,i  #aacth ,,congress  #b;d ,session    
,h4 ,r4 #dfje  ,,in ,,the ,,house ,,of  
,,representatives  ,may #h1 #bjad ,mrs4 
,ellmers 7for herself and ,mr4 ,moran7  
introduced the following bill2 which was
 referred to the ,committee on ,energy  
and ,commerce  ,a ,,bill  ,to amend     
title ,,xix of the ,social ,security    
,act to provide ,states an option to    
cover a children's program of           
all-inclusive coordinated care          
7,chi,p,a,c,c7 under the ,medicaid      
program4  #a4 ,short title ,this ,act   
may be cited as the ,chi,p,a,c,c ,act of
 #bjad4  #b4 ,optional medicaid coverage
 of children's program of all-inclusive 
coordinated care 7,chi,p,a,c,c7  7a7 ,in
 general ,section #aije7;a7 of the      
,social ,security ,act 7#db ,u4,s4,c4   
#acif;d7a77 is amended--  7#a7 by       
striking and at the end of paragraph    
7#bh72  7#b7 by redesignating paragraph 
7#bi7 as paragraph 7#cj72 and  7#c7 by  
inserting after paragraph 7#bh7 the     
following new paragraph3  7#bi7 services

 furnished under a children's program of
 all-inclusive coordinated care         
7,chi,p,a,c,c7 under section #aidd2 and 
4  7b7 ,children's program of           
all-,inclusive coordinated care ,title  
,,xix of such ,act is further amended by
 inserting after section #aidc 7#db     
,u4,s4,c4 #acifw-#c7 the following new  
section3  #aidd4 ,children's program of 
all-inclusive coordinated care  7a7     
,state option  7#a7 ,in general ,a      
,state may elect to provide medical     
assistance under this section to        
,chi,p,a,c,c eligible individuals who   
are eligible for medical assistance     
under the ,state plan under this title  
and who choose to enroll in a children's
 program of all-inclusive coordinated   
care4 ,in the case of an individual who 
chooses to enroll in such a program     
pursuant to such an election--  7,a7 the
 individual shall receive benefits under
 the ,state plan solely through such    
program2 and  7,b7 the health care      
providers furnishing services under such

 program shall receive payment for      
providing such services in accordance   
with the terms of such program4  7#b7   
,numerical and geographical limitations 
permitted ,a ,state may establish--     
7,a7 a numerical limit on the number of 
individuals who may be enrolled in the  
,state's ,chi,p,a,c,c2 and  7,b7        
geographic limitations on the service   
areas for a ,chi,p,a,c,c4  7b7          
,chi,p,a,c,c and other terms defined ,in
 this section3  7#a7 ,children's program
 of all-inclusive coordinated care2     
,chi,p,a,c,c ,the terms children's      
program of all-inclusive coordinated    
care and ,chi,p,a,c,c mean a program of 
coordinated care for ,chi,p,a,c,c       
eligible children that is established by
 a ,state under this section and meets  
the following requirements3  7,a7       
,operation ,the program is administered 
by a single ,state agency4 ,such agency 
may provide for the operation of the    
program through arrangements between one
 or more other entities1 such as a      

,chi,p,a,c,c coordinator 7as defined in 
paragraph 7#c77 and such agency4  7,b7  
,comprehensive benefits  7i7 ,in general
 ,the program provides comprehensive    
health care items and services to       
,chi,p,a,c,c eligible individuals 7as   
defined in paragraph 7#b77 in accordance
 with this section and regulations4     
7ii7 ,scope and plan for services ,such 
items and services shall--  7,i7 include
 items and services described in        
subsection 7c77#a77;,a7 to the extent   
such items and services are appropriate 
for the individual2 and  7,,ii7 be      
provided consistent with a comprehensive
 care plan developed by an              
interdisciplinary health professional   
team 7as defined in paragraph 7#d774    
7iii7 ,qualifications of providers ,such
 items and services are provided through
 health care providers that--  7,i7 meet
 such certification or other quality    
requirements as may be necessary to     
participate in the program of medical   
assistance under this title or in the   

