KIDS Health Act of 2023

I 118TH CONGRESS 1ST SESSION H. R. 3805 To amend title XIX of the Social Security Act to establish a demonstration project testing Whole Child Health Models, and for other purposes. IN THE HOUSE OF REPRESENTATIVES JUNE 5, 2023 Ms. BLUNT ROCHESTER (for herself and Mr. BURGESS) 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 establish a demonstration project testing Whole Child Health Mod- els, and for other purposes. 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 ‘‘Kickstarting Innova- 4 tive Demonstrations Supporting Kids Health Act of 2023’’ 5 or the ‘‘KIDS Health Act of 2023’’. 6 VerDate Sep 11 2014 19:24 Jun 18, 2023 Jkt 039200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H3805.IH H3805 pbinns on DSKJLVW7X2PROD with $$_JOB 2 •HR 3805 IH SEC. 2. ESTABLISHMENT OF WHOLE CHILD HEALTH MOD- 1 ELS. 2 Section 1903 of the Social Security Act (42 U.S.C. 3 1396b) is amended by adding at the end the following new 4 subsection: 5 ‘‘(cc) WHOLE CHILD HEALTH DEMONSTRATION 6 PROJECT.— 7 ‘‘(1) IN GENERAL.—The Secretary, acting 8 through the Deputy Administrator and Director of 9 the Center for Medicaid and CHIP Services, shall 10 conduct a demonstration project (referred to in this 11 subsection as the ‘demonstration project’) under 12 which participating States shall design and imple- 13 ment whole child health models in 1 or more target 14 communities in accordance with the requirements of 15 this subsection. The requirements of section 16 1902(a)(1) (relating to statewideness) shall not 17 apply to the demonstration project. 18 ‘‘(2) DESIGN PHASE.— 19 ‘‘(A) GRANTS.—Not later than 12 months 20 after the date of the enactment of this sub- 21 section, the Secretary shall award up to 15 22 grants to States that submit complete applica- 23 tions for such grants which meet the require- 24 ments of subparagraph (C). 25 VerDate Sep 11 2014 19:24 Jun 18, 2023 Jkt 039200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H3805.IH H3805 pbinns on DSKJLVW7X2PROD with $$_JOB 3 •HR 3805 IH ‘‘(B) SELECTION OF GRANTEES.—In 1 awarding grants under this paragraph, the Sec- 2 retary shall, to the extent possible, prioritize 3 awarding grants to a geographically diverse se- 4 lection of States and target communities of dif- 5 ferent sizes and with varying experience with 6 value-based payment, including rural and urban 7 communities. 8 ‘‘(C) GRANT APPLICATION.—A State shall 9 include in an application for a grant awarded 10 under this paragraph the following: 11 ‘‘(i) A description of each proposed 12 target community in which the State pro- 13 poses to implement a whole child health 14 model. 15 ‘‘(ii) For each target community de- 16 scribed in clause (i), a statement of the 17 proposed objectives of the State in imple- 18 menting a whole child health model in that 19 community. 20 ‘‘(iii) Such other information as the 21 Secretary may require. 22 ‘‘(D) USE OF GRANT FUNDS.— 23 VerDate Sep 11 2014 19:24 Jun 18, 2023 Jkt 039200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H3805.IH H3805 pbinns on DSKJLVW7X2PROD with $$_JOB 4 •HR 3805 IH ‘‘(i) IN GENERAL.—A State awarded a 1 grant under this paragraph shall use the 2 grant funds to— 3 ‘‘(I) conduct or use an existing 4 needs assessment that is not more 5 than two years old and meets the re- 6 quirements of clause (ii) for each pro- 7 posed target community; 8 ‘‘(II) not later than 12 months 9 after being awarded the grant, design 10 and submit for approval by the Sec- 11 retary a proposed whole child health 12 model that meets the requirements of 13 subparagraph (E) for each target 14 community based on the results of the 15 needs assessment and other assess- 16 ments or surveys conducted for that 17 community; and 18 ‘‘(III) implement the whole child 19 health model during the implementa- 20 tion phase described in paragraph (3). 21 ‘‘(ii) NEEDS ASSESSMENT REQUIRE- 22 MENTS.—A needs assessment conducted 23 for a proposed target community with 24 VerDate Sep 11 2014 19:24 Jun 18, 2023 Jkt 039200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H3805.IH H3805 pbinns on DSKJLVW7X2PROD with $$_JOB 5 •HR 3805 IH grant funds awarded to a State shall in- 1 clude the following: 2 ‘‘(I) An evaluation of the physical 3 health, mental, emotional and behav- 4 ioral health, developmental, social, re- 5 lational and substance use disorder 6 service needs of eligible individuals in 7 the target community, including needs 8 that could be addressed through popu- 9 lation-based or community-based 10 interventions. 11 ‘‘(II) A review of the resources 12 available to meet the physical health, 13 mental health, and substance use dis- 14 order service needs of eligible individ- 15 uals in the target community. 16 ‘‘(III) A description of the bar- 17 riers identified in the target commu- 18 nity to eligible individuals accessing 19 resources and services to address their 20 physical health, mental health, and 21 substance use disorder service needs. 