,i  #aac? ,,congress  #b;d ,session  ,h4
 ,r4 #dicj  ,,9 ,,! ,,h\se ,,(          
,,repres5tatives  ,june #bj1 #bjad ,mr4 
,b>ton 7= himself1 ,ms4 ,ca/or (        
,florida1 ,ms4 ,h]r]a ,beutl]1 ,mr4 ,g5e
 ,gre5 ( ,texas1 & ,ms4 ,e%oo7 introduc$
 ! foll[+ bill2 :i* 0 ref]r$ to !       
,committee on ,en]gy & ,comm]ce  ,a     
,,bill  ,to am5d titles ,,xix & ,,xxi ( 
! ,social ,security ,act to provide     
,/ates ) ! option ( provid+ s]vices to  
*ildr5 ) m$ically complex conditions "u 
! ,m$icaid program & ,*ildr5's ,heal?   
,insurance ,program ?r\gh a c>e         
coord9ation program focus$ on improv+   
heal? outcomes = *ildr5 ) m$ically      
complex conditions & l[]+ co/s1 & = o!r 
purposes4  #a4 ,%ort title ,?is ,act may
 be cit$ z ! ,advanc+ ,c>e =            
,exceptional ,kids ,act ( #bjad or !    
,,ace ,kids ,act ( #bjad4  #b4 ,f9d+s   
,congress f9ds ! foll[+3  7#a7          
,approximately #c1jjj1jjj *ildr5 9 !    
,unit$ ,/ates suff] f m$ically complex  
conditions & approximately #b1jjj1jjj ( 

su* *ildr5 are enroll$ 9 ,/ate plans "u 
! ,m$icaid program "u title ,,xix ( !   
,social ,security ,act4  7#b7 ,su*      
*ildr5 acc\nt = an e/imat$ #f p]c5t (   
,m$icaid enrollees & approximately #dj  
p]c5t ( *ildr5's ,m$icaid sp5d+ is due  
to ! sev]ity ( ! illnesses ( su* *ildr54
  7#c7 ,! creation ( nationally         
designat$ *ildr5's hospital networks    
focus$ ^u bett] coord9ation &           
integration ( c>e = su* p$iatric        
population w result 9 improv$ heal?     
outcomes & sav+s "u ! ,m$icaid program &
 ! ,*ildr5's ,heal? ,insurance ,program 
"u title ,,xxi ( ! ,social ,security    
,act4  #c4 ,e/abli%m5t ( ,m$icaid &     
,,*ip ,c>e ,coord9ation program = *ildr5
 ) m$ically complex conditions z        
,m$icaid ,/ate option  7a7 ,m$icaid     
,title ,,xix ( ! ,social ,security ,act 
7#db ,u4,s4,c4 #acif et seq47 is am5d$--
  7#a7 9 section #aije7;a7 7#db         
,u4,s4,c4 #acif;d7a77--  7,a7 by /rik+ &
 at ! end ( p>agraph 7#bg72  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     
items & s]vices furni%$ "u an ,,mccc    
program "u section #aidg to eligible    
*ildr5 enroll$ 9 an ,,mccc program "u   
su* section4  2 &  7#b7 by add+ at ! end
 ! foll[+ new section3  #aidg4 ,m$icaid 
,*ildr5's ,c>e ,coord9ation programs =  
*ildr5 ) complex m$ical conditions  7a7 
,e/abli%m5t  7#a7 ,9 g5]al ,beg9n+      
,janu>y #a1 #bjae1 a ,/ate1 at its      
option z a ,/ate plan am5dm5t1 may elect
 to provide m$ical assi/ance = items &  
s]vices furni%$ to eligible *ildr5      
enroll$ 9 an ,,mccc program t meets !   
requirem5ts ( ?is section4 ,z a         
condition on an eligible *ild's receipt 
( m$ical assi/ance "u ?is title1 ! ,/ate
 %all require1 "u su* an am5dm5t1 t !   
eligible *ild be enroll$ 9 an ,,mccc    
program t meets ! requirem5ts ( ?is     
section4  7b7 ,,mccc program requirem5ts
 ,an ,,mccc program meets ! requirem5ts 
( ?is section if ! ,,mccc program--     
7#a7 coord9ates1 integrates1 & provides 

