PRINTER'S NO. 3491
No. 2521 Session of 2000
INTRODUCED BY TRICH, LESCOVITZ, BELARDI, BELFANTI, DeLUCA,
M. COHEN, DeWEESE, GEORGE, GORDNER, HARHAI, JOSEPHS, McCALL,
MELIO, MYERS, PETRONE, SHANER, SOLOBAY, STURLA, TANGRETTI,
TIGUE, VAN HORNE, VEON, WILLIAMS, WOJNAROSKI AND YOUNGBLOOD,
MAY 4, 2000
REFERRED TO COMMITTEE ON HEALTH AND HUMAN SERVICES, MAY 4, 2000
AN ACT
1 Amending the act of June 13, 1967 (P.L.31, No.21), entitled "An
2 act to consolidate, editorially revise, and codify the public
3 welfare laws of the Commonwealth," further providing medical
4 assistance payments for institutional care and for other
5 medical assistance payments.
6 The General Assembly of the Commonwealth of Pennsylvania
7 hereby enacts as follows:
8 Section 1. Section 443.1 of the act of June 13, 1967
9 (P.L.31, No.21), known as the Public Welfare Code, amended July
10 15, 1976 (P.L.993, No.202), is amended to read:
11 Section 443.1. Medical Assistance Payments for Institutional
12 Care.--The following medical assistance payments shall be made
13 in behalf of eligible persons whose institutional care is
14 prescribed by physicians:
15 (1) The reasonable cost of inpatient hospital care, as
16 specified by regulations of the department adopted under Title
17 XIX of the Federal Social Security Act and certified to the
18 department by the Auditor General for a bed patient on a
1 continuous twenty-four hour a day basis in a multi bed
2 accommodation of a hospital, exclusive of a hospital or distinct
3 part of a hospital wherein twenty-five percent of patients
4 remain six months or more. To be eligible for such payments a
5 hospital must be qualified to participate under Title XIX of the
6 Federal Social Security Act and have entered into a written
7 agreement with the department regarding matters designated by
8 the secretary as necessary to efficient administration, such as
9 hospital utilization, maintenance of proper cost accounting
10 records and access to patients' records. Such efficient
11 administration shall require the department to permit
12 participating hospitals to utilize the same fiscal intermediary
13 for this Title XIX program as such hospitals use for the Title
14 XVIII program;
15 (1.1) For all services rendered after the effective date of
16 this clause before July 1, 2000, the department shall provide
17 each hospital payment for services based on the rates
18 established in the most recently negotiated rate agreement
19 between that hospital and the department, adjusted for
20 inflation. The inflation adjustment shall be equal to the
21 increase in the Standard and Poor DRI for health care services
22 from July 1, 1998, to the effective date of this clause.
23 Beginning in State fiscal year commencing July 1, 2000, the
24 department shall, not later than October 1 of each year, provide
25 each hospital eligible for payment under this act with a
26 schedule outlining the rates that that hospital will be paid
27 during the ensuing fiscal year. The rate schedule for the period
28 from July 1, 2000, through June 30, 2001, shall be not less than
29 the rates in effect on June 30, 2000, plus two and one-half
30 percent, unless otherwise determined through negotiations
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1 between the department and the hospital or its recognized agent.
2 On July 1 of each subsequent year, the rate schedule shall be
3 adjusted so that the rates in effect would be those in effect on
4 June 30 plus two and one-half percent, unless otherwise
5 determined through negotiations between the department and the
6 hospital or its recognized agent;
7 (2) The cost of skilled nursing and intermediate nursing
8 care in State-owned geriatric centers, institutions for the
9 mentally retarded, institutions for the mentally ill, and in
10 county homes which meet the State and Federal requirements for
11 participation under Title XIX of the Federal Social Security Act
12 and which are approved by the department. This cost in county
13 homes shall be as specified by the regulations of the department
14 adopted under Title XIX of the Federal Social Security Act and
15 certified to the department by the Auditor General; elsewhere
16 the cost shall be determined by the department;
17 (3) Rates on a cost-related basis established by the
18 department for skilled nursing home or intermediate care in a
19 non-public nursing home, when furnished by a nursing home
20 licensed or approved by the department and qualified to
21 participate under Title XIX of the Federal Social Security Act;
22 (4) The cost of care in any mental hospital or in a public
23 tuberculosis hospital. To be eligible for such payments a
24 hospital must be qualified to participate under Title XIX of the
25 Federal Social Security Act and have entered into a written
26 agreement with the department regarding matters designated by
27 the secretary as necessary to efficient administration, such as
28 hospital utilization, maintenance of proper cost accounting
29 records and access to patients' records. Care in a private
30 mental hospital shall be limited to sixty days in a benefit
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1 period. Only persons aged twenty-one years or under and aged
2 sixty-five years or older shall be eligible for care in a public
3 mental or tuberculosis hospital. This cost shall be the
4 reasonable cost, as determined by the department for a State
5 institution or as specified by regulations of the department
6 adopted under Title XIX of the Federal Social Security Act and
7 certified to the department by the Auditor General for county
8 and non-public institutions.
