1.Short title; table of contents
(a)This Act may be cited as the MediKids Health Insurance Act of 2009
.
(b)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.
<enum>I</enum><header>MediKids Health Insurance</header>
<section display-inline="no-display-inline" id="H83C2991EEBDD47C28415FC02C1DC6C74"><enum>101.</enum><header>Findings</header>
<subsection id="HD6C686F017E64FE1ABCDFDD4FBCDB133"><enum>(a)</enum><header>Findings</header><text>Congress finds the following:</text>
<paragraph id="HD94F270C75B64548989B2BABC00377F"><enum>(1)</enum><text>More than 9 million American children are uninsured.</text> </paragraph>
<paragraph id="H70C8322DECEE47F1A4DD90531700541D"><enum>(2)</enum><text>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.</text> </paragraph>
<paragraph id="HD69E1E73572F4B53B1EF98A1FDBAC63C"><enum>(3)</enum><text>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.</text> </paragraph>
<paragraph id="H86C2EF8DA5FF4B65A33C173B4704BFA"><enum>(4)</enum><text>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.</text> </paragraph>
<paragraph id="HD0E8C79B19E348B7BC00817228D31B29"><enum>(5)</enum><text>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.</text> </paragraph>
<paragraph id="H58DFC39700F842EFA44233C92700BC00"><enum>(6)</enum><text>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 <quote>MediKids</quote>), 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.</text> </paragraph>
<paragraph id="H937B347BAF0A459786B6146901D44C5"><enum>(7)</enum><text>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.</text> </paragraph>
<paragraph id="H8896EAF7DA864C358FC05283B1CECDEF"><enum>(8)</enum><text>The MediKids program can be administered without impacting the finances or status of the existing Medicare program.</text> </paragraph>
<paragraph id="H3D42B2B96E5C4C3CAEB0B90397D58405"><enum>(9)</enum><text>The MediKids benefit package can be tailored to the special needs of children and updated over time.</text> </paragraph>
<paragraph id="H76E436B7D14C49F9B7C6986F5D6B11CA"><enum>(10)</enum><text>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).</text> </paragraph>
<paragraph id="H547979F9A911434AA7735E00B297C77B"><enum>(11)</enum><text>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.</text> </paragraph>
<paragraph id="H831B1F6DA06448BB85BAE7AEA7D2AF20"><enum>(12)</enum><text>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.</text> </paragraph></subsection></section>
<section id="H5B0CDA3D331A408EB130A23EA7B5DB47"><enum>102.</enum><header>Benefits for all children born after 2009</header>
<subsection id="HEADD2EC2360F463FADC79829213E79BF"><enum>(a)</enum><header>In general</header><text>The <act-name parsable-cite="SSA">Social Security Act</act-name> is amended by adding at the end the following new title:</text>
<quoted-block act-name="Social Security Act" id="H0190405BDE384EE39C08E842776F6885">
<title id="H4275B5772E25456F947B1035008BCC3"><enum>XXII</enum><header>MediKids Program</header>
<section id="HEEDA3B3F8E4947129F82BA207233158E"><enum>2201.</enum><header>Eligibility</header>
<subsection id="H41B4D34BC0A7467BB2D2941FC4F0CC49"><enum>(a)</enum><header>Eligibility of individuals born after December 31, 2009; all children under 23 years of age in fifth year</header><text>An individual who meets the following requirements with respect to a month is eligible to enroll under this title with respect to such month:</text>
<paragraph id="H8999C9FCA4334053B13B5E8BAA096EDA"><enum>(1)</enum><header>Age</header>
<subparagraph id="H87FB181804304AFC9E94142014D0469"><enum>(A)</enum><header>First year</header><text>As of the first day of the first year in which this title is effective, the individual has not attained 6 years of age.</text> </subparagraph>
<subparagraph id="H770C4D33E2DC48CE96002F8D5E399250"><enum>(B)</enum><header>Second year</header><text display-inline="yes-display-inline">As of the first day of the second year in which this title is effective, the individual has not attained 11 years of age.</text> </subparagraph>
<subparagraph id="H9D4558432DAD4288B5B20045351F90AE"><enum>(C)</enum><header>Third year</header><text display-inline="yes-display-inline">As of the first day of the third year in which this title is effective, the individual has not attained 16 years of age.</text> </subparagraph>
<subparagraph id="H4F897DA4181F486086E8C8DA96BA1F06"><enum>(D)</enum><header>Fourth year</header><text display-inline="yes-display-inline">As of the first day of the fourth year in which this title is effective, the individual has not attained 21 years of age.</text> </subparagraph>
<subparagraph id="HFE80A07F7C3144878826B93C092EF049"><enum>(E)</enum><header>Fifth and subsequent years</header><text display-inline="yes-display-inline">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.</text> </subparagraph></paragraph>
<paragraph id="H3FE0779870DF488EB5DB0000E4E1FB6F"><enum>(2)</enum><header>Citizenship</header><text>The individual is a citizen or national of the United States or is permanently residing in the United States under color of law.</text> </paragraph></subsection>
<subsection id="H39F408C2A52A41DEA0095529E954AB93"><enum>(b)</enum><header>Enrollment process</header><text>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—</text>
<paragraph id="H033676EE484948CCAFF485614D6E07CA"><enum>(1)</enum><text>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;</text> </paragraph>
<paragraph id="H294D9E12FB874E3200D651F7551C60B1"><enum>(2)</enum><text>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;</text> </paragraph>
<paragraph id="H5C1B7636A0934F2DB686853431CE4CD0"><enum>(3)</enum><text>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</text> </paragraph>
<paragraph id="H19D332785D26449CBEA785828107EB07"><enum>(4)</enum><text>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.</text> </paragraph><continuation-text continuation-text-level="subsection">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.</continuation-text></subsection>
<subsection id="H05B9B006325C4ECFB9FC9F4FC8F5BBC"><enum>(c)</enum><header>Date coverage begins</header>
<paragraph id="H1AD1EF2A71CF459E92544F6C11226480"><enum>(1)</enum><header>In general</header><text>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:</text>
<subparagraph id="HDD2E6C84F0BB4B6E9607AD104760E31C"><enum>(A)</enum><text>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.</text> </subparagraph>
<subparagraph id="H752F6CEC098346A092CBCC61ED5115CF"><enum>(B)</enum><text>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.</text> </subparagraph>
<subparagraph id="H41EB71EBBB68427BBC8E4CDE344D0559"><enum>(C)</enum><text>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.</text> </subparagraph></paragraph>
<paragraph id="H4E712AC3236B49538F6779668B9CEB8D"><enum>(2)</enum><header>Authority to provide for partial months of coverage</header><text>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.</text> </paragraph>
<paragraph id="H87094F1EF72C4939B63E5745B9767948"><enum>(3)</enum><header>Limitation on payments</header><text>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.</text> </paragraph></subsection>
<subsection id="HD963A090404B43EB96007B4648C08EA9"><enum>(d)</enum><header>Expiration of eligibility</header><text>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).</text> </subsection>
<subsection id="H37628D77A0114C95939CBB65B8F4F4E9"><enum>(e)</enum><header>Entitlement to MediKids benefits for enrolled individuals</header><text>An individual enrolled under this title is entitled to the benefits described in section 2202.</text> </subsection>
<subsection id="HAD79AC26783A476C8C04B5A19D33DE4C"><enum>(f)</enum><header>Low-income information</header>
<paragraph id="HB020086A63374FD193BF92C2C01F3B2D"><enum>(1)</enum><header>Inquiry of income</header><text display-inline="yes-display-inline">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:</text>
<subparagraph id="H92332776F90A43959D188C812D9633A3"><enum>(A)</enum><header>Up to 150 percent of poverty</header><text>The income of the family does not exceed 150 percent of the poverty line for a family of the size involved.</text> </subparagraph>
