---
kind: "section"
citation: "42 U.S.C. § 1320b–9a"
title: "42"
title_heading: "The Public Health and Welfare"
number: "1320b–9a"
heading: "Child health quality measures"
release: "119-102"
date: "2026-07-12"
url: "https://uscodex.org/usc/42/1320b-9a"
units:
  - "Chapter 7 — Social Security"
  - "Subchapter XI — General Provisions, Peer Review, and Administrative Simplification"
  - "Part A — General Provisions"
---

# §1320b–9a. Child health quality measures

- (a) **Development of an initial core set of health care quality measures for children enrolled in Medicaid or CHIP—**
  - (1) **In general—** Not later than January 1, 2010, the [Secretary](/usc/42/1301.md?p=a-6) shall identify and publish for general comment an initial, recommended core set of [child](/usc/42/1382c.md?p=c) health quality measures for use by [State](/usc/42/619.md?p=5) programs administered under subchapters 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.
  - (2) **Identification of initial core measures—** In consultation with the individuals and entities described in [subsection (b)(3)](#b-3), the [Secretary](/usc/42/1301.md?p=a-6) 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](/usc/42/1397jj.md?p=c-3) over time.
  - (3) **Recommendations and dissemination—** Based on such existing and identified measures, the [Secretary](/usc/42/1301.md?p=a-6) shall publish an initial core set of [child](/usc/42/1382c.md?p=c) health quality measures that [includes](/usc/42/1301.md?p=b) (but is not limited to) the following:
    - (A) The duration of children’s [health insurance coverage](/usc/42/1397jj.md?p=c-3) over a 12-month time period.
    - (B) The availability and effectiveness of a full range of—
      - (i) preventive services, [treatments](/usc/42/11851.md?p=11), and services for acute conditions, [including](/usc/42/1301.md?p=b) 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; and
      - (ii) [treatments](/usc/42/11851.md?p=11) to correct or ameliorate the effects of physical and mental conditions, [including](/usc/42/1301.md?p=b) 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.
    - (C) The availability of care in a range of ambulatory and inpatient health care settings in which such care is furnished.
    - (D) The types of measures that, taken together, can be used to estimate the overall national quality of health care for children, [including](/usc/42/1301.md?p=b) children with special needs, and to perform comparative analyses of pediatric health care quality and racial, ethnic, and socioeconomic disparities in [child](/usc/42/1382c.md?p=c) health and health care for children.
  - (4) **Encourage voluntary and standardized reporting and mandatory reporting—**
    - (A) **Voluntary reporting—** Not later than 2 years after February 4, 2009, the [Secretary](/usc/42/1301.md?p=a-6), in consultation with [States](/usc/42/619.md?p=5), shall develop a standardized format for reporting information and procedures and approaches that encourage [States](/usc/42/619.md?p=5) to use the initial core measurement set to voluntarily report information regarding the quality of pediatric health care under subchapters XIX and XXI.
    - (B) **Mandatory reporting—** Beginning with the annual [State](/usc/42/619.md?p=5) report on [fiscal year](/usc/42/619.md?p=3) 2024 required under [subsection (c)(1)](#c-1), the [Secretary](/usc/42/1301.md?p=a-6) shall require [States](/usc/42/619.md?p=5) to use the initial core measurement set and any updates or changes to that set to report information regarding the quality of pediatric health care under subchapters XIX and XXI using the standardized format for reporting information and procedures developed under [subparagraph (A)](#a-4-A).
  - (5) **Adoption of best practices in implementing quality programs—** The [Secretary](/usc/42/1301.md?p=a-6) shall disseminate information to [States](/usc/42/619.md?p=5) regarding best [practices](/usc/42/17061.md?p=19) among [States](/usc/42/619.md?p=5) with respect to measuring and reporting on the quality of health care for children, and shall facilitate the adoption of such best [practices](/usc/42/17061.md?p=19). In developing best [practices](/usc/42/17061.md?p=19) approaches, the [Secretary](/usc/42/1301.md?p=a-6) shall give particular attention to [State](/usc/42/619.md?p=5) 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](/usc/42/1320d.md?p=4) technology.
