PRINTER'S NO. 1869
No. 1514 Session of 2007
INTRODUCED BY MANDERINO, BELFANTI, BISHOP, BLACKWELL,
CALTAGIRONE, CARROLL, COHEN, CURRY, DePASQUALE, DiGIROLAMO,
FABRIZIO, FREEMAN, GALLOWAY, GEORGE, GIBBONS, GOODMAN,
GRUCELA, HARHART, HARKINS, HENNESSEY, JAMES, KILLION, KING,
KORTZ, JOSEPHS, KULA, LEACH, LENTZ, MANN, McILHATTAN, MELIO,
MICOZZIE, MOYER, MUNDY, MYERS, M. O'BRIEN, OLIVER, PAYTON,
REED, RUBLEY, SABATINA, SAINATO, SAYLOR, SHAPIRO, SOLOBAY,
SURRA, J. TAYLOR, THOMAS, WALKO, WHEATLEY, YOUNGBLOOD,
BUXTON, MAHONEY, DALEY AND D. O'BRIEN, JUNE 7, 2007
REFERRED TO COMMITTEE ON HEALTH AND HUMAN SERVICES, JUNE 7, 2007
AN ACT
1 Providing for the availability of and access to obstetrical and
2 neonatal care; establishing a funding formula; requiring
3 funded hospitals to provide notification upon closure;
4 imposing powers and duties upon the Department of Health, the
5 Insurance Commissioner and the Department of Public Welfare;
6 and making an appropriation.
7 The General Assembly of the Commonwealth of Pennsylvania
8 hereby enacts as follows:
9 Section 1. Short title.
10 This act shall be known and may be cited as the Access to
11 Obstetrical and Neonatal Care Act.
12 Section 2. Declaration of policy.
13 The General Assembly finds and declares as follows:
14 (1) It is the purpose of this act to ensure that
15 obstetrical and neonatal care services are available in this
16 Commonwealth.
1 (2) Access to a full spectrum of obstetrical and
2 neonatal care health services must be available across this
3 Commonwealth.
4 (3) Approximately one of every three births in this
5 Commonwealth is covered by medical assistance.
6 (4) To maintain this system, the Commonwealth shall
7 provide financial assistance.
8 Section 3. Definitions.
9 The following words and phrases when used in this act shall
10 have the meanings given to them in this section unless the
11 context clearly indicates otherwise:
12 "Department." The Department of Public Welfare of the
13 Commonwealth.
14 "Hospital." An entity located in this Commonwealth that is
15 licensed as a hospital under the act of July 19, 1979 (P.L.130,
16 No.48), known as the Health Care Facilities Act.
17 "Medical assistance." The program under Article IV(f) of the
18 act of June 13, 1967 (P.L.31, No.21), known as the Public
19 Welfare Code.
20 "Neonatal intensive care services." Neonatal intensive care
21 services provided by a hospital.
22 "Obstetrical services." Obstetrical services provided by a
23 hospital.
24 "Rural." Located in a county outside a Metropolitan
25 Statistical Area established by the United States Office of
26 Management and Budget.
27 "Secretary." The Secretary of Public Welfare of the
28 Commonwealth.
29 Section 4. Qualifications of hospitals.
30 (a) Eligibility.--The following are qualified under this
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1 act:
2 (1) A rural hospital in this Commonwealth which meets
3 one of the following:
4 (i) Ranks in the top one-third of rural hospitals in
5 terms of volume of obstetrical cases covered by medical
6 assistance during the most recent fiscal year with
7 available data.
8 (ii) Has a percentage of its obstetrical cases
9 covered by medical assistance which is greater than 50%
10 of all obstetrical cases during the most recent fiscal
11 year with available data.
12 (iii) Is licensed by the Department of Health to
13 provide neonatal intensive care services.
14 (2) A nonrural hospital in this Commonwealth which meets
15 one of the following:
16 (i) Is in the top one-third of nonrural hospitals in
17 terms of volume of obstetrical cases covered by medical
18 assistance during the most recent fiscal year with
19 available data.
20 (ii) Has a percentage of obstetrical cases covered
21 by medical assistance which is greater than 50% of all
22 obstetrical cases during the most recent fiscal year with
23 available data.
24 (iii) Is in the top one-third of nonrural hospitals
25 in terms of volume of neonatal intensive care cases
26 covered by medical assistance during the most recent
27 fiscal year with available data.