9 Section 2. Section 443.3 of the act, amended November 28,
10 1973 (P.L.364, No.128), is amended to read:
11 Section 443.3. Other Medical Assistance Payments.--Payments
12 on behalf of eligible persons shall be made for other services,
13 as follows:
14 (1) Rates established by the department for outpatient
15 services as specified by regulations of the department adopted
16 under Title XIX of the Federal Social Security Act consisting of
17 preventive, diagnostic, therapeutic, rehabilitative or
18 palliative services; furnished by or under the direction of a
19 physician, chiropractor or podiatrist, by a hospital or
20 outpatient clinic which qualifies to participate under Title XIX
21 of the Federal Social Security Act, to a patient to whom such
22 hospital or outpatient clinic does not furnish room, board and
23 professional services on a continuous, twenty-four hour a day
24 basis.
25 (2) Rates established by the department for (i) other
26 laboratory and X-ray services prescribed by a physician,
27 chiropractor or podiatrist and furnished by a facility other
28 than a hospital which is qualified to participate under Title
29 XIX of the Federal Social Security Act, (ii) physician's
30 services consisting of professional care by a physician,
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1 chiropractor or podiatrist in his office, the patient's home, a
2 hospital, a nursing home or elsewhere, (iii) the first three
3 pints of whole blood, (iv) remedial eye care, as provided in
4 Article VIII consisting of medical or surgical care and aids and
5 services and other vision care provided by a physician skilled
6 in diseases of the eye or by an optometrist which are not
7 otherwise available under this Article, (v) special medical
8 services for school children, as provided in the Public School
9 Code of 1949, consisting of medical, dental, vision care
10 provided by a physician skilled in diseases of the eye or by an
11 optometrist or surgical care and aids and services which are not
12 otherwise available under this article.
13 (3) The department shall annually make payments to eligible
14 hospitals which serve high volumes of uninsured, low-income and
15 medical assistance patients, according to criteria and a formula
16 which the department shall adopt in regulation, as partial
17 compensation for that hospital's uncompensated care. For the
18 State fiscal year beginning July 1, 2000, the amount available
19 for such payments shall equal one hundred and ten percent of the
20 total State contribution for inpatient and outpatient
21 disproportionate share payments, critical access providers and
22 Federal matching funds that were paid to eligible hospitals in
23 State fiscal year 1998-1999. In each subsequent year, the
24 payment for uncompensated care shall equal one hundred and three
25 percent of the amount of State funds allocated to all eligible
26 hospitals for uncompensated care in the prior State fiscal year
27 plus the Federal match. Hospitals which receive payments for
28 uncompensated care, in addition to meeting any other eligibility
29 criteria established pursuant to this act, Federal statute or
30 any regulations issued pursuant thereto, shall agree, as a
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1 condition of receiving such payments, that every physician
2 practice and outpatient clinic owned by that hospital, its
3 parent organization or any subsidiary shall be enrolled as a
4 Medicaid provider and shall agree to accept patients regardless
5 of their ability to pay.
6 (4) The department shall annually make payments to eligible
7 academic health centers and teaching hospitals according to
8 criteria and a formula which the department shall adopt in
9 regulation to support medical education. For the State fiscal
10 year beginning July 1, 2000, the amount available for such
11 payments shall equal one hundred and fifteen percent of the
12 total State contribution for medical education and matching
13 Federal funds that were paid to eligible academic health centers
14 and teaching hospitals in fiscal year 1998-1999. In each
15 subsequent year, the payment for medical education shall equal
16 one hundred and five percent of the amount of State medical
17 education funds allocated to all academic health centers and
18 teaching hospitals in the prior fiscal year plus the Federal
19 match. At least one-quarter of the funds made available through
20 this clause shall be to provide medical education, including the
21 direct provision of care, in outpatient and emergency room
22 settings.
23 Section 3. This act shall take effect immediately.
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