<subparagraph id="HFE31848F90CC4AAFA3C450004C12ABA9"><enum>(B)</enum><header>Between 150 and 200 percent of poverty</header><text>The income of the family exceeds 150 percent, but does not exceed 200 percent, of such poverty line.</text> </subparagraph>
<subparagraph id="H3FC716D3B7B54E1B8349F949F72FA31B"><enum>(C)</enum><header>Between 200 and 300 percent of poverty</header><text>The income of the family exceeds 200 percent, but does not exceed 300 percent, of such poverty line.</text> </subparagraph></paragraph>
<paragraph id="H2F89FB2339BB490EBBB578005BD55965"><enum>(2)</enum><header>Coding</header><text>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.</text> </paragraph>
<paragraph id="HC9D3F2933472494B9028AA48F5F16C4"><enum>(3)</enum><header>Provider verification through electronic system</header><text display-inline="yes-display-inline">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.</text> </paragraph></subsection>
<subsection id="H59C9F0E7D0F34759A66EFF5EAE032026"><enum>(g)</enum><header>Construction</header><text>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.</text> </subsection></section>
<section id="H51CC3A19D92343B28D91FFE1998E8F36"><enum>2202.</enum><header>Benefits</header>
<subsection id="H8AAABABE3C5A477189070082A4E46D60"><enum>(a)</enum><header>Secretarial specification of benefit package</header>
<paragraph id="H98AA08FE620B4640B658DBCCE7FAC6F8"><enum>(1)</enum><header>In general</header><text>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.</text> </paragraph>
<paragraph id="H684808E285F94210843C23268B919575"><enum>(2)</enum><header>Updating</header><text>The Secretary shall update the specification of benefits over time to ensure the inclusion of age-appropriate benefits to reflect the enrollee population.</text> </paragraph>
<paragraph id="HAC2B9AD6E0BF4603942F1BEEF2AEA8DE"><enum>(3)</enum><header>Annual updating</header><text>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.</text> </paragraph>
<paragraph id="H148B3BB47E614184A5269CA3AC39884D"><enum>(4)</enum><header>Input</header><text>The Secretary shall seek the input of the pediatric community in specifying and updating such benefits.</text> </paragraph>
<paragraph id="H01BB50373F31486EA3F2BCF2AD73EE5"><enum>(5)</enum><header>Limitation on updating</header><text>In no case shall updating of benefits under this subsection result in a failure to provide benefits required under subsection (b).</text> </paragraph></subsection>
<subsection id="H4017481DFB12461E902CE275833383D6"><enum>(b)</enum><header>Inclusion of certain benefits</header>
<paragraph id="HBF1DF003AB1D4619B54D00E5ADE954AF"><enum>(1)</enum><header>Medicare core benefits</header><text>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.</text> </paragraph>
<paragraph id="H59ACB43B584347338CD8EECBA5031828"><enum>(2)</enum><header>All required Medicaid benefits</header><text>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.</text> </paragraph>
<paragraph id="HA681C98A98634D7097E6F674F0EC5CD1"><enum>(3)</enum><header>Inclusion of prescription drugs</header><text>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.</text> </paragraph>
<paragraph id="H683F135CB0C747F08EA5A6D81FB7F01C"><enum>(4)</enum><header>Cost-sharing</header>
<subparagraph id="H8417ADB0C4934DD0B8F1F09F6F1B54B3"><enum>(A)</enum><header>In general</header><text display-inline="yes-display-inline">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).</text> </subparagraph>
<subparagraph id="H1EDAE84A422D434182880286B565002F"><enum>(B)</enum><header>Reduced cost-sharing for low income children</header><text>Such benefits shall provide that—</text>
<clause id="H9A74415C249744F599DCF6E9166E2800"><enum>(i)</enum><text>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);</text> </clause>
<clause id="HE25798FCBC634C058DF3D5D79EDAFC1"><enum>(ii)</enum><text display-inline="yes-display-inline">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</text> </clause>
<clause id="HFD560C657F88490D9893D52662129DF2"><enum>(iii)</enum><text display-inline="yes-display-inline">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).</text> </clause></subparagraph>
<subparagraph id="H664BC6055818476788ACA3354146752B"><enum>(C)</enum><header>Catastrophic limit on cost-sharing</header><text>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.</text> </subparagraph></paragraph></subsection>
<subsection id="H75B06A94205140E79D09BDA9D93F4988"><enum>(c)</enum><header>Payment schedule</header><text>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.</text> </subsection>
<subsection id="HD2C087D2D84E44F39770D16B7E00009F"><enum>(d)</enum><header>Input</header><text>The Secretary shall specify such benefits and payment schedules only after obtaining input from appropriate child health providers and experts.</text> </subsection>
<subsection id="HC0E45D6CD41045739B5C07CF966F8678"><enum>(e)</enum><header>Enrollment in health plans</header><text>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.</text> </subsection></section>
<section id="H70702C2692234865A57C12D9243BE8BD"><enum>2203.</enum><header>Premiums</header>
<subsection id="HE7EB4589D3B94FE4A9E9223027F89B8C"><enum>(a)</enum><header>Amount of monthly premiums</header>
<paragraph id="H3D6DF57ABAA849528968AE52C0D4EC00"><enum>(1)</enum><header>In general</header><text>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 <fraction>1/12</fraction> of the annual premium rate computed under subsection (b).</text> </paragraph>
<paragraph id="H87CB2545AFB148F7A78F11F8A76811AF"><enum>(2)</enum><header>Elimination of monthly premium for demonstration of equivalent coverage (including coverage under low-income programs)</header><text>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.</text> </paragraph></subsection>
<subsection id="H85B12E350AD24FC3AC6F50008C4BECB"><enum>(b)</enum><header>Annual premium</header>
<paragraph id="H1216E92813244A5485D41D2FABF89788"><enum>(1)</enum><header>National per capita average</header><text>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).</text> </paragraph>
<paragraph id="HD6172DDB9B0D4DE48B97B95F734DCF1D"><enum>(2)</enum><header>Annual premium</header><text>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.</text> </paragraph></subsection>
<subsection id="HD2848C039FF940E2B45BDC379F118D7D"><enum>(c)</enum><header>Payment of monthly premium</header>
<paragraph id="H00AD52A54F1444B9A6921B0034C300D"><enum>(1)</enum><header>Period of payment</header><text>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.</text> </paragraph>
<paragraph id="H06F5A566D596464E85210645FB24696"><enum>(2)</enum><header>Collection through tax return</header><text>For provisions providing for the payment of monthly premiums under this subsection, see section 59B of the Internal Revenue Code of 1986.</text> </paragraph>
<paragraph id="HB48E34969493436CA23FB025A8947C3"><enum>(3)</enum><header>Protections against fraud and abuse</header><text>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.</text> </paragraph></subsection>
<subsection id="H6372DCEBE6AA41BDB0E28B3007B896EC"><enum>(d)</enum><header>Reduction in premium for certain low-income families</header><text>For provisions reducing the premium under this section for certain low-income families, see section 59B(d) of the Internal Revenue Code of 1986.</text> </subsection></section>
<section id="HC75CE1838D9342CFB82BE0CA00A542A2"><enum>2204.</enum><header>MediKids Trust Fund</header>
<subsection id="H36D7A1C922C64769BB341F62BAA27CE6"><enum>(a)</enum><header>Establishment of Trust Fund</header>
<paragraph id="H0713E027478044E491923635DB727E67"><enum>(1)</enum><header>In general</header><text>There is hereby created on the books of the Treasury of the United States a trust fund to be known as the <quote>MediKids Trust Fund</quote> (in this section referred to as the <quote>Trust Fund</quote>). 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.</text> </paragraph>
<paragraph id="H965EBB6FBB234E4FB2FE3846CEBA85"><enum>(2)</enum><header>Premiums</header><text>Premiums collected under section 59B of the Internal Revenue Code of 1986 shall be periodically transferred to the Trust Fund.</text> </paragraph>
<paragraph id="HB2AE541622004D25BBEB998DFC74FBBC"><enum>(3)</enum><header>Transitional funding before receipt of premiums</header><text>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.</text> </paragraph></subsection>
