PRINTER'S NO.  2427

  

THE GENERAL ASSEMBLY OF PENNSYLVANIA

  

HOUSE BILL

 

No.

1846

Session of

2009

  

  

INTRODUCED BY PALLONE, BELFANTI, DEASY, GIBBONS, HORNAMAN, JOSEPHS, KOTIK, KULA, MILLARD, PASHINSKI, SIPTROTH, K. SMITH, SWANGER AND YOUNGBLOOD, JULY 10, 2009

  

  

REFERRED TO COMMITTEE ON HEALTH AND HUMAN SERVICES, JULY 10, 2009  

  

  

  

AN ACT

  

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Establishing the Community-Based Health Care (CHC) Program in

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the Department of Health; providing for hospital health

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clinics; and establishing the Community-Based Health Care

4

Fund.

5

TABLE OF CONTENTS

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Chapter 1.  Health Care Assistance

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Subchapter A.  Preliminary Provisions

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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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hereby enacts as follows:

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CHAPTER 1

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HEALTH CARE ASSISTANCE

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SUBCHAPTER A

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PRELIMINARY PROVISIONS

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Section 101.  Short title.

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This act shall be known and may be cited as the Community-

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Based Health Care (CHC) Act.

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Section 102.  Definitions.

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The following words and phrases when used in this chapter

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

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context clearly indicates otherwise:

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"Chronic care and disease management."  A model of care that

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includes the following:

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(1)  The provision of effective health management through

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support and information that also promotes patient self-care

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for patients with chronic conditions.

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

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appropriate treatment decisions by health care providers.

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(3)  The coordination of care and use of reasonably

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accessible and updated patient information that encourages

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follow-up care as a standard procedure.

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(4)  The tracking of clinical information for individual

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and general patient populations to guide treatment and

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effectively anticipate community health care problems.

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

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care center located in this Commonwealth that provides

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comprehensive health care services without regard for a

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patient's ability to pay and that:

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(1)  meets either of the following criteria:

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(i)  serves a federally designated medically

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underserved area, a medically underserved population or a

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health professional shortage area; or

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(ii)  serves a patient population with a majority of

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that population having an income less than 200% of the

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Federal poverty income guidelines; and

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(2)  includes any of the following:

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(i)  A federally qualified health center as defined

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in section 1905(l)(2)(B) of the Social Security Act (49

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Stat. 620, 42 U.S.C. § 1396d(l)(2)(B)) or a federally

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qualified health center look-alike.

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(ii)  A rural health clinic as defined in section

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1861(aa)(2) of the Social Security Act (49 Stat. 620, 42

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U.S.C. § 1395x(aa)(2)), certified by Medicare.

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(iii)  A hospital outpatient clinic.

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

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provides medical home and primary care services by

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volunteer and nonvolunteer health care providers.

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

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managed by advanced practice nurses, a federally

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qualified health center or an independent nonprofit

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health or social services agency.

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

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"Fund."  The Community-Based Health Care (CHC) Fund.

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"Health care provider."  A health care provider licensed to

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practice a component of the healing arts by a licensing board

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within the Department of State who provides health care services

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at a community-based health care clinic.

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

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

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No.48), known as the Health Care Facilities Act.

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"Hospital outpatient clinic."  A hospital-operated facility

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that provides primary nonemergency health care on an outpatient

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basis pursuant to 55 Pa. Code Ch. 1221 (relating to clinic and

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emergency room services).

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"Medical assistance."  A State program of medical assistance

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established under Article IV(f) of the act of June 13, 1967

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

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"Medical home."  A community-based health care clinic that

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provides, at a minimum:

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(1)  A health care provider or team of health care

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providers at the practice level to provide first contact,

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continuous, ongoing and comprehensive health care.

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(2)  Arranging care or taking responsibility for the

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arrangement of care that meets the patient's health care

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needs with other qualified professionals in areas including,

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but not limited to, chronic care, acute care, preventive care

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and end-of-life care.

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(3)  The coordination and integration of a patient's

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health care needs across the health care system in areas such

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as subspecialty care, hospital care, home health care,

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nursing home care and community-based services.

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"Patient."  A natural person receiving health care from a

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

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"Program."  The Community-Based Health Care (CHC) Program.

