I 
115TH CONGRESS 
2D SESSION 
H. R. 6560 
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 Medicaid program. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 26, 2018 
Ms. DEGETTE (for herself, Mr. MCCAUL, Mr. BUTTERFIELD, Mr. KELLY of 
Pennsylvania, and Ms. SPEIER) 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 all- 
inclusive coordinated care (ChiPACC) under Medicaid 
program. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘ChiPACC Act of 
2018’’. 
SEC. 2. FINDINGS. 
Congress finds that— 
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(1) serious illnesses and health conditions that 
are potentially life-threatening place significant 
stress on both the child and family; 
(2) palliative care relieves children’s symptoms 
such as pain, fatigue, anxiety, nausea, and sleep 
problems, and may be provided at any age or stage 
of serious illness, and has been shown to enhance 
the quality of life for both the child and family; 
(3) under the existing model under the Med-
icaid program under title XIX of the Social Security 
Act (42 U.S.C. 1396 et seq.), eligible children diag-
nosed with potentially life-limiting illnesses are lim-
ited to receiving hospice services only after they have 
been given a prognosis of six months to live. There 
remain many critical barriers to end-of-life care 
under the current health care system, including re-
luctance of medical professionals and families to ac-
knowledge a limited life expectancy; 
(4) such model offers discrete services, which 
can be difficult to navigate, while the qualifications 
for coverage under the Medicaid program can block 
access to critical care; 
(5) the Children’s Program of All-inclusive Co-
ordinated Care (referred to in this Act as 
‘‘ChiPACC’’) provides all-inclusive care for children 
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with life-threatening conditions and their families 
from the time of diagnosis and— 
(A) fills a gap in coverage under the Med-
icaid program of integrated, multi-disciplinary 
services that are reasonable and necessary for 
the palliation and management of seriously ill 
children; 
(B) serves a population that includes chil-
dren who are not yet hospice eligible; and 
(C) provides greater coordination of pallia-
tive and curative services for children through-
out the course of their illness or condition, 
which may begin at the time of diagnosis; 
(6) some States have opted to provide services 
targeted to this population through waivers under 
subsections (b) and (c) of section 1915 of the Social 
Security Act (42 U.S.C. 1396n), each of which re-
quires the approval of the Centers for Medicare & 
Medicaid Services of the initial waiver application 
and any subsequent renewal of such waiver; 
(7) since 2005, the Secretary of Health and 
Human Services has approved home and community- 
based service waivers under section 1915(c) of such 
Act (42 U.S.C. 1396n(c)) to operate ChiPACC in 
five States; 
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(8) in States operating ChiPACC under such a 
waiver— 
(A) the respective State’s Medicaid pro-
gram achieved significant cost savings through 
a reduction in inpatient care and an increase in 
less expensive outpatient care; 
(B) access to such services in such States 
reduced more costly utilizations of other serv-
ices; and 
(C) services provided through ChiPACC 
are less costly to the State’s Medicaid program 
because ChiPACC facilitates children receiving 
palliative care at home rather than receiving 
such services in an inpatient hospital setting; 
and 
(9) allowing States the option to implement 
ChiPACC through a State plan amendment would— 
(A) give States the ability to make such 
program a part of a State’s Medicaid program 
while avoiding the lengthy waiver process; and 
(B) give States the flexibility to establish 
and design its program to fit the needs of the 
respective State. 
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SEC. 3. OPTIONAL MEDICAID COVERAGE OF CHILDREN’S 
PROGRAM OF ALL-INCLUSIVE COORDINATED 
CARE. 
(a) CHILDREN’S PROGRAM OF ALL-INCLUSIVE CO-
ORDINATED CARE.—Title XIX of such Act is further 
amended by inserting after section 1946 (42 U.S.C. 
1396w–5) the following new section: 
‘‘SEC. 1947. CHILDREN’S PROGRAM OF ALL-INCLUSIVE CO-
ORDINATED CARE. 
‘‘(a) STATE OPTION.— 
‘‘(1) IN GENERAL.—Beginning on January 1, 
2019, a State, at its option as a State plan amend-
ment, may elect to provide for medical assistance 
under this title to ChiPACC eligible individuals who 
choose to enroll in a children’s program of all-inclu-
sive coordinated care. In the case of an individual 
who chooses to enroll in such a program pursuant 
to such an election— 
‘‘(A) the individual shall receive ChiPACC 
benefits in addition to other services under the 
State plan; and 
‘‘(B) the health care providers furnishing 
services under such program shall receive pay-
ment for providing such services in accordance 
with the terms of the State plan. 
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‘‘(2) NUMERICAL AND GEOGRAPHICAL LIMITA-
TIONS PERMITTED.—A State may establish— 
‘‘(A) a numerical limit on the number of 
individuals who may be enrolled in the State’s 
ChiPACC; or 
‘‘(B) geographic limitations on the service 
areas for a ChiPACC. 
‘‘(3) PROCESS FOR DETERMINING ELIGIBLE IN-
DIVIDUALS.—If a State elects to establish a limita-
tion under paragraph (2), the State shall establish 
a process for determining criteria for which individ-
uals who may be enrolled in the State’s ChiPACC. 
‘‘(b) CHIPACC AND OTHER TERMS DEFINED.—In 
this section: 
‘‘(1) CHILDREN’S PROGRAM OF ALL-INCLUSIVE 
COORDINATED
CARE; CHIPACC.—The terms ‘chil-
dren’s program of all-inclusive coordinated care’ and 
‘ChiPACC’ mean a program of coordinated care for 
ChiPACC eligible children that is established by a 
State under this section and meets the following re-
quirements: 
‘‘(A) 
OPERATION.—The 
State 
admin-
istering agency may provide for the operation of 
the program through arrangements between one 
or more other entities that will serve as 
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ChiPACC coordinators (as defined in paragraph 
(3)). 
‘‘(B) COMPREHENSIVE BENEFITS.— 
‘‘(i) IN GENERAL.—The program pro-
vides comprehensive health care items and 
services to ChiPACC eligible individuals 
(as defined in paragraph (2)) in accord-
ance with this section. 
‘‘(ii) SCOPE
AND
PLAN
FOR
SERV-
ICES.—Such items and services shall— 
‘‘(I) include items and services 
described in subsection (c)(1)(A) to 
the extent such items and services are 
reasonable and necessary, as deter-
mined by the State, for the palliation 
and management of the CHIPACC el-
igible individual’s serious illness or 
condition; and 
‘‘(II) be provided consistent with 
a comprehensive care plan developed 
by an interdisciplinary health profes-
sional team (as defined in paragraph 
(4)). 
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