1Establishing the Community-Based Health Care <-Subsidy (CHCS)
2Program in the Department of Health; <-and providing for
3hospital health clinics <-and, for mobile prenatal and natal
4care demonstration project <-and for limitations.

5TABLE OF CONTENTS

6Chapter 1. Health Care Assistance

7Subchapter A. Preliminary Provisions

8Section 101. Short title.

9Section 102. Definitions.

10Subchapter B. Community-Based Health Care <-Subsidy (CHCS)

11Section 111. Community-Based Health Care <-Subsidy (CHCS)
12Program.

13Section 112. Powers and duties of department.

14Section 113. Hospital health clinics.

15Subchapter C. Mobile Prenatal and Natal Care Demonstration

16Project

1Section 121. Establishment.

2Section 122. Applications for planning grants.

3Section 123. Review and approval of grant applications.

4Section 124. Report.

5Chapter 51. Miscellaneous Provisions

6Section 5101. Limitation.

7Section 5102. Effective date.

8The General Assembly of the Commonwealth of Pennsylvania
9hereby enacts as follows:

10CHAPTER 1

11HEALTH CARE ASSISTANCE

12SUBCHAPTER A

13PRELIMINARY PROVISIONS

14Section 101. Short title.

15This act shall be known and may be cited as the Community-
16Based Health Care <-Subsidy (CHCS) Act.

17Section 102. Definitions.

18The following words and phrases when used in this chapter
19shall have the meanings given to them in this section unless the
20context clearly indicates otherwise:

<-21"Advanced practice registered nurse." A registered nurse who
22has been certified in this Commonwealth to practice as:

23(1) a certified clinical nurse specialist;

24(2) a certified registered nurse anesthetist;

25(3) a certified registered nurse practitioner; or

26(4) a certified nurse midwife.

27"Chronic care and disease management." A model of care that 
28includes the following:

29(1) The provision of effective health management through
30support and information that also promotes patient self-care

1for patients with chronic conditions.

2(2) The use of evidence-based medicine to ensure
3appropriate treatment decisions by health care providers.

4(3) The coordination of care and use of reasonably
5accessible and updated patient information that encourages
6follow-up care as a standard procedure.

7(4) The tracking of clinical information for individual
8and general patient populations to guide treatment and
9effectively anticipate community health care problems.

10"Community-based health care clinic." A nonprofit health 
11care center located in this Commonwealth that provides 
12comprehensive health care services without regard for a 
13patient's ability to pay and that:

14(1) meets either of the following criteria:

15(i) serves a federally designated medically
16underserved area, a medically underserved population or a
17health professional shortage area; or

18(ii) serves a patient population with a majority of
19that population having an income less than 200% of the
20Federal poverty income guidelines; and

21(2) includes any of the following:

22(i) A federally qualified health center as defined
23in section 1905(l)(2)(B) of the Social Security Act (49 
24Stat. 620, 42 U.S.C. § 1396d(l)(2)(B)) or a federally
25qualified health center look-alike and is a participating
26provider <-with the Department of Public Welfare under the 
27act of June 13, 1967 (P.L.31, No.21), known as the Public 
28Welfare Code. <-with:

29(A) the Department of Public Welfare under the
30act of June 13, 1967 (P.L.31, No.21), known as the 

1Public Welfare Code; or

2(B) the Children's Health Insurance Program
3under:

4(I) Title XXI of the Social Security Act (49
5Stat. 620, 42 U.S.C. § 1397aa et seq.); and

6(II) Article XXIII of the act of May 17, 
71921 (P.L.682, No.284), known as The Insurance 
8Company Law of 1921, and the regulations
9promulgated thereunder.

10(ii) A rural health clinic as defined in section
111861(aa)(2) of the Social Security Act (49 Stat. 620, 42 
12U.S.C. § 1395x(aa)(2)), certified by Medicare and is a 
13participating provider <-with the Department of Public 
14Welfare under the Public Welfare Code. <-with:

15(A) the Department of Public Welfare under the
16Public Welfare Code; or

17(B) the Children's Health Insurance Program
18under:

19(I) Title XXI of the Social Security Act;
20and

21(II) Article XXIII of The Insurance Company 
22Law of 1921 and the regulations promulgated
23thereunder.

