S1769-118

2. Establishment of whole child health models Section 1903 of the Social Security Act (42 U.S.C. 1396b) is amended by adding at the end the following new subsection: The Secretary, acting through the Deputy Administrator and Director of the Center for Medicaid and CHIP Services, shall conduct a demonstration project (referred to in this subsection as the demonstration project) under which participating States shall design and implement whole child health models in 1 or more target communities in accordance with the requirements of this subsection. The requirements of section 1902(a)(1) (relating to statewideness) shall not apply to the demonstration project. Not later than 12 months after the date of the enactment of this subsection, the Secretary shall award up to 15 grants to States that submit complete applications for such grants which meet the requirements of subparagraph (C). In awarding grants under this paragraph, the Secretary shall, to the extent possible, prioritize awarding grants to a geographically diverse selection of States and target communities of different sizes and with varying experience with value-based payment, including rural and urban communities. A State shall include in an application for a grant awarded under this paragraph the following: A description of each proposed target community in which the State proposes to implement a whole child health model. For each target community described in clause (i), a statement of the proposed objectives of the State in implementing a whole child health model in that community. Such other information as the Secretary may require. A State awarded a grant under this paragraph shall use the grant funds to— conduct or use an existing needs assessment that is not more than two years old and meets the requirements of clause (ii) for each proposed target community; not later than 12 months after being awarded the grant, design and submit for approval by the Secretary a proposed whole child health model that meets the requirements of subparagraph (E) for each target community based on the results of the needs assessment and other assessments or surveys conducted for that community; and implement the whole child health model during the implementation phase described in paragraph (3). A needs assessment conducted for a proposed target community with grant funds awarded to a State shall include the following: An evaluation of the physical health, mental, emotional and behavioral health, developmental, social, relational and substance use disorder service needs of eligible individuals in the target community, including needs that could be addressed through population-based or community-based interventions. A review of the resources available to meet the physical health, mental health, and substance use disorder service needs of eligible individuals in the target community. A description of the barriers identified in the target community to eligible individuals accessing resources and services to address their physical health, mental health, and substance use disorder service needs. A description of health disparities identified in the target community, including input from community residents in the target community. A proposed whole child health model shall include descriptions of the following: How the State and its multi-sector partners will address the physical health, mental, emotional and behavioral health, developmental, social, relational and substance use disorder service needs of eligible individuals in the target community identified in the needs assessment of that community through implementation of the whole child health model and provision of whole child health services. How the State Medicaid, human services, and child welfare agencies will coordinate with community partners to ensure the successful implementation of the whole child health model in the target communities and the provision of whole child health services. The lead agency or other entity the State proposes to designate to coordinate activities carried out to implement the whole child health model in the target communities. A proposed whole child health model shall meet the following requirements: Align with an existing or planned delivery and payment system of the State plan under this title or under a waiver of such plan, including, as applicable, a managed care delivery system. Include partnerships with child and family serving organizations and agencies such as health care providers, payers, school districts, public health and child care. Promote the delivery of trauma-informed and culturally competent care, including strategies to address systemic resource needs, including workforce shortages, in the target community and an assessment of the potential impact of the model on health equity, disparities, and safety net providers in the target community. Coordinate funding sources under the State plan under this title (or under a waiver of plan), the State plans under parts B and E of title IV, and other applicable funding sources, for the whole child health services provided under the model. Include— the design and implementation or adaptation of a value-based payment arrangement for providing whole child health services under the State plan under this title (or under a waiver of such plan) that promotes pediatric health; or in the case of a State that faces significant barriers to implementing or adapting such a value-based payment arrangement, a proposal for steps that the State will take towards advancing value-based care with respect to whole child health services provided under the State plan under this title (or under a waiver of such plan). Include strategies to coordinate referrals to whole child health services, including using telehealth, referral networks and/or other technologies to facilitate access to whole child health services. Include strategies to promote the integration of primary care with whole child health services and substance use disorder services. Include strategies to integrate and streamline eligibility, enrollment, and renewal processes to facilitate enrollment in health coverage and other benefit programs. Include strategies to promote