,i  #aac? ,,congress  #b;d ,session  ,h4
 ,r4 #ecfd  ,,9 ,,! ,,h\se ,,(          
,,repres5tatives  ,july #ca1 #bjad ,mr4 
,pallone 7= himself1 ,mr4 ,waxman1 ,ms4 
,s*ak[sky1 ,ms4 ,ca/or ( ,florida1 ,mrs4
 ,capps1 ,mrs4 ,*ri/5s51 ,mr4 ,g5e ,gre5
 ( ,texas1 ,mr4 ,d+ell1 ,mr4            
,butt]field1 ,mr4 ,s>banes1 ,mr4 ,engel1
 & ,mr4 ,ma!son7 introduc$ ! foll[+     
bill2 :i* 0 ref]r$ to ! ,committee on   
,en]gy & ,comm]ce1 & 9 addition to !    
,committee on ,ways & ,means1 = a p]iod 
to be subsequ5tly det]m9$ by ! ,speak]1 
9 ea* case = consid]ation ( su*         
provisions z fall )9 ! jurisdiction ( ! 
committee conc]n$  ,a ,,bill  ,to am5d  
title ,,xxi ( ! ,social ,security ,act  
to ext5d & improve ! ,*ildr5's ,heal?   
,insurance ,program1 & = o!r purposes4  
#a4 ,%ort title2 am5dm5ts to ,social    
,security ,act2 ref]5ces2 table (       
cont5ts  7a7 ,%ort title ,?is ,act may  
be cit$ z ! ,,*ip ,ext5sion &           
,improvem5t ,act ( #bjad4  7b7 ,ref]5ces
 to ,,*ip2 ,m$icaid2 ,secret>y ,9 ?is   

,act3  7#a7 ,,*ip ,! t]m ,,*ip means !  
,/ate ,*ildr5's ,heal? ,insurance       
,program e/abli%$ "u title ,,xxi ( !    
,social ,security ,act 7#db ,u4,s4,c4   
#acig;aa et seq47 7:e!r implem5t$ "u    
title ,,xix1 ,,xxi1 or bo?1 ( ! ,social 
,security ,act74  7#b7 ,m$icaid ,! t]m  
,m$icaid means ! program = m$ical       
assi/ance e/abli%$ "u title ,,xix ( !   
,social ,security ,act 7#db ,u4,s4,c4   
#acif et seq474  7#c7 ,secret>y ,! t]m  
,secret>y means ! ,secret>y ( ,heal? &  
,human ,s]vices4  7c7 ,table ( cont5ts  
,! table ( cont5ts = ?is ,act is z      
foll[s3  ,sec4 #a4 ,%ort title2 am5dm5ts
 to ,social ,security ,act2 ref]5ces2   
table ( cont5ts4 ,sec4 #b4 ,g5]al       
effective date2 exception = ,/ate       
legislation2 reliance on law4 ,title    
,i--,f9anc+ ,sec4 #aja4 #d-ye> ext5sion 
( ,,*ip fund+4 ,sec4 #ajb4 ,p]=mance    
inc5tive program improvem5ts4 ,sec4     
#ajc4 ,*ild enrollm5t cont+5cy fund     
adju/m5t4 ,title ,,ii--,cov]age         
,/ability & ,r$uc$ ,bureaucracy ,sec4   

#bja4 ,improv+ cov]age /ability4 ,sec4  
#bjb4 ,assur+ c>e cont9uity dur+        
transitions among ,,*ip1 ,m$icaid1 &    
qualifi$ heal? plans4 ,sec4 #bjc4       
,cont9u\s eligibility option = c]ta9    
adults4 ,sec4 #bjd4 ,/ate flexibility to
 use adm9i/rative simplification        
policies = enrollm5t4 ,sec4 #bje4       
,outrea* to t>get$ populations4 ,title  
,,iii--,b5efits & ,af=dability ,sec4    
#cja4 ,/r5g!n$ co/-%>+ protections "u   
,,*ip4 ,sec4 #cjb4 ,ensur+ cov]age (    
prev5tive heal? s]vices "u ,m$icaid &   
,,*ip4 ,sec4 #cjc4 ,timely immunization 
cov]age4 ,sec4 #cjd4 ,paym5t p>ity =    
,m$icaid prim>y c>e s]vices4 ,title     
,,iv--,access & ,quality ,subtitle      
,a--,p$iatric ,quality ,measures ,sec4  
#dja4 ,ext5d+ ! p$iatric quality        
measures program4 ,sec4 #djb4 ,enhanc$  
,,fmap = activities relat$ to p$iatric  
quality measures4 ,sec4 #djc4 ,report+ (
 full set ( p$iatric quality measures4  
,sec4 #djd4 ,te*nical assi/ance to      
,/ates = adopt+ & utiliz+ p$iatric      

quality measures4 ,sec4 #dje4 ,improv+ !
 effectiv5ess ( ! p$iatric quality      
measures4 ,sec4 #djf4 ,reports reg>d+   
,/ate-specific quality ( c>e measures   
appli$ "u ,m$icaid or ,,*ip4 ,sec4 #djg4
 ,advisory panel reg>d+ p$iatric        
quality4 ,sec4 #djh4 ,ext5d+ & exp&+    
demon/ration projects4 ,subtitle        
,b--,cont9u+ ,deliv]y ,sy/em ,re=m ,sec4
 #daa4 ,support+ evid5ce-bas$ c>e       
coord9ation 9 communities4 ,sec4 #dab4  
,ensur+ c>e coord9ation = *ildr54       
,subtitle ,c--,miscellane\s ,sec4 #dba4 
,assur+ cov]age cont9uity = =m] fo/] c>e
 *ildr54 ,sec4 #dbb4 ,def9ition (       
!rapeutic fo/] c>e z m$ical assi/ance4  
,sec4 #dbc4 ,te*nical correction4  #b4  
,g5]al effective date2 exception = ,/ate
 legislation2 reliance on law  7a7      
,g5]al effective date ,unless o!rwise   
provid$ 9 ?is ,act1 subject to          
subsections 7b7 & 7c71 ?is ,act 7& !    
am5dm5ts made by ?is ,act7 %all take    
effect on ,octob] #a1 #bjad1 & %all     
apply to m$ical assi/ance & *ild heal?  

assi/ance furni%$ "u titles ,,xix &     
,,xxi1 respectively1 ( ! ,social        
,security ,act on or aft] t date4  7b7  
,exception = ,/ate legislation ,9 ! case
 ( a ,/ate plan "u title ,,xix ( !      
,social ,security ,act 7#db ,u4,s4,c4   
#acif et seq47 or a ,/ate *ild heal?    
plan "u title ,,xxi ( su* ,act 7#db     
,u4,s4,c4 #acig;aa et seq471 :i* !      
,secret>y det]m9es requires ,/ate       
legislation 9 ord] = ! respective plan  
to meet "o or m additional requirem5ts  
impos$ by am5dm5ts made by ?is ,act1 !  
respective plan %all n be reg>d$ z fail+
 to comply ) ! requirem5ts ( su* title  
solely on ! basis ( its failure to meet 
su* an additional requirem5t be=e ! fir/
 day ( ! fir/ cal5d> qu>t] beg9n+ aft] !
 close ( ! fir/ regul> session ( ! ,/ate
 legislature t beg9s aft] ! date (      
enactm5t ( ?is ,act4 ,= purposes ( !    
previ\s s5t5ce1 9 ! case ( a ,/ate t has
 a #b-ye> legislative session1 ea* ye> (
 ! session %all be consid]$ to be a     
sep>ate regul> session ( ! ,/ate        

legislature4  7c7 ,coord9ation ( ,,*ip  
fund+ = fiscal ye> #bjae ,not)/&+ any   
o!r provision ( law1 ins(> z funds h be5
 appropriat$ "u subsection 7a77#ah7 or  
7m7 ( section #bajd ( ! ,social         
,security ,act 7#db ,u4,s4,c4 #acig;dd71
 z su* subsections are 9 effect on ! day
 be=e ! date ( ! enactm5t ( ?is ,act1 to
 provide allotm5ts to ,/ates "u ,,*ip = 
fiscal ye> #bjae--  7#a7 any am\nts t   
are s appropriat$ t are n s allott$ &   
obligat$ be=e ,april #a1 #bjae1 are     
resc9d$2 &  7#b7 any am\nt provid$ =    
,,*ip allotm5ts to a ,/ate "u ?is ,act  
7& ! am5dm5ts made by ?is ,act7 = su*   
fiscal ye> %all be r$uc$ by ! am\nt (   
su* appropriations s allott$ & obligat$ 
be=e su* date4  7d7 ,reliance on law ,) 
respect to am5dm5ts made by ?is ,act t  
become effective z ( a date--  7#a7 su* 
am5dm5ts are effective z ( su* date :e!r
 or n regulations implem5t+ su* am5dm5ts
 h be5 issu$2 &  7#b7 ,f$]al f9ancial   
p>ticipation = m$ical assi/ance or *ild 
heal? assi/ance furni%$ "u title ,,xix  

or ,,xxi1 respectively1 ( ! ,social     
,security ,act on or aft] su* date by a 
,/ate 9 good fai? reliance on su*       
am5dm5ts be=e ! date ( promulgation (   
f9al regulations1 if any1 to c>ry out   
su* am5dm5ts 7or be=e ! date ( guidance1
 if any1 reg>d+ ! implem5tation ( su*   
am5dm5ts7 %all n be d5i$ on ! basis ( ! 
,/ate's failure to comply ) su*         
regulations or guidance4  ,i ,f9anc+    
#aja4 #d-ye> ext5sion ( ,,*ip fund+  7a7
 ,fund+ ,section #bajd7;a7 ( ! ,social  
,security ,act 7#db ,u4,s4,c4           
#acig;dd7a77 is am5d$--  7#a7 9 p>agraph
 7#ag71 by /rik+ & at ! end2  7#b7 by   
/rik+ p>agraph 7#ah7 & ins]t+ ! foll[+  
new p>agraph3  7#ah7 = fiscal ye> #bjae1
 #ba1jfa1jjj1jjj2  2 &  7#c7 by add+ at 
! end ! foll[+ new p>agraphs3  7#ai7 =  
fiscal ye> #bjaf1 #ai1cjj1jjj1jjj2      
7#bj7 = fiscal ye> #bjag1               
#bj1cjj1jjj1jjj2  7#ba7 = fiscal ye>    
#bjah1 #ba1cjj1jjj1jjj2 &  7#bb7 =      
fiscal ye> #bjai1 = purposes ( mak+ #b  
semi-annual allotm5ts--  7,a7           

