Trial Engrossment of Amendment A02576 to Senate Bill 0695 P.N. 1073, Regular Session 2019-2020

HOUSE AMENDED

A02576

THE GENERAL ASSEMBLY OF PENNSYLVANIA

SENATE BILL

No.

695

Session of

2019

INTRODUCED BY BROOKS, MAY 31, 2019

AS RE-REPORTED FROM COMMITTEE ON APPROPRIATIONS, HOUSE OF

REPRESENTATIVES, AS AMENDED, JUNE 25, 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 medical assistance payments for

institutional care AND FOR NONEMERGENCY MEDICAL

TRANSPORTATION SERVICES AND PROVIDING FOR UNIFORM STATEWIDE

PREFERRED DRUG LIST; in nursing facility assessments, further

providing for DEFINITIONS, FOR CALCULATION, FOR REMEDIES, FOR

REPAYMENT AND FOR time periods; in intermediate care

facilities for persons with an intellectual disability

assessments, further providing for DEFINITIONS AND FOR time

periods; and, in hospital assessments, further providing for

time period.; AND MAKING A RELATED REPEAL.

The General Assembly of the Commonwealth of Pennsylvania

hereby enacts as follows:

Section 1. Sections 443.1(7)(iv), 815-A, 811-C(b) and 808-

E(a) of the act of June 13, 1967 (P.L.31, No.21), known as the

Human Services Code, are amended to read:

SECTION 1. SECTION 443.1(7)(IV) OF THE ACT OF JUNE 13, 1967

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

* * *

(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:

* * *

(iv) Subject to Federal approval of such amendments as may

be necessary to the Commonwealth's approved Title XIX State

Plan, for each fiscal year beginning on or after July 1, 2011,

the department shall apply a revenue adjustment neutrality

factor to county and nonpublic nursing facility payment rates so

that the estimated Statewide day-weighted average payment rate

in effect for that fiscal year is limited to the amount

permitted by the funds appropriated by the General Appropriation

Act for the fiscal year. The revenue adjustment neutrality

factor shall remain in effect until the sooner of June 30,

[2019] 2022, or the date on which a new rate-setting methodology

for medical assistance nursing facility services which replaces

the rate-setting methodology codified in 55 Pa. Code Chs. 1187

(relating to nursing facility services) and 1189 (relating to

county nursing facility services) takes effect.

* * *

SECTION 2. SECTION 443.12 OF THE ACT IS AMENDED BY ADDING

SUBSECTIONS TO READ:

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SECTION 443.12. NONEMERGENCY MEDICAL TRANSPORTATION

SERVICES.--* * *

(D) THE DEPARTMENT MAY NOT ENTER INTO A CONTRACT WITH A

BROKER UNDER SUBSECTION (B) PRIOR TO THE COMPLETION OF THE

ANALYSIS REQUIRED UNDER SUBSECTION (E).

(E) PRIOR TO THE IMPLEMENTATION OF THE FULL-RISK BROKERAGE

MODEL, THE DEPARTMENT, IN COORDINATION WITH THE DEPARTMENT OF

TRANSPORTATION AND THE DEPARTMENT OF AGING, SHALL COMMISSION AN

ANALYSIS THAT PROVIDES AT A MINIMUM THE FOLLOWING:

(1) AN ANALYSIS OF CURRENT FEDERAL AND STATE LAW,

REGULATIONS AND POLICIES CONTROLLING THE NONEMERGENCY MEDICAL

TRANSPORTATION AND OTHER HUMAN SERVICES TRANSPORTATION PROGRAMS

ADMINISTERED IN THE COMMONWEALTH, INCLUDING THE AUTHORIZED

METHODS OF DELIVERY AND LIMITATIONS OR RESTRICTIONS IMPOSED ON

THE METHODS OF DELIVERY.

(2) AN ANALYSIS OF THE EFFECTIVENESS AND EFFICIENCY OF THE

CURRENT NONEMERGENCY TRANSPORTATION SERVICE DELIVERY AS IT

RELATES TO ALL HUMAN SERVICE PROGRAMS IN THIS COMMONWEALTH.

(3) A REVIEW OF OTHER STATES' MODELS OF DELIVERING

NONEMERGENCY MEDICAL AND OTHER HUMAN SERVICES TRANSPORTATION,

INCLUDING THE NUMBER OF OTHER STATES THAT UTILIZE A FULL-RISK

BROKERAGE MODEL AND THE EFFECT A BROKERAGE MODEL HAS HAD ON

PUBLIC TRANSIT IN THOSE STATES.

