1.This Act may be cited as the
Advancing Better Coverage and Care for
Children's Health Act of 2005
or the ABCs for Children's Health Act of
2005
.
2.The table of contents
for this Act is as follows:
Sec. 1. Short
title.
Sec. 2. Table of contents.
TITLE I—Covering Children
Sec. 101. Phased-in application of enhanced FMAP for children
whose eligibility is optional under medicaid.
Sec. 102. Enhanced matching rate for the effective enrollment
and retention of children under medicaid.
Sec. 103. Preserving comprehensive benefits appropriate to
children's needs.
TITLE II—Advancing Quality and Performance: Innovations in
Care
Sec. 201. Purpose.
Sec. 202. National quality forum; advancing consensus-based
pediatric quality and performance measures.
Sec. 203. Research grant program; developing new pediatric
quality and performance measures.
Sec. 204. Medicaid demonstration program; evaluating
evidence-based quality and performance measures for children's health
services.
Sec. 205. Funding.
TITLE III—Ensuring Access to Care
Sec. 301. Pay for performance for children's critical access
hospitals.
Sec. 302. Inclusion of children's hospitals as covered entities
for purposes of limitation of purchased drug price.
<enum>I</enum><header>Covering Children</header>
<section commented="no" display-inline="no-display-inline" id="id9AE2C8F9968642E891DA19640E1404E0" section-type="subsequent-section"><enum>101.</enum><header>Phased-in
application of enhanced fmap for children whose eligibility is optional under
medicaid</header>
<subsection commented="no" display-inline="no-display-inline" id="id449A6C01FB99465EBC37DD17A9EC2485"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">The first sentence of
section 1905 of the Social Security Act (42 U.S.C. 1396d) is amended—</text>
<paragraph commented="no" display-inline="no-display-inline" id="id9A8AF129D0A34A049D5F2A06485EEF4D"><enum>(1)</enum><text display-inline="yes-display-inline">in subsection (b)—</text>
<subparagraph commented="no" display-inline="no-display-inline" id="id3B9123A5AA8C44A3A1C81382F6789F09"><enum>(A)</enum><text display-inline="yes-display-inline">by striking <quote>and (4)</quote> and
inserting <quote>(4)</quote>; and</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="id1F4E073AF4C44B769D8946A7EE51963C"><enum>(B)</enum><text display-inline="yes-display-inline">by inserting before the period the
following: <quote>, and (5) the Federal medical assistance percentage shall be
equal to the applicable percentage determined under subsection (y) with respect
to medical assistance provided to children who are eligible for such assistance
on the basis of subsection (a)(10)(A)(ii), (a)(10)(C), (e)(3), or (e)(9) of
section 1902, or a waiver under subsection (c) or (e) of section 1915, or who
are eligible for such assistance during a presumptive eligibility period under
section 1920A (but only if the child is not eligible for medical assistance on
the basis of section 1902(a)(10)(A)(i))</quote>; and</text>
</subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="idD267CB211AD141F58DA5BAD718AD75DC"><enum>(2)</enum><text display-inline="yes-display-inline">by adding at the end the following:</text>
<quoted-block display-inline="no-display-inline" id="idA7B9CE7A49CA48B9A3A1C54F11A5BF47" style="OLC">
<subsection commented="no" display-inline="no-display-inline" id="idAEC81011E8534F89A0B2C76F0DC23062"><enum>(y)</enum><text display-inline="yes-display-inline">For purposes of the fifth clause of the
first sentence of subsection (b), the applicable percentage determined under
this subsection is—</text>
<paragraph commented="no" display-inline="no-display-inline" id="id63662C14A05746D9AF51D9993C016352"><enum>(1)</enum><text display-inline="yes-display-inline">in the case of fiscal year 2006, the
enhanced FMAP determined under section 2105(b) by substituting <quote>6
percent</quote> for <quote>30 percent</quote> in such section;</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="id60DA57232FDA4122B662071E2CACCAFC"><enum>(2)</enum><text display-inline="yes-display-inline">in the case of fiscal year 2007, the
enhanced FMAP determined under section 2105(b) by substituting <quote>12
percent</quote> for <quote>30 percent</quote> in such section;</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="idAEB8754F86324BEA8B343AF4A7641157"><enum>(3)</enum><text display-inline="yes-display-inline">in the case of fiscal year 2008, the
enhanced FMAP determined under section 2105(b) by substituting <quote>18
percent</quote> for <quote>30 percent</quote> in such section;</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="idCD12CAD09CDB49E88EE60D7793F6FA76"><enum>(4)</enum><text display-inline="yes-display-inline">in the case of fiscal year 2009, the
enhanced FMAP determined under section 2105(b) by substituting <quote>24
percent</quote> for <quote>30 percent</quote> in such section; and</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="idA5E79D64AFF441B9AE544C90D1B3DB78"><enum>(5)</enum><text display-inline="yes-display-inline">in the case of fiscal year 2010 or any
fiscal year thereafter, the enhanced FMAP determined under section
