Regular Session 2015-2016 House Bill 1322 P.N. 2628

SENATE AMENDED

PRIOR PRINTER'S NOS. 1768, 2453

PRINTER'S NO. 2628

THE GENERAL ASSEMBLY OF PENNSYLVANIA

HOUSE BILL

No.

1322

Session of

2015

INTRODUCED BY KAUFER, KNOWLES, ROZZI, McGINNIS, CUTLER, BAKER,

BLOOM, ENGLISH, MILLARD, KAUFFMAN, TOOHIL, DIAMOND, TOEPEL,

ACOSTA, PICKETT, MURT, HICKERNELL, WARD, GROVE, FEE, MILNE,

SAYLOR, HEFFLEY, A. HARRIS, KLUNK, D. COSTA, JOZWIAK, COX,

DAVIS, BOBACK, RADER, WARNER, SIMMONS, KRIEGER, PASHINSKI,

GABLER, GILLEN, SCHLEGEL CULVER, MULLERY, IRVIN, WHITE,

DeLUCA, BURNS, DUSH, ROAE AND MICCARELLI, JUNE 10, 2015

SENATOR VANCE, PUBLIC HEALTH AND WELFARE, IN SENATE, RE-REPORTED

AS AMENDED, DECEMBER 8, 2015

AN ACT

Amending the act of June 13, 1967 (P.L.31, No.21), entitled "An

act to consolidate, editorially revise, and codify the public

welfare laws of the Commonwealth," in public assistance,

further providing for identification and proof of residence.

AMENDING THE ACT OF JUNE 13, 1967 (P.L.31, NO.21), ENTITLED "AN

ACT TO CONSOLIDATE, EDITORIALLY REVISE, AND CODIFY THE PUBLIC

WELFARE LAWS OF THE COMMONWEALTH," AS FOLLOWS:

IN PUBLIC ASSISTANCE:

ESTABLISHING THE KEYSTONE EDUCATION YIELDS SUCCESS

PROGRAM; AND

FURTHER PROVIDING FOR COPAYMENTS FOR SUBSIDIZED CHILD

CARE, FOR IDENTIFICATION AND PROOF OF RESIDENCE, FOR

MEDICAL ASSISTANCE PAYMENTS FOR INSTITUTIONAL CARE, FOR

OTHER MEDICAL ASSISTANCE PAYMENTS, FOR MILEAGE

REIMBURSEMENT AND PARATRANSIT SERVICES FOR INDIVIDUALS

RECEIVING METHADONE TREATMENT.

IN CHILDREN AND YOUTH:

FURTHER PROVIDING FOR PAYMENTS TO COUNTIES FOR

SERVICES TO CHILDREN, FOR PROVIDER SUBMISSION AND FOR

LIMITS ON REIMBURSEMENT TO COUNTIES.

REPEALING PROVISIONS RELATING TO MEDICAID MANAGED CARE

ORGANIZATION ASSESSMENTS.

IN STATEWIDE QUALITY CARE ASSESSMENT:

FURTHER PROVIDING FOR DEFINITIONS, FOR

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IMPLEMENTATION, FOR ADMINISTRATION, FOR RESTRICTED

ACCOUNT AND FOR EXPIRATION.

PROVIDING FOR MANAGED CARE ORGANIZATION ASSESSMENTS.

IN DEPARTMENTAL POWERS AND DUTIES AS TO SUPERVISION:

FURTHER PROVIDING FOR DEFINITIONS.

IN DEPARTMENTAL POWERS AND DUTIES AS TO LICENSING:

FURTHER PROVIDING FOR DEFINITIONS, FOR FEES, FOR

PROVISIONAL LICENSE AND FOR VIOLATION AND PENALTY; AND

REPEALING PROVISIONS RELATING TO REGISTRATION.

IN FAMILY FINDING AND KINSHIP CARE:

FURTHER PROVIDING FOR DEFINITIONS, FOR THE KINSHIP

CARE PROGRAM AND FOR PERMANENT LEGAL CUSTODIANSHIP

SUBSIDY AND REIMBURSEMENT.

MAKING A RELATED REPEAL.

PROVIDING FOR THE LICENSING OF FAMILY CHILD-CARE HOMES.

The General Assembly of the Commonwealth of Pennsylvania

hereby enacts as follows:

Section 1. Section 432.4 of the act of June 13, 1967

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

16, 1994 (P.L.319, No.49) and May 16, 1996 (P.L.175, No.35), is

amended to read:

SECTION 1. SECTION 101 OF THE ACT OF JUNE 13, 1967 (P.L.31,

NO.21), KNOWN AS THE PUBLIC WELFARE CODE, IS AMENDED TO READ:

SECTION 101. SHORT TITLE.--THIS ACT SHALL BE KNOWN AND MAY

BE CITED AS THE ["PUBLIC WELFARE CODE."] "HUMAN SERVICES CODE."

SECTION 2. THE ACT IS AMENDED BY ADDING A SECTION TO READ:

SECTION 405.1B. ESTABLISHMENT OF KEYSTONE EDUCATION YIELDS

SUCCESS.--(A) THERE IS ESTABLISHED IN THE DEPARTMENT A PROGRAM

WHICH SHALL BE KNOWN AS KEYSTONE EDUCATION YIELDS SUCCESS

(KEYS). THE KEYS PROGRAM SHALL BE DESIGNED TO ENABLE AND TO

ASSIST ELIGIBLE INDIVIDUALS RECEIVING TANF OR SNAP BENEFITS TO

ENROLL IN AND PURSUE A CERTIFICATE OR DEGREE PROGRAM WITHIN ONE

OF THE COMMONWEALTH'S COMMUNITY COLLEGES, A CAREER OR TECHNICAL

SCHOOL REGISTERED WITH THE DEPARTMENT OF EDUCATION OR UNIVERSITY

WITHIN THE PENNSYLVANIA STATE SYSTEM OF HIGHER EDUCATION.

(B) A KEYS RECIPIENT SHALL BE PERMITTED TO COUNT VOCATIONAL

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EDUCATION, INCLUDING CLASS TIME, CLINICALS, LABS AND STUDY TIME

AS SET BY THE COMMUNITY COLLEGE, UNIVERSITY OR SCHOOL, TOWARD

THE RECIPIENT'S CORE TANF WORK REQUIREMENT FOR TWENTY-FOUR

MONTHS.

405.1, THE FOLLOWING REQUIREMENTS SHALL APPLY:

(1) A RECIPIENT SHALL BE ENROLLED IN AN APPROVED DEGREE OR

CERTIFICATE PROGRAM THAT WILL ASSIST THE RECIPIENT IN SECURING A

JOB THAT PAYS A FAMILY-SUSTAINING WAGE.

(2) A KEYS RECIPIENT MAY BE GRANTED EXTENSIONS FOR SIX-MONTH

PERIODS TO COMPLETE THE CERTIFICATE OR DEGREE PROGRAM, IF:

(I) THE RECIPIENT IS ENROLLED IN A PROGRAM THAT WILL LEAD TO

A HIGH-PRIORITY OCCUPATION, AS DEFINED IN SECTION 1301 OF THE

ACT OF DECEMBER 18, 2001 (P.L.949, NO.114), KNOWN AS THE

WORKFORCE DEVELOPMENT ACT, OR A PROGRAM THE COMMUNITY COLLEGE

HAS CERTIFIED MEETS THE SAME CRITERIA AS A HIGH-PRIORITY

OCCUPATION;

(II) THE RECIPIENT HAS MAINTAINED A 2.0 GRADE POINT AVERAGE;

AND

(III) THE RECIPIENT HAS MADE SATISFACTORY PROGRESS TOWARD

COMPLETING THE PROGRAM, INCLUDING, BUT NOT LIMITED TO,

COMPLETING ALL REQUIRED DEVELOPMENTAL COURSE WORK AND

SUCCESSFULLY COMPLETING AN AVERAGE OF EIGHT CREDITS PER

SEMESTER.

(D) A PERSON WHO, WITHOUT GOOD CAUSE, FAILS OR REFUSES TO

COMPLY WITH THE TERMS AND CONDITIONS OF THE KEYS PROGRAM SHALL

BE TERMINATED FROM THE PROGRAM.

(E) THE DEPARTMENT IS AUTHORIZED TO PROMULGATE REGULATIONS

TO IMPLEMENT THIS SECTION.

(F) THE DEPARTMENT SHALL IMPLEMENT THIS SECTION IN

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CONFORMITY WITH FEDERAL LAW.

(G) NOTHING IN THIS SECTION SHALL CREATE OR PROVIDE AN

INDIVIDUAL WITH AN ENTITLEMENT TO SERVICES OR BENEFITS. SERVICES

UNDER THIS SECTION SHALL ONLY BE AVAILABLE TO INDIVIDUALS

ENROLLED IN THE KEYS PROGRAM TO THE EXTENT THAT FUNDS ARE

AVAILABLE.

SECTION 3. SECTION 408.3 OF THE ACT, ADDED JUNE 30, 2011

(P.L.89, NO.22), IS AMENDED TO READ:

SECTION 408.3. COPAYMENTS FOR SUBSIDIZED CHILD CARE.--(A)

NOTWITHSTANDING ANY OTHER PROVISION OF LAW OR DEPARTMENTAL

REGULATION, THE PARENT OR CARETAKER OF A CHILD ENROLLED IN

SUBSIDIZED CHILD CARE SHALL PAY A COPAYMENT FOR THE SUBSIDIZED

CHILD CARE BASED ON A PERCENTAGE OF THE FAMILY'S ANNUAL INCOME

AS SPECIFIED IN A COPAYMENT SCHEDULE ESTABLISHED BY THE

DEPARTMENT PURSUANT TO THIS SECTION.

(B) THE DEPARTMENT SHALL PUBLISH A NOTICE SETTING FORTH THE

COPAYMENT SCHEDULE IN THE PENNSYLVANIA BULLETIN.

SECTION, ALL OF THE FOLLOWING SHALL APPLY:

(1) COPAYMENTS SHALL BE [BASED UPON] ON A SLIDING [INCOME]

SCALE BASED ON A PERCENTAGE OF THE FAMILY'S ANNUAL INCOME TAKING

INTO ACCOUNT FEDERAL POVERTY INCOME GUIDELINES. COPAYMENTS SHALL

BE UPDATED ANNUALLY.

(2) AT THE DEPARTMENT'S DISCRETION, COPAYMENTS MAY BE

IMPOSED:

(I) FOR EACH CHILD ENROLLED IN SUBSIDIZED CHILD CARE;

(II) BASED UPON FAMILY SIZE; OR

(III) IN ACCORDANCE WITH BOTH SUBPARAGRAPHS (I) AND (II).

(3) COPAYMENT AMOUNTS SHALL BE A MINIMUM OF FIVE DOLLARS

($5) PER WEEK AND [MAY] SHALL INCREASE IN INCREMENTAL AMOUNTS,

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BASED ON A PERCENTAGE OF THE FAMILY'S ANNUAL INCOME, AS

DETERMINED BY THE DEPARTMENT [TAKING INTO ACCOUNT ANNUAL FAMILY

INCOME].

(3.1) AT INITIAL APPLICATION, THE FAMILY'S ANNUAL INCOME MAY

NOT EXCEED TWO HUNDRED PERCENT OF THE FEDERAL POVERTY INCOME

GUIDELINES.

(3.2) AFTER AN INITIAL DETERMINATION OR REDETERMINATION OF

ELIGIBILITY, A CHILD SHALL CONTINUE TO BE ENROLLED IN SUBSIDIZED

CHILD CARE FOR TWELVE MONTHS REGARDLESS OF EITHER OF THE

FOLLOWING:

(I) A TEMPORARY CHANGE IN THE PARENT OR CARETAKER'S STATUS

AS WORKING OR ATTENDING A JOB TRAINING OR EDUCATIONAL PROGRAM.

(II) AN INCREASE IN THE FAMILY'S ANNUAL INCOME, IF THE

INCOME DOES NOT EXCEED EIGHTY-FIVE PERCENT OF THE STATE MEDIAN

INCOME FOR A FAMILY OF THE SAME SIZE.

(4) [A] SUBJECT TO SUBSECTION (E), A FAMILY'S ANNUAL

COPAYMENT UNDER EITHER PARAGRAPH (1) OR (2) SHALL NOT EXCEED:

(I) EIGHT PERCENT OF THE FAMILY'S ANNUAL INCOME IF THE

FAMILY'S ANNUAL INCOME IS ONE HUNDRED PERCENT OF THE FEDERAL

POVERTY INCOME GUIDELINE OR LESS; [OR]

(II) ELEVEN PERCENT OF THE FAMILY'S ANNUAL INCOME IF THE

FAMILY'S ANNUAL INCOME EXCEEDS ONE HUNDRED PERCENT OF THE

FEDERAL POVERTY INCOME GUIDELINE[.], BUT IS NOT MORE THAN TWO

HUNDRED FIFTY PERCENT OF THE FEDERAL POVERTY INCOME GUIDELINE;

(III) THIRTEEN PERCENT OF THE FAMILY'S ANNUAL INCOME IF THE

FAMILY'S ANNUAL INCOME EXCEEDS TWO HUNDRED FIFTY PERCENT OF THE

FEDERAL POVERTY INCOME GUIDELINE, BUT IS NOT MORE THAN TWO

HUNDRED SEVENTY-FIVE PERCENT OF THE FEDERAL POVERTY INCOME

GUIDELINE; OR

(IV) BEGINNING AFTER JULY 1, 2017, FIFTEEN PERCENT OF THE

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FAMILY'S ANNUAL INCOME IF THE FAMILY'S ANNUAL INCOME EXCEEDS TWO

HUNDRED SEVENTY-FIVE PERCENT OF THE FEDERAL POVERTY INCOME

GUIDELINE, BUT IS NOT MORE THAN THREE HUNDRED PERCENT OF THE

FEDERAL POVERTY INCOME GUIDELINE OR EIGHTY-FIVE PERCENT OF THE

STATE MEDIAN INCOME, WHICHEVER IS LOWER.

(5) NOTWITHSTANDING THIS SUBSECTION, BEGINNING WITH STATE

FISCAL YEAR 2012-2013, THE DEPARTMENT MAY ADJUST THE ANNUAL

COPAYMENT PERCENTAGES SPECIFIED IN THIS SUBSECTION BY

PROMULGATION OF FINAL-OMITTED REGULATIONS UNDER SECTION 204 OF

THE ACT OF JULY 31, 1968 (P.L.769, NO.240), REFERRED TO AS THE

"COMMONWEALTH DOCUMENTS LAW."

(6) SUBJECT TO SUBSECTION (E), AT A REDETERMINATION, AFTER

JUNE 30, 2017, A FAMILY THAT EXCEEDS THE MINIMUM WORK

REQUIREMENTS AS A RESULT OF EACH PARENT OR CARETAKER OR, IN THE

CASE OF A SINGLE PARENT HOUSEHOLD, AS A RESULT OF THE SOLE

PARENT OR CARETAKER, BY WORKING ADDITIONAL WAGE-EARNING HOURS

SHALL HAVE A REDUCED COPAYMENT, NOT TO BE LESS THAN THAT WHICH

IS SET FORTH UNDER PARAGRAPH (3). THIS PARAGRAPH SHALL APPLY

ONLY TO A FAMILY THAT, AFTER MUTUALLY QUALIFYING FOR AND

RECEIVING SUBSIDIZED CHILD CARE AND BEING CURRENT ON THE

REQUIRED COPAYMENTS AS SET FORTH IN THIS SUBSECTION, INCREASES

ITS AVERAGE WORK WEEK AFTER THE EFFECTIVE DATE OF THIS PARAGRAPH

AND HAS INCREASED THE FAMILY'S ANNUAL INCOME AS A RESULT OF

WORKING ADDITIONAL WAGE-EARNING HOURS. THE COPAYMENT DEDUCTION

SHALL BE APPLIED AS FOLLOWS:

(I) FOR AN AVERAGE WORK WEEK OF AT LEAST TWENTY-FIVE WAGE-

EARNING HOURS PER PARENT OR CARETAKER, A THREE-QUARTERS OF ONE

PERCENT DEDUCTION FROM THE AMOUNT SET UNDER THIS SUBSECTION.

(II) FOR AN AVERAGE WORK WEEK OF AT LEAST THIRTY WAGE-

EARNING HOURS PER PARENT OR CARETAKER, A ONE AND ONE-HALF

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PERCENT DEDUCTION FROM THE AMOUNT SET UNDER THIS SUBSECTION.

(III) FOR AN AVERAGE WORK WEEK OF AT LEAST THIRTY-FIVE WAGE-

EARNING HOURS PER PARENT OR CARETAKER, A TWO AND ONE-QUARTER

PERCENT DEDUCTION FROM THE AMOUNT SET UNDER THIS SUBSECTION.

(IV) FOR AN AVERAGE WORK WEEK OF AT LEAST FORTY WAGE-EARNING

HOURS PER PARENT OR CARETAKER, A THREE PERCENT DEDUCTION FROM

THE AMOUNT SET UNDER THIS SUBSECTION.

(7) AT ITS REDETERMINATION OF ELIGIBILITY, A PARENT OR

CARETAKER SHALL PROVIDE DOCUMENTATION OF ITS AVERAGE WORK WEEK

HOURS TO RECEIVE THE CHILD CARE COPAYMENT DEDUCTION. THE

DEPARTMENT SHALL APPLY THE COPAYMENT DEDUCTION AFTER RECEIVING

THE REQUIRED DOCUMENTATION.

