[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 194 Introduced in House (IH)]

111th CONGRESS
  1st Session
                                H. R. 194

To amend the Social Security Act to guarantee comprehensive health care 
   coverage for all children born after 2009, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            January 6, 2009

  Mr. Stark introduced the following bill; which was referred to the 
 Committee on Energy and Commerce, and in addition to the Committee on 
   Ways and Means, 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 the Social Security Act to guarantee comprehensive health care 
   coverage for all children born after 2009, 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; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``MediKids Health 
Insurance Act of 2009''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
                   TITLE I--MEDIKIDS HEALTH INSURANCE

Sec. 101. Findings.
Sec. 102. Benefits for all children born after 2009.
                     ``TITLE XXII--MEDIKIDS PROGRAM

        ``Sec. 2201. Eligibility.
        ``Sec. 2202. Benefits.
        ``Sec. 2203. Premiums.
        ``Sec. 2204. MediKids Trust Fund.
        ``Sec. 2205. Oversight and accountability.
        ``Sec. 2206. Inclusion of care coordination services.
        ``Sec. 2207. Administration and miscellaneous.
Sec. 103. MediKids premium.
Sec. 104. Refundable credit for certain cost-sharing expenses under 
                            MediKids program.
Sec. 105. Report on long-term revenues.
      TITLE II--STRENGTHENING QUALITY OF CARE AND HEALTH OUTCOMES

Sec. 201. Child health quality improvement activities for children 
                            enrolled in MediKids, Medicaid, or CHIP.
Sec. 202. Improved availability of public information regarding 
                            enrollment of children in CHIP and 
                            Medicaid.
Sec. 203. Application of certain managed care quality safeguards to 
                            CHIP.

                   TITLE I--MEDIKIDS HEALTH INSURANCE

SEC. 101. FINDINGS.

    (a) Findings.--Congress finds the following:
            (1) More than 9 million American children are uninsured.
            (2) Children who are uninsured receive less medical care 
        and less preventive care and have a poorer level of health, 
        which result in lifetime costs to themselves and to the entire 
        American economy.
            (3) Although SCHIP and Medicaid are successfully extending 
        a health coverage safety net to a growing portion of the 
        vulnerable low-income population of uninsured children, they 
        alone cannot achieve 100 percent health insurance coverage for 
        our nation's children due to inevitable gaps during outreach 
        and enrollment, fluctuations in eligibility, variations in 
        access to private insurance at all income levels, and 
        variations in States' ability to provide required matching 
        funds.
            (4) As all segments of society continue to become more 
        transient, with many changes in employment over the working 
        lifetime of parents, the need for a reliable safety net of 
        health insurance which follows children across State lines, 
        already a major problem for the children of migrant and 
        seasonal farmworkers, will become a major concern for all 
        families in the United States.
            (5) The medicare program has successfully evolved over the 
        years to provide a stable, universal source of health insurance 
        for the nation's disabled and those over age 65, and provides a 
        tested model for designing a program to reach out to America's 
        children.
            (6) The problem of insuring 100 percent of all American 
        children could be gradually solved by automatically enrolling 
        all children born after December 31, 2009, in a program modeled 
        after Medicare (and to be known as ``MediKids''), and allowing 
        those children to be transferred into other equivalent or 
        better insurance programs, including either private insurance, 
        SCHIP, or Medicaid, if they are eligible to do so, but 
        maintaining the child's default enrollment in MediKids for any 
        times when the child's access to other sources of insurance is 
        lost.
            (7) A family's freedom of choice to use other insurers to 
        cover children would not be interfered with in any way, and 
        children eligible for SCHIP and Medicaid would continue to be 
        enrolled in those programs, but the underlying safety net of 
        MediKids would always be available to cover any gaps in 
        insurance due to changes in medical condition, employment, 
        income, or marital status, or other changes affecting a child's 
        access to alternate forms of insurance.
            (8) The MediKids program can be administered without 
        impacting the finances or status of the existing Medicare 
        program.
            (9) The MediKids benefit package can be tailored to the 
        special needs of children and updated over time.
            (10) The financing of the program can be administered 
        without difficulty by a yearly payment of affordable premiums 
        through a family's tax filing (or adjustment of a family's 
        earned income tax credit).
            (11) The cost of the program will gradually rise as the 
        number of children using MediKids as the insurer of last resort 
        increases, and a future Congress always can accelerate or slow 
        down the enrollment process as desired, while the societal 
        costs for emergency room usage, lost productivity and work 
        days, and poor health status for the next generation of 
        Americans will decline.
            (12) Over time 100 percent of American children will always 
        have basic health insurance, and we can therefore expect a 
        healthier, more equitable, and more productive society.

SEC. 102. BENEFITS FOR ALL CHILDREN BORN AFTER 2009.

    (a) In General.--The Social Security Act is amended by adding at 
the end the following new title:

                     ``TITLE XXII--MEDIKIDS PROGRAM

``SEC. 2201. ELIGIBILITY.

    ``(a) Eligibility of Individuals Born After December 31, 2009; All 
Children Under 23 Years of Age in Fifth Year.--An individual who meets 
the following requirements with respect to a month is eligible to 
enroll under this title with respect to such month:
            ``(1) Age.--
                    ``(A) First year.--As of the first day of the first 
                year in which this title is effective, the individual 
                has not attained 6 years of age.
                    ``(B) Second year.--As of the first day of the 
                second year in which this title is effective, the 
                individual has not attained 11 years of age.
                    ``(C) Third year.--As of the first day of the third 
                year in which this title is effective, the individual 
                has not attained 16 years of age.
                    ``(D) Fourth year.--As of the first day of the 
                fourth year in which this title is effective, the 
                individual has not attained 21 years of age.
                    ``(E) Fifth and subsequent years.--As of the first 
                day of the fifth year in which this title is effective 
                and each subsequent year, the individual has not 
                attained 23 years of age.
            ``(2) Citizenship.--The individual is a citizen or national 
        of the United States or is permanently residing in the United 
        States under color of law.
    ``(b) Enrollment Process.--An individual may enroll in the program 
established under this title only in such manner and form as may be 
prescribed by regulations, and only during an enrollment period 
prescribed by the Secretary consistent with the provisions of this 
section. Such regulations shall provide a process under which--
            ``(1) individuals who are born in the United States after 
        December 31, 2009, are deemed to be enrolled at the time of 
        birth and a parent or guardian of such an individual is 
        permitted to pre-enroll in the month prior to the expected 
        month of birth;
            ``(2) individuals who are born outside the United States 
        after such date and who become eligible to enroll by virtue of 
        immigration into (or an adjustment of immigration status in) 
        the United States are deemed enrolled at the time of entry or 
        adjustment of status;
            ``(3) eligible individuals may otherwise be enrolled at 
        such other times and manner as the Secretary shall specify, 
        including the use of outstationed eligibility sites as 
        described in section 1902(a)(55)(A) and the use of presumptive 
        eligibility provisions like those described in section 1920A; 
        and
            ``(4) at the time of automatic enrollment of a child, the 
        Secretary provides for issuance to a parent or custodian of the 
        individual a card evidencing coverage under this title and for 
        a description of such coverage.
The provisions of section 1837(h) apply with respect to enrollment 
under this title in the same manner as they apply to enrollment under 
part B of title XVIII. An individual who is enrolled under this title 
is not eligible to be enrolled under an MA or MA-PD plan under part C 
of title XVIII.
    ``(c) Date Coverage Begins.--
            ``(1) In general.--The period during which an individual is 
        entitled to benefits under this title shall begin as follows, 
        but in no case earlier than January 1, 2010:
                    ``(A) In the case of an individual who is enrolled 
                under paragraph (1) or (2) of subsection (b), the date 
                of birth or date of obtaining appropriate citizenship 
                or immigration status, as the case may be.
                    ``(B) In the case of another individual who enrolls 
                (including pre-enrolls) before the month in which the 
                individual satisfies eligibility for enrollment under 
                subsection (a), the first day of such month of 
                eligibility.
                    ``(C) In the case of another individual who enrolls 
                during or after the month in which the individual first 
                satisfies eligibility for enrollment under such 
                subsection, the first day of the following month.
            ``(2) Authority to provide for partial months of 
        coverage.--Under regulations, the Secretary may, in the 
        Secretary's discretion, provide for coverage periods that 
        include portions of a month in order to avoid lapses of 
        coverage.
            ``(3) Limitation on payments.--No payments may be made 
        under this title with respect to the expenses of an individual 
        enrolled under this title unless such expenses were incurred by 
        such individual during a period which, with respect to the 
        individual, is a coverage period under this section.
    ``(d) Expiration of Eligibility.--An individual's coverage period 
under this section shall continue until the individual's enrollment has 
been terminated because the individual no longer meets the requirements 
of subsection (a) (whether because of age or change in immigration 
status).
    ``(e) Entitlement to MediKids Benefits for Enrolled Individuals.--
An individual enrolled under this title is entitled to the benefits 
described in section 2202.
    ``(f) Low-Income Information.--
            ``(1) Inquiry of income.--At the time of enrollment of a 
        child under this title, the Secretary shall make an inquiry as 
        to whether the family income (as determined for purposes of 
        section 1905(p)) of the family that includes the child is 
        within any of the following income ranges:
                    ``(A) Up to 150 percent of poverty.--The income of 
                the family does not exceed 150 percent of the poverty 
                line for a family of the size involved.
                    ``(B) Between 150 and 200 percent of poverty.--The 
                income of the family exceeds 150 percent, but does not 
                exceed 200 percent, of such poverty line.
                    ``(C) Between 200 and 300 percent of poverty.--The 
                income of the family exceeds 200 percent, but does not 
                exceed 300 percent, of such poverty line.
            ``(2) Coding.--If the family income is within a range 
        described in paragraph (1), the Secretary shall encode in the 
        identification card issued in connection with eligibility under 
        this title a code indicating the range applicable to the family 
        of the child involved.
            ``(3) Provider verification through electronic system.--The 
        Secretary also shall provide for an electronic system through 
        which providers may verify which income range described in 
        paragraph (1), if any, is applicable to the family of the child 
        involved.
    ``(g) Construction.--Nothing in this title shall be construed as 
requiring (or preventing) an individual who is enrolled under this 
title from seeking medical assistance under a State medicaid plan under 
title XIX or child health assistance under a State child health plan 
under title XXI.

