THE GENERAL ASSEMBLY OF PENNSYLVANIA

HOUSE BILL

INTRODUCED BY GODSHALL, CALTAGIRONE, CREIGHTON, DENLINGER, HARPER, KAUFFMAN, O'NEILL AND SWANGER, JANUARY 27, 2011

REFERRED TO COMMITTEE ON AGING AND OLDER ADULT SERVICES, JANUARY 27, 2011  

AN ACT

Exempting continuing care retirement communities from the

medical assistance bed approval process and allowing nursing

facilities operated by continuing care retirement communities

to obtain medical assistance certified beds under limited

terms and conditions.

The General Assembly of the Commonwealth of Pennsylvania

hereby enacts as follows:

Section 1.  Short title.

This act shall be known and may be cited as the Continuing

Care Retirement Community Act.

Section 2.  Definitions.

The following words and phrases when used in this act shall

have the meanings given to them in this section unless the

context clearly indicates otherwise:

"CCRC."  A continuing care retirement community licensed by

the Insurance Department.

"Department."  The Department of Public Welfare of the

Commonwealth.

Section 3.  Continuing care retirement community exemption.

A licensed nursing facility operated by a licensed CCRC shall

be exempt from the requirements under 55 Pa. Code §§ 1187.21(2)

(relating to nursing facility participation requirements) and

1187.21a (relating to nursing facility participation review

process and guidelines - statement of policy) under the

following conditions:

(1)  The CCRC has admitted residents under a continuing

care agreement.

(2)  The nursing facility is part of the CCRC campus.

Section 4.  Certified and noncertified nursing facilities on

CCRC campus.

If a licensed nursing facility is part of the continuum of

care of a CCRC, notwithstanding whether the nursing facility

currently has beds certified by the medical assistance program,

the nursing facility shall have a limited number of beds

certified by medical assistance through an application to the

department pursuant to the following requirements:

(1)  One or more residents admitted under a continuing

care agreement spend down their resources, including any

funds which may be or may become available, as a full or

partial refund of any entrance fee payments, in order to

become eligible for medical assistance.

(2)  The beds will be used to provide nursing care and to

maintain on the CCRC campus residents who have spent down

their resources in order to become eligible for medical

assistance.

(3)  The number of beds certified by the medical

assistance program may not be greater than 15%, rounded to

the nearest whole number, of the current licensed number of

beds of the CCRC's nursing facility.

Section 5.  Applications for nursing facility beds certified by

the medical assistance program.

(a)  Required information.--The application for a bed

certified by the medical assistance program shall include

documentation that the person for whom the bed is requested was

initially admitted to the CCRC under the terms of a continuing

care agreement.

(b)  Limitation.--All applications for beds certified by the

medical assistance program which satisfy subsection (a) shall be

granted by the department subject to the spend-down medical

assistance bed limitation as specified under section 4(3) and

the notice requirements specified under section 7.

(c)  Agreement.--The nursing facility of the CCRC shall sign

a limited enrollment provider agreement.

Section 6.  Nursing facility medical assistance reimbursement.

The nursing facility of the CCRC shall be eligible for and

shall receive reimbursement under the medical assistance program

as a participating provider effective on the date the medical

assistance eligible resident meets medical assistance

eligibility requirements.

Section 7.  Department notification.

The nursing facility of the CCRC must notify the department

within 30 days of the death or permanent transfer or discharge

of the medical assistance eligible resident from the nursing

facility. Failure of the nursing facility to notify the

department of these events within 30 days may be used as a basis

to deny future applications for certified medical assistance

beds.

Section 20.  Effective date.

This act shall take effect in 60 days.