AN ACT

 

1Amending the act of June 13, 1967 (P.L.31, No.21), entitled "An
2act to consolidate, editorially revise, and codify the public
3welfare laws of the Commonwealth," <-changing the name of the 
4Department of Public Welfare to the Department of Human 
5Services and providing for a transition period; in general 
6powers and duties of the Department of Public Welfare, 
7further providing for county human services consolidated 
8planning and reporting; in public assistance,  further 
9providing for medical assistance payments for institutional 
10care and for medical assistance benefit packages, coverage, 
11copayments, premiums and rates; in children and youth, 
12further providing for payments to counties for services to 
13children and providing for provider submissions; in 
14intermediate care facilities assessments, further providing 
15for time periods and making editorial changes; in hospital 
16assessments, further providing for authorization and for time 
17period; in Statewide quality care assessment, <-reenacting and 
18further defining "net inpatient revenue," providing for 
19implementation, for administration, for limitations and for 
20expiration; in Pennsylvania Trauma Systems Stabilization, 
21further providing for funding; in kinship care, further
22providing for scope and for definitions; <-and providing for
23family finding<-; and, in human services block grant pilot 
24program, further providing for establishment of human 
25services block grant pilot program, for powers and duties of 
26the department, for powers and duties of counties, for 
27allocation and for use of block grant funds.

<-28The General Assembly finds and declares as follows:

29(1) It is the purpose of this act to provide fiscal and

1administrative support that promotes the health, safety and
2welfare of the citizens of this Commonwealth.

3(2) Pennsylvania, through the Department of Public
4Welfare and the counties, provides a broad array of health
5care and other human services to low income families,
6children and youth, those with intellectual and physical
7disabilities and the elderly.

8(3) Section 24 of Article III of the Constitution of
9Pennsylvania requires the General Assembly to adopt all
10appropriations for the operation of government in this
11Commonwealth. The Supreme Court has repeatedly affirmed that,
12"It is fundamental within Pennsylvania's tripartite system
13that the General Assembly enacts the legislation establishing
14those programs which the State provides for its citizens and
15appropriates the funds necessary for their operation."

16(4) Section 11 of Article III of the Constitution of
17Pennsylvania requires the adoption of a general appropriation
18bill that embraces "nothing but appropriations." While actual
19appropriation can be contained in a general appropriations
20act, the achievement and implementation of a comprehensive
21budget involves much more than appropriations. Ultimately,
22the budget has to be balanced under Section 13 of Article
23VIII of the Constitution of Pennsylvania. This may
24necessitate changes to sources of funding and enactment of
25statutes to achieve full compliance with these constitutional
26provisions.

27(5) Therefore, it is the intent of the General Assembly
28through this act to provide further implementation of the
29General Appropriation Act of 2013, as it affects the
30operations and funding for the delivery of health care and

1human services that protect our most vulnerable and needy
2citizens.

3(6) This act shall accomplish all of the following:

4(i) Provide for the expansion of the Human Services
5Block Grant Pilot Program.

6(ii) Extend the authority for State and local
7assessments that support hospitals and intermediate care
8facilities for persons with an intellectual disability
9that serve persons in the medical assistance program.

10(iii) Provide for separate medical assistance fee-
11for-service payments for normal newborn care and for
12mothers' obstetrical delivery.

13(iv) Reauthorize the nursing facility revenue
14adjustment neutrality factor to provide continued
15payments for nursing facilities that serve persons in the
16medical assistance program.

17(v) Provide for quarterly medical assistance day one
18incentive payments to qualified nonpublic nursing
19facilities.

20(vi) Provide for publication of a premium schedule
21for families with children with special needs, who
22receive benefits under the medical assistance program.

23(vii) Establish a process to assure that the revenue
24of the Commonwealth is timely disbursed and expended
25properly for the delivery of public child welfare
26services.

27(viii) Reauthorize the reallocation of excess funds
28for payment to qualifying hospitals accredited or seeking
29accreditation as Level III trauma centers.

30(ix) Change the name of the Department of Public

1Welfare to the Department of Human Services.

2(x) Provide for the development and implementation
3of an enhanced medical services delivery system.

4The General Assembly of the Commonwealth of Pennsylvania
5hereby enacts as follows:

<-6Section 1. The heading of Article XIII of the act of June
713, 1967 (P.L.31, No.21), known as the Public Welfare Code,
8added September 30, 2003 (P.L.169, No.25), is amended to read:

<-9Section 1. Section 102 of the act of June 13, 1967 (P.L.31,
10No.21), known as the Public Welfare Code, is amended to read:

11Section 102. Definitions.--Subject to additional definitions
12contained in subsequent articles of this act, the following
13words when used in this act shall have, unless the context
14clearly indicates otherwise, the meanings given them in this
15section:

16"Department" means the Department of [Public Welfare] Human 
17Services of this Commonwealth.

18"Secretary" means the Secretary of [Public Welfare] Human 
19Services of this Commonwealth.

20Section 2. The act is amended by adding sections to read:

21Section 103. Redesignation.--(a) The Department of Public
22Welfare shall be known as the Department of Human Services.

23(b) A reference to the Department of Public Welfare in a
24statute or a regulation shall be deemed a reference to the
25Department of Human Services.

26(c) In order to provide an efficient and cost-minimizing
27transition, licenses, contracts, deeds and any other official
28actions of the Department of Public Welfare shall not be
29affected by the use of the designation of the department as the
30Department of Human Services. The department may continue to use

1the name Department of Public Welfare on badges, licenses,
2contracts, deeds, stationery and any other official documents
3until existing supplies are exhausted. The Department of Public
4Welfare may substitute the title "Department of Human Services"
5for "Department of Public Welfare" on its documents and
6materials on such schedule as it deems appropriate.

7(d) The Department of Human Services shall not replace
8existing signage at department locations with the redesignated
9name until the signs are worn and in need of replacement. This
10transition shall be coordinated with changes in administration.

11(e) The department shall continue to use the name Department
12of Public Welfare on its computer systems until the time of
13routine upgrades in each computer system in the department. The
14change in name shall be made at the time of the routine upgrade
15to the department computer systems.

16Section 441.10. Enhanced medical services delivery system.--
17(a) Any enhanced medical services delivery system developed
18collaboratively with the United States Department of Health and
19Human Services and approved for this Commonwealth shall consider
20and recognize all of the following design options or reforms:

21(1) Benefit design modifications that make the medical
22assistance program responsive and flexible to changing needs and
23demands, thereby allowing an expansion of coverage to additional
24citizens of this Commonwealth.

25(2) Improved accountability and personal responsibility
26through cost sharing that includes reasonable low-cost premiums
27or copay requirements, which encourage proper utilization and
28the delivery of services to those who need them most.

29(3) Plan design features that parallel the services and
30benefits available to citizens of this Commonwealth with

1commercial insurance coverage and meet the requirements of an
2essential health benefit plan as defined under the Patient
3Protection and Affordable Care Act (Public Law 111-148, 1124
4Stat. 119), including the delivery of behavioral health
5services.

6(4) Maximized use of commercial insurance that takes an
7integrated and market-based approach with new coverage
8opportunities, market competition and alternatives to the
9existing medical assistance program when determined to be more
10fiscally sound and appropriate, including movement to the health
11care exchange for those in the Medical Assistance for Workers
12with Disabilities program.

13(5) Implementation of an enhanced medical services delivery
14system that utilizes existing or supplemental plans for medical
15assistance programs as contracted by the department, using a
16risk-based approach for reimbursing Medicaid managed care
17organizations.

18(6) Continued operation of the Children's Health Insurance
19Program in a form that does not unnecessarily require a shift to
20medical assistance or an enhanced medical services delivery
21system.

22(7) Reasonable employment and job search requirements for
23those physically or mentally able, as well as appropriate limits
24on nonessential benefits, such as nonemergency transportation.

25(8) Improved access and continuity of care, with Federal and
26State support for the use of community-based health centers,
27medical homes, expanded scope of practice and targeted chronic
28care, including a managed long-term care pilot program and other
29long-term care measures, that provide coordination and delivery
30of preventive care and assure the wellness of the served

1population.

2(9) Use of competitive and value-based purchasing from
3medical providers and medical equipment suppliers that promotes
4efficiencies and delivers value to taxpayers.

5(10) Continued emphasis on the reduction of waste, fraud and
6abuse in all facets of the medical services delivery and
7provider system, with focused attention on credible allegations
8of fraud by providers and the use of predictive modeling.

9(11) Resolution on existing Federal deferrals and
10disallowances as they relate to the Pennsylvania Medicaid
11Program with minimal financial impact to the Commonwealth.

12(12) Maintained allowance of the Commonwealth's current
13gross receipts tax on Medicaid managed care organizations for
14the duration of any enhanced medical services delivery system in
15the Commonwealth.

16(13) Application of the Federal financial participation rate
17currently provided to the Commonwealth, based on existing
18Federal calculations, for medical assistance and all other
19eligible programs and services that receive a Federal match.

20(14) Affirmation that any expanded coverage under the
21enhanced medical services delivery system does not constitute an
22entitlement at the Federal or State level.

23(b) The adoption of an agreement to create an enhanced
24medical services delivery system in this Commonwealth for adults
25ranging from 19 to 65 years of age necessitates further
26discussions with the United States Department of Health and
27Human Services to ensure that it can be accomplished in an
28integrated, cost-effective and fiscally sustainable manner and
29that taxpayer dollars derived directly from citizens of this
30Commonwealth, which are going to the Federal Government under

1the Patient Protection and Affordable Care Act (Public Law 111-
2148, 124 Stat. 119), generate services to the citizens of this
3Commonwealth in proportion to that significant investment.

