1Establishing the Community-Based Health Care Provider Access
2(CHCPA) Program in the Department of Health; providing for
3hospital health clinics and for a tax credit; and making
4appropriations.

5The General Assembly finds and declares as follows:

6(1) The purpose of the Community-Based Health Care
7Provider Access Program is to provide access to quality
8community-based health care to improve the health of local
9residents.

10(2) Community health workers play an important role by
11helping individuals who utilize community services understand
12how to navigate the health care system. They provide
13information to patients about staying healthy and managing
14diseases, emphasizing prevention and primary care, resulting
15in more appropriate use of the health care system, leading to
16lower overall costs of care and reducing the burden of
17uncompensated care.

18(3) Specifically this act seeks to:

1(i) Expand and improve health care access and
2services, such as preventative care, chronic care and
3disease management, prenatal, obstetric, postpartum and
4newborn care, dental treatment, behavioral health, mental
5health and substance abuse and primary services resulting
6in improved health statuses of Commonwealth residents
7regardless of insurance status or ability to pay.

8(ii) Reduce unnecessary utilization of hospital
9emergency services by providing an effective alternative
10health care delivery system.

11(iii) Encourage collaborative relationships among
12community-based health care clinics, hospitals and other
13health care providers.

14(4) Community health centers serve millions of patients
15nationally. Federally qualified health centers (FQHCs) alone
16served 521,194 individuals as medical home and family
17physician in this Commonwealth. Health centers are located in
18areas where care is needed but scarce, their costs rank among
19the lowest, and they reduce the need for more expensive
20inpatient and specialty care. Only six states served more
21individuals in FQHCs (California, Florida, Illinois, New
22York, Texas and Washington). Pennsylvania has no direct
23funding of health centers.

24(5) Ninety-one percent of patients served in community
25health centers are of low income, with 71% being families
26with incomes at or below poverty levels. Nearly two-thirds of
27individuals accessing community care are racial and ethnic
28minorities. About 39% of health center patients are
29uninsured, and another 35% depend on Medicaid. About half of
30health center patients reside in rural areas, while the other

1half tend to live in economically depressed inner-city
2communities.

3(6) Expanding and strengthening community-based health
4centers will continue to improve the health outcomes for this
5Commonwealth's medically vulnerable, as well as narrow health
6disparities.

7TABLE OF CONTENTS

8Chapter 1. Health Care Assistance

9Subchapter A. Preliminary Provisions

10Section 101. Short title.

11Section 102. Definitions.

12Subchapter B. Community-Based Health Care Provider Access
13(CHCPA)

14Section 111. Community-Based Health Care Provider Access
15(CHCPA) Program.

16Section 112. Powers and duties of department.

17Section 113. Hospital health clinics.

18Section 114. Community-Based Health Care Provider Access
19(CHCPA) Fund.

20Section 115. Report and program adjustment.

21Subchapter C. Tax Credit

22Section 121. Scope of subchapter.

23Section 122. Definitions.

24Section 123. Establishment of program.

25Section 124. Application.

26Section 125. Tax credit.

27Section 126. Limitations.

28Section 127. Report.

29Chapter 51. Miscellaneous Provisions

30Section 5101. Appropriations.

1Section 5102. Effective date.

2The General Assembly of the Commonwealth of Pennsylvania
3hereby enacts as follows:

4CHAPTER 1

5HEALTH CARE ASSISTANCE

6SUBCHAPTER A

7PRELIMINARY PROVISIONS

8Section 101. Short title.

9This act shall be known and may be cited as the Community-
10Based Health Care Provider Access (CHCPA) Act.

11Section 102. Definitions.

12The following words and phrases when used in this act shall
13have the meanings given to them in this section unless the
14context clearly indicates otherwise:

15"Advanced practice nurse." A registered nurse with a
16master's or doctoral degree licensed to practice as a certified
17registered nurse practitioner, clinical nurse specialist or
18certified nurse-midwife.

19"Chronic care and disease management." A model of care that 
20includes the following:

21(1) The provision of effective health management through
22support and information that also promotes self-care for
23patients with chronic conditions so they can effectively
24manage their health.

25(2) The use of evidence-based medicine to ensure
26appropriate treatment decisions by health care providers.

27(3) Tracking clinical information for individual and
28general patient populations to guide treatment and
29effectively anticipate community health care problems.

