Trial Engrossment of Amendment A02508 to House Bill 0033 P.N. 2182, Regular Session 2019-2020

A02508

THE GENERAL ASSEMBLY OF PENNSYLVANIA

HOUSE BILL

No.

Session of

2019

INTRODUCED BY DUNBAR, SAYLOR, REESE, OBERLANDER, NELSON,

ROTHMAN, MACKENZIE, GREINER, DIAMOND, JONES, PICKETT,

GREGORY, RYAN, BARRAR, GLEIM, GROVE, BERNSTINE, WARNER,

MILLARD, KEEFER, JAMES, PYLE, KAUFFMAN, DeLUCA, BENNINGHOFF,

MASSER AND ROAE, JANUARY 28, 2019

AS RE-REPORTED FROM COMMITTEE ON APPROPRIATIONS, HOUSE OF

REPRESENTATIVES, AS AMENDED, JUNE 18, 2019

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 definitions, for general assistance-

related categorically needy and medically needy only medical

assistance programs and for the medically needy and

determination of eligibility.

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 DEFINITIONS, FOR GENERAL ASSISTANCE-

RELATED CATEGORICALLY NEEDY AND MEDICALLY NEEDY ONLY MEDICAL

ASSISTANCE PROGRAMS, FOR THE MEDICALLY NEEDY AND

DETERMINATION OF ELIGIBILITY AND FOR MEDICAL ASSISTANCE

PAYMENTS FOR INSTITUTIONAL CARE; IN HOSPITAL ASSESSMENTS,

FURTHER PROVIDING FOR DEFINITIONS, FOR AUTHORIZATION, FOR

ADMINISTRATION, FOR NO HOLD HARMLESS, FOR TAX EXEMPTION AND

FOR TIME PERIOD; AND, IN STATEWIDE QUALITY CARE ASSESSMENT,

FURTHER PROVIDING FOR DEFINITIONS.

The General Assembly of the Commonwealth of Pennsylvania

hereby enacts as follows:

Section 1. Section 402 introductory paragraph and the

definition of "general assistance" of the act of June 13, 1967

(P.L.31, No.21), known as the Human Services Code, amended June

30, 2012 (P.L.668, No.80), amendment declared unconstitutional,

188 A.3d 1135, (Pa. 2018), are amended and the section is

amended by adding a definition to read:

Section 402. Definitions.--As used in this article, unless

the [content] context clearly indicates otherwise:

* * *

["General assistance" means assistance granted under the

provisions of section 432(3) of this act.]

"General assistance-related categorically needy medical

assistance" means medical assistance for persons who meet the

requirements under section 432(3).

* * *

Section 2. Section 403.2 of the act, added June 30, 2012

(P.L.668, No.80), addition declared unconstitutional, 188 A.3d

1135, (Pa. 2018), is reenacted and amended to read:

Section 403.2. General Assistance-Related Categorically

Needy and Medically Needy Only Medical Assistance Programs.--(a)

Subject to subsection (b) and notwithstanding any other

provision of law, the general assistance cash assistance program

shall cease [August 1, 2012] July 1, 2019.

(b) The general assistance-related categorically needy

medical assistance program shall continue, including, but not

limited to, the eligibility and work and work-related

requirements under this article. The general assistance-related

medical assistance program for the medically needy only shall

continue.

Section 3. Section 442.1(a)(3) introductory paragraph and

(i) of the act, amended June 30, 2012 (P.L.668, No.80),

amendment declared unconstitutional, 188 A.3d 1135, (Pa. 2018),

are amended to read:

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Section 442.1. The Medically Needy; Determination of

Eligibility.--(a) A person shall be considered medically needy

if that person meets the requirements of clauses (1), (2) and

(3):

* * *

(3) Complies with [either] subclause [(i) or] (ii):

[(i) Receives general assistance in the form of cash.]