#b1hej1jjj1jjj = ! p]iod beg9n+ on      
,octob] #a1 #bjah1 & end+ on ,m>* #ca1  
#bjai2 &  7,b7 #b1hej1jjj1jjj = ! p]iod 
beg9n+ on ,april #a1 #bjai1 & end+ on   
,septemb] #cj1 #bjai4  4  7b7 ,allotm5ts
  7#a7 ,9 g5]al ,section #bajd7m7 ( !   
,social ,security ,act 7#db ,u4,s4,c4   
#acig;dd7m77 is am5d$--  7,a7 9 !       
subsection head+1 by /rik+ #bjae &      
ins]t+ #bjai2  7,b7 9 p>agraph 7#b7--   
7i7 9 ! p>agraph head+1 by /rik+ #bjad &
 ins]t+ #bjah2 &  7ii7 by /rik+         
subp>agraph 7,b7 & ins]t+ ! foll[+ new  
subp>agraph3  7,b7 ,fiscal ye> #bjac &  
ea* succe$+ fiscal ye> ,subject to      
p>agraphs 7#d7 & 7#f71 f ! am\nt made   
available "u p>agraphs 7#af7 ?r\gh 7#ba7
 ( subsection 7a7 = fiscal ye> #bjac &  
ea* succe$+ fiscal ye>1 respectively1 ! 
,secret>y %all compute a ,/ate allotm5t 
= ea* ,/ate 7includ+ ! ,di/rict (       
,columbia & ea* commonweal? & t]ritory7 
= ea* su* fiscal ye> z foll[s3  7i7     
,rebas+ 9 fiscal ye> #bjac & ea* succe$+
 odd-numb]$ fiscal ye> ,= fiscal ye>    

#bjac & ea* succe$+ odd-numb]$ fiscal   
ye>1 ! allotm5t ( ! ,/ate is equal to ! 
,f$]al paym5ts to ! ,/ate t are         
attributable to 7& c\ntable t[>d7 !     
total am\nt ( allotm5ts available "u ?is
 section to ! ,/ate 9 ! prec$+ fiscal   
ye> 7includ+ paym5ts made to ! ,/ate "u 
subsection 7n7 = su* prec$+ fiscal ye> z
 well z am\nts r$i/ribut$ to ! ,/ate 9  
su* prec$+ fiscal ye>71 multipli$ by !  
allotm5t increase factor "u p>agraph    
7#e7 = su* odd-numb]$ fiscal ye>4  7ii7 
,gr[? factor update = fiscal ye> #bjad &
 ea* succe$+ ev5-numb]$ fiscal ye> ,=   
fiscal ye> #bjad & ea* succe$+          
ev5-numb]$ fiscal ye>1 ! allotm5t ( !   
,/ate is equal to ! sum (--  7,i7 !     
am\nt ( ! ,/ate allotm5t "u clause 7i7 =
 ! prec$+ fiscal ye>2 &  7,,ii7 ! am\nt 
( any paym5ts made to ! ,/ate "u        
subsection 7n7 = su* prec$+ fiscal ye>1 
multipli$ by ! allotm5t increase factor 
"u p>agraph 7#e7 = su* ev5-numb]$ fiscal
 ye>4  2  7,c7 9 p>agraph 7#c7--  7i7 9 
! head+1 by /rik+ #bjae & ins]t+ #bjai2 

7ii7 9 subp>agraph 7,a71 by /rik+       
p>agraph 7#ah7 & ins]t+ p>agraph 7#bb72 
7iii7 9 subp>agraph 7,b71 by /rik+      
p>agraph 7#ah7 & ins]t+ p>agraph 7#bb72 
7iv7 9 subp>agraph 7,c7--  7,i7 by /rik+
 #bjad ea* place x appe>s & ins]t+      
#bjah2 &  7,,ii7 by /rik+ #bjae & ins]t+
 #bjai2 &  7v7 9 subp>agraph 7,d7--     
7,i7 9 clause 7i7--  7aa7 9 subclause   
7,i71 by /rik+ subsection 7a77#ah77;,a7 
& ins]t+ subsection 7a77#bb77;,a72 &    
7bb7 9 subclause 7,,ii71 by /rik+       
section #ajh ( ! ,*ildr5's ,heal?       
,insurance ,program ,reau?orization ,act
 ( #bjji & ins]t+ section #aja7;b77#b7 (
 ! ,,*ip ,ext5sion & ,improvem5t ,act ( 
#bjad2 &  7,,ii7 9 clause 7ii77,,ii71 by
 /rik+ subsection 7a77#ah77;,b7 & ins]t+
 subsection 7a77#bb77;,b72  7,d7 9      
p>agraph 7#d71 by /rik+ #bjae & ins]t+  
#bjai2  7,e7 9 p>agraph 7#f7--  7i7 9   
subp>agraph 7,a71 by /rik+ #bjae &      
ins]t+ #bjai2 &  7ii7 9 ! second s5t5ce1
 by /rik+ or fiscal ye> #bjad & ins]t+  
fiscal ye> #bjad1 fiscal ye> #bjaf1 or  

fiscal ye> #bjah2 &  7,f7 9 p>agraph    
7#h7--  7i7 9 ! p>agraph head+1 by /rik+
 #bjae & ins]t+ #bjai2 &  7ii7 by /rik+ 
= a p]iod 9 fiscal ye> #bjae & ins]t+ = 
a p]iod 9 fiscal ye> #bjai4  7#b7       
,supplem5tal appropriation = fiscal ye> 
#bjai ,!re is appropriat$ to !          
,secret>y1 out ( any money 9 ! ,treasury
 n o!rwise appropriat$1 #af1gjj1jjj1jjj 
to accompany ! allotm5t made = ! p]iod  
beg9n+ on ,octob] #a1 #bjah1 & end+ on  
,m>* #ca1 #bjai1 "u section             
#bajd7;a77#bb77;,a7 ( ! ,social         
,security ,act 7#db ,u4,s4,c4           
#acig;dd7a77#bb77;,a77 7z add$ by       
subsection 7a771 to rema9 available     
until exp5d$4 ,su* am\nt %all be us$ to 
provide allotm5ts to ,/ates "u p>agraph 
7#c7 ( section #bajd7m7 ( su* ,act 7#db 
,u4,s4,c4 #acig;dd7m77 7z am5d$ by      
p>agraph 7#a77;,c77 = ! fir/ #f mon?s ( 
fiscal ye> #bjai 9 ! same mann] z       
allotm5ts are provid$ "u subsection     
7a77#bb77;,a7 ( su* section #bajd &     
subject to ! same t]ms & conditions z   

apply to ! allotm5ts provid$ f su*      
subsection 7a77#bb77;,a74  7c7 ,ext5sion
 ( qualify+ /ates option ,section       
#baje7;g77#d7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acig;ee7g77#d77 is     
am5d$--  7#a7 9 ! p>agraph head+1 by    
/rik+ #bjae & ins]t+ #bjai2 &  7#b7 9   
subp>agraph 7,a71 by /rik+ #bjae &      
ins]t+ #bjai4  #ajb4 ,p]=mance inc5tive 
program improvem5ts  7a7 ,ext5sion ?r\gh
 fiscal ye> #bjai ,section #baje7;a77#c7
 ( ! ,social ,security ,act 7#db        
,u4,s4,c4 #acig;ee7a77#c77 is am5d$--   
7#a7 9 subp>agraph 7,a71 by /rik+ #bjac 
& ins]t+ #bjai2  7#b7 9 subp>agraph     
7,e7--  7,a7 9 clause 7ii7--  7i7 9 !   
matt] prec$+ subclause 7,i71 by ins]t+  
aft] ! application ( section            
#bajd7n77#c77;,d77ii7 ) respect to su*  
am\nts1 aft] limitation12  7ii7 by /rik+
 subclause 7,i7 & ins]t+ ! foll[+ new   
subclause3  7,i7 ,unobligat$ national   
allotm5t = fiscal ye>s #bjji ?r\gh #bjae
 ,z ( ,decemb] #ca ( fiscal ye> #bjji1 &
 z ( ,decemb] #ca ( ea* succe$+ fiscal  

ye> ?r\gh fiscal ye> #bjae1 ! portion1  
if any1 ( ! am\nt appropriat$ "u section
 #bajd7;a7 = su* fiscal ye> t is        
unobligat$ = allotm5t to a ,/ate "u     
section #bajd7m7 = su* fiscal ye> or set
 aside "u subsection 7a77#c7 or 7b77#b7 
( section #baaa = su* fiscal ye>4  2    
7iii7 9 subclause 7,,ii71 by /rik+ #bjac
 & ins]t+ #bjae2 &  7iv7 9 subclause    
7,,iii71 by /rik+ #bjac & ins]t+ #bjae2 
7,b7 by r$esignat+ clause 7iii7 z clause
 7iv72 &  7,c7 by ins]t+ aft] clause    
7ii71 ! foll[+ new clause3  7iii7       
,appropriation = fiscal ye>s #bjaf ?r\gh
 #bjai ,out ( any money 9 ! ,treasury n 
o!rwise appropriat$1 !re are appropriat$
 #ejj1jjj1jjj = ea* ( fiscal ye>s #bjaf 
?r\gh #bjai = mak+ paym5ts "u ?is       
p>agraph4 ,am\nts appropriat$ = a fiscal
 ye> "u ?is clause %all rema9 available 
= mak+ paym5ts "u ?is p>agraph until    
,janu>y #a ( ! foll[+ fiscal ye>4 ,any  
am\nts ( su* appropriations t rema9     
unexp5d$ or unobligat$ z ( su* date %all
 be transf]r$ & made available = mak+   