program under title ,,xviii2 and  7,,ii7
 maintain records on ,chi,p,a,c,c       
eligible individuals enrolled in the    
program and to whom the provider        
furnishes services1 reflecting both the 
specific care and services furnished by 
the provider and the relationship of    
those services to the comprehensive plan
 of care for that individual and to the 
delivery of other services to the       
individual through the program4  7#b7   
,chi,p,a,c,c eligible individual ,the   
term ,chi,p,a,c,c eligible individual   
means1 with respect to a ,chi,p,a,c,c1  
an individual--  7,a7 who1 at the time  
of enrollment in the ,chi,p,a,c,c1 is a 
child 7as defined under the ,state plan 
for this purpose7 and who is not older  
than such age as the ,state may specify2
  7,b7 who resides in the service area  
of the ,chi,p,a,c,c2  7,c7 who is       
eligible for medical assistance under   
the ,state plan without regard to this  
section 7or1 but for enrollment in a    
,chi,p,a,c,c would1 based on the        

individual's illness or health condition
 or the projected cost of treatment     
required for such illness or condition1 
become so eligible72  7,d7 who suffers  
from a serious illness or health        
condition2  7,e7 for whom there is a    
reasonable likelihood that the          
individual's life will be threatened by 
such illness or condition2 and  7,f7    
whose health status is expected to      
decline because of such illness or      
condition before attaining full         
adulthood 7as defined under the ,state  
plan74  ,the ,secretary may waive the   
application of subparagraph 7,c7 with   
respect to eligibility for medical      
assistance under the ,state plan without
 regard to this section in the case of  
individuals if the ,state demonstrates  
to the satisfaction of the ,secretary   
that the sum of the additional          
expenditures under this title resulting 
from such waiver in a fiscal year will  
not exceed the aggregate savings in     
expenditures otherwise resulting from   

the implementation of this section in   
the fiscal year4  7#c7 ,chi,p,a,c,c     
coordinator ,the term ,chi,p,a,c,c      
coordinator means1 with respect to a    
,chi,p,a,c,c1 an entity 7which may be   
the ,state administering agency or      
another entity under an arrangement with
 such an agency7 that directs1          
supervises1 and assures the coordination
 of comprehensive services to           
,chi,p,a,c,c eligible individuals       
enrolled in the ,chi,p,a,c,c consistent 
with the following3  7,a7 ,the entity   
must assure the direct and continuous   
involvement of an interdisciplinary     
health professional team in managing and
 coordinating the provision of care and 
services within the coordinator's       
responsibility to each such enrolled    
individual4  7,b7 ,the entity must      
include on its staff1 or otherwise      
arrange for the provision of services1  
through contracts or otherwise1 of each 
of the types of the health care         
professionals and other service         

providers required to provide the items 
and services required under subsection  
7c77#a77;,a74  7#d7 ,interdisciplinary  
health professional team ,the term      
interdisciplinary health professional   
team means1 with respect to a           
,chi,p,a,c,c1 a group of health         
professionals that--  7,a7 includes at  
least--  7i7 one physician 7as defined  
in section #ahfa7r772  7ii7 one         
registered professional nurse2 and      
7iii7 one social worker1 pastoral       
counselor1 or other counselor2  7,b7    
develops a comprehensive plan of care   
for ,chi,p,a,c,c eligible individuals   
enrolled with the ,chi,p,a,c,c and      
furnishes1 or supervises the provision  
of1 care and services described in      
subsection 7c77#a7 to an individual     
enrolled in the ,chi,p,a,c,c2 and  7,c7 
through direct action and communication 
with health care providers furnishing   
services under the ,chi,p,a,c,c1 on     
behalf of or under the direction or     
supervision of a ,state administering   