4(c) Recognition and furtherance of the objectives set forth
5under subsection (a) are essential as the Commonwealth
6vigorously pursues its discussions with the United States
7Department of Health and Human Services to develop and implement
8an agreement with the Secretary of the United States Department
9of Health and Human Services to expand eligibility to persons 
10described under section 1902(a)(10)(A)(i)(VIII) of the Social 
11Security Act (49 Stat. 620, 42 U.S.C. § 1396a(a)(10)(A)(i)
12(VIII)), no later than July 1, 2014. The department shall submit 
13an application for an enhanced medical services delivery system 
14to the United States Department of Health and Human Services for 
15review no later than October 1, 2013. The department shall 
16submit a revised State plan or waiver if required to implement 
17an expansion of eligibility under this subsection.

18(d) This section and the authority to expand eligibility
19under an enhanced medical services delivery system shall cease
20if the Federal medical assistance percentage under section
211905(y) of the Social Security Act (42 U.S.C. § 1396d(y)) is
22less than the following:

23(1) One hundred percent for calendar quarters in 2014, 2015
24and 2016.

25(2) Ninety-five percent for calendar quarters in 2017.

26(3) Ninety-four percent for calendar quarters in 2018.

27(4) Ninety-three percent for calendar quarters in 2019.

28(5) Ninety percent for calendar quarters in 2020 and each
29year thereafter.

30(e) Commencing in fiscal year 2019-2020, continued

1participation by recipients in an enhanced medical services
2delivery system shall be conditioned on the options of increased
3cost-sharing or the purchase of coverage with Federal subsidies
4through the exchange.

5(f) The General Assembly finds and declares as follows:

6(1) The Commonwealth has initiated transformative changes in
7the medical assistance health care delivery system through the
8expansive use of managed care; alignment of payment incentives;
9recognition of the need for rural, underserved and community-
10based health care access; support of community-based health care
11centers; multifaceted initiatives to reduce waste, fraud and
12abuse; targeted resources for the delivery of chronic care; and
13the establishment of medical homes. The Commonwealth is also
14known for its nationally recognized programs to promote patient
15safety and the use of electronic medical records, to reduce
16health care infections and to advance medical, technological and
17biological research, which collectively have contributed to
18advances in the care, treatment and cure of medical disease.

19(2) The Commonwealth established the PACE and PACENET
20programs to provide affordable pharmaceutical drugs for our
21seniors, which became model programs for the nation.

22(3) The Commonwealth created the innovative Children's
23Health Insurance Program, which also became a model for the
24nation by providing access to comprehensive health care services
25for children across this Commonwealth and is a vital program
26that should be preserved.

27(4) In 2001, the Commonwealth established a nonentitlement
28program known as AdultBasic for the purpose of providing health
29care insurance coverage to eligible adults not otherwise
30eligible for medical assistance, initially using funds available

1through the act of June 26, 2001 (P.L.755, No.77), known as the 
2Tobacco Settlement Act. Any agreement between the Commonwealth 
3and the United States Department of Health and Human Services on 
4the establishment of an enhanced medical assistance delivery 
5system will serve to advance these same interests.

6(5) Commonwealth taxpayers currently provide publicly 
7subsidized health care for nearly 2,400,000 thousand citizens of 
8this Commonwealth, or almost 19% of the total population of this 
9Commonwealth, which includes coverage for a broad array of 
10mandatory and optional health care benefits.

11Section 3. Section 443.1 (1.1)(i), (1.4) and (7)(iv) of the
12act, amended or added June 30, 2011 (P.L.89, No.22), are
13amended, paragraph (7) is amended by adding a subparagraph and
14the section is amended by adding a paragraph to read:

15Section 443.1.  Medical Assistance Payments for Institutional
16Care.--The following medical assistance payments shall be made
17on behalf of eligible persons whose institutional care is
18prescribed by physicians:

19* * *

20(1.1) Subject to section 813-G, for inpatient acute care
21hospital services provided during a fiscal year in which an
22assessment is imposed under Article VIII-G, payments under the
23medical assistance fee-for-service program shall be determined
24in accordance with the department's regulations, except as
25follows:

26(i) If the Commonwealth's approved Title XIX State Plan for 
27inpatient hospital services in effect for the period of July 1, 
282010, through June 30, [2013] 2016, specifies a methodology for 
29calculating payments that is different from the department's 
30regulations or authorizes additional payments not specified in
 

1the department's regulations, such as inpatient disproportionate 
2share payments and direct medical education payments, the 
3department shall follow the methodology or make the additional 
4payments as specified in the approved Title XIX State Plan.

5* * *

6(1.4) Subject to section 813-G, for inpatient hospital
7services provided under the physical health medical assistance
8managed care program during State fiscal [year] years 2012-2013,
92013-2014, 2014-2015 and 2015-2016, the following shall apply:

10(A) The department may adjust its capitation payments to
11medical assistance managed care organizations to provide
12additional funds for inpatient hospital services.

13(B) For an out-of-network inpatient discharge of a recipient 
14enrolled in a medical assistance managed care organization that 
15occurs in State fiscal year 2012-2013, 2013-2014, 2014-2015 or 
162015-2016, the medical assistance managed care organization 
17shall pay, and the hospital shall accept as payment in full, the 
18amount that the department's fee-for-service program would have 
19paid for the discharge if the recipient [were] was enrolled in 
20the department's fee-for-service program.

21(C) Nothing in this paragraph shall prohibit an inpatient
22acute care hospital and a medical assistance managed care
23organization from executing a new participation agreement or
24amending an existing participation agreement on or after July 1,
252013.

26* * *

27(1.6) Notwithstanding any other provision of law or
28departmental regulation to the contrary, the department shall
29make separate fee-for-service APR-DRG payments for medically
30necessary inpatient acute care general hospital services

1provided for normal newborn care and for mothers' obstetrical
2delivery.

3* * *

4(7)  After June 30, 2007, payments to county and nonpublic
5nursing facilities enrolled in the medical assistance program as
6providers of nursing facility services shall be determined in
7accordance with the methodologies for establishing payment rates
8for county and nonpublic nursing facilities specified in the
9department's regulations and the Commonwealth's approved Title
10XIX State Plan for nursing facility services in effect after
11June 30, 2007. The following shall apply:

12* * *

13(iv)  Subject to Federal approval of such amendments as may
14be necessary to the Commonwealth's approved Title XIX State
15Plan, for each fiscal year beginning on or after July 1, 2011,
16the department shall apply a revenue adjustment neutrality
17factor to county and nonpublic nursing facility payment rates so
18that the estimated Statewide day-weighted average payment rate
19in effect for that fiscal year is limited to the amount
20permitted by the funds appropriated by the General Appropriation
21Act for the fiscal year. The revenue adjustment neutrality
22factor shall remain in effect until the sooner of June 30,
23[2013] 2016, or the date on which a new rate-setting methodology
24for medical assistance nursing facility services which replaces
25the rate-setting methodology codified in 55 Pa. Code Chs. 1187
26(relating to nursing facility services) and 1189 (relating to
27county nursing facility services) takes effect.

28(v) Subject to Federal approval of such amendments as may be
29necessary to the Commonwealth's approved Title XIX State Plan,
30for fiscal year 2013-2014, the department shall make quarterly

1medical assistance day one incentive payments to qualified
2nonpublic nursing facilities. The department shall determine the
3nonpublic nursing facilities that qualify for the quarterly
4medical assistance day one incentive payments and calculate the
5payments using the Total Pennsylvania medical assistance (PA MA)
6days and Total Resident Days as reported by nonpublic nursing
7facilities under Article VIII-A (relating to nursing facility
8assessments). The department's determination and calculations
9under this subparagraph shall be based on the nursing facility
10assessment quarterly resident day reporting forms available on
11October 31, January 31, April 30 and July 31. The department
12shall not retroactively revise a medical assistance day one
13incentive payment amount based on a nursing facility's late
14submission or revision of its report after these dates. The
15department, however, may recoup payments based on an audit of a
16nursing facility's report. The following shall apply:

17(A) A nonpublic nursing facility shall meet all of the
18following criteria to qualify for a medical assistance day one
19incentive payment:

20(I) The nursing facility shall have an overall occupancy
21rate of at least eighty-five percent during the resident day
22quarter. For purposes of determining a nursing facility's
23overall occupancy rate, a nursing facility's Total Resident
24Days, as reported by the facility under Article VIII-A, shall be
25divided by the product of the facility's licensed bed capacity,
26at the end of the quarter, multiplied by the number of calendar
27days in the quarter.

28(II) The nursing facility shall have a medical assistance
29occupancy rate of at least sixty-five percent during the
30resident day quarter. For purposes of determining a nursing

1facility's medical assistance occupancy rate, the nursing
2facility's Total PA MA days shall be divided by the nursing
3facility's Total Resident Days, as reported by the facility
4under Article VIII-A.

5(III) The nursing facility shall be a nonpublic nursing
6facility for a full resident day quarter prior to the applicable
7quarterly reporting due dates of October 31, January 31, April
830 and July 31.

9(B) The department shall calculate a qualified nonpublic
10nursing facility's medical assistance day one incentive
11quarterly payment as follows:

12(I) The total funds appropriated for payments under this
13subparagraph shall be divided by four.

14(II) To establish the quarterly per diem rate, the amount
15under subclause (I) shall be divided by the Total PA MA days, as
16reported by all qualifying nonpublic nursing facilities under
17Article VIII-A.

18(III) To determine a qualifying nonpublic nursing facility's
19quarterly medical assistance day one incentive payment, the
20quarterly per diem rate shall be multiplied by a nonpublic
21nursing facility's Total PA MA days, as reported by the facility
22under Article VIII-A.

