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| THE GENERAL ASSEMBLY OF PENNSYLVANIA |
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| HOUSE BILL |
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| INTRODUCED BY PALLONE, BELFANTI, DEASY, GIBBONS, HORNAMAN, JOSEPHS, KOTIK, KULA, MILLARD, PASHINSKI, SIPTROTH, K. SMITH, SWANGER AND YOUNGBLOOD, JULY 10, 2009 |
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| REFERRED TO COMMITTEE ON HEALTH AND HUMAN SERVICES, JULY 10, 2009 |
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| AN ACT |
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1 | Establishing the Community-Based Health Care (CHC) Program in |
2 | the Department of Health; providing for hospital health |
3 | clinics; and establishing the Community-Based Health Care |
4 | Fund. |
5 | TABLE OF CONTENTS |
6 | Chapter 1. Health Care Assistance |
7 | Subchapter A. Preliminary Provisions |
8 | Section 101. Short title. |
9 | Section 102. Definitions. |
10 | Subchapter B. Community-Based Health Care (CHC) |
11 | Section 111. Community-Based Health Care (CHC) Program. |
12 | Section 112. Powers and duties of department. |
13 | Section 113. Hospital outpatient clinics. |
14 | Section 114. Community-Based Health Care (CHC) Fund. |
15 | Chapter 51. Miscellaneous Provisions |
16 | Section 5101. Transfers. |
17 | Section 5102. Effective date. |
18 | The General Assembly of the Commonwealth of Pennsylvania |
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1 | hereby enacts as follows: |
2 | CHAPTER 1 |
3 | HEALTH CARE ASSISTANCE |
4 | SUBCHAPTER A |
5 | PRELIMINARY PROVISIONS |
6 | Section 101. Short title. |
7 | This act shall be known and may be cited as the Community- |
8 | Based Health Care (CHC) Act. |
9 | Section 102. Definitions. |
10 | The following words and phrases when used in this chapter |
11 | shall have the meanings given to them in this section unless the |
12 | context clearly indicates otherwise: |
13 | "Chronic care and disease management." A model of care that |
14 | includes the following: |
15 | (1) The provision of effective health management through |
16 | support and information that also promotes patient self-care |
17 | for patients with chronic conditions. |
18 | (2) The use of evidence-based medicine to ensure |
19 | appropriate treatment decisions by health care providers. |
20 | (3) The coordination of care and use of reasonably |
21 | accessible and updated patient information that encourages |
22 | follow-up care as a standard procedure. |
23 | (4) The tracking of clinical information for individual |
24 | and general patient populations to guide treatment and |
25 | effectively anticipate community health care problems. |
26 | "Community-based health care clinic." A nonprofit health |
27 | care center located in this Commonwealth that provides |
28 | comprehensive health care services without regard for a |
29 | patient's ability to pay and that: |
30 | (1) meets either of the following criteria: |
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1 | (i) serves a federally designated medically |
2 | underserved area, a medically underserved population or a |
3 | health professional shortage area; or |
4 | (ii) serves a patient population with a majority of |
5 | that population having an income less than 200% of the |
6 | Federal poverty income guidelines; and |
7 | (2) includes any of the following: |
8 | (i) A federally qualified health center as defined |
9 | in section 1905(l)(2)(B) of the Social Security Act (49 |
10 | Stat. 620, 42 U.S.C. § 1396d(l)(2)(B)) or a federally |
11 | qualified health center look-alike. |
12 | (ii) A rural health clinic as defined in section |
13 | 1861(aa)(2) of the Social Security Act (49 Stat. 620, 42 |
14 | U.S.C. § 1395x(aa)(2)), certified by Medicare. |
15 | (iii) A hospital outpatient clinic. |
16 | (iv) A free or partial-pay health clinic that |
17 | provides medical home and primary care services by |
18 | volunteer and nonvolunteer health care providers. |
19 | (v) A nurse-managed health care clinic that is |
20 | managed by advanced practice nurses, a federally |
21 | qualified health center or an independent nonprofit |
22 | health or social services agency. |
23 | "Department." The Department of Health of the Commonwealth. |
24 | "Fund." The Community-Based Health Care (CHC) Fund. |
25 | "Health care provider." A health care provider licensed to |
26 | practice a component of the healing arts by a licensing board |
27 | within the Department of State who provides health care services |
28 | at a community-based health care clinic. |
29 | "Hospital." An entity located in this Commonwealth that is |
30 | licensed as a hospital under the act of July 19, 1979 (P.L.130, |