24(iii) A hospital health clinic and is a 
25participating provider <-with the Department of Public 
26Welfare under the Public Welfare Code. <-with:

27(A) the Department of Public Welfare under the
28Public Welfare Code; or

29(B) the Children's Health Insurance Program
30under:

1(I) Title XXI of the Social Security Act;
2and

3(II) Article XXIII of The Insurance Company 
4Law of 1921 and the regulations promulgated
5thereunder.

6(iv) A free or partial-pay health clinic that
7provides services by volunteer and nonvolunteer health
8care providers.

9(v) A nurse-managed health care clinic that is
10managed by advanced practice <-registered nurses and is
11associated with a nursing education program, a federally
12qualified health center or an independent nonprofit
13health or social services agency and is a participating 
14provider <-with the Department of Public Welfare under the 
15Public Welfare Code. <-with:

16(A) the Department of Public Welfare under the
17Public Welfare Code; or

18(B) the Children's Health Insurance Program
19under:

20(I) Title XXI of the Social Security Act;
21and

22(II) Article XXIII of The Insurance Company 
23Law of 1921 and the regulations promulgated
24thereunder.

25"Department." Except as provided under section 113, the 
26Department of Health of the Commonwealth.

27"Health care provider." A health care provider licensed to 
28practice a component of the healing arts by a licensing board 
29within the Department of State who provides health care services 
30at a community-based health care clinic.

1"Hospital." An entity located in this Commonwealth that is 
2licensed as a hospital under the act of July 19, 1979 (P.L.130, 
3No.48), known as the Health Care Facilities Act.

4"Low-income patient." A patient whose household income is
5below 200% of the Federal poverty income guidelines.

6"Medical assistance." A State program of medical assistance 
7established under Article IV(f) of the act of June 13, 1967 
8(P.L.31, No.21), known as the Public Welfare Code.

9"Patient." A natural person receiving health care from a 
10health care provider at a community-based health care clinic.

11"Program." The Community-Based Health Care <-Subsidy (CHCS) 
12Program.

13SUBCHAPTER B

14COMMUNITY-BASED HEALTH CARE <-SUBSIDY (CHCS)

15Section 111. Community-Based Health Care <-Subsidy (CHCS)
16Program.

17(a) Establishment.--The Community-Based Health Care <-Subsidy 
18(CHCS) Program is established within the department to provide
19grants to community-based health care clinics to:

20(1) Expand and improve health care access and services,
21such as preventive care, chronic care and disease management,
22prenatal, obstetric, postpartum and newborn care, dental
23treatment, behavioral health and pharmacy services.

24(2) Reduce unnecessary utilization of hospital emergency
25services by providing an effective alternative health care
26delivery system.

27(3) Encourage collaborative relationships among
28community-based health care clinics, hospitals and other
29health care providers.

30(b) Grant award methodology.--A methodology for the

1allocation of grant awards shall be developed by the department
2based on the following distribution:

3(1) Not more than 50% for the expansion of an existing
4or the development of a new community-based health care
5clinic using criteria that include:

6(i) The actual and projected number of total
7patients, new patients and patient visits for all
8patients served or to be served, specifically delineating
9the number of low-income and uninsured patients, who fall
10below 200% of the Federal poverty income guidelines.

11(ii) The addition or expansion of ancillary health
12care services, such as dental, behavioral health and
13pharmacy.

14(iii) The development or enhancement of preventive
15and chronic care and disease management techniques.

16(2) Not more than 25% for improvements in prenatal,
17obstetric, postpartum and newborn care.

18(3) Not more than 20% for improved access and services, 
19including patient transportation, intended to reduce
20unnecessary emergency room utilization.

21(4) Not more than 5% for the establishment of
22collaborative relationships among community-based health care
23clinics, hospitals and other health care providers.

24(5) Not more than 15% of the funds made available for
25the program authorized by this section may be awarded to
26applicants within any one city, town, borough or township of
27this Commonwealth.

<-28(b.1) Limitation.--No more than 25% of the grants awarded
29under subsection (b) may go to federally qualified health
30centers as defined in section 1905(l)(2)(B) of the Social

1Security Act (49 Stat. 620, 42 U.S.C. § 1396d(l)(2)(B)) or
2federally qualified health center look-alikes.

3(c) Distribution.--Funds shall be distributed in a manner
4that improves access and expands services in all geographic
5areas of this Commonwealth.