``SEC. 2202. BENEFITS.

    ``(a) Secretarial Specification of Benefit Package.--
            ``(1) In general.--The Secretary shall specify the benefits 
        to be made available under this title consistent with the 
        provisions of this section and in a manner designed to meet the 
        health needs of enrollees.
            ``(2) Updating.--The Secretary shall update the 
        specification of benefits over time to ensure the inclusion of 
        age-appropriate benefits to reflect the enrollee population.
            ``(3) Annual updating.--The Secretary shall establish 
        procedures for the annual review and updating of such benefits 
        to account for changes in medical practice, new information 
        from medical research, and other relevant developments in 
        health science.
            ``(4) Input.--The Secretary shall seek the input of the 
        pediatric community in specifying and updating such benefits.
            ``(5) Limitation on updating.--In no case shall updating of 
        benefits under this subsection result in a failure to provide 
        benefits required under subsection (b).
    ``(b) Inclusion of Certain Benefits.--
            ``(1) Medicare core benefits.--Such benefits shall include 
        (to the extent consistent with other provisions of this 
        section) at least the same benefits (including coverage, 
        access, availability, duration, and beneficiary rights) that 
        are available under parts A and B of title XVIII.
            ``(2) All required medicaid benefits.--Such benefits shall 
        also include all items and services for which medical 
        assistance is required to be provided under section 
        1902(a)(10)(A) to individuals described in such section, 
        including early and periodic screening, diagnostic services, 
        and treatment services.
            ``(3) Inclusion of prescription drugs.--Such benefits also 
        shall include (as specified by the Secretary) benefits for 
        prescription drugs and biologicals which are not less than the 
        benefits for such drugs and biologicals under the standard 
        option for the service benefit plan described in section 
        8903(1) of title 5, United States Code, offered during 2007.
            ``(4) Cost-sharing.--
                    ``(A) In general.--Subject to subparagraph (B), 
                such benefits also shall include the cost-sharing (in 
                the form of deductibles, coinsurance, and copayments) 
                which is substantially similar to such cost-sharing 
                under the health benefits coverage in any of the four 
                largest health benefits plans (determined by 
                enrollment) offered under chapter 89 of title 5, United 
                States Code, and including an out-of-pocket limit for 
                catastrophic expenditures for covered benefits, except 
                that no cost-sharing shall be imposed with respect to 
                early and periodic screening and diagnostic services 
                included under paragraph (2).
                    ``(B) Reduced cost-sharing for low income 
                children.--Such benefits shall provide that--
                            ``(i) there shall be no cost-sharing for 
                        children in families the income of which is 
                        within the range described in section 
                        2201(f)(1)(A);
                            ``(ii) the cost-sharing otherwise 
                        applicable shall be reduced by 75 percent for 
                        children in families the income of which is 
                        within the range described in section 
                        2201(f)(1)(B); or
                            ``(iii) the cost-sharing otherwise 
                        applicable shall be reduced by 50 percent for 
                        children in families the income of which is 
                        within the range described in section 
                        2201(f)(1)(C).
                    ``(C) Catastrophic limit on cost-sharing.--For a 
                refundable credit for cost-sharing in the case of cost-
                sharing in excess of a percentage of the individual's 
                adjusted gross income, see section 36 of the Internal 
                Revenue Code of 1986.
    ``(c) Payment Schedule.--The Secretary, with the assistance of the 
Medicare Payment Advisory Commission, shall develop and implement a 
payment schedule for benefits covered under this title. To the extent 
feasible, such payment schedule shall be consistent with comparable 
payment schedules and reimbursement methodologies applied under parts A 
and B of title XVIII.
    ``(d) Input.--The Secretary shall specify such benefits and payment 
schedules only after obtaining input from appropriate child health 
providers and experts.
    ``(e) Enrollment in Health Plans.--The Secretary shall provide for 
the offering of benefits under this title through enrollment in a 
health benefit plan that meets the same (or similar) requirements as 
the requirements that apply to Medicare Advantage plans under part C of 
title XVIII (other than any such requirements that relate to part D of 
such title). In the case of individuals enrolled under this title in 
such a plan, the payment rate shall be based on payment rates provided 
for under section 1853(c) in effect before the date of the enactment of 
the Medicare Prescription Drug, Modernization, and Improvement Act of 
2003 (Public Law 108-173), except that such payment rates shall be 
adjusted in an appropriate manner to reflect differences between the 
population served under this title and the population under title 
XVIII.

``SEC. 2203. PREMIUMS.

    ``(a) Amount of Monthly Premiums.--
            ``(1) In general.--The Secretary shall, during September of 
        each year (beginning with 2009), establish a monthly MediKids 
        premium for the following year. Subject to paragraph (2), the 
        monthly MediKids premium for a year is equal to \1/12\ of the 
        annual premium rate computed under subsection (b).
            ``(2) Elimination of monthly premium for demonstration of 
        equivalent coverage (including coverage under low-income 
        programs).--The amount of the monthly premium imposed under 
        this section for an individual for a month shall be zero in the 
        case of an individual who demonstrates to the satisfaction of 
        the Secretary that the individual has basic health insurance 
        coverage for that month. For purposes of the previous sentence 
        enrollment in a medicaid plan under title XIX, a State child 
        health insurance plan under title XXI, or under the medicare 
        program under title XVIII is deemed to constitute basic health 
        insurance coverage described in such sentence.
    ``(b) Annual Premium.--
            ``(1) National per capita average.--The Secretary shall 
        estimate the average, annual per capita amount that would be 
        payable under this title with respect to individuals residing 
        in the United States who meet the requirement of section 
        2201(a)(1) as if all such individuals were eligible for (and 
        enrolled) under this title during the entire year (and assuming 
        that section 1862(b)(2)(A)(i) did not apply).
            ``(2) Annual premium.--Subject to subsection (d), the 
        annual premium under this subsection for months in a year is 
        equal to 25 percent of the average, annual per capita amount 
        estimated under paragraph (1) for the year.
    ``(c) Payment of Monthly Premium.--
            ``(1) Period of payment.--In the case of an individual who 
        participates in the program established by this title, subject 
        to subsection (d), the monthly premium shall be payable for the 
        period commencing with the first month of the individual's 
        coverage period and ending with the month in which the 
        individual's coverage under this title terminates.
            ``(2) Collection through tax return.--For provisions 
        providing for the payment of monthly premiums under this 
        subsection, see section 59B of the Internal Revenue Code of 
        1986.
            ``(3) Protections against fraud and abuse.--The Secretary 
        shall develop, in coordination with States and other health 
        insurance issuers, administrative systems to ensure that claims 
        which are submitted to more than one payor are coordinated and 
        duplicate payments are not made.
    ``(d) Reduction in Premium for Certain Low-Income Families.--For 
provisions reducing the premium under this section for certain low-
income families, see section 59B(d) of the Internal Revenue Code of 
1986.

``SEC. 2204. MEDIKIDS TRUST FUND.

