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SENATE AMENDED
PRIOR PRINTER'S NOS. 2246, 2736, 3675
PRINTER'S NO. 3809
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No.
1677
Session of
2017
INTRODUCED BY ORTITAY, WARD, WATSON, WHEELAND, D. MILLER,
PHILLIPS-HILL AND SAYLOR, JULY 21, 2017
SENATOR BROWNE, APPROPRIATIONS, IN SENATE, RE-REPORTED AS
AMENDED, JUNE 22, 2018
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," in public assistance,
further providing for meeting special needs and work supports
and incentives AND FOR EMPLOYMENT INCENTIVE PAYMENTS; in
departmental powers and duties as to supervision, further
providing for definitions; and, in departmental powers and
duties as to licensing, further providing for definitions.
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," IN GENERAL POWERS AND
DUTIES, PROVIDING FOR COORDINATED SERVICE DELIVERY PILOT
PROGRAM; IN PUBLIC ASSISTANCE, FURTHER PROVIDING FOR MEETING
SPECIAL NEEDS, WORK SUPPORTS AND INCENTIVES, FOR MEDICAL
ASSISTANCE PAYMENTS FOR INSTITUTIONAL CARE AND PROVIDING FOR
NONEMERGENCY MEDICAL TRANSPORTATION SERVICES; CREATING
OPPORTUNITIES FOR HOSPITALS AND MANAGED CARE ORGANIZATIONS TO
IMPROVE HEALTH CARE OUTCOMES AND TO FURTHER REDUCE
UNNECESSARY AND INAPPROPRIATE SERVICES IN THE COMMONWEALTH'S
MEDICAL ASSISTANCE PROGRAM; IN THE AGED, ESTABLISHING THE
LIFE PROGRAM; IN CHILDREN AND YOUTH, FURTHER PROVIDING FOR
PROVIDER SUBMISSIONS; IN STATEWIDE QUALITY CARE ASSESSMENT,
FURTHER PROVIDING FOR DEFINITIONS, FOR IMPLEMENTATION, FOR
ADMINISTRATION, FOR THE QUALITY CARE ASSESSMENT ACCOUNT AND
FOR EXPIRATION; IN DEPARTMENTAL POWERS AND DUTIES AS TO
SUPERVISION, FURTHER PROVIDING FOR DEFINITIONS; IN
DEPARTMENTAL POWERS AND DUTIES AS TO LICENSING, FURTHER
PROVIDING FOR DEFINITIONS; AND IMPOSING A DUTY ON THE
DEPARTMENT OF HUMAN SERVICES.
The General Assembly of the Commonwealth of Pennsylvania
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hereby enacts as follows:
Section 1. Section 408(b) of the act of June 13, 1967
(P.L.31, No.21), known as the Human Services Code, is amended to
read:
SECTION 1. SECTIONS 408(B) AND 491(C)(2) OF THE ACT OF JUNE
13, 1967 (P.L.31, NO.21), KNOWN AS THE HUMAN SERVICES CODE, ARE
AMENDED TO READ:
Section 408. Meeting Special Needs; Work Supports and
Incentives.--* * *
(b) The department may provide assistance to recipients for
child [day] care when the department has determined that,
without such services, the recipient would be exempt from
compliance with the conditions of the agreement of mutual
responsibility or work requirements or when a former recipient
who is employed has ceased to receive cash assistance for a
reason other than a sanction for noncompliance with an
eligibility condition. In establishing the time limits and
levels of access to child [day-care] care funds, the department
shall take into account availability, costs and the number of
assistance groups needing services within the geographic area
and shall seek to provide essential services to the greatest
number of recipients.
* * *
SECTION 491. EMPLOYMENT INCENTIVE PAYMENTS.--* * *
(C) * * *
(2) IF THE EMPLOYER PROVIDES OR PAYS FOR [DAY] CHILD CARE
SERVICES FOR THE CHILDREN OF THE EMPLOYE, THE EMPLOYER SHALL BE
ELIGIBLE TO RECEIVE AN ADDITIONAL EMPLOYMENT INCENTIVE PAYMENT
OF SIX HUNDRED DOLLARS ($600) DURING THE FIRST YEAR OF
EMPLOYMENT, FIVE HUNDRED DOLLARS ($500) DURING THE SECOND YEAR
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OF EMPLOYMENT, AND FOUR HUNDRED DOLLARS ($400) DURING THE THIRD
YEAR OF EMPLOYMENT.
* * *
Section 2. The definitions of "child day care" and
"children's institutions" in section 901 of the act, amended or
added December 28, 2015 (P.L.500, No.92), are amended to read:
Section 901. Definitions.--As used in this article--
"Child [day] care" means care in lieu of parental care given
for part of the twenty-four hour day to a child under sixteen
years of age, away from the child's home but does not include
child [day] care furnished in a place of worship during
religious services.
"Children's institutions" means any incorporated or
unincorporated organization, society, corporation or agency,
public or private, which may receive or care for children, or
place them in foster family homes, either at board, wages or
free; or any individual who, for hire, gain or reward, receives
for care a child, unless he is related to such child by blood or
marriage within the second degree; or any individual, not in the
regular employ of the court or of an organization, society,
association or agency, duly certified by the department, who in
any manner becomes a party to the placing of children in foster
homes, unless he is related to such children by blood or
marriage within the second degree, or is the duly appointed
guardian thereof. The term shall not include a family child care
home or child [day] care center operated for profit and subject
to the provisions of Article X.
* * *
Section 3. The definitions of "child day care," "child day
care center," "facility" and "family child care home" in section
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1001 of the act, amended or added December 28, 2015 (P.L.500,
No.92), are amended to read:
Section 1001. Definitions.--As used in this article--
* * *
"Child [day] care" means care in lieu of parental care given
for part of the twenty-four hour day to children under sixteen
years of age, away from their own homes, but does not include
child [day] care furnished in places of worship during religious
services.
"Child [day] care center" means any premises operated for
profit in which child [day] care is provided simultaneously for
seven or more children who are not relatives of the operator,
except such centers operated under social service auspices.
* * *
"Facility" means an adult day care center, child [day] care
center, family child care home, boarding home for children,
mental health establishment, personal care home, assisted living
residence, nursing home, hospital or maternity home, as defined
herein, except to the extent that such a facility is operated by
the State or Federal governments or those supervised by the
department or licensed pursuant to the act of July 19, 1979
(P.L.130, No.48), known as the "Health Care Facilities Act."
"Family child care home" means a home where child [day] care
is provided at any time to no less than four children and no
more than six children who are not relatives of the caregiver.
* * *
Section 4. Within one year of the effective date of this
section, the Department of Human Services shall amend any
regulation at 55 Pa. Code Pt. V that uses the term "day care" as
it relates to children and replace the term with the term "child
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care."
Section 5. This act shall take effect in 60 days.
SECTION 1. THE ACT OF JUNE 13, 1967 (P.L.31, NO.21), KNOWN
AS THE HUMAN SERVICES CODE, IS AMENDED BY ADDING A SECTION TO
READ:
SECTION 216. COORDINATED SERVICE DELIVERY PILOT PROGRAM.--
(A) TO THE EXTENT PERMITTED BY FEDERAL LAW, THE DEPARTMENT, IN
CONSULTATION WITH THE DEPARTMENT OF EDUCATION, SHALL ESTABLISH A
PILOT PROGRAM AT A SCHOOL ENTITY OR ENTITIES WITHIN THE CITY OF
THE FIRST CLASS TO ASSIST IN THE COORDINATED DELIVERY OF
EDUCATION SERVICES AND HUMAN SERVICES TO STUDENTS AND THEIR
FAMILIES FOR THE PURPOSES OF PROMOTING AND IMPLEMENTING
INNOVATIVE RESEARCH-BASED PRACTICES WITHIN SELECTED SCHOOL
ENTITIES. COORDINATION SHALL BE BASED UPON JOINT PLANNING
BETWEEN THE DEPARTMENT, THE DEPARTMENT OF EDUCATION AND A SCHOOL
ENTITY'S COMPREHENSIVE ASSESSMENTS OF THE NEED TO PROVIDE
SERVICES, COORDINATE SERVICE DELIVERY, CLOSE GAPS IN SERVICES,
AND COORDINATE TO ADDRESS THE PROVISION OF NEEDED SERVICES. IN
ORDER TO ASSIST IN THE COORDINATED DELIVERY OF EDUCATION
SERVICES AND HUMAN SERVICES TO STUDENTS AND THEIR FAMILIES, THE
PILOT PROGRAM MAY CONSIDER THE FOLLOWING:
(1) A SCHOOL ENTITY ASSISTING STUDENTS AND THEIR FAMILIES IN
APPLYING FOR AND RECEIVING EDUCATION SERVICES AND HUMAN
SERVICES.
(2) AN EXPANDED SCHOOL DAY FOR THE PURPOSE OF PROVIDING
OPPORTUNITIES FOR INCREASED INSTRUCTIONAL TIME, TUTORING BY
STAFF, PUPILS AND VOLUNTEERS, AN ENVIRONMENT CONDUCIVE TO
LEARNING BEFORE AND AFTER THE REGULAR SCHOOL DAY AND
PERSONALIZED INSTRUCTION AND MENTORING.
(3) OTHER BEST PRACTICES AS DETERMINED BY THE DEPARTMENT AND
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THE DEPARTMENT OF EDUCATION.