6(d) Reallocation.--The department shall reallocate funds
7among the categories described in subsection (b) if sufficient
8grant requests are not received to use all the funds available
9in a specific category.

10(e) Amount of grants.--A grant under this subsection shall
11require a matching commitment of 25% of the grant, which can be
12in the form of cash or equivalent in-kind services.

13(f) Federal funds.--The department shall seek any available
14Federal funds, as well as any available grants and funding from
15other sources, to supplement amounts made available under this
16subchapter to the extent permitted by law.

17Section 112. Powers and duties of department.

18The department shall have the following powers and duties:

19(1) To administer the program.

20(2) To develop an allocation methodology pursuant to
21section 111(b).

22(3) Within 90 days of the effective date of this
23section, to develop and provide a grant application form
24consistent with this act. The department shall provide
25applications for grants under this section to all known
26community-based health care clinics. A grant under this
27section may be extended over two State fiscal years at the
28request of the community-based health care clinic.

29(4) To calculate and make grants to qualified community-
30based health care clinics.

1(5) To provide an annual report no later than November
230 to the chair and minority chair of the Public Health and
3Welfare Committee of the Senate and the chair and minority
4chair of the Health Committee of the House of
5Representatives. The report shall include all of the
6following:

7(i) The total dollar amount for each grant awarded,
8listing the type of community-based health care clinic
9and the name of the grantee.

10(ii) The use of the grant by each grantee.

11(iii) How each grant expanded access and services
12in accordance with the criteria set forth in section
13111(a) and (b), including specific documentation of low-
14income and uninsured patients served, and the total
15amount of funds allocated in each distribution category
16under section 111(b).

17(iv) The impact of the grant on improving the
18delivery and quality of health care in the community.

19(v) The benefits of the assistance provided under
20this subchapter and any recommendations for changes to
21the program.

22The report shall be made available for public inspection and
23posted on the department's publicly accessible Internet
24website.

25(6) To audit grants awarded under this subchapter to
26ensure that funds have been used in accordance with this
27subchapter and the terms and standards adopted by the
28department.

29(7) To establish and maintain an online database of
30community-based health care clinics.

1(8) To establish a toll-free telephone number for
2individuals to obtain information about community-based
3health care clinics.

4Section 113. Hospital health clinics.

5(a) Program.--The Department of Public Welfare shall, in 
6cooperation with the department, be responsible for
7administering the program as it relates to hospital health
8clinics in accordance with the requirements of this act and
9shall have the following additional duties:

10(1) To develop an application and collect such data and
11information as may be necessary to determine the eligibility
12of hospital health clinics for payments under this section
13using the criteria set forth in section 111(a) and (b).

14(2) To review an application and make a final
15determination regarding a hospital health clinic's
16eligibility for funding within 90 days of receipt.

17(3) To make payments to hospital health clinics in
18accordance with the payment calculation set forth in
19subsection (e).

20(b) Submission of application.--In order to qualify for
21funding under this section, a hospital health clinic shall
22submit the required application to the Department of Public
23Welfare no later than 90 days after the effective date of this
24act.

25(c) Funding.--

26(1) For each fiscal year, upon Federal approval of an
27amendment to the Medicaid State plan, the Department of
28Public Welfare shall annually distribute any available funds
29obtained under this act for hospital health clinics through
30disproportionate share payments to hospitals to provide

1financial assistance that will assure readily available and
2coordinated comprehensive health care to the citizens of this
3Commonwealth.

4(2) The Secretary of Public Welfare shall determine the
5funds available and make appropriate adjustments based on the
6number of qualifying hospitals with hospital health clinics.

7(d) Maximization.--The Department of Public Welfare shall
8seek to maximize any Federal funds, including funds obtained
9under Title XIX of the Social Security Act (49 Stat. 620, 42 
10U.S.C. § 1396 et seq.).

11(e) Payment calculation.--

12(1) Thirty percent of the total amount available shall
13be allocated to eligible hospital health clinics of hospitals
14located in counties of the first and second class. The total
15amount available for each hospital health clinic at a
16hospital in these counties shall be allocated on the basis of
17each hospital's percentage of medical assistance and low-
18income hospital health clinic visits compared to the total
19number of medical assistance and low-income hospital health
20clinic visits for all hospitals in the first and second class
21counties.

