[Congressional Record Volume 151, Number 106 (Friday, July 29, 2005)]
[Senate]
[Pages S9477-S9481]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. DeWINE (for himself and Mrs. Lincoln):
  S. 1563. A bill to amend title XIX of the Social Security Act to 
protect and

[[Page S9478]]

strengthen the safety net of children's public health coverage by 
extending the enhanced Federal matching rate under the State children's 
health insurance program to children covered by Medicaid at State 
option and by encouraging innovations in children's enrollment and 
retention, to advance quality and performance in children's public 
health insurance programs, to provide payments for children's hospitals 
to reward quality and performance, and for other purposes; to the 
Committee on Finance.
  Mr. DeWINE. Mr. President, today I join my friend and colleague from 
Arkansas, Senator Lincoln, to introduce a bill called the Advancing 
Better Coverage and Care for Children's Health Act or the ABCs for 
Children's Health Act. It is an important piece of legislation designed 
to help improve the access and quality of children's health services 
around the country,'' including children's hospitals.
  Children's Hospitals provide care to hundreds of thousands of 
children across our Nation every day. They care for the great majority 
of children who are seriously ill. They are the mainstay of the health 
care safety net for low-income children.
  But, a child who lacks health insurance is still much less likely to 
have timely access to the medical care they need. That's not right. 
Two-thirds of the more than 9 million uninsured children in the United 
States are eligible for Medicaid or SCHIP. They should be enrolled in 
public coverage when eligible, and we should streamline the eligibility 
process to make it easier, not more difficult.
  President Bush said in 2004, ``America's children must also have a 
healthy start in life . . . we will lead an aggressive effort to enroll 
millions of poor children who are eligible but not signed up for the 
government's health insurance programs. We will not allow a lack of 
attention or information to stand between these children and the health 
care they need.'' The bill we are introducing today would do just that.
  Our bill would provide the higher SCHIP federal match to states for 
children covered by Medicaid at the State option so that States think 
twice before removing children from the Medicaid rolls during State 
budget cuts. It also would provide a 90/10 administrative-match to help 
states update enrollment systems for children, including technology for 
``express lane'' enrollment, the determination of eligibility for 
Medicaid and SCHIP when a child applies for another public benefit, 
like the school lunch program, and the allowance for enrollment by mail 
or phone.
  We also need to do more to help strengthen the system of care to 
ensure quality and accountability for children's coverage. Our bill 
would do this by supporting innovative ideas at children's hospitals. 
Quality improvement funding shouldn't just be available to adult 
hospitals. Children's hospitals have good ideas, too, and we should 
support those good ideas.
  Cincinnati Children's Hospital in Ohio is leading the way in 
improving care for children with diabetes, cystic fibrosis and other 
chronic conditions. The hospital is deeply committed to transforming 
health care delivery to improve outcomes for children.
  In 2001, they were selected as one of just seven hospitals in the 
Pursuing Perfection initiative launched by the Robert Wood Johnson 
Foundation, and with this funding from the Foundation, they have made 
significant progress. They can document improvements in patient safety, 
in the effectiveness of care, in operational efficiency, in timely 
access to care, and in more patient-centered care. These are the 
reforms we need to pursue for children in Medicaid and for all 
children. Our bill would help Cincinnati Children's Hospital and our 
other Children's Hospitals speed their journey to better, safer, more 
cost-effective care.
  A hospital that makes the effort to improve care and outcomes for 
children should be compensated for that effort. We need to advance 
quality and performance for children in Medicaid, like we are doing for 
seniors in Medicare. The development of hospital quality measures, 
testing their ability to gauge effective care and rewarding 
performance, should apply to all hospitals, including children's 
hospitals.
  That's why we have worked with the National Association of Children's 
Hospitals to introduce a bill that would provide grants to help improve 
pediatric quality, so that Children's Hospitals can begin to establish 
measures for quality care and share what works--and what doesn't work--
across hospital services for children nationwide.
  Our bill would provide for a demonstration program in Medicaid to 
evaluate evidenced-based quality and performance measures in children's 
health services, with grants for States and/or providers in three 
areas: health information technology and evidenced-based outcome 
measures, disease management for children with chronic conditions, and 
evidenced-based approaches to improving the delivery of hospital care 
for children. The bill also would provide for a national Children's 
Hospital pay-for-performance demonstration program, rewarding 
Children's Hospitals, which provide critical access to services and 
voluntarily participate, for reporting and meeting quality and 
performance measures.
  Evaluating the national measures of quality in Children's Hospitals, 
their success in capturing performance, and their applicability to pay-
for-performance across States' varying methods of payments, would gives 
States, the Federal Government, and Children's Hospitals an essential 
base of information in measuring performance in children's hospital 
care. And that is something we vitally need.
  I urge my colleagues to support and co-sponsor this bill.
  I ask unanimous consent that the text of the bill be printed in the 
Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 1563

