PRIOR PRINTER'S NOS. 1905, 1972 PRINTER'S NO. 2101
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
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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 <--
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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
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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: <--
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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
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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
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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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