Amendment 2562 to House Bill 1351 P.N. 1802, Regular Session 2023-2024

H1351B1802A02562 AJB:EJH 10/16/23 #90 A02562

AMENDMENTS TO HOUSE BILL NO. 1351

Sponsor: SENATOR PITTMAN

Printer's No. 1802

Amend Bill, page 1, lines 1 through 8, 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 medical assistance payments for

institutional care and providing for emergency transportation

services and for case-mix rates for nursing facilities; in

Statewide quality care assessment, further providing for

definitions, for implementation, for administration, for

restricted account and for expiration; continuing the

Pennsylvania Rural Health Redesign Center Authority and the

Pennsylvania Rural Health Redesign Center Fund; and making a

repeal.

Amend Bill, page 1, lines 11 through 20; page 2, lines 1

through 30; page 3, lines 1 through 5; by striking out all of

said lines on said pages and inserting

Section 1. Section 443.1(1.1)(i) of the act of June 13, 1967

(P.L.31, No.21), known as the Human Services Code, is 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, [2023] 2028, specifies a methodology for

calculating payments that is different from the department's

regulations or authorizes additional payments not specified in

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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.

* * *

Section 2. The act is amended by adding sections to read:

Section 443.13. Emergency Transportation Services.--S ubject

to Federal approval as may be necessary and contingent on

Federal financial participation, from money appropriated for the

department under the act of August 3, 2023 (P.L. , No.1A),

known as the General Appropriation Act of 2023, sufficient funds

shall be included to provide reimbursement for ground mileage

for every loaded mile and to provide the greater of Medicare

rates published in the Ambulance Fee Schedule Public Use File

for calendar year 2023 or the current Medicaid Ambulance Fees as

updated by Medical Assistance Bulletin 26-22-07 effective date

January 1, 2023, beginning January 1, 2024, for services

provided under the Medical Assistance - Fee-for-Service, Medical

Assistance - Capitation and Medical Assistance - Community

HealthChoices appropriations in the General Appropriation Act of

2023.

Section 454.1. Case-Mix Rates for Nursing Facilities.--(a)

From money appropriated for medical assistance long-term living

under the act of August 3, 2023 (P.L. , No.1A), known as the

General Appropriation Act of 2023, for fiscal year 2023-2024,

the department shall calculate each nursing facility's case-mix

rate based on the cost database and peer group prices for each

net operating cost center used in the calculation of each

nursing facility's case-mix for fiscal year 2022-2023. Each

nursing facility's case-mix rate shall be adjusted quarterly in

accordance with 55 Pa. Code § 1187.96(a)(5) (relating to price-

and rate-setting computations).

(b) From money appropriated for medical assistance Community

HealthChoices under the General Appropriation Act of 2023, for

fiscal year 2023-2024, the department shall calculate each

nursing facility's case-mix rate based on the cost database and

peer group prices for each net operating cost center used in the

calculation of each nursing facility's case-mix for fiscal year

2022-2023. Each nursing facility's case-mix rate shall be

adjusted quarterly in accordance with 55 Pa. Code § 1187.96(a)

(5).

Section 3. The definitions of "net inpatient revenue" and

"net outpatient revenue" in section 801-G of the act 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 revenues received or earned

by a hospital for inpatient services, including medical

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assistance supplemental revenues received by the hospital for

inpatient 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) 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) the most recent State fiscal year, or part thereof,

if amounts are not available under paragraph (1).]

"Net outpatient revenue." Gross 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) 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) the most recent State fiscal year, or part thereof,

if amounts are not available under paragraph (1).]

* * *

Section 4. Section 803-G(b)(4) and (5) and (c.2) of the act

are amended, subsection (b) is amended by adding paragraphs 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:

* * *

(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[.];

(6) for fiscal year 2023-2024, an amount equal to 3.54%

of the net inpatient revenue of the covered hospital and

1.78% of the net outpatient revenue of the covered hospital;

and

(7) for fiscal years 2024-2025, 2025-2026, 2026-2027 and

2027-2028, an amount equal to 4.36% of the net inpatient

revenue of the covered hospital and 2.20% of the net

outpatient revenue of the covered hospital.

* * *

(c.2) Rebasing net inpatient and net outpatient revenue

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amounts on amounts owed for fiscal years prior to 2023-2024.--

For purposes of calculating the annual assessment amount owed

[on or after July 1, 2018,] for fiscal years 2018-2019, 2019-

2020, 2020-2021, 2021-2022 and 2022-2023, 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

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.

