THE GENERAL ASSEMBLY OF PENNSYLVANIA

HOUSE BILL

INTRODUCED BY STABACK, BELFANTI, BOBACK, FABRIZIO, FREEMAN, GEORGE, GRUCELA, HORNAMAN, JOSEPHS, KORTZ, KOTIK, KULA, McGEEHAN, MUNDY, M. O'BRIEN, PASHINSKI, READSHAW, SEIP, SIPTROTH, K. SMITH, WALKO, WANSACZ, WATSON, YOUNGBLOOD, YUDICHAK, MOUL, J. TAYLOR, DeLUCA, PRESTON, MAHONEY, PALLONE, BEYER AND CALTAGIRONE, FEBRUARY 10, 2009

AS RE-REPORTED FROM COMMITTEE ON APPROPRIATIONS, HOUSE OF REPRESENTATIVES, AS AMENDED, OCTOBER 1, 2009   

AN ACT

Amending the act of June 13, 1967 (P.L.31, No.21), entitled "An

act to consolidate, editorially revise, and codify the public

welfare laws of the Commonwealth," in general powers and

duties of Department of Public Welfare, providing for onsite

complaint investigations and plans of correction and for

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determining whether applicants are veterans; in public

assistance, further providing for establishment of county

boards and expenses and for lifetime limit; and, in hospital

assessment, further providing for definitions, for

authorization, for administration, for no hold harmless, for

tax exemption and for cessation.

The General Assembly of the Commonwealth of Pennsylvania

hereby enacts as follows:

Section 1.  The act of June 13, 1967 (P.L.31, No.21), known

as the Public Welfare Code, is amended by adding a section 

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sections to read:

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Section 211.1.  Onsite Complaint Investigations and Plans of

Correction.--(a)  The department shall initiate onsite

investigations of complaints at personal care homes and assisted

living residences as follows:

(1)  If the complaint is a Class 1 complaint, the onsite

inspection shall be initiated within twenty-four hours of the

complaint intake.

(2)  If the complaint is a Class 2 complaint, the onsite

inspection shall be initiated within seven calendar days of the

complaint intake.

(3)  If the complaint is a Class 3 complaint, the onsite

inspection shall be initiated within twenty-one calendar days of

the complaint intake.

(b)  The department shall contact and coordinate the

investigation with appropriate local agencies, including the

Area Agency on Aging, specifically the Protective Services or

Long-Term Care Ombudsman Program, County Mental Health/Mental

Retardation, local or Pennsylvania State Police, local code

enforcement or fire officials.

(c)  The department shall conduct an unannounced onsite

inspection of the personal care home or assisted living

residence within the time frame established under subsection (a)

(1), (2) or (3). The complaint investigation shall include the

following components and adhere to the following time frames:

(1)  Conduct an entrance interview with administrator or

designee, providing general information regarding the complaint,

but maintaining confidentiality of residents and complainant.

(2)  Interview relevant subjects to the complaint such as

residents, families, staff or other witnesses.

(3)  Preserve evidence by obtaining signed witness

statements, making copies of documents and taking photographs.

(4)  Review relevant documents such as resident, staff and

facility records.

(5)  Observe physical site conditions related to the

complaint.

(6)  Contact the appropriate manager in the department

regarding Class 1 high-risk issues.

(7)  Ensure that immediate threats are resolved before

leaving the personal care home or assisted living residence.

(8)  Record all relevant information, including violations,

as directed by department policies and procedures.

(9)  Conduct an exit interview with the administrator or the

most appropriate employe onsite and provide an opportunity to

respond to preliminary findings, unless the disclosure may

jeopardize ongoing aspects of the investigation.

(10)  Determine and discuss findings with the appropriate

manager in the department and determine if a regulatory

violation is found or requires further investigation.

(11)  Additional collateral contacts, interviews and site

inspections shall be made as indicated by the seriousness of the

complaint allegation and based on the initial onsite inspection.

(12)  The complaint investigation, including all collateral

contacts, interviews and onsite inspections, must be concluded

within fifteen days following the onsite inspection. 

