1.This Act may be cited as
the Children's Health Care Quality
Act
.
<enum>I</enum><header>Advancing new
quality and performance measures for children’s health care</header>
<section id="id6DEABEF84E6149CC9B049A44253CEF02"><enum>101.</enum><header>Pediatric
quality and performance measures program</header><text display-inline="no-display-inline">Title XIX of the Social Security Act (42
U.S.C. 1396 et seq.) is amended by adding at the end the following:</text>
<quoted-block display-inline="no-display-inline" id="idB2DBA2B7137E4C11B0DCD1DB22B1027F" style="traditional">
<section id="id0DB081A7C6004771B23439414F87F6F3"><enum>1942.</enum><header>Pediatric quality and performance measures
program</header><subsection commented="no" display-inline="yes-display-inline" id="id7DD49DE603844C638E8D2D0FA4163F3F"><enum>(a)</enum><header>Establishment</header><text>The
Secretary, acting through the Administrator of the Centers for Medicare &
Medicaid Services and in consultation with the Director of the Agency for
Healthcare Research and Quality, shall establish a program to encourage and
support the development of new and emerging quality and performance measures
for providers of pediatric care and the incorporation of such measures into
systemic approaches to improve care and outcomes for children through the
activities described in subsection (c). In establishing the program, gaps in
existing evidence-based measures and priority areas for advancement shall be
identified.</text>
</subsection><subsection id="id2BD4A08DD14347F5A0F6D6D47EA7627F"><enum>(b)</enum><header>Purpose</header><text>The
purpose of the program is to ensure that—</text>
<paragraph id="id8FD59BE2130047B5B8FBA06EB6402266"><enum>(1)</enum><text>evidence-based
pediatric quality and performance measures are developed;</text>
</paragraph><paragraph id="idB8E4928009AB46659B4AED13A32E7633"><enum>(2)</enum><text>such measures are
available for States, other purchasers of pediatric health care services,
health care providers, and consumers to use; and</text>
</paragraph><paragraph id="id8A360A52BF45499B802EC4ABA8DCD0F3"><enum>(3)</enum><text>technical
assistance is provided to assist with the implementation of such
measures.</text>
</paragraph></subsection><subsection id="ID2235e81c33f244b7abbf3ed2d1dbb6d7"><enum>(c)</enum><header>Program
activities</header>
<paragraph id="ID171832e0e9a34da3a96b6a8b6d8e6534"><enum>(1)</enum><header>Identifying
quality and performance measures for providers of pediatric services and
opportunities for new measures</header><text>Not later than 3 months after the
date of enactment of this section, the Secretary shall identify quality and
performance measures for providers of pediatric services and opportunities for
the development of new measures, taking into consideration existing
evidence-based measures. In conducting this review, the Secretary shall convene
and consult with representatives of—</text>
<subparagraph id="id616E0A268E294EEEA6EAC637D0C1F8A0"><enum>(A)</enum><text>States;</text>
</subparagraph><subparagraph id="id7EF77DF3573F4698ADFAB7AC23B78DB5"><enum>(B)</enum><text>pediatric
hospitals, pediatricians, and other pediatric health professionals;</text>
</subparagraph><subparagraph commented="no" id="idC556E76FF8EB426A8063974718EA8AC2"><enum>(C)</enum><text>national
organizations representing—</text>
<clause commented="no" id="id83C5976DEA5C423AB4C77E74A50EAC15"><enum>(i)</enum><text>consumers of
children’s health care; and</text>
</clause><clause commented="no" id="idA77D75F0C82A4969810F351B3F8E41E0"><enum>(ii)</enum><text>purchasers of
children’s health care;</text>
</clause></subparagraph><subparagraph id="ID06bf6089e8b34d2c9db060432b44730a"><enum>(D)</enum><text>experts in
pediatric quality and performance measurement; and</text>
</subparagraph><subparagraph id="id4ACD256A54B54CA0BE0CFB89530DA1B5"><enum>(E)</enum><text>a voluntary
consensus standards setting organization and other organizations involved in
the advancement of consensus on evidence-based measures of health care.</text>
</subparagraph></paragraph><paragraph id="ID0cc6eb82ce54444a82a3ebc9dc188e0f"><enum>(2)</enum><header>Developing,
validating, and testing new measures</header><text>The Secretary shall award
grants or contracts to eligible entities (as defined in subsection (d)(1)) for
the development, validation, and testing of new and emerging quality and
performance measures for providers of pediatric services. Such measures
shall—</text>
<subparagraph id="idB3124DD459FB4E298FC40594AF6AEB2D"><enum>(A)</enum><text>provide consumers
and purchasers (including States and beneficiaries under the program under this
title and title XXI) with information about provider performance and quality;
and</text>
