SENATE AMENDED

 

PRIOR PRINTER'S NO. 1028

PRINTER'S NO.  2048

  

THE GENERAL ASSEMBLY OF PENNSYLVANIA

  

HOUSE BILL

 

No.

960

Session of

2011

  

  

INTRODUCED BY GINGRICH, AUMENT, BAKER, BARRAR, BEAR, BENNINGHOFF, BOBACK, BOYD, BROOKS, CAUSER, CLYMER, D. COSTA, CREIGHTON, CUTLER, DENLINGER, ELLIS, EVANKOVICH, EVERETT, FLECK, GABLER, GEIST, GIBBONS, GILLEN, GILLESPIE, GODSHALL, GOODMAN, GRELL, GROVE, HAHN, HALUSKA, HARHART, HARPER, HARRIS, HEFFLEY, HESS, HICKERNELL, HUTCHINSON, KAUFFMAN, M. K. KELLER, KNOWLES, KORTZ, KRIEGER, LAWRENCE, MAJOR, MARSHALL, MARSICO, MASSER, METCALFE, MILLARD, MILLER, MILNE, MOUL, MURT, MUSTIO, OBERLANDER, O'NEILL, PAYNE, PERRY, PETRI, PICKETT, PYLE, QUIGLEY, QUINN, RAPP, READSHAW, REED, REICHLEY, ROAE, ROCK, ROSS, SAYLOR, SCAVELLO, SCHRODER, K. SMITH, SONNEY, STERN, STEVENSON, STURLA, SWANGER, TALLMAN, TOBASH, TOEPEL, TOOHIL, VULAKOVICH, WATSON, ADOLPH, FARRY, DELOZIER, MALONEY, STEPHENS AND CALTAGIRONE, MARCH 7, 2011

  

  

SENATOR VANCE, PUBLIC HEALTH AND WELFARE, IN SENATE, AS AMENDED, JUNE 8, 2011   

  

  

  

AN ACT

  

1

Amending the act of June 13, 1967 (P.L.31, No.21), entitled "An

2

act to consolidate, editorially revise, and codify the public

3

welfare laws of the Commonwealth," providing for fraud

4

detection system and, for income eligibility verification

<--

5

system and for inmate medical costs.

<--

6

The General Assembly of the Commonwealth of Pennsylvania

7

hereby enacts as follows:

8

Section 1.  The act of June 13, 1967 (P.L.31, No.21), known

9

as the Public Welfare Code, is amended by adding sections to

10

read:

11

Section 422.1.  Fraud Detection System.--Within six months of

12

the effective date of this section, the department shall

 


1

establish uniform procedures for each county to use to identify,

2

investigate and resolve potential cases of fraud,

3

misrepresentation or inadequate documentation prior to

4

determining an applicant's eligibility for assistance. The

5

procedures shall ensure that every case is reviewed. Each review

<--

6

shall include utilization of apply to all applicants and

<--

7

recipients of assistance. Procedures shall utilize the income

8

eligibility verification system established in section 432.23.

9

Section 432.23.  Income Eligibility Verification System.--(a)  

<--

10

The department shall establish a computerized income eligibility

11

verification system in order to verify eligibility, eliminate

<--

12

duplication of assistance and deter fraud. Prior to awarding

13

assistance under section 432.2(b) or continuing assistance under

14

section 432.2(c), the department shall match the social security

15

number of each applicant and recipient with the following:

16

(1)  Unearned income information maintained by the Internal

17

Revenue Service.

18

(2)  Employer quarterly reports of income and unemployment

19

insurance benefit payment information maintained by the State

20

Wage Information Collection Agency.

21

(3)  Earned income information maintained by the Social

22

Security Administration.

23

(4)  Immigration status information maintained by the

24

Citizenship and Immigration Services.

25

(5)  Death register information maintained by the Social

26

Security Administration.

27

(6)  Prisoner information maintained by the Social Security

28

Administration.

29

(7)  Public housing and section 8 payment information

30

maintained by the Department of Housing and Urban Development.

- 2 -

 


1

(8)  National fleeing felon information maintained by the

2

Federal Bureau of Investigation.

3

(9)  Wage reporting and similar information maintained by

4

states contiguous to this Commonwealth.

5

(10)  Beneficiary Data Exchange (BENDEX) Title H database

6

maintained by the Social Security Administration.

7

(11)  Beneficiary Earnings Exchange Report (BEER) database

8

maintained by the Social Security Administration.