<subsection id="H0820923DD04743CC8C0039DE2D194854"><enum>(b)</enum><header>Incorporation of provisions</header>
<paragraph id="HC30F66D338794462898B10CF5239628B"><enum>(1)</enum><header>In general</header><text>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.</text> </paragraph>
<paragraph id="H4CFEA91D4BEB4D8D97782B01F42FBB9C"><enum>(2)</enum><header>Miscellaneous references</header><text>In applying provisions of section 1841 under paragraph (1)—</text>
<subparagraph id="H197D7E5F46BB42748D6BD558CD98B3FA"><enum>(A)</enum><text>any reference in such section to <quote>this part</quote> is construed to refer to title XXII;</text> </subparagraph>
<subparagraph id="H683EA611F6E647B4A3EB6D741F09F7B1"><enum>(B)</enum><text>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;</text> </subparagraph>
<subparagraph id="HBB0E6A520EFB4A36BACB14B6C016253C"><enum>(C)</enum><text>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</text> </subparagraph>
<subparagraph id="HD887F082C53F4E0ABA243E04650041EC"><enum>(D)</enum><text>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.</text> </subparagraph></paragraph></subsection></section>
<section id="HDA4FD522863A45C3A949F67988002663"><enum>2205.</enum><header>Oversight and accountability</header>
<subsection id="H2B94EF461D6E4C21B7753F55C552BC31"><enum>(a)</enum><header>Periodic GAO reports</header><text>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.</text> </subsection>
<subsection id="H0D0409B6B8114052BA8BDF4FB13DE94"><enum>(b)</enum><header>Periodic MedPAC reports</header><text>The Medicare Payment Advisory Commission shall periodically report to Congress concerning the program under this title.</text> </subsection></section>
<section id="H4A8360072D62494CA310E999FE8F4720"><enum>2206.</enum><header>Inclusion of care coordination services</header>
<subsection id="H5047078A160F4E4C94053E4BFB31A671"><enum>(a)</enum><header>In general</header>
<paragraph id="HC39C0AC425754DF6B5255C070087995E"><enum>(1)</enum><header>Program authority</header><text>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.</text> </paragraph>
<paragraph id="H3F670EAB39E24DCE847F3984C20078FD"><enum>(2)</enum><header>Administration by contract</header><text>The Secretary may administer the program under this section through a contract with an appropriate program administrator.</text> </paragraph>
<paragraph id="HCB846058D2814D639DB51CA62818F04F"><enum>(3)</enum><header>Coverage</header><text>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.</text> </paragraph></subsection>
<subsection id="H3FE8BB85A1364D8985E2EA5649C8FB55"><enum>(b)</enum><header>Eligibility criteria; identification and notification of eligible individuals</header>
<paragraph id="H33D7B757519448DBBC09425C7541BD5C"><enum>(1)</enum><header>Individual eligibility criteria</header><text>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.</text> </paragraph>
<paragraph id="HC1B2A98D6D004C7580AE700891AFE09B"><enum>(2)</enum><header>Procedures to facilitate enrollment</header><text>The Secretary shall develop and implement procedures designed to facilitate enrollment of eligible individuals in the program under this section.</text> </paragraph></subsection>
<subsection id="HAAFE063F6A7B4CFEA73384DBBDD4C1A8"><enum>(c)</enum><header>Enrollment of individuals</header>
<paragraph id="H0EB6CE5B24174EF6977EDA71A21804D3"><enum>(1)</enum><header>Secretary’s determination of eligibility</header><text>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.</text> </paragraph>
<paragraph id="H9D9D1B217D004189A4535D95E8BA44AD"><enum>(2)</enum><header>Enrollment period</header>
<subparagraph id="H3A9C08F43D804F7FA3A6B9C1CC13363F"><enum>(A)</enum><header>Effective date and duration</header><text>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.</text> </subparagraph>
<subparagraph id="H44DA420DA58D42E9BC35A5B187C23FD"><enum>(B)</enum><header>Limitation on reenrollment</header><text>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.</text> </subparagraph></paragraph></subsection>
<subsection id="H50FCBBB7CAFB4B5E0022AFE527A4309F"><enum>(d)</enum><header>Program</header><text>The care coordination services program under this section shall include the following elements:</text>
<paragraph id="H2DF735EC498D4FE5BBDCDF671B61C166"><enum>(1)</enum><header>Basic care coordination services</header>
<subparagraph id="H0083F65043BC4B3FA905E53C2FC233B5"><enum>(A)</enum><header>In general</header><text>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).</text> </subparagraph>
<subparagraph id="H1A5D5A8503A84BCAA15EDE9833CA89DC"><enum>(B)</enum><header>Additional benefits</header><text>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.</text> </subparagraph></paragraph>
<paragraph id="HD6756717427047EFAE36DF6FD799B8"><enum>(2)</enum><header>Care coordination requirement</header><text>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.</text> </paragraph></subsection>
<subsection id="HF020D7A88C544029851E8360F8A6666"><enum>(e)</enum><header>Care coordinators</header>
<paragraph id="HA091CD16ED07402D9E2DAD3BDEC91FC4"><enum>(1)</enum><header>Conditions of participation</header><text>In order to be qualified to furnish care coordination services under this section, an individual or entity shall—</text>
<subparagraph id="HE939982BD83544A08305EFBFAE347E89"><enum>(A)</enum><text>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;</text> </subparagraph>
<subparagraph id="HD252F1DED56344F2949584283EBE5E3C"><enum>(B)</enum><text>have entered into a care coordination agreement; and</text> </subparagraph>
<subparagraph id="HE42E53B937724A84AA22E04232493099"><enum>(C)</enum><text>meet such criteria as the Secretary may establish (which may include experience in the provision of care coordination or primary care physician’s services).</text> </subparagraph></paragraph>
<paragraph id="H3F84A98AFEDE486F9C0011DDBCA397E7"><enum>(2)</enum><header>Agreement term; payment</header>
<subparagraph id="H8CA283B73D1548D2AD00C6002C750062"><enum>(A)</enum><header>Duration and renewal</header><text>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).</text> </subparagraph>
<subparagraph id="HA3DFAA5A85804F538922A963765145E3"><enum>(B)</enum><header>Payment for services</header><text>The Secretary may negotiate or otherwise establish payment terms and rates for services described in subsection (d)(1).</text> </subparagraph>
<subparagraph id="HB631044C840140A69348FC159885FBA9"><enum>(C)</enum><header>Liability</header><text>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.</text> </subparagraph>
<subparagraph id="HB7B2B1E5ECA74A10A93994516FFF45AE"><enum>(D)</enum><header>Terms</header><text>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).</text> </subparagraph></paragraph></subsection></section>
<section id="H6B59518A9C3F450AAEF6C88B3CD7A3A7"><enum>2207.</enum><header>Administration and miscellaneous</header>
<subsection id="HC8A264A46CA4453F8E53F45FF758D4D5"><enum>(a)</enum><header>In general</header><text>Except as otherwise provided in this title—</text>
<paragraph id="H6EA7712C1E0443099772B81D3BFA3714"><enum>(1)</enum><text>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;</text> </paragraph>
<paragraph id="HEC6F49F748C94D969D20FD8B2F583997"><enum>(2)</enum><text>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;</text> </paragraph>
<paragraph id="H8B22FB996DA34EB5B2A8FAE4D8BF1106"><enum>(3)</enum><text>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</text> </paragraph>
<paragraph id="HE9AEC740C74048EB91CAF4766791BF40"><enum>(4)</enum><text>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.</text> </paragraph></subsection>
<subsection id="H11E4D44406B0458D8DA6ADC928589B7"><enum>(b)</enum><header>Coordination with Medicaid and SCHIP</header><text>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—</text>
<paragraph id="H0057FE2046C3485AA92242119B2C2F33"><enum>(1)</enum><text>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</text> </paragraph>
<paragraph id="H18243EB2FBAC4903B8E89328BE3205D8"><enum>(2)</enum><text display-inline="yes-display-inline">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 <quote>wrap-around</quote> basis to the benefits under this title.</text> </paragraph></subsection></section>.