(d)  Within four business days of the conclusion of the

complaint investigation for Class 1 high-risk complaints, within

ten business days of the conclusion of the complaint

investigation for Class 2 complaints and within 15 business days

of the conclusion of the complaint investigation for Class 3

complaints, the department shall prepare a violation report if

applicable, review the violation report with the appropriate

manager in the department and transmit the violation report to

the personal care home or assisted living residence for

corrective action.

(e)  If a violation report is provided by the department, the

personal care home or assisted living residence must submit a

plan of correction within seven calendar days of receipt of the

violation report.

(f)  Within ten business days of receiving the plan of

correction from the personal care home or assisted living

residence, the department shall review the plan of correction

and refer the plan to the appropriate manager in the department

for plan approval or denial.

(g)  If the personal care home or assisted living residence

does not submit a plan of correction within the required seven-

day time frame, the department may revoke or nonrenew a license,

or may issue a ban on admissions for the personal care home or

assisted living residence.

(h)  Once the plan of correction has been approved by the

department, the follow-up complaint inspection of the personal

care home or assisted living residence shall be conducted onsite

after the longest target date for compliance has been reached as

noted on the plan of correction, but no later than ninety days

after the initial onsite complaint inspection by the department

to ensure compliance with the plan of correction.

(i)  If the plan of correction is disapproved, the department

shall contact the personal care home or assisted living

residence within forty-eight hours of the disapproval decision

and require an alternate plan of correction within four business

days. If the personal care home or assisted living residence

returns an approved plan of correction within the required time

frame, the department shall conduct a follow-up onsite

inspection of the personal care home or assisted living

residence as outlined under subsection (h).

(j)  If the alternate plan of correction is not resubmitted

by the personal care home or assisted living residence within

the required time frame, the department may revoke or nonrenew a

license, or may issue a ban on admissions for the personal care

home or assisted living residence.

(k)  Within ten business days of the conclusion of the

investigation and determination on each of the complaint

allegations, the department shall send a complaint response

letter to the complainant.

(l)  The department may exceed the timelines relating to a

Class 3 complaint if it determines that resources are otherwise

necessary to address risks to the health and safety of other

residents in the personal care home or assisted living

residence.

(m)  For purposes of this section:

"Class 1 complaint" shall mean an alleged violation, which,

if verified, would constitute a Class 1 violation as defined in

section 1085. A Class 1 complaint means a complaint with a high

risk, including, but not limited to, incidents related to

immediate fire safety, physical assault or abuse, no food or

water, no heat in winter, no staff or serious illness outbreak.

"Class 2 complaint" shall mean an alleged violation, which,

if verified, would constitute a Class 2 violation as defined in

section 1085. A Class 2 complaint means a complaint with a

medium risk, including, but not limited to, incidents related to

inadequate staffing, quality of care issues, nutrition,

sanitation or medication administration.

"Class 3 complaint" shall mean an alleged violation, which,

if verified, would constitute a Class 3 violation as defined in

section 1085. A Class 3 complaint means a complaint with a low

risk, including, but not limited to, incidents related to menus,

policies, assessments, support plans, financial management or

contracts.

Section 2.  This act shall take effect in 60 days.

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Section 215.  Determining Whether Applicants are Veterans.--

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(a)  The department shall make a good faith effort to determine

whether an applicant for cash, medical or energy assistance is a

veteran. While in the process of making its determination, the

department shall dispense benefits to the applicant, if

otherwise eligible.

(b)  As a condition of eligibility to receive cash, medical

or energy assistance, unless there is good cause not to do so,

an applicant who is a veteran shall be required to contact a

veteran service officer accredited and recognized by the United

States Department of Veterans Affairs, the Department of

Military and Veterans Affairs or the county director of veterans

affairs in which the applicant resides in order to determine the

applicant's eligibility for veteran's benefits or to file a

veteran claims packet. The department shall develop a standard

form to be used by a veteran service officer to verify the

applicant's eligibility for veteran's benefits.

(c)  An applicant who is a veteran shall provide proof of

compliance with this section and the department shall, to the

greatest extent possible, require the applicant to provide

information on the final determination of eligibility for

veteran's benefits and the type of benefits the veteran is

entitled to receive.

