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; providing for family
23finding; and, in human services block grant pilot program, 
24further providing for establishment of human services block 
25grant pilot program, for powers and duties of the department, 
26for powers and duties of counties, for allocation and for use 
27of block grant funds.

28The General Assembly finds and declares as follows:

1(1) It is the purpose of this act to provide fiscal and
2administrative support that promotes the health, safety and
3welfare of the citizens of this Commonwealth.

4(2) Pennsylvania, through the Department of Public
5Welfare and the counties, provides a broad array of health
6care and other human services to low income families,
7children and youth, those with intellectual and physical
8disabilities and the elderly.

9(3) Section 24 of Article III of the Constitution of
10Pennsylvania requires the General Assembly to adopt all
11appropriations for the operation of government in this
12Commonwealth. The Supreme Court has repeatedly affirmed that,
13"It is fundamental within Pennsylvania's tripartite system
14that the General Assembly enacts the legislation establishing
15those programs which the State provides for its citizens and
16appropriates the funds necessary for their operation."

17(4) Section 11 of Article III of the Constitution of
18Pennsylvania requires the adoption of a general appropriation
19bill that embraces "nothing but appropriations." While actual
20appropriation can be contained in a general appropriations
21act, the achievement and implementation of a comprehensive
22budget involves much more than appropriations. Ultimately,
23the budget has to be balanced under Section 13 of Article
24VIII of the Constitution of Pennsylvania. This may
25necessitate changes to sources of funding and enactment of
26statutes to achieve full compliance with these constitutional
27provisions.

28(5) Therefore, it is the intent of the General Assembly
29through this act to provide further implementation of the
30General Appropriation Act of 2013, as it affects the

1operations and funding for the delivery of health care and
2human services that protect our most vulnerable and needy
3citizens.

4(6) This act shall accomplish all of the following:

5(i) Provide for the expansion of the Human Services
6Block Grant Pilot Program.

7(ii) Extend the authority for State and local
8assessments that support hospitals and intermediate care
9facilities for persons with an intellectual disability
10that serve persons in the medical assistance program.

11(iii) Provide for separate medical assistance fee-
12for-service payments for normal newborn care and for
13mothers' obstetrical delivery.

14(iv) Reauthorize the nursing facility revenue
15adjustment neutrality factor to provide continued
16payments for nursing facilities that serve persons in the
17medical assistance program.

18(v) Provide for quarterly medical assistance day one
19incentive payments to qualified nonpublic nursing
20facilities.

21(vi) Provide for publication of a premium schedule
22for families with children with special needs, who
23receive benefits under the medical assistance program.

24(vii) Establish a process to assure that the revenue
25of the Commonwealth is timely disbursed and expended
26properly for the delivery of public child welfare
27services.

28(viii) Reauthorize the reallocation of excess funds
29for payment to qualifying hospitals accredited or seeking
30accreditation as Level III trauma centers.

<-1(ix) Change the name of the Department of Public
2Welfare to the Department of Human Services.

3(x) Provide for the development and implementation
4of an enhanced medical services delivery system.

5The General Assembly of the Commonwealth of Pennsylvania
6hereby enacts as follows:

<-7Section 1. Section 102 of the act of June 13, 1967 (P.L.31,
8No.21), known as the Public Welfare Code, is amended to read:

9Section 102. Definitions.--Subject to additional definitions
10contained in subsequent articles of this act, the following
11words when used in this act shall have, unless the context
12clearly indicates otherwise, the meanings given them in this
13section:

14"Department" means the Department of [Public Welfare] Human
15Services of this Commonwealth.

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

18Section 2. The act is amended by adding sections to read:

19Section 103. Redesignation.--(a) The Department of Public
20Welfare shall be known as the Department of Human Services.

21(b) A reference to the Department of Public Welfare in a
22statute or a regulation shall be deemed a reference to the
23Department of Human Services.

24(c) In order to provide an efficient and cost-minimizing
25transition, licenses, contracts, deeds and any other official
26actions of the Department of Public Welfare shall not be
27affected by the use of the designation of the department as the
28Department of Human Services. The department may continue to use
29the name Department of Public Welfare on badges, licenses,
30contracts, deeds, stationery and any other official documents

1until existing supplies are exhausted. The Department of Public
2Welfare may substitute the title "Department of Human Services"
3for "Department of Public Welfare" on its documents and
4materials on such schedule as it deems appropriate.

5(d) The Department of Human Services shall not replace
6existing signage at department locations with the redesignated
7name until the signs are worn and in need of replacement. This
8transition shall be coordinated with changes in administration.

9(e) The department shall continue to use the name Department
10of Public Welfare on its computer systems until the time of
11routine upgrades in each computer system in the department. The
12change in name shall be made at the time of the routine upgrade
13to the department computer systems.

14Section 441.10. Enhanced medical services delivery system.--
15(a) Any enhanced medical services delivery system developed
16collaboratively with the United States Department of Health and
17Human Services and approved for this Commonwealth shall consider
18and recognize all of the following design options or reforms:

19(1) Benefit design modifications that make the medical
20assistance program responsive and flexible to changing needs and
21demands, thereby allowing an expansion of coverage to additional
22citizens of this Commonwealth.

23(2) Improved accountability and personal responsibility
24through cost sharing that includes reasonable low-cost premiums
25or copay requirements, which encourage proper utilization and
26the delivery of services to those who need them most.

27(3) Plan design features that parallel the services and
28benefits available to citizens of this Commonwealth with
29commercial insurance coverage and meet the requirements of an
30essential health benefit plan as defined under the Patient

1Protection and Affordable Care Act (Public Law 111-148, 1124
2Stat. 119), including the delivery of behavioral health
3services.

4(4) Maximized use of commercial insurance that takes an
5integrated and market-based approach with new coverage
6opportunities, market competition and alternatives to the
7existing medical assistance program when determined to be more
8fiscally sound and appropriate, including movement to the health
9care exchange for those in the Medical Assistance for Workers
10with Disabilities program.

11(5) Implementation of an enhanced medical services delivery
12system that utilizes existing or supplemental plans for medical
13assistance programs as contracted by the department, using a
14risk-based approach for reimbursing Medicaid managed care
15organizations.

16(6) Continued operation of the Children's Health Insurance
17Program in a form that does not unnecessarily require a shift to
18medical assistance or an enhanced medical services delivery
19system.

20(7) Reasonable employment and job search requirements for
21those physically or mentally able, as well as appropriate limits
22on nonessential benefits, such as nonemergency transportation.

23(8) Improved access and continuity of care, with Federal and
24State support for the use of community-based health centers,
25medical homes, expanded scope of practice and targeted chronic
26care, including a managed long-term care pilot program and other
27long-term care measures, that provide coordination and delivery
28of preventive care and assure the wellness of the served
29population.

30(9) Use of competitive and value-based purchasing from

1medical providers and medical equipment suppliers that promotes
2efficiencies and delivers value to taxpayers.

3(10) Continued emphasis on the reduction of waste, fraud and
4abuse in all facets of the medical services delivery and
5provider system, with focused attention on credible allegations
6of fraud by providers and the use of predictive modeling.

7(11) Resolution on existing Federal deferrals and
8disallowances as they relate to the Pennsylvania Medicaid
9Program with minimal financial impact to the Commonwealth.

10(12) Maintained allowance of the Commonwealth's current
11gross receipts tax on Medicaid managed care organizations for
12the duration of any enhanced medical services delivery system in
13the Commonwealth.

14(13) Application of the Federal financial participation rate
15currently provided to the Commonwealth, based on existing
16Federal calculations, for medical assistance and all other
17eligible programs and services that receive a Federal match.

18(14) Affirmation that any expanded coverage under the
19enhanced medical services delivery system does not constitute an
20entitlement at the Federal or State level.

21(b) The adoption of an agreement to create an enhanced
22medical services delivery system in this Commonwealth for adults
23ranging from 19 to 65 years of age necessitates further
24discussions with the United States Department of Health and
25Human Services to ensure that it can be accomplished in an
26integrated, cost-effective and fiscally sustainable manner and
27that taxpayer dollars derived directly from citizens of this
28Commonwealth, which are going to the Federal Government under
29the Patient Protection and Affordable Care Act (Public Law 111-
30148, 124 Stat. 119), generate services to the citizens of this

1Commonwealth in proportion to that significant investment.

