‘‘(iii) 
QUALIFICATIONS
OF
PRO-
VIDERS.—Such items and services are pro-
vided through health care providers that— 
‘‘(I) meet such certification or 
other Federal or State requirements 
as may be necessary to participate in 
the program of medical assistance 
under this title or in the program 
under title XVIII; and 
‘‘(II) 
maintain 
records 
on 
ChiPACC eligible individuals enrolled 
in the program and to whom the pro-
vider furnishes services, reflecting 
both the specific care and services fur-
nished by the provider and the rela-
tionship of those services to the com-
prehensive plan of care for that indi-
vidual and to the delivery of other 
services. 
‘‘(2) CHIPACC
ELIGIBLE
INDIVIDUAL.—The 
term ‘ChiPACC eligible individual’ means, with re-
spect to a ChiPACC, an individual— 
‘‘(A) who, at the time of enrollment in the 
ChiPACC, is under 21 years of age; 
VerDate Sep 11 2014 
23:59 Aug 08, 2018
Jkt 079200
PO 00000
Frm 00008
Fmt 6652
Sfmt 6201
E:\BILLS\H6560.IH
H6560
lotter on DSKBCFDHB2PROD with BILLS
‘‘(B) who resides in the service area of a 
ChiPACC, as defined by the State admin-
istering agency; 
‘‘(C) who is eligible for medical assistance 
under the State plan without regard to this sec-
tion; 
‘‘(D) who suffers from a serious illness or 
health condition and for whom there is a rea-
sonable likelihood that the individual’s life will 
be threatened by such illness or condition; and 
‘‘(E) whose health status is expected to de-
cline because of such illness or condition before 
attaining the age of 21. 
‘‘(3) 
CHIPACC 
COORDINATOR.—The 
term 
‘ChiPACC coordinator’ means, with respect to a 
ChiPACC, an entity (which may be the State admin-
istering agency or another entity under an arrange-
ment with such an agency) that, through the assign-
ment of one or more case managers— 
‘‘(A) directs, supervises, and assures the 
coordination 
of 
comprehensive 
services 
to 
ChiPACC eligible individuals enrolled in the 
ChiPACC; and 
‘‘(B) assures the direct and continuous in-
volvement of an interdisciplinary health profes-
VerDate Sep 11 2014 
23:59 Aug 08, 2018
Jkt 079200
PO 00000
Frm 00009
Fmt 6652
Sfmt 6201
E:\BILLS\H6560.IH
H6560
lotter on DSKBCFDHB2PROD with BILLS
sional team in managing and coordinating the 
provision of care and services within the coordi-
nator’s responsibility to each such enrolled indi-
vidual. 
‘‘(4) INTERDISCIPLINARY
HEALTH
PROFES-
SIONAL
TEAM.—The term ‘interdisciplinary health 
professional team’ means, with respect to a 
ChiPACC, a group of health professionals that— 
‘‘(A) includes at least— 
‘‘(i) one physician (as defined in sec-
tion 1861(r)); 
‘‘(ii) one registered professional nurse; 
‘‘(iii) one social worker, pastoral coun-
selor, or other counselor; and 
‘‘(iv) one case manager who may be 
one of the individuals described in clauses 
(i) through (iii); 
‘‘(B) develops a comprehensive plan of care 
for ChiPACC eligible individuals enrolled with 
the ChiPACC and furnishes, or supervises the 
provision of care and services described in sub-
section (c)(1) to an individual enrolled in the 
ChiPACC in a manner that takes into account 
the best interests of such individual and such 
individual’s family; and 
VerDate Sep 11 2014 
23:59 Aug 08, 2018
Jkt 079200
PO 00000
Frm 00010
Fmt 6652
Sfmt 6201
E:\BILLS\H6560.IH
H6560
lotter on DSKBCFDHB2PROD with BILLS
‘‘(C) through direct action and communica-
tion with health care providers furnishing serv-
ices under the ChiPACC, on behalf of or under 
the direction or supervision of, a State admin-
istering agency or a ChiPACC coordinator, co-
ordinates the care and services furnished to 
such enrollees. 