  - (6) **Reports to Congress—** Not later than January 1, 2011, and every 3 years thereafter, the [Secretary](/usc/42/1301.md?p=a-6) shall report to Congress on—
    - (A) the status of the [Secretary](/usc/42/1301.md?p=a-6)’s efforts to improve—
      - (i) quality related to the duration and stability of [health insurance coverage](/usc/42/1397jj.md?p=c-3) for children under subchapters XIX and XXI;
      - (ii) the quality of children’s health care under such subchapters, [including](/usc/42/1301.md?p=b) preventive health services, dental care, 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; and
      - (iii) the quality of children’s health care under such subchapters across the domains of quality, [including](/usc/42/1301.md?p=b) 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;
    - (B) the status of voluntary reporting by [States](/usc/42/619.md?p=5) under subchapters XIX and XXI, utilizing the initial core quality measurement set and, beginning with the report required on January 1, 2025, and for each annual report thereafter, the status of mandatory reporting by [States](/usc/42/619.md?p=5) under subchapters XIX and XXI, utilizing the initial core quality measurement set and any updates or changes to that set; and
    - (C) any recommendations for legislative changes needed to improve the quality of care provided to children under subchapters XIX and XXI, [including](/usc/42/1301.md?p=b) recommendations for quality reporting by [States](/usc/42/619.md?p=5).
  - (7) **Technical assistance—** The [Secretary](/usc/42/1301.md?p=a-6) shall provide technical assistance to [States](/usc/42/619.md?p=5) to assist them in adopting and utilizing core [child](/usc/42/1382c.md?p=c) health quality measures in administering the [State](/usc/42/619.md?p=5) plans under subchapters XIX and XXI.
  - (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—
    - (A) provide information regarding the quality of health coverage and health care for children;
    - (B) address the needs of children throughout the developmental age span; and
    - (C) allow purchasers, families, and [health care providers](/usc/42/1320d.md?p=3) to understand the quality of care in relation to the preventive needs of children, [treatments](/usc/42/11851.md?p=11) aimed at managing and resolving acute conditions, and diagnostic and [treatment](/usc/42/11851.md?p=11) services whose purpose is to correct or ameliorate physical, mental, or developmental conditions that could, if untreated or poorly treated, become chronic.
- (b) **Advancing and improving pediatric quality measures—**
  - (1) **Establishment of pediatric quality measures program—** Not later than January 1, 2011, the [Secretary](/usc/42/1301.md?p=a-6) shall establish a pediatric quality measures program to—
    - (A) improve and strengthen the initial core [child](/usc/42/1382c.md?p=c) health care quality measures established by the [Secretary](/usc/42/1301.md?p=a-6) under [subsection (a)](#a);
    - (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; and
    - (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.
  - (2) **Evidence-based measures—** The measures developed under the pediatric quality measures program shall, at a minimum, be—
    - (A) evidence-based and, where appropriate, risk adjusted;
    - (B) designed to identify and eliminate racial and ethnic disparities in [child](/usc/42/1382c.md?p=c) health and the provision of health care;
    - (C) designed to ensure that the data required for such measures is collected and reported in a [standard](/usc/42/1320d.md?p=7) format that permits comparison of quality and data at a [State](/usc/42/619.md?p=5), plan, and provider level;
    - (D) periodically updated; and
    - (E) responsive to the [child](/usc/42/1382c.md?p=c) health needs, services, and domains of health care quality described in clauses [(i)](#a-6-A-i), [(ii)](#a-6-A-ii), and [(iii)](#a-6-A-iii) of subsection (a)(6)(A).
  - (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](/usc/42/1301.md?p=a-6) shall consult with—
    - (A) [States](/usc/42/619.md?p=5);
    - (B) pediatricians, children’s [hospitals](/usc/42/300s–3.md?p=1), and other primary and specialized pediatric health care professionals ([including](/usc/42/1301.md?p=b) members of the allied health professions) who specialize in the care and [treatment](/usc/42/11851.md?p=11) of children, particularly children with special physical, mental, and developmental health care needs;