2(c) Recognition and furtherance of the objectives set forth
3under subsection (a) are essential as the Commonwealth
4vigorously pursues its discussions with the United States
5Department of Health and Human Services to develop and implement
6an agreement with the Secretary of the United States Department
7of Health and Human Services to expand eligibility to persons 
8described under section 1902(a)(10)(A)(i)(VIII) of the Social 
9Security Act (49 Stat. 620, 42 U.S.C. § 1396a(a)(10)(A)(i)
10(VIII)), no later than July 1, 2014. The department shall submit 
11an application for an enhanced medical services delivery system 
12to the United States Department of Health and Human Services for 
13review no later than October 1, 2013. The department shall 
14submit a revised State plan or waiver if required to implement 
15an expansion of eligibility under this subsection.

16(d) This section and the authority to expand eligibility
17under an enhanced medical services delivery system shall cease
18if the Federal medical assistance percentage under section
191905(y) of the Social Security Act (42 U.S.C. § 1396d(y)) is
20less than the following:

21(1) One hundred percent for calendar quarters in 2014, 2015
22and 2016.

23(2) Ninety-five percent for calendar quarters in 2017.

24(3) Ninety-four percent for calendar quarters in 2018.

25(4) Ninety-three percent for calendar quarters in 2019.

26(5) Ninety percent for calendar quarters in 2020 and each
27year thereafter.

28(e) Commencing in fiscal year 2019-2020, continued
29participation by recipients in an enhanced medical services
30delivery system shall be conditioned on the options of increased

1cost-sharing or the purchase of coverage with Federal subsidies
2through the exchange.

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

4(1) The Commonwealth has initiated transformative changes in
5the medical assistance health care delivery system through the
6expansive use of managed care; alignment of payment incentives;
7recognition of the need for rural, underserved and community-
8based health care access; support of community-based health care
9centers; multifaceted initiatives to reduce waste, fraud and
10abuse; targeted resources for the delivery of chronic care; and
11the establishment of medical homes. The Commonwealth is also
12known for its nationally recognized programs to promote patient
13safety and the use of electronic medical records, to reduce
14health care infections and to advance medical, technological and
15biological research, which collectively have contributed to
16advances in the care, treatment and cure of medical disease.

17(2) The Commonwealth established the PACE and PACENET
18programs to provide affordable pharmaceutical drugs for our
19seniors, which became model programs for the nation.

20(3) The Commonwealth created the innovative Children's
21Health Insurance Program, which also became a model for the
22nation by providing access to comprehensive health care services
23for children across this Commonwealth and is a vital program
24that should be preserved.

25(4) In 2001, the Commonwealth established a nonentitlement
26program known as AdultBasic for the purpose of providing health
27care insurance coverage to eligible adults not otherwise
28eligible for medical assistance, initially using funds available
29through the act of June 26, 2001 (P.L.755, No.77), known as the 
30Tobacco Settlement Act. Any agreement between the Commonwealth
 

1and the United States Department of Health and Human Services on 
2the establishment of an enhanced medical assistance delivery 
3system will serve to advance these same interests.

4(5) Commonwealth taxpayers currently provide publicly 
5subsidized health care for nearly 2,400,000 thousand citizens of 
6this Commonwealth, or almost 19% of the total population of this 
7Commonwealth, which includes coverage for a broad array of 
8mandatory and optional health care benefits.

9Section 3. Section 443.1 (1.1)(i), (1.4) and (7)(iv) of the
10act, amended or added June 30, 2011 (P.L.89, No.22), are
11amended, paragraph (7) is amended by adding a subparagraph and
12the section is amended by adding a paragraph to read:

<-13Section 1. Section 443.1(1.1)(i), (1.4) and (7)(iv) of the 
14act of June 13, 1967 (P.L.31, No.21), known as the Public 
15Welfare Code, amended or added June 30, 2011 (P.L.89, No.22), 
16are amended, paragraph (7) is amended by adding a subparagraph 
17and the section is amended by adding a paragraph to read:

18Section 443.1.  Medical Assistance Payments for Institutional
19Care.--The following medical assistance payments shall be made
20on behalf of eligible persons whose institutional care is
21prescribed by physicians:

22* * *

23(1.1) Subject to section 813-G, for inpatient acute care
24hospital services provided during a fiscal year in which an
25assessment is imposed under Article VIII-G, payments under the
26medical assistance fee-for-service program shall be determined
27in accordance with the department's regulations, except as
28follows:

29(i) If the Commonwealth's approved Title XIX State Plan for 
30inpatient hospital services in effect for the period of July 1,
 

12010, through June 30, [2013] 2016, specifies a methodology for 
2calculating payments that is different from the department's 
3regulations or authorizes additional payments not specified in 
4the department's regulations, such as inpatient disproportionate 
5share payments and direct medical education payments, the 
6department shall follow the methodology or make the additional 
7payments as specified in the approved Title XIX State Plan.

8* * *

9(1.4) Subject to section 813-G, for inpatient hospital
10services provided under the physical health medical assistance
11managed care program during State fiscal [year] years 2012-2013,
122013-2014, 2014-2015 and 2015-2016, the following shall apply:

13(A) The department may adjust its capitation payments to
14medical assistance managed care organizations to provide
15additional funds for inpatient hospital services.

16(B) For an out-of-network inpatient discharge of a recipient 
17enrolled in a medical assistance managed care organization that 
18occurs in State fiscal year 2012-2013, 2013-2014, 2014-2015 or 
192015-2016, the medical assistance managed care organization 
20shall pay, and the hospital shall accept as payment in full, the 
21amount that the department's fee-for-service program would have 
22paid for the discharge if the recipient [were] was enrolled in 
23the department's fee-for-service program.

24(C) Nothing in this paragraph shall prohibit an inpatient
25acute care hospital and a medical assistance managed care
26organization from executing a new participation agreement or
27amending an existing participation agreement on or after July 1,
282013.

29* * *

30(1.6) Notwithstanding any other provision of law or

1departmental regulation to the contrary, the department shall
2make separate fee-for-service APR-DRG payments for medically
3necessary inpatient acute care general hospital services
4provided for normal newborn care and for mothers' obstetrical
5delivery.

6* * *

7(7)  After June 30, 2007, payments to county and nonpublic
8nursing facilities enrolled in the medical assistance program as
9providers of nursing facility services shall be determined in
10accordance with the methodologies for establishing payment rates
11for county and nonpublic nursing facilities specified in the
12department's regulations and the Commonwealth's approved Title
13XIX State Plan for nursing facility services in effect after
14June 30, 2007. The following shall apply:

15* * *

16(iv)  Subject to Federal approval of such amendments as may
17be necessary to the Commonwealth's approved Title XIX State
18Plan, for each fiscal year beginning on or after July 1, 2011,
19the department shall apply a revenue adjustment neutrality
20factor to county and nonpublic nursing facility payment rates so
21that the estimated Statewide day-weighted average payment rate
22in effect for that fiscal year is limited to the amount
23permitted by the funds appropriated by the General Appropriation
24Act for the fiscal year. The revenue adjustment neutrality
25factor shall remain in effect until the sooner of June 30,
26[2013] 2016, or the date on which a new rate-setting methodology
27for medical assistance nursing facility services which replaces
28the rate-setting methodology codified in 55 Pa. Code Chs. 1187
29(relating to nursing facility services) and 1189 (relating to
30county nursing facility services) takes effect.

1(v) Subject to Federal approval of such amendments as may be
2necessary to the Commonwealth's approved Title XIX State Plan,
3for fiscal year 2013-2014, the department shall make quarterly
4medical assistance day one incentive payments to qualified
5nonpublic nursing facilities. The department shall determine the
6nonpublic nursing facilities that qualify for the quarterly
7medical assistance day one incentive payments and calculate the
8payments using the Total Pennsylvania medical assistance (PA MA)
9days and Total Resident Days as reported by nonpublic nursing
10facilities under Article VIII-A (relating to nursing facility
11assessments). The department's determination and calculations
12under this subparagraph shall be based on the nursing facility
13assessment quarterly resident day reporting forms available on
14October 31, January 31, April 30 and July 31. The department
15shall not retroactively revise a medical assistance day one
16incentive payment amount based on a nursing facility's late
17submission or revision of its report after these dates. The
18department, however, may recoup payments based on an audit of a
19nursing facility's report. The following shall apply:

20(A) A nonpublic nursing facility shall meet all of the
21following criteria to qualify for a medical assistance day one
22incentive payment:

23(I) The nursing facility shall have an overall occupancy
24rate of at least eighty-five percent during the resident day
25quarter. For purposes of determining a nursing facility's
26overall occupancy rate, a nursing facility's Total Resident
27Days, as reported by the facility under Article VIII-A, shall be
28divided by the product of the facility's licensed bed capacity,
29at the end of the quarter, multiplied by the number of calendar
30days in the quarter.