30(4) Ensuring patients get the care they need by

1clarifying roles and tasks of health care providers and
2encouraging coordination of care for all who treat patients,
3having centralized, up-to-date information about the patient
4and ensuring that follow-up care is provided as a standard
5procedure.

6(5) Forming partnerships and alliances with State,
7local, business, religious and other organizations to support
8or expand care for those with chronic disease.

9"Community-based health care clinic." A nonprofit health 
10care center located in this Commonwealth that provides 
11comprehensive health care services without regard for a 
12patient's ability to pay and that:

13(1) meets either of the following criteria:

14(i) serves a federally designated medically
15underserved area, a medically underserved population or a
16health professional shortage area; or

17(ii) serves a patient population with a majority of
18that population having an income less than 200% of the
19Federal poverty income guidelines; and

20(2) includes any of the following:

21(i) A federally qualified health center as defined 
22in section 1905(l)(2)(B) of the Social Security Act (49 
23Stat. 620, 42 U.S.C. § 1396d(l)(2)(B)) or a federally 
24qualified health center look-alike.

25(ii) A rural health clinic as defined in section 
261861(aa)(2) of the Social Security Act (49 Stat. 620, 42 
27U.S.C. § 1395x(aa)(2)), certified by Medicare.

28(iii) A hospital health clinic.

29(iv) A free or partial-pay health clinic that
30provides services by volunteer and nonvolunteer health

1care providers.

2(v) A nurse-managed health care clinic that is
3managed by advanced practice nurses and is associated
4with a nursing education program, a federally qualified
5health center or an independent nonprofit health or
6social services agency.

7(vi) A not-for-profit dental clinic.

8"Community health needs assessment." An assessment conducted
9by a community-based health improvement partnership under
10section 111.

11"Department." Except as provided under section 122, the 
12Department of Health of the Commonwealth.

13"Fund." The Community-Based Health Care Provider Access 
14(CHCPA) Fund.

15"Health care provider." A health care facility or health 
16care practitioner as defined in the act of July 19, 1979 
17(P.L.130, No.48), known as the Health Care Facilities Act, a 
18group practice or a community-based health care provider. A 
19health care provider licensed to practice a component of the 
20healing arts by a licensing board within the Department of State 
21who provides health care services at a community-based health 
22care clinic.

23"Hospital." An entity located in this Commonwealth that is 
24licensed as a hospital under the act of July 19, 1979 (P.L.130, 
25No.48), known as the Health Care Facilities Act.

26"Medical assistance." A State program of medical assistance 
27established under Article IV(f) of the act of June 13, 1967 
28(P.L.31, No.21), known as the Public Welfare Code.

29"Nurse-managed health care clinic." A nurse practice
30arrangement, managed by advanced practice nurses, that provides

1health care services to vulnerable populations and is associated
2with a school, college or department of nursing, a federally
3qualified health center or an independent nonprofit health or
4social services agency.

5"Patient." A natural person receiving health care in or from 
6a health care provider at a community-based health care clinic.

7"Program." The Community-Based Health Care Provider Access 
8(CHCPA) Program.

9SUBCHAPTER B

10COMMUNITY-BASED HEALTH CARE PROVIDER ACCESS (CHCPA)

11Section 111. Community-Based Health Care Provider Access
12(CHCPA) Program.

13(a) Establishment.--The Community-Based Health Care Provider
14Access (CHCPA) Program is established within the department to:

15(1) Improve availability and access to and provide
16quality community-based health care and reduce unnecessary
17utilization of emergency health care services by providing
18and supporting the development and provision of appropriate
19alternatives offered by or through community-based health
20care providers, while reducing duplicative services.

21(2) Expand and improve health care access and services
22to provide medically necessary preventative care, chronic
23care and disease management in an effort to optimize both
24individual health outcomes and the use of health care
25resources, obstetric services, including prenatal, postpartum
26and newborn care, dental treatment, pharmacy services and
27behavioral health care services provided in this Commonwealth
28through community-based health care providers.

29(3) Encourage collaborative relationships among
30community-based health care clinics, hospitals and other

1health care providers, as well as provide outreach into the
2community to identify individuals who would qualify for the
3program and integrate them into the program.

4(4) Assist in covering the reasonable costs of providing
5health care services, outreach and care management
6opportunities to individuals eligible to receive services
7from or through community-based health care providers.

8(5) Provide for the establishment of a case manager
9system for each eligible individual to assist the individual
10in meeting the individual's health care needs.

11(6) Monitor the changes in health status of the low-
12income residents in the community.

