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        PRIOR PRINTER'S NOS. 1905, 1972               PRINTER'S NO. 2101

THE GENERAL ASSEMBLY OF PENNSYLVANIA


HOUSE BILL

No. 1552 Session of 2007


        INTRODUCED BY DeLUCA, MICOZZIE, SHIMKUS, THOMAS, DeWEESE,
           EACHUS, KENNEY, BELFANTI, BIANCUCCI, BLACKWELL, CALTAGIRONE,
           CREIGHTON, FABRIZIO, FRANKEL, FREEMAN, GIBBONS, GRUCELA,
           GOODMAN, HALUSKA, JOSEPHS, KORTZ, KOTIK, KULA, LENTZ,
           MAHONEY, MANDERINO, MARKOSEK, McILVAINE SMITH, MUNDY, MYERS,
           SAYLOR, SOLOBAY, TANGRETTI, J. TAYLOR, R. TAYLOR, WALKO,
           YUDICHAK, WANSACZ, KILLION, JAMES AND MELIO, JUNE 13, 2007

        AS AMENDED ON SECOND CONSIDERATION, HOUSE OF REPRESENTATIVES,
           JUNE 26, 2007

                                     AN ACT

     1  Establishing the Pennsylvania Infection Control Advisory
     2     Committee; providing for duties of the committee, the
     3     Department of Health, the Pennsylvania Health Care Cost
     4     Containment Council and the Patient Safety Authority;
     5     requiring health care facilities to develop and implement
     6     infection control plans; and imposing penalties.

     7                         TABLE OF CONTENTS
     8  Section 1.  Short title.
     9  Section 2.  Definitions.
    10  Section 3.  Committee.
    11  Section 4.  Duties of department.
    12  Section 5.  Collaboratives.
    13  Section 6.  Health care facilities.
    14  Section 7.  Authority.
    15  Section 8.  Nursing homes.
    16  Section 9.  Electronic surveillance.
    17  Section 10.  Violations and penalties.

     1  Section 11.  Effective date.                                      <--
     2  SECTION 11.  PAYMENTS.                                            <--
     3  SECTION 12.  INCENTIVE PAYMENTS.
     4  SECTION 13.  MACHINERY AND EQUIPMENT LOAN FUND ELIGIBILITY.
     5  SECTION 14.  EXPIRATION.
     6  SECTION 15.  EFFECTIVE DATE.
     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 Health Care-
    11  associated Infection Prevention and Control Act.
    12  Section 2.  Definitions.
    13     The following words and phrases when used in this act shall
    14  have the meanings given to them in this section unless the
    15  context clearly indicates otherwise:
    16     "Antimicrobial agent."  A general term for drugs, chemicals
    17  or other substances that kill or slow the growth of microbes,
    18  including, but not limited to, antibacterial drugs, antiviral
    19  agents, antifungal agents and antiparasitic drugs.
    20     "Authority."  The Patient Safety Authority established by the
    21  act of March 20, 2002 (P.L.154, No.13), known as the Medical
    22  Care Availability and Reduction of Error (Mcare) Act.
    23     "BEST PRACTICES."  NATIONALLY RECOGNIZED STANDARDS DEVELOPED   <--
    24  BY ORGANIZATIONS SPECIALIZING IN THE CONTROL OF INFECTIOUS
    25  DISEASES SUCH AS THE SOCIETY FOR HEALTHCARE EPIDEMIOLOGY OF
    26  AMERICA (SHEA), THE ASSOCIATION FOR INFECTION CONTROL AND
    27  EPIDEMIOLOGY AND THE INFECTIOUS DISEASES SOCIETY OF AMERICA AND
    28  THE PROFESSIONALS IN METHODS RECOMMENDATIONS AND GUIDELINES
    29  DEVELOPED BY THE CENTERS FOR DISEASE CONTROL AND PREVENTION AND
    30  ITS NATIONAL HEALTHCARE SAFETY NETWORK THAT SHOULD BE USED BY
    20070H1552B2101                  - 2 -     

     1  HEALTH CARE PROVIDERS TO REDUCE THE RISK OF HARM TO PATIENTS.
     2     "Collaborative."  An organized collaborative designated by
     3  the Department of Health in each region of this Commonwealth. An
     4  organized collaborative shall include at least one hospital and
     5  one nursing facility and may include Federal, State and local
     6  entities, other health care facilities, physician practices,
     7  academic institutions or any other organization that may assist
     8  in efforts to reduce or eliminate health care-associated
     9  infections.
    10     "Collaborative partner."  A health care facility that
    11  partners with a collaborative and uses and accesses the
    12  resources that the collaborative offers in accordance with this
    13  act.
    14     "Colonization."  The first stage of microbial infection or
    15  the presence of nonreplicating microorganisms usually present in
    16  the host tissues that are in contact with the external
    17  environment.
    18     "Committee."  The Pennsylvania Infection Control Advisory
    19  Committee established under section 3.
    20     "Consumer Price Index."  The Consumer Price Index for All
    21  Urban Consumers (CPI-U) for the Pennsylvania, New Jersey,
    22  Delaware and Maryland area for the most recent 12-month period
    23  for which figures have been officially reported by the United
    24  States Department of Labor, Bureau of Labor Statistics,
    25  immediately prior to the subject date.
    26     "Council."  The Pennsylvania Health Care Cost Containment
    27  Council.
    28     "Department."  The Department of Health of the Commonwealth.
    29     "Fund."  The Patient Safety Trust Fund.
    30     "Health care-associated infection."  A localized or systemic
    20070H1552B2101                  - 3 -     