    - (C) dental professionals, [including](/usc/42/1301.md?p=b) pediatric dental professionals;
    - (D) [health care providers](/usc/42/1320d.md?p=3) 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;
    - (E) national organizations representing children, [including](/usc/42/1301.md?p=b) children with disabilities and children with chronic conditions;
    - (F) national organizations representing consumers and purchasers of children’s health care;
    - (G) national organizations and individuals with expertise in pediatric health quality measurement; and
    - (H) voluntary consensus [standards](/usc/42/1320d.md?p=7) setting organizations and other organizations involved in the advancement of evidence-based measures of health care.
  - (4) **Developing, validating, and testing a portfolio of pediatric quality measures—** As part of the program to advance pediatric quality measures, the [Secretary](/usc/42/1301.md?p=a-6) shall—
    - (A) award [grants](/usc/42/1397j.md?p=10) 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)](#a-6-A-i), [(ii)](#a-6-A-ii), and [(iii)](#a-6-A-iii) of subsection (a)(6)(A); and
    - (B) award [grants](/usc/42/1397j.md?p=10) and contracts for—
      - (i) the development of consensus on evidence-based measures for children’s health care services;
      - (ii) the dissemination of such measures to public and private purchasers of health care for children; and
      - (iii) the updating of such measures as necessary.
  - (5) **Revising, strengthening, and improving initial core measures—** Beginning no later than January 1, 2013, and annually thereafter, the [Secretary](/usc/42/1301.md?p=a-6) shall publish recommended changes to the core measures described in [subsection (a)](#a) that shall reflect the testing, validation, and consensus process for the development of pediatric quality measures described in subsection[^1] paragraphs [(1)](#b-1) through [(4)](#b-4).
  - (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](/usc/42/1301.md?p=b) the structure of the clinical care system, the process of care, the outcome of care, or patient experiences in care.
  - (7) **Construction—** Nothing in this section shall be construed as supporting the restriction of coverage, under subchapter XIX or XXI or otherwise, to only those services that are evidence-based.
- (c) **Annual State reports regarding State-specific quality of care measures applied under Medicaid or CHIP—**
  - (1) **Annual State reports—** Each [State](/usc/42/619.md?p=5) with a [State](/usc/42/619.md?p=5) plan approved under subchapter XIX or a [State child health plan](/usc/42/1397jj.md?p=c-7) approved under subchapter XXI shall annually report to the [Secretary](/usc/42/1301.md?p=a-6) on the—
    - (A) [State](/usc/42/619.md?p=5)-specific [child](/usc/42/1382c.md?p=c) health quality measures applied by the [States](/usc/42/619.md?p=5) under such plans, [including](/usc/42/1301.md?p=b) measures described in subparagraphs [(A)](#a-6-A) and [(B)](#a-6-B) of subsection (a)(6) and, beginning with the annual report on [fiscal year](/usc/42/619.md?p=3) 2024, all of the core measures described in [subsection (a)](#a) and any updates or changes to those measures; and
    - (B) [State](/usc/42/619.md?p=5)-specific information on the quality of health care furnished to children under such plans, [including](/usc/42/1301.md?p=b) information collected through external quality reviews of managed care organizations under [section 1396u–2 of this title](/usc/42/1396u–2.md) and benchmark plans under sections [1396u–7](/usc/42/1396u–7.md) and [1397cc](/usc/42/1397cc.md) of this title.
  - (2) **Publication—** Not later than September 30, 2010, and annually thereafter, the [Secretary](/usc/42/1301.md?p=a-6) shall collect, analyze, and make publicly available the information reported by [States](/usc/42/619.md?p=5) under [paragraph (1)](#c-1).
- (d) **Demonstration projects for improving the quality of children’s health care and the use of health information technology—**
  - (1) **In general—** During the period of [fiscal years](/usc/42/619.md?p=3) 2009 through 2013, the [Secretary](/usc/42/1301.md?p=a-6) shall award not more than 10 [grants](/usc/42/1397j.md?p=10) to [States](/usc/42/619.md?p=5) and [child](/usc/42/1382c.md?p=c) health providers to conduct demonstration [projects](/usc/42/13641.md?p=2) to evaluate promising ideas for improving the quality of children’s health care provided under subchapter XIX or XXI, [including](/usc/42/1301.md?p=b) [projects](/usc/42/13641.md?p=2) to—