= ! furni%+ ( ! full range ( ,,mccc     
program s]vices to eligible *ildr5      
enroll$ 9 ! program2  7#b7 enrolls      
eligible *ildr5 9 accordance )          
subsection 7c72  7#c7 is op]at+ "u a    
program agreem5t t meets ! requirem5ts (
 subsection 7d72 &  7#d7 meets !        
p$iatric network adequacy /&>ds develop$
 "u subsection 7e74  7c7 ,eligibility   
det]m9ations2 assignm5t  7#a7 ,enrollm5t
 ,subject to ! assignm5t requirem5ts (  
p>agraph 7#b71 ! enrollm5t & dis5rollm5t
 ( eligible *ildr5 9 an ,,mccc program  
%all be c>ri$ out 9 accordance )        
regulations issu$ by ! ,secret>y & !    
applicable program agreem5t4  7#b7      
,network assignm5t  7,a7 ,9 g5]al       
,eligible *ildr5 %all be prospectively  
enroll$ 9 an ,,mccc program by initially
 assign+ su* eligible *ildr5 to a       
nationally designat$ *ildr5's hospital  
network = a p]iod ( n less ?an #ij days 
beg9n+ on ! date on :i* ! *ild is       
initially assign$ to su* hospital       
network4  7,b7 ,basis = initial         

assignm5t ,su* an assignm5t %all be bas$
 ^u any ( ! foll[+ factors 7or a        
comb9ation !re(73  7i7 ,! preval5ce (   
visits by ! *ild to a p$iatrician or o!r
 speciali/ :o is p>ticipat+ 9 !         
nationally designat$ *ildr5's hospital  
network4  7ii7 ,! selection ( ! *ild's  
family4  7iii7 ,! location ( ! prim>y   
resid5ce ( ! *ild4  7iv7 ,! proximity ( 
! *ild to regional ref]ral networks     
e/abli%$ by ! nationally designat$      
*ildr5's hospital network4  7,c7        
,limitation on c]ta9 assignm5ts ,an     
assignm5t ( a *ild "u clause 7iii7 or   
7iv7 ( subp>agraph 7,b7 may only be made
 9 ! case ( a nationally designat$      
*ildr5's hospital network t (f]s m$ical 
home access )9 #cj miles ( ! prim>y     
resid5ce ( ! *ild4  7,d7 ,reassignm5t   
,foll[+ ! #ij-;day p]iod ref]r$ to 9    
subp>agraph 7,a71 ! *ild may elect--    
7i7 to be assign$ to ! nationally       
designat$ *ildr5's hospital network ( _!
 *oice t has an ,,mccc program agreem5t 
9 effect ) respect to an ,,mccc program 

9 :i* ! *ild is eligible to enroll2 or  
7ii7 to n p>ticipate 9 any ,,mccc       
program & receive c>e ?r\gh enrollm5t 9 
! ,/ate plan "u ?is title or ! ,/ate    
*ild heal? plan "u title ,,xxi4  7d7    
,program agreem5ts  7#a7 ,9 g5]al ,!    
,secret>y1 9 close coop]ation ) ! ,/ate 
adm9i/]+ ag5cies elect+ to provide !    
m$ical assi/ance describ$ 9 subsection  
7a71 %all e/abli% proc$ures = ent]+     
into1 ext5d+1 & t]m9at+ program         
agreem5ts "u ?is section4  7#b7 ,t]ms   
7,a7 ,9 g5]al ,a program agreem5t ent]$ 
into "u ?is section by ! ,secret>y1 a   
,/ate adm9i/]+ ag5cy1 & a nationally    
designat$ *ildr5's hospital network %all
 provide = ea* ( ! foll[+ t]ms3  7i7 ,! 
agreem5t %all designate ! s]vice area ( 
! ,,mccc program t is ! subject ( !     
agreem5t4  7ii7 ,! agreem5t %all be     
effective = a contract ye>1 b may be    
ext5d$ = additional contract ye>s 9 !   
abs5ce ( a notice by a p>ty to t]m9ate1 
& is subject to t]m9ation by ! ,secret>y
 & ! ,/ate adm9i/]+ ag5cy at any "t =   

