I n nOTi2ii>CSOESNSGIRONESS WrWi. K. o£»yrWoOl1 To aiiK'iKl title XIX of tlio Sot-ial Smirity Act to pjxnide an option of States to eover a ehiklren'.s ]>rof>Tani of all-inehisive eooi-diiiated eare (CliiPACC)undertheMedicaidI'l-ogTani. IN THE HOUSE OF REPRESENTATR^S Septp:mbek17,2008 Mr. MoiiiVNofVirginia (forliimselfand Mr. TOMDAVISofVirginia) intro- ducedthefollowinghill;whichwasreferredtotheCommitteeonEnei-gy andCommerce A BILL To amend title XIX of the Social Security Act to pro\ide an option of States to cover a children's program of all-inclusive coordinatedcare (ChiPACC) undertheMed- icaidProgram. 1 BeitenactedhytheSenateandHouseofRepresenta- 2 tivcsoftlieUnitedStatesofAmericainCongressassembled, 3 SECTION1.SHORTTITLE. 4 This Act may be cited as the "ChiPACC Act of 5 2008". 2 1 SEC. 2. OPTIONAL MEDICAID COVERAGE OF CHILDREN'S 2 PROGRAMOFALL-INCLUSIVECOORDINATED 3 CARE(CHIPACC). — 4 (a) InGen?:kal. Seetioii 1905(a) oftheSocialSe- 5 ciirityAct(42U.S.C. 139(i(l(a))isamended— 6 (1) by striking' "and" at the end ofparagraph 7 (27); 8 (2) by redesignating paragraph (28) as para- 9 graph (29); and 10 (3) by inserting after paragraph (27) the fol- 11 lowing:newparagraph: 12 "(28) servicesfurnishednndera children'spro- 13 gram of all-inclusive coordinated care (CliiPACC) 14 undersection 1942; and". 15 (b) Children's Program of All-Inclusr?e Co- 16 ORDINATEDCare (CiiiPACC).—TitleXEXofsuchActis 17 fin-ther amended byadding;atthe endthe followingnew 18 section: 19 "children'sprogRx\mofall-inclusr-e 20 coordinatedcare (chipacc) 21 "Sec. 1942.(a)StateOption.— — 22 "(1) In general. ^A State may elect to pro- 23 "vide medical assistance under this section A\ith re- 24 spect to a children's program ofall-inclusive coordi- 25 nated care to CliiPACC eligible indi\iduals who are 26 ehgible for medical assistance under the State plan •HR6931IH — — . 3 1 andwhoareenrolled in theprogram. In the ease of 2 anindi^^dnalenrolledinsnehaprogi-anipnrsnantto 3 suchanelection 4 "(A) the indi\idnal shall receive benefits 5 under the plan solely through such prog-rani; 6 and 7 "(B) the health care pro^^ders furnishing 8 services under such program shall receive pay- 9 ment inaccordancewith thetermsofsuch pro- 10 gi-amforpro\idingsuchsendees 11 "(2) NuMERICAIj and UEOCiRAPHICAL LIMITA- — 12 TiONSPERMITTED. Statemayestablish 13 "(A) a numerical limit on the number of 14 individuals who may be enroUed in the State's 15 ChiPACC;and 16 "(B) geogi^ai)hic limitations on the service 17 areasforaChiPACC. — 18 "(b) ChiPACC and Other Terms Defined. In 19 thissection: 20 "(1) Children's program of all-inclusive — 21 coordinated CMiE; CHIPACC. The terms 'chil- 22 dren'spro-amofaU-inclusivecoordinatedcare' and 23 'ChiPACC mean a program ofcoordinated care for 24 ChiPACC eligible children that is established by a •HR6931IH —— 4 1 Stateunderthis section and meetsthe following'r-e- 2 (jnirements: — 3 "(A) Operation. Thej^rogfi-amisadmin- 4 istered by a single State agency. Such agency 5 may provide for the operation of the program 6 through arrangements between one or more 7 other entities, such as a ChiPACC coordinator, 8 andsuchagency. 9 "(B) COMPREIIENSnnEBENEFITS. — 10 "(i) In GENERAIj. The program pro- 11 \ddes comprehensive health care items and 12 services to ChiPACC ehgible in(h\iduals in 13 accordance Avith this section and regida- 14 tions. 