    - (A) experiment with, and evaluate the use of, new measures of the quality of children’s health care under such subchapters ([including](/usc/42/1301.md?p=b) testing the validity and suitability for reporting of such measures);
    - (B) promote the use of [health information](/usc/42/1320d.md?p=4) technology in care delivery for children under such subchapters;
    - (C) evaluate provider-based models which improve the delivery of children’s health care services under such subchapters, [including](/usc/42/1301.md?p=b) 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; or
    - (D) demonstrate the impact of the model electronic health record format for children developed and disseminated under [subsection (f)](#f) on improving pediatric health, [including](/usc/42/1301.md?p=b) the effects of chronic childhood health conditions, and pediatric health care quality as well as reducing health care costs.
  - (2) **Requirements—** In awarding [grants](/usc/42/1397j.md?p=10) under this subsection, the [Secretary](/usc/42/1301.md?p=a-6) shall ensure that—
    - (A) only 1 demonstration [project](/usc/42/13641.md?p=2) funded under a [grant](/usc/42/1397j.md?p=10) awarded under this subsection shall be conducted in a [State](/usc/42/619.md?p=5); and
    - (B) demonstration [projects](/usc/42/13641.md?p=2) funded under [grants](/usc/42/1397j.md?p=10) awarded under this subsection shall be conducted evenly between [States](/usc/42/619.md?p=5) with large urban areas and [States](/usc/42/619.md?p=5) with large rural areas.
  - (3) **Authority for multistate projects—** A demonstration [project](/usc/42/13641.md?p=2) conducted with a [grant](/usc/42/1397j.md?p=10) awarded under this subsection may be conducted on a multistate basis, as needed.
  - (4) **Funding—** $20,000,000 of the amount appropriated under [subsection (i)](#i) for a [fiscal year](/usc/42/619.md?p=3) shall be used to carry out this subsection.
- (e) **Childhood obesity demonstration project—**
  - (1) **Authority to conduct demonstration—** The [Secretary](/usc/42/1301.md?p=a-6), in consultation with the [Administrator](/usc/42/4005.md?p=1) of the Centers for Medicare & Medicaid Services, shall conduct a demonstration [project](/usc/42/13641.md?p=2) to develop a comprehensive and systematic model for reducing childhood obesity by awarding [grants](/usc/42/1397j.md?p=10) to [eligible entities](/usc/42/1397j.md?p=7) to carry out such [project](/usc/42/13641.md?p=2). Such model shall—
    - (A) identify, through self-assessment, behavioral risk factors for obesity among children;
    - (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;
    - (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; and
    - (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 subchapter XIX or [child health assistance](/usc/42/1397jj.md?p=a) is available under subchapter XXI among such target individuals.
  - (2) **Eligibility entities 2—** For purposes of this subsection, an [eligible entity](/usc/42/1397j.md?p=7) is any of the following:
    - (A) A city, county, or [Indian tribe](/usc/42/619.md?p=4-A).
    - (B) A local or tribal educational [agency](/usc/42/1397n–12.md?p=1).
    - (C) An accredited university, college, or community college.
    - (D) A Federally-qualified health center.
    - (E) A local health department.
    - (F) A [health care provider](/usc/42/1320d.md?p=3).
    - (G) A community-based organization.
    - (H) Any other entity determined appropriate by the [Secretary](/usc/42/1301.md?p=a-6), [including](/usc/42/1301.md?p=b) a consortia[^3] or partnership of entities described in any of subparagraphs [(A)](#e-2-A) through [(G)](#e-2-G).
  - (3) **Use of funds—** An [eligible entity](/usc/42/1397j.md?p=7) awarded a [grant](/usc/42/1397j.md?p=10) under this subsection shall use the funds made available under the [grant](/usc/42/1397j.md?p=10) to—
    - (A) carry out community-based activities related to reducing childhood obesity, [including](/usc/42/1301.md?p=b) by—
      - (i) forming partnerships with entities, [including](/usc/42/1301.md?p=b) schools and other [facilities](/usc/42/1320a–3.md?p=c-5-B) providing recreational services, to establish programs for after school and weekend community activities that are designed to reduce childhood obesity;
      - (ii) forming partnerships with daycare [facilities](/usc/42/1320a–3.md?p=c-5-B) to establish programs that promote healthy eating behaviors and physical activity; and