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"Rural hospital."  A hospital that is located in a geographic

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area not located in a Core-Based Statistical Area (CBSAs)

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established by the United States Office of Management and

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Budget.

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SUBCHAPTER B

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1

COMMUNITY-BASED HEALTH CARE (CHC)

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Section 111.  Community-Based Health Care (CHC) Program.

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(a)  Establishment.--The Community-Based Health Care (CHC)

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Program is established within the department to provide grants

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to community-based health care clinics to:

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

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such as preventive care, chronic care and disease management,

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prenatal, obstetric, postpartum and newborn care, dental

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treatment, behavioral health and pharmacy services.

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(2)  Reduce unnecessary utilization of hospital emergency

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services by providing an effective alternative health care

12

delivery system.

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(3)  Encourage collaborative relationships among

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community-based health care clinics, hospitals and other

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health care providers.

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(b)  Grant applications.--When considering an application for

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a grant for the expansion of an existing or new community-based

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health care clinic, the department shall consider, at a minimum,

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the following factors: 

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(1)  The health care needs and demographics of the area

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covered under the application that includes, but is not

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limited to, the following: 

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(i)  The population of the uninsured in certain

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areas, such as a county or health service area.

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(ii)  The number of federally qualified health

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centers or federally qualified health center look-alikes,

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rural health clinics and hospital outpatient clinics.

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(iv)  The number of primary care physicians

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practicing in the health service area.

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(v)  Whether the clinic will serve a medically

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underserved area, a medically underserved population or a

2

health professional shortage area. 

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(2)  The request in the application for the addition or

4

expansion of direct or ancillary health care services that

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includes, but is not limited to, the following:

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(i)  Prenatal care, obstetric, postpartum or newborn

7

care.

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(ii)  Comprehensive specialty care.

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(iii)  Dental services.

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(iv)  Behavioral health.

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(v)  Pharmacy.

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(vi)  Transportation.

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(3)  The expansion or increase in services that are

14

intended to reduce unnecessary emergency room utilization.

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(4)  The establishment of collaborative relationships

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among community-based health care clinics, hospitals and

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other health care providers.

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(c)  Distribution.--Funds shall be distributed in a manner

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that improves access and expands services in all geographic

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areas of this Commonwealth.

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(d)  Reallocation.--The department shall reallocate funds

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among the categories described in subsection (b) if sufficient

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grant requests are not received to use all the funds available

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in a specific category.

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(e)  Amount of grants.--A grant under this subsection shall

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not exceed $500,000 and shall require a matching commitment of

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25% of the grant, which can be in the form of cash or equivalent

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in-kind services.

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(f)  Federal funds.--The department shall seek any available

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Federal funds, as well as any available grants and funding from

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other sources, to supplement amounts made available under this

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subchapter to the extent permitted by law.

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Section 112.  Powers and duties of department.

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The department shall have the following powers and duties:

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(1)  To administer the program.

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(2)  To develop an allocation methodology applicable to

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grant applications submitted pursuant to section 111(b).

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(3)  Within 90 days of the effective date of this

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section, to develop and provide a grant application form

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consistent with this act. The department shall provide

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applications for grants under this section to all known

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community-based health care clinics. A grant under this

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section may be extended over two State fiscal years at the

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request of the community-based health care clinic.

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(4)  To calculate and make grants to qualified community-

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based health care clinics.

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(5)  To provide an annual report no later than November

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30 to the chair and minority chair of the Public Health and

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Welfare Committee of the Senate and the chair and minority

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chair of the Health and Human Services Committee of the House

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of Representatives. The report shall include accountability

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measures for all of the following:

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(i)  The total dollar amount for each grant awarded,

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listing the type of community-based health care clinic

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and the name of the grantee.

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(ii)  A summary of the use of the grant by each

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grantee.

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(iii)  A summary of how each grant expanded access

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and services in accordance with the criteria set forth in

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section 111(a) and (b), including a specific

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documentation of low-income and uninsured patients

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served, and the total amount of funds allocated in each

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distribution category under section 111(b).

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(iv)  The impact of the grant on improving the

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delivery and quality of health care in the community.

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(v)  An accountability assessment of the benefits of

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the assistance provided under this subchapter and any

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recommendations for changes to the program.

