Children’s Health Care Quality Act

US Senators Evan Bayh, Orrin Hatch, Blanche Lincoln, Jeff Bingaman, Norm Coleman, and Ken Salazar recently joined bipartisan efforts and introduced new legislation to improve the delivery of health care services to children by advancing pediatric quality measurement and improvement.

This legislation would make the national investment essential to give states and other payers, providers, and consumers a full portfolio of evidence-based pediatric measures from which to choose for accessing and improving children’s health care.

Background:
Children have unique health care needs and experiences, which are often not comparable to adult health care needs and experience, and they require specialized medical expertise. The delivery of health care is increasingly being transformed by the use of quality and performance measures by consumers, insurers, and providers.

A majority of public and private sector investments in the development of quality and performance measures have focused on the experience of adults, particularly the elderly. As a result, the supply of approved and demonstrated quality measures for children's health care, especially pediatric inpatient care, is limited.

Growing numbers of insurers, as well as the Medicaid program and the State Children's Health Insurance Program (SCHIP), are using publicly available measures, which means they have only limited options for measures of pediatric care.

A 2006 national survey found that most State Medicaid programs and SCHIP use largely primary care measures for children, which have been developed and selected as part of the measures States use to fulfill requirements for evaluating health plan performance, not provider performance, under the Medicaid program.

The Centers for Medicare & Medicaid Services (CMS), through its administration of the Medicaid program and SCHIP, is the nation's largest payer of health care for children, covering 1 in every 3 children and more than half of all infants in the Nation. However, CMS lacks explicit authority and has not committed resources to invest in the development of quality and performance measures for children commensurate to the magnitude of pediatric care the agency pays for.

Quality and performance measures should be evidence-based, approved for use through a recognized national consensus development process, and appropriate for public reporting, such as evidence-based hospital measures endorsed by the National Quality Forum and recommended for public reporting by the Hospital Quality Alliance on the Hospital Compare tool on the Web site of the Department of Health and Human Services.

Some believe the Federal Government should have both the legal authority and financial resources to invest in the private sector's development and demonstration of measures of quality and performance of health care for children, including pediatric inpatient care. They feel that the Federal Government should utilize such authority and resources to increase the availability of measures for children for use by public and private health coverage programs.

For more information on this bill, visit www.thomas.gov and search for bill S. 1226.

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