    ``(a) Establishment of Trust Fund.--
            ``(1) In general.--There is hereby created on the books of 
        the Treasury of the United States a trust fund to be known as 
        the `MediKids Trust Fund' (in this section referred to as the 
        `Trust Fund'). The Trust Fund shall consist of such gifts and 
        bequests as may be made as provided in section 201(i)(1) and 
        such amounts as may be deposited in, or appropriated to, such 
        fund as provided in this title.
            ``(2) Premiums.--Premiums collected under section 59B of 
        the Internal Revenue Code of 1986 shall be periodically 
        transferred to the Trust Fund.
            ``(3) Transitional funding before receipt of premiums.--In 
        order to provide for funds in the Trust Fund to cover 
        expenditures from the fund in advance of receipt of premiums 
        under section 2203, there are transferred to the Trust Fund 
        from the general fund of the United States Treasury such 
        amounts as may be necessary.
    ``(b) Incorporation of Provisions.--
            ``(1) In general.--Subject to paragraph (2), subsection (b) 
        (other than the last sentence) and subsections (c) through (i) 
        of section 1841 shall apply with respect to the Trust Fund and 
        this title in the same manner as they apply with respect to the 
        Federal Supplementary Medical Insurance Trust Fund and part B, 
        respectively.
            ``(2) Miscellaneous references.--In applying provisions of 
        section 1841 under paragraph (1)--
                    ``(A) any reference in such section to `this part' 
                is construed to refer to title XXII;
                    ``(B) any reference in section 1841(h) to section 
                1840(d) and in section 1841(i) to sections 1840(b)(1) 
                and 1842(g) are deemed references to comparable 
                authority exercised under this title;
                    ``(C) payments may be made under section 1841(g) to 
                the Trust Funds under sections 1817 and 1841 as 
                reimbursement to such funds for payments they made for 
                benefits provided under this title; and
                    ``(D) the Board of Trustees of the MediKids Trust 
                Fund shall be the same as the Board of Trustees of the 
                Federal Supplementary Medical Insurance Trust Fund.

``SEC. 2205. OVERSIGHT AND ACCOUNTABILITY.

    ``(a) Periodic GAO Reports.--The Comptroller General of the United 
States shall periodically submit to Congress reports on the operation 
of the program under this title, including on the financing of coverage 
provided under this title.
    ``(b) Periodic MedPAC Reports.--The Medicare Payment Advisory 
Commission shall periodically report to Congress concerning the program 
under this title.

``SEC. 2206. INCLUSION OF CARE COORDINATION SERVICES.

    ``(a) In General.--
            ``(1) Program authority.--The Secretary, beginning in 2010, 
        may implement a care coordination services program in 
        accordance with the provisions of this section under which, in 
        appropriate circumstances, eligible individuals under section 
        2201 may elect to have health care services covered under this 
        title managed and coordinated by a designated care coordinator.
            ``(2) Administration by contract.--The Secretary may 
        administer the program under this section through a contract 
        with an appropriate program administrator.
            ``(3) Coverage.--Care coordination services furnished in 
        accordance with this section shall be treated under this title 
        as if they were included in the definition of medical and other 
        health services under section 1861(s) and benefits shall be 
        available under this title with respect to such services 
        without the application of any deductible or coinsurance.
    ``(b) Eligibility Criteria; Identification and Notification of 
Eligible Individuals.--
            ``(1) Individual eligibility criteria.--The Secretary shall 
        specify criteria to be used in making a determination as to 
        whether an individual may appropriately be enrolled in the care 
        coordination services program under this section, which shall 
        include at least a finding by the Secretary that for cohorts of 
        individuals with characteristics identified by the Secretary, 
        professional management and coordination of care can reasonably 
        be expected to improve processes or outcomes of health care and 
        to reduce aggregate costs to the programs under this title.
            ``(2) Procedures to facilitate enrollment.--The Secretary 
        shall develop and implement procedures designed to facilitate 
        enrollment of eligible individuals in the program under this 
        section.
    ``(c) Enrollment of Individuals.--
            ``(1) Secretary's determination of eligibility.--The 
        Secretary shall determine the eligibility for services under 
        this section of individuals who are enrolled in the program 
        under this section and who make application for such services 
        in such form and manner as the Secretary may prescribe.
            ``(2) Enrollment period.--
                    ``(A) Effective date and duration.--Enrollment of 
                an individual in the program under this section shall 
                be effective as of the first day of the month following 
                the month in which the Secretary approves the 
                individual's application under paragraph (1), shall 
                remain in effect for one month (or such longer period 
                as the Secretary may specify), and shall be 
                automatically renewed for additional periods, unless 
                terminated in accordance with such procedures as the 
                Secretary shall establish by regulation. Such 
                procedures shall permit an individual to disenroll for 
                cause at any time and without cause at re-enrollment 
                intervals.
                    ``(B) Limitation on reenrollment.--The Secretary 
                may establish limits on an individual's eligibility to 
                reenroll in the program under this section if the 
                individual has disenrolled from the program more than 
                once during a specified time period.
    ``(d) Program.--The care coordination services program under this 
section shall include the following elements:
            ``(1) Basic care coordination services.--
                    ``(A) In general.--Subject to the cost-
                effectiveness criteria specified in subsection (b)(1), 
                except as otherwise provided in this section, enrolled 
                individuals shall receive services described in section 
                1905(t)(1) and may receive additional items and 
                services as described in subparagraph (B).
                    ``(B) Additional benefits.--The Secretary may 
                specify additional benefits for which payment would not 
                otherwise be made under this title that may be 
                available to individuals enrolled in the program under 
                this section (subject to an assessment by the care 
                coordinator of an individual's circumstance and need 
                for such benefits) in order to encourage enrollment in, 
                or to improve the effectiveness of, such program.
            ``(2) Care coordination requirement.--Notwithstanding any 
        other provision of this title, the Secretary may provide that 
        an individual enrolled in the program under this section may be 
        entitled to payment under this title for any specified health 
        care items or services only if the items or services have been 
        furnished by the care coordinator, or coordinated through the 
        care coordination services program. Under such provision, the 
        Secretary shall prescribe exceptions for emergency medical 
        services as described in section 1852(d)(3), and other 
        exceptions determined by the Secretary for the delivery of 
        timely and needed care.
    ``(e) Care Coordinators.--
            ``(1) Conditions of participation.--In order to be 
        qualified to furnish care coordination services under this 
        section, an individual or entity shall--
                    ``(A) be a health care professional or entity 
                (which may include physicians, physician group 
                practices, or other health care professionals or 
                entities the Secretary may find appropriate) meeting 
                such conditions as the Secretary may specify;
                    ``(B) have entered into a care coordination 
                agreement; and
                    ``(C) meet such criteria as the Secretary may 
                establish (which may include experience in the 
                provision of care coordination or primary care 
                physician's services).
            ``(2) Agreement term; payment.--
                    ``(A) Duration and renewal.--A care coordination 
                agreement under this subsection shall be for one year 
                and may be renewed if the Secretary is satisfied that 
                the care coordinator continues to meet the conditions 
                of participation specified in paragraph (1).
                    ``(B) Payment for services.--The Secretary may 
                negotiate or otherwise establish payment terms and 
                rates for services described in subsection (d)(1).
                    ``(C) Liability.--Care coordinators shall be 
                subject to liability for actual health damages which 
                may be suffered by recipients as a result of the care 
                coordinator's decisions, failure or delay in making 
                decisions, or other actions as a care coordinator.
                    ``(D) Terms.--In addition to such other terms as 
                the Secretary may require, an agreement under this 
                section shall include the terms specified in 
                subparagraphs (A) through (C) of section 1905(t)(3).

``SEC. 2207. ADMINISTRATION AND MISCELLANEOUS.

