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PRINTER'S NO. 2864
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No.
1997
Session of
2018
INTRODUCED BY BERNSTINE, DeLISSIO, BAKER, DRISCOLL, LONGIETTI,
STURLA, PHILLIPS-HILL, KINSEY, SCHLOSSBERG, D. COSTA,
CHARLTON, HILL-EVANS, SCHWEYER AND MURT, JANUARY 5, 2018
REFERRED TO COMMITTEE ON HEALTH, JANUARY 5, 2018
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 medical assistance,
providing for medical assistance deemed eligibility program
for in-patient behavioral health services.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. The act of June 13, 1967 (P.L.31, No.21), known
as the Human Services Code, is amended by adding a section to
read:
Section 449.1. Medical Assistance Deemed Eligibility Program
for In-Patient Behavioral Health Services.--(a) The department
shall establish a deemed eligibility program for in-patient
behavioral health services for the purposes specified under
subsection (b).
(b) The department shall implement the program for the
following purposes:
(1) Preventing harm to an individual with an immediate need
for in-patient behavioral health services as a result of a
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health crisis or emergency based upon prior hospitalizations for
a chronic behavioral health condition.
(2) Providing an individual with an immediate need for in-
patient behavioral health services with access to an emergency
room, a freestanding private psychiatric hospital, a law
enforcement facility or a health crisis center if necessary to
protect the individual's physical or mental health.
(3) Providing medical assistance eligibility for in-patient
behavioral health services during the period of hospitalization
and after discharge from hospitalization.
(4) Authorizing a qualified entity to submit an application
to the department on behalf of an individual to determine the
individual's eligibility to receive medical assistance for in-
patient behavioral health services.
(5) Permitting an individual who is applying for medical
assistance or a qualified entity on behalf of the individual
under paragraph (4) to declare income and assets on an
application form and attest to the accuracy of the income and
assets provided on the application form.
(6) Authorizing a qualified entity to determine if an
individual is deemed eligible to receive medical assistance for
in-patient behavioral health services.
(c) The following apply:
(1) If a qualified entity determines that an individual
is deemed eligible to receive medical assistance under
subsection (b)(6), the individual may begin receiving in-patient
behavioral health services from the qualified entity.
(2) Except as provided under paragraph (3), if a qualified
entity determines that an individual is deemed eligible to
receive medical assistance under subsection (b)(6) and the
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individual is subsequently determined to be ineligible for
medical assistance by the department under subsection (d), the
qualified entity shall not be reimbursed by the Commonwealth for
the cost of in-patient behavioral health services provided
during the period of presumed eligibility.
(3) If an individual provided fraudulent information to a
qualified entity making a determination under subsection (b)(6),
the qualified entity may seek reimbursement from the individual
for the cost of in-patient behavioral health services provided
during the period of presumed eligibility.
(4) Upon request, the department shall provide information
to a qualified entity about Commonwealth policies and procedures
on how to determine whether an individual is deemed eligible for
medical assistance under subsection (b)(6).
(d) The following apply:
(1) Within sixty days of the submission of an application
under subsection (b)(4), the department shall verify the
information on the application and make a final determination of
medical assistance eligibility. The department may request
additional information from an applicant for the purpose of
completing the verification process under this paragraph.
(2) If the department determines that an individual is
eligible under paragraph (1), the department shall authorize
medical assistance payments for in-patient behavioral health
services during the period of presumed eligibility beginning on
the date when the qualified entity was deemed eligible under
subsection (b)(6).
(e) The department shall issue a medical assistance bulletin
which contains the Commonwealth policies and procedures
necessary to implement this section.
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(f) The department shall apply for any necessary Federal
waivers and maximize the use of Federal money for the purpose of
implementing the program.
(g) The department shall issue any revisions to the State
medical assistance plan as required under Title XIX of the
Social Security Act (49 Stat. 620, 42 U.S.C. ยง 1396 et seq.)
before implementing the program.
(h) On or before July 1 of each year, the department shall
issue a report to the General Assembly with the following
information:
(1) The number of individuals participating in the program.
(2) The average cost per individual in the program.
(3) The number of qualified entities in the program.
(4) The administrative cost of the program.
(5) The estimated savings from the program.
(i) The following words and phrases when used in this
section shall have the meaning given to them in this subsection:
"Freestanding private psychiatric hospital" means a hospital
licensed by the department and enrolled in the medical
assistance program as a provider type 01-011.
"In-patient behavioral health services" means medically
necessary treatment and related services provided in a
psychiatric unit of an acute care hospital or a freestanding
private psychiatric hospital and covered under the medical
assistance program.
"Program" means the deemed eligibility program for in-patient
behavioral health services established by the department under
subsection (a).
"Psychiatric unit of a licensed acute care hospital" means a
hospital licensed by the department or the Department of Health
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and enrolled in the medical assistance program as a provider
type 01-022.
"Qualified entity" means a psychiatric unit of a licensed
acute care hospital or a freestanding private psychiatric
hospital authorized by the department to participate in the
program.
Section 2. This act shall take effect in 60 days.
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