13(b) Grant award methodology.--A methodology for the
14allocation of grant awards shall be developed by the department
15based on the following distribution:

16(1) Fifty percent for the expansion of an existing or
17the development of a new community-based health care clinic
18using criteria that include:

19(i) The actual and projected number of total
20patients, new patients and patient visits for all
21patients served or to be served, including the number of
22low-income and uninsured patients, who fall below 200% of
23the Federal poverty income guidelines.

24(ii) The addition or expansion of ancillary health
25care services, such as dental, behavioral health and
26pharmacy.

27(iii) The development or enhancement of preventive
28and chronic care and disease management techniques.

29(2) Twenty-five percent for improvements in prenatal,
30obstetric, postpartum and newborn care.

1(3) Twenty percent for improved access and services, 
2including patient transportation, intended to reduce
3unnecessary emergency room utilization.

4(4) Five percent for the establishment of collaborative
5relationships among community-based health care clinics,
6hospitals and other health care providers.

7(c) Limitation.--No more than 25% of the grants awarded
8under subsection (b) shall go to federally qualified health
9centers or federally qualified health center look-alikes.

10(d) Distribution.--Funds shall be distributed in a manner
11that improves access and expands services in all geographic
12areas of this Commonwealth.

13(e) Reallocation.--The department shall reallocate funds
14among the categories described in subsection (b) if sufficient
15grant requests are not received to use all the funds available
16in a specific category.

17(f) Amount of grants.--A grant under this subsection shall
18not exceed $500,000, and shall require a matching commitment of
1925% of the grant, which can be in the form of cash or equivalent
20in-kind services.

21(g) Federal funds.--The department shall seek any available
22Federal funds, as well as any available grants and funding from
23other sources, to supplement amounts made available under this
24subchapter to the extent permitted by law.

25Section 112. Powers and duties of department.

26The department shall have the following powers and duties:

27(1) To administer the program.

28(2) To develop an allocation methodology under section
29111(b).

30(3) Within 90 days of the effective date of this

1section, to develop and provide a grant application form
2consistent with this act. The department shall provide
3applications for grants under this section to all known
4community-based health care clinics. A grant under this
5section may be extended over two State fiscal years at the
6request of the community-based health care clinic.

7(4) To calculate and make grants to qualified community-
8based health care clinics.

9(5) To provide an annual report no later than November
1030 to the chair and minority chair of the Public Health and
11Welfare Committee of the Senate and the chair and minority
12chair of the Health and Human Services Committee of the House
13of Representatives. The report shall include accountability 
14measures for all of the following:

15(i) The total dollar amount for each grant awarded,
16listing the type of community-based health care clinic
17and the name of the grantee.

18(ii) A summary of the use of the grant by each
19grantee.

20(iii) A summary of how each grant expanded access
21and services in accordance with the criteria set forth in
22section 111(a) and (b), including a specific 
23documentation of low-income and uninsured patients 
24served, and the total amount of funds allocated in each
25distribution category under section 111(b).

26(iv) The impact of the grant on improving the
27delivery and quality of health care in the community.

28(v) An accountability assessment of the benefits of
29the assistance provided under this subchapter and any
30recommendations for changes to the program.

1The report shall be made available for public inspection and
2posted on the department's publicly accessible Internet
3website.

4(6) To audit grants awarded under this subchapter to
5ensure that funds have been used in accordance with this
6subchapter and the terms and standards adopted by the
7department.

8(7) To establish and maintain an online database of
9community-based health care clinics.

10(8) To establish a toll-free telephone number for
11individuals to obtain information about community-based
12health care clinics.

13Section 113. Hospital health clinics.

14(a) Program.--The Department of Public Welfare shall be
15responsible for administering the program as it relates to
16hospital health clinics in accordance with the requirements of
17this act and shall have the following additional duties:

18(1) To develop an application and collect such data and
19information as may be necessary to determine the eligibility
20of hospital health clinics for payments under this section
21using the criteria set forth in section 111(a) and (b).

22(2) To review an application and make a final
23determination regarding a hospital health clinic's
24eligibility for funding within 90 days of receipt.

25(3) To make payments to hospital health clinics in
26accordance with the payment calculation set forth in
27subsection (e).

28(b) Submission of application.--In order to qualify for
29funding pursuant to this section, a hospital health clinic shall
30submit the required application to the Department of Public

1Welfare no later than 90 days after the effective date of this
2act.