       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 ``Advancing Better Coverage 
     and Care for Children's Health Act of 2005'' or the ``ABCs 
     for Children's Health Act of 2005''.

     SEC. 2. TABLE OF CONTENTS.

       The table of contents for this Act is as follows:
Sec. 1. Short title.
Sec. 2. Table of contents.

                       TITLE I--COVERING CHILDREN

Sec. 101. Phased-in application of enhanced FMAP for children whose 
              eligibility is optional under medicaid.
Sec. 102. Enhanced matching rate for the effective enrollment and 
              retention of children under medicaid.
Sec. 103. Preserving comprehensive benefits appropriate to children's 
              needs.

    TITLE II--ADVANCING QUALITY AND PERFORMANCE: INNOVATIONS IN CARE

Sec. 201. Purpose.
Sec. 202. National quality forum; advancing consensus-based pediatric 
              quality and performance measures.
Sec. 203. Research grant program; developing new pediatric quality and 
              performance measures.
Sec. 204. Medicaid demonstration program; evaluating evidence-based 
              quality and performance measures for children's health 
              services.
Sec. 205. Funding.

                   TITLE III--ENSURING ACCESS TO CARE

Sec. 301. Pay for performance for children's critical access hospitals.
Sec. 302. Inclusion of children's hospitals as covered entities for 
              purposes of limitation of purchased drug price.

                       TITLE I--COVERING CHILDREN

     SEC. 101. PHASED-IN APPLICATION OF ENHANCED FMAP FOR CHILDREN 
                   WHOSE ELIGIBILITY IS OPTIONAL UNDER MEDICAID.

       (a) In General.--The first sentence of section 1905 of the 
     Social Security Act (42 U.S.C. 1396d) is amended--
       (1) in subsection (b)--
       (A) by striking ``and (4)'' and inserting ``(4)''; and
       (B) by inserting before the period the following: ``, and 
     (5) the Federal medical assistance percentage shall be equal 
     to the applicable percentage determined under subsection (y) 
     with respect to medical assistance provided to children who 
     are eligible for such assistance on the basis of subsection 
     (a)(10)(A)(ii), (a)(10)(C), (e)(3), or (e)(9) of section 
     1902, or a waiver under subsection (c) or (e) of section 
     1915, or who are eligible for such assistance during a 
     presumptive eligibility period under section 1920A (but only 
     if the child is not eligible for medical assistance on the 
     basis of section 1902(a)(10)(A)(i))''; and
       (2) by adding at the end the following:
       ``(y) For purposes of the fifth clause of the first 
     sentence of subsection (b), the applicable percentage 
     determined under this subsection is--
       ``(1) in the case of fiscal year 2006, the enhanced FMAP 
     determined under section

[[Page S9479]]

     2105(b) by substituting `6 percent' for `30 percent' in such 
     section;
       ``(2) in the case of fiscal year 2007, the enhanced FMAP 
     determined under section 2105(b) by substituting `12 percent' 
     for `30 percent' in such section;
       ``(3) in the case of fiscal year 2008, the enhanced FMAP 
     determined under section 2105(b) by substituting `18 percent' 
     for `30 percent' in such section;
       ``(4) in the case of fiscal year 2009, the enhanced FMAP 
     determined under section 2105(b) by substituting `24 percent' 
     for `30 percent' in such section; and
       ``(5) in the case of fiscal year 2010 or any fiscal year 
     thereafter, the enhanced FMAP determined under section 
     2105(b).''.
       (b) Effective Date.--The amendments made by subsection (a) 
     take effect on October 1, 2005.