(B) A SCHOOL ENTITY PARTICIPATING IN THE PILOT PROGRAM SHALL
SUBMIT REPORTS TO THE DEPARTMENT CONTAINING SUCH INFORMATION AND
IN THE FORM AND BY THE DEADLINE PRESCRIBED BY THE DEPARTMENT.
(C) AS USED IN THIS SECTION, THE TERM "S CHOOL ENTITY" SHALL
MEAN ANY PUBLIC SCHOOL, INCLUDING A CHARTER SCHOOL OR CYBER
CHARTER SCHOOL OR AREA VOCATIONAL-TECHNICAL SCHOOL OPERATING
WITHIN THIS COMMONWEALTH.
SECTION 2. SECTIONS 408(B) AND 443.1(7)(VI) OF THE ACT ARE
AMENDED TO READ:
SECTION 408. MEETING SPECIAL NEEDS; WORK SUPPORTS AND
INCENTIVES.--* * *
(B) THE DEPARTMENT MAY PROVIDE ASSISTANCE TO RECIPIENTS FOR
CHILD [DAY] CARE WHEN THE DEPARTMENT HAS DETERMINED THAT,
WITHOUT SUCH SERVICES, THE RECIPIENT WOULD BE EXEMPT FROM
COMPLIANCE WITH THE CONDITIONS OF THE AGREEMENT OF MUTUAL
RESPONSIBILITY OR WORK REQUIREMENTS OR WHEN A FORMER RECIPIENT
WHO IS EMPLOYED HAS CEASED TO RECEIVE CASH ASSISTANCE FOR A
REASON OTHER THAN A SANCTION FOR NONCOMPLIANCE WITH AN
ELIGIBILITY CONDITION. IN ESTABLISHING THE TIME LIMITS AND
LEVELS OF ACCESS TO CHILD [DAY-CARE] CARE FUNDS, THE DEPARTMENT
SHALL TAKE INTO ACCOUNT AVAILABILITY, COSTS AND THE NUMBER OF
ASSISTANCE GROUPS NEEDING SERVICES WITHIN THE GEOGRAPHIC AREA
AND SHALL SEEK TO PROVIDE ESSENTIAL SERVICES TO THE GREATEST
NUMBER OF RECIPIENTS.
* * *
SECTION 443.1. MEDICAL ASSISTANCE PAYMENTS FOR INSTITUTIONAL
CARE.--THE FOLLOWING MEDICAL ASSISTANCE PAYMENTS SHALL BE MADE
ON BEHALF OF ELIGIBLE PERSONS WHOSE INSTITUTIONAL CARE IS
PRESCRIBED BY PHYSICIANS:
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* * *
(7) AFTER JUNE 30, 2007, PAYMENTS TO COUNTY AND NONPUBLIC
NURSING FACILITIES ENROLLED IN THE MEDICAL ASSISTANCE PROGRAM AS
PROVIDERS OF NURSING FACILITY SERVICES SHALL BE DETERMINED IN
ACCORDANCE WITH THE METHODOLOGIES FOR ESTABLISHING PAYMENT RATES
FOR COUNTY AND NONPUBLIC NURSING FACILITIES SPECIFIED IN THE
DEPARTMENT'S REGULATIONS AND THE COMMONWEALTH'S APPROVED TITLE
XIX STATE PLAN FOR NURSING FACILITY SERVICES IN EFFECT AFTER
JUNE 30, 2007. THE FOLLOWING SHALL APPLY:
* * *
(VI) SUBJECT TO FEDERAL APPROVAL OF SUCH AMENDMENTS AS MAY
BE NECESSARY TO THE COMMONWEALTH'S APPROVED TITLE XIX STATE
PLAN, FOR FISCAL YEARS 2015-2016 [AND], 2016-2017 AND 2018-2019,
THE DEPARTMENT SHALL MAKE UP TO FOUR MEDICAL ASSISTANCE DAY-ONE
INCENTIVE PAYMENTS TO QUALIFIED NONPUBLIC NURSING FACILITIES.
THE DEPARTMENT SHALL DETERMINE THE NONPUBLIC NURSING FACILITIES
THAT QUALIFY FOR THE MEDICAL ASSISTANCE DAY-ONE INCENTIVE
PAYMENTS AND CALCULATE THE PAYMENTS USING THE TOTAL PENNSYLVANIA
MEDICAL ASSISTANCE (PA MA) DAYS AND TOTAL RESIDENT DAYS AS
REPORTED BY NONPUBLIC NURSING FACILITIES UNDER ARTICLE VIII-A.
THE DEPARTMENT'S DETERMINATION AND CALCULATIONS UNDER THIS
SUBPARAGRAPH SHALL BE BASED ON THE NURSING FACILITY ASSESSMENT
QUARTERLY RESIDENT DAY REPORTING FORMS, AS DETERMINED BY THE
DEPARTMENT. THE DEPARTMENT SHALL NOT RETROACTIVELY REVISE A
MEDICAL ASSISTANCE DAY-ONE INCENTIVE PAYMENT AMOUNT BASED ON A
NURSING FACILITY'S LATE SUBMISSION OR REVISION OF THE
DEPARTMENT'S REPORT AFTER THE DATES DESIGNATED BY THE
DEPARTMENT. THE DEPARTMENT, HOWEVER, MAY RECOUP PAYMENTS BASED
ON AN AUDIT OF A NURSING FACILITY'S REPORT. THE FOLLOWING SHALL
APPLY:
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(A) A NONPUBLIC NURSING FACILITY SHALL MEET ALL OF THE
FOLLOWING CRITERIA TO QUALIFY FOR A MEDICAL ASSISTANCE DAY-ONE
INCENTIVE PAYMENT:
(I) THE NURSING FACILITY SHALL HAVE AN OVERALL OCCUPANCY
RATE OF AT LEAST EIGHTY-FIVE PERCENT DURING THE RESIDENT DAY
QUARTER. FOR PURPOSES OF DETERMINING A NURSING FACILITY'S
OVERALL OCCUPANCY RATE, A NURSING FACILITY'S TOTAL RESIDENT
DAYS, AS REPORTED BY THE FACILITY UNDER ARTICLE VIII-A, SHALL BE
DIVIDED BY THE PRODUCT OF THE FACILITY'S LICENSED BED CAPACITY,
AT THE END OF THE QUARTER, MULTIPLIED BY THE NUMBER OF CALENDAR
DAYS IN THE QUARTER.
(II) THE NURSING FACILITY SHALL HAVE A MEDICAL ASSISTANCE
OCCUPANCY RATE OF AT LEAST SIXTY-FIVE PERCENT DURING THE
RESIDENT DAY QUARTER. FOR PURPOSES OF DETERMINING A NURSING
FACILITY'S MEDICAL ASSISTANCE OCCUPANCY RATE, THE NURSING
FACILITY'S TOTAL PA MA DAYS SHALL BE DIVIDED BY THE NURSING
FACILITY'S TOTAL RESIDENT DAYS, AS REPORTED BY THE FACILITY
UNDER ARTICLE VIII-A.
(III) THE NURSING FACILITY SHALL BE A NONPUBLIC NURSING
FACILITY FOR A FULL RESIDENT DAY QUARTER PRIOR TO THE APPLICABLE
QUARTERLY REPORTING DUE DATES, AS DETERMINED BY THE DEPARTMENT.
(B) THE DEPARTMENT SHALL CALCULATE A QUALIFIED NONPUBLIC
NURSING FACILITY'S MEDICAL ASSISTANCE DAY-ONE INCENTIVE PAYMENT
AS FOLLOWS:
(I) THE TOTAL FUNDS APPROPRIATED FOR PAYMENTS UNDER THIS
SUBPARAGRAPH SHALL BE DIVIDED BY THE NUMBER OF PAYMENTS, AS
DETERMINED BY THE DEPARTMENT.
(II) TO ESTABLISH THE PER DIEM RATE FOR A PAYMENT, THE
AMOUNT UNDER SUBCLAUSE (I) SHALL BE DIVIDED BY THE TOTAL PA MA
DAYS, AS REPORTED BY ALL QUALIFYING NONPUBLIC NURSING FACILITIES
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UNDER ARTICLE VIII-A FOR THAT PAYMENT.
(III) TO DETERMINE A QUALIFYING NONPUBLIC NURSING FACILITY'S
MEDICAL ASSISTANCE DAY-ONE INCENTIVE PAYMENT, THE PER DIEM RATE
CALCULATED FOR THE PAYMENT SHALL BE MULTIPLIED BY A NONPUBLIC
NURSING FACILITY'S TOTAL PA MA DAYS, AS REPORTED BY THE FACILITY
UNDER ARTICLE VIII-A FOR THE PAYMENT.
(C) FOR FISCAL YEARS 2015-2016 [AND], 2016-2017 AND 2018-
2019, THE STATE FUNDS AVAILABLE FOR THE NONPUBLIC NURSING
FACILITY MEDICAL ASSISTANCE DAY-ONE INCENTIVE PAYMENTS SHALL
EQUAL EIGHT MILLION DOLLARS ($8,000,000).
* * *
SECTION 3. THE ACT IS AMENDED BY ADDING A SECTION TO READ:
SECTION 443.12. NONEMERGENCY MEDICAL TRANSPORTATION
SERVICES.--(A) THE DEPARTMENT SHALL AMEND THE COMMONWEALTH'S
STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT (49 STAT.
620, 42 U.S.C. § 1396 ET SEQ.) TO PROVIDE NONEMERGENCY MEDICAL
TRANSPORTATION SERVICES TO ELIGIBLE AND ENROLLED MEDICAL
ASSISTANCE RECIPIENTS UTILIZING A STATEWIDE OR REGIONAL FULL-
RISK BROKERAGE MODEL.
