I 
110TH CONGRESS 
2D SESSION 
H. R. 7130 
To amend title XIX of the Social Security Act to establish a State plan 
option under Medicaid to provide an all-inclusive program of care for 
children who are medically fragile or have one or more chronic conditions 
that impede their ability to function. 
IN THE HOUSE OF REPRESENTATIVES 
SEPTEMBER 26, 2008 
Ms. BALDWIN (for herself, Mr. BROWN of South Carolina, and Mr. SPRATT) 
introduced the following bill; which was referred to the Committee on En-
ergy and Commerce 
A BILL 
To amend title XIX of the Social Security Act to establish 
a State plan option under Medicaid to provide an all- 
inclusive program of care for children who are medically 
fragile or have one or more chronic conditions that im-
pede their ability to function. 
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 ‘‘Medically Fragile Chil-
dren’s Act of 2008’’. 
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SEC. 2. ESTABLISHMENT OF PROGRAM OF ALL-INCLUSIVE 
CARE FOR MEDICALLY FRAGILE CHILDREN 
AS A MEDICAID STATE OPTION. 
(a) IN GENERAL.—Title XIX of the Social Security 
Act is amended— 
(1) in section 1902(a)(10)(A)(ii)— 
(A) in subclause (XVIII) by striking ‘‘or’’ 
at the end; 
(B) in subclause (XIX), by adding ‘‘or’’ 
after the semicolon; and 
(C) by inserting after subclause (XIX) the 
following: 
‘‘(XX) who are medically fragile 
children described in section 1942;’’; 
(2) in section 1905(a), in the matter preceding 
paragraph (1)— 
(A) in clause (xii), by striking ‘‘or’’ at the 
end; 
(B) in clause (xiii), by adding ‘‘or’’ after 
the comma; and 
(C) by inserting after clause (xiii) the fol-
lowing: 
‘‘(xiv) medically fragile children de-
scribed in section 1942;’’; and 
(3) by adding at the end the following: 
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‘‘PROGRAM OF ALL-INCLUSIVE CARE FOR MEDICALLY 
FRAGILE CHILDREN 
‘‘SEC. 1942. (a) STATE OPTION TO ESTABLISH ALL- 
INCLUSIVE
CARE
FOR
MEDICALLY
FRAGILE
CHIL-
DREN.— 
‘‘(1) STATE PLAN AMENDMENT.— 
‘‘(A) IN
GENERAL.—A State may elect 
through a State plan amendment to provide 
medical assistance and other services described 
under this section by means of a program of 
all-inclusive care described in subsection (b) for 
eligible children described in paragraph (2). In 
the case of an eligible child enrolled with an all- 
inclusive care program pursuant to such an 
election— 
‘‘(i) the child shall receive benefits 
under the plan, as well as items and serv-
ices described in section 1905(r) solely 
through such programs; and 
‘‘(ii) program providers shall receive 
an all-inclusive payment in accordance with 
a program agreement for the provision of 
such care that meets the requirements of 
this section. 
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‘‘(B) OPTION TO LIMIT ENROLLMENT.—A 
State may establish a numerical limit on the 
number of eligible children who may be enrolled 
in an all-inclusive care program under a pro-
gram agreement under this section. 
‘‘(2) DEFINITION
OF
ELIGIBLE
CHILD; PRO-
GRAM PROVIDER.—In this section, 
‘‘(A) ELIGIBLE CHILD.—The term ‘eligible 
child’ means an individual who— 
‘‘(i) has not attained age 25; 
‘‘(ii) is— 
‘‘(I) determined by the State to 
be medically fragile based on health 
status and related indicators (such as 
medical diagnoses and measures of ac-
tivities of daily living, instrumental 
activities of daily living, and cognitive 
impairment); or 
‘‘(II) diagnosed as having 1 or 
more chronic conditions; 
‘‘(iii) requires daily monitoring of a 
significant medical condition necessitating 
overall care planning in order to achieve or 
maintain optimum health and develop-
mental status, achieve community integra-
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tion to the maximum extent possible, and 
requires both medical assistance and at 
least 2 additional services furnished under 
an all-inclusive program as a result of 
functional deficits; 
‘‘(iv) resides in the service area of a 
program provider with a program agree-
ment under this section; and 
‘‘(v) meets such other eligibility re-
quirements (including eligibility standards 
related to family income and resources) as 
the State may establish pursuant to sec-
tion 1902(r)(2). 
‘‘(B) PROGRAM
PROVIDER.—The term 
‘program provider’ means an organization with 
an agreement with the State to provide a pro-
gram of all-inclusive care for eligible children 
enrolled with the organization in accordance 
with this section and the terms of such agree-
ment. 