school-based health and wellness. Describe how the State will leverage or enhance existing health information technology infrastructure and cross-sector data-sharing capabilities to support the provision of enhanced care coordination services, including with respect to claiming administrative matching funds for the design, development, and installation of data systems to allow or enhance coordination among State agencies and other entities. Describe how the State will evaluate the impact of the model on child health and disparities in health outcomes, according to requirements outlined by the Secretary. Include other such population health strategies or core services as the State determines appropriate. The Secretary may waive or otherwise modify the requirements for a whole child health model described in clause (ii) to the extent necessary to permit Indian tribes to participate in such a model. After the design period, the implementation phase of the demonstration project shall be conducted for a period of not less than 48 months and not more than 72 months. There are authorized to be appropriated to the Secretary for the purpose of carrying out this subsection, out of any funds in the Treasury not otherwise appropriated, $125,000,000, to remain available until expended. From any amounts appropriated pursuant to this paragraph, the Secretary shall use— not more than $2,000,000 for administrative costs, staffing, and reporting requirements; not more than $10,000,000 for learning platforms, staffing, and technical assistance related directly to the design and implementation of whole child health models, and to carry out activities under this subsection; and not more than $3,000,0000 may be used for carrying out evaluations described in paragraph (5). For each fiscal quarter occurring during the implementation phase of the demonstration project, subject to clause (ii), the Secretary shall pay each State selected to participate in that phase of the project, an amount equal to 80 percent of the amounts expended by the State during such quarter for providing whole child health services to eligible individuals in the target communities net of any Federal payments made to the State for such expenditures, under this title or otherwise. The additional Federal funds paid to a State under this subparagraph shall be used to supplement, not supplant, the level of State funds expended for services that are treated as whole child health services under the demonstration project. A State that is selected to participate in the demonstration project shall report on the outcomes under the entity's whole child health model pursuant to periodic reporting requirements established by the Secretary. Each State awarded a grant under this subsection shall submit the following reports to the Secretary: An interim report at the end of the first 24 months of the implementation phase of the project that describes— the progress of the State’s implementation of the whole child health model in the target communities; the organizations and providers that are participating in the implementation of the model in the target communities; the number of eligible individuals in the target communities receiving enhanced care coordination services; and such other information as the Secretary may require. A final report not later than 1 year after the end of the implementation phase of the demonstration project that describes— best practices and challenges in implementing the whole child health model in the target communities; the impact of the model on child well-being, health care outcomes and health disparities in the target communities; and such other information as the Secretary may require. Not later than 3 years after the first grant is awarded under this subsection, the Comptroller General of the United States shall submit a report to Congress evaluating the individual, financial, and systems-level impacts associated with whole child health models implemented under the demonstration project. A State awarded a grant under paragraph (2) shall consult with stakeholders, such as eligible individuals and their primary caregivers, schools, health care, mental health, and substance use disorder treatment organizations, pediatric providers, public health departments, child care providers, juvenile justice programs, child welfare programs, and community-based organizations, in designing and carrying out the activities required under paragraph (2), and with respect to the implementation and evaluation of the whole child health models implemented by the State. Such consultation may include establishment of a Community Advisory Board as defined by the Secretary. The Secretary shall provide States awarded a grant under paragraph (2) with technical assistance with respect to the design of whole child health models. Such assistance may include assisting States with moving along a whole child health model and utilizing innovative financing strategies, such as braiding public and private funds. As feasible, the Secretary may partner with other Federal agencies, including the Office of Management and Budget, when providing technical assistance to promote a whole child health approach. The Secretary shall also provide such States with technical assistance with respect to implementation of such models. The Secretary shall facilitate shared learning, such as a learning collaborative, among the States participating in the demonstration project. The Secretary shall submit to the Committee on Finance of the Senate and the Committee on Energy and Commerce of the House of Representatives the following reports: Not later than 36 months after the date on which design grant funds are first awarded under paragraph (2), a report that describes the whole child health models proposed by States. Not later than 3 years after the date on which the implementation phase of the demonstration project begins, an interim report. Not later than 2 years after the date on which the demonstration project ends, a final report. The interim and final reports required under this clause shall include the following: A summary of the whole child health models being implemented under the