* * *

Section 4. This act shall take effect as follows:

(1) The amendment of section 442.1(a)(3) introductory

paragraph and (i) of the act shall take effect July 1, 2019.

(2) The remainder of this act shall take effect

immediately.

SECTION 1. SECTION 402 INTRODUCTORY PARAGRAPH AND THE

DEFINITION OF "GENERAL ASSISTANCE" OF THE ACT OF JUNE 13, 1967

(P.L.31, NO.21), KNOWN AS THE HUMAN SERVICES CODE, AMENDED JUNE

30, 2012 (P.L.668, NO.80), AMENDMENT DECLARED UNCONSTITUTIONAL,

188 A.3D 1135, (PA. 2018), ARE AMENDED AND THE SECTION IS

AMENDED BY ADDING A DEFINITION TO READ:

SECTION 402. DEFINITIONS.--AS USED IN THIS ARTICLE, UNLESS

THE [CONTENT] CONTEXT CLEARLY INDICATES OTHERWISE:

* * *

["GENERAL ASSISTANCE" MEANS ASSISTANCE GRANTED UNDER THE

PROVISIONS OF SECTION 432(3) OF THIS ACT.]

"GENERAL ASSISTANCE-RELATED CATEGORICALLY NEEDY MEDICAL

ASSISTANCE" MEANS MEDICAL ASSISTANCE FOR PERSONS WHO MEET THE

REQUIREMENTS UNDER SECTION 432(3).

* * *

SECTION 2. SECTION 403.2 OF THE ACT, ADDED JUNE 30, 2012

(P.L.668, NO.80), ADDITION DECLARED UNCONSTITUTIONAL, 188 A.3D

A02508 - 3 -

1135, (PA. 2018), IS REENACTED AND AMENDED TO READ:

SECTION 403.2. GENERAL ASSISTANCE-RELATED CATEGORICALLY

NEEDY AND MEDICALLY NEEDY ONLY MEDICAL ASSISTANCE PROGRAMS.--(A)

(1) SUBJECT TO SUBSECTION (B) AND NOTWITHSTANDING ANY OTHER

PROVISION OF LAW, THE GENERAL ASSISTANCE CASH ASSISTANCE PROGRAM

SHALL CEASE [AUGUST 1, 2012] AUGUST 1, 2019.

(2) Paragraph (1) shall not apply to victims of human

trafficking.

(B) THE GENERAL ASSISTANCE-RELATED CATEGORICALLY NEEDY

MEDICAL ASSISTANCE PROGRAM SHALL CONTINUE, INCLUDING, BUT NOT

LIMITED TO, THE ELIGIBILITY AND WORK AND WORK-RELATED

REQUIREMENTS UNDER THIS ARTICLE. THE GENERAL ASSISTANCE-RELATED

MEDICAL ASSISTANCE PROGRAM FOR THE MEDICALLY NEEDY ONLY SHALL

CONTINUE.

SECTION 3. SECTION 442.1(A)(3) INTRODUCTORY PARAGRAPH AND

(I) OF THE ACT, AMENDED JUNE 30, 2012 (P.L.668, NO.80),

AMENDMENT DECLARED UNCONSTITUTIONAL, 188 A.3D 1135, (PA. 2018),

ARE AMENDED TO READ:

SECTION 442.1. THE MEDICALLY NEEDY; DETERMINATION OF

ELIGIBILITY.--(A) A PERSON SHALL BE CONSIDERED MEDICALLY NEEDY

IF THAT PERSON MEETS THE REQUIREMENTS OF CLAUSES (1), (2) AND

(3):

* * *

(3) COMPLIES WITH [EITHER] SUBCLAUSE [(I) OR] (II):

[(I) RECEIVES GENERAL ASSISTANCE IN THE FORM OF CASH.]

