ChiPACC Act of 2021
This bill provides statutory authority for states to cover children's programs of all-inclusive coordinated care under Medicaid.
[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4952 Introduced in House (IH)]
<DOC>
117th CONGRESS
1st Session
H. R. 4952
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.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
August 6, 2021
Ms. DeGette (for herself and Mr. McCaul) 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 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.
<all>
Introduced in House
Introduced in House
Referred to the House Committee on Energy and Commerce.
Referred to the Subcommittee on Health.
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