demonstration project. An assessment of the impacts of such models on the physical and mental health and well-being of eligible individuals in the target communities. A description of the most effective strategies of such models in promoting the physical and mental health of eligible individuals, including the effectiveness of such strategies in reducing health disparities and improving health equity. A summary of the information reported to the Secretary by States. In addition to the information required under item (cc), the final report submitted under item (bb) shall include recommendations for such Federal legislative changes, if any, as the Secretary recommends to implement positive outcomes identified by the use of whole child health models under the demonstration project. In this subsection: The term eligible individual means an individual who has not attained age 21 and who is eligible for medical assistance under a State plan under this title or under a waiver of such plan, or for assistance under a State child health plan under title XXI or under a waiver of such plan. The term Indian Tribe has the meaning given that term in section 4(e) of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 5304(e)). The term target community means, with respect to a State, the boundaries of a geographic area within the State in which the State proposes to implement a whole child health model. The term whole child health services means the following: Comprehensive care management. Enhanced care coordination services and referrals to health, developmental and social supports that include strategies to— identify and address the physical, mental, emotional, and behavioral health, developmental, relational and social needs of eligible individuals; coordinate referrals, as needed, to health care, mental, emotional, and behavioral health, substance use disorder treatment, child development, and social service providers; ensure that eligible individuals follow up with service providers to whom they are referred; and facilitate the ability of eligible individuals to access needed services by centralizing, coordinating with, or co-locating resources. Not later than 365 days after the selection of eligible entities under this subsection, the Secretary shall issue and disseminate guidance and technical assistance to grant awardees to clarify strategies and best practices to combine funds, including Medicaid, in the context of a child health and wellness fund, consistent with Federal law, and shall make such guidance publicly available. (cc)Whole child health demonstration project (1)In generalThe Secretary, acting through the Deputy Administrator and Director of the Center for Medicaid and CHIP Services, shall conduct a demonstration project (referred to in this subsection as the demonstration project) under which participating States shall design and implement whole child health models in 1 or more target communities in accordance with the requirements of this subsection. The requirements of section 1902(a)(1) (relating to statewideness) shall not apply to the demonstration project. (2)Design phase (A)GrantsNot later than 12 months after the date of the enactment of this subsection, the Secretary shall award up to 15 grants to States that submit complete applications for such grants which meet the requirements of subparagraph (C). (B)Selection of granteesIn awarding grants under this paragraph, the Secretary shall, to the extent possible, prioritize awarding grants to a geographically diverse selection of States and target communities of different sizes and with varying experience with value-based payment, including rural and urban communities. (C)Grant applicationA State shall include in an application for a grant awarded under this paragraph the following: (i)A description of each proposed target community in which the State proposes to implement a whole child health model. (ii)For each target community described in clause (i), a statement of the proposed objectives of the State in implementing a whole child health model in that community. (iii)Such other information as the Secretary may require. (D)Use of grant funds (i)In generalA State awarded a grant under this paragraph shall use the grant funds to— (I)conduct or use an existing needs assessment that is not more than two years old and meets the requirements of clause (ii) for each proposed target community; (II)not later than 12 months after being awarded the grant, design and submit for approval by the Secretary a proposed whole child health model that meets the requirements of subparagraph (E) for each target community based on the results of the needs assessment and other assessments or surveys conducted for that community; and (III)implement the whole child health model during the implementation phase described in paragraph (3). (ii)Needs assessment requirementsA needs assessment conducted for a proposed target community with grant funds awarded to a State shall include the following: (I)An evaluation of the physical health, mental, emotional and behavioral health, developmental, social, relational and substance use disorder service needs of eligible individuals in the target community, including needs that could be addressed through population-based or community-based interventions. (II)A review of the resources available to meet the physical health, mental health, and substance use disorder service needs of eligible individuals in the target community. (III)A description of the barriers identified in the target community to eligible individuals accessing resources and services to address their physical health, mental health, and substance use disorder service needs. (IV)A description of health disparities identified in the target community, including input from community residents in the target community. (E)Whole child health model requirements (i)In generalA proposed whole child health model shall include descriptions of the following: (I)How the State and its multi-sector partners will address the physical health, mental, emotional and behavioral health, developmental, social, relational and substance use disorder service needs of eligible individuals in the