110 HR 2723 IH: Children's Health Care Quality Act
U.S. House of Representatives
2007-06-14
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EN
Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.
1.This Act may be cited as the Children's Health Care Quality Act
.
2.Congress makes the following findings:
(1)Children have unique health care needs and experiences, which are often not comparable to adult health care needs and experience, and they require specialized medical expertise.
(2)The delivery of health care is increasingly being transformed by the use of quality and performance measures by consumers, insurers, and providers.
(3)A majority of public and private sector investments in the development of quality and performance measures have focused on the experience of adults, particularly the elderly.
(4)As a result, the supply of approved and demonstrated quality measures for children’s health care, especially pediatric inpatient care, is limited.
(5)Growing numbers of insurers, as well as the Medicaid program and the State Children’s Health Insurance Program (SCHIP), are using publicly available measures, which means they have only limited options for measures of pediatric care.
(6)A 2006 national survey found that most State Medicaid programs and SCHIP use largely primary care measures for children, which have been developed and selected as part of the measures States use to fulfill requirements for evaluating health plan performance, not provider performance, under the Medicaid program.
(7)The Centers for Medicare & Medicaid Services (CMS), through its administration of the Medicaid program and SCHIP, is the nation’s largest payer of health care for children, covering 1 in every 3 children and more than half of all infants in the Nation. However, CMS lacks explicit authority and has not committed resources to invest in the development of quality and performance measures for children commensurate to the magnitude of pediatric care the agency pays for.
(8)Most States do not have a large enough population of children upon which to develop appropriate measures, particularly for the treatment of serious and complex conditions that only small numbers of children in any one state may experience.
(9)Quality and performance measures should be evidence-based, approved for use through a recognized national consensus development process, and appropriate for public reporting, such as evidence-based hospital measures endorsed by the National Quality Forum and recommended for public reporting by the Hospital Quality Alliance on the Hospital Compare tool on the website of the Department of Health and Human Services.
(10)The Federal Government should have both the legal authority and financial resources to invest in the private sector’s development and demonstration of measures of quality and performance of health care for children, including pediatric inpatient care. The Federal Government should utilize such authority and resources to increase the availability of measures for children for use by public and private health coverage programs.
<enum>I</enum><header>Advancing new quality and performance measures for children’s health care</header>
<section id="HF14A03F300FB41249442D24DCA008163"><enum>101.</enum><header>Pediatric quality and performance measures program</header><text display-inline="no-display-inline">Title XIX of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396">42 U.S.C. 1396 et seq.</external-xref>) is amended—</text>
<paragraph id="HC574397ADE0F470487F0197957458208"><enum>(1)</enum><text>by redesignating section 1939 as section 1941; and</text></paragraph>
<paragraph id="H77884248A2904D7DBF75060742CD21E2"><enum>(2)</enum><text>by inserting after section 1938 the following:</text>
<quoted-block display-inline="no-display-inline" id="H2584649477E84E65949C5658D84F1EF4" style="traditional">
<section id="H7D6E56B2D0C8467B81CCDE2BF5E8201"><enum>1939.</enum><header>Pediatric quality and performance measures program</header>
<subsection commented="no" display-inline="yes-display-inline" id="H66A648DEE0D245B0BDFB4C4666F76624"><enum>(a)</enum><header>Establishment</header><text>The Secretary, acting through the Administrator of the Centers for Medicare & Medicaid Services and in consultation with the Director of the Agency for Healthcare Research and Quality, shall establish a program to encourage and support the development of new and emerging quality and performance measures for providers of pediatric care through the activities described in subsection (c). In establishing the program, gaps in existing evidence-based measures and priority areas for advancement shall be identified.</text></subsection>