2105(b).</text>
</paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="idA97A245CB3A5495389F56CD38DC18890"><enum>(b)</enum><header>Effective
date</header><text display-inline="yes-display-inline">The amendments made by
subsection (a) take effect on October 1, 2005.</text>
</subsection></section><section commented="no" display-inline="no-display-inline" id="id17F9709943834128BCA4661555B93B4A" section-type="subsequent-section"><enum>102.</enum><header>Enhanced matching
rate for the effective enrollment and retention of children under
medicaid</header>
<subsection commented="no" display-inline="no-display-inline" id="id201727E360BC4506A15E4788532E40E7"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">Section 1903(a)(3) of
the Social Security Act (42 U.S.C. 1396b(a)(3)) is amended—</text>
<paragraph commented="no" display-inline="no-display-inline" id="idD2CB97B36ABA44348BC51ABFC5D20B23"><enum>(1)</enum><text display-inline="yes-display-inline">in subparagraph (E), by striking
<quote>plus</quote> at the end and inserting <quote>and</quote>; and</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="idC7BBF57E19DD44EF9A3B6AAE9648DA15"><enum>(2)</enum><text display-inline="yes-display-inline">by adding at the end the following:</text>
<quoted-block display-inline="no-display-inline" id="id27E7F96365D34907B2F237265F75F9CF" style="OLC">
<subparagraph commented="no" display-inline="no-display-inline" id="id1950B7736698472695147A124C6D758E"><enum>(F)</enum><text display-inline="yes-display-inline">90 percent of the sums expended during such
quarter which are attributable to the design, development, implementation, and
evaluation of such enrollment systems as the Secretary determines are likely to
provide more efficient and effective administration of the plan’s enrollment
and retention of eligible children, including—</text>
<clause commented="no" display-inline="no-display-inline" id="id1B3D2FC9CCE146FCA7777FEE354B2137"><enum>(i)</enum><text display-inline="yes-display-inline"><quote>express lane</quote> enrollment for
children through procedures to ensure that children's eligibility for medical
assistance is determined and expedited through the use of technology and shared
information with other public benefit programs, such as the school lunch
program under the Richard B. Russell National School Lunch Act and the food
stamp program under the Food Stamp Act of 1977;</text>
</clause><clause commented="no" display-inline="no-display-inline" id="id8B43C59D80394E90BCE6C0B4B34AA68E"><enum>(ii)</enum><text display-inline="yes-display-inline">a single, simplified application form for
medical assistance under this title and for children's health assistance under
title XXI;</text>
</clause><clause commented="no" display-inline="no-display-inline" id="id27EE6C0F45284D138F9DF3A79F4A5AF8"><enum>(iii)</enum><text display-inline="yes-display-inline">procedures which allow for the enrollment
of children by mail or through the Internet;</text>
</clause><clause commented="no" display-inline="no-display-inline" id="id372768BFF5674128B0DD6663F0A30D57"><enum>(iv)</enum><text display-inline="yes-display-inline">the timely evaluation, assistance, and
determination of presumptive eligibility under section 1920A;</text>
</clause><clause commented="no" display-inline="no-display-inline" id="idB71271A05B5045A08C08800824C2A2A6"><enum>(v)</enum><text display-inline="yes-display-inline">procedures which allow for passive
reenrollment of children to protect against the loss of coverage among eligible
children; and</text>
</clause><clause commented="no" display-inline="no-display-inline" id="id4580E5927DC34C44B62391352FD0BF6D"><enum>(vi)</enum><text display-inline="yes-display-inline">such other enrollment system changes as the
Secretary determines are likely to provide more efficient and effective
administration of the plan's enrollment and retention of eligible children;
plus</text>
</clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="id928C04A9A66C49C19FA2EA9DF2C8198B"><enum>(b)</enum><header>Exclusion from
erroneous excess payment determination</header><text display-inline="yes-display-inline">Section 1903(u)(1)(D) of such Act (42
U.S.C. 1396a(u)(1)(D)) is amended by adding at the end the following:</text>
<quoted-block display-inline="no-display-inline" id="id6E82D4EE38D543CFBF8CEBE502D1AD80" style="OLC">
<clause commented="no" display-inline="no-display-inline" id="id1FB9A47E6A61484A989582696BAB2053"><enum>(vi)</enum><subclause commented="no" display-inline="yes-display-inline" id="id5D0B629AD5B3452493E75A7A8920F055"><enum>(I)</enum><text display-inline="yes-display-inline">Notwithstanding clauses (ii) and (iii), and
subject to subclause (II), in determining the amount of erroneous excess
payments, there shall not be included any erroneous payments made with respect
to medical assistance provided to children who are erroneously enrolled or
erroneously provided with continued enrollment under this title as a result of
the application of enrollment systems described in subsection (a)(3)(F).</text>