‘‘(b) PROGRAM REQUIREMENTS.—In order to satisfy 
the requirements of this section, a program of all-inclusive 
care for eligible children shall include, subject to sub-
section (d), the following: 
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‘‘(1) COMPREHENSIVE
BENEFITS.—The pro-
gram shall provide items, benefits, and services to el-
igible children enrolled in the program through an 
all-inclusive and comprehensive, multidisciplinary 
health and social services delivery system. Each par-
ticipating system in a State shall have the dem-
onstrated ability to undertake the following: 
‘‘(A) MEDICAL
ASSISTANCE.—Furnish or 
arrange for the items and services described in 
section 1905(r) (early and periodic screening, 
diagnostic, and treatment services), as well as 
any other item or service for which Federal fi-
nancial participation may be available under 
this Act. 
‘‘(B) ADMINISTRATIVE ACTIVITIES TO AS-
SURE
ACCESS
TO
PREVENTIVE, ACUTE, PRI-
MARY, SPECIALIZED, AND
LONG
TERM
CARE 
AND MEDICALLY APPROPRIATE UTILIZATION OF 
CARE.—The administration activities described 
in section 1902(a)(43) (related to administra-
tive activities to assure receipt of services de-
scribed 
in 
section 
1905(r)) 
and 
section 
1905(a)(19) (related to medical assistance case 
management services). 
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‘‘(C) ADDITIONAL SERVICES.—Social work 
services, transportation services, family support 
services, care coordination, coordination of pro-
gram services with educational, and social serv-
ices for which the child is eligible, nutrition as-
sessment and counseling, personal care services, 
respite care, and home and vehicle modification 
services. 
‘‘(2) AVAILABILITY
OF
SERVICES.—Access to 
necessary medical care for acute conditions 24 hours 
per day, every day of the year. 
‘‘(3) QUALITY
ASSURANCE; 
PATIENT
SAFE-
GUARDS.—At a minimum— 
‘‘(A) for each enrolled child, a written plan 
of quality assurance and improvement that is 
periodically reviewed and updated, and proce-
dures for implementing such plan and moni-
toring and reviewing the quality of care; 
‘‘(B) coverage of emergency services de-
scribed in section 1932(b)(2); 
‘‘(C) the provision of information to fami-
lies whose children are enrolled in the program 
in easily understood form; and 
‘‘(D) written safeguards regarding the 
rights of enrolled eligible children (including a 
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patients bill of rights and written procedures 
for grievances and appeals, which shall be no 
less stringent than procedures applicable to en-
tities participating in a State plan for medical 
assistance pursuant to section 1932 of the Act). 
‘‘(4) 
VOLUNTARY
ENROLLMENT
AND 
DISENROLLMENT.—Voluntary 
enrollment 
and 
disenrollment without cause at any time. 
‘‘(5) TRANSITION ASSISTANCE.—In the case of 
a child who is enrolled under the program under this 
section and whose enrollment ceases for any reason 
(including that the child no longer qualifies as an el-
igible child), assistance to the child in obtaining nec-
essary transitional care through appropriate refer-
rals and making the child’s medical records available 
to new providers. 
‘‘(c) PROVIDER AGREEMENTS; USE OF ALL-INCLU-
SIVE PAYMENT METHODOLOGY.— 
‘‘(1) IN GENERAL.— 
‘‘(A) PROVIDER
AGREEMENTS.—A State 
that elects the option under this section shall 
enter into an agreement with a program pro-
vider that has agreed to provide a program of 
all-inclusive care in accordance with the provi-
sions of this section for eligible children who re-
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side in the geographic area served by the pro-
vider (and specified in such agreement) and 
elect to enroll with the provider. 
‘‘(B) CHOICE AND COMPETITION.—To the 
extent feasible, the State shall enter into agree-
ments with multiple providers in a single geo-
graphic area, and enter into agreements that 
provide coverage to as much of the State as is 
practicable. 
‘‘(C) 
REPORTING
REQUIREMENT.—An 
agreement entered into under subparagraph (A) 
shall require that a program provider submit to 
the Secretary, in a form and manner specified 
by the Secretary and for each eligible child who 
is enrolled with the program provider under 
such an agreement, the following: 
‘‘(i) Service utilization data. 
‘‘(ii) Expenditures. 
‘‘(iii) Quality and health status meas-
ures (as identified by the Secretary). 
‘‘(2) PAYMENT.— 
‘‘(A) The State may utilize a negotiated, 
all-inclusive payment method that reflects the 
full range of medical assistance and related ad-
ministrative activities recognized under section 
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