,i  #aag? ,,congress  #a/ ,session  ,h4 
,r4 #dieb  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,augu/ #f1 #bjba,ms4  
,de,gette 7= h]self & ,mr4 ,mc,caul7    
introduc$ ! foll[+ bill2 :i* 0 ref]r$ to
 ! ,committee on ,en]gy & ,comm]ce  ,a  
,,bill  ,to am5d title ,,xix ( ! ,social
 ,security ,act to provide ,/ates an    
option to cov] a *ildr5's program (     
all-inclusive coord9at$ c>e             
7,chi,p,a,c,c7 "u ,m$icaid program4  #a4
 ,%ort title ,?is ,act may be cit$ z !  
,chi,p,a,c,c ,act ( #bjba4  #b4 ,f9d+s  
,congress f9ds t-- 7#a7 s]i\s illnesses 
& heal? conditions t are pot5tially     
life-?reat5+ place significant /ress on 
bo? ! *ild & family2  7#b7 palliative   
c>e relieves *ildr5's symptoms su* z    
pa91 fatigue1 anxiety1 nausea1 & sleep  
problems1 & may be provid$ at any age or
 /age ( s]i\s illness1 & has be5 %[n to 
enhance ! quality ( life = bo? ! *ild & 
family2  7#c7 _m critical b>ri]s to     
end-(-life c>e = *ildr5 exi/ "u ! curr5t
 heal? c>e sy/em1 includ+ ! limitation (

 hospice c>e "u ! ,m$icaid program to   
*ildr5 expect$ to live six mon?s or     
less1 a prognosis t m$ical pr(essionals 
& families are reluctant to make2  7#d7 
! ,*ildr5's ,program ( ,all-inclusive   
,coord9at$ ,c>e 7ref]r$ to 9 ?is ,act z 
,chi,p,a,c,c7 provides all-inclusive c>e
 = *ildr5 ) life-?reat5+ conditions & _!
 families f ! "t ( diagnosis &-- 7,a7   
fills a gap 9 cov]age "u ! ,m$icaid     
program ( integrat$1 multi-discipl9>y   
s]vices t are reasonable & necess>y = ! 
palliation & managem5t ( s]i\sly ill    
*ildr52  7,b7 s]ves a population t      
includes *ildr5 :o are n yet hospice    
eligible2 &  7,c7 provides great]       
coord9ation ( palliative & curative     
s]vices = *ildr5 ?r\gh\t ! c\rse ( _!   
illness or condition1 :i* may beg9 at ! 
"t ( diagnosis2  7#e7 "s ,/ates h opt$  
to provide s]vices t>get$ to ?is        
population ?r\gh waiv]s "u subsections  
7b7 & 7c7 ( section #aiae ( ! ,social   
,security ,act 7#db ,u4,s4,c4 #acifn71  
ea* ( :i* requires ! approval ( ! ,c5t]s

 = ,m$ic>e  ,m$icaid ,s]vices ( !       
initial waiv] application & any         
subsequ5t r5ewal ( su* waiv]2  7#f7 s9ce
 #bjje1 ! ,secret>y ( ,heal? & ,human   
,s]vices has approv$ home &             
community-bas$ s]vice waiv]s "u section 
#aiae7;c7 ( su* ,act 7#db ,u4,s4,c4     
#acifn7c77 to op]ate ,chi,p,a,c,c 9 five
 ,/ates2  7#g7 9 ,/ates op]at+          
,chi,p,a,c,c "u su* a waiv]-- 7,a7 !    
respective ,/ate's ,m$icaid program     
a*iev$ significant co/ sav+s ?r\gh a    
r$uction 9 inpati5t c>e & an increase 9 
less exp5sive outpati5t c>e2  7,b7      
access to ,,*ipacc s]vices 9 su* ,/ates 
r$uc$ m co/ly utilizations ( o!r        
s]vices2 &  7,c7 s]vices provid$ ?r\gh  
,chi,p,a,c,c are less co/ly to ! ,/ate's
 ,m$icaid program because ,chi,p,a,c,c  
facilitates *ildr5 receiv+ palliative   
c>e at home r ?an receiv+ su* s]vices 9 
an inpati5t hospital sett+2 &  7#h7     
all[+ ,/ates ! option to implem5t       
,chi,p,a,c,c ?r\gh a ,/ate plan am5dm5t 
w\ld-- 7,a7 give ,/ates ! ability to    