paym5ts "u section #bajd7n74  2 &  7#c7 
9 subp>agraph 7,f77iii71 by /rik+ #bjac 
& ins]t+ #bjai4  7b7 ,updat$ p]=mance   
inc5tive crit]ia = fiscal ye>s #bjae    
?r\gh #bjai ,section #baje7;a7 ( !      
,social ,security ,act 7#db ,u4,s4,c4   
#acig;ee7a77 is am5d$--  7#a7 9 p>agraph
 7#c77;,a71 by ins]t+ or 7#e7 aft]      
p>agraph 7#d72  7#b7 9 p>agraph 7#d7--  
7,a7 9 ! head+1 by ins]t+ fiscal ye>s   
#bjji ?r\gh #bjad aft] = *ildr52 &  7,b7
 9 ! matt] prec$+ subp>agraph 7,a71 by  
/rik+ = a fiscal ye> if & ins]t+ =      
fiscal ye>s #bjji ?r\gh #bjad if2 &     
7#c7 by add+ at ! end ! foll[+ new      
p>agraph3  7#e7 ,enrollm5t & ret5tion   
provisions = *ildr5 = fiscal ye> #bjae &
 succe$+ fiscal ye>s  7,a7 ,9 g5]al ,=  
purposes ( p>agraph 7#c77;,a71 a ,/ate  
meets ! condition ( ?is p>agraph =      
fiscal ye> #bjae & any succe$+ fiscal   
ye> if x is implem5t+ at lea/ #e ( !    
enrollm5t & ret5tion provisions specifi$
 9 subp>agraph 7,b7 7treat+ ea* clause z
 a sep>ate enrollm5t & ret5tion         

provision7 ?r\gh\t ! entire fiscal ye>4 
7,b7 ,enrollm5t & ret5tion provisions ,!
 enrollm5t & ret5tion provisions        
specifi$ 9 ?is subp>agraph are ! foll[+3
  7i7 ,cont9u\s eligibility ,! ,/ate has
 elect$ ! option ( cont9u\s eligibility 
= a full #ab mon?s = all *ildr5 7z def9$
 9 section #aijb7;e77#ac77;,g771 z well 
z apply+ su* policy "u its ,/ate *ild   
heal? plan "u ?is title4  7ii7 ,express 
,lane eligibility ,! ,/ate is implem5t+ 
! option describ$ 9 section             
#aijb7;e77#ac7 "u title ,,xix z well z1 
pursuant to section #bajg7;e77#a71 "u   
?is title4  7iii7 ,presumptive          
eligibility ,! ,/ate is implem5t+       
section #aibj;,a "u title ,,xix z well  
z1 pursuant to section #bajg7;e77#a71 "u
 ?is title4  7iv7 ,premium assi/ance =  
employ]-sponsor$ plans ,! ,/ate is      
implem5t+ section #aijf;,a "u title     
,,xix or ! option describ$ 9 section    
#baje7;c77#aj7 "u ?is title4  7v7       
,seamless cov]age options ,9 ! case ( a 
,/ate t provides m$ical assi/ance "u !  

,/ate plan "u title ,,xix ?r\gh manag$  
c>e entities 7z def9$ 9 section         
#aicb7;a77#a77;,b77 or heal? b5efits    
cov]age "u ! ,/ate *ild heal? plan ?r\gh
 su* entities1 ! ,/ate %all ensure t at 
lea/ "o su* entity (f]s a qualifi$ heal?
 plan ?r\gh ! ,ex*ange e/abli%$ "u title
 ,i ( ! ,pati5t ,protection & ,af=dable 
,c>e ,act 9 ! ,/ate4  7vi7 ,retroactive 
cov]age re9/atem5t ^u premium paym5t ,! 
,/ate *ild heal? plan1 9 ! case ( an    
individual ^: cov]age "u ! plan has be5 
t]m9at$ = failure to make premium       
paym5ts1 provides assi/ance to su*      
individual = purposes ( ! imm$iate      
re5rollm5t ( ! individual ^u paym5t (   
out/&+ premiums1 ) cov]age retroactive  
to ! beg9n+ ( ! mo/ rec5t mon? = :i* an 
out/&+ premium has be5 paid1 & %all n   
impose any wait+ p]iod or fee z a       
condition ( su* re5rollm5t4  7vii7      
,effective transition to ! community =  
vuln]able y\?  7,i7 ,9 g5]al ,subject to
 ! subdivision 7,a7 foll[+ p>agraph     
7#bi7 ( section #aije7;a71 ! ,/ate1 be=e

 ! date ( ! release ( an eligible       
juv5ile f any public in/itution1 &      
not)/&+ t ! juv5ile is an inmate ( a    
public in/itution--  7aa7 scre5s =      
eligibility = & processes any           
application = m$ical assi/ance submitt$ 
by1 or on behalf (1 su* an eligible     
juv5ile2 &  7bb7 ref]s su* juv5ile to   
heal? c>e provid]s = purposes ( receiv+ 
! s]vices describ$ 9 section            
#aije7;a77#d77;,b7 7relat+ to e>ly &    
p]iodic scre5+1 diagno/ic1 & treatm5t   
s]vices def9$ 9 section #aije7r774      
7,,ii7 ,eligible juv5ile ,= purposes (  
subclause 7,i71 ! t]m eligible juv5ile  
means an individual :o--  7aa7 is "u #ai
 ye>s ( age 7or su* high] age z ! ,/ate 
has elect$ "u section                   
#dge7h77;,b77iii772 &  7bb7 is an inmate
 ( a public in/itution4  7,,iii7 ,inmate
 ( a public in/itution ,= purposes ( ?is
 clause1 ! t]m inmate ( a public        
in/itution has ! mean+ giv5 su* t]m =   
purposes ( apply+ ! subdivision 7,a7    
foll[+ p>agraph 7#bi7 ( section         

#aije7;a71 tak+ into acc\nt ! exception 
9 su* subdivision = a pati5t ( a m$ical 
in/itution4  4  #ajc4 ,*ild enrollm5t   
cont+5cy fund adju/m5t  7a7 ,9 g5]al    
,section #bajd7n7 ( ! ,social ,security 
,act 7#db ,u4,s4,c4 #acig;dd7n77 is     
am5d$--  7#a7 9 p>agraph 7#b7--  7,a7 by
 /rik+ #bjad & ins]t+ #bjah ea* place x 
appe>s 9 subp>agraphs 7,a77ii7 & 7,b72 &
  7,b7 by /rik+ #bjae & ins]t+ #bjai ea*
 place x appe>s 9 subp>agraphs 7,a77ii7 
& 7,b72  7#b7 9 p>agraph 7#c7--  7,a7 9 
subp>agraph 7,a7--  7i7 9 ! head+1 by   
/rik+ ,9 g5]al & ins]t+ ,fiscal ye>s    
#bjji ?r\gh #bjae2  7ii7 9 ! matt]      
prec$+ clause 7i7--  7,i7 by /rik+ a    
semi-annual allotm5t p]iod =2 &  7,,ii7 
by /rik+ 7det]m9$ )\t reg>d to any      
r$i/ribution x receives "u subsection   
7f7 t is available = exp5diture dur+ su*
 fiscal ye> or p]iod1 b includ+ any     
c>ryov] f a previ\s fiscal ye>72  7iii7 
by /rik+ or p]iod ea* place x appe>s2 & 
7iv7 9 clause 7ii71 by /rik+ 7or 9 :i* !
 p]iod occurs72  7,b7 9 subp>agraph     

7,b77ii71 by /rik+ 7or semi-annual p]iod
 occurr+ 9 a fiscal ye>72  7,c7 9       
subp>agraph 7,c77ii71 by /rik+ 7or      
semi-annual p]iod occurr+ 9 a fiscal    
ye>72  7,d7 by r$esignat+ subp>agraphs  
7,d71 7,e71 7,f71 & 7,g7 z subp>agraphs 
7,e71 7,f71 7,g71 & 7,h71 respectively2 
7,e7 by ins]t+ aft] subp>agraph 7,c7 !  
foll[+ new subp>agraph3  7,d7 ,fiscal   
ye>s #bjaf ?r\gh #bjai  7i7 ,9 g5]al ,= 
ea* ( fiscal ye>s #bjaf ?r\gh #bjah &   
ea* semi-annual allotm5t p]iod = fiscal 
ye> #bjai1 if ! ,secret>y det]m9es t a  
,/ate is a %ortfall ,/ate describ$ 9    
subp>agraph 7,i7 = t fiscal ye> or      
p]iod1 ! ,secret>y %all pay ! ,/ate f ! 
,fund1 9 addition to any o!r paym5ts    
made to a ,/ate "u ?is title = ! fiscal 
ye> or p]iod an am\nt equal to ! am\nt (
 project$ exp5ditures = ! ,/ate "u ?is  
title = ! fiscal ye> or p]iod t exce$s !
 sum det]m9$ "u subp>agraph 7,i7 = !    
,/ate & fiscal ye> or p]iod4  7ii7      
,transf]s ,not)/&+ any o!r provision (  
?is title1 ! foll[+ am\nts %all also be 

available1 )\t fiscal ye> limitation1 = 
mak+ paym5ts f ! ,fund3  7,i7           
,unobligat$ national allotm5t = fiscal  
ye>s beg9n+ ) fiscal ye> #bjaf ,z (     
,decemb] #ca ( fiscal ye> #bjaf1 & z (  
,decemb] #ca ( ea* succe$+ fiscal ye>1 !
 portion1 if any1 ( ! am\nt appropriat$ 
"u subsection 7a7 = su* fiscal ye> t is 
unobligat$ = allotm5t to a ,/ate "u     
subsection 7m7 = su* fiscal ye>4  7,,ii7
 ,unexp5d$ allotm5ts n us$ =            
r$i/ribution ,z ( ,novemb] #ae ( fiscal 
ye> #bjaf & ea* succe$+ fiscal ye>1 !   
total am\nt ( allotm5ts made to ,/ates  
"u subsection 7a7 = ! second prec$+     
fiscal ye> t is n exp5d$ or r$i/ribut$  
"u subsection 7f7 dur+ ! p]iod 9 :i* su*
 allotm5ts are available = obligation4  
7,,iii7 ,unexp5d$ p]=mance inc5tive     
funds ,z ( ,septemb] #a1 #bjag1 & z (   
,septemb] #a ( ea* succe$+ cal5d> ye>1 !
 portion1 if any1 ( ! am\nt appropriat$ 
"u subp>agraph 7,e77iii7 ( section      
#baje7;a77#c7 = ! prec$+ fiscal ye> t is
 n exp5d$ or obligat$ "u su* section4   

