,i  #aac? ,,congress  #b;d ,session  ,h4
 ,r4 #dfje  ,,9 ,,! ,,h\se ,,(          
,,repres5tatives  ,may #h1 #bjad ,mrs4  
,ellm]s 7= h]self & ,mr4 ,moran7        
introduc$ ! foll[+ bill2 :i* 0 ref]r$ to
 ! ,committee on ,en]gy & ,comm]ce  ,a  
,,bill  ,to am5d title ,,xix ( ! ,social
 ,security ,act to provide ,/ates an    
option to cov] a *ildr5's program (     
all-inclusive coord9at$ c>e             
7,chi,p,a,c,c7 "u ! ,m$icaid program4   
#a4 ,%ort title ,?is ,act may be cit$ z 
! ,chi,p,a,c,c ,act ( #bjad4  #b4       
,optional m$icaid cov]age ( *ildr5's    
program ( all-inclusive coord9at$ c>e   
7,chi,p,a,c,c7  7a7 ,9 g5]al ,section   
#aije7;a7 ( ! ,social ,security ,act    
7#db ,u4,s4,c4 #acif;d7a77 is am5d$--   
7#a7 by /rik+ & at ! end ( p>agraph     
7#bh72  7#b7 by r$esignat+ p>agraph     
7#bi7 z p>agraph 7#cj72 &  7#c7 by      
ins]t+ aft] p>agraph 7#bh7 ! foll[+ new 
p>agraph3  7#bi7 s]vices furni%$ "u a   
*ildr5's program ( all-inclusive        
coord9at$ c>e 7,chi,p,a,c,c7 "u section 

#aidd2 &  4  7b7 ,*ildr5's program (    
all-,inclusive coord9at$ c>e ,title     
,,xix ( su* ,act is fur!r am5d$ by      
ins]t+ aft] section #aidc 7#db ,u4,s4,c4
 #acifw-#c7 ! foll[+ new section3       
#aidd4 ,*ildr5's program ( all-inclusive
 coord9at$ c>e  7a7 ,/ate option  7#a7  
,9 g5]al ,a ,/ate may elect to provide  
m$ical assi/ance "u ?is section to      
,chi,p,a,c,c eligible individuals :o are
 eligible = m$ical assi/ance "u ! ,/ate 
plan "u ?is title & :o *oose to enroll 9
 a *ildr5's program ( all-inclusive     
coord9at$ c>e4 ,9 ! case ( an individual
 :o *ooses to enroll 9 su* a program    
pursuant to su* an election--  7,a7 !   
individual %all receive b5efits "u !    
,/ate plan solely ?r\gh su* program2 &  
7,b7 ! heal? c>e provid]s furni%+       
s]vices "u su* program %all receive     
paym5t = provid+ su* s]vices 9          
accordance ) ! t]ms ( su* program4  7#b7
 ,num]ical & geographical limitations   
p]mitt$ ,a ,/ate may e/abli%--  7,a7 a  
num]ical limit on ! numb] ( individuals 

:o may be enroll$ 9 ! ,/ate's           
,chi,p,a,c,c2 &  7,b7 geographic        
limitations on ! s]vice areas = a       
,chi,p,a,c,c4  7b7 ,chi,p,a,c,c & o!r   
t]ms def9$ ,9 ?is section3  7#a7        
,*ildr5's program ( all-inclusive       
coord9at$ c>e2 ,chi,p,a,c,c ,! t]ms     
*ildr5's program ( all-inclusive        
coord9at$ c>e & ,chi,p,a,c,c mean a     
program ( coord9at$ c>e = ,chi,p,a,c,c  
eligible *ildr5 t is e/abli%$ by a ,/ate
 "u ?is section & meets ! foll[+        
requirem5ts3  7,a7 ,op]ation ,! program 
is adm9i/]$ by a s+le ,/ate ag5cy4 ,su* 
ag5cy may provide = ! op]ation ( !      
program ?r\gh arrangem5ts betwe5 "o or m
 o!r entities1 su* z a ,chi,p,a,c,c     
coord9ator 7z def9$ 9 p>agraph 7#c77 &  
su* ag5cy4  7,b7 ,compreh5sive b5efits  
7i7 ,9 g5]al ,! program provides        
compreh5sive heal? c>e items & s]vices  
to ,chi,p,a,c,c eligible individuals 7z 
def9$ 9 p>agraph 7#b77 9 accordance )   
?is section & regulations4  7ii7 ,scope 
& plan = s]vices ,su* items & s]vices   