agency or a ,chi,p,a,c,c coordinator1   
coordinates the care and services       
furnished to such enrollees in a manner 
that takes into account the best        
interests of each such enrollee and the 
enrollee's family4  7#e7 ,state         
administering agency ,the term ,state   
administering agency means1 with respect
 to the operation of a ,chi,p,a,c,c in a
 ,state1 the agency of that ,state      
7which may be the single agency         
responsible for administration of the   
,state plan under this title in the     
,state7 responsible for the             
implementation1 either directly or      
through arrangements with one or more   
,chi,p,a,c,c coordinators1 of the       
,chi,p,a,c,c under this section in the  
,state4  7#f7 ,regulations ,except as   
otherwise provided1 the term regulations
 refers to interim final or final       
regulations promulgated under subsection
 7f74  7c7 ,scope of benefits2          
beneficiary safeguards  7#a7 ,in general
 ,under a ,chi,p,a,c,c of a ,state1 the 

,state administering agency shall assure
 that--  7,a7 an individual enrolled in 
the ,chi,p,a,c,c is covered for1 at a   
minimum--  7i7 all items and services   
that are covered for any individual     
under this title1 and all additional    
items and services specified in         
regulations1 but without any limitation 
or condition as to amount1 duration1 or 
scope2  7ii7 access to covered items and
 services1 as needed1 #bd hours per day1
 every day of the year2 and  7iii7      
services that include comprehensive1    
integrated palliative and curative      
services1 expressive therapy and        
counseling1 and counseling and          
anticipatory bereavement services to    
immediate family members of the         
,chi,p,a,c,c eligible individual1 as    
part of the services to the eligible    
individual2  7,b7 provision of such     
services to such individuals through a  
comprehensive and interdisciplinary     
health and social services delivery     
system which integrates1 as appropriate 

to the individual recipient of services1
 acute and long-term care services1     
palliative1 respite and curative        
treatment1 counseling and support for   
family members who are caretakers or    
otherwise relevant to appropriate care  
and treatment of the individual1 and    
such other services as may be furnished 
pursuant to regulations and the         
provisions of the applicable ,state     
plan2 and  7,c7 the ,chi,p,a,c,c is     
operated1 and the services to enrolled  
individuals are furnished1 in a manner  
that is consistent with ,standards of   
,care and ,practice ,guidelines         
developed by ,children's ,hospice       
,international for a ,program of        
,all-,inclusive ,care for ,children 7as 
in effect as of the date of the         
enactment of this section or such later 
date as the ,secretary may specify74    
7#b7 ,quality assurance2 patient        
safeguards ,with respect to a           
,chi,p,a,c,c1 the ,state administering  
agency shall assure all of the          

following3  7,a7 ,the provision of      
services under the ,chi,p,a,c,c meets   
all applicable ,federal and ,state      
guidelines for quality assurance4  7,b7 
,necessary safeguards have been         
established to protect the health and   
welfare of individuals enrolled in the  
,chi,p,a,c,c under this section4  7,c7  
,there is a written plan of quality     
assurance1 and procedures implementing  
such plan1 in accordance with           
regulations4  7,d7 ,written safeguards  
of the rights of individuals enrolled in
 the ,chi,p,a,c,c1 including a patient  
bill of rights and procedures for       
grievances and appeals1 in accordance   
with regulations and with other         
requirements of this title and ,federal 
and ,state law designed for the         
protection of patients4  7#c7           
,cost-sharing waiver ,a ,state          
administering agency may1 in the case of
 a ,chi,p,a,c,c eligible individual     
enrolled in the ,state's ,chi,p,a,c,c1  
waive deductibles1 copayments1          

