THE GENERAL ASSEMBLY OF PENNSYLVANIA

SENATE BILL

INTRODUCED BY KITCHEN, WASHINGTON, TARTAGLIONE, FONTANA, HUGHES, DINNIMAN AND WILLIAMS, JUNE 5, 2009

REFERRED TO PUBLIC HEALTH AND WELFARE, JUNE 5, 2009  

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," further providing for

lifetime limit; further defining "exempt hospital"; and

further providing for administration.

The General Assembly of the Commonwealth of Pennsylvania

hereby enacts as follows:

Section 1.  Section 441.4 of the act of June 13, 1967

(P.L.31, No.21), known as the Public Welfare Code, added July 7,

2005 (P.L.177, No.42), is amended to read:

Section 441.4.  [Lifetime Limit] Reasonable Limits on

Allowable Income Deductions for Medical Expenses When

Determining Payment Toward the Cost of Long-Term Care

Services.--(a)  [Necessary medical or remedial care expenses

recognized under Federal or State law but not paid for by the

medical assistance program are allowable income deductions when

determining a recipient's payment toward the cost of long-term

care services. An allowable income deduction for unpaid medical

expenses incurred prior to the authorization of medical

assistance eligibility and those medical expenses incurred for

long-term care services after medical assistance is authorized

shall be subject to a lifetime maximum of ten thousand dollars

($10,000) unless application of the limit would result in undue

hardship.] When determining a recipient's payment toward the

cost of long-term care services, long-term care medical expenses

incurred six months or more prior to application for medical

assistance are disallowed as a deduction, and medical and

remedial expenses that were incurred as a result of a transfer

of assets penalty shall be limited to zero unless application of

these limits would result in undue hardship.

(b)  As used in this section, the term "undue hardship" shall

mean that either:

(1)  denial of medical assistance would deprive the

individual of medical care and endanger the individual's health

or life; or

(2)  the individual or a financially dependent family member

would be deprived of food, shelter or the necessities of life.

Section 2.  The definition of "exempt hospital" in section

801-E of the act, added July 4, 2008 (P.L.557, No.44), is

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:

* * *

"Exempt hospital."  A hospital that the Secretary of Public

Welfare 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 Pt. 412

(relating to prospective payment systems for inpatient hospital

services).

(2)  Is a Federal veterans' affairs hospital.

(3)  Is part of an institution with State-related status as

that term is defined in 22 Pa. Code § 31.2 (relating to

definitions) and provides over 100,000 days of care to medical

assistance patients annually.

(4)  Provides care, including inpatient hospital services, to

all patients free of charge.

* * *

Section 3.  Section 804-E of the act, added July 4, 2008

(P.L.557, No.44), is 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

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 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 the department for purposes of making

supplemental or increased medical assistance payments for

emergency department 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.

Section 4.  This act shall take effect immediately.