HOUSE AMENDED

THE GENERAL ASSEMBLY OF PENNSYLVANIA

SENATE BILL

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

AS AMENDED ON THIRD CONSIDERATION, HOUSE OF REPRESENTATIVES, OCTOBER 6, 2010  

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 general powers and

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duties of the Department of Public Welfare, providing for

determining whether applicants are veterans; and, in public

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assistance, further providing for establishment of county

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boards and expenses and for lifetime limit; further defining

"general acute care hospital" and "high volume Medicaid

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hospital"; providing for a definition; and further providing

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for authorization, for administration, for no hold harmless,

for tax exemption and, for cessation and for Statewide

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Quality Care Assessment implementation; providing for the

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availability of and access to a comprehensive trauma care

system; imposing powers and duties upon the Department of

Public Welfare; and making a related repeal.

The General Assembly of the Commonwealth of Pennsylvania

hereby enacts as follows:

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 1.  The act of June 13, 1967 (P.L.31, No.21), known

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as the Public Welfare Code, is amended by adding a section to

read:

Section 215.  Determining Whether Applicants are Veterans.--

(a)  The department shall make a good faith effort to determine

whether an applicant for cash, medical or energy assistance is a

veteran. While in the process of making its determination, the

department shall dispense benefits to the applicant, if

otherwise eligible.

(b)  As a condition of eligibility to receive cash, medical

or energy assistance, unless there is good cause not to do so,

an applicant who is a veteran shall be required to contact a

veteran service officer accredited and recognized by the United

States Department of Veterans Affairs, the Department of

Military and Veterans Affairs or the county director of veterans

affairs in which the applicant resides in order to determine the

applicant's eligibility for veteran's benefits or to file a

veteran claims packet. The department shall develop a standard

form to be used by a veteran service officer to verify the

applicant's eligibility for veteran's benefits.

(c)  An applicant who is a veteran shall provide proof of

compliance with this section and the department shall, to the

greatest extent possible, require the applicant to provide

information on the final determination of eligibility for

veteran's benefits and the type of benefits the veteran is

entitled to receive.

(d)  As used in this section, the following words and phrases

shall have the following meanings:

"Assistance" means money, services and payment for medical

coverage or energy assistance for needy persons who are

residents of this Commonwealth, are in need of assistance and

meet all conditions of eligibility.

"Veteran claims packet" means an application requesting a

determination or entitlement or evidencing a belief in

entitlement to a benefit as provided for in 38 CFR (relating to

pensions, bonuses, and veterans' relief) or 51 Pa.C.S. (relating

to military affairs).

Section 2.  Section 415 of the act 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 3.  Section 441.4 of the act, added July 7, 2005

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(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 shall be 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.

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, amended

December 17, 2009 (P.L.598, No.54), is reenacted to read:

Section 441.4.  Reasonable Limits on Allowable Income

Deductions for Medical Expenses When Determining Payment Toward

the Cost of Long-Term Care Services.--(a)  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 shall be 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 3 4.  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 2.  The definitions of "general acute care hospital"

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and "high volume Medicaid hospital" in section 801-E of the act,

added or amended December 17, 2009 (P.L.598, No.54), are

reenacted 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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"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.

"General acute care hospital."  A hospital other than a

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

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

read:

Section 3.  Sections 802-E, 804-E, 805-E, 807-E and 808-E of

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the act, amended December 17, 2009 (P.L.598, No.54), are

reenacted to read:

Section 802-E.  Authorization.

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

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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

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

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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, 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.

(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 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

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of operating public health clinics and to fund a portion of its

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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.

No general acute care hospital or high volume Medicaid

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hospital or high volume Medicaid hospital shall be directly

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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

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volume Medicaid hospital or high volume Medicaid hospital in the

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municipality shall be exempt from the assessment.

Section 808-E.  [Cessation] Time period.

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(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 808-E.  Time period.