7iii7 ,inve/m5t ( fund ,! ,secret>y ( ! 
,treasury %all inve/1 9 int]e/ be>+     
securities ( ! ,unit$ ,/ates1 su*       
curr5tly available portions ( ! ,fund z 
are n imm$iately requir$ = paym5ts f !  
,fund4 ,! income d]iv$ f ^! inve/m5ts   
con/itutes a "p ( ! ,fund4  2  7,f7 9   
subp>agraph 7,e7 7z s r$esignat$71 by   
ins]t+ or 7,d7 aft] subp>agraph 7,a72 & 
7,g7 9 subp>agraph 7,h7 7z s            
r$esignat$71 by ins]t+ & reg>d+ !       
exp5ditures "u ! ,/ate *ild heal? plan  
aft] subp>agraphs 7,a7 & 7,b72 &  7#c7  
by add+ at ! end ! foll[+ new           
subp>agraph3  7,i7 ,%ortfall ,/ates     
describ$ ,= purposes ( subp>agraph 7,d71
 ) respect to a fiscal ye> or           
semi-annual allotm5t p]iod1 a %ortfall  
,/ate is a ,/ate = :i* ! ,secret>y      
e/imates1 on ! basis ( ! mo/ rec5t data 
available to ! ,secret>y1 t ! project$  
exp5ditures = ! ,/ate = ! fiscal ye> or 
p]iod "u ?is title 7includ+ 9 ! =m (    
cov]age describ$ 9 p>agraph 7#a7 or 7#b7
 ( section #baja1 or bo?7 w exce$ ! sum 

(--  7i7 ! am\nt ( ! ,/ate's allotm5ts =
 any prec$+ fiscal ye> or p]iod t rema9s
 available = exp5diture & t w n be      
exp5d$ by ! end ( ! imm$iately prec$+   
fiscal ye>2  7ii7 ! am\nt 7if any7 t w  
be r$i/ribut$ to ! ,/ate "u subsection  
7f7 = ! fiscal ye> or p]iod2  7iii7 !   
portion1 if any1 ( ! am\nt appropriat$  
"u subp>agraph 7,e77iii7 ( section      
#baje7;a77#c7 = ! prec$+ fiscal ye> or  
p]iod t is n exp5d$ or obligat$ "u su*  
section2 &  7iv7 ! am\nt ( ! ,/ate's    
allotm5t = ! fiscal ye> or p]iod4  4    
7b7 ,con=m+ am5dm5ts ,section           
#bajd7;f77#b77;,a7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4                    
#acieg;dd7f77#b77;,a77 is am5d$--  7#a7 
9 clause 7i71 by ins]t+ & at ! end2     
7#b7 by /rik+ clause 7ii72 &  7#c7 by   
r$esignat+ clause 7iii7 z clause 7ii74  
,,ii ,cov]age ,/ability & ,r$uc$        
,bureaucracy  #bja4 ,improv+ cov]age    
/ability  7a7 ,9 g5]al ,section         
#bajb7;b77#a77;,b7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4                    

#acig;bb7b77#a77;,b77 is am5d$--  7#a7 9
 clause 7iii71 by /rik+ 9 ! case ( a    
t>get$ l[-income pregnant woman provid$ 
pregnancy-relat$ assi/ance "u section   
#baab2 &  7#b7 9 clause 7iv71 by /rik+  
at ,/ate option14  7b7 ,con=m+ am5dm5ts 
7#a7 ,section #baje7;c77#aj7 ( ! ,social
 ,security ,act 7#db ,u4,s4,c4          
#acig7;ee77#aj77 is am5d$--  7,a7 by    
/rik+ subp>agraph 7,f72 &  7,b7 by      
r$esignat+ subp>agraphs 7,g7 ?r\gh 7,m7 
z subp>agraphs 7,f7 ?r\gh 7,l71         
respectively4  7#b7 ,section            
#baab7;b77#e7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acigll7b77#e77 is      
am5d$--  7,a7 9 ! head+1 by /rik+ or    
wait+ p]iod2 &  7,b7 by /rik+ or any    
wait+ p]iod & all t foll[s ?r\gh receipt
 ( su* assi/ance4  7c7 ,effective date  
,! am5dm5ts made by ?is section %all    
take effect on ! date ( enactm5t ( ?is  
,act4  #bjb4 ,assur+ c>e cont9uity dur+ 
transitions among ,,*ip1 ,m$icaid1 &    
qualifi$ heal? plans  7a7 ,m9imum       
ess5tial cov]age  7#a7 ,9 g5]al ,section

 #ejjj;,a7f7 ( ! ,int]nal ,rev5ue ,code 
( #aihf is am5d$ by add+ at ! end !     
foll[+3  7#f7 ,pregnancy-relat$         
assi/ance "u ,,*ip ,) respect to a      
t>get$ l[-income pregnant woman 7z def9$
 9 section #baab7;d77#b7 ( ! ,social    
,security ,act 7#db ,u4,s4,c4           
#acigll7d77#b7771 not)/&+ p>agraph      
7#a77;,a77iii71 ! t]m m9imum ess5tial   
cov]age1 at ! option ( su* a woman1 %all
 n include pregnancy-relat$ assi/ance 7z
 def9$ 9 section #baab7;d77#a7 ( !      
,social ,security ,act 7#db ,u4,s4,c4   
#acigll7d77#a7774  4  7#b7 ,effective   
date ,! am5dm5t made by ?is subsection  
applies to taxable ye>s beg9n+ aft]     
,decemb] #ca1 #bjad4  7b7 ,cont9uity (  
c>e ,! ,secret>y ( ,heal? & ,human      
,s]vices %all issue regulations =       
purposes ( ensur+ cont9uity ( c>e =     
*ildr5 :o--  7#a7 are und]go+ an active 
c\rse ( treatm5t2 &  7#b7 involunt>ily  
*ange cov]age "u heal? insurance1 !     
,/ate plan "u ! ,m$icaid program "u     
title ,,xix ( ! ,social ,security ,act1 

or ! ,/ate *ild heal? plan "u title     
,,xxi ( su* ,act dur+ su* c\rse (       
treatm5t = any reason1 includ+ a reason 
relat$ to a *ange 9 income1 heal? plan  
t]m9ation1 or a mat]ial *ange or *anges 
to ! plan's heal? b5efits cov]age4  7c7 
,ensur+ comp>ability ( cov]age  7#a7 ,9 
g5]al ,n lat] ?an #ah mon?s aft] ! date 
( ! enactm5t ( ! ,,*ip ,ext5sion &      
,improvem5t ,act ( #bjad1 ! ,secret>y ( 
,heal? & ,human ,s]vices %all review1 ) 
respect to a ,/ate1 ! b5efits 7by ea*   
b5efit class7 (f]$ = *ildr5 & ! co/-%>+ 
impos$ ) respect to su* b5efits by      
qualifi$ heal? plans (f]$ ?r\gh an      
,ex*ange e/abli%$ "u title ,i ( !       
,pati5t ,protection & ,af=dable ,c>e    
,act 9 ! ,/ate4 ,! ,secret>y %all make !
 f9d+s ( su* review available on !      
public ,int]net site ( ! ,dep>tm5t (    
,heal? & ,human ,s]vices4  7#b7         
,regulations requir$ ,if1 foll[+ su*    
review1 ! ,secret>y det]m9es t b5efits &
 co/-%>+ protections ref]r$ to 9        
p>agraph 7#a7 are n comp>able to !      

b5efits 7by ea* b5efit class7 (f]$ &    
co/-%>+ protections provid$ "u ! ,/ate  
*ild heal? plan "u title ,,xxi ( !      
,social ,security ,act 7#db ,u4,s4,c4   
#acig;aa et seq47 9 ! ,/ate1 !          
,secret>y1 n lat] ?an ,janu>y #a1 #bjag1
 %all issue a rule1 to apply ) respect  
to plan ye>s beg9n+ 9 #bjai1 e/abli%+   
requirem5ts design$ to ensure t su*     
qualifi$ heal? plans (f] b5efits &      
co/-%>+ protections t are comp>able to !
 b5efits & co/-%>+ protections provid$  
"u su* ,/ate *ild heal? plan = plan ye> 
#bjai4  #bjc4 ,/ate flexibility to      
provide = cont9u\s eligibility ,section 
#aijb7;e77#ab7 ( ! ,social ,security    
,act 7#db ,u4,s4,c4 #acif;a7e77#ab77 is 
am5d$ to read z foll[s3  7#ab7 ,cont9u\s
 eligibility option  7,a7 ,*ildr5 ,at ! 
option ( ! ,/ate1 ! plan may provide t a
 *ild 7z def9$ 9 p>agraph 7#ac77;,g77 :o
 is det]m9$ to be eligible = b5efits "u 
a ,/ate plan approv$ "u ?is title "u    
subsection 7a77#aj77;,a7 %all rema9     
eligible = ^? b5efits until ! e>li] (-- 

7i7 ! end ( a p]iod 7n to exce$ #ab     
mon?s7 foll[+ ! det]m9ation2 or  7ii7 ! 
"t t ! *ild exce$s ! age specifi$ 9 su* 
p>agraph 7#ac77;,g74  7,b7 ,c]ta9       
noneld]ly adults  7i7 ,9 g5]al ,at !    
option ( ! ,/ate1 ! plan may provide t 9
 ! case ( an eligible adult :o is       
det]m9$ to be eligible = b5efits "u a   
,/ate plan approv$ "u ?is title 7or a   
waiv] ( su* plan71 ! eligible adult %all
 rema9 eligible = ^? b5efits until ! end
 ( a p]iod 7n to exce$ #ab mon?s7 foll[+
 ! det]m9ation4  7ii7 ,eligible adult   
def9$ ,9 ?is subp>agraph1 ! t]m eligible
 adult means--  7,i7 an individual 7o!r 
?an a *ild7 ^: income eligibility "u !  
,/ate plan or "u a waiv] ( ! plan =     
m$ical assi/ance is det]m9$ "u p>agraph 
7#ad72 &  7,,ii7 an individual includ$ 9
 any o!r gr\p ( individuals ! ,secret>y 
det]m9es appropriate4  4  #bjd4 ,/ate   
flexibility to use adm9i/rative         
simplification policies = enrollm5t  7a7
 ,p]man5t ext5sion ( ,m$icaid & ,,*ip   
express lane option ,section            

