1Amending the act of June 13, 1967 (P.L.31, No.21), entitled "An
2act to consolidate, editorially revise, and codify the public
3welfare laws of the Commonwealth," further providing for
4other medical assistance payments; and establishing payments
5for cognitive rehabilitation therapy.

6The General Assembly of the Commonwealth of Pennsylvania
7hereby enacts as follows:

8Section 1.  Section 443.3(a) of the act of June 13, 1967
9(P.L.31, No.21), known as the Public Welfare Code, amended July
107, 2005 (P.L.177, No.42), is amended to read:

11Section 443.3. Other Medical Assistance Payments.--(a)
12Payments on behalf of eligible persons shall be made for other
13services, as follows:

14(1) Rates established by the department for outpatient 
15services as specified by regulations of the department adopted 
16under Title XIX of the Social Security Act (49 Stat. 620, 42 
17U.S.C. § 1396 et seq.) consisting of preventive, diagnostic, 
18therapeutic, rehabilitative or palliative services; furnished by 
19or under the direction of a physician, chiropractor or 

1podiatrist, by a hospital or outpatient clinic which qualifies 
2to participate under Title XIX of the Social Security Act, to a 
3patient to whom such hospital or outpatient clinic does not 
4furnish room, board and professional services on a continuous, 
5twenty-four hour a day basis.

6(2) Rates established by the department for (i) other
7laboratory and X-ray services prescribed by a physician,
8chiropractor or podiatrist and furnished by a facility other
9than a hospital which is qualified to participate under Title
10XIX of the Social Security Act, (ii) physician's services
11consisting of professional care by a physician, chiropractor or
12podiatrist in his office, the patient's home, a hospital, a
13nursing facility or elsewhere, (iii) the first three pints of
14whole blood, (iv) remedial eye care, as provided in [Article
15VIII] subarticle (b) of Article XXII of the act of April 9, 1929 
16(P.L.177, No.175), known as "The Administrative Code of 1929,"
17consisting of medical or surgical care and aids and services and
18other vision care provided by a physician skilled in diseases of
19the eye or by an optometrist which are not otherwise available
20under this [Article] article, (v) special medical services for
21school children, as provided in the [Public School Code of
221949,] act of March 10, 1949 (P.L.30, No.14), known as the 
23"Public School Code of 1949," consisting of medical, dental,
24vision care provided by a physician skilled in diseases of the
25eye or by an optometrist or surgical care and aids and services
26which are not otherwise available under this article.

27(3) Notwithstanding any other provision of law, for
28recipients aged twenty-one years or older receiving services
29under the fee for service delivery system who are eligible for
30medical assistance under Title XIX of the Social Security Act

1and for recipients aged twenty-one years or older receiving
2services under the fee-for-service delivery system who are
3eligible for general assistance-related categories of medical
4assistance, the following medically necessary services:

5(i) Psychiatric outpatient clinic services not to exceed
6five hours or ten one-half-hour sessions per thirty consecutive
7day period.

8(ii) Psychiatric partial hospitalization not to exceed five
9hundred forty hours per fiscal year.

10* * *

11Section 2. The act is amended by adding a section to read:

12Section 443.12. Payments to Providers for Cognitive
13Rehabilitation Therapy.--(a)  The department shall provide
14payment to participating Medicaid providers for cognitive
15rehabilitation therapy as a covered service when deemed to be
16medically necessary by a licensed physician.

17(b) Cognitive rehabilitation therapy will be considered
18medically necessary as adjunctive treatment of cognitive
19deficits including, but not limited to, attention, language,
20memory, reasoning, executive functions, problem solving, and
21visual processing, when all of the following are met:

22(1) The cognitive deficits have been acquired as a result of
23neurologic impairment due to traumatic brain injury, stroke or
24encephalopathy.

25(2) The individual has been seen and evaluated by a
26neuropsychiatrist or neuropsychologist.

27(3) Neuropsychological testing has been performed and
28neuropsychological results will be used in treatment planning
29and directing rehabilitation strategies.

30(4) The individual is expected to make significant cognitive 

1improvement, and includes not being in a vegetative or custodial 
2state.

3(c)  In order to implement reimbursement payments for these
4services, the department shall file a State plan amendment with
5the Centers for Medicare and Medicaid Services of the United
6States Department of Health and Human Services pursuant to Title
7XIX of the Social Security Act (49 Stat. 620, 42 U.S.C. § 1396
8et seq.) by June 30, 2012. The program shall be structured and
9administered by the department in accordance with Federal law
10and applicable Federal guidelines for qualified State cognitive
11rehabilitation therapy.

12(d)  The following words and phrases when used in this
13section shall have the meanings given to them in this subsection
14unless the context clearly indicates otherwise:

15"Cognitive rehabilitation therapy" means services that are
16designed to improve cognitive functioning after central nervous
17system insult and that assist with the improvement of attention,
18auditory and visual processing, concentration, decision making,
19judgment, language, learning, memory perception, planning,
20problem solving, reasoning, sequencing, thinking and executive
21functions, including compensatory training and direct patient
22contact performed by a licensed physician, psychologist,
23physical, occupational or speech therapist with the desired
24outcomes of an enhanced capacity to process and interpret
25information and an improved ability to function in home and
26community life.

27Section 3.  This act shall take effect immediately.