(4) AN ANALYSIS OF THE POSITIVE AND NEGATIVE IMPACT OF

MAINTAINING THE CURRENT TRANSPORTATION DELIVERY MODEL VERSUS

IMPLEMENTING A FULL-RISK BROKERAGE MODEL AS IT RELATES TO THE

STATE AND LOCAL GOVERNMENT ENTITIES, INCLUDING FINANCIAL IMPACT.

(5) AN ANALYSIS OF THE IMPACT ON CONSUMERS, INCLUDING AN

INCREASE OR DECREASE IN QUALITY AND SERVICE AVAILABILITY.

(F) THE ANALYSIS UNDER SUBSECTION (E) SHALL BE COMPLETED NO

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LATER THAN NINETY one hundred eighty DAYS FROM THE EFFECTIVE

DATE OF THIS SUBSECTION , AND . A preliminary report of the

analysis under subsection ( e) shall be completed no later than

ninety days from the effective date of this subsection. The

analysis under subsection (e) and the preliminary report under

this subsection SHALL BE DELIVERED TO THE FOLLOWING:

(1) THE SECRETARY OF HUMAN SERVICES.

(2) THE SECRETARY OF AGING.

(3) THE SECRETARY OF TRANSPORTATION.

(4) THE CHAIRPERSON AND MINORITY CHAIRPERSON OF THE

APPROPRIATIONS COMMITTEE OF THE SENATE.

(5) THE CHAIRPERSON AND MINORITY CHAIRPERSON OF THE

APPROPRIATIONS COMMITTEE OF THE HOUSE OF REPRESENTATIVES.

(6) THE CHAIRPERSON AND MINORITY CHAIRPERSON OF THE HEALTH

AND HUMAN SERVICES COMMITTEE OF THE SENATE.

(7) THE CHAIRPERSON AND MINORITY CHAIRPERSON OF THE HEALTH

COMMITTEE OF THE HOUSE OF REPRESENTATIVES.

(g) The Department of the Auditor General shall perform an

audit of all nonemergency medical transportation service

providers operating in this Commonwealth that receive funds from

the department or from a county to provide services to medical

assistance recipients. Copies of all audits made by the

Department of the Auditor General shall be promptly submitted to

the President pro tempore of the Senate, the Speaker of the

House of Representatives, the Minority Lead er of the Senate and

the Minority Leader of the House of Representatives.

SECTION 3. THE ACT IS AMENDED BY ADDING A SECTION TO READ:

SECTION 459.1. UNIFORM STATEWIDE PREFERRED DRUG LIST.--(A)

THE DEPARTMENT MAY NOT IMPLEMENT A UNIFORM STATEWIDE PREFERRED

DRUG LIST FOR THE MEDICAL ASSISTANCE MANAGED CARE ORGANIZATIONS

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UNTIL AN ANALYSIS HAS BEEN CONDUCTED, AS COMMISSIONED BY THE

DEPARTMENT, TO DETERMINE THE PROJECTED COST TO THE MEDICAL

ASSISTANCE MANAGED CARE ORGANIZATION AND THE PROJECTED

SUPPLEMENTAL REBATES THAT COULD BE OBTAINED BY THE DEPARTMENT

THROUGH THE USE OF A UNIFORM STATEWIDE PREFERRED DRUG LIST.

(B) THE ANALYSIS UNDER SUBSECTION (A) SHALL BE COMPLETED

WITHIN SIXTY DAYS OF THE EFFECTIVE DATE OF THIS SUBSECTION. THE

ANALYSIS SHALL BE DELIVERED TO THE FOLLOWING:

(1) THE CHAIRPERSON AND MINORITY CHAIRPERSON OF THE

APPROPRIATIONS COMMITTEE OF THE SENATE.

(2) THE CHAIRPERSON AND MINORITY CHAIRPERSON OF THE HEALTH

AND HUMAN SERVICES COMMITTEE OF THE SENATE.

(3) THE CHAIRPERSON AND MINORITY CHAIRPERSON OF THE

APPROPRIATIONS COMMITTEE OF THE HOUSE OF REPRESENTATIVES.

(4) THE CHAIRPERSON AND MINORITY CHAIRPERSON OF THE HEALTH

COMMITTEE OF THE HOUSE OF REPRESENTATIVES.