1(II) The nursing facility shall have a medical assistance
2occupancy rate of at least sixty-five percent during the
3resident day quarter. For purposes of determining a nursing
4facility's medical assistance occupancy rate, the nursing
5facility's Total PA MA days shall be divided by the nursing
6facility's Total Resident Days, as reported by the facility
7under Article VIII-A.

8(III) The nursing facility shall be a nonpublic nursing
9facility for a full resident day quarter prior to the applicable
10quarterly reporting due dates of October 31, January 31, April
1130 and July 31.

12(B) The department shall calculate a qualified nonpublic
13nursing facility's medical assistance day one incentive
14quarterly payment as follows:

15(I) The total funds appropriated for payments under this
16subparagraph shall be divided by four.

17(II) To establish the quarterly per diem rate, the amount
18under subclause (I) shall be divided by the Total PA MA days, as
19reported by all qualifying nonpublic nursing facilities under
20Article VIII-A.

21(III) To determine a qualifying nonpublic nursing facility's
22quarterly medical assistance day one incentive payment, the
23quarterly per diem rate shall be multiplied by a nonpublic
24nursing facility's Total PA MA days, as reported by the facility
25under Article VIII-A.

26(C) For fiscal year 2013-2014, the State funds available for
27the nonpublic nursing facility medical assistance day one
28incentive payments shall equal <-seven million dollars
29($7,000,000) <-eight million dollars ($8,000,000).

30* * *

1Section <-4 2. Section 454(a) of the act, amended June 30,
22011 (P.L.89, No.22), is amended to read:

3Section 454. Medical Assistance Benefit Packages; Coverage,
4Copayments, Premiums and Rates.--(a) Notwithstanding any other
5provision of law to the contrary, the department shall
6promulgate regulations as provided in subsection (b) to
7establish provider payment rates; the benefit packages and any
8copayments for adults eligible for medical assistance under
9Title XIX of the Social Security Act (49 Stat 620, 42 U.S.C. §
101396 et seq.) and adults eligible for medical assistance in
11general assistance-related categories; and the premium or 
12copayment requirements for disabled children whose family income
13is above two hundred percent of the Federal poverty income
14limit. Subject to such Federal approval as may be necessary, the
15regulations shall authorize and describe the available benefit
16packages and any copayments and premiums, except that the 
17department shall set forth the copayment and premium schedule 
18for disabled children whose family income is above two hundred 
19percent of the Federal poverty income limit by publishing a 
20notice in the Pennsylvania Bulletin. The department may adjust 
21such copayments and premiums for disabled children by notice 
22published in the Pennsylvania Bulletin. The regulations shall
23also specify the effective date for provider payment rates.

24* * *

25Section <-5 3. Section 704.1(g) of the act, added July 9, 1976
26(P.L.846, No.148), is amended and the section is amended by
27adding subsections to read:

28Section 704.1. Payments to Counties for Services to
29Children.--* * *

30(g) The department shall[, within forty-five days of each

1calendar quarter, pay fifty percent of the department's share of
2the county institution district's or its successor's estimated
3expenditures for that quarter.] process payments to each county 
4pursuant to this article from funds appropriated by the General 
5Assembly for each fiscal year, within 15 days of passage of the 
6general appropriation bill or by a date specified under 
7paragraphs (1), (2), (3), (4) or (5), whichever is later. The 
8department shall process the following applicable payments to 
9the county:

10(1) By July 15, twenty-five percent of the amount of State
11funds allocated to the county under section 709.3.

12(2) By August 31, or upon approval by the department of the
13county's final cumulative report for its expenditures for the
14prior fiscal year, whichever is later, twenty-five percent of
15the amount of State funds allocated to the county under section
16709.3, reduced by the amount of aggregate unspent State funds
17provided to the county during the previous fiscal year.

18(3) By November 30, or upon approval by the department of
19the county's report for its expenditures for the first quarter
20of the fiscal year, whichever is later, twenty-five percent of
21the amount of State funds allocated to the county under section
22709.3, reduced by the amount of unspent State funds already
23provided to the county for the first quarter of the fiscal year.

24(4) By February 28, or upon approval by the department of
25the county's report for its expenditures for the second quarter
26of the fiscal year, whichever is later, twelve and five-tenths
27percent of the amount of State funds allocated to the county
28under section 709.3, adjusted by the amount of overspending or
29underspending of State funds in the previous quarters, but not
30to exceed eighty-seven and five-tenths percent of the county's

1approved State allocation.

2(5) Upon approval by the department of the county's final
3cumulative report for its expenditures for the fiscal year,
4twelve and five-tenths percent of the amount of State funds
5allocated to the county under section 709.3, adjusted by the
6amount of overspending or underspending of State funds in the
7previous quarters.

8(g.1) After the final cumulative report for expenditures has
9been approved, if a county has adjustments to revenues or
10expenditures for the time period covered by the expenditure
11report in addition to the payments under subsection (g), the
12county shall submit to the department a revised expenditure
13report. After the report is approved, the department may adjust
14any payment under subsection (g) to account for any revision to
15a county's expenditure report.

16(g.2)  Service contracts or agreements shall include a timely
17payment provision that requires counties to make payment to
18service providers within thirty days of the county's receipt of
19an invoice under both of the following conditions:

20(1) The invoice satisfies the county's requirements for a
21complete and accurate invoice.

22(2) Funds have been appropriated to the department for
23payments to counties under subsection (g).

24* * *

25Section <-6 4. The act is amended by adding a section to read:

26Section 704.3. Provider submissions.--(a) For fiscal year
272013-2014, a provider shall submit documentation of its costs of
28providing services and the department shall use such
29documentation, to the extent necessary, to support the
30department's claim for Federal funding and for State

1reimbursement for allowable direct and indirect costs incurred
2in the provision of out-of-home placement services.

3(b) The department shall convene a task force to include
4representatives from public and private children and youth
5social service agencies and other appropriate stakeholders as
6determined by the secretary or deputy secretary for the Office
7of Children, Youth and Families.

8(c) The task force established under subsection (b) shall
9develop recommendations for a methodology to determine
10reimbursement for actual and projected costs, which are
11reasonable and allowable, for the purchase of services from
12providers and for other purchased services. The task force shall
13provide written recommendations for the purchase of services
14from providers to the General Assembly no later than April 30,
152014. The task force shall provide written recommendations for
16other purchased services no later than December 31, 2014. The
17task force shall be convened within sixty days after the
18effective date of this section.

19(d) As used in this section, the term "provider" means an
20entity licensed or certified to provide twenty-four-hour out-of-
21home community-based or institutional care and supervision of a
22child, with the care and supervision being paid for or provided
23by a county using Federal or State funds disbursed under this
24article.

25Section <-7 5. The heading of Article VIII-C of the act, added
26July 4, 2004 (P.L.528, No.69) is amended to read:

27ARTICLE VIII-C

28INTERMEDIATE CARE FACILITIES FOR [MENTALLY RETARDED] PERSONS
29WITH AN INTELLECTUAL DISABILITY

30ASSESSMENTS

1Section <-8 6. Sections 801-C, 802-C, 803-C, 804-C, 805-C,
2806-C, 807-C, 808-C, 809-C and 810-C of the act, added July 4,
32004 (P.L.528, No.69), are amended to read:

4Section 801-C.  Definitions.

5The following words and phrases when used in this article
6shall have the meanings given to them in this section unless the
7context clearly indicates otherwise:

8"Assessment."  The fee implemented pursuant to this article
9on every intermediate care facility for [mentally retarded]
10persons with an intellectual disability.

11"Department."  The Department of Public Welfare of the
12Commonwealth.

13"Intermediate care facility for [mentally retarded] persons
14with an intellectual disability" or "[ICF/MR] ICF/ID."  A public
15or private facility defined in section 1905 of the Social
16Security Act (49 Stat. 620, 42 U.S.C. § 1905).

17"Medicaid."  The program established under Title XIX of the
18Social Security Act (49 Stat. 620, 42 U.S.C. § 1396 et seq.).

19"Medical assistance program" or "program."  The medical
20assistance program as administered by the Department of Public
21Welfare.

22"Secretary."  The Secretary of Public Welfare of the
23Commonwealth.

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

25Section 802-C.  Authorization.

26In order to generate additional revenues for medical
27assistance program recipients to have access to medically
28necessary [mental retardation] intellectual disability services,
29the department shall implement a monetary assessment on each
30[ICF/MR] ICF/ID subject to the conditions and requirements

1specified in this article.

2Section 803-C.  Implementation.

