[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 1769 Introduced in Senate (IS)]
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118th CONGRESS
1st Session
S. 1769
To amend title XIX of the Social Security Act to establish a
demonstration project testing Whole Child Health Models, and for other
purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
May 31 (legislative day, May 30), 2023
Mr. Carper (for himself and Mr. Sullivan) introduced the following
bill; which was read twice and referred to the Committee on Finance
_______________________________________________________________________
A BILL
To amend title XIX of the Social Security Act to establish a
demonstration project testing Whole Child Health Models, and for other
purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Kickstarting Innovative
Demonstrations Supporting Kids Health Act of 2023'' or the ``KIDS
Health Act of 2023''.
SEC. 2. ESTABLISHMENT OF WHOLE CHILD HEALTH MODELS.
Section 1903 of the Social Security Act (42 U.S.C. 1396b) is
amended by adding at the end the following new subsection:
``(cc) Whole Child Health Demonstration Project.--
``(1) In general.--The Secretary, acting through the Deputy
Administrator and Director of the Center for Medicaid and CHIP
Services, shall conduct a demonstration project (referred to in
this subsection as the `demonstration project') under which
participating States shall design and implement whole child
health models in 1 or more target communities in accordance
with the requirements of this subsection. The requirements of
section 1902(a)(1) (relating to statewideness) shall not apply
to the demonstration project.
``(2) Design phase.--
``(A) Grants.--Not later than 12 months after the
date of the enactment of this subsection, the Secretary
shall award up to 15 grants to States that submit
complete applications for such grants which meet the
requirements of subparagraph (C).
``(B) Selection of grantees.--In awarding grants
under this paragraph, the Secretary shall, to the
extent possible, prioritize awarding grants to a
geographically diverse selection of States and target
communities of different sizes and with varying
experience with value-based payment, including rural
and urban communities.
``(C) Grant application.--A State shall include in
an application for a grant awarded under this paragraph
the following:
``(i) A description of each proposed target
community in which the State proposes to
implement a whole child health model.
``(ii) For each target community described
in clause (i), a statement of the proposed
objectives of the State in implementing a whole
child health model in that community.
``(iii) Such other information as the
Secretary may require.
``(D) Use of grant funds.--
``(i) In general.--A State awarded a grant
under this paragraph shall use the grant funds
to--
``(I) conduct or use an existing
needs assessment that is not more than
two years old and meets the
requirements of clause (ii) for each
proposed target community;
``(II) not later than 12 months
after being awarded the grant, design
and submit for approval by the
Secretary a proposed whole child health
model that meets the requirements of
subparagraph (E) for each target
community based on the results of the
needs assessment and other assessments
or surveys conducted for that
community; and
``(III) implement the whole child
health model during the implementation
phase described in paragraph (3).
``(ii) Needs assessment requirements.--A
needs assessment conducted for a proposed
target community with grant funds awarded to a
State shall include the following:
``(I) An evaluation of the physical
health, mental, emotional and
behavioral health, developmental,
social, relational and substance use
disorder service needs of eligible
individuals in the target community,
including needs that could be addressed
through population-based or community-
based interventions.
``(II) A review of the resources
available to meet the physical health,
mental health, and substance use
disorder service needs of eligible
individuals in the target community.
``(III) A description of the
barriers identified in the target
community to eligible individuals
accessing resources and services to
address their physical health, mental
health, and substance use disorder
service needs.
``(IV) A description of health
disparities identified in the target
community, including input from
community residents in the target
community.
``(E) Whole child health model requirements.--
``(i) In general.--A proposed whole child
health model shall include descriptions of the
following:
``(I) How the State and its multi-
sector partners will address the
physical health, mental, emotional and
behavioral health, developmental,
social, relational and substance use
disorder service needs of eligible
individuals in the target community
identified in the needs assessment of
that community through implementation
of the whole child health model and
provision of whole child health
services.
``(II) How the State Medicaid,
human services, and child welfare
agencies will coordinate with community
partners to ensure the successful
implementation of the whole child
health model in the target communities
and the provision of whole child health
services.
``(III) The lead agency or other
entity the State proposes to designate
to coordinate activities carried out to
implement the whole child health model
in the target communities.
``(ii) Requirements.--A proposed whole
child health model shall meet the following
requirements:
``(I) Align with an existing or
planned delivery and payment system of
the State plan under this title or
under a waiver of such plan, including,
as applicable, a managed care delivery
system.
``(II) Include partnerships with
child and family serving organizations
and agencies such as health care
providers, payers, school districts,
public health and child care.
