CHILD Act

I 116TH CONGRESS 1ST SESSION H. R. 660 To improve the health outcomes in communities through community-relevant health information and new health supporting incentives and programs funded without further appropriations. IN THE HOUSE OF REPRESENTATIVES JANUARY 17, 2019 Mr. FORTENBERRY (for himself and Ms. JOHNSON of Texas) introduced the following bill; which was referred to the Committee on Energy and Commerce A BILL To improve the health outcomes in communities through community-relevant health information and new health supporting incentives and programs funded without fur- ther appropriations. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Community Health Im- 4 provement, Leadership, and Development Act of 2019’’ or 5 the ‘‘CHILD Act’’. 6 VerDate Sep 11 2014 21:36 Jan 30, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H660.IH H660 pamtmann on DSKBFK8HB2PROD with BILLS 2 •HR 660 IH SEC. 2. LOCALIZED COMMUNITY HEALTH IMPROVEMENT 1 PROGRAMS. 2 (a) MAKING EPIDEMIOLOGY AND CLAIMS DATA REL- 3 EVANT TO COMMUNITY HEALTH IMPROVEMENT.— 4 (1) IN GENERAL.—Not later than April 1, 5 2020, the Secretary of Health and Human Services, 6 through the Director of the Centers for Disease 7 Control and Prevention in collaboration with the Ad- 8 ministrator of the Centers for Medicare & Medicaid 9 Services, shall, subject to paragraph (2), provide for 10 the maintenance of a database of de-identified epide- 11 miological and claims health information for the pur- 12 pose of making such information available in a use- 13 ful and informative manner to participating commu- 14 nities (as referenced in subsection (b)(3)(B)) in par- 15 ticipating States (as referenced in subsection (b)(1)) 16 to support such communities in reducing rates of ill- 17 ness (as compared to the rate of illness within such 18 community as of a period specified by the Secretary) 19 and improving the management of illnesses to reduce 20 the cost of health care delivery. In carrying out this 21 subsection, the Director and Administrator shall, 22 subject to paragraph (2), provide— 23 (A) for a mechanism that enables the inte- 24 gration of such epidemiological and claims 25 health information for such purposes; 26 VerDate Sep 11 2014 21:36 Jan 30, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H660.IH H660 pamtmann on DSKBFK8HB2PROD with BILLS 3 •HR 660 IH (B) that such health information is avail- 1 able for at least the 20 health conditions and 2 treatments that are associated with the highest 3 expenditures under the Medicaid program 4 under title XIX of the Social Security Act; 5 (C) that such health information is made 6 available to participating States in such a man- 7 ner that enables participating communities 8 within such States to access such information 9 that is relevant specifically to such commu- 10 nities; and 11 (D) for a mechanism by which the Director 12 and Administrator may— 13 (i) update such information specific to 14 each such community, to the extent prac- 15 ticable, in real-time or near real-time and 16 as specified by the Director and Adminis- 17 trator; 18 (ii) verify the validity of such informa- 19 tion and the validity of the changes in such 20 information for each such community over 21 such specified periods; and 22 (iii) assess and measure the extent of 23 such changes for each such participating 24 community, including the amount of any 25 VerDate Sep 11 2014 20:56 Feb 02, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H660.IH H660 pamtmann on DSKBFK8HB2PROD with BILLS 4 •HR 660 IH reductions in expenditures under the State 1 plan under title XIX of the Social Security 2 Act and the extent to which such reduc- 3 tions are attributable to such changes with 4 respect to each such community in such 5 State. 6 (2) NO ADDITIONAL FUNDING.—No additional 7 funds are authorized to be appropriated to carry out 8 this subsection. This subsection shall be carried out 9 using amounts otherwise made available to the Sec- 10 retary. 11 (b) LOCALIZED COMMUNITY HEALTH IMPROVEMENT 12 PROGRAM GRANTS.— 13 (1) IN GENERAL.—The Secretary of Health and 14 Human Services shall, subject to paragraph (5), 15 carry out a grant program under which the Sec- 16 retary may award grants to States for purposes of 17 carrying out localized community health improve- 18 ment programs described in paragraph (3). In this 19 section such States awarded such grants are referred 20 to as ‘‘participating States’’. 