      - (iii) developing and evaluating community educational activities targeting good nutrition and promoting healthy eating behaviors;
    - (B) carry out age-appropriate school-based activities that are designed to reduce childhood obesity, [including](/usc/42/1301.md?p=b) by—
      - (i) developing and testing educational curricula and [intervention](/usc/42/1397n–12.md?p=2) programs designed to promote healthy eating behaviors and habits in [youth](/usc/42/629a.md?p=a-11), which may include—
        - (I) after hours physical activity programs; and
        - (II) science-based [interventions](/usc/42/1397n–12.md?p=2) with multiple components to prevent eating disorders [including](/usc/42/1301.md?p=b) 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;
      - (ii) providing education and training to educational professionals regarding how to promote a healthy lifestyle and a healthy school environment for children;
      - (iii) planning and implementing a healthy lifestyle curriculum or program with an emphasis on healthy eating behaviors and physical activity; and
      - (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;
    - (C) carry out educational, counseling, promotional, and training activities through the local health care delivery systems [including](/usc/42/1301.md?p=b) by—
      - (i) promoting healthy eating behaviors and physical activity services to treat or prevent eating disorders, being overweight, and obesity;
      - (ii) providing patient education and counseling to increase physical activity and promote healthy eating behaviors;
      - (iii) training health professionals on how to identify and treat obese and overweight individuals which may include nutrition and physical activity counseling; and
      - (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; and
    - (D) provide, through qualified health professionals, training and supervision for community health workers to—
      - (i) educate families regarding the relationship between nutrition, eating habits, physical activity, and obesity;
      - (ii) educate families about effective strategies to improve nutrition, establish healthy eating patterns, and establish appropriate levels of physical activity; and
      - (iii) educate and guide parents regarding the ability to model and communicate positive health behaviors.
  - (4) **Priority—** In awarding [grants](/usc/42/1397j.md?p=10) under [paragraph (1)](#e-1), the [Secretary](/usc/42/1301.md?p=a-6) shall give priority to awarding [grants](/usc/42/1397j.md?p=10) to [eligible entities](/usc/42/1397j.md?p=7)—
    - (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](/usc/42/1397j.md?p=10) are effective;
    - (B) that will carry out programs or activities that seek to accomplish a goal or goals set by the [State](/usc/42/619.md?p=5) in the Healthy People 2010 plan of the [State](/usc/42/619.md?p=5);
    - (C) that provide non-Federal contributions, either in cash or in-kind, to the costs of funding activities under the [grants](/usc/42/1397j.md?p=10);
    - (D) that develop comprehensive plans that include a strategy for extending program activities developed under [grants](/usc/42/1397j.md?p=10) in the years following the [fiscal years](/usc/42/619.md?p=3) for which they receive [grants](/usc/42/1397j.md?p=10) under this subsection;
    - (E) located in communities that are medically underserved, as determined by the [Secretary](/usc/42/1301.md?p=a-6);
    - (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](/usc/42/619.md?p=5) involved, as determined by the [Secretary](/usc/42/1301.md?p=a-6); and
    - (G) that submit plans that exhibit multisectoral, cooperative conduct that [includes](/usc/42/1301.md?p=b) the involvement of a broad range of stakeholders, [including](/usc/42/1301.md?p=b)—
      - (i) community-based organizations;
      - (ii) local governments;
      - (iii) local educational [agencies](/usc/42/1397n–12.md?p=1);
      - (iv) the private sector;
      - (v) [State](/usc/42/619.md?p=5) or local departments of health;
      - (vi) accredited colleges, universities, and community colleges;
      - (vii) [health care providers](/usc/42/1320d.md?p=3);
      - (viii) [State](/usc/42/619.md?p=5) and local departments of transportation and city planning; and
      - (ix) other entities determined appropriate by the [Secretary](/usc/42/1301.md?p=a-6).