    ``(a) In General.--Except as otherwise provided in this title--
            ``(1) the Secretary shall enter into appropriate contracts 
        with providers of services, other health care providers, 
        carriers, and fiscal intermediaries, taking into account the 
        types of contracts used under title XVIII with respect to such 
        entities, to administer the program under this title;
            ``(2) beneficiary protections for individuals enrolled 
        under this title shall not be less than the beneficiary 
        protections (including limits on balance billing) provided 
        medicare beneficiaries under title XVIII;
            ``(3) benefits described in section 2202 that are payable 
        under this title to such individuals shall be paid in a manner 
        specified by the Secretary (taking into account, and based to 
        the greatest extent practicable upon, the manner in which they 
        are provided under title XVIII); and
            ``(4) provider participation agreements under title XVIII 
        shall apply to enrollees and benefits under this title in the 
        same manner as they apply to enrollees and benefits under title 
        XVIII.
    ``(b) Coordination With Medicaid and SCHIP.--Notwithstanding any 
other provision of law, individuals entitled to benefits for items and 
services under this title who also qualify for benefits under title XIX 
or XXI or any other Federally funded health care program that provides 
basic health insurance coverage described in section 2203(a)(2) may 
continue to qualify and obtain benefits under such other title or 
program, and in such case such an individual shall elect either--
            ``(1) such other title or program to be primary payor to 
        benefits under this title, in which case no benefits shall be 
        payable under this title and the monthly premium under section 
        2203 shall be zero; or
            ``(2) benefits under this title shall be primary payor to 
        benefits provided under such title or program, in which case 
        the Secretary shall enter into agreements with States as may be 
        appropriate to provide that, in the case of such individuals, 
        the benefits under titles XIX and XXI or such other program 
        (including reduction of cost-sharing) are provided on a `wrap-
        around' basis to the benefits under this title.''.
    (b) Conforming Amendments to Social Security Act Provisions.--
            (1) Section 201(i)(1) of the Social Security Act (42 U.S.C. 
        401(i)(1)) is amended by striking ``or the Federal 
        Supplementary Medical Insurance Trust Fund'' and inserting 
        ``the Federal Supplementary Medical Insurance Trust Fund, and 
        the MediKids Trust Fund''.
            (2) Section 201(g)(1)(A) of such Act (42 U.S.C. 
        401(g)(1)(A)) is amended by striking ``and the Federal 
        Supplementary Medical Insurance Trust Fund established by title 
        XVIII'' and inserting ``, the Federal Supplementary Medical 
        Insurance Trust Fund, and the MediKids Trust Fund established 
        by title XVIII''.
    (c) Maintenance of Medicaid Eligibility and Benefits for 
Children.--
            (1) In general.--In order for a State to continue to be 
        eligible for payments under section 1903(a) of the Social 
        Security Act (42 U.S.C. 1396b(a))--
                    (A) the State may not reduce standards of 
                eligibility, or benefits, provided under its State 
                medicaid plan under title XIX of the Social Security 
                Act or under its State child health plan under title 
                XXI of such Act for individuals under 23 years of age 
                below such standards of eligibility, and benefits, in 
                effect on the date of the enactment of this Act; and
                    (B) the State shall demonstrate to the satisfaction 
                of the Secretary of Health and Human Services that any 
                savings in State expenditures under title XIX or XXI of 
                the Social Security Act that results from children 
                enrolling under title XXII of such Act shall be used in 
                a manner that improves services to beneficiaries under 
                title XIX of such Act, such as through expansion of 
                eligibility, improved nurse and nurse aide staffing and 
                improved inspections of nursing facilities, and 
                coverage of additional services.
            (2) Medikids as primary payor.--In applying title XIX of 
        the Social Security Act, the MediKids program under title XXII 
        of such Act shall be treated as a primary payor in cases in 
        which the election described in section 2207(b)(2) of such Act, 
        as added by subsection (a), has been made.
    (d) Expansion of Medpac Membership to 19.--
            (1) In general.--Section 1805(c) of the Social Security Act 
        (42 U.S.C. 1395b-6(c)) is amended--
                    (A) in paragraph (1), by striking ``17'' and 
                inserting ``19''; and
                    (B) in paragraph (2)(B), by inserting ``experts in 
                children's health,'' after ``other health 
                professionals,''.
            (2) Initial terms of additional members.--
                    (A) In general.--For purposes of staggering the 
                initial terms of members of the Medicare Payment 
                Advisory Commission under section 1805(c)(3) of the 
                Social Security Act (42 U.S.C. 1395b-6(c)(3)), the 
                initial terms of the 2 additional members of the 
                Commission provided for by the amendment under 
                subsection (a)(1) are as follows:
                            (i) One member shall be appointed for 1 
                        year.
                            (ii) One member shall be appointed for 2 
                        years.
                    (B) Commencement of terms.--Such terms shall begin 
                on January 1, 2009.
            (3) Duties.--Section 1805(b)(1)(A) of such Act (42 U.S.C. 
        1395b-6(b)(1)(A)) is amended by inserting before the semicolon 
        at the end the following: ``and payment policies under title 
        XXII''.

SEC. 103. MEDIKIDS PREMIUM.

    (a) General Rule.--Subchapter A of chapter 1 of the Internal 
Revenue Code of 1986 (relating to determination of tax liability) is 
amended by adding at the end the following new part:

                     ``PART VIII--MEDIKIDS PREMIUM

``Sec. 59B. MediKids premium.

``SEC. 59B. MEDIKIDS PREMIUM.

    ``(a) Imposition of Tax.--In the case of a taxpayer to whom this 
section applies, there is hereby imposed (in addition to any other tax 
imposed by this subtitle) a MediKids premium for the taxable year.
    ``(b) Individuals Subject to Premium.--
            ``(1) In general.--This section shall apply to a taxpayer 
        if a MediKid is a dependent of the taxpayer for the taxable 
        year.
            ``(2) Medikid.--For purposes of this section, the term 
        `MediKid' means any individual enrolled in the MediKids program 
        under title XXII of the Social Security Act.
    ``(c) Amount of Premium.--For purposes of this section, the 
MediKids premium for a taxable year is the sum of the monthly premiums 
(for months in the taxable year) determined under section 2203 of the 
Social Security Act with respect to each MediKid who is a dependent of 
the taxpayer for the taxable year.
    ``(d) Exceptions Based on Adjusted Gross Income.--
            ``(1) Exemption for very low-income taxpayers.--
                    ``(A) In general.--No premium shall be imposed by 
                this section on any taxpayer having an adjusted gross 
                income not in excess of the exemption amount.
                    ``(B) Exemption amount.--For purposes of this 
                paragraph, the exemption amount is--
                            ``(i) $20,535 in the case of a taxpayer 
                        having 1 MediKid,
                            ``(ii) $25,755 in the case of a taxpayer 
                        having 2 MediKids,
                            ``(iii) $30,975 in the case of a taxpayer 
                        having 3 MediKids, and
                            ``(iv) $35,195 in the case of a taxpayer 
                        having 4 or more MediKids.
                    ``(C) Phaseout of exemption.--In the case of a 
                taxpayer having an adjusted gross income which exceeds 
                the exemption amount but does not exceed twice the 
                exemption amount, the premium shall be the amount which 
                bears the same ratio to the premium which would (but 
                for this subparagraph) apply to the taxpayer as such 
                excess bears to the exemption amount.
                    ``(D) Inflation adjustment of exemption amounts.--
                In the case of any taxable year beginning in a calendar 
                year after 2008, each dollar amount contained in 
                subparagraph (C) shall be increased by an amount equal 
                to the product of--
                            ``(i) such dollar amount, and
                            ``(ii) the cost-of-living adjustment 
                        determined under section 1(f)(3) for the 
                        calendar year in which the taxable year begins, 
                        determined by substituting `calendar year 2007' 
                        for `calendar year 1992' in subparagraph (B) 
                        thereof.
                If any increase determined under the preceding sentence 
                is not a multiple of $50, such increase shall be 
                rounded to the nearest multiple of $50.
            ``(2) Premium limited to 5 percent of adjusted gross 
        income.--In no event shall any taxpayer be required to pay a 
        premium under this section in excess of an amount equal to 5 
        percent of the taxpayer's adjusted gross income.
    ``(e) Coordination With Other Provisions.--
            ``(1) Not treated as medical expense.--For purposes of this 
        chapter, any premium paid under this section shall not be 
        treated as expense for medical care.
            ``(2) Not treated as tax for certain purposes.--The premium 
        paid under this section shall not be treated as a tax imposed 
        by this chapter for purposes of determining--
                    ``(A) the amount of any credit allowable under this 
                chapter, or
                    ``(B) the amount of the minimum tax imposed by 
                section 55.
            ``(3) Treatment under subtitle f.--For purposes of subtitle 
        F, the premium paid under this section shall be treated as if 
        it were a tax imposed by section 1.''.
    (b) Technical Amendments.--
            (1) Subsection (a) of section 6012 of such Code is amended 
        by inserting after paragraph (9) the following new paragraph:
            ``(10) Every individual liable for a premium under section 
        59B.''.
            (2) The table of parts for subchapter A of chapter 1 of 
        such Code is amended by adding at the end the following new 
        item:

                    ``Part VIII. MediKids Premium''.

    (c) Effective Date.--The amendments made by this section shall 
apply to months beginning after December 2008, in taxable years ending 
after such date.

SEC. 104. REFUNDABLE CREDIT FOR CERTAIN COST-SHARING EXPENSES UNDER 
              MEDIKIDS PROGRAM.