(c.3) Rebasing net inpatient revenue and net outpatient

revenue amounts on amounts owed for fiscal year 2023-2024 and

thereafter.--For purposes of calculating the annual assessment

amount owed on or after July 1, 2023, 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, 2018. 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, 2019, the secretary shall

transmit a notice to the Legislative Reference Bureau for

publication in the next available issue of the Pennsylvania

Bulletin specifying the State fiscal year for which the net

inpatient revenue 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 5. Section 804-G(a), (a.1) and (a.3) 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] net inpatient revenue and

net outpatient revenue, 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

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assessment amount using] calculate the assessment as follows:

(i) [the hospital's net inpatient revenue for State

fiscal year 2010-2011 if the change of ownership occurs

before July 1, 2018;] if the change of ownership occurs

before July 1, 2018, the department shall calculate the

assessment using the hospital's net inpatient revenue and

net outpatient revenue amounts for State fiscal year

2018-2019, or a later fiscal year that has been specified

by the secretary in accordance with section 803-G(c.3);

(ii) if the change of ownership occurs on or after

July 1, 2018, the department shall calculate the

assessment using the hospital's net inpatient revenue and

net outpatient revenue amounts for State fiscal year

[2014-2015] 2018-2019, 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] in accordance with section 803-

G(c.3); 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

subparagraph (ii) is not available.] if the net inpatient

revenue and net outpatient revenue amounts for the State

fiscal year 2018-2019, or a later fiscal year that has

been specified by the secretary in accordance with

section 803-G(c.3), are unavailable due to a covered

hospital's establishment as a new hospital under

subsection (a.3), the department will calculate the

assessment using the hospital's net inpatient revenue and

net outpatient revenue amounts under subsection (a.3).

(1.1) 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] as follows:

(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;]

if the merger or consolidation occurs before July 1,

2018, the department shall calculate the assessment using

the merged or consolidated hospitals' combined net

inpatient revenue and net outpatient revenue amounts for

State fiscal year 2018-2019, or a later fiscal year that

has been specified by the secretary in accordance with

section 803-G(c.3);

(ii) if the merger or consolidation occurs on or

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after July 1, 2018, the department shall calculate the

assessment using the merged or consolidated hospitals'

combined net inpatient revenue and net outpatient revenue

amounts for State fiscal year [2014-2015] 2018-2019 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 merger or

consolidation occurs, if the merger or consolidation

occurs on or after July 1, 2018] in accordance with

section 803-G(c.3); 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

subparagraph (ii) is not available, for any covered

hospitals that were merged or consolidated into the

single covered hospital.] if one or more hospital's net

inpatient revenue and net outpatient revenue amounts for

the State fiscal year 2018-2019, or a later fiscal year

that has been specified by the secretary in accordance

with section 803-G(c.3), is unavailable due to the

hospital's establishment as a new hospital under

subsection (a.3), the following apply:

(A) The department shall calculate the

assessment using the new hospital's net inpatient

revenue and net outpatient revenue amounts under

subsection (a.3).

(B) For a hospital that is not a new hospital,

the department shall calculate the hospital's net

inpatient revenue and net outpatient revenue amounts

for State fiscal year 2018-2019, or a later fiscal

year that has been specified by the secretary in

accordance with section 803-G(c.3).

calculated under clause (A) with the amount

calculated under clause (B) to determine the combined

net inpatient revenue and net outpatient revenue

amounts for the merged or consolidated hospitals.

(3) 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] after July 1,

2018, 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

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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 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.] 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 through the end of

the State fiscal year.

(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] year

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. For subsequent State fiscal years, the

department shall use the net inpatient revenue and net

outpatient revenue calculated under this paragraph, or a

later fiscal year that has been specified by the secretary in

accordance with section 803-G(c.3).

(4) If estimated net inpatient revenue and net

outpatient revenue is used in calculating a covered

hospital's assessment under this subsection, the department

shall reconcile any amounts received based on reported actual

net inpatient revenues and net outpatient revenues.

* * *

Section 6. Section 805-G(a)(2) and (b)(5) of the act are

amended and subsection (b) is amended by adding paragraphs to

read:

Section 805-G. Restricted account.

