,,ii  #aaf? ,,congress  #a/ ,session    
,s4 #cag  ,,9 ,,! ,,s5ate ,,( ,,!       
,,unit$ ,,/ates  ,febru>y #d1 #bjai ,mr4
 ,grassley 7= himself & ,mr4 ,b5net7    
introduc$ ! foll[+ bill2 :i* 0 read     
twice & ref]r$ to ! ,committee on       
,f9ance  ,a ,,bill  ,to am5d title ,,xix
 ( ! ,social ,security ,act to provide  
,/ates ) ! option ( provid+ coord9at$   
c>e = *ildr5 ) complex m$ical conditions
 ?r\gh a heal? home4  #a4 ,%ort title   
,?is ,act may be cit$ z ! ,advanc+ ,c>e 
= ,exceptional ,kids ,act ( #bjai or !  
,,ace ,kids ,act ( #bjai4  #b4 ,/ate    
option to provide coord9at$ c>e ?r\gh a 
heal? home = *ildr5 ) m$ically complex  
conditions ,title ,,xix ( ! ,social     
,security ,act 7#db ,u4,s4,c4 #acif et  
seq47 is am5d$ by ins]t+ aft] section   
#aide ! foll[+ new section3  #aide;,a4  
,/ate option to provide coord9at$ c>e   
?r\gh a heal? home = *ildr5 ) m$ically  
complex conditions  7a7 ,9 g5]al        
,not)/&+ section #aijb7;a77#a7 7relat+  
to /atewid5ess7 & section               

#aijb7;a77#aj77;,b7 7relat+ to          
comp>ability71 beg9n+ ,octob] #a1 #bjbb1
 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 *oose to enroll 9 
a heal? home "u ?is section by select+ a
 designat$ provid]1 a team ( heal? c>e  
pr(essionals op]at+ ) su* a provid]1 or 
a heal? team z ! *ild's heal? home =    
purposes ( provid+ ! *ild ) heal? home  
s]vices4  7b7 ,heal? home qualification 
/&>ds ,! ,secret>y %all e/abli% /&>ds = 
qualification z a heal? home = purposes 
( ?is section4 ,su* /&>ds %all include  
requir+ designat$ provid]s1 teams (     
heal? c>e pr(essionals op]at+ ) su*     
provid]s1 & heal? teams to demon/rate to
 ! ,/ate ! ability to d ! foll[+3  7#a7 
,coord9ate prompt c>e = *ildr5 )        
m$ically complex conditions1 includ+    
access to p$iatric em]g5cy s]vices at   
all times4  7#b7 ,develop an            
individualiz$ compreh5sive p$iatric     
family-c5t]$ c>e plan = *ildr5 )        

m$ically complex conditions t           
accommodates pati5t pref]5ces4  7#c7 ,"w
 9 a culturally & l+ui/ically           
appropriate mann] ) ! family ( a *ild ) 
m$ically complex conditions to develop &
 incorporate into su* *ild's c>e plan1 9
 a mann] consi/5t ) ! ne$s ( ! *ild & ! 
*oices ( ! *ild's family1 ongo+ home    
c>e1 community-bas$ p$iatric prim>y c>e1
 p$iatric inpati5t c>e1 social support  
s]vices1 & local hospital p$iatric      
em]g5cy c>e4  7#d7 ,coord9ate access    
to-- 7,a7 subspecializ$ p$iatric s]vices
 & programs = *ildr5 ) m$ically complex 
conditions1 includ+ ! mo/ int5sive      
diagno/ic1 treatm5t1 & critical c>e     
levels z m$ically necess>y2 &  7,b7     
palliative s]vices if ! ,/ate provides  
su* s]vices "u ! ,/ate plan 7or a waiv] 
( su* plan74  7#e7 ,coord9ate c>e =     
*ildr5 ) m$ically complex conditions )  
out-(-,/ate provid]s furni%+ c>e to su* 
*ildr5 to ! maximum ext5t practicable = 
! families ( su* *ildr5 & :]e m$ically  
necess>y1 9 accordance ) guidance issu$ 

