AN ACT

 

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

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

17Section 121.  Establishment.

1Section 122.  Applications for planning grants.

2Section 123.  Review and approval of grant applications.

3Section 124.  Report.

4Chapter 51.  Miscellaneous Provisions

5Section 5101.  Limitation.

6Section 5102.  Effective date.

7The General Assembly of the Commonwealth of Pennsylvania
8hereby enacts as follows:

9CHAPTER 1

10HEALTH CARE ASSISTANCE

11SUBCHAPTER A

12PRELIMINARY PROVISIONS

13Section 101.  Short title.

14This act shall be known and may be cited as the Community-
15Based Health Care Subsidy (CHCS) Act.

16Section 102.  Definitions.

17The following words and phrases when used in this chapter
18shall have the meanings given to them in this section unless the
19context clearly indicates otherwise:

20"Chronic care and disease management."  A model of care that 
21includes the following:

22(1)  The provision of effective health management through
23support and information that also promotes patient self-care
24for patients with chronic conditions.

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

27(3)  The coordination of care and use of reasonably
28accessible and updated patient information that encourages
29follow-up care as a standard procedure.

30(4)  The tracking of clinical information for individual

1and general patient populations to guide treatment and
2effectively anticipate community health care problems.

3"Community-based health care clinic."  A nonprofit health 
4care center located in this Commonwealth that provides 
5comprehensive health care services without regard for a 
6patient's ability to pay and that:

7(1)  meets either of the following criteria:

8(i)  serves a federally designated medically
9underserved area, a medically underserved population or a
10health professional shortage area; or

11(ii)  serves a patient population with a majority of
12that population having an income less than 200% of the
13Federal poverty income guidelines; and

14(2)  includes any of the following:

15(i)  A federally qualified health center as defined
16in section 1905(l)(2)(B) of the Social Security Act (49 
17Stat. 620, 42 U.S.C. § 1396d(l)(2)(B)) or a federally
18qualified health center look-alike and is a participating
19provider with the Department of Public Welfare under the
20act of June 13, 1967 (P.L.31, No.21), known as the Public
21Welfare Code.

22(ii)  A rural health clinic as defined in section
231861(aa)(2) of the Social Security Act (49 Stat. 620, 42 
24U.S.C. § 1395x(aa)(2)), certified by Medicare and is a 
25participating provider with the Department of Public 
26Welfare under the Public Welfare Code.

27(iii)  A hospital health clinic and is a 
28participating provider with the Department of Public 
29Welfare under the Public Welfare Code.

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

1provides services by volunteer and nonvolunteer health
2care providers.

3(v)  A nurse-managed health care clinic that is
4managed by advanced practice nurses and is associated
5with a nursing education program, a federally qualified
6health center or an independent nonprofit health or
7social services agency and is a participating provider 
8with the Department of Public Welfare under the Public 
9Welfare Code.

10"Department."  Except as provided under section 113, the 
11Department of Health of the Commonwealth.

12"Health care provider."  A health care provider licensed to 
13practice a component of the healing arts by a licensing board 
14within the Department of State who provides health care services 
15at a community-based health care clinic.

16"Hospital."  An entity located in this Commonwealth that is 
17licensed as a hospital under the act of July 19, 1979 (P.L.130, 
18No.48), known as the Health Care Facilities Act.

19"Low-income patient."  A patient whose household income is
20below 200% of the Federal poverty income guidelines.

21"Medical assistance."  A State program of medical assistance 
22established under Article IV(f) of the act of June 13, 1967 
23(P.L.31, No.21), known as the Public Welfare Code.

24"Patient."  A natural person receiving health care from a 
25health care provider at a community-based health care clinic.

26"Program."  The Community-Based Health Care Subsidy (CHCS) 
27Program.

28SUBCHAPTER B

29COMMUNITY-BASED HEALTH CARE SUBSIDY (CHCS)

30Section 111.  Community-Based Health Care Subsidy (CHCS)

1Program.

2(a)  Establishment.--The Community-Based Health Care Subsidy
3(CHCS) Program is established within the department to provide
4grants to community-based health care clinics to:

5(1)  Expand and improve health care access and services,
6such as preventive care, chronic care and disease management,
7prenatal, obstetric, postpartum and newborn care, dental
8treatment, behavioral health and pharmacy services.

9(2)  Reduce unnecessary utilization of hospital emergency
10services by providing an effective alternative health care
11delivery system.

12(3)  Encourage collaborative relationships among
13community-based health care clinics, hospitals and other
14health care providers.