SECTION 4. THE DEFINITIONS OF "COUNTY NURSING FACILITY,"

"MEDICAL ASSISTANCE PROVIDER" AND "NURSING FACILITY" IN SECTION

801-A OF THE ACT ARE AMENDED AND THE SECTION IS AMENDED BY

ADDING A DEFINITION TO READ:

SECTION 801-A. DEFINITIONS.--AS USED IN THIS ARTICLE--

* * *

"COUNTY NURSING FACILITY" MEANS A LONG-TERM CARE NURSING

FACILITY THAT IS LICENSED BY THE DEPARTMENT OF HEALTH UNDER THE

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

FACILITIES ACT," AND CONTROLLED BY THE COUNTY INSTITUTION

DISTRICT OR COUNTY GOVERNMENT IF NO COUNTY INSTITUTION DISTRICT

EXISTS. THE TERM DOES NOT INCLUDE INTERMEDIATE CARE FACILITIES

FOR [THE MENTALLY RETARDED] INDIVIDUALS WITH AN INTELLECTUAL

DISABILITY CONTROLLED BY THE COUNTY INSTITUTION DISTRICT OR

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COUNTY GOVERNMENT.

"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. §

1396B(M)(1)(A)) THAT IS A PARTY TO A MEDICAID MANAGED CARE

CONTRACT WITH THE DEPARTMENT. THE TERM SHALL NOT INCLUDE A

BEHAVIORAL HEALTH MANAGED CARE ORGANIZATION THAT IS A PARTY TO A

MEDICAID MANAGED CARE CONTRACT WITH THE DEPARTMENT.

"MEDICAL ASSISTANCE PROVIDER" MEANS A PERSON OR ENTITY

ENROLLED BY THE [DEPARTMENT OF HUMAN SERVICES] DEPARTMENT AS A

PROVIDER OF SERVICES IN THE MEDICAL ASSISTANCE PROGRAM.

"NURSING FACILITY" MEANS A NON-FEDERAL, NONPUBLIC LONG-TERM

CARE NURSING FACILITY LICENSED BY THE DEPARTMENT OF HEALTH

PURSUANT TO THE ACT OF JULY 19, 1979 (P.L.130, NO.48), KNOWN AS

THE "HEALTH CARE FACILITIES ACT." THE TERM DOES NOT INCLUDE

INTERMEDIATE CARE FACILITIES FOR [THE MENTALLY RETARDED]

INDIVIDUALS WITH AN INTELLECTUAL DISABILITY.

* * *

SECTION 5. SECTIONS 807-A, 810-A(3) AND 813-A OF THE ACT ARE

AMENDED TO READ:

SECTION 807-A. [CALCULATION.--USING THE ASSESSMENT RATES

IMPLEMENTED BY THE SECRETARY PURSUANT TO SECTION 805-A(A), EACH

NURSING FACILITY SHALL CALCULATE THE ASSESSMENT AMOUNT IT OWES

FOR A CALENDAR QUARTER ON A FORM SPECIFIED BY THE DEPARTMENT AND

SHALL SUBMIT THE FORM AND THE AMOUNT OWED TO THE DEPARTMENT NO

LATER THAN THE LAST DAY OF THAT CALENDAR QUARTER OR THIRTY (30)

DAYS FROM THE DATE OF THE SECOND NOTICE PUBLISHED PURSUANT TO

SECTION 805-A(A), WHICHEVER IS LATER. A NURSING FACILITY'S

CALCULATION OF THE ASSESSMENT AMOUNT OWED IN ANY QUARTER IS

SUBJECT TO VERIFICATION BY THE DEPARTMENT PURSUANT TO SECTION

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808-A.] ASSESSMENT AMOUNT AND TIMING.--EACH NURSING FACILITY

SHALL REMIT THE ASSESSMENT AMOUNTS DUE AS DETERMINED BY THE

DEPARTMENT PURSUANT TO SECTION 805-A(A) IN PERIODIC SUBMISSIONS,

NOT TO EXCEED FIVE TIMES PER YEAR, AS SPECIFIED BY THE

DEPARTMENT. A NURSING FACILITY SHALL REPORT AND REMIT THE TOTAL

ASSESSMENT AMOUNT OWED ELECTRONICALLY ON FORMS AND IN ACCORDANCE

WITH INSTRUCTIONS AND BY THE DUE DATES PRESCRIBED BY THE

DEPARTMENT. THE PRESCRIBED DUE DATES SHALL BE AT LEAST THIRTY

(30) DAYS AFTER THE DATE OF PUBLICATION OF THE SECOND NOTICE

UNDER SECTION 805-A(A).