</subparagraph><subparagraph id="id5FEC5505B0C245C88491E0088FDF1124"><enum>(B)</enum><text>assist health
care providers in improving the quality of the services they provide and their
performance with respect to the provision of such services.</text>
</subparagraph></paragraph><paragraph id="idD0E932284C144AE3971A78134B968074"><enum>(3)</enum><header>Achieving
consensus on evidence-based measures</header><text>The Secretary shall award
grants or contracts to eligible consensus entities (as defined in subsection
(d)(2)) for the development of consensus on evidence-based measures for
pediatric care that have broad acceptability in the health care
industry.</text>
</paragraph></subsection><subsection id="ID773f9b34c0344656a8936a0b9306e1e8"><enum>(d)</enum><header>Eligible
entities</header>
<paragraph id="idB255DB186FB3419A8A0923DFFAEF40E6"><enum>(1)</enum><header>Development,
validation, and testing</header><text>For purposes of paragraph (2) of
subsection (c), the term <term>eligible entity</term> means—</text>
<subparagraph id="id0FC46A79938D43369182CF93A2DD578D"><enum>(A)</enum><text>organizations
with demonstrated expertise and capacity in the development and evaluation of
pediatric quality and performance measures;</text>
</subparagraph><subparagraph id="id49C43036F9AA42F293DA0A8BA0E293A2"><enum>(B)</enum><text>an organization
or association of health care providers with demonstrated experience in working
with accrediting organizations in developing pediatric quality and performance
measures; and</text>
</subparagraph><subparagraph id="id9B786B00F84640B7A6A800474AED7998"><enum>(C)</enum><text>a collaboration
of national pediatric organizations working to improve pediatric quality and
performance in the delivery of children's health care.</text>
</subparagraph></paragraph><paragraph id="ID0355d995b9ee46508e40a3fa69a174f9"><enum>(2)</enum><header>Achievement of
consensus</header><text>For purposes of paragraph (3) of such subsection, the
term <term>eligible consensus entity</term> means an organization, including a
voluntary consensus standards setting organization, involved in the advancement
of consensus on evidence-based measures of health care.</text>
</paragraph></subsection><subsection id="id92AB3793335D474EA2303817D5E6A30F"><enum>(e)</enum><header>Ongoing
authority To update and adjust pediatric measures</header><text>The Secretary
may update and adjust measures developed and advanced under the program under
this section in accordance with—</text>
<paragraph id="id22A0B73356714090A1825838F9711BE4"><enum>(1)</enum><text>any changes that
a voluntary consensus standards setting organization determines should be made
with respect to such measures; or</text>
</paragraph><paragraph id="id19F3D84B88664F80B3AD5C66A0B5A2F1"><enum>(2)</enum><text>new evidence
indicating the need for changes with respect to such measures.</text>
</paragraph></subsection><subsection id="idCBEE34DB36C54BFCAE57A8CCDDA53FBF"><enum>(f)</enum><header>Addition of
pediatric consumer assessment measures to CAHPS Hospital Survey conducted by
AHRQ</header><text>The Director of the Agency for Healthcare Research and
Quality shall ensure that consumer assessment measures for hospital services
for children are added to the Consumer Assessment of Healthcare Providers and
Systems (CAHPS) Hospital survey conducted by such Agency.</text>
</subsection><subsection id="ID3994a617dec446edb47906f068f5c4a6"><enum>(g)</enum><header>Appropriation</header><text>There
are authorized to be appropriated and there are appropriated, for the purpose
of carrying out this section, $10,000,000, for each of fiscal years 2009
through 2013, to remain available until
expended.</text>
</subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
</section><enum>II</enum><header>State
transformation grants for pediatric care</header>
<section id="ID46e6c63b772c4b91bdf10a3476d8ab43"><enum>201.</enum><header>Grants to
States for demonstration projects transforming delivery of pediatric
care</header><text display-inline="no-display-inline">Title XIX of the Social
Security Act (42 U.S.C. 1396 et seq.), as amended by section 101, is amended by
adding at the end the following:</text>
<quoted-block display-inline="no-display-inline" id="id533656EECEB74C0B96A9F362909C241D" style="traditional">
<section id="id9F904DEB90634DE59446F6E0ECFE7F29"><enum>1943.</enum><header>Grants to State for demonstration projects transforming
delivery of pediatric care</header><subsection commented="no" display-inline="yes-display-inline" id="id3D1EA0F138FB4815B081BD503C008F8A"><enum>(a)</enum><header>Establishment</header><text>The
Secretary, acting through the Administrator of the Centers for Medicare &
