THE GENERAL ASSEMBLY OF PENNSYLVANIA

SENATE BILL

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

SENATOR CORMAN, APPROPRIATIONS, RE-REPORTED AS AMENDED, OCTOBER 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 

establishment of county boards and expenses and for lifetime

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limit; further defining "exempt hospital" "general acute care

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hospital"; providing for a definition; and further providing

for authorization, for administration, for no hold harmless,

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for tax exemption and for cessation.

The General Assembly of the Commonwealth of Pennsylvania

hereby enacts as follows:

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

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(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 1.  Section 415 of the act of June 13, 1967 (P.L.31,

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No.21), known as the Public Welfare Code, is amended to read:

Section 415.  Establishment of County Boards; Expenses.--For

each county of the Commonwealth, there is hereby established a

county board of assistance, to be known as the County Board of

Assistance and referred to in this Article IV as the "county

board," which shall be composed of men and women, to be

appointed by the Governor [with the advice and consent of two-

thirds of all members of the Senate]. Each appointment by the

Governor shall bear the endorsement of the senator of the

district in which the nominee resides. In the case of a vacancy

in that senatorial district, the nominee shall be endorsed by

the senator of an adjacent district. The county boards shall be

composed as far as possible of persons engaged or interested in

business, social welfare, labor, industry, education or public

administration. The members of the county boards shall serve

without compensation, but shall be reimbursed for necessary

expenses. No member of a county board shall hold office in any

political party. Not all of the members of a county board shall

belong to the same political party.

Section 2.  Section 441.4 of the act, 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 shall be disallowed as a deduction, and medical

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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

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

amended to read:

Section 3.  The definition of "general acute care hospital"

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in section 801-E of the act, added July 4, 2008 (P.L.557,

No.44), is amended and the section is amended by adding a

definition 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:

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

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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.

"General acute care hospital."  A hospital other than [an

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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 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.

"High volume Medicaid hospital."  A hospital that the

Secretary of Public Welfare 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 more than 90,000 days of care to medical

assistance patients annually.

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

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(P.L.557, No.44), is amended to read:

Section 4.  Sections 802-E, 804-E, 805-E, 807-E and 808-E of

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the act, added July 4, 2008 (P.L.557, No.44), are amended to

read:

Section 802-E.  Authorization.

(a)  General rule.--In order to generate additional revenues

for the purpose of assuring that medical assistance recipients

have access to hospital 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, [impose] do 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 [subject

to the conditions and requirements specified under this

article].

(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.

(b)  Administrative provisions.--The [ordinance] ordinances

adopted pursuant to subsection (a) may include appropriate

administrative provisions including, without limitation,

provisions for the collection of interest and penalties.

(c)  Maximum assessment.--In each year in which the

assessment is implemented, the assessment shall be subject to

the maximum aggregate amount that may be assessed under 42 CFR

433.68(f)(3)(i) (relating to permissible health care-related

taxes) or any other maximum established under Federal law.

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 805-E.  No hold harmless.

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No general acute care hospital or high volume Medicaid

hospital 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

harmless, as those terms are used under 42 CFR 433.68(f)(i). The

secretary shall submit any State Medicaid 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 shall be exempt

from the assessment.

Section 808-E.  [Cessation] Time period.

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

shall cease June 30, 2013.

(b)  Assessment.--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.

Section 4 5.  This act shall take effect immediately.

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