,i  #aae? ,,congress  #a/ ,session  ,h4 
,r4 #ccbe  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,july #bj1 #bjag,mr4  
,b>ton 7= himself1 ,ms4 ,ca/or (        
,florida1 ,mr4 ,g5e ,gre5 ( ,texas1 ,ms4
 ,e%oo1 ,mr4 ,rei*]t1 & ,ms4 ,h]r]a     
,beutl]7 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 ) ! option ( provid+     
coord9at$ c>e = *ildr5 ) complex m$ical 
conditions ?r\gh a heal? home1 & = o!r  
purposes4  #a4 ,%ort title ,?is ,act may
 be cit$ z ! ,advanc+ ,c>e =            
,exceptional ,kids ,act or ! ,,ace ,kids
 ,act4  #b4 ,e/abli%m5t ( ,/ate ,m$icaid
 option to provide coord9at$ c>e ?r\gh a
 heal? home = *ildr5 ) complex m$ical   
conditions ,title ,,xix ( ! ,social     
,security ,act 7#db ,u4,s4,c4 #acif et  
seq47 is am5d$ by add+ at ! end ! foll[+
 new section3  #aidg4 ,/ate option to   
provide coord9at$ c>e ?r\gh a heal? home
 = *ildr5 ) complex m$ical conditions   

7a7 ,9 ,g5]al ,not)/&+ section          
#aijb7;a77#a7 7relat+ to /atewid5ess71  
section #aijb7;a77#aj77;,b7 7relat+ to  
comp>ability71 section #aijb7;a77#bc7   
7relat+ to fre$om ( *oice71 section     
#aijb7;a77#cj77;,a7 7relat+ to equal    
access71 & any o!r provision ( ?is title
 :i* ! ,secret>y det]m9es x is necess>y 
to waive 9 ord] to implem5t ?is section 
7o!r ?an section #aije7;a77#d77;,b7     
7relat+ to e>ly & p]iodic scre5+1       
diagno/ic1 & treatm5t s]vices771 beg9n+ 
on ,janu>y #a1 #bjah1 a ,/ate1 at its   
option z a ,/ate plan am5dm5t1 may      
provide = m$ical assi/ance "u ?is title 
to *ildr5 ) m$ically complex conditions 
:o select 7or = :om is select$7 a       
designat$ provid]1 or a team ( heal? c>e
 pr(essionals1 z ! individual's heal?   
home = purposes ( provid+ su* *ildr5 )  
heal? home s]vices4  7b7 ,paym5ts  7#a7 
,9 g5]al ,a ,/ate %all provide1 )       
respect to heal? home s]vices furni%$ to
 ea* *ild ) m$ically complex conditions 
:o selects or = :om !re is select$ a    

designat$ provid] or a team z ! *ild's  
heal? home pursuant to ?is section1 to  
su* designat$ provid] or team ) paym5ts 
= ! provision ( su* heal? home s]vices4 
,! ,/ate %all make su* paym5ts reg>dless
 ( :e!r a *ild ) m$ically complex       
conditions describ$ 9 ! prec$+ s5t5ce   
receives heal? home s]vices "u ?is      
section ?r\gh a fee-=-s]vice or manag$  
c>e sy/em4 ,su* paym5ts = su* s]vices   
%all be treat$ z m$ical assi/ance 7z    
def9$ 9 section #aije7;a77 = purposes ( 
paym5ts made "u section #aijc7;a71      
except t1 dur+ ! fir/ #h fiscal ye>     
qu>t]s t ! ,/ate plan am5dm5t is 9      
effect1 ! ,f$]al m$ical assi/ance       
p]c5tage applicable to su* paym5ts %all 
be increas$ by #bj p]c5tage po9ts1 b 9  
no case %all exce$ #ij p]c5t4  7#b7     
,me?odology  7,a7 ,9 g5]al ,! ,/ate %all
 specify 9 ! ,/ate plan am5dm5t !       
me?odology ! ,/ate w use = det]m9+      
paym5t "u p>agraph 7#a74 ,su* me?odology
 = det]m9+ paym5t--  7i7 may be ti]$ to 
reflect1 ) respect to ea* *ild )        