9

(12)  State New Hire database maintained by the Commonwealth.

10

(13)  National New Hire database maintained by the Federal

11

Government.

12

(14)  State Data Exchange (SDX) database maintained by the

13

Social Security Administration.

14

(15)  Veterans Benefits and Veterans Medical (PARIS)

15

maintained by the Department of Veterans Affairs with

16

coordination through the Department of Health and Human

17

Services.

18

(16)  Day care subsidy payments maintained by the

19

Commonwealth.

20

(17)  Low-Income Energy Assistance Program Reporting Utility

21

Expenses maintained by the Commonwealth.

22

(18)  A database which is substantially similar to or a

23

successor of a database set forth in this subsection.

24

(19)  The database of all persons who currently hold a

25

license, permit or certificate from a Commonwealth agency the

26

cost of which exceeds one thousand dollars ($1,000).

27

(b)  If a discrepancy results between the applicant's or a

28

recipient's social security number and one or more of the

29

databases set forth in subsection (a), the department shall

30

review the applicant's or recipient's case using the following

- 3 -

 


1

procedure:

2

(1)  If the information discovered under subsection (a) does

3

not result in ineligibility or modification of the amount or

4

type of assistance, the department shall take no further action.

5

(2)  If the information discovered under subsection (a) would

6

result in ineligibility or modification of the amount or type of

7

assistance, the applicant or the recipient shall be given an

<--

8

opportunity to explain the discrepancy. The department shall

9

provide written notice to the applicant or recipient which shall

10

describe in sufficient detail the circumstances of the

11

discrepancy, the manner in which the applicant or recipient may

<--

12

respond opportunity for a hearing or review and the consequences

<--

13

of failing to take action. The applicant or recipient shall have

14

ten business days to respond in an attempt writing to resolve

<--

15

the discrepancy. The explanation of the recipient or applicant

<--

16

shall be given in writing. After receiving the explanation, the 

17

department may request additional documentation if it determines

<--

18

that there is a substantial risk of fraud as necessary.

<--

19

(3)  If the applicant or recipient does not respond to the

20

notice, the department shall deny assistance for failure to

<--

21

cooperate, in which case the. The department shall provide 

<--

22

written notice of intent to discontinue assistance. Eligibility

<--

23

for assistance shall not be reestablished until the significant

<--

24

discrepancy has been resolved applicant or recipient complies

<--

25

with paragraph (2).

26

(4)  If an applicant or recipient responds to the notice and 

<--

27

or disagrees with the findings of the a match between his or her 

<--

28

social security number and one or more database a database under

<--

29

subsection (a), the department shall reinvestigate the matter.

30

If the department finds that determines there has been an error,

<--

- 4 -

 


1

the department shall take immediate action to correct it and no

<--

2

further action shall be taken correct the error. If, after

<--

3

investigation, the department determines that there is no error,

4

the department shall determine the effect on the applicant's or

5

recipient's case and take appropriate action. Written notice of

<--

6

the department's action shall be given to the applicant or

7

recipient.

8

(5)  If the applicant or recipient agrees with the findings

9

of the match between the applicant's or recipient's social

10

security number and one or more database, the department shall

11

determine the effect on the applicant's or recipient's case and

12

take appropriate action. Written notice of the department's take

<--

13

appropriate action.

14

(6)  Written notice of the department's action under

<--

15

paragraph (4) or (5) shall be given to the applicant or

16

recipient.

17

(c)  In no case shall the department discontinue or modify

<--

18

the amount or type of assistance as a result of a match between

19

the applicant's or recipient's social security number and one or

20

more database until the applicant or recipient has been given

21

notice of the discrepancy and the opportunity to respond.

22

(d) (c)  No later than one year after the effective date of

<--

23

this section and every year thereafter, the department shall

24

provide a written report to the Governor, the General Assembly

25

and the Inspector General detailing the results achieved under 

<--

26

of the implementation of this section and the amount of case

<--

27

closures and savings that resulted.

28

(e) (d)  As used in this section, the following words and

<--

29

phrases shall have the meanings given to them in this

30

subsection:

- 5 -

 


1

"Discrepancy" means information regarding assets, income,

2

resources or status of an applicant or recipient of assistance,

3

derived from one or more of the database in a database under 

<--

4

subsection (a), which gives the department grounds to suspect 

<--

5

that indicates that either:

<--

6

(i)  an applicant or recipient is ineligible to receive

7

assistance under Federal or State law; or

8

(ii)  the assets, income or resources of an applicant or

9

recipient are at least, in terms of a dollar amount, ten percent

10

greater than the dollar amount reflected in the information the

11

department possesses about the applicant or recipient with

12

respect to the applicant's or recipient's assets, income or

13

resources.

