HR 462 IHCommentsClose CommentsPermalink

To amend titles XIX and XXI of the Social Security Act to improve dental benefits under Medicaid and the State Children’s Health Insurance Program (SCHIP), and for other purposes.CommentsClose CommentsPermalink

January 13, 2009CommentsClose CommentsPermalink

Mr. CUMMINGS introduced the following bill; which was referred to the Committee on Energy and CommerceCommentsClose CommentsPermalink

To amend titles XIX and XXI of the Social Security Act to improve dental benefits under Medicaid and the State Children’s Health Insurance Program (SCHIP), and for other purposes.CommentsClose CommentsPermalink

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

SECTION 1. SHORT TITLE.

This Act may be cited as the ‘Medicaid-SCHIP Dental Benefits Improvement Act of 2009’.CommentsClose CommentsPermalink

SEC. 2. DENTAL BENEFITS.

(a) Coverage-CommentsClose CommentsPermalink





(1) IN GENERAL- Section 2103 of the Social Security Act (42 U.S.C. 1397cc) is amended--CommentsClose CommentsPermalink





(A) in subsection (a)--CommentsClose CommentsPermalink





(i) in the matter before paragraph (1), by striking ‘subsection (c)(5)’ and inserting ‘paragraphs (5) and (6) of subsection (c)’ ; andCommentsClose CommentsPermalink





(ii) in paragraph (I) , by inserting ‘at least’ after ‘that is’; andCommentsClose CommentsPermalink





(B) in subsection (c)--CommentsClose CommentsPermalink





(i) by redesignating paragraph (5) as paragraph (6); andCommentsClose CommentsPermalink





(ii) by inserting after paragraph (4), the following:CommentsClose CommentsPermalink





‘(5) DENTAL BENEFITS-CommentsClose CommentsPermalink





‘(A) IN GENERAL- The child health assistance provided to a targeted low-income child shall include coverage of dental services necessary to prevent disease and promote oral health, restore oral structures to health and function, and treat emergency conditions.CommentsClose CommentsPermalink





‘(B) PERMITTING USE OF DENTAL BENCHMARK PLANS BY CERTAIN STATES- A State may elect to meet the requirement of subparagraph (A) through dental coverage that is equivalent to a benchmark dental benefit package described in subparagraph (C).CommentsClose CommentsPermalink





‘(C) BENCHMARK DENTAL BENEFIT PACKAGES- The benchmark dental benefit packages are as follows:CommentsClose CommentsPermalink





‘(i) FEHBP CHILDREN’S DENTAL COVERAGE- A dental benefits plan under chapter 89A of title 5, United States Code, that has been selected most frequently by employees seeking dependent coverage, among such plans that provide such dependent coverage, in either of the previous 2 plan years.CommentsClose CommentsPermalink





‘(ii) STATE EMPLOYEE DEPENDENT DENTAL COVERAGE- A dental benefits plan that is offered and generally available to State employees in the State involved and that has been selected most frequently by employees seeking dependent coverage, among such plans that provide such dependent coverage, in either of the previous 2 plan years.CommentsClose CommentsPermalink





‘(iii) COVERAGE OFFERED THROUGH COMMERCIAL DENTAL PLAN- A dental benefits plan that has the largest insured commercial, non-medicaid enrollment of dependent covered lives of such plans that is offered in the State involved.’.CommentsClose CommentsPermalink





(2) ASSURING ACCESS TO CARE- Section 2102(a)(7)(B) of such Act (42 U.S.C. 1397bb(c)(2)) is amended by inserting ‘and services described in section 2103(c)(5)’ after ‘emergency services’.CommentsClose CommentsPermalink





(3) EFFECTIVE DATE- The amendments made by paragraph (1) shall apply to coverage of items and services furnished on or after October 1, 2009.CommentsClose CommentsPermalink





(b) Dental Education for Parents of Newborns- The Secretary of Health and Human Services shall develop and implement, through entities that fund or provide perinatal care services to targeted low-income children under a State child health plan under title XXI of the Social Security Act, a program to deliver oral health educational materials that inform new parents about risks for, and prevention of, early childhood caries and the need for a dental visit within their newborn’s first year of life.CommentsClose CommentsPermalink