(8) A FAMILY THAT HAS PREVIOUSLY QUALIFIED FOR A DEDUCTION

IN THE CHILD CARE COPAYMENT SHALL CONTINUE TO REMAIN ELIGIBLE

FOR THE COPAYMENT DEDUCTION IF:

(I) THE FAMILY'S ANNUAL INCOME DOES NOT EXCEED THREE HUNDRED

PERCENT OF THE FEDERAL POVERTY INCOME GUIDELINE OR EIGHTY-FIVE

PERCENT OF THE STATE MEDIAN INCOME, WHICHEVER IS LOWER;

(II) THE PARENT OR CARETAKER HAS BEEN IN COMPLIANCE WITH

PARAGRAPH (7);

(III) THE PARENT OR CARETAKER CONTINUES TO EXCEED THE

MINIMUM WORK REQUIREMENTS BY WORKING ADDITIONAL WAGE-EARNING

HOURS;

(IV) THE FAMILY'S ANNUAL INCOME HAS INCREASED AS A RESULT OF

WORKING ADDITIONAL WAGE-EARNING HOURS; AND

(V) THE PARENT OR CARETAKER IS CURRENT AND REMAINS CURRENT

WITH MAKING ITS COPAYMENT TO THE CHILD CARE PROVIDER.

(9) THE AVERAGE WORK WEEK OF A FAMILY SHALL BE CALCULATED BY

REVIEWING THE FAMILY'S INCOME STATEMENTS AND TAKING THE NUMBER

OF HOURS WORKED PER PARENT OVER A TWELVE-MONTH PERIOD AND

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DIVIDING BY FIFTY-TWO.

(D) NOTWITHSTANDING SUBSECTION (A) OR (C), A PARENT OR

CARETAKER COPAYMENT MAY BE [WAIVED] ADJUSTED IN ACCORDANCE WITH

DEPARTMENT REGULATIONS.

(E) TO THE EXTENT THAT MONEY IS APPROPRIATED FOR THE

PURPOSE, THE DEPARTMENT SHALL INCREASE ELIGIBILITY UNDER

SUBSECTION (C)(4) FOR SUBSIDIZED CHILD CARE FROM TWO HUNDRED

THIRTY-FIVE PERCENT OF THE FEDERAL POVERTY INCOME GUIDELINE UP

TO THREE HUNDRED PERCENT OF THE FEDERAL POVERTY INCOME GUIDELINE

AND SHALL APPLY A COPAYMENT DEDUCTION UNDER SUBSECTION (C)(6).

THE DEPARTMENT SHALL NOT BE REQUIRED TO MAINTAIN ELIGIBILITY

ABOVE TWO HUNDRED THIRTY-FIVE PERCENT OF THE FEDERAL POVERTY

INCOME GUIDELINE OR APPLY A COPAYMENT DEDUCTION UNLESS FUNDING

IS APPROPRIATED BY THE GENERAL ASSEMBLY.

(F) AS USED IN THIS SECTION, "WAGE-EARNING HOURS" MEANS

HOURS FOR WHICH AN INDIVIDUAL IS FINANCIALLY COMPENSATED BY AN

EMPLOYER. THE TERM DOES NOT INCLUDE HOURS SPENT VOLUNTEERING, IN

EDUCATION OR IN JOB TRAINING, UNLESS THOSE HOURS ARE COMPENSATED

AS A CONDITION OF EMPLOYMENT.

SECTION 4. SECTION 432.4 OF THE ACT, AMENDED JUNE 16, 1994

(P.L.319, NO.49) AND MAY 16, 1996 (P.L.175, NO.35), IS AMENDED

TO READ:

Section 432.4. Identification and Proof of Residence.--(a)

All persons applying for assistance shall provide acceptable

identification and proof of residence[; the department shall by

regulations specify what constitutes acceptable identification

and proof of residence]. A person shall be deemed to be a

resident when he or she documents his or her residency and that

residency is verified by the department. Verification may

include, but is not limited to the production of rent receipts,

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mortgage payment receipts, utility receipts, bank accounts or

enrollment of children in local schools. General assistance

applicants must establish that they have been residents of the

Commonwealth for at least twelve months immediately preceding

their application[.] and they are not receiving assistance from

any other state. General assistance applicants shall disclose,

in their application, all states in which they have resided and

in which they have collected a form of public assistance in the

last five years. The provisions of this subsection shall not

apply to General Assistance applicants who can establish that

they moved to this Commonwealth to escape an abusive living

situation. The department shall adopt rules governing the proof

required to establish that the applicant has moved to this

Commonwealth to escape an abusive living situation.

(a.1) When a general assistance applicant provides

information that the applicant has collected IS RECEIVING a form

of public assistance in another state, the Commonwealth shall

notify DEPARTMENT MAY NOT AUTHORIZE GENERAL ASSISTANCE UNTIL IT

RECEIVES VERIFICATION THAT THE PUBLIC ASSISTANCE IS SCHEDULED TO

CLOSE IN the other state of the change in residency of the

applicant .

(b) For the purpose of determining eligibility for

assistance, the continued absence of a recipient from the

Commonwealth for a period of thirty days or longer shall be

prima facie evidence of the intent of the recipient to have

changed his residence to a place outside the Commonwealth.

cause from returning to the Commonwealth at the end of thirty

days, and has not acted to establish residence elsewhere, he

shall not be deemed to have lost his residence in the

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Commonwealth.

(d) When a recipient of aid to families with dependent

children or general assistance is absent from the United States

for a period in excess of thirty days, his aid shall thereafter

be suspended whenever need cannot be determined for the ensuing

period of his absence.

(e) Beginning no later than September 1, 1994, the

department shall collect information on all general assistance

applicants to determine how long they have been residents of

this Commonwealth. The department shall report its findings to

the Governor and the General Assembly no later than December 31,

1995. Based on its findings, the department may make

recommendations to the Governor and the General Assembly on

changes to the residency requirement for general assistance

recipients.

Section 2. This act shall take effect in 60 days.

SECTION 5. SECTION 443.1(1.1) INTRODUCTORY PARAGRAPH AND

(I), (1.4) AND (6) OF THE ACT, AMENDED JUNE 30, 2007 (P.L.49,

NO.16) AND JULY 9, 2013 (P.L.369, NO.55), ARE AMENDED AND

PARAGRAPH (7) IS AMENDED BY ADDING A SUBPARAGRAPH TO READ:

SECTION 443.1. MEDICAL ASSISTANCE PAYMENTS FOR INSTITUTIONAL

CARE.--THE FOLLOWING MEDICAL ASSISTANCE PAYMENTS SHALL BE MADE

ON BEHALF OF ELIGIBLE PERSONS WHOSE INSTITUTIONAL CARE IS

PRESCRIBED BY PHYSICIANS:

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(1.1) SUBJECT TO SECTION 813-G, FOR INPATIENT [ACUTE CARE]

HOSPITAL SERVICES PROVIDED DURING A FISCAL YEAR IN WHICH AN

ASSESSMENT IS IMPOSED UNDER ARTICLE VIII-G, PAYMENTS UNDER THE

MEDICAL ASSISTANCE FEE-FOR-SERVICE PROGRAM SHALL BE DETERMINED

IN ACCORDANCE WITH THE DEPARTMENT'S REGULATIONS, EXCEPT AS

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FOLLOWS:

(I) IF THE COMMONWEALTH'S APPROVED TITLE XIX STATE PLAN FOR

INPATIENT HOSPITAL SERVICES IN EFFECT FOR THE PERIOD OF JULY 1,

2010, THROUGH JUNE 30, [2016] 2018, SPECIFIES A METHODOLOGY FOR

CALCULATING PAYMENTS THAT IS DIFFERENT FROM THE DEPARTMENT'S

REGULATIONS OR AUTHORIZES ADDITIONAL PAYMENTS NOT SPECIFIED IN

THE DEPARTMENT'S REGULATIONS, SUCH AS INPATIENT DISPROPORTIONATE

SHARE PAYMENTS AND DIRECT MEDICAL EDUCATION PAYMENTS, THE

DEPARTMENT SHALL FOLLOW THE METHODOLOGY OR MAKE THE ADDITIONAL

PAYMENTS AS SPECIFIED IN THE APPROVED TITLE XIX STATE PLAN.

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(1.4) SUBJECT TO SECTION 813-G, FOR INPATIENT HOSPITAL

SERVICES PROVIDED UNDER THE PHYSICAL HEALTH MEDICAL ASSISTANCE

MANAGED CARE PROGRAM DURING STATE FISCAL YEARS 2012-2013, 2013-

2014, 2014-2015 [AND], 2015-2016, 2016-2017 AND 2017-2018, THE

FOLLOWING SHALL APPLY:

(A) THE DEPARTMENT MAY ADJUST ITS CAPITATION PAYMENTS TO

MEDICAL ASSISTANCE MANAGED CARE ORGANIZATIONS TO PROVIDE

ADDITIONAL FUNDS FOR INPATIENT AND OUTPATIENT HOSPITAL SERVICES.

(B) FOR AN OUT-OF-NETWORK INPATIENT DISCHARGE OF A RECIPIENT

ENROLLED IN A MEDICAL ASSISTANCE MANAGED CARE ORGANIZATION THAT

OCCURS IN STATE FISCAL YEAR 2012-2013, 2013-2014, 2014-2015

[OR], 2015-2016, 2016-2017 AND 2017-2018, THE MEDICAL ASSISTANCE

MANAGED CARE ORGANIZATION SHALL PAY, AND THE HOSPITAL SHALL

ACCEPT AS PAYMENT IN FULL, THE AMOUNT THAT THE DEPARTMENT'S FEE-

FOR-SERVICE PROGRAM WOULD HAVE PAID FOR THE DISCHARGE IF THE

RECIPIENT WAS ENROLLED IN THE DEPARTMENT'S FEE-FOR-SERVICE

PROGRAM.

ACUTE CARE HOSPITAL AND A MEDICAL ASSISTANCE MANAGED CARE

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ORGANIZATION FROM EXECUTING A NEW PARTICIPATION AGREEMENT OR

AMENDING AN EXISTING PARTICIPATION AGREEMENT ON OR AFTER JULY 1,

2013.

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(6) FOR PUBLIC NURSING HOME CARE PROVIDED ON OR AFTER JULY

1, 2005, THE DEPARTMENT [SHALL] MAY RECOGNIZE THE COSTS INCURRED

BY COUNTY NURSING FACILITIES TO PROVIDE SERVICES TO ELIGIBLE

PERSONS AS MEDICAL ASSISTANCE PROGRAM EXPENDITURES TO THE EXTENT

THE COSTS QUALIFY FOR FEDERAL MATCHING FUNDS AND SO LONG AS THE

COSTS ARE ALLOWABLE AS DETERMINED BY THE DEPARTMENT AND REPORTED

AND CERTIFIED BY THE COUNTY NURSING FACILITIES IN A FORM AND

MANNER SPECIFIED BY THE DEPARTMENT. EXPENDITURES REPORTED AND

CERTIFIED BY COUNTY NURSING FACILITIES SHALL BE SUBJECT TO

PERIODIC REVIEW AND VERIFICATION BY THE DEPARTMENT OR THE

AUDITOR GENERAL. NOTWITHSTANDING THIS PARAGRAPH, COUNTY NURSING

FACILITIES SHALL BE PAID BASED UPON RATES DETERMINED IN

ACCORDANCE WITH PARAGRAPHS (5) AND (7).

(7) AFTER JUNE 30, 2007, PAYMENTS TO COUNTY AND NONPUBLIC

NURSING FACILITIES ENROLLED IN THE MEDICAL ASSISTANCE PROGRAM AS

PROVIDERS OF NURSING FACILITY SERVICES SHALL BE DETERMINED IN

ACCORDANCE WITH THE METHODOLOGIES FOR ESTABLISHING PAYMENT RATES

FOR COUNTY AND NONPUBLIC NURSING FACILITIES SPECIFIED IN THE

DEPARTMENT'S REGULATIONS AND THE COMMONWEALTH'S APPROVED TITLE

XIX STATE PLAN FOR NURSING FACILITY SERVICES IN EFFECT AFTER

JUNE 30, 2007. THE FOLLOWING SHALL APPLY:

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(VI) SUBJECT TO FEDERAL APPROVAL OF SUCH AMENDMENTS AS MAY

BE NECESSARY TO THE COMMONWEALTH'S APPROVED TITLE XIX STATE

PLAN, FOR FISCAL YEAR 2015-2016, THE DEPARTMENT SHALL MAKE UP TO

FOUR MEDICAL ASSISTANCE DAY-ONE INCENTIVE PAYMENTS TO QUALIFIED

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NONPUBLIC NURSING FACILITIES. THE DEPARTMENT SHALL DETERMINE THE

NONPUBLIC NURSING FACILITIES THAT QUALIFY FOR THE MEDICAL

ASSISTANCE DAY-ONE INCENTIVE PAYMENTS AND CALCULATE THE PAYMENTS

USING THE TOTAL PENNSYLVANIA MEDICAL ASSISTANCE (PA MA) DAYS AND

TOTAL RESIDENT DAYS AS REPORTED BY NONPUBLIC NURSING FACILITIES

UNDER ARTICLE VIII-A. THE DEPARTMENT'S DETERMINATION AND

CALCULATIONS UNDER THIS SUBPARAGRAPH SHALL BE BASED ON THE

NURSING FACILITY ASSESSMENT QUARTERLY RESIDENT DAY REPORTING

FORMS, AS DETERMINED BY THE DEPARTMENT. THE DEPARTMENT SHALL NOT

RETROACTIVELY REVISE A MEDICAL ASSISTANCE DAY-ONE INCENTIVE

PAYMENT AMOUNT BASED ON A NURSING FACILITY'S LATE SUBMISSION OR

REVISION OF THE DEPARTMENT'S REPORT AFTER THE DATES DESIGNATED

BY THE DEPARTMENT. THE DEPARTMENT, HOWEVER, MAY RECOUP PAYMENTS

BASED ON AN AUDIT OF A NURSING FACILITY'S REPORT. THE FOLLOWING

SHALL APPLY:

(A) A NONPUBLIC NURSING FACILITY SHALL MEET ALL OF THE

FOLLOWING CRITERIA TO QUALIFY FOR A MEDICAL ASSISTANCE DAY-ONE

INCENTIVE PAYMENT:

(I) THE NURSING FACILITY SHALL HAVE AN OVERALL OCCUPANCY

RATE OF AT LEAST EIGHTY-FIVE PERCENT DURING THE RESIDENT DAY

QUARTER. FOR PURPOSES OF DETERMINING A NURSING FACILITY'S

OVERALL OCCUPANCY RATE, A NURSING FACILITY'S TOTAL RESIDENT

DAYS, AS REPORTED BY THE FACILITY UNDER ARTICLE VIII-A, SHALL BE

DIVIDED BY THE PRODUCT OF THE FACILITY'S LICENSED BED CAPACITY,

AT THE END OF THE QUARTER, MULTIPLIED BY THE NUMBER OF CALENDAR

DAYS IN THE QUARTER.

(II) THE NURSING FACILITY SHALL HAVE A MEDICAL ASSISTANCE

OCCUPANCY RATE OF AT LEAST SIXTY-FIVE PERCENT DURING THE

RESIDENT DAY QUARTER. FOR PURPOSES OF DETERMINING A NURSING

FACILITY'S MEDICAL ASSISTANCE OCCUPANCY RATE, THE NURSING

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FACILITY'S TOTAL PA MA DAYS SHALL BE DIVIDED BY THE NURSING

FACILITY'S TOTAL RESIDENT DAYS, AS REPORTED BY THE FACILITY

UNDER ARTICLE VIII-A.

(III) THE NURSING FACILITY SHALL BE A NONPUBLIC NURSING

FACILITY FOR A FULL RESIDENT DAY QUARTER PRIOR TO THE APPLICABLE

QUARTERLY REPORTING DUE DATES, AS DETERMINED BY THE DEPARTMENT.

(B) THE DEPARTMENT SHALL CALCULATE A QUALIFIED NONPUBLIC

NURSING FACILITY'S MEDICAL ASSISTANCE DAY-ONE INCENTIVE PAYMENT

AS FOLLOWS:

(I) THE TOTAL FUNDS APPROPRIATED FOR PAYMENTS UNDER THIS

SUBPARAGRAPH SHALL BE DIVIDED BY THE NUMBER OF PAYMENTS, AS

DETERMINED BY THE DEPARTMENT.

(II) TO ESTABLISH THE PER DIEM RATE FOR A PAYMENT, THE

AMOUNT UNDER SUBCLAUSE (I) SHALL BE DIVIDED BY THE TOTAL PA MA

DAYS, AS REPORTED BY ALL QUALIFYING NONPUBLIC NURSING FACILITIES

UNDER ARTICLE VIII-A FOR THAT PAYMENT.

(III) TO DETERMINE A QUALIFYING NONPUBLIC NURSING FACILITY'S

MEDICAL ASSISTANCE DAY-ONE INCENTIVE PAYMENT, THE PER DIEM RATE

CALCULATED FOR THE PAYMENT SHALL BE MULTIPLIED BY A NONPUBLIC

NURSING FACILITY'S TOTAL PA MA DAYS, AS REPORTED BY THE FACILITY

UNDER ARTICLE VIII-A FOR THE PAYMENT.

THE NONPUBLIC NURSING FACILITY MEDICAL ASSISTANCE DAY-ONE

INCENTIVE PAYMENTS SHALL EQUAL EIGHT MILLION DOLLARS

($8,000,000).