(a) Establishment.--There is established a restricted

account, known as the Quality Care Assessment Account, in the

General Fund for the receipt and deposit of revenues collected

under this article. Funds in the account are appropriated to the

department for the following:

* * *

(2) Making [adjusted capitation] payments to medical

assistance managed care organizations for additional payments

for inpatient hospital services in accordance with section

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443.1(1.2), (1.3) and (1.4) and outpatient services.

* * *

(b) Limitations.--

* * *

(4.5) For State fiscal year 2023-2024, 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 $368,000,000.

(4.6) For State fiscal years 2024-2025, 2025-2026, 2026-

2027 and 2027-2028, 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

$452,000,000.

(5) The amounts retained by the department pursuant to

paragraphs (1), (2), (4), (4.1), (4.2), (4.3) [and], (4.4),

(4.5) and (4.6) 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).

* * *

Section 7. Section 815-G of the act is amended to read:

Section 815-G. Expiration.

The assessment under this article shall expire June 30,

[2023] 2028.

Section 8. The act is amended by adding an article to read:

ARTICLE XIV-D

PENNSYLVANIA RURAL HEALTH REDESIGN

CENTER AUTHORITY

SUBARTICLE A

PRELIMINARY PROVISIONS

Section 1401-D. Scope of article.

This article relates to the Pennsylvania Rural Health

Redesign Center Authority.

Section 1402-D. Purpose.

It is the purpose of this article to protect and promote

access by the residents of this Commonwealth to high-quality

health care in rural communities by encouraging innovation in

health care delivery.

Section 1403-D. 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:

"A cute care hospital." A facility that provides inpatient

and outpatient services, which may include an emergency

department or intensive care unit.

"Authority." The Pennsylvania Rural Health Redesign Center

Authority continued in section 1411-D.

"Board." The governing body of the authority.

2023/90AJB/HB1351A02562 - 8 -

"Conflict of interest." A situation in which a board member:

(1) Has an interest in one or more parties involved in

an action under sectio n 1412-D.

(2) May gain access to competitively sensitive or

strategically relevant information about a participating

payer or participant rural hospital.

"Critical access hospital." As defined in 42 U.S.C. §

1395x(mm)(1) (relating to definitions) .

"Eligible hospital services." All inpatient and hospital-

based outpatient items and services. The term shall exclude all

other items and services, including the following:

(1) Postacute care.

(2) Professional services.

(3) Durable medical equipment.

(4) Dental services.

(5) Noninpatient or non-hospital-based outpatient

behavioral health services.

(6) Long-term care services, except for swing bed

services for critical access hospitals.

"Fund." The Pennsylvania Rural Health Redesign Center Fund

continued in section 1441-D.

"Global budget." The prospectively set annual budget that is

the basis for payment for each participant rural hospital for

eligible hospital services by participating payers.

"Global budget model." An innovative payment and service

delivery model that is intended to reduce health care costs

while maintaining access to care, improving the quality of care

in rural counties and meeting the health needs of participant

rural hospitals' local communities, and under which

participating payers pay participant rural hospitals using a

global budget methodology established by the authority.

"Government program." A health benefit plan offered or

administered by or on behalf of the United States or the

Commonwealth or an agency or instrumentality of either,

including:

(1) The medical assistance program.

(2) The children's health insurance program established

under Article XXIII-A of the act of May 17, 1921 (P.L.682,

No.284), known as The Insurance Company Law of 1921.

(3) A health benefit plan offered or administered by or

on behalf of the Commonwealth or an agency or instrumentality

of the Commonwealth.

(4) Health care benefits administered under 10 U.S.C.

(relating to armed forces) or 38 U.S.C. (relating to

veterans' benefits).

(5) The Medicare program established under 42 U.S.C. Ch.

7 Subch. XVIII (relating to health insurance for aged and

disabled).

"Insurer." A person, corporation or other entity licensed by

the Commonwealth with authority to offer, issue or renew an

insurance policy, subscriber contract or certificate providing

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health care coverage, including:

(1) An insurance company, association or exchange

governed by The Insurance Company Law of 1921, including

section 630 and Article XXIV of The Insurance Company Law of

1921.

(2) A hospital plan corporation as defined in 40 Pa.C.S.

Ch. 61 (relating to hospital plan corporations).

(3) A professional health service corporation as defined

in 40 Pa.C.S. Ch. 63 (relating to professional health

services plan corporations).

(4) A health maintenance organization governed by the

act of December 29, 1972 (P.L.1701, No.364), known as the

Health Maintenance Organization Act.