(c) Provision of Dental Services Through FQHCs-CommentsClose CommentsPermalink





(1) MEDICAID- Section 1902(a) of such Act (42 U.S.C. 1396a(a)) is amended--CommentsClose CommentsPermalink





(A) by striking ‘and’ at the end of paragraph (70);CommentsClose CommentsPermalink





(B) by striking the period at the end of paragraph (71) and inserting ‘; and’; andCommentsClose CommentsPermalink





(C) by inserting after paragraph (71) the following new paragraph:CommentsClose CommentsPermalink





‘(72) provide that the State will not prevent a Federally-qualified health center from entering into contractual relationships with private practice dental providers in the provision of Federally-qualified health center services.’.CommentsClose CommentsPermalink





(2) CHIP- Section 2107(e)(1) of such Act (42 U.S.C. 1397g(e)(1)) is amended by redesignating subparagraphs (B) through (D) as subparagraphs (C) through (E), respectively, and by inserting after subparagraph (A) the following new subparagraph:CommentsClose CommentsPermalink





‘(B) Section 1902(a)(72) (relating to limiting FQHC contracting for provision of dental services).’.CommentsClose CommentsPermalink





(3) EFFECTIVE DATE- The amendments made by this subsection shall take effect on January 1, 2009.CommentsClose CommentsPermalink





(d) Reporting Information on Dental Health-CommentsClose CommentsPermalink





(1) MEDICAID- Section 1902(a)(43)(D)(iii) of such Act (42 U.S.C. 1396a(a)(43)(D)(iii)) is amended by inserting ‘and other information relating to the provision of dental services to such children described in section 2108(e)’ after ‘receiving dental services,’.CommentsClose CommentsPermalink





(2) CHIP- Section 2108 of such Act (42 U.S.C. 1397hh) is amended by adding at the end the following new subsection:CommentsClose CommentsPermalink





‘(e) Information on Dental Care for Children-CommentsClose CommentsPermalink





‘(1) IN GENERAL- Each annual report under subsection (a) shall include the following information with respect to care and services described in section 1905(r)(3) provided to targeted low-income children enrolled in the State child health plan under this title at any time during the year involved:CommentsClose CommentsPermalink





‘(A) The number of enrolled children by age grouping used for reporting purposes under section 1902(a)(43).CommentsClose CommentsPermalink





‘(B) For children within each such age grouping, information of the type contained in questions 12(a)-(c) of CMS Form 416 (that consists of the number of enrolled targeted low income children who receive any, preventive, or restorative dental care under the State plan).CommentsClose CommentsPermalink





‘(C) For the age grouping that includes children 8 years of age, the number of such children who have received a protective sealant on at least one permanent molar tooth.CommentsClose CommentsPermalink





‘(2) INCLUSION OF INFORMATION ON ENROLLEES IN MANAGED CARE PLANS- The information under paragraph (1) shall include information on children who are enrolled in managed care plans and other private health plans and contracts with such plans under this title shall provide for the reporting of such information by such plans to the State.’.CommentsClose CommentsPermalink





(3) EFFECTIVE DATE- The amendments made by this subsection shall be effective for annual reports submitted for years beginning after date of enactment.CommentsClose CommentsPermalink





(e) Improved Accessibility of Dental Provider Information to Enrollees Under Medicaid and Chip- The Secretary of Health and Human Services shall--CommentsClose CommentsPermalink





(1) work with States, pediatric dentists, and other dental providers (including providers that are, or are affiliated with, a school of dentistry) to include, not later than 6 months after the date of the enactment of this Act, on the Insure Kids Now website (http://www.insurekidsnow.gov/) and hotline (1-877-KIDS-NOW) (or on any successor websites or hotlines) a current and accurate list of all such dentists and providers within each State that provide dental services to children enrolled in the State plan (or waiver) under Medicaid or the State child health plan (or waiver) under title XXI of the Social Security Act, and shall ensure that such list is updated at least quarterly; andCommentsClose CommentsPermalink





