PRINTER'S NO. 2363
No. 1564 Session of 2008
INTRODUCED BY BRUBAKER, PILEGGI, WONDERLING, VANCE, CORMAN,
EARLL, M. WHITE, ORIE, RAFFERTY, BROWNE, WOZNIAK AND BAKER,
SEPTEMBER 16, 2008
REFERRED TO PUBLIC HEALTH AND WELFARE, SEPTEMBER 16, 2008
AN ACT
1 Establishing the Keystone Care Program in the Department of
2 Health to provide grants for health care services; and making
3 an appropriation.
4 The General Assembly of the Commonwealth of Pennsylvania
5 hereby enacts as follows:
6 CHAPTER 1
7 PRELIMINARY PROVISIONS
8 Section 101. Short title.
9 This act shall be known and may be cited as the Keystone Care
10 Program Act.
11 Section 102. Definitions.
12 The following words and phrases when used in this act shall
13 have the meanings given to them in this section unless the
14 context clearly indicates otherwise:
15 "Community-based health care clinic." A nonprofit health
16 care center located in this Commonwealth that provides health
17 care services to low-income and uninsured individuals, and meets
18 either of the following criteria:
1 (1) serves a federally designated medically underserved
2 area, a medically underserved population or a health
3 professional shortage area; or
4 (2) serves a patient population with a majority of that
5 population having an income less than 200% of the Federal
6 poverty income guidelines, including:
7 (i) A federally qualified health center as defined
8 in section 1905(l)(2)(B) of the Social Security Act (49
9 Stat. 620, 42 U.S.C. § 1396d(l)(2)(B)) or a federally
10 qualified health center look-alike.
11 (ii) A rural health clinic as defined in section
12 1861(aa)(2) of the Social Security Act (49 Stat. 620, 42
13 U.S.C. § 1395x(aa)(2)), certified by Medicare.
14 (iii) A hospital health clinic.
15 (iv) A free or partial-pay health clinic that
16 provides services by volunteer and nonvolunteer health
17 care providers.
18 (v) A nurse-managed health care clinic that is
19 managed by advanced practice nurses and is associated
20 with a department of nursing, a federally qualified
21 health center or an independent nonprofit health or
22 social services agency.
23 "Health care resource network." A sustainable, integrated
24 network organized by a nonprofit entity to use community-based
25 health care clinics and an organized physician volunteer
26 component to provide access to a full continuum of health care
27 services for participating patients residing in a local delivery
28 area.
29 "Local delivery area." A city, county, multicounty or other
30 regional area within this Commonwealth that institutes a health
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1 care resource network in accordance with this act.
2 "Participating patient." An individual who meets the
3 criteria set forth in section 303.
4 "Program." The Keystone Care (KeyCare) Program established
5 in section 301.
6 CHAPTER 3
7 KEYCARE PROGRAM
8 Section 301. Program.
9 (a) Establishment of KeyCare Program.--The Keystone Care
10 (KeyCare) Program is hereby established within the Department of
11 Health to administer and provide grants to an approved health
12 care resource network.
13 (b) Purpose.--Health care resource networks across this
14 Commonwealth shall be created to do all of the following:
15 (1) Encourage physicians, hospitals, dentists and other
16 health care partners such as nurses, nurse practitioners,
17 physician assistants, certified nurse midwives and dental
18 hygienists to volunteer for participation in a health care
19 resource network.
20 (2) Establish a referral system for participating
21 patients with preference given to individuals referred from
22 community-based health care clinics.
23 (3) Promote the support and involvement of interested
24 persons, businesses and charitable organizations and
25 foundations within local delivery areas for the formation and
26 operation of networks.
27 Section 302. Health care resource network capacity and access.
28 A health care resource network shall make available the
29 following health care services for participating patients:
30 (1) Expanded health care capacity and access for
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1 participating patients.
2 (2) Participation of voluntary health care providers who
3 donate their services and agree to see a set number of
4 participating patients per year.
5 (3) Structured private physician specialty and primary
6 care referral.
7 (4) Structured dentist referral that may include a
8 network of dental services utilizing dental hygienist
9 services under general dental supervision.
10 (5) Health care services which may vary by network.
11 (6) Preventative and chronic care and disease management
12 that promotes wellness and patient responsibility and
13 accountability through responsibility agreements by
14 participating patients.
15 (7) Diagnostic and ancillary services.
16 (8) Centralized financial screening, enrollment and
17 patient referrals.
18 Section 303. Participating patient requirements.
19 A participating patient shall meet all of the following
20 requirements:
21 (1) Be a Pennsylvania resident and reside in the local
22 delivery area health care resource network for at least six
23 months.
24 (2) Be at least 19 but less than 65 years of age.
25 (3) Have income that does not exceed 200% of Federal
26 poverty income guidelines.
27 (4) Not receive or be eligible for Medicare or Medicaid.
28 (5) Not receive any other Federal or State medical
29 benefits.
30 (6) Not be covered by any other private health
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1 insurance.
2 (7) Show an established health care need for primary or
3 specialty medical care services.
4 Section 304. Administration.
5 The Department of Health shall do all of the following:
6 (1) Administer the KeyCare Program.
7 (2) Within 90 days of the effective date of this
8 section, develop and provide an application form consistent
9 with this act. A grant under this section may be extended
10 over two State fiscal years at the request of a health care
11 resource network.
12 (3) Establish a process to allocate funding and issue
13 grants based on any of the following:
14 (i) Initial creation of a health care resource
15 network in a local delivery area.
16 (ii) Operation of a network in accordance with the
17 requirements of this act.
18 (iii) Administration of a patient referral system
19 that includes patient appointment reminder telephone
20 calls.
21 (iv) Partnership between local government
22 administration, private physicians, community-based
23 health care clinics, medical societies, hospitals, area
24 health education centers, pharmacists, social services
25 and patients located in a local delivery area.
26 (4) Calculate and make grants to qualified health care
27 resource networks from the funds deposited in the fund.
28 (5) Make the report required in section 305 available
29 for public inspection and posted on the Department of
30 Health's publicly accessible Internet website.
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1 (6) Establish a Statewide association to assist local
2 delivery areas in their efforts to create and sustain health
3 care resource networks.
4 (7) Establish an online database of health care resource
5 networks and local delivery areas.
6 Section 305. Report.
7 The Department of Health shall provide an annual report no
8 later than November 30 to the chairman and minority chairman of
9 the Public Health and Welfare Committee of the Senate and the
10 chairman and minority chairman of the Health and Human Services
11 Committee of the House of Representatives. The report shall
12 include:
13 (1) The total dollar amount for each grant awarded by
14 name of grantee.
15 (2) The impact of the grant on improving the delivery
16 and quality of health care in the local delivery area.
17 (3) The total amount of funds spent.
18 (4) Any recommendations for program improvements.
19 CHAPTER 21
20 MISCELLANEOUS PROVISIONS
21 Section 2101. Limitations on payments by Department of Health.
22 Grants provided by the program shall not exceed the amount of
23 funds available for the program and any payment shall not
24 constitute an entitlement from the Commonwealth or a claim on
25 any other funds of the Commonwealth.
26 Section 2102. Appropriation.
27 The sum of $4,000,000 is hereby appropriated to the
28 Department of Health to carry out the provisions of this act.
29 Section 2103. Effective date.
30 This act shall take effect in 90 days.
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