     1  condition that results from an adverse reaction to the presence
     2  of an infectious agent or its toxins that:
     3         (1)  occurs in a patient in a health care setting within
     4     48 hours after admission;
     5         (2)  was not present or incubating at the time of
     6     admission, unless the infection was related to a previous
     7     admission to the same setting; and
     8         (3)  if occurring in a hospital setting, meets the
     9     criteria for a specific infection site as defined by the
    10     Centers for Disease Control and Prevention and its National
    11     Healthcare Safety Network.
    12     "Health care facility."  Any health care facility providing
    13  clinically related health services including, but not limited
    14  to, a general or special hospital, including psychiatric
    15  hospitals, rehabilitation hospitals, ambulatory surgical
    16  facilities, long-term care nursing facilities, abortion
    17  facilities, cancer treatment centers using radiation therapy on
    18  an ambulatory basis and inpatient drug and alcohol treatment
    19  facilities, both profit and nonprofit and including those
    20  operated by an agency or State or local government. The term
    21  shall also include hospice. The term shall not include an office
    22  used primarily for the private or group practice by health care
    23  practitioners where no reviewable clinically related health
    24  service is offered, a facility providing treatment solely on the
    25  basis of prayer or spiritual means in accordance with the tenets
    26  of any church or religious denomination or a facility conducted
    27  by a religious organization for the purpose of providing health
    28  care services exclusively to clergy or other persons in a
    29  religious profession who are members of the religious
    30  denominations conducting the facility. FOR THE PURPOSES OF        <--
    20070H1552B2101                  - 4 -     

     1  REPORTING, THE TERM SHALL ONLY APPLY TO HOSPITALS AND NURSING
     2  HOMES.
     3     "HEALTH PAYOR."  AN INDIVIDUAL OR ENTITY PROVIDING A GROUP OR
     4  INDIVIDUAL HEALTH, SICKNESS OR ACCIDENT POLICY, SUBSCRIBER
     5  CONTRACT OR PROGRAM ISSUED OR PROVIDED BY AN ENTITY SUBJECT TO
     6  ANY ONE OF THE FOLLOWING:
     7         (1)  THE ACT OF JUNE 2, 1915 (P.L.736, NO.338), KNOWN AS
     8     THE WORKERS' COMPENSATION ACT.
     9         (2)  SECTION 630 OF THE ACT OF MAY 17, 1921 (P.L.682,
    10     NO.284), KNOWN AS THE INSURANCE COMPANY LAW OF 1921.
    11         (3)  THE ACT OF DECEMBER 29, 1972 (P.L.1701, NO.364),
    12     KNOWN AS THE HEALTH MAINTENANCE ORGANIZATION ACT.
    13         (4)  THE ACT OF MAY 18, 1976 (P.L.123, NO.54), KNOWN AS
    14     THE INDIVIDUAL ACCIDENT AND SICKNESS INSURANCE MINIMUM
    15     STANDARDS ACT.
    16         (5)  40 PA.C.S. CH. 61 (RELATING TO HOSPITAL PLAN
    17     CORPORATIONS) OR 63 (RELATING TO PROFESSIONAL HEALTH SERVICES
    18     PLAN CORPORATIONS).
    19     "Mcare Act."  The act of March 20, 2002 (P.L.154, No.13),
    20  known as the Medical Care Availability and Reduction of Error
    21  (Mcare) Act.
    22     "MEDICAID."  THE PROGRAM ESTABLISHED UNDER TITLE XIX OF THE    <--
    23  SOCIAL SECURITY ACT (49 STAT. 620, 42 U.S.C. § 1396 ET SEQ.).
    24     "MRSA."  Methicillin-resistant staphylococcus aureus, a more
    25  serious form of bacterial health care-associated infection that
    26  is resistant to commonly used antibiotics.
    27     "Multidrug resistant organisms" or "MDROO."  Microorganisms,
    28  predominantly bacteria, that are resistant to one or more
    29  classes of antimicrobial agents.
    30     "Safe practices."  The set of standards endorsed by the        <--
    20070H1552B2101                  - 5 -     

     1  National Quality Forum that should be used by health care
     2  providers to reduce the risk of harm to patients.
     3  Section 3.  Committee.
     4     (a)  Establishment.--The Pennsylvania Infection Control
     5  Advisory Committee is hereby established.
     6     (b)  Membership.--The advisory committee shall consist of the
     7  following members who shall serve until the expiration of their
     8  terms, membership or employment or until their successors are
     9  appointed:
    10         (1)  The Secretary of Health.
    11         (2)  The executive director of the authority or a
    12     designee.
    13         (3)  The executive director of the council or a designee.
    14         (4)  The director of the Office of Health Care Reform or
    15     a designee.
    16         (5)  The following members chosen by the Governor:
    17             (i)  A representative of each collaborative from a
    18         list submitted by the respective collaborative.
    19             (ii)  Two individuals representing hospitals who are
    20         members of the Hospital and Healthsystem Association of
    21         Pennsylvania.
    22             (iii)  One individual representing a nonprofit
    23         nursing home.
    24             (iv)  One individual representing a for-profit
    25         nursing home.
    26             (v)  Two individuals with a background in infection
    27         control who are members of either the Association of
    28         Professionals in Infection Control (APIC) or the Society
    29         of Healthcare Epidemiology of America (SHEA).
    30             (vi)  One individual who is a patient advocate.
    20070H1552B2101                  - 6 -     