m$ically complex conditions & ea*       
designat$ provid]1 or team ( heal? c>e  
pr(essionals1 ! sev]ity or numb] ( su*  
*ild's *ronic conditions1 life-?reat5+  
illnesses1 disabilities1 or r>e diseases
 or ! specific capabilities ( su*       
provid] or su* team2  7ii7 %all be      
e/abli%$ consi/5t ) section             
#aijb7;a77#cj77;,a72 &  7iii7 %all take 
into acc\nt any fe$back ! ,/ate receives
 f /akehold]s4  7,b7 ,models ( paym5t ,!
 me?odology "u subp>agraph 7,a7 may     
include paym5ts made on a p]-memb]1     
p]-mon? basis & may include %>$ sav+s   
models1 pay-=-p]=mance models1 cont+5cy 
aw>ds dep5d5t on r$uc+ utilization (    
em]g5cy dep>tm5ts1 or o!r inc5tive-bas$ 
approa*es1 z def9$ by ! ,/ate4  7,c7    
,ensur+ high-quality c>e ,! me?odology  
"u subp>agraph 7,a7 %all include !      
,/ate's /rategy = evaluat+ ! quality (  
c>e provid$ )9 a heal? home pursuant to 
?is section4 ,su* /rategy %all take into
 acc\nt ! foll[+ quality measures t may 
be applicable = heal? homes t s]ve      

*ildr5 ) m$ically complex conditions3   
7i7 ,*ild heal? quality measures &      
measures = c5t]s ( excell5ce = *ildr5 ) 
complex ne$s develop$ "u ?is title1     
title ,,xxi1 & section #aaci;,a4  7ii7  
,! ,heal?c>e ,effectiv5ess ,data &      
,in=mation ,set 7,,h$is74  7iii7 ,!     
heal? home's exp]tise 9 provid+1        
integrat+1 or coord9at+ prompt c>e =    
*ildr5 ) complex m$ical conditions1     
includ+ access to p$iatric em]g5cy      
s]vices at all times4  7iv7 ,! heal?    
home's ability to coord9ate & integrate 
! full range ( p$iatric m$ical1         
surgical1 & behavioral speciali/s &     
subspeciali/s ne$$1 bas$ on cl9ical     
qualifications 7su* z bo>d c]tification7
 & pati5t pref]5ce on ! c>e team to c>e 
= *ildr5 ) complex m$ical conditions1 z 
well z provid]s (f]+ specializ$ s]vices1
 su* z rehabilitative & habilitative    
heal? c>e & private-duty nurs+1 if ne$$4
  7v7 ,! heal? home's ability to        
coord9ate ! provision ( outpati5t c>e   
ne$s1 includ+ durable m$ical equipm5t1  

m$ical supplies1 & m$ical foods1 if     
ne$$4  7vi7 ,! heal? home's ability to  
arrange & coord9ate c>e = *ildr5 )      
complex m$ical conditions f out-(-,/ate 
provid]s to ! maximum ext5t practicable 
= ! families ( su* *ildr5 & :]e m$ically
 necess>y 9 accordance ) ! guidance f ! 
,adm9i/rator ( ! ,c5t]s = ,m$ic>e       
,m$icaid ,s]vices issu$ pursuant to     
section #d ( ! ,,ace ,kids ,act4  7vii7 
,! heal? home's ability to coord9ate &  
collect paym5ts f liable ?ird p>ties    
7includ+ p>ties describ$ 9 section      
#aijb7;a77#be77;,a77 = c>e & s]vices    
provid$ or arrang$ = by ! entity4       
7viii7 ,! heal? home's ability to       
collect & report on ! in=mation requir$ 
"u subsection 7d77#a74  7c7 ,coord9at+  
c>e  7#a7 ,hospital ref]rals ,a ,/ate   
%all include 9 ! ,/ate plan am5dm5t "u  
?is section-- 7,a7 a requirem5t =       
hospitals p>ticipat+ "u ! ,/ate plan "u 
?is title or a waiv] ( su* plan to      
e/abli% proc$ures = hospital em]g5cy    
dep>tm5ts to ref] *ildr5 ) m$ically     