(B) SUBJECT TO FEDERAL APPROVAL OF THE AMENDMENTS TO THE
COMMONWEALTH'S APPROVED TITLE XIX STATE PLAN, THE DEPARTMENT
SHALL DEVELOP A PROPOSAL AND SOLICIT A BROKER TO ADMINISTER THE
PROGRAM. A BROKER DETERMINED ELIGIBLE BY THE DEPARTMENT MAY
SUBMIT A PROPOSAL. THE DEPARTMENT SHALL ENTER INTO A CONTRACT
WITH EACH BROKER WHOSE PROPOSAL HAS BEEN SELECTED TO ADMINISTER
THE PROGRAM.
(C) THE DEPARTMENT SHALL ISSUE THE SOLICITATION FOR A
STATEWIDE OR REGIONAL FULL-RISK BROKERAGE MODEL WITHIN ONE
HUNDRED EIGHTY DAYS AFTER THE EFFECTIVE DATE OF THIS SUBSECTION.
SECTION 3.1. THE ACT IS AMENDED BY ADDING AN ARTICLE TO
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READ:
ARTICLE V-A
HEALTH CARE OUTCOMES
SUBARTICLE A
PRELIMINARY PROVISIONS
SECTION 501-A. DEFINITIONS.
THE FOLLOWING WORDS AND PHRASES WHEN USED IN THIS ARTICLE
SHALL HAVE THE MEANINGS GIVEN TO THEM IN THIS SECTION UNLESS THE
CONTEXT CLEARLY INDICATES OTHERWISE:
"ALL PATIENT REFINED DIAGNOSIS RELATED GROUPS." A VERSION OF
DIAGNOSIS RELATED GROUPS THAT FURTHER SUBDIVIDE THE DIAGNOSIS
RELATED GROUPS INTO FOUR SEVERITY-OF-ILLNESS AND FOUR RISK-OF-
MORTALITY SUBCLASSES WITHIN EACH DIAGNOSIS RELATED GROUPS.
"DIAGNOSIS RELATED GROUPS." A CLASSIFICATION SYSTEM THAT
USES PATIENT DISCHARGE INFORMATION TO CLASSIFY PATIENTS INTO
CLINICALLY MEANINGFUL GROUPS.
"HOSPITAL." A PUBLIC OR PRIVATE INSTITUTION LICENSED AS A
HOSPITAL UNDER THE LAWS OF THIS COMMONWEALTH THAT PARTICIPATES
IN THE MEDICAID PROGRAM.
"MANAGED CARE ORGANIZATION." A LICENSED MANAGED CARE
ORGANIZATION WITH WHOM THE DEPARTMENT HAS CONTRACTED TO PROVIDE
OR ARRANGE FOR SERVICES TO A MEDICAID RECIPIENT.
"MEDICAID PROGRAM." THE COMMONWEALTH'S MEDICAL ASSISTANCE
PROGRAM AUTHORIZED UNDER ARTICLE IV.
"POTENTIALLY AVOIDABLE ADMISSION." AN ADMISSION OF AN
INDIVIDUAL TO A HOSPITAL OR LONG-TERM CARE FACILITY THAT MAY
HAVE REASONABLY BEEN PREVENTED WITH ADEQUATE ACCESS TO
AMBULATORY CARE OR HEALTH CARE COORDINATION.
"POTENTIALLY AVOIDABLE COMPLICATION." A HARMFUL EVENT OR
NEGATIVE OUTCOME WITH RESPECT TO AN INDIVIDUAL, INCLUDING AN
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INFECTION OR SURGICAL COMPLICATION, THAT:
(1) OCCURS AFTER THE PERSON'S ADMISSION TO A HOSPITAL OR
LONG-TERM CARE FACILITY; AND
(2) MAY HAVE RESULTED FROM THE CARE, LACK OF CARE OR
TREATMENT PROVIDED DURING THE HOSPITAL OR LONG-TERM CARE
FACILITY STAY RATHER THAN FROM A NATURAL PROGRESSION OF AN
UNDERLYING DISEASE.
"POTENTIALLY AVOIDABLE EMERGENCY VISIT." TREATMENT OF AN
INDIVIDUAL IN A HOSPITAL EMERGENCY ROOM OR FREESTANDING
EMERGENCY MEDICAL CARE FACILITY FOR A CONDITION THAT MAY NOT
REQUIRE EMERGENCY MEDICAL ATTENTION BECAUSE THE CONDITION COULD
BE OR COULD HAVE BEEN TREATED OR PREVENTED BY A PHYSICIAN OR
OTHER HEALTH CARE PROVIDER IN A NONEMERGENCY SETTING.
"POTENTIALLY AVOIDABLE EVENT." ANY OF THE FOLLOWING:
(1) A POTENTIALLY AVOIDABLE ADMISSION.
(2) A POTENTIALLY AVOIDABLE COMPLICATION.
(3) A POTENTIALLY AVOIDABLE EMERGENCY VISIT.
(4) A POTENTIALLY AVOIDABLE READMISSION.
(5) A COMBINATION OF THE EVENTS LISTED UNDER THIS
DEFINITION.
"POTENTIALLY AVOIDABLE READMISSION." A RETURN
HOSPITALIZATION OF AN INDIVIDUAL WITHIN A PERIOD SPECIFIED BY
THE DEPARTMENT THAT MAY HAVE RESULTED FROM A DEFICIENCY IN THE
CARE OR TREATMENT PROVIDED TO THE INDIVIDUAL DURING A PREVIOUS
HOSPITAL STAY OR FROM A DEFICIENCY IN POST-HOSPITAL DISCHARGE
FOLLOW-UP. THE TERM DOES NOT INCLUDE A HOSPITAL READMISSION
NECESSITATED BY THE OCCURRENCE OF UNRELATED EVENTS AFTER THE
DISCHARGE. THE TERM INCLUDES THE READMISSION OF AN INDIVIDUAL TO
A HOSPITAL FOR:
(1) THE SAME CONDITION OR PROCEDURE FOR WHICH THE
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INDIVIDUAL WAS PREVIOUSLY ADMITTED.
(2) AN INFECTION OR OTHER COMPLICATION RESULTING FROM
CARE PREVIOUSLY PROVIDED.
(3) A CONDITION OR PROCEDURE THAT INDICATES THAT A
SURGICAL INTERVENTION PERFORMED DURING A PREVIOUS ADMISSION
WAS UNSUCCESSFUL IN ACHIEVING THE ANTICIPATED OUTCOME.
SECTION 502-A. APPLICABILITY.
THIS ARTICLE SHALL APPLY TO THE EXTENT PERMITTED BY FEDERAL
LAW.
SUBARTICLE B
MEDICAID OUTCOMES-BASED PROGRAMS
SECTION 511-A. ESTABLISHMENT.
THE DEPARTMENT SHALL ESTABLISH THE FOLLOWING LINKED MEDICAID
OUTCOMES-BASED PROGRAMS:
(1) A HOSPITAL OUTCOMES PROGRAM DESIGNED TO PROVIDE A
HOSPITAL WITH INFORMATION TO REDUCE POTENTIALLY AVOIDABLE
EVENTS AND FURTHER INCREASE EFFICIENCY IN MEDICAID HOSPITAL
SERVICES.
(2) A MANAGED CARE ORGANIZATION OUTCOMES PROGRAM
DESIGNED TO PROVIDE A MEDICAID MANAGED CARE ORGANIZATION WITH
INFORMATION TO REDUCE POTENTIALLY AVOIDABLE EVENTS AND
FURTHER INCREASE EFFICIENCY IN MEDICAID MANAGED CARE
PROGRAMS.
SECTION 512-A. SELECTION OF POTENTIALLY AVOIDABLE EVENT
METHODOLOGY.
THE DEPARTMENT SHALL SELECT A METHODOLOGY FOR IDENTIFYING
POTENTIALLY AVOIDABLE EVENTS AND THE COSTS ASSOCIATED WITH THE
EVENTS AND FOR MEASURING HOSPITAL AND MANAGED CARE ORGANIZATION
PERFORMANCE WITH RESPECT TO THE EVENTS. THE FOLLOWING SHALL
APPLY:
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(1) THE DEPARTMENT SHALL DEVELOP PARAMETERS FOR EACH OF
THE POTENTIALLY AVOIDABLE EVENTS IN ACCORDANCE WITH THE
SELECTED METHODOLOGY.
(2) TO THE EXTENT POSSIBLE, THE METHODOLOGY SHALL BE ONE
THAT HAS BEEN USED BY A STATE PROGRAM UNDER TITLE XIX OF THE
SOCIAL SECURITY ACT (49 STAT. 620, 42 U.S.C. § 301 ET SEQ.)
OR BY A COMMERCIAL PAYER IN HEALTH CARE OUTCOMES PERFORMANCE
MEASUREMENT AND IN OUTCOME-BASED PROGRAMS.
(3) THE METHODOLOGY SHALL UTILIZE A CLINICAL CATEGORICAL
MODEL, ENABLE THE PROVISION OF PERFORMANCE INFORMATION ON
BOTH THE AGGREGATE AND CASE LEVEL AND RISK ADJUST SCORING TO
ACCOUNT FOR PATIENT SEVERITY OF ILLNESS AND POPULATION
CHRONIC ILLNESS BURDEN.
SECTION 513-A. STATEWIDE ANALYSIS OF MEDICAID SYSTEM.