     1             (vii)  Two individuals with a background in
     2         epidemiology.
     3             (viii)  Two individuals representing other licensed
     4         health care facilities.
     5             (IX)  ONE INDIVIDUAL FROM A LIST OF TWO RECOMMENDED    <--
     6         BY THE PENNSYLVANIA CHAMBER OF BUSINESS AND INDUSTRY
     7         CHOSEN FROM THE BUSINESS COMMUNITY REPRESENTATIVES
     8         APPOINTED TO THE COUNCIL UNDER SECTION 4(B)(4) OF THE ACT
     9         OF JULY 8, 1986 (P.L.408, NO.89), KNOWN AS THE HEALTH
    10         CARE COST CONTAINMENT ACT.
    11             (X)  ONE INDIVIDUAL FROM A LIST OF TWO RECOMMENDED BY
    12         THE PENNSYLVANIA AFL-CIO CHOSEN FROM THE ORGANIZED LABOR
    13         REPRESENTATIVES APPOINTED TO THE COUNCIL UNDER SECTION
    14         4(B)(5) OF THE HEALTH CARE COST CONTAINMENT ACT.
    15     (c)  Chairperson.--The Secretary of Health shall be the
    16  chairperson of the committee.
    17     (d)  Meetings.--The committee shall meet quarterly and at
    18  other times at the call of the chairperson.
    19     (e)  Organization.--The committee shall be organized within
    20  the department for organizational, budgetary and administrative
    21  purposes.
    22     (f)  General powers and duties.--The committee shall do the
    23  following:
    24         (1)  Encourage cooperation among Federal, State and local
    25     government agencies, academic institutions and the private
    26     sector to assist in improving best practices and promoting     <--
    27     those WHICH INCLUDE IMPLEMENTING NATIONALLY RECOGNIZED         <--
    28     STANDARDS THAT PROMOTE practices and programs that TO reduce   <--
    29     or eliminate health care-associated infections.
    30         (2)  Serve as a forum for presenting information and
    20070H1552B2101                  - 7 -     

     1     studying programs being used within this Commonwealth.
     2         (3)  Develop recommendations regarding best practices to
     3     effectuate screenings of high-risk patients consistent with
     4     the provisions of this act and other means of reduction and
     5     elimination of health care-associated infections and how
     6     these practices may apply to health care facilities.
     7         (4)  Identify financial and technological needs of health
     8     care facilities regarding infection control and prevention.
     9         (5)  Develop recommendations on how best to implement an
    10     outreach process that includes notifying a receiving health
    11     care facility of any patient known to be colonized prior to
    12     transfer to another facility.
    13         (6)  Develop recommendations regarding evidence-based
    14     screening protocols of patients and residents for MDROO. upon  <--
    15     admission and randomized screening of inpatients and
    16     residents for MDROO after admission.
    17         (7)  Recommend process for establishing benchmarks based
    18     upon a uniform database that identifies and quantifies health
    19     care-associated infections and will be based on actual
    20     observed experiences of health care facilities in managing
    21     infections to evaluate health care-associated infections for
    22     the department's use during licensure or inspection of a
    23     health care facility. The uniform database shall be
    24     established using payment claims data that is currently
    25     submitted to the Commonwealth and shall be an extension of
    26     the base categorical DRG structure and be based on standard
    27     administrative data. No additional data elements or changes
    28     to the current claim form shall be required. Benchmarks will
    29     be reviewed and updated annually.
    30         (7)  RECOMMEND A METHODOLOGY AND A DEFINED PROCESS USING   <--
    20070H1552B2101                  - 8 -     

     1     NATIONALLY RECOGNIZED STANDARDS FOR DETERMINING AND ASSESSING
     2     THE RATE OF HEALTH CARE-ASSOCIATED INFECTIONS THAT OCCUR IN
     3     HEALTH CARE FACILITIES IN THIS COMMONWEALTH. THE PROCESS
     4     SHALL INCLUDE ESTABLISHMENT OF BENCHMARKS TO MEASURE HEALTH
     5     CARE FACILITIES' MANAGEMENT OF HEALTH CARE-ASSOCIATED
     6     INFECTIONS, WHICH THE DEPARTMENT MAY USE DURING LICENSURE OR
     7     INSPECTION OF A HEALTH CARE FACILITY. METHODOLOGY, PROCESS
     8     AND BENCHMARKS SHALL BE REVIEWED AND UPDATED ANNUALLY.
     9         (8)  Provide recommendations to the department on the
    10     distribution of any available funds to collaboratives.
    11         (9)  Issue reports on health care facility infection
    12     control and prevention in this Commonwealth.
    13         (10)  Develop annual infection control and prevention
    14     priorities.
    15         (11)  RECOMMEND SYSTEM REQUIREMENTS AND ELEMENTS FOR       <--
    16     HEALTH CARE-ASSOCIATED INFECTION ELECTRONIC SURVEILLANCE
    17     SYSTEMS TO BE USED BY HEALTH CARE FACILITIES. CONSIDERATION
    18     SHOULD BE GIVEN TO ELEMENTS WHICH PROVIDE:
    19             (I)  EXTRACTION OF EXISTING ELECTRONIC CLINICAL DATA
    20         FROM HEALTH CARE FACILITIES SYSTEMS ON AN ONGOING BASIS.
    21             (II)  TRANSLATION OF NONSTANDARDIZED LABORATORY,
    22         PHARMACY AND/OR RADIOLOGY DATA INTO UNIFORM INFORMATION
    23         THAT CAN BE ANALYZED ON A POPULATION-WIDE BASIS.
    24             (III)  CLINICAL SUPPORT, EDUCATIONAL TOOLS AND
    25         TRAINING TO ENSURE THAT INFORMATION PROVIDED UNDER THIS
    26         SUBSECTION WILL LEAD TO CHANGE.
    27             (IV)  CLINICAL IMPROVEMENT MEASUREMENT AND THE
    28         STRUCTURE TO PROVIDE ONGOING POSITIVE AND NEGATIVE
    29         FEEDBACK TO HEALTH CARE FACILITIES STAFF WHO IMPLEMENT
    30         CHANGE.
    20070H1552B2101                  - 9 -     

