PRIOR PRINTER'S NO. 1869 PRINTER'S NO. 2727
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, D. O'BRIEN, LONGIETTI, BENNINGTON, FLECK, GERBER, HORNAMAN, SIPTROTH, WAGNER AND CAUSER, JUNE 7, 2007
AS REPORTED FROM COMMITTEE ON HEALTH AND HUMAN SERVICES, HOUSE OF REPRESENTATIVES, AS AMENDED, OCTOBER 24, 2007
AN ACT 1 Providing for the availability of and access to HOSPITAL <-- 2 obstetrical and neonatal care; establishing a funding 3 formula; requiring funded hospitals to provide notification <-- 4 upon closure SERVICES; imposing powers and duties upon the <-- 5 Department of Health, the Insurance Commissioner and the <-- 6 Department of Public Welfare.; 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 HOSPITAL Obstetrical and Neonatal Care SERVICES 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 HOSPITAL obstetrical and neonatal care services are available <--
1 in this Commonwealth. 2 (2) Access to a full spectrum of HOSPITAL obstetrical <-- 3 and neonatal care health services must be available across 4 this Commonwealth. 5 (3) Approximately one of every three births in this 6 Commonwealth is covered by medical assistance. 7 (4) To maintain this system, the Commonwealth shall 8 provide financial assistance. 9 Section 3. Definitions. 10 The following words and phrases when used in this act shall 11 have the meanings given to them in this section unless the 12 context clearly indicates otherwise: 13 "Department." The Department of Public Welfare of the 14 Commonwealth. 15 "Hospital." An entity located in this Commonwealth that is 16 licensed as a hospital under the act of July 19, 1979 (P.L.130, 17 No.48), known as the Health Care Facilities Act. 18 "Medical assistance." The program under Article IV(f) of the 19 act of June 13, 1967 (P.L.31, No.21), known as the Public 20 Welfare Code. 21 "Neonatal intensive care services." Neonatal intensive care 22 services provided by a hospital. 23 "Obstetrical services." Obstetrical services provided by a 24 hospital. 25 "Rural." Located in a county outside a Metropolitan 26 Statistical Area established by the United States Office of 27 Management and Budget. 28 "Secretary." The Secretary of Public Welfare of the 29 Commonwealth. 30 Section 4. Qualifications of hospitals. 20070H1514B2727 - 2 -
1 (a) Eligibility.--The following are qualified under this 2 act: 3 (1) A rural hospital in this Commonwealth which meets 4 one of the following: 5 (i) Ranks in the top one-third of rural hospitals in 6 terms of volume of obstetrical cases covered by medical 7 assistance during the most recent fiscal year with 8 available data. 9 (ii) Has a percentage of its obstetrical cases 10 covered by medical assistance which is greater than 50% 11 of all obstetrical cases during the most recent fiscal 12 year with available data. 13 (iii) Is licensed by the Department of Health to 14 provide neonatal intensive care services. 15 (2) A nonrural hospital in this Commonwealth which meets 16 one of the following: 17 (i) Is RANKS in the top one-third of nonrural <-- 18 hospitals in terms of volume of obstetrical cases covered 19 by medical assistance during the most recent fiscal year 20 with available data. 21 (ii) Has a percentage of obstetrical cases covered 22 by medical assistance which is greater than 50% of all 23 obstetrical cases during the most recent fiscal year with 24 available data. 25 (III) PROVIDES OBSTETRICAL CARE SERVICES AND IS <-- 26 LOCATED WITHIN FIVE MILES OF ANY HOSPITAL THAT CLOSED ITS 27 OBSTETRICAL SERVICE DURING THE PREVIOUS THREE YEARS. 28 (iii) Is (IV) RANKS in the top one-third of <-- 29 nonrural hospitals in terms of volume of neonatal 30 intensive care cases covered by medical assistance during 20070H1514B2727 - 3 -
1 the most recent fiscal year with available data. 2 (iv) (V) Has a percentage of neonatal intensive care <-- 3 cases covered by medical assistance which is greater than 4 50% of all neonatal intensive care cases during the most 5 recent fiscal year with available data. 6 (b) Initial submission of qualifications NOTIFICATION.--The <-- 7 Department of Health shall notify the department of those 8 hospitals which are determined to be eligible no later than 30 9 days after the effective date of this section. AFTER THE INITIAL <-- 10 NOTIFICATION UNDER THIS SUBSECTION, NOTICE SHALL BE PROVIDED TO 11 THE DEPARTMENT AT LEAST 30 DAYS PRIOR TO THE BEGINNING OF THE 12 FISCAL YEAR. 13 Section 5. Funding. 14 (a) Distribution.