<subsection id="HDF2895EF42E34ABE9BEED7009B4E47F1"><enum>(b)</enum><header>Purpose</header><text>The purpose of the program is to ensure that—</text>
<paragraph id="HD7252622EE2F471894608DA09ED4BD33"><enum>(1)</enum><text>evidence-based pediatric quality and performance measures are developed; and</text></paragraph>
<paragraph id="H9531FDCE866042F4B1AD27BFB2007E97"><enum>(2)</enum><text>such measures are available for States, other purchasers of pediatric health care services, health care providers, and consumers to use.</text></paragraph></subsection>
<subsection id="HC512BD03EB6D410DA8002DA5DBB9D854"><enum>(c)</enum><header>Program activities</header>
<paragraph id="HA34CB24613984DEC007293DC03FD4B32"><enum>(1)</enum><header>Identifying quality and performance measures for providers of pediatric services and opportunities for new measures</header><text>Not later than 3 months after the date of enactment of this section, the Secretary shall identify quality and performance measures for providers of pediatric services and opportunities for the development of new measures, taking into consideration existing evidence-based measures. In conducting this review, the Secretary shall convene and consult with representatives of—</text>
<subparagraph id="H613F5D5BCC584A87987FF21005CD731F"><enum>(A)</enum><text>States;</text></subparagraph>
<subparagraph id="H7059729B262B4B9C9ED23FC63B08E95C"><enum>(B)</enum><text>pediatric hospitals, pediatricians, and other pediatric health professionals;</text></subparagraph>
<subparagraph commented="no" id="H4840490AA94A4CED823484E436128F51"><enum>(C)</enum><text>national organizations representing—</text>
<clause commented="no" id="H1E1D4F44D0A24C138E86C0F0F3000851"><enum>(i)</enum><text>consumers of children’s health care; and</text></clause>
<clause commented="no" id="HDC9DFD4E5945401C97A82DA9E799E2D4"><enum>(ii)</enum><text>purchasers of children’s health care;</text></clause></subparagraph>
<subparagraph id="H62782F4C35CD40BF8D1CAB4474C30021"><enum>(D)</enum><text>experts in pediatric quality and performance measurement; and</text></subparagraph>
<subparagraph id="HF439BD07496C443487007ED0C6175773"><enum>(E)</enum><text>a voluntary consensus standards setting organization and other organizations involved in the advancement of consensus on evidence-based measures of health care.</text></subparagraph></paragraph>
<paragraph id="H0709DBA1FBC84B1699B23CA77C42DF00"><enum>(2)</enum><header>Developing, validating, and testing new measures</header><text>The Secretary shall award grants or contracts to eligible entities (as defined in subsection (d)(1)) for the development, validation, and testing of new and emerging quality and performance measures for providers of pediatric services. Such measures shall—</text>
<subparagraph id="H8420BEC19B5A4A8FB46433F67C7D93B4"><enum>(A)</enum><text>provide consumers and purchasers (including States and beneficiaries under the program under this title and title XXI) with information about provider performance and quality; and</text></subparagraph>
<subparagraph id="HAA5D7AAB052F4332AB4C29CBEBEB1E8E"><enum>(B)</enum><text>assist health care providers in improving the quality of the items and services they provide and their performance with respect to the provision of such items and services.</text></subparagraph></paragraph>
<paragraph id="H61D41ABE12104A6A80DFE5B3A87CB288"><enum>(3)</enum><header>Achieving consensus on evidence-based measures</header><text>The Secretary shall award grants or contracts to eligible consensus entities (as defined in subsection (d)(2)) for the development of consensus on evidence-based measures for pediatric care that have broad acceptability in the health care industry.</text></paragraph></subsection>
<subsection id="H3C45900DA6EE44AC9227B6204CBB48A9"><enum>(d)</enum><header>Eligible entities</header>
<paragraph id="H1604AF9457EB474FB70057B9E6C524E9"><enum>(1)</enum><header>Development, validation, and testing</header><text>For purposes of paragraph (2) of subsection (c), the term <quote>eligible entity</quote> means—</text>