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(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.  Section 803-G(c) of the act, added July 9, 2010

(P.L.336, No.49), is amended to read:

Section 803-G.  Implementation.

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(c)  Adjustments to assessment percentage.--The secretary may

adjust the assessment percentage specified in subsection [(b)

(2)] (b), subject to the following:

(1)  Before adjusting, the secretary shall publish a

notice in the Pennsylvania Bulletin that specifies the

proposed assessment percentage and identifies the aggregate

impact on covered hospitals subject to the assessment.

Interested parties shall have 30 days in which to submit

comments to the secretary. Upon expiration of the 30-day

comment period, the secretary, after consideration of the

comments, shall publish a second notice in the Pennsylvania

Bulletin announcing the assessment percentage.

(2)  The secretary may not adjust the assessment

percentages to exceed 2.95% of the net inpatient revenue of

covered hospitals.

(3)  An adjustment in the assessment percentage shall be

approved by the Governor.

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Section 6 5.  The act is amended by adding an article to

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read:

ARTICLE VIII-H

PENNSYLVANIA TRAUMA SYSTEMS STABILIZATION

Section 801-H.  Scope of article.

This article relates to Pennsylvania trauma systems

stabilization.

Section 802-H.  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:

"Comprehensive emergency services."  The capacity of a

hospital emergency department to maintain staff and provide

immediate and advanced care for Pennsylvania patients who

require trauma care treatment 24 hours per day and seven days

per week based on the availability of the following services:

(1)  At least two qualified physicians to staff the

emergency department during periods of peak utilization.

(2)  At least one registered nurse or technician with

specialized training in advanced life support techniques.

(3)  Anesthesia services at all times.

(4)  Physician specialists who can immediately consult by

telephone or radio and can report immediately to the hospital

emergency department as needed.

(5)  Ancillary services, such as laboratory, radiology,

pharmacy and respiratory therapy, at all times, with

appropriate personnel who can report immediately to the

hospital emergency department as needed.

"Foundation."  The Pennsylvania Trauma Systems Foundation as

defined in 35 Pa.C.S. § 8103 (relating to definitions).

"Hospital."  An entity located in this Commonwealth that is

licensed as a hospital under the act of July 19, 1979 (P.L.130,

No.48), known as the Health Care Facilities Act, or an out-of-

State hospital licensed by its home state.

"Trauma care."  Medical services provided to an individual

with a severe, life-threatening injury which is likely to

produce mortality or permanent disability.

"Trauma center."  Includes:

(1)  A hospital accredited as a Level I, Level II or

Level III trauma center by the Pennsylvania Trauma Systems

Foundation in accordance with this article and 35 Pa.C.S.

§ 8107 (relating to Pennsylvania Trauma Systems Foundation).

(2)  An out-of-State hospital that qualifies as a trauma

center under the State plan for medical assistance and:

(i)  has paid to the foundation the annual

participation fees that would be due if it were to obtain

accreditation from the foundation; and

(ii)  has submitted to the foundation on an annual

basis:

(A)  the clinical patient data that the hospital

submits to the National Trauma Database regarding

Pennsylvania residents who receive trauma services

from the hospital; and

(B)  the information necessary to calculate the

supplemental payment referenced in section 805-H as

provided in the State plan for medical assistance.

"Travel distance."  The distance traveled by a motor vehicle

on paved public roads having at least two driving lanes of width

and on which a motor vehicle would reasonably travel in the

transport of patients.

Section 803-H.  Accreditation of Level III trauma centers.

(a)  Standards.--The foundation shall accredit Level III

trauma centers in accordance with established standards, which

shall be based upon the current guidelines for trauma centers as

defined by the American College of Surgeons for Level III trauma

centers. The accreditation process shall be conducted in

compliance with 35 Pa.C.S. § 8107 (relating to Pennsylvania

Trauma Systems Foundation).