THE DEPARTMENT SHALL CONDUCT A COMPREHENSIVE ANALYSIS OF
EXISTING RELEVANT STATE DATABASES TO INCREASE EFFICIENCY IN THE
MEDICAID SYSTEM. THE FOLLOWING SHALL APPLY:
(1) THE ANALYSIS SHALL IDENTIFY INSTANCES OF POTENTIALLY
AVOIDABLE EVENTS IN THE MEDICAID SYSTEM AND THE COSTS
ASSOCIATED WITH THESE CASES.
(2) THE OVERALL ESTIMATE OF COST SHALL BE BROKEN DOWN
INTO ACTIONABLE CATEGORIES, INCLUDING, BUT NOT LIMITED TO,
REGIONS, HOSPITALS, MANAGED CARE ORGANIZATIONS, PHYSICIANS,
SERVICE LINES, DIAGNOSIS RELATED GROUPS, MEDICAL CONDITIONS
AND PROCEDURES, PATIENT CHARACTERISTICS, PROVIDER
CHARACTERISTICS AND MEDICAID PROGRAM TYPE.
(3) INFORMATION COLLECTED FROM THE POTENTIALLY AVOIDABLE
EVENT STUDY SHALL BE UTILIZED IN THE HOSPITAL OUTCOMES
PROGRAM AND MANAGED CARE ORGANIZATION OUTCOMES PROGRAM.
SECTION 514-A. REPORT ON STATEWIDE ANALYSIS OF MEDICAID SYSTEM.
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(A) REPORT.--THE DEPARTMENT SHALL PROVIDE A REPORT ON THE
COMPREHENSIVE ANALYSIS CONDUCTED UNDER SECTION 513-A TO THE
GENERAL ASSEMBLY NO LATER THAN DECEMBER 31, 2019.
(B) RECOMMENDATIONS.-- THE REPORT SHALL INCLUDE
RECOMMENDATIONS ON HOW HOSPITALS AND MANAGED CARE ORGANIZATIONS
CAN IMPROVE EFFICIENCY AND OUTCOMES BY REDUCING UNNECESSARY
SERVICES. THE DEPARTMENT SHALL ALIGN THE RECOMMENDATIONS WITH
THE DEPARTMENT'S OBJECTIVES TO ADVANCE HIGH-VALUE CARE, IMPROVE
POPULATION HEALTH, ENGAGE AND SUPPORT PROVIDERS AND ESTABLISH A
SUSTAINABLE MEDICAID PROGRAM WITH PREDICTABLE COSTS .
SUBARTICLE C
HOSPITAL OUTCOMES PROGRAM
SECTION 521-A. PROCEDURE.
THE HOSPITAL OUTCOMES PROGRAM SHALL:
(1) TARGET REDUCTION OF POTENTIALLY AVOIDABLE
READMISSIONS AND COMPLICATIONS.
(2) APPLY TO EACH STATE ACUTE CARE HOSPITAL
PARTICIPATING IN THE MEDICAID PROGRAM, EXCEPT THAT PROGRAM
ADJUSTMENTS MAY BE MADE FOR CERTAIN TYPES OF HOSPITALS.
(3) ESTABLISH A PERFORMANCE REPORTING SYSTEM FOR
POTENTIALLY AVOIDABLE READMISSIONS AND COMPLICATIONS FOR
HOSPITALS PARTICIPATING IN MEDICAID.
SECTION 522-A. HOSPITAL PERFORMANCE REPORTING.
THE DEPARTMENT SHALL DEVELOP AND MAINTAIN A REPORTING SYSTEM
TO PROVIDE EACH HOSPITAL WITH REGULAR CONFIDENTIAL REPORTS
REGARDING THE HOSPITAL'S PERFORMANCE WITH RESPECT TO POTENTIALLY
AVOIDABLE READMISSIONS AND POTENTIALLY AVOIDABLE COMPLICATIONS.
THE DEPARTMENT SHALL:
(1) CONDUCT ONGOING ANALYSES OF EXISTING AND RELEVANT
STATE CLAIMS DATABASES TO IDENTIFY INSTANCES OF POTENTIALLY
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AVOIDABLE COMPLICATIONS AND READMISSIONS AND THE EXPENDITURES
ASSOCIATED WITH THE CASES.
(2) CREATE OR LOCATE STATEWIDE COMPLICATIONS AND
READMISSIONS NORMS.
(3) MEASURE ACTUAL-TO-EXPECTED HOSPITAL PERFORMANCE
COMPARED TO STATEWIDE NORMS.
(4) COMPARE HOSPITALS WITH THE HOSPITALS' PEERS USING
RISK ADJUSTMENT PROCEDURES THAT ACCOUNT FOR THE SEVERITY OF
ILLNESS OF EACH HOSPITAL'S PATIENTS.
(5) DISTRIBUTE REPORTS TO HOSPITALS TO PROVIDE THEM WITH
ACTIONABLE INFORMATION TO CREATE POLICIES, CONTRACTS AND
PROGRAMS DESIGNED TO IMPROVE TARGET OUTCOMES.
(6) FOSTER COLLABORATION AMONG HOSPITALS IN SHARING BEST
PRACTICES.
SECTION 523-A. HOSPITAL OUTCOMES INFORMATION SHARING.
A HOSPITAL MAY SHARE THE INFORMATION CONTAINED IN THE OUTCOME
PERFORMANCE REPORTS WITH PHYSICIANS AND OTHER HEALTH CARE
PROVIDERS PROVIDING SERVICES AT THE HOSPITAL TO FOSTER
COORDINATION AND COOPERATION IN THE HOSPITAL'S OUTCOME
IMPROVEMENT AND EFFICIENCY INITIATIVES.
SECTION 524-A. VALUE-BASED MODELS.
AFTER THE IMPLEMENTATION OF THE REPORTING SYSTEM UNDER
SECTION 522-A, THE DEPARTMENT SHALL EVALUATE VALUE-BASED MODELS
THAT WILL SUPPORT HOSPITALS IN REDUCING RATES OF POTENTIALLY
AVOIDABLE COMPLICATIONS AND READMISSIONS.
SECTION 525-A. MEDICAID ENROLLED HOSPITAL CONTRACT.
THE DEPARTMENT SHALL AMEND CONTRACTS ENTERED INTO OR RENEWED
ON OR AFTER THE EFFECTIVE DATE OF THIS SECTION WITH THE
DEPARTMENT'S MEDICAID ENROLLED HOSPITALS AS NECESSARY TO
INCORPORATE THE HOSPITAL OUTCOMES PROGRAM.
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SECTION 526-A. PROGRESS REPORT ON HOSPITAL OUTCOMES PROGRAM.
BY MARCH 1, 2020, AND EACH MARCH 1 THEREAFTER, THE DEPARTMENT
SHALL PROVIDE A REPORT ON THE PROGRESS OF THE HOSPITAL OUTCOMES
PROGRAM TO THE GENERAL ASSEMBLY. THE REPORT SHALL CHART THE
REDUCTIONS IN THE RATES OF POTENTIALLY AVOIDABLE COMPLICATIONS
AND READMISSIONS AND THE IMPACT OF SUCH REDUCTIONS ON MEDICAID
COSTS.
SUBARTICLE D
MANAGED CARE ORGANIZATION OUTCOMES PROGRAM
SECTION 531-A. PROCEDURE.
THE MANAGED CARE ORGANIZATION OUTCOMES PROGRAM SHALL:
(1) TARGET REDUCTION OF AVOIDABLE ADMISSIONS,
READMISSIONS AND EMERGENCY VISITS.
(2) APPLY TO EACH MANAGED CARE ORGANIZATION
PARTICIPATING IN THE MEDICAID PROGRAM.
(3) ESTABLISH A PERFORMANCE REPORTING SYSTEM FOR
POTENTIALLY AVOIDABLE ADMISSIONS, READMISSIONS AND EMERGENCY
VISITS FOR MANAGED CARE ORGANIZATIONS PARTICIPATING IN
MEDICAID MANAGED CARE.
(4) ACCOUNT FOR THE DIVERSE MEDICALLY COMPLEX
POPULATIONS.
SECTION 532-A. MANAGED CARE ORGANIZATION PERFORMANCE REPORTING.
THE DEPARTMENT SHALL DEVELOP AND MAINTAIN A REPORTING SYSTEM
TO PROVIDE EACH MANAGED CARE ORGANIZATION WITH REGULAR
CONFIDENTIAL REPORTS REGARDING THE MANAGED CARE ORGANIZATION'S
PERFORMANCE WITH RESPECT TO POTENTIALLY AVOIDABLE ADMISSIONS,
READMISSIONS AND EMERGENCY VISITS. THE DEPARTMENT SHALL:
(1) CONDUCT ONGOING ANALYSES OF EXISTING AND RELEVANT
STATE CLAIMS DATABASES TO IDENTIFY INSTANCES OF POTENTIALLY
AVOIDABLE ADMISSIONS, READMISSIONS AND EMERGENCY VISITS WITH
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POTENTIAL EXCESS EXPENDITURES ASSOCIATED WITH THE CASES.
(2) CREATE OR LOCATE STATEWIDE NORMS FOR ADMISSIONS,
READMISSIONS AND EMERGENCY VISITS.
(3) MEASURE ACTUAL-TO-EXPECTED MANAGED CARE ORGANIZATION
PERFORMANCE COMPARED TO STATEWIDE NORMS.
(4) COMPARE MANAGED CARE ORGANIZATIONS WITH THE MANAGED
CARE ORGANIZATIONS' PEERS USING RISK ADJUSTMENT PROCEDURES
THAT ACCOUNT FOR THE CHRONIC ILLNESS BURDEN OF EACH PLAN'S
ENROLLEES.