"u subsection 7e77#a7 & section #dca4eb 
( title #db1 ,code ( ,f$]al             
,regulations4  7#f7 ,collect & report   
in=mation "u subsection 7g77#a74  7c7   
,paym5ts  7#a7 ,9 g5]al ,a ,/ate %all   
provide a designat$ provid]1 a team (   
heal? c>e pr(essionals op]at+ ) su* a   
provid]1 or a heal? team ) paym5ts = !  
provision ( heal? home s]vices to ea*   
*ild ) m$ically complex conditions t    
selects su* provid]1 team ( heal? c>e   
pr(essionals1 or heal? team z ! *ild's  
heal? home4 ,paym5ts made to a designat$
 provid]1 a team ( heal? c>e            
pr(essionals op]at+ ) su* a provid]1 or 
a heal? team = su* s]vices %all be      
treat$ z m$ical assi/ance = purposes (  
section #aijc7;a71 except t1 dur+ ! fir/
 #b fiscal ye> qu>t]s t ! ,/ate plan    
am5dm5t is 9 effect1 ! ,f$]al m$ical    
assi/ance p]c5tage applicable to su*    
paym5ts %all be increas$ by #ae p]c5tage
 po9ts1 b 9 no case may 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 = ! provision ( heal?    
home s]vices4 ,su* me?odology = det]m9+ 
paym5t--  7i7 may be ti]$ to reflect1 ) 
respect to ea* *ild ) m$ically complex  
conditions provid$ su* s]vices by a     
designat$ provid]1 a team ( heal? c>e   
pr(essionals op]at+ ) su* a provid]1 or 
a heal? team1 ! sev]ity or numb] ( ea*  
su* *ild's *ronic conditions1           
life-?reat5+ illnesses1 disabilities1 or
 r>e diseases1 or ! specific            
capabilities ( ! provid]1 team ( heal?  
c>e pr(essionals1 or heal? team2 &  7ii7
 %all be e/abli%$ consi/5t ) section    
#aijb7;a77#cj77;,a74  7,b7 ,alt]nate    
models ( paym5t ,! me?odology = det]m9+ 
paym5t = provision ( heal? home s]vices 
"u ?is section %all n be limit$ to a    
p]-memb] p]-mon? basis & may provide 7z 
propos$ by ! ,/ate & subject to approval
 by ! ,secret>y7 = alt]nate models (    
paym5t4  7#c7 ,plann+ grants  7,a7 ,9   
g5]al ,beg9n+ ,octob] #a1 #bjbb1 !      
,secret>y may aw>d plann+ grants to     

,/ates = purposes ( develop+ a ,/ate    
plan am5dm5t "u ?is section4 ,a plann+  
grant aw>d$ to a ,/ate "u ?is p>agraph  
%all rema9 available until exp5d$4  7,b7
 ,/ate contribution ,a ,/ate aw>d$ a    
plann+ grant %all contribute an am\nt   
equal to ! ,/ate p]c5tage det]m9$ "u    
section #aije7;b7 7)\t reg>d to section 
#ejja ( ,public ,law #aaa-e7 = ea*      
fiscal ye> = :i* ! grant is aw>d$4  7,c7
 ,limitation ,! total am\nt ( paym5ts   
made to ,/ates "u ?is p>agraph %all n   
exce$ #e1jjj1jjj4  7d7 ,coord9at+ c>e   
7#a7 ,hospital notification ,a ,/ate ) a
 ,/ate plan am5dm5t approv$ "u ?is      
section %all require ea* hospital t is a
 p>ticipat+ provid] "u ! ,/ate plan 7or 
a waiv] ( su* plan7 to e/abli% proc$ures
 =1 9 ! case ( a *ild ) m$ically complex
 conditions :o is enroll$ 9 a heal? home
 pursuant to ?is section & seeks        
treatm5t 9 ! em]g5cy dep>tm5t ( su*     
hospital1 notify+ ! heal? home ( su*    
*ild ( su* treatm5t4  7#b7 ,education ) 
respect to availability ( heal? home    