SECTION 6. SECTION 443.3(A) OF THE ACT IS AMENDED BY A

PARAGRAPH TO READ:

SECTION 443.3. OTHER MEDICAL ASSISTANCE PAYMENTS.--(A)

PAYMENTS ON BEHALF OF ELIGIBLE PERSONS SHALL BE MADE FOR OTHER

SERVICES, AS FOLLOWS:

20150HB1322PN2628 - 14 -

* * *

(1.1) RATES ESTABLISHED BY THE DEPARTMENT FOR OBSERVATION

SERVICES PROVIDED BY OR FURNISHED UNDER THE DIRECTION OF A

PHYSICIAN AND FURNISHED BY A HOSPITAL. PAYMENT FOR OBSERVATION

SERVICES SHALL BE MADE IN AN AMOUNT SPECIFIED BY THE DEPARTMENT

BY NOTICE IN THE PENNSYLVANIA BULLETIN AND SHALL BE EFFECTIVE

FOR DATES OF SERVICE ON OR AFTER JULY 1, 2016. PAYMENT FOR

OBSERVATION SERVICES SHALL BE SUBJECT TO CONDITIONS SPECIFIED IN

THE DEPARTMENT'S REGULATIONS, INCLUDING REGULATIONS ADOPTED BY

THE DEPARTMENT TO IMPLEMENT THIS PARAGRAPH. PENDING ADOPTION OF

REGULATIONS IMPLEMENTING THIS PARAGRAPH, THE CONDITIONS FOR

PAYMENT OF OBSERVATION SERVICES SHALL BE SPECIFIED IN A MEDICAL

ASSISTANCE BULLETIN.

* * *

SECTION 7. SECTION 443.11(D) OF THE ACT, ADDED DECEMBER 22,

2011 (P.L.561, NO.121), IS AMENDED TO READ:

SECTION 443.11. MILEAGE REIMBURSEMENT AND PARATRANSIT

SERVICES FOR INDIVIDUALS RECEIVING METHADONE TREATMENT.--* * *

[(D) THE DEPARTMENT SHALL ISSUE BIENNIAL REPORTS TO THE

GENERAL ASSEMBLY AND THE GOVERNOR DETAILING COSTS AND COST

SAVINGS RELATED TO IMPLEMENTING THE PROVISIONS OF THIS SECTION.

THE FIRST BIENNIAL REPORT SHALL BE ISSUED NOT LATER THAN ONE

YEAR FROM THE EFFECTIVE DATE OF THIS SECTION.]

SECTION 8. SECTION 472 OF THE ACT, AMENDED JULY 7, 2005

(P.L.177, NO.42), IS AMENDED TO READ:

SECTION 472. OTHER COMPUTATIONS AFFECTING COUNTIES.--TO

COMPUTE FOR EACH MONTH THE AMOUNT EXPENDED AS MEDICAL ASSISTANCE

FOR PUBLIC NURSING HOME CARE ON BEHALF OF PERSONS AT EACH PUBLIC

MEDICAL INSTITUTION OPERATED BY A COUNTY, COUNTY INSTITUTION

DISTRICT OR MUNICIPALITY AND THE AMOUNT EXPENDED IN EACH COUNTY

20150HB1322PN2628 - 15 -

FOR AID TO FAMILIES WITH DEPENDENT CHILDREN ON BEHALF OF

CHILDREN IN FOSTER FAMILY HOMES OR CHILD-CARING INSTITUTIONS,

PLUS THE COST OF ADMINISTERING SUCH ASSISTANCE. FROM SUCH TOTAL

AMOUNT THE DEPARTMENT SHALL DEDUCT THE AMOUNT OF FEDERAL FUNDS

PROPERLY RECEIVED OR TO BE RECEIVED BY THE DEPARTMENT ON ACCOUNT

OF SUCH EXPENDITURES, AND SHALL CERTIFY THE REMAINDER INCREASED

OR DECREASED, AS THE CASE MAY BE, BY ANY AMOUNT BY WHICH THE SUM

CERTIFIED FOR ANY PREVIOUS MONTH DIFFERED FROM THE AMOUNT WHICH

SHOULD HAVE BEEN CERTIFIED FOR SUCH PREVIOUS MONTH, AND BY THE

PROPORTIONATE SHARE OF ANY REFUNDS OF SUCH ASSISTANCE, TO EACH

APPROPRIATE COUNTY, COUNTY INSTITUTION DISTRICT OR MUNICIPALITY.

THE AMOUNTS SO CERTIFIED SHALL BECOME OBLIGATIONS OF SUCH

COUNTIES, COUNTY INSTITUTION DISTRICTS OR MUNICIPALITIES TO BE

PAID TO THE DEPARTMENT FOR ASSISTANCE: PROVIDED, HOWEVER, THAT

FOR FISCAL YEAR 1979-80 AND THEREAFTER, THE OBLIGATIONS OF THE

COUNTIES SHALL BE THE AMOUNTS SO CERTIFIED REPRESENTING AID TO

DEPENDENT CHILDREN FOSTER CARE AS COMPUTED ABOVE PLUS ONE-TENTH

OF THE AMOUNT SO CERTIFIED ABOVE FOR PUBLIC NURSING HOME CARE:

AND PROVIDED FURTHER, THAT AS TO PUBLIC NURSING HOME CARE, FOR

FISCAL YEAR 2005-2006 AND THEREAFTER, THE OBLIGATIONS OF THE

COUNTIES SHALL BE THE AMOUNT SO CERTIFIED ABOVE, LESS NINE-

TENTHS OF THE NON-FEDERAL SHARE OF PAYMENTS MADE BY THE

DEPARTMENT DURING THE FISCAL YEAR TO COUNTY HOMES FOR PUBLIC

NURSING CARE AT RATES ESTABLISHED IN ACCORDANCE WITH SECTION

443.1(5) AND (7).

SECTION 9. SECTIONS 704.1(G) AND (G.2) AND 704.3(A) OF THE

ACT, AMENDED OR ADDED JULY 9, 2013 (P.L.369, NO.55), ARE AMENDED

TO READ:

SECTION 704.1. PAYMENTS TO COUNTIES FOR SERVICES TO

CHILDREN.--* * *

20150HB1322PN2628 - 16 -

(G) [THE] EXCEPT AS PROVIDED BY AN EXECUTIVE APPROVAL OR

APPROPRIATION UNDER THE ACT OF APRIL 9, 1929 (P.L.343, NO.176),

KNOWN AS THE FISCAL CODE, AS AMENDED, THE DEPARTMENT SHALL

PROCESS PAYMENTS TO EACH COUNTY PURSUANT TO THIS ARTICLE FROM

FUNDS APPROPRIATED BY THE GENERAL ASSEMBLY [FOR EACH FISCAL

YEAR], WITHIN FIFTEEN DAYS OF PASSAGE OF THE GENERAL

APPROPRIATION BILL OR BY A DATE SPECIFIED UNDER PARAGRAPH (1),

(2), (3), (4) OR (5), WHICHEVER IS LATER. THE DEPARTMENT SHALL

PROCESS THE FOLLOWING APPLICABLE PAYMENTS TO THE COUNTY:

(1) BY JULY 15, TWENTY-FIVE PERCENT OF THE AMOUNT OF STATE

FUNDS ALLOCATED TO THE COUNTY UNDER SECTION 709.3.

(2) BY AUGUST 31, OR UPON APPROVAL BY THE DEPARTMENT OF THE

COUNTY'S FINAL CUMULATIVE REPORT FOR ITS EXPENDITURES FOR THE

PRIOR FISCAL YEAR, WHICHEVER IS LATER, TWENTY-FIVE PERCENT OF

THE AMOUNT OF STATE FUNDS ALLOCATED TO THE COUNTY UNDER SECTION

709.3, REDUCED BY THE AMOUNT OF AGGREGATE UNSPENT STATE FUNDS

PROVIDED TO THE COUNTY DURING THE PREVIOUS FISCAL YEAR.

(3) BY NOVEMBER 30, OR UPON APPROVAL BY THE DEPARTMENT OF

THE COUNTY'S REPORT FOR ITS EXPENDITURES FOR THE FIRST QUARTER

OF THE FISCAL YEAR, WHICHEVER IS LATER, TWENTY-FIVE PERCENT OF

THE AMOUNT OF STATE FUNDS ALLOCATED TO THE COUNTY UNDER SECTION

709.3, REDUCED BY THE AMOUNT OF UNSPENT STATE FUNDS ALREADY

PROVIDED TO THE COUNTY FOR THE FIRST QUARTER OF THE FISCAL YEAR.

(4) BY FEBRUARY 28, OR UPON APPROVAL BY THE DEPARTMENT OF

THE COUNTY'S REPORT FOR ITS EXPENDITURES FOR THE SECOND QUARTER

OF THE FISCAL YEAR, WHICHEVER IS LATER, TWELVE AND ONE-HALF

PERCENT OF THE AMOUNT OF STATE FUNDS ALLOCATED TO THE COUNTY

UNDER SECTION 709.3, ADJUSTED BY THE AMOUNT OF OVERSPENDING OR

UNDERSPENDING OF STATE FUNDS IN THE PREVIOUS QUARTERS, BUT NOT

TO EXCEED EIGHTY-SEVEN AND ONE-HALF PERCENT OF THE COUNTY'S

20150HB1322PN2628 - 17 -

APPROVED STATE ALLOCATION.

(5) UPON APPROVAL BY THE DEPARTMENT OF THE COUNTY'S FINAL

CUMULATIVE REPORT FOR ITS EXPENDITURES FOR THE FISCAL YEAR,

TWELVE AND ONE-HALF PERCENT OF THE AMOUNT OF STATE FUNDS

ALLOCATED TO THE COUNTY UNDER SECTION 709.3, ADJUSTED BY THE

AMOUNT OF OVERSPENDING OR UNDERSPENDING OF STATE FUNDS IN THE

PREVIOUS QUARTERS.

* * *

(G.2) SERVICE CONTRACTS OR AGREEMENTS SHALL INCLUDE A TIMELY

PAYMENT PROVISION THAT REQUIRES COUNTIES TO MAKE PAYMENT TO

SERVICE PROVIDERS WITHIN THIRTY DAYS OF THE COUNTY'S RECEIPT OF

AN INVOICE UNDER BOTH OF THE FOLLOWING CONDITIONS:

(1) THE INVOICE SATISFIES THE COUNTY'S REQUIREMENTS FOR A

COMPLETE AND ACCURATE INVOICE.

(2) FUNDS HAVE BEEN APPROPRIATED TO THE DEPARTMENT OR

APPROVED BY THE GOVERNOR FOR PAYMENTS TO COUNTIES UNDER

SUBSECTION (G).

* * *

SECTION 704.3. PROVIDER SUBMISSIONS.--(A) FOR FISCAL [YEAR]

YEARS 2013-2014, 2014-2015 AND 2015-2016, A PROVIDER SHALL

SUBMIT DOCUMENTATION OF ITS COSTS OF PROVIDING SERVICES; AND THE

DEPARTMENT SHALL USE SUCH DOCUMENTATION, TO THE EXTENT

NECESSARY, TO SUPPORT THE DEPARTMENT'S CLAIM FOR FEDERAL FUNDING

AND FOR STATE REIMBURSEMENT FOR ALLOWABLE DIRECT AND INDIRECT

COSTS INCURRED IN THE PROVISION OF OUT-OF-HOME PLACEMENT

SERVICES.

* * *

SECTION 10. SECTION 709.3 OF THE ACT, ADDED AUGUST 5, 1991

(P.L.315, NO.30), IS AMENDED TO READ:

SECTION 709.3. LIMITS ON REIMBURSEMENTS TO COUNTIES.--(A)

20150HB1322PN2628 - 18 -

REIMBURSEMENT FOR CHILD WELFARE SERVICES [MADE] BY THE

DEPARTMENT TO COUNTIES DURING A FISCAL YEAR PURSUANT TO SECTION

704.1 SHALL NOT EXCEED THE FUNDS APPROPRIATED [EACH FISCAL

YEAR].

(A.1) REIMBURSEMENT FOR CHILD WELFARE SERVICES PROVIDED IN A

FISCAL YEAR SHALL BE APPROPRIATED OVER TWO FISCAL YEARS.

(B) THE ALLOCATION FOR EACH COUNTY PURSUANT TO SECTION

704.1(A) SHALL BE CALCULATED BY MULTIPLYING THE SUM OF THE

SOCIAL SECURITY ACT (PUBLIC LAW 74-271, 42 U.S.C. § 301 ET SEQ.)

TITLE IV-B FUNDS AND STATE FUNDS APPROPRIATED TO REIMBURSE

COUNTIES PURSUANT TO SECTION 704.1(A) BY A FRACTION, THE

NUMERATOR OF WHICH IS THE AMOUNT DETERMINED FOR THAT COUNTY'S

CHILD WELFARE NEEDS-BASED BUDGET AND THE DENOMINATOR IS THE

AGGREGATE CHILD WELFARE NEEDS-BASED BUDGET.

UNDER [SECTION 704.1(A)] SUBSECTION (A) DURING THE FISCAL YEAR

IS NOT AT LEAST EQUIVALENT TO THE AGGREGATE CHILD WELFARE NEEDS-

BASED BUDGET FOR THAT FISCAL YEAR:

(1) EACH COUNTY SHALL BE PROVIDED A PROPORTIONATE SHARE

ALLOCATION OF THAT APPROPRIATION CALCULATED BY MULTIPLYING THE

SUM OF THE AMOUNTS APPROPRIATED FOR REIMBURSEMENT UNDER [SECTION

704.1(A)] SUBSECTION (A) BY A FRACTION, THE NUMERATOR OF WHICH

IS THE AMOUNT DETERMINED FOR THAT COUNTY'S CHILD WELFARE NEEDS-

BASED BUDGET AND THE DENOMINATOR IS THE AGGREGATE CHILD WELFARE

NEEDS-BASED BUDGET.

(2) NOTWITHSTANDING SUBSECTION (A), A COUNTY SHALL BE

ALLOWED REIMBURSEMENT BEYOND ITS PROPORTIONATE SHARE ALLOCATION

FOR THAT FISCAL YEAR FOR EXPENDITURES MADE IN ACCORDANCE WITH AN

APPROVED PLAN AND NEEDS-BASED BUDGET, BUT NOT ABOVE THAT AMOUNT

DETERMINED TO BE ITS NEEDS-BASED BUDGET.

20150HB1322PN2628 - 19 -

(C.1) THE DEPARTMENT SHALL REIMBURSE COUNTIES WITH FUNDS

APPROPRIATED IN THE FISCAL YEAR IN WHICH THE DEPARTMENT IS TO

MAKE THE REIMBURSEMENT PAYMENT FOR CHILD WELFARE SERVICES ON THE

EARLIEST DATE UNDER SECTION 704.1. THE AGGREGATE REIMBURSEMENT

FOR CHILD WELFARE SERVICES PROVIDED DURING A FISCAL YEAR SHALL

NOT EXCEED THE AMOUNT SPECIFIED AS THE AGGREGATE CHILD WELFARE

NEEDS-BASED BUDGET ALLOCATION BY THE GENERAL ASSEMBLY AS

NECESSARY TO FUND CHILD WELFARE SERVICES IN THE GENERAL

APPROPRIATION ACT FOR THAT FISCAL YEAR.

(D) FOR THE PURPOSE OF THIS SECTION, AN APPROPRIATION SHALL

BE CONSIDERED EQUIVALENT TO THE AGGREGATE CHILD WELFARE NEEDS IF

IT IS EQUIVALENT TO THE RESULT OBTAINED BY CALCULATING THE

AGGREGATE CHILD WELFARE NEEDS MINUS THE COUNTY SHARE OF YOUTH

DEVELOPMENT CENTER COSTS AND MINUS THE SOCIAL SECURITY ACT TITLE

IV-B FUNDING, PROVIDED, HOWEVER, AN APPROPRIATION SHALL BE

DEEMED EQUIVALENT IF IT IS EQUAL TO EIGHTY-TWO PERCENT OF THE

RESULT IN 1991-1992, NINETY PERCENT OF THE RESULT IN 1992-1993

AND NINETY-FIVE PERCENT OF THE RESULT IN 1993-1994.

(E) THE DEPARTMENT SHALL, BY REGULATION, DEFINE ALLOWABLE

COSTS FOR AUTHORIZED CHILD WELFARE SERVICES, PROVIDED THAT NO

REGULATION RELATING TO ALLOWABLE COSTS SHALL BE ADOPTED AS AN

EMERGENCY REGULATION PURSUANT TO SECTION 6(B) OF THE ACT OF JUNE

25, 1982 (P.L.633, NO.181), KNOWN AS THE "REGULATORY REVIEW

ACT."

SECTION 11. ARTICLE VII-F OF THE ACT IS REPEALED:

[ARTICLE VIII-F

MEDICAID MANAGED CARE ORGANIZATION ASSESSMENTS

SECTION 801-F. DEFINITIONS.

THE FOLLOWING WORDS AND PHRASES WHEN USED IN THIS ARTICLE

SHALL HAVE THE MEANINGS GIVEN TO THEM IN THIS SECTION UNLESS THE

20150HB1322PN2628 - 20 -

CONTEXT CLEARLY INDICATES OTHERWISE:

"ASSESSMENT PERCENTAGE." THE RATE ASSESSED PURSUANT TO THIS

ARTICLE ON EVERY MEDICAID MANAGED CARE ORGANIZATION.

"ASSESSMENT PERIOD." THE TIME PERIOD IDENTIFIED IN THE

CONTRACT.

"ASSESSMENT PROCEEDS." THE STATE REVENUE COLLECTED FROM THE

ASSESSMENT PROVIDED FOR IN THIS ARTICLE, ANY FEDERAL FUNDS

RECEIVED BY THE COMMONWEALTH AS A DIRECT RESULT OF THE

ASSESSMENT AND ANY PENALTIES AND INTEREST RECEIVED UNDER SECTION

810-F.