(5) DISTRIBUTE REPORTS TO MANAGED CARE ORGANIZATIONS TO
PROVIDE THE MANAGED CARE ORGANIZATIONS WITH ACTIONABLE
INFORMATION TO CREATE POLICIES, CONTRACTS AND PROGRAMS
DESIGNED TO IMPROVE TARGET OUTCOMES.
SECTION 533-A. MANAGED CARE ORGANIZATION OUTCOMES INFORMATION
SHARING.
A MANAGED CARE ORGANIZATION MAY SHARE THE INFORMATION
CONTAINED IN THE OUTCOME PERFORMANCE REPORTS WITH THE MANAGED
CARE ORGANIZATION'S PARTICIPATING PROVIDERS TO FOSTER
COORDINATION AND COOPERATION IN THE MANAGED CARE ORGANIZATION'S
OUTCOME IMPROVEMENT AND EFFICIENCY INITIATIVES.
SECTION 534-A. VALUE-BASED MODELS.
AFTER THE IMPLEMENTATION OF THE REPORTING SYSTEM UNDER
SECTION 532-A, THE DEPARTMENT SHALL EVALUATE VALUE-BASED MODELS
THAT WILL SUPPORT MANAGED CARE ORGANIZATIONS IN REDUCING RATES
OF POTENTIALLY AVOIDABLE ADMISSIONS, READMISSIONS AND EMERGENCY
VISITS.
SECTION 535-A. MANAGED CARE ORGANIZATION MEDICAID CONTRACTS.
THE DEPARTMENT SHALL AMEND CONTRACTS ENTERED INTO OR RENEWED
ON OR AFTER THE EFFECTIVE DATE OF THIS SECTION WITH THE
DEPARTMENT'S PARTICIPATING MANAGED CARE ORGANIZATIONS AS
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NECESSARY TO INCORPORATE THE MANAGED CARE ORGANIZATION OUTCOMES
PROGRAM.
SECTION 536-A. PROGRESS REPORT ON MANAGED CARE ORGANIZATION
OUTCOMES PROGRAM.
BY MARCH 1, 2020, AND EACH MARCH 1 THEREAFTER, THE DEPARTMENT
SHALL PROVIDE A REPORT ON THE PROGRESS OF THE MANAGED CARE
ORGANIZATION OUTCOMES PROGRAM TO THE GENERAL ASSEMBLY. THE
REPORT SHALL CHART THE REDUCTIONS IN THE RATES OF POTENTIALLY
AVOIDABLE COMPLICATIONS, READMISSIONS AND EMERGENCY ROOM VISITS
AND THE IMPACT OF SUCH REDUCTIONS ON MEDICAID COSTS.
SECTION 3.2. THE ACT IS AMENDED BY ADDING A SECTION TO READ:
SECTION 602. LIFE PROGRAM.--(A) INFORMATIONAL MATERIALS AND
DEPARTMENT CORRESPONDENCE USED BY THE DEPARTMENT TO EDUCATE OR
NOTIFY AN ELIGIBLE INDIVIDUAL ABOUT LONG-TERM CARE SERVICES AND
SUPPORTS, INCLUDING AN INDIVIDUAL'S RIGHTS, RESPONSIBILITIES AND
CHOICE OF MANAGED CARE ORGANIZATION TO COVER LONG-TERM CARE
SERVICES AND SUPPORTS, SHALL INCLUDE THE FOLLOWING:
(1) A DESCRIPTION OF THE LIFE PROGRAM.
(2) A STATEMENT THAT AN ELIGIBLE INDIVIDUAL HAS THE OPTION
TO ENROLL IN THE LIFE PROGRAM OR A MANAGED CARE ORGANIZATION
UNDER THE COMMUNITY HEALTH CHOICES PROGRAM.
(3) CONTACT INFORMATION FOR LIFE PROVIDERS.
(B) THE DEPARTMENT SHALL CONTINUE TO PROVIDE TRAINING TO THE
INDEPENDENT ENROLLMENT BROKER ON THE LIFE PROGRAM THROUGH THE
INDEPENDENT ENROLLMENT BROKER LIFE MODULE TO BETTER EDUCATE THE
INDEPENDENT ENROLLMENT BROKER.
(C) AT THE END OF EACH QUARTER, THE DEPARTMENT SHALL ISSUE A
REPORT THAT TRACKS BY COUNTY THE ENROLLMENT OF ELIGIBLE
INDIVIDUALS IN LONG-TERM CARE SERVICE PROGRAMS, INCLUDING
MANAGED CARE ORGANIZATIONS AND LIFE PROGRAMS.
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(D) AS USED IN THIS SECTION, THE FOLLOWING WORDS AND PHRASES
SHALL HAVE THE MEANINGS GIVEN TO THEM IN THIS SUBSECTION UNLESS
THE CONTEXT CLEARLY INDICATES OTHERWISE:
"ELIGIBLE INDIVIDUAL." AN INDIVIDUAL, AGE 55 OR OLDER, WHO
IS A RESIDENT OF THIS COMMONWEALTH AND WHO REQUIRES LONG-TERM
SERVICES OR SUPPORTS IN ORDER TO REMAIN LIVING IN THE COMMUNITY
AND NOT IN A NURSING FACILITY.
"INDEPENDENT ENROLLMENT BROKER." A CONTRACTED STATEWIDE
ENTITY THAT FACILITATES THE ELIGIBILITY AND ENROLLMENT PROCESS
FOR INDIVIDUALS SEEKING HOME AND COMMUNITY-BASED SERVICES AND
WORKS WITH SERVICE COORDINATION PROVIDERS TO RESPOND TO
PARTICIPANTS' NEEDS.
"LIFE PROGRAM." A PROGRAM WHICH IS A MANAGED CARE PROGRAM
THAT PROVIDES ALL-INCLUSIVE CARE FOR ELDERLY INDIVIDUALS IN THIS
COMMONWEALTH AS ESTABLISHED IN ACCORDANCE WITH 42 CFR PT. 460
(RELATING TO PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY
(PACE)).
SECTION 4. SECTION 704.3(A) OF THE ACT IS AMENDED TO READ:
SECTION 704.3. PROVIDER SUBMISSIONS.--(A) [FOR FISCAL YEARS
2013-2014, 2014-2015, 2015-2016 AND 2016-2017, A] A PROVIDER
SHALL SUBMIT DOCUMENTATION OF ITS COSTS OF PROVIDING SERVICES;
AND THE DEPARTMENT SHALL USE SUCH DOCUMENTATION, TO THE EXTENT
NECESSARY, TO SUPPORT THE DEPARTMENT'S CLAIM FOR FEDERAL FUNDING
AND FOR STATE REIMBURSEMENT FOR ALLOWABLE DIRECT AND INDIRECT
COSTS INCURRED IN THE PROVISION OF OUT-OF-HOME PLACEMENT
SERVICES. THE DEPARTMENT MAY INCLUDE COMPONENTS OF THE
RECOMMENDATIONS OF THE RATE METHODOLOGY TASK FORCE ESTABLISHED
UNDER THIS SECTION AS PART OF THE PROVIDER DOCUMENTATION TO
ENSURE FEDERAL REIMBURSEMENT.
* * *
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SECTION 5. THE DEFINITION OF "NET INPATIENT REVENUE" IN
SECTION 801-G OF THE ACT IS AMENDED AND THE SECTION IS AMENDED
BY ADDING A DEFINITION TO READ:
SECTION 801-G. DEFINITIONS.
THE FOLLOWING WORDS AND PHRASES WHEN USED IN THIS ARTICLE
SHALL HAVE THE MEANINGS GIVEN TO THEM IN THIS SECTION UNLESS THE
CONTEXT CLEARLY INDICATES OTHERWISE:
* * *
"NET INPATIENT REVENUE." GROSS CHARGES FOR FACILITIES FOR
INPATIENT SERVICES LESS ANY DEDUCTED AMOUNTS FOR BAD DEBT
EXPENSE, CHARITY CARE EXPENSE AND CONTRACTUAL ALLOWANCES AS
REPORTED ON FORMS SPECIFIED BY THE DEPARTMENT AND:
(1) AS IDENTIFIED IN THE HOSPITAL'S RECORDS FOR THE
STATE FISCAL YEAR COMMENCING JULY 1, [2010] 2014, OR SUCH
LATER STATE FISCAL YEAR, AS MAY BE SPECIFIED BY THE
DEPARTMENT FOR USE IN DETERMINING AN ANNUAL ASSESSMENT AMOUNT
OWED ON OR AFTER JULY 1, [2016] 2018; OR
(2) AS IDENTIFIED IN THE HOSPITAL'S RECORDS FOR THE MOST
RECENT STATE FISCAL YEAR, OR PART THEREOF, IF AMOUNTS ARE NOT
AVAILABLE UNDER PARAGRAPH (1).
"NET OUTPATIENT REVENUE." GROSS CHARGES FOR FACILITIES FOR
OUTPATIENT SERVICES LESS ANY DEDUCTED AMOUNTS FOR BAD DEBT
EXPENSE, CHARITY CARE EXPENSE AND CONTRACTUAL ALLOWANCES AS
REPORTED ON FORMS SPECIFIED BY THE DEPARTMENT AND:
(1) AS IDENTIFIED IN THE HOSPITAL'S RECORDS FOR THE
STATE FISCAL YEAR COMMENCING JULY 1, 2014, OR A LATER STATE
FISCAL YEAR, AS MAY BE SPECIFIED BY THE DEPARTMENT FOR USE IN
DETERMINING AN ANNUAL ASSESSMENT AMOUNT OWED ON OR AFTER JULY
1, 2018; OR
(2) AS IDENTIFIED IN THE HOSPITAL'S RECORDS FOR THE MOST
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RECENT STATE FISCAL YEAR, OR PART THEREOF, IF AMOUNTS ARE NOT
AVAILABLE UNDER PARAGRAPH (1).