  - (5) **Program design—**
    - (A) **Initial design—** Not later than 1 year after February 4, 2009, the [Secretary](/usc/42/1301.md?p=a-6) shall design the demonstration [project](/usc/42/13641.md?p=2). The demonstration should draw upon promising, innovative models and incentives to reduce behavioral risk factors. The [Administrator](/usc/42/4005.md?p=1) of the Centers for Medicare & Medicaid Services shall consult with the [Director](/usc/42/11851.md?p=5) of the Centers for Disease Control and Prevention, the [Director](/usc/42/11851.md?p=5) of the Office of Minority Health, the heads of other [agencies](/usc/42/1397n–12.md?p=1) in the Department of Health and Human Services, and such professional organizations, as the [Secretary](/usc/42/1301.md?p=a-6) determines to be appropriate, on the design, conduct, and evaluation of the demonstration.
    - (B) **Number and project areas—** Not later than 2 years after February 4, 2009, the [Secretary](/usc/42/1301.md?p=a-6) shall award 1 [grant](/usc/42/1397j.md?p=10) 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](/usc/42/1397jj.md?p=a) under [State child health plans](/usc/42/1397jj.md?p=c-7) under subchapter XXI in order to reduce the incidence of childhood obesity among such population.
  - (6) **Report to Congress—** Not later than 3 years after the date the [Secretary](/usc/42/1301.md?p=a-6) implements the demonstration [project](/usc/42/13641.md?p=2) under this subsection, the [Secretary](/usc/42/1301.md?p=a-6) shall submit to Congress a report that describes the [project](/usc/42/13641.md?p=2), evaluates the effectiveness and cost effectiveness of the [project](/usc/42/13641.md?p=2), evaluates the beneficiary satisfaction under the [project](/usc/42/13641.md?p=2), and [includes](/usc/42/1301.md?p=b) any such other information as the [Secretary](/usc/42/1301.md?p=a-6) determines to be appropriate.
  - (7) **Definitions—** In this subsection:
    - (A) **Federally-qualified health center—** The term “Federally-qualified health center” has the meaning given that term in [section 1396d(l)(2)(B)](/usc/42/1396d.md?p=l-2-B) of this title.
    - (B) **Indian tribe—** The term “[Indian tribe](/usc/42/619.md?p=4-A)” has the meaning given that term in [section 1603 of title 25](/usc/25/1603.md).
    - (C) **Self-assessment—** The term “self-assessment” means a form that—
      - (i) [includes](/usc/42/1301.md?p=b) questions regarding—
        - (I) behavioral risk factors;
        - (II) needed preventive and screening services; and
        - (III) target individuals’ preferences for receiving follow-up information;
      - (ii) is assessed using such computer generated assessment programs; and
      - (iii) allows for the provision of such ongoing support to the individual as the [Secretary](/usc/42/1301.md?p=a-6) determines appropriate.
    - (D) **Ongoing support—** The term “ongoing support” means—
      - (i) to provide any target individual with information, feedback, health coaching, and recommendations regarding—
        - (I) the results of a self-assessment given to the individual;
        - (II) behavior modification based on the self-assessment; and
        - (III) any need for clinical preventive and screening services or [treatment](/usc/42/11851.md?p=11) [including](/usc/42/1301.md?p=b) medical nutrition therapy;
      - (ii) to provide any target individual with referrals to community resources and programs available to assist the target individual in reducing health risks; and
      - (iii) to provide the information described in [clause (i)](#e-7-D-i) to a [health care provider](/usc/42/1320d.md?p=3), if designated by the target individual to receive such information.
  - (8) **Appropriation—** Out of any funds in the Treasury not otherwise appropriated, there is appropriated to carry out this subsection, $25,000,000 for the period of [fiscal years](/usc/42/619.md?p=3) 2010 through 2014,,[^1] $10,000,000 for the period of [fiscal years](/usc/42/619.md?p=3) 2016 and 2017, and $30,000,000 for the period of [fiscal years](/usc/42/619.md?p=3) 2018 through 2023.
- (f) **Development of model electronic health record format for children enrolled in Medicaid or CHIP—**
  - (1) **In general—** Not later than January 1, 2010, the [Secretary](/usc/42/1301.md?p=a-6) shall establish a program to encourage the development and dissemination of a model electronic health record format for children enrolled in the [State](/usc/42/619.md?p=5) plan under subchapter XIX or the [State child health plan](/usc/42/1397jj.md?p=c-7) under subchapter XXI that is—
