THE GENERAL ASSEMBLY OF PENNSYLVANIA

SENATE BILL

INTRODUCED BY ERICKSON, EICHELBERGER, PILEGGI, SCARNATI, D. WHITE, BAKER, M. WHITE, RAFFERTY, GREENLEAF, VANCE, COSTA, GORDNER, ORIE, ALLOWAY, KITCHEN, SMUCKER, FONTANA, CORMAN, EARLL, YAW, WAUGH, FOLMER, ROBBINS, BROWNE, BRUBAKER, WARD AND PIPPY, FEBRUARY 17, 2011

REFERRED TO PUBLIC HEALTH AND WELFARE, FEBRUARY 17, 2011  

AN ACT

Establishing the Community-Based Health Care (CHC) Program in

the Department of Health; and providing for hospital health

clinics.

TABLE OF CONTENTS

Chapter 1.  Health Care Assistance

Subchapter A.  Preliminary Provisions

Section 101.  Short title.

Section 102.  Definitions.

Subchapter B.  Community-Based Health Care (CHC)

Section 111.  Community-Based Health Care (CHC) Program.

Section 112.  Powers and duties of department.

Section 113.  Hospital health clinics.

Chapter 51.  Miscellaneous Provisions

Section 5101.  Limitation.

Section 5102.  Effective date.

The General Assembly of the Commonwealth of Pennsylvania

hereby enacts as follows:

CHAPTER 1

HEALTH CARE ASSISTANCE

SUBCHAPTER A

PRELIMINARY PROVISIONS

Section 101.  Short title.

This act shall be known and may be cited as the Community-

Based Health Care (CHC) Act.

Section 102.  Definitions.

The following words and phrases when used in this chapter

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

context clearly indicates otherwise:

"Chronic care and disease management."  A model of care that

includes the following:

(1)  The provision of effective health management through

support and information that also promotes patient self-care

for patients with chronic conditions.

(2)  The use of evidence-based medicine to ensure

appropriate treatment decisions by health care providers.

(3)  The coordination of care and use of reasonably

accessible and updated patient information that encourages

follow-up care as a standard procedure.

(4)  The tracking of clinical information for individual

and general patient populations to guide treatment and

effectively anticipate community health care problems.

"Community-based health care clinic."  A nonprofit health

care center located in this Commonwealth that provides

comprehensive health care services without regard for a

patient's ability to pay and that:

(1)  meets either of the following criteria:

(i)  serves a federally designated medically

underserved area, a medically underserved population or a

health professional shortage area; or

(ii)  serves a patient population with a majority of

that population having an income less than 200% of the

Federal poverty income guidelines; and

(2)  includes any of the following:

(i)  A federally qualified health center as defined

in section 1905(l)(2)(B) of the Social Security Act (49

Stat. 620, 42 U.S.C. § 1396d(l)(2)(B)) or a federally

qualified health center look-alike.

(ii)  A rural health clinic as defined in section

1861(aa)(2) of the Social Security Act (49 Stat. 620, 42

U.S.C. § 1395x(aa)(2)), certified by Medicare.

(iii)  A hospital health clinic.

(iv)  A free or partial-pay health clinic that

provides services by volunteer and nonvolunteer health

care providers.

(v)  A nurse-managed health care clinic that is

managed by advanced practice nurses and is associated

with a nursing education program, a federally qualified

health center or an independent nonprofit health or

social services agency.

"Department."  Except as provided under section 113, the

Department of Health of the Commonwealth.

"Health care provider."  A health care provider licensed to

practice a component of the healing arts by a licensing board

within the Department of State who provides health care services

at a community-based health care clinic.

"Hospital."  An entity located in this Commonwealth that is

licensed as a hospital under the act of July 19, 1979 (P.L.130,

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

"Medical assistance."  A State program of medical assistance

established under Article IV(f) of the act of June 13, 1967

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

"Patient."  A natural person receiving health care from a

health care provider at a community-based health care clinic.

"Program."  The Community-Based Health Care (CHC) Program.

SUBCHAPTER B

COMMUNITY-BASED HEALTH CARE (CHC)

Section 111.  Community-Based Health Care (CHC) Program.

(a)  Establishment.--The Community-Based Health Care (CHC)

Program is established within the department to provide grants

to community-based health care clinics to:

(1)  Expand and improve health care access and services,

such as preventive care, chronic care and disease management,

prenatal, obstetric, postpartum and newborn care, dental

treatment, behavioral health and pharmacy services.

(2)  Reduce unnecessary utilization of hospital emergency

services by providing an effective alternative health care

delivery system.

(3)  Encourage collaborative relationships among

community-based health care clinics, hospitals and other

health care providers.

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

allocation of grant awards shall be developed by the department

based on the following distribution:

(1)  Fifty percent for the expansion of an existing or

the development of a new community-based health care clinic

using criteria that include:

(i)  The actual and projected number of total

patients, new patients and patient visits for all

patients served or to be served, specifically delineating

the number of low-income and uninsured patients, who fall

below 200% of the Federal poverty income guidelines.

(ii)  The addition or expansion of ancillary health

care services, such as dental, behavioral health and

pharmacy.

(iii)  The development or enhancement of preventive

and chronic care and disease management techniques.

(2)  Twenty-five percent for improvements in prenatal,

obstetric, postpartum and newborn care.

(3)  Twenty percent for improved access and services,

including patient transportation, intended to reduce

unnecessary emergency room utilization.

(4)  Five percent for the establishment of collaborative

relationships among community-based health care clinics,

hospitals and other health care providers.

(c)  Limitation.--No more than 25% of the grants awarded

under subsection (b) shall go to federally qualified health

centers or federally qualified health center look-alikes.