</subclause><subclause commented="no" display-inline="no-display-inline" id="idA8F19FA258B8490084BEBB30691995FF" indent="up1"><enum>(II)</enum><text display-inline="yes-display-inline">Subclause (I) shall only apply with respect
to erroneous payments made during the first 5 fiscal years that begin on or
after the date of enactment of this
clause.</text>
</subclause></clause><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection></section><section commented="no" display-inline="no-display-inline" id="ID2909E954E5554DC8A22B72F4C2236522" section-type="subsequent-section"><enum>103.</enum><header>Preserving
comprehensive benefits appropriate to children's needs</header>
<subsection commented="no" display-inline="no-display-inline" id="idBEF7A15DD8894E04B8CC416EAB67C147"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">Title XIX of the
<act-name parsable-cite="SSA">Social Security Act</act-name> is amended by
inserting after section 1925 the following:</text>
<quoted-block act-name="Social Security Act" display-inline="no-display-inline" id="ID42110733CC224C43B57C4C215382A6C0" style="traditional"><section commented="no" display-inline="no-display-inline" id="ID30CA6D18BC654228BA365682D362D89C" section-type="subsequent-section"><enum>1926.</enum><header>Clarification of authority under section
1115 </header><text display-inline="yes-display-inline">The Secretary may not impose or approve
under the authority of section 1115 an elimination or modification of the
amount, duration, or scope of the services described in section 1905(a)(4)(B)
(relating to early and periodic screening, diagnostic, and treatment services
(as defined in section 1905(r))) or of the requirements of subparagraphs (A)
through (C) of section
1902(a)(43).</text>
</section><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection commented="no" display-inline="no-display-inline" id="id82E11E2F2C1B4E43A628E991A30873D4"><enum>(b)</enum><header>Effective
date</header>
<paragraph commented="no" display-inline="no-display-inline" id="IDA74EE074094C4D328B37DBE9ADB1B037"><enum>(1)</enum><header>In
general</header><text display-inline="yes-display-inline">Except as provided in
paragraph (2), section 1926 of the Social Security Act, as added by subsection
(a), shall apply to the approval on or after the date of enactment of this Act
of—</text>
<subparagraph commented="no" display-inline="no-display-inline" id="IDE9EE82C5C1A2498495FCDB8948305D98"><enum>(A)</enum><text display-inline="yes-display-inline">a waiver, experimental, pilot, or
demonstration project under section 1115 of the <act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C. 1315); and</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="IDAD1851F24DDD438185FF42A94967F521"><enum>(B)</enum><text display-inline="yes-display-inline">an amendment or extension of such a
project.</text>
</subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="ID6213B6C0A6C945B7BCEF2133C877001A"><enum>(2)</enum><header>Exception</header><text display-inline="yes-display-inline">Section 1926 of the Social Security Act, as
so added, shall not apply with respect to any extension of approval of a
waiver, experimental, pilot, or demonstration project with respect to title XIX
of the <act-name parsable-cite="SSA">Social Security Act</act-name> that was
first approved before 1994 and that provides a comprehensive and preventive
child health program under such project that includes screening, diagnosis, and
treatment of children who have not attained age 21.</text>
</paragraph></subsection></section><enum>II</enum><header>Advancing Quality and Performance:
Innovations in Care</header>
<section commented="no" display-inline="no-display-inline" id="idE4EFFDA5C2D1499490E8E82F07CD0B88" section-type="subsequent-section"><enum>201.</enum><header>Purpose</header><text display-inline="no-display-inline">The purpose of this title is to increase the
quality of the health care furnished to children under the health insurance
programs under titles XIX and XXI of the Social Security Act.</text>
</section><section commented="no" display-inline="no-display-inline" id="idC19DE4383F8D4B04AB72EABB22FA85A8" section-type="subsequent-section"><enum>202.</enum><header>National quality
forum; advancing consensus-based pediatric quality and performance
measures</header>
<subsection commented="no" display-inline="no-display-inline" id="id9D00D3BB71B64DA8B15D0776BA098980"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">The Secretary of
Health and Human Services (in this title referred to as the
<quote>Secretary</quote>), acting through the Director of the Center for
Medicaid and State Operations of the Centers for Medicare & Medicaid
Services, shall enter into agreements with the National Quality Forum to
facilitate the development of consensus-based pediatric quality and performance
measures.</text>
</subsection><subsection commented="no" display-inline="no-display-inline" id="id9F9B5A3B4F6947128A17CBBBD1325EA2"><enum>(b)</enum><header>Consultation</header><text display-inline="yes-display-inline">In carrying out agreements under subsection
(a), the Director of the Center for Medicaid and State Operations shall consult