‘‘(5) PALLIATIVE SERVICES.—The term ‘pallia-
tive services’ means patient and family-centered care 
that optimizes quality of life for an individual with 
a serious illness or condition by— 
‘‘(A) anticipating, preventing, and treating 
the individual’s suffering throughout the con-
tinuum of illness; 
‘‘(B) addressing the physical, intellectual, 
emotional, social and spiritual needs of the indi-
vidual; and 
‘‘(C) facilitating the individual’s autonomy, 
access to information, and choice. 
‘‘(6) STATE
ADMINISTERING
AGENCY.—The 
term ‘State administering agency’ means the State 
agency administering the State plan under this title 
(or a waiver of such plan). 
‘‘(c) SCOPE OF BENEFITS.— 
VerDate Sep 11 2014 
23:59 Aug 08, 2018
Jkt 079200
PO 00000
Frm 00011
Fmt 6652
Sfmt 6201
E:\BILLS\H6560.IH
H6560
lotter on DSKBCFDHB2PROD with BILLS
‘‘(1) IN
GENERAL.—Under a ChiPACC of a 
State, the State administering agency shall assure 
that— 
‘‘(A) 
an 
individual 
enrolled 
in 
the 
ChiPACC is covered for, at least— 
‘‘(i) comprehensive, integrated pallia-
tive and curative services; 
‘‘(ii) any long-term care services and 
supports provided under the State plan 
under this title (or waiver of such plan); 
‘‘(iii) counseling services and expres-
sive therapy; 
‘‘(iv) respite care; and 
‘‘(v) anticipatory bereavement services 
to the immediate family members of the 
ChiPACC eligible individual; and 
‘‘(B) the ChiPACC is operated, and the 
services to enrolled individuals are furnished, in 
a manner that is consistent with Standards of 
Care and Practice Guidelines developed by Chil-
dren’s Hospice International for a Program of 
All-Inclusive Care for Children (as in effect as 
of the date of the enactment of this section or 
such later date as the Secretary may specify) or 
VerDate Sep 11 2014 
23:59 Aug 08, 2018
Jkt 079200
PO 00000
Frm 00012
Fmt 6652
Sfmt 6201
E:\BILLS\H6560.IH
H6560
lotter on DSKBCFDHB2PROD with BILLS
such other standards as the Secretary may pro-
vide. 
‘‘(2) CONSTRUCTION.—Nothing in this sub-
section shall be construed to preclude a ChiPACC el-
igible individual’s eligibility to receive other services 
under the State plan (or a waiver of such plan), in-
cluding early and periodic screening, diagnostic, and 
treatment services under section 1905(a)(4)(B). 
‘‘(3) QUALITY
ASSURANCE; 
PATIENT
SAFE-
GUARDS.— 
‘‘(A) IN
GENERAL.—With respect to a 
ChiPACC, quality assurance and patient safe-
guards shall be established by the State admin-
istering agency or shall be consistent with exist-
ing State systems. 
‘‘(B) CONSTRUCTION.—Nothing in this 
subsection shall be construed as preventing the 
Secretary from imposing requirements to ensure 
the health and safety of individuals enrolled in 
a ChiPACC under this section that are in addi-
tion to those otherwise provided under this sec-
tion. 
‘‘(4) COST-SHARING WAIVER.—A State admin-
istering agency may, in the case of a ChiPACC eligi-
ble individual enrolled in the State’s ChiPACC, 
VerDate Sep 11 2014 
23:59 Aug 08, 2018
Jkt 079200
PO 00000
Frm 00013
Fmt 6652
Sfmt 6201
E:\BILLS\H6560.IH
H6560
lotter on DSKBCFDHB2PROD with BILLS
waive deductibles, copayments, coinsurance, or other 
cost-sharing that would otherwise apply under the 
State plan under this title. 