    (a) In General.--Subpart C of part IV of subchapter A of chapter 1 
of the Internal Revenue Code of 1986 (relating to refundable credits) 
is amended by redesignating section 37 as section 37A and by inserting 
after section 36 the following new section:

``SEC. 37. CATASTROPHIC LIMIT ON COST-SHARING EXPENSES UNDER MEDIKIDS 
              PROGRAM.

    ``(a) In General.--In the case of a taxpayer who has a MediKid (as 
defined in section 59B) at any time during the taxable year, there 
shall be allowed as a credit against the tax imposed by this subtitle 
an amount equal to the excess of--
            ``(1) the amount paid by the taxpayer during the taxable 
        year as cost-sharing under section 2202(b)(4) of the Social 
        Security Act, over
            ``(2) 5 percent of the taxpayer's adjusted gross income for 
        the taxable year.
    ``(b) Coordination With Other Provisions.--The excess described in 
subsection (a) shall not be taken into account in computing the amount 
allowable to the taxpayer as a deduction under section 162(l) or 
213(a).''.
    (b) Technical Amendments.--
            (1) The table of sections for subpart C of part IV of 
        subchapter A of chapter 1 of such Code is amended by 
        redesignating the item relating to section 37 as an item 
        relating to section 37A and by inserting before such item the 
        following new item:

``Sec. 37. Catastrophic limit on cost-sharing expenses under MediKids 
                            program.''.
            (2) Paragraph (2) of section 1324(b) of title 31, United 
        States Code, is amended by inserting ``, 37,'' after ``section 
        35''.
    (c) Effective Date.--The amendments made by this section shall 
apply to taxable years beginning after December 31, 2009.

SEC. 105. REPORT ON LONG-TERM REVENUES.

    Within one year after the date of the enactment of this Act, the 
Secretary of the Treasury shall propose a gradual schedule of 
progressive tax changes to fund the program under title XXII of the 
Social Security Act, as the number of enrollees grows in the out-years.

      TITLE II--STRENGTHENING QUALITY OF CARE AND HEALTH OUTCOMES

SEC. 201. CHILD HEALTH QUALITY IMPROVEMENT ACTIVITIES FOR CHILDREN 
              ENROLLED IN MEDIKIDS, MEDICAID, OR CHIP.

    (a) Development of Child Health Quality Measures for Children 
Enrolled in MediKids, Medicaid, or CHIP.--Title XI of the Social 
Security Act (42 U.S.C. 1301 et seq.) is amended by inserting after 
section 1139 the following new section:

``SEC. 1139A. CHILD HEALTH QUALITY MEASURES.

