the program.
``(B) Peer review of adverse clinical
determinations.--A utilization review program shall
provide that clinical peers shall evaluate the clinical
appropriateness of adverse clinical determinations and
divergent clinical options.
``SEC. 2773. APPEALS AND GRIEVANCE MECHANISMS FOR CHILDREN.
``(a) Internal Appeals Process.--A group health plan with respect
to covered children, and a health insurance issuer in connection with
the provision of health insurance coverage for children, shall
establish and maintain a system to provide for the resolution of
complaints and appeals regarding all aspects of such coverage for
children. Such a system shall include an expedited procedure for
appeals on behalf of a child enrollee in situations in which the time
frame of a standard appeal would jeopardize the life, health, or
development of the child.
``(b) External Appeals Process.--A group health plan that covers
children, and a health insurance issuer in connection with the
provision of health insurance coverage for children, shall provide for
an independent external review process with respect to claims for
children that meets the following requirements:
``(1) External appeal activities shall be conducted through
clinical peers, a physician or other health care professional
who is appropriately credentialed in pediatrics with the same
or similar specialty and typically manages the condition,
procedure, or treatment under review or appeal.
``(2) External appeal activities shall be conducted through
an entity that has sufficient pediatric expertise, including
subspecialty expertise, and staffing to conduct external appeal
activities on a timely basis.
``(3) Such a review process shall include an expedited
procedure for appeals on behalf of a child in which the time
frame of a standard appeal would jeopardize the life, health,
or development of the child.
``SEC. 2774. ACCOUNTABILITY THROUGH DISTRIBUTION OF INFORMATION.
``(a) In General.--A group health plan that covers children and a
health insurance issuer in connection with the provision of health
insurance coverage for children shall submit to participants and
enrollees (and prospective participants and enrollees), and make
available to the public, in writing the health-related information
described in subsection (b).
``(b) Information.--The health-related information to be provided
under subsection (a) shall include a description of the distinctions in
the benefits, processes and outcomes under the plan or coverage between
adult participants, beneficiaries, and enrollees and child
beneficiaries and enrollees and shall include measures with respect to
outcomes that are specific to each such group.''.
(b) Application to Group Health Insurance Coverage.--
(1) In general.--Subpart 2 of part A of title XXVII of the
Public Health Service Act is amended by adding at the end the
following new section:
``SEC. 2706. CHILDREN'S HEALTH ACCOUNTABILITY STANDARDS.
``(a) In General.--Each group health plan, and each health
insurance issuer with respect to group health insurance coverage it
offers, shall comply with children's health accountability requirements
under part C.
``(b) Assuring Coordination.--The Secretary of Health and Human
Services and the Secretary of Labor shall ensure, through the execution
of an interagency memorandum of understanding between such Secretaries,
that--
``(1) regulations, rulings, and interpretations issued by
such Secretaries relating to the same matter over which such
Secretaries have responsibility under part C (and this section)
and section 713 of the Employee Retirement Income Security Act
of 1974 are administered so as to have the same effect at all
times; and
``(2) coordination of policies relating to enforcing the
same requirements through such Secretaries in order to have a
coordinated enforcement strategy that avoids duplication of
enforcement efforts and assigns priorities in enforcement.''.
(2) Conforming amendment.--Section 2792 of the Public
Health Service Act (42 U.S.C. 300gg-92) is amended by inserting
``and section 2706(b)'' after ``of 1996''.
(c) Application to Individual Health Insurance Coverage.--Part B of
title XXVII of the Public Health Service Act is amended by inserting
after section 2751 the following new section:
``SEC. 2752. CHILDREN'S HEALTH ACCOUNTABILITY STANDARDS.
``Each health insurance issuer shall comply with children's health
accountability requirements under part C with respect to individual
health insurance coverage it offers.''.
(d) Modification of Preemption Standards.--
(1) Group health insurance coverage.--Section 2723 of the
Public Health Service Act (42 U.S.C. 300gg-23) is amended--
(A) in subsection (a)(1), by striking ``subsection
(b)'' and inserting ``subsection (b) and (c)'';
(B) by redesignating subsections (c) and (d) as
subsections (d) and (e), respectively; and
(C) by inserting after subsection (b) the following
new subsection:
``(c) Special Rules in Case of Children's Health Accountability
Requirements.--Subject to subsection (a)(2), the provisions of section
2706 and part C, and part D insofar as it applies to section 2706 or
part C, shall not prevent a State from establishing requirements
relating to the subject matter of such provisions so long as such
requirements are at least as stringent on health insurance issuers as
the requirements imposed under such provisions.''.