<subparagraph id="HB5B514B6E55B41D599FDA772FFB1A8F"><enum>(A)</enum><text>organizations with demonstrated expertise and capacity in the development and evaluation of pediatric quality and performance measures;</text></subparagraph>
<subparagraph id="HA085A6DFE57D44E68C27BE9CF65C0556"><enum>(B)</enum><text>an organization or association of health care providers with demonstrated experience in working with accrediting organizations in developing pediatric quality and performance measures; and</text></subparagraph>
<subparagraph id="H86309E3AAB004DD5A2C78E3FF75041DB"><enum>(C)</enum><text>a collaboration of national pediatric organizations working to improve pediatric quality and performance measures.</text></subparagraph></paragraph>
<paragraph id="H8F75B09A365047F5B6D4524082D5783F"><enum>(2)</enum><header>Achievement of consensus</header><text>For purposes of paragraph (3) of such subsection, the term <quote>eligible consensus entity</quote> means an organization, including a voluntary consensus standards setting organization, involved in the advancement of consensus on evidence-based measures of health care.</text></paragraph></subsection>
<subsection id="H3FC7A44C7DFD4DCE94FB00DAB63FBA0"><enum>(e)</enum><header>Ongoing authority To update and adjust pediatric measures</header><text>The Secretary may update and adjust measures developed and advanced under the program under this section in accordance with—</text>
<paragraph id="H67740BB9192046BFABF9B242292D46FA"><enum>(1)</enum><text>any changes that a voluntary consensus standards setting organization determines should be made with respect to such measures; or</text></paragraph>
<paragraph id="H9A8B75919A154094935344E3DAA68FD6"><enum>(2)</enum><text>new evidence indicating the need for changes with respect to such measures.</text></paragraph></subsection>
<subsection id="H9EF010B11DD84836837082AE8D00C6D0"><enum>(f)</enum><header>Addition of pediatric consumer assessment measures to CAHPS Hospital Survey conducted by AHRQ</header><text>The Director of the Agency for Healthcare Research and Quality shall ensure that consumer assessment measures for hospital services for children are added to the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospital survey conducted by such Agency.</text></subsection>
<subsection id="H39647A579DE54DE2B0732FEE4E1C8694"><enum>(g)</enum><header>Appropriation</header><text>There are authorized to be appropriated and there are appropriated, for the purpose of carrying out this section, $10,000,000, for each of fiscal years 2008 through 2012, to remain available until expended.</text></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></section>
<enum>II</enum><header>State transformation grants for pediatric care</header>
<section id="H2870F23F994544BDB472EBF9622BFC8B"><enum>201.</enum><header>Grants to states for demonstration projects transforming delivery of pediatric care</header><text display-inline="no-display-inline">Title XIX of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396">42 U.S.C. 1396 et seq.</external-xref>), as amended by section 101, is amended by inserting after section 1939 the following:</text>
<quoted-block display-inline="no-display-inline" id="H4D6AC7B7C5564D1E81D7E4628879F9A7" style="traditional">
<section id="H70D136E559B048C3832D725CDB495D1C"><enum>1940.</enum><header>Grants to state for demonstration projects transforming delivery of pediatric care</header>
<subsection commented="no" display-inline="yes-display-inline" id="H4B3A3BBFF74146B8970489CFB7468076"><enum>(a)</enum><header>Establishment</header><text>The Secretary, acting through the Administrator of the Centers for Medicare & Medicaid Services, shall establish demonstration projects, including demonstration projects in each of the 4 categories described in subsection (d), to award grants to States to improve the delivery of health care services provided to children under this title and title XXI.</text></subsection>
<subsection id="HD6778DF9069048F7B4C0B88114F100A2"><enum>(b)</enum><header>Duration</header><text>The demonstration projects shall be conducted for a period of 4 years.</text></subsection>
<subsection id="HEDA4F299C97D4520B713E05B67AD98EF"><enum>(c)</enum><header>Eligibility</header><text>A State shall not be eligible to receive a grant under this section unless the State has demonstrated experience or commitment to the concept of transformation in the delivery of pediatric care.</text></subsection>