Medicaid Services, shall establish demonstration projects, including
demonstration projects in multiple States in each of the 4 categories described
in subsection (d), to award grants to States to improve the delivery of health
care services provided to children under this title and title XXI.</text>
</subsection><subsection id="id08C24AF0FCFB46528436E384974C2EEF"><enum>(b)</enum><header>Duration</header><text>The
demonstration projects shall be conducted for a period of 4 years.</text>
</subsection><subsection id="IDbd65d19b3af94bfcb7cde0019f7ff31c"><enum>(c)</enum><header>Eligibility</header><text>A
State shall not be eligible to receive a grant under this section unless the
State has demonstrated experience or commitment to the concept of
transformation in the delivery of pediatric care.</text>
</subsection><subsection id="IDf063dbb0cab040c2afe3c990cc1ad4da"><enum>(d)</enum><header>Categories of
projects</header><text>The following categories of projects are described in
this subsection:</text>
<paragraph id="ID115cd4833f4c4cbe893b265a7233e90a"><enum>(1)</enum><header>Health
information technology systems</header><text>Projects for developing health
information technology systems, including technology acquisition, electronic
health record development, data standards development, and software
development, for pediatric hospital and physician services and other
community-based services; implementing model systems; and evaluating their
impact on the quality, safety, and costs of care.</text>
</paragraph><paragraph id="ID10c2a157b7f845139551e886ec090ad3"><enum>(2)</enum><header>Disease
management</header><text>Projects for providing provider-based care management
for children with chronic conditions (including physical, developmental,
behavioral, and psychological conditions), demonstrating the effectiveness of
provider-based management models in promoting better care, reducing adverse
health outcomes, and preventing avoidable hospitalizations.</text>
</paragraph><paragraph id="IDcf8e8bcebe37402fba9dfb1c9c01ec6a"><enum>(3)</enum><header>Evidence-based
quality improvements</header><text>Projects for implementing evidence-based
approaches to improving efficiency, safety, and effectiveness in the delivery
of hospital care for children across hospital services, evaluating the
translation of successful models of such evidence-based approaches to other
institutions, and the impact of such changes on the quality, safety, and costs
of care.</text>
</paragraph><paragraph id="ID10d315e752774013bd31724e674a2dae"><enum>(4)</enum><header>Quality and
performance measures for providers of children’s health care
services</header><text>Projects to pilot test evidence-based pediatric quality
and performance measures for inpatient hospital services, physician services,
or services of other health professionals, determining the reliability,
feasibility, and validity of such measures, and evaluating their potential
impact on improving the quality and delivery of children’s health care. To the
extent feasible, such measures shall have been approved by consensus standards
setting organizations.</text>
</paragraph></subsection><subsection id="IDf9d6b775b8f24f4e9af9077c9c2f6b2e"><enum>(e)</enum><header>Uniform
metrics</header><text>The Secretary shall establish uniform metrics (adjusted,
as appropriate, for patient acuity), collect data, and conduct evaluations with
respect to each demonstration project category described in subsection (d). In
establishing such metrics, collecting such data, and conducting such
evaluations, the Secretary shall consult with—</text>
<paragraph id="idF615F3C7EA084AD6BD956285A4F9BD5A"><enum>(1)</enum><text>experts in each
such demonstration project category;</text>
</paragraph><paragraph id="idBF16FC791028440D89D0916EF25EA539"><enum>(2)</enum><text>participating
States;</text>
</paragraph><paragraph id="id209B8B119E42437F969CA05AA7BEA18E"><enum>(3)</enum><text>national
pediatric provider organizations;</text>
</paragraph><paragraph id="id8DC667F6593341FA9AA06F0AE1B58FB8"><enum>(4)</enum><text>health care
consumers; and</text>
</paragraph><paragraph id="id7957AF2787DB4F93BEE239F94CD2ED49"><enum>(5)</enum><text>such other
entities or individuals with relevant expertise as the Secretary determines
appropriate.</text>
</paragraph></subsection><subsection id="ID30f34d4c0fce43219d09d4b294327398"><enum>(f)</enum><header>Evaluation and
report</header><text>The Secretary shall evaluate the demonstration projects
conducted under this section and submit a report to Congress not later than 3
months before the completion of each demonstration project that includes the
findings of the evaluation and recommendations with respect to—</text>
<paragraph id="ID447f20bf21eb4172a5d91d66accb0d6f"><enum>(1)</enum><text>expansion of the
