[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[S. 206 Introduced in Senate (IS)]







106th CONGRESS
  1st Session
                                 S. 206

 To amend title XXI of the Social Security Act to provide for improved 
 data collection and evaluations of State Children's Health Insurance 
                   Programs, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                            January 19, 1999

  Mr. Moynihan (for himself and Mr. Chafee) introduced the following 
  bill; which was read twice and referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
 To amend title XXI of the Social Security Act to provide for improved 
 data collection and evaluations of State Children's Health Insurance 
                   Programs, 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 ``CHIP Data and Evaluation Improvement 
Act of 1999.''.

SEC. 2. FUNDING FOR RELIABLE ANNUAL STATE-BY-STATE ESTIMATES ON THE 
              NUMBER OF CHILDREN WHO DO NOT HAVE HEALTH INSURANCE 
              COVERAGE.

    Section 2108 of the Social Security Act (42 U.S.C.1397hh) is 
amended by adding at the end the following:
    ``(c) Adjustment to Current Population Survey To Include State-by-
State Data Relating to Children Without Health Insurance Coverage.--
            ``(1) In general.--The Secretary of Commerce shall make 
        appropriate adjustments to the annual Current Population Survey 
        conducted by the Bureau of the Census in order to produce 
        statistically reliable annual State data on the number of low-
        income children who do not have health insurance coverage, so 
        that real changes in the uninsurance rates of children can 
        reasonably be detected. The Current Population Survey should 
        produce data under this subsection that categorizes such 
        children by family income, age, and race or ethnicity. The 
        adjustments made to produce such data shall include, where 
        appropriate, expanding the sample size used in the State 
        sampling units, expanding the number of sampling units in a 
        State, and an appropriate verification element.
            ``(2) Appropriation.--Out of any money in the Treasury of 
        the United States not otherwise appropriated, there are 
        appropriated $10,000,000 for fiscal year 2000 and each fiscal 
        year thereafter for the purpose of carrying out this 
        subsection.''.

SEC. 3. FUNDING FOR CHILDREN'S HEALTH CARE ACCESS AND UTILIZATION 
              STATE-BY-STATE DATA.

    Section 2108 of the Social Security Act (42 U.S.C. 1397hh), as 
amended by section 2, is amended by adding at the end the following:
    ``(d) Collection of Children's Health Care Access and Utilization 
State-Level Data.--
            ``(1) In general.--The Secretary, acting through the 
        National Center for Health Statistics (in this subsection 
        referred to as the `Center'), shall collect data on children's 
        health insurance through the State and Local Area Integrated 
        Telephone Survey (SLAITS) for the 50 States and the District of 
        Columbia. Sufficient data shall be collected so as to provide 
        reliable, annual, State-by-State information on the health care 
        access and utilization of children in low-income households, 
        and to allow for comparisons between demographic subgroups 
        categorized with respect to family income, age, and race or 
        ethnicity.
            ``(2) Survey design and content.--
                    ``(A) In general.--In carrying out paragraph (1), 
                the Secretary, acting through the Center--
                            ``(i) shall obtain input from appropriate 
                        sources, including States, in designing the 
                        survey and making content decisions; and
                            ``(ii) at the request of a State, may 
                        collect additional data to assist with a 
                        State's evaluation of the program established 
                        under this title.
                    ``(B) Reimbursement of costs of additional data.--A 
                State shall reimburse the Center for services provided 
                under subparagraph (A)(ii).
            ``(3) Appropriation.--Out of any money in the Treasury of 
        the United States not otherwise appropriated, there are 
        appropriated $9,000,000 for fiscal year 2000 and each fiscal 
        year thereafter for the purpose of carrying out this 
        subsection.''.

SEC. 4. FEDERAL EVALUATION OF STATE CHILDREN'S HEALTH INSURANCE 
              PROGRAMS.