<subsection id="HE370E10E1F224DF8A7F1D843ED692C14"><enum>(d)</enum><header>Categories of projects</header><text>The following categories of projects are described in this subsection:</text>
<paragraph id="H236F85AD9B91417580C1626920AB946E"><enum>(1)</enum><header>Health information technology systems</header><text>Projects for developing health information technology systems, including technology acquisition, electronic health record development, data standards development, and software development, for pediatric hospital and physician services and other community-based services; implementing model systems; and evaluating their impact on the quality, safety, and costs of care.</text></paragraph>
<paragraph id="HC0A55675ECEA4A708B756462182848D6"><enum>(2)</enum><header>Disease management</header><text>Projects for providing provider-based care disease management for children with chronic conditions (including physical, developmental, behavioral, and psychological conditions), demonstrating the effectiveness of provider-based management models in promoting better care, reducing adverse health outcomes, and preventing avoidable hospitalizations.</text></paragraph>
<paragraph id="HA91ECABB6CFD47758600401021CDA9C"><enum>(3)</enum><header>Evidence-based quality improvements</header><text>Projects for implementing evidence-based approaches to improving efficiency, safety, and effectiveness in the delivery of hospital care for children across hospital services, evaluating the translation of successful models of such evidence-based approaches to other institutions, and the impact of such changes on the quality, safety, and costs of care.</text></paragraph>
<paragraph id="H27AB51C6E59F4D38ACF73ED4CFD84681"><enum>(4)</enum><header>Quality and performance measures for providers of children’s health care services</header><text>Projects to pilot test evidence-based pediatric quality and performance measures for inpatient hospital services, physician services, or services of other health professionals, determining the reliability, feasibility, and validity of such measures, and evaluating their potential impact on improving the quality and delivery of children’s health care. To the extent feasible, such measures shall have been approved by consensus standards setting organizations.</text></paragraph></subsection>
<subsection id="HF7557D864BFF401D8DBAE8345DC3E2CE"><enum>(e)</enum><header>Uniform metrics</header><text>The Secretary shall establish uniform metrics (adjusted, as appropriate, for patient acuity), collect data, and conduct evaluations with respect to each demonstration project category described in subsection (d). In establishing such metrics, collecting such data, and conducting such evaluations, the Secretary shall consult with—</text>
<paragraph id="H5733F2BD42C14624A33D21E6C8C64113"><enum>(1)</enum><text>experts in each such demonstration project category;</text></paragraph>
<paragraph id="H807D2C0B939846A6BA38B76324B1F6C5"><enum>(2)</enum><text>participating States;</text></paragraph>
<paragraph id="H25AE7B8E0E76409E82B90571DD60F971"><enum>(3)</enum><text>national pediatric provider organizations;</text></paragraph>
<paragraph id="HCEA5024F03A34B018D18CD26006B7096"><enum>(4)</enum><text>health care consumers; and</text></paragraph>
<paragraph id="H494638A220BF41B0AB827B08B1CAD149"><enum>(5)</enum><text>such other entities or individuals with relevant expertise as the Secretary determines appropriate.</text></paragraph></subsection>
<subsection id="HBE6DCFC0C4F340758FE3FA688C7708A0"><enum>(f)</enum><header>Evaluation and report</header><text>The Secretary shall evaluate the demonstration projects conducted under this section and submit a report to Congress not later than 3 months before the completion of each demonstration project that includes the findings of the evaluation and recommendations with respect to—</text>
<paragraph id="H87A1CB32081A4F57B0D2BFA048B35BE2"><enum>(1)</enum><text>expansion of the demonstration project to additional States and sites; and</text></paragraph>
<paragraph id="H909FA16CF641417F9FD4DC83D7CB6E9"><enum>(2)</enum><text>the broader implementation of approaches identified as being successful in advancing quality and performance in the delivery of medical assistance provided to children under this title and title XXI.</text></paragraph></subsection>