"CONTRACT." THE AGREEMENT BETWEEN A MEDICAID MANAGED CARE

ORGANIZATION AND THE DEPARTMENT OF PUBLIC WELFARE.

"COUNTY MEDICAID MANAGED CARE ORGANIZATION." A COUNTY, OR AN

ENTITY ORGANIZED AND CONTROLLED DIRECTLY OR INDIRECTLY BY A

COUNTY OR A CITY OF THE FIRST CLASS, THAT IS A PARTY TO A

MEDICAID MANAGED CARE CONTRACT WITH THE DEPARTMENT OF PUBLIC

WELFARE.

"DEPARTMENT." THE DEPARTMENT OF PUBLIC WELFARE OF THE

COMMONWEALTH.

"MEDICAID." THE PROGRAM ESTABLISHED UNDER TITLE XIX OF THE

SOCIAL SECURITY ACT (49 STAT. 620, 42 U.S.C. § 1396 ET SEQ.).

"MEDICAID MANAGED CARE ORGANIZATION." A MEDICAID MANAGED

CARE ORGANIZATION AS DEFINED IN SECTION 1903(M)(1)(A) OF THE

SOCIAL SECURITY ACT (49 STAT. 620, 42 U.S.C. § 1396B(M)(1)(A))

THAT IS A PARTY TO A MEDICAID MANAGED CARE CONTRACT WITH THE

DEPARTMENT OF PUBLIC WELFARE. THE TERM SHALL INCLUDE A COUNTY

MEDICAID MANAGED CARE ORGANIZATION AND A PERMITTED ASSIGNEE OF A

MEDICAID MANAGED CARE CONTRACT BUT SHALL NOT INCLUDE AN ASSIGNOR

OF A MEDICAID MANAGED CARE CONTRACT.

"SECRETARY." THE SECRETARY OF PUBLIC WELFARE OF THE

20150HB1322PN2628 - 21 -

COMMONWEALTH.

"SOCIAL SECURITY ACT." 49 STAT. 620, 42 U.S.C. § 301 ET SEQ.

SECTION 802-F. AUTHORIZATION.

THE DEPARTMENT SHALL IMPLEMENT AN ASSESSMENT ON EACH MEDICAID

MANAGED CARE ORGANIZATION, SUBJECT TO THE CONDITIONS AND

REQUIREMENTS SPECIFIED IN THIS ARTICLE.

SECTION 803-F. IMPLEMENTATION.

THE ASSESSMENT SHALL BE IMPLEMENTED ON AN ANNUAL BASIS,

THROUGH PERIODIC SUBMISSIONS NOT TO EXCEED FIVE TIMES PER YEAR

BY MEDICAID MANAGED CARE ORGANIZATIONS, AS A HEALTH CARE-RELATED

FEE AS DEFINED IN SECTION 1903(W)(3)(B) OF THE SOCIAL SECURITY

ACT, OR ANY AMENDMENTS THERETO, AND MAY BE IMPOSED AND IS

REQUIRED TO BE PAID ONLY TO THE EXTENT THAT THE REVENUES

GENERATED FROM THE ASSESSMENT QUALIFY AS THE STATE SHARE OF

PROGRAM EXPENDITURES ELIGIBLE FOR FEDERAL FINANCIAL

PARTICIPATION.

SECTION 804-F. ASSESSMENT PERCENTAGE.

(A) AMOUNT.--THE ASSESSMENT PERCENTAGE SHALL BE UNIFORM FOR

ALL MEDICAID MANAGED CARE ORGANIZATIONS, DETERMINED IN

ACCORDANCE WITH THIS SECTION AND IMPLEMENTED BY THE DEPARTMENT

AS APPROVED BY THE GOVERNOR AFTER NOTIFICATION TO AND IN

CONSULTATION WITH THE MEDICAID MANAGED CARE ORGANIZATIONS. THE

ASSESSMENT PERCENTAGE SHALL BE SUBJECT TO THE MAXIMUM AGGREGATE

AMOUNT THAT MAY BE ASSESSED PURSUANT TO 42 CFR 433.68(F)(3)(I)

(RELATING TO PERMISSIBLE HEALTH CARE-RELATED TAXES) OR ANY

SUBSEQUENT MAXIMUM ESTABLISHED BY FEDERAL LAW.

(B) NOTICE.--SUBJECT TO THE PROVISIONS OF SUBSECTION (C),

THE DEPARTMENT SHALL NOTIFY EACH MEDICAID MANAGED CARE

ORGANIZATION OF A PROPOSED ASSESSMENT PERCENTAGE. MEDICAID

MANAGED CARE ORGANIZATIONS SHALL HAVE 30 DAYS FROM THE DATE OF

20150HB1322PN2628 - 22 -

THE PROPOSED ASSESSMENT PERCENTAGE NOTICE TO PROVIDE WRITTEN

COMMENTS TO THE DEPARTMENT REGARDING THE PROPOSED ASSESSMENT.

UPON EXPIRATION OF THE 30-DAY COMMENT PERIOD, THE DEPARTMENT,

AFTER CONSIDERATION OF THE COMMENTS, SHALL PROVIDE EACH MEDICAID

MANAGED CARE ORGANIZATION WITH A SECOND NOTICE ANNOUNCING THE

ASSESSMENT PERCENTAGE. ONCE EFFECTIVE, AN ASSESSMENT PERCENTAGE

WILL REMAIN IN EFFECT UNTIL THE DEPARTMENT NOTIFIES EACH

MEDICAID MANAGED CARE ORGANIZATION OF A NEW ASSESSMENT

PERCENTAGE IN ACCORDANCE WITH THE NOTICE PROVISIONS CONTAINED IN

THIS SECTION.

MAY BE IMPOSED RETROACTIVELY TO THE BEGINNING OF AN ASSESSMENT

PERIOD BEGINNING ON OR AFTER JULY 1, 2004. ONCE EFFECTIVE, THE

INITIAL ASSESSMENT PERCENTAGE WILL REMAIN IN EFFECT UNTIL THE

DEPARTMENT NOTIFIES EACH MEDICAID MANAGED CARE ORGANIZATION OF A

NEW ASSESSMENT PERCENTAGE IN ACCORDANCE WITH THE NOTICE

PROVISIONS CONTAINED IN THIS SECTION.

SECTION 805-F. CALCULATION AND PAYMENT.

USING THE ASSESSMENT PERCENTAGE ESTABLISHED UNDER SECTION

804-F, EACH MEDICAID MANAGED CARE ORGANIZATION SHALL CALCULATE

THE ASSESSMENT AMOUNT FOR EACH ASSESSMENT PERIOD ON A REPORT

FORM SPECIFIED BY THE CONTRACT AND SHALL SUBMIT THE COMPLETED

REPORT FORM AND TOTAL AMOUNT OWED TO THE DEPARTMENT ON A DUE

DATE SPECIFIED BY THE CONTRACT. THE MEDICAID MANAGED CARE

ORGANIZATION SHALL REPORT NET OPERATING REVENUE FOR PURPOSES OF

THE ASSESSMENT CALCULATION AS SPECIFIED IN THE CONTRACT.

SECTION 806-F. USE OF ASSESSMENT PROCEEDS.

NO MEDICAID MANAGED CARE ORGANIZATION SHALL BE GUARANTEED A

REPAYMENT OF ITS ASSESSMENT IN DEROGATION OF 42 CFR 433.68(F)

(RELATING TO PERMISSIBLE HEALTH CARE-RELATED TAXES), PROVIDED,

20150HB1322PN2628 - 23 -

HOWEVER, IN EACH FISCAL YEAR IN WHICH AN ASSESSMENT IS

IMPLEMENTED, THE DEPARTMENT SHALL USE THE ASSESSMENT PROCEEDS TO

MAINTAIN ACTUARIALLY SOUND RATES AS DEFINED IN THE CONTRACT FOR

THE MEDICAID MANAGED CARE ORGANIZATIONS TO THE EXTENT

PERMISSIBLE UNDER FEDERAL AND STATE LAW OR REGULATION AND

WITHOUT CREATING A GUARANTEE TO HOLD HARMLESS, AS THOSE TERMS

ARE USED IN 42 CFR 433.68(F).

SECTION 807-F. RECORDS.

UPON WRITTEN REQUEST BY THE DEPARTMENT, A MEDICAID MANAGED

CARE ORGANIZATION SHALL FURNISH TO THE DEPARTMENT SUCH RECORDS

AS THE DEPARTMENT MAY SPECIFY IN ORDER TO DETERMINE THE AMOUNT

OF ASSESSMENT DUE FROM THE MEDICAID MANAGED CARE ORGANIZATION OR

TO VERIFY THAT THE MEDICAID MANAGED CARE ORGANIZATION HAS

CALCULATED AND PAID THE CORRECT AMOUNT DUE. THE REQUESTED

RECORDS SHALL BE PROVIDED TO THE DEPARTMENT WITHIN 30 DAYS FROM

THE DATE OF THE MEDICAID MANAGED CARE ORGANIZATION'S RECEIPT OF

THE WRITTEN REQUEST UNLESS REQUIRED AT AN EARLIER DATE FOR

PURPOSES OF THE DEPARTMENT'S COMPLIANCE WITH A REQUEST FROM A

FEDERAL OR ANOTHER STATE AGENCY.

SECTION 808-F. PAYMENT OF ASSESSMENT.

IN THE EVENT THAT THE DEPARTMENT DETERMINES THAT A MEDICAID

MANAGED CARE ORGANIZATION HAS FAILED TO PAY AN ASSESSMENT OR

THAT IT HAS UNDERPAID AN ASSESSMENT, THE DEPARTMENT SHALL

PROVIDE WRITTEN NOTIFICATION TO THE MEDICAID MANAGED CARE

ORGANIZATION WITHIN 180 DAYS OF THE ORIGINAL DUE DATE OF THE

AMOUNT DUE, INCLUDING INTEREST, AND THE DATE ON WHICH THE AMOUNT

DUE MUST BE PAID, WHICH SHALL NOT BE LESS THAN 30 DAYS FROM THE

DATE OF THE NOTICE. IN THE EVENT THAT THE DEPARTMENT DETERMINES

THAT A MEDICAID MANAGED CARE ORGANIZATION HAS OVERPAID AN

ASSESSMENT, THE DEPARTMENT SHALL NOTIFY THE MEDICAID MANAGED

20150HB1322PN2628 - 24 -

CARE ORGANIZATION IN WRITING OF THE OVERPAYMENT, AND, WITHIN 30

DAYS OF THE DATE OF THE NOTICE OF THE OVERPAYMENT, THE MEDICAID

MANAGED CARE ORGANIZATION SHALL ADVISE THE DEPARTMENT TO EITHER

AUTHORIZE A REFUND OF THE AMOUNT OF THE OVERPAYMENT OR OFFSET

THE AMOUNT OF THE OVERPAYMENT AGAINST ANY AMOUNT THAT MAY BE

OWED TO THE DEPARTMENT BY THE MEDICAID MANAGED CARE

ORGANIZATION.

SECTION 809-F. APPEAL RIGHTS.

A MEDICAID MANAGED CARE ORGANIZATION THAT IS AGGRIEVED BY A

DETERMINATION OF THE DEPARTMENT RELATING TO THE ASSESSMENT MAY

FILE A REQUEST FOR REVIEW OF THE DECISION OF THE DEPARTMENT BY

THE BUREAU OF HEARINGS AND APPEALS WITHIN THE DEPARTMENT, WHICH

SHALL HAVE EXCLUSIVE PRIMARY JURISDICTION IN SUCH MATTERS. THE

PROCEDURES AND REQUIREMENTS OF 67 PA.C.S. CH. 11 (RELATING TO

MEDICAL ASSISTANCE HEARINGS AND APPEALS) SHALL APPLY TO REQUESTS

FOR REVIEW FILED PURSUANT TO THIS SECTION EXCEPT THAT, IN ANY

SUCH REQUEST FOR REVIEW, A MEDICAID MANAGED CARE ORGANIZATION

MAY NOT CHALLENGE THE ASSESSMENT PERCENTAGE DETERMINED BY THE

DEPARTMENT PURSUANT TO SECTION 804-F.

SECTION 810-F. ENFORCEMENT.

IN ADDITION TO ANY OTHER REMEDY PROVIDED BY LAW, THE

DEPARTMENT MAY ENFORCE THIS ARTICLE BY IMPOSING ONE OR MORE OF

THE FOLLOWING REMEDIES:

(1) WHEN A MEDICAID MANAGED CARE ORGANIZATION FAILS TO

PAY AN ASSESSMENT OR PENALTY IN THE AMOUNT OR ON THE DATE

REQUIRED BY THIS ARTICLE, THE DEPARTMENT MAY ADD INTEREST AT

THE RATE PROVIDED IN SECTION 806 OF THE ACT OF APRIL 9, 1929

(P.L.343, NO.176), KNOWN AS THE FISCAL CODE, TO THE UNPAID

AMOUNT OF THE ASSESSMENT OR PENALTY FROM THE DATE PRESCRIBED

FOR ITS PAYMENT UNTIL THE DATE IT IS PAID.

20150HB1322PN2628 - 25 -

(2) WHEN A MEDICAID MANAGED CARE ORGANIZATION FAILS TO

SUBMIT A REPORT FORM CONCERNING THE CALCULATION OF THE

ASSESSMENT OR TO FURNISH RECORDS TO THE DEPARTMENT AS

REQUIRED BY THIS ARTICLE, THE DEPARTMENT MAY IMPOSE A PENALTY

AGAINST THE MEDICAID MANAGED CARE ORGANIZATION IN THE AMOUNT

OF $1,000 PER DAY FOR EACH DAY THE REPORT FORM OR REQUIRED

RECORDS ARE NOT SUBMITTED OR FURNISHED TO THE DEPARTMENT. IF

THE $1,000 PER DAY PENALTY IS IMPOSED, IT SHALL COMMENCE ON

THE FIRST DAY AFTER THE DATE FOR WHICH A REPORT FORM OR

RECORDS ARE DUE.

(3) WHEN A MEDICAID MANAGED CARE ORGANIZATION FAILS TO

PAY ALL OR PART OF AN ASSESSMENT OR PENALTY WITHIN 30 DAYS OF

THE DATE THAT PAYMENT IS DUE, THE DEPARTMENT MAY DEDUCT THE

UNPAID ASSESSMENT OR PENALTY AND ANY INTEREST OWED FROM ANY

CAPITATION PAYMENTS DUE TO THE MEDICAID MANAGED CARE

ORGANIZATION UNTIL THE FULL AMOUNT IS RECOVERED. ANY

DEDUCTION SHALL BE MADE ONLY AFTER WRITTEN NOTICE TO THE

MEDICAID MANAGED CARE ORGANIZATION.

(4) UPON WRITTEN REQUEST BY A MEDICAID MANAGED CARE

ORGANIZATION TO THE SECRETARY, THE SECRETARY MAY WAIVE ALL OR

PART OF THE INTEREST OR PENALTIES ASSESSED AGAINST A MEDICAID

MANAGED CARE ORGANIZATION PURSUANT TO THIS ARTICLE FOR GOOD

CAUSE AS SHOWN BY THE MEDICAID MANAGED CARE ORGANIZATION.

SECTION 811-F. TIME PERIODS.

THE ASSESSMENT AUTHORIZED IN THIS ARTICLE SHALL NOT BE

IMPOSED OR PAID PRIOR TO JULY 1, 2004, OR IN THE ABSENCE OF

FEDERAL FINANCIAL PARTICIPATION AS DESCRIBED IN SECTION 803-F.

THE ASSESSMENT SHALL CEASE ON JUNE 30, 2013, OR EARLIER IF

REQUIRED BY LAW.]

SECTION 12. THE DEFINITIONS OF "EXEMPT HOSPITAL" AND "NET

20150HB1322PN2628 - 26 -

INPATIENT REVENUE" IN SECTION 801-G OF THE ACT, REENACTED AND

AMENDED JULY 9, 2013 (P.L.369, NO.55), ARE AMENDED TO READ:

SECTION 801-G. DEFINITIONS.

THE FOLLOWING WORDS AND PHRASES WHEN USED IN THIS ARTICLE

SHALL HAVE THE MEANINGS GIVEN TO THEM IN THIS SECTION UNLESS THE

CONTEXT CLEARLY INDICATES OTHERWISE:

* * *

"EXEMPT HOSPITAL." ANY OF THE FOLLOWING:

(1) A FEDERAL VETERANS' AFFAIRS HOSPITAL.

(2) A HOSPITAL THAT PROVIDES CARE, INCLUDING INPATIENT

HOSPITAL SERVICES, TO ALL PATIENTS FREE OF CHARGE.

(3) A PRIVATE PSYCHIATRIC HOSPITAL.

(4) A STATE-OWNED PSYCHIATRIC HOSPITAL.

(5) A CRITICAL ACCESS HOSPITAL.

(6) A LONG-TERM ACUTE CARE HOSPITAL.

(7) A FREE-STANDING ACUTE CARE HOSPITAL ORGANIZED

PRIMARILY FOR THE TREATMENT OF AND RESEARCH ON CANCER IN

WHICH AT LEAST 30% OF THE INPATIENT ADMISSIONS HAD CANCER AS

THE PRINCIPAL DIAGNOSIS BASED ON PENNSYLVANIA HEALTH CARE

COST CONTAINMENT COUNCIL CY 2014 INPATIENT DISCHARGE DATA.