(2) work with States to include, not later than 6 months after the date of the enactment of this Act, a description of the dental services provided under each State plan (or waiver) under Medicaid and each State child health plan (or waiver) under title XXI of the Social Security Act on such Insure Kids Now website, and shall ensure that such list is updated at least annually.CommentsClose CommentsPermalink





(f) GAO Study and Report-CommentsClose CommentsPermalink





(1) STUDY- The Comptroller General of the United States shall provide for a study that examines--CommentsClose CommentsPermalink





(A) access to dental services by children in underserved areas;CommentsClose CommentsPermalink





(B) children’s access to oral health care, including preventive and restorative services, under Medicaid and the State Children’s Health Insurance Program, including--CommentsClose CommentsPermalink





(i) the extent to which dental providers are willing to treat children eligible for such programs;CommentsClose CommentsPermalink





(ii) information on such children’s access to networks of care, including such networks that serve special needs children; andCommentsClose CommentsPermalink





(iii) geographic availability of oral health care, including preventive and restorative services, under such programs; andCommentsClose CommentsPermalink





(C) the feasibility and appropriateness of using qualified mid-level dental health providers, in coordination with dentists, to improve access for children to oral health services and public health overall.CommentsClose CommentsPermalink





(2) REPORT- Not later than 18 months after the date of the enactment of this Act, the Comptroller General shall submit to Congress a report on the study conducted under paragraph (1). The report shall include recommendations for such Federal and State legislative and administrative changes as the Comptroller General determines are necessary to address any barriers to access to oral health care, including preventive and restorative services, under Medicaid and the State Children’s Health Insurance Program that may exist.CommentsClose CommentsPermalink

SEC. 3. CHILD HEALTH QUALITY IMPROVEMENT ACTIVITIES FOR CHILDREN ENROLLED IN MEDICAID OR CHIP.

(a) Development of Child Health Quality Measures for Children Enrolled in Medicaid or Chip- 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:CommentsClose CommentsPermalink

‘SEC. 1139A. CHILD HEALTH QUALITY MEASURES.

‘(a) Development of an Initial Core Set of Health Care Quality Measures for Children Enrolled in Medicaid or Chip-CommentsClose CommentsPermalink





‘(1) IN GENERAL- 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 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.CommentsClose CommentsPermalink





‘(2) IDENTIFICATION OF INITIAL CORE MEASURES- 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.CommentsClose CommentsPermalink





‘(3) RECOMMENDATIONS AND DISSEMINATION- 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:CommentsClose CommentsPermalink





‘(A) The duration of children’s health insurance coverage over a 12-month time period.CommentsClose CommentsPermalink





‘(B) The availability and effectiveness of a full range of--CommentsClose CommentsPermalink





‘(i) 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; andCommentsClose CommentsPermalink





‘(ii) treatments to correct or ameliorate the effects of physical and mental conditions, including chronic conditions, and, with respect to dental care, conditions requiring the restoration of teeth, relief of pain and infection, and maintenance of dental health, in infants, young children, school-age children, and adolescents.CommentsClose CommentsPermalink





‘(C) The availability of care in a range of ambulatory and inpatient health care settings in which such care is furnished.CommentsClose CommentsPermalink





‘(D) 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.CommentsClose CommentsPermalink





‘(4) ENCOURAGE VOLUNTARY AND STANDARDIZED REPORTING- Not later than 2 years after the date of enactment 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.CommentsClose CommentsPermalink





‘(5) ADOPTION OF BEST PRACTICES IN IMPLEMENTING QUALITY PROGRAMS- 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.CommentsClose CommentsPermalink





‘(6) REPORTS TO CONGRESS- Not later than January 1, 2011, and every 3 years thereafter, the Secretary shall report to Congress on--CommentsClose CommentsPermalink





‘(A) the status of the Secretary’s efforts to improve--CommentsClose CommentsPermalink





‘(i) quality related to the duration and stability of health insurance coverage for children under titles XIX and XXI;CommentsClose CommentsPermalink





‘(ii) the quality of children’s health care under such titles, including preventive health services, dental 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; andCommentsClose CommentsPermalink





‘(iii) 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;CommentsClose CommentsPermalink





