[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 660 Introduced in House (IH)]

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116th CONGRESS
  1st Session
                                H. R. 660

    To improve the health outcomes in communities through community-
 relevant health information and new health supporting incentives and 
            programs funded without further appropriations.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            January 17, 2019

 Mr. Fortenberry (for himself and Ms. Johnson of Texas) introduced the 
   following bill; which was referred to the Committee on Energy and 
                                Commerce

_______________________________________________________________________

                                 A BILL


 
    To improve the health outcomes in communities through community-
 relevant health information and new health supporting incentives and 
            programs funded without further appropriations.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Community Health Improvement, 
Leadership, and Development Act of 2019'' or the ``CHILD Act''.

SEC. 2. LOCALIZED COMMUNITY HEALTH IMPROVEMENT PROGRAMS.

    (a) Making Epidemiology and Claims Data Relevant to Community 
Health Improvement.--
            (1) In general.--Not later than April 1, 2020, the 
        Secretary of Health and Human Services, through the Director of 
        the Centers for Disease Control and Prevention in collaboration 
        with the Administrator of the Centers for Medicare & Medicaid 
        Services, shall, subject to paragraph (2), provide for the 
        maintenance of a database of de-identified epidemiological and 
        claims health information for the purpose of making such 
        information available in a useful and informative manner to 
        participating communities (as referenced in subsection 
        (b)(3)(B)) in participating States (as referenced in subsection 
        (b)(1)) to support such communities in reducing rates of 
        illness (as compared to the rate of illness within such 
        community as of a period specified by the Secretary) and 
        improving the management of illnesses to reduce the cost of 
        health care delivery. In carrying out this subsection, the 
        Director and Administrator shall, subject to paragraph (2), 
        provide--
                    (A) for a mechanism that enables the integration of 
                such epidemiological and claims health information for 
                such purposes;
                    (B) that such health information is available for 
                at least the 20 health conditions and treatments that 
                are associated with the highest expenditures under the 
                Medicaid program under title XIX of the Social Security 
                Act;
                    (C) that such health information is made available 
                to participating States in such a manner that enables 
                participating communities within such States to access 
                such information that is relevant specifically to such 
                communities; and
                    (D) for a mechanism by which the Director and 
                Administrator may--
                            (i) update such information specific to 
                        each such community, to the extent practicable, 
                        in real-time or near real-time and as specified 
                        by the Director and Administrator;
                            (ii) verify the validity of such 
                        information and the validity of the changes in 
                        such information for each such community over 
                        such specified periods; and
                            (iii) assess and measure the extent of such 
                        changes for each such participating community, 
                        including the amount of any reductions in 
                        expenditures under the State plan under title 
                        XIX of the Social Security Act and the extent 
                        to which such reductions are attributable to 
                        such changes with respect to each such 
                        community in such State.
            (2) No additional funding.--No additional funds are 
        authorized to be appropriated to carry out this subsection. 
        This subsection shall be carried out using amounts otherwise 
        made available to the Secretary.
    (b) Localized Community Health Improvement Program Grants.--
            (1) In general.--The Secretary of Health and Human Services 
        shall, subject to paragraph (5), carry out a grant program 
        under which the Secretary may award grants to States for 
        purposes of carrying out localized community health improvement 
        programs described in paragraph (3). In this section such 
        States awarded such grants are referred to as ``participating 
        States''.
            (2) Application.--To be eligible for a grant under this 
        subsection, a State shall--
                    (A) submit to the Secretary an application, in such 
                manner, at such time, and containing such information 
                as specified by the Secretary; and
                    (B) enter into an arrangement with the Secretary 
                under which--
                            (i) the State agrees to establish and 
                        maintain a localized community health 
                        improvement program described in paragraph (3);
                            (ii) the Secretary agrees to provide the 
                        State with integrated epidemiological and 
                        claims health information maintained in the 
                        database established under subsection (a) 
                        specific to each participating community within 
                        the State; and
                            (iii) the State and Secretary carry out the 
                        community shared savings account agreement 
                        terms described in subsection (c).
            (3) Localized community health improvement program.--For 
        purposes of this subsection, a localized community health 
        improvement program of a State is a program under which the 
        State--
                    (A) maintains the integrated health information 
                provided to the State by the Secretary pursuant to the 
                arrangement described in paragraph (2)(B);
                    (B) makes such information available to qualifying 