"Medicaid managed care organization." An entity as defined

in 42 U.S.C. § 1396b(m)(1)(A) (relating to payment to states)

that is a party to an agreement with the department, including a

county Medicaid managed care organization and a permitted

assignee of an agreement. The term does not include an assignor

of an agreement.

"Participant rural hospital." A rural hospital that has been

selected and signs an agreement to participate in the global

budget model.

"Participating payer." A payer that operates in rural

counties and, with respect to one or more specified products,

programs or payment arrangements, signs an agreement with the

authority to participate in the global budget model.

"Payer." An insurer, government program or Medicaid managed

care organization that pays or administers payment for health

care services under an insurance policy, subscriber contract,

certificate, administrative services arrangement or other

payment arrangement.

"Rural county." A county within this Commonwealth where the

population density is less than 284 persons per square mile as

defined by the Center for Rural Pennsylvania, established under

section 301 of the act of June 30, 1987 (P.L.163, No.16), known

as the Rural Pennsylvania Revitalization Act.

"Rural hospital." An acute care hospital or critical access

hospital located in a rural county.

"Rural hospital transformation plan." A description of the

health care delivery system transformation that a participant

rural hospital will undergo under the global budget model, as

approved by the board and the Federal Government.

"Swing bed." A hospital bed that has been approved by the

Medicare program established under under 42 U.S.C. Ch. 7 Subch.

XVIII to provide posthospital skilled nursing facility care when

the rural hospital participates in the Medicare program.

SUBARTICLE B

PENNSYLVANIA RURAL HEALTH REDESIGN

CENTER AUTHORITY

Section 1411-D. Pennsylvania Rural Health Redesign Center

Authority.

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(a) Continuation.--The Pennsylvania Rural Health Redesign

Center Authority is continued as a body corporate and politic

constituting a public corporation and government

instrumentality. The powers and duties of the authority shall be

vested in and exercised by the board, which shall have the sole

power to employ staff, including an executive director, legal

counsel, consultants or any other staff deemed necessary by the

board to effectuate the purposes of this article. Individuals

employed by the board shall not be employees of the Commonwealth

for any purpose, including for purposes of compensation, pension

benefits or retirement.

(b) Composition.--The board shall consist of the following

members:

(1) The Secretary of Health or a designee, who shall be

an employee of the Department of Health designated in writing

prior to service.

(2) The secretary or a designee, who shall be an

employee of the department designated in writing prior to

service.

(3) The Insurance Commissioner or a designee, who shall

be an employee of the Insurance Department designated in

writing prior to service.

(4) One member selected by each participating payer that

is an insurer on behalf of the participating payer and the

participating payer's parents, affiliates, subsidiaries,

other associated entities and successors. The selection under

this paragraph shall exclude any affiliated, subsidiary or

otherwise associated Medicaid managed care organization.

(5) One member selected by each participating payer that

is a Medicaid managed care organization.

(6) One member selected by the organization representing

hospitals and health systems in this Commonwealth. This

member shall be considered a participant rural hospital

member on the board.

(7) Participant rural hospital members, the number of

which shall not exceed the number of participating payer

members. The participant rural hospital members shall

represent the participant rural hospitals and shall be

selected from different, geographically diverse participant

rural hospitals and appointed as follows:

(i) The President pro tempore of the Senate, the

Minority Leader of the Senate, the Speaker of the House

of Representatives and the Minority Leader of the House

of the Representatives shall each appoint one member.

(ii) The Governor shall appoint the remaining

members.

(8) Two members appointed by the Governor who are

nationally recognized experts in rural health care delivery

or in developing and administering global budgets.

members of the board:

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(1) The terms of the members specified under subsection

(b)(1), (2) and (3) shall be concurrent with their holding of

public office.

(2) The board members specified in subsection (b)(4),

(5) and (6) shall serve for a term of three years and shall

not be eligible to serve more than two full consecutive

three-year terms.

(3) A board member specified in subsection (b)(7) shall

serve for a term of two years and shall not be eligible to

serve more than two full consecutive two-year terms.

(4) A board member specified in subsection (b)(8) shall

serve for a term of four years and shall not be eligible to

serve more than two full consecutive four-year terms.

(5) If a member of the board leaves prior to completing

a term due to change in professional status, including, but

not limited to, retirement, changing jobs, failure to qualify

or other reason, a new member shall be appointed or selected

within 60 days of the seat becoming vacant.