3The [ICF/MR] ICF/ID assessments shall be implemented on an
4annual basis as a health care-related tax as defined in section
51903(w)(3)(B) of the Social Security Act, or any amendments
6thereto, and may be imposed and is required to be paid only to
7the extent that the revenues generated from the assessment will
8qualify as the State share of program expenditures eligible for
9Federal financial participation.

10Section 804-C.  Amount.

11The assessment rate shall be determined in accordance with
12this article and implemented on an annual basis by the
13department, as approved by the Governor, upon notification to
14and in consultation with the [ICFs/MR] ICFs/ID. In each year in
15which the assessment is implemented, the assessment rate shall
16equal the amount established by the department subject to the
17maximum aggregate amount that may be assessed pursuant to the 6%
18indirect guarantee threshold set forth in 42 CFR 433.68(f)(3)(i)
19(relating to permissible health care-related taxes [after the
20transition period]) or any other maximum aggregate amount
21established by law.

22Section 805-C.  Administration.

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

1comment period, the secretary, after consideration of the
2comments, shall publish a second notice in the Pennsylvania
3Bulletin announcing the rate of the assessment.

4(b)  Review of assessment.--Except as permitted under section
5809-C, the secretary's determination of the aggregate amount and
6the rate of the assessment pursuant to subsection (a) shall not
7be subject to administrative or judicial review under 2 Pa.C.S.
8Chs. 5 Subch. A (relating to practice and procedure of
9Commonwealth agencies) and 7 Subch. A (relating to judicial
10review of Commonwealth agency action) or any other provision of
11law. No assessment implemented under this article nor forms or
12reports required to be completed by [ICFs/MR] ICFs/ID pursuant
13to this article shall be subject to the act of July 31, 1968
14(P.L.769, No.240), referred to as the Commonwealth Documents
15Law, the act of October 15, 1980 (P.L.950, No.164), known as the
16Commonwealth Attorneys Act, or the act of June 25, 1982
17(P.L.633, No.181), known as the Regulatory Review Act.

18Section 806-C.  Calculation.

19Using the assessment rate implemented by the secretary
20pursuant to section 804-C, each [ICF/MR] ICF/ID shall calculate
21the assessment amounts it owes for a calendar quarter on a form
22specified by the department and shall submit the form and the
23amount owed to the department no later than the last day of that
24calendar quarter or 30 days from the date of the department's
25second notice published pursuant to section 805-C(a), whichever
26is later.

27Section 807-C.  Purposes and uses.

28No [ICF/MR] ICF/ID shall be directly guaranteed a repayment
29of its assessment in derogation of 42 CFR 433.68 (relating to
30permissible health care-related taxes [after the transition

1period]), provided, however, in each fiscal year in which an
2assessment is implemented, the department shall use the State
3revenue collected from the assessment and any Federal funds
4received by the Commonwealth as a direct result of the
5assessment to fund services for persons with [mental
6retardation] an intellectual disability.

7Section 808-C.  Records.

8Upon request by the department, an [ICF/MR] ICF/ID shall
9furnish to the department such records as the department may
10specify in order to determine the assessment rate for a fiscal
11year or the amount of the assessment due from the [ICF/MR]
12ICF/ID or to verify that the [ICF/MR] ICF/ID has paid the
13correct amount due. In the event that the department determines
14that an [ICF/MR] ICF/ID has failed to pay an assessment or that
15it has underpaid an assessment, the department shall notify the
16[ICF/MR] ICF/ID in writing of the amount due, including
17interest, and the date on which the amount due must be paid,
18which shall not be less than 30 days from the date of the
19notice. In the event that the department determines that an
20[ICF/MR] ICF/ID has overpaid an assessment, the department shall
21notify the [ICF/MR] ICF/ID in writing of the overpayment and,
22within 30 days of the date of the notice of the overpayment,
23shall either authorize a refund of the amount of the overpayment
24or offset the amount of the overpayment against any amount that
25may be owed to the department by the [ICF/MR] ICF/ID.

26Section 809-C.  Appeal rights.

27An [ICF/MR] ICF/ID that is aggrieved by a determination of
28the department as to the amount of the assessment due from the
29[ICF/MR] ICF/ID or a remedy imposed pursuant to section 810-C
30may file a request for review of the decision of the department

1by the Bureau of Hearings and Appeals within the department,
2which shall have exclusive jurisdiction in such matters. The
3procedures and requirements of 67 Pa.C.S. Ch. 11 (relating to
4medical assistance hearings and appeals) shall apply to requests
5for review filed pursuant to this section except that, in any
6such request for review, an [ICF/MR] ICF/ID may not challenge
7the assessment rate determined by the secretary, but only
8whether the department correctly determined the assessment
9amount due from the [ICF/MR] ICF/ID using the assessment rate in
10effect for the fiscal year.

11Section 810-C.  Enforcement.

12In addition to any other remedy provided by law, the
13department may enforce this article by imposing one or more of
14the following remedies:

15(1)  When an [ICF/MR] ICF/ID fails to pay an assessment
16or penalty in the amount or on the date required by this
17article, the department may add interest at the rate provided
18in section 806 of the act of April 9, 1929 (P.L.343, No.176),
19known as The Fiscal Code, to the unpaid amount of the
20assessment or penalty from the date prescribed for its
21payment until the date it is paid.

22(2)  When an [ICF/MR] ICF/ID fails to file a report or to
23furnish records to the department as required by this
24article, the department may impose a penalty against the
25[ICF/MR] ICF/ID in the amount of $1,000 per day for each day
26the report or required records are not filed or furnished to
27the department.

28(3)  When an [ICF/MR] ICF/ID fails to pay all or part of
29an assessment or penalty within 60 days of the date that
30payment is due, the department may terminate the [ICF/MR]

1ICF/ID from participation in the medical assistance program
2and/or deduct the unpaid assessment or penalty and any
3interest owed thereon from any payments due to the [ICF/MR]
4ICF/ID until the full amount is recovered. Any such
5termination or payment deduction shall be made only after
6written notice to the [ICF/MR] ICF/ID.

7(4)  The secretary may waive all or part of the interest
8or penalties assessed against an [ICF/MR] ICF/ID pursuant to
9this article for good cause as shown by the [ICF/MR] ICF/ID.

10Section <-9 7.  Section 811-C of the act, amended July 4, 2008
11(P.L.557, No.44), is amended to read:

12Section 811-C.  Time periods.

13(a)  Imposition.--The assessment authorized under this
14article shall not be imposed as follows:

15(1)  Prior to July 1, 2003, for private [ICFs/MR]
16ICFs/ID.

17(2)  Prior to July 1, 2004, for public [ICFs/MR] ICFs/ID.

18(3)  In the absence of Federal financial participation as
19described under section 803-C.

20(b)  Cessation.--The assessment authorized under this article
21shall cease June 30, [2013] 2016, or earlier, if required by
22law.

23Section <-10 8.  Section 802-E of the act is amended by adding
24a subsection to read:

25Section 802-E.  Authorization.

26* * *

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

28(1)  For State fiscal years beginning after June 30, 
292013, and subject to the advance written approval of the 
30secretary as prescribed by the department, the municipality
 

1may make a uniform adjustment to an assessment percentage 
2established by ordinance under subsection (a).

3(2)  After receiving written approval under paragraph (1) 
4and before implementing an adjustment, the municipality shall 
5provide advance public notice. The notice shall specify the 
6proposed adjusted assessment percentage and identify the 
7aggregate impact on hospitals located in the municipality 
8subject to an assessment. An interested party shall have 30 
9days in which to submit comments to the municipality. Upon 
10expiration of the 30-day comment period, the municipality, 
11after consideration of the comments, shall publish a 
12subsequent notice announcing the adjusted assessment 
13percentage.

14* * *

15Section <-11 9. Section 808-E of the act, reenacted October
1622, 2010 (P.L.829, No.84), is amended to read:

17Section 808-E.  Time period.

18(a)  Cessation.--The assessment authorized under this article
19shall cease June 30, [2013] 2016.

20(b)  Assessment.--

21(1)  A municipality shall have the power to enact the
22assessment authorized in section 802-E(a)(2) either prior to
23or during its fiscal year ending June 30, 2010.

24(2)  A municipality may adjust an assessment percentage 
25as specified under section 802-E(a.1) either prior to or 
26during the fiscal year in which the adjusted assessment 
27percentage takes effect.

28Section <-12 <-10. The heading of Article VIII-G of the act, 
29added July 9, 2010 (P.L.336, No.49), is reenacted to read:

30ARTICLE VIII-G

1STATEWIDE QUALITY CARE ASSESSMENT

2Section <-12.1 <-11. Section 801-G of the act, added or amended
3July 9, 2010 (P.L.336, No.49) and June 30, 2011 (P.L.89, No.22),
4is reenacted and amended to read:

5Section 801-G. Definitions.

