THE GENERAL ASSEMBLY OF PENNSYLVANIA

SENATE BILL

INTRODUCED BY BROWNE, VANCE, SCARNATI, ORIE, BAKER, FOLMER, BOSCOLA, WASHINGTON, M. WHITE, ALLOWAY, SCHWANK, COSTA, SOLOBAY, YAW, EARLL, FERLO, STACK, PIPPY, ERICKSON AND MENSCH, DECEMBER 14, 2011

REFERRED TO PUBLIC HEALTH AND WELFARE, DECEMBER 14, 2011  

AN ACT

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

act to consolidate, editorially revise, and codify the public

welfare laws of the Commonwealth," further providing for

medical assistance payments; and providing for gaining access

to physicians via telehealth.

The General Assembly of the Commonwealth of Pennsylvania

hereby enacts as follows:

Section 1.  Section 443.3(a) of the act of June 13, 1967

(P.L.31, No.21), known as the Public Welfare Code, amended July

7, 2005 (P.L.177, No.42), is amended to read:

Section 443.3.  Other Medical Assistance Payments.--(a)

Payments on behalf of eligible persons shall be made for other

services, as follows:

(1)  Rates established by the department for outpatient

services as specified by regulations of the department adopted

under Title XIX of the Social Security Act (49 Stat. 620, 42

U.S.C. § 1396 et seq.) consisting of preventive, diagnostic,

therapeutic, rehabilitative or palliative services; furnished by

or under the direction of a physician, chiropractor or

podiatrist, by a hospital or outpatient clinic which qualifies

to participate under Title XIX of the Social Security Act, to a

patient to whom such hospital or outpatient clinic does not

furnish room, board and professional services on a continuous,

twenty-four hour a day basis.

(2)  Rates established by the department for (i) other

laboratory and X-ray services prescribed by a physician,

chiropractor or podiatrist and furnished by a facility other

than a hospital which is qualified to participate under Title

XIX of the Social Security Act, (ii) physician's services

consisting of professional care by a physician, chiropractor or

podiatrist in his office, the patient's home, a hospital, a

nursing facility or elsewhere, (iii) the first three pints of

whole blood, (iv) remedial eye care, as provided in [Article

VIII] subarticle (b) of Article XXII of the act of April 9, 1929

(P.L.177, No.175), known as The Administrative Code of 1929, 

consisting of medical or surgical care and aids and services and

other vision care provided by a physician skilled in diseases of

the eye or by an optometrist which are not otherwise available

under this [Article] article, (v) special medical services for

school children, as provided in the act of May 10, 1949 (P.L.30,

No.14), known as the Public School Code of 1949, consisting of

medical, dental, vision care provided by a physician skilled in

diseases of the eye or by an optometrist or surgical care and

aids and services which are not otherwise available under this

article.

(3)  Notwithstanding any other provision of law, for

recipients aged twenty-one years or older receiving services

under the fee for service delivery system who are eligible for

medical assistance under Title XIX of the Social Security Act

and for recipients aged twenty-one years or older receiving

services under the fee-for-service delivery system who are

eligible for general assistance-related categories of medical

assistance, the following medically necessary services:

(i)  Psychiatric outpatient clinic services not to exceed

five hours or ten one-half-hour sessions per thirty consecutive

day period.

(ii)  Psychiatric partial hospitalization not to exceed five

hundred forty hours per fiscal year.

* * *

Section 2.  The act is amended by adding a section to read: 

Section 443.11. Gaining Access to Physicians via

Telehealth.--(a)  The department shall eliminate any regulation

which requires a health care professional utilizing telehealth

to be in the physical presence of the patient in order for

Medicaid reimbursement to occur.

(b)  Rates established by the department for telehealth

services delivered to a Medicaid beneficiary shall be the same

as if those services were provided in person to a Medicaid

beneficiary.

(c)  The department may file a State plan amendment with the

Centers for Medicare and Medicaid Services of the United States

Department of Health and Human Services pursuant to Title XIX of

the Social Security Act (49 Stat. 620, 42 U.S.C. § 1396 et seq.)

by June 30, 2012. The program shall be structured and

administered by the department in accordance with Federal law

and applicable Federal guidelines for qualified State telehealth

services.

(d)  The following words and phrases when used in this

section shall have the meanings given to them in this subsection

unless the context clearly indicates otherwise:

"Health care professional"  means an individual who is

licensed, certified or otherwise regulated to provide health

care services under the laws of this Commonwealth.

"Health care services"  means services for the diagnosis,

prevention, treatment cure or relief of a health condition,

injury, disease or illness.

"Telehealth"  means the remote interaction between a health

care professional and a patient through the use of any of the

following:

(1)  An audio/video transmission.

(2)  A computer-based audio/video transmission.

(3)  An electronic health monitoring device.

(4)  Another telecommunications device that delivers health

information concerning a patient to a health care professional.

Section 3.  This act shall take effect immediately.