3(c) Funding.--

4(1) For fiscal year 2012-2013 and each year thereafter,
5upon Federal approval of an amendment to the Medicaid State
6plan, the Department of Public Welfare shall annually
7distribute any available funds obtained under this act for
8hospital health clinics through disproportionate share
9payments to hospitals to provide financial assistance that
10will assure readily available and coordinated comprehensive
11health care to the citizens of this Commonwealth.

12(2) The Secretary of Public Welfare shall determine the
13funds available and make appropriate adjustments based on the
14number of qualifying hospitals with hospital health clinics.

15(d) Maximization.--The Department of Public Welfare shall 
16seek to maximize any Federal funds, including funds obtained 
17under Title XIX of the Social Security Act (49 Stat. 620, 42 
18U.S.C. § 1396 et seq.).

19(e) Payment calculation.--

20(1) Thirty percent of the total amount available shall
21be allocated to eligible hospital health clinics of hospitals
22located in counties of the first and second class. The total
23amount available for each hospital health clinic at a
24hospital in these counties shall be allocated on the basis of
25each hospital's percentage of medical assistance and low-
26income hospital health clinic visits compared to the total
27number of medical assistance and low-income hospital health
28clinic visits for all hospitals in these counties.

29(2) Fifty percent of the total amount available shall be
30allocated to eligible hospital health clinics of hospitals

1located in counties of the third, fourth and fifth class. The
2total amount available for each hospital health clinic at a
3hospital in these counties shall be allocated on the basis of
4each hospital's percentage of medical assistance and low-
5income hospital health clinic visits compared to the total
6number of medical assistance and low-income hospital health
7clinic visits for all hospitals in these counties.

8(3) Twenty percent of the total amount available shall
9be allocated to eligible hospital health clinics of hospitals
10located in counties of the sixth, seventh and eighth class.
11The total amount available for each hospital health clinic at
12a hospital in these counties shall be allocated on the basis
13of each hospital's percentage of medical assistance and low-
14income hospital health clinic visits compared to the total
15number of medical assistance and low-income hospital health
16clinic visits for all hospitals in these counties.

17(4) Any hospital that has reached its disproportionate
18share limit under Title XIX of the Social Security Act shall
19receive its share of the State funds available under this
20act.

21(f) Definition.--As used in this section, the term "low-
22income" means under 200% of the Federal poverty income 
23guidelines.

24Section 114. Community-Based Health Care Provider Access
25(CHCPA) Fund.

26(a) Establishment.--The Community-Based Health Care Provider
27Access (CHCPA) Fund is established in the State Treasury.

28(b) Funding sources.--Funding sources for the fund shall
29include all of the following:

30(1) Transfers or appropriations to the fund.

1(2) Money received from the Federal Government or other
2sources.

3(3) Money required to be deposited in the fund pursuant
4to other provisions under this act or any other law.

5(4) Investment earnings from the fund, net of investment
6costs.

7(c) Use.--The department shall utilize the fund to carry out
8the program.

9Section 115. Report and program adjustment.

10(a) Report.--The department shall provide a report to the
11chair and minority chair of the Public Health and Welfare
12Committee of the Senate and the chair and minority chair of the
13Health and Human Services Committee of the House of
14Representatives no later than July 1, 2014, that includes an
15assessment of the effectiveness of the initial phase of the
16program and describes any changes in the allocation of funds
17described in section 111(b) that the department intends to make
18beginning in the fourth year of the program.

19(b) Consultation.--The department shall develop the program
20changes anticipated by this subsection and included in the
21report under subsection (a) after consultation with and
22receiving input from community-based health care providers,
23consumers and others with an interest in the provision of
24community-based health care.

25(c) Revision.--The department, after determining program
26changes, shall make necessary revisions in the program
27requirements and procedures and provide notice to prospective
28applicants, such that grants can be awarded on a timely basis
29beginning in the fourth year of the program.

30(d) Providers.--A community-based health care provider that

1receives a grant under this act shall report at least annually
2to the department, which report shall include a description of:

3(1) The community-based health care provider's efforts
4to improve access to and the delivery and management of
5health care services.

6(2) The reduction of unnecessary and duplicative health
7care services.

8(3) Changes in overall health indicators and in
9utilization of health care services among the communities and
10individuals served by the community-based health care
11providers, with particular emphasis on indicators, including,
12but not limited to:

13(i) The creation and maintenance of relationships
14between health care providers and individuals directed at
15establishing a medical home for such individuals and the
16provision of preventative and chronic care management
17services.

