1Establishing the Community-Based Health Care Program in the
2Department of Health; and providing for hospital health
3clinics, for mobile prenatal and natal care demonstration
4project and for limitations.

5TABLE OF CONTENTS

6Chapter 1. Health Care Assistance

7Subchapter A. Preliminary Provisions

8Section 101. Short title.

9Section 102. Definitions.

10Subchapter B. Community-Based Health Care

11Section 111. Community-Based Health Care Program.

12Section 112. Powers and duties of department.

13Section 113. Hospital health clinics.

14Subchapter C. Mobile Prenatal and Natal Care Demonstration

15Project

16Section 121. Establishment.

1Section 122. Applications for planning grants.

2Section 123. Review and approval of grant applications.

3Section 124. Report.

4Chapter 51. Miscellaneous Provisions

5Section 5101. Limitation.

6Section 5102. Effective date.

7The General Assembly of the Commonwealth of Pennsylvania
8hereby enacts as follows:

9CHAPTER 1

10HEALTH CARE ASSISTANCE

11SUBCHAPTER A

12PRELIMINARY PROVISIONS

13Section 101. Short title.

14This act shall be known and may be cited as the Community-
15Based Health Care Act.

16Section 102. Definitions.

17The following words and phrases when used in this chapter
18shall have the meanings given to them in this section unless the
19context clearly indicates otherwise:

20"Advanced practice registered nurse." A registered nurse who
21has been certified in this Commonwealth to practice as:

22(1) a certified clinical nurse specialist;

23(2) a certified registered nurse anesthetist;

24(3) a certified registered nurse practitioner; or

25(4) a certified nurse midwife.

26"Chronic care and disease management." A model of care that 
27includes the following:

28(1) The provision of effective health management through
29support and information that also promotes patient self-care
30for patients with chronic conditions.

1(2) The use of evidence-based medicine to ensure
2appropriate treatment decisions by health care providers.

3(3) The coordination of care and use of reasonably
4accessible and updated patient information that encourages
5follow-up care as a standard procedure.

6(4) The tracking of clinical information for individual
7and general patient populations to guide treatment and
8effectively anticipate community health care problems.

9"Community-based health care clinic." A nonprofit health 
10care center located in this Commonwealth that provides 
11comprehensive health care services without regard for a 
12patient's ability to pay and that:

13(1) meets either of the following criteria:

14(i) serves a federally designated medically
15underserved area, a medically underserved population or a
16health professional shortage area; or

17(ii) serves a patient population with a majority of
18that population having an income less than 200% of the
19Federal poverty income guidelines; and

20(2) includes any of the following:

21(i) A federally qualified health center as defined
22in section 1905(l)(2)(B) of the Social Security Act (49 
23Stat. 620, 42 U.S.C. § 1396d(l)(2)(B)) or a federally
24qualified health center look-alike and is a participating
25provider with:

26(A) the Department of Public Welfare under the
27act of June 13, 1967 (P.L.31, No.21), known as the 
28Public Welfare Code; or

29(B) the Children's Health Insurance Program
30under:

1(I) Title XXI of the Social Security Act (49
2Stat. 620, 42 U.S.C. § 1397aa et seq.); and

3(II) Article XXIII of the act of May 17, 
41921 (P.L.682, No.284), known as The Insurance 
5Company Law of 1921, and the regulations
6promulgated thereunder.

7(ii) A rural health clinic as defined in section
81861(aa)(2) of the Social Security Act (49 Stat. 620, 42 
9U.S.C. § 1395x(aa)(2)), certified by Medicare and is a 
10participating provider with:

11(A) the Department of Public Welfare under the
12Public Welfare Code; or

13(B) the Children's Health Insurance Program
14under:

15(I) Title XXI of the Social Security Act;
16and

17(II) Article XXIII of The Insurance Company 
18Law of 1921 and the regulations promulgated
19thereunder.

20(iii) A hospital health clinic and is a 
21participating provider with:

22(A) the Department of Public Welfare under the
23Public Welfare Code; or

24(B) the Children's Health Insurance Program
25under:

26(I) Title XXI of the Social Security Act;
27and

28(II) Article XXIII of The Insurance Company 
29Law of 1921 and the regulations promulgated
30thereunder.