demonstration project to additional States and sites; and</text>
</paragraph><paragraph id="IDde30d285d0cc4004878443b530f84faa"><enum>(2)</enum><text>the broader
implementation of approaches identified as being successful in advancing
quality and performance in the delivery of medical assistance provided to
children under this title and title XXI.</text>
</paragraph></subsection><subsection id="id493787D5979641A78A8D3E77FA07936B"><enum>(g)</enum><header>Waiver</header><text>The
Secretary may waive the requirements of this title and title XXI to the extent
necessary to carry out the demonstration projects under this section.</text>
</subsection><subsection id="ID1c557c4f57f94ef0ba7b516d48f59847"><enum>(h)</enum><header>Amounts paid to
a State</header><text>Amounts paid to a State under this section—</text>
<paragraph id="idEA2C49EEA6464F6EB56395600C5B148B"><enum>(1)</enum><text>shall be in
addition to Federal payments made to the State under section 1903(a);</text>
</paragraph><paragraph id="id312B2009E41F4251A96E66140C99E4B5"><enum>(2)</enum><text>shall not be used
for the State share of any expenditures claimed for payment under such section;
and</text>
</paragraph><paragraph id="id9B95EB1147DC451094C61593C81F1FF2"><enum>(3)</enum><text>shall be used
only for expenditures of the State for participating in the demonstration
projects, or for expenditures of providers in participating in the
demonstration projects, including—</text>
<subparagraph id="idD824DB814D654285AEBBFA0052E3CFC5"><enum>(A)</enum><text>administrative
costs of States and participating providers (such as costs associated with the
design and evaluation of, and data collection under, the demonstration
projects); and</text>
</subparagraph><subparagraph id="idE7E483F3CA3E4F479DF59EDE8E6F44BD"><enum>(B)</enum><text>such other
expenditures that are not otherwise eligible for reimbursement under this title
or title XXI as the Secretary may determine appropriate.</text>
</subparagraph></paragraph></subsection><subsection id="id17D19D3E93324FAA822B927EBD0A5CAD"><enum>(i)</enum><header>Appropriation</header><text>There
are authorized to be appropriated and there are appropriated, for the purpose
of carrying out this section, to remain available until expended $10,000,000
for each of fiscal years 2009 through
2013.</text>
</subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
</section><section id="idA284E4A7A12441FBB97CBA9A33DFF823"><enum>202.</enum><header>Report by the
comptroller general on design and implementation of a demonstration project
evaluating existing quality and performance measures for children’s inpatient
hospital services</header>
<subsection id="id9181857D82104B598410045A9E6844AA"><enum>(a)</enum><header>In
general</header><text>Not later than 12 months after the date of enactment of
this Act, the Comptroller General of the United States (in this section
referred to as the <quote>Comptroller General</quote>) shall submit a report to
Congress containing recommendations for the design and implementation of a
demonstration project to evaluate the suitability of existing quality and
performance measures for children’s inpatient hospital services for public
reporting, differentiating quality, identifying best practices, and providing a
basis for payment rewards.</text>
</subsection><subsection id="idF11FDE693DAA4EBEB8504EB1FB20C1ED"><enum>(b)</enum><header>Development of
recommendations</header><text>In developing the recommendations submitted under
subsection (a), the Comptroller General shall accomplish the following:</text>
<paragraph id="ID36e3fa03586c4ddd88d706c184899e14"><enum>(1)</enum><text>Consider which
agency within the Department of Health and Human Services should have primary
responsibility and oversight for such a demonstration project.</text>
</paragraph><paragraph id="IDd71fc815f2ef4ed7a67abafdf574a289"><enum>(2)</enum><text>Determine a
sufficient number of participating hospitals and volume of children’s cases,
given existing measures that might be chosen for evaluation under such a
demonstration project.</text>
</paragraph><paragraph id="ID2fa8b362efc1459481c9677fa655cab9"><enum>(3)</enum><text>Determine the
number of States and variety of geographic locations that may be required to
conduct such a demonstration project.</text>
</paragraph><paragraph id="ID8c31d3b7228f46b998b1c153a6004347"><enum>(4)</enum><text>Describe
alternatives for administering and directing funding for such a demonstration
project, taking into consideration the potential involvement of multiple
States, State plans under title XIX of the Social Security Act (42 U.S.C. 1396
et seq.), and State child health plans under title XXI of such Act (42 U.S.C.