23(C) For fiscal year 2013-2014, the State funds available for
24the nonpublic nursing facility medical assistance day one
25incentive payments shall equal seven million dollars
26($7,000,000).

27* * *

28Section 4. Section 454(a) of the act, amended June 30, 2011
29(P.L.89, No.22), is amended to read:

30Section 454. Medical Assistance Benefit Packages; Coverage,

1Copayments, Premiums and Rates.--(a) Notwithstanding any other
2provision of law to the contrary, the department shall
3promulgate regulations as provided in subsection (b) to
4establish provider payment rates; the benefit packages and any
5copayments for adults eligible for medical assistance under
6Title XIX of the Social Security Act (49 Stat 620, 42 U.S.C. §
71396 et seq.) and adults eligible for medical assistance in
8general assistance-related categories; and the premium or 
9copayment requirements for disabled children whose family income
10is above two hundred percent of the Federal poverty income
11limit. Subject to such Federal approval as may be necessary, the
12regulations shall authorize and describe the available benefit
13packages and any copayments and premiums, except that the 
14department shall set forth the copayment and premium schedule 
15for disabled children whose family income is above two hundred 
16percent of the Federal poverty income limit by publishing a 
17notice in the Pennsylvania Bulletin. The department may adjust 
18such copayments and premiums for disabled children by notice 
19published in the Pennsylvania Bulletin. The regulations shall
20also specify the effective date for provider payment rates.

21* * *

22Section 5. Section 704.1(g) of the act, added July 9, 1976
23(P.L.846, No.148), is amended and the section is amended by
24adding subsections to read:

25Section 704.1. Payments to Counties for Services to
26Children.--* * *

27(g) The department shall[, within forty-five days of each
28calendar quarter, pay fifty percent of the department's share of
29the county institution district's or its successor's estimated
30expenditures for that quarter.] process payments to each county
 

1pursuant to this article from funds appropriated by the General 
2Assembly for each fiscal year, within 15 days of passage of the 
3general appropriation bill or by a date specified under 
4paragraphs (1), (2), (3), (4) or (5), whichever is later. The 
5department shall process the following applicable payments to 
6the county:

7(1) By July 15, twenty-five percent of the amount of State
8funds allocated to the county under section 709.3.

9(2) By August 31, or upon approval by the department of the
10county's final cumulative report for its expenditures for the
11prior fiscal year, whichever is later, twenty-five percent of
12the amount of State funds allocated to the county under section
13709.3, reduced by the amount of aggregate unspent State funds
14provided to the county during the previous fiscal year.

15(3) By November 30, or upon approval by the department of
16the county's report for its expenditures for the first quarter
17of the fiscal year, whichever is later, twenty-five percent of
18the amount of State funds allocated to the county under section
19709.3, reduced by the amount of unspent State funds already
20provided to the county for the first quarter of the fiscal year.

21(4) By February 28, or upon approval by the department of
22the county's report for its expenditures for the second quarter
23of the fiscal year, whichever is later, twelve and five-tenths
24percent of the amount of State funds allocated to the county
25under section 709.3, adjusted by the amount of overspending or
26underspending of State funds in the previous quarters, but not
27to exceed eighty-seven and five-tenths percent of the county's
28approved State allocation.

29(5) Upon approval by the department of the county's final
30cumulative report for its expenditures for the fiscal year,

1twelve and five-tenths percent of the amount of State funds
2allocated to the county under section 709.3, adjusted by the
3amount of overspending or underspending of State funds in the
4previous quarters.

5(g.1) After the final cumulative report for expenditures has
6been approved, if a county has adjustments to revenues or
7expenditures for the time period covered by the expenditure
8report in addition to the payments under subsection (g), the
9county shall submit to the department a revised expenditure
10report. After the report is approved, the department may adjust
11any payment under subsection (g) to account for any revision to
12a county's expenditure report.

13(g.2)  Service contracts or agreements shall include a timely
14payment provision that requires counties to make payment to
15service providers within thirty days of the county's receipt of
16an invoice under both of the following conditions:

17(1) The invoice satisfies the county's requirements for a
18complete and accurate invoice.

19(2) Funds have been appropriated to the department for
20payments to counties under subsection (g).

21* * *

22Section 6. The act is amended by adding a section to read:

23Section 704.3. Provider submissions.--(a) For fiscal year
242013-2014, a provider shall submit documentation of its costs of
25providing services and the department shall use such
26documentation, to the extent necessary, to support the
27department's claim for Federal funding and for State
28reimbursement for allowable direct and indirect costs incurred
29in the provision of out-of-home placement services.

30(b) The department shall convene a task force to include

1representatives from public and private children and youth
2social service agencies and other appropriate stakeholders as
3determined by the secretary or deputy secretary for the Office
4of Children, Youth and Families.

5(c) The task force established under subsection (b) shall
6develop recommendations for a methodology to determine
7reimbursement for actual and projected costs, which are
8reasonable and allowable, for the purchase of services from
9providers and for other purchased services. The task force shall
10provide written recommendations for the purchase of services
11from providers to the General Assembly no later than April 30,
122014. The task force shall provide written recommendations for
13other purchased services no later than December 31, 2014. The
14task force shall be convened within sixty days after the
15effective date of this section.

16(d) As used in this section, the term "provider" means an
17entity licensed or certified to provide twenty-four-hour out-of-
18home community-based or institutional care and supervision of a
19child, with the care and supervision being paid for or provided
20by a county using Federal or State funds disbursed under this
21article.

22Section 7. The heading of Article VIII-C of the act, added
23July 4, 2004 (P.L.528, No.69) is amended to read:

24ARTICLE VIII-C

25INTERMEDIATE CARE FACILITIES FOR [MENTALLY RETARDED] PERSONS
26WITH AN INTELLECTUAL DISABILITY

27ASSESSMENTS

28Section 8. Sections 801-C, 802-C, 803-C, 804-C, 805-C, 806-
29C, 807-C, 808-C, 809-C and 810-C of the act, added July 4, 2004
30(P.L.528, No.69), are amended to read:

1Section 801-C.  Definitions.

2The following words and phrases when used in this article
3shall have the meanings given to them in this section unless the
4context clearly indicates otherwise:

5"Assessment."  The fee implemented pursuant to this article
6on every intermediate care facility for [mentally retarded]
7persons with an intellectual disability.

8"Department."  The Department of Public Welfare of the
9Commonwealth.

10"Intermediate care facility for [mentally retarded] persons
11with an intellectual disability" or "[ICF/MR] ICF/ID."  A public
12or private facility defined in section 1905 of the Social
13Security Act (49 Stat. 620, 42 U.S.C. § 1905).

14"Medicaid."  The program established under Title XIX of the
15Social Security Act (49 Stat. 620, 42 U.S.C. § 1396 et seq.).

16"Medical assistance program" or "program."  The medical
17assistance program as administered by the Department of Public
18Welfare.

19"Secretary."  The Secretary of Public Welfare of the
20Commonwealth.

21"Social Security Act."  49 Stat. 620, 42 U.S.C. § 301 et seq.

22Section 802-C.  Authorization.

23In order to generate additional revenues for medical
24assistance program recipients to have access to medically
25necessary [mental retardation] intellectual disability services,
26the department shall implement a monetary assessment on each
27[ICF/MR] ICF/ID subject to the conditions and requirements
28specified in this article.

29Section 803-C.  Implementation.

30The [ICF/MR] ICF/ID assessments shall be implemented on an

1annual basis as a health care-related tax as defined in section
21903(w)(3)(B) of the Social Security Act, or any amendments
3thereto, and may be imposed and is required to be paid only to
4the extent that the revenues generated from the assessment will
5qualify as the State share of program expenditures eligible for
6Federal financial participation.

7Section 804-C.  Amount.

8The assessment rate shall be determined in accordance with
9this article and implemented on an annual basis by the
10department, as approved by the Governor, upon notification to
11and in consultation with the [ICFs/MR] ICFs/ID. In each year in
12which the assessment is implemented, the assessment rate shall
13equal the amount established by the department subject to the
14maximum aggregate amount that may be assessed pursuant to the 6%
15indirect guarantee threshold set forth in 42 CFR 433.68(f)(3)(i)
16(relating to permissible health care-related taxes [after the
17transition period]) or any other maximum aggregate amount
18established by law.

19Section 805-C.  Administration.

20(a)  Notice of assessment.--The secretary, before
21implementing an assessment in any fiscal year, shall publish a
22notice in the Pennsylvania Bulletin that specifies the amount of
23the assessment being proposed and an explanation of the
24assessment methodology and amount determination that identifies
25the aggregate impact on [ICFs/MR] ICFs/ID subject to the
26assessment. Interested parties shall have 30 days in which to
27submit comments to the secretary. Upon expiration of the 30-day
28comment period, the secretary, after consideration of the
29comments, shall publish a second notice in the Pennsylvania
30Bulletin announcing the rate of the assessment.

1(b)  Review of assessment.--Except as permitted under section
2809-C, the secretary's determination of the aggregate amount and
3the rate of the assessment pursuant to subsection (a) shall not
4be subject to administrative or judicial review under 2 Pa.C.S.
5Chs. 5 Subch. A (relating to practice and procedure of
6Commonwealth agencies) and 7 Subch. A (relating to judicial
7review of Commonwealth agency action) or any other provision of
8law. No assessment implemented under this article nor forms or
9reports required to be completed by [ICFs/MR] ICFs/ID pursuant
10to this article shall be subject to the act of July 31, 1968
11(P.L.769, No.240), referred to as the Commonwealth Documents
12Law, the act of October 15, 1980 (P.L.950, No.164), known as the
13Commonwealth Attorneys Act, or the act of June 25, 1982
14(P.L.633, No.181), known as the Regulatory Review Act.