6The following words and phrases when used in this article
7shall have the meanings given to them in this section unless the
8context clearly indicates otherwise:

9"Assessment." The fee, known as the Quality Care Assessment,
10authorized to be implemented under this article on every covered
11hospital.

12"Bad debt expense." The cost of care for which a hospital
13expected payment from the patient or a third-party payer, but
14which the hospital subsequently determines to be uncollectible,
15as further described in the Medicare Provider Reimbursement
16Manual published by the United States Department of Health and
17Human Services.

18"Charity care expense." The cost of care for which a
19hospital ordinarily charges a fee but which is provided free or
20at a reduced rate to patients who cannot afford to pay but who
21are not eligible for public programs, and from whom the hospital
22did not expect payment in accordance with the hospital's charity
23care policy, as further described in the Medicare Provider
24Reimbursement Manual published by the United States Department
25of Health and Human Services.

26"Contractual allowance." The difference between what a
27hospital charges for services and the amounts that certain
28payers have agreed to pay for the services as further described
29in the Medicare Provider Reimbursement Manual published by the
30United States Department of Health and Human Services.

1"Covered hospital." A hospital other than an exempt
2hospital.

3"Critical access hospital." Any hospital that has qualified
4under section 1861(mm)(1) of the Social Security Act (49 Stat.
5620, 42 U.S.C. § 1395x(mm)(1)) as a critical access hospital
6under Medicare.

7"Exempt hospital." Any of the following:

8(1) A Federal veterans' affairs hospital.

9(2) A hospital that provides care, including inpatient
10hospital services, to all patients free of charge.

11(3) A private psychiatric hospital.

12(4) A State-owned psychiatric hospital.

13(5) A critical access hospital.

14(6) A long-term acute care hospital.

15"Hospital." A facility licensed as a hospital under 28
16Pa.Code Pt. IV Subpt. B (relating to general and special
17hospitals).

18"Long-term acute care hospital." A hospital or unit of a
19hospital whose patients have a length of stay of greater than 25
20days and that provides specialized acute care of medically
21complex patients who are critically ill.

22"Medical assistance managed care organization." A Medicaid
23managed care organization as defined in section 1903(m)(1)(a) of
24the Social Security Act (49 Stat. 620, 42 U.S.C. § 1396b(m)(1)
25(a)) that is a party to a Medicaid managed care contract with
26the department. The term shall not include a behavioral health
27managed care organization that is a party to a Medicaid managed
28care contract with the department.

29"Net inpatient revenue." Gross charges for facilities for
30inpatient services less any deducted amounts for bad debt

1expense, charity care expense and contractual allowances as
2reported on forms specified by the department and:

3(1) as identified in the hospital's records for the
4State fiscal year commencing July 1, [2007] 2010; or

5(2) as identified in the hospital's records for the most
6recent State fiscal year, or part thereof, if amounts are not
7available under paragraph (1).

8"Program." The Commonwealth's medical assistance program as
9authorized under Article IV.

10Section <-12.2 <-12. Section 802-G of the act, added July 9, 
112010, (P.L.336, No.49), is reenacted to read:

12Section 802-G. Authorization.

13In order to generate additional revenues for the purpose of
14assuring that medical assistance recipients have access to
15hospital services, the department shall implement a monetary
16assessment, known as the Quality Care Assessment, on each
17covered hospital subject to the conditions and requirements
18specified in this article, including section 813-G.

19Section <-12.3 <-12.1. Section 803-G of the act, added or
20amended July 9, 2010 (P.L.336, No.49) and June 30, 2011 (P.L.89,
21No.22), is reenacted and amended to read:

22Section 803-G. Implementation.

23(a) Health care-related fee.--The assessment authorized
24under this article, once imposed, shall be implemented as a
25health care-related fee as defined under section 1903(w)(3)(B)
26of the Social Security Act (49 Stat. 620, 42 U.S.C. § 1396b(w)
27(3)(B)) or any amendments thereto and may be collected only to
28the extent and for the periods that the secretary determines
29that revenues generated by the assessment will qualify as the
30State share of program expenditures eligible for Federal

1financial participation.

2(b) Assessment percentage.--Subject to subsection (c), each
3covered hospital shall be assessed as follows:

4(1) for fiscal year 2010-2011, each covered hospital
5shall be assessed an amount equal to 2.69% of the net
6inpatient revenue of the covered hospital; and

7(2) for fiscal years 2011-2012 [and] , 2012-2013, 2013-
82014, 2014-2015 and 2015-2016, an amount equal to 3.22% of
9the net inpatient revenue of the covered hospital.

10(c) Adjustments to assessment percentage.--The secretary may
11adjust the assessment percentage specified in subsection (b),
12provided that, before adjusting, the secretary shall publish a
13notice in the Pennsylvania Bulletin that specifies the proposed
14assessment percentage and identifies the aggregate impact on
15covered hospitals subject to the assessment. Interested parties
16shall have 30 days in which to submit comments to the secretary.
17Upon expiration of the 30-day comment period, the secretary,
18after consideration of the comments, shall publish a second
19notice in the Pennsylvania Bulletin announcing the assessment
20percentage.

21(d) Maximum amount.--In each year in which the assessment is
22implemented, the assessment shall be subject to the maximum
23aggregate amount that may be assessed under 42 CFR 433.68(f)(3)
24(i) (relating to permissible health care-related taxes) or any
25other maximum established under Federal law.

26(e) Limited review.--Except as permitted under section 810-
27G, the secretary's determination of the assessment percentage
28pursuant to subsection (b) shall not be subject to
29administrative or judicial review under 2 Pa.C.S. Chs. 5 Subch.
30A (relating to practice and procedure of Commonwealth agencies)

1and 7 Subch. A (relating to judicial review of Commonwealth
2agency action) or any other provision of law; nor shall any
3assessments implemented under this article or forms or reports
4required to be completed by covered hospitals pursuant to this
5article be subject to the act of July 31, 1968 (P.L.769,
6No.240), referred to as the Commonwealth Documents Law, the act
7of October 15, 1980 (P.L.950, No.164), known as the Commonwealth
8Attorneys Act, and the act of June 25, 1982 (P.L.633, No.181),
9known as the Regulatory Review Act.

10Section <-12.4 <-12.2. Section 804-G of the act, amended June
1130, 2011 (P.L.89, No.22), is reenacted and amended to read:

12Section 804-G. Administration.

13(a) Calculation and notice of assessment amount.--Using the
14assessment percentage established under section 803-G and
15covered hospitals' net inpatient revenue, the department shall
16calculate and notify each covered hospital of the assessment
17amount owed for the fiscal year. Notification pursuant to this
18subsection may be made in writing or electronically at the
19discretion of the department.

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

21(1) If a single covered hospital changes ownership or
22control, the department will continue to calculate the
23assessment amount using the hospital's net inpatient revenue
24for State fiscal year [2008-2009] 2010-2011 or for the most
25recent State fiscal year, or part thereof, if the State
26fiscal year [2008-2009] 2010-2011 amounts are not available.
27The covered hospital is liable for any outstanding assessment
28amounts, including outstanding amounts related to periods
29prior to the change of ownership or control.

30(2) If two or more hospitals merge or consolidate into a

1single covered hospital as a result of a change in ownership
2or control, the department will calculate the covered
3hospital assessment amount using the combined net inpatient
4revenue for State fiscal year [2008-2009] 2010-2011 or for
5the most recent State fiscal year, or part thereof, if the
6State fiscal year [2008-2009] 2010-2011 amounts are not
7available, of any covered hospitals that were merged or
8consolidated into the single covered hospital. The single
9covered hospital is liable for any outstanding assessment
10amounts, including outstanding amounts related to periods
11prior to the change of ownership or control, of any covered
12hospital that was merged or consolidated.

13(a.2) Calculation of assessment with closures or other
14changes in operation.--Except as provided in subsection (a.1)
15(2), a covered hospital that closes or that becomes an exempt
16hospital during a fiscal year is liable for both:

17(1) The annual assessment amount for the fiscal year in
18which the closure or change occurs prorated by the number of
19days in the fiscal year during which the covered hospital was
20in operation.

21(2) Any outstanding assessment amounts related to
22periods prior to the closure or change in operation.

23(a.3) Calculation of assessment for new hospitals.--A
24hospital that begins operation as a covered hospital during a
25fiscal year in which an assessment is in effect shall be
26assessed as follows:

27(1) During the State fiscal year in which a covered
28hospital begins operation or in which a hospital becomes a
29covered hospital, the covered hospital is not subject to the
30assessment.