coinsurance1 or other cost-sharing that 
would otherwise apply under the ,state  
plan under this title4  7d7 ,eligibility
 determinations  7#a7 ,in general ,in   
determining whether an individual is a  
,chi,p,a,c,c eligible individual1 the   
,state administering agency shall       
conduct an independent evaluation and   
assessment1 which shall include at least
 the following3  7,a7 ,where            
appropriate1 consultation with the      
individual's family1 guardian1 or other 
responsible individual4  7,b7           
,consultation with appropriate treating 
and consulting health and support       
professionals caring for the individual4
  7,c7 ,an examination of the           
individual's relevant history1 medical  
records1 and care and support needs1    
guided by best practices and research on
 effective strategies that result in    
improved health and quality of life     
outcomes4  7#b7 ,certification ,upon    
completion of the evaluation and        
assessment described in paragraph 7#a71 

an individual meeting the criteria of a 
,chi,p,a,c,c eligible individual shall  
be certified as such1 pursuant to       
procedures specified in regulations and 
the applicable ,state plan4  7#c7       
,continuation of eligibility ,an        
individual who is a ,chi,p,a,c,c        
eligible individual may be deemed to    
continue to be such an individual       
notwithstanding a determination that the
 individual no longer meets the         
requirements of subparagraphs 7,d71     
7,e71 and 7,f7 of subsection 7b77#b71   
if1 in accordance with regulations1 it  
is reasonably foreseeable that1 if the  
individual is not furnished services    
under this section1 the severity or     
impact of the individual's illness or   
condition would increase to a degree    
that the individual would again meet    
such requirement before the individual  
attains adulthood or within the         
succeeding #ab-month period4  7#d7      
,enrollment and disenrollment  7,a7     
,voluntary disenrollment at any time    

,the enrollment and disenrollment of    
,chi,p,a,c,c eligible individuals in a  
,chi,p,a,c,c shall be pursuant to       
procedures specified in regulations and 
the ,state plan1 but shall permit an    
enrollee1 or an enrollee's guardian or  
other legal representative1 acting on   
behalf of an enrollee1 to voluntarily   
disenroll for any reason at any time4   
7,b7 ,appeals  7i7 ,upon application ,if
 an individual is determined not to be a
 ,chi,p,a,c,c eligible individual upon  
application1 then the ,state plan under 
this title shall allow for an appeal of 
such determination4 ,during the course  
of such appeal1 the individual shall not
 begin to receive benefits through the  
,chi,p,a,c,c unless and until the appeal
 is resolved favorably for the          
individual4  7ii7 ,subsequently ,if an  
individual is determined not to be a    
,chi,p,a,c,c eligible individual at any 
time after enrollment in a ,chi,p,a,c,c1
 or is otherwise disenrolled from a     
,chi,p,a,c,c1 then the ,state plan under

 this title shall allow for an appeal of
 such determination4 ,during the course 
of such appeal1 the individual shall    
continue to be enrolled in the          
,chi,p,a,c,c and to receive benefits    
through the ,chi,p,a,c,c4  7#e7         
,construction ,the fact that a          
,chi,p,a,c,c eligible individual is     
enrolled under a ,chi,p,a,c,c shall not 
be construed as adversely affecting the 
eligibility of the individual's parents 
or caretaker relatives for medical      
assistance under this title4  7e7       
,payments to health care providers under
 ,chi,p,a,c,c  7#a7 ,in general         
,payments to health care providers      
furnishing items and services under a   
,chi,p,a,c,c shall be paid on a         
capitated or fee-for-service basis1     
according to regulations and as         
specified in the applicable ,state plan 
consistent with this subsection4  7#b7  
,use of integrated1 budget-neutral      
financing ,payments under this          
subsection shall be made in amounts that

 are designed1 according to regulations1
 to ensure that aggregate payments under
 this section for individuals enrolled  
in a ,chi,p,a,c,c1 whether made on a    
capitated basis or fee-for-service      
basis1 do not exceed on average the     
aggregate payments that would have been 
paid under the ,state plan for such     
individuals if they were not so         
enrolled1 taking into account the       
comparative case mix of ,chi,p,a,c,c    
enrollees and such other factors as the 
,secretary determines to be appropriate4
  7f7 ,regulations  7#a7 ,in general    
,the ,secretary shall issue such        
regulations1 including interim final    
regulations1 as may be necessary to     
carry out this section4  7#b7           
,continuation of modifications or       
waivers operational requirements ,if a  
,state agency administering a program of
 all-inclusive coordinated care for     
seriously ill children approved pursuant
 to waiver authority under section #aaae
 or #aiae7;c7 has contractual or other  