cause 7z provid$ "u ! agreem5t74  7iii7 
,! agreem5t %all require t ! nationally 
designat$ *ildr5's hospital network     
submit c>e managem5t network & cov]age  
plans to ! ,secret>y t are c5t]$ ar\nd  
m$ical home models & t describe !       
gov]nance ( ! network4  7iv7 ,! agreem5t
 %all require ! hospital network to meet
 all applicable requirem5ts impos$ by   
,/ate & local laws4  7v7 ,! agreem5t    
%all require su* ,/ate1 9 ! case (      
eligible *ildr5 :o are resid5ts ( !     
,/ate1 to make paym5ts to ! hospital    
network1 reg>dless ( :e!r ,,mccc program
 s]vices are furni%$ to su* eligible    
*ildr5 9 ano!r ,/ate4  7vi7 ,! agreem5t 
%all require t ! /&>ds & measures       
develop$ "u subsection 7e7 be appli$ to 
! hospital network1 includ+ measures    
requir+1 ) respect to network adequacy  
/&>ds1 t ! hospital network e/abli% su* 
provid] networks = prim>y1 second>y1 &  
t]ti>y c>e z are necess>y to ensure !   
adequate furni%+ ( ,,mccc program       
s]vices to eligible *ildr5 enroll$ 9 !  

,,mccc program t is ! subject ( !       
agreem5t4  7vii7 ,! agreem5t %all       
require ! hospital network to comply ) !
 data collection & recordkeep+          
requirem5ts ( subp>agraph 7,c74  7viii7 
,! agreem5t %all require ! hospital     
network to accept z paym5t any paym5t   
made us+ ! risk-bas$ me?odology develop$
 "u subsection 7g74  7ix7 ,! agreem5t   
%all conta9 su* additional t]ms &       
conditions z ! p>ties may agree to1 s   
long z su* t]ms & conditions are        
consi/5t ) ?is section4  7,b7 ,s]vice   
area ov]lap ,9 designat+ a s]vice area  
"u subp>agraph 7,a77i71 ! ,secret>y 79  
consultation ) ! relevant ,/ate adm9i/]+
 ag5cy7 %all consid] ! impacts (        
designat+ an area t is already cov]$ "u 
ano!r program agreem5t1 = purposes (    
avoid+ ! unnecess>y duplication (       
s]vices & ! impairm5t ( ! f9ancial &    
s]vice viability ( ano!r ,,mccc program4
  7,c7 ,data & recordkeep+ requirem5ts  
,! data collection & recordkeep+        
requirem5ts "u ?is subp>agraph1 )       

respect to a nationally designat$       
*ildr5's hospital network1 are z foll[s3
  7i7 ,! hospital network %all collect  
claims data on claims submitt$ ) respect
 to eligible *ildr5 :o are furni%$      
,,mccc program s]vices "u an ,,mccc     
program4 ,su* data %all be report$ 9 a  
/&>diz$ =mat & made available to !      
public = purposes ( e/abli%+ a national 
database on su* claims4  7ii7 ,!        
hospital network %all ma9ta91 & provide 
! ,secret>y & ! ,/ate adm9i/]+ ag5cy    
access to1 ! records relat+ to ! ,,mccc 
program op]at$ by ! hospital network1   
includ+ p]t95t f9ancial1 m$ical1 &      
p]sonnel records4  7iii7 ,! hospital    
network %all submit to ! ,secret>y & !  
,/ate adm9i/]+ ag5cy su* reports z !    
,secret>y f9ds 79 consultation ) ! ,/ate
 adm9i/]+ ag5cy7 necess>y to monitor !  
op]ation1 co/1 & effectiv5ess ( ! ,,mccc
 program op]at$ by ! hospital network4  
7#c7 ,t]m9ation ( agreem5ts ,! ,secret>y
 %all issue regulations e/abli%+ !      
circum/ances "u :i*--  7,a7 ! ,secret>y 

or a ,/ate adm9i/]+ ag5cy may t]m9ate an
 ,,mccc program agreem5t = cause2 &     
7,b7 a nationally designat$ *ildr5's    
hospital network may t]m9ate su* an     
agreem5t aft] appropriate notice to !   
,secret>y1 ! ,/ate adm9i/]+ ag5cy1 &    
enrollees4  7e7 ,quality assurance  7#a7
 ,developm5t ( /&>ds & measures ,!      
,secret>y %all1 9 consultation )        
nationally designat$ *ildr5's hospital  
networks & national p$iatric policy     
organizations 7su* z ! ,*ildr5's        
,hospital ,association & ! ,am]ican     
,academy ( ,p$iatrics7--  7,a7 e/abli% a
 national set ( quality assurance &     
improvem5t protocols & proc$ures to     
apply "u ,,mccc programs2  7,b7 develop 
p$iatric quality measures2  7,c7 develop
 p$iatric network adequacy /&>ds =      
access by eligible *ildr5 to ,,mccc     
program s]vices2 &  7,d7 develop crit]ia
 = national p$iatric-focus$ c>e         
coord9ation = eligible *ildr54  7#b7    
,use ( pqmp measures ,9 c>ry+ out       
subp>agraph 7,a71 ! ,secret>y %all      