%all--  7,i7 include items & s]vices    
describ$ 9 subsection 7c77#a77;,a7 to ! 
ext5t su* items & s]vices are           
appropriate = ! individual2 &  7,,ii7 be
 provid$ consi/5t ) a compreh5sive c>e  
plan develop$ by an int]discipl9>y heal?
 pr(essional team 7z def9$ 9 p>agraph   
7#d774  7iii7 ,qualifications ( provid]s
 ,su* items & s]vices are provid$ ?r\gh 
heal? c>e provid]s t--  7,i7 meet su*   
c]tification or o!r quality requirem5ts 
z may be necess>y to p>ticipate 9 !     
program ( m$ical assi/ance "u ?is title 
or 9 ! program "u title ,,xviii2 &      
7,,ii7 ma9ta9 records on ,chi,p,a,c,c   
eligible individuals enroll$ 9 ! program
 & to :om ! provid] furni%es s]vices1   
reflect+ bo? ! specific c>e & s]vices   
furni%$ by ! provid] & ! relation%ip (  
^? s]vices to ! compreh5sive plan ( c>e 
= t individual & to ! deliv]y ( o!r     
s]vices to ! individual ?r\gh ! program4
  7#b7 ,chi,p,a,c,c eligible individual 
,! t]m ,chi,p,a,c,c eligible individual 
means1 ) respect to a ,chi,p,a,c,c1 an  

individual--  7,a7 :o1 at ! "t (        
enrollm5t 9 ! ,chi,p,a,c,c1 is a *ild 7z
 def9$ "u ! ,/ate plan = ?is purpose7 & 
:o is n old] ?an su* age z ! ,/ate may  
specify2  7,b7 :o resides 9 ! s]vice    
area ( ! ,chi,p,a,c,c2  7,c7 :o is      
eligible = m$ical assi/ance "u ! ,/ate  
plan )\t reg>d to ?is section 7or1 b =  
enrollm5t 9 a ,chi,p,a,c,c w\ld1 bas$ on
 ! individual's illness or heal?        
condition or ! project$ co/ ( treatm5t  
requir$ = su* illness or condition1     
become s eligible72  7,d7 :o suff]s f a 
s]i\s illness or heal? condition2  7,e7 
= :om !re is a reasonable likelihood t !
 individual's life w be ?reat5$ by su*  
illness or condition2 &  7,f7 ^: heal?  
/atus is expect$ to decl9e because ( su*
 illness or condition be=e atta9+ full  
adul?ood 7z def9$ "u ! ,/ate plan74  ,! 
,secret>y may waive ! application (     
subp>agraph 7,c7 ) respect to           
eligibility = m$ical assi/ance "u !     
,/ate plan )\t reg>d to ?is section 9 ! 
case ( individuals if ! ,/ate           

demon/rates to ! satisfaction ( !       
,secret>y t ! sum ( ! additional        
exp5ditures "u ?is title result+ f su*  
waiv] 9 a fiscal ye> w n exce$ !        
aggregate sav+s 9 exp5ditures o!rwise   
result+ f ! implem5tation ( ?is section 
9 ! fiscal ye>4  7#c7 ,chi,p,a,c,c      
coord9ator ,! t]m ,chi,p,a,c,c          
coord9ator means1 ) respect to a        
,chi,p,a,c,c1 an entity 7:i* may be !   
,/ate adm9i/]+ ag5cy or ano!r entity "u 
an arrangem5t ) su* an ag5cy7 t directs1
 sup]vises1 & assures ! coord9ation (   
compreh5sive s]vices to ,chi,p,a,c,c    
eligible individuals enroll$ 9 !        
,chi,p,a,c,c consi/5t ) ! foll[+3  7,a7 
,! entity mu/ assure ! direct & cont9u\s
 involvem5t ( an int]discipl9>y heal?   
pr(essional team 9 manag+ & coord9at+ ! 
provision ( c>e & s]vices )9 !          
coord9ator's responsibility to ea* su*  
enroll$ individual4  7,b7 ,! entity mu/ 
include on its /aff1 or o!rwise arrange 
= ! provision ( s]vices1 ?r\gh contracts
 or o!rwise1 ( ea* ( ! types ( ! heal?  