with—</text>
<paragraph commented="no" display-inline="no-display-inline" id="id71A181ED96CF475BBD6C34A0DC02D631"><enum>(1)</enum><text display-inline="yes-display-inline">the Agency for Healthcare Research and
Quality; and</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="id27D94F4595C94745BF9FA916BB544AA4"><enum>(2)</enum><text display-inline="yes-display-inline">national pediatric provider groups.</text>
</paragraph></subsection></section><section commented="no" display-inline="no-display-inline" id="id12A1CAC9EF044A11A99D6897560B2E0F" section-type="subsequent-section"><enum>203.</enum><header>Research grant
program; developing new pediatric quality and performance measures</header>
<subsection commented="no" display-inline="no-display-inline" id="idF4DA96619B3B49BFAFED96C207D9EBD5"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">The Secretary, acting
through the Administrator of the Agency for Healthcare Research and Quality,
shall award grants to eligible entities for the development and evaluation of
pediatric quality and performance measures.</text>
</subsection><subsection commented="no" display-inline="no-display-inline" id="idC658FB4CC2F14BD5BA00B6F2309D2F51"><enum>(b)</enum><header>Eligible entity
defined</header><text display-inline="yes-display-inline">In this section, the
term <quote>eligible entity</quote> means—</text>
<paragraph commented="no" display-inline="no-display-inline" id="id9A0A723814D9493A994D78E024803E90"><enum>(1)</enum><text display-inline="yes-display-inline">an institution or multiple institutions
with demonstrated expertise and capacity to evaluate pediatric quality and
performance measures;</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="id60D51F18BCE14F5CBDA85C17A2AF9489"><enum>(2)</enum><text display-inline="yes-display-inline">a National nonprofit association of
pediatric academic medical centers with demonstrated experience in working with
other pediatric provider and accrediting organizations in developing quality
and performance measures for children’s inpatient and outpatient care;
and</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="id5B3A02F4D63845BF8E41A74026C4A154"><enum>(3)</enum><text display-inline="yes-display-inline">a collaboration of national pediatric
organizations working to improve quality and performance in pediatric critical
care.</text>
</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="id8A8D4E79EF7A4D80865324B66B421446"><enum>(c)</enum><header>Application</header><text display-inline="yes-display-inline">Each eligible entity desiring a grant under
this section shall submit an application to the Secretary at such time, in such
manner, and accompanied by such information as the Secretary may
require.</text>
</subsection></section><section commented="no" display-inline="no-display-inline" id="idB821B965AAEC450EBF0C7FF90A446CA3" section-type="subsequent-section"><enum>204.</enum><header>Medicaid
demonstration program; evaluating evidence-based quality and performance
measures for children's health services</header>
<subsection commented="no" display-inline="no-display-inline" id="id16C3C598DED7429E8492F8770D2DFB71"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">Not later than 1 year
after the date of enactment of this Act, the Secretary, acting through the
Director of the Center for Medicaid and State Operations of the Centers for
Medicare & Medicaid Services, shall establish demonstration projects in
each of the 3 categories described in subsection (c) to advance quality and
performance in the delivery of medical assistance provided to children under
the medicaid program established under title XIX of the Social Security Act (42
U.S.C. 1396 et seq.).</text>
</subsection><subsection commented="no" display-inline="no-display-inline" id="id89869AD041B44309BD9B8D553654EB94"><enum>(b)</enum><header>Authority</header>
<paragraph commented="no" display-inline="no-display-inline" id="id68B538665F134606828928A255806E0E"><enum>(1)</enum><header>In
general</header><text display-inline="yes-display-inline">The Secretary is
authorized to award grants to States or providers to conduct such
projects.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="id1C5CE0E30FD9426DB91693A9DCD44F0C"><enum>(2)</enum><header>Use of
funds</header><text display-inline="yes-display-inline">Funds provided under a
grant awarded under this section may be used for administrative costs,
including costs associated with the design, data collection, and evaluation of
the demonstration project conducted with such funds, and other expenditures
that are not otherwise eligible for reimbursement under the medicaid
program.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="id6C8FEFDE75EE48BEACCB1EB6E6B3106F"><enum>(3)</enum><header>Evidence of
organizational commitment required for award of grants</header><text display-inline="yes-display-inline">A State or provider shall not be eligible
to receive a grant to conduct a demonstration project under this section unless
the State or provider demonstrates a commitment to the concept of change and