apply1 to ! ext5t applicable1 *ild heal?
 quality measures & measures = c5t]s (  
excell5ce = *ildr5 ) complex ne$s       
develop$ "u ?is title1 title ,,xxi1 &   
section #aaci;,a & take into acc\nt     
,,h$is quality measures z requir$ "u    
section #aheb7;e77#c7 & o!r quality     
measures4  7f7 ,/&>d ,m$icaid data set  
7#a7 ,9 g5]al ,! ,secret>y1 ! ,/ates1 & 
! nationally designat$ *ildr5's hospital
 networks %all collaborate to obta9     
consi/5t & v]ifiable ,m$icaid ,analytic 
,extract data or a comp>able data set & 
%all e/abli% data-%>+ agreem5ts to fur!r
 support collaborative plann+ & c>e     
coord9ation = m$ically complex *ildr54  
7#b7 ,claims analysis ,! ,secret>y      
%all--  7,a7 p]=m claims analysis on !  
data set develop$ "u p>agraph 7#a7 to   
det]m9e ! utilization ( items & s]vices 
furni%$ "u an ,,mccc program to eligible
 *ildr52 &  7,b7 submit to ,congress &  
make publicly available on ! ,int]net   
site ( ! ,c5t]s = ,m$ic>e & ,m$icaid    
s]vices1 a report on su* claims 9 a     

/&>diz$ =mat = purposes ( build+ a      
national database4  7#c7 ,paym5t =      
report+ inc5tives ,! ,secret>y may      
provide = pay-=-report+ inc5tives dur+ !
 fir/ two ye>s ( any ,,mccc program     
agreem5t ent]$ into "u ?is section to   
ensure p>ticipation & analysis (        
consi/5t data "u ?is p>agraph to enable 
! developm5t ( an appropriate risk-bas$ 
paym5t me?odology "u subsection 7g74    
7g7 ,paym5ts to nationally designat$    
*ildr5's hospital networks  7#a7 ,9     
g5]al ,! ,/ate plan %all provide =      
paym5t to nationally designat$ *ildr5's 
hospital networks pursuant to ! t]ms (  
an ,,mccc program agreem5t us+ a        
risk-bas$ paym5t me?odology 7or         
me?odologies7 e/abli%$ by ! ,secret>y 9 
accordance ) ?is subsection4  7#b7      
,transition f fee-=-s]vice to risk-bas$ 
paym5t model  7,a7 ,9 g5]al ,paym5t to  
nationally designat$ *ildr5's hospital  
networks "u ?is subsection %all be bas$ 
initially on a fee-=-s]vice paym5t model
 & %all gradually transition1 ov] a     

#e-ye> p]iod1 to an equitable1 risk-bas$
 paym5t model us+ a me?odology develop$ 
"u p>agraph 7#c74 ,= ! fir/ two ye>s (  
su* p]iod1 a nationally designat$       
*ildr5's hospital network may receive1 9
 addition to any fee-=-s]vice paym5ts   
made to su* hospital network1 p] capita 
c>e coord9ation paym5ts ) respect to    
exp5ditures = items & s]vices furni%$ to
 eligible *ildr5 enroll$ 9 ! ,,mccc     
program op]at$ by ! hospital network    
?r\gh m$ical home programs & o!r c>e    
coord9ation activities = :i* an         
all-inclusive paym5t model is m suitable
 ?an fee-=-s]vice reimbursem5t4  7,b7   
,data analysis dur+ initial p]iod ,dur+ 
! fir/ two ye>s ( ! implem5tation ( an  
,,mccc program1 ! ,secret>y %all analyze
 data collect$ "u subsection 7f7 =      
purposes ( develop+ a risk-bas$ paym5t  
me?odology t w\ld be implem5t$ beg9n+ ) 
! ?ird ye> ( implem5tation ( ! ,,mccc   
program4  7#c7 ,developm5t ( risk-bas$  
paym5t me?odology ,! ,secret>y %all     
develop paym5t me?odologies "u ?is      

