THE GENERAL ASSEMBLY OF PENNSYLVANIA

HOUSE BILL

INTRODUCED BY WATSON, BOYD, REICHLEY, KILLION, ADOLPH, CUTLER, BAKER, CAUSER, CLYMER, ELLIS, FLECK, GOODMAN, HARHART, HORNAMAN, MILNE, O'NEILL, PICKETT, SAYLOR, SWANGER, VULAKOVICH, YOUNGBLOOD AND DENLINGER, JUNE 8, 2009

REFERRED TO COMMITTEE ON HEALTH AND HUMAN SERVICES, JUNE 8, 2009  

AN ACT

Amending Title 35 (Health and Safety) of the Pennsylvania

Consolidated Statutes, providing for community-based health

care; making an appropriation; and making a related repeal.

WHEREAS, The General Assembly recognizes that there exists a

need for increased access to community-based health care

services throughout this Commonwealth in order to allow for

individuals to establish medical homes and obtain preventive

care, reduce the inappropriate use of emergency health care

services by providing effective alternatives to such services,

reduce the burden of uncompensated care, address the needs of

the uninsured, and improve maternal and child health. The

General Assembly finds it is in the best interests of the

Commonwealth to create a program to increase the availability of

such community-based health care services by assisting in the

expansion of community-based health care providers through the

provision of additional resources and generally promoting their

use as a cost-effective supplement to other providers of health

care services.

The General Assembly of the Commonwealth of Pennsylvania

hereby enacts as follows:

Section 1.  Title 35 of the Pennsylvania Consolidated Statues

is amended by adding a part to read:

PART II

DEPARTMENT OF HEALTH

Chapter

12.  Community-Based Health Care

CHAPTER 12

COMMUNITY-BASED HEALTH CARE

Sec.

1201.  Scope of chapter.

1202.  Definitions.

1203.  Establishment.

1204.  Applications for grants.

1205.  Review of applications.

1206.  Approval of applications.

1207.  Exception.

1208.  Limitations.

1209.  Departmental responsibilities.

1210.  Department of Public Welfare responsibilities.

1211.  Mobile Prenatal and Natal Care Demonstration Project.

§ 1201.  Scope of chapter.

This chapter relates to community-based health care.

§ 1202.  Definitions.

The following words and phrases when used in this chapter

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

context clearly indicates otherwise:

"Advanced practice nurse."  An individual who is licensed as

a registered nurse by the State Board of Nursing in the

Department of State and who practices as a nurse practitioner,

certified registered nurse anesthetist, clinical nurse

specialist or nurse midwife.

"Ancillary health care services."  Dental, behavioral health

and pharmacy services.

"Applicant."  A person who applies for a grant under section

1204 (relating to applications for grants).

"Chronic care and disease management."  Health care that

includes all of the following:

(1)  The provision of effective health management through

support and information that promotes self-care for patients

with chronic conditions.

(2)  The use of evidence-based medicine to ensure

appropriate treatment decisions by health care providers.

(3)  The coordination of continuing care and use of

reasonably accessible and updated patient information.

(4)  The monitoring of clinical information for

populations to guide treatment and effectively anticipate and

address community health care issues.

"Community-based health care clinic."  A nonprofit health

care center located in this Commonwealth which provides

comprehensive health care services without regard for a

patient's ability to pay and which is all of the following:

(1)  Serves either:

(i)  A federally designated medically underserved

area, a medically underserved population or a health

professional shortage area.

(ii)  A patient population whose majority population

has a household income less than 200% of the Federal

poverty income guidelines.

(2)  Is any of the following:

(i)  A federally qualified health center or a

federally qualified health center look-alike.

(ii)  A rural health clinic.

(iii)    A health care clinic associated with a

hospital.

(iv)  A free or partial-pay health clinic that

provides services by volunteer and nonvolunteer health

care providers.

(v)  A nurse-managed health care clinic which is

managed by an advanced practice nurse and is associated

with a nursing education program, a federally qualified

health center or an independent nonprofit health or

social services agency.