(d) Quorum.--A majority of the members of the board shall

constitute a quorum. Action may be taken by the board at a

meeting upon a vote of a majority of its members present in

person or through electronic means. If a tie vote occurs at any

meeting, it shall be the duty of the chairperson to cast the

deciding vote.

(e) Meetings.--The board shall meet at the call of the

chairperson or as may be provided in the bylaws of the board.

The board shall hold meetings at least quarterly, which shall be

subject to the requirements of 65 Pa.C.S. Ch. 7 (relating to

open meetings).

(f) Chairperson.--The Governor shall appoint a chairperson

from among the board members.

(g) Formation.--The board shall be formed within 90 days of

the effective date of this section.

(h) Conflict of interest.--Board members shall recuse

themselves from discussions and actions where a conflict of

interest may exist. Board members may not receive confidential

information, data or material related to an entity where a

conflict of interest may exist.

(i) Compensation and expenses.--Members of the board shall

not receive a salary or per diem allowance for serving as

members of the board but shall be reimbursed for actual and

necessary expenses incurred in the performance of their duties.

Reasonable expenses may include reimbursement of travel and

living expenses while engaged in board business. The expenses

shall be paid for by the fund.

Section 1412-D. Powers and duties.

(a) General rule.--The board shall exercise all powers

necessary and appropriate to carry out its duties under this

article, including the following:

(1) Adopt bylaws necessary to carry out the provisions

of this article. The bylaws shall include a provision

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addressing conflicts of interest as well as a provision that

restricts board discussions and decisions to the

administration of the global budget model as provided under

subsection (b).

(2) Make, execute and deliver contracts, grants and

other instruments necessary or convenient to exercise the

powers and duties of the board.

(3) Apply for, solicit, receive, establish priorities

for, allocate, disburse, contract or grant for, administer

and expend money in the fund and other money made available

to the authority from any other source consistent with the

purposes of this article. The authority shall be exempt from

the provisions of 62 Pa.C.S. Pts. I (relating to Commonwealth

Procurement Code) and II (relating to general procurement

provisions).

(4) Apply for, accept and administer grants and loans to

carry out the purposes of the authority.

(5) Accept money from both public and private sources,

consistent with Federal and State law.

(6) Take, hold, administer, assign, lend, encumber,

mortgage, invest or otherwise dispose of, at public or

private sale, on behalf of the authority and for any of the

authority's purposes, real property, personal property and

money or any interest therein, including any mortgage or loan

interest owned by the authority or under its control or in

its possession and the income therefrom either absolutely or

in trust. The following apply:

(i) The board may acquire property or money for this

purpose by purchase or lease and by the acceptance of

gifts, grants, bequests, devises or loans, but no

obligation of the authority shall be a debt of the

Commonwealth, and the authority shall have no power to

pledge the credit or taxing power of the Commonwealth nor

to make its debts payable out of any money except those

of the corporation. This subparagraph is not intended to

mean that the board may acquire rural hospitals or

participant rural hospitals.

(ii) All accrued and future earnings from money

invested by the board and other accrued and future

nonappropriated funds, including, but not limited to,

funds obtained from the Federal Government and

contributions, shall be available to the authority and

shall be deposited in the State Treasury and may be

utilized at the discretion of the board for carrying out

any of the corporate purposes of the authority. Any

placement of the funds by the State Treasurer in

depositories or investments shall be consistent with

guidelines approved by the board. For the purpose of

administration, the authority shall be subject to

sections 610, 613 and 614 of the act of April 9, 1929

(P.L.177, No.175), known as The Administrative Code of

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1929.

(7) Seek waivers from State agency requirements as

necessary to carry out the purposes of this article.

(8) Coordinate with the appropriate State agency to seek

waivers from Federal requirements as necessary to carry out

the purposes of this article.

(9) Establish advisory groups with a diverse membership

representing interested and affected groups and individuals

as the board finds necessary to carry out the purposes of

this article.

(10) Collaborate with all applicable State agencies for

purposes of implementing this article.

(11) Perform all other activities necessary to further

the purposes of this article.

(b) Global budget model.--The board is responsible for

administering the global budget model and shall:

(1) Evaluate and select rural hospitals for

participation in the global budget model as a participant

rural health hospital on the basis of diversity, vision and

commitment to health care delivery transformation.

(2) Provide technical assistance, training and education

to rural hospitals and participant rural hospitals.

