Sec. 5. MACPAC report
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/bill/115/hr/3325/ih/section-5·A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
Not later than 24 months after the date of the enactment of this Act, the Medicaid and CHIP Payment and Access Commission established under section 1900 of the Social Security Act ( 42 U.S.C. 1396 ) shall submit to Congress and the Secretary of Health and Human Services a report on children with medically complex conditions that— describes options for defining the characteristics of such children; includes the information described in subsection (b); and includes such recommendations as the Commission determines is appropriate.
The information described in this subsection is, to the extent practical and available, the following information: With respect to the characteristics of children with medically complex conditions (as defined in section 1947 of the Social Security Act (as added by section 2 of this Act))— a literature review examining— research on such children; clinical measures or other groupings which enable comparison among such children; and demographic characteristics, including primary language, based on available data; and information gathered from consultation with medical and academic experts engaged in research about, or the treatment of, such children.
Information relating to children with medically complex conditions who are receiving medical assistance under a State Medicaid plan under title XIX of the Social Security Act (or a waiver of such plan), including— the number of such children; the chronic conditions, life-threatening illnesses, disabilities, injuries, or rare diseases that such children have; the number of such children receiving services under each delivery system or payment model, including health homes (as defined in such section 1947), fee-for-service systems, primary care case managers, or managed care plans; and the extent to which such children receive care coordination services.
Information on the providers who furnish health care items and services to children with medically complex conditions, such as physicians (including pediatricians and pediatric specialty or subspecialty providers), children’s hospitals, clinical practices or clinical group practices, rural clinics, community health centers, community mental health centers, or home health agencies. The extent to which children with medically complex conditions receive (or are denied) health care items and services from out-of-State providers that receive payment under the State Medicaid plan under title XIX of the Social Security Act (or a waiver of such plan) and any barriers to receiving such services from such providers in a timely fashion, including any variation in access to such services furnished by such providers, disaggregated by delivery system.
The amount and nature of the total resources used to provide care to individual children with medically complex conditions during the period in which such a child is enrolled in a health home, including— the amount of capital spent in providing such care; the resources used to provide such care during any waiting period with respect to the enrollment of the child in the State plan under title XIX of the Social Security Act (or a waiver of such plan) or any necessary approval under the State plan for the furnishing of such services (such as inpatient costs awaiting discharge); the cost of the coordination of such child’s care; the cost of providing to such child any non-medical benefits (such as transportation and home services); and the clinical costs of providing such care.
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