     1         (12)  RECOMMEND UNIFORM REPORTING REQUIREMENTS FOR HEALTH
     2     CARE FACILITIES TO REPORT HEALTH CARE-ASSOCIATED INFECTIONS
     3     TO THE DEPARTMENT, THE COUNCIL AND THE AUTHORITY. THE
     4     RECOMMENDATION SHALL INCLUDE THE FORM AND CONTENT OF THE
     5     REQUIRED REPORTS.
     6  Section 4.  Duties of department.
     7     The department shall MAY do the following:                     <--
     8         (1)  Designate six infection prevention and control
     9     regions within this Commonwealth.
    10         (2)  Issue grants to collaboratives.
    11         (3)  Designate at least one collaborative in each region.
    12         (4)  When reviewing applications for designating a
    13     collaborative, the department shall give preference to groups
    14     that are currently meeting the requirements of this act and
    15     are implementing best practices to reduce health care-
    16     associated infections.
    17         (5)  In cooperation with the authority, develop a public
    18     outreach program on health care-associated infections. The
    19     program shall:
    20             (i)  Provide information to the public on causes and
    21         symptoms of health care-associated infections, prevention
    22         methods and the proper use of antibiotics.
    23             (ii)  Encourage that individuals receiving treatment
    24         or admitted to a health care facility ask health care
    25         professionals about efforts to control and eliminate
    26         health care-associated infections within the health care
    27         facility.
    28             (iii)  Determine the process to be used by health
    29         care facilities for notifying a health care facility of
    30         any patient known to be colonized prior to transfer
    20070H1552B2101                 - 10 -     

     1         within or between health care facilities.
     2         (6)  Develop programs that inform facilities of the
     3     purpose and function of collaboratives and encourage the use
     4     of collaboratives for assistance.
     5         (7)  Publish in the Pennsylvania Bulletin, within 45 days
     6     after receipt of the committee's recommendation on
     7     METHODOLOGY, PROCESS AND benchmarks, the specific benchmarks   <--
     8     the department shall use to measure the progress of health
     9     care facilities in reducing health care-associated
    10     infections.
    11         (8)  Require best practices to effectuate screenings of
    12     staff and patients based on suspicion of transmission of an
    13     infection.
    14         (9)  In cooperation with the authority, act as a
    15     repository for information on current health care-associated
    16     infections and for newly identified infections and treatment
    17     protocols.
    18         (10)  PUBLISH A NOTICE IN THE PENNSYLVANIA BULLETIN        <--
    19     STATING THE UNIFORM REPORTING REQUIREMENTS, INCLUDING BOTH
    20     FORM AND CONTENT, FOR HEALTH CARE-ASSOCIATED INFECTIONS BASED
    21     ON RECOMMENDATIONS MADE BY THE COMMITTEE. THE UNIFORM
    22     REPORTING REQUIREMENTS SHALL APPLY AND BE UTILIZED FOR
    23     REPORTS MADE TO THE DEPARTMENT, THE COUNCIL AND THE
    24     AUTHORITY. THE EFFECTIVE DATE FOR THE COMMENCEMENT OF
    25     REQUIRED REPORTING BY HEALTH CARE FACILITIES CONSISTENT WITH
    26     THIS ACT, AT A MINIMUM, SHALL BEGIN NO LATER THAN 120 DAYS
    27     AFTER PUBLICATION OF THE NOTICE. REPORTING REQUIREMENTS
    28     CONTAINED IN SECTION 6 OF THE ACT OF JULY 8, 1986 (P.L.408,
    29     NO.89), KNOWN AS THE HEALTH CARE COST CONTAINMENT ACT, AS
    30     THEY RELATE TO HEALTH CARE-ASSOCIATED INFECTIONS SHALL REMAIN
    20070H1552B2101                 - 11 -     