15Section 806-C.  Calculation.

16Using the assessment rate implemented by the secretary
17pursuant to section 804-C, each [ICF/MR] ICF/ID shall calculate
18the assessment amounts it owes for a calendar quarter on a form
19specified by the department and shall submit the form and the
20amount owed to the department no later than the last day of that
21calendar quarter or 30 days from the date of the department's
22second notice published pursuant to section 805-C(a), whichever
23is later.

24Section 807-C.  Purposes and uses.

25No [ICF/MR] ICF/ID shall be directly guaranteed a repayment
26of its assessment in derogation of 42 CFR 433.68 (relating to
27permissible health care-related taxes [after the transition
28period]), provided, however, in each fiscal year in which an
29assessment is implemented, the department shall use the State
30revenue collected from the assessment and any Federal funds

1received by the Commonwealth as a direct result of the
2assessment to fund services for persons with [mental
3retardation] an intellectual disability.

4Section 808-C.  Records.

5Upon request by the department, an [ICF/MR] ICF/ID shall
6furnish to the department such records as the department may
7specify in order to determine the assessment rate for a fiscal
8year or the amount of the assessment due from the [ICF/MR]
9ICF/ID or to verify that the [ICF/MR] ICF/ID has paid the
10correct amount due. In the event that the department determines
11that an [ICF/MR] ICF/ID has failed to pay an assessment or that
12it has underpaid an assessment, the department shall notify the
13[ICF/MR] ICF/ID in writing of the amount due, including
14interest, and the date on which the amount due must be paid,
15which shall not be less than 30 days from the date of the
16notice. In the event that the department determines that an
17[ICF/MR] ICF/ID has overpaid an assessment, the department shall
18notify the [ICF/MR] ICF/ID in writing of the overpayment and,
19within 30 days of the date of the notice of the overpayment,
20shall either authorize a refund of the amount of the overpayment
21or offset the amount of the overpayment against any amount that
22may be owed to the department by the [ICF/MR] ICF/ID.

23Section 809-C.  Appeal rights.

24An [ICF/MR] ICF/ID that is aggrieved by a determination of
25the department as to the amount of the assessment due from the
26[ICF/MR] ICF/ID or a remedy imposed pursuant to section 810-C
27may file a request for review of the decision of the department
28by the Bureau of Hearings and Appeals within the department,
29which shall have exclusive jurisdiction in such matters. The
30procedures and requirements of 67 Pa.C.S. Ch. 11 (relating to

1medical assistance hearings and appeals) shall apply to requests
2for review filed pursuant to this section except that, in any
3such request for review, an [ICF/MR] ICF/ID may not challenge
4the assessment rate determined by the secretary, but only
5whether the department correctly determined the assessment
6amount due from the [ICF/MR] ICF/ID using the assessment rate in
7effect for the fiscal year.

8Section 810-C.  Enforcement.

9In addition to any other remedy provided by law, the
10department may enforce this article by imposing one or more of
11the following remedies:

12(1)  When an [ICF/MR] ICF/ID fails to pay an assessment
13or penalty in the amount or on the date required by this
14article, the department may add interest at the rate provided
15in section 806 of the act of April 9, 1929 (P.L.343, No.176),
16known as The Fiscal Code, to the unpaid amount of the
17assessment or penalty from the date prescribed for its
18payment until the date it is paid.

19(2)  When an [ICF/MR] ICF/ID fails to file a report or to
20furnish records to the department as required by this
21article, the department may impose a penalty against the
22[ICF/MR] ICF/ID in the amount of $1,000 per day for each day
23the report or required records are not filed or furnished to
24the department.

25(3)  When an [ICF/MR] ICF/ID fails to pay all or part of
26an assessment or penalty within 60 days of the date that
27payment is due, the department may terminate the [ICF/MR]
28ICF/ID from participation in the medical assistance program
29and/or deduct the unpaid assessment or penalty and any
30interest owed thereon from any payments due to the [ICF/MR]

1ICF/ID until the full amount is recovered. Any such
2termination or payment deduction shall be made only after
3written notice to the [ICF/MR] ICF/ID.

4(4)  The secretary may waive all or part of the interest
5or penalties assessed against an [ICF/MR] ICF/ID pursuant to
6this article for good cause as shown by the [ICF/MR] ICF/ID.

7Section 9.  Section 811-C of the act, amended July 4, 2008
8(P.L.557, No.44), is amended to read:

9Section 811-C.  Time periods.

10(a)  Imposition.--The assessment authorized under this
11article shall not be imposed as follows:

12(1)  Prior to July 1, 2003, for private [ICFs/MR]
13ICFs/ID.

14(2)  Prior to July 1, 2004, for public [ICFs/MR] ICFs/ID.

15(3)  In the absence of Federal financial participation as
16described under section 803-C.

17(b)  Cessation.--The assessment authorized under this article
18shall cease June 30, [2013] 2016, or earlier, if required by
19law.

20Section 10.  Section 802-E of the act is amended by adding a
21subsection to read:

22Section 802-E.  Authorization.

23* * *

24(a.1)  Adjustments to assessment percentage.--

25(1)  For State fiscal years beginning after June 30, 
262013, and subject to the advance written approval of the 
27secretary as prescribed by the department, the municipality 
28may make a uniform adjustment to an assessment percentage 
29established by ordinance under subsection (a).

30(2)  After receiving written approval under paragraph (1)
 

1and before implementing an adjustment, the municipality shall 
2provide advance public notice. The notice shall specify the 
3proposed adjusted assessment percentage and identify the 
4aggregate impact on hospitals located in the municipality 
5subject to an assessment. An interested party shall have 30 
6days in which to submit comments to the municipality. Upon 
7expiration of the 30-day comment period, the municipality, 
8after consideration of the comments, shall publish a 
9subsequent notice announcing the adjusted assessment 
10percentage.

11* * *

12Section 11. Section 808-E of the act, reenacted October 22,
132010 (P.L.829, No.84), is amended to read:

14Section 808-E.  Time period.

15(a)  Cessation.--The assessment authorized under this article
16shall cease June 30, [2013] 2016.

17(b)  Assessment.--

18(1)  A municipality shall have the power to enact the
19assessment authorized in section 802-E(a)(2) either prior to
20or during its fiscal year ending June 30, 2010.

21(2)  A municipality may adjust an assessment percentage 
22as specified under section 802-E(a.1) either prior to or 
23during the fiscal year in which the adjusted assessment 
24percentage takes effect.

<-25Section 12. The definition of "net inpatient revenue" in
26section 801-G of the act, amended June 30, 2011 (P.L.89, No.22),
27is amended to read:

28Section 801-G. Definitions.

29The following words and phrases when used in this article
30shall have the meanings given to them in this section unless the

1context clearly indicates otherwise:

2* * *

3"Net inpatient revenue." Gross charges for facilities for
4inpatient services less any deducted amounts for bad debt
5expense, charity care expense and contractual allowances as
6reported on forms specified by the department and:

7(1) as identified in the hospital's records for the
8State fiscal year commencing July 1, [2007] 2010; or

9(2) as identified in the hospital's records for the most
10recent State fiscal year, or part thereof, if amounts are not
11available under paragraph (1).

12* * *

13Section 13. Section 803-G(b) of the act, amended June 30,
142011 (P.L.89, No.22), is amended to read:

15Section 803-G. Implementation.

16* * *

17(b) Assessment percentage.--Subject to subsection (c), each
18covered hospital shall be assessed as follows:

19(1) for fiscal year 2010-2011, each covered hospital
20shall be assessed an amount equal to 2.69% of the net
21inpatient revenue of the covered hospital; and

22(2) for fiscal years 2011-2012 [and] , 2012-2013, 2013-
232014, 2014-2015 and 2015-2016, an amount equal to 3.22% of
24the net inpatient revenue of the covered hospital.

25* * *

26Section 14. Section 804-G(a.1) of the act, amended June 30,
272011 (P.L.89, No.22), is amended and the section is amended by
28adding a subsection to read:

29Section 804-G. Administration.

30* * *

1(a.1) Calculation of assessment with changes of ownership.--

2(1) If a single covered hospital changes ownership or
3control, the department will continue to calculate the
4assessment amount using the hospital's net inpatient revenue
5for State fiscal year [2008-2009] 2010-2011 or for the most
6recent State fiscal year, or part thereof, if the State
7fiscal year [2008-2009] 2010-2011 amounts are not available.
8The covered hospital is liable for any outstanding assessment
9amounts, including outstanding amounts related to periods
10prior to the change of ownership or control.

11(2) If two or more hospitals merge or consolidate into a
12single covered hospital as a result of a change in ownership
13or control, the department will calculate the covered
14hospital assessment amount using the combined net inpatient
15revenue for State fiscal year [2008-2009] 2010-2011 or for
16the most recent State fiscal year, or part thereof, if the
17State fiscal year [2008-2009] 2010-2011 amounts are not
18available, of any covered hospitals that were merged or
19consolidated into the single covered hospital. The single
20covered hospital is liable for any outstanding assessment
21amounts, including outstanding amounts related to periods
22prior to the change of ownership or control, of any covered
23hospital that was merged or consolidated.

24* * *

25(a.3) Calculation of assessment for new hospitals.--A
26hospital that begins operation as a covered hospital during a
27fiscal year in which an assessment is in effect shall be
28assessed as follows:

29(1) During the State fiscal year in which a covered
30hospital begins operation or in which a hospital becomes a

1covered hospital, the covered hospital is not subject to the
2assessment.

