• Analysis or Summary
  • October 11, 2018

ACE Kids Act: Provision Changes to Date

The ACE Kids Act of 2017 — introduced as S. 428 by Sens. Grassley, R-Iowa, and Bennet, D-Colo., and as H.R. 3325 by Reps. Barton, R-Texas, and Castor, D-Fla. — would improve the delivery of care for children with medical complexity in Medicaid. Although the bills are not identical, there are many similarities. The bills:

  • Use the health home option that exists in current statute to create specially designed health homes for children with medically complex conditions
  • Outline the definition of children with medically complex conditions who would be eligible to participate in the program
  • Provide a time-limited higher federal matching rate to participating states for those health home services defined in the current Medicaid statute
  • Allow states to determine the payment methodology that will be used for the health homes of children with medically complex conditions
  • Clarify that participation in the program is voluntary for states, providers and families
  • Include provisions to allow for data collection/reporting on children with medical complexity and quality measures appropriate for this population
  • Require the secretary of the U.S. Department of Health and Human Services (HHS) to issue guidance to state Medicaid directors on best practices for ensuring this population receives prompt care from out-of-state providers when medically necessary
  • Require the Medicaid and CHIP Payment and Access Commission to submit a report to Congress and the secretary on the characteristics of children who are eligible for health homes and the effectiveness of the program overall

Both the House and the Senate bills incorporate significant changes from versions introduced in 2015 based on a thorough review of stakeholder feedback. The major changes include:

  • Using the health home option in the Affordable Care Act as the framework for health homes specifically for children with medically complex conditions; the legislation no longer includes definitions of nationally designated children’s hospital networks or “anchor” children’s hospitals
  • Refining the definition of children with medically complex conditions
  • As outlined above, adding time-limited incentives for states to participate in the program through a higher federal Medicaid matching rate for health home services
  • As outlined above, requiring the secretary of HHS to provide guidance to states on best practices related to providing care across state lines
  • As outlined above, clarifying that the program is voluntary for states, providers and families