    ``(a) Development of an Initial Core Set of Health Care Quality 
Measures for Children Enrolled in MediKids, Medicaid, or CHIP.--
            ``(1) In general.--Not later than January 1, 2010, the 
        Secretary shall identify and publish for general comment an 
        initial, recommended core set of child health quality measures 
        for use under title XXII, by State programs administered under 
        titles XIX and XXI, health insurance issuers and managed care 
        entities that enter into contracts with such programs, and 
        providers of items and services under such programs.
            ``(2) Identification of initial core measures.--In 
        consultation with the individuals and entities described in 
        subsection (b)(3), the Secretary shall identify existing 
        quality of care measures for children that are in use under 
        public and privately sponsored health care coverage 
        arrangements, or that are part of reporting systems that 
        measure both the presence and duration of health insurance 
        coverage over time.
            ``(3) Recommendations and dissemination.--Based on such 
        existing and identified measures, the Secretary shall publish 
        an initial core set of child health quality measures that 
        includes (but is not limited to) the following:
                    ``(A) The duration of children's health insurance 
                coverage over a 12-month time period.
                    ``(B) The availability and effectiveness of a full 
                range of--
                            ``(i) preventive services, treatments, and 
                        services for acute conditions, including 
                        services to promote healthy birth, prevent and 
                        treat premature birth, and detect the presence 
                        or risk of physical or mental conditions that 
                        could adversely affect growth and development; 
                        and
                            ``(ii) treatments to correct or ameliorate 
                        the effects of physical and mental conditions, 
                        including chronic conditions, in infants, young 
                        children, school-age children, and adolescents.
                    ``(C) The availability of care in a range of 
                ambulatory and inpatient health care settings in which 
                such care is furnished.
                    ``(D) The types of measures that, taken together, 
                can be used to estimate the overall national quality of 
                health care for children, including children with 
                special needs, and to perform comparative analyses of 
                pediatric health care quality and racial, ethnic, and 
                socioeconomic disparities in child health and health 
                care for children.
            ``(4) Encourage voluntary and standardized reporting.--Not 
        later than 2 years after the date of this section, the 
        Secretary, in consultation with States, shall develop a 
        standardized format for reporting information and procedures 
        and approaches that encourage States to use the initial core 
        measurement set to voluntarily report information regarding the 
        quality of pediatric health care under titles XIX and XXI and 
        for the reporting of such standardized reporting under title 
        XXII.
            ``(5) Adoption of best practices in implementing quality 
        programs.--The Secretary shall disseminate information to 
        States regarding best practices among States with respect to 
        measuring and reporting on the quality of health care for 
        children, and shall facilitate the adoption of such best 
        practices. In developing best practices approaches, the 
        Secretary shall give particular attention to State measurement 
        techniques that ensure the timeliness and accuracy of provider 
        reporting, encourage provider reporting compliance, encourage 
        successful quality improvement strategies, and improve 
        efficiency in data collection using health information 
        technology.
            ``(6) Reports to congress.--Not later than January 1, 2011, 
        and every 3 years thereafter, the Secretary shall report to 
        Congress on--
                    ``(A) the status of the Secretary's efforts to 
                improve--
                            ``(i) quality related to the duration and 
                        stability of health insurance coverage for 
                        children under titles XIX, XXI, and XXII;
                            ``(ii) the quality of children's health 
                        care under such titles, including preventive 
                        health services, health care for acute 
                        conditions, chronic health care, and health 
                        services to ameliorate the effects of physical 
                        and mental conditions and to aid in growth and 
                        development of infants, young children, school-
                        age children, and adolescents with special 
                        health care needs; and
                            ``(iii) the quality of children's health 
                        care under such titles across the domains of 
                        quality, including clinical quality, health 
                        care safety, family experience with health 
                        care, health care in the most integrated 
                        setting, and elimination of racial, ethnic, and 
                        socioeconomic disparities in health and health 
                        care;
                    ``(B) the status of voluntary reporting by States 
                under titles XIX and XXI, and reporting by the 
                Secretary under title XXII, utilizing the initial core 
                quality measurement set; and
                    ``(C) any recommendations for legislative changes 
                needed to improve the quality of care provided to 
                children under titles XIX, XXI, and XXII, including 
                recommendations for quality reporting by States.
            ``(7) Technical assistance.--The Secretary shall provide 
        technical assistance to States to assist them in adopting and 
        utilizing core child health quality measures in administering 
        the State plans under titles XIX and XXI.
            ``(8) Definition of core set.--In this section, the term 
        `core set' means a group of valid, reliable, and evidence-based 
        quality measures that, taken together--
                    ``(A) provide information regarding the quality of 
                health coverage and health care for children;
                    ``(B) address the needs of children throughout the 
                developmental age span; and
                    ``(C) allow purchasers, families, and health care 
                providers to understand the quality of care in relation 
                to the preventive needs of children, treatments aimed 
                at managing and resolving acute conditions, and 
                diagnostic and treatment services whose purpose is to 
                correct or ameliorate physical, mental, or 
                developmental conditions that could, if untreated or 
                poorly treated, become chronic.
    ``(b) Advancing and Improving Pediatric Quality Measures.--
            ``(1) Establishment of pediatric quality measures 
        program.--Not later than January 1, 2011, the Secretary shall 
        establish a pediatric quality measures program to--
                    ``(A) improve and strengthen the initial core child 
                health care quality measures established by the 
                Secretary under subsection (a);
                    ``(B) expand on existing pediatric quality measures 
                used by public and private health care purchasers and 
                advance the development of such new and emerging 
                quality measures; and
                    ``(C) increase the portfolio of evidence-based, 
                consensus pediatric quality measures available to 
                public and private purchasers of children's health care 
                services, providers, and consumers.
            ``(2) Evidence-based measures.--The measures developed 
        under the pediatric quality measures program shall, at a 
        minimum, be--
                    ``(A) evidence-based and, where appropriate, risk 
                adjusted;
                    ``(B) designed to identify and eliminate racial and 
                ethnic disparities in child health and the provision of 
                health care;
                    ``(C) designed to ensure that the data required for 
                such measures is collected and reported in a standard 
                format that permits comparison of quality and data at a 
                State, plan, and provider level;
                    ``(D) periodically updated; and
                    ``(E) responsive to the child health needs, 
                services, and domains of health care quality described 
                in clauses (i), (ii), and (iii) of subsection 
                (a)(6)(A).
            ``(3) Process for pediatric quality measures program.--In 
        identifying gaps in existing pediatric quality measures and 
        establishing priorities for development and advancement of such 
        measures, the Secretary shall consult with--
                    ``(A) States;
                    ``(B) pediatricians, children's hospitals, and 
                other primary and specialized pediatric health care 
                professionals (including members of the allied health 
                professions) who specialize in the care and treatment 
                of children, particularly children with special 
                physical, mental, and developmental health care needs;
                    ``(C) dental professionals, including pediatric 
                dental professionals;
                    ``(D) health care providers that furnish primary 
                health care to children and families who live in urban 
                and rural medically underserved communities or who are 
                members of distinct population sub-groups at heightened 
                risk for poor health outcomes;
                    ``(E) national organizations representing children, 
                including children with disabilities and children with 
                chronic conditions;
                    ``(F) national organizations representing consumers 
                and purchasers of children's health care;
                    ``(G) national organizations and individuals with 
                expertise in pediatric health quality measurement; and
                    ``(H) voluntary consensus standards setting 
                organizations and other organizations involved in the 
                advancement of evidence-based measures of health care.
            ``(4) Developing, validating, and testing a portfolio of 
        pediatric quality measures.--As part of the program to advance 
        pediatric quality measures, the Secretary shall--
                    ``(A) award grants and contracts for the 
                development, testing, and validation of new, emerging, 
                and innovative evidence-based measures for children's 
                health care services across the domains of quality 
                described in clauses (i), (ii), and (iii) of subsection 
                (a)(6)(A); and
                    ``(B) award grants and contracts for--
                            ``(i) the development of consensus on 
                        evidence-based measures for children's health 
                        care services;
                            ``(ii) the dissemination of such measures 
                        to public and private purchasers of health care 
                        for children; and
                            ``(iii) the updating of such measures as 
                        necessary.
            ``(5) Revising, strengthening, and improving initial core 
        measures.--Beginning no later than January 1, 2013, and 
        annually thereafter, the Secretary shall publish recommended 
        changes to the core measures described in subsection (a) that 
        shall reflect the testing, validation, and consensus process 
        for the development of pediatric quality measures described in 
        subsection paragraphs (1) through (4).
            ``(6) Definition of pediatric quality measure.--In this 
        subsection, the term `pediatric quality measure' means a 
        measurement of clinical care that is capable of being examined 
        through the collection and analysis of relevant information, 
        that is developed in order to assess 1 or more aspects of 
        pediatric health care quality in various institutional and 
        ambulatory health care settings, including the structure of the 
        clinical care system, the process of care, the outcome of care, 
        or patient experiences in care.
            ``(7) Construction.--Nothing in this section shall be 
        construed as supporting the restriction of coverage, under 
        title XIX, XXI, or XXII or otherwise, to only those services 
        that are evidence-based.
    ``(c) Annual State Reports Regarding State-Specific Quality of Care 
Measures Applied Under Medicaid or CHIP.--
            ``(1) Annual state reports.--Each State with a State plan 
        approved under title XIX or a State child health plan approved 
        under title XXI shall annually report to the Secretary on the--
                    ``(A) State-specific child health quality measures 
                applied by the States under such plans, including 
                measures described in subparagraphs (A) and (B) of 
                subsection (a)(6); and
                    ``(B) State-specific information on the quality of 
                health care furnished to children under such plans, 
                including information collected through external 
                quality reviews of managed care organizations under 
                section 1932 of the Social Security Act (42 U.S.C. 
                1396u-4) and benchmark plans under sections 1937 and 
                2103 of such Act (42 U.S.C. 1396u-7, 1397cc).
        The Secretary shall collect such information with respect to 
        children under title XXII.
            ``(2) Publication.--Not later than September 30, 2010, and 
        annually thereafter, the Secretary shall collect, analyze, and 
        make publicly available the information reported by States 
        under paragraph (1) or collected by the Secretary under such 
        paragraph.
    ``(d) Demonstration Projects for Improving the Quality of 
Children's Health Care and the Use of Health Information Technology.--
            ``(1) In general.--During the period of fiscal years 2009 
        through 2013, the Secretary shall award not more than 10 grants 
        to States and child health providers to conduct demonstration 
        projects to evaluate promising ideas for improving the quality 
        of children's health care provided under title XIX, XXI, or 
        XXII, including projects to--
                    ``(A) experiment with, and evaluate the use of, new 
                measures of the quality of children's health care under 
                such titles (including testing the validity and 
                suitability for reporting of such measures);
                    ``(B) promote the use of health information 
                technology in care delivery for children under such 
                titles;
                    ``(C) evaluate provider-based models which improve 
                the delivery of children's health care services under 
                such titles, including care management for children 
                with chronic conditions and the use of evidence-based 
                approaches to improve the effectiveness, safety, and 
                efficiency of health care services for children; or
                    ``(D) demonstrate the impact of the model 
                electronic health record format for children developed 
                and disseminated under subsection (f) on improving 
                pediatric health, including the effects of chronic 
                childhood health conditions, and pediatric health care 
                quality as well as reducing health care costs.
            ``(2) Requirements.--In awarding grants under this 
        subsection, the Secretary shall ensure that--
                    ``(A) only 1 demonstration project funded under a 
                grant awarded under this subsection shall be conducted 
                in a State; and
                    ``(B) demonstration projects funded under grants 
                awarded under this subsection shall be conducted evenly 
                between States with large urban areas and States with 
                large rural areas.
            ``(3) Authority for multistate projects.--A demonstration 
        project conducted with a grant awarded under this subsection 
        may be conducted on a multistate basis, as needed.
            ``(4) Funding.--$20,000,000 of the amount appropriated 
        under subsection (i) for a fiscal year shall be used to carry 
        out this subsection.
    ``(e) Childhood Obesity Demonstration Project.--
            ``(1) Authority to conduct demonstration.--The Secretary, 
        in consultation with the Administrator of the Centers for 
        Medicare & Medicaid Services, shall conduct a demonstration 
        project to develop a comprehensive and systematic model for 
        reducing childhood obesity by awarding grants to eligible 
        entities to carry out such project. Such model shall--
                    ``(A) identify, through self-assessment, behavioral 
                risk factors for obesity among children;
                    ``(B) identify, through self-assessment, needed 
                clinical preventive and screening benefits among those 
                children identified as target individuals on the basis 
                of such risk factors;
                    ``(C) provide ongoing support to such target 
                individuals and their families to reduce risk factors 
                and promote the appropriate use of preventive and 
                screening benefits; and
                    ``(D) be designed to improve health outcomes, 
                satisfaction, quality of life, and appropriate use of 
                items and services for which medical assistance is 
                available under title XIX, child health assistance is 
                available under title XXI, or benefits are available 
                under title XXII among such target individuals.
            ``(2) Eligibility entities.--For purposes of this 
        subsection, an eligible entity is any of the following:
                    ``(A) A city, county, or Indian tribe.