target community identified in the needs assessment of that community through implementation of the whole child health model and provision of whole child health services. (II)How the State Medicaid, human services, and child welfare agencies will coordinate with community partners to ensure the successful implementation of the whole child health model in the target communities and the provision of whole child health services. (III)The lead agency or other entity the State proposes to designate to coordinate activities carried out to implement the whole child health model in the target communities. (ii)RequirementsA proposed whole child health model shall meet the following requirements: (I)Align with an existing or planned delivery and payment system of the State plan under this title or under a waiver of such plan, including, as applicable, a managed care delivery system. (II)Include partnerships with child and family serving organizations and agencies such as health care providers, payers, school districts, public health and child care. (III)Promote the delivery of trauma-informed and culturally competent care, including strategies to address systemic resource needs, including workforce shortages, in the target community and an assessment of the potential impact of the model on health equity, disparities, and safety net providers in the target community. (IV)Coordinate funding sources under the State plan under this title (or under a waiver of plan), the State plans under parts B and E of title IV, and other applicable funding sources, for the whole child health services provided under the model. (V)Include— (aa)the design and implementation or adaptation of a value-based payment arrangement for providing whole child health services under the State plan under this title (or under a waiver of such plan) that promotes pediatric health; or (bb)in the case of a State that faces significant barriers to implementing or adapting such a value-based payment arrangement, a proposal for steps that the State will take towards advancing value-based care with respect to whole child health services provided under the State plan under this title (or under a waiver of such plan). (VI)Include strategies to coordinate referrals to whole child health services, including using telehealth, referral networks and/or other technologies to facilitate access to whole child health services. (VII)Include strategies to promote the integration of primary care with whole child health services and substance use disorder services. (VIII)Include strategies to integrate and streamline eligibility, enrollment, and renewal processes to facilitate enrollment in health coverage and other benefit programs. (IX)Include strategies to promote school-based health and wellness. (X)Describe how the State will leverage or enhance existing health information technology infrastructure and cross-sector data-sharing capabilities to support the provision of enhanced care coordination services, including with respect to claiming administrative matching funds for the design, development, and installation of data systems to allow or enhance coordination among State agencies and other entities. (XI)Describe how the State will evaluate the impact of the model on child health and disparities in health outcomes, according to requirements outlined by the Secretary. (XII)Include other such population health strategies or core services as the State determines appropriate. (iii)Participation by Indian tribes in whole child health modelsThe Secretary may waive or otherwise modify the requirements for a whole child health model described in clause (ii) to the extent necessary to permit Indian tribes to participate in such a model. (3)Implementation phaseAfter the design period, the implementation phase of the demonstration project shall be conducted for a period of not less than 48 months and not more than 72 months. (4)Authorization of appropriations (A)In generalThere are authorized to be appropriated to the Secretary for the purpose of carrying out this subsection, out of any funds in the Treasury not otherwise appropriated, $125,000,000, to remain available until expended. (B)Limitation on use of fundsFrom any amounts appropriated pursuant to this paragraph, the Secretary shall use— (i)not more than $2,000,000 for administrative costs, staffing, and reporting requirements; (ii)not more than $10,000,000 for learning platforms, staffing, and technical assistance related directly to the design and implementation of whole child health models, and to carry out activities under this subsection; and (iii)not more than $3,000,0000 may be used for carrying out evaluations described in paragraph (5). (C)Payment for whole child health services (i)In generalFor each fiscal quarter occurring during the implementation phase of the demonstration project, subject to clause (ii), the Secretary shall pay each State selected to participate in that phase of the project, an amount equal to 80 percent of the amounts expended by the State during such quarter for providing whole child health services to eligible individuals in the target communities net of any Federal payments made to the State for such expenditures, under this title or otherwise. (ii)RequirementThe additional Federal funds paid to a State under this subparagraph shall be used to supplement, not supplant, the level of State funds expended for services that are treated as whole child health services under the demonstration project. (5)Reports and evaluation (A)In generalA State that is selected to participate in the demonstration project shall report on the outcomes under the entity's whole child health model pursuant to periodic reporting requirements established by the Secretary. (B)State reportsEach State awarded a grant under this subsection shall submit the following reports to the Secretary: (i)Interim reportAn interim report at the end of the first 24 months of the implementation phase of the project that describes— (I)the progress of the State’s implementation of the whole child health model in the target communities; (II)the organizations and providers that are participating in the implementation of the model in