make su* program a "p ( a ,/ate's       
,m$icaid program :ile avoid+ ! l5g?y    
waiv] process2 &  7,b7 give ,/ates !    
flexibility to e/abli% & design its     
program to fit ! ne$s ( ! respective    
,/ate4  #c4 ,optional m$icaid cov]age ( 
*ildr5's program ( all-inclusive        
coord9at$ c>e  7a7 ,*ildr5's program (  
all-,inclusive coord9at$ c>e ,title     
,,xix ( ! ,social ,security ,act 7#db   
,u4,s4,c4 #acif;a et seq471 z am5d$ by  
section #ihac ( ! ,am]ican ,rescue ,plan
 ,act ( #bjba1 is fur!r am5d$ by ins]t+ 
aft] section #aidg ! foll[+ new section3
  #aidh4 ,*ildr5's program (            
all-inclusive coord9at$ c>e  7a7 ,/ate  
option  7#a7 ,9 g5]al ,beg9n+ on ,janu>y
 #a1 #bjbb1 a ,/ate1 at its option z a  
,/ate plan am5dm5t1 may elect to provide
 = ,chi,p,a,c,c s]vices "u ?is title to 
,chi,p,a,c,c eligible individuals :o    
*oose to enroll 9 a *ildr5's program (  
all-inclusive coord9at$ c>e4 ,9 ! case (
 an individual :o *ooses to enroll 9 su*
 a program-- 7,a7 ! individual %all     

receive ,chi,p,a,c,c s]vices 7z describ$
 9 subsection 7c771 includ+ b n limit$  
to s]vices "u ! ,/ate plan2 &  7,b7 !   
heal? c>e provid]s furni%+ s]vices "u   
su* program %all receive paym5t =       
provid+ su* s]vices 9 accordance ) !    
t]ms ( ! ,/ate plan4  7#b7 ,process =   
det]m9+ eligible individuals ,if a ,/ate
 elects to e/abli% a limitation "u      
p>agraph 7#b71 ! ,/ate %all e/abli% a   
process1 z describ$ 9 subsection 7e71 = 
det]m9+ crit]ia = :i* individuals :o may
 be enroll$ 9 ! ,/ate's ,chi,p,a,c,c4   
7#c7 ,/ate adm9i/ration ,! ,chi,p,a,c,c 
%all be adm9i/]$ by ! s+le ,/ate ag5cy z
 describ$ 9 section #aijd7;a77#e74  7#d7
 ,mat*+ rate ,! ,f$]al m$ical assi/ance 
p]c5tage = ,chi,p,a,c,c coord9ation1 &  
s]vices %all be t o!rwise applicable to 
m$ical assi/ance = ! ,/ate4  7b7        
,chi,p,a,c,c & o!r t]ms def9$ ,9 ?is    
section3 7#a7 ,*ildr5's program (       
all-inclusive coord9at$ c>e2 *ipacc ,!  
t]ms *ildr5's program ( all-inclusive   
coord9at$ c>e & ,chi,p,a,c,c mean a     