* * *

SECTION 4. SECTION 443.1(1.1)(I) AND (7)(VI) OF THE ACT,

AMENDED JUNE 22, 2018 (P.L.258, NO.40), ARE AMENDED TO READ:

SECTION 443.1. MEDICAL ASSISTANCE PAYMENTS FOR INSTITUTIONAL

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

A02508 - 4 -

ON BEHALF OF ELIGIBLE PERSONS WHOSE INSTITUTIONAL CARE IS

PRESCRIBED BY PHYSICIANS:

* * *

(1.1) SUBJECT TO SECTION 813-G, FOR INPATIENT 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 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, [2018] 2023, 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.

* * *

(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:

* * *

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

BE NECESSARY TO THE COMMONWEALTH'S APPROVED TITLE XIX STATE

PLAN, FOR FISCAL YEARS 2015-2016, 2016-2017 [AND], 2018-2019 AND

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2019-2020, THE DEPARTMENT SHALL MAKE UP TO FOUR MEDICAL

ASSISTANCE DAY-ONE INCENTIVE PAYMENTS TO QUALIFIED 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

A02508 - 6 -

RESIDENT DAY QUARTER. FOR PURPOSES OF DETERMINING A NURSING

FACILITY'S MEDICAL ASSISTANCE OCCUPANCY RATE, THE NURSING

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.

(I) FOR FISCAL YEARS 2015-2016, 2016-2017 AND 2018-2019, THE

STATE FUNDS AVAILABLE FOR THE NONPUBLIC NURSING FACILITY MEDICAL

ASSISTANCE DAY-ONE INCENTIVE PAYMENTS SHALL EQUAL EIGHT MILLION

DOLLARS ($8,000,000).

(II) FOR FISCAL YEARS 2019-2020, THE STATE FUNDS AVAILABLE

FOR THE NONPUBLIC NURSING FACILITY MEDICAL ASSISTANCE DAY-ONE

A02508 - 7 -

INCENTIVE PAYMENTS SHALL EQUAL SIXTEEN MILLION DOLLARS

($16,000,000).

* * *

SECTION 5. THE DEFINITIONS OF "ASSESSMENT," "GENERAL ACUTE

CARE HOSPITAL," "HIGH VOLUME MEDICAID HOSPITAL," "HOSPITAL" AND

"NET OPERATING REVENUE" IN SECTION 801-E OF THE ACT ARE AMENDED

TO READ:

SECTION 801-E. 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." THE FEE AUTHORIZED TO BE IMPLEMENTED UNDER

THIS ARTICLE [ON EVERY GENERAL ACUTE CARE HOSPITAL WITHIN A

MUNICIPALITY].

* * *

"GENERAL ACUTE CARE HOSPITAL." A HOSPITAL OTHER THAN A

HOSPITAL THAT THE [SECRETARY OF HUMAN SERVICES] SECRETARY HAS

DETERMINED MEETS ONE OF THE FOLLOWING:

(1) IS EXCLUDED UNDER 42 CFR 412.23(A), (B), (D), (E) AND

(F) (RELATING TO EXCLUDED HOSPITALS: CLASSIFICATIONS) AS OF

MARCH 20, 2008, FROM REIMBURSEMENT OF CERTAIN FEDERAL FUNDS

UNDER THE PROSPECTIVE PAYMENT SYSTEM DESCRIBED BY 42 CFR 412

(RELATING TO PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL

SERVICES).

(2) IS A FEDERAL VETERANS' AFFAIRS HOSPITAL.

(3) IS A HIGH VOLUME MEDICAID HOSPITAL.

(4) PROVIDES CARE, INCLUDING INPATIENT HOSPITAL SERVICES, TO

ALL PATIENTS FREE OF CHARGE.

(5) IS A FREE-STANDING ACUTE CARE HOSPITAL ORGANIZED

PRIMARILY FOR THE TREATMENT OF AND RESEARCH ON CANCER AND WHICH

A02508 - 8 -

IS AN EXEMPT HOSPITAL UNDER SECTION 801-G.