c>e pr(essionals & o!r s]vice provid]s  
requir$ to provide ! items & s]vices    
requir$ "u subsection 7c77#a77;,a74     
7#d7 ,int]discipl9>y heal? pr(essional  
team ,! t]m int]discipl9>y heal?        
pr(essional team means1 ) respect to a  
,chi,p,a,c,c1 a gr\p ( heal?            
pr(essionals t--  7,a7 includes at      
lea/--  7i7 "o physician 7z def9$ 9     
section #ahfa7r772  7ii7 "o regi/]$     
pr(essional nurse2 &  7iii7 "o social   
work]1 pa/oral c\nselor1 or o!r         
c\nselor2  7,b7 develops a compreh5sive 
plan ( c>e = ,chi,p,a,c,c eligible      
individuals enroll$ ) ! ,chi,p,a,c,c &  
furni%es1 or sup]vises ! provision (1   
c>e & s]vices describ$ 9 subsection     
7c77#a7 to an individual enroll$ 9 !    
,chi,p,a,c,c2 &  7,c7 ?r\gh direct      
action & communication ) heal? c>e      
provid]s furni%+ s]vices "u !           
,chi,p,a,c,c1 on behalf ( or "u !       
direction or sup]vision ( a ,/ate       
adm9i/]+ ag5cy or a ,chi,p,a,c,c        
coord9ator1 coord9ates ! c>e & s]vices  

furni%$ to su* enrollees 9 a mann] t    
takes into acc\nt ! be/ int]e/s ( ea*   
su* enrollee & ! enrollee's family4     
7#e7 ,/ate adm9i/]+ ag5cy ,! t]m ,/ate  
adm9i/]+ ag5cy means1 ) respect to !    
op]ation ( a ,chi,p,a,c,c 9 a ,/ate1 !  
ag5cy ( t ,/ate 7:i* may be ! s+le ag5cy
 responsible = adm9i/ration ( ! ,/ate   
plan "u ?is title 9 ! ,/ate7 responsible
 = ! implem5tation1 ei!r directly or    
?r\gh arrangem5ts ) "o or m ,chi,p,a,c,c
 coord9ators1 ( ! ,chi,p,a,c,c "u ?is   
section 9 ! ,/ate4  7#f7 ,regulations   
,except z o!rwise provid$1 ! t]m        
regulations ref]s to int]im f9al or f9al
 regulations promulgat$ "u subsection   
7f74  7c7 ,scope ( b5efits2 b5efici>y   
safegu>ds  7#a7 ,9 g5]al ,"u a          
,chi,p,a,c,c ( a ,/ate1 ! ,/ate adm9i/]+
 ag5cy %all assure t--  7,a7 an         
individual enroll$ 9 ! ,chi,p,a,c,c is  
cov]$ =1 at a m9imum--  7i7 all items & 
s]vices t are cov]$ = any individual "u 
?is title1 & all additional items &     
s]vices specifi$ 9 regulations1 b )\t   

any limitation or condition z to am\nt1 
duration1 or scope2  7ii7 access to     
cov]$ items & s]vices1 z ne$$1 #bd h\rs 
p] day1 e day ( ! ye>2 &  7iii7 s]vices 
t include compreh5sive1 integrat$       
palliative & curative s]vices1          
expressive !rapy & c\nsel+1 & c\nsel+ & 
anticipatory b]eavem5t s]vices to       
imm$iate family memb]s ( ! ,chi,p,a,c,c 
eligible individual1 z "p ( ! s]vices to
 ! eligible individual2  7,b7 provision 
( su* s]vices to su* individuals ?r\gh a
 compreh5sive & int]discipl9>y heal? &  
social s]vices deliv]y sy/em :i*        
integrates1 z appropriate to !          
individual recipi5t ( s]vices1 acute &  
long-t]m c>e s]vices1 palliative1       
respite & curative treatm5t1 c\nsel+ &  
support = family memb]s :o are c>etak]s 
or o!rwise relevant to appropriate c>e &
 treatm5t ( ! individual1 & su* o!r     
s]vices z may be furni%$ pursuant to    
regulations & ! provisions ( !          
applicable ,/ate plan2 &  7,c7 !        
,chi,p,a,c,c is op]at$1 & ! s]vices to  