3(2) For the State fiscal year following the State fiscal
4year under paragraph (1), the department shall calculate the
5hospital's assessment amount using the net inpatient revenue
6from the State fiscal year in which the covered hospital
7began operation or became a covered hospital.

8(3) For the State fiscal years following the first full
9State fiscal year under paragraph (2), the department shall
10calculate the hospital's assessment amount using the net
11inpatient revenue from the prior State fiscal year.

12* * *

13Section 15. Section 805-G(a)(3) and (b)(5) of the act,
14amended June 30, 2011 (P.L.89, No.22), is amended and subsection
15(b) is amended by adding paragraphs to read:

16Section 805-G. Restricted account.

17(a) Establishment.--There is established a restricted
18account, known as the Quality Care Assessment Account, in the
19General Fund for the receipt and deposit of revenues collected
20under this article. Funds in the account are appropriated to the
21department for the following:

22* * *

23(3) Any other purpose approved by the secretary for
24inpatient hospital, outpatient hospital and hospital-related
25services.

26(b) Limitations.--

27* * *

28(4.1) For State fiscal years 2013-2014 and 2014-2015,
29the amount used for the medical assistance payment for
30hospitals and medical assistance managed care organizations

1may not exceed the aggregate amount of the assessment funds
2collected for the year less $150,000,000.

3(4.2) For State fiscal year 2015-2016, the amount used
4for the medical assistance payment for hospitals and medical
5assistance managed care organizations may not exceed the
6aggregate amount of the assessment funds collected for the
7year less $140,000,000.

8(5) The amounts retained by the department pursuant to
9paragraphs (1), (2) [and], (4), (4.1) and (4.2) and any
10additional amounts remaining in the restricted accounts after
11the payments described in subsection (a)(1) and (2) are made
12shall be used for purposes approved by the secretary under
13subsection (a)(3).

14* * *

15Section 16. Section 815-G of the act, added July 9, 2010
16(P.L.336, No.49), is amended to read:

17Section 815-G. Expiration.

18This article shall expire June 30, [2013] 2016.

<-19Section 12. The heading of Article VIII-G of the act, added 
20July 9, 2010 (P.L.336, No.49), is reenacted to read:

21ARTICLE VIII-G

22STATEWIDE QUALITY CARE ASSESSMENT

23Section 12.1. Section 801-G of the act, added or amended
24July 9, 2010 (P.L.336, No.49) and June 30, 2011 (P.L.89, No.22),
25is reenacted and amended to read:

26Section 801-G. Definitions.

27The following words and phrases when used in this article
28shall have the meanings given to them in this section unless the
29context clearly indicates otherwise:

30"Assessment." The fee, known as the Quality Care Assessment,

1authorized to be implemented under this article on every covered
2hospital.

3"Bad debt expense." The cost of care for which a hospital
4expected payment from the patient or a third-party payer, but
5which the hospital subsequently determines to be uncollectible,
6as further described in the Medicare Provider Reimbursement
7Manual published by the United States Department of Health and
8Human Services.

9"Charity care expense." The cost of care for which a
10hospital ordinarily charges a fee but which is provided free or
11at a reduced rate to patients who cannot afford to pay but who
12are not eligible for public programs, and from whom the hospital
13did not expect payment in accordance with the hospital's charity
14care policy, as further described in the Medicare Provider
15Reimbursement Manual published by the United States Department
16of Health and Human Services.

17"Contractual allowance." The difference between what a
18hospital charges for services and the amounts that certain
19payers have agreed to pay for the services as further described
20in the Medicare Provider Reimbursement Manual published by the
21United States Department of Health and Human Services.

22"Covered hospital." A hospital other than an exempt
23hospital.

24"Critical access hospital." Any hospital that has qualified
25under section 1861(mm)(1) of the Social Security Act (49 Stat.
26620, 42 U.S.C. § 1395x(mm)(1)) as a critical access hospital
27under Medicare.

28"Exempt hospital." Any of the following:

29(1) A Federal veterans' affairs hospital.

30(2) A hospital that provides care, including inpatient

1hospital services, to all patients free of charge.

2(3) A private psychiatric hospital.

3(4) A State-owned psychiatric hospital.

4(5) A critical access hospital.

5(6) A long-term acute care hospital.

6"Hospital." A facility licensed as a hospital under 28
7Pa.Code Pt. IV Subpt. B (relating to general and special
8hospitals).

9"Long-term acute care hospital." A hospital or unit of a
10hospital whose patients have a length of stay of greater than 25
11days and that provides specialized acute care of medically
12complex patients who are critically ill.

13"Medical assistance managed care organization." A Medicaid
14managed care organization as defined in section 1903(m)(1)(a) of
15the Social Security Act (49 Stat. 620, 42 U.S.C. § 1396b(m)(1)
16(a)) that is a party to a Medicaid managed care contract with
17the department. The term shall not include a behavioral health
18managed care organization that is a party to a Medicaid managed
19care contract with the department.

20"Net inpatient revenue." Gross charges for facilities for
21inpatient services less any deducted amounts for bad debt
22expense, charity care expense and contractual allowances as
23reported on forms specified by the department and:

24(1) as identified in the hospital's records for the
25State fiscal year commencing July 1, [2007] 2010; or

26(2) as identified in the hospital's records for the most
27recent State fiscal year, or part thereof, if amounts are not
28available under paragraph (1).

29"Program." The Commonwealth's medical assistance program as
30authorized under Article IV.

1Section 12.2. Section 802-G of the act, added July 9, 2010, 
2(P.L.336, No.49), is reenacted to read:

3Section 802-G. Authorization.

4In order to generate additional revenues for the purpose of
5assuring that medical assistance recipients have access to
6hospital services, the department shall implement a monetary
7assessment, known as the Quality Care Assessment, on each
8covered hospital subject to the conditions and requirements
9specified in this article, including section 813-G.

10Section 12.3. Section 803-G of the act, added or amended
11July 9, 2010 (P.L.336, No.49) and June 30, 2011 (P.L.89, No.22),
12is reenacted and amended to read:

13Section 803-G. Implementation.

14(a) Health care-related fee.--The assessment authorized
15under this article, once imposed, shall be implemented as a
16health care-related fee as defined under section 1903(w)(3)(B)
17of the Social Security Act (49 Stat. 620, 42 U.S.C. § 1396b(w)
18(3)(B)) or any amendments thereto and may be collected only to
19the extent and for the periods that the secretary determines
20that revenues generated by the assessment will qualify as the
21State share of program expenditures eligible for Federal
22financial participation.

23(b) Assessment percentage.--Subject to subsection (c), each
24covered hospital shall be assessed as follows:

25(1) for fiscal year 2010-2011, each covered hospital
26shall be assessed an amount equal to 2.69% of the net
27inpatient revenue of the covered hospital; and

28(2) for fiscal years 2011-2012 [and] , 2012-2013, 2013-
292014, 2014-2015 and 2015-2016, an amount equal to 3.22% of
30the net inpatient revenue of the covered hospital.

1(c) Adjustments to assessment percentage.--The secretary may
2adjust the assessment percentage specified in subsection (b),
3provided that, before adjusting, the secretary shall publish a
4notice in the Pennsylvania Bulletin that specifies the proposed
5assessment percentage and identifies the aggregate impact on
6covered hospitals subject to the assessment. Interested parties
7shall have 30 days in which to submit comments to the secretary.
8Upon expiration of the 30-day comment period, the secretary,
9after consideration of the comments, shall publish a second
10notice in the Pennsylvania Bulletin announcing the assessment
11percentage.

12(d) Maximum amount.--In each year in which the assessment is
13implemented, the assessment shall be subject to the maximum
14aggregate amount that may be assessed under 42 CFR 433.68(f)(3)
15(i) (relating to permissible health care-related taxes) or any
16other maximum established under Federal law.

17(e) Limited review.--Except as permitted under section 810-
18G, the secretary's determination of the assessment percentage
19pursuant to subsection (b) shall not be subject to
20administrative or judicial review under 2 Pa.C.S. Chs. 5 Subch.
21A (relating to practice and procedure of Commonwealth agencies)
22and 7 Subch. A (relating to judicial review of Commonwealth
23agency action) or any other provision of law; nor shall any
24assessments implemented under this article or forms or reports
25required to be completed by covered hospitals pursuant to this
26article be subject to the act of July 31, 1968 (P.L.769,
27No.240), referred to as the Commonwealth Documents Law, the act
28of October 15, 1980 (P.L.950, No.164), known as the Commonwealth
29Attorneys Act, and the act of June 25, 1982 (P.L.633, No.181),
30known as the Regulatory Review Act.

1Section 12.4. Section 804-G of the act, amended June 30,
22011 (P.L.89, No.22), is reenacted and amended to read:

3Section 804-G. Administration.

4(a) Calculation and notice of assessment amount.--Using the
5assessment percentage established under section 803-G and
6covered hospitals' net inpatient revenue, the department shall
7calculate and notify each covered hospital of the assessment
8amount owed for the fiscal year. Notification pursuant to this
9subsection may be made in writing or electronically at the
10discretion of the department.

11(a.1) Calculation of assessment with changes of ownership.--

12(1) If a single covered hospital changes ownership or
13control, the department will continue to calculate the
14assessment amount using the hospital's net inpatient revenue
15for State fiscal year [2008-2009] 2010-2011 or for the most
16recent State fiscal year, or part thereof, if the State
17fiscal year [2008-2009] 2010-2011 amounts are not available.
18The covered hospital is liable for any outstanding assessment
19amounts, including outstanding amounts related to periods
20prior to the change of ownership or control.