subsection 9 coord9ation ) ! ,m$icaid & 
,,*ip ,paym5t & ,access ,commission & ! 
p$iatric heal? c>e provid] community t--
  7,a7 take into acc\nt ! data analyz$  
"u p>agraph 7#b77;,b72  7,b7 are        
actu>ially s\nd1 z det]m9$ by !         
,secret>y & ! relevant ,/ate adm9i/]+   
ag5cy1 9 coord9ation ) ,national        
,association ( ,insurance ,commission]s1
 us+ an actu>ial me?odology t is adopt$ 
us+ hi/oric p$iatric claims data2  7,c7 
include--  7i7 a risk adju/m5t me?od1   
re-insurance sy/em1 & risk-corridor     
proc$ure to acc\nt = v>iations 9 acuity 
( ! eligible *ildr5 enroll$ 9 ,,mccc    
programs2 &  7ii7 a %>$-sav+s compon5t2 
&  7,d7 may provide = an model = mak+   
paym5ts o!r ?an paym5ts made on a       
p]-memb]1 p]-mon? basis4  7h7 ,waiv]s ( 
requirem5ts ,) respect to c>ry+ out an  
,,mccc program "u ?is section1 ! foll[+ 
provisions ( law %all n apply3  7#a7    
,section #aijb7;a77#a71 relat+ to       
/atewid5ess4  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$om ( *oice 
( provid]s4  7#d7 ,section              
#aijc7m77#b77;,a71 ins(> z su* section  
w\ld prohibit a nationally designat$    
*ildr5's hospital network f receiv+     
c]ta9 paym5ts4  7#e7 ,su* o!r provisions
 ( ?is title1 title ,,xviii1 sections   
#aabh;,a & #aabh;,b1 & any provisions ( 
! ,f$]al antitru/ laws z ! ,secret>y    
det]m9es are inapplicable or ! waiv] (  
:i* are necess>y = purposes ( c>ry+ out 
an ,,mccc program "u ?is section4  7i7  
,preemption ( ,/ate law  ,a ,/ate may n 
impose any requirem5t on ! nationally   
qualifi$ *ildr5's hospital network's    
op]ation ( an ,,mccc program "u a       
program agreem5t t meets ! requirem5ts (
 ?is section t is inconsi/5t ) or w\ld  
o!rwise imp$e ! satisfaction by su*     
hospital network ( ! requirem5ts ( ?is  
section 7includ+ ! requirem5ts ( su*    
program agreem5t74  7j7 ,def9itions ,9  

?is section3  7#a7 ,eligible *ild ,! t]m
 eligible *ild means1 ) respect to an   
,,mccc program1 an individual :o is "u !
 age ( #ah & :o--  7,a7 is eligible =   
m$ical assi/ance "u ! ,/ate plan "u ?is 
title or *ild heal? assi/ance "u ! ,/ate
 *ild heal? plan "u title ,,xxi2 &  7,b7
 has1 or is at a height5$ risk (        
develop+1 a *ronic1 physical1           
developm5tal1 behavioral1 or emotional  
condition t--  7i7 affects two or m body
 sy/ems2  7ii7 requires int5sive c>e    
coord9ation to avoid excessive          
hospitalizations or em]g5cy dep>tm5t    
visits2 or  7iii7 meets ! crit]ia =     
m$ical complexity us+ risk adju/m5t     
me?odologies 7su* z ,cl9ical ,risk      
,gr\ps7 agre$ ^u by ! ,secret>y 9       
coord9ation ) a national panel (        
p$iatric exp]ts4  7#b7 ,,mccc program ,!
 t]m ,,mccc program means a ,m$icaid    
coord9at$ c>e program t provides        
eligible *ildr5 ) ,,mccc program s]vices
 ?r\gh a nationally designat$ *ildr5's  
hospital network 9 accordance ) a       

program agreem5t t meets ! requirem5ts (
 subsection 7d74  7#c7 ,,mccc program   
s]vices ,! t]m ,,mccc program s]vices   
means ! full range ( items & s]vices =  
:i* m$ical assi/ance is available "u a  
,/ate plan = *ildr51 includ+ p$iatric   
c>e managem5t s]vices & p$iatric-focus$ 
c>e coord9ation & heal? promotion1 z    
specifi$ 9 ! program agreem5t4  7#d7    
,qualifi$ *ildr5's hospital ,! t]m      
qualifi$ *ildr5's hospital means a      
*ildr5's hospital t--  7,a7 qualifies to
 receive paym5t "u section #cdj;,e ( !  
,public ,heal? ,s]vice ,act 7relat+ to  
*ildr5's hospitals t op]ate graduate    
m$ical education programs72 or  7,b7    
meets #c or m ( ! foll[+ crit]ia3  7i7  
,m9imum p$iatric dis*>ges ,! hospital   
has at lea/ #e1jjj annual p$iatric      
dis*>ges 7includ+ neonates1 b exclud+   
ob/etrics & normal newborns7 = ! mo/    
rec5t co/ report+ p]iod = :i* data are  
available4  7ii7 ,m9imum numb] ( b$s ,! 
hospital has #ajj lic5s$ p$iatric b$s1 n
 includ+ b$s 9 neonatal int5sive c>e    

