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) ANNUAL
REEVALUATIONS.—Subject to 
such limitations as the Secretary may by regulation 
prescribe, the eligibility determination made under 
this subsection shall be reevaluated annually, except 
that such an annual evaluation may be waived, in 
accordance with regulations, in a case where the ad-
ministering State agency determines that there is no 
reasonable expectation of improvement or significant 
change in the individual’s illness or condition during 
a period to which the reevaluation requirement 
would otherwise be applicable. 
‘‘(5) ENROLLMENT AND DISENROLLMENT.— 
‘‘(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, 
VerDate Mar 15 2010 
23:51 Mar 06, 2012
Jkt 019200
PO 00000
Frm 00015
Fmt 6652
Sfmt 6201
E:\BILLS\H4147.IH
H4147
rfrederick on DSK6VPTVN1PROD with BILLS
to voluntarily disenroll for any reason at any 
time. 
‘‘(B) LIMITATIONS ON DISENROLLMENT.— 
‘‘(i) IN GENERAL.—Regulations, and 
the applicable State plan, shall provide 
that a ChiPACC may not involuntarily 
disenroll a ChiPACC eligible individual en-
rolled in the ChiPACC except— 
‘‘(I) for disruptive or threatening 
behavior by the enrollee, or by a fam-
ily member with whom a health care 
provider providing services under the 
ChiPACC necessarily has contact in 
the provision of services, as defined in 
provisions of regulations (developed in 
close consultation with State admin-
istering agencies); or 
‘‘(II) if there is a change in the 
individual’s medical condition, resi-
dency or geographic location, or finan-
cial situation such that the individual 
no longer is a ChiPACC eligible indi-
vidual and paragraph (3) does not 
apply to warrant continuation of en-
rollment. 
VerDate Mar 15 2010 
23:51 Mar 06, 2012
Jkt 019200
PO 00000
Frm 00016
Fmt 6652
Sfmt 6201
E:\BILLS\H4147.IH
H4147
rfrederick on DSK6VPTVN1PROD with BILLS
‘‘(ii) NO DISENROLLMENT FOR NON-
COMPLIANT BEHAVIOR.—Except as allowed 
under regulations, a ChiPACC may not 
disenroll a ChiPACC eligible individual on 
the ground that the individual has engaged 
in noncompliant behavior if such behavior 
is related to a mental or physical condition 
of the individual. For purposes of the pre-
ceding sentence, the term ‘noncompliant 
behavior’ includes repeated noncompliance 
with medical advice and repeated failure to 
appear for appointments. 
‘‘(iii) TIMELY REVIEW OF PROPOSED 
NONVOLUNTARY DISENROLLMENT.—A pro-
posed involuntary disenrollment under this 
subparagraph shall be subject to timely re-
view and final determination by the Sec-
retary or by the State administering agen-
cy (as applicable), prior to the proposed 
disenrollment becoming effective, pursuant 
to procedures prescribed in regulations. 
‘‘(C) APPEALS.—If an individual is deter-
mined not to be a ChiPACC eligible individual 
upon application, any time after such services 
begin, or is disenrolled from a ChiPACC for 
VerDate Mar 15 2010 
23:51 Mar 06, 2012
Jkt 019200
PO 00000
Frm 00017
Fmt 6652
Sfmt 6201
E:\BILLS\H4147.IH
H4147
rfrederick on DSK6VPTVN1PROD with BILLS
reasons described in subparagraph (B)(i)(I), the 
State plan under this title shall allow for an ap-
peal of such determination. During the course 
of the appeals process, an individual previously 
enrolled in a ChiPACC shall continue to be so 
enrolled and to receive benefits through the 
ChiPACC. 
‘‘(6) 
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— 
VerDate Mar 15 2010 
23:51 Mar 06, 2012
Jkt 019200
PO 00000
Frm 00018
Fmt 6652
Sfmt 6201
E:\BILLS\H4147.IH
H4147
rfrederick on DSK6VPTVN1PROD with BILLS
‘‘(A) on a basis that permits provision for 
integrated financing methodologies that allow 
providers to pool payments received from public 
and private programs and individuals; and 
‘‘(B) in amounts that are designed, accord-
ing to regulations, to ensure that aggregate 
payments under this section for individuals en-
rolled in a ChiPACC, whether made on a 
capitated basis or fee-for-service basis, do not 
exceed on average the aggregate payments that 
would have been paid under the State plan for 
such individuals if they were not so enrolled, 
taking into account the comparative case-mix of 
ChiPACC enrollees and such other factors as 
the Secretary determines to be appropriate. 