18(ii) Prenatal, postpartum, newborn and infant care.

19(iii) Such other matters as may be specified by the
20department.

21SUBCHAPTER C

22TAX CREDIT

23Section 121. Scope of subchapter.

24This subchapter deals with the community-based health care
25clinic tax credit.

26Section 122. Definitions.

27The following words and phrases when used in this subchapter
28shall have the meanings given to them in this section unless the
29context clearly indicates otherwise:

30"Business firm." An entity authorized to do business in this 

1Commonwealth and subject to taxes imposed under Article IV, VI, 
2VII, VIII, IX or XV of the act of March 4, 1971 (P.L.6, No.2), 
3known as the Tax Reform Code of 1971.

4"Contribution." A donation of cash or personal property by 
5the business firm to the Commonwealth.

6"Department." Notwithstanding section 102, the Department of 
7Community and Economic Development of the Commonwealth.

8Section 123. Establishment of program.

9A community-based health care clinic tax credit program is
10established in order to fund the Community-Based Health Care
11Provider Access (CHCPA) Program.

12Section 124. Application.

13(a) Application.--A business firm shall apply to the
14department in a form and manner determined by the department for
15a tax credit under section 125.

16(b) Availability of tax credits.--Tax credits under this
17subchapter shall be made available by the department on a first-
18come, first-served basis within the limitations established
19under section 126.

20(c) Contributions.--A contribution shall be made no later
21than 60 days following the approval of an application under
22subsection (a).

23Section 125. Tax credit.

24(a) Grant.--The Department of Revenue shall grant a tax 
25credit against any tax due under Article IV, VI, VII, VIII, IX 
26or XV of the act of March 4, 1971 (P.L.6, No.2), known as the 
27Tax Reform Code of 1971, to a business firm that has applied 
28for, been approved for and made a contribution. In the taxable 
29year in which the contribution is made, the credit shall not 
30exceed 75% of the total amount contributed by the business firm. 

1The credit shall not exceed $100,000 annually per business firm.

2(b) Expense.--All money received from business firms in
3accordance with this subchapter shall be expended solely for
4community-based health care clinics pursuant to Subchapter A.

5Section 126. Limitations.

6(a) Amount.--The total aggregate amount of all tax credits
7approved under this subchapter shall not exceed $5,000,000 in a
8fiscal year.

9(b) Activities.--No tax credit shall be approved for
10activities that are a part of a business firm's normal course of
11business.

12(c) Tax liability.--A tax credit granted for any one taxable
13year may not exceed the tax liability of a business firm.

14(d) Use.--A tax credit not used in the taxable year the
15contribution was made may not be carried forward or carried back
16and is not refundable or transferable.

17Section 127. Report.

18(a) Delivery.--The department shall provide a report to the
19chair and minority chair of the Appropriations Committee of the
20Senate, the chair and minority chair of the Public Health and
21Welfare Committee of the Senate, the chair and minority chair of
22the Appropriations Committee of the House of Representatives and
23the chair and minority chair of the Health and Human Services
24Committee of the House of Representatives.

25(b) Substance.--The report shall include:

26(1) The total amount of the tax credits awarded.

27(2) The total amount of the contributions from all
28business firms.

29(3) The total number of additional persons served
30through the program due to contributions from business firms,

1by county.

2CHAPTER 51

3MISCELLANEOUS PROVISIONS

4Section 5101. Appropriations.

5(a) Department of Health.--The sum of $35,000,000 from the
6Community-Based Health Care Provider Access (CHCPA) Fund is
7hereby appropriated to the Department of Health for the fiscal
8year July 1, 2012, to June 30, 2013, to carry out the provisions
9of Ch. 1 Subch. B, with the exception of funding under section
10113.

11(b) Department of Public Welfare.--The sum of $10,000,000
12from the Community-Based Health Care Provider Access (CHCPA)
13Fund is appropriated to the Department of Public Welfare for the
14fiscal year July 1, 2012, to June 30, 2013, to carry out the
15provisions of Ch. 1 Subch. B and the funding of hospital health
16clinics under section 113.

17(c) Limitations on payments.--Payments to community-based
18health care clinics for assistance under this act shall not
19exceed the amount of funds available for the program, and any
20payment under this act shall not constitute an entitlement from
21the Commonwealth or a claim on any other funds of the
22Commonwealth.

23Section 5102. Effective date.

24This act shall take effect in 90 days.