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1 | No.48), known as the Health Care Facilities Act. |
2 | "Hospital outpatient clinic." A hospital-operated facility |
3 | that provides primary nonemergency health care on an outpatient |
4 | basis pursuant to 55 Pa. Code Ch. 1221 (relating to clinic and |
5 | emergency room services). |
6 | "Medical assistance." A State program of medical assistance |
7 | established under Article IV(f) of the act of June 13, 1967 |
8 | (P.L.31, No.21), known as the Public Welfare Code. |
9 | "Medical home." A community-based health care clinic that |
10 | provides, at a minimum: |
11 | (1) A health care provider or team of health care |
12 | providers at the practice level to provide first contact, |
13 | continuous, ongoing and comprehensive health care. |
14 | (2) Arranging care or taking responsibility for the |
15 | arrangement of care that meets the patient's health care |
16 | needs with other qualified professionals in areas including, |
17 | but not limited to, chronic care, acute care, preventive care |
18 | and end-of-life care. |
19 | (3) The coordination and integration of a patient's |
20 | health care needs across the health care system in areas such |
21 | as subspecialty care, hospital care, home health care, |
22 | nursing home care and community-based services. |
23 | "Patient." A natural person receiving health care from a |
24 | health care provider at a community-based health care clinic. |
25 | "Program." The Community-Based Health Care (CHC) Program. |
26 | "Rural hospital." A hospital that is located in a geographic |
27 | area not located in a Core-Based Statistical Area (CBSAs) |
28 | established by the United States Office of Management and |
29 | Budget. |
30 | SUBCHAPTER B |
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1 | COMMUNITY-BASED HEALTH CARE (CHC) |
2 | Section 111. Community-Based Health Care (CHC) Program. |
3 | (a) Establishment.--The Community-Based Health Care (CHC) |
4 | Program is established within the department to provide grants |
5 | to community-based health care clinics to: |
6 | (1) Expand and improve health care access and services, |
7 | such as preventive care, chronic care and disease management, |
8 | prenatal, obstetric, postpartum and newborn care, dental |
9 | treatment, behavioral health and pharmacy services. |
10 | (2) Reduce unnecessary utilization of hospital emergency |
11 | services by providing an effective alternative health care |
12 | delivery system. |
13 | (3) Encourage collaborative relationships among |
14 | community-based health care clinics, hospitals and other |
15 | health care providers. |
16 | (b) Grant applications.--When considering an application for |
17 | a grant for the expansion of an existing or new community-based |
18 | health care clinic, the department shall consider, at a minimum, |
19 | the following factors: |
20 | (1) The health care needs and demographics of the area |
21 | covered under the application that includes, but is not |
22 | limited to, the following: |
23 | (i) The population of the uninsured in certain |
24 | areas, such as a county or health service area. |
25 | (ii) The number of federally qualified health |
26 | centers or federally qualified health center look-alikes, |
27 | rural health clinics and hospital outpatient clinics. |
28 | (iv) The number of primary care physicians |
29 | practicing in the health service area. |
30 | (v) Whether the clinic will serve a medically |
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1 | underserved area, a medically underserved population or a |
2 | health professional shortage area. |
3 | (2) The request in the application for the addition or |
4 | expansion of direct or ancillary health care services that |
5 | includes, but is not limited to, the following: |
6 | (i) Prenatal care, obstetric, postpartum or newborn |
7 | care. |
8 | (ii) Comprehensive specialty care. |
9 | (iii) Dental services. |
10 | (iv) Behavioral health. |
11 | (v) Pharmacy. |
12 | (vi) Transportation. |
13 | (3) The expansion or increase in services that are |
14 | intended to reduce unnecessary emergency room utilization. |
15 | (4) The establishment of collaborative relationships |
16 | among community-based health care clinics, hospitals and |
17 | other health care providers. |
18 | (c) Distribution.--Funds shall be distributed in a manner |
19 | that improves access and expands services in all geographic |
20 | areas of this Commonwealth. |
21 | (d) Reallocation.--The department shall reallocate funds |
22 | among the categories described in subsection (b) if sufficient |
23 | grant requests are not received to use all the funds available |
24 | in a specific category. |
