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                                                      PRINTER'S NO. 1375

THE GENERAL ASSEMBLY OF PENNSYLVANIA


HOUSE BILL

No. 1124 Session of 2007


        INTRODUCED BY WANSACZ, CONKLIN, GERGELY, STABACK, SURRA,
           BELFANTI, CAPPELLI, FABRIZIO, HENNESSEY, KORTZ, READSHAW,
           REICHLEY, YUDICHAK AND JAMES, APRIL 23, 2007

        REFERRED TO COMMITTEE ON HEALTH AND HUMAN SERVICES,
           APRIL 23, 2007

                                     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 for
     4     medical assistance payments.

     5     The General Assembly of the Commonwealth of Pennsylvania
     6  hereby enacts as follows:
     7     Section 1.  Section 443.1 of the act of June 13, 1967
     8  (P.L.31, No.21), known as the Public Welfare Code, amended July
     9  7, 2005 (P.L.177, No.42), is amended to read:
    10     Section 443.1.  Medical Assistance Payments for Institutional
    11  Care.--(a)  The following medical assistance payments shall be
    12  made in behalf of eligible persons whose institutional care is
    13  prescribed by physicians:
    14     (1)  Payments as determined by the department for inpatient
    15  hospital care consistent with Title XIX of the Social Security
    16  Act (49 Stat. 620, 42 U.S.C. § 1396 et seq.). To be eligible for
    17  such payments a hospital must be qualified to participate under
    18  Title XIX of the Social Security Act and have entered into a

     1  written agreement with the department regarding matters
     2  designated by the secretary as necessary to efficient
     3  administration, such as hospital utilization, maintenance of
     4  proper cost accounting records and access to patients' records.
     5  Such efficient administration shall require the department to
     6  permit participating hospitals to utilize the same fiscal
     7  intermediary for this Title XIX program as such hospitals use
     8  for the Title XVIII program;
     9     (2)  The cost of skilled nursing and intermediate nursing
    10  care in State-owned geriatric centers, institutions for the
    11  mentally retarded, institutions for the mentally ill, and the
    12  cost of skilled and intermediate nursing care provided prior to
    13  June 30, 2004, in county homes which meet the State and Federal
    14  requirements for participation under Title XIX of the Social
    15  Security Act and which are approved by the department. This cost
    16  in county homes shall be as specified by the regulations of the
    17  department adopted under Title XIX of the Social Security Act
    18  and certified to the department by the Auditor General;
    19  elsewhere the cost shall be determined by the department;
    20     (3)  Rates on a cost-related basis established by the
    21  department for skilled nursing home or intermediate care in a
    22  non-public nursing home, when furnished by a nursing home
    23  licensed or approved by the department and qualified to
    24  participate under Title XIX of the Social Security Act and
    25  provided prior to June 30, 2004;
    26     (4)  Payments as determined by the department for inpatient
    27  psychiatric care consistent with Title XIX of the Social
    28  Security Act. To be eligible for such payments a hospital must
    29  be qualified to participate under Title XIX of the Social
    30  Security Act and have entered into a written agreement with the
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     1  department regarding matters designated by the secretary as
     2  necessary to efficient administration, such as hospital
     3  utilization, maintenance of proper cost accounting records and
     4  access to patients' records. Care in a private mental hospital
     5  provided under the fee for service delivery system shall be
     6  limited to thirty days in any fiscal year for recipients aged
     7  twenty-one years or older who are eligible for medical
     8  assistance under Title XIX of the Social Security Act and for
     9  recipients aged twenty-one years or older who are eligible for
    10  general assistance-related medical assistance. Exceptions to the
    11  thirty-day limit may be granted under section 443.3. Only
    12  persons aged twenty-one years or under and aged sixty-five years
    13  or older shall be eligible for care in a public mental hospital.
    14  This cost shall be as specified by regulations of the department
    15  adopted under Title XIX of the Social Security Act and certified
    16  to the department by the Auditor General for county and non-
    17  public institutions;
    18     (5)  On or after July 1, 2004, and until such time as
    19  regulations are adopted pursuant to subclause (iii), payments to
    20  county and nonpublic nursing facilities certified to participate
    21  as providers under Title XIX of the Social Security Act for
    22  nursing facility services shall be calculated and made as
    23  specified in the department's regulations in effect on July 1,
    24  2003, except as may be otherwise required by:
    25     (i)  the Commonwealth's approved Title XIX Plan for nursing
    26  facility services;
    27     (ii)  regulations promulgated by the department pursuant to
    28  section 454; and
    29     (iii)  regulations promulgated by the department pursuant to
    30  section 204(1)(iv) of the act of July 31, 1968 (P.L.769,
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     1  No.240), referred to as the Commonwealth Documents Law,
     2  specifying the methods and standards which the department will
     3  use to set rates and make payments for nursing facility services
     4  effective July 1, 2006. Notwithstanding any other provision of
     5  law, including section 814-A, the promulgation of regulations
     6  under this subsection shall, until June 30, 2006, be exempt from
     7  the following:
     8     (A)  Section 205 of the Commonwealth Documents Law.
     9     (B)  Section 204(b) of the act of October 15, 1980 (P.L.950,
    10  No.164), known as the "Commonwealth Attorneys Act."
    11     (C)  The act of June 25, 1982 (P.L.633, No.181), known as the
    12  "Regulatory Review Act."
    13     (6)  For public nursing home care provided on or after July
    14  1, 2005, the department shall recognize the costs incurred by
    15  county nursing facilities to provide services to eligible
    16  persons as medical assistance program expenditures to the extent
    17  the costs qualify for Federal matching funds and so long as the
    18  costs are allowable as determined by the department and reported
    19  and certified by the county nursing facilities in a form and
    20  manner specified by the department. Notwithstanding this
    21  paragraph, county nursing facilities shall be paid based upon
    22  rates determined in accordance with paragraph (5).
    23     (b)  Payments to any county and nonpublic nursing facility
    24  that is not within a Metropolitan Statistical Area (MSA) but is
    25  within one mile of the border of the MSA shall be made at the
    26  same rate as if the facility was within the MSA.
    27     Section 2.  This act shall take effect in 60 days.


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