‘(B) the status of voluntary reporting by States under titles XIX and XXI, utilizing the initial core quality measurement set; andCommentsClose CommentsPermalink





‘(C) any recommendations for legislative changes needed to improve the quality of care provided to children under titles XIX and XXI, including recommendations for quality reporting by States.CommentsClose CommentsPermalink





‘(7) TECHNICAL ASSISTANCE- 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.CommentsClose CommentsPermalink





‘(8) DEFINITION OF CORE SET- In this section, the term ‘core set’ means a group of valid, reliable, and evidence-based quality measures that, taken together--CommentsClose CommentsPermalink





‘(A) provide information regarding the quality of health coverage and health care for children;CommentsClose CommentsPermalink





‘(B) address the needs of children throughout the developmental age span; andCommentsClose CommentsPermalink





‘(C) 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.CommentsClose CommentsPermalink





‘(b) Advancing and Improving Pediatric Quality Measures-CommentsClose CommentsPermalink





‘(1) ESTABLISHMENT OF PEDIATRIC QUALITY MEASURES PROGRAM- Not later than January 1, 2011, the Secretary shall establish a pediatric quality measures program to--CommentsClose CommentsPermalink





‘(A) improve and strengthen the initial core child health care quality measures established by the Secretary under subsection (a);CommentsClose CommentsPermalink





‘(B) 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; andCommentsClose CommentsPermalink





‘(C) 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.CommentsClose CommentsPermalink





‘(2) EVIDENCE-BASED MEASURES- The measures developed under the pediatric quality measures program shall, at a minimum, be--CommentsClose CommentsPermalink





‘(A) evidence-based and, where appropriate, risk adjusted;CommentsClose CommentsPermalink





‘(B) designed to identify and eliminate racial and ethnic disparities in child health and the provision of health care;CommentsClose CommentsPermalink





‘(C) 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;CommentsClose CommentsPermalink





‘(D) periodically updated; andCommentsClose CommentsPermalink





‘(E) 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).CommentsClose CommentsPermalink





‘(3) PROCESS FOR PEDIATRIC QUALITY MEASURES PROGRAM- In identifying gaps in existing pediatric quality measures and establishing priorities for development and advancement of such measures, the Secretary shall consult with--CommentsClose CommentsPermalink





‘(A) States;CommentsClose CommentsPermalink





‘(B) 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;CommentsClose CommentsPermalink





‘(C) dental professionals, including pediatric dental professionals;CommentsClose CommentsPermalink





‘(D) 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;CommentsClose CommentsPermalink





‘(E) national organizations representing children, including children with disabilities and children with chronic conditions;CommentsClose CommentsPermalink





‘(F) national organizations representing consumers and purchasers of children’s health care;CommentsClose CommentsPermalink





‘(G) national organizations and individuals with expertise in pediatric health quality measurement; andCommentsClose CommentsPermalink





‘(H) voluntary consensus standards setting organizations and other organizations involved in the advancement of evidence-based measures of health care.CommentsClose CommentsPermalink





‘(4) DEVELOPING, VALIDATING, AND TESTING A PORTFOLIO OF PEDIATRIC QUALITY MEASURES- As part of the program to advance pediatric quality measures, the Secretary shall--CommentsClose CommentsPermalink





‘(A) 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); andCommentsClose CommentsPermalink





‘(B) award grants and contracts for--CommentsClose CommentsPermalink





‘(i) the development of consensus on evidence-based measures for children’s health care services;CommentsClose CommentsPermalink





‘(ii) the dissemination of such measures to public and private purchasers of health care for children; andCommentsClose CommentsPermalink





‘(iii) the updating of such measures as necessary.CommentsClose CommentsPermalink





‘(5) REVISING, STRENGTHENING, AND IMPROVING INITIAL CORE MEASURES- 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).CommentsClose CommentsPermalink





‘(6) DEFINITION OF PEDIATRIC QUALITY MEASURE- In this subsection, the term ‘pediatric quality measure’ 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.CommentsClose CommentsPermalink





‘(7) CONSTRUCTION- Nothing in this section shall be construed as supporting the restriction of coverage, under title XIX or XXI or otherwise, to only those services that are evidence-based.CommentsClose CommentsPermalink