1397aa et seq.). Such description shall be included in the recommendations
submitted under subsection (a).</text>
</paragraph><paragraph id="ID11c9a68038fa4b02ac243ac8217519a4"><enum>(5)</enum><text>Determine
requirements for consistency in measures, metrics, and risk adjustment for such
a demonstration project, across hospitals and across State lines.</text>
</paragraph><paragraph id="IDff4ab0b5824849fa9b40b4ae30f41f5e"><enum>(6)</enum><text>Consider the
infrastructure requirements involved in public reporting of quality and
performance measures for children’s inpatient hospital services at the national
and State levels, including the requirements involved with respect to
maintaining such measures and data.</text>
</paragraph><paragraph id="ID05906c98752543eb8b317fe612998066"><enum>(7)</enum><text>Estimate the cost
of undertaking such a demonstration project.</text>
</paragraph></subsection><subsection id="id021EB08AA9CD4C97B9796C5CED24F9AD"><enum>(c)</enum><header>Suggestion of
existing measures for evaluation under the demonstration project</header>
<paragraph id="idBB3A6E04ABED4699A02AE089A0E30B81"><enum>(1)</enum><header>In
general</header><text>The report submitted under subsection (a) shall include
suggestions for existing measures to be evaluated under the demonstration
project recommended in such report, including, to the extent feasible, measures
with respect to—</text>
<subparagraph id="ID1fcf0005884e40ffadf48c5b11ee7e0f"><enum>(A)</enum><text>high volume
pediatric inpatient conditions;</text>
</subparagraph><subparagraph id="ID067da05361684d0ab40355224f5c8ba6"><enum>(B)</enum><text>high cost
pediatric inpatient services;</text>
</subparagraph><subparagraph id="ID69ddfce87fb748fb8a8ac96c5a4e56fe"><enum>(C)</enum><text>pediatric
conditions with predicted high morbidities; and</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="IDc4ef353d402142f9aae24007a54f27af"><enum>(D)</enum><text>pediatric cases
at high risk of patient safety failures.</text>
</subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="idD25535C4357E478C91A7B32170754DF2"><enum>(2)</enum><header>Suggested
measures</header><text>The measures suggested under paragraph (1) shall be
measures representing process, structure, patient outcomes, or patient and
family experience—</text>
<subparagraph id="ID756f83c0a72c458388fb8acaf1b75460"><enum>(A)</enum><text>that are
evidence-based;</text>
</subparagraph><subparagraph id="ID0388ad069e804a9c919506ae45a01f59"><enum>(B)</enum><text>that are feasible
to collect and report;</text>
</subparagraph><subparagraph id="IDca7617e709fb47d1ab7127a9b7fd6e5d"><enum>(C)</enum><text>that include a
mechanism for risk adjustment when necessary; and</text>
</subparagraph><subparagraph id="IDe25fff7f3923489dbf0a2484ae2f08f9"><enum>(D)</enum><text>for which there
is a consensus within the pediatric hospital community or a consensus
determined by a voluntary consensus standards setting organization involved in
the advancement of evidence-based measures of health care.</text>
</subparagraph></paragraph><paragraph id="id53E1ECADA4E14ED8A38A5AA90FC031E6"><enum>(3)</enum><header>Consultation</header><text>In
determining the existing measures suggested under paragraph (1), the
Comptroller General shall consult with representatives of the following:</text>
<subparagraph id="ID0aa0d7b2a49e4d1eb7e9f9dcdeaa1bea"><enum>(A)</enum><text>National
associations of pediatric hospitals and pediatric health professionals.</text>
</subparagraph><subparagraph id="IDdc9c4e0c13304d0bb6367ea14baee9bc"><enum>(B)</enum><text>Experts in
pediatric quality and performance measurement.</text>
</subparagraph><subparagraph id="ID6d78a1e7ae474dce88f070326bf05685"><enum>(C)</enum><text>Voluntary
consensus standards setting organizations and other organizations involved in
the advancement of consensus on evidence-based measures.</text>
</subparagraph><subparagraph id="ID3c382abec4e842a098ca39eaadbefc7c"><enum>(D)</enum><text>The Department of
Health and Human Services, States, and other purchasers of health care items
and services.</text>
</subparagraph></paragraph></subsection></section>