transformation in the delivery of children's health services. Dedication of
financial resources of the State or provider to the project may be deemed to
demonstrate evidence of such a commitment.</text>
</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="id381422CCDBB4442083185D9A7315BFAB"><enum>(c)</enum><header>Project
categories described</header><text display-inline="yes-display-inline">The 3
demonstration project categories described in this subsection are the
following:</text>
<paragraph commented="no" display-inline="no-display-inline" id="idE3E2A78653924B99AFC509B136C4F852"><enum>(1)</enum><text display-inline="yes-display-inline">Projects that adopt and use health
information technology and evidenced-based outcome measures for pediatric
inpatient and sub-specialty physician care and evaluate the impact of such
technology and measures on the quality, safety, and costs of such care.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="id735AD3943D404524BD9F38CAB72314C6"><enum>(2)</enum><text display-inline="yes-display-inline">Projects that demonstrate and evaluate care
management for children with chronic conditions to determine the extent to
which such management promotes continuity of care, stabilization of medical
conditions, and functional outcomes, prevents or minimizes acute exacerbations
of chronic conditions, and reduces adverse health outcomes and avoidable
hospitalizations.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="id32D626DBD903428D93F17E971D3F7034"><enum>(3)</enum><text display-inline="yes-display-inline">Projects that implement evidenced-based
approaches to improving efficiency, safety, and effectiveness in the delivery
of hospital care for children across hospital services and evaluate the impact
of such changes on the quality and costs of such care.</text>
</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="idE5544F7D0B004487BAD42DBDDA6425DF"><enum>(d)</enum><header>Sites</header><text display-inline="yes-display-inline">To the extent practicable, the Secretary
shall use multiple sites in different geographical locations in conducting each
of the 3 demonstration project categories described in subsection (c).</text>
</subsection><subsection commented="no" display-inline="no-display-inline" id="id06BD2E14C5AA4477B3409C9B910B8449"><enum>(e)</enum><header>Uniform
measures, data, project evaluations</header><text display-inline="yes-display-inline">Working in consultation with experts
described in subsection (f) and with participating States or providers, the
Secretary shall establish uniform measures (adjusted for patient acuity),
collect data, and conduct evaluations with respect to the 3 demonstration
project categories described in subsection (c).</text>
</subsection><subsection commented="no" display-inline="no-display-inline" id="id63CDE0C1AE604BD2B11B2F76870F140D"><enum>(f)</enum><header>Consultation</header><text display-inline="yes-display-inline">In developing and implementing
demonstration projects under this section, the Secretary shall consult with
national pediatric provider organizations, consumers, and such other entities
or individuals with relevant expertise as the Secretary deems necessary.</text>
</subsection><subsection commented="no" display-inline="no-display-inline" id="idCB1D8AE901CA4E719A7B749066CD7028"><enum>(g)</enum><header>Report</header><text display-inline="yes-display-inline">Not later than 6 months after the
completion of all demonstration projects conducted under this section, the
Secretary shall evaluate such projects and submit a report to Congress that
includes the findings of the evaluation and recommendations with respect
to—</text>
<paragraph commented="no" display-inline="no-display-inline" id="id5D0395E8F34742BAAF17ED8740D77758"><enum>(1)</enum><text display-inline="yes-display-inline">expanding the projects to additional sites;
and</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="id71025773E2F2434D807A773F7D745D62"><enum>(2)</enum><text display-inline="yes-display-inline">the broad implementation of identified
successful approaches in advancing quality and performance in the delivery of
medical assistance provided to children under the medicaid program.</text>
</paragraph></subsection></section><section commented="no" display-inline="no-display-inline" id="idFC38813413154A399C77D88DADFF2A18" section-type="subsequent-section"><enum>205.</enum><header>Funding</header><text display-inline="no-display-inline">In order to carry out the provisions of this
title, out of funds in the Treasury not otherwise appropriated, there are
appropriated to the Secretary—</text>
<paragraph commented="no" display-inline="no-display-inline" id="idF91F430173A24324B0CC483D89492ABE"><enum>(1)</enum><text display-inline="yes-display-inline">$25,000,000 for fiscal year 2006;</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="id1E4D871D00104A08A6A60506609358FE"><enum>(2)</enum><text display-inline="yes-display-inline">$30,000,000 for fiscal year 2007;
and</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="id87E49E60E16D43639677C75576FCB0F7"><enum>(3)</enum><text display-inline="yes-display-inline">$35,000,000 for each of the fiscal years