15 "(ii) Scope and plan for serv- — 16 ICES. Suchitemsandsendeesshall 17 "(I) include items and services 18 described in subsection (c)(1)(A) to 19 theextentsuchitemsandservicesare 20 appropriatetotheindividual;and 21 "(II) be provided consistent with 22 a comprehensive care plan developed 23 by an interdisciplinar}' health profes- 24 sionalteam. •HR6931IH — — 5 1 "(iii) QUM^IPICATIONS OF PRO- — 2 VIDEKS. Such items and services arepro- 3 videdtliroug'h health carepro\idersthat 4 "(I) meet such eertifieation or 5 other (iiiahty requirements as may be 6 necessary to participate in the i)ro- 7 f^-am ofme(hcal assistanceunderthis 8 title or in the ])ro«Tam under title 9 XVlll;and 10 "(11) maintain records on 11 ChiPACC elio^ible indi^^duals enrolled 12 in the prt)g:ram andtowhom the pro- 13 vider furnishes services, reflecting 14 boththespecificcareandservicesfur- 15 nished by the pro\ider and the rela- 16 tionship ofthose services to the com- 17 preliensive plan ofcare for that indi- 18 \idual and to the deliver}^ of other 19 sendees to the indi\idual through the 20 program. 21 "(2) ChiPACC eligible individual.—The 22 term 'ChiPACC eligible indixadual' means, with re- 23 specttoaChiPACC, anindi\idnal 24 "(A) who, atthe time ofenrollment in the 25 ChiPACCisachild (asdefinedunderthe State •HR6931IH 6 1 planforthispnqjose) andwhoisnotolderthan 2 suchao'eastheStatemayspecify; 3 "(B) who suffers from a serious illness or 4 health(conditionthatislifethreatening-; 5 "(C) forwhom thei'e is a reasonablelikeli- 6 hood that the child's life will be threatened by 7 suchillnessorcondition; 8 "(D)whosehealthstatusisexj^eetedtode- 9 clinebecause ofsuch illness orconditionbefore 10 attaining- full adulthood (as defined under the 11 Stateplan); 12 "(E) resides in the service area of the 13 ChiPACC;and 14 "(F) is eligible for medical assistance 15 undertheStateplanwithoutregardtothissec- 16 tion (or, but for enrollment in a ChiPACC 17 would, based on the indi\'iduars illness or 18 health condition or the projected cost oftreat- 19 merit required for such illness orcondition, be- 20 comesoeligible). 21 TheSeeretaiymaywaivetheapplicationofsubpara- 22 graph (F) with respect to eligibihty for medical as- 23 sistanceunderthe Stateplanwithout reg^ardtothis 24 section in the case ofindi\iduals ifthe State dem- 25 onstrates to the satisfaction of the Secretary that •HR6931III 7 1 the sum of the additional expeiKhtures niider this 2 title resulting-from such waiver in a fiscal yearwill 3 not exceed the ago-regate sa\angs in ex])enditures 4 othen\ise resulting from the imj^lementation ofthis 5 sectioninthefiscalyear. — 6 "(3) C^inPACC COOKDINATOK. The term 7 'ChiPACt' coordinator' means, "with i-es])ect to a 8 ChiPACC,anentity(whichmaybetheStateadmin- 9 istering^agencyor another entityunder an arrange- 10 ment with such an agency) that chrects, supenises, 11 and assuresthe coordination ofcomprehensive serv- 12 ices to ChiPACC eligible indi\iduals enrolled in the 13 ChiPACCconsistentwiththefollowing:: 14 "(A) Theentitymustassurethedirectand 15 continuous involvement of an interdisciplinaiy 16 health professional team in managing and co- 17 ordinating the pro\ision of care and senices 18 within the coordinator's responsibility to each 19 suchenrolledindividual. 