SECTION 810-A. 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:

* * *

(3) WHEN A NURSING FACILITY THAT IS A MEDICAL ASSISTANCE

PROVIDER OR 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 FAILS TO PAY ALL

OR PART OF AN ASSESSMENT OR PENALTY WITHIN SIXTY (60) DAYS OF

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

INSTRUCT A MEDICAL ASSISTANCE MANAGED CARE ORGANIZATION TO

DEDUCT THE UNPAID ASSESSMENT OR PENALTY AND ANY INTEREST OWED

THEREON FROM ANY MEDICAL ASSISTANCE PAYMENTS DUE TO THE NURSING

FACILITY OR TO ANY RELATED MEDICAL ASSISTANCE PROVIDER UNTIL THE

FULL AMOUNT IS RECOVERED. ANY SUCH DEDUCTION SHALL BE MADE ONLY

AFTER WRITTEN NOTICE TO THE MEDICAL ASSISTANCE PROVIDER AND MAY

BE TAKEN IN AMOUNTS OVER A PERIOD OF TIME TAKING INTO ACCOUNT

THE FINANCIAL CONDITION OF THE MEDICAL ASSISTANCE PROVIDER.

* * *

SECTION 813-A. REPAYMENT.--NO NURSING FACILITY SHALL BE

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DIRECTLY GUARANTEED A REPAYMENT OF ITS ASSESSMENT IN DEROGATION

OF 42 CFR 433.68(F) (RELATING TO PERMISSIBLE HEALTH CARE-RELATED

TAXES AFTER THE TRANSITION PERIOD): PROVIDED, HOWEVER, THAT IN

EACH FISCAL YEAR IN WHICH AN ASSESSMENT IS IMPLEMENTED, THE

DEPARTMENT SHALL USE THE STATE REVENUE COLLECTED FROM THE

ASSESSMENT AND ANY FEDERAL FUNDS RECEIVED BY THE COMMONWEALTH AS

A DIRECT RESULT OF THE ASSESSMENTS TO [MAINTAIN AND INCREASE

PROGRAM PAYMENTS] MAKE PROGRAM PAYMENTS THROUGH FEE-FOR-SERVICE

OR MANAGED CARE TO MEDICAL ASSISTANCE NURSING FACILITY PROVIDERS

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 IN 42 CFR 433.68(F). IF THE

DEPARTMENT IMPLEMENTS AN ASSESSMENT ON COUNTY NURSING

FACILITIES, THE DEPARTMENT SHALL ALLOCATE ASSESSMENT REVENUES

AVAILABLE TO [MAINTAIN AND INCREASE PROGRAM PAYMENTS] MAKE

PROGRAM PAYMENTS THROUGH FEE-FOR-SERVICE OR MANAGED CARE TO BOTH

COUNTY AND NON COUNTY NURSING FACILITIES IN A MANNER THAT IS

CONSISTENT WITH FEDERAL LAW AND WITHOUT CREATING A DIRECT OR AN

INDIRECT GUARANTEE TO HOLD ANY NURSING FACILITY HARMLESS. 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 [PAYMENT

INCREASES] PAYMENTS.

SECTION 6. SECTION 815-A OF THE ACT, AMENDED JUNE 30, 2012

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

1135 (PA. 2018), AND AMENDED JULY 8, 2016 (P.L.480, NO.76), IS

REENACTED AND AMENDED TO READ:

Section 815-A. Time periods.--The assessment authorized in

this article shall [not be imposed prior to July 1, 2003, or

after June 30, [2012] BE IMPOSED JULY 1, 2003, THROUGH JUNE 30,

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2022.

SECTION 7. THE DEFINITIONS OF "DEPARTMENT" AND "SECRETARY"

IN SECTION 801-C OF THE ACT ARE AMENDED TO READ:

SECTION 801-C. 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:

* * *

["DEPARTMENT." THE DEPARTMENT OF HUMAN SERVICES OF THE

COMMONWEALTH.]

* * *

["SECRETARY." THE SECRETARY OF HUMAN SERVICES OF THE

COMMONWEALTH.]

* * *

SECTION 8. SECTION 811-C(B) AND 808-E(A) OF THE ACT ARE of

the act is AMENDED TO READ:

Section 811-C. Time periods.

* * *

(b) Cessation.--The assessment authorized under this article

shall cease June 30, [2019] 2022 2024 , or earlier, if required

by law.

Section 808-E. Time period.

(a) Cessation.--The assessment authorized under this article

shall cease June 30, [2019] 2022.

* * *

SECTION 9. REPEALS ARE AS FOLLOWS:

(1) THE GENERAL ASSEMBLY DECLARES THAT THE REPEAL UNDER

PARAGRAPH (2) IS NECESSARY TO EFFECTUATE THE REENACTMENT OR

AMENDMENT OF SECTIONS 801-A, 807-A, 810-A(3), 813-A AND 815-A

OF THE ACT.

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(2) SECTION 1729-E(2)(II) OF THE ACT OF APRIL 9, 1929

(P.L.343, NO.176), KNOWN AS THE FISCAL CODE, IS REPEALED.

Section 2 10. This act shall take effect immediately.

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