[Congressional Bills 103th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4810 Introduced in House (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.
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