(3)  Is a participating provider with the Department of

Public Welfare under the act of June 13, 1967 (P.L.31,

No.21), known as the Public Welfare Code.

"Department."  The Department of Health of the Commonwealth.

"Federally qualified health center."  As defined in section

1905(l)(2)(B) of the Social Security Act (49 Stat. 620, 42

U.S.C. § 1396d(l)(2)(B)).

"Federally qualified health center look-alike."  A public or

a private nonprofit entity which does all of the following:

(1)  Serves, in whole or in part, a federally designated

medically underserved area or medically underserved

population.

(2)  Meets the statutory, regulatory and program

requirements for grantees supported under section 330 of the

Public Health Service Act (58 Stat. 682, 42 U.S.C. § 254b).

(3)  Complies with the policy implementation documents

specified in section II of Public Information Notice 1998-10

(PIN 98-10) entitled "The Balanced Budget Act of 1997

Medicaid Managed Care Amendments: Implications for Federally

Qualified Health Centers" issued April 28, 1998, by the

Bureau of Primary Health Care, United States Department of

Health and Human Services.

"Health care provider."  A health care provider that is all

of the following:

(1)  Licensed to practice a component of the healing arts

by a licensing board within the Department of State.

(2)  A provider of health care services at a community-

based health care clinic.

(3)  A participating provider with the Department of

Public Welfare under the act of June 13, 1967 (P.L.31,

No.21), known as the Public Welfare Code.

"Hospital."  An entity located in this Commonwealth which is

licensed as a hospital under the act of July 19, 1979 (P.L.130,

No.48), known as the Health Care Facilities Act, and which is a

participating provider with the Department of Public Welfare

under the act of June 13, 1967 (P.L.31, No.21), known as the

Public Welfare Code.

"Low-income patient."  A patient whose household income is

below 200% of the Federal poverty income guidelines.

"Matching funds."  Cash or the cash equivalent of in-kind

services.

"Medical assistance."  The State program of medical

assistance established under Article IV(f) of the act of June

13, 1967 (P.L.31, No.21), known as the Public Welfare Code.

"Medically underserved area."  As defined in section 330I(a)

(4) of the Public Health Service Act (58 Stat. 682, 42 U.S.C. §

254c-14(a)(4)).

"Medically underserved population."  As defined in section

330(b)(3) of the Public Health Service Act (58 Stat. 682, 42

U.S.C. § 254b(b)(3)).

"Patient."  An individual who receives health care from a

health care provider at a community-based health care clinic.

"Program."  The Community-Based Health Care Subsidy Program

established in this chapter.

"Rural health clinic."  As defined in section 1861(aa)(2) of

the Social Security Act (49 Stat. 620, 42 U.S.C. § 1395x(aa)

(2)).

§ 1203.  Establishment.

There is established within the department a program to be

known as the Community-Based Health Care Subsidy Program. The

program shall do all of the following:

(1)  Expand and improve health care access and services,

including preventive care, chronic care and disease

management, prenatal, obstetric, postpartum and newborn care,

dental treatment, behavioral health and pharmacy services.

(2)  Reduce unnecessary utilization of hospital emergency

services by providing an effective alternative health care

delivery system.

(3)  Encourage collaborative relationships among

community-based health care clinics, hospitals and other

health care providers.

§ 1204.  Applications for grants.

A community-based health care clinic, health care provider or

hospital may submit an application to the department requesting

a grant for the expansion of an existing community-based health

care clinic; the establishment of a new community-based health

care clinic; improvements in prenatal, obstetric, postpartum or

newborn care; improved access and services, including patient

transportation, which are intended to reduce unnecessary

emergency room utilization; or the establishment of

collaborative relationships among community-based health care

clinics, hospitals and other health care providers. The

application shall be on the form required by the department and

shall include or demonstrate all of the following:

(1)  The applicant's name and address.

(2)  A description of how the grant will be used. If the

request is for the expansion of an existing community-based

health care clinic or the establishment of a new

community-based health care clinic, the application shall

additionally state all of the following:

(i)  The projected number of total patients to be

served if the grant is awarded.