2008, 2009, and 2010.</text>
</paragraph></section><enum>III</enum><header>Ensuring Access to Care</header>
<section commented="no" display-inline="no-display-inline" id="id67AD50A26AB54BDE8CD6E097248F497D" section-type="subsequent-section"><enum>301.</enum><header>Pay for performance
for children's critical access hospitals</header>
<subsection commented="no" display-inline="no-display-inline" id="id988CBA52A9354F14A782FC31AC781890"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">The Secretary of
Health and Human Services (in this section referred to as the
<quote>Secretary</quote>), acting through the Administrator of the Centers for
Medicare & Medicaid Services (in this section referred to as the
<quote>Administrator</quote>), shall implement a 4-year program to develop,
implement, and evaluate a pay-for-performance program for eligible children’s
hospitals providing critical access to children eligible for medical assistance
under the medicaid program established under title XIX of the Social Security
Act (42 U.S.C. 1396 et seq.).</text>
</subsection><subsection commented="no" display-inline="no-display-inline" id="idE0BA71D8F3F14FF785F343B5FBDF5338"><enum>(b)</enum><header>Consultation</header><text display-inline="yes-display-inline">Measures of quality and performance
utilized in the program will be determined by the Administrator in
collaboration with participating eligible children's hospitals and in
consultation with States, the National Association of Children’s Hospitals and
Related Institutions, the Agency for Healthcare Research and Quality, the
National Quality Forum, and such other entities or individuals with expertise
in pediatric quality and performance measures as the Administrator deems
appropriate.</text>
</subsection><subsection commented="no" display-inline="no-display-inline" id="idE98C3F9BED934031B370F865AB26EEFB"><enum>(c)</enum><header>Eligible
children's hospitals</header><text display-inline="yes-display-inline">For
purposes of this section, an eligible children's hospital is a children's
hospital that, not later than January 1, 2006, has submitted an application to
the Secretary to participate in the program established under this section and
has been certified by the Secretary as—</text>
<paragraph commented="no" display-inline="no-display-inline" id="idC55D9368D3424182A4EC87100CD56714"><enum>(1)</enum><text display-inline="yes-display-inline">meeting the criteria described in
subsection (d);</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="idE190BAE7B48E4C0AB6552C5D3E16F2EF"><enum>(2)</enum><text display-inline="yes-display-inline">agreeing to report data on quality and
performance measures; and</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="id3CFF89D13AA24FDA924954FCC691AD7E"><enum>(3)</enum><text display-inline="yes-display-inline">meeting or exceeding such measures as are
established by the Secretary with respect to the provision of care by the
hospital.</text>
</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="idDB6D9A48E1C94F9494D607F5ADC13F14"><enum>(d)</enum><header>Criteria
described</header><text display-inline="yes-display-inline">In order to be
certified as meeting the criteria described in this subsection, a hospital
shall be a general acute care children’s hospital or a specialty children’s
hospital as defined under 1886(d)(1)(B)(iii) of the Social Security Act (42
U.S.C. 1395ww(d)(1)(B)(iii)), or a non-freestanding general acute care
children’s hospital which shares a provider number with another hospital or
hospital system that—</text>
<paragraph commented="no" display-inline="no-display-inline" id="id448515BB29614079B3ED2D24C30DBA42"><enum>(1)</enum><text display-inline="yes-display-inline">has 62 or more total pediatric beds;</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="id0738284BF4F140B685FF645BAF368EE8"><enum>(2)</enum><text display-inline="yes-display-inline">has 38 or more total combined pediatric
general medical or surgical and pediatric intensive care beds;</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="id1F935D9549CC4F33806969747CCF83BE"><enum>(3)</enum><text display-inline="yes-display-inline">has at least 4 pediatric intensive care
beds;</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="idBE98B8788AEF475AB68A3A402B939335"><enum>(4)</enum><text display-inline="yes-display-inline">has a pediatric emergency room in the
hospital or access to an emergency room with pediatric services through the
hospital system; and</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="id9F067A1449284948B88725A6B1C76C8E"><enum>(5)</enum><text display-inline="yes-display-inline">provides a minimum of 25 percent of its
days of care to patients eligible for medical assistance under the medicaid
program.</text>
</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="idDDFFFFCF44FB4F71943A096AC0923CE4"><enum>(e)</enum><header>Payment
methodology</header>
<paragraph commented="no" display-inline="no-display-inline" id="id3FBE064F484B4DD083896BA8DA78AE2C"><enum>(1)</enum><header>In
