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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