s]vices ,9 ord] = a ,/ate plan am5dm5t  
to be approv$ "u ?is section1 a ,/ate   
%all include 9 ! ,/ate plan am5dm5t a   
description ( ! ,/ate's process =       
educat+ provid]s p>ticipat+ 9 ! ,/ate   
plan 7or a waiv] ( su* plan7 on !       
availability ( heal? home s]vices =     
*ildr5 ) m$ically complex conditions1   
includ+ ! process by :i* su* provid]s c 
ref] su* *ildr5 to a designat$ provid]1 
team ( heal? c>e pr(essionals op]at+ su*
 a provid]1 or heal? team = ! purpose ( 
e/abli%+ a heal? home ?r\gh :i* su*     
*ildr5 may receive su* s]vices4  7#c7   
,family education ,9 ord] = a ,/ate plan
 am5dm5t to be approv$ "u ?is section1 a
 ,/ate %all include 9 ! ,/ate plan      
am5dm5t 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 %all       
include ! p>ticipation (                
family-to-family entities or o!r public 
or private organizations or entities :o 

provide outrea* & in=mation on !        
availability ( heal? c>e items & s]vices
 to families ( individuals eligible to  
receive m$ical assi/ance "u ! ,/ate plan
 7or a waiv] ( su* plan74  7#d7 ,m5tal  
heal? coord9ation ,a ,/ate ) a ,/ate    
plan am5dm5t approv$ "u ?is section %all
 consult & coord9ate1 z appropriate1 ) !
 ,secret>y 9 address+ issues reg>d+ !   
prev5tion & treatm5t ( m5tal illness &  
sub/ance use among *ildr5 ) m$ically    
complex conditions receiv+ heal? home   
s]vices "u ?is section4  7e7 ,guidance  
on coord9at+ c>e f out-(-,/ate provid]s 
7#a7 ,9 g5]al ,n lat] ?an ,octob] #a1   
#bjbj1 ! ,secret>y %all issue 7& update 
z ! ,secret>y det]m9es necess>y7        
guidance to ,/ate ,m$icaid directors    
on--  7,a7 be/ practices = us+          
out-(-,/ate provid]s to provide c>e to  
*ildr5 ) m$ically complex conditions2   
7,b7 coord9at+ c>e = su* *ildr5 provid$ 
by su* out-(-,/ate provid]s 7includ+ :5 
provid$ 9 em]g5cy & non-em]g5cy         
situations72  7,c7 r$uc+ b>ri]s = su*   

*ildr5 receiv+ c>e f su* provid]s 9 a   
timely fa%ion2 &  7,d7 processes =      
scre5+ & enroll+ su* provid]s 9 !       
respective ,/ate plan 7or a waiv] ( su* 
plan71 includ+ ef=ts to /reaml9e su*    
processes or r$uce ! burd5 ( su*        
processes on su* provid]s4  7#b7        
,/akehold] input ,9 c>ry+ out p>agraph  
7#a71 ! ,secret>y %all issue a reque/ = 
in=mation to seek input f *ildr5 )      
m$ically complex conditions & _!        
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 provid$ by out-(-,/ate provid]s4 
7f7 ,monitor+ ,a ,/ate %all include 9 ! 
,/ate plan am5dm5t-- 7#a7 a me?odology =
 track+ r$uctions 9 inpati5t days &     
r$uctions 9 ! total co/ ( c>e result+ f 
improv$ c>e coord9ation & managem5t "u  
?is section2  7#b7 a proposal = use (   
heal? in=mation te*nology 9 provid+     

heal? home s]vices "u ?is section &     
improv+ s]vice deliv]y & coord9ation    
across ! c>e cont9uum 7includ+ ! use (  
wireless pati5t te*nology to improve    
coord9ation & managem5t ( c>e & pati5t  
adh]5ce to recomm5dations made by _!    
provid]72 &  7#c7 a me?odology = track+ 
prompt & timely access to m$ically      
necess>y c>e = *ildr5 ) m$ically complex
 conditions f out-(-,/ate provid]s4  7g7
 ,data collection  7#a7 ,provid] report+
 requirem5ts ,9 ord] to receive paym5ts 
f a ,/ate "u subsection 7c71 a designat$
 provid]1 a team ( heal? c>e            
pr(essionals op]at+ ) su* a provid]1 or 
a heal? team %all report to ! ,/ate1 at 
su* "t & 9 su* =m & mann] z may be      
requir$ by ! ,/ate1 ! foll[+ in=mation3 
7,a7 ,) respect to ea* su* provid]1 team
 ( heal? c>e pr(essionals1 or heal?     
team1 ! "n1 ,national ,provid]          
,id5tification numb]1 address1 &        
specific heal? c>e s]vices (f]$ to be   
provid$ to *ildr5 ) m$ically complex    
conditions :o h select$ su* provid]1    