                communities (as defined in paragraph (4)) within such 
                State which request such information and agree to the 
                terms described in subparagraph (D) and subsection (c) 
                (in this section referred to as ``participating 
                communities'') in a secure manner and format that is 
                most informative to such communities in assisting such 
                communities in analyzing and applying such data to the 
                specific needs of such communities to reduce the rates 
                of illness and reduce the costs of health care within 
                such communities;
                    (C) submits such data as is required by the 
                Secretary to assess the extent to which the health care 
                interventions implemented to address needs of such 
                communities identified through the program are 
                affecting the rates of illness and costs of health care 
                within the State and communities within the State; and
                    (D) requires that in order for communities to 
                participate in such program, the communities agree--
                            (i) to provide for a secure method to make 
                        such information available to health care and 
                        other relevant community workers, including 
                        through an interactive dashboard system; and
                            (ii) to submit such data as is required by 
                        the State or Secretary to assess the extent to 
                        which health care interventions implemented to 
                        address needs of such communities identified 
                        through the program are affecting the rates of 
                        illness and costs of health care within the 
                        communities.
            (4) Qualifying community defined.--For purposes of this 
        section, the term ``qualifying community'' means a local 
        community determined by census block or census track level 
        (based on geographic information system data) with a defined 
        jurisdictional boundary (such as a local community established 
        by a high school feeder pattern or by the boundaries of a town 
        if such town has a population of fewer than 25,000 residents) 
        or a county.
            (5) No additional funding.--No additional funds are 
        authorized to be appropriated to carry out this subsection. 
        This subsection shall be carried out using amounts otherwise 
        made available to the Secretary.
    (c) Community Shared Savings Account Agreement Terms.--For purposes 
of subsection (b)(2)(B)(iii), community shared savings account terms 
described in this subsection, with respect to the Secretary, a 
participating State, and participating communities within such State, 
are the following:
            (1) In the case that the database established under 
        subsection (a), through the mechanism provided for under 
        subsection (a)(4), demonstrates for any specified period (as 
        determined by the Secretary) that there are verified reductions 
        in expenditures under the State plan under title XIX of the 
        Social Security Act, which results in reductions in 
        expenditures by the Federal Government under such title, and 
        attributes such reductions to one or more of the participating 
        communities within such State, the Secretary shall transfer to 
        the community shared savings account established by the State 
        under subsection (e) an amount equal to 70 percent of the 
        amount of such reduction so demonstrated for such specified 
        period.
            (2) The State establishes such a community shared savings 
        account in accordance with subsection (e) and agrees to 
        transfer to each participating community within such State 100 
        percent of such amounts transferred under paragraph (1) that 
        are verified by the Secretary as attributable to such 
        community.
            (3) Each participating community in such State--
                    (A) establishes a community shared savings board 
                described in subsection (d) that determines how funds 
                transferred to such community under paragraph (2) are 
                to be used for purposes of promoting the health and 
                wellness of residents of such community; and
                    (B) uses such funds only for such purposes and in 
                accordance with the uses determined by such board.
    (d) Community Shared Savings Board.--For purposes of this section, 
a community shared savings board, with respect to a participating 
community (which may be a county) within a participating State, is a 
board--
            (1) consisting of at least 7 members, appointed by the 
        governing officials of the community through such a process 
        that is specified by the community (and approved by the State), 
        including--
                    (A) at least 1 member with public health 
                experience; and
                    (B) members with business, civic, educational, or 
                faith-based experience;
            (2) that is representative of the geographic components 
        that are included in the community; and
            (3) that hires a fiduciary agent to manage a community 
        shared savings account on behalf of the board.
    (e) Community Shared Savings Account.--For purposes of this 
section, the term ``community shared savings account'' means, with 
respect to a participating community within a participating State, a 
trust created or organized in the United States for the exclusive 
benefit of the community, as defined by the community shared savings 
board under subsection (d) for such participating community, but only 
if the written governing instrument creating the trust meets the 
following requirements:
            (1) The trustee is a bank (as defined in section 408(n) of 
        the Internal Revenue Code of 1986) or such other person who 
        demonstrates to the satisfaction of the Director that the 
        manner in which such other person will administer the trust 
        will be consistent with the requirements of this section.
            (2) No contribution will be accepted unless it is in cash.
            (3) Withdrawals may only be made by the fiduciary agent 
        described in subsection (d)(3) hired by such board pursuant to 
        a plan developed by the community and approved by the State and 
        local government.
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