FOR THE PURPOSES OF MEETING THIS DEFINITION, ONLY DISCHARGES

WITH ICD-9-CM PRINCIPAL DIAGNOSES CODES OF 140 THROUGH 239,

V58.0, V58.1, V66.1, V66.2 OR 990 ARE CONSIDERED.

* * *

"NET INPATIENT REVENUE." GROSS CHARGES FOR FACILITIES FOR

INPATIENT SERVICES LESS ANY DEDUCTED AMOUNTS FOR BAD DEBT

EXPENSE, CHARITY CARE EXPENSE AND CONTRACTUAL ALLOWANCES AS

REPORTED ON FORMS SPECIFIED BY THE DEPARTMENT AND:

(1) AS IDENTIFIED IN THE HOSPITAL'S RECORDS FOR THE

STATE FISCAL YEAR COMMENCING JULY 1, 2010, OR SUCH LATER

20150HB1322PN2628 - 27 -

STATE FISCAL YEAR, AS MAY BE SPECIFIED BY THE DEPARTMENT FOR

USE IN DETERMINING AN ANNUAL ASSESSMENT AMOUNT OWED ON OR

AFTER JULY 1, 2016; OR

(2) AS IDENTIFIED IN THE HOSPITAL'S RECORDS FOR THE MOST

RECENT STATE FISCAL YEAR, OR PART THEREOF, IF AMOUNTS ARE NOT

AVAILABLE UNDER PARAGRAPH (1).

* * *

SECTION 13. SECTIONS 803-G(B) AND (C) AND 804-G(A.1) AND (B)

OF THE ACT, REENACTED AND AMENDED JULY 9, 2013 (P.L.369, NO.55),

ARE AMENDED TO READ:

SECTION 803-G. IMPLEMENTATION.

* * *

(B) ASSESSMENT PERCENTAGE.--SUBJECT TO SUBSECTION (C), EACH

COVERED HOSPITAL SHALL BE ASSESSED AS FOLLOWS:

(1) FOR FISCAL YEAR 2010-2011, EACH COVERED HOSPITAL

SHALL BE ASSESSED AN AMOUNT EQUAL TO 2.69% OF THE NET

INPATIENT REVENUE OF THE COVERED HOSPITAL; [AND]

(2) FOR FISCAL YEARS 2011-2012, 2012-2013, 2013-2014[,]

AND 2014-2015 [AND 2015-2016], AN AMOUNT EQUAL TO 3.22% OF

THE NET INPATIENT REVENUE OF THE COVERED HOSPITAL[.]; AND

(3) FOR FISCAL YEARS 2015-2016, 2016-2017 AND 2017-2018,

AN AMOUNT EQUAL TO 3.71% OF THE NET INPATIENT REVENUE OF THE

COVERED HOSPITAL.

ADJUST THE ASSESSMENT PERCENTAGE SPECIFIED IN SUBSECTION (B),

PROVIDED THAT, BEFORE [ADJUSTING] IMPLEMENTING AN ADJUSTMENT,

THE SECRETARY SHALL PUBLISH A NOTICE IN THE PENNSYLVANIA

BULLETIN THAT SPECIFIES THE PROPOSED ASSESSMENT PERCENTAGE AND

IDENTIFIES THE AGGREGATE IMPACT ON COVERED HOSPITALS SUBJECT TO

THE ASSESSMENT. INTERESTED PARTIES SHALL HAVE 30 DAYS IN WHICH

20150HB1322PN2628 - 28 -

TO SUBMIT COMMENTS TO THE SECRETARY. UPON EXPIRATION OF THE 30-

DAY COMMENT PERIOD, THE SECRETARY, AFTER CONSIDERATION OF THE

COMMENTS, SHALL PUBLISH A SECOND NOTICE IN THE PENNSYLVANIA

BULLETIN ANNOUNCING THE ASSESSMENT PERCENTAGE.

(C.1) REBASING NET INPATIENT REVENUE AMOUNTS.--FOR PURPOSES

OF CALCULATING THE ANNUAL ASSESSMENT AMOUNT OWED ON OR AFTER

JULY 1, 2016, THE SECRETARY MAY REQUIRE THE USE OF NET INPATIENT

REVENUE AMOUNTS AS IDENTIFIED IN THE RECORDS OF COVERED

HOSPITALS FOR A STATE FISCAL YEAR COMMENCING ON OR AFTER JULY 1,

2011. IF THE SECRETARY DECIDES THAT THE NET INPATIENT REVENUE

AMOUNTS SHOULD BE REBASED, THE SECRETARY SHALL PUBLISH A NOTICE

IN THE PENNSYLVANIA BULLETIN SPECIFYING THE STATE FISCAL YEAR

FOR WHICH THE NET INPATIENT REVENUE AMOUNTS WILL BE USED AT

LEAST 30 DAYS PRIOR TO THE DATE ON WHICH AN ASSESSMENT AMOUNT

CALCULATED WITH THOSE REBASED AMOUNTS IS DUE TO BE PAID TO THE

DEPARTMENT.

* * *

SECTION 804-G. ADMINISTRATION.

* * *

(A.1) CALCULATION OF ASSESSMENT WITH CHANGES OF OWNERSHIP.--

(1) IF A SINGLE COVERED HOSPITAL CHANGES OWNERSHIP OR

CONTROL, THE DEPARTMENT WILL CONTINUE TO CALCULATE THE

ASSESSMENT AMOUNT USING THE HOSPITAL'S NET INPATIENT REVENUE

FOR:

(I) STATE FISCAL YEAR 2010-2011 [OR FOR]; OR

(II) FOR A CHANGE ON OR AFTER JULY 1, 2016, THE

LATER STATE FISCAL YEAR, IF ANY, THAT HAS BEEN SPECIFIED

BY THE SECRETARY FOR USE IN DETERMINING THE ASSESSMENT

AMOUNTS DUE FOR THE FISCAL YEAR IN WHICH THE CHANGE

OCCURS; OR

20150HB1322PN2628 - 29 -

(III) THE MOST RECENT STATE FISCAL YEAR, OR PART

THEREOF, IF THE [STATE FISCAL YEAR 2010-2011] NET

INPATIENT REVENUE AMOUNTS SPECIFIED IN SUBPARAGRAPHS (I)

AND (II) ARE NOT AVAILABLE. THE COVERED HOSPITAL IS

LIABLE FOR ANY OUTSTANDING ASSESSMENT AMOUNTS, INCLUDING

OUTSTANDING AMOUNTS RELATED TO PERIODS PRIOR TO THE

CHANGE OF OWNERSHIP OR CONTROL.

(2) IF TWO OR MORE HOSPITALS MERGE OR CONSOLIDATE INTO A

SINGLE COVERED HOSPITAL AS A RESULT OF A CHANGE IN OWNERSHIP

OR CONTROL, THE DEPARTMENT WILL CALCULATE THE [COVERED

HOSPITAL] ASSESSMENT AMOUNT OWED BY THE SINGLE COVERED

HOSPITAL RESULTING FROM THE MERGER OR CONSOLIDATION USING THE

MERGED OR CONSOLIDATED HOSPITALS' COMBINED NET INPATIENT

REVENUE FOR:

(I) STATE FISCAL YEAR 2010-2011 [OR FOR]; OR

(II) FOR A MERGER OR CONSOLIDATION ON OR AFTER JULY

1, 2016, THE LATER STATE FISCAL YEAR, IF ANY, THAT HAS

BEEN SPECIFIED BY THE SECRETARY FOR USE IN DETERMINING

THE ASSESSMENT AMOUNTS DUE FOR THE FISCAL YEAR IN WHICH

THE MERGER OR CONSOLIDATION OCCURS; OR

(III) THE MOST RECENT STATE FISCAL YEAR, OR PART

THEREOF, IF THE [STATE FISCAL YEAR 2010-2011] NET

INPATIENT REVENUE AMOUNTS SPECIFIED IN SUBPARAGRAPHS (I)

AND (II) ARE NOT AVAILABLE, OF ANY COVERED HOSPITALS THAT

WERE MERGED OR CONSOLIDATED INTO THE SINGLE COVERED

HOSPITAL. THE SINGLE COVERED HOSPITAL IS LIABLE FOR ANY

OUTSTANDING ASSESSMENT AMOUNTS, INCLUDING OUTSTANDING

AMOUNTS RELATED TO PERIODS PRIOR TO THE CHANGE OF

OWNERSHIP OR CONTROL, OF ANY COVERED HOSPITAL THAT WAS

MERGED OR CONSOLIDATED.

20150HB1322PN2628 - 30 -

* * *

(B) PAYMENT.--A COVERED HOSPITAL SHALL PAY THE ASSESSMENT

AMOUNT DUE FOR A FISCAL YEAR IN FOUR QUARTERLY INSTALLMENTS.

PAYMENT OF A QUARTERLY INSTALLMENT SHALL BE MADE ELECTRONICALLY

ON OR BEFORE THE FIRST DAY OF THE SECOND MONTH OF THE QUARTER OR

30 DAYS FROM THE DATE OF THE NOTICE OF THE QUARTERLY ASSESSMENT

AMOUNT, WHICHEVER DAY IS LATER.

* * *

SECTION 14. SECTIONS 805-G AND 815-G OF THE ACT, REENACTED

AND AMENDED JULY 9, 2013 (P.L.369, NO.55), ARE AMENDED TO READ:

SECTION 805-G. RESTRICTED ACCOUNT.

(A) ESTABLISHMENT.--THERE IS ESTABLISHED A RESTRICTED

ACCOUNT, KNOWN AS THE QUALITY CARE ASSESSMENT ACCOUNT, IN THE

GENERAL FUND FOR THE RECEIPT AND DEPOSIT OF REVENUES COLLECTED

UNDER THIS ARTICLE. FUNDS IN THE ACCOUNT ARE APPROPRIATED TO THE

DEPARTMENT FOR THE FOLLOWING:

(1) MAKING MEDICAL ASSISTANCE PAYMENTS TO HOSPITALS FOR

INPATIENT SERVICES IN ACCORDANCE WITH SECTION 443.1(1.1), AND

OUTPATIENT SERVICES, INCLUDING FOR OBSERVATION SERVICES IN

ACCORDANCE WITH SECTION 443.3(A)(1.1), AND AS OTHERWISE

SPECIFIED IN THE COMMONWEALTH'S APPROVED TITLE XIX STATE

PLAN.

(2) MAKING ADJUSTED CAPITATION PAYMENTS TO MEDICAL

ASSISTANCE MANAGED CARE ORGANIZATIONS FOR ADDITIONAL PAYMENTS

FOR INPATIENT HOSPITAL SERVICES IN ACCORDANCE WITH SECTION

443.1(1.2), (1.3) AND (1.4) AND OUTPATIENT SERVICES.

(3) ANY OTHER PURPOSE APPROVED BY THE SECRETARY FOR

INPATIENT HOSPITAL, OUTPATIENT HOSPITAL AND HOSPITAL-RELATED

SERVICES.

(B) LIMITATIONS.--

20150HB1322PN2628 - 31 -

(1) FOR THE FIRST YEAR OF THE ASSESSMENT, THE AMOUNT

USED FOR THE MEDICAL ASSISTANCE PAYMENTS FOR HOSPITALS AND

MEDICAID MANAGED CARE ORGANIZATIONS MAY NOT EXCEED THE

AGGREGATE AMOUNT OF ASSESSMENT FUNDS COLLECTED FOR THE YEAR

LESS $121,000,000.

(2) FOR THE SECOND YEAR OF THE ASSESSMENT, THE AMOUNT

USED FOR THE MEDICAL ASSISTANCE PAYMENTS FOR HOSPITALS AND

MEDICAL ASSISTANCE MANAGED CARE ORGANIZATIONS MAY NOT EXCEED

THE AGGREGATE AMOUNT OF ASSESSMENT FUNDS COLLECTED FOR THE

YEAR LESS $109,000,000.

(4) FOR THE THIRD YEAR OF THE ASSESSMENT, THE AMOUNT

USED FOR THE MEDICAL ASSISTANCE PAYMENT FOR HOSPITALS AND

MEDICAL ASSISTANCE MANAGED CARE ORGANIZATIONS MAY NOT EXCEED

THE AGGREGATE AMOUNT OF THE ASSESSMENT FUNDS COLLECTED FOR

THE YEAR LESS $109,000,000.

(4.1) FOR STATE FISCAL YEARS 2013-2014 AND 2014-2015,

THE AMOUNT USED FOR THE MEDICAL ASSISTANCE PAYMENT FOR

HOSPITALS AND MEDICAL ASSISTANCE MANAGED CARE ORGANIZATIONS

MAY NOT EXCEED THE AGGREGATE AMOUNT OF THE ASSESSMENT FUNDS

COLLECTED FOR THE YEAR LESS $150,000,000.

(4.2) FOR STATE FISCAL [YEAR] YEARS 2015-2016, 2016-2017

AND 2017-2018, THE AMOUNT USED FOR THE MEDICAL ASSISTANCE

PAYMENT FOR HOSPITALS AND MEDICAL ASSISTANCE MANAGED CARE

ORGANIZATIONS MAY NOT EXCEED THE AGGREGATE AMOUNT OF THE

ASSESSMENT FUNDS COLLECTED FOR THE YEAR LESS [$140,000,000]

$220,000,000.

(5) THE AMOUNTS RETAINED BY THE DEPARTMENT PURSUANT TO

PARAGRAPHS (1), (2), (4), (4.1) AND (4.2) AND ANY ADDITIONAL

AMOUNTS REMAINING IN THE RESTRICTED ACCOUNTS AFTER THE

PAYMENTS DESCRIBED IN SUBSECTION (A)(1) AND (2) ARE MADE

20150HB1322PN2628 - 32 -

SHALL BE USED FOR PURPOSES APPROVED BY THE SECRETARY UNDER

SUBSECTION (A)(3).

SHALL NOT LAPSE TO THE GENERAL FUND AT THE END OF A FISCAL YEAR.

IF THIS ARTICLE EXPIRES, THE DEPARTMENT SHALL USE ANY REMAINING

FUNDS FOR THE PURPOSES STATED IN THIS SECTION UNTIL THE FUNDS IN

THE QUALITY CARE ASSESSMENT ACCOUNT ARE EXHAUSTED.

SECTION 815-G. EXPIRATION.

[THIS] THE ASSESSMENT UNDER THIS ARTICLE SHALL EXPIRE JUNE

30, [2016] 2018.

SECTION 15. THE ACT IS AMENDED BY ADDING AN ARTICLE TO READ:

ARTICLE VIII-I

MANAGED CARE ORGANIZATION ASSESSMENTS

SECTION 801-I. DEFINITIONS.

THE FOLLOWING WORDS AND PHRASES WHEN USED IN THIS ARTICLE

SHALL HAVE THE MEANINGS GIVEN TO THEM IN THIS SECTION UNLESS THE

CONTEXT CLEARLY INDICATES OTHERWISE:

"ASSESSMENT PROCEEDS." THE STATE REVENUE COLLECTED FROM THE

ASSESSMENT PROVIDED FOR UNDER THIS ARTICLE, ANY FEDERAL FUNDS

RECEIVED BY THE COMMONWEALTH AS A DIRECT RESULT OF THE

ASSESSMENT AND ANY PENALTIES AND INTEREST RECEIVED.

"CHILDREN'S HEALTH INSURANCE PROGRAM" OR "CHIP." THE

CHILDREN'S HEALTH CARE PROGRAM UNDER ARTICLE XXIII OF THE ACT OF

MAY 17, 1921 (P.L.682, NO.284), KNOWN AS THE INSURANCE COMPANY

LAW OF 1921 .

"CONTRACT." THE AGREEMENT BETWEEN A MEDICAID MANAGED CARE

ORGANIZATION AND THE DEPARTMENT.

"COUNTY MEDICAID MANAGED CARE ORGANIZATION." A COUNTY, OR AN

ENTITY ORGANIZED AND CONTROLLED DIRECTLY OR INDIRECTLY BY A

COUNTY OR A CITY OF THE FIRST CLASS, THAT IS A PARTY TO A

20150HB1322PN2628 - 33 -

MEDICAID MANAGED CARE CONTRACT WITH THE DEPARTMENT.

"DEPARTMENT." THE DEPARTMENT OF HUMAN SERVICES OF THE

COMMONWEALTH.

"FIXED FEE." THE ASSESSMENT AMOUNT IMPOSED ON A PER MEMBER

PER MONTH BASIS AS SPECIFIED UNDER SECTION 803-I(B).

"INSURANCE DEPARTMENT." THE INSURANCE DEPARTMENT OF THE

COMMONWEALTH.

"MANAGED CARE ORGANIZATION." A MEDICAID MANAGED CARE

ORGANIZATION OR A MANAGED CARE SERVICE ENTITY.

"MANAGED CARE SERVICE ENTITY." AN ENTITY, OTHER THAN A

MEDICAID MANAGED CARE ORGANIZATION, THAT:

(1) IS A MANAGED CARE PLAN AS DEFINED IN THE ACT OF JUNE

17, 1998 (P.L.464, NO.68).

(2) (I) PROVIDES MANAGED HEALTH CARE COVERAGE THROUGH A

STATE PROGRAM FOR PERSONS OF LOW INCOME OR THROUGH CHIP; AND

(II) IS OBLIGATED TO COMPLY WITH THE REQUIREMENTS OF

THE ACT OF JUNE 17, 1998 (P.L.464, NO.68).

"MEDICAID." THE PROGRAM ESTABLISHED UNDER TITLE XIX OF THE

SOCIAL SECURITY ACT (49 STAT. 620, 42 U.S.C. § 1396 ET SEQ.).