21 (2) APPLICATION.—To be eligible for a grant 22 under this subsection, a State shall— 23 (A) submit to the Secretary an application, 24 in such manner, at such time, and containing 25 VerDate Sep 11 2014 21:36 Jan 30, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H660.IH H660 pamtmann on DSKBFK8HB2PROD with BILLS 5 •HR 660 IH such information as specified by the Secretary; 1 and 2 (B) enter into an arrangement with the 3 Secretary under which— 4 (i) the State agrees to establish and 5 maintain a localized community health im- 6 provement program described in paragraph 7 (3); 8 (ii) the Secretary agrees to provide 9 the State with integrated epidemiological 10 and claims health information maintained 11 in the database established under sub- 12 section (a) specific to each participating 13 community within the State; and 14 (iii) the State and Secretary carry out 15 the community shared savings account 16 agreement terms described in subsection 17 (c). 18 (3) LOCALIZED COMMUNITY HEALTH IMPROVE- 19 MENT PROGRAM.—For purposes of this subsection, a 20 localized community health improvement program of 21 a State is a program under which the State— 22 (A) maintains the integrated health infor- 23 mation provided to the State by the Secretary 24 VerDate Sep 11 2014 21:36 Jan 30, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H660.IH H660 pamtmann on DSKBFK8HB2PROD with BILLS 6 •HR 660 IH pursuant to the arrangement described in para- 1 graph (2)(B); 2 (B) makes such information available to 3 qualifying communities (as defined in para- 4 graph (4)) within such State which request 5 such information and agree to the terms de- 6 scribed in subparagraph (D) and subsection (c) 7 (in this section referred to as ‘‘participating 8 communities’’) in a secure manner and format 9 that is most informative to such communities in 10 assisting such communities in analyzing and 11 applying such data to the specific needs of such 12 communities to reduce the rates of illness and 13 reduce the costs of health care within such com- 14 munities; 15 (C) submits such data as is required by 16 the Secretary to assess the extent to which the 17 health care interventions implemented to ad- 18 dress needs of such communities identified 19 through the program are affecting the rates of 20 illness and costs of health care within the State 21 and communities within the State; and 22 (D) requires that in order for communities 23 to participate in such program, the communities 24 agree— 25 VerDate Sep 11 2014 21:36 Jan 30, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H660.IH H660 pamtmann on DSKBFK8HB2PROD with BILLS 7 •HR 660 IH (i) to provide for a secure method to 1 make such information available to health 2 care and other relevant community work- 3 ers, including through an interactive dash- 4 board system; and 5 (ii) to submit such data as is required 6 by the State or Secretary to assess the ex- 7 tent to which health care interventions im- 8 plemented to address needs of such com- 9 munities identified through the program 10 are affecting the rates of illness and costs 11 of health care within the communities. 12 (4) QUALIFYING COMMUNITY DEFINED.—For 13 purposes of this section, the term ‘‘qualifying com- 14 munity’’ means a local community determined by 15 census block or census track level (based on geo- 16 graphic information system data) with a defined ju- 17 risdictional boundary (such as a local community es- 18 tablished by a high school feeder pattern or by the 19 boundaries of a town if such town has a population 20 of fewer than 25,000 residents) or a county. 21 (5) NO ADDITIONAL FUNDING.—No additional 22 funds are authorized to be appropriated to carry out 23 this subsection. This subsection shall be carried out 24 VerDate Sep 11 2014 21:36 Jan 30, 2019 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H660.IH H660 pamtmann on DSKBFK8HB2PROD with BILLS 8 •HR 660 IH using amounts otherwise made available to the Sec- 1 retary. 2 (c) COMMUNITY SHARED SAVINGS ACCOUNT AGREE- 3 MENT TERMS.