25 | (e) Amount of grants.--A grant under this subsection shall |
26 | not exceed $500,000 and shall require a matching commitment of |
27 | 25% of the grant, which can be in the form of cash or equivalent |
28 | in-kind services. |
29 | (f) Federal funds.--The department shall seek any available |
30 | Federal funds, as well as any available grants and funding from |
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1 | other sources, to supplement amounts made available under this |
2 | subchapter to the extent permitted by law. |
3 | Section 112. Powers and duties of department. |
4 | The department shall have the following powers and duties: |
5 | (1) To administer the program. |
6 | (2) To develop an allocation methodology applicable to |
7 | grant applications submitted pursuant to section 111(b). |
8 | (3) Within 90 days of the effective date of this |
9 | section, to develop and provide a grant application form |
10 | consistent with this act. The department shall provide |
11 | applications for grants under this section to all known |
12 | community-based health care clinics. A grant under this |
13 | section may be extended over two State fiscal years at the |
14 | request of the community-based health care clinic. |
15 | (4) To calculate and make grants to qualified community- |
16 | based health care clinics. |
17 | (5) To provide an annual report no later than November |
18 | 30 to the chair and minority chair of the Public Health and |
19 | Welfare Committee of the Senate and the chair and minority |
20 | chair of the Health and Human Services Committee of the House |
21 | of Representatives. The report shall include accountability |
22 | measures for all of the following: |
23 | (i) The total dollar amount for each grant awarded, |
24 | listing the type of community-based health care clinic |
25 | and the name of the grantee. |
26 | (ii) A summary of the use of the grant by each |
27 | grantee. |
28 | (iii) A summary of how each grant expanded access |
29 | and services in accordance with the criteria set forth in |
30 | section 111(a) and (b), including a specific |
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1 | documentation of low-income and uninsured patients |
2 | served, and the total amount of funds allocated in each |
3 | distribution category under section 111(b). |
4 | (iv) The impact of the grant on improving the |
5 | delivery and quality of health care in the community. |
6 | (v) An accountability assessment of the benefits of |
7 | the assistance provided under this subchapter and any |
8 | recommendations for changes to the program. |
9 | The report shall be made available for public inspection and |
10 | posted on the department's publicly accessible Internet |
11 | website. |
12 | (6) To audit grants awarded under this subchapter to |
13 | ensure that funds have been used in accordance with this |
14 | subchapter and the terms and standards adopted by the |
15 | department. |
16 | (7) To establish and maintain an online database of |
17 | community-based health care clinics. |
18 | (8) To establish a toll-free telephone number for |
19 | individuals to obtain information about community-based |
20 | health care clinics. |
21 | Section 113. Hospital outpatient clinics. |
22 | (a) Establishment.--The Hospital Outpatient Program is |
23 | established within the Community-Based Health Care Program to |
24 | provide payments by the Department of Public Welfare for |
25 | hospital outpatient clinics. |
26 | (b) Purpose.--The Hospital Outpatient Program shall assist |
27 | hospital outpatient clinics to: |
28 | (1) Expand and improve health care access and services, |
29 | such as preventive care, chronic care and disease management, |
30 | prenatal, obstetric, postpartum and newborn care, dental |
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1 | treatment, behavioral health and pharmacy services. |
2 | (2) Reduce unnecessary utilization of hospital emergency |
3 | services by providing an effective alternative health care |
4 | delivery system. |
5 | (3) Encourage collaborative relationships among |
6 | community-based health care clinics, hospitals and other |
7 | health care providers. |
8 | (c) Funding.-- |
9 | (1) Upon Federal approval of an amendment to the |
10 | Medicaid State plan, the Department of Public Welfare shall |
11 | annually distribute any available funds obtained under this |
12 | act for hospital outpatient clinics through disproportionate |
13 | share payments to hospitals to provide financial assistance |
14 | that will assure readily available and coordinated |
15 | comprehensive health care to the citizens of this |
16 | Commonwealth. |
17 | (2) The Secretary of Public Welfare shall determine the |