complex conditions enroll$ 9 a heal?    
home pursuant to ?is section to         
designat$ provid]s or teams ( heal? c>e 
pr(essionals :o are p>ticipat+ 9 su*    
heal? home2 &  7,b7 a requirem5t = !    
,/ate to notify su* hospitals ( any     
designat$ provid]s or teams ( heal? c>e 
pr(essionals :o are p>ticipat+ 9 a heal?
 home4  7#b7 ,education ) respect to    
availability ( heal? home s]vices ,a    
,/ate %all include 9 ! ,/ate plan       
am5dm5t "u ?is section a description ( !
 ,/ate's process = educat+ provid]s     
p>ticipat+ 9 ! ,/ate plan "u ?is title  
or a waiv] ( su* plan ab\t !            
availability ( heal? home s]vices =     
*ildr5 ) m$ically complex conditions1   
includ+ ! process by :i* su* provid]s c 
ref] su* *ildr5 to designat$ provid]s   
7or a team ( heal? c>e pr(essionals7 to 
receive su* s]vices4  7#c7 ,family      
education ,a ,/ate %all include 9 !     
,/ate plan am5dm5t "u ?is section a     
description ( ! ,/ate's process =       
educat+ families ) *ildr5 eligible to   

receive heal? home s]vices pursuant to  
?is section ( ! availability ( su*      
s]vices4 ,su* process may include !     
p>ticipation ( family-to-family entities
 or o!r public or private organizations 
or entities :o provide outrea* &        
in=mation ab\t ! availability ( heal?   
c>e items & s]vices to families (       
individuals eligible to receive m$ical  
assi/ance "u ! ,/ate plan "u ?is title  
7or a waiv] ( ! plan74  7#d7 ,coord9at+ 
c>e f out-(-,/ate provid]s  7,a7 ,9     
g5]al ,a ,/ate elect+ to provide m$ical 
assi/ance pursuant to subsection 7a7    
%all provide guidance1 consi/5t )       
guidance f ! ,adm9i/rator ( ! ,c5t]s =  
,m$ic>e  ,m$icaid ,s]vices issu$        
pursuant to section #d ( ! ,,ace ,kids  
,act1 to designat$ provid]s1 or teams ( 
heal? c>e pr(essionals1 receiv+ paym5t  
"u ?is section1 reg>d+ ! ,/ate's        
policies & proc$ures = access+ c>e =    
*ildr5 ) m$ically complex conditions f  
out-(-,/ate provid]s4 ,! guidance       
provid$ by ! ,/ate "u ! prec$+ s5t5ce   

%all include in=mation on h[ out-(-,/ate
 provid]s :o provide s]vices to *ildr5 )
 m$ically complex conditions enroll$ 9 a
 heal? home 9 su* ,/ate pursuant to ?is 
section may receive paym5t "u ! ,/ate   
plan "u ?is title 7or a waiv] ( ! plan74
  7,b7 ,be/ practices ,a ,/ate elect+ to
 provide m$ical assi/ance pursuant to   
subsection 7a7 %all1 to ! ext5t         
practicable1 adopt be/ practices =      
provid+ access to out-(-,/ate provid]s =
 *ildr5 ) m$ically complex conditions   
consi/5t ) guidance issu$ by !          
,adm9i/rator ( ! ,c5t]s = ,m$ic>e       
,m$icaid ,s]vices pursuant to section #d
 ( ! ,,ace ,kids ,act4 ,! ,adm9i/rator (
 ! ,c5t]s = ,m$ic>e  ,m$icaid ,s]vices  
%all make available on a public ,int]net
 website ( ! ,c5t]s = ,m$ic>e  ,m$icaid 
,s]vices a li/ ( ! ,/ates ) a ,/ate plan
 am5dm5t approv$ "u ?is section & !     
degree to :i* 7z det]m9$ by !           
,adm9i/rator7 su* ,/ates h adopt$ ! be/ 
practices recomm5d$ by ! ,adm9i/rator 9 
su* guidance4  7,c7 ,m5tal heal?        

