I 

113TH CONGRESS 

2D SESSION H. R. 4605 

To amend title XIX of the Social Security Act to provide States an option 

to cover a children’s program of all-inclusive coordinated care (ChiPACC) 

under the Medicaid program. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 8, 2014 

Mrs. ELLMERS (for herself and Mr. MORAN) introduced the following bill; 

which was referred to the Committee on Energy and Commerce 

A BILL 

To amend title XIX of the Social Security Act to provide 

States an option to cover a children’s program of allinclusive coordinated care (ChiPACC) under the Medicaid program. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘ChiPACC Act of 

5 2014’’. 


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1 SEC. 2. OPTIONAL MEDICAID COVERAGE OF CHILDREN’S 

2 PROGRAM OF ALL-INCLUSIVE COORDINATED 

3 CARE (CHIPACC). 

4 (a) IN GENERAL.—Section 1905(a) of the Social Se5 curity Act (42 U.S.C. 1396d(a)) is amended— 

6 (1) by striking ‘‘and’’ at the end of paragraph 

7 (28); 

8 (2) by redesignating paragraph (29) as para9 graph (30); and 

10 (3) by inserting after paragraph (28) the fol11 lowing new paragraph: 

12 ‘‘(29) services furnished under a children’s pro13 gram of all-inclusive coordinated care (ChiPACC) 

14 under section 1944; and’’. 

15 (b) CHILDREN’S PROGRAM OF ALL-INCLUSIVE CO16 ORDINATED CARE.—Title XIX of such Act is further 

17 amended by inserting after section 1943 (42 U.S.C. 

18 1396w–3) the following new section: 

19 ‘‘CHILDREN’S PROGRAM OF ALL-INCLUSIVE

20 COORDINATED CARE

21 ‘‘SEC. 1944. 

22 ‘‘(a) STATE OPTION.— 

23 ‘‘(1) IN GENERAL.—A State may elect to pro24 vide medical assistance under this section to 

25 ChiPACC eligible individuals who are eligible for 

26 medical assistance under the State plan under this 


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1 title and who choose to enroll in a children’s pro2 gram of all-inclusive coordinated care. In the case of 

3 an individual who chooses to enroll in such a pro4 gram pursuant to such an election— 

5 ‘‘(A) the individual shall receive benefits 

6 under the State plan solely through such pro7 gram; and 

8 ‘‘(B) the health care providers furnishing 

9 services under such program shall receive pay10 ment for providing such services in accordance 

11 with the terms of such program. 

12 ‘‘(2) NUMERICAL AND GEOGRAPHICAL LIMITA13 TIONS PERMITTED.—A State may establish— 

14 ‘‘(A) a numerical limit on the number of 

15 individuals who may be enrolled in the State’s 

16 ChiPACC; and 

17 ‘‘(B) geographic limitations on the service 

18 areas for a ChiPACC. 

19 ‘‘(b) CHIPACC AND OTHER TERMS DEFINED.—In 

20 this section: 

21 ‘‘(1) CHILDREN’S PROGRAM OF ALL-INCLUSIVE

22 COORDINATED CARE; CHIPACC.—The terms ‘chil23 dren’s program of all-inclusive coordinated care’ and 

24 ‘ChiPACC’ mean a program of coordinated care for 

25 ChiPACC eligible children that is established by a 


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1 State under this section and meets the following re2 quirements: 

3 ‘‘(A) OPERATION.—The program is admin4 istered by a single State agency. Such agency 

5 may provide for the operation of the program 

6 through arrangements between one or more 

7 other entities, such as a ChiPACC coordinator 

8 (as defined in paragraph (3)) and such agency. 

9 ‘‘(B) COMPREHENSIVE BENEFITS.— 

10 ‘‘(i) IN GENERAL.—The program pro11 vides comprehensive health care items and 

12 services to ChiPACC eligible individuals 

13 (as defined in paragraph (2)) in accord14 ance with this section and regulations. 

15 ‘‘(ii) SCOPE AND PLAN FOR SERV16 ICES.—Such items and services shall— 

17 ‘‘(I) include items and services 

18 described in subsection (c)(1)(A) to 

19 the extent such items and services are 

20 appropriate for the individual; and 

21 ‘‘(II) be provided consistent with 

22 a comprehensive care plan developed 

23 by an interdisciplinary health profes24 sional team (as defined in paragraph 

25 (4)). 