``(III) Promote the delivery of
trauma-informed and culturally
competent care, including strategies to
address systemic resource needs,
including workforce shortages, in the
target community and an assessment of
the potential impact of the model on
health equity, disparities, and safety
net providers in the target community.
``(IV) Coordinate funding sources
under the State plan under this title
(or under a waiver of plan), the State
plans under parts B and E of title IV,
and other applicable funding sources,
for the whole child health services
provided under the model.
``(V) Include--
``(aa) the design and
implementation or adaptation of
a value-based payment
arrangement for providing whole
child health services under the
State plan under this title (or
under a waiver of such plan)
that promotes pediatric health;
or
``(bb) in the case of a
State that faces significant
barriers to implementing or
adapting such a value-based
payment arrangement, a proposal
for steps that the State will
take towards advancing value-
based care with respect to
whole child health services
provided under the State plan
under this title (or under a
waiver of such plan).
``(VI) Include strategies to
coordinate referrals to whole child
health services, including using
telehealth, referral networks and/or
other technologies to facilitate access
to whole child health services.
``(VII) Include strategies to
promote the integration of primary care
with whole child health services and
substance use disorder services.
``(VIII) Include strategies to
integrate and streamline eligibility,
enrollment, and renewal processes to
facilitate enrollment in health
coverage and other benefit programs.
``(IX) Include strategies to
promote school-based health and
wellness.
``(X) Describe how the State will
leverage or enhance existing health
information technology infrastructure
and cross-sector data-sharing
capabilities to support the provision
of enhanced care coordination services,
including with respect to claiming
administrative matching funds for the
design, development, and installation
of data systems to allow or enhance
coordination among State agencies and
other entities.
``(XI) Describe how the State will
evaluate the impact of the model on
child health and disparities in health
outcomes, according to requirements
outlined by the Secretary.
``(XII) Include other such
population health strategies or core
services as the State determines
appropriate.
``(iii) Participation by indian tribes in
whole child health models.--The Secretary may
waive or otherwise modify the requirements for
a whole child health model described in clause
(ii) to the extent necessary to permit Indian
tribes to participate in such a model.
``(3) Implementation phase.--After the design period, the
implementation phase of the demonstration project shall be
conducted for a period of not less than 48 months and not more
than 72 months.
``(4) Authorization of appropriations.--
``(A) In general.--There are authorized to be
appropriated to the Secretary for the purpose of
carrying out this subsection, out of any funds in the
Treasury not otherwise appropriated, $125,000,000, to
remain available until expended.
``(B) Limitation on use of funds.--From any amounts
appropriated pursuant to this paragraph, the Secretary
shall use--
``(i) not more than $2,000,000 for
administrative costs, staffing, and reporting
requirements;
``(ii) not more than $10,000,000 for
learning platforms, staffing, and technical
assistance related directly to the design and
implementation of whole child health models,
and to carry out activities under this
subsection; and
``(iii) not more than $3,000,0000 may be
used for carrying out evaluations described in
paragraph (5).
``(C) Payment for whole child health services.--
``(i) In general.--For each fiscal quarter
occurring during the implementation phase of
the demonstration project, subject to clause
(ii), the Secretary shall pay each State
selected to participate in that phase of the
project, an amount equal to 80 percent of the
amounts expended by the State during such
quarter for providing whole child health
services to eligible individuals in the target
communities net of any Federal payments made to
the State for such expenditures, under this
title or otherwise.
``(ii) Requirement.--The additional Federal
funds paid to a State under this subparagraph
shall be used to supplement, not supplant, the
level of State funds expended for services that
are treated as whole child health services
under the demonstration project.
``(5) Reports and evaluation.--
``(A) In general.--A State that is selected to
participate in the demonstration project shall report
on the outcomes under the entity's whole child health
model pursuant to periodic reporting requirements
established by the Secretary.
``(B) State reports.--Each State awarded a grant
under this subsection shall submit the following
reports to the Secretary:
``(i) Interim report.--An interim report at
the end of the first 24 months of the
implementation phase of the project that
describes--
``(I) the progress of the State's
implementation of the whole child
health model in the target communities;
``(II) the organizations and
providers that are participating in the
implementation of the model in the
target communities;
``(III) the number of eligible
individuals in the target communities
receiving enhanced care coordination
services; and
``(IV) such other information as
the Secretary may require.
``(ii) Final report.--A final report not
later than 1 year after the end of the
implementation phase of the demonstration
project that describes--
``(I) best practices and challenges
in implementing the whole child health
model in the target communities;
``(II) the impact of the model on
child well-being, health care outcomes
and health disparities in the target
communities; and
``(III) such other information as
the Secretary may require.