1(iv) A free or partial-pay health clinic that
2provides services by volunteer and nonvolunteer health
3care providers.

4(v) A nurse-managed health care clinic that is
5managed by advanced practice registered nurses and is
6associated with a nursing education program, a federally
7qualified health center or an independent nonprofit
8health or social services agency and is a participating 
9provider with:

10(A) the Department of Public Welfare under the
11Public Welfare Code; or

12(B) the Children's Health Insurance Program
13under:

14(I) Title XXI of the Social Security Act;
15and

16(II) Article XXIII of The Insurance Company 
17Law of 1921 and the regulations promulgated
18thereunder.

19"Department." Except as provided under section 113, the 
20Department of Health of the Commonwealth.

21"Health care provider." A health care provider licensed to 
22practice a component of the healing arts by a licensing board 
23within the Department of State who provides health care services 
24at a community-based health care clinic.

25"Hospital." An entity located in this Commonwealth that is 
26licensed as a hospital under the act of July 19, 1979 (P.L.130, 
27No.48), known as the Health Care Facilities Act.

28"Low-income patient." A patient whose household income is
29below 200% of the Federal poverty income guidelines.

30"Medical assistance." A State program of medical assistance 

1established under Article IV(f) of the act of June 13, 1967 
2(P.L.31, No.21), known as the Public Welfare Code.

3"Patient." A natural person receiving health care from a 
4health care provider at a community-based health care clinic.

5"Program." The Community-Based Health Care Program.

6SUBCHAPTER B

7COMMUNITY-BASED HEALTH CARE

8Section 111. Community-Based Health Care Program.

9(a) Establishment.--The Community-Based Health Care Program
10is established within the department to provide grants to
11community-based health care clinics to:

12(1) Expand and improve health care access and services,
13such as preventive care, chronic care and disease management,
14prenatal, obstetric, postpartum and newborn care, dental
15treatment, behavioral health and pharmacy services.

16(2) Reduce unnecessary utilization of hospital emergency
17services by providing an effective alternative health care
18delivery system.

19(3) Encourage collaborative relationships among
20community-based health care clinics, hospitals and other
21health care providers.

22(b) Grant award methodology.--A methodology for the
23allocation of grant awards shall be developed by the department
24based on the following distribution:

25(1) Not more than 50% for the expansion of an existing
26or the development of a new community-based health care
27clinic using criteria that include:

28(i) The actual and projected number of total
29patients, new patients and patient visits for all
30patients served or to be served, specifically delineating

1the number of low-income and uninsured patients, who fall
2below 200% of the Federal poverty income guidelines.

3(ii) The addition or expansion of ancillary health
4care services, such as dental, behavioral health and
5pharmacy.

6(iii) The development or enhancement of preventive
7and chronic care and disease management techniques.

8(2) Not more than 25% for improvements in prenatal,
9obstetric, postpartum and newborn care.

10(3) Not more than 20% for improved access and services, 
11including patient transportation, intended to reduce
12unnecessary emergency room utilization.

13(4) Not more than 5% for the establishment of
14collaborative relationships among community-based health care
15clinics, hospitals and other health care providers.

16(5) Not more than 15% of the funds made available for
17the program authorized by this section may be awarded to
18applicants within any one city, town, borough or township of
19this Commonwealth.

20(b.1) Limitation.--No more than 25% of the grants awarded
21under subsection (b) may go to federally qualified health
22centers as defined in section 1905(l)(2)(B) of the Social
23Security Act (49 Stat. 620, 42 U.S.C. § 1396d(l)(2)(B)) or
24federally qualified health center look-alikes.

25(c) Distribution.--Funds shall be distributed in a manner
26that improves access and expands services in all geographic
27areas of this Commonwealth.

28(d) Reallocation.--The department shall reallocate funds
29among the categories described in subsection (b) if sufficient 
<-30qualified grant requests are not received to use all the funds

1available in a specific category.