     SEC. 102. ENHANCED MATCHING RATE FOR THE EFFECTIVE ENROLLMENT 
                   AND RETENTION OF CHILDREN UNDER MEDICAID.

       (a) In General.--Section 1903(a)(3) of the Social Security 
     Act (42 U.S.C. 1396b(a)(3)) is amended--
       (1) in subparagraph (E), by striking ``plus'' at the end 
     and inserting ``and''; and
       (2) by adding at the end the following:
       ``(F) 90 percent of the sums expended during such quarter 
     which are attributable to the design, development, 
     implementation, and evaluation of such enrollment systems as 
     the Secretary determines are likely to provide more efficient 
     and effective administration of the plan's enrollment and 
     retention of eligible children, including--
       ``(i) `express lane' enrollment for children through 
     procedures to ensure that children's eligibility for medical 
     assistance is determined and expedited through the use of 
     technology and shared information with other public benefit 
     programs, such as the school lunch program under the Richard 
     B. Russell National School Lunch Act and the food stamp 
     program under the Food Stamp Act of 1977;
       ``(ii) a single, simplified application form for medical 
     assistance under this title and for children's health 
     assistance under title XXI;
       ``(iii) procedures which allow for the enrollment of 
     children by mail or through the Internet;
       ``(iv) the timely evaluation, assistance, and determination 
     of presumptive eligibility under section 1920A;
       ``(v) procedures which allow for passive reenrollment of 
     children to protect against the loss of coverage among 
     eligible children; and
       ``(vi) such other enrollment system changes as the 
     Secretary determines are likely to provide more efficient and 
     effective administration of the plan's enrollment and 
     retention of eligible children; plus''.
       (b) Exclusion From Erroneous Excess Payment 
     Determination.--Section 1903(u)(1)(D) of such Act (42 U.S.C. 
     1396a(u)(1)(D)) is amended by adding at the end the 
     following:
       ``(vi)(I) Notwithstanding clauses (ii) and (iii), and 
     subject to subclause (II), in determining the amount of 
     erroneous excess payments, there shall not be included any 
     erroneous payments made with respect to medical assistance 
     provided to children who are erroneously enrolled or 
     erroneously provided with continued enrollment under this 
     title as a result of the application of enrollment systems 
     described in subsection (a)(3)(F).
       ``(II) Subclause (I) shall only apply with respect to 
     erroneous payments made during the first 5 fiscal years that 
     begin on or after the date of enactment of this clause.''.

     SEC. 103. PRESERVING COMPREHENSIVE BENEFITS APPROPRIATE TO 
                   CHILDREN'S NEEDS.

       (a) In General.--Title XIX of the Social Security Act is 
     amended by inserting after section 1925 the following:


            ``CLARIFICATION OF AUTHORITY UNDER SECTION 1115

       ``Sec. 1926. The Secretary may not impose or approve under 
     the authority of section 1115 an elimination or modification 
     of the amount, duration, or scope of the services described 
     in section 1905(a)(4)(B) (relating to early and periodic 
     screening, diagnostic, and treatment services (as defined in 
     section 1905(r))) or of the requirements of subparagraphs (A) 
     through (C) of section 1902(a)(43).''.
       (b) Effective Date.--
       (1) In general.--Except as provided in paragraph (2), 
     section 1926 of the Social Security Act, as added by 
     subsection (a), shall apply to the approval on or after the 
     date of enactment of this Act of--
       (A) a waiver, experimental, pilot, or demonstration project 
     under section 1115 of the Social Security Act (42 U.S.C. 
     1315); and
       (B) an amendment or extension of such a project.
       (2) Exception.--Section 1926 of the Social Security Act, as 
     so added, shall not apply with respect to any extension of 
     approval of a waiver, experimental, pilot, or demonstration 
     project with respect to title XIX of the Social Security Act 
     that was first approved before 1994 and that provides a 
     comprehensive and preventive child health program under such 
     project that includes screening, diagnosis, and treatment of 
     children who have not attained age 21.