22(2) Fifty percent of the total amount available shall be
23allocated to eligible hospital health clinics of hospitals
24located in counties of the third, fourth and fifth class. The
25total amount available for each hospital health clinic at a
26hospital in these counties shall be allocated on the basis of
27each hospital's percentage of medical assistance and low-
28income hospital health clinic visits compared to the total
29number of medical assistance and low-income hospital health
30clinic visits for all hospitals in the third, fourth and

1fifth class counties.

2(3) Twenty percent of the total amount available shall
3be allocated to eligible hospital health clinics of hospitals
4located in counties of the sixth, seventh and eighth class.
5The total amount available for each hospital health clinic at
6a hospital in these counties shall be allocated on the basis
7of each hospital's percentage of medical assistance and low-
8income hospital health clinic visits compared to the total
9number of medical assistance and low-income hospital health
10clinic visits for all hospitals in the sixth, seventh and
11eighth class counties.

12(4) Any hospital that has reached its disproportionate
13share limit under Title XIX of the Social Security Act shall
14receive its share of the State funds available under this
15act.

16SUBCHAPTER C

17MOBILE PRENATAL AND

18NATAL CARE DEMONSTRATION PROJECT

19Section 121. Establishment.

20There is established within the department a program to be
21known as the Mobile Prenatal and Natal Care Demonstration
22Project. The program shall provide prenatal, obstetric,
23postpartum and newborn care to individuals on a mobile basis.

24Section 122. Applications for planning grants.

25A hospital or health care provider may submit an application
26to the department requesting a grant for costs associated with
27establishing a mobile unit to provide prenatal, obstetric,
28postpartum and newborn care. The application shall be on the
29form required by the department and shall include all of the
30following:

1(1) The applicant's name and address.

2(2) The geographic region where the unit will operate.

3(3) A statement of the services to be provided.

4(4) An estimate of the cost of the mobile unit.

5(5) Proof of participation in the medical assistance
6program.

7(6) Any other information required by the department.

8Section 123. Review and approval of grant applications.

9(a) Review.--The department shall review the applications.
10Preference shall be given to applicants in communities where
11prenatal, obstetric, postpartum and newborn care is limited.
12Upon being satisfied that all requirements have been met, the
13department may approve four applications and award grants. The
14following grants shall be awarded:

15(1) One to an applicant which seeks to provide services
16in an urban setting.

17(2) One to an applicant which seeks to provide services
18in a suburban setting.

19(3) One to an applicant which seeks to provide services
20in a rural setting.

21(4) One to an underserved area which is most likely to
22benefit from a mobile clinic.

23(b) Limit.--Grants awarded may not be more than $100,000.

24Section 124. Report.

25By May 1, 2016, the department shall file a report with the
26chairman and minority chairman of the Public Health and Welfare
27Committee of the Senate, the chairman and minority chairman of
28the Health Committee of the House of Representatives and the
29chairman and minority chairman of the Human Services Committee
30of the House of Representatives. The report shall additionally

1be posted on the department's publicly accessible Internet
2website and shall include all of the following for each grant
3made in the prior calendar year:

4(1) The name of each grantee.

5(2) The amount of each grant awarded.

6(3) The use of each grant by each grantee.

7(4) A summary of how each grant expanded access and
8services and improved the delivery and quality of health care
9in the community, including a comparison of the rate of
10infant mortality and low birth weight in the community for
11the year immediately prior to the award of the grant with
12those rates in the community for the year of the grant.

13(5) The types of services and the amount spent on each
14type of service provided by each grantee.

15(6) Any recommendations for changes to the program.

16CHAPTER 51

17MISCELLANEOUS PROVISIONS

18Section 5101. Limitations.

<-19Payments to community-based health care clinics and the 
20Mobile Prenatal and Natal Care Demonstration Project for 
21assistance under this act shall not exceed the amount of funds 
22available for the program, and any <-The payments made under the 
23program shall not exceed the amount of funds appropriated for 
24the program, and the payments made for the Mobile Prenatal and 
25Natal Care Demonstration Project shall not exceed the amount of 
26funds appropriated for the Mobile Prenatal and Natal Care 
27Demonstration Project. A payment under this act shall not
28constitute an entitlement from the Commonwealth or a claim on
29any other funds of the Commonwealth.

30Section 5102. Effective date.

1This act shall take effect in 90 days.