"HIGH VOLUME MEDICAID HOSPITAL." A HOSPITAL THAT THE

[SECRETARY OF HUMAN SERVICES] SECRETARY HAS DETERMINED MEETS ALL

OF THE FOLLOWING:

(1) IS A NONPROFIT HOSPITAL SUBSIDIARY OF A STATE-RELATED

INSTITUTION AS THAT TERM IS DEFINED IN 62 PA.C.S. § 103

(RELATING TO DEFINITIONS); AND

(2) [PROVIDES] HAS PROVIDED MORE THAN [90,000] 60,000

INPATIENT ACUTE CARE DAYS OF CARE TO PENNSYLVANIA MEDICAL

ASSISTANCE PATIENTS [ANNUALLY] AS REPORTED BY THE HOSPITAL'S

STATE FISCAL YEAR 2014-2015 MEDICAL ASSISTANCE HOSPITAL COST

REPORT ON FILE WITH THE DEPARTMENT AS OF JUNE 6, 2018.

"HOSPITAL." A FACILITY OR THE SITE OF A FACILITY THAT IS

LICENSED AS A HOSPITAL UNDER 28 PA. CODE PT. IV SUBPT. B

(RELATING TO GENERAL AND SPECIAL HOSPITALS) AND LOCATED WITHIN A

MUNICIPALITY.

* * *

"NET [OPERATING] PATIENT REVENUE." GROSS [CHARGES FOR

FACILITIES] REVENUES RECEIVED OR EARNED BY A HOSPITAL FOR

INPATIENT AND OUTPATIENT HOSPITAL SERVICES, INCLUDING MEDICAL

ASSISTANCE SUPPLEMENTAL REVENUES RECEIVED BY THE HOSPITAL FOR

INPATIENT AND OUTPATIENT HOSPITAL SERVICES, LESS ANY DEDUCTED

AMOUNTS FOR BAD DEBT EXPENSE, CHARITY CARE EXPENSE AND

CONTRACTUAL ALLOWANCES AS IDENTIFIED IN THE HOSPITAL'S RECORDS

OR ON FORMS AS SPECIFIED BY THE DEPARTMENT.

* * *

SECTION 6. SECTION 802-E(A), (A.1) AND (B) OF THE ACT ARE

AMENDED AND THE SECTION IS AMENDED BY ADDING A SUBSECTION TO

READ:

SECTION 802-E. AUTHORIZATION.

A02508 - 9 -

(A) GENERAL RULE.--IN ORDER TO GENERATE ADDITIONAL REVENUES

FOR THE PURPOSE OF ASSURING THAT MEDICAL ASSISTANCE RECIPIENTS

HAVE ACCESS TO HOSPITAL AND OTHER HEALTH CARE SERVICES [AND THAT

ALL CITIZENS HAVE ACCESS TO EMERGENCY DEPARTMENT SERVICES], AND

SUBJECT TO THE CONDITIONS AND REQUIREMENTS SPECIFIED UNDER THIS

ARTICLE, A MUNICIPALITY MAY, BY ORDINANCE, [DO] IMPOSE AN

ASSESSMENT ON THE FOLLOWING:

(1) [IMPOSE A MONETARY ASSESSMENT ON THE NET OPERATING

REVENUE REDUCED BY ALL REVENUES RECEIVED FROM MEDICARE OF

EACH GENERAL ACUTE CARE HOSPITAL LOCATED IN THE

MUNICIPALITY.] EACH GENERAL ACUTE CARE HOSPITAL.

(2) [BEGINNING ON OR AFTER JULY 1, 2009, AND SUBJECT TO

THE ADVANCE WRITTEN APPROVAL BY THE SECRETARY, IMPOSE A

MONETARY ASSESSMENT ON THE NET OPERATING REVENUES REDUCED BY

ALL REVENUES RECEIVED FROM MEDICARE OF EACH HIGH VOLUME

MEDICAID HOSPITAL LOCATED IN THE MUNICIPALITY.] EACH HIGH

VOLUME MEDICAID HOSPITAL.