* * *
SECTION 6. SECTION 803-G(B), (C) AND (C.1) OF THE ACT ARE
AMENDED AND THE SECTION IS AMENDED BY ADDING A SUBSECTION TO
READ:
SECTION 803-G. IMPLEMENTATION.
* * *
(B) ASSESSMENT PERCENTAGE.--SUBJECT TO SUBSECTION (C), EACH
COVERED HOSPITAL SHALL BE ASSESSED AS FOLLOWS:
(1) FOR FISCAL YEAR 2010-2011, EACH COVERED HOSPITAL
SHALL BE ASSESSED AN AMOUNT EQUAL TO 2.69% OF THE NET
INPATIENT REVENUE OF THE COVERED HOSPITAL;
(2) FOR FISCAL YEARS 2011-2012, 2012-2013, 2013-2014 AND
2014-2015, AN AMOUNT EQUAL TO 3.22% OF THE NET INPATIENT
REVENUE OF THE COVERED HOSPITAL; [AND]
(3) FOR FISCAL YEARS 2015-2016, 2016-2017 AND 2017-2018,
AN AMOUNT EQUAL TO 3.71% OF THE NET INPATIENT REVENUE OF THE
COVERED HOSPITAL[.];
(4) FOR FISCAL YEAR 2018-2019, AN AMOUNT EQUAL TO 2.98%
OF THE NET INPATIENT REVENUE OF THE COVERED HOSPITAL AND
1.55% OF THE NET OUTPATIENT REVENUE OF THE COVERED HOSPITAL;
AND
(5) FOR FISCAL YEARS 2019-2020, 2020-2021, 2021-2022 AND
2022-2023, AN AMOUNT EQUAL TO 3.32% OF THE NET INPATIENT
REVENUE OF THE COVERED HOSPITAL AND 1.73% OF THE NET
OUTPATIENT REVENUE OF THE COVERED HOSPITAL.
(C) ADJUSTMENTS TO ASSESSMENT PERCENTAGE.--THE SECRETARY MAY
ADJUST THE ASSESSMENT PERCENTAGE SPECIFIED IN SUBSECTION (B) FOR
ALL OR PART OF THE FISCAL YEAR FOR INPATIENT SERVICES,
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OUTPATIENT SERVICES OR BOTH, PROVIDED THAT, BEFORE IMPLEMENTING
AN ADJUSTMENT, THE SECRETARY SHALL PUBLISH A NOTICE IN THE
PENNSYLVANIA BULLETIN THAT SPECIFIES THE PROPOSED ASSESSMENT
PERCENTAGE AND IDENTIFIES THE AGGREGATE IMPACT ON COVERED
HOSPITALS SUBJECT TO THE ASSESSMENT. INTERESTED PARTIES SHALL
HAVE 30 DAYS IN WHICH TO SUBMIT COMMENTS TO THE SECRETARY. UPON
EXPIRATION OF THE 30-DAY COMMENT PERIOD, THE SECRETARY, AFTER
CONSIDERATION OF THE COMMENTS, SHALL PUBLISH A SECOND NOTICE IN
THE PENNSYLVANIA BULLETIN ANNOUNCING THE ASSESSMENT PERCENTAGE.
(C.1) REBASING NET INPATIENT REVENUE AMOUNTS.--FOR PURPOSES
OF CALCULATING THE ANNUAL ASSESSMENT AMOUNT OWED [ON OR AFTER
JULY 1, 2016] FOR FISCAL YEARS 2016-2017 AND 2017-2018, THE
SECRETARY MAY REQUIRE THE USE OF NET INPATIENT REVENUE AMOUNTS
AS IDENTIFIED IN THE RECORDS OF COVERED HOSPITALS FOR A STATE
FISCAL YEAR COMMENCING ON OR AFTER JULY 1, 2011. IF THE
SECRETARY DECIDES THAT THE NET INPATIENT REVENUE AMOUNTS SHOULD
BE REBASED, THE SECRETARY SHALL PUBLISH A NOTICE IN THE
PENNSYLVANIA BULLETIN SPECIFYING THE STATE FISCAL YEAR FOR WHICH
THE NET INPATIENT REVENUE AMOUNTS WILL BE USED AT LEAST 30 DAYS
PRIOR TO THE DATE ON WHICH AN ASSESSMENT AMOUNT CALCULATED WITH
THOSE REBASED AMOUNTS IS DUE TO BE PAID TO THE DEPARTMENT.
(C.2) REBASING NET INPATIENT AND NET OUTPATIENT REVENUE
AMOUNTS.--FOR PURPOSES OF CALCULATING THE ANNUAL ASSESSMENT
AMOUNT OWED ON OR AFTER JULY 1, 2018, THE SECRETARY MAY REQUIRE
THE USE OF NET INPATIENT REVENUE AND NET OUTPATIENT REVENUE
AMOUNTS AS IDENTIFIED IN THE RECORDS OF COVERED HOSPITALS FOR A
STATE FISCAL YEAR COMMENCING ON OR AFTER JULY 1, 2015. IF THE
SECRETARY DECIDES THAT THE NET INPATIENT AND NET OUTPATIENT
REVENUE AMOUNTS SHOULD BE BASED ON A STATE FISCAL YEAR
COMMENCING ON OR AFTER JULY 1, 2015, THE SECRETARY SHALL
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TRANSMIT A NOTICE TO THE LEGISLATIVE REFERENCE BUREAU FOR
PUBLICATION IN THE PENNSYLVANIA BULLETIN SPECIFYING THE STATE
FISCAL YEAR FOR WHICH THE NET INPATIENT AND NET OUTPATIENT
REVENUE AMOUNTS WILL BE USED AT LEAST 30 DAYS PRIOR TO THE DATE
ON WHICH AN ASSESSMENT AMOUNT CALCULATED WITH THE REBASED
AMOUNTS IS DUE TO BE PAID TO THE DEPARTMENT.
* * *
SECTION 7. SECTIONS 804-G(A), (A.1), (A.3), (C) AND (D),
805-G(B) AND 815-G OF THE ACT ARE AMENDED TO READ:
SECTION 804-G. ADMINISTRATION.
(A) CALCULATION AND NOTICE OF ASSESSMENT AMOUNT.--USING THE
ASSESSMENT PERCENTAGE ESTABLISHED UNDER SECTION 803-G AND
COVERED HOSPITALS' NET INPATIENT REVENUE FOR FISCAL YEARS
COMMENCING PRIOR TO JULY 1, 2018, OR COVERED HOSPITALS' NET
INPATIENT REVENUE AND NET OUTPATIENT REVENUE FOR FISCAL YEARS
COMMENCING ON OR AFTER JULY 1, 2018, THE DEPARTMENT SHALL
CALCULATE AND NOTIFY EACH COVERED HOSPITAL OF THE ASSESSMENT
AMOUNT OWED FOR THE FISCAL YEAR. NOTIFICATION PURSUANT TO THIS
SUBSECTION MAY BE MADE IN WRITING OR ELECTRONICALLY AT THE
DISCRETION OF THE DEPARTMENT.
(A.1) CALCULATION OF ASSESSMENT WITH CHANGES OF OWNERSHIP.--
(1) IF A SINGLE COVERED HOSPITAL CHANGES OWNERSHIP OR
CONTROL, THE DEPARTMENT WILL CONTINUE TO CALCULATE THE
ASSESSMENT AMOUNT USING [THE HOSPITAL'S NET INPATIENT REVENUE
FOR]:
(I) THE HOSPITAL'S NET INPATIENT REVENUE FOR STATE
FISCAL YEAR 2010-2011 IF THE CHANGE OF OWNERSHIP OCCURS
BEFORE JULY 1, 2018;
(II) [FOR A CHANGE ON OR AFTER JULY 1, 2016, THE
LATER STATE FISCAL YEAR, IF ANY,] THE HOSPITAL'S NET
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INPATIENT REVENUE AND NET OUTPATIENT REVENUE AMOUNTS FOR
STATE FISCAL YEAR 2014-2015, OR A LATER FISCAL YEAR THAT
HAS BEEN SPECIFIED BY THE SECRETARY FOR USE IN
DETERMINING THE ASSESSMENT AMOUNTS DUE FOR THE FISCAL
YEAR IN WHICH THE CHANGE OCCURS, IF THE CHANGE OF
OWNERSHIP OCCURS ON OR AFTER JULY 1, 2018; OR
(III) THE HOSPITAL'S NET INPATIENT REVENUE AND NET
OUTPATIENT REVENUE AMOUNTS FOR THE MOST RECENT STATE
FISCAL YEAR, OR PART THEREOF, IF THE NET INPATIENT
REVENUE AND NET OUTPATIENT REVENUE AMOUNTS SPECIFIED IN
[SUBPARAGRAPHS (I) AND (II) ARE] SUBPARAGRAPH (II) IS NOT
AVAILABLE. THE COVERED HOSPITAL IS LIABLE FOR ANY
OUTSTANDING ASSESSMENT AMOUNTS, INCLUDING OUTSTANDING
AMOUNTS RELATED TO PERIODS PRIOR TO THE CHANGE OF
OWNERSHIP OR CONTROL.