#aijb7;e77#ac7 ( ! ,social ,security    
,act 7#db ,u4,s4,c4 #acif;a7e77#ac77 is 
am5d$ by /rik+ subp>agraph 7,i74  7b7   
,ext5d+ ,express ,lane eligibility to   
adults ,section #aijb7;e77#ac77;,a7 ( ! 
,social ,security ,act 7#db ,u4,s4,c4   
#acif;a7e77#ac77;,a77 is am5d$ by add+  
at ! end ! foll[+ new clause3  7iii7    
,/ate option to ext5d express lane      
eligibility to adults  7,i7 ,9 g5]al ,at
 ! option ( ! ,/ate1 ! ,/ate may apply !
 provisions ( ?is p>agraph ) respect to 
det]m9+ eligibility "u ?is title = an   
eligible individual 7z def9$ 9 subclause
 7,,ii774 ,9 apply+ ?is p>agraph 9 !    
case ( a ,/ate mak+ su* an option1 any  
ref]5ce 9 ?is p>agraph to a *ild )      
respect to ?is title 7o!r ?an a ref]5ce 
to *ild heal? assi/ance7 %all be deem$  
to be a ref]5ce to an eligible          
individual4  7,,ii7 ,eligible individual
 def9$ ,9 ?is clause1 ! t]m eligible    
individual means--  7aa7 any individual 
7o!r ?an a *ild7 ^: income eligibility  
"u ! ,/ate plan or "u a waiv] ( ! plan =

 m$ical assi/ance is det]m9$ "u p>agraph
 7#ad72 &  7bb7 an individual includ$ 9 
any o!r gr\p ( individuals ! ,secret>y  
det]m9es appropriate4  4  #bje4 ,outrea*
 to t>get$ populations  7a7 ,outrea* &  
enrollm5t grants ,section #baac ( !     
,social ,security ,act 7#db ,u4,s4,c4   
#acigmm7 is am5d$--  7#a7 9 subsection  
7a7--  7,a7 9 p>agraph 7#a71 by /rik+   
dur+ ! p]iod ( fiscal ye>s #bjji ?r\gh  
#bjae 2 &  7,b7 9 p>agraph 7#b7--  7i7 9
 ! head+1 by /rik+ ,t5 p]c5t set aside &
 ins]t+ ,set aside2 &  7ii7 by /rik+ #aj
 p]c5t & ins]t+ #ae p]c5t2 &  7#b7 9    
subsection 7g71 by ins]t+ & #dj1jjj1jjj 
= ea* fiscal ye> !reaft]1 to rema9      
available until exp5d$ aft] #bjae14  7b7
 ,requirem5t t manag$ c>e organizations 
provide language s]vices to enrollees   
,section #aicb7;b7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4 #acifu-#b7;b77 is  
am5d$ by add+ at ! end ! foll[+ new     
p>agraph3  7#i7 ,language s]vices ,ea*  
contract ) a manag$ c>e entity "u       
section #aijc7m7 or "u section          

#aije7t77#c7 %all require ! entity to   
provide & pay = language s]vices1       
includ+ oral int]pretation & writt5     
translation s]vices1 = an individual & !
 p>5t or gu>dian ( su* individual :o is 
eligible = m$ical assi/ance "u ! ,/ate  
plan "u ?is title & is enroll$ ) !      
entity & is limit$ ,engli% pr(ici5t :5  
int]act+ ) ! entity or ) any provid]    
receiv+ paym5t f ! entity4 ,su* language
 s]vices %all be provid$ 9 conjunction )
 all cov]$ items & s]vices t are        
available to su* individuals "u !       
contract4  4  7c7 ,m$icaid heal? c>e    
disp>ities ,section #aidf ( ! ,social   
,security ,act 7#db ,u4,s4,c4 #acifw-#e7
 is am5d$ by add+ at ! end ! foll[+ new 
subsection3  7d7 ,appropriation ,out (  
any funds 9 ! ,treasury n o!rwise       
appropriat$1 !re are appropriat$ to c>ry
 out ?is section #bj1jjj1jjj1 to rema9  
available until exp5d$4  4  7d7         
,effective date ,! am5dm5ts made by ?is 
section take effect on ! date ( enactm5t
 ( ?is ,act4  ,,iii ,b5efits &          

,af=dability  #cja4 ,/r5g!n$ co/-%>+    
protections "u ,,*ip  ,section #bajc7;e7
 ( ! ,social ,security ,act 7#db        
,u4,s4,c4 #acig;cc7e77 is am5d$--  7#a7 
9 p>agraph 7#c77;,b7--  7,a7 by ins]t+ 1
 includ+ ) respect to b5efits = d5tal   
s]vices1 aft] ,/ate *ild heal? plan2    
7,b7 by /rik+ annual aggregate co/-%>+ &
 ins]t+ aggregate co/-%>+2 &  7,c7 by   
/rik+ = ! ye> involv$ & ins]t+ 1 z      
appli$ on a qu>t]ly or mon?ly basis 7z  
specifi$ by ! ,/ate72 &  7#b7 by add+ at
 ! end ! foll[+ new p>agraph3  7#e7     
,additional requirem5ts  7,a7 ,track+ ( 
exp5ses2 notice ,except z provid$ 9     
subp>agraph 7,b71 9 ! case ( a ,/ate    
*ild heal? plan t imposes premiums1     
d$uctibles1 co/ %>+1 or simil> *>ges t  
c\ld 7z det]m9$ by ! ,secret>y7 cause   
families t include a t>get$ l[-income   
*ild or a t>get$ l[-income pregnant     
woman to h out-(-pocket exp5ses t exce$ 
! limit impos$ "u p>agraph 7#c77;,b7 = a
 mon? or qu>t] 7z applicable "u ! ,/ate 
plan71 ! ,/ate *ild heal? plan %all--   

7i7 e/abli% an electronic process =     
track+ su* exp5ses t does n rely on     
docum5tation provid$ by ! t>get$        
l[-income *ild1 ! t>get$ l[-income      
pregnant woman1 or ! family2 &  7ii7    
notify ea* su* family--  7,i7 ( !       
aggregate mon?ly or qu>t]ly limits on   
out-(-pocket exp5ses applicable to !    
family impos$ "u p>agraph 7#c77;,b72 &  
7,,ii7 t no premiums1 d$uctibles1 co/   
%>+1 or simil> *>ges %all be impos$ on  
any t>get$ l[-income *ild or t>get$     
l[-income pregnant woman 9 ! family = ! 
rema9d] ( any mon? or qu>t] ) respect to
 :i* ! family has rea*$ ! aggregate     
mon?ly or qu>t]ly family limit impos$ "u
 su* p>agraph applicable to ! family4   
7,b7 ,manag$ c>e entities or            
organizations ,9 ! case ( a ,/ate *ild  
heal? plan t provides *ild heal?        
assi/ance ?r\gh manag$ c>e entities or  
organizations1 ! entities or            
organizations %all1 ) respect to        
families describ$ 9 subp>agraph 7,a7--  
7i7 e/abli% an electronic process       

describ$ 9 subp>agraph 7,a77i72 &  7ii7 
coord9ate ) ! ,/ate ag5cy responsible = 
implem5t+ ! ,/ate *ild heal? plan "u ?is
 title to ensure t any premiums1        
d$uctibles1 co/ %>+1 or simil> *>ges    
impos$ on su* a family are includ$ 9 !  
aggregate limit applicable to ! family  
"u p>agraph 7#c77;,b74  4  #cjb4 ,ensur+
 cov]age ( prev5tive heal? s]vices "u   
,m$icaid & ,,*ip  7a7 ,m$icaid  7#a7    
,cl>ify+ prev5tive cov]age ,section     
#aije7;a77#ac7 ( ! ,social ,security    
,act 7#db ,u4,s4,c4 #acif;d7a77#ac77 is 
am5d$--  7,a7 by /rik+ subp>agraphs 7,a7
 & 7,b72  7,b7 by r$esignat+ subp>agraph
 7,c7 z subp>agraph 7,b72 &  7,c7 by    
ins]t+ be=e subp>agraph 7,b7 7z s       
r$esignat$7 ! foll[+ new subp>agraph3   
7,a7 ! items & s]vices describ$ 9       
p>agraphs 7#a7 ?r\gh 7#e7 ( section     
#bgac7;a7 ( ! ,public ,heal? ,s]vice    
,act2 &  4  7#b7 ,con=m+ am5dm5t        
,section #aijb7;a77#aj77;,a7 ( ! ,social
 ,security ,act 7#db ,u4,s4,c4          
#acif;a7a77#aj77;,a77 is am5d$ 9 ! matt]

 prec$+ clause 7i71 by ins]t+ 1         
7#ac77;,a7 be=e 1 7#ag74  7b7 ,,*ip     
,section #bajc7;c77#a77;,d7 ( ! ,social 
,security ,act 7#db ,u4,s4,c4           
#acig;cc7c77#a77;,d77 is am5d$ by /rik+ 
,well-baby & ins]t+ ,items & s]vices    
describ$ 9 p>agraphs 7#a7 ?r\gh 7#e7 (  
section #bgac7;a7 ( ! ,public ,heal?    
,s]vice ,act1 includ+ well-baby4  7c7   
,co/-,%>+ prohibitions  7#a7 ,9 g5]al   
,section #aiaf ( ! ,social ,security    
,act 7#db ,u4,s4,c4 #acif7o77 is am5d$--
  7,a7 9 subsection 7a77#b7--  7i7 9    
subp>agraph 7,d71 by /rik+ or at ! end2 
7ii7 9 subp>agraph 7,e71 by /rik+       
hospice c>e 7z def9$ 9 section          
#aije7o772 & at ! end & ins]t+ hospice  
c>e 7z def9$ 9 section #aije7o771 or2 & 
7iii7 by add+ at ! end ! foll[+ new     
subp>agraph3  7,f7 items & s]vices      
describ$ 9 section #aije7;a77#ac77;,a72 
&  2 &  7,b7 9 subsection 7b77#b7--  7i7
 9 subp>agraph 7,d71 by /rik+ or at !   
end2  7ii7 9 subp>agraph 7,e71 by /rik+ 
hospice c>e 7z def9$ 9 section          