21(2) If two or more hospitals merge or consolidate into a
22single covered hospital as a result of a change in ownership
23or control, the department will calculate the covered
24hospital assessment amount using the combined net inpatient
25revenue for State fiscal year [2008-2009] 2010-2011 or for
26the most recent State fiscal year, or part thereof, if the
27State fiscal year [2008-2009] 2010-2011 amounts are not
28available, of any covered hospitals that were merged or
29consolidated into the single covered hospital. The single
30covered hospital is liable for any outstanding assessment

1amounts, including outstanding amounts related to periods
2prior to the change of ownership or control, of any covered
3hospital that was merged or consolidated.

4(a.2) Calculation of assessment with closures or other
5changes in operation.--Except as provided in subsection (a.1)
6(2), a covered hospital that closes or that becomes an exempt
7hospital during a fiscal year is liable for both:

8(1) The annual assessment amount for the fiscal year in
9which the closure or change occurs prorated by the number of
10days in the fiscal year during which the covered hospital was
11in operation.

12(2) Any outstanding assessment amounts related to
13periods prior to the closure or change in operation.

14(a.3) Calculation of assessment for new hospitals.--A
15hospital that begins operation as a covered hospital during a
16fiscal year in which an assessment is in effect shall be
17assessed as follows:

18(1) During the State fiscal year in which a covered
19hospital begins operation or in which a hospital becomes a
20covered hospital, the covered hospital is not subject to the
21assessment.

22(2) For the State fiscal year following the State fiscal
23year under paragraph (1), the department shall calculate the
24hospital's assessment amount using the net inpatient revenue
25from the State fiscal year in which the covered hospital
26began operation or became a covered hospital.

27(3) For the State fiscal years following the first full
28State fiscal year under paragraph (2), the department shall
29calculate the hospital's assessment amount using the net
30inpatient revenue from the prior State fiscal year.

1(b) Payment.--A covered hospital shall pay the assessment
2amount due for a fiscal year in four quarterly installments.
3Payment of a quarterly installment shall be made on or before
4the first day of the second month of the quarter or 30 days from
5the date of the notice of the quarterly assessment amount,
6whichever day is later.

7(c) Records.--Upon request by the department, a covered
8hospital shall furnish to the department such records as the
9department may specify in order for the department to validate 
10the net inpatient revenue reported by the hospital or to
11determine the assessment for a fiscal year or the amount of the
12assessment due from the covered hospital or to verify that the
13covered hospital has paid the correct amount due.

14(d) Underpayments and overpayments.--In the event that the
15department determines that a covered hospital has failed to pay
16an assessment or that it has underpaid an assessment, the
17department shall notify the covered hospital in writing of the
18amount due, including interest, and the date on which the amount
19due must be paid, which shall not be less than 30 days from the
20date of the notice. In the event that the department determines
21that a covered hospital has overpaid an assessment, the
22department shall notify the covered hospital in writing of the
23overpayment and, within 30 days of the date of the notice of the
24overpayment, shall either refund the amount of the overpayment
25or offset the amount of the overpayment against any amount that
26may be owed to the department from the covered hospital.

27Section 12.5. Section 805-G of the act, amended or added
28July 9, 2010 (P.L.336, No.49) and June 30, 2011 (P.L.89, No.22),
29is reenacted and amended to read:

30Section 805-G. Restricted account.

1(a) Establishment.--There is established a restricted
2account, known as the Quality Care Assessment Account, in the
3General Fund for the receipt and deposit of revenues collected
4under this article. Funds in the account are appropriated to the
5department for the following:

6(1) Making medical assistance payments to hospitals in
7accordance with section 443.1(1.1) and as otherwise specified
8in the Commonwealth's approved Title XIX State Plan.

9(2) Making adjusted capitation payments to medical
10assistance managed care organizations for additional payments
11for inpatient hospital services in accordance with section
12443.1(1.2), (1.3) and (1.4).

13(3) Any other purpose approved by the secretary for 
14inpatient hospital, outpatient hospital and hospital-related 
15services.

16(b) Limitations.--

17(1) For the first year of the assessment, the amount
18used for the medical assistance payments for hospitals and
19Medicaid managed care organizations may not exceed the
20aggregate amount of assessment funds collected for the year
21less $121,000,000.

22(2) For the second year of the assessment, the amount
23used for the medical assistance payments for hospitals and
24medical assistance managed care organizations may not exceed
25the aggregate amount of assessment funds collected for the
26year less $109,000,000.

27(4) For the third year of the assessment, the amount
28used for the medical assistance payment for hospitals and
29medical assistance managed care organizations may not exceed
30the aggregate amount of the assessment funds collected for

1the year less $109,000,000.

2(4.1) For State fiscal years 2013-2014 and 2014-2015,
3the amount used for the medical assistance payment for
4hospitals and medical assistance managed care organizations
5may not exceed the aggregate amount of the assessment funds
6collected for the year less $150,000,000.

7(4.2) For State fiscal year 2015-2016, the amount used
8for the medical assistance payment for hospitals and medical
9assistance managed care organizations may not exceed the
10aggregate amount of the assessment funds collected for the
11year less $140,000,000.

12(5) The amounts retained by the department pursuant to 
13paragraphs (1), (2) [and], (4), (4.1) and (4.2) and any 
14additional amounts remaining in the restricted accounts after 
15the payments described in subsection (a)(1) and (2) are made 
16shall be used for purposes approved by the secretary under 
17subsection (a)(3).

18(c) Lapse.--Funds in the Quality Care Assessment Account
19shall not lapse to the General Fund at the end of a fiscal year.
20If this article expires, the department shall use any remaining
21funds for the purposes stated in this section until the funds in
22the Quality Care Assessment Account are exhausted.

23Section 13. Sections 806-G, 807-G, 808-G, 809-G, 810-G, 811-
24G and 812-G of the act, added July 9, 2010, (P.L.336, No.49),
25are reenacted to read:

26Section 806-G. No hold harmless.

27No covered hospital shall be directly guaranteed a repayment
28of its assessment in derogation of 42 CFR 433.68(f) (relating to
29permissible health care-related taxes), except that, in each
30fiscal year in which an assessment is implemented, the

1department shall use the funds received under this article for
2the purposes outlined under section 805-G to the extent
3permissible under Federal and State law or regulation and
4without creating an indirect guarantee to hold harmless, as
5those terms are used under 42 CFR 433.68(f)(i). The secretary
6shall submit to the United States Department of Health and Human
7Services any State Medicaid plan amendments that are necessary
8to make the payments authorized under section 805-G.

9Section 807-G. Federal waiver.

10To the extent necessary in order to implement this article,
11the department shall seek a waiver under 42 CFR 433.68(e)
12(relating to permissible health care-related taxes) from the
13Centers for Medicare and Medicaid Services of the United States
14Department of Health and Human Services. The department shall
15not implement the assessment until approval of the waiver is
16obtained. Upon approval of the waiver, the assessment shall be
17implemented retroactive to the first day of the fiscal year to
18which the waiver applies.

19Section 808-G. Tax exemption.

20(a) General rule.--Notwithstanding any exemptions granted by
21any other Federal, State or local tax or other law, no covered
22hospital other than an exempt hospital shall be exempt from the
23assessment.

24(b) Interpretation.--The assessment imposed under this
25article shall be recognized by the Commonwealth as uncompensated
26goods and services under the act of November 26, 1997 (P.L.508,
27No.55), known as the Institutions of Purely Public Charity Act,
28and shall be considered a community benefit for purposes of any
29required or voluntary community benefit report filed or prepared
30by a covered hospital.

1Section 809-G. Remedies.

2In addition to any other remedy provided by law, the
3department may enforce this article by imposing one or more of
4the following remedies:

5(1) When a covered hospital fails to pay an assessment
6or penalty in the amount or on the date required by this
7article, the department shall add interest at the rate
8provided in section 806 of the act of April 9, 1929 (P.L.343,
9No.176), known as The Fiscal Code, to the unpaid amount of
10the assessment or penalty from the date prescribed for its
11payment until the date it is paid.

12(2) When a covered hospital fails to file a report or to
13furnish records to the department as required by this
14article, the department shall impose a penalty against the
15covered hospital in the amount of $1,000, plus an additional
16amount of $200 per day for each additional day that the
17failure to file the report or furnish the records continues.

18(3) When a covered hospital that is a medical assistance
19provider, or that is related through common ownership or
20control as defined in 42 CFR 413.17(b) (relating to cost to
21related organizations) to a medical assistance provider,
22fails to pay all or part of an assessment or penalty within
2360 days of the date that payment is due, the department may
24deduct the unpaid assessment or penalty and any interest owed
25thereon from any medical assistance payments due to the
26covered hospital or to any related medical assistance
27provider until the full amount is recovered. Any such
28deduction shall be made only after written notice to the
29covered hospital and medical assistance provider and may be
30taken in installments over a period of time, taking into

1account the financial condition of the medical assistance
2provider.

3(4) Within 60 days after the end of each calendar
4quarter, the department shall notify the Department of Health
5of any covered hospital that has assessment, penalty or
6interest amounts that have remained unpaid for 90 days or
7more. The Department of Health shall not renew the license of
8any such covered hospital until the department notifies the
9Department of Health that the covered hospital has paid the
10outstanding amount in its entirety or that the department has
11agreed to permit the covered hospital to repay the
12outstanding amount in installments and that, to date, the
13covered hospital has paid the installments in the amount and
14by the date required by the department.

15(5) The secretary may waive all or part of the interest
16or penalties assessed against a covered hospital pursuant to
17this article for good cause as shown by the covered hospital.