<subsection id="HFF4FCCDC809F46DE995961B1957CC600"><enum>(g)</enum><header>Waiver</header><text>The Secretary may waive the requirements of this title and title XXI to the extent necessary to carry out the demonstration projects under this section.</text></subsection>
<subsection id="H45BFDA14268043D2A24C1118493737A3"><enum>(h)</enum><header>Amounts paid to a State</header><text>Amounts paid to a State under this section—</text>
<paragraph id="H0B77B205AD394958BEFA2DA4DF9E2162"><enum>(1)</enum><text>shall be in addition to Federal payments made to the State under section 1903(a);</text></paragraph>
<paragraph id="H71755D68E0214E79A3A3D5FC95A3E247"><enum>(2)</enum><text>shall not be used for the State share of any expenditures claimed for payment under such section; and</text></paragraph>
<paragraph id="H863F07D827A14BB5965FF7A46FC3D6DC"><enum>(3)</enum><text>shall be used only for expenditures of the State for participating in the demonstration projects, or for expenditures of providers in participating in the demonstration projects, including—</text>
<subparagraph id="HD38A2D3C085C46DF9CA260AD87DEF9DD"><enum>(A)</enum><text>administrative costs of States and participating providers (such as costs associated with the design and evaluation of, and data collection under, the demonstration projects); and</text></subparagraph>
<subparagraph id="H11CB616EC65D44E5A1CB90312EB00023"><enum>(B)</enum><text>such other expenditures that are not otherwise eligible for reimbursement under this title or title XXI as the Secretary may determine appropriate.</text></subparagraph></paragraph></subsection>
<subsection id="H4C8A9AC9DA56440AA0E650AA7E00173F"><enum>(i)</enum><header>Appropriation</header><text>There are authorized to be appropriated and there are appropriated, for the purpose of carrying out this section, to remain available until expended $10,000,000 for each of fiscal years 2008 through 2012.</text></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block></section>
<section id="H57A0E3D42D3E487CBB2C68001D84D1E4"><enum>202.</enum><header>Report by the comptroller general on design and implementation of a demonstration project evaluating existing quality and performance measures for children’s inpatient hospital services</header>
<subsection id="H52797EDFF241434B95CFF5FA27C215F6"><enum>(a)</enum><header>In general</header><text>Not later than 12 months after the date of enactment of this Act, the Comptroller General of the United States (in this section referred to as the <quote>Comptroller General</quote>) shall submit a report to Congress containing recommendations for the design and implementation of a demonstration project to evaluate the suitability of existing quality and performance measures for children’s inpatient hospital services for public reporting, differentiating quality, identifying best practices, and providing a basis for payment rewards.</text></subsection>
<subsection id="H679A672ECDF14677AA4102494819F0F5"><enum>(b)</enum><header>Development of recommendations</header><text>In developing the recommendations submitted under subsection (a), the Comptroller General shall accomplish the following:</text>
<paragraph id="H6766CC1F56A54FB5A0847BF8F65664E"><enum>(1)</enum><text>Consider which agency within the Department of Health and Human Services should have primary responsibility and oversight for such a demonstration project.</text></paragraph>
<paragraph id="HA4CD4A04DFC64E048F31C4E7C0D4F4E"><enum>(2)</enum><text>Determine a sufficient number of participating hospitals and volume of children’s cases, given existing measures that might be chosen for evaluation under such a demonstration project.</text></paragraph>
<paragraph id="H48D2F8DECFF8468788CE8893F158B7D9"><enum>(3)</enum><text>Determine the number of States and variety of geographic locations that may be required to conduct such a demonstration project.</text></paragraph>