enroll$ individuals are furni%$1 9 a    
mann] t is consi/5t ) ,/&>ds ( ,c>e &   
,practice ,guidel9es develop$ by        
,*ildr5's ,hospice ,int]national = a    
,program ( ,all-,inclusive ,c>e =       
,*ildr5 7z 9 effect z ( ! date ( !      
enactm5t ( ?is section or su* lat] date 
z ! ,secret>y may specify74  7#b7       
,quality assurance2 pati5t safegu>ds ,) 
respect to a ,chi,p,a,c,c1 ! ,/ate      
adm9i/]+ ag5cy %all assure all ( !      
foll[+3  7,a7 ,! provision ( s]vices "u 
! ,chi,p,a,c,c meets all applicable     
,f$]al & ,/ate guidel9es = quality      
assurance4  7,b7 ,necess>y safegu>ds h  
be5 e/abli%$ to protect ! heal? & welf>e
 ( individuals enroll$ 9 ! ,chi,p,a,c,c 
"u ?is section4  7,c7 ,!re is a writt5  
plan ( quality assurance1 & proc$ures   
implem5t+ su* plan1 9 accordance )      
regulations4  7,d7 ,writt5 safegu>ds ( !
 rights ( individuals enroll$ 9 !       
,chi,p,a,c,c1 includ+ a pati5t bill (   
rights & proc$ures = grievances &       
appeals1 9 accordance ) regulations & ) 

o!r requirem5ts ( ?is title & ,f$]al &  
,/ate law design$ = ! protection (      
pati5ts4  7#c7 ,co/-%>+ waiv] ,a ,/ate  
adm9i/]+ ag5cy may1 9 ! case ( a        
,chi,p,a,c,c eligible individual enroll$
 9 ! ,/ate's ,chi,p,a,c,c1 waive        
d$uctibles1 copaym5ts1 co9surance1 or   
o!r co/-%>+ t w\ld o!rwise apply "u !   
,/ate plan "u ?is title4  7d7           
,eligibility det]m9ations  7#a7 ,9 g5]al
 ,9 det]m9+ :e!r an individual is a     
,chi,p,a,c,c eligible individual1 !     
,/ate adm9i/]+ ag5cy %all conduct an    
indep5d5t evaluation & assessm5t1 :i*   
%all include at lea/ ! foll[+3  7,a7    
,:]e appropriate1 consultation ) !      
individual's family1 gu>dian1 or o!r    
responsible individual4  7,b7           
,consultation ) appropriate treat+ &    
consult+ heal? & support pr(essionals   
c>+ = ! individual4  7,c7 ,an exam9ation
 ( ! individual's relevant hi/ory1      
m$ical records1 & c>e & support ne$s1   
guid$ by be/ practices & rese>* on      
effective /rategies t result 9 improv$  

heal? & quality ( life outcomes4  7#b7  
,c]tification ,^u completion ( !        
evaluation & assessm5t describ$ 9       
p>agraph 7#a71 an individual meet+ !    
crit]ia ( a ,chi,p,a,c,c eligible       
individual %all be c]tifi$ z su*1       
pursuant to proc$ures specifi$ 9        
regulations & ! applicable ,/ate plan4  
7#c7 ,cont9uation ( eligibility ,an     
individual :o is a ,chi,p,a,c,c eligible
 individual may be deem$ to cont9ue to  
be su* an individual not)/&+ a          
det]m9ation t ! individual no long]     
meets ! requirem5ts ( subp>agraphs 7,d71
 7,e71 & 7,f7 ( subsection 7b77#b71 if1 
9 accordance ) regulations1 x is        
reasonably =eseeable t1 if ! individual 
is n furni%$ s]vices "u ?is section1 !  
sev]ity or impact ( ! individual's      
illness or condition w\ld increase to a 
degree t ! individual w\ld aga9 meet su*
 requirem5t be=e ! individual atta9s    
adul?ood or )9 ! succe$+ #ab-mon? p]iod4
  7#d7 ,enrollm5t & dis5rollm5t  7,a7   
,volunt>y dis5rollm5t at any "t ,!      