18Section 810-G. Request for review.

19A covered hospital that is aggrieved by a determination of
20the department as to the amount of the assessment due from the
21covered hospital or a remedy imposed pursuant to section 809-G
22may file a request for review of the decision of the department
23by the Bureau of Hearings and Appeals, which shall have
24exclusive jurisdiction in such matters. The procedures and
25requirements of 67 Pa.C.S. Ch. 11 (relating to medical
26assistance hearings and appeals) shall apply to requests for
27review filed pursuant to this section, except that in any such
28request for review, a covered hospital may not challenge an
29assessment percentage determined by the secretary pursuant to
30section 803-G(b) but only whether the department correctly

1determined the assessment amount due from the covered hospital
2using the assessment percentage in effect for the fiscal year. A
3notice of review filed pursuant to this section shall not
4operate as a stay of the covered hospital's obligation to pay
5the assessment amount due for a fiscal year as specified in
6section 804-G(b).

7Section 811-G. Liens.

8Any assessments implemented and interest and penalties
9assessed against a covered hospital under this article shall be
10a lien on the real and personal property of the covered hospital
11in the manner provided by section 1401 of the act of April 9,
121929 (P.L.343, No.176), known as The Fiscal Code, may be entered
13by the department in the manner provided by section 1404 of The
14Fiscal Code and shall continue and retain priority in the manner
15provided in section 1404.1 of The Fiscal Code.

16Section 812-G. Regulations.

17The department may issue such regulations and orders as may
18be necessary to implement the Quality Care Assessment program in
19accordance with the requirements of this article.

20Section 14. Section 813-G of the act, amended June 30, 2011 
21(P.L.89, No.22), is reenacted to read:

22Section 813-G. Conditions for payments.

23The department shall not be required to make payments as
24specified in section 443.1(1.1), (1.2), (1.3) and (1.4) and a
25covered hospital shall not be required to pay the Quality Care
26Assessment as specified in section 804-G(b) unless all of the
27following have occurred:

28(1) The department receives Federal approval of a waiver
29under 42 CFR 433.68(e) (relating to permissible health care-
30related taxes) authorizing the department to implement the

1Quality Care Assessment as specified in this article.

2(2) The department receives Federal approval of a State
3plan amendment authorizing the changes to its payment methods
4and standards specified in § 443.1(1.1)(ii).

5(3) The department receives Federal approval of
6amendments to its medical assistance managed care
7organization contracts authorizing adjustments to its
8capitation payments funded in accordance with section 805-G.

9Section 15. Section 814-G of the act, added July 9, 2010 
10(P.L.336, No.49), is reenacted to read:

11Section 814-G. Report.

12Not later than 180 days prior to the expiration date
13specified in section 815-G, the department shall prepare and
14submit a report to the chair and minority chair of the Public
15Health and Welfare Committee of the Senate, the chair and
16minority chair of the Appropriations Committee of the Senate,
17the chair and minority chair of the Health and Human Services
18Committee of the House of Representatives and the chair and
19minority chair of the Appropriations Committee of the House of
20Representatives. The report shall include the following:

21(1) The name, address and amount of assessment for each
22covered hospital subject to the Quality Care Assessment.

23(2) The total amount of assessment revenue collected for
24each year.

25(3) The amount of assessment paid by each covered
26hospital, including any interest and penalties paid.

27(4) The name and address of each hospital receiving
28supplemental payments instituted as a result of the Quality
29Care Assessment.

30(5) The payment amount and type of supplemental payment

1received by each hospital.

2(6) The total amount of fee-for-service inpatient acute
3care payment made to each hospital.

4(7) The number of medical assistance patient days and
5discharges by hospital.

6(8) Any proposed changes to the payment methodologies
7and standards.

8Section 15.1. Section 815-G of the act, added July 9, 2010 
9(P.L.336, No.49), is reenacted and amended to read:

10Section 815-G. Expiration.

11This article shall expire June 30, [2013] 2016.

12Section 16. Section 816-G of the act, added July 9, 2010
13(P.L.336, No.49), is reenacted to read:

14Section 816-G. Retroactive applicability.

15This article shall apply retroactively to July 1, 2010.

16Section 17. Section 805-H(c) of the act is amended by adding
17a paragraph to read:

18Section 805-H. Funding.

19* * *

20(c) Payment calculation.--

21* * *

22(5) Funds not used to make payments to qualifying
23hospitals accredited or seeking accreditation as Level III
24trauma centers shall be used to make payments to qualifying
25hospitals accredited as Level I and Level II trauma centers.

26* * *

27Section 18. The heading of Article XIII of the act, added
28September 30, 2003 (P.L.169, No.25), is amended to read:

29ARTICLE XIII

30FAMILY FINDING AND KINSHIP CARE

1Section <-2 19. Section 1301 of the act, added September 30,
22003 (P.L.169, No.25), is amended to read:

3Section 1301. [Scope] Legislative intent.

4[This article relates to the Kinship Care Program.] This 
5article is intended to ensure that family finding occurs on an 
6ongoing basis for all children entering the child welfare 
7system. This article is also intended to promote the use of 
8kinship care when it is necessary to remove a child from the 
9child's home in an effort to:

10(1) Identify and build positive connections between the
11child and the child's relatives and kin.

12(2) Support the engagement of relatives and kin in
13children and youth social service planning and delivery.

14(3) Create a network of extended family support to
15assist in remedying the concerns that led the child to be
16involved with the county agency.

17Section <-3 20. Section 1302 of the act is amended by adding
18definitions to read:

19Section 1302. Definitions.

20The following words and phrases when used in this article
21shall have the meanings given to them in this section unless the
22context clearly indicates otherwise:

23"Accept for service." Decide on the basis of the needs and
24problems of an individual to admit or receive the individual as
25a client of the county agency or as required by a court order
26entered under 42 Pa.C.S. Ch. 63 (relating to juvenile matters).

27* * *

28"Family finding." Ongoing diligent efforts between a county
29agency, or its contracted providers, and relatives and kin to:

30(1) Search for and identify adult <-maternal and paternal

1relatives and kin and engage them in children and youth
2social service planning and delivery.

3(2) Gain commitment from relatives and kin to support a
4child or parent receiving children and youth social services.

5* * *

6Section <-4 21. The act is amended by adding sections to read:

7Section 1302.1. Family finding required.

8Family finding shall be conducted for a child when the child
9is accepted for services and at least annually thereafter, until
10the child's involvement with the county agency is terminated or
11the family finding is discontinued in accordance with section
121302.2.

13Section 1302.2. Discontinuance of family finding.

14(a) General rule.--A county agency may discontinue family
15finding for a child under the following circumstances:

16(1) The child has been adjudicated dependent pursuant to
1742 Pa.C.S. Ch. 63 (relating to juvenile matters) and a court
18has made a specific determination that continued family
19finding no longer serves the best interests of the child or
20is a threat to the child's safety.

21(2) The child is not under the jurisdiction of a court
22and the county agency has determined that continued family
23finding is a threat to the child's safety. A determination
24that continued family finding is a threat to the child's
25safety must be based on credible information about a specific
26safety threat, and the county agency shall document the
27reasons for its determination.

28(3) The child is in a preadoptive placement, and court
29proceedings to adopt the child have been commenced pursuant
30to 23 Pa.C.S. Part III (relating to adoption).

1(b) Resuming family finding.--Notwithstanding the provisions
2of subsection (a), a county agency shall resume family finding
3for a child if:

4(1) the child is under the jurisdiction of a court, and
5the court determines that resuming family finding is best
6suited to the safety, protection and physical, mental and
7moral welfare of the child and does not pose a threat to the
8child's safety; or

9(2) the child is not under the jurisdiction of a court,
10and <-the county agency determines that resuming family finding
11serves the best interest of the child and does not pose a
12threat to the child's safety.

<-13Section 5. Within one year of the effective date of the
14amendment or addition of sections 1301, 1302, 1302.1 and 1302.2
15of the act, the Department of Public Welfare shall promulgate
16regulations providing for the requirements of county agencies.

17Section 6. This act shall take effect in 60 days.

<-18Section 22.  Sections 1402-B, 1404-B, 1405-B and 1406-B of
19the act, added June 30, 2012 (P.L.668, No.80), are amended to
20read:

21Section 1402-B. Establishment of Human Services Block Grant
22Pilot Program.

23The following shall apply to the Human Services Block Grant
24Pilot Program.

25(1) The Human Services Block Grant Pilot Program is
26established for the purpose of allocating block grant funds to
27county governments to provide locally identified county-based
28human services that will meet the service needs of county
29residents. A county's request to participate in the block grant
30shall be on a form and contain such information as the

1department may prescribe.

2(2) The department[, in its discretion,] may approve a
3county's request based on [criteria determined by the
4department.] the county's plan to provide human services and 
5integrate its human service programs. A county with a history of 
6participation or application to participate in the block grant 
7shall have priority over a county which has not previously 
8applied for the block grant. The department shall also consider 
9diversity in representation of counties, regarding such factors 
10as:

11(i) Geographic location.

12(ii) Total population.

13(iii) Urban, rural and suburban population.

14(iv) Proximity to a large urban area.

15(v) County class.

16(vi) Form of county government.

17(vii) Whether the county is part of a local collaborative
18arrangement.

19(viii) The county's human services administrative structure.

20(3) No more than [20] 30 counties may participate in the
21block grant in any fiscal year. A county's participation in the 
22block grant is voluntary.

23Section 1404-B.  Powers and duties of counties.