     1     IN EFFECT UNTIL 120 DAYS AFTER PUBLICATION OF THE NOTICE.
     2  Section 5.  Collaboratives.
     3     To receive grant funding, a collaborative shall do the
     4  following:
     5         (1)  Establish an advisory body that includes, but is not
     6     limited to, the following:
     7             (i)  An epidemiologist with a background in health
     8         care-associated infections.
     9             (ii)  An infection control professional.
    10             (iii)  A professional from a laboratory that tests
    11         samples for testing of microbial infection or the
    12         presence of nonreplicating microorganisms.
    13         (2)  Establish an educational structure that can work
    14     with the authority and other organizations to offer various
    15     options for training in best practices.
    16         (3)  Identify effective measures for the detection,
    17     control and prevention of health care-associated infections
    18     that include, but are not limited to, the following:
    19             (i)  An active culture surveillance process and
    20         policies.
    21             (ii)  A system to identify and designate patients
    22         known to be colonized or infected with MRSA or other
    23         MDROO in accordance with the requirements of this act.
    24             (iii)  An infection control intervention protocol
    25         which, at a minimum, addresses:
    26                 (A)  Infection control precautions based on best
    27             practices for general surveillance of infected or
    28             colonized patients.
    29                 (B)  Treatment protocols based on evidence-based
    30             standards.
    20070H1552B2101                 - 12 -     

     1                 (C)  Isolation procedures.
     2                 (D)  Physical plant operations related to
     3             infection control.
     4                 (E)  Educational programs for personnel.
     5                 (F)  Fiscal and human resource requirements
     6             related to infection control and prevention.
     7         (4)  Use grant money to provide financial assistance to
     8     health care facilities to invest in technologies and
     9     infrastructure designed to reduce health care-associated
    10     infections.
    11  Section 6.  Health care facilities.
    12     (a)  Development and compliance.--Within 120 days after
    13  enactment, a health care facility shall develop and implement an
    14  internal infection control plan that shall include, but is not
    15  limited to, the following:
    16         (1)  A multidisciplinary committee including
    17     representatives from each of the following IF APPLICABLE TO    <--
    18     THAT PARTICULAR HEALTH CARE FACILITY:
    19             (i)  Medical staff, including the chief medical
    20         officer.
    21             (ii)  Administration, including the chief executive
    22         officer and the chief financial officer. For a nursing
    23         home the committee shall include the director.
    24             (iii)  Laboratory personnel.
    25             (iv)  Nursing, including the director of nursing.
    26             (v)  Pharmacy, including the chief of pharmacy.
    27             (vi)  The physical plant manager.
    28             (vii)  A patient safety officer.
    29             (viii)  Members from the infection control team.
    30         (2)  In addition to standards adopted by the department:   <--
    20070H1552B2101                 - 13 -     

     1         (2)  HEALTH CARE FACILITIES SHALL ADOPT:                   <--
     2             (i)  Effective measures for the detection, control
     3         and prevention of health care-associated infections.
     4             (ii)  An active culture surveillance process and
     5         policies.
     6             (iii)  A system to identify and designate patients
     7         known to be colonized or infected with MRSA or other
     8         MDROO.
     9             (iv)  Procedures for identifying other high-risk
    10         patients admitted to the health care facility who shall
    11         receive routine cultures and screenings.
    12             (v)  An outreach process for notifying a receiving
    13         health care facility of any patient known to be colonized
    14         prior to transfer within or between facilities BASED ON    <--
    15         RECOMMENDATIONS MADE BY THE COMMITTEE.
    16             (vi)  A required facility-specific infection control
    17         intervention protocol which, at a minimum, addresses:
    18                 (A)  Infection control precautions based on
    19             nationally recognized standards for general
    20             surveillance of infected or colonized patients.
    21                 (B)  Treatment protocols based on evidence-based
    22             standards.
    23                 (C)  Isolation procedures.
    24                 (D)  Physical plant operations related to
    25             infection control.
    26                 (E)  Appropriate use of antimicrobial agents and
    27             antibiotics.
    28                 (F)  Mandatory educational programs for
    29             personnel.
    30                 (G)  Fiscal and human resource requirements
    20070H1552B2101                 - 14 -     

     1             related to infection control and prevention.
     2         (3)  Any other requirements that the department shall      <--
     3     require through rules and regulations.
     4     (b)  Department review.--The department shall review each
     5  health care facility's infection control plan to ensure
     6  compliance with this act in accordance with the department's
     7  authority under 28 Pa. Code Ch. 146 (relating to infection
     8  control) during its regular licensure inspection process.
     9     (c)  Notification.--Upon approval of its infection control
    10  plan, a health care facility shall notify all health care
    11  workers and medical staff of the health care facility of the
    12  infection control plan. Compliance with the infection control
    13  plan shall be required as a condition of licensure, employment
    14  or credentialing at the health care facility.
    15  Section 7.  Authority.
    16     (a)  Duties.--In addition to its existing responsibilities,
    17  the authority is responsible for all of the following:
    18         (1)  Providing nursing homes with patient safety
    19     advisories issued by the authority pursuant to section
    20     304(a)(7) of the Mcare Act.
    21         (2)  Issuing alerts and reports to health care facilities
    22     as required by the board.
    23         (3)  Including a separate category for providing
    24     information about health care-associated infections in the
    25     annual report under section 304(c) of the Mcare Act.
    26     (b)  Training.--The authority shall as recommended by the
    27  board create and conduct training programs for infection control
    28  teams, health care workers and consumers about the prevention
    29  and control of health care-associated infections. Nothing in
    30  this act precludes the authority from collaborating with the
    20070H1552B2101                 - 15 -     