team ( heal? c>e pr(essionals1 or heal? 
team z ! heal? home ( su* *ildr54  7,b7 
,in=mation on all applicable measures = 
det]m9+ ! quality ( heal? home s]vices  
provid$ by su* provid]1 team ( heal? c>e
 pr(essionals1 or heal? team1 includ+1  
to ! ext5t applicable1 *ild heal?       
quality measures & measures = c5t]s (   
excell5ce = *ildr5 ) complex ne$s       
develop$ "u ?is title1 title ,,xxi1 &   
section #aaci;,a4  7,c7 ,su* o!r        
in=mation z ! ,secret>y %all specify 9  
guidance4  ,:5 appropriate & feasible1  
su* provid]1 team ( heal? c>e           
pr(essionals1 or heal? team1 z ! case   
may be1 %all use heal? in=mation        
te*nology 9 provid+ ! ,/ate ) su*       
in=mation4  7#b7 ,/ate report+          
requirem5ts  7,a7 ,compreh5sive report  
,a ,/ate ) a ,/ate plan am5dm5t approv$ 
"u ?is section %all report to !         
,secret>y 7&1 ^u reque/1 to ! ,m$icaid &
 ,,*ip ,paym5t & ,access ,commission71  
at su* "t & 9 su* =m & mann] det]m9$ by 
! ,secret>y to be reasonable & m9imally 

burd5some1 ! foll[+ in=mation3  7i7     
,in=mation report$ "u p>agraph 7#a74    
7ii7 ,! numb] ( *ildr5 ) m$ically       
complex conditions :o h select$ a heal? 
home pursuant to ?is section4  7iii7 ,! 
nature1 numb]1 & preval5ce ( *ronic     
conditions1 life-?reat5+ illnesses1     
disabilities1 or r>e diseases t su*     
*ildr5 h4  7iv7 ,! type ( deliv]y sy/ems
 & paym5t models us$ to provide s]vices 
to su* *ildr5 "u ?is section4  7v7 ,!   
numb] & *>act]i/ics ( designat$         
provid]s1 teams ( heal? c>e pr(essionals
 op]at+ ) su* provid]s1 & heal? teams   
select$ z heal? homes pursuant to ?is   
section1 includ+ ! numb] & *>act]i/ics (
 out-(-,/ate provid]s1 teams ( heal? c>e
 pr(essionals op]at+ ) su* provid]s1 &  
heal? teams :o h provid$ heal? c>e items
 & s]vices to su* *ildr54  7vi7 ,! ext5t
 to :i* su* *ildr5 receive heal? c>e    
items & s]vices "u ! ,/ate plan4  7vii7 
,quality measures develop$ specifically 
) respect to heal? c>e items & s]vices  
provid$ to *ildr5 ) m$ically complex    

conditions4  7,b7 ,report on be/        
practices ,n lat] ?an #ij days aft] a   
,/ate has a ,/ate plan am5dm5t approv$  
"u ?is section1 su* ,/ate %all submit to
 ! ,secret>y1 & make publicly available 
on ! appropriate ,/ate website1 a report
 on h[ ! ,/ate is implem5t+ guidance    
issu$ "u subsection 7e77#a71 includ+    
?r\gh any be/ practices adopt$ by !     
,/ate4  7h7 ,rule ( con/ruction ,no?+ 9 
?is section may be con/ru$-- 7#a7 to    
require a *ild ) m$ically complex       
conditions to enroll 9 a heal? home "u  
?is section2  7#b7 to limit ! *oice ( a 
*ild ) m$ically complex conditions 9    
select+ a designat$ provid]1 team (     
heal? c>e pr(essionals op]at+ ) su* a   
provid]1 or heal? team t meets ! heal?  
home qualification /&>ds e/abli%$ "u    
subsection 7b7 z ! *ild's heal? home2 or
  7#c7 to r$uce or o!rwise modify-- 7,a7
 ! entitlem5t ( *ildr5 ) m$ically       
complex conditions to e>ly & p]iodic    
scre5+1 diagno/ic1 & treatm5t s]vices 7z
 def9$ 9 section #aije7r772 or  7,b7 !  