(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 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 payorIn 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)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)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)Such terms shall begin on January 1, 2009.
(3)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
.
103.
(a)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:
VIII
Sec. 59B. MediKids premium.
59B.
(a)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)This section shall apply to a taxpayer if a MediKid is a dependent of the taxpayer for the taxable year.
(2)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)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)No premium shall be imposed by this section on any taxpayer having an adjusted gross income not in excess of the exemption amount.
(B)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)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 amountsIn 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 incomeIn 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 expenseFor 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 purposesThe 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 fFor purposes of subtitle F, the premium paid under this section shall be treated as if it were a tax imposed by section 1. .
(b)
(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)The amendments made by this section shall apply to months beginning after December 2008, in taxable years ending after such date.
104.Refundable credit for certain cost-sharing expenses under MediKids program
(a)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:
37.Catastrophic limit on cost-sharing expenses under MediKids program
(a)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 provisionsThe 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)
(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)The amendments made by this section shall apply to taxable years beginning after December 31, 2009.
105.Report on long-term revenuesWithin 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.
<enum>II</enum><header>Strengthening Quality of Care and Health Outcomes</header>
<section id="HF4874A56BAB9429CBB44D0A2A16B9269"><enum>201.</enum><header>Child health quality improvement activities for children enrolled in MediKids, Medicaid, or CHIP</header>
<subsection id="HB122341BF93E4F3A8ECB757425792E77"><enum>(a)</enum><header>Development of Child Health Quality Measures for Children Enrolled in MediKids, Medicaid, or CHIP</header><text>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:</text>
<quoted-block id="HD3B59CC21B444E489F75C32F090397F7" style="OLC">
<section id="H4F157152E6914102A9F071DC906CFBC3"><enum>1139A.</enum><header>Child health quality measures</header>
<subsection id="HB98BAA7BA5D84AAFA069C2ADECC700B7"><enum>(a)</enum><header>Development of an Initial Core Set of Health Care Quality Measures for Children Enrolled in MediKids, Medicaid, or CHIP</header>
<paragraph id="H6CDB4BB0B693495DB3052680FBF4E246"><enum>(1)</enum><header>In general</header><text>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.</text> </paragraph>
<paragraph id="H434A6C8D1DCD4BBEA4D6A8765805EB09"><enum>(2)</enum><header>Identification of initial core measures</header><text>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.</text> </paragraph>
<paragraph id="HB2D23D25707441329F931299BA196FC5"><enum>(3)</enum><header>Recommendations and dissemination</header><text>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:</text>
<subparagraph id="H9E7563D9C3B14D59866DDCA49C178D87"><enum>(A)</enum><text>The duration of children’s health insurance coverage over a 12-month time period.</text> </subparagraph>
<subparagraph id="H760905EC8B0442D4BAF1462576009B14"><enum>(B)</enum><text>The availability and effectiveness of a full range of—</text>
<clause id="H619AE10F48C348FC857E2164C2AC7B1C"><enum>(i)</enum><text>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</text> </clause>
<clause id="H626A9B13FD84453283DBE53A5AF611C"><enum>(ii)</enum><text>treatments to correct or ameliorate the effects of physical and mental conditions, including chronic conditions, in infants, young children, school-age children, and adolescents.</text> </clause></subparagraph>
<subparagraph id="H71639E2882224BF48049A3489374E4E2"><enum>(C)</enum><text>The availability of care in a range of ambulatory and inpatient health care settings in which such care is furnished.</text> </subparagraph>
<subparagraph id="HB7DFAF68BDD94DA8AFB364F272198700"><enum>(D)</enum><text>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.</text> </subparagraph></paragraph>
<paragraph id="H297AECD7B3544416975D948477EE1590"><enum>(4)</enum><header>Encourage voluntary and standardized reporting</header><text>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.</text> </paragraph>
<paragraph id="H41934192280C4773B41FF9B7C061E1A"><enum>(5)</enum><header>Adoption of best practices in implementing quality programs</header><text>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.</text> </paragraph>
<paragraph id="HBA97268FEC834B2AA9873FABD65C8252"><enum>(6)</enum><header>Reports to congress</header><text>Not later than January 1, 2011, and every 3 years thereafter, the Secretary shall report to Congress on—</text>
<subparagraph id="HFD68DD61018A458E97E646E0416BAB5"><enum>(A)</enum><text>the status of the Secretary’s efforts to improve—</text>
<clause id="H1A87DC6202704B4EA9735129648006E9"><enum>(i)</enum><text>quality related to the duration and stability of health insurance coverage for children under titles XIX, XXI, and XXII;</text> </clause>
<clause id="H7ECE5724AD5341FB83761C92AAADE49C"><enum>(ii)</enum><text>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</text> </clause>
<clause id="H4B9E37D0C22340B09B5BEC309D859BC6"><enum>(iii)</enum><text>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;</text> </clause></subparagraph>
<subparagraph id="H8A2F36A744F84670B36B335CDB4BDD08"><enum>(B)</enum><text>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</text> </subparagraph>
<subparagraph id="H50700042FDAC47838B8BE3B2FC551567"><enum>(C)</enum><text>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.</text> </subparagraph></paragraph>
<paragraph id="HAB785C6EAE5B4F45B64BC32EDD4CE36F"><enum>(7)</enum><header>Technical assistance</header><text>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.</text> </paragraph>
<paragraph id="H47950807E8584EA784C822CB49C4935E"><enum>(8)</enum><header>Definition of core set</header><text>In this section, the term <term>core set</term> means a group of valid, reliable, and evidence-based quality measures that, taken together—</text>
<subparagraph id="HA6A4C5FA80244C69A7A24DCFD3369078"><enum>(A)</enum><text>provide information regarding the quality of health coverage and health care for children;</text> </subparagraph>
<subparagraph id="HB41B5AC56C0B4A20BD81E7D265D24469"><enum>(B)</enum><text>address the needs of children throughout the developmental age span; and</text> </subparagraph>
<subparagraph id="H91094E9B932C46E8A3E4607468A3CB38"><enum>(C)</enum><text>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.</text> </subparagraph></paragraph></subsection>
<subsection id="H2DFD9433B136495CB5845B936815C7FA"><enum>(b)</enum><header>Advancing and Improving Pediatric Quality Measures</header>
<paragraph id="HB40F5A8C0830435B8DD19C184DA435EB"><enum>(1)</enum><header>Establishment of pediatric quality measures program</header><text>Not later than January 1, 2011, the Secretary shall establish a pediatric quality measures program to—</text>
<subparagraph id="H7345F3413C0846619D25501281CF3618"><enum>(A)</enum><text>improve and strengthen the initial core child health care quality measures established by the Secretary under subsection (a);</text> </subparagraph>