28 (iv) Has a percentage of neonatal intensive care
29 cases covered by medical assistance which is greater than
30 50% of all neonatal intensive care cases during the most
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1 recent fiscal year with available data.
2 (b) Initial submission of qualifications.--The Department of
3 Health shall notify the department of those hospitals which are
4 determined to be eligible no later than 30 days after the
5 effective date of this section.
6 Section 5. Funding.
7 (a) Distribution.--
8 (1) For fiscal years beginning after June 30, 2007, upon
9 Federal approval of an amendment to the medical assistance
10 State plan, the department shall distribute annually from
11 funds appropriated for this purpose disproportionate share
12 payments to hospitals qualified under section 4 to provide
13 financial assistance to assure readily available and
14 coordinated obstetrical and neonatal intensive care of the
15 highest quality to the citizens of this Commonwealth.
16 (2) On July 1, the secretary may evaluate the funds
17 available and may make appropriate adjustments based on the
18 number of qualified hospitals and changes in the additional
19 costs required to provide obstetrical and neonatal intensive
20 care services.
21 (b) Funding.--The department shall seek to maximize Federal
22 funds, including funds obtained pursuant to Title XIX of the
23 Social Security Act (49 Stat. 620, 42 U.S.C. § 1396 et seq.),
24 available for maternal and infant care.
25 (c) Payment calculation.--Payment to qualified hospitals
26 shall be allocated according to the following:
27 (1) Fifteen percent of the total amount available shall
28 be allocated to qualified rural hospitals as follows:
29 (i) Under this subparagraph, 52.5% of the allocation
30 under this paragraph is the amount available for
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1 distribution to qualified rural hospitals obstetrical
2 cases covered by medical assistance. The distribution
3 shall be made under the following formula:
4 (A) For each hospital, determine the ratio of:
5 (I) the hospital's medical assistance
6 obstetrical cases; to
7 (II) all obstetrical cases for the hospital.
8 (B) For each hospital, multiply:
9 (I) the ratio under clause (A); by
10 (II) the number of the hospital's medical
11 assistance obstetrical cases.
12 (C) Add the products under clause (B) for all
13 hospitals.
14 (D) Divide:
15 (I) the amount available for distribution
16 under this subparagraph; by
17 (II) the sum under clause (C).
18 (E) Multiply:
19 (I) the quotient under clause (D); by
20 (II) the product under clause (B).
21 (ii) Under this subparagraph, 32.5% of the
22 allocation under this paragraph is the amount available
23 for distribution to qualified rural hospitals with
24 neonatal intensive-care cases covered by medical
25 assistance. The distribution shall be made under the
26 following formula:
27 (A) For each hospital, determine the ratio of:
28 (I) the hospital's medical assistance
29 neonatal intensive-care cases; to
30 (II) all neonatal intensive-care cases for
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1 the hospital.
2 (B) for each hospital, multiply:
3 (I) the ratio under clause (A); by
4 (II) the number of the hospital's medical
5 assistance neonatal intensive-care cases.
6 (C) Add the products under clause (B) for all
7 hospitals.
8 (D) Divide:
9 (I) the amount available for distribution
10 under this subparagraph; by
11 (II) the sum under clause (C).
12 (E) Multiply:
13 (I) the quotient under clause (D); by
14 (II) the product under clause (B).
15 (iii) Fifteen percent of the allocation under this
16 paragraph shall be distributed equally among qualified
17 rural hospitals with obstetrical cases.
18 (iv) For calculations under this paragraph, each
19 hospital shall use both in-State and out-of-State cases.
20 (2) Eighty-five percent of the total amount available
21 shall be allocated to qualified nonrural hospitals as
22 follows:
23 (i) Under this subparagraph, 52.5% of the allocation
24 under this paragraph is the amount available for
25 distribution to qualified nonrural hospitals obstetrical
26 cases covered by medical assistance. The distribution
27 shall be made under the following formula:
28 (A) For each hospital, determine the ratio of:
29 (I) the hospital's medical assistance
30 obstetrical cases; to
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1 (II) all obstetrical cases for the hospital.
2 (B) For each hospital, multiply:
3 (I) the ratio under clause (A); by
4 (II) the number of the hospital's medical
5 assistance obstetrical cases.
6 (C) Add the products under clause (B) for all
7 hospitals.
8 (D) Divide:
9 (I) the amount available for distribution
10 under this subparagraph; by
11 (II) the sum under clause (C).