    TITLE II--ADVANCING QUALITY AND PERFORMANCE: INNOVATIONS IN CARE

     SEC. 201. PURPOSE.

       [The purpose of this title is to increase the quality of 
     the health care furnished to children under the health 
     insurance programs under titles XIX and XXI of the Social 
     Security Act].

     SEC. 202. NATIONAL QUALITY FORUM; ADVANCING CONSENSUS-BASED 
                   PEDIATRIC QUALITY AND PERFORMANCE MEASURES.

       (a) In General.--The Secretary of Health and Human Services 
     (in this title referred to as the ``Secretary''), acting 
     through the Director of the Center for Medicaid and State 
     Operations of the Centers for Medicare & Medicaid Services, 
     shall enter into agreements with the National Quality Forum 
     to facilitate the development of consensus-based pediatric 
     quality and performance measures.
       (b) Consultation.--In carrying out agreements under 
     subsection (a), the Director of the Center for Medicaid and 
     State Operations shall consult with--
       (1) the Agency for Healthcare Research and Quality; and
       (2) national pediatric provider groups.

     SEC. 203. RESEARCH GRANT PROGRAM; DEVELOPING NEW PEDIATRIC 
                   QUALITY AND PERFORMANCE MEASURES.

       (a) In General.--The Secretary, acting through the 
     Administrator of the Agency for Healthcare Research and 
     Quality, shall award grants to eligible entities for the 
     development and evaluation of pediatric quality and 
     performance measures.
       (b) Eligible Entity Defined.--In this section, the term 
     ``eligible entity'' means--
       (1) an institution or multiple institutions with 
     demonstrated expertise and capacity to evaluate pediatric 
     quality and performance measures;
       (2) a National nonprofit association of pediatric academic 
     medical centers with demonstrated experience in working with 
     other pediatric provider and accrediting organizations in 
     developing quality and performance measures for children's 
     inpatient and outpatient care; and
       (3) a collaboration of national pediatric organizations 
     working to improve quality and performance in pediatric 
     critical care.
       (c) Application.--Each eligible entity desiring a grant 
     under this section shall submit an application to the 
     Secretary at such time, in such manner, and accompanied by 
     such information as the Secretary may require.

     SEC. 204. MEDICAID DEMONSTRATION PROGRAM; EVALUATING 
                   EVIDENCE-BASED QUALITY AND PERFORMANCE MEASURES 
                   FOR CHILDREN'S HEALTH SERVICES.

       (a) In General.--Not later than 1 year after the date of 
     enactment of this Act, the Secretary, acting through the 
     Director of the Center for Medicaid and State Operations of 
     the Centers for Medicare & Medicaid Services, shall establish 
     demonstration projects in each of the 3 categories described 
     in subsection (c) to advance quality and performance in the 
     delivery of medical assistance provided to children under the 
     medicaid program established under title XIX of the Social 
     Security Act (42 U.S.C. 1396 et seq.).
       (b) Authority.--
       (1) In general.--The Secretary is authorized to award 
     grants to States or providers to conduct such projects.
       (2) Use of funds.--Funds provided under a grant awarded 
     under this section may be used for administrative costs, 
     including costs associated with the design, data collection, 
     and evaluation of the demonstration project conducted with 
     such funds, and other expenditures that are not otherwise 
     eligible for reimbursement under the medicaid program.
       (3) Evidence of organizational commitment required for 
     award of grants.--A State or provider shall not be eligible 
     to receive a grant to conduct a demonstration project under 
     this section unless the State or provider demonstrates a 
     commitment to the concept of change and transformation in the 
     delivery of children's health services. Dedication of 
     financial resources of the State or provider to the project 
     may be deemed to demonstrate evidence of such a commitment.
       (c) Project Categories Described.--The 3 demonstration 
     project categories described in this subsection are the 
     following:
       (1) Projects that adopt and use health information 
     technology and evidenced-based outcome measures for pediatric 
     inpatient and sub-specialty physician care and evaluate the 
     impact of such technology and measures on the quality, 
     safety, and costs of such care.
       (2) Projects that demonstrate and evaluate care management 
     for children with chronic conditions to determine the extent 
     to which such management promotes continuity of care, 
     stabilization of medical conditions, and functional outcomes, 
     prevents or minimizes acute exacerbations of chronic 
     conditions, and reduces adverse health outcomes and avoidable 
     hospitalizations.
       (3) Projects that implement evidenced-based approaches to 
     improving efficiency, safety, and effectiveness in the 
     delivery of hospital care for children across hospital 
     services and evaluate the impact of such changes on the 
     quality and costs of such care.
       (d) Sites.--To the extent practicable, the Secretary shall 
     use multiple sites in different geographical locations in 
     conducting each of the 3 demonstration project categories 
     described in subsection (c).
       (e) Uniform Measures, Data, Project Evaluations.--Working 
     in consultation with