22 ‘‘(IV) A description of health dis- 23 parities identified in the target com- 24 munity, including input from commu- 25 VerDate Sep 11 2014 19:24 Jun 18, 2023 Jkt 039200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H3805.IH H3805 pbinns on DSKJLVW7X2PROD with $$_JOB 6 •HR 3805 IH nity residents in the target commu- 1 nity. 2 ‘‘(E) WHOLE CHILD HEALTH MODEL RE- 3 QUIREMENTS.— 4 ‘‘(i) IN GENERAL.—A proposed whole 5 child health model shall include descrip- 6 tions of the following: 7 ‘‘(I) How the State and its multi- 8 sector partners will address the phys- 9 ical health, mental, emotional and be- 10 havioral health, developmental, social, 11 relational and substance use disorder 12 service needs of eligible individuals in 13 the target community identified in the 14 needs assessment of that community 15 through implementation of the whole 16 child health model and provision of 17 whole child health services. 18 ‘‘(II) How the State Medicaid, 19 human services, and child welfare 20 agencies will coordinate with commu- 21 nity partners to ensure the successful 22 implementation of the whole child 23 health model in the target commu- 24 VerDate Sep 11 2014 19:24 Jun 18, 2023 Jkt 039200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H3805.IH H3805 pbinns on DSKJLVW7X2PROD with $$_JOB 7 •HR 3805 IH nities and the provision of whole child 1 health services. 2 ‘‘(III) The lead agency or other 3 entity the State proposes to designate 4 to coordinate activities carried out to 5 implement the whole child health 6 model in the target communities. 7 ‘‘(ii) REQUIREMENTS.—A proposed 8 whole child health model shall meet the fol- 9 lowing requirements: 10 ‘‘(I) Align with an existing or 11 planned delivery and payment system 12 of the State plan under this title or 13 under a waiver of such plan, includ- 14 ing, as applicable, a managed care de- 15 livery system. 16 ‘‘(II) Include partnerships with 17 child and family serving organizations 18 and agencies such as health care pro- 19 viders, payers, school districts, public 20 health and child care. 21 ‘‘(III) Promote the delivery of 22 trauma-informed and culturally com- 23 petent care, including strategies to ad- 24 dress systemic resource needs, includ- 25 VerDate Sep 11 2014 19:24 Jun 18, 2023 Jkt 039200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H3805.IH H3805 pbinns on DSKJLVW7X2PROD with $$_JOB 8 •HR 3805 IH ing workforce shortages, in the target 1 community and an assessment of the 2 potential impact of the model on 3 health equity, disparities, and safety 4 net providers in the target commu- 5 nity. 6 ‘‘(IV) Coordinate funding sources 7 under the State plan under this title 8 (or under a waiver of plan), the State 9 plans under parts B and E of title IV, 10 and other applicable funding sources, 11 for the whole child health services pro- 12 vided under the model. 13 ‘‘(V) Include— 14 ‘‘(aa) the design and imple- 15 mentation or adaptation of a 16 value-based payment arrange- 17 ment for providing whole child 18 health services under the State 19 plan under this title (or under a 20 waiver of such plan) that pro- 21 motes pediatric health; or 22 ‘‘(bb) in the case of a State 23 that faces significant barriers to 24 implementing or adapting such a 25 VerDate Sep 11 2014 19:24 Jun 18, 2023 Jkt 039200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H3805.IH H3805 pbinns on DSKJLVW7X2PROD with $$_JOB 9 •HR 3805 IH value-based payment arrange- 1 ment, a proposal for steps that 2 the State will take towards ad- 3 vancing value-based care with re- 4 spect to whole child health serv- 5 ices provided under the State 6 plan under this title (or under a 7 waiver of such plan). 8 ‘‘(VI) Include strategies to co- 9 ordinate referrals to whole child 10 health services, including using tele- 11 health, referral networks and/or other 12 technologies to facilitate access to 13 whole child health services. 14 ‘‘(VII) Include strategies to pro- 15 mote the integration of primary care 16 with whole child health services and 17 substance use disorder services. 18 ‘‘(VIII) Include strategies to inte- 19 grate and streamline eligibility, enroll- 20 ment, and renewal processes to facili- 21 tate enrollment in health coverage and 22 other benefit programs. 23 VerDate Sep 11 2014 19:24 Jun 18, 2023 Jkt 039200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H3805.IH H3805 pbinns on DSKJLVW7X2PROD with $$_JOB 10 •HR 3805 IH ‘‘(IX) Include strategies to pro- 1 mote school-based health and 2 wellness. 3 ‘‘(X) Describe how the State will 4 leverage or enhance existing health in- 5 formation technology infrastructure 6 and cross-sector data-sharing capabili- 7 ties to support the provision of en- 8 hanced care coordination services, in- 9 cluding with respect to claiming ad- 10 ministrative matching funds for the 11 design, development, and installation 12 of data systems to allow or enhance 13 coordination among State agencies 14 and other entities. 