<subparagraph id="H9836E19E8C194875A14EDEA9B4C3572E"><enum>(B)</enum><text>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</text> </subparagraph>
<subparagraph id="H27433F8A7E8346919E479431BA33F122"><enum>(C)</enum><text>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.</text> </subparagraph></paragraph>
<paragraph id="H0B9B0958FCBE43C797CE699EDE3DBCD9"><enum>(2)</enum><header>Evidence-based measures</header><text>The measures developed under the pediatric quality measures program shall, at a minimum, be—</text>
<subparagraph id="H4416F78D2A84426B9E273530FEEAF544"><enum>(A)</enum><text>evidence-based and, where appropriate, risk adjusted;</text> </subparagraph>
<subparagraph id="H4A873A556068417F98D3000000AB2119"><enum>(B)</enum><text>designed to identify and eliminate racial and ethnic disparities in child health and the provision of health care;</text> </subparagraph>
<subparagraph id="H790711F96B50402987474E6F8BEA00D6"><enum>(C)</enum><text>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;</text> </subparagraph>
<subparagraph id="H04E5D307AEBA45E3B095EE9C1FB3A021"><enum>(D)</enum><text>periodically updated; and</text> </subparagraph>
<subparagraph id="H4E0D1B34A4AD49E5AFABEDDDA5887EBB"><enum>(E)</enum><text>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).</text> </subparagraph></paragraph>
<paragraph id="H0C5F5DAE99064302AFEE06E684F003D"><enum>(3)</enum><header>Process for pediatric quality measures program</header><text>In identifying gaps in existing pediatric quality measures and establishing priorities for development and advancement of such measures, the Secretary shall consult with—</text>
<subparagraph id="HA1024ADFB05046808700284CAD7EAEE1"><enum>(A)</enum><text>States;</text> </subparagraph>
<subparagraph id="H545BF9912C3C47518B794BAC00C6F6E4"><enum>(B)</enum><text>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;</text> </subparagraph>
<subparagraph id="HEA522C8BEB844285AA4869C132DCCCA"><enum>(C)</enum><text>dental professionals, including pediatric dental professionals;</text> </subparagraph>
<subparagraph id="H8E8A3E087858499DA833402748BA7D46"><enum>(D)</enum><text>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;</text> </subparagraph>
<subparagraph id="H95AC730111EF443C8CDDED39C1EDA358"><enum>(E)</enum><text>national organizations representing children, including children with disabilities and children with chronic conditions;</text> </subparagraph>
<subparagraph id="HDC960E0DA3684A50818D12E9F9FD6100"><enum>(F)</enum><text>national organizations representing consumers and purchasers of children’s health care;</text> </subparagraph>
<subparagraph id="H4FFCC726D3A748BAB6396DF93EC10333"><enum>(G)</enum><text>national organizations and individuals with expertise in pediatric health quality measurement; and</text> </subparagraph>
<subparagraph id="H05DB6187D0C94CFCA52356176E30EE10"><enum>(H)</enum><text>voluntary consensus standards setting organizations and other organizations involved in the advancement of evidence-based measures of health care.</text> </subparagraph></paragraph>
<paragraph id="HD4CAB2355A1945F5A53536601E0148EA"><enum>(4)</enum><header>Developing, validating, and testing a portfolio of pediatric quality measures</header><text>As part of the program to advance pediatric quality measures, the Secretary shall—</text>
<subparagraph id="H88F125D1841E4253B3B6AE7ED6004C39"><enum>(A)</enum><text>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</text> </subparagraph>
<subparagraph id="H3B3A6305B4534EEBA9B9F4C42CE1E05D"><enum>(B)</enum><text>award grants and contracts for—</text>
<clause id="H675ECC0BBEEE47088779065B32E875A7"><enum>(i)</enum><text>the development of consensus on evidence-based measures for children’s health care services;</text> </clause>
<clause id="HEB94D64EFBCE42B488AE69015487A9FA"><enum>(ii)</enum><text>the dissemination of such measures to public and private purchasers of health care for children; and</text> </clause>
<clause id="H1BE420784ECA4E8E8FEB54F79B59D989"><enum>(iii)</enum><text>the updating of such measures as necessary.</text> </clause></subparagraph></paragraph>
<paragraph id="H26DC09A18EE144D7A6C06CC66D2B461B"><enum>(5)</enum><header>Revising, strengthening, and improving initial core measures</header><text>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).</text> </paragraph>
<paragraph id="HE07E848304EA4A17A57F002FE187ACEE"><enum>(6)</enum><header>Definition of pediatric quality measure</header><text>In this subsection, the term <term>pediatric quality measure</term> 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.</text> </paragraph>
<paragraph id="HA32236D7E5C147B1ACF61B7C6BFDC6E5"><enum>(7)</enum><header>Construction</header><text>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.</text> </paragraph></subsection>
<subsection id="H2FBF40B64D5E4C349C3CAFE2E05DB1F5"><enum>(c)</enum><header>Annual State Reports Regarding State-Specific Quality of Care Measures Applied Under Medicaid or CHIP</header>
<paragraph id="H38123AC5C3D549008FC256541E31CB9D"><enum>(1)</enum><header>Annual state reports</header><text>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—</text>
<subparagraph id="HC6D20FB36CF04172006090AEE92821A4"><enum>(A)</enum><text>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</text> </subparagraph>
<subparagraph id="H96C142FE7664481090772DC4B1AA89A6"><enum>(B)</enum><text>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 <act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C. 1396u–4) and benchmark plans under sections 1937 and 2103 of such Act (42 U.S.C. 1396u–7, 1397cc).</text> </subparagraph><continuation-text continuation-text-level="paragraph">The Secretary shall collect such information with respect to children under title XXII.</continuation-text></paragraph>
<paragraph id="HEA97654A18144103845351C8BB003374"><enum>(2)</enum><header>Publication</header><text>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.</text> </paragraph></subsection>
<subsection id="HD041917C375546299636BA002D32EAAB"><enum>(d)</enum><header>Demonstration Projects for Improving the Quality of Children’s Health Care and the Use of Health Information Technology</header>
<paragraph id="HCE2F69CD4F0D455A8B00724739FC2BA2"><enum>(1)</enum><header>In general</header><text>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—</text>
<subparagraph id="HFEC86FFE5B454982BE67981CA47B9B87"><enum>(A)</enum><text>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);</text> </subparagraph>
<subparagraph id="H86DF5858E97F4349863FA87CB5074F07"><enum>(B)</enum><text>promote the use of health information technology in care delivery for children under such titles;</text> </subparagraph>
<subparagraph id="H3B150AA16E2E4B1EA2A8238C336B1038"><enum>(C)</enum><text>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</text> </subparagraph>
<subparagraph id="H05AE089C4C604C17ABD707E2F3434587"><enum>(D)</enum><text>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.</text> </subparagraph></paragraph>
<paragraph id="H5A1633571B064C8898D5E3003FB5A721"><enum>(2)</enum><header>Requirements</header><text>In awarding grants under this subsection, the Secretary shall ensure that—</text>
<subparagraph id="HAE487BD093D2423F001B89CD8B2F1D20"><enum>(A)</enum><text>only 1 demonstration project funded under a grant awarded under this subsection shall be conducted in a State; and</text> </subparagraph>
<subparagraph id="H0C18C5692BB241BFB7C5CEB9AB76B5C6"><enum>(B)</enum><text>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.</text> </subparagraph></paragraph>
<paragraph id="H4C6C8FE6541A4186825D608FB43B01"><enum>(3)</enum><header>Authority for multistate projects</header><text>A demonstration project conducted with a grant awarded under this subsection may be conducted on a multistate basis, as needed.</text> </paragraph>