15(b)  Grant award methodology.--A methodology for the
16allocation of grant awards shall be developed by the department
17based on the following distribution:

18(1)  Not more than 50% for the expansion of an existing
19or the development of a new community-based health care
20clinic using criteria that include:

21(i)  The actual and projected number of total
22patients, new patients and patient visits for all
23patients served or to be served, specifically delineating
24the number of low-income and uninsured patients, who fall
25below 200% of the Federal poverty income guidelines.

26(ii)  The addition or expansion of ancillary health
27care services, such as dental, behavioral health and
28pharmacy.

29(iii)  The development or enhancement of preventive
30and chronic care and disease management techniques.

1(2)  Not more than 25% for improvements in prenatal,
2obstetric, postpartum and newborn care.

3(3)  Not more than 20% for improved access and services, 
4including patient transportation, intended to reduce
5unnecessary emergency room utilization.

6(4)  Not more than 5% for the establishment of
7collaborative relationships among community-based health care
8clinics, hospitals and other health care providers.

9(5)  Not more than 15% of the funds made available for
10the program authorized by this section may be awarded to
11applicants within any one city, town, borough or township of
12this Commonwealth.

13(c)  Distribution.--Funds shall be distributed in a manner
14that improves access and expands services in all geographic
15areas of this Commonwealth.

16(d)  Reallocation.--The department shall reallocate funds
17among the categories described in subsection (b) if sufficient
18grant requests are not received to use all the funds available
19in a specific category.

20(e)  Amount of grants.--A grant under this subsection shall
21require a matching commitment of 25% of the grant, which can be
22in the form of cash or equivalent in-kind services.

23(f)  Federal funds.--The department shall seek any available
24Federal funds, as well as any available grants and funding from
25other sources, to supplement amounts made available under this
26subchapter to the extent permitted by law.

27Section 112.  Powers and duties of department.

28The department shall have the following powers and duties:

29(1)  To administer the program.

30(2)  To develop an allocation methodology pursuant to

1section 111(b).

2(3)  Within 90 days of the effective date of this
3section, to develop and provide a grant application form
4consistent with this act. The department shall provide
5applications for grants under this section to all known
6community-based health care clinics. A grant under this
7section may be extended over two State fiscal years at the
8request of the community-based health care clinic.

9(4)  To calculate and make grants to qualified community-
10based health care clinics.

11(5)  To provide an annual report no later than November
1230 to the chair and minority chair of the Public Health and
13Welfare Committee of the Senate and the chair and minority
14chair of the Health Committee of the House of
15Representatives. The report shall include all of the
16following:

17(i)  The total dollar amount for each grant awarded,
18listing the type of community-based health care clinic
19and the name of the grantee.

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

21(iii)   How each grant expanded access and services
22in accordance with the criteria set forth in section
23111(a) and (b), including specific documentation of low-
24income and uninsured patients served, and the total
25amount of funds allocated in each distribution category
26under section 111(b).

27(iv)  The impact of the grant on improving the
28delivery and quality of health care in the community.

29(v)  The benefits of the assistance provided under
30this subchapter and any recommendations for changes to

1the program.

2The report shall be made available for public inspection and
3posted on the department's publicly accessible Internet
4website.

5(6)  To audit grants awarded under this subchapter to
6ensure that funds have been used in accordance with this
7subchapter and the terms and standards adopted by the
8department.

9(7)  To establish and maintain an online database of
10community-based health care clinics.

11(8)  To establish a toll-free telephone number for
12individuals to obtain information about community-based
13health care clinics.

14Section 113.  Hospital health clinics.

15(a)  Program.--The Department of Public Welfare shall, in 
16cooperation with the department, be responsible for
17administering the program as it relates to hospital health
18clinics in accordance with the requirements of this act and
19shall have the following additional duties:

20(1)  To develop an application and collect such data and
21information as may be necessary to determine the eligibility
22of hospital health clinics for payments under this section
23using the criteria set forth in section 111(a) and (b).

24(2)  To review an application and make a final
25determination regarding a hospital health clinic's
26eligibility for funding within 90 days of receipt.

27(3)  To make payments to hospital health clinics in
28accordance with the payment calculation set forth in
29subsection (e).

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

1funding under this section, a hospital health clinic shall
2submit the required application to the Department of Public
3Welfare no later than 90 days after the effective date of this
4act.

5(c)  Funding.--

6(1)  For each fiscal year, upon Federal approval of an
7amendment to the Medicaid State plan, the Department of
8Public Welfare shall annually distribute any available funds
9obtained under this act for hospital health clinics through
10disproportionate share payments to hospitals to provide
11financial assistance that will assure readily available and
12coordinated comprehensive health care to the citizens of this
13Commonwealth.