units b includ+ b$s 9 p$iatric int5sive 
c>e units & o!r acute c>e b$s4  7iii7   
,access to p$iatric em]g5cy s]vices ,!  
hospital has access 7?r\gh own]%ip or   
o!rwise7 to p$iatric em]g5cy s]vices4   
7iv7 ,m$icaid reliant ,at lea/ #cj p]c5t
 ( ! p$iatric dis*>ges or inpati5t days 
7exclud+ obs]vation days7 9 ! hospital =
 ! mo/ rec5t co/ report+ p]iod = :i*    
data are available 7 *ildr5 eligible =  
m$ical assi/ance "u ?is title or =      
*ildr5's heal? assi/ance "u title ,,xxi4
  7v7 ,affiliation ) accr$it$ p$iatric  
resid5cy tra9+ program ,! hospital      
sponsors or is affiliat$ ) a p$iatric   
resid5cy program t is accr$it$ by !     
,accr$itation ,c\ncil = ,graduate       
,m$ical ,education4  7vi7 ,p$iatric     
m$ical home programs ,! hospital has    
e/abli%$ & implem5t$ demon/rable        
p$iatric m$ical home programs d$icat$ to
 m$ically complex *ildr54  7#e7         
,nationally designat$ *ildr5's hospital 
network ,! t]m nationally designat$     
*ildr5's hospital network means a       

network ( hospitals & heal? c>e         
provid]s--  7,a7 an*or$ by a qualifi$   
*ildr5's hospital or hospitals )        
pr9cipal gov]nance responsibility ov] ! 
hospital network2  7,b7 9 :i* ! full    
complem5t ( heal? c>e provid]s ne$$ to  
provide ! be/ c>e = *ildr5 9 ! network  
p>ticipate2 &  7,c7 t repres5ts !       
int]e/s ( physicians1 o!r heal? c>e     
provid]s1 p>5ts ( m$ically complex      
*ildr51 & o!r relatives ( su* *ildr54   
7#f7 ,program agreem5t ,! t]m program   
agreem5t means1 ) respect to a          
nationally designat$ *ildr5's hospital  
network1 an agreem5t1 betwe5 ! hospital 
network1 ! ,secret>y1 & a ,/ate adm9i/]+
 ag5cy = ! op]ation ( an ,,mccc program 
by ! hospital network 9 ! ,/ate t meets 
! requirem5ts ( ?is section4  7#g7 ,/ate
 adm9i/]+ ag5cy ,! t]m ,/ate adm9i/]+   
ag5cy means1 ) respect to ! op]ation (  
an ,,mccc program 9 a ,/ate1 ! ag5cy ( t
 ,/ate 7:i* may be ! s+le ag5cy         
responsible = adm9i/ration ( ! ,/ate    
plan "u ?is title 9 ! ,/ate7 responsible

 = adm9i/]+ program agreem5ts "u ?is    
section4  4  7b7 ,application "u ,,*ip  
,section #bajg7;e77#a7 ( ! ,social      
,security ,act 7#db ,u4,s4,c4           
#acig;gg7e77#a77 is am5d$ by add+ at !  
end ! foll[+ new subp>agraph3  7,p7     
,section #aidg 7relat+ to ,m$icaid      
*ildr5's c>e coord9ation programs =     
*ildr5 ) complex m$ical conditions74  4 
7c7 ,regulations ,n lat] ?an #abj days  
aft] ! date ( ! enactm5t ( ?is ,act1 !  
,secret>y ( ,heal? & ,human ,s]vices    
%all make rules on ! record1 aft]       
opportunity = an ag5cy he>+ to c>ry out 
! am5dm5ts made by ?is section 9        
accordance ) sections #eef & #eeg (     
title #e1 ,unit$ ,/ates ,code4