enrollm5t & dis5rollm5t ( ,chi,p,a,c,c  
eligible individuals 9 a ,chi,p,a,c,c   
%all be pursuant to proc$ures specifi$ 9
 regulations & ! ,/ate plan1 b %all     
p]mit an enrollee1 or an enrollee's     
gu>dian or o!r legal repres5tative1 act+
 on behalf ( an enrollee1 to volunt>ily 
dis5roll = any reason at any "t4  7,b7  
,appeals  7i7 ,^u application ,if an    
individual is det]m9$ n to be a         
,chi,p,a,c,c eligible individual ^u     
application1 !n ! ,/ate plan "u ?is     
title %all all[ = an appeal ( su*       
det]m9ation4 ,dur+ ! c\rse ( su* appeal1
 ! individual %all n beg9 to receive    
b5efits ?r\gh ! ,chi,p,a,c,c unless &   
until ! appeal is resolv$ favorably = ! 
individual4  7ii7 ,subsequ5tly ,if an   
individual is det]m9$ n to be a         
,chi,p,a,c,c eligible individual at any 
"t aft] enrollm5t 9 a ,chi,p,a,c,c1 or  
is o!rwise dis5roll$ f a ,chi,p,a,c,c1  
!n ! ,/ate plan "u ?is title %all all[ =
 an appeal ( su* det]m9ation4 ,dur+ !   
c\rse ( su* appeal1 ! individual %all   

cont9ue to be enroll$ 9 ! ,chi,p,a,c,c &
 to receive b5efits ?r\gh !             
,chi,p,a,c,c4  7#e7 ,con/ruction ,! fact
 t a ,chi,p,a,c,c eligible individual is
 enroll$ "u a ,chi,p,a,c,c %all n be    
con/ru$ z adv]sely affect+ ! eligibility
 ( ! individual's p>5ts or c>etak]      
relatives = m$ical assi/ance "u ?is     
title4  7e7 ,paym5ts to heal? c>e       
provid]s "u ,chi,p,a,c,c  7#a7 ,9 g5]al 
,paym5ts to heal? c>e provid]s furni%+  
items & s]vices "u a ,chi,p,a,c,c %all  
be paid on a capitat$ or fee-=-s]vice   
basis1 accord+ to regulations & z       
specifi$ 9 ! applicable ,/ate plan      
consi/5t ) ?is subsection4  7#b7 ,use ( 
integrat$1 budget-neutral f9anc+        
,paym5ts "u ?is subsection %all be made 
9 am\nts t are design$1 accord+ to      
regulations1 to ensure t aggregate      
paym5ts "u ?is section = individuals    
enroll$ 9 a ,chi,p,a,c,c1 :e!r made on a
 capitat$ basis or fee-=-s]vice basis1 d
 n exce$ on av]age ! aggregate paym5ts t
 w\ld h be5 paid "u ! ,/ate plan = su*  

individuals if !y 7 n s enroll$1 tak+   
into acc\nt ! comp>ative case mix (     
,chi,p,a,c,c enrollees & su* o!r factors
 z ! ,secret>y det]m9es to be           
appropriate4  7f7 ,regulations  7#a7 ,9 
g5]al ,! ,secret>y %all issue su*       
regulations1 includ+ int]im f9al        
regulations1 z may be necess>y to c>ry  
out ?is section4  7#b7 ,cont9uation (   
modifications or waiv]s op]ational      
requirem5ts ,if a ,/ate ag5cy adm9i/]+ a
 program ( all-inclusive coord9at$ c>e =
 s]i\sly ill *ildr5 approv$ pursuant to 
waiv] au?ority "u section #aaae or      
#aiae7;c7 has contractual or o!r op]at+ 
arrangem5ts relat+ to su* program :i*   
are n o!rwise recogniz$ 9 regulation &  
:i* 7 9 effect z ( ! date ( ! enactm5t (
 ?is section1 ! ,secret>y %all p]mit !  
ag5cy to cont9ue su* arrangem5ts s long 
z su* arrangem5ts are f\nd by !         
,secret>y to be reasonably consi/5t ) ! 
objectives ( a ,chi,p,a,c,c4  7#c7      
,con/ruction ,no?+ 9 ?is subsection %all
 be con/ru$ z prev5t+ ! ,secret>y f     