     1  department, collaboratives or other organizations in conducting
     2  these programs.
     3     (c)  Monitoring.--Health care facility patient safety plans
     4  will identify how the facility will distribute patient safety
     5  advisories, alerts and reports required under this act so that
     6  they are easily accessible and widely distributed in each health
     7  care facility to administrative staff, medical personnel and
     8  health care workers.
     9  Section 8.  Nursing homes.
    10     (a)  Reporting.--Nursing homes shall report to the council     <--
    11     (A)  REPORTING.--                                              <--
    12         (1)  NURSING HOMES SHALL REPORT TO THE COUNCIL the same
    13     infections and in the same manner that hospitals are required
    14     to report to the council under the act of July 8, 1986
    15     (P.L.408, No.89), known as the Health Care Cost Containment
    16     Act. Reporting shall begin within 30 days following the
    17     effective date of this section. For purposes of this section,
    18     nursing homes shall be additional data sources as defined in
    19     the Health Care Cost Containment Act, and covered services as
    20     defined in that act shall include those services provided by
    21     nursing homes.
    22         (2)  NO LATER THAN 120 DAYS FOLLOWING THE DATE THE         <--
    23     DEPARTMENT PUBLISHES THE UNIFORM REPORTING REQUIREMENTS IN
    24     THE PENNSYLVANIA BULLETIN, PURSUANT TO SECTION 7(A)(1),
    25     NURSING HOMES SHALL REPORT INFORMATION PERTAINING TO
    26     HOSPITAL-ASSOCIATED INFECTIONS TO THE AUTHORITY IN THE FORM
    27     SO REQUIRED BY THE AUTHORITY. FOR THE PURPOSES OF THE
    28     REPORTING REQUIREMENTS CONTAINED IN THIS SECTION, THE
    29     CONFIDENTIALITY PROTECTIONS CONTAINED IN SECTION 311 OF THE
    30     ACT OF MARCH 20, 2002 (P.L.154, NO.13), KNOWN AS THE MEDICAL
    20070H1552B2101                 - 16 -     

     1     CARE AVAILABILITY AND REDUCTION OF ERROR (MCARE) ACT, SHALL
     2     APPLY TO NURSING HOMES.
     3     (b)  Analysis of nursing home data by authority.--
     4         (1)  At the request of the department or the board         <--
     5     COMMITTEE, but no less frequently than once per year, the      <--
     6     authority shall analyze data without patient identifying
     7     information reported to the department by nursing homes with   <--
     8     respect to events compromising patient safety as required by
     9     28 Pa. Code § 51.3 (relating to notification) TO THE           <--
    10     DEPARTMENT, THE COUNCIL AND THE AUTHORITY BY NURSING HOMES.
    11         (2)  A nursing home may request the authority to conduct
    12     an analysis of the data collected under paragraph (1) in
    13     order to provide information to nursing homes which can be
    14     used to improve patient safety and quality of care.
    15     (c)  Surcharge.--Commencing January 1, 2008, each nursing
    16  home shall pay the department a surcharge on its licensing fee
    17  as necessary to provide sufficient revenues to operate the
    18  authority for its responsibilities under this act. The following
    19  apply:
    20         (1)  For each calendar year, the department shall
    21     determine and assess each nursing home its proportionate
    22     share of the authority's budget for its responsibilities
    23     under this act. The total assessment amount shall not be more
    24     than $1,000,000 in fiscal year 2007-2008 and shall be
    25     increased according to the Consumer Price Index in each
    26     succeeding fiscal year.
    27         (2)  THE ANNUAL ASSESSMENT AMOUNT PAID BY A NURSING        <--
    28     FACILITY SHALL BE A REIMBURSABLE COST UNDER THE MEDICAL
    29     ASSISTANCE PROGRAM. THE DEPARTMENT OF PUBLIC WELFARE SHALL
    30     PAY EACH NURSING FACILITY, AS A SEPARATE, PASS-THROUGH
    20070H1552B2101                 - 17 -     

     1     PAYMENT, AN AMOUNT EQUAL TO THE ASSESSMENT PAID BY A NURSING
     2     FACILITY MULTIPLIED BY THE FACILITY'S MEDICAL ASSISTANCE
     3     OCCUPANCY AS REPORTED IN ITS ANNUAL COST REPORT.
     4         (2) (3)  Money appropriated to the fund under this act     <--
     5     shall be expended by the authority to implement this act.
     6         (3) (4)  In the event that the fund is discontinued or     <--
     7     the authority is dissolved by operation of law, any balance
     8     paid by nursing homes remaining in the fund, after deducting
     9     administrative costs of liquidation, shall be returned to the
    10     nursing homes in proportion to their financial contributions
    11     to the fund in the preceding licensing period.
    12         (4) (5)  If after 30 days' notice a nursing home fails to  <--
    13     pay a surcharge levied by the department under this section,
    14     the department may assess an administrative penalty of $1,000
    15     per day until the surcharge is paid.
    16  Section 9.  Electronic surveillance.
    17     (a)  Electronic surveillance of health care-associated
    18  infections.--By January 1, 2008, the department shall, BASED ON   <--
    19  RECOMMENDATIONS OF THE COMMITTEE, identify qualified systems      <--
    20  SYSTEM COMPONENTS AND ELEMENTS which can be used by health care   <--
    21  facilities by July 1, 2008., to report health care-associated     <--
    22  infections to the council. Qualified systems shall include the
    23  following minimum elements:
    24         (1)  Extraction of existing electronic clinical data from
    25     hospital systems on an ongoing basis.
    26         (2)  Translation of nonstandardized laboratory, pharmacy
    27     and/or radiology data into uniform information that can be
    28     analyzed on a population-wide basis.
    29         (3)  Clinical support, educational tools and training to
    30     ensure that information provided under this subsection will
    20070H1552B2101                 - 18 -     