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

6(3) For the State fiscal years following the first full
7State fiscal year under paragraph (2), the department shall
8calculate the hospital's assessment amount using the net
9inpatient revenue from the prior State fiscal year.

10(b) Payment.--A covered hospital shall pay the assessment
11amount due for a fiscal year in four quarterly installments.
12Payment of a quarterly installment shall be made on or before
13the first day of the second month of the quarter or 30 days from
14the date of the notice of the quarterly assessment amount,
15whichever day is later.

16(c) Records.--Upon request by the department, a covered
17hospital shall furnish to the department such records as the
18department may specify in order for the department to validate 
19the net inpatient revenue reported by the hospital or to
20determine the assessment for a fiscal year or the amount of the
21assessment due from the covered hospital or to verify that the
22covered hospital has paid the correct amount due.

23(d) Underpayments and overpayments.--In the event that the
24department determines that a covered hospital has failed to pay
25an assessment or that it has underpaid an assessment, the
26department shall notify the covered hospital in writing of the
27amount due, including interest, and the date on which the amount
28due must be paid, which shall not be less than 30 days from the
29date of the notice. In the event that the department determines
30that a covered hospital has overpaid an assessment, the

1department shall notify the covered hospital in writing of the
2overpayment and, within 30 days of the date of the notice of the
3overpayment, shall either refund the amount of the overpayment
4or offset the amount of the overpayment against any amount that
5may be owed to the department from the covered hospital.

6Section <-12.5 <-12.3. Section 805-G of the act, amended or
7added July 9, 2010 (P.L.336, No.49) and June 30, 2011 (P.L.89,
8No.22), is reenacted and amended to read:

9Section 805-G. Restricted account.

10(a) Establishment.--There is established a restricted
11account, known as the Quality Care Assessment Account, in the
12General Fund for the receipt and deposit of revenues collected
13under this article. Funds in the account are appropriated to the
14department for the following:

15(1) Making medical assistance payments to hospitals in
16accordance with section 443.1(1.1) and as otherwise specified
17in the Commonwealth's approved Title XIX State Plan.

18(2) Making adjusted capitation payments to medical
19assistance managed care organizations for additional payments
20for inpatient hospital services in accordance with section
21443.1(1.2), (1.3) and (1.4).

22(3) Any other purpose approved by the secretary for 
23inpatient hospital, outpatient hospital and hospital-related 
24services.

25(b) Limitations.--

26(1) For the first year of the assessment, the amount
27used for the medical assistance payments for hospitals and
28Medicaid managed care organizations may not exceed the
29aggregate amount of assessment funds collected for the year
30less $121,000,000.

1(2) For the second year of the assessment, the amount
2used for the medical assistance payments for hospitals and
3medical assistance managed care organizations may not exceed
4the aggregate amount of assessment funds collected for the
5year less $109,000,000.

6(4) For the third year of the assessment, the amount
7used for the medical assistance payment for hospitals and
8medical assistance managed care organizations may not exceed
9the aggregate amount of the assessment funds collected for
10the year less $109,000,000.

11(4.1) For State fiscal years 2013-2014 and 2014-2015,
12the amount used for the medical assistance payment for
13hospitals and medical assistance managed care organizations
14may not exceed the aggregate amount of the assessment funds
15collected for the year less $150,000,000.

16(4.2) For State fiscal year 2015-2016, the amount used
17for the medical assistance payment for hospitals and medical
18assistance managed care organizations may not exceed the
19aggregate amount of the assessment funds collected for the
20year less $140,000,000.

21(5) The amounts retained by the department pursuant to 
22paragraphs (1), (2) [and], (4), (4.1) and (4.2) and any 
23additional amounts remaining in the restricted accounts after 
24the payments described in subsection (a)(1) and (2) are made 
25shall be used for purposes approved by the secretary under 
26subsection (a)(3).

27(c) Lapse.--Funds in the Quality Care Assessment Account
28shall not lapse to the General Fund at the end of a fiscal year.
29If this article expires, the department shall use any remaining
30funds for the purposes stated in this section until the funds in

1the Quality Care Assessment Account are exhausted.

2Section 13. Sections 806-G, 807-G, 808-G, 809-G, 810-G, 811-
3G and 812-G of the act, added July 9, 2010, (P.L.336, No.49),
4are reenacted to read:

5Section 806-G. No hold harmless.

6No covered hospital shall be directly guaranteed a repayment
7of its assessment in derogation of 42 CFR 433.68(f) (relating to
8permissible health care-related taxes), except that, in each
9fiscal year in which an assessment is implemented, the
10department shall use the funds received under this article for
11the purposes outlined under section 805-G to the extent
12permissible under Federal and State law or regulation and
13without creating an indirect guarantee to hold harmless, as
14those terms are used under 42 CFR 433.68(f)(i). The secretary
15shall submit to the United States Department of Health and Human
16Services any State Medicaid plan amendments that are necessary
17to make the payments authorized under section 805-G.

18Section 807-G. Federal waiver.

19To the extent necessary in order to implement this article,
20the department shall seek a waiver under 42 CFR 433.68(e)
21(relating to permissible health care-related taxes) from the
22Centers for Medicare and Medicaid Services of the United States
23Department of Health and Human Services. The department shall
24not implement the assessment until approval of the waiver is
25obtained. Upon approval of the waiver, the assessment shall be
26implemented retroactive to the first day of the fiscal year to
27which the waiver applies.

28Section 808-G. Tax exemption.

29(a) General rule.--Notwithstanding any exemptions granted by
30any other Federal, State or local tax or other law, no covered

1hospital other than an exempt hospital shall be exempt from the
2assessment.

3(b) Interpretation.--The assessment imposed under this
4article shall be recognized by the Commonwealth as uncompensated
5goods and services under the act of November 26, 1997 (P.L.508,
6No.55), known as the Institutions of Purely Public Charity Act,
7and shall be considered a community benefit for purposes of any
8required or voluntary community benefit report filed or prepared
9by a covered hospital.

10Section 809-G. Remedies.

11In addition to any other remedy provided by law, the
12department may enforce this article by imposing one or more of
13the following remedies:

14(1) When a covered hospital fails to pay an assessment
15or penalty in the amount or on the date required by this
16article, the department shall add interest at the rate
17provided in section 806 of the act of April 9, 1929 (P.L.343,
18No.176), known as The Fiscal Code, to the unpaid amount of
19the assessment or penalty from the date prescribed for its
20payment until the date it is paid.

21(2) When a covered hospital fails to file a report or to
22furnish records to the department as required by this
23article, the department shall impose a penalty against the
24covered hospital in the amount of $1,000, plus an additional
25amount of $200 per day for each additional day that the
26failure to file the report or furnish the records continues.

27(3) When a covered hospital that is a medical assistance
28provider, or that is related through common ownership or
29control as defined in 42 CFR 413.17(b) (relating to cost to
30related organizations) to a medical assistance provider,

1fails to pay all or part of an assessment or penalty within
260 days of the date that payment is due, the department may
3deduct the unpaid assessment or penalty and any interest owed
4thereon from any medical assistance payments due to the
5covered hospital or to any related medical assistance
6provider until the full amount is recovered. Any such
7deduction shall be made only after written notice to the
8covered hospital and medical assistance provider and may be
9taken in installments over a period of time, taking into
10account the financial condition of the medical assistance
11provider.

12(4) Within 60 days after the end of each calendar
13quarter, the department shall notify the Department of Health
14of any covered hospital that has assessment, penalty or
15interest amounts that have remained unpaid for 90 days or
16more. The Department of Health shall not renew the license of
17any such covered hospital until the department notifies the
18Department of Health that the covered hospital has paid the
19outstanding amount in its entirety or that the department has
20agreed to permit the covered hospital to repay the
21outstanding amount in installments and that, to date, the
22covered hospital has paid the installments in the amount and
23by the date required by the department.

24(5) The secretary may waive all or part of the interest
25or penalties assessed against a covered hospital pursuant to
26this article for good cause as shown by the covered hospital.

27Section 810-G. Request for review.