24The local county officials of each county government
25participating in the block grant shall have the power and duty
26to:

27(1)  Administer and disburse block grant funds for the
28provision of county-based human services in accordance with
29this article and regulations promulgated under section 1403-
30B(10) and Federal requirements.

1(2)  Establish or maintain, in agreement with another
2county or counties, local collaborative arrangements for the
3delivery of any county-based human service. Counties may
4establish new local collaborative arrangements under this
5paragraph for the provision of a specific county-based human
6service or county-based human services, subject to approval
7by the secretary.

8(3)  Determine and redetermine, when necessary, whether a
9person is eligible to participate in a county-based human
10service, subject to appeal under 2 Pa.C.S. Ch. 5 Subch. B
11(relating to practice and procedures of local agencies).

12(4)  Submit required reports under section 1403-B(b)(4).

13(5)  Submit to the department an annual Human Services
14Block Grant Pilot Plan to include the intended delivery of
15county-based human services by client population to be
16served, including a detailed description of how the county
17intends to serve its residents in the least restrictive
18setting appropriate to their needs and the distribution and
19the projected expenditure level of block grant funds by
20county-based human services allocated under this article in
21such form and containing such information as the department
22may require. Prior to submitting the annual Human Services
23Block Grant Pilot Plan to the department, the county shall
24hold at least two public hearings on the plan under 65
25Pa.C.S. Ch. 7 (relating to open meetings), which shall
26include an opportunity for individuals and families who
27receive services to testify about the plan.

28(6)  Submit to the department a written notice if a
29county intends to opt out of the block grant. Such opt out
30shall take effect at the beginning of the next State fiscal

1year.

2Section 1405-B.  Allocation.

3(a)  Allocation.--The department shall allocate State block
4grant funds to counties as follows:

5(1)  The department shall allocate State block grant
6funds according to each county's proportional share of the
7aggregate amount of the following State funds allocated for
8fiscal year 2011-2012:

9(i)  Funds allocated to counties under the act of
10October 5, 1994 (P.L.531, No.78), known as the Human
11Services Development Fund Act.

12(ii)  Funds allocated to counties for mental health
13and intellectual disability services under the act of
14October 20, 1966 (3rd Sp.Sess., P.L.96, No.6), known as
15the Mental Health and Intellectual Disability Act of
161966.

17(iii)  Funds allocated to counties for behavioral
18health services.

19(iv)  Funds allocated to counties for drug and
20alcohol services under section 2334 of the act of April
219, 1929 (P.L.177, No.175), known as The Administrative
22Code of 1929.

23(v)  Funds allocated to counties for the provision of
24services to the homeless.

25(vi)  Funds allocated to county child welfare
26agencies as certain additional grants under section
27704.1(b).

28(2)  The department shall allocate Federal block grant
29funds to counties according to each county's fiscal year
302011-2012 proportional share of each Federal appropriation

1associated with the funds identified in paragraph (1).

2(3)  Funds identified in paragraphs (1) and (2) that were
3allocated to county local collaborative arrangements shall be
4allocated to individual counties based on the individual
5county population.

6(4)  The department may revise the allocation of Federal
7funds identified in paragraph (2) as necessary to comply with
8applicable Federal requirements.

9(a.1)  Adjustment of allocation.--The department may adjust 
10grants under this article to a county participating in the block 
11grant based on the county's demonstrated need for funds to meet 
12the specific human services needs of its residents for a fiscal 
13year. Such adjustment shall not be considered in the county's 
14allocation under subsection (a) for any subsequent fiscal year.

15(b)  Expenditure.--Each county participating in the block
16grant shall expend its allocated block grant funds as follows:

17(1)  For State fiscal year 2012-2013, each county shall
18expend on each of the following county-based human services
19at least 80% of the amount the county is allocated under the
20funds identified in subsection (a)(1) for that county-based
21human service:

22(i)  Community-based mental health services.

23(ii)  Intellectual disability services.

24(iii) Child welfare services.

25(iv)  Drug and alcohol treatment and prevention
26services.

27(v)  Homeless assistance services.

28(vi)  Behavioral health services.

29(2)  For State fiscal year 2013-2014, each county shall
30expend on each of the following county-based human services

1at least 75% of the amount the county was allocated under the
2funds identified in subsection (a)(1) for that county-based
3human service:

4(i)  Community-based mental health services.

5(ii)  Intellectual disability services.

6(iii)  Child welfare services.

7(iv)  Drug and alcohol treatment and prevention
8services.

9(v)  Homeless assistance services.

10(vi)  Behavioral health services.

11(3)  For State fiscal year 2014-2015, each county shall
12expend on each of the following county-based human services
13at least 50% of the amount the county is allocated under the
14funds identified in subsection (a)(1) for that county-based
15human service:

16(i)  Community-based mental health services.

17(ii)  Intellectual disability services.

18(iii)  Child welfare services.

19(iv)  Drug and alcohol treatment and prevention
20services.

21(v)  Homeless assistance services.

22(vi)  Behavioral health services.

23(4)  For State fiscal year 2015-2016, each county shall
24expend on each of the following county-based human services
25at least 25% of the amount the county is allocated under the
26funds identified in subsection (a)(1), for that county-based
27human service:

28(i)  Community-based mental health services.

29(ii)  Intellectual disability services.

30(iii)  Child welfare services.

1(iv)  Drug and alcohol treatment and prevention
2services.

3(v)  Homeless assistance services.

4(vi)  Behavioral health services.

5(5)  For State fiscal year 2016-2017 and thereafter,
6counties may expend block grant funds on county-based human
7services as determined by local need.

8(c)  Waiver.--A county may request in writing that the
9department waive the requirements of subsection (b). [The
10department may, in its discretion, grant the request upon good
11cause shown by the county.] The department may grant the request 
12upon a showing by the county that specific circumstances create 
13a local need for funds to provide a human service that cannot be 
14met without a waiver, and that adequate and appropriate access 
15to other human services will remain available in the county. A 
16request for a waiver under this subsection shall specify the 
17amount of funds and the human services on which those funds will 
18be transferred and expended.

19(d)  Use of remaining funds.--Except as provided in
20subsection (b), counties may expend the remaining block grant
21funds on county-based human services needs as determined by
22county officials.

23(e)  Contribution to local collaborative arrangement.--Each
24county that is part of a local collaborative arrangement in
25accordance with section 1404-B(2) shall contribute at a minimum
26the percentage of funds specified in subsection (b) to the local
27collaborative arrangement for the provision of the county-based
28human services delivered by the local collaborative arrangement.

29Section 1406-B.  Use of block grant funds.

30(a)  General rule.--Block grant funds received by counties

1under this article shall be used solely for the provision of
2county-based human services.

3(b)  Reinvestment.--A county participating in the block grant 
4may submit to the department a written plan to reinvest up to 3% 
5of its block grant allocation for any State fiscal year to be 
6expended on county-based human services in the next State fiscal 
7year. The 3% limitation may be waived by the department upon 
8[good cause shown by the county.] a showing by the county that 
9it has a specific and detailed plan to reinvest the funds to 
10expand access to human services based on local need and that 
11adequate and available human services will remain available in 
12the county. A request for a waiver under this subsection shall 
13include all of the following:

14(1) The specific amount of funds the county seeks to
15reinvest.

16(2) An explanation why the funds were not expended for
17human services during the fiscal year.

18(3) An explanation how the reinvestment will support the
19plan submitted under section 1404-B(5).

20(4) The projected time period for expenditure of the
21funds.

22(c)  Eligibility.--No county shall be required to expend
23block grant funds under this article on behalf of an individual
24until the individual has exhausted eligibility and receipt of
25benefits under all other existing Federal, State, local or
26private programs.

27(d)  Allocation.--For State fiscal year 2012-2013, each
28county in expending block grant funds shall provide local
29matching funds for block grant funds allocated to it in the same
30percentage as that county's aggregate local match percentage for

1the State funds identified in section 1405-B(a)(1) in State
2fiscal year 2010-2011. For each State fiscal year thereafter,
3each county in expending block grant funds shall provide local
4matching funds for State block grant funds allocated to it in
5the same percentage as that county's aggregate local match
6percentage for the State funds identified in section 1405-B(a)
7(1) in State fiscal year 2011-2012.

8(e)  County obligation.--Except as provided in subsection
9(d), counties shall have no financial obligation to provide
10human services under this article in excess of their allocation
11of block grant funds for any fiscal year.

12Section 23. This act shall take effect as follows:

13(1) The amendment or addition of sections 102 and 103 of
14the act shall take effect December 31, 2013.

15(2) The following provisions shall take effect
16immediately:

17(i) The addition of section 441.10 of the act.

18(ii) The amendment of section 443.1(1.1)(i), (1.4)
19and (7)(iv) and (v) of the act.

20(iii) The amendment or addition of sections
21704.1(g), (g.1) and (g.2) and 704.3 of the act.

22(iv) The amendment of the heading of Article VIII-C
23and sections 801-C, 802-C, 803-C, 804-C, 805-C, 806-C,
24807-C, 808-C, 809-C, 810-C and 811-C of the act.

25(v) The amendment of sections 802-E and 808-E of the
26act.

<-27(vi) The amendment or addition of the definition of
28"net inpatient revenue" in section 801-G and sections
29803-G(b), 804-G(a.1) and (a.3), 805-G(a)(3), (b)(4.1),
30(4.2) and (5) and 815-G of the act.

<-1(vi) The reenactment and amendment of Article VIII-G
2of the act.

3(vii) The amendment of the heading of Article XIV-B,
4and sections 1402-B, 1403-B, 1404-B, 1405-B and 1406-B of
5the act.

6(viii) This section.

7(3) The remainder of this act shall take effect in 60
8days.