H.R. 4810 (103rd): Integrated Child Health Care Network Act of 1994

103rd Congress, 1993–1994. Text as of Jul 21, 1994 (Introduced).

Status & Summary | PDF | Source: GPO

HR 4810 IH

103d CONGRESS

2d Session

H. R. 4810

To amend title XIX of the Social Security Act to prohibit the Secretary of Health and Human Services from granting a waiver under the medicaid program to permit a State to require children enrolled in the program to receive medical assistance under the program through managed care plans unless such assistance is provided through an integrated child health care network, and for other purposes.

IN THE HOUSE OF REPRESENTATIVES

JULY 21, 1994

Ms. SCHENK (for herself and Mr. LEHMAN) introduced the following bill; which was referred to the Committee on Energy and Commerce


A BILL

To amend title XIX of the Social Security Act to prohibit the Secretary of Health and Human Services from granting a waiver under the medicaid program to permit a State to require children enrolled in the program to receive medical assistance under the program through managed care plans unless such assistance is provided through an integrated child health care network, 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 ‘Integrated Child Health Care Network Act of 1994’.

SEC. 2. LIMITATION ON MANAGED CARE WAIVERS AFFECTING CHILDREN UNDER MEDICAID.

    (a) REQUIRING MEDICAL ASSISTANCE FOR CHILDREN FURNISHED THROUGH MANAGED CARE TO BE FURNISHED THROUGH INTEGRATED NETWORKS- Section 1915 of the Social Security Act (42 U.S.C. 1396n) is amended by adding at the end the following new subsection:

    ‘(i)(1) The Secretary may not grant a waiver under this section, section 1115, or any provision of this Act that includes a waiver of the requirements of section 1902(a)(23) to permit a State to restrict the medical assistance furnished under the State plan to a child to assistance furnished through a primary care case-management plan under subsection (b)(1) or a capitated managed care plan unless such a plan--

      ‘(A) furnishes such assistance to the individual through an integrated child health network described in paragraph (2);

      ‘(B) provides assurances that the capitated payments made to providers for assistance furnished to children enrolled in the plan are determined on the basis of children’s health care needs and utilization of services; and

      ‘(C) submits reports (at such intervals as the Secretary may require) to the Secretary and the State containing such information as the Secretary and the State may require to assure that the plan meets the requirements of subparagraphs (A) and (B), and makes the reports available to the public.

    ‘(2) In this subsection:

      ‘(A) A ‘capitated managed care plan’ means an entity which--

        ‘(i) has a contract with the State agency under which such entity is paid a fixed amount for providing or arranging for the provision of health care items or services specified in such contract to an individual eligible for medical assistance under the State plan and enrolled with such entity, regardless of whether such items or services are furnished to such individual; and

        ‘(ii) is liable for all or part of the cost of furnishing any of such items or services, regardless of whether such cost exceeds such fixed payment.

      ‘(B) A ‘child’ is an individual under 18 years of age.

      ‘(C) An ‘integrated child health network’ means a network of providers with expertise in providing services to children that meets the following requirements (together with any other requirements that Secretary may impose):

        ‘(i) The network includes (but is not limited to)--

          ‘(I) pediatricians and pediatric specialists, family practice physicians, and other pediatric health professionals;

          ‘(II) community-based clinics that provide services of providers described in subclause (I); and

          ‘(III) hospitals with pediatric units which are a distinct part of the hospital (as defined by the Secretary), hospitals whose inpatients are predominantly children, and specialty hospitals whose inpatients are predominantly children (including rehabilitation and long-term care hospitals).

        ‘(ii) The network has an explicit mission of meeting the health care needs of children.

        ‘(iii) The network participates in graduate medical education programs for primary and specialty pediatric care services.

        ‘(iv) The network provides for the coordination of pediatric specialty and subspecialty care for children with special health care needs, including (but not limited to)--

          ‘(I) children eligible for supplemental security income under title XVI;

          ‘(II) children described in section 501(a)(1)(D); and

          ‘(III) children described in section 1902(e)(3).’.

    (b) EFFECTIVE DATE- The amendment made by subsection (a) shall apply to quarters beginning on or after the expiration of the 6-month period that begins on the date of the enactment of this Act.

SEC. 3. GRANTS FOR ESTABLISHMENT OF INTEGRATED CHILD HEALTH NETWORKS APPLYING SEPARATE CAPITATED PAYMENT RATE FOR CHILDREN.

    (a) AVAILABILITY OF GRANTS-

      (1) IN GENERAL- The Secretary of Health and Human Services shall make grants to eligible entities over a 3-year period for the establishment, initial operation, and the continuing operation of integrated child health networks using different payment models, including grants to demonstrate the operation of networks applying a separate capitated payment rate with respect to children enrolled with the network. The previous sentence shall apply to demonstrations of such networks initiated by States.

      (2) INTEGRATED CHILD HEALTH NETWORK DEFINED- In this section, the term ‘integrated child health network’ has the meaning given such term in section 1915(i)(2)(C) of the Social Security Act (as added by section 2(a)).

    (b) ELIGIBILITY OF ENTITIES- An entity is eligible to receive a grant under subsection (a) if the entity submits to the Secretary (at such time and in such form as the Secretary may require) an application containing--

      (1) assurances that the entity has established or is in the process of establishing an integrated child health network;

      (2) assurances that the entity will submit reports on the activities of the entity that are funded through the grant; and

      (3) such other information and assurances as the Secretary may require.

    (c) AUTHORIZATION OF APPROPRIATIONS- There are authorized to be appropriated such sums as may be necessary for grants under subsection (a).

    (d) REPORT TO CONGRESS- Not later than 3 years after the first grant is awarded under subsection (a), the Secretary shall submit a report to Congress on the grants made under subsection (a) and the activities funded through such grants.