coord9ation ,a ,/ate %all consult &     
coord9ate1 z appropriate1 ) ! ,assi/ant 
,secret>y = ,m5tal ,heal? & ,sub/ance   
,use1 9 address+ issues reg>d+ !        
prev5tion & treatm5t ( m5tal illness &  
sub/ance use among *ildr5 ) m$ically    
complex conditions receiv+ home heal?   
s]vices pursuant to ?is section4  7,d7  
,failure to implem5t be/ practices      
,beg9n+ #ahj days aft] ! date on :i*    
guidance is issu$ by ! ,adm9i/rator ( ! 
,c5t]s = ,m$ic>e  ,m$icaid ,s]vices     
pursuant to section #d ( ! ,,ace ,kids  
,act1 9 ! case ( a ,/ate ) a ,/ate plan 
am5dm5t approv$ "u ?is section t !      
,adm9i/rator ( ! ,c5t]s = ,m$ic>e       
,m$icaid ,s]vices det]m9es has n adopt$ 
! be/ practices recomm5d$ by !          
,adm9i/rator 9 su* guidance1 ! increase 
( ! ,f$]al m$ical assi/ance p]c5tage    
appli$ "u subsection 7b77#a7 %all be    
r$uc$ by #aj p]c5tage po9ts4  7d7 ,data 
collection  7#a7 ,provid] report+       
requirem5ts ,z a condition ( receiv+    
paym5t "u ?is section1 a designat$      

provid] or team ( heal? c>e pr(essionals
 receiv+ paym5t = heal? home s]vices "u 
?is section %all report to ! ,/ate !    
foll[+ in=mation3  7,a7 ,) respect to   
ea* su* provid] or team1 ! "n1 ,national
 ,provid] ,id5tification numb]1 address1
 & specific heal? c>e s]vices (f]$ to be
 provid$ to *ildr5 ) m$ically complex   
conditions enroll$ 9 ! heal? home       
involv$4  7,b7 ,in=mation on all        
applicable measures us$ by su* provid]  
or team = purposes ( assi/+ 9 assess+ ! 
quality & effectiv5ess ( su* s]vices4   
7,c7 ,o!r su* in=mation z ! ,adm9i/rator
 ( ! ,c5t]s = ,m$ic>e  ,m$icaid ,s]vices
 %all specify 9 guidance4  7#b7 ,/ate   
report+ requirem5ts ,a ,/ate elect+ to  
provide m$ical assi/ance pursuant to    
subsection 7a7 %all collect & provide to
 ! ,adm9i/rator ( ! ,c5t]s = ,m$ic>e    
,m$icaid ,s]vices 7& to ! ,m$icaid &    
,,*ip ,paym5t & ,access ,commission ^u  
reque/71 9 a =m & mann] det]m9$ by !    
,adm9i/rator to be reasonable & m9imally
 burd5some1 ! foll[+ in=mation3  7,a7   

,in=mation report$ "u p>agraph 7#a74    
7,b7 ,! numb] ( *ildr5 ) m$ically       
complex conditions :o h select$ a heal? 
home or = :om a heal? home 0 select$    
pursuant to ?is section4  7,c7 ,!       
nature1 numb]1 & preval5ce ( *ronic     
conditions1 life-?reat5+ illnesses1     
disabilities1 or r>e diseases t su*     
*ildr5 h4  7,d7 ,! type ( deliv]y sy/ems
 & paym5t models us$ to provide s]vices 
to su* *ildr5 "u ?is section4  7,e7 ,!  
numb] & *>act]i/ics ( provid]s or heal? 
c>e pr(essionals designat$ z heal? homes
 pursuant to ?is section1 includ+ !     
numb] & *>act]i/ics ( out-(-,/ate       
provid]s or heal? c>e pr(essionals :o   
provide heal? c>e items & s]vices to su*
 *ildr54  7,f7 ,! ext5t to :i* su*      
*ildr5 receive heal? c>e items & s]vices
 "u a ,/ate plan "u ?is title or a waiv]
 ( su* plan f out-(-,/ate provid]s1 & ! 
ext5t to :i* su* s]vices 7 provid$ on an
 em]g5cy or non-em]g5cy basis4  7,g7    
,quality measures develop$ specifically 
) respect to heal? c>e items & s]vices  