14

"Status" means the applicant or recipient is in the United

<--

15

States illegally, is no longer living, is an inmate in a prison

16

or jail or is a fleeing felon.

17

Section 2.  This act shall take effect immediately.

18

Section 2.  The act is amended by adding an article to read:

<--

19

ARTICLE XIV-A

20

INMATE MEDICAL COSTS

21

Section 1401-A.  Definitions.

22

The following words and phrases when used in this article

23

shall have the meanings given to them in this section unless the

24

context clearly indicates otherwise:

25

"Correctional institution."  A State or county correctional

26

institution or jail, group home, prerelease center, community

27

corrections center, parole center or facility that houses a

28

person convicted of a criminal offense or awaiting trial,

29

sentencing or extradition in a criminal proceeding. The term

30

does not include a facility or institution operated, supervised

- 6 -

 


1

or licensed under this act.

2

"Drug."  The term shall mean:

3

(1)  Substances recognized in the official United States

4

Pharmacopeia, or official National Formulary, or supplement

5

to either of them.

6

(2)  Substances intended for use in the diagnosis, cure,

7

mitigation, treatment or prevention of disease in man or

8

other animals.

9

(3)  Substances, other than food, intended to affect the

10

structure or function of the human body or other animal body.

11

(4)  Substances intended for use as a component of an

12

article specified in paragraph (1), (2) or (3), but not

13

including devices or their components, parts or accessories.

14

"Health care facility."  A health care facility as defined

15

under section 802.1 of the act of July 19, 1979 (P.L.130,

16

No.48), known as the Health Care Facilities Act, or an entity

17

licensed as a hospital under this act.

18

"Health care provider."  A health care facility or a person,

19

including a corporation, university or other educational

20

institution, licensed or approved by the Commonwealth to provide

21

health care or professional medical services. The term shall

22

include a physician, certified nurse midwife, podiatrist,

23

certified registered nurse practitioner, physician assistant,

24

chiropractor, hospital, ambulatory surgery center, nursing home

25

or birth center.

26

"Inmate."  A person committed to a term of imprisonment or

27

otherwise confined under the custody of a State or county

28

correctional institution.

29

"Inpatient care."  The provision of medical, nursing,

30

counseling or therapeutic services 24 hours a day in a hospital

- 7 -

 


1

or other health care facility, according to individualized

2

treatment plans.

3

"Medicare."  The Federal program established under Title

4

XVIII of the Social Security Act (49 Stat. 620, 42 U.S.C. § 1395

5

et seq.).

6

"Outpatient care."  The provision of medical, nursing,

7

counseling or therapeutic services in a hospital or other health

8

care facility on a regular and predetermined schedule according

9

to individualized treatment plans.

10

"Prescription."  A written or oral order issued by a duly

11

licensed medical practitioner in the course of his professional

12

practice for a controlled substance, other drug or device or

13

medication which is dispensed for use by a consumer.

14

Section 1402-A.  Inmate medical cost containment.

15

(a)  Inpatient care.--A health care provider who provides

16

inpatient care to an inmate shall not charge the State or county

17

correctional institution or its medical services contractor more

18

than the maximum allowable rate payable for the goods, services

19

and supplies under the medical assistance program. This

20

subsection shall include goods and services furnished by the

21

health care provider to the inmate, including the cost of

22

medications and prescription drugs.

23

(b)  Outpatient care.--A health care provider who provides

24

outpatient care to an inmate shall not charge the State or

25

county correctional institution or its medical services

26

contractor more than the maximum allowable rate payable for

27

goods, services and supplies under the Medicare program. This

28

subsection includes goods and services furnished by the health

29

care provider to the inmate, including the cost of medications

30

and prescription drugs.

- 8 -

 


1

(c)  Limitation.--Nothing in this article shall be construed

2

to prevent a health care provider from contracting with a

3

correctional institution to provide outpatient care to inmates

4

at rates higher than those established by this article.

5

Section 3.  This act shall take effect as follows:

6

(1)  The addition of Article XIV-A of the act shall take

7

effect in 60 days.

8

(2)  The remainder of this act shall take effect

9

immediately.

- 9 -