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 all- 
inclusive coordinated care (ChiPACC) under the Med-
icaid 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 
2014’’. 
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SEC. 2. OPTIONAL MEDICAID COVERAGE OF CHILDREN’S 
PROGRAM OF ALL-INCLUSIVE COORDINATED 
CARE (CHIPACC). 
(a) IN GENERAL.—Section 1905(a) of the Social Se-
curity Act (42 U.S.C. 1396d(a)) is amended— 
(1) by striking ‘‘and’’ at the end of paragraph 
(28); 
(2) by redesignating paragraph (29) as para-
graph (30); and 
(3) by inserting after paragraph (28) the fol-
lowing new paragraph: 
‘‘(29) services furnished under a children’s pro-
gram of all-inclusive coordinated care (ChiPACC) 
under section 1944; and’’. 
(b) CHILDREN’S PROGRAM OF ALL-INCLUSIVE CO-
ORDINATED CARE.—Title XIX of such Act is further 
amended by inserting after section 1943 (42 U.S.C. 
1396w–3) the following new section: 
‘‘CHILDREN’S PROGRAM OF ALL-INCLUSIVE 
COORDINATED CARE 
‘‘SEC. 1944. 
‘‘(a) STATE OPTION.— 
‘‘(1) IN GENERAL.—A State may elect to pro-
vide medical assistance under this section to 
ChiPACC eligible individuals who are eligible for 
medical assistance under the State plan under this 
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title and who choose to enroll in a children’s pro-
gram of all-inclusive coordinated care. In the case of 
an individual who chooses to enroll in such a pro-
gram pursuant to such an election— 
‘‘(A) the individual shall receive benefits 
under the State plan solely through such pro-
gram; 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 such program. 
‘‘(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; and 
‘‘(B) geographic limitations on the service 
areas for a 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 
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State under this section and meets the following re-
quirements: 
‘‘(A) OPERATION.—The program is admin-
istered by a single State agency. Such agency 
may provide for the operation of the program 
through arrangements between one or more 
other entities, such as a ChiPACC coordinator 
(as defined in paragraph (3)) and such agency. 
‘‘(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 and regulations. 
‘‘(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 
appropriate for the individual; 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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‘‘(iii) 
QUALIFICATIONS
OF
PRO-
VIDERS.—Such items and services are pro-
vided through health care providers that— 
‘‘(I) meet such certification or 
other quality requirements as may be 
necessary to participate in the pro-
gram 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 to the individual through the 
program. 
‘‘(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 a child (as defined under the State 
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plan for this purpose) and who is not older than 
such age as the State may specify; 
‘‘(B) who resides in the service area of the 
ChiPACC; 
‘‘(C) who is eligible for medical assistance 
under the State plan without regard to this sec-
tion (or, but for enrollment in a ChiPACC 
would, based on the individual’s illness or 
health condition or the projected cost of treat-
ment required for such illness or condition, be-
come so eligible); 
‘‘(D) who suffers from a serious illness or 
health condition; 
‘‘(E) for whom there is a reasonable likeli-
hood that the individual’s life will be threatened 
by such illness or condition; and 
‘‘(F) whose health status is expected to de-
cline because of such illness or condition before 
attaining full adulthood (as defined under the 
State plan). 
The Secretary may waive the application of subpara-
graph (C) with respect to eligibility for medical as-
sistance under the State plan without regard to this 
section in the case of individuals if the State dem-
onstrates to the satisfaction of the Secretary that 
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the sum of the additional expenditures under this 
title resulting from such waiver in a fiscal year will 
not exceed the aggregate savings in expenditures 
otherwise resulting from the implementation of this 
section in the fiscal year. 
‘‘(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 directs, supervises, 
and assures the coordination of comprehensive serv-
ices to ChiPACC eligible individuals enrolled in the 
ChiPACC consistent with the following: 
‘‘(A) The entity must assure the direct and 
continuous involvement of an interdisciplinary 
health professional team in managing and co-
ordinating the provision of care and services 
within the coordinator’s responsibility to each 
such enrolled individual. 
‘‘(B) The entity must include on its staff, 
or otherwise arrange for the provision of serv-
ices, through contracts or otherwise, of each of 
the types of the health care professionals and 
other service providers required to provide the 
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items and services required under subsection 
(c)(1)(A). 
‘‘(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; 
and 
‘‘(iii) one social worker, pastoral coun-
selor, or other counselor; 
‘‘(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; and 
‘‘(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 
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such enrollees in a manner that takes into ac-
count the best interests of each such enrollee 
and the enrollee’s family. 
‘‘(5) STATE
ADMINISTERING
AGENCY.—The 
term ‘State administering agency’ means, with re-
spect to the operation of a ChiPACC in a State, the 
agency of that State (which may be the single agen-
cy responsible for administration of the State plan 
under this title in the State) responsible for the im-
plementation, either directly or through arrange-
ments with one or more ChiPACC coordinators, of 
the ChiPACC under this section in the State. 
‘‘(6) REGULATIONS.—Except as otherwise pro-
vided, the term ‘regulations’ refers to interim final 
or final regulations promulgated under subsection 
(f). 
‘‘(c) SCOPE
OF BENEFITS; BENEFICIARY SAFE-
GUARDS.— 
‘‘(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 a minimum— 
‘‘(i) all items and services that are 
covered for any individual under this title, 
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and all additional items and services speci-
fied in regulations, but without any limita-
tion or condition as to amount, duration, 
or scope; 
‘‘(ii) access to covered items and serv-
ices, as needed, 24 hours per day, every 
day of the year; and 
‘‘(iii) services that include comprehen-
sive, integrated palliative and curative 
services, expressive therapy and counseling, 
and counseling and anticipatory bereave-
ment services to immediate family mem-
bers of the ChiPACC eligible individual, as 
part of the services to the eligible indi-
vidual; 
‘‘(B) provision of such services to such in-
dividuals through a comprehensive and inter-
disciplinary health and social services delivery 
system which integrates, as appropriate to the 
individual recipient of services, acute and long- 
term care services, palliative, respite and cura-
tive treatment, counseling and support for fam-
ily members who are caretakers or otherwise 
relevant to appropriate care and treatment of 
the individual, and such other services as may 
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