2(e) Amount of grants.--A grant under this subsection shall
3require a matching commitment of 25% of the grant, which can be
4in the form of cash or equivalent in-kind services.

5(f) Federal funds.--The department shall seek any available
6Federal funds, as well as any available grants and funding from
7other sources, to supplement amounts made available under this
8subchapter to the extent permitted by law.

9Section 112. Powers and duties of department.

10The department shall have the following powers and duties:

11(1) To administer the program.

12(2) To develop an allocation methodology pursuant to
13section 111(b).

14(3) Within 90 days of the effective date of this
15section, to develop and provide a grant application form
16consistent with this act. The department shall provide
17applications for grants under this section to all known
18community-based health care clinics. A grant under this
19section may be extended over two State fiscal years at the
20request of the community-based health care clinic.

21(4) To calculate and make grants to qualified community-
22based health care clinics.

23(5) To provide an annual report no later than November
2430 to the chair and minority chair of the Public Health and
25Welfare Committee of the Senate and the chair and minority
26chair of the Health Committee of the House of
27Representatives. The report shall include all of the
28following:

29(i) The total dollar amount for each grant awarded,
30listing the type of community-based health care clinic

1and the name of the grantee.

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

3(iii) How each grant expanded access and services
4in accordance with the criteria set forth in section
5111(a) and (b), including specific documentation of low-
6income and uninsured patients served, and the total
7amount of funds allocated in each distribution category
8under section 111(b).

9(iv) The impact of the grant on improving the
10delivery and quality of health care in the community.

11(v) The benefits of the assistance provided under
12this subchapter and any recommendations for changes to
13the program.

14The report shall be made available for public inspection and
15posted on the department's publicly accessible Internet
16website.

17(6) To audit grants awarded under this subchapter to
18ensure that funds have been used in accordance with this
19subchapter and the terms and standards adopted by the
20department.

21(7) To establish and maintain an online database of
22community-based health care clinics.

23(8) To establish a toll-free telephone number for
24individuals to obtain information about community-based
25health care clinics.

26Section 113. Hospital health clinics.

27(a) Program.--The Department of Public Welfare shall, in 
28cooperation with the department, be responsible for
29administering the program as it relates to hospital health
30clinics in accordance with the requirements of this act and

1shall have the following additional duties:

2(1) To develop an application and collect such data and
3information as may be necessary to determine the eligibility
4of hospital health clinics for payments under this section
5using the criteria set forth in section 111(a) and (b).

6(2) To review an application and make a final
7determination regarding a hospital health clinic's
8eligibility for funding within 90 days of receipt.

9(3) To make payments to hospital health clinics in
10accordance with the payment calculation set forth in
11subsection (e).

12(b) Submission of application.--In order to qualify for
13funding under this section, a hospital health clinic shall
14submit the required application to the Department of Public
15Welfare no later than 90 days after the effective date of this
16act.

17(c) Funding.--

18(1) For each fiscal year, upon Federal approval of an
19amendment to the Medicaid State plan, the Department of
20Public Welfare shall annually distribute any available funds
21obtained under this act for hospital health clinics through
22disproportionate share payments to hospitals to provide
23financial assistance that will assure readily available and
24coordinated comprehensive health care to the citizens of this
25Commonwealth.

26(2) The Secretary of Public Welfare shall determine the
27funds available and make appropriate adjustments based on the
28number of qualifying hospitals with hospital health clinics.

29(d) Maximization.--The Department of Public Welfare shall
30seek to maximize any Federal funds, including funds obtained

1under Title XIX of the Social Security Act (49 Stat. 620, 42 
2U.S.C. § 1396 et seq.).

3(e) Payment calculation.--

4(1) Thirty percent of the total amount available shall
5be allocated to eligible hospital health clinics of hospitals
6located in counties of the first and second class. The total
7amount available for each hospital health clinic at a
8hospital in these counties shall be allocated on the basis of
9each hospital's percentage of medical assistance and low-
10income hospital health clinic visits compared to the total
11number of medical assistance and low-income hospital health
12clinic visits for all hospitals in the first and second class
13counties.

