H0033B0047A02102 MSP:JMT 06/17/19 #90 A02102
AMENDMENTS TO HOUSE BILL NO. 33
Sponsor: REPRESENTATIVE DUNBAR
Printer's No. 47
Amend Bill, page 1, lines 1 through 7, by striking out all of
said lines and inserting
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 definitions, for general assistance-
related categorically needy and medically needy only medical
assistance programs, for the medically needy and
determination of eligibility and for medical assistance
payments for institutional care; in hospital assessments,
further providing for definitions, for authorization, for
administration, for no hold harmless, for tax exemption and
for time period; and, in Statewide quality care assessment,
further providing for definitions.
Amend Bill, page 1, lines 10 through 19; page 2, lines 1
through 30; page 3, lines 1 through 6; by striking out all of
said lines on said pages and inserting
Section 1. Section 402 introductory paragraph and the
definition of "general assistance" of the act of June 13, 1967
(P.L.31, No.21), known as the Human Services Code, amended June
30, 2012 (P.L.668, No.80), amendment declared unconstitutional,
188 A.3d 1135, (Pa. 2018), are amended and the section is
amended by adding a definition to read:
Section 402. Definitions.--As used in this article, unless
the [content] context clearly indicates otherwise:
* * *
["General assistance" means assistance granted under the
provisions of section 432(3) of this act.]
"General assistance-related categorically needy medical
assistance" means medical assistance for persons who meet the
requirements under section 432(3).
* * *
Section 2. Section 403.2 of the act, added June 30, 2012
(P.L.668, No.80), addition declared unconstitutional, 188 A.3d
1135, (Pa. 2018), is reenacted and amended to read:
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Section 403.2. General Assistance-Related Categorically
Needy and Medically Needy Only Medical Assistance Programs.--(a)
Subject to subsection (b) and notwithstanding any other
provision of law, the general assistance cash assistance program
shall cease [August 1, 2012] August 1, 2019.
(b) The general assistance-related categorically needy
medical assistance program shall continue, including, but not
limited to, the eligibility and work and work-related
requirements under this article. The general assistance-related
medical assistance program for the medically needy only shall
continue.
Section 3. Section 442.1(a)(3) introductory paragraph and
(i) of the act, amended June 30, 2012 (P.L.668, No.80),
amendment declared unconstitutional, 188 A.3d 1135, (Pa. 2018),
are amended to read:
Section 442.1. The Medically Needy; Determination of
Eligibility.--(a) A person shall be considered medically needy
if that person meets the requirements of clauses (1), (2) and
(3):
* * *
(3) Complies with [either] subclause [(i) or] (ii):
[(i) Receives general assistance in the form of cash.]
* * *
Section 4. Section 443.1(1.1)(i) and (7)(vi) of the act,
amended June 22, 2018 (P.L.258, No.40), are amended to read:
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:
* * *
(1.1) Subject to section 813-G, for inpatient hospital
services provided during a fiscal year in which an assessment is
imposed under Article VIII-G, payments under the medical
assistance fee-for-service program shall be determined in
accordance with the department's regulations, except as follows:
(i) If the Commonwealth's approved Title XIX State Plan for
inpatient hospital services in effect for the period of July 1,
2010, through June 30, [2018] 2023, specifies a methodology for
calculating payments that is different from the department's
regulations or authorizes additional payments not specified in
the department's regulations, such as inpatient disproportionate
share payments and direct medical education payments, the
department shall follow the methodology or make the additional
payments as specified in the approved Title XIX State Plan.
* * *
(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
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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, 2016-2017 [and], 2018-2019 and
2019-2020, 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:
(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
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amount under subclause (I) shall be divided by the total PA MA
days, as reported by all qualifying nonpublic nursing facilities
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) The following shall apply:
(I) For fiscal years 2015-2016, 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).
(II) For fiscal years 2019-2020, the State funds available
for the nonpublic nursing facility medical assistance day-one
incentive payments shall equal sixteen million dollars
($16,000,000).
* * *
Section 5. The definitions of "assessment," "general acute
care hospital," "high volume Medicaid hospital," "hospital" and
"net operating revenue" in section 801-E of the act are amended
to read:
Section 801-E. 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:
"Assessment." The fee authorized to be implemented under
this article [on every general acute care hospital within a
municipality].