                    ``(B) A local or tribal educational agency.
                    ``(C) An accredited university, college, or 
                community college.
                    ``(D) A Federally-qualified health center.
                    ``(E) A local health department.
                    ``(F) A health care provider.
                    ``(G) A community-based organization.
                    ``(H) Any other entity determined appropriate by 
                the Secretary, including a consortia or partnership of 
                entities described in any of subparagraphs (A) through 
                (G).
            ``(3) Use of funds.--An eligible entity awarded a grant 
        under this subsection shall use the funds made available under 
        the grant to--
                    ``(A) carry out community-based activities related 
                to reducing childhood obesity, including by--
                            ``(i) forming partnerships with entities, 
                        including schools and other facilities 
                        providing recreational services, to establish 
                        programs for after school and weekend community 
                        activities that are designed to reduce 
                        childhood obesity;
                            ``(ii) forming partnerships with daycare 
                        facilities to establish programs that promote 
                        healthy eating behaviors and physical activity; 
                        and
                            ``(iii) developing and evaluating community 
                        educational activities targeting good nutrition 
                        and promoting healthy eating behaviors;
                    ``(B) carry out age-appropriate school-based 
                activities that are designed to reduce childhood 
                obesity, including by--
                            ``(i) developing and testing educational 
                        curricula and intervention programs designed to 
                        promote healthy eating behaviors and habits in 
                        youth, which may include--
                                    ``(I) after hours physical activity 
                                programs; and
                                    ``(II) science-based interventions 
                                with multiple components to prevent 
                                eating disorders including nutritional 
                                content, understanding and responding 
                                to hunger and satiety, positive body 
                                image development, positive self-esteem 
                                development, and learning life skills 
                                (such as stress management, 
                                communication skills, problemsolving 
                                and decisionmaking skills), as well as 
                                consideration of cultural and 
                                developmental issues, and the role of 
                                family, school, and community;
                            ``(ii) providing education and training to 
                        educational professionals regarding how to 
                        promote a healthy lifestyle and a healthy 
                        school environment for children;
                            ``(iii) planning and implementing a healthy 
                        lifestyle curriculum or program with an 
                        emphasis on healthy eating behaviors and 
                        physical activity; and
                            ``(iv) planning and implementing healthy 
                        lifestyle classes or programs for parents or 
                        guardians, with an emphasis on healthy eating 
                        behaviors and physical activity for children;
                    ``(C) carry out educational, counseling, 
                promotional, and training activities through the local 
                health care delivery systems including by--
                            ``(i) promoting healthy eating behaviors 
                        and physical activity services to treat or 
                        prevent eating disorders, being overweight, and 
                        obesity;
                            ``(ii) providing patient education and 
                        counseling to increase physical activity and 
                        promote healthy eating behaviors;
                            ``(iii) training health professionals on 
                        how to identify and treat obese and overweight 
                        individuals which may include nutrition and 
                        physical activity counseling; and
                            ``(iv) providing community education by a 
                        health professional on good nutrition and 
                        physical activity to develop a better 
                        understanding of the relationship between diet, 
                        physical activity, and eating disorders, 
                        obesity, or being overweight; and
                    ``(D) provide, through qualified health 
                professionals, training and supervision for community 
                health workers to--
                            ``(i) educate families regarding the 
                        relationship between nutrition, eating habits, 
                        physical activity, and obesity;
                            ``(ii) educate families about effective 
                        strategies to improve nutrition, establish 
                        healthy eating patterns, and establish 
                        appropriate levels of physical activity; and
                            ``(iii) educate and guide parents regarding 
                        the ability to model and communicate positive 
                        health behaviors.
            ``(4) Priority.--In awarding grants under paragraph (1), 
        the Secretary shall give priority to awarding grants to 
        eligible entities--
                    ``(A) that demonstrate that they have previously 
                applied successfully for funds to carry out activities 
                that seek to promote individual and community health 
                and to prevent the incidence of chronic disease and 
                that can cite published and peer-reviewed research 
                demonstrating that the activities that the entities 
                propose to carry out with funds made available under 
                the grant are effective;
                    ``(B) that will carry out programs or activities 
                that seek to accomplish a goal or goals set by the 
                State in the Healthy People 2010 plan of the State;
                    ``(C) that provide non-Federal contributions, 
                either in cash or in-kind, to the costs of funding 
                activities under the grants;
                    ``(D) that develop comprehensive plans that include 
                a strategy for extending program activities developed 
                under grants in the years following the fiscal years 
                for which they receive grants under this subsection;
                    ``(E) located in communities that are medically 
                underserved, as determined by the Secretary;
                    ``(F) located in areas in which the average poverty 
                rate is at least 150 percent or higher of the average 
                poverty rate in the State involved, as determined by 
                the Secretary; and
                    ``(G) that submit plans that exhibit multisectoral, 
                cooperative conduct that includes the involvement of a 
                broad range of stakeholders, including--
                            ``(i) community-based organizations;
                            ``(ii) local governments;
                            ``(iii) local educational agencies;
                            ``(iv) the private sector;
                            ``(v) State or local departments of health;
                            ``(vi) accredited colleges, universities, 
                        and community colleges;
                            ``(vii) health care providers;
                            ``(viii) State and local departments of 
                        transportation and city planning; and
                            ``(ix) other entities determined 
                        appropriate by the Secretary.
            ``(5) Program design.--
                    ``(A) Initial design.--Not later than 1 year after 
                the date of enactment of this section, the Secretary 
                shall design the demonstration project. The 
                demonstration should draw upon promising, innovative 
                models and incentives to reduce behavioral risk 
                factors. The Administrator of the Centers for Medicare 
                & Medicaid Services shall consult with the Director of 
                the Centers for Disease Control and Prevention, the 
                Director of the Office of Minority Health, the heads of 
                other agencies in the Department of Health and Human 
                Services, and such professional organizations, as the 
                Secretary determines to be appropriate, on the design, 
                conduct, and evaluation of the demonstration.
                    ``(B) Number and project areas.--Not later than 2 
                years after the date of enactment of this section, the 
                Secretary shall award 1 grant that is specifically 
                designed to determine whether programs similar to 
                programs to be conducted by other grantees under this 
                subsection should be implemented with respect to the 
                general population of children who are eligible for 
                child health assistance under State child health plans 
                under title XXI or for benefits under title XXII in 
                order to reduce the incidence of childhood obesity 
                among such population.
            ``(6) Report to congress.--Not later than 3 years after the 
        date the Secretary implements the demonstration project under 
        this subsection, the Secretary shall submit to Congress a 
        report that describes the project, evaluates the effectiveness 
        and cost effectiveness of the project, evaluates the 
        beneficiary satisfaction under the project, and includes any 
        such other information as the Secretary determines to be 
        appropriate.
            ``(7) Definitions.--In this subsection:
                    ``(A) Federally-qualified health center.--The term 
                `Federally-qualified health center' has the meaning 
                given that term in section 1905(l)(2)(B).
                    ``(B) Indian tribe.--The term `Indian tribe' has 
                the meaning given that term in section 4 of the Indian 
                Health Care Improvement Act (25 U.S.C. 1603).
                    ``(C) Self-assessment.--The term `self-assessment' 
                means a form that--
                            ``(i) includes questions regarding--
                                    ``(I) behavioral risk factors;
                                    ``(II) needed preventive and 
                                screening services; and
                                    ``(III) target individuals' 
                                preferences for receiving follow-up 
                                information;
                            ``(ii) is assessed using such computer 
                        generated assessment programs; and
                            ``(iii) allows for the provision of such 
                        ongoing support to the individual as the 
                        Secretary determines appropriate.
                    ``(D) Ongoing support.--The term `ongoing support' 
                means--
                            ``(i) to provide any target individual with 
                        information, feedback, health coaching, and 
                        recommendations regarding--
                                    ``(I) the results of a self-
                                assessment given to the individual;
                                    ``(II) behavior modification based 
                                on the self-assessment; and
                                    ``(III) any need for clinical 
                                preventive and screening services or 
                                treatment including medical nutrition 
                                therapy;
                            ``(ii) to provide any target individual 
                        with referrals to community resources and 
                        programs available to assist the target 
                        individual in reducing health risks; and
                            ``(iii) to provide the information 
                        described in clause (i) to a health care 
                        provider, if designated by the target 
                        individual to receive such information.
            ``(8) Authorization of appropriations.--There is authorized 
        to be appropriated to carry out this subsection, $25,000,000 
        for the period of fiscal years 2009 through 2013.
    ``(f) Development of Model Electronic Health Record Format for 
Children Enrolled in Medicaid or CHIP.--
            ``(1) In general.--Not later than January 1, 2010, the 
        Secretary shall establish a program to encourage the 
        development and dissemination of a model electronic health 
        record format for children enrolled in the State plan under 
        title XIX, the State child health plan under title XXI, or the 
        MediKids program under title XXII that is--
                    ``(A) subject to State laws, accessible to parents, 
                caregivers, and other consumers for the sole purpose of 
                demonstrating compliance with school or leisure 
                activity requirements, such as appropriate 
                immunizations or physicals;
                    ``(B) designed to allow interoperable exchanges 
                that conform with Federal and State privacy and 
                security requirements;
                    ``(C) structured in a manner that permits parents 
                and caregivers to view and understand the extent to 
                which the care their children receive is clinically 
                appropriate and of high quality; and
                    ``(D) capable of being incorporated into, and 
                otherwise compatible with, other standards developed 
                for electronic health records.
            ``(2) Funding.--$5,000,000 of the amount appropriated under 
        subsection (i) for a fiscal year shall be used to carry out 
        this subsection.
    ``(g) Study of Pediatric Health and Health Care Quality Measures.--
            ``(1) In general.--Not later than July 1, 2010, the 
        Institute of Medicine shall study and report to Congress on the 
        extent and quality of efforts to measure child health status 
        and the quality of health care for children across the age span 
        and in relation to preventive care, treatments for acute 
        conditions, and treatments aimed at ameliorating or correcting 
        physical, mental, and developmental conditions in children. In 
        conducting such study and preparing such report, the Institute 
        of Medicine shall--
                    ``(A) consider all of the major national 
                population-based reporting systems sponsored by the 
                Federal Government that are currently in place, 
                including reporting requirements under Federal grant 
                programs and national population surveys and estimates 
                conducted directly by the Federal Government;
                    ``(B) identify the information regarding child 
                health and health care quality that each system is 
                designed to capture and generate, the study and 
                reporting periods covered by each system, and the 
                extent to which the information so generated is made 
                widely available through publication;
                    ``(C) identify gaps in knowledge related to 
                children's health status, health disparities among 
                subgroups of children, the effects of social conditions 
                on children's health status and use and effectiveness 
                of health care, and the relationship between child 
                health status and family income, family stability and 
                preservation, and children's school readiness and 
                educational achievement and attainment; and
                    ``(D) make recommendations regarding improving and 
                strengthening the timeliness, quality, and public 
                transparency and accessibility of information about 
                child health and health care quality.
            ``(2) Funding.--Up to $1,000,000 of the amount appropriated 
        under subsection (i) for a fiscal year shall be used to carry 
        out this subsection.
    ``(h) Rule of Construction.--Notwithstanding any other provision in 
this section, no evidence based quality measure developed, published, 
or used as a basis of measurement or reporting under this section may 
be used to establish an irrebuttable presumption regarding either the 
medical necessity of care or the maximum permissible coverage for any 
individual child who is eligible for and receiving medical assistance 
under title XIX, child health assistance under title XXI, or benefits 
under title XXII.
    ``(i) Appropriation.--Out of any funds in the Treasury not 
otherwise appropriated, there is appropriated for each of fiscal years 
2009 through 2013, $45,000,000 for the purpose of carrying out this 
section (other than subsection (e)). Funds appropriated under this 
subsection shall remain available until expended.''.
    (b) Increased Matching Rate for Collecting and Reporting on Child 
Health Measures.--Section 1903(a)(3)(A) of the Social Security Act (42 
U.S.C. 1396b(a)(3)(A)) is amended--
            (1) by striking ``and'' at the end of clause (i); and
            (2) by adding at the end the following new clause:
                    ``(iii) an amount equal to the Federal medical 
                assistance percentage (as defined in section 1905(b)) 
                of so much of the sums expended during such quarter (as 
                found necessary by the Secretary for the proper and 
                efficient administration of the State plan) as are 
                attributable to such developments or modifications of 
                systems of the type described in clause (i) as are 
                necessary for the efficient collection and reporting on 
                child health measures; and''.