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     experts described in subsection (f) and with participating 
     States or providers, the Secretary shall establish uniform 
     measures (adjusted for patient acuity), collect data, and 
     conduct evaluations with respect to the 3 demonstration 
     project categories described in subsection (c).
       (f) Consultation.--In developing and implementing 
     demonstration projects under this section, the Secretary 
     shall consult with national pediatric provider organizations, 
     consumers, and such other entities or individuals with 
     relevant expertise as the Secretary deems necessary.
       (g) Report.--Not later than 6 months after the completion 
     of all demonstration projects conducted under this section, 
     the Secretary shall evaluate such projects and submit a 
     report to Congress that includes the findings of the 
     evaluation and recommendations with respect to--
       (1) expanding the projects to additional sites; and
       (2) the broad implementation of identified successful 
     approaches in advancing quality and performance in the 
     delivery of medical assistance provided to children under the 
     medicaid program.

     SEC. 205. FUNDING.

       In order to carry out the provisions of this title, out of 
     funds in the Treasury not otherwise appropriated, there are 
     appropriated to the Secretary--
       (1) $25,000,000 for fiscal year 2006;
       (2) $30,000,000 for fiscal year 2007; and
       (3) $35,000,000 for each of the fiscal years 2008, 2009, 
     and 2010.

                   TITLE III--ENSURING ACCESS TO CARE

     SEC. 301. PAY FOR PERFORMANCE FOR CHILDREN'S CRITICAL ACCESS 
                   HOSPITALS.