program ( coord9at$ c>e = ,chi,p,a,c,c  
eligible *ildr5 t is e/abli%$ by a ,/ate
 "u ?is section & t meets ! foll[+      
requirem5ts3 7,a7 ,op]ation ,! ,/ate    
%all provide = ! op]ation ( ! program   
directly1 s]v+ z ,chi,p,a,c,c coord9ator
 7z def9$ 9 p>agraph #c71 or ?r\gh      
arrangem5ts ) "o or m o!r entities t w  
s]ve z ,chi,p,a,c,c coord9ators4  7,b7  
,compreh5sive b5efits  7i7 ,9 g5]al ,!  
program provides or coord9ates !        
provision ( compreh5sive items & s]vices
 to ,chi,p,a,c,c eligible individuals 7z
 def9$ 9 p>agraph 7#b77 9 accordance )  
?is section4  7ii7 ,scope & plan =      
s]vices ,su* items & s]vices %all-- 7,i7
 include items & s]vices describ$ 9     
subsections 7c77#a7 & 7c77#b71 to !     
ext5t su* items & s]vices are m$ically  
necess>y z det]m9$ by ! ,/ate2 &  7,,ii7
 be provid$ consi/5t ) a compreh5sive   
c>e plan develop$ by an int]discipl9>y  
heal? pr(essional team 7z def9$ 9       
p>agraph 7#d774  7,c7 ,qualifications ( 
provid]s ,su* items & s]vices are       

provid$ ?r\gh-- 7i7 heal? c>e provid]s t
 meet su* c]tification or o!r ,f$]al or 
,/ate requirem5ts z may be necess>y to  
p>ticipate 9 ! program ( m$ical         
assi/ance "u ?is title or 9 ! program "u
 title ,,xviii2 or  7ii7 9 ! case (     
c\nselors z describ$ 9 7#d77;iii71      
individuals :o are legally au?oriz$ to  
provide c\nsel+ s]vices "u ,/ate law or 
a regulatory me*anism provid$ by ,/ate  
law or1 if no law or regulatory me*anism
 is applicable1 by det]m9ation ( !      
,/ate4  7,d7 ,/&>ds & guidel9es ,!      
,chi,p,a,c,c is op]at$ & ! s]vices to   
enroll$ individuals are furni%$ 9 a     
mann] t is in=m$ by g5]ally recogniz$   
pr(essional guidel9es1 ! ,secret>y may  
sub/itute ! revision ?r\gh              
sub-regulatory guidance4 ,! ,secret>y   
may adopt o!r /&>ds & guidel9es consi/5t
 ) ! purposes ( ?is section4  7#b7      
,chi,p,a,c,c eligible individual ,! t]m 
,chi,p,a,c,c eligible individual means1 
) respect to a ,chi,p,a,c,c1 an         
individual-- 7,a7 :o1 at ! "t (         

enrollm5t 9 ! ,chi,p,a,c,c1 is "u #ba   
ye>s ( age2  7,b7 :o resides 9 ! s]vice 
area ( a ,chi,p,a,c,c z det]m9$ by !    
,/ate2  7,c7 :o is eligible = m$ical    
assi/ance "u ! ,/ate plan )\t reg>d to  
?is section2  7,d7 :o suff]s f a s]i\s  
illness or heal? condition & = :om !re  
is a reasonable likelihood t !          
individual's life w be ?reat5$ by su*   
illness or condition2 &  7,e7 ^: heal?  
/atus is expect$ to decl9e because ( su*
 illness or condition be=e atta9+ ! age 
( #ba4  7#c7 ,chi,p,a,c,c coord9ator ,! 
t]m ,chi,p,a,c,c coord9ator means1 )    
respect to a ,chi,p,a,c,c1 an entity t1 
?r\gh ! assignm5t ( "o or m case        
manag]s-- 7,a7 directs1 sup]vises1 &    
ensures ! coord9ation ( s]vices to      
,chi,p,a,c,c eligible individuals       
enroll$ 9 ! ,chi,p,a,c,c2 &  7,b7       
ensures ! direct & cont9u\s involvem5t (
 an int]discipl9>y heal? pr(essional    
team 7z describ$ 9 p>agraph 7#d77 9     
manag+ & coord9at+ ! provision ( c>e &  
s]vices )9 ! coord9ator's               