(3) Collect and maintain data from rural hospitals and

participant rural hospitals, participating payers and others

as necessary to carry out the responsibilities of this

article.

(4) Perform data analysis and quality assurance.

(5) Calculate, approve and administer global budgets.

The global budgets may include payments for eligible hospital

services provided under a participant rural hospital's

employee health plan.

(6) Consistent with Federal and State law, review and

approve rural hospital transformation plans, advise and

approve changes to operational and payment mechanisms and

approve exceptions to agreed-upon payment rules through an

approved procedure provided in the board's bylaws.

(7) Assist rural hospitals and participant rural

hospitals in working with community-based organizations to

determine the targeted population health improvement goals.

(8) Evaluate the progress of the implementation of each

participant rural hospital's global budget toward population

health improvement goals and the cost of achieving health

care goals.

(9) Monitor global budgets and quality metrics for

participant rural hospitals.

(10) Provide an annual assessment of each participant

rural hospital's compliance with its rural hospital

transformation plan and global budget targets.

(11) Require a participant rural hospital to submit a

corrective action plan for failure to submit a rural hospital

transformation plan, comply with its rural hospital

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transformation plan or meet its global budget targets.

(12) Terminate a participant rural hospital from the

global budget model in accordance with the participant rural

hospital's participation agreement.

(13) Contract with an independent evaluation group to

provide the board and executive director with an evaluation

of the global budget model's progress in the areas of

population health, quality of care and cost targets.

(14) Review and update the definition of "eligible

hospital services" by transmitting a notice to the

Legislative Reference Bureau for publication in the

Pennsylvania Bulletin, subject to obtaining all necessary

Federal approvals. The board shall use data collected under

paragraph (3) in its review.

(1) The accounts and books of the authority shall be

examined and audited annually by an independent certified

public accounting firm. The audit shall be public

information.

(2) The authority shall, by December 31 of each year,

file a copy of the audit of the preceding Commonwealth fiscal

year required under paragraph (1) with the Secretary of the

Senate and the Chief Clerk of the House of Representatives

and provide a copy to the Department of Health.

(d) Reports.--The authority shall:

(1) Electronically submit an annual report on the

performance and compliance of each participant rural hospital

to the Department of Health and to other appropriate parties,

including associations, foundations, academic institutions

and community-based organizations, as determined by the

board.

(2) Electronically submit an annual report to the

Governor, the President pro tempore of the Senate and the

Speaker of the House of Representatives for distribution to

the Health and Human Services Committee of the Senate and the

Health Committee of the House of Representatives on the

activities of the authority for the year.

(3) Comply with applicable Federal reporting

requirements.

(e) Publication.--The authority shall annually transmit a

financial statement and the authority's audit as a notice to the

Legislative Reference Bureau for publication in the next

available issue of the Pennsylvania Bulletin.

SUBARTICLE C

PARTICIPATION IN GLOBAL BUDGET MODEL

Section 1421-D. Roles of participating payers.

(a) Letter of interest.--A payer may submit a letter of

interest to the authority to participate in the global budget

model.

(b) Agreement to participate.--As a condition of

participation, a participating payer shall sign an agreement

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with the authority. The agreement shall detail the terms and

conditions of participation in the global budget model.

participation with a participant rural hospital according to the

terms and conditions of the agreement under subsection (b).

Section 1422-D. Roles of participant rural hospitals.

(a) Letter of interest.--A rural hospital may submit a

letter of interest to the authority to participate in the global

budget model.

(b) Condition of participation.--As a condition of

participation, the following shall occur:

(1) A rural hospital shall submit an initial rural

hospital transformation plan in the manner and form

prescribed by the authority for review and approval.

(2) A participant rural hospital shall sign an agreement

with the authority. The agreement shall detail the terms and

conditions of participation in the global budget model.

(3) A participant rural hospital shall submit annual

updates to its rural hospital transformation plan in the

manner and form prescribed by the authority for review and

approval.

SUBARTICLE D

DATA COLLECTION AND CONFIDENTIALITY

Section 1431-D. Data collection and retention.

(a) Authority.--The authority may collect and analyze data

from participating payers, rural hospitals, participant rural

hospitals and the department necessary to carry out the

authority's responsibilities under this article. Data collected

by the authority shall only be used for administering the global

budget model. The authority shall obtain the written approval of

a participating payer, rural hospital, participant rural

hospital or the department before the authority can use the

entity's data for any other purpose. The authority shall retain

the data for no more than seven years.