(2) Individual health insurance coverage.--Section 2762 of
the Public Health Service Act (42 U.S.C. 300gg-62), as added by
section 605(b)(3)(B) of Public Law 104-204, is amended--
(A) in subsection (a), by striking ``subsection
(b), nothing in this part'' and inserting ``subsections
(b) and (c)'', and
(B) by adding at the end the following new
subsection:
``(c) Special Rules in Case of Children's Health Accountability
Requirements.--Subject to subsection (b), the provisions of section
2752 and part C, and part D insofar as it applies to section 2752 or
part C, shall not prevent a State from establishing requirements
relating to the subject matter of such provisions so long as such
requirements are at least as stringent on health insurance issuers as
the requirements imposed under such section.''.
SEC. 3. AMENDMENTS TO THE EMPLOYEE RETIREMENT INCOME SECURITY ACT OF
1974.
(a) In General.--Subpart B of part 7 of subtitle B of title I of
the Employee Retirement Income Security Act of 1974 is amended by
adding at the end the following:
``SEC. 713. CHILDREN'S HEALTH ACCOUNTABILITY STANDARDS.
``(a) In General.--Subject to subsection (b), the provisions of
part C of title XXVII of the Public Health Service Act shall apply
under this subpart and part to a group health plan (and group health
insurance coverage offered in connection with a group health plan) as
if such part were incorporated in this section.
``(b) Application.--In applying subsection (a) under this subpart
and part, and reference in such part C--
``(1) to health insurance coverage is deemed to be a
reference only to group health insurance coverage offered in
connection with a group health plan and to also be a reference
to coverage under a group health plan;
``(2) to a health insurance issuer is deemed to be a
reference only to such an issuer in relation to group health
insurance coverage or, with respect to a group health plan, to
the plan;
``(3) to the Secretary is deemed to be a reference to the
Secretary of Labor; and
``(4) to an enrollee with respect to health insurance
coverage is deemed to include a reference to a participant or
beneficiary with respect to a group health plan.''.
(b) Modification of Preemption Standards.--Section 731 of such Act
(42 U.S.C. 1191) is amended--
(1) in subsection (a)(1), by striking ``subsection (b)''
and inserting ``subsections (b) and (c)'';
(2) by redesignating subsections (c) and (d) as subsections
(d) and (e), respectively; and
(3) by inserting after subsection (b) the following new
subsection:
``(c) Special Rules in Case of Patient Accountability
Requirements.--Subject to subsection (a)(2), the provisions of section
713, shall not prevent a State from establishing requirements relating
to the subject matter of such provisions so long as such requirements
are at least as stringent on group health plans and health insurance
issuers in connection with group health insurance coverage as the
requirements imposed under such provisions.''.
(c) Conforming Amendments.--
(1) Section 732(a) of such Act (29 U.S.C. 1185(a)) is
amended by striking ``section 711'' and inserting ``sections
711 and 713''.
(2) The table of contents in section 1 of such Act is
amended by inserting after the item relating to section 712 the
following new item:
``Sec. 713. Children's health accountability standards.''.
SEC. 4. STUDIES.
(a) By Secretary.--Not later than 1 year after the date of
enactment of this Act, the Secretary of Health and Human Services shall
conduct a study, and prepare and submit to Congress a report,
concerning--
(1) the unique characteristics of patterns of illness,
disability, and injury in children;
(2) the development of measures of quality of care and
outcomes related to the health care of children; and
(3) the access of children to primary mental health
services and the coordination of managed behavioral health
services.
(b) By GAO.--
(1) Managed care.--Not later than 1 year after the date of
enactment of this Act, the General Accounting Office shall
conduct a study, and prepare and submit to the Committee on
Labor and Human Resources of the Senate and the Committee on
Commerce of the House of Representatives a report, concerning--
(A) an assessment of the structure and performance
of non-governmental health plans, medicaid managed care
organizations, plans under title XIX of the Social
Security Act (42 U.S.C. 1396 et seq.), and the program
under title XXI of the Social Security Act (42 U.S.C.
1397aa et seq.) serving the needs of children with
special health care needs;
(B) an assessment of the structure and performance
of non-governmental plans in serving the needs of
children as compared to medicaid managed care
organizations under title XIX of the Social Security
Act (42 U.S.C. 1396 et seq.); and
(C) the emphasis that private managed care health
plans place on primary care and the control of services
as it relates to care and services provided to children
with special health care needs.
(2) Plan survey.--Not later than 1 year after the date of
enactment of this Act, the General Accounting Office shall
prepare and submit to the Committee on Labor and Human
Resources of the Senate and the Committee on Commerce of the
House of Representatives a report that contains a survey of
health plan activities that address the unique health needs of
adolescents, including quality measures for adolescents and
innovative practice arrangement.
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