‘(c) Annual State Reports Regarding State-Specific Quality of Care Measures Applied Under Medicaid or Chip-CommentsClose CommentsPermalink





‘(1) ANNUAL STATE REPORTS- 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--CommentsClose CommentsPermalink





‘(A) 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); andCommentsClose CommentsPermalink





‘(B) 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 Social Security Act (42 U.S.C. 1396u-4) and benchmark plans under sections 1937 and 2103 of such Act (42 U.S.C. 1396u-7, 1397cc).CommentsClose CommentsPermalink





‘(2) PUBLICATION- 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).CommentsClose CommentsPermalink





‘(d) Demonstration Projects for Improving the Quality of Children’s Health Care and the Use of Health Information Technology-CommentsClose CommentsPermalink





‘(1) IN GENERAL- 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 or XXI, including projects to--CommentsClose CommentsPermalink





‘(A) 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);CommentsClose CommentsPermalink





‘(B) promote the use of health information technology in care delivery for children under such titles;CommentsClose CommentsPermalink





‘(C) 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; orCommentsClose CommentsPermalink





‘(D) 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.CommentsClose CommentsPermalink





‘(2) REQUIREMENTS- In awarding grants under this subsection, the Secretary shall ensure that--CommentsClose CommentsPermalink





‘(A) only 1 demonstration project funded under a grant awarded under this subsection shall be conducted in a State; andCommentsClose CommentsPermalink





‘(B) 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.CommentsClose CommentsPermalink





‘(3) AUTHORITY FOR MULTISTATE PROJECTS- A demonstration project conducted with a grant awarded under this subsection may be conducted on a multistate basis, as needed.CommentsClose CommentsPermalink





‘(4) FUNDING- $20,000,000 of the amount appropriated under subsection (i) for a fiscal year shall be used to carry out this subsection.CommentsClose CommentsPermalink





‘(e) Childhood Obesity Demonstration Project-CommentsClose CommentsPermalink





‘(1) AUTHORITY TO CONDUCT DEMONSTRATION- 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--CommentsClose CommentsPermalink





‘(A) identify, through self-assessment, behavioral risk factors for obesity among children;CommentsClose CommentsPermalink





‘(B) identify, through self-assessment, needed clinical preventive and screening benefits among those children identified as target individuals on the basis of such risk factors;CommentsClose CommentsPermalink





‘(C) provide ongoing support to such target individuals and their families to reduce risk factors and promote the appropriate use of preventive and screening benefits; andCommentsClose CommentsPermalink





‘(D) 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 or child health assistance is available under title XXI among such target individuals.CommentsClose CommentsPermalink





‘(2) ELIGIBILITY ENTITIES- For purposes of this subsection, an eligible entity is any of the following:CommentsClose CommentsPermalink





‘(A) A city, county, or Indian tribe.CommentsClose CommentsPermalink





‘(B) A local or tribal educational agency.CommentsClose CommentsPermalink





‘(C) An accredited university, college, or community college.CommentsClose CommentsPermalink





‘(D) A Federally-qualified health center.CommentsClose CommentsPermalink





‘(E) A local health department.CommentsClose CommentsPermalink





‘(F) A health care provider.CommentsClose CommentsPermalink





‘(G) A community-based organization.CommentsClose CommentsPermalink





‘(H) Any other entity determined appropriate by the Secretary, including a consortia or partnership of entities described in any of subparagraphs (A) through (G).CommentsClose CommentsPermalink





‘(3) USE OF FUNDS- An eligible entity awarded a grant under this subsection shall use the funds made available under the grant to--CommentsClose CommentsPermalink





‘(A) carry out community-based activities related to reducing childhood obesity, including by--CommentsClose CommentsPermalink





‘(i) 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;CommentsClose CommentsPermalink





‘(ii) forming partnerships with daycare facilities to establish programs that promote healthy eating behaviors and physical activity; andCommentsClose CommentsPermalink





‘(iii) developing and evaluating community educational activities targeting good nutrition and promoting healthy eating behaviors;CommentsClose CommentsPermalink