‘‘(f) TERMINATION PROCEDURES.— 
‘‘(1) IN GENERAL.—Under regulations— 
‘‘(A) the Secretary may require a State ad-
ministering agency to terminate the participa-
tion of a ChiPACC coordinator for cause; and 
‘‘(B) a State administering agency may 
terminate operation of a ChiPACC after appro-
priate notice to the Secretary and enrollees. 
‘‘(2) 
CAUSES
FOR
COORDINATOR
TERMI-
NATION.—In accordance with regulations estab-
VerDate Mar 15 2010 
23:51 Mar 06, 2012
Jkt 019200
PO 00000
Frm 00019
Fmt 6652
Sfmt 6201
E:\BILLS\H4147.IH
H4147
rfrederick on DSK6VPTVN1PROD with BILLS
lishing procedures for termination of participation of 
ChiPACC coordinators, the Secretary may require a 
State administering agency to terminate participa-
tion of a ChiPACC coordinator for, among other 
reasons, the fact that— 
‘‘(A) the Secretary determines that the 
ChiPACC coordinator has failed to comply sub-
stantially with requirements for a ChiPACC co-
ordinator under this section; and 
‘‘(B) the State administering agency has 
failed to develop and successfully initiate, with-
in 30 days of the date of the receipt of written 
notice of such a determination for the ChiPACC 
coordinator, a plan to correct the coordinator’s 
deficiencies, or has failed to continue implemen-
tation of such a plan of correction. 
‘‘(g) REGULATIONS.— 
‘‘(1) IN GENERAL.—The Secretary shall issue 
interim final or final regulations to carry out this 
section. 
‘‘(2) USE OF EXISTING STANDARDS.— 
‘‘(A) IN GENERAL.—In issuing such regu-
lations, the Secretary shall, to the extent appro-
priate and consistent with the provisions of this 
section, incorporate the standards and require-
VerDate Mar 15 2010 
23:51 Mar 06, 2012
Jkt 019200
PO 00000
Frm 00020
Fmt 6652
Sfmt 6201
E:\BILLS\H4147.IH
H4147
rfrederick on DSK6VPTVN1PROD with BILLS
ments applied to Programs of All-Inclusive Care 
for Children demonstration waiver programs 
that have been implemented before (or as of) 
the date of the enactment of this section, in-
cluding standards of care and practice guide-
lines applied under such programs. 
‘‘(B) FLEXIBILITY.—In order to provide 
for reasonable flexibility in adapting the service 
delivery model described in subparagraph (A) to 
the needs of particular organizations (such as 
those in rural areas or those that may deter-
mine it appropriate to use nonstaff physicians 
according to State licensing law requirements) 
under this section, the Secretary (in close con-
sultation with State administering agencies) 
may modify or waive provisions described in 
subparagraph (A) so long as any such modifica-
tion or waiver is not inconsistent with and 
would not impair the essential elements, objec-
tives, and requirements of this section, but may 
not modify or waive any of the following provi-
sions: 
‘‘(i) The requirement of delivery of 
comprehensive, integrated palliative, res-
pite and curative services, therapy, coun-
VerDate Mar 15 2010 
23:51 Mar 06, 2012
Jkt 019200
PO 00000
Frm 00021
Fmt 6652
Sfmt 6201
E:\BILLS\H4147.IH
H4147
rfrederick on DSK6VPTVN1PROD with BILLS
seling and other medical and psycho-social 
services for ChiPACC eligible individual, to 
the extent such services would benefit the 
individual. 
‘‘(ii) The requirement of delivery of 
counseling and bereavement services to im-
mediate family members of the ChiPACC 
enrollees as part of the services to the en-
rollee. 
‘‘(iii) The requirement of an inter-
disciplinary health professional team ap-
proach to care management and service de-
livery to ChiPACC eligible individuals. 
‘‘(iv) The provision of integrated fi-
nancing methodologies that allow for the 
pooling of payments received from public 
and private programs and individuals. 
‘‘(v) The limitation on average aggre-
gate payment under subsection (e)(2). 
