be furnished pursuant to regulations and the 
provisions of the applicable State plan; and 
‘‘(C) 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). 
‘‘(2) QUALITY
ASSURANCE; 
PATIENT
SAFE-
GUARDS.—With respect to a ChiPACC, the State 
administering agency shall assure all of the fol-
lowing: 
‘‘(A) The provision of services under the 
ChiPACC meets all applicable Federal and 
State guidelines for quality assurance. 
‘‘(B) Necessary safeguards have been es-
tablished to protect the health and welfare of 
individuals enrolled in the ChiPACC under this 
section. 
‘‘(C) There is a written plan of quality as-
surance, and procedures implementing such 
plan, in accordance with regulations. 
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‘‘(D) Written safeguards of the rights of 
individuals enrolled in the ChiPACC, including 
a patient bill of rights and procedures for griev-
ances and appeals, in accordance with regula-
tions and with other requirements of this title 
and Federal and State law designed for the pro-
tection of patients. 
‘‘(3) COST-SHARING WAIVER.—A State admin-
istering agency may, in the case of a ChiPACC eligi-
ble individual enrolled in the State’s ChiPACC, 
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) Where appropriate, consultation with 
the individual’s family, guardian, or other re-
sponsible individual. 
‘‘(B) Consultation with appropriate treat-
ing and consulting health and support profes-
sionals caring for the individual. 
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‘‘(C) 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. 
‘‘(2) CERTIFICATION.—Upon completion of the 
evaluation and assessment described in paragraph 
(1), an individual meeting the criteria of a ChiPACC 
eligible individual shall be certified as such, pursuant 
to procedures specified in regulations and the appli-
cable State plan. 
‘‘(3) CONTINUATION OF ELIGIBILITY.—An indi-
vidual who is a ChiPACC eligible individual may be 
deemed to continue to be such an individual notwith-
standing a determination that the individual no 
longer meets the requirements of subparagraphs 
(D), (E), and (F) of subsection (b)(2), if, in accord-
ance with regulations, it is reasonably foreseeable 
that, if the individual is not furnished services under 
this section, the severity or impact of the individual’s 
illness or condition would increase to a degree that 
the individual would again meet such requirement 
before the individual attains adulthood or within the 
succeeding 12-month period. 
‘‘(4) ENROLLMENT AND DISENROLLMENT.— 
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‘‘(A) VOLUNTARY DISENROLLMENT AT ANY 
TIME.—The enrollment and disenrollment of 
ChiPACC eligible individuals in a ChiPACC 
shall be pursuant to procedures specified in reg-
ulations and the State plan, but shall permit an 
enrollee, or an enrollee’s guardian or other legal 
representative, acting on behalf of an enrollee, 
to voluntarily disenroll for any reason at any 
time. 
‘‘(B) APPEALS.— 
‘‘(i) UPON APPLICATION.—If an indi-
vidual is determined not to be a ChiPACC 
eligible individual upon application, then 
the State plan under this title shall allow 
for an appeal of such determination. Dur-
ing the course of such appeal, the indi-
vidual shall not begin to receive benefits 
through the ChiPACC unless and until the 
appeal is resolved favorably for the indi-
vidual. 
‘‘(ii) SUBSEQUENTLY.—If an indi-
vidual is determined not to be a ChiPACC 
eligible individual at any time after enroll-
ment in a ChiPACC, or is otherwise 
disenrolled from a ChiPACC, then the 
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State plan under this title shall allow for 
an appeal of such determination. During 
the course of such appeal, the individual 
shall continue to be enrolled in the 
ChiPACC and to receive benefits through 
the ChiPACC. 
‘‘(5) 
CONSTRUCTION.—The 
fact 
that 
a 
ChiPACC eligible individual is enrolled under a 
ChiPACC shall not be construed as adversely affect-
ing the eligibility of the individual’s parents or care-
taker relatives for medical assistance under this 
title. 
‘‘(e) PAYMENTS
TO
HEALTH
CARE
PROVIDERS 
UNDER CHIPACC.— 
‘‘(1) IN GENERAL.—Payments to health care 
providers furnishing items and services under a 
ChiPACC shall be paid on a capitated or fee-for- 
service basis, according to regulations and as speci-
fied in the applicable State plan consistent with this 
subsection. 
‘‘(2) USE OF INTEGRATED, BUDGET-NEUTRAL 
FINANCING.—Payments under this subsection shall 
be made in amounts that are designed, according to 
regulations, to ensure that aggregate payments 
under this section for individuals enrolled in a 
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