the target communities; (III)the number of eligible individuals in the target communities receiving enhanced care coordination services; and (IV)such other information as the Secretary may require. (ii)Final reportA final report not later than 1 year after the end of the implementation phase of the demonstration project that describes— (I)best practices and challenges in implementing the whole child health model in the target communities; (II)the impact of the model on child well-being, health care outcomes and health disparities in the target communities; and (III)such other information as the Secretary may require. (C)GAO reportNot later than 3 years after the first grant is awarded under this subsection, the Comptroller General of the United States shall submit a report to Congress evaluating the individual, financial, and systems-level impacts associated with whole child health models implemented under the demonstration project. (6)ConsultationA State awarded a grant under paragraph (2) shall consult with stakeholders, such as eligible individuals and their primary caregivers, schools, health care, mental health, and substance use disorder treatment organizations, pediatric providers, public health departments, child care providers, juvenile justice programs, child welfare programs, and community-based organizations, in designing and carrying out the activities required under paragraph (2), and with respect to the implementation and evaluation of the whole child health models implemented by the State. Such consultation may include establishment of a Community Advisory Board as defined by the Secretary. (7)Responsibilities of the secretary (A)Technical assistance (i)In generalThe Secretary shall provide States awarded a grant under paragraph (2) with technical assistance with respect to the design of whole child health models. Such assistance may include assisting States with moving along a whole child health model and utilizing innovative financing strategies, such as braiding public and private funds. As feasible, the Secretary may partner with other Federal agencies, including the Office of Management and Budget, when providing technical assistance to promote a whole child health approach. The Secretary shall also provide such States with technical assistance with respect to implementation of such models. (ii)Shared learningThe Secretary shall facilitate shared learning, such as a learning collaborative, among the States participating in the demonstration project. (iii)Reports to congressThe Secretary shall submit to the Committee on Finance of the Senate and the Committee on Energy and Commerce of the House of Representatives the following reports: (I)Design phaseNot later than 36 months after the date on which design grant funds are first awarded under paragraph (2), a report that describes the whole child health models proposed by States. (II)Implementation phase (aa)Interim reportNot later than 3 years after the date on which the implementation phase of the demonstration project begins, an interim report. (bb)Final reportNot later than 2 years after the date on which the demonstration project ends, a final report. (cc)ContentThe interim and final reports required under this clause shall include the following: (AA)A summary of the whole child health models being implemented under the demonstration project. (BB)An assessment of the impacts of such models on the physical and mental health and well-being of eligible individuals in the target communities. (CC)A description of the most effective strategies of such models in promoting the physical and mental health of eligible individuals, including the effectiveness of such strategies in reducing health disparities and improving health equity. (DD)A summary of the information reported to the Secretary by States. (dd)Legislative recommendationsIn addition to the information required under item (cc), the final report submitted under item (bb) shall include recommendations for such Federal legislative changes, if any, as the Secretary recommends to implement positive outcomes identified by the use of whole child health models under the demonstration project. (8)DefinitionsIn this subsection: (A)Eligible individualThe term eligible individual means an individual who has not attained age 21 and who is eligible for medical assistance under a State plan under this title or under a waiver of such plan, or for assistance under a State child health plan under title XXI or under a waiver of such plan. (B)Indian tribeThe term Indian Tribe has the meaning given that term in section 4(e) of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 5304(e)). (C)Target communityThe term target community means, with respect to a State, the boundaries of a geographic area within the State in which the State proposes to implement a whole child health model. (D)Whole child health servicesThe term whole child health services means the following: (i)Comprehensive care management. (ii)Enhanced care coordination services and referrals to health, developmental and social supports that include strategies to— (I)identify and address the physical, mental, emotional, and behavioral health, developmental, relational and social needs of eligible individuals; (II)coordinate referrals, as needed, to health care, mental, emotional, and behavioral health, substance use disorder treatment, child development, and social service providers; (III)ensure that eligible individuals follow up with service providers to whom they are referred; and (IV)facilitate the ability of eligible individuals to access needed services by centralizing, coordinating with, or co-locating resources. (9)Requirement to issue guidance on combining Federal and non-Federal funds to address social drivers of health in low-income populationsNot later than 365 days after the selection of eligible entities under this subsection, the Secretary shall issue and disseminate guidance and technical assistance to grant awardees to clarify strategies and best practices to combine funds, including Medicaid, in the context of a child health and wellness fund, consistent with Federal law, and shall make such guidance publicly available..