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1 ‘‘(iii) QUALIFICATIONS OF PRO2 VIDERS.—Such items and services are pro3 vided through health care providers that— 

4 ‘‘(I) meet such certification or 

5 other quality requirements as may be 

6 necessary to participate in the pro7 gram of medical assistance under this 

8 title or in the program under title 

9 XVIII; and 

10 ‘‘(II) maintain records on 

11 ChiPACC eligible individuals enrolled 

12 in the program and to whom the pro13 vider furnishes services, reflecting 

14 both the specific care and services fur15 nished by the provider and the rela16 tionship of those services to the com17 prehensive plan of care for that indi18 vidual and to the delivery of other 

19 services to the individual through the 

20 program. 

21 ‘‘(2) CHIPACC ELIGIBLE INDIVIDUAL.—The 

22 term ‘ChiPACC eligible individual’ means, with re23 spect to a ChiPACC, an individual— 

24 ‘‘(A) who, at the time of enrollment in the 

25 ChiPACC, is a child (as defined under the State 


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1 plan for this purpose) and who is not older than 

2 such age as the State may specify; 

3 ‘‘(B) who resides in the service area of the 

4 ChiPACC; 

5 ‘‘(C) who is eligible for medical assistance 

6 under the State plan without regard to this sec7 tion (or, but for enrollment in a ChiPACC 

8 would, based on the individual’s illness or 

9 health condition or the projected cost of treat10 ment required for such illness or condition, be11 come so eligible); 

12 ‘‘(D) who suffers from a serious illness or 

13 health condition; 

14 ‘‘(E) for whom there is a reasonable likeli15 hood that the individual’s life will be threatened 

16 by such illness or condition; and 

17 ‘‘(F) whose health status is expected to de18 cline because of such illness or condition before 

19 attaining full adulthood (as defined under the 

20 State plan). 

21 The Secretary may waive the application of subpara22 graph (C) with respect to eligibility for medical as23 sistance under the State plan without regard to this 

24 section in the case of individuals if the State dem25 onstrates to the satisfaction of the Secretary that 


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1 the sum of the additional expenditures under this 

2 title resulting from such waiver in a fiscal year will 

3 not exceed the aggregate savings in expenditures 

4 otherwise resulting from the implementation of this 

5 section in the fiscal year. 

6 ‘‘(3) CHIPACC COORDINATOR.—The term 

7 ‘ChiPACC coordinator’ means, with respect to a 

8 ChiPACC, an entity (which may be the State admin9 istering agency or another entity under an arrange10 ment with such an agency) that directs, supervises, 

11 and assures the coordination of comprehensive serv12 ices to ChiPACC eligible individuals enrolled in the 

13 ChiPACC consistent with the following: 

14 ‘‘(A) The entity must assure the direct and 

15 continuous involvement of an interdisciplinary 

16 health professional team in managing and co17 ordinating the provision of care and services 

18 within the coordinator’s responsibility to each 

19 such enrolled individual. 

20 ‘‘(B) The entity must include on its staff, 

21 or otherwise arrange for the provision of serv22 ices, through contracts or otherwise, of each of 

23 the types of the health care professionals and 

24 other service providers required to provide the 


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1 items and services required under subsection 

2 (c)(1)(A). 

3 ‘‘(4) INTERDISCIPLINARY HEALTH PROFES4 SIONAL TEAM.—The term ‘interdisciplinary health 

5 professional team’ means, with respect to a 

6 ChiPACC, a group of health professionals that— 

7 ‘‘(A) includes at least— 

8 ‘‘(i) one physician (as defined in sec9 tion 1861(r)); 

10 ‘‘(ii) one registered professional nurse; 

11 and 

12 ‘‘(iii) one social worker, pastoral coun13 selor, or other counselor; 

14 ‘‘(B) develops a comprehensive plan of care 

15 for ChiPACC eligible individuals enrolled with 

16 the ChiPACC and furnishes, or supervises the 

17 provision of, care and services described in sub18 section (c)(1) to an individual enrolled in the 

19 ChiPACC; and 

20 ‘‘(C) through direct action and communica21 tion with health care providers furnishing serv22 ices under the ChiPACC, on behalf of or under 

23 the direction or supervision of a State admin24 istering agency or a ChiPACC coordinator, co25 ordinates the care and services furnished to 


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1 such enrollees in a manner that takes into ac2 count the best interests of each such enrollee 

3 and the enrollee’s family. 

