ChiPACC Act of 2021
Bill: H.R.4952 | Sponsor: Rep. DeGette, Diana (D-CO)
Policy area: Health

Summary:
ChiPACC Act of 2021
This bill provides statutory authority for states to cover children's programs of all-inclusive coordinated care under Medicaid.

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 Medicaid program.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``ChiPACC Act of 2021''.

SEC. 2. FINDINGS.

    Congress finds that--
            (1) serious illnesses and health conditions that are 
        potentially life-threatening place significant stress on both 
        the child and family;
            (2) palliative care relieves children's symptoms such as 
        pain, fatigue, anxiety, nausea, and sleep problems, and may be 
        provided at any age or stage of serious illness, and has been 
        shown to enhance the quality of life for both the child and 
        family;
            (3) many critical barriers to end-of-life care for children 
        exist under the current health care system, including the 
        limitation of hospice care under the Medicaid program to 
        children expected to live six months or less, a prognosis that 
        medical professionals and families are reluctant to make;
            (4) the Children's Program of All-inclusive Coordinated 
        Care (referred to in this Act as ``ChiPACC'') provides all-
        inclusive care for children with life-threatening conditions 
        and their families from the time of diagnosis and--
                    (A) fills a gap in coverage under the Medicaid 
                program of integrated, multi-disciplinary services that 
                are reasonable and necessary for the palliation and 
                management of seriously ill children;
                    (B) serves a population that includes children who 
                are not yet hospice eligible; and
                    (C) provides greater coordination of palliative and 
                curative services for children throughout the course of 
                their illness or condition, which may begin at the time 
                of diagnosis;
            (5) some States have opted to provide services targeted to 
        this population through waivers under subsections (b) and (c) 
        of section 1915 of the Social Security Act (42 U.S.C. 1396n), 
        each of which requires the approval of the Centers for Medicare 
        & Medicaid Services of the initial waiver application and any 
        subsequent renewal of such waiver;
            (6) since 2005, the Secretary of Health and Human Services 
        has approved home and community-based service waivers under 
        section 1915(c) of such Act (42 U.S.C. 1396n(c)) to operate 
        ChiPACC in five States;
            (7) in States operating ChiPACC under such a waiver--
                    (A) the respective State's Medicaid program 
                achieved significant cost savings through a reduction 
                in inpatient care and an increase in less expensive 
                outpatient care;
                    (B) access to CHIPACC services in such States 
                reduced more costly utilizations of other services; and
                    (C) services provided through ChiPACC are less 
                costly to the State's Medicaid program because ChiPACC 
                facilitates children receiving palliative care at home 
                rather than receiving such services in an inpatient 
                hospital setting; and
            (8) allowing States the option to implement ChiPACC through 
        a State plan amendment would--
                    (A) give States the ability to make such program a 
                part of a State's Medicaid program while avoiding the 
                lengthy waiver process; and
                    (B) give States the flexibility to establish and 
                design its program to fit the needs of the respective 
                State.

SEC. 3. OPTIONAL MEDICAID COVERAGE OF CHILDREN'S PROGRAM OF ALL-
              INCLUSIVE COORDINATED CARE.

    (a) Children's Program of All-Inclusive Coordinated Care.--Title 
XIX of the Social Security Act (42 U.S.C. 1396a et seq.), as amended by 
section 9813 of the American Rescue Plan Act of 2021, is further 
amended by inserting after section 1947 the following new section:

``SEC. 1948. CHILDREN'S PROGRAM OF ALL-INCLUSIVE COORDINATED CARE.