15 ‘‘(XI) Describe how the State will 16 evaluate the impact of the model on 17 child health and disparities in health 18 outcomes, according to requirements 19 outlined by the Secretary. 20 ‘‘(XII) Include other such popu- 21 lation health strategies or core serv- 22 ices as the State determines appro- 23 priate. 24 VerDate Sep 11 2014 19:24 Jun 18, 2023 Jkt 039200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H3805.IH H3805 pbinns on DSKJLVW7X2PROD with $$_JOB 11 •HR 3805 IH ‘‘(iii) PARTICIPATION BY INDIAN 1 TRIBES IN WHOLE CHILD HEALTH MOD- 2 ELS.—The Secretary may waive or other- 3 wise modify the requirements for a whole 4 child health model described in clause (ii) 5 to the extent necessary to permit Indian 6 tribes to participate in such a model. 7 ‘‘(3) IMPLEMENTATION PHASE.—After the de- 8 sign period, the implementation phase of the dem- 9 onstration project shall be conducted for a period of 10 not less than 48 months and not more than 72 11 months. 12 ‘‘(4) AUTHORIZATION OF APPROPRIATIONS.— 13 ‘‘(A) IN GENERAL.—There are authorized 14 to be appropriated to the Secretary for the pur- 15 pose of carrying out this subsection, out of any 16 funds in the Treasury not otherwise appro- 17 priated, $125,000,000, to remain available until 18 expended. 19 ‘‘(B) LIMITATION ON USE OF FUNDS.— 20 From any amounts appropriated pursuant to 21 this paragraph, the Secretary shall use— 22 ‘‘(i) not more than $2,000,000 for ad- 23 ministrative costs, staffing, and reporting 24 requirements; 25 VerDate Sep 11 2014 19:24 Jun 18, 2023 Jkt 039200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H3805.IH H3805 pbinns on DSKJLVW7X2PROD with $$_JOB 12 •HR 3805 IH ‘‘(ii) not more than $10,000,000 for 1 learning platforms, staffing, and technical 2 assistance related directly to the design 3 and implementation of whole child health 4 models, and to carry out activities under 5 this subsection; and 6 ‘‘(iii) not more than $3,000,0000 may 7 be used for carrying out evaluations de- 8 scribed in paragraph (5). 9 ‘‘(C) PAYMENT FOR WHOLE CHILD 10 HEALTH SERVICES.— 11 ‘‘(i) IN GENERAL.—For each fiscal 12 quarter occurring during the implementa- 13 tion phase of the demonstration project, 14 subject to clause (ii), the Secretary shall 15 pay each State selected to participate in 16 that phase of the project, an amount equal 17 to 80 percent of the amounts expended by 18 the State during such quarter for pro- 19 viding whole child health services to eligible 20 individuals in the target communities net 21 of any Federal payments made to the 22 State for such expenditures, under this 23 title or otherwise. 24 VerDate Sep 11 2014 19:24 Jun 18, 2023 Jkt 039200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\H3805.IH H3805 pbinns on DSKJLVW7X2PROD with $$_JOB 13 •HR 3805 IH ‘‘(ii) REQUIREMENT.—The additional 1 Federal funds paid to a State under this 2 subparagraph shall be used to supplement, 3 not supplant, the level of State funds ex- 4 pended for services that are treated as 5 whole child health services under the dem- 6 onstration project. 7 ‘‘(5) REPORTS AND EVALUATION.— 8 ‘‘(A) IN GENERAL.—A State that is se- 9 lected to participate in the demonstration 10 project shall report on the outcomes under the 11 entity’s whole child health model pursuant to 12 periodic reporting requirements established by 13 the Secretary. 14 ‘‘(B) STATE REPORTS.—Each State 15 awarded a grant under this subsection shall 16 submit the following reports to the Secretary: 17 ‘‘(i) INTERIM REPORT.—An interim 18 report at the end of the first 24 months of 19 the implementation phase of the project 20 that describes— 21 ‘‘(I) the progress of the State’s 22 implementation of the whole child 23 health model in the target commu- 24 nities; 25 VerDate Sep 11 2014 19:24 Jun 18, 2023 Jkt 039200 PO 00000 Frm 00013 Fmt 6652 Sfmt 6201 E:\BILLS\H3805.IH H3805 pbinns on DSKJLVW7X2PROD with $$_JOB 14 •HR 3805 IH ‘‘(II) the organizations and pro- 1 viders that are participating in the 2 implementation of the model in the 3 target communities; 4 ‘‘(III) the number of eligible indi- 5 viduals in the target communities re- 6 ceiving enhanced care coordination 7 services; and 8 ‘‘(IV) such other information as 9 the Secretary may require. 10 ‘‘(ii) FINAL REPORT.—A final report 11 not later than 1 year after the end of the 12 implementation phase of the demonstration 13 project that describes— 14 ‘‘(I) best practices and challenges 15 in implementing the whole child 16 health model in the target commu- 17 nities; 18 ‘‘(II) the impact of the model on 19 child well-being, health [Text truncated for display. 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