includ+ 9 regulations provisions to     
ensure ! heal? & safety ( individuals   
enroll$ 9 a ,chi,p,a,c,c "u ?is section 
t are 9 addition to ^? o!rwise provid$  
"u ?is section4  7g7 ,applicability (   
requirem5ts ,) respect to c>ry+ out a   
,chi,p,a,c,c "u ?is section1 ! foll[+   
requirem5ts ( ?is title 7& regulations  
relat+ to su* requirem5ts7 %all n apply3
  7#a7 ,section #aijb7;a77#a71 relat+ to
 any requirem5t t ,chi,p,a,c,cs or      
,chi,p,a,c,c s]vices be provid$ 9 all   
areas ( a ,/ate4  7#b7 ,section         
#aijb7;a77#aj71 ins(> z su* section     
relates to comp>ability ( s]vices among 
diff]5t population gr\ps4  7#c7         
,sections #aijb7;a77#bc7 &              
#aiae7;b77#d71 relat+ to fre$om ( *oice 
( provid]s "u a ,chi,p,a,c,c4  7#d7     
,section #aijc7m77#b77;,a71 ins(> z x   
re/ricts a ,chi,p,a,c,c provid] f       
receiv+ prepaid capitation paym5ts4     
7#e7 ,section #aije7o71 limit+ ! scope (
 hospice c>e4  7#f7 ,su* o!r provisions 
( ?is title t ! ,secret>y det]m9es are  

inapplicable to c>ry+ out a ,chi,p,a,c,c
 "u ?is section4  4  7c7 ,cont9u$       
demon/ration project au?ority ,section  
#aidd ( ! ,social ,security ,act1 z add$
 by subsection 7b71 %all n be con/ru$ z 
prev5t+ a ,/ate f develop+1 or !        
,secret>y ( ,heal? & ,human ,s]vices f  
approv+1 a project simil> to or relat$  
to ,chi,p,a,c,cs 7z describ$ 9 su*      
section7 "u exi/+ au?orities1 includ+   
demon/ration project & waiv] au?orities 
"u title ,,xix ( su* ,act or o!r        
provisions ( su* ,act4  7d7 ,o!r con=m+ 
am5dm5ts ,section #aije7r77#e7 ( su*    
,act 7#db ,u4,s4,c4 #acif;d7r77#e77 is  
am5d$ by ins]t+ be=e ! p]iod at ! end ! 
foll[+3 1 o!r ?an items & s]vices t are 
only cov]$ z section #aidd ,chi,p,a,c,c 
b5efits4  7e7 ,timely issuance (        
regulations2 effective date ,! ,secret>y
 ( ,heal? & ,human ,s]vices %all        
promulgate regulations to c>ry out !    
am5dm5ts made by ?is section 9 a timely 
mann]1 s z to assure t x w be feasible =
 ,/ate ag5cies & entities to e/abli% &  

op]ate ,chi,p,a,c,cs = p]iods beg9n+ n  
lat] ?an #a ye> aft] ! date ( ! enactm5t
 ( ?is ,act4  7f7 ,funds = te*nical     
assi/ance ,! ,secret>y is au?oriz$ to   
exp5d funds appropriat$ to c>ry out     
title ,,xix ( ! ,social ,security ,act  
to make grants to1 or ent] into         
contracts )1 private entities or        
organizations t are qualifi$ to provide 
te*nical or o!r assi/ance 9 develop+ &  
e/abli%+ ,chi,p,a,c,cs )9 ! ,/ates1     
except t--  7#a7 su* funds may be exp5d$
 solely = ! purposes ( implem5t+ ?is    
section2 &  7#b7 a private entity or    
organization 9 receipt ( su* funds mu/ h
 demon/rat$ exp]tise & a m9imum ( #e    
ye>s ( exp]i5ce 9 work+ ) or assi/+ 9 ! 
e/abli%m5t ( programs = compreh5sive c>e
 ( *ildr5 meet+ ! description (         
,chi,p,a,c,c eligible individuals "u    
section #aidd7;b7 ( ! ,social ,security 
,act1 z add$ by subsection 7b74