    ``(a) State Option.--
            ``(1) In general.--Beginning on January 1, 2022, a State, 
        at its option as a State plan amendment, may elect to provide 
        for ChiPACC services under this title to ChiPACC eligible 
        individuals who choose to enroll in a children's program of 
        all-inclusive coordinated care. In the case of an individual 
        who chooses to enroll in such a program--
                    ``(A) the individual shall receive ChiPACC services 
                (as described in subsection (c)), including but not 
                limited to services under the State plan; and
                    ``(B) the health care providers furnishing services 
                under such program shall receive payment for providing 
                such services in accordance with the terms of the State 
                plan.
            ``(2) Process for determining eligible individuals.--If a 
        State elects to establish a limitation under paragraph (2), the 
        State shall establish a process, as described in subsection 
        (e), for determining criteria for which individuals who may be 
        enrolled in the State's ChiPACC.
            ``(3) State administration.--The ChiPACC shall be 
        administered by the single State agency as described in section 
        1904(a)(5).
            ``(4) Matching rate.--The Federal medical assistance 
        percentage for ChiPACC coordination, and services shall be that 
        otherwise applicable to medical assistance for the State.
    ``(b) ChiPACC and Other Terms Defined.--In this section:
            ``(1) Children's program of all-inclusive coordinated care; 
        chipacc.--The terms `children's program of all-inclusive 
        coordinated care' and `ChiPACC' mean a program of coordinated 
        care for ChiPACC eligible children that is established by a 
        State under this section and that meets the following 
        requirements:
                    ``(A) Operation.--The State shall provide for the 
                operation of the program directly, serving as ChiPACC 
                coordinator (as defined in paragraph 3), or through 
                arrangements with one or more other entities that will 
                serve as ChiPACC coordinators.
                    ``(B) Comprehensive benefits.--
                            ``(i) In general.--The program provides or 
                        coordinates the provision of comprehensive 
                        items and services to ChiPACC eligible 
                        individuals (as defined in paragraph (2)) in 
                        accordance with this section.
                            ``(ii) Scope and plan for services.--Such 
                        items and services shall--
                                    ``(I) include items and services 
                                described in subsections (c)(1) and 
                                (c)(2), to the extent such items and 
                                services are medically necessary as 
                                determined by the State; and
                                    ``(II) be provided consistent with 
                                a comprehensive care plan developed by 
                                an interdisciplinary health 
                                professional team (as defined in 
                                paragraph (4)).
                    ``(C) Qualifications of providers.--Such items and 
                services are provided through--
                            ``(i) health care providers that 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; or
                            ``(ii) in the case of counselors as 
                        described in (4)(iii), individuals who are 
                        legally authorized to provide counseling 
                        services under State law or a regulatory 
                        mechanism provided by State law or, if no law 
                        or regulatory mechanism is applicable, by 
                        determination of the State.
                    ``(D) Standards and guidelines.--The ChiPACC is 
                operated and the services to enrolled individuals are 
                furnished in a manner that is informed by generally 
                recognized professional guidelines, the Secretary may 
                substitute the revision through sub-regulatory 
                guidance. The Secretary may adopt other standards and 
                guidelines consistent with the purposes of this 
                section.
            ``(2) ChiPACC eligible individual.--The term `ChiPACC 
        eligible individual' means, with respect to a ChiPACC, an 
        individual--
                    ``(A) who, at the time of enrollment in the 
                ChiPACC, is under 21 years of age;
                    ``(B) who resides in the service area of a ChiPACC 
                as determined by the State;
                    ``(C) who is eligible for medical assistance under 
                the State plan without regard to this section;
                    ``(D) who suffers from a serious illness or health 
                condition and for whom there is a reasonable likelihood 
                that the individual's life will be threatened by such 
                illness or condition; and
                    ``(E) whose health status is expected to decline 
                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 that, through the 
        assignment of one or more case managers--
                    ``(A) directs, supervises, and ensures the 
                coordination of services to ChiPACC eligible 
                individuals enrolled in the ChiPACC; and
                    ``(B) ensures the direct and continuous involvement 
                of an interdisciplinary health professional team (as 
                described in paragraph (4)) in managing and 
                coordinating the provision of care and services within 
                the coordinator's responsibility, as determined by the 
                State, to each such enrolled individual.
            ``(4) Interdisciplinary health professional team.--The term 
        `interdisciplinary health professional team' means, with 
        respect to a ChiPACC, a group of professionals that--