<paragraph id="HB2C0F171C85E45B3ABFCCC9FA8F8746E"><enum>(4)</enum><header>Funding</header><text>$20,000,000 of the amount appropriated under subsection (i) for a fiscal year shall be used to carry out this subsection.</text> </paragraph></subsection>
<subsection id="H356B0B27E59E4259A45CD05967E30021"><enum>(e)</enum><header>Childhood Obesity Demonstration Project</header>
<paragraph id="H021A9B636D5D430598F7B60328695FD4"><enum>(1)</enum><header>Authority to conduct demonstration</header><text>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—</text>
<subparagraph id="H6980DB6E7A6D4B2DB93954003B2690A1"><enum>(A)</enum><text>identify, through self-assessment, behavioral risk factors for obesity among children;</text> </subparagraph>
<subparagraph id="H35D6482193144E33B7E68F3DD2DC449C"><enum>(B)</enum><text>identify, through self-assessment, needed clinical preventive and screening benefits among those children identified as target individuals on the basis of such risk factors;</text> </subparagraph>
<subparagraph id="H96B5D129A01D4CF99B0177422C5C0221"><enum>(C)</enum><text>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</text> </subparagraph>
<subparagraph id="H420B89D3E93E4CB686F34EF0963897AF"><enum>(D)</enum><text>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.</text> </subparagraph></paragraph>
<paragraph id="H2743AAE29F4441A99520FA2CEA2D6995"><enum>(2)</enum><header>Eligibility entities</header><text>For purposes of this subsection, an eligible entity is any of the following:</text>
<subparagraph id="HCCEBF02130094DCAB0AD4C688E901489"><enum>(A)</enum><text>A city, county, or Indian tribe.</text> </subparagraph>
<subparagraph id="H298F28D45B624E79B1FCD1BED46B0A"><enum>(B)</enum><text>A local or tribal educational agency.</text> </subparagraph>
<subparagraph id="H355879938522476CA4F46B73A8862952"><enum>(C)</enum><text>An accredited university, college, or community college.</text> </subparagraph>
<subparagraph id="H1DC03BA774BB4922B1427BBB70F524B5"><enum>(D)</enum><text>A Federally-qualified health center.</text> </subparagraph>
<subparagraph id="H84A46DB7FDE1423EAC00CC5BEA622306"><enum>(E)</enum><text>A local health department.</text> </subparagraph>
<subparagraph id="H84F0E695D4C54EE08789EF2E8777E49"><enum>(F)</enum><text>A health care provider.</text> </subparagraph>
<subparagraph id="H4AB1E59FBD2B48F0A4DEB346EDBDCB29"><enum>(G)</enum><text>A community-based organization.</text> </subparagraph>
<subparagraph id="H141E8F87D3DF4E0999DB78D550F0321"><enum>(H)</enum><text>Any other entity determined appropriate by the Secretary, including a consortia or partnership of entities described in any of subparagraphs (A) through (G).</text> </subparagraph></paragraph>
<paragraph id="H5055FF17C8DC424700C628028BDDD6FB"><enum>(3)</enum><header>Use of funds</header><text>An eligible entity awarded a grant under this subsection shall use the funds made available under the grant to—</text>
<subparagraph id="HA4FED5953C4A4793A3E8F18B9F6CAB"><enum>(A)</enum><text>carry out community-based activities related to reducing childhood obesity, including by—</text>
<clause id="H49F7280742144A82A2E0A739951E7F99"><enum>(i)</enum><text>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;</text> </clause>
<clause id="H5ADD753860244498BCB5E62899B554B1"><enum>(ii)</enum><text>forming partnerships with daycare facilities to establish programs that promote healthy eating behaviors and physical activity; and</text> </clause>
<clause id="HEB4659FCB0B448398699A36BEC62E386"><enum>(iii)</enum><text>developing and evaluating community educational activities targeting good nutrition and promoting healthy eating behaviors;</text> </clause></subparagraph>
<subparagraph id="H463C28686CC24205B22501A0C20801B7"><enum>(B)</enum><text>carry out age-appropriate school-based activities that are designed to reduce childhood obesity, including by—</text>
<clause id="H1CF44FA1F44C49A6BE81B818F2BA7154"><enum>(i)</enum><text>developing and testing educational curricula and intervention programs designed to promote healthy eating behaviors and habits in youth, which may include—</text>
<subclause id="H17ADD2266C9D4E4FB900CC75AB4134A6"><enum>(I)</enum><text>after hours physical activity programs; and</text> </subclause>
<subclause id="H2233123DA769462EB86EB1CE631C55C8"><enum>(II)</enum><text>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;</text> </subclause></clause>
<clause id="H6704D4E5BF0D4D109C488D70AA6615E1"><enum>(ii)</enum><text>providing education and training to educational professionals regarding how to promote a healthy lifestyle and a healthy school environment for children;</text> </clause>
<clause id="H225363EA68AD474D9C4FBB34B1895D00"><enum>(iii)</enum><text>planning and implementing a healthy lifestyle curriculum or program with an emphasis on healthy eating behaviors and physical activity; and</text> </clause>
<clause id="H7BB066A09D784A35A428008983B180B7"><enum>(iv)</enum><text>planning and implementing healthy lifestyle classes or programs for parents or guardians, with an emphasis on healthy eating behaviors and physical activity for children;</text> </clause></subparagraph>
<subparagraph id="H7BAC7FB0120843079BA508A84775615F"><enum>(C)</enum><text>carry out educational, counseling, promotional, and training activities through the local health care delivery systems including by—</text>
<clause id="HAD59A6AFBE9D4CB5AE3E75A6C6A19772"><enum>(i)</enum><text>promoting healthy eating behaviors and physical activity services to treat or prevent eating disorders, being overweight, and obesity;</text> </clause>
<clause id="HEF6111E1CAAC4EFEBDD9EAE7969B146B"><enum>(ii)</enum><text>providing patient education and counseling to increase physical activity and promote healthy eating behaviors;</text> </clause>
<clause id="H59E2DF96BA684DBA97447000D03F14F2"><enum>(iii)</enum><text>training health professionals on how to identify and treat obese and overweight individuals which may include nutrition and physical activity counseling; and</text> </clause>
<clause id="H438F70D12137495A8B1D5F6E120312C2"><enum>(iv)</enum><text>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</text> </clause></subparagraph>
<subparagraph id="H964DCCED13DB4F049C38D637A6D91949"><enum>(D)</enum><text>provide, through qualified health professionals, training and supervision for community health workers to—</text>
<clause id="H35A2E7E49C1B4A9BBADCFB1CA7D6D4F9"><enum>(i)</enum><text>educate families regarding the relationship between nutrition, eating habits, physical activity, and obesity;</text> </clause>
<clause id="H9D847A22CF2D48A8B951D8B8FC2500F3"><enum>(ii)</enum><text>educate families about effective strategies to improve nutrition, establish healthy eating patterns, and establish appropriate levels of physical activity; and</text> </clause>
<clause id="HB29F25209DC2487795CAF959CAFB6334"><enum>(iii)</enum><text>educate and guide parents regarding the ability to model and communicate positive health behaviors.</text> </clause></subparagraph></paragraph>
<paragraph id="H3BF41A889E464F36A4F18325B9E56851"><enum>(4)</enum><header>Priority</header><text>In awarding grants under paragraph (1), the Secretary shall give priority to awarding grants to eligible entities—</text>
<subparagraph id="H8DEA874F4775491AA25FED9011CB5772"><enum>(A)</enum><text>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;</text> </subparagraph>
<subparagraph id="HD3F1877D2D44464EB9FD18CDA110C877"><enum>(B)</enum><text>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;</text> </subparagraph>
<subparagraph id="H29AB64F4D898474EBECFE13864ADE157"><enum>(C)</enum><text>that provide non-Federal contributions, either in cash or in-kind, to the costs of funding activities under the grants;</text> </subparagraph>
<subparagraph id="H904A577DFF30479AB83063EFDA1BF5C9"><enum>(D)</enum><text>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;</text> </subparagraph>