28A covered hospital that is aggrieved by a determination of
29the department as to the amount of the assessment due from the
30covered hospital or a remedy imposed pursuant to section 809-G

1may file a request for review of the decision of the department
2by the Bureau of Hearings and Appeals, which shall have
3exclusive jurisdiction in such matters. The procedures and
4requirements of 67 Pa.C.S. Ch. 11 (relating to medical
5assistance hearings and appeals) shall apply to requests for
6review filed pursuant to this section, except that in any such
7request for review, a covered hospital may not challenge an
8assessment percentage determined by the secretary pursuant to
9section 803-G(b) but only whether the department correctly
10determined the assessment amount due from the covered hospital
11using the assessment percentage in effect for the fiscal year. A
12notice of review filed pursuant to this section shall not
13operate as a stay of the covered hospital's obligation to pay
14the assessment amount due for a fiscal year as specified in
15section 804-G(b).

16Section 811-G. Liens.

17Any assessments implemented and interest and penalties
18assessed against a covered hospital under this article shall be
19a lien on the real and personal property of the covered hospital
20in the manner provided by section 1401 of the act of April 9,
211929 (P.L.343, No.176), known as The Fiscal Code, may be entered
22by the department in the manner provided by section 1404 of The
23Fiscal Code and shall continue and retain priority in the manner
24provided in section 1404.1 of The Fiscal Code.

25Section 812-G. Regulations.

26The department may issue such regulations and orders as may
27be necessary to implement the Quality Care Assessment program in
28accordance with the requirements of this article.

29Section 14. Section 813-G of the act, amended June 30, 2011 
30(P.L.89, No.22), is reenacted to read:

1Section 813-G. Conditions for payments.

2The department shall not be required to make payments as
3specified in section 443.1(1.1), (1.2), (1.3) and (1.4) and a
4covered hospital shall not be required to pay the Quality Care
5Assessment as specified in section 804-G(b) unless all of the
6following have occurred:

7(1) The department receives Federal approval of a waiver
8under 42 CFR 433.68(e) (relating to permissible health care-
9related taxes) authorizing the department to implement the
10Quality Care Assessment as specified in this article.

11(2) The department receives Federal approval of a State
12plan amendment authorizing the changes to its payment methods
13and standards specified in § 443.1(1.1)(ii).

14(3) The department receives Federal approval of
15amendments to its medical assistance managed care
16organization contracts authorizing adjustments to its
17capitation payments funded in accordance with section 805-G.

18Section 15. Section 814-G of the act, added July 9, 2010 
19(P.L.336, No.49), is reenacted to read:

20Section 814-G. Report.

21Not later than 180 days prior to the expiration date
22specified in section 815-G, the department shall prepare and
23submit a report to the chair and minority chair of the Public
24Health and Welfare Committee of the Senate, the chair and
25minority chair of the Appropriations Committee of the Senate,
26the chair and minority chair of the Health and Human Services
27Committee of the House of Representatives and the chair and
28minority chair of the Appropriations Committee of the House of
29Representatives. The report shall include the following:

30(1) The name, address and amount of assessment for each

1covered hospital subject to the Quality Care Assessment.

2(2) The total amount of assessment revenue collected for
3each year.

4(3) The amount of assessment paid by each covered
5hospital, including any interest and penalties paid.

6(4) The name and address of each hospital receiving
7supplemental payments instituted as a result of the Quality
8Care Assessment.

9(5) The payment amount and type of supplemental payment
10received by each hospital.

11(6) The total amount of fee-for-service inpatient acute
12care payment made to each hospital.

13(7) The number of medical assistance patient days and
14discharges by hospital.

15(8) Any proposed changes to the payment methodologies
16and standards.

17Section 15.1. Section 815-G of the act, added July 9, 2010 
18(P.L.336, No.49), is reenacted and amended to read:

19Section 815-G. Expiration.

20This article shall expire June 30, [2013] 2016.

21Section 16. Section 816-G of the act, added July 9, 2010
22(P.L.336, No.49), is reenacted to read:

23Section 816-G. Retroactive applicability.

24This article shall apply retroactively to July 1, 2010.

25Section 17. Section 805-H(c) of the act is amended by adding
26a paragraph to read:

27Section 805-H. Funding.

28* * *

29(c) Payment calculation.--

30* * *

1(5) Funds not used to make payments to qualifying
2hospitals accredited or seeking accreditation as Level III
3trauma centers shall be used to make payments to qualifying
4hospitals accredited as Level I and Level II trauma centers.

5* * *

6Section 18. The heading of Article XIII of the act, added
7September 30, 2003 (P.L.169, No.25), is amended to read:

8ARTICLE XIII

9FAMILY FINDING AND KINSHIP CARE

10Section 19. Section 1301 of the act, added September 30,
112003 (P.L.169, No.25), is amended to read:

12Section 1301. [Scope] Legislative intent.

13[This article relates to the Kinship Care Program.] This 
14article is intended to ensure that family finding occurs on an 
15ongoing basis for all children entering the child welfare 
16system. This article is also intended to promote the use of 
17kinship care when it is necessary to remove a child from the 
18child's home in an effort to:

19(1) Identify and build positive connections between the
20child and the child's relatives and kin.

21(2) Support the engagement of relatives and kin in
22children and youth social service planning and delivery.

23(3) Create a network of extended family support to
24assist in remedying the concerns that led the child to be
25involved with the county agency.

26Section 20. Section 1302 of the act is amended by adding
27definitions to read:

28Section 1302. 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"Accept for service." Decide on the basis of the needs and
3problems of an individual to admit or receive the individual as
4a client of the county agency or as required by a court order
5entered under 42 Pa.C.S. Ch. 63 (relating to juvenile matters).

6* * *

7"Family finding." Ongoing diligent efforts between a county
8agency, or its contracted providers, and relatives and kin to:

9(1) Search for and identify adult relatives and kin and
10engage them in children and youth social service planning and
11delivery.

12(2) Gain commitment from relatives and kin to support a
13child or parent receiving children and youth social services.

14* * *

15Section 21. The act is amended by adding sections to read:

16Section 1302.1. Family finding required.

17Family finding shall be conducted for a child when the child
18is accepted for services and at least annually thereafter, until
19the child's involvement with the county agency is terminated or
20the family finding is discontinued in accordance with section
211302.2.

22Section 1302.2. Discontinuance of family finding.

23(a) General rule.--A county agency may discontinue family
24finding for a child under the following circumstances:

25(1) The child has been adjudicated dependent pursuant to
2642 Pa.C.S. Ch. 63 (relating to juvenile matters) and a court
27has made a specific determination that continued family
28finding no longer serves the best interests of the child or
29is a threat to the child's safety.

30(2) The child is not under the jurisdiction of a court

1and the county agency has determined that continued family
2finding is a threat to the child's safety. A determination
3that continued family finding is a threat to the child's
4safety must be based on credible information about a specific
5safety threat, and the county agency shall document the
6reasons for its determination.

7(3) The child is in a preadoptive placement, and court
8proceedings to adopt the child have been commenced pursuant
9to 23 Pa.C.S. Part III (relating to adoption).

10(b) Resuming family finding.--Notwithstanding the provisions
11of subsection (a), a county agency shall resume family finding
12for a child if:

13(1) the child is under the jurisdiction of a court, and
14the court determines that resuming family finding is best
15suited to the safety, protection and physical, mental and
16moral welfare of the child and does not pose a threat to the
17child's safety; or

18(2) the child is not under the jurisdiction of a court,
19and the county agency determines that resuming family finding
20serves the best interest of the child and does not pose a
21threat to the child's safety.

22Section 22.  Sections 1402-B, 1404-B, 1405-B and 1406-B of 
23the act, added June 30, 2012 (P.L.668, No.80), are amended to 
24read:

25Section 1402-B. Establishment of Human Services Block Grant
26Pilot Program.

27The following shall apply to the Human Services Block Grant
28Pilot Program.

29(1) The Human Services Block Grant Pilot Program is
30established for the purpose of allocating block grant funds to

1county governments to provide locally identified county-based
2human services that will meet the service needs of county
3residents. A county's request to participate in the block grant
4shall be on a form and contain such information as the
5department may prescribe.

6(2) The department[, in its discretion,] may approve a
7county's request based on [criteria determined by the
8department.] the county's plan to provide human services and 
9integrate its human service programs. A county with a history of 
10participation or application to participate in the block grant 
11shall have priority over a county which has not previously 
12applied for the block grant. The department shall also consider 
13diversity in representation of counties, regarding such factors 
14as:

15(i) Geographic location.

16(ii) Total population.

17(iii) Urban, rural and suburban population.

18(iv) Proximity to a large urban area.

19(v) County class.

20(vi) Form of county government.

21(vii) Whether the county is part of a local collaborative
22arrangement.

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

24(3) No more than [20] 30 counties may participate in the
25block grant in any fiscal year. A county's participation in the 
26block grant is voluntary.

27Section 1404-B.  Powers and duties of counties.