     1     lead to change.
     2         (4)  Clinical improvement measurement and the structure
     3     to provide ongoing positive and negative feedback to hospital
     4     staff who implement change.
     5     (b)  Classifications.--Hospitals shall report the following
     6  classifications of infections and, as to each infection acquired
     7  in the facility, whether the infection was caused by a
     8  multidrug-resistant organism:
     9         (1)  Patients with positive MRSA at admission or
    10     preadmission screening.
    11         (2)  Urinary tract infections.
    12         (3)  Surgical site infections.
    13         (4)  Ventilator-associated pneumonia.
    14         (5)  Blood stream infections.
    15         (6)  Bone and joint infections.
    16         (7)  Central nervous system infections.
    17         (8)  Cardiovascular infections.
    18         (9)  Eye, ear, nose and throat infections.
    19         (10)  Gastrointestinal infections.
    20         (11)  Lower respiratory infections.
    21         (12)  Reproductive system infections.
    22         (13)  Systemic infections.
    23         (14)  Multiple infections.
    24     (A.1)  NO LATER THAN DECEMBER 30, 2008, HOSPITALS MUST HAVE    <--
    25  IN PLACE A QUALIFIED SYSTEM FOR THE ELECTRONIC SURVEILLANCE OF
    26  HEALTH CARE-ASSOCIATED INFECTIONS.
    27     (c)  (B)  Benchmarks.--The department shall establish          <--
    28  reasonable benchmarks against which to measure the progress of
    29  health care facilities to reduce health care-associated
    30  infections. All HEALTH CARE facilities will be measured against   <--
    20070H1552B2101                 - 19 -     

     1  the benchmarks ESTABLISHED BY THE DEPARTMENT PURSUANT TO          <--
     2  RECOMMENDATIONS OF THE COMMITTEE. Those facilities with rates of
     3  associated infections that are above the benchmark will be
     4  required to submit a plan of remediation to the department
     5  within 60 days after being notified of missing the standard. If
     6  after 180 days, the facility has shown no progress in reducing
     7  rates of infections, the facility is required to consult with
     8  the regional collaborative to further develop a plan of
     9  remediation. If after an additional 180 days the facility
    10  continues to fail to progress in lowering its rates of
    11  infection, the penalties in section 10 shall apply.
    12     (d) (C)  Other technologies.--Nothing in this section shall    <--
    13  prevent health care facilities from having the flexibility to
    14  use other technologies to manage infections as they see fit.
    15     (D)  PAYOR.--A PAYOR MAY REDUCE ALL PAYMENTS TO A FACILITY     <--
    16  WHICH FAILS TO MEET THE ESTABLISHED BENCHMARKS FOR A GIVEN YEAR
    17  BY 2% FOR EACH PAYMENT OWED TO A FACILITY FOR SERVICES PROVIDED
    18  UNTIL THE DEPARTMENT CERTIFIES THE FACILITY HAS MET THE
    19  BENCHMARKS FOR THAT YEAR.
    20  Section 10.  Violations and penalties.
    21     (a)  General rule.--When appropriate, the department will
    22  work with the health care facility to rectify a violation of
    23  this act.
    24     (b)  Health care facility violations.--A health care facility
    25  that violates this act may be subject to sanctions by the
    26  department, which include:
    27         (1)  Suspension of its license.
    28         (2)  Revocation of its license.
    29         (3)  Refusal to renew its license.
    30         (4)  Limitation of its license as to operation of a
    20070H1552B2101                 - 20 -     

     1     portion of the health care facility or to the services which
     2     may be provided at the health care facility.
     3         (5)  Issuance of a provisional license.
     4         (6)  Submission of a plan of correction.
     5         (7)  Limitation or suspension of admissions to the health
     6     care facility.
     7     (c)  Penalty.--A facility who violates this act may be
     8  subject to a civil penalty not to exceed $500 per day.
     9  SECTION 11.  PAYMENTS.                                            <--
    10     (A)  PAYMENT FOR PERFORMING ROUTINE CULTURES AND SCREENINGS
    11  IN HOSPITALS.--THE COST OF ROUTINE CULTURES AND SCREENINGS
    12  PERFORMED ON PATIENTS IN HOSPITALS IN COMPLIANCE WITH THE HEALTH
    13  CARE FACILITY'S INFECTION CONTROL PLAN SHALL BE CONSIDERED A
    14  REIMBURSABLE COST TO BE PAID BY HEALTH PAYORS AND MEDICAID,
    15  SUBJECT TO ANY COPAYMENT, COINSURANCE OR DEDUCTIBLE AMOUNTS
    16  IMPOSED IN ANY APPLICABLE POLICY OR BENEFIT ISSUED BY A HEALTH
    17  PAYOR OR PROVIDED BY MEDICAID AND TO ANY AGREEMENTS BETWEEN A
    18  HEALTH CARE FACILITY AND A PAYOR OR MEDICAID.
    19     (B)  PAYMENT FOR PERFORMING ROUTINE CULTURES AND SCREENINGS
    20  IN NURSING HOMES.--THE FULL COST OF ROUTINE CULTURES AND
    21  SCREENINGS PERFORMED ON PATIENTS IN NURSING HOMES IN COMPLIANCE
    22  WITH A HEALTH CARE FACILITY'S INFECTION CONTROL PLAN SHALL BE
    23  PAID BY HEALTH PAYORS AND MEDICAID.
    24  SECTION 12.  INCENTIVE PAYMENTS.
    25     (A)  GENERAL RULE.--COMMENCING JANUARY 1, 2009, A HEALTH CARE
    26  FACILITY THAT EXCEEDS THE BENCHMARK PUBLISHED BY THE DEPARTMENT
    27  SHALL BE ELIGIBLE FOR AN INCENTIVE PAYMENT. FOR CALENDAR YEAR
    28  2010 AND THEREAFTER, THE DEPARTMENT OF PUBLIC WELFARE SHALL
    29  CONSULT WITH THE DEPARTMENT TO ESTABLISH APPROPRIATE PERCENTAGE
    30  BENCHMARKS FOR THE REDUCTION OF HEALTH CARE-ASSOCIATED
    20070H1552B2101                 - 21 -     