(d)  As used in this section, the following words and phrases

shall have the following meanings:

"Assistance" means money, services and payment for medical

coverage or energy assistance for needy persons who are

residents of this Commonwealth, are in need of assistance and

meet all conditions of eligibility.

"Veteran claims packet" means an application requesting a

determination or entitlement or evidencing a belief in

entitlement to a benefit as provided for in 38 CFR (relating to

pensions, bonuses, and veterans' relief) or 51 Pa.C.S. (relating

to military affairs).

Section 2.  Section 415 of the act is amended to read:

Section 415.  Establishment of County Boards; Expenses.--For

each county of the Commonwealth, there is hereby established a

county board of assistance, to be known as the County Board of

Assistance and referred to in this Article IV as the "county

board," which shall be composed of men and women, to be

appointed by the Governor [with the advice and consent of two-

thirds of all members of the Senate]. Each appointment by the

Governor shall bear the endorsement of the senator of the

district in which the nominee resides. In the case of a vacancy

in that senatorial district, the nominee shall be endorsed by

the senator of an adjacent district. The county boards shall be

composed as far as possible of persons engaged or interested in

business, social welfare, labor, industry, education or public

administration. The members of the county boards shall serve

without compensation, but shall be reimbursed for necessary

expenses. No member of a county board shall hold office in any

political party. Not all of the members of a county board shall

belong to the same political party.

Section 3.  Section 441.4 of the act, added July 7, 2005

(P.L.177, No.42), is amended to read:

Section 441.4.  [Lifetime Limit] Reasonable Limits on

Allowable Income Deductions for Medical Expenses When

Determining Payment Toward the Cost of Long-Term Care

Services.--(a)  [Necessary medical or remedial care expenses

recognized under Federal or State law but not paid for by the

medical assistance program are allowable income deductions when

determining a recipient's payment toward the cost of long-term

care services. An allowable income deduction for unpaid medical

expenses incurred prior to the authorization of medical

assistance eligibility and those medical expenses incurred for

long-term care services after medical assistance is authorized

shall be subject to a lifetime maximum of ten thousand dollars

($10,000) unless application of the limit would result in undue

hardship.] When determining a recipient's payment toward the

cost of long-term care services, long-term care medical expenses

incurred six months or more prior to application for medical

assistance shall be disallowed as a deduction, and medical and

remedial expenses that were incurred as a result of a transfer

of assets penalty shall be limited to zero unless application of

these limits would result in undue hardship.

(b)  As used in this section, the term "undue hardship" shall

mean that either:

(1)  denial of medical assistance would deprive the

individual of medical care and endanger the individual's health

or life; or

(2)  the individual or a financially dependent family member

would be deprived of food, shelter or the necessities of life.

Section 4.  The definitions of "exempt hospital" and "general

acute care hospital" in section 801-E of the act, added July 4,

2008 (P.L.557, No.44), are amended and the section is amended by

adding a definition to read:

Section 801-E.  Definitions.

The following words and phrases when used in this article

shall have the meanings given to them in this section unless the

context clearly indicates otherwise:

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["Exempt hospital."  A hospital that the Secretary of Public

Welfare has determined meets one of the following:

(1)  Is excluded under 42 CFR 412.23(a), (b), (d) and (f)

(relating to excluded hospitals: classifications) as of March

20, 2008, from reimbursement of certain Federal funds under

the prospective payment system described by 42 CFR Pt. 412

(relating to prospective payment systems for inpatient

hospital services).

(2)  Is a Federal veterans' affairs hospital.

(3)  Is part of an institution with State-related status

as that term is defined in 22 Pa. Code § 31.2 (relating to

definitions) and provides over 100,000 days of care to

medical assistance patients annually.

(4)  Provides care, including inpatient hospital

services, to all patients free of charge.]

"General acute care hospital."  A hospital other than [an

exempt hospital.] a hospital that the Secretary of Public

Welfare has determined meets one of the following:

(1)  Is excluded under 42 CFR 412.23(a), (b), (d), (e)

and (f) (relating to excluded hospitals: Classifications) as

of March 20, 2008, from reimbursement of certain Federal

funds under the prospective payment system described by 42

CFR 412 (relating to prospective payment systems for

inpatient hospital services).