general</header><text display-inline="yes-display-inline">An eligible
children's hospital that participates in the program established under this
section shall receive supplemental Federal payments for inpatient and
outpatient care (which shall be in addition to any other payments the hospitals
receive for such care under the medicaid program) for cost reporting periods or
portions of such reporting periods occurring during fiscal years 2007 through
2010 in accordance with the following:</text>
<subparagraph commented="no" display-inline="no-display-inline" id="idA99BB07A10DB4BE08C19EA13272D34C1"><enum>(A)</enum><header>Fiscal years
2007 and 2008</header>
<clause commented="no" display-inline="no-display-inline" id="idFAEC3953F1D443489E33C1F846783E4F"><enum>(i)</enum><header>In
general</header><text display-inline="yes-display-inline">For hospital cost
reporting periods or portions of such reporting periods occurring during fiscal
year 2007 or 2008, hospitals reporting data for quality and performance
measures established under the program and participating in the development of
pay-for-performance methodology under this section, subject to clause (ii),
shall receive with respect to inpatient or outpatient care that is determined
to meet such measures, a Federal supplemental payment increase equal to the
amount received under the medicaid program for such care multiplied by the
market basket percentage increase for the year (as defined under section
1886(b)(3)(B)(iii) of the Social Security Act (42 U.S.C.
1395ww(b)(3)(B)(iii)).</text>
</clause><clause commented="no" display-inline="no-display-inline" id="idCECF343B82BF4A8384BCA48E0E6D2279"><enum>(ii)</enum><header>Limitation</header><text display-inline="yes-display-inline">The total amount of all Federal
supplemental payments made with respect to cost reporting periods or portions
of such periods described in clause (i) shall not exceed the amounts
appropriated under this section for fiscal years 2007 and 2008.</text>
</clause></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="id1CAD8101A35D4BAFB04F77FC930A3520"><enum>(B)</enum><header>Fiscal years
2009 and 2010</header>
<clause commented="no" display-inline="no-display-inline" id="id8687CDA353E5414EB28BA3E7DC30CFE8"><enum>(i)</enum><header>In
general</header><text display-inline="yes-display-inline">For cost reporting
periods or portions of such periods occurring during fiscal year 2009 or 2010,
hospitals shall receive supplemental Federal payments reflecting measures of
quality and performance and a pay-for-performance methodology developed by the
Secretary in consultation with the entities described in subsection (b). Such
methodology shall recognize clinical measures, patient satisfaction and
adoption of information technology.</text>
</clause><clause commented="no" display-inline="no-display-inline" id="id66A393E39E834B0BA30BF2D0A59FBF16"><enum>(ii)</enum><header>Limitation</header><text display-inline="yes-display-inline">The total amount of all Federal
supplemental payments made for cost reporting periods or portions of such
periods described in clause (i) shall not exceed the amounts appropriated under
this section for fiscal years 2009 and 2010.</text>
</clause></subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="id8BDE3D70AAC84D29AA3DA79E3B6FE6FA"><enum>(2)</enum><header>State
maintenance of effort</header><text display-inline="yes-display-inline">With
respect to the periods for payment of the Federal supplemental payments
established under paragraph (1), in no case shall a State—</text>
<subparagraph commented="no" display-inline="no-display-inline" id="id898157BC515042CBA8242B69F196DDE6"><enum>(A)</enum><text display-inline="yes-display-inline">pay a participating hospital less for
services for children eligible for medical assistance under the medicaid
program than the hospital was paid with respect to the most recent cost
reporting period ending before the date of enactment of this Act; or</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="idEE79F13C83D043BD907781576FAF3C31"><enum>(B)</enum><text display-inline="yes-display-inline">not provide an eligible children’s hospital
participating in the program established under this section (determined on a
facility-specific basis) with the same increase in payment that the State may
provide to any other hospital participating in the State medicaid program,
including any State-owned or operated hospital or any hospital operated by a
State university system.</text>
</subparagraph></paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="idB2B6403FE2454B8889515FE4AD168306"><enum>(f)</enum><header>Appropriations</header>
<paragraph commented="no" display-inline="no-display-inline" id="id05BCB2646F674A109509C986958BFE52"><enum>(1)</enum><header>In
general</header><text display-inline="yes-display-inline">Out of funds in the
Treasury not otherwise appropriated, there are appropriated for making payments
under this section—</text>