    Section 2108 of the Social Security Act (42 U.S.C.1397hh), as 
amended by sections 2 and 3, is amended--
            (1) by redesignating subsections (c) and (d) as subsections 
        (d) and (e), respectively; and
            (2) by inserting after subsection (b) the following:
    ``(c) Federal Evaluation.--
            ``(1) In general.--The Secretary, directly or through 
        contracts or interagency agreements, shall conduct an 
        independent evaluation of 10 States with approved child health 
        plans.
            ``(2) Selection of States.--In selecting States for the 
        evaluation conducted under this subsection, the Secretary shall 
        choose 10 States that utilize diverse approaches to providing 
        child health assistance, represent various geographic areas 
        (including a mix of rural and urban areas), and contain a 
        significant portion of uncovered children.
            ``(3) Matters included.--In addition to the elements 
        described in subsection (b)(1), the evaluation conducted under 
        this subsection shall include, but is not limited to, the 
        following:
                    ``(A) Surveys of the target population (enrollees, 
                disenrollees, and individuals eligible for but not 
                enrolled in the program under this title).
                    ``(B) Evaluation of effective and ineffective 
                outreach and enrollment practices with respect to 
                children (for both the program under this title and the 
                medicaid program under title XIX), and identification 
                of enrollment barriers and key elements of effective 
                outreach and enrollment practices, including practices 
                that have successfully enrolled hard-to-reach 
                populations such as children who are eligible for 
                medical assistance under title XIX but have not been 
                enrolled previously in the medicaid program under that 
                title.
                    ``(C) Evaluation of the extent to which State 
                medicaid eligibility practices and procedures under the 
                medicaid program under title XIX are a barrier to the 
                enrollment of children under that program, and the 
                extent to which coordination (or lack of coordination) 
                between that program and the program under this title 
                affects the enrollment of children under both programs.
                    ``(D) An assessment of the effect of cost-sharing 
                on utilization, enrollment, and coverage retention.
                    ``(E) Evaluation of disenrollment or other 
                retention issues, such as switching to private 
                coverage, failure to pay premiums, or barriers in the 
                recertification process.
            ``(4) Submission to congress.--Not later than December 31, 
        2001, the Secretary shall submit to Congress the results of the 
        evaluation conducted under this subsection.
            ``(5) Funding.--Out of any money in the Treasury of the 
        United States not otherwise appropriated, there are 
        appropriated $10,000,000 for fiscal year 2000 for the purpose 
        of conducting the evaluation authorized under this subsection. 
        Amounts appropriated under this paragraph shall remain 
        available without fiscal year limitation.''.

SEC. 5. STANDARDIZED REPORTING REQUIREMENTS FOR ANNUAL REPORTS.

    Section 2108(a) of the Social Security Act (42 U.S.C. 1397hh(a)) is 
amended by--
            (1) redesignating paragraphs (1) and (2) as subparagraphs 
        (A) and (B), respectively and indenting appropriately;
            (2) by striking ``The State shall--'' and inserting the 
        following
            ``(1) In general.--The State shall--''; and
            (3) by adding at the end the following:
            ``(2) Standardized reporting requirements.--Each annual 
        report submitted under this subsection shall, in addition to 
        expenditure and other reporting requirements specified by the 
        Secretary, include the following:
                    ``(A) Enrollee counts categorized by income (that 
                at least identifies enrollees with income below the 
                poverty line), age, and race or ethnicity, and, if 
                income levels used in State reporting differ from that 
                prescribed by the Secretary, a detailed description of 
                the eligibility methodologies used by the State, 
                including all relevant income disregards, exempted 
                income, and eligibility family units.
                    ``(B) The annual percentages of those individuals 
                who sought coverage (as determined by the Secretary) 
                through the screening and enrollment process 
                established under the State program under this title 
                who were--
                            ``(i) enrolled in the program under this 
                        title;
                            ``(ii) enrolled in the medicaid program 
                        under title XIX; or
                            ``(iii) determined eligible for, but not 
                        enrolled in, the program under this title or 
                        the medicaid program under title XIX.''.

SEC. 6. INSPECTOR GENERAL AUDIT AND GAO REPORT ON ENROLLEES ELIGIBLE 
              FOR MEDICAID.

    Section 2108 of the Social Security Act (42 U.S.C.1397hh), as 
amended by section 4, is amended by adding at the end the following:
    ``(f) Inspector General Audit and GAO Report.--
            ``(1) Audit.--Beginning with fiscal year 2000, and every 
        third fiscal year thereafter, the Secretary, through the 
        Inspector General of the Department of Health and Human 
        Services, shall audit a sample from among the States described 
        in paragraph (2) in order to--
                    ``(A) determine the number, if any, of enrollees 
                under the plan under this title who are eligible for 
                medical assistance under title XIX (other than as an 
                optional targeted low-income children under section 
                1902(a)(10)(A)(ii)(XIV)); and
                    ``(B) assess the progress made in reducing the 
                number of targeted uncovered low-income children 
                relative to the goals established in the State child 
                health plan, as reported to the Secretary in accordance 
                with subsection (a)(2).
            ``(2) State described.--A State described in this paragraph 
        is a State with an approved State child health plan under this 
        title that does not, as part of such plan, provide health 
        benefits coverage under the State's medicaid program under 
        title XIX.
            ``(3) Monitoring and report from gao.--The Comptroller 
        General of the United States shall monitor the audits conducted 
        under this subsection and, not later than March 1 of each 
        fiscal year after a fiscal year in which an audit is conducted 
        under this subsection, shall submit a report to Congress on the 
        results of the audit conducted during the prior fiscal year.''.

SEC. 7. COORDINATION OF DATA COLLECTION WITH DATA REQUIREMENTS UNDER 
              THE MATERNAL AND CHILD HEALTH SERVICES BLOCK GRANT.

    Subparagraphs (C)(ii) and (D)(ii) of section 506(a)(2) of the 
Social Security Act (42 U.S.C. 706(a)(2)) are each amended by inserting 
``or the State plan under title XXI'' after ``title XIX''.

SEC. 8. COORDINATION OF DATA SURVEYS AND REPORTS.

    The Secretary of Health and Human Services, through the Assistant 
Secretary for Planning and Evaluation, shall establish a clearinghouse 
for the consolidation and coordination of all Federal data bases and 
reports regarding children's health.
                                 <all>