(2)  Is a Federal veterans' affairs hospital.

(3)  Is a high volume Medicaid hospital.

(4)  Provides care, including inpatient hospital

services, to all patients free of charge.

"High volume Medicaid hospital."  A hospital that the

Secretary of Public Welfare has determined meets all of the

following:

(1)  Is a nonprofit hospital subsidiary of a State-

related institution as that term is defined in 62 Pa.C.S. § 

103 (relating to definitions); and

(2)  Provides more than 90,000 days of care to medical

assistance patients annually.

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Section 5.  Sections 802-E, 804-E, 805-E, 807-E and 808-E of

the act, added July 4, 2008 (P.L.557, No.44), are amended to

read:

Section 802-E.  Authorization.

(a)  General rule.--In order to generate additional revenues

for the purpose of assuring that medical assistance recipients

have access to hospital services and that all citizens have

access to emergency department services, and subject to the

conditions and requirements specified under this article, a

municipality may, by ordinance, [impose] do the following:

(1)  Impose a monetary assessment on the net operating

revenue reduced by all revenues received from Medicare of

each general acute care hospital located in the municipality

[subject to the conditions and requirements specified under

this article].

(2)  Beginning on or after July 1, 2009, and subject to

the advance written approval by the secretary, impose a

monetary assessment on the net operating revenues reduced by

all revenues received from Medicare of each high volume

Medicaid hospital located in the municipality.

(b)  Administrative provisions.--The [ordinance] ordinances

adopted pursuant to subsection (a) may include appropriate

administrative provisions including, without limitation,

provisions for the collection of interest and penalties.

(c)  Maximum assessment.--In each year in which the

assessment is implemented, the assessment shall be subject to

the maximum aggregate amount that may be assessed under 42 CFR

433.68(f)(3)(i) (relating to permissible health care-related

taxes) or any other maximum established under Federal law.

Section 804-E.  Administration.

(a)  Remittance.--Upon collection of the funds generated by

the assessment authorized under this article, the municipality

shall remit a portion of the funds to the Commonwealth for the

purposes set forth under section 802-E, except that the

municipality may retain funds in an amount necessary to

reimburse it for its reasonable costs in the administration and

collection of the assessment and to fund a portion of its costs

of operating public health clinics as set forth in an agreement

to be entered into between the municipality and the Commonwealth

acting through the secretary.

(b)  Establishment.--There is established a restricted

account in the General Fund for the receipt and deposit of funds

under subsection (a). Funds in the account are hereby

appropriated to the department for purposes of making

supplemental or increased medical assistance payments for

emergency department services to general acute care hospitals

within the municipality and to maintain or increase other

medical assistance payments to hospitals within the

municipality, as specified in the Commonwealth's approved Title

XIX State Plan.

Section 805-E.  No hold harmless.

No general acute care hospital or high volume Medicaid

hospital shall be directly guaranteed a repayment of its

assessment in derogation of 42 CFR 433.68(f) (relating to

permissible health care-related taxes), except that, in each

fiscal year in which an assessment is implemented, the

department shall use a portion of the funds received under

section 804-E(a) for the purposes outlined under section 804-

E(b) to the extent permissible under Federal and State law or

regulation and without creating an indirect guarantee to hold

harmless, as those terms are used under 42 CFR 433.68(f)(i). The

secretary shall submit any State Medicaid plan amendments to the

United States Department of Health and Human Services that are

necessary to make the payments authorized under section 804-

E(b).

Section 807-E.  Tax exemption.

Notwithstanding any exemptions granted by any other Federal,

State or local tax or other law, including section 204(a)(3) of

the act of May 22, 1933 (P.L.853, No.155), known as The General

County Assessment Law, no general acute care hospital or high

volume Medicaid hospital in the municipality shall be exempt

from the assessment.

Section 808-E.  [Cessation] Time period.

(a)  Cessation.--The assessment authorized under this article

shall cease June 30, 2013.

(b)  Assessment.--A municipality shall have the power to

enact the assessment authorized in section 802-E(a)(2) either

prior to or during its fiscal year ending June 30, 2010.

Section 6.  This act shall take effect immediately.