-- 15 (1) For fiscal years beginning after June 30, 2007, upon 16 Federal approval of an amendment to the medical assistance 17 State plan, the department shall distribute annually from 18 funds appropriated for this purpose disproportionate share 19 payments to hospitals qualified under section 4 to provide 20 financial assistance to assure readily available and 21 coordinated obstetrical and neonatal intensive care of the 22 highest quality to the citizens of this Commonwealth. 23 (2) On July 1, the secretary may evaluate the funds 24 available and may make appropriate adjustments based on the 25 number of qualified hospitals and changes in the additional 26 costs required to provide obstetrical and neonatal intensive 27 care services. 28 (b) Funding FEDERAL FUNDING.--The department shall seek to <-- 29 maximize Federal funds, including funds obtained pursuant to 30 Title XIX of the Social Security Act (49 Stat. 620, 42 U.S.C. § 20070H1514B2727 - 4 -
1 1396 et seq.), available for maternal and infant care. 2 (c) Payment calculation.--Payment to qualified hospitals 3 shall be allocated according to the following: 4 (1) Fifteen percent of the total amount available shall 5 be allocated to qualified rural hospitals as follows: 6 (i) Under this subparagraph, 52.5% of the allocation 7 under this paragraph is the amount available for 8 distribution to qualified rural hospitals obstetrical 9 cases covered by medical assistance. The distribution 10 shall be made under the following formula: 11 (A) For each hospital, determine the ratio of: 12 (I) the hospital's medical assistance 13 obstetrical cases; to 14 (II) all obstetrical cases for the hospital. 15 (B) For each hospital, multiply: 16 (I) the ratio under clause (A); by 17 (II) the number of the hospital's medical 18 assistance obstetrical cases. 19 (C) Add the products under clause (B) for all 20 hospitals. 21 (D) Divide: 22 (I) the amount available for distribution 23 under this subparagraph; by 24 (II) the sum under clause (C). 25 (E) Multiply: 26 (I) the quotient under clause (D); by 27 (II) the product under clause (B). 28 (ii) Under this subparagraph, 32.5% of the 29 allocation under this paragraph is the amount available 30 for distribution to qualified rural hospitals with 20070H1514B2727 - 5 -
1 neonatal intensive-care cases covered by medical 2 assistance. The distribution shall be made under the 3 following formula: 4 (A) For each hospital, determine the ratio of: 5 (I) the hospital's medical assistance 6 neonatal intensive-care cases; to 7 (II) all neonatal intensive-care cases for 8 the hospital. 9 (B) for each hospital, multiply: 10 (I) the ratio under clause (A); by 11 (II) the number of the hospital's medical 12 assistance neonatal intensive-care cases. 13 (C) Add the products under clause (B) for all 14 hospitals. 15 (D) Divide: 16 (I) the amount available for distribution 17 under this subparagraph; by 18 (II) the sum under clause (C). 19 (E) Multiply: 20 (I) the quotient under clause (D); by 21 (II) the product under clause (B). 22 (iii) Fifteen percent of the allocation under this 23 paragraph shall be distributed equally among qualified 24 rural hospitals with obstetrical cases. 25 (iv) For calculations under this paragraph, each 26 hospital shall use both in-State and out-of-State cases. 27 (2) Eighty-five percent of the total amount available 28 shall be allocated to qualified nonrural hospitals as 29 follows: 30 (i) Under this subparagraph, 52.5% of the allocation 20070H1514B2727 - 6 -
1 under this paragraph is the amount available for 2 distribution to qualified nonrural hospitals obstetrical 3 cases covered by medical assistance. The distribution 4 shall be made under the following formula: 5 (A) For each hospital, determine the ratio of: 6 (I) the hospital's medical assistance 7 obstetrical cases; to 8 (II) all obstetrical cases for the hospital. 9 (B) For each hospital, multiply: 10 (I) the ratio under clause (A); by 11 (II) the number of the hospital's medical 12 assistance obstetrical cases. 13 (C) Add the products under clause (B) for all 14 hospitals. 15 (D) Divide: 16 (I) the amount available for distribution 17 under this subparagraph; by 18 (II) the sum under clause (C). 19 (E) Multiply: 20 (I) the quotient under clause (D); by 21 (II) the product under clause (B). 22 (ii) Under this subparagraph, 32.5% of the 23 allocation under this paragraph is the amount available 24 for distribution to qualified nonrural hospitals with 25 neonatal intensive-care cases covered by medical 26 assistance. The distribution shall be made under the 27 following formula: 28 (A) For each hospital, determine the ratio of: 29 (I) the hospital's medical assistance 30 neonatal intensive-care cases; to 20070H1514B2727 - 7 -