4 ‘‘(5) STATE ADMINISTERING AGENCY.—The 

5 term ‘State administering agency’ means, with re6 spect to the operation of a ChiPACC in a State, the 

7 agency of that State (which may be the single agen8 cy responsible for administration of the State plan 

9 under this title in the State) responsible for the im10 plementation, either directly or through arrange11 ments with one or more ChiPACC coordinators, of 

12 the ChiPACC under this section in the State. 

13 ‘‘(6) REGULATIONS.—Except as otherwise pro14 vided, the term ‘regulations’ refers to interim final 

15 or final regulations promulgated under subsection 

16 (f). 

17 ‘‘(c) SCOPE OF BENEFITS; BENEFICIARY SAFE18 GUARDS.— 

19 ‘‘(1) IN GENERAL.—Under a ChiPACC of a 

20 State, the State administering agency shall assure 

21 that— 

22 ‘‘(A) an individual enrolled in the 

23 ChiPACC is covered for, at a minimum— 

24 ‘‘(i) all items and services that are 

25 covered for any individual under this title, 


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1 and all additional items and services speci2 fied in regulations, but without any limita3 tion or condition as to amount, duration, 

4 or scope; 

5 ‘‘(ii) access to covered items and serv6 ices, as needed, 24 hours per day, every 

7 day of the year; and 

8 ‘‘(iii) services that include comprehen9 sive, integrated palliative and curative 

10 services, expressive therapy and counseling, 

11 and counseling and anticipatory bereave12 ment services to immediate family mem13 bers of the ChiPACC eligible individual, as 

14 part of the services to the eligible indi15 vidual; 

16 ‘‘(B) provision of such services to such in17 dividuals through a comprehensive and inter18 disciplinary health and social services delivery 

19 system which integrates, as appropriate to the 

20 individual recipient of services, acute and long21 term care services, palliative, respite and cura22 tive treatment, counseling and support for fam23 ily members who are caretakers or otherwise 

24 relevant to appropriate care and treatment of 

25 the individual, and such other services as may 


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1 be furnished pursuant to regulations and the 

2 provisions of the applicable State plan; and 

3 ‘‘(C) the ChiPACC is operated, and the 

4 services to enrolled individuals are furnished, in 

5 a manner that is consistent with Standards of 

6 Care and Practice Guidelines developed by Chil7 dren’s Hospice International for a Program of 

8 All-Inclusive Care for Children (as in effect as 

9 of the date of the enactment of this section or 

10 such later date as the Secretary may specify). 

11 ‘‘(2) QUALITY ASSURANCE; PATIENT SAFE12 GUARDS.—With respect to a ChiPACC, the State 

13 administering agency shall assure all of the fol14 lowing: 

15 ‘‘(A) The provision of services under the 

16 ChiPACC meets all applicable Federal and 

17 State guidelines for quality assurance. 

18 ‘‘(B) Necessary safeguards have been es19 tablished to protect the health and welfare of 

20 individuals enrolled in the ChiPACC under this 

21 section. 

22 ‘‘(C) There is a written plan of quality as23 surance, and procedures implementing such 

24 plan, in accordance with regulations. 


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1 ‘‘(D) Written safeguards of the rights of 

2 individuals enrolled in the ChiPACC, including 

3 a patient bill of rights and procedures for griev4 ances and appeals, in accordance with regula5 tions and with other requirements of this title 

6 and Federal and State law designed for the pro7 tection of patients. 

8 ‘‘(3) COST-SHARING WAIVER.—A State admin9 istering agency may, in the case of a ChiPACC eligi10 ble individual enrolled in the State’s ChiPACC, 

11 waive deductibles, copayments, coinsurance, or other 

12 cost-sharing that would otherwise apply under the 

13 State plan under this title. 

14 ‘‘(d) ELIGIBILITY DETERMINATIONS.— 

15 ‘‘(1) IN GENERAL.—In determining whether an 

16 individual is a ChiPACC eligible individual, the 

17 State administering agency shall conduct an inde18 pendent evaluation and assessment, which shall in19 clude at least the following: 

20 ‘‘(A) Where appropriate, consultation with 

21 the individual’s family, guardian, or other re22 sponsible individual. 