‘‘(C) CONTINUATION
OF
MODIFICATIONS 
OR WAIVERS OPERATIONAL REQUIREMENTS.—If 
a State agency administering a program of all- 
inclusive coordinated care for seriously ill chil-
dren approved pursuant to waiver authority 
under section 1115 or 1915(c) has contractual 
VerDate Mar 15 2010 
23:51 Mar 06, 2012
Jkt 019200
PO 00000
Frm 00022
Fmt 6652
Sfmt 6201
E:\BILLS\H4147.IH
H4147
rfrederick on DSK6VPTVN1PROD with BILLS
or other operating arrangements relating to 
such program which are not otherwise recog-
nized in regulation and which were in effect as 
of the date of the enactment of this section, the 
Secretary shall permit the agency to continue 
such arrangements so long as such arrange-
ments are found by the Secretary to be reason-
ably consistent with the objectives of a 
ChiPACC. 
‘‘(3) CONSTRUCTION.—Nothing in this sub-
section shall be construed as preventing the Sec-
retary from including in regulations provisions to en-
sure the health and safety of individuals enrolled in 
a ChiPACC under this section that are in addition 
to those otherwise provided under this section. 
‘‘(h) 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. 
VerDate Mar 15 2010 
23:51 Mar 06, 2012
Jkt 019200
PO 00000
Frm 00023
Fmt 6652
Sfmt 6201
E:\BILLS\H4147.IH
H4147
rfrederick on DSK6VPTVN1PROD with BILLS
‘‘(3) Sections 1902(a)(23) and 1915(b)(4), re-
lating to freedom of choice of providers under a 
ChiPACC. 
‘‘(4) Section 1903(m)(2)(A), insofar as it re-
stricts a ChiPACC provider from receiving prepaid 
capitation payments. 
‘‘(5) Section 1905(o), limiting the scope of hos-
pice care. 
‘‘(6) Such other provisions of this title that the 
Secretary determines are inapplicable to carrying out 
a ChiPACC under this section.’’. 
(c) CONTINUED
DEMONSTRATION
PROJECT
AU-
THORITY.—Section 1944 of the Social Security Act, as 
added by subsection (b) shall not be construed as pre-
venting a State from developing, or the Secretary from 
approving, a project similar to or related to ChiPACCs 
(as described in such section) under existing authorities, 
including demonstration project and waiver authorities 
under this title or other provisions of this Act. 
(d) OTHER CONFORMING AMENDMENTS.—Section 
1905(r)(5) of such Act (42 U.S.C. 1396d(r)(5)) is amend-
ed by inserting before the period at the end the following: 
‘‘, other than items and services that are only covered as 
section 1944 ChiPACC benefits’’. 
VerDate Mar 15 2010 
23:51 Mar 06, 2012
Jkt 019200
PO 00000
Frm 00024
Fmt 6652
Sfmt 6201
E:\BILLS\H4147.IH
H4147
rfrederick on DSK6VPTVN1PROD with BILLS
(e) TIMELY ISSUANCE OF REGULATIONS; EFFECTIVE 
DATE.—The Secretary of Health and Human Services 
shall promulgate regulations to carry out the amendments 
made by this section in a timely manner, so as to assure 
that it will be feasible for State agencies and entities to 
establish and operate ChiPACCs for periods beginning not 
later than 1 year after the date of the enactment of this 
Act. 
(f) FUNDS FOR TECHNICAL ASSISTANCE.—The Sec-
retary is authorized to expend funds appropriated to carry 
out title XIX of the Social Security Act to make grants 
to, or enter into contracts with, private entities or organi-
zations that are qualified to provide technical or other as-
sistance in developing and establishing ChiPACCs within 
the States, except that— 
(1) such funds may be expended solely for the 
purposes of implementing this section; and 
(2) a private entity or organization in receipt of 
such funds must have demonstrated expertise and a 
minimum of 5 years of experience in working with 
or assisting in the establishment of programs for 
comprehensive care of children meeting the descrip-
tion of ChiPACC eligible individuals under section 
VerDate Mar 15 2010 
23:51 Mar 06, 2012
Jkt 019200
PO 00000
Frm 00025
Fmt 6652
Sfmt 6201
E:\BILLS\H4147.IH
H4147
rfrederick on DSK6VPTVN1PROD with BILLS
1944(b) of the Social Security Act, as added by sub-
section (b). 
Æ 
VerDate Mar 15 2010 
23:51 Mar 06, 2012
Jkt 019200
PO 00000
Frm 00026
Fmt 6652
Sfmt 6301
E:\BILLS\H4147.IH
H4147
rfrederick on DSK6VPTVN1PROD with BILLS