PRINTER'S NO. 75
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No.
107
Session of
2021
INTRODUCED BY SANKEY, GAYDOS, OWLETT, THOMAS, IRVIN, GROVE,
RYAN, KAUFFMAN, SAYLOR, BERNSTINE AND WEBSTER,
JANUARY 11, 2021
REFERRED TO COMMITTEE ON HUMAN SERVICES, JANUARY 11, 2021
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,
providing for medical assistance managed care organization
rate setting.
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 449.2. Medical Assistance Managed Care Organization
Rate Setting.--(a) The department shall annually adjust the
medical assistance managed care organization financial reporting
that is used as the basis of rate setting by the value of
provider-preventable conditions in no less than facility place
of service paid by the medical assistance managed care
organization to ensure that Federal and State funds are not used
to pay for improper payments.
(b) The department shall annually report the value of
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adjustments by the medical assistance managed care organization
under subsection (a) as part of the reports required under
Article V-A.
(c) As used in this section, the following words and phrases
shall have the meanings given to them in this subsection:
"Medical assistance managed care organization" means 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. ยง
1903(m)(1)(A)) that is a party to a Medicaid managed care
contract with the department to provide physical or behavioral
health services.
"Provider-preventable conditions" means any conditions
occurring in a health care setting that meet the following
criteria:
(1) Is identified in the State plan in line with the fee-
for-service model.
(2) Has been found by the Commonwealth, based upon a review
of medical literature by qualified professionals, to be
reasonably preventable through the application of procedures
supported by evidence-based guidelines.
(3) Has a negative consequence for the patient.
(4) Is auditable.
(5) Includes, at a minimum, any of the following:
(i) A wrong surgical or other invasive procedure performed
on a patient.
(ii) A surgical or other invasive procedure performed on the
wrong body part.
(iii) A surgical or other invasive procedure performed on
the wrong patient.
Section 2. This act shall take effect in 60 days.
20210HB0107PN0075 - 2 -
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