23 ‘‘(B) Consultation with appropriate treat24 ing and consulting health and support profes25 sionals caring for the individual. 


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1 ‘‘(C) An examination of the individual’s 

2 relevant history, medical records, and care and 

3 support needs, guided by best practices and re4 search on effective strategies that result in im5 proved health and quality of life outcomes. 

6 ‘‘(2) CERTIFICATION.—Upon completion of the 

7 evaluation and assessment described in paragraph 

8 (1), an individual meeting the criteria of a ChiPACC 

9 eligible individual shall be certified as such, pursuant 

10 to procedures specified in regulations and the appli11 cable State plan. 

12 ‘‘(3) CONTINUATION OF ELIGIBILITY.—An indi13 vidual who is a ChiPACC eligible individual may be 

14 deemed to continue to be such an individual notwith15 standing a determination that the individual no 

16 longer meets the requirements of subparagraphs 

17 (D), (E), and (F) of subsection (b)(2), if, in accord18 ance with regulations, it is reasonably foreseeable 

19 that, if the individual is not furnished services under 

20 this section, the severity or impact of the individual’s 

21 illness or condition would increase to a degree that 

22 the individual would again meet such requirement 

23 before the individual attains adulthood or within the 

24 succeeding 12-month period. 

25 ‘‘(4) ENROLLMENT AND DISENROLLMENT.— 


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1 ‘‘(A) VOLUNTARY DISENROLLMENT AT ANY

2 TIME.—The enrollment and disenrollment of 

3 ChiPACC eligible individuals in a ChiPACC 

4 shall be pursuant to procedures specified in reg5 ulations and the State plan, but shall permit an 

6 enrollee, or an enrollee’s guardian or other legal 

7 representative, acting on behalf of an enrollee, 

8 to voluntarily disenroll for any reason at any 

9 time. 

10 ‘‘(B) APPEALS.— 

11 ‘‘(i) UPON APPLICATION.—If an indi12 vidual is determined not to be a ChiPACC 

13 eligible individual upon application, then 

14 the State plan under this title shall allow 

15 for an appeal of such determination. Dur16 ing the course of such appeal, the indi17 vidual shall not begin to receive benefits 

18 through the ChiPACC unless and until the 

19 appeal is resolved favorably for the indi20 vidual. 

21 ‘‘(ii) SUBSEQUENTLY.—If an indi22 vidual is determined not to be a ChiPACC 

23 eligible individual at any time after enroll24 ment in a ChiPACC, or is otherwise 

25 disenrolled from a ChiPACC, then the 


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1 State plan under this title shall allow for 

2 an appeal of such determination. During 

3 the course of such appeal, the individual 

4 shall continue to be enrolled in the 

5 ChiPACC and to receive benefits through 

6 the ChiPACC. 

7 ‘‘(5) CONSTRUCTION.—The fact that a 

8 ChiPACC eligible individual is enrolled under a 

9 ChiPACC shall not be construed as adversely affect10 ing the eligibility of the individual’s parents or care11 taker relatives for medical assistance under this 

12 title. 

13 ‘‘(e) PAYMENTS TO HEALTH CARE PROVIDERS

14 UNDER CHIPACC.— 

15 ‘‘(1) IN GENERAL.—Payments to health care 

16 providers furnishing items and services under a 

17 ChiPACC shall be paid on a capitated or fee-for18 service basis, according to regulations and as speci19 fied in the applicable State plan consistent with this 

20 subsection. 

21 ‘‘(2) USE OF INTEGRATED, BUDGET-NEUTRAL

22 FINANCING.—Payments under this subsection shall 

23 be made in amounts that are designed, according to 

24 regulations, to ensure that aggregate payments 

25 under this section for individuals enrolled in a 


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1 ChiPACC, whether made on a capitated basis or fee2 for-service basis, do not exceed on average the ag3 gregate payments that would have been paid under 

4 the State plan for such individuals if they were not 

5 so enrolled, taking into account the comparative case 

6 mix of ChiPACC enrollees and such other factors as 

7 the Secretary determines to be appropriate. 