1 (II) all neonatal intensive-care cases for 2 the hospital. 3 (B) For each hospital, multiply: 4 (I) the ratio under clause (A); by 5 (II) the number of the hospital's medical 6 assistance neonatal intensive-care cases. 7 (C) Add the products under clause (B) for all 8 hospitals. 9 (D) Divide: 10 (I) the amount available for distribution 11 under this subparagraph; by 12 (II) the sum under clause (C). 13 (E) Multiply: 14 (I) the quotient under clause (D); by 15 (II) the product under clause (B). 16 (iii) Fifteen percent of the allocation under this 17 paragraph shall be distributed equally among qualified 18 nonrural hospitals with obstetrical cases. 19 (iv) For calculations under this paragraph, each 20 hospital shall use both in-State and out-of-State cases. 21 (3) A qualified hospital which has reached its 22 disproportionate share limit under Title XIX of the Social 23 Security Act shall receive its share of the State funds 24 available under this act. 25 SECTION 6. SERVICE REQUIREMENT. <-- 26 A QUALIFIED HOSPITAL THAT ACCEPTS ANY FUNDS PROVIDED UNDER 27 THIS ACT SHALL PROVIDE OBSTETRICAL SERVICES FOR THE ENTIRE 28 FISCAL YEAR IN WHICH ANY PAYMENTS ARE RECEIVED. FAILURE TO 29 COMPLY WITH THIS SECTION SHALL RESULT IN FORFEITURE OF THESE 30 FUNDS. ANY FORFEITED FUNDS SHALL BE REDISTRIBUTED AMONG THE 20070H1514B2727 - 8 -
1 REMAINING QUALIFIED HOSPITALS. 2 Section 6 7. Reporting. <-- 3 (a) Requirement.--By March 1, the department shall make an 4 annual report to the Public Health and Welfare Committee of the 5 Senate and the Health and Human Services Committee of the House 6 of Representatives on the hospitals funded under this act. 7 (b) Contents.--The report shall contain all of the 8 following: 9 (1) For each hospital receiving funds: 10 (i) identity; 11 (ii) amount received; and 12 (iii) number of obstetrical and neonatal intensive- 13 care cases. 14 (2) Recommendations for improvement under this act to 15 further promote the availability of obstetrical and neonatal 16 care to the citizens of this Commonwealth. 17 Section 7. Notification of closure. <-- 18 A hospital which receives funds under this act shall notify 19 the department and the Department of Health of its intent to 20 cease operation of its obstetrical or neonatal intensive-care 21 services no later than 60 days prior to closure. 22 Section 8. Physician and nurse midwife services. 23 (a) Secretary of Health.-- 24 (1) The Secretary of Health shall study the availability 25 of obstetricians and nurse midwives to assure readily 26 available and coordinated obstetrical care of the highest 27 quality to the citizens of this Commonwealth. 28 (2) The Secretary of Health shall make recommendations 29 on improving the availability of obstetrical services. 30 (b) Report.-- 20070H1514B2727 - 9 -
1 (1) By December 1, 2007, the Secretary of Health, in 2 cooperation with the secretary and Insurance Commissioner, 3 shall make a report to all of the following: 4 (i) Banking and Insurance Committee of the Senate. 5 (ii) Public Health and Welfare Committee of the 6 Senate. 7 (iii) Health and Human Services Committee of the 8 House of Representatives. 9 (iv) The Insurance Committee of the House of 10 Representatives. 11 (2) The report shall contain all of the following: 12 (i) Number of physicians and certified nurse 13 midwives providing obstetrical services by county for the 14 last five years. 15 (ii) Number of births by county for the last five 16 years. 17 (iii) Fees paid for physician and nurse midwife 18 services by the department. 19 (iv) Fees paid for physician and nurse midwife 20 services by other health care insurers or payors. 21 Section 28. Appropriation. 22 (a) General fund.--The sum of $15,000,000, or as much 23 thereof as may be necessary, is hereby appropriated to the 24 Department of Public Welfare for the fiscal year July 1, 2007, 25 to June 30, 2008, to provide for medical assistance payments to 26 qualifying hospitals covered under this act. 27 (b) Supplement.--The sum of $18,000,000 from Federal medical 28 assistance amounts are appropriated to supplement the sum 29 appropriated under subsection (a). 30 Section 29. Applicability. 20070H1514B2727 - 10 -
1 If section 5(a)(2) takes effect after July 1, 2007, section 2 5(a)(2) shall apply retroactively to July 1, 2007. 3 Section 30. Effective date. 4 This act shall take effect as follows: 5 (1) This section shall take effect immediately. 6 (2) Section 6 shall take effect January 1, 2008. 7 (3) The remainder of this act shall take effect July 1, 8 2007, or immediately, whichever is later. 9 SECTION 29. RETROACTIVITY. <-- 10 SECTION 5(A)(2) SHALL APPLY RETROACTIVELY TO JULY 1, 2007. 11 SECTION 30. EFFECTIVE DATE. 12 THIS ACT SHALL TAKE EFFECT IMMEDIATELY. F5L35MSP/20070H1514B2727 - 11 -