(2) IF TWO OR MORE HOSPITALS MERGE OR CONSOLIDATE INTO A
SINGLE COVERED HOSPITAL AS A RESULT OF A CHANGE IN OWNERSHIP
OR CONTROL, THE DEPARTMENT WILL CALCULATE THE ASSESSMENT
AMOUNT OWED BY THE SINGLE COVERED HOSPITAL RESULTING FROM THE
MERGER OR CONSOLIDATION USING [THE MERGED OR CONSOLIDATED
HOSPITALS' COMBINED NET INPATIENT REVENUE FOR]:
(I) THE MERGED OR CONSOLIDATED HOSPITALS' COMBINED
NET INPATIENT REVENUE FOR STATE FISCAL YEAR 2010-2011 IF
THE MERGER OR CONSOLIDATION OCCURS BEFORE JULY 1, 2018;
(II) [FOR A MERGER OR CONSOLIDATION ON OR AFTER JULY
1, 2016, THE LATER STATE FISCAL YEAR, IF ANY,] THE MERGED
OR CONSOLIDATED HOSPITALS' COMBINED NET INPATIENT REVENUE
AND NET OUTPATIENT REVENUE AMOUNTS FOR STATE FISCAL YEAR
2014-2015 OR A LATER FISCAL YEAR THAT HAS BEEN SPECIFIED
BY THE SECRETARY FOR USE IN DETERMINING THE ASSESSMENT
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AMOUNTS DUE FOR THE FISCAL YEAR IN WHICH THE MERGER OR
CONSOLIDATION OCCURS, IF THE MERGER OR CONSOLIDATION
OCCURS ON OR AFTER JULY 1, 2018; OR
(III) THE HOSPITAL'S NET INPATIENT REVENUE AND NET
OUTPATIENT REVENUE AMOUNTS FOR THE MOST RECENT STATE
FISCAL YEAR, OR PART THEREOF, IF THE NET INPATIENT
REVENUE AND NET OUTPATIENT REVENUE AMOUNTS SPECIFIED IN
[SUBPARAGRAPHS (I) AND (II) ARE] SUBPARAGRAPH (II) IS NOT
AVAILABLE, [OF] FOR ANY COVERED HOSPITALS THAT WERE
MERGED OR CONSOLIDATED INTO THE SINGLE COVERED HOSPITAL.
THE SINGLE COVERED HOSPITAL IS LIABLE FOR ANY OUTSTANDING
ASSESSMENT AMOUNTS, INCLUDING OUTSTANDING AMOUNTS RELATED
TO PERIODS PRIOR TO THE CHANGE OF OWNERSHIP OR CONTROL,
OF ANY COVERED HOSPITAL THAT WAS MERGED OR CONSOLIDATED.
* * *
(A.3) CALCULATION OF ASSESSMENT FOR NEW HOSPITALS.--A
HOSPITAL THAT BEGINS OPERATION AS A COVERED HOSPITAL DURING A
FISCAL YEAR IN WHICH AN ASSESSMENT IS IN EFFECT SHALL BE
ASSESSED AS FOLLOWS:
(1) DURING THE STATE FISCAL YEAR IN WHICH A COVERED
HOSPITAL BEGINS OPERATION OR IN WHICH A HOSPITAL BECOMES A
COVERED HOSPITAL, THE COVERED HOSPITAL IS NOT SUBJECT TO THE
ASSESSMENT.
(2) FOR THE STATE FISCAL YEAR FOLLOWING THE STATE FISCAL
YEAR UNDER PARAGRAPH (1), THE DEPARTMENT SHALL CALCULATE THE
HOSPITAL'S ASSESSMENT AMOUNT USING:
(I) THE NET INPATIENT REVENUE FROM THE STATE FISCAL
YEAR IN WHICH THE COVERED HOSPITAL BEGAN OPERATION OR
BECAME A COVERED HOSPITAL[.] IF THE COVERED HOSPITAL
BEGAN OPERATION OR BECAME A COVERED HOSPITAL PRIOR TO
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JULY 1, 2018; OR
(II) USING THE NET INPATIENT REVENUE AND NET
OUTPATIENT REVENUE FROM THE STATE FISCAL YEAR IN WHICH
THE COVERED HOSPITAL BEGAN OPERATION OR BECAME A COVERED
HOSPITAL IF THE COVERED HOSPITAL BEGAN OPERATION OR
BECAME A COVERED HOSPITAL ON OR AFTER JULY 1, 2018.
(3) FOR THE STATE FISCAL YEARS FOLLOWING THE FIRST FULL
STATE FISCAL YEAR UNDER PARAGRAPH (2) BUT ENDING PRIOR TO
JULY 1, 2018, THE DEPARTMENT SHALL CALCULATE THE HOSPITAL'S
ASSESSMENT AMOUNT USING THE NET INPATIENT REVENUE FROM THE
PRIOR STATE FISCAL YEAR. FOR THE STATE FISCAL YEARS FOLLOWING
THE FIRST FULL STATE FISCAL YEAR UNDER PARAGRAPH (2)
COMMENCING ON OR AFTER JULY 1, 2018, THE DEPARTMENT SHALL
CALCULATE THE HOSPITAL'S ASSESSMENT AMOUNT USING THE NET
INPATIENT AND NET OUTPATIENT REVENUE FROM THE PRIOR STATE
FISCAL YEAR.
* * *
(C) RECORDS.--UPON REQUEST BY THE DEPARTMENT, A COVERED
HOSPITAL SHALL FURNISH TO THE DEPARTMENT SUCH RECORDS AS THE
DEPARTMENT MAY SPECIFY IN ORDER FOR THE DEPARTMENT TO VALIDATE
THE NET INPATIENT [REVENUE] AND NET OUTPATIENT REVENUES REPORTED
BY THE HOSPITAL OR TO DETERMINE THE ASSESSMENT FOR A FISCAL YEAR
OR THE AMOUNT OF THE ASSESSMENT DUE FROM THE COVERED HOSPITAL OR
TO VERIFY THAT THE COVERED HOSPITAL HAS PAID THE CORRECT AMOUNT
DUE.
(D) UNDERPAYMENTS AND OVERPAYMENTS.--IN THE EVENT THAT THE
DEPARTMENT DETERMINES THAT A COVERED HOSPITAL HAS FAILED TO PAY
AN ASSESSMENT OR THAT IT HAS UNDERPAID AN ASSESSMENT, THE
DEPARTMENT SHALL NOTIFY THE COVERED HOSPITAL IN WRITING OF THE
AMOUNT DUE, INCLUDING INTEREST, AND THE DATE ON WHICH THE AMOUNT
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DUE MUST BE PAID, WHICH SHALL NOT BE LESS THAN 30 DAYS FROM THE
DATE OF THE NOTICE. IN THE EVENT THAT THE DEPARTMENT DETERMINES
THAT A COVERED HOSPITAL HAS OVERPAID AN ASSESSMENT, THE
DEPARTMENT SHALL NOTIFY THE COVERED HOSPITAL IN WRITING OF THE
OVERPAYMENT AND, WITHIN 30 DAYS OF THE DATE OF THE NOTICE OF THE
OVERPAYMENT, SHALL [EITHER REFUND THE AMOUNT OF THE OVERPAYMENT
OR] OFFSET THE AMOUNT OF THE OVERPAYMENT AGAINST ANY AMOUNT THAT
MAY BE OWED TO THE DEPARTMENT FROM THE COVERED HOSPITAL.
SECTION 805-G. RESTRICTED ACCOUNT.
* * *
(B) LIMITATIONS.--
(1) FOR THE FIRST YEAR OF THE ASSESSMENT, THE AMOUNT
USED FOR THE MEDICAL ASSISTANCE PAYMENTS FOR HOSPITALS AND
MEDICAID MANAGED CARE ORGANIZATIONS MAY NOT EXCEED THE
AGGREGATE AMOUNT OF ASSESSMENT FUNDS COLLECTED FOR THE YEAR
LESS $121,000,000.
(2) FOR THE SECOND YEAR OF THE ASSESSMENT, THE AMOUNT
USED FOR THE MEDICAL ASSISTANCE PAYMENTS FOR HOSPITALS AND
MEDICAL ASSISTANCE MANAGED CARE ORGANIZATIONS MAY NOT EXCEED
THE AGGREGATE AMOUNT OF ASSESSMENT FUNDS COLLECTED FOR THE
YEAR LESS $109,000,000.
(4) FOR THE THIRD YEAR OF THE ASSESSMENT, THE AMOUNT
USED FOR THE MEDICAL ASSISTANCE PAYMENT FOR HOSPITALS AND
MEDICAL ASSISTANCE MANAGED CARE ORGANIZATIONS MAY NOT EXCEED
THE AGGREGATE AMOUNT OF THE ASSESSMENT FUNDS COLLECTED FOR
THE YEAR LESS $109,000,000.
(4.1) FOR STATE FISCAL YEARS 2013-2014 AND 2014-2015,
THE AMOUNT USED FOR THE MEDICAL ASSISTANCE PAYMENT FOR
HOSPITALS AND MEDICAL ASSISTANCE MANAGED CARE ORGANIZATIONS
MAY NOT EXCEED THE AGGREGATE AMOUNT OF THE ASSESSMENT FUNDS
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COLLECTED FOR THE YEAR LESS $150,000,000.
