PRINTER'S NO. 1296

THE GENERAL ASSEMBLY OF PENNSYLVANIA

HOUSE BILL

No.

1015

Session of

2015

INTRODUCED BY MURT, V. BROWN, COHEN, FLYNN, HARHAI, HARKINS,

McCARTER, ROZZI, SCHLOSSBERG AND WATSON, APRIL 20, 2015

REFERRED TO COMMITTEE ON HEALTH, APRIL 20, 2015

The General Assembly of the Commonwealth of Pennsylvania

hereby enacts as follows:

Section 1. Section 443.3(a) of the act of June 13, 1967

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

7, 2005 (P.L.177, No.42), is amended to read:

Section 443.3. Other Medical Assistance Payments.--(a)

Payments on behalf of eligible persons shall be made for other

services, as follows:

(1) Rates established by the department for outpatient

services as specified by regulations of the department adopted

patient to whom such hospital or outpatient clinic does not

furnish room, board and professional services on a continuous,

twenty-four hour a day basis.

(2) Rates established by the department for (i) other

laboratory and X-ray services prescribed by a physician,

chiropractor or podiatrist and furnished by a facility other

than a hospital which is qualified to participate under Title

XIX of the Social Security Act, (ii) physician's services

consisting of professional care by a physician, chiropractor or

podiatrist in his office, the patient's home, a hospital, a

nursing facility or elsewhere, (iii) the first three pints of

under this [Article] article, (v) special medical services for

school children, as provided in the [Public School Code of

1949,] act of March 10, 1949 (P.L.30, No.14), known as the

"Public School Code of 1949," consisting of medical, dental,

vision care provided by a physician skilled in diseases of the

eye or by an optometrist or surgical care and aids and services

which are not otherwise available under this article.

(3) Notwithstanding any other provision of law, for

recipients aged twenty-one years or older receiving services

under the fee for service delivery system who are eligible for

eligible for general assistance-related categories of medical

assistance, the following medically necessary services:

(i) Psychiatric outpatient clinic services not to exceed

five hours or ten one-half-hour sessions per thirty consecutive

day period.

(ii) Psychiatric partial hospitalization not to exceed five

hundred forty hours per fiscal year.

* * *

rehabilitation therapy as a covered service when deemed to be

medically necessary by a licensed physician.

(b) Cognitive rehabilitation therapy will be considered

medically necessary as adjunctive treatment of cognitive

deficits, including, but not limited to, attention, language,

memory, reasoning, executive functions, problem solving and

visual processing, when all of the following are met:

(1) The cognitive deficits have been acquired as a result of

neurologic impairment due to traumatic brain injury, stroke or

encephalopathy.

improvement, and includes not being in a vegetative or custodial

state.

(c) In order to implement reimbursement payments for these

services, the department shall file a State plan amendment with

the Centers for Medicare and Medicaid Services of the United

States Department of Health and Human Services pursuant to Title

XIX of the Social Security Act (49 Stat. 620, 42 U.S.C. § 1396

et seq.) by June 30, 2015. The program shall be structured and

administered by the department in accordance with Federal law

and applicable Federal guidelines for qualified State cognitive

system insult and that assist with the improvement of attention,

auditory and visual processing, concentration, decision making,

judgment, language, learning, memory, perception, planning,

problem solving, reasoning, sequencing, thinking and executive

functions, including compensatory training and direct patient

contact performed by a licensed physician or licensed

psychologist or a licensed physical, occupational or speech

therapist with the desired outcomes of an enhanced capacity to

process and interpret information and an improved ability to

function in home and community life.