PRINTER'S NO. 1062
No. 904 Session of 2007
INTRODUCED BY ORIE, BAKER, KITCHEN, O'PAKE, RAFFERTY,
TARTAGLIONE, VANCE, C. WILLIAMS AND ERICKSON, MAY 29, 2007
REFERRED TO PUBLIC HEALTH AND WELFARE, MAY 29, 2007
AN ACT
1 Providing for the availability of and access to obstetrical and
2 neonatal care; establishing a funding formula; requiring
3 funded hospitals to provide notification upon closure;
4 imposing powers and duties upon the Department of Health, the
5 Insurance Commissioner and the Department of Public Welfare;
6 and making an appropriation.
7 The General Assembly of the Commonwealth of Pennsylvania
8 hereby enacts as follows:
9 Section 1. Short title.
10 This act shall be known and may be cited as the Access to
11 Obstetrical and Neonatal Care Act.
12 Section 2. Declaration of policy.
13 The General Assembly finds and declares as follows:
14 (1) It is the purpose of this act to ensure that
15 obstetrical and neonatal care services are available in this
16 Commonwealth.
17 (2) Access to a full spectrum of obstetrical and
18 neonatal care health services must be available across this
19 Commonwealth.
20 (3) Approximately one of every three births in this
1 Commonwealth is covered by medical assistance.
2 (4) To maintain this system, the Commonwealth shall
3 provide financial assistance.
4 Section 3. Definitions.
5 The following words and phrases when used in this act shall
6 have the meanings given to them in this section unless the
7 context clearly indicates otherwise:
8 "Department." The Department of Public Welfare of the
9 Commonwealth.
10 "Hospital." An entity located in this Commonwealth that is
11 licensed as a hospital under the act of July 19, 1979 (P.L.130,
12 No.48), known as the Health Care Facilities Act.
13 "Medical assistance." The program under Article IV(f) of the
14 act of June 13, 1967 (P.L.31, No.21), known as the Public
15 Welfare Code.
16 "Neonatal intensive care services." Neonatal intensive care
17 services provided by a hospital.
18 "Obstetrical services." Obstetrical services provided by a
19 hospital.
20 "Rural." Located in a county outside a Metropolitan
21 Statistical Area established by the United States Office of
22 Management and Budget.
23 "Secretary." The Secretary of Public Welfare of the
24 Commonwealth.
25 Section 4. Qualifications of hospitals.
26 (a) Eligibility.--The following are qualified under this
27 act:
28 (1) A rural hospital in this Commonwealth which meets
29 one of the following:
30 (i) Ranks in the top one-third of rural hospitals in
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1 terms of volume of obstetrical cases covered by medical
2 assistance during the most recent fiscal year with
3 available data.
4 (ii) Has a percentage of its obstetrical cases
5 covered by medical assistance which is greater than 50%
6 of all obstetrical cases during the most recent fiscal
7 year with available data.
8 (iii) Is licensed by the Department of Health to
9 provide neonatal intensive care services.
10 (2) A nonrural hospital in this Commonwealth which meets
11 one of the following:
12 (i) Is in the top one-third of nonrural hospitals in
13 terms of volume of obstetrical cases covered by medical
14 assistance during the most recent fiscal year with
15 available data.
16 (ii) Has a percentage of obstetrical cases covered
17 by medical assistance which is greater than 50% of all
18 obstetrical cases during the most recent fiscal year with
19 available data.
20 (iii) Is in the top one-third of nonrural hospitals
21 in terms of volume of neonatal intensive care cases
22 covered by medical assistance during the most recent
23 fiscal year with available data.
24 (iv) Has a percentage of neonatal intensive care
25 cases covered by medical assistance which is greater than
26 50% of all neonatal intensive care cases during the most
27 recent fiscal year with available data.
28 (b) Initial submission of qualifications.--The Department of
29 Health shall notify the department of those hospitals which are
30 determined to be eligible no later than 30 days after the
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1 effective date of this section.