in=m+1 provid+1 arrang+1 & report+      
requirem5ts ( a ,/ate "u section        
#aijb7;a77#dc74  7i7 ,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$ical assi/ance "u ! ,/ate plan 7or  
"u a waiv] ( su* plan72 &  7ii7 has at  
lea/--  7,i7 "o or m *ronic conditions t
 cumulatively affect ?ree or m organ    
sy/ems & sev]ely r$uces cognitive or    
physical function+ 7su* z ! ability to  
eat1 dr9k1 or brea! indep5d5tly7 & t    
also requires ! use ( m$ication1 durable
 m$ical equipm5t1 !rapy1 surg]y1 or o!r 
treatm5ts2 or  7,,ii7 "o 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;ff7a77#c7774  7,b7 ,rule 
( con/ruction ,no?+ 9 ?is p>agraph %all 
prev5t ! ,secret>y f e/abli%+ high]     
levels z to ! numb] or sev]ity ( *ronic1

 life ?reat5+ illnesses1 disabilities1  
r>e diseases or m5tal heal? conditions =
 purposes ( det]m9+ eligibility =       
receipt ( heal? home s]vices "u ?is     
section4  7#b7 ,*ronic condition ,! t]m 
*ronic condition means a s]i\s1 long-t]m
 physical1 m5tal1 or developm5tal       
disability or disease4  7#c7 ,heal? home
 ,! t]m heal? home means a designat$    
provid] 7includ+ a provid] t op]ates 9  
coord9ation ) a team ( heal? c>e        
pr(essionals7 or a heal? team select$ by
 a *ild ) m$ically complex conditions   
7or ! family ( su* *ild7 to provide     
heal? home s]vices4  7#d7 ,heal? home   
s]vices  7,a7 ,9 g5]al ,! t]m heal? home
 s]vices means compreh5sive & timely    
high-quality s]vices describ$ 9         
subp>agraph 7,b7 t are provid$ by a     
designat$ provid]1 a team ( heal? c>e   
pr(essionals op]at+ ) su* a provid]1 or 
a heal? team4  7,b7 ,s]vices describ$ ,!
 s]vices describ$ 9 ?is subp>agraph %all
 include-- 7i7 compreh5sive c>e         
managem5t2  7ii7 c>e coord9ation1 heal? 

promotion1 & provid+ access to ! full   
range ( p$iatric specialty &            
subspecialty m$ical s]vices1 includ+    
s]vices f out-(-,/ate provid]s1 z       
m$ically necess>y2  7iii7 compreh5sive  
transitional c>e1 includ+ appropriate   
foll[-up1 f inpati5t to o!r sett+s2     
7iv7 pati5t & family support 7includ+   
au?oriz$ repres5tatives72  7v7 ref]rals 
to community & social support s]vices1  
if relevant2 &  7vi7 use ( heal?        
in=mation te*nology to l9k s]vices1 z   
feasible & appropriate4  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>y71 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 ! ,secret>y 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 ,! 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--  7,a7   
include-- 7i7 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 ! ,secret>y2  7ii7 an entity or      
individual :o is designat$ to coord9ate 

su* a team2 &  7iii7 community heal?    
work]s1 translators1 & o!r individuals )
 culturally-appropriate exp]tise2 &     
7,b7 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 ! ,secret>y4  7#g7 
,heal? team ,! t]m heal? team has !     
mean+ giv5 su* t]m = purposes ( section 
#cejb ( ,public ,law #aaa-adh4  4