     1  INFECTIONS IN HEALTH CARE FACILITIES.
     2     (B)  DISTRIBUTION OF FUNDS.--FUNDS FOR THE PURPOSE OF
     3  IMPLEMENTING THIS SECTION SHALL BE APPROPRIATED TO THE
     4  DEPARTMENT OF PUBLIC WELFARE AND DISTRIBUTED TO ELIGIBLE HEALTH
     5  CARE FACILITIES AS SET FORTH IN THIS SECTION. INCENTIVE PAYMENTS
     6  TO HEALTH CARE FACILITIES SHALL BE LIMITED TO FUNDS AVAILABLE
     7  FOR THIS PURPOSE.
     8     (C)  FUNDS SEPARATE.--FUNDS APPROPRIATED FOR INCENTIVE
     9  PAYMENTS SHALL BE SEPARATE FROM AND NOT OTHERWISE UTILIZE, RELY
    10  ON OR DIMINISH FUNDS NECESSARY FOR PAYMENTS TO BE MADE TO LONG-
    11  TERM CARE FACILITIES FOR THE PROVISION OF NURSING FACILITY
    12  SERVICES AND SHALL BE PAID IN ADDITION TO SUCH OTHER PAYMENTS.
    13  SECTION 13.  MACHINERY AND EQUIPMENT LOAN FUND ELIGIBILITY.
    14     (A)  FUNDS AVAILABLE.--UP TO $25,000,000 OF THE FUNDS
    15  APPROPRIATED BY THE GENERAL ASSEMBLY FOR THE MACHINERY AND
    16  EQUIPMENT LOAN FUND SHALL BE MADE AVAILABLE FOR LOAN TO HEALTH
    17  CARE FACILITIES TO ASSIST IN ACQUIRING SYSTEMS OR TECHNOLOGIES
    18  THAT ASSIST THE FACILITY IN REDUCING HEALTH CARE-ASSOCIATED
    19  INFECTIONS. LOANS SHALL NOT EXCEED 50% OF A HEALTH CARE
    20  FACILITY'S COSTS, WHICH SHALL BE APPROVED BY THE DEPARTMENT OF
    21  COMMUNITY AND ECONOMIC DEVELOPMENT.
    22     (B)  CRITERIA.--THE DEPARTMENT OF COMMUNITY AND ECONOMIC
    23  DEVELOPMENT SHALL DEVELOP CRITERIA FOR EVALUATING APPLICATIONS
    24  FOR LOANS THAT CONSIDER THE FISCAL CONDITION OF THE HEALTH CARE
    25  FACILITY, THE ABILITY OF THE HEALTH CARE FACILITY TO IMPLEMENT
    26  THE TECHNOLOGY AND THE POTENTIAL SAVINGS THROUGH AVOIDED COSTS
    27  AND REDUCED HEALTH CARE FACILITY-ACQUIRED INFECTION RATES. THE
    28  CRITERIA SHALL BE FORWARDED BY THE DEPARTMENT OF COMMUNITY AND
    29  ECONOMIC DEVELOPMENT TO THE LEGISLATIVE REFERENCE BUREAU FOR
    30  PUBLICATION AS A NOTICE IN THE PENNSYLVANIA BULLETIN.
    20070H1552B2101                 - 22 -     

     1     (C)  ELIGIBILITY.--ADDITIONALLY, TO BE ELIGIBLE FOR A LOAN, A
     2  HEALTH CARE FACILITY MUST BE IN COMPLIANCE WITH HEALTH CARE-
     3  ASSOCIATED INFECTION REPORTING REQUIREMENTS CONTAINED IN THIS
     4  ACT, THE ACT OF MARCH 20, 2002 (P.L.154, NO.13), KNOWN AS THE
     5  MEDICAL CARE AVAILABILITY AND REDUCTION OF ERROR (MCARE) ACT,
     6  AND THE ACT OF JULY 8, 1986 (P.L.408, NO.89), KNOWN AS THE
     7  HEALTH CARE COST CONTAINMENT ACT.
     8  SECTION 14.  EXPIRATION.
     9     THIS ACT EXPIRES DECEMBER 31, 2012.
    10  Section 11 15.  Effective date.                                   <--
    11     This act shall take effect in 90 days.













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