       (a) In General.--The Secretary of Health and Human Services 
     (in this section referred to as the ``Secretary''), acting 
     through the Administrator of the Centers for Medicare & 
     Medicaid Services (in this section referred to as the 
     ``Administrator''), shall implement a 4-year program to 
     develop, implement, and evaluate a pay-for-performance 
     program for eligible children's hospitals providing critical 
     access to children eligible for medical assistance under the 
     medicaid program established under title XIX of the Social 
     Security Act (42 U.S.C. 1396 et seq.).
       (b) Consultation.--Measures of quality and performance 
     utilized in the program will be determined by the 
     Administrator in collaboration with participating eligible 
     children's hospitals and in consultation with States, the 
     National Association of Children's Hospitals and Related 
     Institutions, the Agency for Healthcare Research and Quality, 
     the National Quality Forum, and such other entities or 
     individuals with expertise in pediatric quality and 
     performance measures as the Administrator deems appropriate.
       (c) Eligible Children's Hospitals.--For purposes of this 
     section, an eligible children's hospital is a children's 
     hospital that, not later than January 1, 2006, has submitted 
     an application to the Secretary to participate in the program 
     established under this section and has been certified by the 
     Secretary as--
       (1) meeting the criteria described in subsection (d);
       (2) agreeing to report data on quality and performance 
     measures; and
       (3) meeting or exceeding such measures as are established 
     by the Secretary with respect to the provision of care by the 
     hospital.
       (d) Criteria Described.--In order to be certified as 
     meeting the criteria described in this subsection, a hospital 
     shall be a general acute care children's hospital or a 
     specialty children's hospital as defined under 
     1886(d)(1)(B)(iii) of the Social Security Act (42 U.S.C. 
     1395ww(d)(1)(B)(iii)), or a non-freestanding general acute 
     care children's hospital which shares a provider number with 
     another hospital or hospital system that--
       (1) has 62 or more total pediatric beds;
       (2) has 38 or more total combined pediatric general medical 
     or surgical and pediatric intensive care beds;
       (3) has at least 4 pediatric intensive care beds;
       (4) has a pediatric emergency room in the hospital or 
     access to an emergency room with pediatric services through 
     the hospital system; and
       (5) provides a minimum of 25 percent of its days of care to 
     patients eligible for medical assistance under the medicaid 
     program.
       (e) Payment Methodology.--
       (1) In general.--An eligible children's hospital that 
     participates in the program established under this section 
     shall receive supplemental Federal payments for inpatient and 
     outpatient care (which shall be in addition to any other 
     payments the hospitals receive for such care under the 
     medicaid program) for cost reporting periods or portions of 
     such reporting periods occurring during fiscal years 2007 
     through 2010 in accordance with the following:
       (A) Fiscal years 2007 and 2008.--
       (i) In general.--For hospital cost reporting periods or 
     portions of such reporting periods occurring during fiscal 
     year 2007 or 2008, hospitals reporting data for quality and 
     performance measures established under the program and 
     participating in the development of pay-for-performance 
     methodology under this section, subject to clause (ii), shall 
     receive with respect to inpatient or outpatient care that is 
     determined to meet such measures, a Federal supplemental 
     payment increase equal to the amount received under the 
     medicaid program for such care multiplied by the market 
     basket percentage increase for the year (as defined under 
     section 1886(b)(3)(B)(iii) of the Social Security Act (42 
     U.S.C. 1395ww(b)(3)(B)(iii)).
       (ii) Limitation.--The total amount of all Federal 
     supplemental payments made with respect to cost reporting 
     periods or portions of such periods described in clause (i) 
     shall not exceed the amounts appropriated under this section 
     for fiscal years 2007 and 2008.
       (B) Fiscal years 2009 and 2010.--
       (i) In general.--For cost reporting periods or portions of 
     such periods occurring during fiscal year 2009 or 2010, 
     hospitals shall receive supplemental Federal payments 
     reflecting measures of quality and performance and a pay-for-
     performance methodology developed by the Secretary in 
     consultation with the entities described in subsection (b). 
     Such methodology shall recognize clinical measures, patient 
     satisfaction and adoption of information technology.
       (ii) Limitation.--The total amount of all Federal 
     supplemental payments made for cost reporting periods or 
     portions of such periods described in clause (i) shall not 
     exceed the amounts appropriated under this section for fiscal 
     years 2009 and 2010.
       (2) State maintenance of effort.--With respect to the 
     periods for payment of the Federal supplemental payments 
     established under paragraph (1), in no case shall a State--
       (A) pay a participating hospital less for services for 
     children eligible for medical assistance under the medicaid 
     program than the hospital was paid with respect to the most 
     recent cost reporting period ending before the date of 
     enactment of this Act; or
       (B) not provide an eligible children's hospital 
     participating in the program established under this section 
     (determined on a facility-specific basis) with the same 
     increase in payment that the State may provide to any other 
     hospital participating in the State medicaid program, 
     including any State-owned or operated hospital or any 
     hospital operated by a State university system.
       (f) Appropriations.--
       (1) In general.--Out of funds in the Treasury not otherwise 
     appropriated, there are appropriated for making payments 
     under this section--
       (A) for fiscal year 2007, $80,000,000;
       (B) for fiscal year 2008, $100,000,000; and
       (C) for each of fiscal years 2009 and 2010, $120,000,000.
       (2) Carryover.--Any amount appropriated under paragraph (1) 
     with respect to a fiscal year that remains unobligated as of 
     the end of that fiscal year, shall remain available for 
     obligation during the succeeding fiscal year, in addition to 
     the amount appropriated under that paragraph for such 
     succeeding fiscal year.
       (g) Evaluation and Report.--Not later than September 1, 
     2010, the Secretary shall report to Congress on the program 
     established under this section. In providing such a report, 
     the Secretary shall--
       (1) conduct an independent evaluation;
       (2) consult with States, eligible children's hospitals 
     participating in the program, the National Association of 
     Children's Hospitals and Related Institutions, and other 
     national pediatric organizations and individuals with 
     expertise in pediatric measures of quality and performance;
       (3) include a detailed description of the measures and 
     payment enhancements used in determining and rewarding 
     performance under the program;
       (4) assess the impact of rewarding performance through the 
     Federal supplemental payments provided under the program, 
     including with respect to any improvements and innovations in 
     the delivery of children's hospital care and children's 
     access to appropriate care;
       (5) assess how State hospital payment methodologies under 
     the medicaid program, including hospital and physician 
     payments and coverage, affect the capacity of the medicaid 
     program to reward performance; and
       (6) include recommendations to the Committee on Finance of 
     the Senate and the Committee on Energy and Commerce of the 
     House of Representatives regarding the implementation and 
     design of the performance-based payments made under the 
     program, whether to continue such program, and potential 
     alternative approaches to making performance-based payments 
     to such hospitals.