#aije7o772 & at ! end & ins]t+ hospice  
c>e 7z def9$ 9 section #aije7o771 or2 & 
7iii7 by add+ at ! end ! foll[+ new     
subp>agraph3  7,f7 items & s]vices      
describ$ 9 section #aije7;a77#ac77;,a72 
&  4  7#b7 ,/ate option ,section        
#aiaf;,a7b77#c77;,b7 ( ! ,social        
,security ,act 7#db ,u4,s4,c4           
#acifo-#a7;b77#c77;,b77 is am5d$ by add+
 at ! end ! foll[+ new clause3  7xi7    
,items & s]vices describ$ 9 section     
#aije7;a77#ac77;,a74  4  #cjc4 ,timely  
immunization cov]age  7a7 ,cov]age =    
newly approv$ vacc9es )9 #cj days  7#a7 
,9 g5]al ,section #aibh7;e7 ( ! ,social 
,security ,act 7#db ,u4,s4,c4 #acifs7e77
 is am5d$ by add+ at ! end ! foll[+ new 
s5t5ce3 ,ea* revision ( ! li/ e/abli%$  
by su* ,advisory ,committee %all apply  
to ! pur*ase1 deliv]y1 & adm9i/ration ( 
p$iatric vacc9es "u ?is section n lat]  
?an #cj days aft] ! date su* ,advisory  
,committee approves ! revision44  7#b7  
,con=m+ am5dm5t ,section                
#bajc7;c77#a77;,d7 ( ! ,social ,security

 ,act 7#db ,u4,s4,c4                    
#acig;cc7c77#a77;,d77 is am5d$ by ins]t+
 1 adm9i/]$ 9 accordance ) ! s*$ule     
ref]r$ to 9 section                     
#aibh7;c77#b77;,b77i7 = p$iatric vacc9es
 aft] immunizations4  7b7 ,treatm5t (   
,,*ip-,eligible *ildr5 z f$]ally        
vacc9e-,eligible *ildr5 ,section        
#aibh7;b77#b7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acifs7b77#b77 is       
am5d$--  7#a7 9 subp>agraph 7,a77i71 by 
ins]t+ or ,,*ip-eligible aft]           
m$icaid-eligible2 &  7#b7 9 subp>agraph 
7,b71 by /rik+ clause 7i7 & ins]t+ !    
foll[+3  7i7 ,! t]m m$icaid-eligible or 
,,*ip-eligible *ild means1 ) respect to 
a *ild1 a *ild :o is entitl$ to m$ical  
assi/ance "u a ,/ate plan approv$ "u ?is
 title or a waiv] ( su* plan1 or :o is  
eligible = *ild heal? assi/ance "u a    
,/ate *ild heal? plan approv$ "u title  
,,xxi4  4  7c7 ,effective date ,!       
am5dm5ts made by ?is section take effect
 on ! date ( enactm5t ( ?is ,act4  #cjd4
 ,paym5t p>ity = ,m$icaid prim>y c>e    

s]vices  7a7 ,9 g5]al ,section          
#aijb7;a77#ac77;,c7 ( ! ,social         
,security ,act 7#db ,u4,s4,c4           
#acif;a7a77#ac77;,c77 is am5d$--  7#a7  
by /rik+ #bjac & #bjad & ins]t+ cal5d>  
ye>s #bjad ?r\gh #bjai2  7#b7 by /rik+ 1
 g5]al int]nal m$ic9e & ins]t+ 1 g5]al  
int]nal m$ic9e1 neurology1 psy*iatry1   
ob/etrics & gynecology2  7#c7 by ins]t+ 
or a heal? c>e practition] :o is a nurse
 practition]1 physician assi/ant1 or    
cl9ical nurse speciali/ 7z su* t]ms are 
def9$ 9 section #ahfa7;aa77#e77 or a    
c]tifi$ nurse midwife 7z def9$ 9 section
 #ahfa7;gg77#b77 aft] p$iatric m$ic9e2 &
  7#d7 by /rik+ su* s]vices & physician 
& ins]t+ su* s]vices & physician or     
heal? c>e practition]4  7b7 ,effective  
date ,! am5dm5ts made by ?is section    
%all apply to items & s]vices furni%$ on
 or aft] ! fir/ day ( ! fir/ cal5d>     
qu>t] t beg9s aft] ! date ( ! enactm5t (
 ?is ,act4  ,,iv ,access & ,quality  ,a 
,p$iatric ,quality ,measures  #dja4     
,ext5d+ ! p$iatric quality measures     

program ,section #aaci;,a7i7 ( ! ,social
 ,security ,act 7#db ,u4,s4,c4          
#acbj;b-#i;a7i77 is am5d$ by ins]t+ 1 & 
= ea* ( fiscal ye>s #bjae ?r\gh #bjai1  
#ej1jjj1jjj1 aft] #de1jjj1jjj4  #djb4   
,enhanc$ ,,fmap = activities relat$ to  
p$iatric quality measures ,section      
#aijc7;a77#c77;,a77iii7 ( ! ,social     
,security ,act 7#db ,u4,s4,c4           
#acif;b7a77#c77;,a77iii77 is am5d$ to   
read z foll[s3  7iii7 #ie p]c5t ( s mu* 
( ! sums exp5d$ dur+ any su* qu>t] 9    
fiscal ye>s #bjae1 #bjaf1 & #bjag1 #ij  
p]c5t ( s mu* ( ! sums exp5d$ dur+ any  
su* qu>t] 9 fiscal ye>s #bjah & #bjai1 &
 ! high] ( an am\nt equal to ! ,f$]al   
m$ical assi/ance p]c5tage 7z def9$ 9    
section #aije7;b77 or #ge p]c5t ( s mu* 
( ! sums exp5d$ dur+ any su* qu>t] 9 any
 fiscal ye> !reaft] 7z f\nd necess>y by 
! ,secret>y = ! prop] & effici5t        
adm9i/ration ( ! ,/ate plan7 z are      
attributable to su* developm5ts or      
modifications ( sy/ems ( ! type describ$
 9 clause 7i7 z are necess>y = !        

effici5t collection & report+ on ! core 
set ( *ild heal? quality measures "u    
subsections 7a71 7b71 7c71 & 7f7 (      
section #aaci;,a2 &  4  #djc4 ,report+ (
 full set ( p$iatric quality measures   
,section #aaci;,a7a77#d7 ( ! ,social    
,security ,act 7#db ,u4,s4,c4           
#acbj;b-#i;a7a77#d77 is am5d$--  7#a7 9 
! head+1 by /rik+ ,enc\rage volunt>y &  
/&>diz$ & ins]t+ ,/&>diz$2  7#b7 by     
/rik+ ,n lat] ?an & ins]t+ ! foll[+3    
7,a7 ,enc\rag+ volunt>y report+ ,n lat] 
?an  2 &  7#c7 by add+ at ! end ! foll[+
 new subp>agraph3  7,b7 ,o!r report+ ,n 
lat] ?an five ye>s aft] ! date ( !      
enactm5t ( ! ,,*ip ,ext5sion &          
,improvem5t ,act ( #bjad1 ! ,secret>y   
%all require t ea* ,/ate submit         
in=mation on ! core set ( *ild heal?    
quality measures 7z 9 effect on su* date
 ( enactm5t71 z updat$ "u subsection    
7b77#e74  4  #djd4 ,te*nical assi/ance  
to ,/ates = adopt+ & utiliz+ p$iatric   
quality measures ,section               
#aaci;,a7a77#g7 ( ! ,social ,security   

,act 7#db ,u4,s4,c4 #acbj;b-#i;a7a77#g77
 is am5d$ to read z foll[s3  7#g7       
,te*nical assi/ance  7,a7 ,9 g5]al ,!   
,secret>y %all provide te*nical         
assi/ance to ,/ates to assi/ !m 9 adopt+
 & utiliz+ ! core set ( *ild heal?      
measures 9 adm9i/]+ ! ,/ate plans "u    
titles ,,xix & ,,xxi1 includ+ by assi/+ 
,/ates 9 build+ _! data collection      
infra/ructures4  7,b7 ,fund+ #e1jjj1jjj 
( ! am\nt appropriat$ "u subsection 7i7 
= a fiscal ye> %all be us$ to c>ry out  
?is p>agraph4  4  #dje4 ,improv+ !      
effectiv5ess ( ! p$iatric quality       
measures ,section #aaci;,a7b7 ( !       
,social ,security ,act 7#db ,u4,s4,c4   
#acbj;b-#i;a7b77 is am5d$--  7#a7 9     
p>agraph 7#d7--  7,a7 by /rik+ !        
p>agraph head+ & ins]t+ ! foll[+3       
,ensur+ ! developm5t1 ma9t5ance1 &      
report+ ( a portfolio ( p$iatric quality
 measures2  7,b7 9 subp>agraph 7,a71 by 
/rik+ & at ! end2  7,c7 9 subp>agraph   
7,b77iii7--  7i7 by ins]t+ e/abli%m5t ( 
a su/a9able me*anism = ma9ta9+ & be=e   

updat+2 &  7ii7 by /rik+ z necess>y4 &  
ins]t+ 9 alignm5t ) ! mo/ rec5t v]sion (
 ! ,bluepr9t = ! ,measures ,managem5t   
,sy/em publi%$ by ! ,c5t]s = ,m$ic>e    
,m$icaid ,s]vices1 z necess>y2 &2 &     
7,d7 by add+ at ! end ! foll[+ new      
subp>agraph3  7,c7 aw>d grants or       
contracts to cont9ue & enhance !        
p$iatric quality measures program1 :i*  
%all include aw>d+ grants & contracts ) 
a p>ticul> emphasis on--  7i7 pati5t &  
family exp]i5ce or coord9ation ( c>e2   
7ii7 p$iatric populations t are small 9 
size & may be mo/ effectively address$  
by aggregat+ data across multiple       
,/ates1 includ+ p$iatric populations )  
m$ical complexity & p$iatric populations
 ) r>e conditions2  7iii7 ! impacts (   
*anges 9 life ev5ts ov] v>i\s /ages (   
*ild & adolesc5t developm5t1 includ+    
*anges 9 morbidity & mortality1 dep5d5ce
 /atus1 & developm5tal /ages1 & !       
impacts ( su* *anges on subsequ5t heal? 
& heal? c>e quality2 &  7iv7 e/abli%+ a 
su/a9able me*anism = id5tify+ & assi/+  