``(C) GAO report.--Not later than 3 years after the
first grant is awarded under this subsection, the
Comptroller General of the United States shall submit a
report to Congress evaluating the individual,
financial, and systems-level impacts associated with
whole child health models implemented under the
demonstration project.
``(6) Consultation.--A State awarded a grant under
paragraph (2) shall consult with stakeholders, such as eligible
individuals and their primary caregivers, schools, health care,
mental health, and substance use disorder treatment
organizations, pediatric providers, public health departments,
child care providers, juvenile justice programs, child welfare
programs, and community-based organizations, in designing and
carrying out the activities required under paragraph (2), and
with respect to the implementation and evaluation of the whole
child health models implemented by the State. Such consultation
may include establishment of a Community Advisory Board as
defined by the Secretary.
``(7) Responsibilities of the secretary.--
``(A) Technical assistance.--
``(i) In general.--The Secretary shall
provide States awarded a grant under paragraph
(2) with technical assistance with respect to
the design of whole child health models. Such
assistance may include assisting States with
moving along a whole child health model and
utilizing innovative financing strategies, such
as braiding public and private funds. As
feasible, the Secretary may partner with other
Federal agencies, including the Office of
Management and Budget, when providing technical
assistance to promote a whole child health
approach. The Secretary shall also provide such
States with technical assistance with respect
to implementation of such models.
``(ii) Shared learning.--The Secretary
shall facilitate shared learning, such as a
learning collaborative, among the States
participating in the demonstration project.
``(iii) Reports to congress.--The Secretary
shall submit to the Committee on Finance of the
Senate and the Committee on Energy and Commerce
of the House of Representatives the following
reports:
``(I) Design phase.--Not later than
36 months after the date on which
design grant funds are first awarded
under paragraph (2), a report that
describes the whole child health models
proposed by States.
``(II) Implementation phase.--
``(aa) Interim report.--Not
later than 3 years after the
date on which the
implementation phase of the
demonstration project begins,
an interim report.
``(bb) Final report.--Not
later than 2 years after the
date on which the demonstration
project ends, a final report.
``(cc) Content.--The
interim and final reports
required under this clause
shall include the following:
``(AA) A summary of
the whole child health
models being
implemented under the
demonstration project.
``(BB) An
assessment of the
impacts of such models
on the physical and
mental health and well-
being of eligible
individuals in the
target communities.
``(CC) A
description of the most
effective strategies of
such models in
promoting the physical
and mental health of
eligible individuals,
including the
effectiveness of such
strategies in reducing
health disparities and
improving health
equity.
``(DD) A summary of
the information
reported to the
Secretary by States.
``(dd) Legislative
recommendations.--In addition
to the information required
under item (cc), the final
report submitted under item
(bb) shall include
recommendations for such
Federal legislative changes, if
any, as the Secretary
recommends to implement
positive outcomes identified by
the use of whole child health
models under the demonstration
project.
``(8) Definitions.--In this subsection:
``(A) Eligible individual.--The term `eligible
individual' means an individual who has not attained
age 21 and who is eligible for medical assistance under
a State plan under this title or under a waiver of such
plan, or for assistance under a State child health plan
under title XXI or under a waiver of such plan.
``(B) Indian tribe.--The term `Indian Tribe' has
the meaning given that term in section 4(e) of the
Indian Self-Determination and Education Assistance Act
(25 U.S.C. 5304(e)).
``(C) Target community.--The term `target
community' means, with respect to a State, the
boundaries of a geographic area within the State in
which the State proposes to implement a whole child
health model.
``(D) Whole child health services.--The term `whole
child health services' means the following:
``(i) Comprehensive care management.
``(ii) Enhanced care coordination services
and referrals to health, developmental and
social supports that include strategies to--
``(I) identify and address the
physical, mental, emotional, and
behavioral health, developmental,
relational and social needs of eligible
individuals;
``(II) coordinate referrals, as
needed, to health care, mental,
emotional, and behavioral health,
substance use disorder treatment, child
development, and social service
providers;
``(III) ensure that eligible
individuals follow up with service
providers to whom they are referred;
and
``(IV) facilitate the ability of
eligible individuals to access needed
services by centralizing, coordinating
with, or co-locating resources.
``(9) Requirement to issue guidance on combining federal
and non-federal funds to address social drivers of health in
low-income populations.--Not later than 365 days after the
selection of eligible entities under this subsection, the
Secretary shall issue and disseminate guidance and technical
assistance to grant awardees to clarify strategies and best
practices to combine funds, including Medicaid, in the context
of a child health and wellness fund, consistent with Federal
law, and shall make such guidance publicly available.''.
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