(d)  Distribution.--Funds shall be distributed in a manner

that improves access and expands services in all geographic

areas of this Commonwealth.

(e)  Reallocation.--The department shall reallocate funds

among the categories described in subsection (b) if sufficient

grant requests are not received to use all the funds available

in a specific category.

(f)  Amount of grants.--A grant under this subsection shall

not exceed $500,000 of the total amount of funds available and

shall require a matching commitment of 25% of the grant, which

can be in the form of cash or equivalent in-kind services.

(g)  Federal funds.--The department shall seek any available

Federal funds, as well as any available grants and funding from

other sources, to supplement amounts made available under this

subchapter to the extent permitted by law.

Section 112.  Powers and duties of department.

The department shall have the following powers and duties:

(1)  To administer the program.

(2)  To develop an allocation methodology pursuant to

section 111(b).

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

section, to develop and provide a grant application form

consistent with this act. The department shall provide

applications for grants under this section to all known

community-based health care clinics. A grant under this

section may be extended over two State fiscal years at the

request of the community-based health care clinic.

(4)  To calculate and make grants to qualified community-

based health care clinics.

(5)  To provide an annual report no later than November

30 to the chair and minority chair of the Public Health and

Welfare Committee of the Senate and the chair and minority

chair of the Health Committee of the House of

Representatives. The report shall include accountability

measures for all of the following:

(i)  The total dollar amount for each grant awarded,

listing the type of community-based health care clinic

and the name of the grantee.

(ii)  A summary of the use of the grant by each

grantee.

(iii)  A summary of how each grant expanded access

and services in accordance with the criteria set forth in

section 111(a) and (b), including a specific

documentation of low-income and uninsured patients

served, and the total amount of funds allocated in each

distribution category under section 111(b).

(iv)  The impact of the grant on improving the

delivery and quality of health care in the community.

(v)  An accountability assessment of the benefits of

the assistance provided under this subchapter and any

recommendations for changes to the program.

The report shall be made available for public inspection and

posted on the department's publicly accessible Internet

website.

(6)  To audit grants awarded under this subchapter to

ensure that funds have been used in accordance with this

subchapter and the terms and standards adopted by the

department.

(7)  To establish and maintain an online database of

community-based health care clinics.

(8)  To establish a toll-free telephone number for

individuals to obtain information about community-based

health care clinics.

Section 113.  Hospital health clinics.

(a)  Program.--The Department of Public Welfare shall be

responsible for administering the program as it relates to

hospital health clinics in accordance with the requirements of

this act and shall have the following additional duties:

(1)  To develop an application and collect such data and

information as may be necessary to determine the eligibility

of hospital health clinics for payments under this section

using the criteria set forth in section 111(a) and (b).

(2)  To review an application and make a final

determination regarding a hospital health clinic's

eligibility for funding within 90 days of receipt.

(3)  To make payments to hospital health clinics in

accordance with the payment calculation set forth in

subsection (e).

(b)  Submission of application.--In order to qualify for

funding under this section, a hospital health clinic shall

submit the required application to the Department of Public

Welfare no later than 90 days after the effective date of this

act.

(c)  Funding.--

(1)  For each fiscal year, upon Federal approval of an

amendment to the Medicaid State plan, the Department of

Public Welfare shall annually distribute any available funds

obtained under this act for hospital health clinics through

disproportionate share payments to hospitals to provide

financial assistance that will assure readily available and

coordinated comprehensive health care to the citizens of this

Commonwealth.

(2)  The Secretary of Public Welfare shall determine the

funds available and make appropriate adjustments based on the

number of qualifying hospitals with hospital health clinics.

(d)  Maximization.--The Department of Public Welfare shall

seek to maximize any Federal funds, including funds obtained

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

U.S.C. § 1396 et seq.).

(e)  Payment calculation.--

(1)  Thirty percent of the total amount available shall

be allocated to eligible hospital health clinics of hospitals

located in counties of the first and second class. The total

amount available for each hospital health clinic at a

hospital in these counties shall be allocated on the basis of

each hospital's percentage of medical assistance and low-

income hospital health clinic visits compared to the total

number of medical assistance and low-income hospital health

clinic visits for all hospitals in these counties.

(2)  Fifty percent of the total amount available shall be

allocated to eligible hospital health clinics of hospitals

located in counties of the third, fourth and fifth class. The

total amount available for each hospital health clinic at a

hospital in these counties shall be allocated on the basis of

each hospital's percentage of medical assistance and low-

income hospital health clinic visits compared to the total

number of medical assistance and low-income hospital health

clinic visits for all hospitals in these counties.

(3)  Twenty percent of the total amount available shall

be allocated to eligible hospital health clinics of hospitals

located in counties of the sixth, seventh and eighth class.

The total amount available for each hospital health clinic at

a hospital in these counties shall be allocated on the basis

of each hospital's percentage of medical assistance and low-

income hospital health clinic visits compared to the total

number of medical assistance and low-income hospital health

clinic visits for all hospitals in these counties.

(4)  Any hospital that has reached its disproportionate

share limit under Title XIX of the Social Security Act shall

receive its share of the State funds available under this

act.

(f)  Definition.--As used in this section, the term "low-

income" means under 200% of the Federal poverty income

guidelines.

CHAPTER 51

MISCELLANEOUS PROVISIONS

Section 5101.  Limitations.

Payments to community-based health care clinics for

assistance under this act shall not exceed the amount of funds

available for the program, and any payment under this act shall

not constitute an entitlement from the Commonwealth or a claim

on any other funds of the Commonwealth.

Section 5102.  Effective date.

This act shall take effect in 90 days.