(ii)  The number of current patients served, if any.

(iii)    The projected number of low-income and

uninsured patients to be served if the grant is awarded.

(iv)  The number of current low-income and uninsured

patients served, if any.

(v)  If the grant will be used to expand or develop

ancillary health care services or preventive and chronic

care and disease management techniques.

(3)  A statement of the amount of the grant sought.

(4)  A statement of the amount of matching funds.

(5)  The source of any matching funds.

(6)  Any other information required by the board.

§ 1205.  Review of applications.

The department shall review each application to determine all

of the following:

(1)  That the application is for the expansion of an

existing community-based health care clinic; the

establishment of a new community-based health care clinic;

improvements in prenatal, obstetric, postpartum or newborn

care; improved access and services which are intended to

reduce unnecessary emergency room utilization; or the

establishment of collaborative relationships among

community-based health care clinics, hospitals and other

health care providers.

(2)  That the project will increase access to

community-based health care services.

(3)  That the statement of the estimated cost is

reasonable based upon the locality of the project.

(4)  That the amount of matching funds are at least 25%

of the amount of the grant request.

(5)  That the source of the matching funds is not the

Commonwealth or a Commonwealth agency.

(6)  That the applicant complied with all other criteria

established by the department.

§ 1206.  Approval of applications.

Upon being satisfied that all requirements have been met, the

department may approve the application. If the applicant of an

approved application is not a hospital, the department shall

award the grant to the applicant. Except as provided in section

1207 (relating to exception), if the applicant of an approved

application is a hospital, the department shall transfer the

grant funds to the Department of Public Welfare who shall

distribute the grant to the applicant as a disproportionate

share payment after seeking Federal matching funds.

§ 1207.  Exception.

If the applicant of an approved application is a hospital and

the disproportionate share payment limit of the hospital has

been reached, the department shall award the hospital that

portion of the grant funds which would be limited under the

Social Security Act (49 Stat. 620, 42 U.S.C. § 301 et seq.)

directly as a grant.

§ 1208.  Limitations.

(1)  A grant awarded under section 1206 (relating to

approval of applications) shall be not more than $500,000.

(2)  A grant awarded under section 1206 shall be not more

than 75% of the total amount of the project.

(3)  Not more than 50% of the grants awarded under

section 1206 in any one fiscal year shall be awarded for the

expansion of or the establishment of a community-based health

care clinic. Not more than 25% of the grants awarded under

section 1206 in any one fiscal year shall be awarded for

improvements in prenatal, obstetric, postpartum or newborn

care. Not more than 20% of the grants awarded under section

1206 in any one fiscal year shall be awarded for improvements

in access and services. Not more than 5% of the grants

awarded under section 1206 in any one fiscal year shall be

awarded for the establishment of collaborative relationships.

(4)  Not more than 75% of the grants awarded under

section 1206 in any one fiscal year shall be awarded to

applicants who are federally qualified health centers or

federally qualified health center look-alikes.

(5)  Not more than 15% of the funds made available for

the program authorized by this section may be awarded to

applicants located within any one city, town, borough or

township of this Commonwealth.

(6)  For calendar years 2009, 2010 and 2011, a community-

based health care clinic, health care provider or hospital

directly receiving Federal funds under the American Recovery

and Reinvestment Act of 2009 (Public Law 111-5, 123 Stat.

115) shall be ineligible to receive a grant under this

chapter.

§ 1209.  Departmental responsibilities.

The department shall do all of the following:

(1)  Administer the program. The department shall seek

any available private or Federal funds to supplement amounts

appropriated to the program. The department shall cooperate

with the Department of Public Welfare in awarding grants to

applicants which are hospitals.

(2)  Develop and provide a grant application form

consistent with this chapter. The department shall provide

applications for grants under this section to all known

community-based health care clinics within 90 days of the

effective date of this paragraph.

(3)  Report annually to the chair and minority chair of

the Public Health and Welfare Committee of the Senate and the

chair and minority chair of the Health and Human Services

Committee of the House of Representatives. The report shall

be posted on the department's publicly accessible Internet

website and shall include all of the following for each grant

made in the prior calendar year:

(i)  The name of each grantee.