(A.1) ASSESSMENT IMPOSED BY ORDINANCE.--A MUNICIPALITY

SHALL, BY ORDINANCE, ESTABLISH THE ASSESSMENT IMPOSED UNDER

SUBSECTION (A)(1) AND (2) AS A PERCENTAGE OF EACH HOSPITAL ' S NET

PATIENT REVENUE REDUCED BY ALL REVENUES RECEIVED FROM MEDICARE

FOR THE YEAR AS THE MUNICIPALITY SHALL SPECIFY, AND MAY

ESTABLISH DIFFERENT ASSESSMENT PERCENTAGES UNDER SUBSECTION (A)

(1) OR (2).

(A.2) ADJUSTMENTS TO ASSESSMENT PERCENTAGE.--

(1) FOR STATE FISCAL YEARS BEGINNING AFTER JUNE 30,

2013, AND SUBJECT TO THE ADVANCE WRITTEN APPROVAL OF THE

SECRETARY AS PRESCRIBED BY THE DEPARTMENT, THE MUNICIPALITY

MAY MAKE A UNIFORM ADJUSTMENT TO AN ASSESSMENT PERCENTAGE

ESTABLISHED BY ORDINANCE UNDER SUBSECTION (A).

A02508 - 10 -

(2) AFTER RECEIVING WRITTEN APPROVAL UNDER PARAGRAPH (1)

AND BEFORE IMPLEMENTING AN ADJUSTMENT, THE MUNICIPALITY SHALL

PROVIDE ADVANCE PUBLIC NOTICE. THE NOTICE SHALL SPECIFY THE

PROPOSED ADJUSTED ASSESSMENT PERCENTAGE AND IDENTIFY THE

AGGREGATE IMPACT ON HOSPITALS [LOCATED IN THE MUNICIPALITY]

SUBJECT TO AN ASSESSMENT. AN INTERESTED PARTY SHALL HAVE 30

DAYS IN WHICH TO SUBMIT COMMENTS TO THE MUNICIPALITY. UPON

EXPIRATION OF THE 30-DAY COMMENT PERIOD, THE MUNICIPALITY,

AFTER CONSIDERATION OF THE COMMENTS, SHALL PUBLISH A

SUBSEQUENT NOTICE ANNOUNCING THE ADJUSTED ASSESSMENT

PERCENTAGE.

(B) ADMINISTRATIVE PROVISIONS.--THE ORDINANCES ADOPTED

PURSUANT TO [SUBSECTION] SUBSECTIONS (A), (A.1) AND (A.2) MAY

INCLUDE APPROPRIATE ADMINISTRATIVE PROVISIONS INCLUDING, WITHOUT

LIMITATION, PROVISIONS FOR THE COLLECTION OF INTEREST AND

PENALTIES[.] AND PROVISIONS FOR THE CALCULATION AND IMPOSITION

OF THE ASSESSMENT ON A HOSPITAL SUBJECT TO AN ASSESSMENT WHICH,

DURING A FISCAL YEAR IN WHICH AN ASSESSMENT IS IMPOSED UNDER

THIS ARTICLE, CHANGES OWNERSHIP OR CONTROL, BEGINS OPERATIONS,

CLOSES OR EXPERIENCES ANY OTHER CHANGE THAT AFFECTS ITS STATUS

AS A GENERAL ACUTE CARE HOSPITAL OR HIGH VOLUME MEDICAID

HOSPITAL.

* * *

SECTION 7. SECTIONS 804-E, 805-E, 807-E AND 808-E OF THE ACT

ARE AMENDED TO READ:

SECTION 804-E. ADMINISTRATION.