    - (A) subject to [State](/usc/42/619.md?p=5) laws, accessible to parents, [caregivers](/usc/42/1397j.md?p=3), and other consumers for the sole purpose of demonstrating compliance with school or leisure activity requirements, such as appropriate immunizations or physicals;
    - (B) designed to allow interoperable exchanges that conform with Federal and [State](/usc/42/619.md?p=5) privacy and security requirements;
    - (C) structured in a manner that permits parents and [caregivers](/usc/42/1397j.md?p=3) to view and understand the extent to which the care their children receive is clinically appropriate and of high quality; and
    - (D) capable of being incorporated into, and otherwise compatible with, other [standards](/usc/42/1320d.md?p=7) developed for electronic health records.
  - (2) **Funding—** $5,000,000 of the amount appropriated under [subsection (i)](#i) for a [fiscal year](/usc/42/619.md?p=3) shall be used to carry out this subsection.
- (g) **Study of pediatric health and health care quality measures—**
  - (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](/usc/42/1382c.md?p=c) health status and the quality of health care for children across the age span and in relation to preventive care, [treatments](/usc/42/11851.md?p=11) for acute conditions, and [treatments](/usc/42/11851.md?p=11) 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—
    - (A) consider all of the major national population-based reporting systems sponsored by the Federal Government that are currently in place, [including](/usc/42/1301.md?p=b) reporting requirements under Federal [grant](/usc/42/1397j.md?p=10) programs and national population surveys and estimates conducted directly by the Federal Government;
    - (B) identify the information regarding [child](/usc/42/1382c.md?p=c) health and health care quality that each system is designed to capture and [generate](/usc/42/2021b.md?p=8), the study and reporting periods covered by each system, and the extent to which the information so generated is made widely available through publication;
    - (C) identify gaps in knowledge related to children’s health status, health disparities among subgroups of children, the effects of [social](/usc/42/1397j.md?p=20) conditions on children’s health status and use and effectiveness of health care, and the relationship between [child](/usc/42/1382c.md?p=c) health status and family income, family stability and preservation, and children’s school readiness and educational achievement and attainment; and
    - (D) make recommendations regarding improving and strengthening the timeliness, quality, and public transparency and accessibility of information about [child](/usc/42/1382c.md?p=c) health and health care quality.
  - (2) **Funding—** Up to $1,000,000 of the amount appropriated under [subsection (i)](#i) for a [fiscal year](/usc/42/619.md?p=3) shall be used to carry out this subsection.
- (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](/usc/42/1382c.md?p=c) who is eligible for and receiving medical assistance under subchapter XIX or [child health assistance](/usc/42/1397jj.md?p=a) under subchapter XXI.
- (i) **Appropriation—**
  - (1) **In general—** Out of any funds in the Treasury not otherwise appropriated, there is appropriated—
    - (A) for each of [fiscal years](/usc/42/619.md?p=3) 2009 through 2013, $45,000,000 for the purpose of carrying out this section (other than [subsection (e)](#e));
    - (B) for the period of [fiscal years](/usc/42/619.md?p=3) 2016 and 2017, $20,000,000 for the purpose of carrying out this section (other than subsections [(e)](#e), [(f)](#f), and [(g)](#g));
    - (C) for the period of [fiscal years](/usc/42/619.md?p=3) 2018 through 2023, $90,000,000 for the purpose of carrying out this section (other than subsections [(e)](#e), [(f)](#f), and [(g)](#g));
    - (D) for the period of [fiscal years](/usc/42/619.md?p=3) 2024 through 2027, $60,000,000 for the purpose of carrying out this section (other than subsections [(e)](#e), [(f)](#f), and [(g)](#g)); and
    - (E) for each of [fiscal years](/usc/42/619.md?p=3) 2028 and 2029, $15,000,000 for the purpose of carrying out this section (other than subsections [(e)](#e), [(f)](#f), and [(g)](#g)).
  - (2) **Availability—** Funds appropriated under this subsection shall remain available until expended.