<subparagraph id="H159E0D2ACC0E4CF7978B7BB20081B43B"><enum>(E)</enum><text>located in communities that are medically underserved, as determined by the Secretary;</text> </subparagraph>
<subparagraph id="HC8A0500B50C24D428EDA669EE9301049"><enum>(F)</enum><text>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</text> </subparagraph>
<subparagraph id="H05137B0CBB7948658C672D1872A1E500"><enum>(G)</enum><text>that submit plans that exhibit multisectoral, cooperative conduct that includes the involvement of a broad range of stakeholders, including—</text>
<clause id="HCE7A440B2A9942D383D601B9322C6E5B"><enum>(i)</enum><text>community-based organizations;</text> </clause>
<clause id="H9E1CEEBB11344AF596000055FB00F4C3"><enum>(ii)</enum><text>local governments;</text> </clause>
<clause id="HA75D1FE5D22F406BB56330001E519437"><enum>(iii)</enum><text>local educational agencies;</text> </clause>
<clause id="HD67467EA5DE4424F97D7F52217CE862"><enum>(iv)</enum><text>the private sector;</text> </clause>
<clause id="HBF08F434A778471199BACB95AB035851"><enum>(v)</enum><text>State or local departments of health;</text> </clause>
<clause id="HA99FE64C81E1442A94E700FEEE751DB0"><enum>(vi)</enum><text>accredited colleges, universities, and community colleges;</text> </clause>
<clause id="HD09E6CC4F578499ABE50AE655F4696C8"><enum>(vii)</enum><text>health care providers;</text> </clause>
<clause id="HAD79FD382F3645BDB4E6E1F6D88B100"><enum>(viii)</enum><text>State and local departments of transportation and city planning; and</text> </clause>
<clause id="HBF1E6997B33F49C181D250BC84A28B92"><enum>(ix)</enum><text>other entities determined appropriate by the Secretary.</text> </clause></subparagraph></paragraph>
<paragraph id="H30BA38D091EB468A904EE1D619D7E01F"><enum>(5)</enum><header>Program design</header>
<subparagraph id="H05EC4105EC814DB1007F3E5BE865FB78"><enum>(A)</enum><header>Initial design</header><text>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.</text> </subparagraph>
<subparagraph id="HAB6A82B19E66494894213FD18F618AD"><enum>(B)</enum><header>Number and project areas</header><text>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.</text> </subparagraph></paragraph>
<paragraph id="HD8B4C6ECA3DE452D8D23BF9F8044A7B1"><enum>(6)</enum><header>Report to congress</header><text>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.</text> </paragraph>
<paragraph id="HD72A7EE43EA9431E8ED42E379E634484"><enum>(7)</enum><header>Definitions</header><text>In this subsection:</text>
<subparagraph id="H9ADBACCE7C034387AFA8CFA5D0D5332E"><enum>(A)</enum><header>Federally-qualified health center</header><text>The term <term>Federally-qualified health center</term> has the meaning given that term in section 1905(l)(2)(B).</text> </subparagraph>
<subparagraph id="H4A31F6AEEABA42D687D448BE5ECBF07E"><enum>(B)</enum><header>Indian tribe</header><text>The term <term>Indian tribe</term> has the meaning given that term in section 4 of the <act-name parsable-cite="IHCIA">Indian Health Care Improvement Act</act-name> (25 U.S.C. 1603).</text> </subparagraph>
<subparagraph id="H9FC3880296E64D75A3C8277D0134100"><enum>(C)</enum><header>Self-assessment</header><text>The term <term>self-assessment</term> means a form that—</text>
<clause id="HA30593E4A00F4D0BB294C455CDD84513"><enum>(i)</enum><text>includes questions regarding—</text>
<subclause id="H7B8ED26C4F9842AA9FA0997648D009F0"><enum>(I)</enum><text>behavioral risk factors;</text> </subclause>
<subclause id="H21FC5EFF11ED44EC8579D8E311D31CD0"><enum>(II)</enum><text>needed preventive and screening services; and</text> </subclause>
<subclause id="H55ACCAF2E4E14798B82720F128338EB8"><enum>(III)</enum><text>target individuals’ preferences for receiving follow-up information;</text> </subclause></clause>
<clause id="HB1E006CCE8194DF4BACAA39022CCDFFD"><enum>(ii)</enum><text>is assessed using such computer generated assessment programs; and</text> </clause>
<clause id="H04C8E55F37B046BD90A8294BE5D26419"><enum>(iii)</enum><text>allows for the provision of such ongoing support to the individual as the Secretary determines appropriate.</text> </clause></subparagraph>
<subparagraph id="H146EEA13D04948F9BAE84986EE498366"><enum>(D)</enum><header>Ongoing support</header><text>The term <term>ongoing support</term> means—</text>
<clause id="H93D9FF984D794339BDC568E2EF968D7E"><enum>(i)</enum><text>to provide any target individual with information, feedback, health coaching, and recommendations regarding—</text>
<subclause id="H4EC0A04B11B74DCD8535D0477BF5968C"><enum>(I)</enum><text>the results of a self-assessment given to the individual;</text> </subclause>
<subclause id="H54C77EB925C84C41943F2564D1B62679"><enum>(II)</enum><text>behavior modification based on the self-assessment; and</text> </subclause>
<subclause id="HFB7E1D0571A04018BEF8BAEBAFEF600"><enum>(III)</enum><text>any need for clinical preventive and screening services or treatment including medical nutrition therapy;</text> </subclause></clause>
<clause id="H4F13CC2AD1074BED8C70B51000F97468"><enum>(ii)</enum><text>to provide any target individual with referrals to community resources and programs available to assist the target individual in reducing health risks; and</text> </clause>
<clause id="HF94949C69BA54315A91393FFF4C0E116"><enum>(iii)</enum><text>to provide the information described in clause (i) to a health care provider, if designated by the target individual to receive such information.</text> </clause></subparagraph></paragraph>
<paragraph id="HD1C0CE3A299348249FE4F988973E29C9"><enum>(8)</enum><header>Authorization of appropriations</header><text>There is authorized to be appropriated to carry out this subsection, $25,000,000 for the period of fiscal years 2009 through 2013.</text> </paragraph></subsection>
<subsection id="H2A72B53633BE488F91543E1833A1C915"><enum>(f)</enum><header>Development of Model Electronic Health Record Format for Children Enrolled in Medicaid or CHIP</header>
<paragraph id="H0A7C00EB4F144283B7F357C0C303302"><enum>(1)</enum><header>In general</header><text>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—</text>
<subparagraph id="H869E7771BFB3480BA0FDDEBDDBBEC800"><enum>(A)</enum><text>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;</text> </subparagraph>
<subparagraph id="HBB37B7D2CC4C4675BB6CE464D5086300"><enum>(B)</enum><text>designed to allow interoperable exchanges that conform with Federal and State privacy and security requirements;</text> </subparagraph>
<subparagraph id="H406135CB491E48EBB3E783AB06246F62"><enum>(C)</enum><text>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</text> </subparagraph>
<subparagraph id="H687CF8236D1646C39484E756EE400C4"><enum>(D)</enum><text>capable of being incorporated into, and otherwise compatible with, other standards developed for electronic health records.</text> </subparagraph></paragraph>
<paragraph id="H20107F9BF8624B3F83DD39C12E73E432"><enum>(2)</enum><header>Funding</header><text>$5,000,000 of the amount appropriated under subsection (i) for a fiscal year shall be used to carry out this subsection.</text> </paragraph></subsection>
<subsection id="HA37B9447AD6C4EB29CD23475D16708D"><enum>(g)</enum><header>Study of Pediatric Health and Health Care Quality Measures</header>
<paragraph id="H8EED48C4BD4B4F2782B8DAAAE6645F91"><enum>(1)</enum><header>In general</header><text>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—</text>
<subparagraph id="HA6F0B21B284747D0921C11643819EC43"><enum>(A)</enum><text>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;</text> </subparagraph>
<subparagraph id="H618DA9E772DF45AC93534CE7808C67F"><enum>(B)</enum><text>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;</text> </subparagraph>
<subparagraph id="HFD05D3BBE78F40E986950284C47FA9C1"><enum>(C)</enum><text>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</text> </subparagraph>