,/ates 9 develop+ a /&>diz$ data        
infra/ructure = ! collection & national 
report+ ( p$iatric quality measures1    
includ+ develop+ precise data elem5t    
def9itions & utiliz+ consi/5t data      
collection me?ods4  2  7#b7 by /rik+    
p>agraph 7#e7 & ins]t+ ! foll[+ new     
p>agraph3  7#e7 ,revis+1 /r5g!n+1 &     
improv+ initial core measures  7,a7 ,9  
g5]al ,! ,secret>y %all annually issue a
 rule 79 accordance ) section #eec (    
title #e1 ,unit$ ,/ates ,code7 to am5d !
 core set ( *ild heal? quality measures 
describ$ 9 subsection 7a7 s t su* core  
set--  7i7 is consi/5t ) ! purposes ( ! 
p$iatric quality measures program       
e/abli%$ "u p>agraph 7#a72  7ii7 meets !
 conditions specifi$ 9 p>agraph 7#b72   
7iii7 includes measures t--  7,i7 7     
develop$ by ! ,secret>y 9 consultation )
 ! entities specifi$ 9 subp>agraphs 7,a7
 ?r\gh 7,h7 ( p>agraph 7#c72  7,,ii7 7  
develop$1 validat$1 te/$1 or ma9ta9$    
?r\gh a grant or contract aw>d$ "u      
p>agraph 7#d72 &  7,,iii7 7 submitt$ to 

! ,secret>y = consid]ation t 7 n        
develop$ "u su* a grant or contract2 &  
7iv7 takes into acc\nt ! reports &      
demon/ration projects describ$ 9        
subp>agraphs 7c71 7d71 7e71 & 7f7 ( ?is 
section4  7,b7 ,additional *anges       
,beg9n+ n lat] ?an "o ye> aft] ! date ( 
! enactm5t ( ! ,,*ip ,ext5sion &        
,improvem5t ,act ( #bjad1 ! am5dm5ts    
made to ! core set ( measures "u        
subp>agraph 7,a7 %all include *anges--  
7i7 to measure ! type ( *ildr5's heal?  
insurance cov]age or o!r heal? b5efits  
cov]age available ov] "t1 9 addition to 
! pres5ce1 /ability1 & duration ( su*   
heal? insurance cov]age or su* heal?    
b5efits cov]age ov] "t1 = purposes (    
exam9+ enrollm5t *anges ( a *ild f "o   
type ( cov]age to ano!r2  7ii7 to ensure
 t ! measures reflect ! c>e provid$ to !
 div]se p$iatric population1 includ+    
adolesc5ts & *ildr5 ) special heal? c>e 
ne$s & ! managem5t ( acute & *ronic     
conditions2  7iii7 to ensure t !        
measures reflect c>e provid$ 9 all heal?

 c>e sett+s 9 :i* an individual enroll$ 
9 ! ,/ate plan "u title ,,xix receives  
c>e2 &  7iv7 to enc\rage ! adoption (   
p$iatric quality measures at ! ,/ate1   
plan1 community1 facility1 & provid]    
level attribution1 z well z across      
diff]5t heal? c>e deliv]y & cov]age     
sy/ems1 includ+ cov]age provid$ ?r\gh ! 
,ex*anges e/abli%$ "u title ,i ( !      
,pati5t ,protection & ,af=dable ,c>e    
,act4  2  7#c7 9 p>agraph 7#f7--  7,a7  
by /rik+ cl9ical c>e & ins]t+ cl9ical   
effectiv5ess1 pati5t safety1 population 
& public heal?1 pati5t & family         
engagem5t1 c>e coord9ation1 or          
effici5cy2 &  7,b7 by /rik+ 9 v>i\s     
in/itutional & ambulatory heal? c>e     
sett+s2 &  7#d7 by add+ at ! end !      
foll[+ new p>agraph3  7#h7 ,fund+       
#bj1jjj1jjj ( ! am\nt appropriat$ "u    
subsection 7i7 = a fiscal ye> %all be   
us$ to c>ry out ?is subsection4  4      
#djf4 ,reports reg>d+ ,/ate-specific    
quality ( c>e measures appli$ "u        
,m$icaid or ,,*ip ,section              

#aaci;,a7c77#a7 ( ! ,social ,security   
,act 7#db ,u4,s4,c4 #acbj;b-#i;a7c77 is 
am5d$--  7#a7 9 subp>agraph 7,a71 by    
/rik+ & at ! end2  7#b7 9 subp>agraph   
7,b71 by /rik+ ! p]iod at ! end & ins]t+
 a semicolon2 &  7#c7 by add+ at ! end !
 foll[+ new subp>agraphs3  7,c7         
,/ate-specific in=mation on ! annual    
progress t[>d1 & ef=ts to ov]come b>ri]s
 to1 report+ on all quality measures )9 
! core set ( *ild heal? quality         
measures1 z updat$ "u subsection        
7b77#e72 &  7,d7 beg9n+ n lat] ?an #e   
ye>s aft] ! date ( ! enactm5t ( ?is     
subp>agraph1 ,/ate-specific in=mation on
 all quality measures )9 ! core set (   
*ild heal? quality measures1 z updat$ "u
 subsection 7b77#e74  4  #djg4 ,advisory
 panel reg>d+ p$iatric quality  7a7 ,9  
g5]al ,section #aaci;,a7g7 ( ! ,social  
,security ,act 7#db ,u4,s4,c4           
#acbj;b-#i;a7g77 is am5d$--  7#a7 9 !   
head+1 by /rik+ ,/udy ( & ins]t+        
,/akehold] input & reports on2  7#b7 by 
r$esignat+ p>agraph 7#b7 z p>agraph     

7#c72 &  7#c7 by ins]t+ aft] p>agraph   
7#a7 ! foll[+ new p>agraph3  7#b7       
,p$iatric ,quality ,measurem5t ,n lat]  
?an #ah mon?s aft] ! date ( ! enactm5t (
 ?is p>agraph1 ! ,secret>y1 9           
consultation ) repres5tatives ( ,/ate   
ag5cies responsible = adm9i/]+ !        
,m$icaid program "u title ,,xix & !     
,*ildr5's ,heal? ,insurance ,program "u 
title ,,xxi & repres5tatives ( relevant 
provid] organizations1 %all submit 7&   
p]iodically update7 to ! ,committee on  
,en]gy & ,comm]ce ( ! ,h\se (           
,repres5tatives & ! ,committee on       
,f9ance ( ! ,s5ate a report t takes into
 acc\nt ! priorities & goals to be      
e/abli%$ pursuant to section            
#ahij7;b77#g77;,e74 ,su* report %all    
include--  7,a7 /rategic & detail$      
op]ational plans to address & ov]come   
b>ri]s to ,/ate collection (1 & report+ 
(1 all quality measures )9 ! core set ( 
*ild heal? quality measures1 z updat$ "u
 subsection 7b77#e72  7,b7 an analysis (
 ! types ( inc5tives1 includ+ ,f$]al    

fund+ & any associat$ am\nts necess>y = 
,/ates to collect & report on all       
quality measures )9 ! core set ( *ild   
heal? quality measures1 z updat$ "u     
subsection 7b77#e72 &  7,c7 a /&>diz$   
=mat & plan = ,/ates to collect & report
 on all quality measures )9 ! core set (
 *ild heal? quality measures1 z updat$  
"u subsection 7b77#e74  4  7b7          
,inclusion ( *ild & adult heal? quality 
measures = multi-,/akehold] gr\p input  
,section #ahij7;b77#g7 ( ! ,social      
,security ,act 7#db ,u4,s4,c4           
#acie;aaa7b77#g77 is am5d$--  7#a7 9    
subp>agraph 7,b77i77,i71 by ins]t+      
#aaci;,a7a71 #aaci;,b1 aft] sections2 & 
7#b7 by add+ at ! end ! foll[+ new      
subp>agraph3  7,e7 ,p$iatric ,quality   
,measurem5t ,) respect to quality &     
effici5cy measures = use pursuant to    
section #aaci;,a7a71 ! entity %all      
conv5e a panel1 compos$ ( heal? exp]ts  
7includ+ exp]ts employ$ by ! ,f$]al     
,gov]nm5t & exp]ts n s employ$7 to      
e/abli% priorities & goals = *ild heal? 

to--  7i7 advise & make recomm5dations  
to ! ,secret>y reg>d+ *anges t may be   
made to ! core set ( *ild heal? quality 
measures1 z updat$ "u section           
#aaci;,a7b77#e72  7ii7 e/abli% /&>ds = !
 timel9ess & accuracy ( data collect$ & 
report$ = purposes ( su* measures2 &    
7iii7 review & make recomm5dations1 at  
lea/ annually1 = /rategies to enhance ! 
timel9ess1 accuracy1 & utility ( su*    
measures4  4  #djh4 ,ext5d+ & exp&+     
demon/ration projects  7a7 ,/r5g!n+     
demon/ration projects = improv+ !       
quality ( *ildr5's heal? c>e & ! use (  
heal? in=mation te*nology ,section      
#aaci;,a7d7 ( ! ,social ,security ,act  
7#db ,u4,s4,c4 #acbj;b-#i;a7d77 is      
am5d$--  7#a7 9 p>agraph 7#a7--  7,a7 9 
! matt] prec$+ subp>agraph 7,a7--  7i7  
by /rik+ #bjji ?r\gh #bjac1 ! ,secret>y 
%all aw>d n m ?an #aj grants & ins]t+   
#bjae ?r\gh #bjai1 ! ,secret>y %all aw>d
 n few] ?an #aj grants12 &  7ii7 by     
ins]t+ 7includ+ oral c>e7 aft] heal?    
c>e2  7,b7 9 subp>agraph 7,c71 by /rik+ 

or at ! end2  7,c7 9 subp>agraph 7,d71  
by /rik+ ! p]iod at ! end & ins]t+ a    
semicolon2 &  7,d7 by add+ at ! end !   
foll[+ new subp>agraphs3  7,e7 exam9e & 
address b>ri]s to effective deliv]y (   
p]9atal c>e & its impact on bir?        
outcomes & subsequ5t pregnancies &      
*ildr5's heal?2  7,f7 implem5t & exp&   
p$iatric & p]9atal le>n+ & quality      
improvem5t collaboratives on ! quality (
 *ildr5's & pregnant wom5's heal? c>e1  
includ+ improv+ pati5t outcomes1 r$uc+  
heal? co/s1 & address+ heal? disp>ities2
  7,g7 enc\rage & evaluate ! use at !   
,/ate level ( paym5t re=m & relat$      
policy proposals = purposes ( promot+   
high] quality ( c>e = *ildr51 includ+ ! 
%>$ sav+s program e/abli%$ "u section   
#ahii & o!r me?ods ( enc\rag+ integrat$ 
c>e models2 or  7,h7 ) respect to !     
model electronic heal? record =mat =    
*ildr5 develop$ & dissem9at$ "u         
subsection 7f7--  7i7 assess ! ext5t to 
:i* ! =mat has be5 incorporat$ into     
widely us$ electronic heal? record      