(b) Participant rural hospital.--A participant rural

hospital may authorize its insurer or administrator to provide

data to the authority regarding payments for eligible hospital

services provided under the hospital's employee health plan.

this article, the authority may not release and no data source,

person, member of the public or other user of any data of the

authority may gain access to:

(1) Raw data which could reasonably be expected to

reveal the identity of an individual patient.

(2) Raw data disclosing discounts or allowances between

participating payers and participant rural hospitals which is

prejudicial to an individual participating payer or

participant rural hospital.

(3) Data which the department provides to the authority,

unless the secretary or the designee of the secretary

specifically authorizes the release or access.

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(4) Any data where a conflict of interest occurs.

Section 1432-D. Confidentiality of data, contracts and

agreements.

(a) Right-to-Know Law inapplicable.--Any contract or

agreement between participating payers and participant rural

hospitals or any data, including patient data, provided by a

participating payer, a participant rural hospital, including a

participant rural hospital's insurer or administrator, a rural

hospital or the department to the authority and maintained by

the authority for the purposes of carrying out the requirements

of this article shall be confidential and shall not be subject

to the act of February 14, 2008 (P.L.6, No.3), known as the

Right-to-Know Law, or discoverable or admissible as evidence in

any civil, criminal or administrative action or proceeding.

(b) Authority access to data.--Nothing in this section shall

prohibit the authority from accessing the data to carry out its

responsibilities in accordance with law.

Medicare and Medicaid Services, or any other entity, by the

authority shall be provided consistent with applicable laws and

regulations, including the Health Insurance Portability and

Accountability Act of 1996 (Public Law 104-191, 110 Stat. 1936),

the Health Information Technology for Economic and Clinical

Health Act (Public Law 111-5, 123 Stat. 226-279 and 467-496) and

implementing regulations, to the extent allowed by law and

written agreements between the authority and each participating

payer and participant rural hospital.

SUBARTICLE E

PENNSYLVANIA RURAL HEALTH REDESIGN

CENTER FUND

Section 1441-D. Continuation of fund.

The Pennsylvania Rural Health Redesign Center Fund is

continued as a separate fund in the State Treasury.

Section 1442-D. Money in fund.

The General Assembly may appropriate money to carry out the

provisions of this article. All money deposited into the fund

shall be held for the purposes of the authority and may not be

considered a part of the General Fund but shall be used only to

effectuate the purposes of this article as determined by the

authority. All interest earned from the investment or deposit of

money accumulated in the fund shall be deposited in the fund for

the same use. Any money returned to the authority by any party

shall be deposited into the fund.

Section 9. Repeals are as follows:

(1) The General Assembly declares that the repeal under

paragraph (2) is necessary to effectuate the addition of

Article XIV-D of the act.

(2) The act of November 27, 2019 (P.L.742, No.108),

known as the Pennsylvania Rural Health Redesign Center

Authority Act, is repealed.

Section 10. The addition of Article XIV-D of the act is a

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continuation of the act of November 27, 2019 (P.L.742, No.108),

known as the Pennsylvania Rural Health Redesign Center Authority

Act. The following apply:

(1) Except as otherwise provided in addition of Article

XIV-D of the act, all activities initiated under the

Pennsylvania Rural Health Redesign Center Authority Act shall

continue and remain in full force and effect and may be

completed under the addition of Article XIV-D of the act.

Orders, regulations, rules and decisions which were made

under the Pennsylvania Rural Health Redesign Center Authority

Act and which are in effect on the effective date of section

9 of this act shall remain in full force and effect until

revoked, vacated or modified under addition of Article XIV-D

of the act. Contracts, obligations and collective bargaining

agreements entered into under the Pennsylvania Rural Health

Redesign Center Authority Act are not affected nor impaired

by the repeal of the Pennsylvania Rural Health Redesign

Center Authority Act.

(2) Except as set forth in paragraph (3), any difference

in language between the addition of Article XIV-D of the act

and the Pennsylvania Rural Health Redesign Center Authority

Act is not intended to change or affect the legislative

intent, judicial construction or administration and

implementation of the the Pennsylvania Rural Health Redesign

Center Authority.

(3) Paragraph (2) does not apply to the addition of the

following provisions:

(i) Section 1411-D(c) of the act.

(ii) Section 1442-D of the act.

Section 11. This act shall take effect immediately.

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