14(2)  The Secretary of Public Welfare shall determine the
15funds available and make appropriate adjustments based on the
16number of qualifying hospitals with hospital health clinics.

17(d)  Maximization.--The Department of Public Welfare shall
18seek to maximize any Federal funds, including funds obtained
19under Title XIX of the Social Security Act (49 Stat. 620, 42 
20U.S.C. § 1396 et seq.).

21(e)  Payment calculation.--

22(1)  Thirty percent of the total amount available shall
23be allocated to eligible hospital health clinics of hospitals
24located in counties of the first and second class. The total
25amount 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 first and second class

1counties.

2(2)  Fifty percent of the total amount available shall be
3allocated to eligible hospital health clinics of hospitals
4located in counties of the third, fourth and fifth class. The
5total amount available for each hospital health clinic at a
6hospital in these counties shall be allocated on the basis of
7each 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 third, fourth and
11fifth class counties.

12(3)  Twenty percent of the total amount available shall
13be allocated to eligible hospital health clinics of hospitals
14located in counties of the sixth, seventh and eighth class.
15The total amount available for each hospital health clinic at
16a hospital in these counties shall be allocated on the basis
17of each 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 sixth, seventh and
21eighth class counties.

22(4)  Any hospital that has reached its disproportionate
23share limit under Title XIX of the Social Security Act shall
24receive its share of the State funds available under this
25act.

26SUBCHAPTER C

27MOBILE PRENATAL AND

28NATAL CARE DEMONSTRATION PROJECT

29Section 121.  Establishment.

30There is established within the department a program to be

1known as the Mobile Prenatal and Natal Care Demonstration
2Project. The program shall provide prenatal, obstetric,
3postpartum and newborn care to individuals on a mobile basis.

4Section 122.  Applications for planning grants.

5A hospital or health care provider may submit an application
6to the department requesting a grant for costs associated with
7establishing a mobile unit to provide prenatal, obstetric,
8postpartum and newborn care. The application shall be on the
9form required by the department and shall include all of the
10following:

11(1)  The applicant's name and address.

12(2)  The geographic region where the unit will operate.

13(3)  A statement of the services to be provided.

14(4)  An estimate of the cost of the mobile unit.

15(5)  Proof of participation in the medical assistance
16program.

17(6)  Any other information required by the department.

18Section 123.  Review and approval of grant applications.

19(a)  Review.--The department shall review the applications.
20Preference shall be given to applicants in communities where
21prenatal, obstetric, postpartum and newborn care is limited.
22Upon being satisfied that all requirements have been met, the
23department may approve four applications and award grants. The
24following grants shall be awarded:

25(1)  One to an applicant which seeks to provide services
26in an urban setting.

27(2)  One to an applicant which seeks to provide services
28in a suburban setting.

29(3)  One to an applicant which seeks to provide services
30in a rural setting.

1(4)  One to an underserved area which is most likely to
2benefit from a mobile clinic.

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

4Section 124.  Report.

5By May 1, 2016, the department shall file a report with the
6chairman and minority chairman of the Public Health and Welfare
7Committee of the Senate, the chairman and minority chairman of
8the Health Committee of the House of Representatives and the
9chairman and minority chairman of the Human Services Committee
10of the House of Representatives. The report shall additionally
11be posted on the department's publicly accessible Internet
12website and shall include all of the following for each grant
13made in the prior calendar year:

14(1)  The name of each grantee.

15(2)  The amount of each grant awarded.

16(3)  The use of each grant by each grantee.

17(4)  A summary of how each grant expanded access and
18services and improved the delivery and quality of health care
19in the community, including a comparison of the rate of
20infant mortality and low birth weight in the community for
21the year immediately prior to the award of the grant with
22those rates in the community for the year of the grant.

23(5)  The types of services and the amount spent on each
24type of service provided by each grantee.

25(6)  Any recommendations for changes to the program.

26CHAPTER 51

27MISCELLANEOUS PROVISIONS

28Section 5101.  Limitations.

29Payments to community-based health care clinics and the 
30Mobile Prenatal and Natal Care Demonstration Project for

1assistance under this act shall not exceed the amount of funds
2available for the program, and any payment under this act shall
3not constitute an entitlement from the Commonwealth or a claim
4on any other funds of the Commonwealth.

5Section 5102.  Effective date.

6This act shall take effect in 90 days.

 

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