14(2) Fifty percent of the total amount available shall be
15allocated to eligible hospital health clinics of hospitals
16located in counties of the third, fourth and fifth class. The
17total amount available for each hospital health clinic at a
18hospital in these counties shall be allocated on the basis of
19each hospital's percentage of medical assistance and low-
20income hospital health clinic visits compared to the total
21number of medical assistance and low-income hospital health
22clinic visits for all hospitals in the third, fourth and
23fifth class counties.

24(3) Twenty percent of the total amount available shall
25be allocated to eligible hospital health clinics of hospitals
26located in counties of the sixth, seventh and eighth class.
27The total amount available for each hospital health clinic at
28a hospital in these counties shall be allocated on the basis
29of each hospital's percentage of medical assistance and low-
30income hospital health clinic visits compared to the total

1number of medical assistance and low-income hospital health
2clinic visits for all hospitals in the sixth, seventh and
3eighth class counties.

4(4) Any hospital that has reached its disproportionate
5share limit under Title XIX of the Social Security Act shall
6receive its share of the State funds available under this
7act.

8SUBCHAPTER C

9MOBILE PRENATAL AND

10NATAL CARE DEMONSTRATION PROJECT

11Section 121. Establishment.

12There is established within the department a program to be
13known as the Mobile Prenatal and Natal Care Demonstration
14Project. The program shall provide prenatal, obstetric,
15postpartum and newborn care to individuals on a mobile basis.

16Section 122. Applications for planning grants.

17A hospital or health care provider may submit an application
18to the department requesting a grant for costs associated with
19establishing a mobile unit to provide prenatal, obstetric,
20postpartum and newborn care. The application shall be on the
21form required by the department and shall include all of the
22following:

23(1) The applicant's name and address.

24(2) The geographic region where the unit will operate.

25(3) A statement of the services to be provided.

26(4) An estimate of the cost of the mobile unit.

27(5) Proof of participation in the medical assistance
28program.

29(6) Any other information required by the department.

30Section 123. Review and approval of grant applications.

1(a) Review.--The department shall review the applications.
2Preference shall be given to applicants in communities where
3prenatal, obstetric, postpartum and newborn care is limited.
4Upon being satisfied that all requirements have been met, the
5department may approve four applications and award grants. The
6following grants shall be awarded:

7(1) One to an applicant which seeks to provide services
8in an urban setting.

9(2) One to an applicant which seeks to provide services
10in a suburban setting.

11(3) One to an applicant which seeks to provide services
12in a rural setting.

13(4) One to an underserved area which is most likely to
14benefit from a mobile clinic.

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

16Section 124. Report.

17By May 1, 2016, the department shall file a report with the
18chairman and minority chairman of the Public Health and Welfare
19Committee of the Senate, the chairman and minority chairman of
20the Health Committee of the House of Representatives and the
21chairman and minority chairman of the Human Services Committee
22of the House of Representatives. The report shall additionally
23be posted on the department's publicly accessible Internet
24website and shall include all of the following for each grant
25made in the prior calendar year:

26(1) The name of each grantee.

27(2) The amount of each grant awarded.

28(3) The use of each grant by each grantee.

29(4) A summary of how each grant expanded access and
30services and improved the delivery and quality of health care

1in the community, including a comparison of the rate of
2infant mortality and low birth weight in the community for
3the year immediately prior to the award of the grant with
4those rates in the community for the year of the grant.

5(5) The types of services and the amount spent on each
6type of service provided by each grantee.

7(6) Any recommendations for changes to the program.

8CHAPTER 51

9MISCELLANEOUS PROVISIONS

10Section 5101. Limitations.

11The payments made under the program shall not exceed the 
12amount of funds appropriated for the program, and the payments 
13made for the Mobile Prenatal and Natal Care Demonstration 
14Project shall not exceed the amount of funds appropriated for 
15the Mobile Prenatal and Natal Care Demonstration Project. A
16payment under this act shall not constitute an entitlement from
17the Commonwealth or a claim on any other funds of the
18Commonwealth.

19Section 5102. Effective date.

20This act shall take effect in 90 days.