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The report shall be made available for public inspection and

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posted on the department's publicly accessible Internet

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website.

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(6)  To audit grants awarded under this subchapter to

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ensure that funds have been used in accordance with this

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subchapter and the terms and standards adopted by the

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department.

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(7)  To establish and maintain an online database of

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community-based health care clinics.

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(8)  To establish a toll-free telephone number for

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individuals to obtain information about community-based

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health care clinics.

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Section 113.  Hospital outpatient clinics.

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(a)  Establishment.--The Hospital Outpatient Program is

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established within the Community-Based Health Care Program to

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provide payments by the Department of Public Welfare for

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hospital outpatient clinics.

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(b)  Purpose.--The Hospital Outpatient Program shall assist

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hospital outpatient clinics to:

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

29

such as preventive care, chronic care and disease management,

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prenatal, obstetric, postpartum and newborn care, dental

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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.--

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(1)  Upon Federal approval of an amendment to the

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Medicaid State plan, the Department of Public Welfare shall

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annually distribute any available funds obtained under this

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act for hospital outpatient clinics through disproportionate

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share payments to hospitals to provide financial assistance

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that will assure readily available and coordinated

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comprehensive health care to the citizens of this

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Commonwealth.

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(2)  The Secretary of Public Welfare shall determine the

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funds available and make appropriate adjustments based on the

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number of qualifying hospitals with hospital health clinics.

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(d)  Maximization.--The Department of Public Welfare shall

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seek to maximize any Federal funds, including funds obtained

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under Title XIX of the Social Security Act (49 Stat. 620, 42

23

U.S.C. § 1396 et seq.).

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(e)  Payment calculation.--

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(1)  Fifteen percent of the total amount available shall

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be allocated to rural hospitals located in this Commonwealth

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as follows:

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(i)  Twenty-five percent of the total amount

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available for rural hospitals shall be allocated equally

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among each rural hospital.

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(ii)  Seventy-five percent of the total amount

2

available for rural hospitals shall be allocated on the

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basis of each hospital's percentage of medical assistance

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hospital outpatient clinic service visits compared to the

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Statewide total number of medical assistance hospital

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outpatient clinic service visits for all rural hospitals.

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(2)  Eighty-five percent of the total amount available

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shall be allocated to qualified nonrural hospitals located in

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this Commonwealth as follows:

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(i)  Twenty-five percent of the total amount

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available for nonrural hospitals shall be allocated

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equally among nonrural hospitals.

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(ii)  Seventy-five percent of the total amount

14

available for nonrural hospitals shall be allocated on

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the basis of each hospital's percentage of medical

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assistance hospital outpatient clinic service visits

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compared to the Statewide total number of medical

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assistance hospital outpatient clinic visits for all

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nonrural hospitals.

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(f)  Attestation.--Before receiving any payment under this

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section, a hospital shall complete an attestation form approved

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by the department that contains, at a minimum, the following:

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(1)  The payment shall be used for the purposes under

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section 111(a).

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(2)  The payment shall be used to enhance the

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availability of outpatient service visits within the year the

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funds were requested.

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(3)  The hospital will continue to provide outpatient

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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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sex, race, color, national origin, age, income or handicap or

2

disability.

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(4)  If the hospital closes a hospital outpatient clinic,

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then any payment received under this section shall be

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returned to the department.

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(g)  Reporting.--After receiving a payment under this section

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a hospital shall provide to the department, on an expenditure

8

reporting form approved by the department, an accounting of how

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the payment was used by the hospital.

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(h)  Audit.--The department may audit the expenditure of a

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payment received under this section. 

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Section 114.  Community-Based Health Care (CHC) Fund.

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(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

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include all of the following:

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(1)  Transfers or appropriations to the fund.

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(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.

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(c)  Use.--The department and the Department of Public

25

Welfare shall utilize the fund to carry out the program.

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CHAPTER 51

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MISCELLANEOUS PROVISIONS

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Section 5101.  Transfers.

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(a)  Transfer from fund.--The Secretary of the Budget shall

30

annually transfer moneys from the fund necessary for:

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(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.

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Section 5102.  Effective date.

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This act shall take effect in 90 days.

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