responsibility1 z det]m9$ by ! ,/ate1 to
 ea* su* enroll$ individual4  7#d7      
,int]discipl9>y heal? pr(essional team  
,! t]m int]discipl9>y heal? pr(essional 
team means1 ) respect to a ,chi,p,a,c,c1
 a gr\p ( pr(essionals t-- 7,a7 includes
 at lea/-- 7i7 "o physician 7z describ$ 
9 section #ahfa7r772  7ii7 "o regi/]$   
nurse2  7iii7 "o social work]1 pa/oral  
c\nselor1 or o!r c\nselor2 &  7iv7 "o   
case manag]1 :o may be "o ( !           
individuals describ$ 9 clauses 7i7 ?r\gh
 7iii72  7,b7 develops a compreh5sive   
c>e plan = ea* ,chi,p,a,c,c eligible    
individual enroll$ ) ! ,chi,p,a,c,c t   
takes into acc\nt ! be/ int]e/s ( su*   
individual & su* individual's family2 & 
7,c7 coord9ates ! provision ( s]vices   
describ$ 9 subsections 7c77#a7 &        
7c77#b71 z det]m9$ by ! /ate1 to an     
individual enroll$ 9 ! ,chi,p,a,c,c by  
memb]s ( ! team or by o!r provid]s (    
s]vices4  7#e7 ,palliative s]vices ,!   
t]m palliative s]vices means1 = !       
purposes ( ?is section1 pati5t &        

family-c5t]$ c>e t optimizes quality (  
life = an individual ) a s]i\s illness  
or condition by-- 7,a7 anticipat+1      
prev5t+1 & treat+ ! individual's suff]+ 
?r\gh\t ! cont9uum ( illness2  7,b7     
address+ ! physical1 intellectual1      
emotional1 social & spiritual ne$s ( !  
individual2 &  7,c7 facilitat+ !        
individual's autonomy1 access to        
in=mation1 & *oice4  7c7 ,scope (       
b5efits  7#a7 ,9 g5]al ,"u a            
,chi,p,a,c,c ( a ,/ate1 ! ,/ate %all    
ensure t an individual enroll$ 9 !      
,chi,p,a,c,c is cov]$ = necess>y s]vices
 includ+-- 7,a7 any e>ly & p]iodic      
scre5+ diagno/ic & treatm5t s]vice1 z   
describ$ 9 section #aije7r72 &  7,b7 any
 additional s]vices t may be necess>y to
 ensure t su* cov]age includes at lea/ !
 elem5ts describ$ 9 p>agraph 7#b74  7#b7
 ,elem5ts ( a program ( all-inclusive   
coord9at$ c>e ,! elem5ts ref]r$ to 9    
p>agraph 7#a77;,a77ii7 are-- 7,a7 m$ical
 & long-t]m c>e s]vices & supports z    
describ$ 9 section #aije or z may be    

available to ! individual "u waiv]      
programs approv$ "u section #aiae2  7,b7
 palliative s]vices z describ$ 9        
subsection 7b77#e72  7,c7 c\nsel+       
s]vices & expressive !rapy2  7,d7       
respite c>e2 &  7,e7 anticipatory       
b]eavem5t & b]eavem5t s]vices to !      
imm$iate family memb]s ( ! ,chi,p,a,c,c 
eligible individual4  7#c7 ,co/-%>+     
waiv]s ,a ,/ate may1 9 ! case ( a       
,chi,p,a,c,c eligible individual enroll$
 9 ! ,/ate's ,chi,p,a,c,c1 waive        
d$uctibles1 copaym5ts1 co9surance1 or   
o!r co/-%>+ t w\ld o!rwise apply "u !   
,/ate plan "u ?is title1 z describ$ 9   
sections #aiaf & #aiaf;,a4  7d7 ,records
 ,a provid] p>ticipat+ 9 an             
int]discipl9>y heal? pr(essional team   
%all ma9ta9 records on ,chi,p,a,c,c     
eligible individuals enroll$ 9 ! program
 & to :om ! provid] furni%es s]vices1   
reflect+ bo? ! specific c>e & s]vices   
furni%$ by ! provid] & ! relation%ip (  
^? s]vices to ! compreh5sive plan ( c>e 
= t individual & to ! deliv]y ( o!r     