                    ``(A) includes at least--
                            ``(i) one physician (as described in 
                        section 1861(r));
                            ``(ii) one registered nurse;
                            ``(iii) one social worker, pastoral 
                        counselor, 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 care plan for each 
                ChiPACC eligible individual enrolled with the ChiPACC 
                that takes into account the best interests of such 
                individual and such individual's family; and
                    ``(C) coordinates the provision of services 
                described in subsections (c)(1) and (c)(2), as 
                determined by the state, to an individual enrolled in 
                the ChiPACC by members of the team or by other 
                providers of services.
            ``(5) Palliative services.--The term `palliative services' 
        means, for the purposes of this section, 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 continuum of 
                illness;
                    ``(B) addressing the physical, intellectual, 
                emotional, social and spiritual needs of the 
                individual; and
                    ``(C) facilitating the individual's autonomy, 
                access to information, and choice.
    ``(c) Scope of Benefits.--
            ``(1) In general.--Under a ChiPACC of a State, the State 
        shall ensure that an individual enrolled in the ChiPACC is 
        covered for necessary services including--
                    ``(A) any early and periodic screening diagnostic 
                and treatment service, as described in section 1905(r); 
                and
                    ``(B) any additional services that may be necessary 
                to ensure that such coverage includes at least the 
                elements described in paragraph (2).
            ``(2) Elements of a program of all-inclusive coordinated 
        care.--The elements referred to in paragraph (1)(A)(ii) are--
                    ``(A) medical and long-term care services and 
                supports as described in section 1905 or as may be 
                available to the individual under waiver programs 
                approved under section 1915;
                    ``(B) palliative services as described in 
                subsection (b)(5);
                    ``(C) counseling services and expressive therapy;
                    ``(D) respite care; and
                    ``(E) anticipatory bereavement and bereavement 
                services to the immediate family members of the ChiPACC 
                eligible individual.
            ``(3) Cost-sharing waivers.--A State may, in the case of a 
        ChiPACC eligible 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, as described in sections 1916 and 1916A.
    ``(d) Records.--A provider participating in an interdisciplinary 
health professional team shall maintain records on ChiPACC eligible 
individuals enrolled in the program and to whom the provider furnishes 
services, reflecting both the specific care and services furnished by 
the provider and the relationship of those services to the 
comprehensive plan of care for that individual and to the delivery of 
other services.
    ``(e) Eligibility Determinations.--In determining whether an 
individual is a ChiPACC eligible individual, the State shall conduct, 
directly or under arrangement, an assessment based on a determination 
by a physician and consultation with appropriate treating and 
consulting health and support professionals caring for the individual.
    ``(f) Payments to Health Care Providers and ChiPACC Coordinators 
Under ChiPACC.--Payments to health care providers, a ChiPACC 
coordinator, or members of an interdisciplinary health professional 
team furnishing items and services under a ChiPACC shall be made on a 
fee-for-service basis, through a Medicaid managed care organization (as 
described in section 1903(m)(1)), or as otherwise allowable under the 
State plan under this title, and determined in a manner to ensure such 
payments are sufficient to support the ongoing care provided by such 
providers, coordinator, and team.
    ``(g) Quality Assurance; Patient Safeguards.--
            ``(1) In general.--With respect to a ChiPACC, the State 
        shall adopt quality assurance provisions and patient 
        safeguards, which may be the same as those in existing State 
        systems, applicable to ChiPACC coordinators and 
        interdisciplinary health professional teams.
            ``(2) Construction.--Nothing in this section 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 addition 
        to those otherwise provided under this section.
    ``(h) Applicability of Requirements.--With respect to a State plan 
amendment under this section, the following requirements of this title 
(and regulations relating to such requirements) shall not apply:
            ``(1) Section 1902(a)(1), relating to any requirement that 
        ChiPACCs or ChiPACC services be provided in all areas of a 
        State.
            ``(2) Section 1902(a)(10), insofar as such section relates 
        to comparability of services among different population groups, 
        and to permit a ChiPACC program operating under this State plan 
        amendment to enroll only individuals under age 21.
            ``(3) Section 1905(o), insofar as it limits eligibility for 
        hospice care to individuals with a medical prognosis of a life 
        expectancy of six months or less, as described in section 
        1861(dd)(3)(A).''.
    (b) Application Under Chip.--Section 2107(e)(1) of the Social 
Security Act (42 U.S.C. 1397gg(e)(1)), as amended by section 9822 of 
the American Rescue Plan Act of 2021, is further amended by adding at 
the end the following new subparagraph:
                    ``(U) Section 1948 (relating to Medicaid children's 
                program of all-inclusive coordinated care).''.
    (c) Continued Demonstration Project Authority.--Section 1948 of the 
Social Security Act, as added by subsection (a), shall not be construed 
as preventing 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 demonstration project and waiver authorities under title XIX 
of such Act or other provisions of such Act.
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