<subparagraph commented="no" display-inline="no-display-inline" id="id4534382204A64DDA997A1B9C274A8797"><enum>(A)</enum><text display-inline="yes-display-inline">for fiscal year 2007, $80,000,000;</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="id2A8FE3EB0C7D4DE28B92452258F17F45"><enum>(B)</enum><text display-inline="yes-display-inline">for fiscal year 2008, $100,000,000;
and</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="id782F5B9B2CED4F9BBC2CA13339483922"><enum>(C)</enum><text display-inline="yes-display-inline">for each of fiscal years 2009 and 2010,
$120,000,000.</text>
</subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="id373A78BF8377436A8E6E02D52872E1B0"><enum>(2)</enum><header>Carryover</header><text display-inline="yes-display-inline">Any amount appropriated under paragraph (1)
with respect to a fiscal year that remains unobligated as of the end of that
fiscal year, shall remain available for obligation during the succeeding fiscal
year, in addition to the amount appropriated under that paragraph for such
succeeding fiscal year.</text>
</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="idDB4FFE28B2574BC292868FB6C5EB55DE"><enum>(g)</enum><header>Evaluation and
report</header><text display-inline="yes-display-inline">Not later than
September 1, 2010, the Secretary shall report to Congress on the program
established under this section. In providing such a report, the Secretary
shall—</text>
<paragraph commented="no" display-inline="no-display-inline" id="id8626C06ED44F4B39A9BBC618273C075B"><enum>(1)</enum><text display-inline="yes-display-inline">conduct an independent evaluation;</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="id6BE2E624543149AA924F59B3D2F71AAA"><enum>(2)</enum><text display-inline="yes-display-inline">consult with States, eligible children's
hospitals participating in the program, the National Association of Children’s
Hospitals and Related Institutions, and other national pediatric organizations
and individuals with expertise in pediatric measures of quality and
performance;</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="id0BBA4E1FA0E04D708B435C9D52C86005"><enum>(3)</enum><text display-inline="yes-display-inline">include a detailed description of the
measures and payment enhancements used in determining and rewarding performance
under the program;</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="id9F5AA1858B054941ADB07B217542A80B"><enum>(4)</enum><text display-inline="yes-display-inline">assess the impact of rewarding performance
through the Federal supplemental payments provided under the program, including
with respect to any improvements and innovations in the delivery of children's
hospital care and children's access to appropriate care;</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="idE7EE2982630040DE9FC28C29C9A5404C"><enum>(5)</enum><text display-inline="yes-display-inline">assess how State hospital payment
methodologies under the medicaid program, including hospital and physician
payments and coverage, affect the capacity of the medicaid program to reward
performance; and</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="idFF1FAA9E195D4CF2ABA2351FC20DC5A9"><enum>(6)</enum><text display-inline="yes-display-inline">include recommendations to the Committee on
Finance of the Senate and the Committee on Energy and Commerce of the House of
Representatives regarding the implementation and design of the
performance-based payments made under the program, whether to continue such
program, and potential alternative approaches to making performance-based
payments to such hospitals.</text>
</paragraph></subsection></section><section commented="no" display-inline="no-display-inline" id="id806AD89459EB4A1D9F7A1FD5F04D2631" section-type="subsequent-section"><enum>302.</enum><header>Inclusion of
children's hospitals as covered entities for purposes of limitation of
purchased drug price</header>
<subsection commented="no" display-inline="no-display-inline" id="idC39638C980FE47089ECBBDDF9E6A695E"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">Section 340B(a)(4) of
the Public Health Services Act (42 U.S.C. 256b(a)(4)) is amended by adding at
the end the following new subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="id30042CFC952F4690AB484A90C0148640" style="OLC">
<subparagraph commented="no" display-inline="no-display-inline" id="id21F226FF11D6474893AFD6397E227320"><enum>(M)</enum><text display-inline="yes-display-inline">A children's hospital described in section
1886(d)(1)(B)(iii) of the Social Security Act which meets the requirements of
clauses (i) and (iii) of subparagraph (L) and which would meet the requirements
of clause (ii) of such subparagraph if that clause were applied by taking into
account the percentage of care provided by the hospital to patients eligible
for medical assistance under the medicaid
program.</text>
</subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection commented="no" display-inline="no-display-inline" id="idDAAE939F676745379F1C65E16B272249"><enum>(b)</enum><header>Effective
Date</header><text display-inline="yes-display-inline">The amendment made by
subsection (a) shall apply to drugs purchased on or after the date of enactment
of this Act.</text>
</subsection></section>