furni%$ to *ildr5 ) m$ically complex    
conditions4  7e7 ,def9itions ,9 ?is     
section3 7#a7 ,*ild ) m$ically complex  
conditions  7,a7 ,9 g5]al ,subject to   
subp>agraph 7,b71 ! t]m *ild ) m$ically 
complex conditions means an individual  
"u #ba ye>s ( age :o--  7i7 is eligible 
= m$ical assi/ance "u ! ,/ate plan "u   
?is title or "u a waiv] ( su* plan2 &   
7ii7 has at lea/-- 7,i7 #a *ronic       
condition t affects ?ree or m organ     
sy/ems & sev]ely r$uces cognitive or    
physical function+ 7su* z ! ability to  
eat1 dr9k1 or brea! indep5d5tly7 & :i*  
also requires ! use ( m$ication1 durable
 m$ical equipm5t1 !rapy1 surg]y1 or o!r 
treatm5t or treatm5ts2 or  7,,ii7 #a    
life-limit+ illness or r>e p$iatric     
disease 7z def9$ 9 section #ebi7;a77#c7 
( ! ,f$]al ,food1 ,drug1 & ,cosmetic    
,act 7#ba ,u4,s4,c4 #cfj;fff7a77#c7771  
su* z a =m ( canc]4  7,b7 ,rule (       
con/ruction ,no?+ 9 ?is p>agraph %all   
prev5t a ,/ate ) a ,/ate plan am5dm5t   
approv$ "u ?is section1 ) respect to    

det]m9+ ! eligibility ( a *ildr5 )      
m$ically complex conditions to receive  
heal? home s]vices "u su* ,/ate plan    
am5dm5t1 f increas+ ! numb] or sev]ity (
 *ronic conditions1 life-?reat5+        
illnesses1 disabilities1 or r>e         
diseases4  7#b7 ,*ronic condition ,! t]m
 *ronic condition means a s]i\s1        
long-t]m physical1 m5tal1 or            
developm5tal disability or disease1 su* 
z any ( ! foll[+3  7,a7 ,c]ebral palsy4 
7,b7 ,cy/ic fibrosis4  7,c7             
,,hiv_/,,aids4  7,d7 ,blood diseases1   
su* z anemia or sickle cell disease4    
7,e7 ,muscul> dy/rophy4  7,f7 ,sp9a     
bifida4  7,g7 ,epilepsy4  7,h7 ,sev]e   
autism spectrum disord]4  7,i7 ,s]i\s   
emotional di/urbance or s]i\s m5tal     
heal? illness4  7#c7 ,heal? home ,! t]m 
heal? home means a designat$ provid] or 
a team ( heal? c>e pr(essionals select$ 
to provide heal? home s]vices to a *ild 
) m$ically complex conditions4  7#d7    
,heal? home s]vices  7,a7 ,9 g5]al ,!   
t]m heal? home s]vices means ! s]vices  

describ$ 9 subp>agraph 7,b7 t are       
provid$ by a designat$ provid]1 or a    
team ( heal? c>e pr(essionals 9 a timely
 mann] & on a high-quality basis4  7,b7 
,s]vices describ$ ,! s]vices describ$ 9 
?is subp>agraph %all1 at a m9imum1      
include-- 7i7 an individualiz$          
compreh5sive p$iatric family-c5t]$ c>e  
plan = ea* *ild ) complex m$ical        
conditions assign$ to ! heal? home t    
provides seamless p$iatric c>e          
coord9ation by a cu/omiz$ c>e team ) a  
designat$ team lead = ea* su* *ild & !  
*ild's family2  7ii7 c>e coord9ation1   
heal? promotion1 & provid+ access to !  
full range ( p$iatric specialty &       
subspecialty m$ical s]vices1 includ+    
e>ly & p]iodic scre5+1 diagno/ic1 &     
treatm5t s]vices describ$ 9 section     
#aije7;a77#d77;,b7 & s]vices f          
out-(-,/ate provid]s1 z m$ically        
necess>y2  7iii7 compreh5sive           
transitional c>e1 includ+ appropriate   
foll[-up1 f inpati5t to o!r sett+s2     
7iv7 work+ ) ! family ( ea* *ild )      