(b)  Additional requirements.--In addition to the Level III

standards established by the foundation under subsection (a), a

hospital must meet all of the following criteria to qualify for

Level III accreditation:

(1)  Provide comprehensive emergency services.

(2)  Total on an annual basis at least 4,000 inpatient

admissions from its emergency department.

(3)  Be located in a third to eighth class county.

(4)  Be located more than 25 miles of travel distance

established by roadways from a Level I, Level II or Level III

trauma center.

The requirements of paragraph (3) and (4) shall not apply to

Level III trauma centers accredited or seeking accreditation as

of the effective date of this subsection.

(c)  Submission of application required.--To be eligible for

accreditation as a Level III trauma center and to qualify for

funds under this article, a hospital must submit an application

to the foundation for the purpose of determining compliance with

the criteria under subsection (b).

(d)  Review of application.--Within 120 days of the receipt

of an application, the foundation shall complete its review of

the application to determine compliance with the criteria under

subsection (b). No later than 240 days from the completion of a

site survey, the foundation shall grant or deny a certificate to

those hospitals seeking to be accredited as Level III trauma

centers.

(e)  Other trauma center references.--A Level III trauma

center accredited under this article shall not be considered an

accredited trauma center for purposes of any other act.

Section 804-H.  Submission of list.

(a)  Level I and Level II trauma centers.--The foundation

shall annually submit to the department its list of accredited

Level I and Level II trauma centers with updates as necessary.

The list shall include all Level I and Level II trauma centers

as defined under this article.

(b)  Level III trauma centers.--Within 15 days of the initial

approval of an accredited Level III trauma center under section

803-H(d), the foundation shall submit that information to the

department. The foundation shall maintain a complete list of all

accredited Level III trauma centers and provide the list to the

department on an annual basis with updates as necessary.

Section 805-H.  Funding.

(a)  Distribution.--Effective for fiscal year 2008-2009 and

each year thereafter, the department shall distribute annually

from available funds appropriated for this purpose a

supplemental payment to each accredited Level I or Level II

trauma center or each Level III trauma center or hospital

seeking Level III accreditation as provided in section 803-H(b)

for the purpose of improving access to readily available and

coordinated trauma care for the citizens of this Commonwealth.

(b)  Funding.--The department shall seek to maximize any

Federal funds, including funds obtained pursuant to Title XIX of

the Social Security Act (49 Stat. 620, 42 U.S.C. § 1396 et seq.)

available for trauma care stabilization.

(c)  Payment calculation.--

(1)  Payment shall be allocated as follows:

(i)  Ninety percent of available funds shall be

allocated to accredited Level I and Level II trauma

centers.

(ii)  The remaining 10% shall be allocated to

hospitals accredited as Level III trauma centers and

hospitals seeking Level III accreditation for up to four

years with documented evidence of progression toward

accreditation and achievement of benchmarks as verified

and established by the foundation in collaboration with

the department.

(2)  Payment to each qualifying Level I or Level II

trauma center shall be calculated using data provided by the

foundation as follows:

(i)  Fifty percent of the total amount available for

Level I and Level II trauma centers shall be allocated

equally among Level I and Level II trauma centers.

(ii)  Fifty percent of the total amount available for

Level I and Level II trauma centers shall be allocated on

the basis of each trauma center's percentage of medical

assistance and uninsured trauma cases and patient days

compared to the Statewide total number of medical

assistance and uninsured trauma cases and patient days

for all Level I and Level II trauma centers.

(3)  Subject to paragraph (4), payment to each qualifying

hospital accredited or seeking accreditation as a Level III

trauma center shall be calculated using the information and

data provided by the foundation as follows:

(i)  Fifty percent of the total amount available for

Level III trauma centers shall be allocated equally among

all Level III trauma centers.

(ii)  Fifty percent of the total amount available for

Level III trauma centers shall be allocated on the basis

of each trauma center's percentage of medical assistance

and uninsured trauma cases and patient days compared to

the Statewide total number of medical assistance and

uninsured trauma cases and patient days for all Level III

trauma centers.