* * *
"General acute care hospital." A hospital other than a
hospital that the [Secretary of Human Services] secretary has
determined meets one of the following:
(1) Is excluded under 42 CFR 412.23(a), (b), (d), (e) and
(f) (relating to Excluded hospitals: Classifications) as of
March 20, 2008, from reimbursement of certain Federal funds
under the prospective payment system described by 42 CFR 412
(relating to prospective payment systems for inpatient hospital
services).
(2) Is a Federal veterans' affairs hospital.
(3) Is a high volume Medicaid hospital.
(4) Provides care, including inpatient hospital services, to
all patients free of charge.
(5) Is a free-standing acute care hospital organized
primarily for the treatment of and research on cancer and which
is an exempt hospital under section 801-G.
"High volume Medicaid hospital." A hospital that the
[Secretary of Human Services] secretary has determined meets all
of the following:
(1) is a nonprofit hospital subsidiary of a State-related
institution as that term is defined in 62 Pa.C.S. ยง 103
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(relating to definitions); and
(2) [provides] has provided more than [90,000] 60,000
inpatient acute care days of care to Pennsylvania medical
assistance patients [annually] as reported by the hospital's
State fiscal year 2014-2015 medical assistance hospital cost
report on file with the department as of June 6, 2018.
"Hospital." A facility or the site of a facility that is
licensed as a hospital under 28 Pa. Code Pt. IV Subpt. B
(relating to general and special hospitals) and located within a
municipality.
* * *
"Net [operating] patient revenue." Gross [charges for
facilities] revenues received or earned by a hospital for
inpatient and outpatient hospital services, including medical
assistance supplemental revenues received by the hospital for
inpatient and outpatient hospital services, less any deducted
amounts for bad debt expense, charity care expense and
contractual allowances as identified in the hospital's records
or on forms as specified by the department.
* * *
Section 6. Section 802-E(a), (a.1) and (b) of the act are
amended and the section is amended by adding a subsection to
read:
Section 802-E. Authorization.
(a) General rule.--In order to generate additional revenues
for the purpose of assuring that medical assistance recipients
have access to hospital and other health care services [and that
all citizens have access to emergency department services], and
subject to the conditions and requirements specified under this
article, a municipality may, by ordinance, [do] impose an
assessment on the following:
(1) [Impose a monetary assessment on the net operating
revenue reduced by all revenues received from Medicare of
each general acute care hospital located in the
municipality.] Each general acute care hospital.
(2) [Beginning on or after July 1, 2009, and subject to
the advance written approval by the secretary, impose a
monetary assessment on the net operating revenues reduced by
all revenues received from Medicare of each high volume
Medicaid hospital located in the municipality.] Each high
volume Medicaid hospital.
(a.1) Assessment imposed by ordinance.--A municipality
shall, by ordinance, establish the assessment imposed under
subsection (a)(1) and (2) as a percentage of each hospital ' s net
patient revenue reduced by all revenues received from Medicare
for the year as the municipality shall specify, and may
establish different assessment percentages under subsection (a)
(1) or (2).
(a.2) Adjustments to assessment percentage.--
(1) For State fiscal years beginning after June 30,
2013, and subject to the advance written approval of the
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secretary as prescribed by the department, the municipality
may make a uniform adjustment to an assessment percentage
established by ordinance under subsection (a).
(2) After receiving written approval under paragraph (1)
and before implementing an adjustment, the municipality shall
provide advance public notice. The notice shall specify the
proposed adjusted assessment percentage and identify the
aggregate impact on hospitals [located in the municipality]
subject to an assessment. An interested party shall have 30
days in which to submit comments to the municipality. Upon
expiration of the 30-day comment period, the municipality,
after consideration of the comments, shall publish a
subsequent notice announcing the adjusted assessment
percentage.
(b) Administrative provisions.--The ordinances adopted
pursuant to [subsection] subsections (a), (a.1) and (a.2) may
include appropriate administrative provisions including, without
limitation, provisions for the collection of interest and
penalties[.] and provisions for the calculation and imposition
of the assessment on a hospital subject to an assessment which,
during a fiscal year in which an assessment is imposed under
this article, changes ownership or control, begins operations,
closes or experiences any other change that affects its status
as a general acute care hospital or high volume Medicaid
hospital.