2 Section 5. Funding.
3 (a) Distribution.--
4 (1) For fiscal years beginning after June 30, 2007, upon
5 Federal approval of an amendment to the medical assistance
6 State plan, the department shall distribute annually from
7 funds appropriated for this purpose disproportionate share
8 payments to hospitals qualified under section 4 to provide
9 financial assistance to assure readily available and
10 coordinated obstetrical and neonatal intensive care of the
11 highest quality to the citizens of this Commonwealth.
12 (2) On July 1, the secretary may evaluate the funds
13 available and may make appropriate adjustments based on the
14 number of qualified hospitals and changes in the additional
15 costs required to provide obstetrical and neonatal intensive
16 care services.
17 (b) Funding.--The department shall seek to maximize Federal
18 funds, including funds obtained pursuant to Title XIX of the
19 Social Security Act (49 Stat. 620, 42 U.S.C. § 1396 et seq.),
20 available for maternal and infant care.
21 (c) Payment calculation.--Payment to qualified hospitals
22 shall be allocated according to the following:
23 (1) Fifteen percent of the total amount available shall
24 be allocated to qualified rural hospitals as follows:
25 (i) Under this subparagraph, 52.5% of the allocation
26 under this paragraph is the amount available for
27 distribution to qualified rural hospitals obstetrical
28 cases covered by medical assistance. The distribution
29 shall be made under the following formula:
30 (A) For each hospital, determine the ratio of:
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1 (I) the hospital's medical assistance
2 obstetrical cases; to
3 (II) all obstetrical cases for the hospital.
4 (B) For each hospital, multiply:
5 (I) the ratio under clause (A); by
6 (II) the number of the hospital's medical
7 assistance obstetrical cases.
8 (C) Add the products under clause (B) for all
9 hospitals.
10 (D) Divide:
11 (I) the amount available for distribution
12 under this subparagraph; by
13 (II) the sum under clause (C).
14 (E) Multiply:
15 (I) the quotient under clause (D); by
16 (II) the product under clause (B).
17 (ii) Under this subparagraph, 32.5% of the
18 allocation under this paragraph is the amount available
19 for distribution to qualified rural hospitals with
20 neonatal intensive-care cases covered by medical
21 assistance. The distribution shall be made under the
22 following formula:
23 (A) For each hospital, determine the ratio of:
24 (I) the hospital's medical assistance
25 neonatal intensive-care cases; to
26 (II) all neonatal intensive-care cases for
27 the hospital.
28 (B) for each hospital, multiply:
29 (I) the ratio under clause (A); by
30 (II) the number of the hospital's medical
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1 assistance neonatal intensive-care cases.
2 (C) Add the products under clause (B) for all
3 hospitals.
4 (D) Divide:
5 (I) the amount available for distribution
6 under this subparagraph; by
7 (II) the sum under clause (C).
8 (E) Multiply:
9 (I) the quotient under clause (D); by
10 (II) the product under clause (B).
11 (iii) Fifteen percent of the allocation under this
12 paragraph shall be distributed equally among qualified
13 rural hospitals with obstetrical cases.
14 (iv) For calculations under this paragraph, each
15 hospital shall use both in-State and out-of-State cases.
16 (2) Eighty-five percent of the total amount available
17 shall be allocated to qualified nonrural hospitals as
18 follows:
19 (i) Under this subparagraph, 52.5% of the allocation
20 under this paragraph is the amount available for
21 distribution to qualified nonrural hospitals obstetrical
22 cases covered by medical assistance. The distribution
23 shall be made under the following formula:
24 (A) For each hospital, determine the ratio of:
25 (I) the hospital's medical assistance
26 obstetrical cases; to
27 (II) all obstetrical cases for the hospital.
28 (B) For each hospital, multiply:
29 (I) the ratio under clause (A); by
30 (II) the number of the hospital's medical
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1 assistance obstetrical cases.
2 (C) Add the products under clause (B) for all
3 hospitals.
4 (D) Divide:
5 (I) the amount available for distribution
6 under this subparagraph; by
7 (II) the sum under clause (C).
8 (E) Multiply:
9 (I) the quotient under clause (D); by
10 (II) the product under clause (B).
