PRINTER'S NO. 4360
No. 2878 Session of 2002
INTRODUCED BY TULLI, VEON, NICKOL, MANN, CAPPELLI, CREIGHTON,
BROWNE, DeLUCA, HARHAI, HORSEY, LAUGHLIN, MELIO, R. MILLER,
MYERS, SCRIMENTI, SHANER, SOLOBAY, STEELMAN, THOMAS AND
YOUNGBLOOD, OCTOBER 1, 2002
REFERRED TO COMMITTEE ON HEALTH AND HUMAN SERVICES,
OCTOBER 1, 2002
AN ACT
1 Amending the act of June 13, 1967 (P.L.31, No.21), entitled "An
2 act to consolidate, editorially revise, and codify the public
3 welfare laws of the Commonwealth," further providing for
4 medical assistance payments for institutional care.
5 The General Assembly of the Commonwealth of Pennsylvania
6 hereby enacts as follows:
7 Section 1. Section 443.1 of the act of June 13, 1967
8 (P.L.31, No.21), known as the Public Welfare Code, amended July
9 15, 1976 (P.L.993, No.202), is amended to read:
10 Section 443.1. Medical Assistance Payments for Institutional
11 Care.--The following medical assistance payments shall be made
12 in behalf of eligible persons whose institutional care is
13 prescribed by physicians:
14 (1) The reasonable cost of inpatient hospital care, as
15 specified by regulations of the department adopted under Title
16 XIX of the Federal Social Security Act and certified to the
17 department by the Auditor General for a bed patient on a
1 continuous twenty-four hour a day basis in a multi bed
2 accommodation of a hospital, exclusive of a hospital or distinct
3 part of a hospital wherein twenty-five percent of patients
4 remain six months or more. To be eligible for such payments a
5 hospital must be qualified to participate under Title XIX of the
6 Federal Social Security Act and have entered into a written
7 agreement with the department regarding matters designated by
8 the secretary as necessary to efficient administration, such as
9 hospital utilization, maintenance of proper cost accounting
10 records and access to patients' records. Such efficient
11 administration shall require the department to permit
12 participating hospitals to utilize the same fiscal intermediary
13 for this Title XIX program as such hospitals use for the Title
14 XVIII program;
15 (1.1) Notwithstanding any other provision of law, the
16 department shall use a classification system to pay prospective
17 rates for inpatient hospital care that:
18 (i) is based on clinically homogeneous diagnosis-related
19 groups;
20 (ii) is based on standard administrative claims-based data;
21 (iii) effectively classifies the entire hospital patient
22 population, especially children and neonates;
23 (iv) takes into account the interaction of multiple
24 diseases, conditions and comorbidities for each patient;
25 (v) separately and explicitly stratifies patients by
26 severity of illness and risk of mortality;
27 (vi) enables the department to set and adjust reimbursement
28 rates without changing the underlying clinical classification of
29 patients;
30 (vii) is consistent with, and allows comparison of
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1 Pennsylvania data with, inpatient hospital data from the largest
2 practical number of other states and hospitals;
3 (viii) will support efforts by hospitals to assess and
4 improve quality of care and efficiency in operation;
5 (ix) has a demonstrated record of being kept current and
6 consistent with best classification practices; and
7 (x) has achieved the greatest level of acceptance and
8 adoption by State agencies responsible for the collection,
9 analysis and dissemination of inpatient hospital data.
10 (2) The cost of skilled nursing and intermediate nursing
11 care in State-owned geriatric centers, institutions for the
12 mentally retarded, institutions for the mentally ill, and in
13 county homes which meet the State and Federal requirements for
14 participation under Title XIX of the Federal Social Security Act
15 and which are approved by the department. This cost in county
16 homes shall be as specified by the regulations of the department
17 adopted under Title XIX of the Federal Social Security Act and
18 certified to the department by the Auditor General; elsewhere
19 the cost shall be determined by the department;
20 (3) Rates on a cost-related basis established by the
21 department for skilled nursing home or intermediate care in a
22 non-public nursing home, when furnished by a nursing home
23 licensed or approved by the department and qualified to
24 participate under Title XIX of the Federal Social Security Act;
25 (4) The cost of care in any mental hospital or in a public
26 tuberculosis hospital. To be eligible for such payments a
27 hospital must be qualified to participate under Title XIX of the
28 Federal Social Security Act and have entered into a written
29 agreement with the department regarding matters designated by
30 the secretary as necessary to efficient administration, such as
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1 hospital utilization, maintenance of proper cost accounting
2 records and access to patients' records. Care in a private
3 mental hospital shall be limited to sixty days in a benefit
4 period. Only persons aged twenty-one years or under and aged
5 sixty-five years or older shall be eligible for care in a public
6 mental or tuberculosis hospital. This cost shall be the
7 reasonable cost, as determined by the department for a State
8 institution or as specified by regulations of the department
9 adopted under Title XIX of the Federal Social Security Act and
10 certified to the department by the Auditor General for county
11 and non-public institutions.
12 Section 2. This act shall take effect in 60 days.
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