<paragraph id="HE583C52EF45840A0B5C04358E9BD41FD"><enum>(4)</enum><text>Describe alternatives for administering and directing funding for such a demonstration project, taking into consideration the potential involvement of multiple States, State plans under title XIX of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396">42 U.S.C. 1396 et seq.</external-xref>), and State child health plans under title XXI of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1397aa">42 U.S.C. 1397aa et seq.</external-xref>). Such description shall be included in the recommendations submitted under subsection (a).</text></paragraph>
<paragraph id="HC8EFFB7243B54DDDA1B2968B02862EB0"><enum>(5)</enum><text>Determine requirements for consistency in measures, metrics, and risk adjustment for such a demonstration project, across hospitals and across State lines.</text></paragraph>
<paragraph id="H74842899286D46BB0068C065EF7A68E"><enum>(6)</enum><text>Consider the infrastructure requirements involved in public reporting of quality and performance measures for children’s inpatient hospital services at the national and State levels, including the requirements involved with respect to maintaining such measures and data.</text></paragraph>
<paragraph id="HA3AEA9BE937E4AA58F43BFE0E782E274"><enum>(7)</enum><text>Estimate the cost of undertaking such a demonstration project.</text></paragraph></subsection>
<subsection id="H224D910C4F2745CFA85175ADA9B8A90"><enum>(c)</enum><header>Suggestion of existing measures for evaluation under the demonstration project</header>
<paragraph id="H190EF5993ACB472D86EEED796D14BCCF"><enum>(1)</enum><header>In general</header><text>The report submitted under subsection (a) shall include suggestions for existing measures to be evaluated under the demonstration project recommended in such report, including, to the extent feasible, measures with respect to—</text>
<subparagraph id="H9800F12E7CA04CA596D84CBFCEBFB27"><enum>(A)</enum><text>high volume pediatric inpatient conditions;</text></subparagraph>
<subparagraph id="HA79E8B37559D470B8DB15C8B994B9330"><enum>(B)</enum><text>high cost pediatric inpatient services;</text></subparagraph>
<subparagraph id="H75440C6F61A9450CAC8BDA934CF2C8B3"><enum>(C)</enum><text>pediatric conditions with predicted high morbidities; and</text></subparagraph>
<subparagraph commented="no" display-inline="no-display-inline" id="HBAED2997287943579C56CA27AA2F4BA"><enum>(D)</enum><text>pediatric cases at high risk of patient safety failures.</text></subparagraph></paragraph>
<paragraph commented="no" display-inline="no-display-inline" id="HB562C10E11A84924A3EE90EB7804E1A6"><enum>(2)</enum><header>Suggested measures</header><text>The measures suggested under paragraph (1) shall be measures representing process, structure, patient outcomes, or patient and family experience—</text>
<subparagraph id="H1663ED7123704208A79CD94CEF3F3C6C"><enum>(A)</enum><text>that are evidence-based;</text></subparagraph>
<subparagraph id="H7DD7134963424531A3EBB8531D677FD5"><enum>(B)</enum><text>that are feasible to collect and report;</text></subparagraph>
<subparagraph id="H00E91739A185471ABAA2AAA230AA9D8F"><enum>(C)</enum><text>that include a mechanism for risk adjustment when necessary; and</text></subparagraph>
<subparagraph id="HC7AEABB75CFC4F17B3B94350BC31752C"><enum>(D)</enum><text>for which there is a consensus within the pediatric hospital community or a consensus determined by a voluntary consensus standards setting organization involved in the advancement of evidence-based measures of health care.</text></subparagraph></paragraph>
<paragraph id="H968075E24F0F4067B858A3A881EA7438"><enum>(3)</enum><header>Consultation</header><text>In determining the existing measures suggested under paragraph (1), the Comptroller General shall consult with representatives of the following:</text>
<subparagraph id="HC41B1C6F9BD1437D976E6B06E89B4C21"><enum>(A)</enum><text>National associations of pediatric hospitals and pediatric health professionals.</text></subparagraph>
<subparagraph id="H65310EAB6D134FFBB427C2B6F6BA57DE"><enum>(B)</enum><text>Experts in pediatric quality and performance measurement.</text></subparagraph>
<subparagraph id="HAE272907D4764FC1889C1C9E73A06230"><enum>(C)</enum><text>Voluntary consensus standards setting organizations and other organizations involved in the advancement of consensus on evidence-based measures.</text></subparagraph>
<subparagraph id="H49B900EA71264251BD2BDCE8BDDAF733"><enum>(D)</enum><text>The Department of Health and Human Services, States, and other purchasers of health care items and services.</text></subparagraph></paragraph></subsection></section>