20 "(B) The entity must include on its staff, 21 or otherwise arrange for the pro\ision of ser\'- 22 ices, through contracts or otherwise, ofeach of 23 the types of the health care professionals and 24 other senice providers required to provide the 25 items and sendees required under subsection •HR6931IH — — — 8 1 (e)(1)(A), to theextentsiieli items and services 2 arenecessarvand ai)i)ropriatetothecareofan 3 em-olledindividual. 4 "(C) To the extent consistent with ])rovi- 5 sion of the highest qnahty of care to enrolled 6 individuals 7 "(i) promote the utilization ofvolun- 8 teers in the provision ofcare and services 9 under the ChiPACC, in accordance with 10 standards set by the Secretary, which 11 standardsshallensureacontinuinglevelof 12 efforttoutilizesuchvolunteers;and 13 "(ii) ensure that records are main- 14 tained on the use of such volunteers and 15 thecostsavingsandexjjansionofcare and 16 services achieved through the use of such 17 vohniteers. 18 "(4) Interdisciplinary heai.th propes- — 19 8I0N.VL TEAM. The term 'interdisciplinars" health 20 i)rofessional team' means, with respect to a 21 CliiPACC,agi'oupofhealthprofessionalsthat 22 "(A)includesatleast 23 "(i) one physician (as defined in sec- 24 tion 1861(r)(l)); •HR6931IH 9 1 "(ii) oneregisteredprofessionalnurse; 2 and 3 "(iii) onesocialworker,pastoralcoun- 4 selor,orothercounselor; 5 "(B) developsa conii)reliensivei)lanofcare 6 for CliiPAC-C eligible indi\ndiials enrolled with 7 the C'liiPACC and fiu-nishes, or sni)ervises the 8 provisionof, careand servicesdescribed in sub- 9 section (c)(1) to an individual enrolled in the 10 ChiPACC;and 11 "(C)throughdirectactionandcommunica- 12 tionwith health care providers furnishing: serv- 13 icesunderthe CliiPACC, on behalfoforunder 14 the direction or supervision of a State admin- 15 istering- agency or a ChiPACC coordinator, co- 16 ordinates the care and services furnished to 17 such enroUees in a manner that takes into ac- 18 count the best interests of each such enrollee 19 and the enrollee's family, as well as consider- 20 ations ofcost and efficient use ofavailable re- 21 sources. — 22 "(5) State administering agenct. The 23 term 'State administering agency' means, with re- 24 spectto theoperationofa ChiPACC ina State, the 25 agencyofthat State (which maybethesingle agen- m •HR6931 — — 10 1 t'v resjionsible for adniiiiisti'ation of the State i)laii 2 underthistitle in the State) responsible forthe ini- 3 plementation, either direetly or thnmofh arrange- 4 ments with one or more ChiPACC coordinators, of 5 theChiPACCunderthissectionintheState. — 6 "(6) Re(Uilations. Except as othenvise pro- 7 ^^ded, the term 'regulations' refers to interim thial 8 or final regulations pronmlgated under subsection 9 (g). 10 "(c) Scope of Benefits; Beneficiary Safe- 11 GUARDS. 12 "(1) In GENEii.\i..—Under a ChiPACC of a 13 State, the State administering- agency shall assure 14 that— 15 "(A) indi^iduals enrolled in the ChiPACC 16 arefurnished,ataminimum 17 "(i) all items and services that are 18 necessar\' and appropriate to their care 19 and that are covered under this title, and 20 all additional items and services specified 21 m regulations, but v\ithout any limitation 22 or condition as to amount, duration, or 23 scope; <HR6931IH