<subparagraph id="HB3CA57EBDB864D6D9F19DE61F1F8F71C"><enum>(D)</enum><text>make recommendations regarding improving and strengthening the timeliness, quality, and public transparency and accessibility of information about child health and health care quality.</text> </subparagraph></paragraph>
<paragraph id="H948CCCBAE0144624A1ED73BB83836DF"><enum>(2)</enum><header>Funding</header><text>Up to $1,000,000 of the amount appropriated under subsection (i) for a fiscal year shall be used to carry out this subsection.</text> </paragraph></subsection>
<subsection id="H8A95CF37917345D1995CFCC4B4EE4379"><enum>(h)</enum><header>Rule of Construction</header><text>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.</text> </subsection>
<subsection id="H6219B2B9C3A045FBA9D59CC837DA013E"><enum>(i)</enum><header>Appropriation</header><text>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.</text> </subsection></section><after-quoted-block>.</after-quoted-block></quoted-block> </subsection>
<subsection id="HD31E5385D1A1463BA47CB1881FAF69D7"><enum>(b)</enum><header>Increased Matching Rate for Collecting and Reporting on Child Health Measures</header><text>Section 1903(a)(3)(A) of the Social Security Act (42 U.S.C. 1396b(a)(3)(A)) is amended—</text>
<paragraph id="H92F4FB66849941848279617B9638C7AE"><enum>(1)</enum><text>by striking <quote>and</quote> at the end of clause (i); and</text> </paragraph>
<paragraph id="H21A4BD98926042F3A7D903A8EFA9283C"><enum>(2)</enum><text>by adding at the end the following new clause:</text>
<quoted-block id="HA25A09D7E3F347CCA090202300C6E7B7" style="OLC">
<clause id="H7355AA3DA3EC436D9DCD9D008649454F" indent="up1"><enum>(iii)</enum><text>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</text> </clause><after-quoted-block>.</after-quoted-block></quoted-block> </paragraph></subsection></section>
<section display-inline="no-display-inline" id="H65ADE79964A649DC8F74D1C30090FE84" section-type="subsequent-section"><enum>202.</enum><header>Improved availability of public information regarding enrollment of children in CHIP and Medicaid</header>
<subsection id="HC4252118D9A240AD9CAD45CF21EA00BB"><enum>(a)</enum><header>Inclusion of Process and Access Measures in Annual State Reports</header><text>Section 2108 of the Social Security Act (42 U.S.C. 1397hh) is amended—</text>
<paragraph id="H8965579C16ED4656A9A1468EA37F2DF5"><enum>(1)</enum><text>in subsection (a), in the matter preceding paragraph (1), by striking <quote>The State</quote> and inserting <quote>Subject to subsection (e), the State</quote>; and</text> </paragraph>
<paragraph id="H8D7437715B734940AC1E7BA405FBAAF"><enum>(2)</enum><text>by adding at the end the following new subsection:</text>
<quoted-block id="HF012582BCE704448A8FED9A522693D90" style="OLC">
<subsection id="HE8EC70AC8BF14CC7A9C47E74B919934D"><enum>(e)</enum><header>Information Required for Inclusion in State Annual Report</header><text>The State shall include the following information in the annual report required under subsection (a):</text>
<paragraph id="HEB260E87EAD04DFEAB0575A6A242F482"><enum>(1)</enum><text>Eligibility criteria, enrollment, and retention data (including data with respect to continuity of coverage or duration of benefits).</text> </paragraph>
<paragraph id="H2013A41CBA0445478760EBD5D0008C60"><enum>(2)</enum><text>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.</text> </paragraph>
<paragraph id="HBBFD7587AF7943D2828136F2251FBD92"><enum>(3)</enum><text>Data regarding denials of eligibility and redeterminations of eligibility.</text> </paragraph>
<paragraph id="HC8F327028631458EB6153664F0D7504C"><enum>(4)</enum><text>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.</text> </paragraph>
<paragraph id="H290E77294BB7444DBA7D2CFDAB908126"><enum>(5)</enum><text>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.</text> </paragraph>
<paragraph id="HD8C0B92074A84933A21DC8AA523037E2"><enum>(6)</enum><text>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.</text> </paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block> </paragraph></subsection>
<subsection id="HA43EFE60B68D4FA3AC861BB5B44E6962"><enum>(b)</enum><header>Standardized reporting format</header>
<paragraph id="H7C02E7239015427E84BC2DE2A2B9B3F8"><enum>(1)</enum><header>In general</header><text>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).</text> </paragraph>
<paragraph id="H538A65049535402E00B5304F3D9F01C3"><enum>(2)</enum><header>Transition period for states</header><text>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).</text> </paragraph></subsection>
<subsection display-inline="no-display-inline" id="H5437C66231EA47B493DCE93E493E6055"><enum>(c)</enum><header>Additional Funding for the Secretary To Improve Timeliness of Data Reporting and Analysis for Purposes of Determining Enrollment Increases Under Medicaid and CHIP</header>
<paragraph id="H8697B5FEBF9F4FD5A0007009E669163F"><enum>(1)</enum><header>Appropriation</header><text>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.</text> </paragraph>
<paragraph id="HE1A3049D50424CD1AF7E15FF00604544"><enum>(2)</enum><header>Requirements</header><text>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 <act-name parsable-cite="SSA">Social Security Act</act-name> (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.</text> </paragraph></subsection>
<subsection id="HCB5CCA6816C34946B292E20474ABF379"><enum>(d)</enum><header>GAO Study and Report on Access to Primary and Specialty Services</header>
<paragraph id="H3C34E7530A70497B831C733C002C70FC"><enum>(1)</enum><header>In general</header><text>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—</text>
<subparagraph id="HEF582C28BD7A44B7B432FAFF7547614B"><enum>(A)</enum><text>the extent to which providers are willing to treat children eligible for such programs;</text> </subparagraph>
<subparagraph id="HB8411E641979480AA7B6AADCB571D180"><enum>(B)</enum><text>information on such children’s access to networks of care;</text> </subparagraph>
<subparagraph id="H78F3448A55DB4D77A3F65DFA429EE8CB"><enum>(C)</enum><text>geographic availability of primary and specialty services under such programs;</text> </subparagraph>
<subparagraph id="H49FD646F9320440EAF705471ABB5BC13"><enum>(D)</enum><text>the extent to which care coordination is provided for children’s care under Medicaid, CHIP, and MediKids; and</text> </subparagraph>
<subparagraph id="H736A41556CB2458585FA00CFD45357A0"><enum>(E)</enum><text>as appropriate, information on the degree of availability of services for children under such programs.</text> </subparagraph></paragraph>
<paragraph id="H74BFBF3538BD484882AAF277EBC16173"><enum>(2)</enum><header>Report</header><text display-inline="yes-display-inline">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.</text> </paragraph></subsection></section>
<section display-inline="no-display-inline" id="H7C494B80BBEE41079D2F0194CED380E2" section-type="subsequent-section"><enum>203.</enum><header>Application of certain managed care quality safeguards to CHIP</header>
<subsection id="HF453978B705341BB9FF560FAD48DC36"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Section 2103(f) of Social Security Act (42 U.S.C. 1397bb(f)) is amended by adding at the end the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="HCBFD318329524CB1AB652D5344FC056F" style="OLC">
<paragraph id="HE8E8F1E7F1BE4F159C81C23357730066"><enum>(3)</enum><header>Compliance with managed care requirements</header><text display-inline="yes-display-inline">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.</text> </paragraph><after-quoted-block>. </after-quoted-block></quoted-block> </subsection>
<subsection id="HA52E9C2AA8B94CCF8E8193A8AA169210"><enum>(b)</enum><header>Effective date</header><text>The amendment made by subsection (a) shall apply to contract years for health plans beginning on or after July 1, 2009.</text> </subsection></section>