11 (ii) Under this subparagraph, 32.5% of the
12 allocation under this paragraph is the amount available
13 for distribution to qualified nonrural hospitals with
14 neonatal intensive-care cases covered by medical
15 assistance. The distribution shall be made under the
16 following formula:
17 (A) For each hospital, determine the ratio of:
18 (I) the hospital's medical assistance
19 neonatal intensive-care cases; to
20 (II) all neonatal intensive-care cases for
21 the hospital.
22 (B) For each hospital, multiply:
23 (I) the ratio under clause (A); by
24 (II) the number of the hospital's medical
25 assistance neonatal intensive-care cases.
26 (C) Add the products under clause (B) for all
27 hospitals.
28 (D) Divide:
29 (I) the amount available for distribution
30 under this subparagraph; by
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1 (II) the sum under clause (C).
2 (E) Multiply:
3 (I) the quotient under clause (D); by
4 (II) the product under clause (B).
5 (iii) Fifteen percent of the allocation under this
6 paragraph shall be distributed equally among qualified
7 nonrural hospitals with obstetrical cases.
8 (iv) For calculations under this paragraph, each
9 hospital shall use both in-State and out-of-State cases.
10 (3) A qualified hospital which has reached its
11 disproportionate share limit under Title XIX of the Social
12 Security Act shall receive its share of the State funds
13 available under this act.
14 Section 6. Reporting.
15 (a) Requirement.--By March 1, the department shall make an
16 annual report to the Public Health and Welfare Committee of the
17 Senate and the Health and Human Services Committee of the House
18 of Representatives on the hospitals funded under this act.
19 (b) Contents.--The report shall contain all of the
20 following:
21 (1) For each hospital receiving funds:
22 (i) identity;
23 (ii) amount received; and
24 (iii) number of obstetrical and neonatal intensive-
25 care cases.
26 (2) Recommendations for improvement under this act to
27 further promote the availability of obstetrical and neonatal
28 care to the citizens of this Commonwealth.
29 Section 7. Notification of closure.
30 A hospital which receives funds under this act shall notify
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1 the department and the Department of Health of its intent to
2 cease operation of its obstetrical or neonatal intensive-care
3 services no later than 60 days prior to closure.
4 Section 8. Physician and nurse midwife services.
5 (a) Secretary of Health.--
6 (1) The Secretary of Health shall study the availability
7 of obstetricians and nurse midwives to assure readily
8 available and coordinated obstetrical care of the highest
9 quality to the citizens of this Commonwealth.
10 (2) The Secretary of Health shall make recommendations
11 on improving the availability of obstetrical services.
12 (b) Report.--
13 (1) By December 1, 2007, the Secretary of Health, in
14 cooperation with the secretary and Insurance Commissioner,
15 shall make a report to all of the following:
16 (i) Banking and Insurance Committee of the Senate.
17 (ii) Public Health and Welfare Committee of the
18 Senate.
19 (iii) Health and Human Services Committee of the
20 House of Representatives.
21 (iv) The Insurance Committee of the House of
22 Representatives.
23 (2) The report shall contain all of the following:
24 (i) Number of physicians and certified nurse
25 midwives providing obstetrical services by county for the
26 last five years.
27 (ii) Number of births by county for the last five
28 years.
29 (iii) Fees paid for physician and nurse midwife
30 services by the department.
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1 (iv) Fees paid for physician and nurse midwife
2 services by other health care insurers or payors.
3 Section 28. Appropriation.
4 (a) General fund.--The sum of $150,000, or as much thereof
5 as may be necessary, is hereby appropriated to the Department of
6 Public Welfare for the fiscal year July 1, 2007, to June 30,
7 2008, to provide for medical assistance payments to qualifying
8 hospitals covered under this act.
9 (b) Supplement.--The sum of $180,000 from Federal medical
10 assistance amounts are appropriated to supplement the sum
11 appropriated under subsection (a).
12 Section 29. Applicability.
13 If section 5(a)(2) takes effect after July 1, 2007, section
14 5(a)(2) shall apply retroactively to July 1, 2007.
15 Section 30. Effective date.
16 This act shall take effect as follows:
17 (1) This section shall take effect immediately.
18 (2) Section 6 shall take effect January 1, 2008.
19 (3) The remainder of this act shall take effect July 1,
20 2007, or immediately, whichever is later.
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