complex m$ical conditions assign$ to !  
heal? home to develop & incorporate     
ongo+ home c>e1 community bas$ p$iatric 
prim>y c>e1 c>e f ! mo/ m$ically        
appropriate or family-pref]r$ *ildr5's  
hospital1 social support s]vices1 &     
local hospital p$iatric em]g5cy c>e into
 ! *ild's c>e plan1 to ! ext5t consi/5t 
) family *oice & ! ne$s ( ! *ild2  7v7  
ref]rals to community & social support  
s]vices1 if relevant2  7vi7 use ( heal? 
in=mation te*nology to l9k s]vices1 z   
feasible & appropriate2  7vii7 9 ! case 
( a ,/ate t1 z ( ! date ( ! enactm5t ( !
 ,,ace ,kids ,act1 provides "u ! ,/ate  
plan "u ?is title 7or a waiv] ( su*     
plan7 = palliative s]vices1 palliative  
s]vices2  7viii7 ef=ts to include1 )    
respect to ! deliv]y ( c>e & !          
developm5t1 op]ation1 & evaluation ( !  
heal? home's s]vices1 ! families (      
*ildr5 ) complex m$ical conditions2     
7ix7 ensur+ t any int]actions ) ea* *ild
 ) complex m$ical conditions & ! *ild's 
family occurs 9 a culturally &          

l+ui/ically appropriate mann]2 &  7x7   
provid+ integration )1 & access to1     
subspecializ$ p$iatric s]vices &        
programs = *ildr5 ) complex m$ical      
conditions1 includ+ ! mo/ int5sive      
diagno/ic1 treatm5t1 & critical c>e     
levels z m$ically necess>y & appropriate
 out-(-,/ate c>e4  7#e7 ,designat$      
provid] ,! t]m designat$ provid] means a
 physician 7includ+ a p$iatrician or a  
p$iatric specialty or subspecialty      
provid]71 *ildr5's hospital1 cl9ical    
practice or cl9ical gr\p practice1      
prepaid inpati5t heal? plan or prepaid  
ambulatory heal? plan 7z def9$ by !     
,secret>y ( ,heal? & ,human ,s]vices71  
rural cl9ic1 community heal? c5t]1      
community m5tal heal? c5t]1 home heal?  
ag5cy1 or any o!r entity or provid] t is
 det]m9$ by ! ,/ate & approv$ by !      
,adm9i/rator ( ! ,c5t]s = ,m$ic>e       
,m$icaid ,s]vices to be qualifi$ to be a
 heal? home = *ildr5 ) m$ically complex 
conditions on ! basis ( docum5tation    
evid5c+ t ! entity has ! sy/ems1        

exp]tise1 & infra/ructure 9 place to    
provide heal? home s]vices4 ,su* t]m may
 include provid]s :o are employ$ by1 or 
affiliat$ )1 a *ildr5's hospital4  7#f7 
,team ( heal? c>e pr(essionals  7,a7 ,9 
g5]al ,! t]m team ( heal? c>e           
pr(essionals means a team ( heal? c>e   
pr(essionals 7z describ$ 9 ! ,/ate plan 
am5dm5t "u ?is section7 t may--  7i7    
include physicians & o!r pr(essionals1  
su* z p$iatricians or p$iatric specialty
 or subspecialty provid]s1 nurse c>e    
coord9ators1 dietitians1 nutritioni/s1  
social work]s1 behavioral heal?         
pr(essionals1 physical !rapi/s1         
occupational !rapi/s1 spee* pa?ologi/s1 
nurses1 individuals ) exp]i5ce 9 m$ical 
supportive te*nologies1 or any          
pr(essionals det]m9$ to be appropriate  
by ! ,/ate & approv$ by ! ,adm9i/rator (
 ! ,c5t]s = ,m$ic>e  ,m$icaid ,s]vices2 
&  7ii7 be free /&+1 virtual1 or bas$ at
 a *ildr5's hospital1 hospital1         
community heal? c5t]1 community m5tal   
heal? c5t]1 rural cl9ic1 cl9ical        

