PRIOR PRINTER'S NOS. 1234, 2038, 2063

PRINTER'S NO. 2068

THE GENERAL ASSEMBLY OF PENNSYLVANIA

SENATE BILL

No.

912

Session of

2017

INTRODUCED BY BROOKS, STREET, WHITE, BREWSTER, GREENLEAF,

MENSCH, COSTA, HAYWOOD, BROWNE, VULAKOVICH, SCHWANK, MARTIN,

BAKER, HUGHES, LEACH, VOGEL, TARTAGLIONE, WAGNER, REGAN AND

providing for medical assistance deemed eligibility program

for home care, home health and older adult daily living

center 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 443.13. Medical Assistance Deemed Eligibility

Program for Home Care , Home Health and Older Adult Daily Living

care and assistance with daily living in a less restrictive

setting.

(b) The program shall:

(1) be designed to provide home care services, home health

services and older adult daily living center services only for

individuals who are sixty-five years of age or older and nursing

facility clinically eligible;

(2) permit a qualified entity to submit an application for

medical assistance on behalf of individuals to the department;

(c) The following apply:

(1) If a qualified entity determines that an individual is

deemed eligible to receive medical assistance under subsection

(b)(4), the individual may begin receiving home care services,

home health services and older adult daily living center

services from a medical assistance provider as soon as T HE

INDIVIDUAL SIGNS a preliminary service plan is de veloped FOR

THOSE SERVICES . As authorized under Federal law, the department

shall apply a final determination of medical assistance

eligibility beginning on the date that a qualified entity

home health services and older adult daily living center

services by the department, the medical assistance provider

which provided home care services, home health services and

older adult daily living center services under clause (1) shall

not be rei mbursed by RECEIVE PAYMENT FROM the Commonwealth for

the co st of the home care services, home health services and

older adult daily living center services provided during the

period of deemed eligibility. If the individual provided

eligibility, the department shall authorize medical assistance

payments FOR THE INDIVIDUAL for the first sixty days of AFTER

THE DATE THE INDIVIDUAL SIGNS A PRELIMINARY SERVICE PLAN LIMITED

TO THE home care services, home health services and older adult

daily living center services provided during the period o f

deemed eligibility following the date that the qualified entity

established the preliminary service plan .

(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

(e) The department shall issue a medical assistance bulletin

which contains the Commonwealth policies and procedures

necessary to implement this section. PO LICIES AND PROCEDURES

UNDER THIS SUBSECTION ARE NOT 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; OR THE ACT OF JUNE 25,

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

620, 42 U.S.C. 1396 ET SEQ.) . Fifteen days prior to applying for

any necessary Federal waiver or State plan amendment, the

department shall submit the proposed application to the Health

and Human Services Committee of the Senate, the Health Committee

of the House of Representatives and the Human Services Committee

of the House of Representatives. The department shall maximize

the use of Federal money for the program.

(g) Within seventy-five days of the effective date of this

subsection, 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. § 1396 et seq.).

(h) (G) On or before January 1 of each year, the department

shall issue a report to the General Assembly with the following

information about the program:

(1) The number of individuals who participated in the

program.

(2) The average cost for each individual in the program.

(3) The number of qualified entities in the program.

(4) The administration costs.

by October 31, 2023.

(j) (I) This section shall expire October 31, 2024.

(k) (J) As used in this section, the following words and

phrases shall have the following meanings:

"Home care services." As defined in 28 Pa. Code § 611.5

(relating to definitions).

"Home health services." Part-time, intermittent skilled

nursing services and therapy services provided under 28 Pa. Code

Ch. 601 (relating to home health care agencies) at an

individual's place of residence.

"Nursing facility clinically eligible." An individual who:

physician which requires the individual to receive health

services in accordance with the f ollowing :

(i) Ski lled THE DEFINITION OF SKILLED nursing and skilled

rehabilitation services as def ined in 42 CFR 409.31 (relating to

level of care requirement) . ;

(ii) 42 CFR 409.32 (relating to criteria for skilled

services and the need for skilled services) . ;

(iii) 42 CFR 409.33 (relating to examples of skilled nursing

context of a planned program of health care and management which

was only previously available through an institutional facility.

"Nursing facility services." As defined in 42 CFR 440.40

(relating to nursing facility services for individuals age 21 or

older (other than services in an institution for mental

disease), EPSDT, and family planning services and supplies) or

42 CFR 440.155 (relating to nursing facility services, other

than in institutions for mental diseases).

"Older adult daily living center services." Services

provided to assist an individual with activities of daily living

and essential activities of daily living at an older adult daily

older adult daily living center or an organization authorized by

the department which elects to determine the deemed eligibility

of individuals to receive medical assistance under subsection

(b)(4).

Section 2. The Secretary of Human Services shall transmit to

the Legislative Reference Bureau, for publication in the

Pennsylvania Bulletin, notice of approval of any necessary

Federal waiver or State plan amendment under section 443.13 of

the act.

SECTION 2. IF A NECESSARY FEDERAL WAIVER OR STATE PLAN

AMENDMENT UNDER SECTION 443.13 OF THE ACT IS APPROVED BY THE

CENTERS FOR MEDICARE AND MEDICAID SERVICES FOR FEDERAL

REIMBURSEMENT FOR SERVICES PROVIDED TO AN INDIVIDUAL DEEMED

ELIGIBLE FOR HOME CARE SERVICES, HOME HEALTH SERVICES OR OLDER

following publication of the notice in which the Centers for

Medicare and Medicaid Services approve Federal reimbursement

for services provided to an individual deemed eligible for

home care services, home health services and older adult

daily living center services under section 2.

take effect immediately.

immediately.