SEC. 202. IMPROVED AVAILABILITY OF PUBLIC INFORMATION REGARDING 
              ENROLLMENT OF CHILDREN IN CHIP AND MEDICAID.

    (a) Inclusion of Process and Access Measures in Annual State 
Reports.--Section 2108 of the Social Security Act (42 U.S.C. 1397hh) is 
amended--
            (1) in subsection (a), in the matter preceding paragraph 
        (1), by striking ``The State'' and inserting ``Subject to 
        subsection (e), the State''; and
            (2) by adding at the end the following new subsection:
    ``(e) Information Required for Inclusion in State Annual Report.--
The State shall include the following information in the annual report 
required under subsection (a):
            ``(1) Eligibility criteria, enrollment, and retention data 
        (including data with respect to continuity of coverage or 
        duration of benefits).
            ``(2) Data regarding the extent to which the State uses 
        process measures with respect to determining the eligibility of 
        children under the State child health plan, including measures 
        such as 12-month continuous eligibility, self-declaration of 
        income for applications or renewals, or presumptive 
        eligibility.
            ``(3) Data regarding denials of eligibility and 
        redeterminations of eligibility.
            ``(4) Data regarding access to primary and specialty 
        services, access to networks of care, and care coordination 
        provided under the State child health plan, using quality care 
        and consumer satisfaction measures included in the Consumer 
        Assessment of Healthcare Providers and Systems (CAHPS) survey.
            ``(5) If the State provides child health assistance in the 
        form of premium assistance for the purchase of coverage under a 
        group health plan, data regarding the provision of such 
        assistance, including the extent to which employer-sponsored 
        health insurance coverage is available for children eligible 
        for child health assistance under the State child health plan, 
        the range of the monthly amount of such assistance provided on 
        behalf of a child or family, the number of children or families 
        provided such assistance on a monthly basis, the income of the 
        children or families provided such assistance, the benefits and 
        cost-sharing protection provided under the State child health 
        plan to supplement the coverage purchased with such premium 
        assistance, the effective strategies the State engages in to 
        reduce any administrative barriers to the provision of such 
        assistance, and, the effects, if any, of the provision of such 
        assistance on preventing the coverage provided under the State 
        child health plan from substituting for coverage provided under 
        employer-sponsored health insurance offered in the State.
            ``(6) To the extent applicable, a description of any State 
        activities that are designed to reduce the number of uncovered 
        children in the State, including through a State health 
        insurance connector program or support for innovative private 
        health coverage initiatives.''.
    (b) Standardized Reporting Format.--
            (1) In general.--Not later than 1 year after the date of 
        enactment of this Act, the Secretary shall specify a 
        standardized format for States to use for reporting the 
        information required under section 2108(e) of the Social 
        Security Act, as added by subsection (a)(2).
            (2) Transition period for states.--Each State that is 
        required to submit a report under subsection (a) of section 
        2108 of the Social Security Act that includes the information 
        required under subsection (e) of such section may use up to 3 
        reporting periods to transition to the reporting of such 
        information in accordance with the standardized format 
        specified by the Secretary under paragraph (1).
    (c) Additional Funding for the Secretary To Improve Timeliness of 
Data Reporting and Analysis for Purposes of Determining Enrollment 
Increases Under Medicaid and CHIP.--
            (1) Appropriation.--There is appropriated, out of any money 
        in the Treasury not otherwise appropriated, $5,000,000 to the 
        Secretary for fiscal year 2009 for the purpose of improving the 
        timeliness of the data reported and analyzed from the Medicaid 
        Statistical Information System (MSIS) for purposes of providing 
        more timely data on enrollment and eligibility of children 
        under Medicaid and CHIP and to provide guidance to States with 
        respect to any new reporting requirements related to such 
        improvements. Amounts appropriated under this paragraph shall 
        remain available until expended.
            (2) Requirements.--The improvements made by the Secretary 
        under paragraph (1) shall be designed and implemented 
        (including with respect to any necessary guidance for States to 
        report such information in a complete and expeditious manner) 
        so that, beginning no later than October 1, 2009, data 
        regarding the enrollment of low-income children (as defined in 
        section 2110(c)(4) of the Social Security Act (42 U.S.C. 
        1397jj(c)(4)) of a State enrolled in the State plan under 
        Medicaid or the State child health plan under CHIP with respect 
        to a fiscal year shall be collected and analyzed by the 
        Secretary within 6 months of submission.
    (d) GAO Study and Report on Access to Primary and Specialty 
Services.--
            (1) In general.--The Comptroller General of the United 
        States shall conduct a study of children's access to primary 
        and specialty services under Medicaid, CHIP, and MediKids, 
        including--
                    (A) the extent to which providers are willing to 
                treat children eligible for such programs;
                    (B) information on such children's access to 
                networks of care;
                    (C) geographic availability of primary and 
                specialty services under such programs;
                    (D) the extent to which care coordination is 
                provided for children's care under Medicaid, CHIP, and 
                MediKids; and
                    (E) as appropriate, information on the degree of 
                availability of services for children under such 
                programs.
            (2) Report.--Not later than 2 years after the date of 
        enactment of this Act, the Comptroller General shall submit a 
        report to the Committee on Finance of the Senate and the 
        Committee on Energy and Commerce of the House of 
        Representatives on the study conducted under paragraph (1) that 
        includes recommendations for such Federal and State legislative 
        and administrative changes as the Comptroller General 
        determines are necessary to address any barriers to access to 
        children's care under Medicaid, CHIP, and MediKids that may 
        exist.

SEC. 203. APPLICATION OF CERTAIN MANAGED CARE QUALITY SAFEGUARDS TO 
              CHIP.

    (a) In General.--Section 2103(f) of Social Security Act (42 U.S.C. 
1397bb(f)) is amended by adding at the end the following new paragraph:
            ``(3) Compliance with managed care requirements.--The State 
        child health plan shall provide for the application of 
        subsections (a)(4), (a)(5), (b), (c), (d), and (e) of section 
        1932 (relating to requirements for managed care) to coverage, 
        State agencies, enrollment brokers, managed care entities, and 
        managed care organizations under this title in the same manner 
        as such subsections apply to coverage and such entities and 
        organizations under title XIX.''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
apply to contract years for health plans beginning on or after July 1, 
2009.
                                 <all>