practice or cl9ical gr\p practice1      
academic heal? c5t]1 or any entity      
det]m9$ to be appropriate by ! ,/ate &  
approv$ by ! ,adm9i/rator ( ! ,c5t]s =  
,m$ic>e  ,m$icaid ,s]vices4  7,b7       
,inclusion ,su* t]m includes-- 7i7 an   
entity or individual :o is designat$ to 
coord9ate su* team2 &  7ii7 community   
heal? work]s1 translators1 & o!r        
individuals ) culturally-appropriate    
exp]tise4  4  #c4 ,rule ( con/ruction on
 fre$om ( *oice ,no?+ 9 section #aidg ( 
! ,social ,security ,act 7z add$ by     
section #b ( ?is ,act7 may be con/ru$1 )
 respect to *ildr5 ) m$ically complex   
conditions 7z def9$ 9 su* section       
#aidg71 to limit ! *oice ( su* *ildr5 or
 _! families to p>ticipate 7or n        
p>ticipate 97 a heal? home 7z def9$ 9   
su* section #aidg74  #d4 ,guidance on   
coord9at+ c>e f out-(-,/ate provid]s    
7a7 ,9 g5]al ,n lat] ?an "o ye> aft] !  
date ( ! enactm5t ( ?is ,act1 !         
,adm9i/rator ( ! ,c5t]s = ,m$ic>e       
,m$icaid ,s]vices %all issue guidance to

 ,/ate ,m$icaid ,directors on be/       
practices = us+ out-(-,/ate provid]s to 
provide c>e to *ildr5 ) m$ically complex
 conditions 7z def9$ 9 section #aidg ( !
 ,social ,security ,act1 z add$ by      
section #b ( ?is ,act71 includ+ guidance
 reg>d+--  7#a7 arrang+ access to1 &    
provid+ paym5t =1 c>e = su* *ildr5      
furni%$ by su* out-(-,/ate provid]s     
7includ+ :5 provid$ 9 em]g5cy &         
non-em]g5cy situations72  7#b7 r$uc+    
b>ri]s = su* *ildr5 receiv+ c>e f su*   
provid]s 9 a timely fa%ion2 &  7#c7     
processes = scre5+ & enroll+ su*        
provid]s 9 ! ,/ate plan "u title ,,xix (
 ! ,social ,security ,act 7or a waiv] ( 
! plan71 includ+ ef=ts to /reaml9e su*  
processes or r$uce ! burd5 ( su*        
processes on provid]s4  7b7 ,/akehold]  
input ,9 c>ry+ out subsection 7a71 !    
,adm9i/rator ( ! ,c5t]s = ,m$ic>e       
,m$icaid ,s]vices %all issue a reque/ = 
in=mation to seek input f *ildr5 )      
m$ically complex conditions 7z def9$ 9  
section #aidg ( ! ,social ,security     

,act1 z add$ by section #b ( ?is ,act7 &
 _! families1 ,/ates1 provid]s 7includ+ 
*ildr5's hospitals1 hospitals1          
p$iatricians1 & o!r provid]s71 manag$   
c>e plans1 *ildr5's heal? gr\ps1 family 
& b5efici>y advocates1 & o!r /akehold]s 
) respect to coord9at+ ! c>e = su*      
*ildr5 furni%$ by out-(-,/ate provid]s4 
7c7 ,/ate p>ticipation ,n lat] ?an #ij  
days aft] ! issuance ( ! be/ practice   
guidel9es "u subsection 7a71 ,/ates ) a 
,/ate plan am5dm5t 9 effect "u section  
#aidg ( ! ,social ,security ,act %all   
submit to ! ,secret>y ( ,heal? & ,human 
,s]vices1 & make publicly available on !
 appropriate ,int]net website ( ! ,/ate1
 in=mation on h[ ! ,/ate is a*iev+ !    
purposes describ$ 9 su* subsection1     
includ+ any ( su* be/ practices adopt$  
by ! ,/ate4  #e4 ,,macpac report  7a7 ,9
 g5]al ,n lat] ?an #bd mon?s aft] ! date
 ( ! enactm5t ( ?is ,act1 ! ,m$icaid &  
,,*ip ,paym5t & ,access ,commission     
e/abli%$ "u section #aijj ( ! ,social   
,security ,act 7#db ,u4,s4,c4 #acif7    