"MEDICAID MANAGED CARE ORGANIZATION." A MEDICAID MANAGED

CARE ORGANIZATION AS DEFINED IN SECTION 1903(M)(1)(A) OF THE

SOCIAL SECURITY ACT (49 STAT. 620, 42 U.S.C. § 1396B(M)(1)(A))

THAT IS A PARTY TO A CONTRACT WITH THE DEPARTMENT. THE TERM

INCLUDES A COUNTY MEDICAID MANAGED CARE ORGANIZATION AND A

PERMITTED ASSIGNEE OF A CONTRACT. THE TERM DOES NOT INCLUDE AN

ASSIGNOR OF A CONTRACT.

"MEMBER." A POLICYHOLDER, SUBSCRIBER, COVERED PERSON OR

OTHER INDIVIDUAL WHO IS ENROLLED TO RECEIVE HEALTH CARE SERVICES

THROUGH A CONTRACT OR FROM A MANAGED CARE SERVICES ENTITY. THE

TERM SHALL NOT INCLUDE INDIVIDUALS WHO RECEIVE HEALTH CARE

20150HB1322PN2628 - 34 -

SERVICES UNDER ANY OF THE FOLLOWING:

(1) A MEDICARE ADVANTAGE PLAN.

(2) A TRICARE OR OTHER HEALTH CARE PLAN PROVIDED THROUGH

THE CIVILIAN HEALTH AND MEDICAL PROGRAM OF THE UNIFORMED

SERVICES (CHAMPUS) AS DEFINED UNDER 10 U.S.C. § 1072.

(3) A HEALTH CARE PLAN PROVIDED THROUGH THE FEDERAL

EMPLOYEES HEALTH BENEFITS PROGRAM ESTABLISHED UNDER THE

FEDERAL EMPLOYEES HEALTH BENEFIT ACT (5 U.S.C. CH. 89

(RELATING TO HEALTH INSURANCE)).

"PROGRAM." THE COMMONWEALTH'S MEDICAL ASSISTANCE PROGRAM AS

AUTHORIZED UNDER ARTICLE IV.

"SOCIAL SECURITY ACT." THE SOCIAL SECURITY ACT (49 STAT.

620, 42 U.S.C. § 301 ET SEQ.).

SECTION 802-I. AUTHORIZATION.

THE DEPARTMENT SHALL IMPLEMENT AN ASSESSMENT ON EACH MANAGED

CARE ORGANIZATION OPERATING IN THIS COMMONWEALTH, SUBJECT TO THE

FOLLOWING CONDITIONS AND REQUIREMENTS:

(1) THE ASSESSMENT SHALL BE IMPLEMENTED AS A HEALTH

CARE-RELATED FEE AS DEFINED IN SECTION 1903(W)(3)(B) OF THE

SOCIAL SECURITY ACT (42 U.S.C. § 1396B(W)(3)(B)), OR ANY

AMENDMENTS THERETO, AND MAY BE IMPOSED AND IS REQUIRED TO BE

PAID ONLY TO THE EXTENT THAT THE REVENUES GENERATED FROM THE

ASSESSMENT QUALIFY AS THE STATE SHARE OF PROGRAM EXPENDITURES

ELIGIBLE FOR FEDERAL FINANCIAL PARTICIPATION.

(2) A MANAGED CARE ORGANIZATION SHALL REPORT THE TOTAL

ASSESSMENT AMOUNT OWED ON FORMS AND IN ACCORDANCE WITH

INSTRUCTIONS PRESCRIBED BY THE DEPARTMENT.

(3) A MANAGED CARE ORGANIZATION SHALL REMIT THE TOTAL

ASSESSMENT AMOUNT DUE BY THE DUE DATE SPECIFIED BY THE

DEPARTMENT.

20150HB1322PN2628 - 35 -

(4) IN THE EVENT THAT THE DEPARTMENT DETERMINES THAT A

MANAGED CARE ORGANIZATION HAS FAILED TO PAY AN ASSESSMENT OR

THAT IT HAS UNDERPAID AN ASSESSMENT, THE DEPARTMENT SHALL

NOTIFY THE MANAGED CARE ORGANIZATION IN WRITING OF THE AMOUNT

DUE, INCLUDING INTEREST, AND THE DATE ON WHICH THE AMOUNT DUE

MUST BE PAID. THE DATE THE AMOUNT IS DUE SHALL NOT BE LESS

THAN 30 DAYS FROM THE DATE OF THE NOTICE.

(5) IN THE EVENT THAT THE DEPARTMENT DETERMINES THAT A

MANAGED CARE ORGANIZATION HAS OVERPAID AN ASSESSMENT, THE

DEPARTMENT SHALL NOTIFY THE MANAGED CARE ORGANIZATION IN

WRITING OF THE OVERPAYMENT, AND WITHIN 30 DAYS OF THE DATE OF

THE NOTICE OF THE OVERPAYMENT, THE MANAGED CARE ORGANIZATION

SHALL ADVISE THE DEPARTMENT TO EITHER AUTHORIZE A REFUND OF

THE AMOUNT OF THE OVERPAYMENT OR OFFSET THE AMOUNT OF THE

OVERPAYMENT AGAINST ANY AMOUNT THAT MAY BE OWED TO THE

DEPARTMENT BY THE MANAGED CARE ORGANIZATION.

(6) AN ASSESSMENT IMPLEMENTED UNDER THIS ARTICLE, AND

ANY INSTRUCTIONS, FORMS OR REPORTS ISSUED BY THE DEPARTMENT

AND REQUIRED TO BE COMPLETED BY A MANAGED CARE ORGANIZATION

UNDER THIS ARTICLE SHALL NOT BE SUBJECT TO THE ACT OF JULY

31, 1968 (P.L.769, NO.240), REFERRED TO AS THE COMMONWEALTH

DOCUMENTS LAW, THE ACT OF OCTOBER 15, 1980 (P.L.950, NO.164),

KNOWN AS THE COMMONWEALTH ATTORNEYS ACT, AND THE ACT OF JUNE

25, 1982 (P.L.633, NO.181), KNOWN AS THE REGULATORY REVIEW

ACT.

SECTION 803-I. ASSESSMENT AMOUNT.

(A) ASSESSMENT.--THE ASSESSMENT IMPLEMENTED UNDER THIS

ARTICLE SHALL BE IMPOSED AS A FIXED FEE IN ACCORDANCE WITH

SUBSECTION (B). THE ASSESSMENT SHALL BE REMITTED ELECTRONICALLY

IN PERIODIC SUBMISSIONS AS SPECIFIED BY THE DEPARTMENT NOT TO

20150HB1322PN2628 - 36 -

EXCEED FIVE TIMES PER YEAR.

(B) FIXED FEE.--BEGINNING JULY 1, 2016, AND ENDING JUNE 30,

2020, THE MANAGED CARE ORGANIZATION SHALL BE ASSESSED A FIXED

FEE OF $13.48 FOR EACH UNDUPLICATED MEMBER FOR EACH MONTH THE

MEMBER IS ENROLLED FOR ANY PERIOD OF TIME WITH THE MANAGED CARE

ORGANIZATION.

TO THE FIXED FEE SPECIFIED UNDER SUBSECTION (B) FOR ALL OR PART

OF THE FISCAL YEAR SO LONG AS THE ASSESSMENT DOES NOT EXCEED THE

MAXIMUM LIMIT SPECIFIED UNDER SUBSECTION (D). BEFORE ADJUSTING

THE FIXED FEE, THE SECRETARY SHALL PUBLISH A NOTICE IN THE

PENNSYLVANIA BULLETIN THAT SPECIFIES THE PROPOSED ADJUSTED FIXED

FEE AND IDENTIFIES THE ESTIMATED AGGREGATE IMPACT ON MANAGED

CARE ORGANIZATIONS. INTERESTED PARTIES SHALL HAVE 30 DAYS IN

WHICH TO SUBMIT COMMENTS TO THE SECRETARY. UPON EXPIRATION OF

THE 30-DAY COMMENT PERIOD, THE SECRETARY, AFTER CONSIDERATION OF

THE COMMENTS, SHALL PUBLISH A SECOND NOTICE IN THE PENNSYLVANIA

BULLETIN ANNOUNCING THE ADJUSTED FIXED FEE.

(D) MAXIMUM AMOUNT.--IN EACH YEAR IN WHICH THE ASSESSMENT IS

IMPLEMENTED, THE ASSESSMENT SHALL NOT EXCEED THE MAXIMUM

AGGREGATE AMOUNT THAT MAY BE ASSESSED UNDER 42 CFR 433.68(F)(3)

(I) (RELATING TO PERMISSIBLE HEALTH CARE-RELATED TAXES) OR ANY

OTHER MAXIMUM ESTABLISHED UNDER FEDERAL LAW.

(E) LIMITED REVIEW.--

(1) EXCEPT AS PERMITTED UNDER SECTION 809-I, THE

SECRETARY'S DETERMINATION OF THE ASSESSMENT AMOUNTS UNDER

SUBSECTIONS (B) AND (C) SHALL NOT BE SUBJECT TO

ADMINISTRATIVE OR JUDICIAL REVIEW UNDER 2 PA.C.S. CHS. 5

SUBCH. A (RELATING TO PRACTICE AND PROCEDURE OF COMMONWEALTH

AGENCIES) AND 7 SUBCH. A (RELATING TO JUDICIAL REVIEW OF

20150HB1322PN2628 - 37 -

COMMONWEALTH AGENCY ACTION) OR ANY OTHER PROVISION OF LAW.

(2) ANY ASSESSMENTS IMPLEMENTED UNDER THIS ARTICLE OR

FORMS OR REPORTS REQUIRED TO BE COMPLETED BY MANAGED CARE

ORGANIZATIONS UNDER THIS ARTICLE SHALL NOT BE SUBJECT TO THE

ACT OF JULY 31, 1968 (P.L.769, NO.240), REFERRED TO AS THE

COMMONWEALTH DOCUMENTS LAW, THE ACT OF OCTOBER 15, 1980

(P.L.950, NO.164), KNOWN AS THE COMMONWEALTH ATTORNEYS ACT,

AND THE ACT OF JUNE 25, 1982 (P.L.633, NO.181), KNOWN AS THE

REGULATORY REVIEW ACT.

SECTION 804-I. NO HOLD HARMLESS.

NO MANAGED CARE ORGANIZATION SHALL BE GUARANTEED A REPAYMENT

OF ITS ASSESSMENT IN DEROGATION OF 42 CFR 433.68(F) (RELATING TO

PERMISSIBLE HEALTH CARE-RELATED TAXES), EXCEPT THAT, IN EACH

FISCAL YEAR IN WHICH AN ASSESSMENT IS IMPLEMENTED, THE

DEPARTMENT SHALL USE THE ASSESSMENT PROCEEDS FOR THE PURPOSES

SPECIFIED IN SECTION 805-I TO THE EXTENT PERMISSIBLE UNDER

FEDERAL AND STATE LAW OR REGULATION AND WITHOUT CREATING AN

INDIRECT GUARANTEE TO HOLD HARMLESS, AS THOSE TERMS ARE USED

UNDER 42 CFR 433.68(F).

SECTION 805-I. RESTRICTED ACCOUNT.

THERE IS ESTABLISHED A RESTRICTED ACCOUNT IN THE GENERAL FUND

FOR THE RECEIPT AND DEPOSIT OF ASSESSMENT PROCEEDS. FUNDS IN THE

ACCOUNT ARE APPROPRIATED TO THE DEPARTMENT AND SHALL BE USED TO

MAINTAIN ACTUARIALLY SOUND RATES FOR THE MEDICAID MANAGED CARE

ORGANIZATIONS AND TO FUND OTHER MEDICAL ASSISTANCE EXPENDITURES.

FUNDS IN THE ACCOUNT MAY BE USED TO FUND EXPENDITURES FOR

MANAGED CARE HEALTH COVERAGE PROVIDED THROUGH STATE ADMINISTERED

PROGRAMS FOR PERSONS OF LOW INCOME OR CHIP, TO THE EXTENT

PERMISSIBLE UNDER FEDERAL AND STATE LAW OR REGULATION AND

WITHOUT CREATING A GUARANTEE TO HOLD HARMLESS, AS THOSE TERMS

20150HB1322PN2628 - 38 -

ARE USED IN 42 CFR 433.68(F) (RELATING TO PERMISSIBLE HEALTH-

CARE RELATED TAXES).

SECTION 806-I. ACCESS TO INFORMATION AND RECORDS.

(A) REPORTS AND ACCESS.--A MANAGED CARE ORGANIZATION SHALL

REPORT SUCH INFORMATION AND SHALL PROVIDE ACCESS TO AND SHALL

FURNISH SUCH RECORDS TO THE DEPARTMENT, WITHOUT CHARGE, AS THE

DEPARTMENT MAY SPECIFY IN ORDER FOR THE DEPARTMENT TO:

(1) DETERMINE THE AMOUNT OF ASSESSMENT DUE FROM THE

MANAGED CARE ORGANIZATION;

(2) VERIFY THAT THE MANAGED CARE ORGANIZATION HAS

CALCULATED AND PAID THE CORRECT AMOUNT DUE; OR

(3) DETERMINE THAT THE ASSESSMENT, AS A PERCENTAGE OF

MANAGED CARE REVENUE, DOES NOT EXCEED THE MAXIMUM LIMIT

SPECIFIED IN SECTION 803-I(D).

(B) USE.--INFORMATION AND RECORDS SUBMITTED TO THE

DEPARTMENT UNDER THIS SECTION SHALL BE USED ONLY FOR THE

PURPOSES SPECIFIED IN THIS SECTION.

SECTION 807-I. REMEDIES.

IN ADDITION TO ANY OTHER REMEDY PROVIDED BY LAW, THE

DEPARTMENT MAY ENFORCE THIS ARTICLE BY IMPOSING ONE OR MORE OF

THE FOLLOWING REMEDIES:

(1) IF A MANAGED CARE ORGANIZATION FAILS TO PAY AN

ASSESSMENT OR PENALTY IN THE AMOUNT OR ON THE DATE REQUIRED

BY THIS ARTICLE, THE DEPARTMENT SHALL ADD INTEREST AT THE

RATE PROVIDED IN SECTION 806 OF THE ACT OF APRIL 9, 1929

(P.L.343, NO.176), KNOWN AS THE FISCAL CODE, TO THE UNPAID

AMOUNT OF THE ASSESSMENT OR PENALTY FROM THE DATE PRESCRIBED

FOR ITS PAYMENT UNTIL THE DATE IT IS PAID.

(2) IF A MANAGED CARE ORGANIZATION FAILS TO FILE A

REPORT OR TO FURNISH RECORDS TO THE DEPARTMENT AS REQUIRED BY

20150HB1322PN2628 - 39 -

THIS ARTICLE, THE DEPARTMENT SHALL IMPOSE A PENALTY AGAINST

THE MANAGED CARE ORGANIZATION IN THE AMOUNT OF $1,000 PER DAY

FOR EACH DAY THE REPORT OR REQUIRED RECORDS ARE NOT SUBMITTED

OR FURNISHED TO THE DEPARTMENT. IF THE PENALTY UNDER THIS

PARAGRAPH IS IMPOSED, IT SHALL COMMENCE ON THE FIRST DAY

AFTER THE DATE FOR WHICH A REPORT FORM OR RECORDS ARE DUE.

(3) IF A MEDICAID MANAGED CARE ORGANIZATION, OR A

MANAGED CARE ORGANIZATION THAT IS RELATED THROUGH COMMON

OWNERSHIP OR CONTROL AS DEFINED IN 42 CFR 413.17(B) (RELATING

TO COST TO RELATED ORGANIZATIONS) TO A MEDICAL ASSISTANCE

PROVIDER OR TO A MANAGED CARE SERVICES ENTITY PROVIDING

MANAGED HEALTH CARE COVERAGE THROUGH A STATE PROGRAM FOR

PERSONS OF LOW INCOME OR CHIP, FAILS TO PAY ALL OR PART OF AN

ASSESSMENT OR PENALTY WITHIN 60 DAYS OF THE DATE THAT PAYMENT

IS DUE, AT THE DIRECTION OF THE DEPARTMENT, THE AMOUNT OF THE

UNPAID ASSESSMENT OR PENALTY AND ANY INTEREST OWED BY THE

MANAGED CARE ORGANIZATION, MAY BE DEDUCTED FROM ANY MEDICAL

ASSISTANCE PAYMENTS DUE TO THE MEDICAID MANAGED CARE

ORGANIZATION OR TO ANY RELATED MEDICAL ASSISTANCE PROVIDER OR

FROM ANY OTHER STATE PAYMENTS DUE TO A RELATED MANAGED CARE

SERVICE ENTITY UNTIL THE FULL AMOUNT IS RECOVERED. ANY SUCH

DEDUCTION SHALL BE MADE ONLY AFTER WRITTEN NOTICE TO THE

MEDICAID MANAGED CARE ORGANIZATION AND THE RELATED MEDICAL

ASSISTANCE PROVIDER OR MANAGED CARE SERVICE ENTITY AND MAY BE

TAKEN IN INSTALLMENTS OVER A PERIOD OF TIME, TAKING INTO

ACCOUNT THE FINANCIAL CONDITION OF THE MEDICAL ASSISTANCE

PROVIDER OR MANAGED CARE SERVICE ENTITY.

(4) THE SECRETARY MAY WAIVE ALL OR PART OF THE INTEREST

OR PENALTIES ASSESSED AGAINST A MANAGED CARE ORGANIZATION

UNDER THIS ARTICLE FOR GOOD CAUSE SHOWN BY THE MANAGED CARE

20150HB1322PN2628 - 40 -

ORGANIZATION.

SECTION 808-I. LIENS.