(4)  Payment to each qualifying hospital accredited as a

Level III may not be greater than 50% of the average

Statewide annual payment to a Level II trauma center as

determined in the methodology described in paragraph (2).

(d)  Out-of-State trauma centers.--Any hospital with a Level

I or Level II trauma center not licensed in this Commonwealth

shall be eligible for payment under this article if it meets the

definition of "trauma center" in section 802-H.

Section 806-H.  Notification of trauma center closure.

A hospital that receives funds pursuant to this article shall

notify the department, the foundation and the Department of

Health of its intent to cease operation of its trauma center no

later than 60 days prior to closure of that trauma center.

Section 807-H.  Reporting.

(a)  General rule.--On March 1, 2011, and annually

thereafter, the department shall report to the Public Health and

Welfare Committee of the Senate and the Health and Human

Services Committee of the House of Representatives on the trauma

centers funded under this article.

(b)  Contents of report.--The report shall do all of the

following:

(1)  Identify the trauma centers receiving funds.

(2)  State the amount received and the number of

individuals served.

(3)  Make any recommendations for improvements in this

article which further promote the availability of trauma care

services to the citizens of this Commonwealth.

Section 808-H.  Certification and financial report.

(a)  Certification.--Before funds are provided, a trauma

center qualifying for funds under this article shall certify

that the funds are intended to be used for developing and

providing for the availability of and access to trauma care for

Pennsylvania residents.

(b)  Report.--Each trauma center which receives funds under

this article shall report to the department the following:

(1)  An expenditure report six months after the end of

the fiscal year accounting for how the funds were spent.

(2)  The amount received and the number of individuals

served.

(3)  How funds received through this article improved

access to trauma care for Pennsylvania residents.

Section 7 6.  The addition of Article VIII-H of the act is a

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continuation of the act of March 24, 2004 (P.L.148, No.15),

known as the Pennsylvania Trauma Systems Stabilization Act. The

following apply:

(1)  Except as otherwise provided in Article VIII-H of

the act, all activities initiated under the Pennsylvania

Trauma Systems Stabilization Act shall continue and remain in

full force and effect and may be completed under Article

VIII-H of the act. Resolutions, orders, regulations, rules

and decisions which were made under the Pennsylvania Trauma

Systems Stabilization Act and which are in effect on the

effective date of this section shall remain in full force and

effect until revoked, vacated or modified under Article VIII-

H of the act. Contracts, obligations and agreements entered

into under the Pennsylvania Trauma Systems Stabilization Act

are not affected nor impaired by the repeal of the

Pennsylvania Trauma Systems Stabilization Act.

(2)  Except as set forth in paragraph (3), any difference

in language between Article VIII-H of the act and the

Pennsylvania Trauma Systems Stabilization Act is intended

only to conform to the style of the act of June 13, 1967

(P.L.31, No.21), known as the Public Welfare Code, and is not

intended to change or affect the legislative intent, judicial

construction or administrative interpretation and

implementation of the Pennsylvania Trauma Systems

Stabilization Act.

(3)  Paragraph (2) does not apply to the following:

(i)  The addition of the definitions of

"comprehensive emergency services," "hospital," "trauma

center" and "travel distance" in section 802-H of the

act.

(ii)  The addition of sections 803-H(b), (c) and (d),

804-H(a), 805-H(a), (c) and (d) and 808-H of the act.

Section 8 7.  Repeals are as follows:

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(1)  The General Assembly declares that the repeal under

paragraph (2) is necessary to effectuate the addition of

Article VIII-H of the act.

(2)  The act of March 24, 2004 (P.L.148, No.15), known as

the Pennsylvania Trauma Systems Stabilization Act, is

repealed.

Section 5 6 9 8.  This act shall take effect immediately.

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