‘(B) carry out age-appropriate school-based activities that are designed to reduce childhood obesity, including by--CommentsClose CommentsPermalink





‘(i) developing and testing educational curricula and intervention programs designed to promote healthy eating behaviors and habits in youth, which may include--CommentsClose CommentsPermalink





‘(I) after hours physical activity programs; andCommentsClose CommentsPermalink





‘(II) 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;CommentsClose CommentsPermalink





‘(ii) providing education and training to educational professionals regarding how to promote a healthy lifestyle and a healthy school environment for children;CommentsClose CommentsPermalink





‘(iii) planning and implementing a healthy lifestyle curriculum or program with an emphasis on healthy eating behaviors and physical activity; andCommentsClose CommentsPermalink





‘(iv) planning and implementing healthy lifestyle classes or programs for parents or guardians, with an emphasis on healthy eating behaviors and physical activity for children;CommentsClose CommentsPermalink





‘(C) carry out educational, counseling, promotional, and training activities through the local health care delivery systems including by--CommentsClose CommentsPermalink





‘(i) promoting healthy eating behaviors and physical activity services to treat or prevent eating disorders, being overweight, and obesity;CommentsClose CommentsPermalink





‘(ii) providing patient education and counseling to increase physical activity and promote healthy eating behaviors;CommentsClose CommentsPermalink





‘(iii) training health professionals on how to identify and treat obese and overweight individuals which may include nutrition and physical activity counseling; andCommentsClose CommentsPermalink





‘(iv) 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; andCommentsClose CommentsPermalink





‘(D) provide, through qualified health professionals, training and supervision for community health workers to--CommentsClose CommentsPermalink





‘(i) educate families regarding the relationship between nutrition, eating habits, physical activity, and obesity;CommentsClose CommentsPermalink





‘(ii) educate families about effective strategies to improve nutrition, establish healthy eating patterns, and establish appropriate levels of physical activity; andCommentsClose CommentsPermalink





‘(iii) educate and guide parents regarding the ability to model and communicate positive health behaviors.CommentsClose CommentsPermalink





‘(4) PRIORITY- In awarding grants under paragraph (1), the Secretary shall give priority to awarding grants to eligible entities--CommentsClose CommentsPermalink





‘(A) 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;CommentsClose CommentsPermalink





‘(B) 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;CommentsClose CommentsPermalink





‘(C) that provide non-Federal contributions, either in cash or in-kind, to the costs of funding activities under the grants;CommentsClose CommentsPermalink





‘(D) 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;CommentsClose CommentsPermalink





‘(E) located in communities that are medically underserved, as determined by the Secretary;CommentsClose CommentsPermalink





‘(F) 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; andCommentsClose CommentsPermalink





‘(G) that submit plans that exhibit multisectoral, cooperative conduct that includes the involvement of a broad range of stakeholders, including--CommentsClose CommentsPermalink





‘(i) community-based organizations;CommentsClose CommentsPermalink





‘(ii) local governments;CommentsClose CommentsPermalink





‘(iii) local educational agencies;CommentsClose CommentsPermalink





‘(iv) the private sector;CommentsClose CommentsPermalink





‘(v) State or local departments of health;CommentsClose CommentsPermalink





‘(vi) accredited colleges, universities, and community colleges;CommentsClose CommentsPermalink





‘(vii) health care providers;CommentsClose CommentsPermalink





‘(viii) State and local departments of transportation and city planning; andCommentsClose CommentsPermalink





‘(ix) other entities determined appropriate by the Secretary.CommentsClose CommentsPermalink





‘(5) PROGRAM DESIGN-CommentsClose CommentsPermalink





‘(A) INITIAL DESIGN- 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.CommentsClose CommentsPermalink





‘(B) NUMBER AND PROJECT AREAS- 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 in order to reduce the incidence of childhood obesity among such population.CommentsClose CommentsPermalink





‘(6) REPORT TO CONGRESS- 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.CommentsClose CommentsPermalink





‘(7) DEFINITIONS- In this subsection:CommentsClose CommentsPermalink





‘(A) FEDERALLY-QUALIFIED HEALTH CENTER- The term ‘Federally-qualified health center’ has the meaning given that term in section 1905(l)(2)(B).CommentsClose CommentsPermalink





