HOUSE AMENDED

THE GENERAL ASSEMBLY OF PENNSYLVANIA

SENATE BILL

INTRODUCED BY ERICKSON, EICHELBERGER, PILEGGI, SCARNATI, D. WHITE, BAKER, M. WHITE, RAFFERTY, GREENLEAF, VANCE, COSTA, GORDNER, ORIE, ALLOWAY, KITCHEN, SMUCKER, FONTANA, CORMAN, EARLL, YAW, WAUGH, FOLMER, ROBBINS, BROWNE, BRUBAKER, WARD, PIPPY, MENSCH, WOZNIAK AND DINNIMAN, FEBRUARY 17, 2011

AS REPORTED FROM COMMITTEE ON HEALTH, HOUSE OF REPRESENTATIVES, AS AMENDED, JUNE 27, 2012   

AN ACT

Establishing the Community-Based Health Care SUBSIDY (CHCS)

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Program in the Department of Health; and providing for

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hospital health clinics and for mobile prenatal and natal

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care demonstration project.

TABLE OF CONTENTS

Chapter 1.  Health Care Assistance

Subchapter A.  Preliminary Provisions

Section 101.  Short title.

Section 102.  Definitions.

Subchapter B.  Community-Based Health Care SUBSIDY (CHCS)

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Section 111.  Community-Based Health Care SUBSIDY (CHCS) 

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Program.

Section 112.  Powers and duties of department.

Section 113.  Hospital health clinics.

Subchapter C.  Mobile Prenatal and Natal Care Demonstration

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Project

Section 121.  Establishment.

Section 122.  Applications for planning grants.

Section 123.  Review and approval of grant applications.

Section 124.  Report.

Chapter 51.  Miscellaneous Provisions

Section 5101.  Limitation.

Section 5102.  Effective date.

The General Assembly of the Commonwealth of Pennsylvania

hereby enacts as follows:

CHAPTER 1

HEALTH CARE ASSISTANCE

SUBCHAPTER A

PRELIMINARY PROVISIONS

Section 101.  Short title.

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

Based Health Care SUBSIDY (CHCS) Act.

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Section 102.  Definitions.

The following words and phrases when used in this chapter

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

context clearly indicates otherwise:

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

includes the following:

(1)  The provision of effective health management through

support and information that also promotes patient 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 care and use of reasonably

accessible and updated patient information that encourages

follow-up care as a standard procedure.

(4)  The tracking of clinical information for individual

and general patient populations to guide treatment and

effectively anticipate community health care problems.

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

care center located in this Commonwealth that provides

comprehensive health care services without regard for a

patient's ability to pay and that:

(1)  meets either of the following criteria:

(i)  serves a federally designated medically

underserved area, a medically underserved population or a

health professional shortage area; or

(ii)  serves a patient population with a majority of

that population having an income less than 200% of the

Federal poverty income guidelines; and

(2)  includes any of the following:

(i)  A 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)) or a federally

qualified health center look-alike and is a participating

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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.

(ii)  A 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)), certified by Medicare and is a

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participating provider with the Department of Public

Welfare under the Public Welfare Code.

(iii)  A hospital health clinic and is a

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participating provider with the Department of Public

Welfare under the Public Welfare Code.

(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 that is

managed by advanced practice nurses and is associated

with a nursing education program, a federally qualified

health center or an independent nonprofit health or

social services agency and is a participating provider

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with the Department of Public Welfare under the Public

Welfare Code.

"Department."  Except as provided under section 113, the

Department of Health of the Commonwealth.

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

practice a component of the healing arts by a licensing board

within the Department of State who provides health care services

at a community-based health care clinic.

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

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

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

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

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below 200% of the Federal poverty income guidelines.

"Medical assistance."  A 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.

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

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

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

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(CHCS) Program.

SUBCHAPTER B

COMMUNITY-BASED HEALTH CARE (CHC) SUBSIDY (CHCS)

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Section 111.  Community-Based Health Care (CHC) Subsidy (CHCS) 

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Program.