%all submit to ,congress & ! ,secret>y (
 ,heal? & ,human ,s]vices a report on   
*ildr5 ) m$ically complex conditions t--
  7#a7 describes options = def9+ !      
*>act]i/ics ( su* *ildr52  7#b7 includes
 ! in=mation describ$ 9 subsection 7b72 
&  7#c7 includes su* recomm5dations z ! 
,commission det]m9es is appropriate4    
7b7 ,in=mation ,to be includ$ ,!        
in=mation describ$ 9 ?is subsection is1 
to ! ext5t practical & available1 !     
foll[+ in=mation3  7#a7 ,) respect to ! 
*>act]i/ics ( *ildr5 ) m$ically complex 
conditions 7z def9$ 9 section #aidg ( ! 
,social ,security ,act 7z add$ by       
section #b ( ?is ,act77--  7,a7 a       
lit]ature review exam9+-- 7i7 rese>* on 
su* *ildr52  7ii7 cl9ical measures or   
o!r gr\p+s :i* enable comp>ison among   
su* *ildr52 &  7iii7 demographic        
*>act]i/ics1 includ+ prim>y language1   
bas$ on available data2 &  7,b7         
in=mation ga!r$ f consultation ) m$ical 
& academic exp]ts engag$ 9 rese>* ab\t1 
or ! treatm5t (1 su* *ildr54  7#b7      

,in=mation relat+ to *ildr5 ) m$ically  
complex conditions :o are receiv+ m$ical
 assi/ance "u a ,/ate ,m$icaid plan "u  
title ,,xix ( ! ,social ,security ,act  
7or a waiv] ( su* plan71 includ+--  7,a7
 ! numb] ( su* *ildr52  7,b7 ! *ronic   
conditions1 life-?reat5+ illnesses1     
disabilities1 injuries1 or r>e diseases 
t su* *ildr5 h2  7,c7 ! numb] ( su*     
*ildr5 receiv+ s]vices "u ea* deliv]y   
sy/em or paym5t model1 includ+ heal?    
homes 7z def9$ 9 su* section #aidg71    
fee-=-s]vice sy/ems1 prim>y c>e case    
manag]s1 or manag$ c>e plans2 &  7,d7 ! 
ext5t to :i* su* *ildr5 receive c>e     
coord9ation s]vices4  7#c7 ,in=mation on
 ! provid]s :o furni% heal? c>e items & 
s]vices to *ildr5 ) m$ically complex    
conditions1 su* z physicians 7includ+   
p$iatricians & p$iatric specialty or    
subspecialty provid]s71 *ildr5's        
hospitals1 cl9ical practices or cl9ical 
gr\p practices1 rural cl9ics1 community 
heal? c5t]s1 community m5tal heal?      
c5t]s1 or home heal? ag5cies4  7#d7 ,!  

ext5t to :i* *ildr5 ) m$ically complex  
conditions receive 7or are d5i$7 heal?  
c>e items & s]vices f out-(-,/ate       
provid]s t receive paym5t "u ! ,/ate    
,m$icaid plan "u title ,,xix ( ! ,social
 ,security ,act 7or a waiv] ( su* plan7 
& any b>ri]s to receiv+ su* s]vices f   
su* provid]s 9 a timely fa%ion1 includ+ 
any v>iation 9 access to su* s]vices    
furni%$ by su* provid]s1 disaggregat$ by
 deliv]y sy/em4  7#e7 ,! am\nt & nature 
( ! total res\rces us$ to provide c>e to
 individual *ildr5 ) m$ically complex   
conditions dur+ ! p]iod 9 :i* su* a *ild
 is enroll$ 9 a heal? home1 includ+--   
7,a7 ! am\nt ( capital sp5t 9 provid+   
su* c>e2  7,b7 ! res\rces us$ to provide
 su* c>e dur+ any wait+ p]iod ) respect 
to ! enrollm5t ( ! *ild 9 ! ,/ate plan  
"u title ,,xix ( ! ,social ,security    
,act 7or a waiv] ( su* plan7 or any     
necess>y approval "u ! ,/ate plan = !   
furni%+ ( su* s]vices 7su* z inpati5t   
co/s await+ dis*>ge72  7,c7 ! co/ ( !   
coord9ation ( su* *ild's c>e2  7,d7 !   

co/ ( provid+ to su* *ild any non-m$ical
 b5efits 7su* z transportation & home   
s]vices72 &  7,e7 ! cl9ical co/s (      
provid+ su* c>e4