(ii)  The amount of each grant awarded.

(iii)  The use of each grant by each grantee.

(iv)  A summary of how each grant expanded access and

services and improved the delivery and quality of health

care in the community, including a comparison of

emergency room utilization in the community for the year

immediately prior to the awarding of the grant with

utilization in the community for the year of the awarding

of the grant.

(v)  Any recommendations for changes to the program.

(4)  Audit grants awarded under this chapter to ensure

that funds have been used in accordance with this chapter and

the terms and standards adopted by the department.

(5)  Establish and maintain an online database of

community-based health care clinics.

(6)  Establish a toll-free telephone number for

individuals to obtain information about community-based

health care clinics.

§ 1210.  Department of Public Welfare responsibilities.

The Department of Public Welfare shall do all of the

following:

(1)  Within 45 days of the effective date of this

paragraph, file an amendment of the Medicaid State plan with

the Federal Government seeking approval of the

disproportional share payments made under the programs.

(2)  Cooperate with the department in administering the

program when the grantee is a hospital.

§ 1211.  Mobile Prenatal and Natal Care Demonstration Project.

(a)  Establishment.--There is established within the

department a program to be known as the Mobile Prenatal and

Natal Care Demonstration Project. The program shall provide

prenatal, obstetric, postpartum and newborn care to individuals

on a mobile basis.

(b)  Applications for planning grants.--A hospital or health

care provider may submit an application to the department

requesting a grant for costs associated with establishing a

mobile unit to provide prenatal, obstetric, postpartum and

newborn care. The application shall be on the form required by

the department and shall include or demonstrate all of the

following:

(1)  The applicant's name and address.

(2)  The geographic region where the unit will operate.

(3)  A statement of the services to be provided.

(4)  An estimate of the cost of the mobile unit.

(5)  Any other information required by the board.

(c)  Review and approval of grant applications.--The

department shall review the applications. Preference shall be

given to applicants in communities where prenatal, obstetric,

postpartum and newborn care are limited. Upon being satisfied

that all requirements have been met, the department may approve

four applications and award grants. One grant shall be awarded

to an applicant which seeks to provide services in an urban

setting, one grant shall be awarded to an applicant which seeks

to provide services in a suburban setting, one grant shall be

awarded to an applicant which seeks to provide services in a

rural setting and one grant shall be awarded to an underserved

area which is most likely to benefit from a mobile clinic.

Grants awarded may not be more than $500,000.

(d)  Report.--By May 1, 2011, the department shall file a

report with the chair and minority chair of the Public Health

and Welfare Committee of the Senate and the chair and minority

chair of the Health and Human Services Committee of the House of

Representatives. The report shall additionally be posted on the

department's publicly accessible Internet website and shall

include all of the following for each grant made in the prior

calendar year:

(1)  The name of each grantee.

(2)  The amount of each grant awarded.

(3)  The use of each grant by each grantee.

(4)  A summary of how each grant expanded access and

services and improved the delivery and quality of health care

in the community, including a comparison of the rate of

infant mortality and low birth weight in the community for

the year immediately prior to the award of the grant with

those rates in the community for the year of the grant.

(5)  Any recommendations for changes to the program.

Section 2.  The following shall apply:

(1)  The sum of $25,000,000 is annually appropriated from

the General Fund to the Department of Health from the

proceeds of the tax imposed by section 1206 of the act of

March 4, 1971 (P.L.6, No.2), known as the Tax Reform Code of

1971, for the Community-Based Health Care Subsidy Program.

(2)  The sum of $2,000,000 is appropriated from the

General Fund to the Department of Health for the Mobile

Prenatal and Natal Care Demonstration Project.

Section 3.  (a)  The repeals in this section are necessary to

effectuate this act.

(b)  The following acts and parts of acts are repealed:

Section 1211 of the act of March 4, 1971 (P.L.6, No.2),

known as the Tax Reform Code of 1971.

Section 4.  This act shall take effect July 1, 2009, or

immediately, whichever is later.