(A) REMITTANCE.--UPON COLLECTION OF THE FUNDS GENERATED BY

THE ASSESSMENT AUTHORIZED UNDER THIS ARTICLE, THE MUNICIPALITY

SHALL REMIT A PORTION OF THE FUNDS TO THE COMMONWEALTH FOR THE

PURPOSES SET FORTH UNDER SECTION 802-E, EXCEPT THAT THE

A02508 - 11 -

MUNICIPALITY MAY RETAIN FUNDS IN AN AMOUNT NECESSARY TO

REIMBURSE IT FOR ITS REASONABLE COSTS IN THE ADMINISTRATION AND

COLLECTION OF THE ASSESSMENT AND TO FUND A PORTION OF ITS COSTS

OF OPERATING PUBLIC HEALTH CLINICS AND PUBLIC HEALTH PROGRAMS AS

SET FORTH IN AN AGREEMENT TO BE ENTERED INTO BETWEEN THE

MUNICIPALITY AND THE COMMONWEALTH ACTING THROUGH THE SECRETARY.

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

ACCOUNT IN THE GENERAL FUND FOR THE RECEIPT AND DEPOSIT OF FUNDS

UNDER SUBSECTION (A). FUNDS IN THE ACCOUNT [ARE HEREBY

APPROPRIATED TO] SHALL BE USED BY THE DEPARTMENT FOR EITHER OR

BOTH OF THE FOLLOWING PURPOSES [OF MAKING]:

(1) MAKING SUPPLEMENTAL OR INCREASED MEDICAL ASSISTANCE

PAYMENTS FOR [EMERGENCY DEPARTMENT] HOSPITAL SERVICES TO

[GENERAL ACUTE CARE] HOSPITALS [WITHIN THE MUNICIPALITY] AND TO

MAINTAIN OR INCREASE OTHER MEDICAL ASSISTANCE PAYMENTS TO

HOSPITALS [WITHIN THE MUNICIPALITY], AS 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 HEALTH CARE SERVICES WITHIN THE MUNICIPALITY.

SECTION 805-E. NO HOLD HARMLESS.

NO [GENERAL ACUTE CARE HOSPITAL OR HIGH VOLUME MEDICAID]

HOSPITAL SUBJECT TO THE ASSESSMENT SHALL BE DIRECTLY 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 A PORTION OF THE FUNDS RECEIVED UNDER

SECTION 804-E(A) FOR THE PURPOSES OUTLINED UNDER SECTION 804-

E(B) TO THE EXTENT PERMISSIBLE UNDER FEDERAL AND STATE LAW OR

REGULATION AND WITHOUT CREATING AN INDIRECT GUARANTEE TO HOLD

A02508 - 12 -

HARMLESS, AS THOSE TERMS ARE USED UNDER 42 CFR 433.68(F)(I). THE

SECRETARY SHALL SUBMIT ANY [STATE MEDICAID PLAN] TITLE XIX STATE

PLAN AMENDMENTS TO THE UNITED STATES DEPARTMENT OF HEALTH AND

HUMAN SERVICES THAT ARE NECESSARY TO MAKE THE PAYMENTS

AUTHORIZED UNDER SECTION 804-E(B).

SECTION 807-E. TAX EXEMPTION.

NOTWITHSTANDING ANY EXEMPTIONS GRANTED BY ANY OTHER FEDERAL,

STATE OR LOCAL TAX OR OTHER LAW, INCLUDING SECTION 204(A)(3) OF

THE ACT OF MAY 22, 1933 (P.L.853, NO.155), KNOWN AS THE GENERAL

COUNTY ASSESSMENT LAW, NO [GENERAL ACUTE CARE HOSPITAL OR HIGH

VOLUME MEDICAID] HOSPITAL [IN THE MUNICIPALITY] SUBJECT TO THE

ASSESSMENT SHALL BE EXEMPT FROM THE ASSESSMENT.

SECTION 808-E. TIME PERIOD.