‘(B) INDIAN TRIBE- The term ‘Indian tribe’ has the meaning given that term in section 4 of the Indian Health Care Improvement Act (25 U.S.C. 1603).CommentsClose CommentsPermalink





‘(C) SELF-ASSESSMENT- The term ‘self-assessment’ means a form that--CommentsClose CommentsPermalink





‘(i) includes questions regarding--CommentsClose CommentsPermalink





‘(I) behavioral risk factors;CommentsClose CommentsPermalink





‘(II) needed preventive and screening services; andCommentsClose CommentsPermalink





‘(III) target individuals’ preferences for receiving follow-up information;CommentsClose CommentsPermalink





‘(ii) is assessed using such computer generated assessment programs; andCommentsClose CommentsPermalink





‘(iii) allows for the provision of such ongoing support to the individual as the Secretary determines appropriate.CommentsClose CommentsPermalink





‘(D) ONGOING SUPPORT- The term ‘ongoing support’ means--CommentsClose CommentsPermalink





‘(i) to provide any target individual with information, feedback, health coaching, and recommendations regarding--CommentsClose CommentsPermalink





‘(I) the results of a self-assessment given to the individual;CommentsClose CommentsPermalink





‘(II) behavior modification based on the self-assessment; andCommentsClose CommentsPermalink





‘(III) any need for clinical preventive and screening services or treatment including medical nutrition therapy;CommentsClose CommentsPermalink





‘(ii) to provide any target individual with referrals to community resources and programs available to assist the target individual in reducing health risks; andCommentsClose CommentsPermalink





‘(iii) to provide the information described in clause (i) to a health care provider, if designated by the target individual to receive such information.CommentsClose CommentsPermalink





‘(8) AUTHORIZATION OF APPROPRIATIONS- There is authorized to be appropriated to carry out this subsection, $25,000,000 for the period of fiscal years 2009 through 2013.CommentsClose CommentsPermalink





‘(f) Development of Model Electronic Health Record Format for Children Enrolled in Medicaid or CHIP-CommentsClose CommentsPermalink





‘(1) IN GENERAL- 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 or the State child health plan under title XXI that is--CommentsClose CommentsPermalink





‘(A) 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;CommentsClose CommentsPermalink





‘(B) designed to allow interoperable exchanges that conform with Federal and State privacy and security requirements;CommentsClose CommentsPermalink





‘(C) 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; andCommentsClose CommentsPermalink





‘(D) capable of being incorporated into, and otherwise compatible with, other standards developed for electronic health records.CommentsClose CommentsPermalink





‘(2) FUNDING- $5,000,000 of the amount appropriated under subsection (i) for a fiscal year shall be used to carry out this subsection.CommentsClose CommentsPermalink





‘(g) Study of Pediatric Health and Health Care Quality Measures-CommentsClose CommentsPermalink





‘(1) IN GENERAL- 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--CommentsClose CommentsPermalink





‘(A) 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;CommentsClose CommentsPermalink





‘(B) 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;CommentsClose CommentsPermalink





‘(C) 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; andCommentsClose CommentsPermalink





‘(D) make recommendations regarding improving and strengthening the timeliness, quality, and public transparency and accessibility of information about child health and health care quality.CommentsClose CommentsPermalink





‘(2) FUNDING- Up to $1,000,000 of the amount appropriated under subsection (i) for a fiscal year shall be used to carry out this subsection.CommentsClose CommentsPermalink





‘(h) Rule of Construction- 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 or child health assistance under title XXI.CommentsClose CommentsPermalink





‘(i) Appropriation- 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.’.CommentsClose CommentsPermalink





(b) Increased Matching Rate for Collecting and Reporting on Child Health Measures- Section 1903(a)(3)(A) of such Act (42 U.S.C. 1396b(a)(3)(A)), is amended--CommentsClose CommentsPermalink





(1) by striking ‘and’ at the end of clause (i); andCommentsClose CommentsPermalink





(2) by adding at the end the following new clause:CommentsClose CommentsPermalink





‘(iii) 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’.CommentsClose CommentsPermalink