18 | funds available and make appropriate adjustments based on the |
19 | number of qualifying hospitals with hospital health clinics. |
20 | (d) Maximization.--The Department of Public Welfare shall |
21 | seek to maximize any Federal funds, including funds obtained |
22 | under Title XIX of the Social Security Act (49 Stat. 620, 42 |
23 | U.S.C. § 1396 et seq.). |
24 | (e) Payment calculation.-- |
25 | (1) Fifteen percent of the total amount available shall |
26 | be allocated to rural hospitals located in this Commonwealth |
27 | as follows: |
28 | (i) Twenty-five percent of the total amount |
29 | available for rural hospitals shall be allocated equally |
30 | among each rural hospital. |
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1 | (ii) Seventy-five percent of the total amount |
2 | available for rural hospitals shall be allocated on the |
3 | basis of each hospital's percentage of medical assistance |
4 | hospital outpatient clinic service visits compared to the |
5 | Statewide total number of medical assistance hospital |
6 | outpatient clinic service visits for all rural hospitals. |
7 | (2) Eighty-five percent of the total amount available |
8 | shall be allocated to qualified nonrural hospitals located in |
9 | this Commonwealth as follows: |
10 | (i) Twenty-five percent of the total amount |
11 | available for nonrural hospitals shall be allocated |
12 | equally among nonrural hospitals. |
13 | (ii) Seventy-five percent of the total amount |
14 | available for nonrural hospitals shall be allocated on |
15 | the basis of each hospital's percentage of medical |
16 | assistance hospital outpatient clinic service visits |
17 | compared to the Statewide total number of medical |
18 | assistance hospital outpatient clinic visits for all |
19 | nonrural hospitals. |
20 | (f) Attestation.--Before receiving any payment under this |
21 | section, a hospital shall complete an attestation form approved |
22 | by the department that contains, at a minimum, the following: |
23 | (1) The payment shall be used for the purposes under |
24 | section 111(a). |
25 | (2) The payment shall be used to enhance the |
26 | availability of outpatient service visits within the year the |
27 | funds were requested. |
28 | (3) The hospital will continue to provide outpatient |
29 | service visits during the calendar year that the moneys were |
30 | requested and will do so without restriction by reason of |
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1 | sex, race, color, national origin, age, income or handicap or |
2 | disability. |
3 | (4) If the hospital closes a hospital outpatient clinic, |
4 | then any payment received under this section shall be |
5 | returned to the department. |
6 | (g) Reporting.--After receiving a payment under this section |
7 | a hospital shall provide to the department, on an expenditure |
8 | reporting form approved by the department, an accounting of how |
9 | the payment was used by the hospital. |
10 | (h) Audit.--The department may audit the expenditure of a |
11 | payment received under this section. |
12 | Section 114. Community-Based Health Care (CHC) Fund. |
13 | (a) Establishment.--The Community-Based Health Care (CHC) |
14 | Fund is established in the State Treasury. |
15 | (b) Funding sources.--Funding sources for the fund shall |
16 | include all of the following: |
17 | (1) Transfers or appropriations to the fund. |
18 | (2) Money received from the Federal Government or other |
19 | sources. |
20 | (3) Money required to be deposited in the fund under |
21 | other provisions of this act or any other law. |
22 | (4) Investment earnings from the fund, net of investment |
23 | costs. |
24 | (c) Use.--The department and the Department of Public |
25 | Welfare shall utilize the fund to carry out the program. |
26 | CHAPTER 51 |
27 | MISCELLANEOUS PROVISIONS |
28 | Section 5101. Transfers. |
29 | (a) Transfer from fund.--The Secretary of the Budget shall |
30 | annually transfer moneys from the fund necessary for: |
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1 | (1) The department to carry out the provisions of |
2 | section 111. |
3 | (2) The Department of Public Welfare to carry out the |
4 | provisions of section 113. |
5 | (b) Limitations on payments.--Payments to either community- |
6 | based health care clinics or hospital outpatient clinics for |
7 | assistance under this act shall not exceed the amount of funds |
8 | available for the program, and any payment under this act shall |
9 | not constitute an entitlement from the Commonwealth or a claim |
10 | on any other funds of the Commonwealth. |
11 | Section 5102. Effective date. |
12 | This act shall take effect in 90 days. |
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