     SEC. 302. INCLUSION OF CHILDREN'S HOSPITALS AS COVERED 
                   ENTITIES FOR PURPOSES OF LIMITATION OF 
                   PURCHASED DRUG PRICE.

       (a) In General.--Section 340B(a)(4) of the Public Health 
     Services Act (42 U.S.C. 256b(a)(4)) is amended by adding at 
     the end the following new subparagraph:
       ``(M) A children's hospital described in section 
     1886(d)(1)(B)(iii) of the Social Security Act which meets the 
     requirements of clauses (i) and (iii) of subparagraph (L) and 
     which would meet the requirements of clause (ii) of such 
     subparagraph if that clause were applied by taking into 
     account the percentage of care provided by the hospital to 
     patients eligible for medical assistance under the medicaid 
     program.''.
       (b) Effective Date.--The amendment made by subsection (a) 
     shall apply to drugs purchased on or after the date of 
     enactment of this Act.

  Mrs. LINCOLN. Mr. President, I am pleased to join my colleague 
Senator Mike DeWine to introduce ``The ABCs for Children's Health Act 
of 2005,'' which seeks to expand access to quality health care for all 
children who are

[[Page S9481]]

eligible for Medicaid. The bill also ensures that children get the best 
health care at the right time.
  Medicaid is the single largest insurer for children. Twenty-five 
million children in America, one out of every four, depend on Medicaid 
for their health care coverage. In Arkansas, more than half of the 
births are financed by Medicaid. Over half of the children in Arkansas 
are on Medicaid or received Medicaid services in the last year. 
Medicaid covers half of the care, on average, that children's hospitals 
provide. As a result, the availability and quality of health care for 
all children relies greatly on Medicaid.
  As a result of progress in children's Medicaid coverage and the 
enactment of the State Children's Health Insurance Program, Congress 
has achieved an essential health care safety net for lower income 
children and children with special health care needs. Medicaid has 
saved millions of children from being uninsured when parents are faced 
with hard times and it has come to the aid of working families when 
children have exceptional medical costs. I believe that we must 
continue to build on that progress.
  The ABCs for Children's Health Act of 2005 encourages States to 
provide care for more children under Medicaid. It also helps states to 
ensure that all eligible children are enrolled and that they get the 
high quality care they need. The bill would provide the same 
investments in quality and performance in children's health care 
service's that are being made in Medicare. National quality and 
performance measures for children are far behind those for adults.
  I encourage my colleagues to join us as supporters of this important 
legislation to ensure that children get the quality health care they 
need to grow and prosper. Our Nation's children deserve the best health 
care we can offer. And this is a step in the right direction.
                                 ______