ANY ASSESSMENTS IMPLEMENTED AND INTEREST AND PENALTIES

ASSESSED AGAINST A MANAGED CARE ORGANIZATION UNDER THIS ARTICLE

SHALL BE A LIEN ON THE REAL AND PERSONAL PROPERTY OF THE MANAGED

CARE ORGANIZATION IN THE MANNER PROVIDED BY SECTION 1401 OF THE

ACT OF APRIL 9, 1929 (P.L.343, NO.176), KNOWN AS THE FISCAL

CODE, MAY BE ENTERED BY THE DEPARTMENT IN THE MANNER PROVIDED BY

SECTION 1404 OF THE FISCAL CODE AND SHALL CONTINUE AND RETAIN

PRIORITY IN THE MANNER PROVIDED IN SECTION 1404.1 OF THE FISCAL

CODE.

SECTION 809-I. APPEAL RIGHTS.

(A) REQUEST FOR REVIEW.--A MANAGED CARE ORGANIZATION THAT IS

AGGRIEVED BY A DETERMINATION OF THE DEPARTMENT AS TO THE AMOUNT

OF THE ASSESSMENT DUE FROM THE MANAGED CARE ORGANIZATION OR A

REMEDY IMPOSED UNDER SECTION 807-I MAY FILE A REQUEST FOR REVIEW

OF THE DECISION OF THE DEPARTMENT BY THE BUREAU OF HEARINGS AND

APPEALS, WHICH SHALL HAVE EXCLUSIVE JURISDICTION IN SUCH

MATTERS.

(B) PROCEDURES.--THE PROCEDURES AND REQUIREMENTS OF 67

PA.C.S. CH. 11 (RELATING TO MEDICAL ASSISTANCE HEARINGS AND

APPEALS) SHALL APPLY TO REQUESTS FOR REVIEW FILED UNDER THIS

SECTION, EXCEPT THAT IN ANY SUCH REQUEST FOR REVIEW, A MANAGED

CARE ORGANIZATION MAY NOT CHALLENGE THE FIXED FEE UNDER SECTION

803-I, BUT ONLY WHETHER THE DEPARTMENT CORRECTLY DETERMINED THE

ASSESSMENT AMOUNT DUE FROM THE MANAGED CARE ORGANIZATION USING

THE APPLICABLE FIXED FEE IN EFFECT FOR THE FISCAL YEAR.

THIS SECTION SHALL NOT OPERATE AS A STAY OF THE MANAGED CARE

ORGANIZATION'S OBLIGATION TO PAY THE ASSESSMENT AMOUNT DUE FOR A

20150HB1322PN2628 - 41 -

FISCAL YEAR.

SECTION 810-I. TAX EXEMPTION PROVISIONS SUPERSEDED.

THE PROVISIONS OF THE FOLLOWING ACTS SHALL NOT APPLY TO THE

ASSESSMENT IMPOSED BY THIS ARTICLE:

(1) SECTION 2462 OF THE ACT OF MAY 17, 1921 (P.L.682,

NO.284), KNOWN AS THE INSURANCE COMPANY LAW OF 1921.

(2) SECTION 13 OF THE ACT OF DECEMBER 29, 1972

(P.L.1701, NO. 364), KNOWN AS THE HEALTH MAINTENANCE

ORGANIZATION ACT.

(3) THE PROVISIONS OF 40 PA.C.S. § 6103(B) (RELATING TO

EXEMPTION APPLICABLE TO CERTIFIED HOSPITAL PLAN

CORPORATIONS).

(4) THE PROVISIONS OF 40 PA.C.S. § 6307(B) (RELATING TO

EXEMPTIONS APPLICABLE TO CERTIFICATED PROFESSIONAL HEALTH

SERVICE CORPORATIONS).

SECTION 811-I. EXPIRATION.

THE ASSESSMENT AUTHORIZED UNDER THIS ARTICLE SHALL EXPIRE

JUNE 30, 2020.

SECTION 812-I. COORDINATION WITH OTHER AGENCIES.

CONSISTENT WITH ITS AUTHORITY AS THE ONLY COMMONWEALTH AGENCY

RESPONSIBLE FOR THE MEDICAL ASSISTANCE PROGRAM, THE DEPARTMENT

MAY DELEGATE RESPONSIBILITY TO PERFORM FUNCTIONS AND ACTIVITIES

REQUIRED TO IMPLEMENT THE ASSESSMENT AUTHORIZED UNDER THIS

ARTICLE TO OTHER COMMONWEALTH DEPARTMENTS AND AGENCIES UNDER

SECTIONS 501 AND 502 OF THE ACT OF APRIL 9, 1929 (P.L.177,

NO.175), KNOWN AS THE ADMINISTRATIVE CODE OF 1929.

SECTION 15.1. THE DEFINITION OF "CHILDREN'S INSTITUTIONS" IN

SECTION 901 OF THE ACT, AMENDED DECEMBER 5, 1980 (P.L.1112,

NO.193), IS AMENDED AND THE SECTION IS AMENDED BY ADDING A

DEFINITION TO READ:

20150HB1322PN2628 - 42 -

SECTION 901. DEFINITIONS.--AS USED IN THIS ARTICLE--

"CHILD DAY CARE" MEANS CARE IN LIEU OF PARENTAL CARE GIVEN

FOR PART OF THE TWENTY-FOUR HOUR DAY TO A CHILD UNDER SIXTEEN

YEARS OF AGE, AWAY FROM THE CHILD'S HOME, BUT DOES NOT INCLUDE

CHILD DAY CARE FURNISHED IN A PLACE OF WORSHIP DURING RELIGIOUS

SERVICES.

"CHILDREN'S INSTITUTIONS" MEANS ANY INCORPORATED OR

UNINCORPORATED ORGANIZATION, SOCIETY, CORPORATION OR AGENCY,

PUBLIC OR PRIVATE, WHICH MAY RECEIVE OR CARE FOR CHILDREN, OR

PLACE THEM IN FOSTER FAMILY HOMES, EITHER AT BOARD, WAGES OR

FREE; OR ANY INDIVIDUAL WHO, FOR HIRE, GAIN OR REWARD, RECEIVES

FOR CARE A CHILD, UNLESS HE IS RELATED TO SUCH CHILD BY BLOOD OR

MARRIAGE WITHIN THE SECOND DEGREE; OR ANY INDIVIDUAL, NOT IN THE

REGULAR EMPLOY OF THE COURT OR OF AN ORGANIZATION, SOCIETY,

ASSOCIATION OR AGENCY, DULY CERTIFIED BY THE DEPARTMENT, WHO IN

ANY MANNER BECOMES A PARTY TO THE PLACING OF CHILDREN IN FOSTER

HOMES, UNLESS HE IS RELATED TO SUCH CHILDREN BY BLOOD OR

MARRIAGE WITHIN THE SECOND DEGREE, OR IS THE DULY APPOINTED

GUARDIAN THEREOF. THE TERM SHALL NOT INCLUDE A FAMILY [DAY]

CHILD CARE HOME [IN WHICH CARE IS PROVIDED IN LIEU OF PARENTAL

CARE TO SIX OR LESS CHILDREN FOR PART OF A TWENTY-FOUR HOUR DAY]

OR CHILD DAY CARE CENTER OPERATED FOR PROFIT AND SUBJECT TO THE

PROVISIONS OF ARTICLE X.

* * *

SECTION 15.2. THE DEFINITION OF "FACILITY" IN SECTION 1001

OF THE ACT, AMENDED JULY 25, 2007 (P.L.402, NO.56), IS AMENDED

AND THE SECTION IS AMENDED BY ADDING A DEFINITION TO READ:

SECTION 1001. DEFINITIONS.--AS USED IN THIS ARTICLE--

* * *

"FACILITY" MEANS AN ADULT DAY CARE CENTER, CHILD DAY CARE

20150HB1322PN2628 - 43 -

CENTER, FAMILY [DAY] CHILD CARE HOME, BOARDING HOME FOR

CHILDREN, MENTAL HEALTH ESTABLISHMENT, PERSONAL CARE HOME,

ASSISTED LIVING RESIDENCE, NURSING HOME, HOSPITAL OR MATERNITY

HOME, AS DEFINED HEREIN, EXCEPT TO THE EXTENT THAT SUCH A

FACILITY IS OPERATED BY THE STATE OR FEDERAL GOVERNMENTS OR

THOSE SUPERVISED BY THE DEPARTMENT, OR LICENSED PURSUANT TO THE

ACT OF JULY 19, 1979 (P.L.130, NO.48), KNOWN AS THE "HEALTH CARE

FACILITIES ACT."

"FAMILY CHILD CARE HOME" MEANS A HOME WHERE CHILD DAY CARE IS

PROVIDED AT ANY TIME TO NO LESS THAN FOUR CHILDREN AND NO MORE

THAN SIX CHILDREN WHO ARE NOT RELATIVES OF THE CAREGIVER.

* * *

SECTION 15.3. SECTION 1006 OF THE ACT, AMENDED DECEMBER 21,

1988 (P.L.1883, NO.185), IS AMENDED TO READ:

SECTION 1006. FEES.--ANNUAL LICENSES SHALL BE ISSUED WHEN

THE PROPER FEE, IF REQUIRED, IS RECEIVED BY THE DEPARTMENT AND

ALL THE OTHER CONDITIONS PRESCRIBED IN THIS ACT ARE MET. FOR

PERSONAL CARE HOMES, THE FEE SHALL BE AN APPLICATION FEE. THE

FEES SHALL BE:

FACILITY ANNUAL FEE

ADULT DAY CARE CENTER $ 15

MENTAL HEALTH ESTABLISHMENT 50

PERSONAL CARE HOME-- 0 - 20 BEDS 15

-- 21 - 50 BEDS 20

-- 51 - 100 BEDS 30

--101 BEDS AND ABOVE 50

NO FEE SHALL BE REQUIRED FOR THE ANNUAL LICENSE IN THE CASE

OF DAY CARE CENTERS, FAMILY [DAY] CHILD CARE HOMES, BOARDING

HOMES FOR CHILDREN OR FOR PUBLIC OR NONPROFIT MENTAL

INSTITUTIONS.

20150HB1322PN2628 - 44 -

SECTION 15.4. SECTION 1008 OF THE ACT IS AMENDED TO READ:

SECTION 1008. PROVISIONAL LICENSE.--(A) WHEN THERE HAS BEEN

SUBSTANTIAL BUT NOT COMPLETE COMPLIANCE WITH ALL THE APPLICABLE

STATUTES, ORDINANCES AND REGULATIONS AND WHEN THE APPLICANT HAS

TAKEN APPROPRIATE STEPS TO CORRECT DEFICIENCIES, THE DEPARTMENT

SHALL ISSUE A PROVISIONAL LICENSE [FOR A SPECIFIED PERIOD OF NOT

MORE THAN SIX MONTHS WHICH MAY BE RENEWED THREE TIMES. UPON FULL

COMPLIANCE, A REGULAR LICENSE SHALL BE ISSUED IMMEDIATELY].

(B) THE DEPARTMENT MAY ISSUE A PROVISIONAL LICENSE UNDER

THIS SECTION WHEN IT IS UNABLE TO ASSESS COMPLIANCE WITH ALL

STATUTES, ORDINANCES AND REGULATIONS BECAUSE THE FACILITY HAS

NOT YET BEGUN TO OPERATE.

NOT MORE THAN SIX MONTHS WHICH MAY BE RENEWED NO MORE THAN THREE

TIMES.

(D) UPON FULL COMPLIANCE BY THE FACILITY, THE DEPARTMENT

SHALL ISSUE A REGULAR LICENSE IMMEDIATELY.

SECTION 15.5. SECTION 1031 OF THE ACT IS AMENDED TO READ:

SECTION 1031. VIOLATION; PENALTY.--(A) ANY PERSON OPERATING

A FACILITY WITHIN THIS COMMONWEALTH WITHOUT A LICENSE REQUIRED

BY THIS ACT, SHALL UPON CONVICTION [THEREOF IN A SUMMARY

PROCEEDING BE SENTENCED TO PAY A FINE OF NOT LESS THAN TWENTY-

FIVE DOLLARS ($25) NOR MORE THAN THREE HUNDRED DOLLARS ($300),

AND COSTS OF PROSECUTION, AND IN DEFAULT OF THE PAYMENT THEREOF

TO UNDERGO IMPRISONMENT FOR NOT LESS THAN TEN DAYS NOR MORE THAN

THIRTY DAYS. EACH DAY OF OPERATING A FACILITY WITHOUT A LICENSE

REQUIRED BY THIS ACT SHALL CONSTITUTE A SEPARATE OFFENSE.] BE

SENTENCED AS FOLLOWS:

(1) FOR A FIRST OFFENSE, THE PERSON COMMITS A SUMMARY

OFFENSE AND SHALL, UPON CONVICTION, BE SENTENCED TO PAY A FINE

20150HB1322PN2628 - 45 -

NOT LESS THAN TWENTY-FIVE DOLLARS ($25) NOR MORE THAN THREE

HUNDRED DOLLARS ($300), COSTS OF PROSECUTION, AND IF IN DEFAULT

OF PAYMENT THEREOF, TO IMPRISONMENT FOR NOT LESS THAN TEN DAYS

NOR MORE THAN THIRTY DAYS.

(2) FOR A SECOND OFFENSE, THE PERSON COMMITS A MISDEMEANOR

OF THE THIRD DEGREE AND SHALL, UPON CONVICTION, BE SENTENCED TO

PAY A FINE NOT LESS THAN FIVE HUNDRED DOLLARS ($500) NOR MORE

THAN TWO THOUSAND DOLLARS ($2,000), COSTS OF PROSECUTION, AND IF

IN DEFAULT OF PAYMENT THEREOF, TO IMPRISONMENT FOR NOT LESS THAN

THIRTY DAYS NOR MORE THAN ONE YEAR.

(3) FOR A THIRD OFFENSE OR IF THE OPERATION OF THE

UNLICENSED FACILITY RESULTED IN A BODILY INJURY AS DEFINED IN 18

PA.C.S. § 2301 (RELATING TO DEFINITIONS), THE PERSON COMMITS A

MISDEMEANOR OF THE SECOND DEGREE AND SHALL, UPON CONVICTION, BE

SENTENCED TO PAY A FINE OF NOT LESS THAN TWO THOUSAND FIVE

HUNDRED DOLLARS ($2,500) NOR MORE THAN FIVE THOUSAND DOLLARS

($5,000), COSTS OF PROSECUTION, AND IF IN DEFAULT IN PAYMENT

THEREOF, TO IMPRISONMENT FOR NOT LESS THAN ONE YEAR NOR MORE

THAN TWO YEARS.

(4) FOR A FOURTH OR SUBSEQUENT OFFENSE, OR IF THE OPERATION

OF THE UNLICENSED FACILITY RESULTED IN A SERIOUS BODILY INJURY,

AS DEFINED IN 18 PA.C.S. § 2301, OR DEATH, THE PERSON COMMITS A

FELONY OF THE THIRD DEGREE AND SHALL, UPON CONVICTION, BE

SENTENCED TO PAY A FINE OF NOT LESS THAN TEN THOUSAND DOLLARS

($10,000), COSTS OF PROSECUTION, AND IF IN DEFAULT IN PAYMENT

THEREOF, TO IMPRISONMENT FOR NOT LESS THAN FIVE YEARS NOR MORE

THAN SEVEN YEARS.

(B) (1) IF, AFTER FOURTEEN DAYS, A PROVIDER CITED FOR

OPERATING WITHOUT A LICENSE FAILS TO FILE AN APPLICATION FOR A

LICENSE, THE DEPARTMENT SHALL ASSESS AN ADDITIONAL TWENTY

20150HB1322PN2628 - 46 -

DOLLARS ($20) FOR EACH RESIDENT FOR EACH DAY IN WHICH THE

FACILITY FAILS TO MAKE AN APPLICATION. EACH DAY OF OPERATING A

FACILITY WITHOUT A LICENSE REQUIRED BY THIS ACT SHALL CONSTITUTE

A SEPARATE OFFENSE.

(2) WHEN A NON-RESIDENTIAL FACILITY IS FOUND TO BE OPERATING

ON MULTIPLE DAYS, THERE SHALL BE A REBUTTABLE PRESUMPTION THAT

THE FACILITY WAS OPERATING EACH BUSINESS DAY BETWEEN THE DAYS IT

WAS FOUND TO BE IN OPERATION. WHEN A RESIDENTIAL FACILITY IS

FOUND TO BE OPERATING ON MULTIPLE DAYS, THERE SHALL BE A

REBUTTABLE PRESUMPTION THAT A FACILITY WAS OPERATING EACH

CALENDAR DAY BETWEEN THE DAYS IT WAS FOUND TO BE IN OPERATION.

(3) ANY PROVIDER CHARGED WITH VIOLATION OF THIS SUBSECTION

SHALL HAVE THIRTY DAYS TO PAY THE ASSESSED PENALTY IN FULL, OR,

IF THE PROVIDER WISHES TO CONTEST EITHER THE AMOUNT OF THE

PENALTY OR THE FACT OF THE VIOLATION, THE PARTY SHALL FORWARD

THE ASSESSED PENALTY TO THE SECRETARY OF HUMAN SERVICES FOR

PLACEMENT IN AN ESCROW ACCOUNT WITH THE STATE TREASURER. IF,

THROUGH ADMINISTRATIVE HEARING OR JUDICIAL REVIEW OF THE

PROPOSED PENALTY, IT IS DETERMINED THAT NO VIOLATION OCCURRED OR

THAT THE AMOUNT OF THE PENALTY SHALL BE REDUCED, THE SECRETARY

SHALL WITHIN THIRTY DAYS REMIT THE APPROPRIATE AMOUNT TO THE

PROVIDER WITH ANY INTEREST ACCUMULATED BY THE ESCROW DEPOSIT.