operating arrangements relating to such 
program which are not otherwise         
recognized in regulation and which were 
in effect as of the date of the         
enactment of this section1 the          
,secretary shall permit the agency to   
continue such arrangements so long as   
such arrangements are found by the      
,secretary to be reasonably consistent  
with the objectives of a ,chi,p,a,c,c4  
7#c7 ,construction ,nothing in this     
subsection shall be construed as        
preventing the ,secretary from including
 in regulations provisions to ensure the
 health and safety of individuals       
enrolled in a ,chi,p,a,c,c under this   
section that are in addition to those   
otherwise provided under this section4  
7g7 ,applicability of requirements ,with
 respect to carrying out a ,chi,p,a,c,c 
under this section1 the following       
requirements of this title 7and         
regulations relating to such            
requirements7 shall not apply3  7#a7    
,section #aijb7;a77#a71 relating to any 

requirement that ,chi,p,a,c,cs or       
,chi,p,a,c,c services be provided in all
 areas of a ,state4  7#b7 ,section      
#aijb7;a77#aj71 insofar as such section 
relates to comparability of services    
among different population groups4  7#c7
 ,sections #aijb7;a77#bc7 and           
#aiae7;b77#d71 relating to freedom of   
choice of providers under a             
,chi,p,a,c,c4  7#d7 ,section            
#aijc7m77#b77;,a71 insofar as it        
restricts a ,chi,p,a,c,c provider from  
receiving prepaid capitation payments4  
7#e7 ,section #aije7o71 limiting the    
scope of hospice care4  7#f7 ,such other
 provisions of this title that the      
,secretary determines are inapplicable  
to carrying out a ,chi,p,a,c,c under    
this section4  4  7c7 ,continued        
demonstration project authority ,section
 #aidd of the ,social ,security ,act1 as
 added by subsection 7b71 shall not be  
construed as preventing a ,state from   
developing1 or the ,secretary of ,health
 and ,human ,services from approving1 a 

project similar to or related to        
,chi,p,a,c,cs 7as described in such     
section7 under existing authorities1    
including demonstration project and     
waiver authorities under title ,,xix of 
such ,act or other provisions of such   
,act4  7d7 ,other conforming amendments 
,section #aije7r77#e7 of such ,act 7#db 
,u4,s4,c4 #acif;d7r77#e77 is amended by 
inserting before the period at the end  
the following3 1 other than items and   
services that are only covered as       
section #aidd ,chi,p,a,c,c benefits4    
7e7 ,timely issuance of regulations2    
effective date ,the ,secretary of       
,health and ,human ,services shall      
promulgate regulations to carry out the 
amendments made by this section in a    
timely manner1 so as to assure that it  
will be feasible for ,state agencies and
 entities to establish and operate      
,chi,p,a,c,cs for periods beginning not 
later than #a year after the date of the
 enactment of this ,act4  7f7 ,funds for
 technical assistance ,the ,secretary is

 authorized to expend funds appropriated
 to carry out title ,,xix of the ,social
 ,security ,act to make grants to1 or   
enter into contracts with1 private      
entities or organizations that are      
qualified to provide technical or other 
assistance in developing and            
establishing ,chi,p,a,c,cs within the   
,states1 except that--  7#a7 such funds 
may be expended solely for the purposes 
of implementing this section2 and  7#b7 
a private entity or organization in     
receipt of such funds must have         
demonstrated expertise and a minimum of 
#e years of experience in working with  
or assisting in the establishment of    
programs for comprehensive care of      
children meeting the description of     
,chi,p,a,c,c eligible individuals under 
section #aidd7;b7 of the ,social        
,security ,act1 as added by subsection  
7b74