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

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Subsidy (CHCS) Program is established within the department to

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provide grants to community-based health care clinics to:

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

such as 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.

(b)  Grant award methodology.--A methodology for the

allocation of grant awards shall be developed by the department

based on the following distribution:

(1)  Fifty percent Not more than 50% for the expansion of

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an existing or the development of a new community-based

health care clinic using criteria that include:

(i)  The actual and projected number of total

patients, new patients and patient visits for all

patients served or to be served, specifically delineating

the number of low-income and uninsured patients, who fall

below 200% of the Federal poverty income guidelines.

(ii)  The addition or expansion of ancillary health

care services, such as dental, behavioral health and

pharmacy.

(iii)  The development or enhancement of preventive

and chronic care and disease management techniques.

(2)  Twenty-five percent Not more than 25% for

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improvements in prenatal, obstetric, postpartum and newborn

care.

(3)  Twenty percent Not more than 20% for improved access

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and services, including patient transportation, intended to

reduce unnecessary emergency room utilization.

(4)  Five percent Not more than 5% for the establishment

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of collaborative relationships among community-based health

care clinics, hospitals and other health care providers.

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

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the program authorized by this section may be awarded to

applicants within any one city, town, borough or township of

this Commonwealth.

(c)  Limitation.--No more than 25% of the grants awarded

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under subsection (b) shall go to federally qualified health

centers or federally qualified health center look-alikes.

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

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manner that improves access and expands services in all

geographic areas of this Commonwealth.

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

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among the categories described in subsection (b) if sufficient

grant requests are not received to use all the funds available

in a specific category.

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

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shall require a matching commitment of 25% of the grant, which

can be in the form of cash or equivalent in-kind services.

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

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available Federal funds, as well as any available grants and

funding from other sources, to supplement amounts made available

under this subchapter to the extent permitted by law.

Section 112.  Powers and duties of department.

The department shall have the following powers and duties:

(1)  To administer the program.

(2)  To develop an allocation methodology pursuant to

section 111(b).

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

section, to develop and provide a grant application form

consistent with this act. The department shall provide

applications for grants under this section to all known

community-based health care clinics. A grant under this

section may be extended over two State fiscal years at the

request of the community-based health care clinic.

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

based health care clinics.

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

30 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 Committee of the House of

Representatives. The report shall include all of the

following:

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

listing the type of community-based health care clinic

and the name of the grantee.

(ii)   The use of the grant by each grantee.

(iii)   How each grant expanded access and services

in accordance with the criteria set forth in section

111(a) and (b), including specific documentation of low-

income and uninsured patients served, and the total

amount of funds allocated in each distribution category

under section 111(b).

(iv)  The impact of the grant on improving the

delivery and quality of health care in the community.

(v)  The benefits of the assistance provided under

this subchapter and any recommendations for changes to

the program.

The report shall be made available for public inspection and

posted on the department's publicly accessible Internet

website.

(6)  To audit grants awarded under this subchapter to

ensure that funds have been used in accordance with this

subchapter and the terms and standards adopted by the

department.

(7)  To establish and maintain an online database of

community-based health care clinics.

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

individuals to obtain information about community-based

health care clinics.

Section 113.  Hospital health clinics.

(a)  Program.--The Department of Public Welfare shall, in

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cooperation with the department, be responsible for

administering the program as it relates to hospital health

clinics in accordance with the requirements of this act and

shall have the following additional duties:

(1)  To develop an application and collect such data and

information as may be necessary to determine the eligibility

of hospital health clinics for payments under this section

using the criteria set forth in section 111(a) and (b).

(2)  To review an application and make a final

determination regarding a hospital health clinic's

eligibility for funding within 90 days of receipt.

(3)  To make payments to hospital health clinics in

accordance with the payment calculation set forth in

subsection (e).

(b)  Submission of application.--In order to qualify for

funding under this section, a hospital health clinic shall

submit the required application to the Department of Public

Welfare no later than 90 days after the effective date of this

act.