FAILURE TO FORWARD THE PAYMENT TO THE SECRETARY WITHIN THIRTY

DAYS SHALL RESULT IN A WAIVER OF RIGHTS TO CONTEST THE FACT OF

THE VIOLATION OR THE AMOUNT OF THE PENALTY. THE AMOUNT ASSESSED

AFTER ADMINISTRATIVE HEARING OR A WAIVER OF THE ADMINISTRATIVE

HEARING SHALL BE PAYABLE TO THE COMMONWEALTH OF PENNSYLVANIA AND

SHALL BE COLLECTIBLE IN ANY MANNER PROVIDED BY LAW FOR THE

COLLECTION OF DEBTS. IF ANY PROVIDER LIABLE TO PAY SUCH PENALTY

NEGLECTS OR REFUSES TO PAY THE SAME AFTER DEMAND, SUCH FAILURE

20150HB1322PN2628 - 47 -

TO PAY SHALL CONSTITUTE A JUDGMENT IN FAVOR OF THE COMMONWEALTH

IN THE AMOUNT OF THE PENALTY, TOGETHER WITH THE INTEREST AND ANY

COSTS THAT MAY ACCRUE.

(4) MONEY COLLECTED BY THE DEPARTMENT UNDER THIS SECTION

SHALL BE PLACED IN A SPECIAL RESTRICTED RECEIPT ACCOUNT AND

SHALL BE FIRST USED TO DEFRAY THE EXPENSES INCURRED BY RESIDENTS

RELOCATED UNDER THIS ACT. ANY MONEYS REMAINING IN THIS ACCOUNT

SHALL ANNUALLY BE REMITTED TO THE DEPARTMENT FOR ENFORCING THE

PROVISIONS OF THIS ARTICLE. FINES COLLECTED PURSUANT TO THIS ACT

SHALL NOT BE SUBJECT TO THE PROVISIONS OF 42 PA.C.S. § 3733

(RELATING TO DEPOSITS INTO ACCOUNT).

IMPOSED IN ADDITION TO EACH OTHER AND TO ANY OTHER APPLICABLE

CRIMINAL, CIVIL, OR ADMINISTRATIVE PENALTY, ACTION OR SANCTION

OTHERWISE PROVIDED BY LAW.

SECTION 16. SUBARTICLE (C) OF ARTICLE X OF THE ACT IS

REPEALED:

[(C) REGISTRATION PROVISIONS

SECTION 1070. DEFINITIONS.--AS USED IN THIS ARTICLE.--

"CHILD DAY CARE" MEANS CARE IN LIEU OF PARENTAL CARE GIVEN

FOR PART OF THE TWENTY-FOUR HOUR DAY TO CHILDREN AWAY FROM THEIR

OWN HOMES.

"FAMILY DAY CARE HOME" MEANS ANY HOME IN WHICH CHILD DAY CARE

IS PROVIDED AT ANY ONE TIME TO FOUR THROUGH SIX CHILDREN WHO ARE

NOT RELATIVES OF THE CAREGIVER.

SECTION 1071. OPERATION WITHOUT REGISTRATION CERTIFICATE

PROHIBITED.--NO INDIVIDUAL SHALL OPERATE A FAMILY DAY CARE HOME

WITHOUT A REGISTRATION CERTIFICATE ISSUED THEREFOR BY THE

DEPARTMENT.

SECTION 1072. APPLICATION FOR REGISTRATION CERTIFICATE.--(A)

20150HB1322PN2628 - 48 -

ANY INDIVIDUAL DESIRING TO SECURE A REGISTRATION CERTIFICATE

SHALL SUBMIT AN APPLICATION THEREFOR TO THE DEPARTMENT UPON

FORMS PREPARED AND FURNISHED BY THE DEPARTMENT, AND, AT THE SAME

TIME, SHALL CERTIFY IN WRITING THAT HE/SHE AND THE FACILITY

NAMED IN THE APPLICATION ARE IN COMPLIANCE WITH APPLICABLE

DEPARTMENT REGULATIONS.

(B) APPLICATION FOR RENEWAL OF THE REGISTRATION CERTIFICATE

SHALL BE MADE EVERY TWO YEARS IN THE SAME MANNER AS APPLICATION

FOR THE ORIGINAL REGISTRATION CERTIFICATE.

FAMILY DAY CARE HOME.

SECTION 1073. ISSUANCE OF REGISTRATION CERTIFICATE.--UPON

RECEIPT OF AN APPLICATION AND THE APPLICANT'S WRITTEN

CERTIFICATION OF COMPLIANCE WITH APPLICABLE DEPARTMENT

REGULATIONS, THE DEPARTMENT SHALL ISSUE A REGISTRATION

CERTIFICATE TO THE APPLICANT FOR THE PREMISES NAMED IN THE

APPLICATION. A REGISTRATION CERTIFICATE SHALL BE ISSUED FOR A

PERIOD OF TWO YEARS.

SECTION 1074. VISITATION AND INSPECTION.--THE DEPARTMENT OR

AUTHORIZED AGENT OF THE DEPARTMENT SHALL HAVE THE RIGHT TO

ENTER, VISIT AND INSPECT ON A RANDOM SAMPLE BASIS, UPON

COMPLAINT, OR UPON REQUEST OF THE CAREGIVER, ANY FAMILY DAY CARE

HOME REGISTERED OR REQUIRING REGISTRATION UNDER THIS ARTICLE AND

SHALL HAVE FREE AND FULL ACCESS TO THE PREMISES, WHERE CHILDREN

ARE CARED FOR, ALL RECORDS OF THE PREMISES WHICH RELATE TO THE

CHILDREN'S CARE, AND TO THE CHILDREN CARED FOR THEREIN AND FULL

OPPORTUNITY TO SPEAK WITH OR OBSERVE SUCH CHILDREN.

SECTION 1075. RECORDS.--EVERY INDIVIDUAL WHO OPERATES A

FAMILY DAY CARE HOME REGISTERED UNDER THIS ARTICLE SHALL KEEP

AND MAINTAIN SUCH RECORDS AS REQUIRED BY THE DEPARTMENT.

20150HB1322PN2628 - 49 -

SECTION 1076. REGULATIONS.--THE DEPARTMENT IS HEREBY

AUTHORIZED AND EMPOWERED TO ADOPT REGULATIONS ESTABLISHING

MINIMUM AND REASONABLE STANDARDS FOR THE OPERATION OF FAMILY DAY

CARE HOMES AND THE ISSUANCE OF REGISTRATION CERTIFICATES. THESE

REGULATIONS WILL ESTABLISH THE MINIMUM STANDARDS OF SAFETY AND

CARE WHICH WILL BE REQUIRED IN FAMILY DAY CARE HOMES AND WILL

RECOGNIZE THE VITAL ROLE WHICH PARENTS AND GUARDIANS PLAY IN

MONITORING THE CARE PROVIDED IN FAMILY DAY CARE HOMES.

SECTION 1077. TECHNICAL ASSISTANCE.--THE DEPARTMENT MAY

OFFER AND PROVIDE UPON REQUEST TECHNICAL ASSISTANCE TO

CAREGIVERS TO ASSIST THEM IN COMPLYING WITH DEPARTMENT

REGULATIONS.

SECTION 1078. OPERATION WITHOUT REGISTRATION CERTIFICATE.--

NO INDIVIDUAL SHALL OPERATE A FAMILY DAY CARE HOME WITHOUT

HAVING A REGISTRATION CERTIFICATE. ANY INDIVIDUAL OPERATING A

FAMILY DAY CARE HOME WITHOUT A REGISTRATION CERTIFICATE, AFTER

BEING NOTIFIED THAT SUCH A REGISTRATION IS REQUIRED, SHALL UPON

CONVICTION PAY A FINE OF NOT LESS THAN TWENTY DOLLARS ($20) NOR

MORE THAN ONE HUNDRED DOLLARS ($100) AND COSTS OF PROSECUTION.

EACH DAY OF OPERATING WITHOUT A REGISTRATION CERTIFICATE SHALL

CONSTITUTE A SEPARATE OFFENSE.

SECTION 1079. DENIAL, NONRENEWAL, OR REVOCATION.--(A)

WHENEVER A CAREGIVER DOES NOT CERTIFY COMPLIANCE OR WHENEVER

UPON INSPECTION THE DEPARTMENT OBSERVES NONCOMPLIANCE WITH

APPLICABLE DEPARTMENT REGULATIONS, THE DEPARTMENT SHALL GIVE

WRITTEN NOTICE THEREOF TO THE OFFENDING PERSON. SUCH NOTICE

SHALL DENY ISSUANCE OF A REGISTRATION CERTIFICATE, DENY RENEWAL

OF A REGISTRATION CERTIFICATE, OR SHALL REQUIRE THE OFFENDING

PERSON TO TAKE ACTION TO BRING THE FACILITY INTO COMPLIANCE WITH

REGULATIONS.

20150HB1322PN2628 - 50 -

(B) THE DEPARTMENT SHALL REFUSE TO ISSUE OR RENEW A

REGISTRATION CERTIFICATE OR SHALL REVOKE A REGISTRATION

CERTIFICATE FOR ANY OF THE FOLLOWING REASONS:

(1) NONCOMPLIANCE WITH DEPARTMENT REGULATIONS.

(2) FRAUD OR DECEIT IN THE SELF-CERTIFICATION PROCESS.

(3) LENDING, BORROWING, OR USING THE REGISTRATION

CERTIFICATE OF ANOTHER CAREGIVER, OR IN ANY WAY KNOWINGLY AIDING

THE IMPROPER ISSUANCE OF A REGISTRATION CERTIFICATE.

(4) GROSS INCOMPETENCE, NEGLIGENCE, OR MISCONDUCT IN

OPERATING THE FACILITY.

(5) MISTREATING OR ABUSING CHILDREN CARED FOR IN THE

FACILITY.

SECTION 1080. EMERGENCY CLOSURE.--IF THE DEPARTMENT, OR

AUTHORIZED AGENT OF THE DEPARTMENT OBSERVES A CONDITION AT A

FAMILY DAY CARE HOME WHICH PLACES THE CHILDREN CARED FOR THEREIN

IN IMMEDIATE LIFE-THREATENING DANGER, THE DEPARTMENT SHALL

MAINTAIN AN ACTION IN THE NAME OF THE COMMONWEALTH FOR AN

INJUNCTION OR OTHER PROCESS RESTRAINING OR PROHIBITING THE

OPERATION OF THE FACILITY.]

SECTION 17. THE DEFINITION OF "ELIGIBLE PERMANENT LEGAL

CUSTODIAN" IN SECTION 1302 OF THE ACT, AMENDED JUNE 30, 2012

(P.L.668, NO.80), IS AMENDED AND THE SECTION IS AMENDED BY

ADDING DEFINITIONS TO READ:

SECTION 1302. DEFINITIONS.

THE FOLLOWING WORDS AND PHRASES WHEN USED IN THIS ARTICLE

SHALL HAVE THE MEANINGS GIVEN TO THEM IN THIS SECTION UNLESS THE

CONTEXT CLEARLY INDICATES OTHERWISE:

* * *

"ELIGIBLE PERMANENT LEGAL CUSTODIAN." A RELATIVE OR KIN:

(1) WHOSE HOME IS APPROVED PURSUANT TO APPLICABLE

20150HB1322PN2628 - 51 -

REGULATIONS FOR PLACEMENT OF FOSTER CHILDREN;

(2) WITH WHOM AN ELIGIBLE CHILD HAS RESIDED FOR AT LEAST

SIX MONTHS, WHICH NEED NOT BE CONSECUTIVE; AND

(3) WHO MEETS THE REQUIREMENTS [FOR EMPLOYMENT IN CHILD-

CARE SERVICES PURSUANT TO] TO BE APPROVED AS A FOSTER PARENT

UNDER 23 PA.C.S. § 6344 (RELATING TO [INFORMATION RELATING TO

PROSPECTIVE CHILD-CARE PERSONNEL] EMPLOYEES HAVING CONTACT

WITH CHILDREN; ADOPTIVE AND FOSTER PARENTS).

* * *

"SIBLING." AN INDIVIDUAL WHO HAS AT LEAST ONE PARENT IN

COMMON WITH ANOTHER INDIVIDUAL, WHETHER BY BLOOD, MARRIAGE OR

ADOPTION, REGARDLESS OF WHETHER OR NOT THERE IS A TERMINATION OF

PARENTAL RIGHTS OR PARENTAL DEATH. THE TERM INCLUDES BIOLOGICAL,

ADOPTIVE, STEP AND HALF SIBLINGS.

* * *

"SUCCESSOR PERMANENT LEGAL CUSTODIAN." A RELATIVE OR KIN:

(1) WITH WHOM AN ELIGIBLE CHILD RESIDES FOR ANY PERIOD

OF TIME;

(2) WHO HAS BEEN NAMED AS A SUCCESSOR IN A PERMANENT

LEGAL CUSTODIANSHIP AGREEMENT EXECUTED BY AN ELIGIBLE CHILD'S

PREVIOUS ELIGIBLE PERMANENT LEGAL CUSTODIAN; AND

(3) WHO MEETS THE REQUIREMENTS FOR EMPLOYMENT IN CHILD-

CARE SERVICES AND APPROVAL AS A FOSTER OR ADOPTIVE PARENT

UNDER 23 PA.C.S. § 6344 (RELATING TO EMPLOYEES HAVING CONTACT

WITH CHILDREN; ADOPTIVE AND FOSTER PARENTS).

SECTION 18. SECTIONS 1303(A.1) AND 1303.2(A) OF THE ACT,

ADDED JUNE 30, 2012 (P.L.668, NO.80), ARE AMENDED TO READ:

SECTION 1303. KINSHIP CARE PROGRAM.

* * *

(A.1) RELATIVE NOTIFICATION.--EXCEPT IN SITUATIONS OF FAMILY

20150HB1322PN2628 - 52 -

OR DOMESTIC VIOLENCE, THE COUNTY AGENCY SHALL EXERCISE DUE

DILIGENCE TO IDENTIFY AND NOTIFY ALL GRANDPARENTS AND OTHER

ADULT RELATIVES TO THE FIFTH DEGREE OF CONSANGUINITY OR AFFINITY

TO THE PARENT OR STEPPARENT OF A DEPENDENT CHILD AND EACH PARENT

WHO HAS LEGAL CUSTODY OF A SIBLING OF A DEPENDENT CHILD WITHIN

30 DAYS OF THE CHILD'S REMOVAL FROM THE CHILD'S HOME WHEN

TEMPORARY LEGAL AND PHYSICAL CUSTODY HAS BEEN TRANSFERRED TO THE

COUNTY AGENCY. THE NOTICE MUST EXPLAIN ALL OF THE FOLLOWING:

(1) ANY OPTIONS UNDER FEDERAL AND STATE LAW AVAILABLE TO

THE RELATIVE TO PARTICIPATE IN THE CARE AND PLACEMENT OF THE

CHILD, INCLUDING ANY OPTIONS THAT WOULD BE LOST BY FAILING TO

RESPOND TO THE NOTICE.

(2) THE REQUIREMENTS TO BECOME A FOSTER PARENT,

PERMANENT LEGAL CUSTODIAN OR ADOPTIVE PARENT.

(3) THE ADDITIONAL SUPPORTS THAT ARE AVAILABLE FOR

CHILDREN REMOVED FROM THE CHILD'S HOME.

* * *

SECTION 1303.2. PERMANENT LEGAL CUSTODIANSHIP SUBSIDY AND

REIMBURSEMENT.

(A) AMOUNT.--THE AMOUNT OF PERMANENT LEGAL CUSTODIANSHIP

SUBSIDY FOR MAINTENANCE COSTS TO A PERMANENT LEGAL CUSTODIAN OR

A SUCCESSOR PERMANENT LEGAL CUSTODIAN SHALL NOT EXCEED THE

MONTHLY PAYMENT RATE FOR FOSTER FAMILY CARE IN THE COUNTY IN

WHICH THE CHILD RESIDES.

* * *

SECTION 19. (RESERVED).

SECTION 20. THE REQUIREMENT THAT A FAMILY CHILD CARE HOME BE

LICENSED AS A FACILITY AS DEFINED IN SECTION 1001 OF THE ACT

SHALL APPLY UPON EXPIRATION OF THE FAMILY CHILD CARE HOME'S

CURRENT CERTIFICATE OF REGISTRATION.

20150HB1322PN2628 - 53 -

SECTION 21. THIS ACT SHALL TAKE EFFECT AS FOLLOWS:

(1) THE FOLLOWING PROVISIONS SHALL TAKE EFFECT IN 60

DAYS:

(I) THE ADDITION OF SECTION 405.1B.

(II) THE AMENDMENT OF SECTION 432.4 OF THE ACT.

(2) EXCEPT AS SET FORTH IN PARAGRAPH (3), THE ADDITION

OF ARTICLE VIII-I OF THE ACT SHALL TAKE EFFECT ON JULY 1,

2016, OR IMMEDIATELY, WHICHEVER IS LATER.

(3) THE ADDITION OF SECTIONS 801-I, 806-I AND 807-I(2)

OF THE ACT SHALL TAKE EFFECT IMMEDIATELY.

(4) THE FOLLOWING PROVISIONS SHALL TAKE EFFECT

IMMEDIATELY:

(I) THIS SECTION.

(II) THE REMAINDER OF THIS ACT.

20150HB1322PN2628 - 54 -