8 ‘‘(f) REGULATIONS.— 

9 ‘‘(1) IN GENERAL.—The Secretary shall issue 

10 such regulations, including interim final regulations, 

11 as may be necessary to carry out this section. 

12 ‘‘(2) CONTINUATION OF MODIFICATIONS OR

13 WAIVERS OPERATIONAL REQUIREMENTS.—If a State 

14 agency administering a program of all-inclusive co15 ordinated care for seriously ill children approved 

16 pursuant to waiver authority under section 1115 or 

17 1915(c) has contractual or other operating arrange18 ments relating to such program which are not other19 wise recognized in regulation and which were in ef20 fect as of the date of the enactment of this section, 

21 the Secretary shall permit the agency to continue 

22 such arrangements so long as such arrangements 

23 are found by the Secretary to be reasonably con24 sistent with the objectives of a ChiPACC. 


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1 ‘‘(3) CONSTRUCTION.—Nothing in this sub2 section shall be construed as preventing the Sec3 retary from including in regulations provisions to en4 sure the health and safety of individuals enrolled in 

5 a ChiPACC under this section that are in addition 

6 to those otherwise provided under this section. 

7 ‘‘(g) APPLICABILITY OF REQUIREMENTS.—With re8 spect to carrying out a ChiPACC under this section, the 

9 following requirements of this title (and regulations relat10 ing to such requirements) shall not apply: 

11 ‘‘(1) Section 1902(a)(1), relating to any re12 quirement that ChiPACCs or ChiPACC services be 

13 provided in all areas of a State. 

14 ‘‘(2) Section 1902(a)(10), insofar as such sec15 tion relates to comparability of services among dif16 ferent population groups. 

17 ‘‘(3) Sections 1902(a)(23) and 1915(b)(4), re18 lating to freedom of choice of providers under a 

19 ChiPACC. 

20 ‘‘(4) Section 1903(m)(2)(A), insofar as it re21 stricts a ChiPACC provider from receiving prepaid 

22 capitation payments. 

23 ‘‘(5) Section 1905(o), limiting the scope of hos24 pice care. 


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1 ‘‘(6) Such other provisions of this title that the 

2 Secretary determines are inapplicable to carrying out 

3 a ChiPACC under this section.’’. 

4 (c) CONTINUED DEMONSTRATION PROJECT AU5 THORITY.—Section 1944 of the Social Security Act, as 

6 added by subsection (b), shall not be construed as pre7 venting a State from developing, or the Secretary of 

8 Health and Human Services from approving, a project 

9 similar to or related to ChiPACCs (as described in such 

10 section) under existing authorities, including demonstra11 tion project and waiver authorities under title XIX of such 

12 Act or other provisions of such Act. 

13 (d) OTHER CONFORMING AMENDMENTS.—Section 

14 1905(r)(5) of such Act (42 U.S.C. 1396d(r)(5)) is amend15 ed by inserting before the period at the end the following: 

16 ‘‘, other than items and services that are only covered as 

17 section 1944 ChiPACC benefits’’. 

18 (e) TIMELY ISSUANCE OF REGULATIONS; EFFECTIVE

19 DATE.—The Secretary of Health and Human Services 

20 shall promulgate regulations to carry out the amendments 

21 made by this section in a timely manner, so as to assure 

22 that it will be feasible for State agencies and entities to 

23 establish and operate ChiPACCs for periods beginning not 

24 later than 1 year after the date of the enactment of this 

25 Act. 


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1 (f) FUNDS FOR TECHNICAL ASSISTANCE.—The Sec2 retary is authorized to expend funds appropriated to carry 

3 out title XIX of the Social Security Act to make grants 

4 to, or enter into contracts with, private entities or organi5 zations that are qualified to provide technical or other as6 sistance in developing and establishing ChiPACCs within 

7 the States, except that— 

8 (1) such funds may be expended solely for the 

9 purposes of implementing this section; and 

10 (2) a private entity or organization in receipt of 

11 such funds must have demonstrated expertise and a 

12 minimum of 5 years of experience in working with 

13 or assisting in the establishment of programs for 

14 comprehensive care of children meeting the descrip15 tion of ChiPACC eligible individuals under section 

16 1944(b) of the Social Security Act, as added by sub17 section (b). 

Æ 


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