s]vices4  7e7 ,eligibility det]m9ations 
,9 det]m9+ :e!r an individual is a      
,chi,p,a,c,c eligible individual1 !     
,/ate %all conduct1 directly or "u      
arrangem5t1 an assessm5t bas$ on a      
det]m9ation by a physician &            
consultation ) appropriate treat+ &     
consult+ heal? & support pr(essionals   
c>+ = ! individual4  7f7 ,paym5ts to    
heal? c>e provid]s & ,chi,p,a,c,c       
coord9ators "u ,chi,p,a,c,c ,paym5ts to 
heal? c>e provid]s1 a ,chi,p,a,c,c      
coord9ator1 or memb]s ( an              
int]discipl9>y heal? pr(essional team   
furni%+ items & s]vices "u a            
,chi,p,a,c,c %all be made on a          
fee-=-s]vice basis1 ?r\gh a ,m$icaid    
manag$ c>e organization 7z describ$ 9   
section #aijc7m77#a771 or z o!rwise     
all[able "u ! ,/ate plan "u ?is title1 &
 det]m9$ 9 a mann] to ensure su* paym5ts
 are suffici5t to support ! ongo+ c>e   
provid$ by su* provid]s1 coord9ator1 &  
team4  7g7 ,quality assurance2 pati5t   
safegu>ds  7#a7 ,9 g5]al ,) respect to a

 ,chi,p,a,c,c1 ! ,/ate %all adopt       
quality assurance provisions & pati5t   
safegu>ds1 :i* may be ! same z ^? 9     
exi/+ ,/ate sy/ems1 applicable to       
,chi,p,a,c,c coord9ators &              
int]discipl9>y heal? pr(essional teams4 
7#b7 ,con/ruction ,no?+ 9 ?is section   
%all be con/ru$ z prev5t+ ! ,secret>y f 
impos+ requirem5ts to ensure ! heal? &  
safety ( individuals enroll$ 9 a        
,chi,p,a,c,c "u ?is section t are 9     
addition to ^? o!rwise provid$ "u ?is   
section4  7h7 ,applicability (          
requirem5ts ,) respect to a ,/ate plan  
am5dm5t "u ?is section1 ! foll[+        
requirem5ts ( ?is title 7& regulations  
relat+ to su* requirem5ts7 %all n apply3
 7#a7 ,section #aijb7;a77#a71 relat+ to 
any requirem5t t ,chi,p,a,c,cs or       
,chi,p,a,c,c s]vices be provid$ 9 all   
areas ( a ,/ate4  7#b7 ,section         
#aijb7;a77#aj71 ins(> z su* section     
relates to comp>ability ( s]vices among 
diff]5t population gr\ps1 & to p]mit a  
,chi,p,a,c,c program op]at+ "u ?is ,/ate

 plan am5dm5t to enroll only individuals
 "u age #ba4  7#c7 ,section #aije7o71   
ins(> z x limits eligibility = hospice  
c>e to individuals ) a m$ical prognosis 
( a life expectancy ( six mon?s or less1
 z describ$ 9 section                   
#ahfa7;dd77#c77;,a74  4  7b7            
,application "u *ip ,section            
#bajg7;e77#a7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acig;gg7e77#a771 z     
am5d$ by section #ihbb ( ! ,am]ican     
,rescue ,plan ,act ( #bjba1 is fur!r    
am5d$ by add+ at ! end ! foll[+ new     
subp>agraph3  7,u7 ,section #aidh       
7relat+ to ,m$icaid *ildr5's program (  
all-inclusive coord9at$ c>e74  4  7c7   
,cont9u$ demon/ration project au?ority  
,section #aidh ( ! ,social ,security    
,act1 z add$ by subsection 7a71 %all n  
be con/ru$ z prev5t+ a ,/ate f develop+1
 or ! ,secret>y ( ,heal? & ,human       
,s]vices f approv+1 a project simil> to 
or relat$ to ,chi,p,a,c,cs 7z describ$ 9
 su* section7 "u alt]native au?orities1 
includ+ demon/ration project & waiv]    

au?orities "u title ,,xix ( su* ,act or 
o!r provisions ( su* ,act4