=mats2  7ii7 implem5t /&>ds & activities
 t result 9 increas$ use ( su* =mat2 &  
7iii7 evaluate ! impact ( ! increas$ use
 ( su* =mat4  2  7#b7 9 p>agraph 7#b7-- 
7,a7 9 subp>agraph 7,a71 by /rik+ & at !
 end2  7,b7 9 subp>agraph 7,b71 by /rik+
 ! p]iod at ! end & ins]t+ 2 &2 &  7,c7 
by add+ at ! end ! foll[+ new           
subp>agraph3  7,c7 ) respect to grants  
aw>d$ = projects describ$ 9 p>agraph    
7#a77;,f7--  7i7 give priority to       
collaboratives t w\ld demon/rate        
sub/antial impacts on ! p$iatric        
population by--  7,i7 affect+ a l>ge    
p]c5tage ( su* population or by         
sub/antially improv+ outcomes 9 a small]
 population2  7,,ii7 r$uc+ ! co/ (1 &   
o!r b>ri]s to access to1 heal? c>e =    
*ildr51 includ+ *ildr5 ) m$ically       
complex illnesses or *ronic conditions2 
7,,iii7 hav+ a high likelihood to r$uce 
disp>ities 9 heal? /atus2 or  7,,iv7    
pot5tially hav+ long-t]m heal? impacts  
by address+ *ildhood precursors to adult
 conditions2 &  7ii7 enc\rage           

coord9ation ) o!r s\rces ( fund+ 9 !    
expansion ( p$iatric le>n+              
collaboratives1 includ+ by coord9at+ c>e
 & utiliz+ community heal? work]s 7z    
def9$ 9 section #cii,v7k7 ( ! ,public   
,heal? ,s]vice ,act 7#db ,u4,s4,c4      
#bhj;g-#aa7k7774  2 &  7#c7 9 p>agraph  
7#d7--  7,a7 by ins]t+ ,= ea* ( fiscal  
ye>s #bjji ?r\gh #bjac1 be=e            
#bj1jjj1jjj2 &  7,b7 by add+ at ! end ! 
foll[+ new s5t5ce3 ,= ea* ( fiscal ye>s 
#bjae ?r\gh #bjai1 #be1jjj1jjj ( ! am\nt
 appropriat$ "u subsection 7i7 = a      
fiscal ye> %all be us$ to c>ry out ?is  
subsection44  7b7 ,ext5d+ fund+ =       
*ildhood obesity demon/ration projects  
,section #aaci;,a7e77#h7 ( ! ,social    
,security ,act 7#db ,u4,s4,c4           
#acbj;b-#i;a7e77#h77 is am5d$ by ins]t+ 
1 & = ! p]iod ( fiscal ye>s #bjae ?r\gh 
#bjai1 #be1jjj1jjj aft] #bjad4  ,b      
,cont9u+ ,deliv]y ,sy/em ,re=m  #daa4   
,support+ evid5ce-bas$ c>e coord9ation 9
 communities  7a7 ,9 g5]al ,section     
#eaa7;j77#a7 ( ! ,social ,security ,act 

7#db ,u4,s4,c4 #gaa7;j77#a77 is am5d$-- 
7#a7 9 subp>agraph 7,d71 by ins]t+ & at 
! end2  7#b7 9 subp>agraph 7,e71 by     
/rik+ fiscal ye> #bjad2 & & ins]t+ ea* (
 fiscal ye>s #bjad ?r\gh #bjai42 &  7#c7
 by /rik+ subp>agraph 7,f74  7b7        
,effective date ,! am5dm5ts made by ?is 
section %all take effect on ! date (    
enactm5t ( ?is ,act4  #dab4 ,ensur+ c>e 
coord9ation = *ildr5 ,section #bgjf ( ! 
,pati5t ,protection & ,af=dable ,c>e    
,act 7#db ,u4,s4,c4 #acif;a note7 is    
am5d$--  7#a7 9 subsection 7a77#b71 by  
/rik+ #bjaf & ins]t+ #bjai2 &  7#b7 9   
subsection 7e71 by /rik+ appropriat$ &  
all t foll[s ?r\gh ! p]iod at ! end &   
ins]t+ ! foll[+3  appropriat$ to c>ry   
out ?is section-- 7#a7 = fiscal ye>     
#bjad1 su* sums z are necess>y2  7#b7 = 
ea* ( fiscal ye>s #bjae ?r\gh #bjai1    
#ajj1jjj1jjj2 &  7#c7 = ! p]iod beg9n+  
on ,octob] #a1 #bjai1 & end+ on ,decemb]
 #ca1 #bjai1 #be1jjj1jjj4  4  ,c        
,miscellane\s  #dba4 ,assur+ cov]age    
cont9uity = =m] fo/] c>e *ildr5  7a7 ,9 

g5]al ,section                          
#aijb7;a77#aj77;,a77i77,,ix7 ( ! ,social
 ,security ,act 7#db ,u4,s4,c4          
#acif;a7a77#aj77;,a77i77,,ix77 is       
am5d$--  7#a7 9 item 7bb71 by /rik+ are 
n describ$ 9 or enroll$ "u & ins]t+ are 
n describ$ 9 & are n enroll$ "u2  7#b7 9
 item 7cc71 by /rik+ responsibility ( ! 
,/ate & ins]t+ responsibility ( a ,/ate2
 &  7#c7 9 item 7dd71 by /rik+ ! ,/ate  
plan "u ?is title or "u a waiv] ( ! &   
ins]t+ a ,/ate plan "u ?is title or "u a
 waiv] ( su* a4  7b7 ,effective date ,! 
am5dm5ts made by ?is section %all take  
effect on ,july #a1 #bjae4  #dbb4       
,def9ition ( !rapeutic fo/] c>e z m$ical
 assi/ance  7a7 ,9 g5]al ,section #aije 
( ! ,social ,security ,act 7#db         
,u4,s4,c4 #acif;d7 is am5d$--  7#a7 9   
subsection 7a7--  7,a7 9 p>agraph 7#bh71
 by /rik+ & at ! end2  7,b7 by          
r$esignat+ p>agraph 7#bi7 z p>agraph    
7#cj72 &  7,c7 by ins]t+ aft] p>agraph  
7#bh7 ! foll[+ new p>agraph3  7#bi7     
!rapeutic fo/] c>e s]vices describ$ 9   

subsection 7ee72 &  2 &  7#b7 by add+ at
 ! end ! foll[+ new subsection3  7ee7   
7#a7 ,= purposes ( subsection 7a77#bi71 
subject to subp>agraph 7,c71 !rapeutic  
fo/] c>e s]vices describ$ 9 ?is         
subsection are s]vices provid$ = *ildr5 
:o h n atta9$ age #ba1 & :o1 z a result 
( m5tal illness1 o!r emotional or       
behavioral disord]s1 m$ically fragile   
conditions1 or developm5tal             
disabilities1 ne$ ! level ( c>e provid$ 
9 an in/itution 7includ+ a psy*iatric   
resid5tial treatm5t facility7 or nurs+  
facility ! co/ ( :i* c\ld be reimburs$  
"u ! ,/ate plan b :o c be c>$ = or      
ma9ta9$ 9 a community placem5t1 ?r\gh a 
qualifi$ !rapeutic fo/] c>e program     
describ$ 9 p>agraph 7#b74  7#b7 ,a      
qualifi$ !rapeutic fo/] c>e program     
describ$ 9 ?is p>agraph is a program t--
  7,a7 is lic5s$ by ! ,/ate & accr$it$  
by ! ,jo9t ,commission on ,accr$itation 
( ,heal?c>e ,organizations1 !           
,commission on ,accr$itation (          
,rehabilitation ,facilities1 ! ,c\ncil  

on ,accr$itation1 or by ano!r equival5t 
accr$itation ag5cy 7or ag5cies7 z !     
,secret>y may recognize2  7,b7 provides 
/ructur$ daily activities1 includ+ !    
developm5t1 improvem5t1 monitor+1 &     
re9=c+ ( age-appropriate social1        
communication & behavioral skills1      
trauma-in=m$ & g5d]-responsive s]vices1 
crisis int]v5tion & crisis support      
s]vices1 m$ication monitor+1 c\nsel+1 & 
case managem5t1 & may furni% o!r        
int5sive community s]vices2 &  7,c7     
provides fo/] c>e p>5ts ) specializ$    
tra9+ & consultation 9 ! managem5t (    
*ildr5 ) m5tal illness1 trauma1 o!r     
emotional or behavioral disord]s1       
m$ically fragile conditions1 or         
developm5tal disabilities1 & specific   
additional tra9+ on ! ne$s ( ea* *ild   
provid$ su* s]vices4  7#c7 ,9 mak+      
cov]age det]m9ations "u p>agraph 7#a71 a
 ,/ate may employ m$ical necessity      
crit]ia t are simil> to ! m$ical        
necessity crit]ia appli$ to cov]age     
det]m9ations = o!r s]vices & supports "u

 ?is title4  7#d7 ,! s]vices describ$ 9 
?is subsection d n include ! tra9+      
ref]r$ to 9 p>agraph 7#b77;,c74  4  7b7 
,effective date ,! am5dm5ts made by     
subsection 7a7 %all apply to cal5d>     
qu>t]s beg9n+ on or aft] ! date (       
enactm5t ( ?is ,act4  #dbc4 ,te*nical   
correction  7a7 ,9 g5]al ,section       
#aiag7;d77#d77;,a7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4 #acifp7d77#d77;,a77
 is am5d$ by ins]t+ ! individual1 aft] =
 ! b5efit ( su* individual by4  7b7     
,effective date ,! am5dm5t made by      
subsection 7a7 %all apply to tru/s      
e/abli%$ on or aft] ! date ( ! enactm5t 
( ?is ,act4