12 (E) Multiply:
13 (I) the quotient under clause (D); by
14 (II) the product under clause (B).
15 (ii) Under this subparagraph, 32.5% of the
16 allocation under this paragraph is the amount available
17 for distribution to qualified nonrural hospitals with
18 neonatal intensive-care cases covered by medical
19 assistance. The distribution shall be made under the
20 following formula:
21 (A) For each hospital, determine the ratio of:
22 (I) the hospital's medical assistance
23 neonatal intensive-care cases; to
24 (II) all neonatal intensive-care cases for
25 the hospital.
26 (B) For each hospital, multiply:
27 (I) the ratio under clause (A); by
28 (II) the number of the hospital's medical
29 assistance neonatal intensive-care cases.
30 (C) Add the products under clause (B) for all
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1 hospitals.
2 (D) Divide:
3 (I) the amount available for distribution
4 under this subparagraph; by
5 (II) the sum under clause (C).
6 (E) Multiply:
7 (I) the quotient under clause (D); by
8 (II) the product under clause (B).
9 (iii) Fifteen percent of the allocation under this
10 paragraph shall be distributed equally among qualified
11 nonrural hospitals with obstetrical cases.
12 (iv) For calculations under this paragraph, each
13 hospital shall use both in-State and out-of-State cases.
14 (3) A qualified hospital which has reached its
15 disproportionate share limit under Title XIX of the Social
16 Security Act shall receive its share of the State funds
17 available under this act.
18 Section 6. Reporting.
19 (a) Requirement.--By March 1, the department shall make an
20 annual report to the Public Health and Welfare Committee of the
21 Senate and the Health and Human Services Committee of the House
22 of Representatives on the hospitals funded under this act.
23 (b) Contents.--The report shall contain all of the
24 following:
25 (1) For each hospital receiving funds:
26 (i) identity;
27 (ii) amount received; and
28 (iii) number of obstetrical and neonatal intensive-
29 care cases.
30 (2) Recommendations for improvement under this act to
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1 further promote the availability of obstetrical and neonatal
2 care to the citizens of this Commonwealth.
3 Section 7. Notification of closure.
4 A hospital which receives funds under this act shall notify
5 the department and the Department of Health of its intent to
6 cease operation of its obstetrical or neonatal intensive-care
7 services no later than 60 days prior to closure.
8 Section 8. Physician and nurse midwife services.
9 (a) Secretary of Health.--
10 (1) The Secretary of Health shall study the availability
11 of obstetricians and nurse midwives to assure readily
12 available and coordinated obstetrical care of the highest
13 quality to the citizens of this Commonwealth.
14 (2) The Secretary of Health shall make recommendations
15 on improving the availability of obstetrical services.
16 (b) Report.--
17 (1) By December 1, 2007, the Secretary of Health, in
18 cooperation with the secretary and Insurance Commissioner,
19 shall make a report to all of the following:
20 (i) Banking and Insurance Committee of the Senate.
21 (ii) Public Health and Welfare Committee of the
22 Senate.
23 (iii) Health and Human Services Committee of the
24 House of Representatives.
25 (iv) The Insurance Committee of the House of
26 Representatives.
27 (2) The report shall contain all of the following:
28 (i) Number of physicians and certified nurse
29 midwives providing obstetrical services by county for the
30 last five years.
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1 (ii) Number of births by county for the last five
2 years.
3 (iii) Fees paid for physician and nurse midwife
4 services by the department.
5 (iv) Fees paid for physician and nurse midwife
6 services by other health care insurers or payors.
7 Section 28. Appropriation.
8 (a) General fund.--The sum of $15,000,000, or as much
9 thereof as may be necessary, is hereby appropriated to the
10 Department of Public Welfare for the fiscal year July 1, 2007,
11 to June 30, 2008, to provide for medical assistance payments to
12 qualifying hospitals covered under this act.
13 (b) Supplement.--The sum of $18,000,000 from Federal medical
14 assistance amounts are appropriated to supplement the sum
15 appropriated under subsection (a).
16 Section 29. Applicability.
17 If section 5(a)(2) takes effect after July 1, 2007, section
18 5(a)(2) shall apply retroactively to July 1, 2007.
19 Section 30. Effective date.
20 This act shall take effect as follows:
21 (1) This section shall take effect immediately.
22 (2) Section 6 shall take effect January 1, 2008.
23 (3) The remainder of this act shall take effect July 1,
24 2007, or immediately, whichever is later.
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