## Footnotes

[^1]: So in original.
[^2]: So in original. Probably should be “Eligible entities”.
[^3]: So in original. Probably should be “consortium”.

## Source credit

(Aug. 14, 1935, ch. 531, title XI, § 1139A, as added and amended Pub. L. 111–3, title IV, § 401(a), title V, § 501(g), Feb. 4, 2009, 123 Stat. 72, 88; Pub. L. 111–148, title IV, § 4306, Mar. 23, 2010, 124 Stat. 587; Pub. L. 114–10, title III, § 304, Apr. 16, 2015, 129 Stat. 158; Pub. L. 115–120, div. C, § 3003, Jan. 22, 2018, 132 Stat. 36; Pub. L. 115–123, div. E, title I, § 50102, Feb. 9, 2018, 132 Stat. 175; Pub. L. 117–328, div. FF, title V, § 5111(c)(1), Dec. 29, 2022, 136 Stat. 5939.)

## Notes

### Editorial Notes

### Amendments

2022—Subsec. (i)(1)(E). Pub. L. 117–328 added subpar. (E).

2018—Subsec. (a)(4). Pub. L. 115–123, § 50102(b)(1)(A), (B), inserted “and mandatory reporting” after “reporting” in par. heading, designated existing provisions as subpar. (A), inserted subpar. heading, and added subpar. (B).

Subsec. (a)(6)(B). Pub. L. 115–123, § 50102(b)(1)(C), inserted “and, beginning with the report required on January 1, 2025, and for each annual report thereafter, the status of mandatory reporting by States under subchapters XIX and XXI, utilizing the initial core quality measurement set and any updates or changes to that set” before semicolon.

Subsec. (c)(1)(A). Pub. L. 115–123, § 50102(b)(2), inserted “and, beginning with the annual report on fiscal year 2024, all of the core measures described in subsection (a) and any updates or changes to those measures” before semicolon.

Subsec. (e)(8). Pub. L. 115–120, § 3003(a), substituted “, $10,000,000” for “and $10,000,000” and inserted “, and $30,000,000 for the period of fiscal years 2018 through 2023” after “2017”.

Subsec. (i). Pub. L. 115–120, § 3003(b), restructured existing text into par. (1), including subpars. (A) and (B), and par. (2), inserted par. headings, and added par. (1)(C).

Subsec. (i)(1)(D). Pub. L. 115–123, § 50102(a), added subpar. (D).

2015—Subsec. (e)(8). Pub. L. 114–10, § 304(a), inserted “, and $10,000,000 for the period of fiscal years 2016 and 2017” after “2014”.

Subsec. (i). Pub. L. 114–10, § 304(b), inserted “, and there is appropriated for the period of fiscal years 2016 and 2017, $20,000,000 for the purpose of carrying out this section (other than subsections (e), (f), and (g))” after “(other than subsection (e))”.

2010—Subsec. (e)(8). Pub. L. 111–148 amended par. (8) generally. Prior to amendment, text read as follows: “There is authorized to be appropriated to carry out this subsection, $25,000,000 for the period of fiscal years 2009 through 2013.”

2009—Subsec. (a)(3)(B)(ii). Pub. L. 111–3, § 501(g)(1), inserted “and, with respect to dental care, conditions requiring the restoration of teeth, relief of pain and infection, and maintenance of dental health” after “chronic conditions”.

Subsec. (a)(6)(A)(ii). Pub. L. 111–3, § 501(g)(2), inserted “dental care,” after “preventive health services,”.

### Statutory Notes and Related Subsidiaries

### Effective Date

Section and amendment by Pub. L. 111–3 effective Apr. 1, 2009, and applicable to child health assistance and medical assistance provided on or after that date, with certain exceptions, see section 3 of Pub. L. 111–3, set out as a note under section 1396 of this title.