(A) CESSATION.--THE ASSESSMENT AUTHORIZED UNDER THIS ARTICLE

SHALL CEASE JUNE 30, [2019] 2024.

(B) ASSESSMENT.--

(1) A MUNICIPALITY SHALL HAVE THE POWER TO ENACT THE

ASSESSMENT AUTHORIZED IN SECTION 802-E(A)(2) EITHER PRIOR TO

OR DURING ITS FISCAL YEAR ENDING JUNE 30, 2010.

(2) A MUNICIPALITY MAY ADJUST AN ASSESSMENT PERCENTAGE

AS SPECIFIED UNDER SECTION [802-E(A.1)] 802-E(A.2) EITHER

PRIOR TO OR DURING THE FISCAL YEAR IN WHICH THE ADJUSTED

ASSESSMENT PERCENTAGE TAKES EFFECT.

SECTION 8. THE DEFINITIONS OF "NET INPATIENT REVENUE" AND

"NET OUTPATIENT REVENUE" IN SECTION 801-G OF THE ACT, AMENDED OR

ADDED JUNE 22, 2018 (P.L.258, NO.40), 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:

A02508 - 13 -

* * *

"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:] REVENUES

RECEIVED OR EARNED BY A HOSPITAL FOR INPATIENT SERVICES,

INCLUDING MEDICAL ASSISTANCE SUPPLEMENTAL REVENUES RECEIVED BY

THE HOSPITAL FOR INPATIENT HOSPITAL SERVICES, LESS ANY DEDUCTED

AMOUNTS FOR BAD DEBT EXPENSE, CHARITY CARE EXPENSE AND

CONTRACTUAL ALLOWANCES AS IDENTIFIED IN THE HOSPITAL'S RECORDS

AND REPORTED ON FORMS SPECIFIED BY THE DEPARTMENT FOR:

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

STATE FISCAL YEAR COMMENCING JULY 1, 2014, OR SUCH LATER

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

USE IN DETERMINING AN ANNUAL ASSESSMENT AMOUNT OWED ON OR

AFTER JULY 1, 2018; 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).

"NET OUTPATIENT REVENUE." GROSS [CHARGES FOR FACILITIES FOR

OUTPATIENT SERVICES LESS ANY DEDUCTED AMOUNTS FOR BAD DEBT

EXPENSE, CHARITY CARE EXPENSE AND CONTRACTUAL ALLOWANCES AS

REPORTED ON FORMS SPECIFIED BY THE DEPARTMENT AND:] REVENUES

RECEIVED OR EARNED BY A HOSPITAL FOR OUTPATIENT SERVICES,

INCLUDING MEDICAL ASSISTANCE SUPPLEMENTAL REVENUES RECEIVED BY

THE HOSPITAL FOR OUTPATIENT HOSPITAL SERVICES, LESS ANY DEDUCTED

AMOUNTS FOR BAD DEBT EXPENSE, CHARITY CARE EXPENSE AND

CONTRACTUAL ALLOWANCES AS IDENTIFIED IN THE HOSPITAL'S RECORDS

AND REPORTED ON FORMS SPECIFIED BY THE DEPARTMENT FOR:

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

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STATE FISCAL YEAR COMMENCING JULY 1, 2014, OR A LATER STATE

FISCAL YEAR, AS MAY BE SPECIFIED BY THE DEPARTMENT FOR USE IN

DETERMINING AN ANNUAL ASSESSMENT AMOUNT OWED ON OR AFTER JULY

1, 2018; 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 9. THIS ACT SHALL TAKE EFFECT AS FOLLOWS:

(1) THE AMENDMENT OF SECTION 442.1(A)(3) INTRODUCTORY

PARAGRAPH AND (I) OF THE ACT SHALL TAKE EFFECT AUGUST 1,

2019.

(2) THE REMAINDER OF THIS ACT SHALL TAKE EFFECT JULY 1,

2019, OR IMMEDIATELY, WHICHEVER IS LATER.

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