(c)  Funding.--

(1)  For each fiscal year, upon Federal approval of an

amendment to the Medicaid State plan, the Department of

Public Welfare shall annually distribute any available funds

obtained under this act for hospital health clinics through

disproportionate share payments to hospitals to provide

financial assistance that will assure readily available and

coordinated comprehensive health care to the citizens of this

Commonwealth.

(2)  The Secretary of Public Welfare shall determine the

funds available and make appropriate adjustments based on the

number of qualifying hospitals with hospital health clinics.

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

seek to maximize any Federal funds, including funds obtained

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

U.S.C. § 1396 et seq.).

(e)  Payment calculation.--

(1)  Thirty percent of the total amount available shall

be allocated to eligible hospital health clinics of hospitals

located in counties of the first and second class. The total

amount available for each hospital health clinic at a

hospital in these counties shall be allocated on the basis of

each hospital's percentage of medical assistance and low-

income hospital health clinic visits compared to the total

number of medical assistance and low-income hospital health

clinic visits for all hospitals in the first and second class 

counties.

(2)  Fifty percent of the total amount available shall be

allocated to eligible hospital health clinics of hospitals

located in counties of the third, fourth and fifth class. The

total amount available for each hospital health clinic at a

hospital in these counties shall be allocated on the basis of

each hospital's percentage of medical assistance and low-

income hospital health clinic visits compared to the total

number of medical assistance and low-income hospital health

clinic visits for all hospitals in the third, fourth and

fifth class counties.

(3)  Twenty percent of the total amount available shall

be allocated to eligible hospital health clinics of hospitals

located in counties of the sixth, seventh and eighth class.

The total amount available for each hospital health clinic at

a hospital in these counties shall be allocated on the basis

of each hospital's percentage of medical assistance and low-

income hospital health clinic visits compared to the total

number of medical assistance and low-income hospital health

clinic visits for all hospitals in the sixth, seventh and

eighth class counties.

(4)  Any hospital that has reached its disproportionate

share limit under Title XIX of the Social Security Act shall

receive its share of the State funds available under this

act.

(f)  Definition.--As used in this section, the term "low-

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income" means under 200% of the Federal poverty income

guidelines.

SUBCHAPTER C

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MOBILE PRENATAL AND

NATAL CARE DEMONSTRATION PROJECT

Section 121.  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.

Section 122.  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 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)  Proof of participation in the medical assistance

program.

(6)  Any other information required by the department.

Section 123.  Review and approval of grant applications.

(a)  Review.--The department shall review the applications.

Preference shall be given to applicants in communities where

prenatal, obstetric, postpartum and newborn care is limited.

Upon being satisfied that all requirements have been met, the

department may approve four applications and award grants. The

following grants shall be awarded:

(1)  One to an applicant which seeks to provide services

in an urban setting.

(2)  One to an applicant which seeks to provide services

in a suburban setting.

(3)  One to an applicant which seeks to provide services

in a rural setting.

(4)  One to an underserved area which is most likely to

benefit from a mobile clinic.

(b)  Limit.--Grants awarded may not be more than $100,000.

Section 124.  Report.

By May 1, 2014, the department shall file a report with the

chairman and minority chairman of the Public Health and Welfare

Committee of the Senate, the chairman and minority chairman of

the Health Committee of the House of Representatives and the

chairman and minority chairman of the 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)  The types of services and the amount spent on each

type of service provided by each grantee.

(6)  Any recommendations for changes to the program.

CHAPTER 51

MISCELLANEOUS PROVISIONS

Section 5101.  Limitations.

Payments to community-based health care clinics and the

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Mobile Prenatal and Natal Care Demonstration Project for

assistance under this act shall not exceed the amount of funds

available for the program, and any payment under this act shall

not constitute an entitlement from the Commonwealth or a claim

on any other funds of the Commonwealth.

Section 5102.  Effective date.

This act shall take effect in 90 days.