(4.2) FOR STATE FISCAL YEARS 2015-2016, 2016-2017 AND
2017-2018, THE AMOUNT USED FOR THE MEDICAL ASSISTANCE PAYMENT
FOR HOSPITALS AND MEDICAL ASSISTANCE MANAGED CARE
ORGANIZATIONS MAY NOT EXCEED THE AGGREGATE AMOUNT OF THE
ASSESSMENT FUNDS COLLECTED FOR THE YEAR LESS $220,000,000.
(4.3) FOR STATE FISCAL YEARS 2018-2019, 2019-2020 AND
2020-2021, THE AMOUNT USED FOR THE MEDICAL ASSISTANCE PAYMENT
FOR HOSPITALS AND MEDICAL ASSISTANCE MANAGED CARE
ORGANIZATIONS MAY NOT EXCEED THE AGGREGATE AMOUNT OF THE
ASSESSMENT FUNDS COLLECTED FOR THE YEAR LESS $295,000,000.
(4.4) FOR STATE FISCAL YEARS 2021-2022 AND 2022-2023,
THE AMOUNT USED FOR THE MEDICAL ASSISTANCE PAYMENT FOR
HOSPITALS AND MEDICAL ASSISTANCE MANAGED CARE ORGANIZATIONS
MAY NOT EXCEED THE AGGREGATE AMOUNT OF THE ASSESSMENT FUNDS
COLLECTED FOR THE YEAR LESS $300,000,000.
(5) THE AMOUNTS RETAINED BY THE DEPARTMENT PURSUANT TO
PARAGRAPHS (1), (2), (4), (4.1) [AND (4.2)], (4.2), (4.3) AND
(4.4) AND ANY ADDITIONAL AMOUNTS REMAINING IN THE RESTRICTED
ACCOUNTS AFTER THE PAYMENTS DESCRIBED IN SUBSECTION (A)(1)
AND (2) ARE MADE SHALL BE USED FOR PURPOSES APPROVED BY THE
SECRETARY UNDER SUBSECTION (A)(3), SUBJECT TO PARAGRAPH (7).
(6) NOT LATER THAN 180 DAYS FOLLOWING THE END OF THE
STATE FISCAL YEAR, THE DEPARTMENT SHALL PREPARE A REVENUE
RECONCILIATION SCHEDULE FOR THE PRIOR STATE FISCAL YEAR THAT
INCLUDES INFORMATION SUPPORTING THE AMOUNTS RECEIVED OR
DEPOSITED INTO AND PAID OUT OF THE RESTRICTED ACCOUNT TO
SUPPORT ACTUAL PAYMENTS TO HOSPITALS AND MANAGED CARE
ORGANIZATIONS PURSUANT TO SUBSECTION (A)(1) AND (2).
(7) ANY POSITIVE BALANCE REMAINING IN THE RESTRICTED
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ACCOUNT IN EXCESS OF $10,000,000 ANNUALLY, WHICH IS NOT USED
BY THE COMMONWEALTH TO OBTAIN FEDERAL MATCHING FUNDS AND PAID
OUT FOR HOSPITAL PAYMENTS, SHALL BE FACTORED INTO THE
CALCULATION OF A NEW ASSESSMENT RATE BY REDUCING THE AMOUNT
OF HOSPITAL ASSESSMENT FUNDS THAT MUST BE GENERATED DURING
THE NEXT FISCAL YEAR IN WHICH THE DEPARTMENT IS ABLE TO
CALCULATE A NEW RATE. IF A NEW ASSESSMENT RATE IS NOT
CALCULATED, THE FUNDS REMAINING IN THE RESTRICTED ACCOUNT
SHALL BE REFUNDED TO THE COVERED HOSPITAL THAT PAID THE
ASSESSMENT IN PROPORTION TO THE COVERED HOSPITAL'S ASSESSMENT
AMOUNT PAID IN THE FISCAL YEAR.
* * *
SECTION 815-G. EXPIRATION.
THE ASSESSMENT UNDER THIS ARTICLE SHALL EXPIRE JUNE 30,
[2018] 2023.
SECTION 8. THE DEFINITIONS OF "CHILD DAY CARE" AND
"CHILDREN'S INSTITUTIONS" IN SECTION 901 OF THE ACT ARE AMENDED
TO READ:
SECTION 901. DEFINITIONS.--AS USED IN THIS ARTICLE--
"CHILD [DAY] CARE" MEANS CARE IN LIEU OF PARENTAL CARE GIVEN
FOR PART OF THE TWENTY-FOUR HOUR DAY TO A CHILD UNDER SIXTEEN
YEARS OF AGE, AWAY FROM THE CHILD'S HOME BUT DOES NOT INCLUDE
CHILD [DAY] CARE FURNISHED IN A PLACE OF WORSHIP DURING
RELIGIOUS SERVICES.
"CHILDREN'S INSTITUTIONS" MEANS ANY INCORPORATED OR
UNINCORPORATED ORGANIZATION, SOCIETY, CORPORATION OR AGENCY,
PUBLIC OR PRIVATE, WHICH MAY RECEIVE OR CARE FOR CHILDREN, OR
PLACE THEM IN FOSTER FAMILY HOMES, EITHER AT BOARD, WAGES OR
FREE; OR ANY INDIVIDUAL WHO, FOR HIRE, GAIN OR REWARD, RECEIVES
FOR CARE A CHILD, UNLESS HE IS RELATED TO SUCH CHILD BY BLOOD OR
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MARRIAGE WITHIN THE SECOND DEGREE; OR ANY INDIVIDUAL, NOT IN THE
REGULAR EMPLOY OF THE COURT OR OF AN ORGANIZATION, SOCIETY,
ASSOCIATION OR AGENCY, DULY CERTIFIED BY THE DEPARTMENT, WHO IN
ANY MANNER BECOMES A PARTY TO THE PLACING OF CHILDREN IN FOSTER
HOMES, UNLESS HE IS RELATED TO SUCH CHILDREN BY BLOOD OR
MARRIAGE WITHIN THE SECOND DEGREE, OR IS THE DULY APPOINTED
GUARDIAN THEREOF. THE TERM SHALL NOT INCLUDE A FAMILY CHILD CARE
HOME OR CHILD [DAY] CARE CENTER OPERATED FOR PROFIT AND SUBJECT
TO THE PROVISIONS OF ARTICLE X.
* * *
SECTION 9. THE DEFINITIONS OF "CHILD DAY CARE," "CHILD DAY
CARE CENTER," "FACILITY" AND "FAMILY CHILD CARE HOME" IN SECTION
1001 OF THE ACT ARE AMENDED TO READ:
SECTION 1001. DEFINITIONS.--AS USED IN THIS ARTICLE--
* * *
"CHILD [DAY] CARE" MEANS CARE IN LIEU OF PARENTAL CARE GIVEN
FOR PART OF THE TWENTY-FOUR HOUR DAY TO CHILDREN UNDER SIXTEEN
YEARS OF AGE, AWAY FROM THEIR OWN HOMES, BUT DOES NOT INCLUDE
CHILD [DAY] CARE FURNISHED IN PLACES OF WORSHIP DURING RELIGIOUS
SERVICES.
"CHILD [DAY] CARE CENTER" MEANS ANY PREMISES OPERATED FOR
PROFIT IN WHICH CHILD [DAY] CARE IS PROVIDED SIMULTANEOUSLY FOR
SEVEN OR MORE CHILDREN WHO ARE NOT RELATIVES OF THE OPERATOR,
EXCEPT SUCH CENTERS OPERATED UNDER SOCIAL SERVICE AUSPICES.
* * *
"FACILITY" MEANS AN ADULT DAY CARE CENTER, CHILD [DAY] CARE
CENTER, FAMILY CHILD CARE HOME, BOARDING HOME FOR CHILDREN,
MENTAL HEALTH ESTABLISHMENT, PERSONAL CARE HOME, ASSISTED LIVING
RESIDENCE, NURSING HOME, HOSPITAL OR MATERNITY HOME, AS DEFINED
HEREIN, EXCEPT TO THE EXTENT THAT SUCH A FACILITY IS OPERATED BY
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THE STATE OR FEDERAL GOVERNMENTS OR THOSE SUPERVISED BY THE
DEPARTMENT OR LICENSED PURSUANT TO THE ACT OF JULY 19, 1979
(P.L.130, NO.48), KNOWN AS THE "HEALTH CARE FACILITIES ACT."
"FAMILY CHILD CARE HOME" MEANS A HOME WHERE CHILD [DAY] CARE
IS PROVIDED AT ANY TIME TO NO LESS THAN FOUR CHILDREN AND NO
MORE THAN SIX CHILDREN WHO ARE NOT RELATIVES OF THE CAREGIVER.
* * *
SECTION 10. WITHIN ONE YEAR OF THE EFFECTIVE DATE OF THIS
SECTION, THE DEPARTMENT OF HUMAN SERVICES SHALL AMEND ANY
REGULATION AT 55 PA. CODE PT. V THAT USES THE TERM "DAY CARE" AS
IT RELATES TO CHILDREN AND REPLACE THE TERM WITH THE TERM "CHILD
CARE."
SECTION 11. THIS ACT SHALL TAKE EFFECT AS FOLLOWS:
(1) THE ADDITION OF ARTICLE V-A OF THE ACT SHALL TAKE
EFFECT MARCH 31, 2019.
(2) THIS SECTION SHALL TAKE EFFECT JULY 1, 2018, OR
IMMEDIATELY, WHICHEVER IS LATER.
(3) THE REMAINDER OF THIS ACT SHALL TAKE EFFECT JULY 1,
2018, OR IMMEDIATELY, WHICHEVER IS LATER.
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