* * *
Section 7. Sections 804-E, 805-E, 807-E and 808-E of the act
are amended to read:
Section 804-E. Administration.
(a) Remittance.--Upon collection of the funds generated by
the assessment authorized under this article, the municipality
shall remit a portion of the funds to the Commonwealth for the
purposes set forth under section 802-E, except that the
municipality may retain funds in an amount necessary to
reimburse it for its reasonable costs in the administration and
collection of the assessment and to fund a portion of its costs
of operating public health clinics and public health programs as
set forth in an agreement to be entered into between the
municipality and the Commonwealth acting through the secretary.
(b) Establishment.--There is established a restricted
account in the General Fund for the receipt and deposit of funds
under subsection (a). Funds in the account [are hereby
appropriated to] shall be used by the department for either or
both of the following purposes [of making]:
(1) Making supplemental or increased medical assistance
payments for [emergency department] hospital services to
[general acute care] hospitals [within the municipality] and to
maintain or increase other medical assistance payments to
hospitals [within the municipality], as specified in the
Commonwealth's approved Title XIX State Plan.
(2) Making adjusted capitation payments to medical
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assistance managed care organizations for additional payments
for health care services within the municipality.
Section 805-E. No hold harmless.
No [general acute care hospital or high volume Medicaid]
hospital subject to the assessment shall be directly guaranteed
a repayment of its assessment in derogation of 42 CFR 433.68(f)
(relating to permissible health care-related taxes), except
that, in each fiscal year in which an assessment is implemented,
the department shall use a portion of the funds received under
section 804-E(a) for the purposes outlined under section 804-
E(b) to the extent permissible under Federal and State law or
regulation and without creating an indirect guarantee to hold
harmless, as those terms are used under 42 CFR 433.68(f)(i). The
secretary shall submit any [State Medicaid plan] Title XIX State
Plan amendments to the United States Department of Health and
Human Services that are necessary to make the payments
authorized under section 804-E(b).
Section 807-E. Tax exemption.
Notwithstanding any exemptions granted by any other Federal,
State or local tax or other law, including section 204(a)(3) of
the act of May 22, 1933 (P.L.853, No.155), known as The General
County Assessment Law, no [general acute care hospital or high
volume Medicaid] hospital [in the municipality] subject to the
assessment shall be exempt from the assessment.
Section 808-E. Time period.
(a) Cessation.--The assessment authorized under this article
shall cease June 30, [2019] 2024.
(b) Assessment.--
(1) A municipality shall have the power to enact the
assessment authorized in section 802-E(a)(2) either prior to
or during its fiscal year ending June 30, 2010.
(2) A municipality may adjust an assessment percentage
as specified under section [802-E(a.1)] 802-E(a.2) either
prior to or during the fiscal year in which the adjusted
assessment percentage takes effect.
Section 8. The definitions of "net inpatient revenue" and
"net outpatient revenue" in section 801-G of the act, amended or
added June 22, 2018 (P.L.258, No.40), are amended 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] revenues
received or earned by a hospital for inpatient services,
including medical assistance supplemental revenues received by
the hospital for inpatient hospital services, less any deducted
amounts for bad debt expense, charity care expense and
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contractual allowances as identified in the hospital's records
and reported on forms specified by the department for:
(1) [as identified in the hospital's records for] the
State fiscal year commencing July 1, 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, 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] revenues
received or earned by a hospital for outpatient services,
including medical assistance supplemental revenues received by
the hospital for outpatient hospital services, less any deducted
amounts for bad debt expense, charity care expense and
contractual allowances as identified in the hospital's records
and reported on forms specified by the department for:
(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 recent State fiscal year, or part thereof, if amounts
are not available under paragraph (1).
* * *
Section 9. This act shall take effect as follows:
(1) The amendment of section 442.1(a)(3) introductory
paragraph and (i) of the act shall take effect August 1,
2019.
(2) The remainder of this act shall take effect July 1,
2019, or immediately, whichever is later.
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See A02102 in
the context
of HB0033