—For purposes of subsection (b)(2)(B)(iii), 4 community shared savings account terms described in this 5 subsection, with respect to the Secretary, a participating 6 State, and participating communities within such State, 7 are the following: 8 (1) In the case that the database established 9 under subsection (a), through the mechanism pro- 10 vided for under subsection (a)(4), demonstrates for 11 any specified period (as determined by the Sec- 12 retary) that there are verified reductions in expendi- 13 tures under the State plan under title XIX of the 14 Social Security Act, which results in reductions in 15 expenditures by the Federal Government under such 16 title, and attributes such reductions to one or more 17 of the participating communities within such State, 18 the Secretary shall transfer to the community shared 19 savings account established by the State under sub- 20 section (e) an amount equal to 70 percent of the 21 amount of such reduction so demonstrated for such 22 specified period. 23 (2) The State establishes such a community 24 shared savings account in accordance with sub- 25 VerDate Sep 11 2014 21:36 Jan 30, 2019 Jkt 089200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H660.IH H660 pamtmann on DSKBFK8HB2PROD with BILLS 9 •HR 660 IH section (e) and agrees to transfer to each partici- 1 pating community within such State 100 percent of 2 such amounts transferred under paragraph (1) that 3 are verified by the Secretary as attributable to such 4 community. 5 (3) Each participating community in such 6 State— 7 (A) establishes a community shared sav- 8 ings board described in subsection (d) that de- 9 termines how funds transferred to such commu- 10 nity under paragraph (2) are to be used for 11 purposes of promoting the health and wellness 12 of residents of such community; and 13 (B) uses such funds only for such purposes 14 and in accordance with the uses determined by 15 such board. 16 (d) COMMUNITY SHARED SAVINGS BOARD.—For 17 purposes of this section, a community shared savings 18 board, with respect to a participating community (which 19 may be a county) within a participating State, is a 20 board— 21 (1) consisting of at least 7 members, appointed 22 by the governing officials of the community through 23 such a process that is specified by the community 24 (and approved by the State), including— 25 VerDate Sep 11 2014 21:36 Jan 30, 2019 Jkt 089200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H660.IH H660 pamtmann on DSKBFK8HB2PROD with BILLS 10 •HR 660 IH (A) at least 1 member with public health 1 experience; and 2 (B) members with business, civic, edu- 3 cational, or faith-based experience; 4 (2) that is representative of the geographic 5 components that are included in the community; and 6 (3) that hires a fiduciary agent to manage a 7 community shared savings account on behalf of the 8 board. 9 (e) COMMUNITY SHARED SAVINGS ACCOUNT.—For 10 purposes of this section, the term ‘‘community shared sav- 11 ings account’’ means, with respect to a participating com- 12 munity within a participating State, a trust created or or- 13 ganized in the United States for the exclusive benefit of 14 the community, as defined by the community shared sav- 15 ings board under subsection (d) for such participating 16 community, but only if the written governing instrument 17 creating the trust meets the following requirements: 18 (1) The trustee is a bank (as defined in section 19 408(n) of the Internal Revenue Code of 1986) or 20 such other person who demonstrates to the satisfac- 21 tion of the Director that the manner in which such 22 other person will administer the trust will be con- 23 sistent with the requirements of this section. 24 VerDate Sep 11 2014 21:36 Jan 30, 2019 Jkt 089200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H660.IH H660 pamtmann on DSKBFK8HB2PROD with BILLS 11 •HR 660 IH (2) No contribution will be accepted unless it is 1 in cash. 2 (3) Withdrawals may only be made by the fidu- 3 ciary agent described in subsection (d)(3) hired by 4 such board pursuant to a plan developed by the com- 5 munity and approved by the State and local govern- 6 ment. 7 Æ VerDate Sep 11 2014 21:36 Jan 30, 2019 Jkt 089200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6301 E:\BILLS\H660.IH H660 pamtmann on DSKBFK8HB2PROD with BILLS