‘‘(d) ELIGIBILITY DETERMINATIONS.— 
‘‘(1) IN GENERAL.—In determining whether an 
individual is a ChiPACC eligible individual, the 
State administering agency shall conduct an inde-
pendent evaluation and assessment, which shall in-
clude at least the following: 
‘‘(A) Consultation with appropriate treat-
ing and consulting health and support profes-
sionals caring for the individual. 
‘‘(B) An examination of the individual’s 
relevant history, medical records, and care and 
support needs, guided by best practices and re-
search on effective strategies that result in im-
proved health and quality of life outcomes. 
‘‘(C) To the extent appropriate, consulta-
tion with the individual, individual’s family, 
guardian, or other responsible individual. 
‘‘(2) RECORDKEEPING; APPEALS.—Any entity 
making the eligibility determination under para-
graph (1) under contract with the State admin-
istering agency shall be subject to the recordkeeping 
VerDate Sep 11 2014 
23:59 Aug 08, 2018
Jkt 079200
PO 00000
Frm 00014
Fmt 6652
Sfmt 6201
E:\BILLS\H6560.IH
H6560
lotter on DSKBCFDHB2PROD with BILLS
and appeals processes requirements specified in sec-
tion 1902(a)(3). 
‘‘(e) PAYMENTS TO HEALTH CARE PROVIDERS AND 
CHIPACC COORDINATORS UNDER CHIPACC.—Payments 
to health care providers, a ChiPACC coordinator, or an 
interdisciplinary health professional team furnishing items 
and services under a ChiPACC shall be paid on a capitated 
or fee-for-service basis (or as otherwise allowable under 
the State plan under this title). 
‘‘(f) APPLICABILITY OF REQUIREMENTS.—With re-
spect to carrying out a ChiPACC under this section, the 
following requirements of this title (and regulations relat-
ing to such requirements) shall not apply: 
‘‘(1) Section 1902(a)(1), relating to any re-
quirement that ChiPACCs or ChiPACC services be 
provided in all areas of a State. 
‘‘(2) Section 1902(a)(10), insofar as such sec-
tion relates to comparability of services among dif-
ferent population groups. 
‘‘(3) Sections 1902(a)(23) and 1915(b)(4), re-
lating to freedom of choice of providers. 
‘‘(4) Section 1903(m)(2)(A), insofar as it re-
stricts a ChiPACC provider from receiving prepaid 
capitation payments. 
VerDate Sep 11 2014 
23:59 Aug 08, 2018
Jkt 079200
PO 00000
Frm 00015
Fmt 6652
Sfmt 6201
E:\BILLS\H6560.IH
H6560
lotter on DSKBCFDHB2PROD with BILLS
‘‘(5) Section 1905(o), limiting the scope of hos-
pice care. 
‘‘(6) Such other provisions of this title that the 
Secretary determines are inapplicable.’’. 
(b) 
APPLICATION
UNDER
CHIP.—Section 
2107(e)(1) of the Social Security Act (42 U.S.C. 
1397gg(e)(1)) is amended by adding at the end the fol-
lowing new subparagraph: 
‘‘(S) Section 1947 (relating to Medicaid 
children’s program of all-inclusive coordinated 
care).’’. 
(c) CONTINUED
DEMONSTRATION
PROJECT
AU-
THORITY.—Section 1947 of the Social Security Act, as 
added by subsection (a), shall not be construed as pre-
venting a State from developing, or the Secretary of 
Health and Human Services from approving, a project 
similar to or related to ChiPACCs (as described in such 
section) under alternative authorities, including dem-
onstration project and waiver authorities under title XIX 
of such Act or other provisions of such Act. 
Æ 
VerDate Sep 11 2014 
23:59 Aug 08, 2018
Jkt 079200
PO 00000
Frm 00016
Fmt 6652
Sfmt 6301
E:\BILLS\H6560.IH
H6560
lotter on DSKBCFDHB2PROD with BILLS