28The local county officials of each county government
29participating in the block grant shall have the power and duty
30to:

1(1)  Administer and disburse block grant funds for the
2provision of county-based human services in accordance with
3this article and regulations promulgated under section 1403-
4B(10) and Federal requirements.

5(2)  Establish or maintain, in agreement with another
6county or counties, local collaborative arrangements for the
7delivery of any county-based human service. Counties may
8establish new local collaborative arrangements under this
9paragraph for the provision of a specific county-based human
10service or county-based human services, subject to approval
11by the secretary.

12(3)  Determine and redetermine, when necessary, whether a
13person is eligible to participate in a county-based human
14service, subject to appeal under 2 Pa.C.S. Ch. 5 Subch. B
15(relating to practice and procedures of local agencies).

16(4)  Submit required reports under section 1403-B(b)(4).

17(5)  Submit to the department an annual Human Services
18Block Grant Pilot Plan to include the intended delivery of
19county-based human services by client population to be
20served, including a detailed description of how the county
21intends to serve its residents in the least restrictive
22setting appropriate to their needs and the distribution and
23the projected expenditure level of block grant funds by
24county-based human services allocated under this article in
25such form and containing such information as the department
26may require. Prior to submitting the annual Human Services
27Block Grant Pilot Plan to the department, the county shall
28hold at least two public hearings on the plan under 65
29Pa.C.S. Ch. 7 (relating to open meetings), which shall
30include an opportunity for individuals and families who

1receive services to testify about the plan.

2(6)  Submit to the department a written notice if a
3county intends to opt out of the block grant. Such opt out
4shall take effect at the beginning of the next State fiscal
5year.

6Section 1405-B.  Allocation.

7(a)  Allocation.--The department shall allocate State block
8grant funds to counties as follows:

9(1)  The department shall allocate State block grant
10funds according to each county's proportional share of the
11aggregate amount of the following State funds allocated for
12fiscal year 2011-2012:

13(i)  Funds allocated to counties under the act of
14October 5, 1994 (P.L.531, No.78), known as the Human
15Services Development Fund Act.

16(ii)  Funds allocated to counties for mental health
17and intellectual disability services under the act of
18October 20, 1966 (3rd Sp.Sess., P.L.96, No.6), known as
19the Mental Health and Intellectual Disability Act of
201966.

21(iii)  Funds allocated to counties for behavioral
22health services.

23(iv)  Funds allocated to counties for drug and
24alcohol services under section 2334 of the act of April
259, 1929 (P.L.177, No.175), known as The Administrative
26Code of 1929.

27(v)  Funds allocated to counties for the provision of
28services to the homeless.

29(vi)  Funds allocated to county child welfare
30agencies as certain additional grants under section

1704.1(b).

2(2)  The department shall allocate Federal block grant
3funds to counties according to each county's fiscal year
42011-2012 proportional share of each Federal appropriation
5associated with the funds identified in paragraph (1).

6(3)  Funds identified in paragraphs (1) and (2) that were
7allocated to county local collaborative arrangements shall be
8allocated to individual counties based on the individual
9county population.

10(4)  The department may revise the allocation of Federal
11funds identified in paragraph (2) as necessary to comply with
12applicable Federal requirements.

13(a.1)  Adjustment of allocation.--The department may adjust 
14grants under this article to a county participating in the block 
15grant based on the county's demonstrated need for funds to meet 
16the specific human services needs of its residents for a fiscal 
17year. Such adjustment shall not be considered in the county's 
18allocation under subsection (a) for any subsequent fiscal year.

19(b)  Expenditure.--Each county participating in the block
20grant shall expend its allocated block grant funds as follows:

21(1)  For State fiscal year 2012-2013, each county shall
22expend on each of the following county-based human services
23at least 80% of the amount the county is allocated under the
24funds identified in subsection (a)(1) for that county-based
25human service:

26(i)  Community-based mental health services.

27(ii)  Intellectual disability services.

28(iii) Child welfare services.

29(iv)  Drug and alcohol treatment and prevention
30services.

1(v)  Homeless assistance services.

2(vi)  Behavioral health services.

3(2)  For State fiscal year 2013-2014, each county shall
4expend on each of the following county-based human services
5at least 75% of the amount the county was allocated under the
6funds identified in subsection (a)(1) for that county-based
7human service:

8(i)  Community-based mental health services.

9(ii)  Intellectual disability services.

10(iii)  Child welfare services.

11(iv)  Drug and alcohol treatment and prevention
12services.

13(v)  Homeless assistance services.

14(vi)  Behavioral health services.

15(3)  For State fiscal year 2014-2015, each county shall
16expend on each of the following county-based human services
17at least 50% of the amount the county is allocated under the
18funds identified in subsection (a)(1) for that county-based
19human service:

20(i)  Community-based mental health services.

21(ii)  Intellectual disability services.

22(iii)  Child welfare services.

23(iv)  Drug and alcohol treatment and prevention
24services.

25(v)  Homeless assistance services.

26(vi)  Behavioral health services.

27(4)  For State fiscal year 2015-2016, each county shall
28expend on each of the following county-based human services
29at least 25% of the amount the county is allocated under the
30funds identified in subsection (a)(1), for that county-based

1human service:

2(i)  Community-based mental health services.

3(ii)  Intellectual disability services.

4(iii)  Child welfare services.

5(iv)  Drug and alcohol treatment and prevention
6services.

7(v)  Homeless assistance services.

8(vi)  Behavioral health services.

9(5)  For State fiscal year 2016-2017 and thereafter,
10counties may expend block grant funds on county-based human
11services as determined by local need.

12(c)  Waiver.--A county may request in writing that the
13department waive the requirements of subsection (b). [The
14department may, in its discretion, grant the request upon good
15cause shown by the county.] The department may grant the request 
16upon a showing by the county that specific circumstances create 
17a local need for funds to provide a human service that cannot be 
18met without a waiver, and that adequate and appropriate access 
19to other human services will remain available in the county. A 
20request for a waiver under this subsection shall specify the 
21amount of funds and the human services on which those funds will 
22be transferred and expended.

23(d)  Use of remaining funds.--Except as provided in
24subsection (b), counties may expend the remaining block grant
25funds on county-based human services needs as determined by
26county officials.

27(e)  Contribution to local collaborative arrangement.--Each
28county that is part of a local collaborative arrangement in
29accordance with section 1404-B(2) shall contribute at a minimum
30the percentage of funds specified in subsection (b) to the local

1collaborative arrangement for the provision of the county-based
2human services delivered by the local collaborative arrangement.

3Section 1406-B.  Use of block grant funds.

4(a)  General rule.--Block grant funds received by counties
5under this article shall be used solely for the provision of
6county-based human services.

7(b)  Reinvestment.--A county participating in the block grant 
8may submit to the department a written plan to reinvest up to 3% 
9of its block grant allocation for any State fiscal year to be 
10expended on county-based human services in the next State fiscal 
11year. The 3% limitation may be waived by the department upon 
12[good cause shown by the county.] a showing by the county that 
13it has a specific and detailed plan to reinvest the funds to 
14expand access to human services based on local need and that 
15adequate and available human services will remain available in 
16the county. A request for a waiver under this subsection shall 
17include all of the following:

18(1) The specific amount of funds the county seeks to
19reinvest.

20(2) An explanation why the funds were not expended for
21human services during the fiscal year.

22(3) An explanation how the reinvestment will support the
23plan submitted under section 1404-B(5).

24(4) The projected time period for expenditure of the
25funds.

26(c)  Eligibility.--No county shall be required to expend
27block grant funds under this article on behalf of an individual
28until the individual has exhausted eligibility and receipt of
29benefits under all other existing Federal, State, local or
30private programs.

1(d)  Allocation.--For State fiscal year 2012-2013, each
2county in expending block grant funds shall provide local
3matching funds for block grant funds allocated to it in the same
4percentage as that county's aggregate local match percentage for
5the State funds identified in section 1405-B(a)(1) in State
6fiscal year 2010-2011. For each State fiscal year thereafter,
7each county in expending block grant funds shall provide local
8matching funds for State block grant funds allocated to it in
9the same percentage as that county's aggregate local match
10percentage for the State funds identified in section 1405-B(a)
11(1) in State fiscal year 2011-2012.

12(e)  County obligation.--Except as provided in subsection
13(d), counties shall have no financial obligation to provide
14human services under this article in excess of their allocation
15of block grant funds for any fiscal year.

16Section 23. This act shall take effect as follows:

17(1) The amendment or addition of sections 102 and 103 of
18the act shall take effect December 31, 2013.

19(2) The following provisions shall take effect
20immediately:

21(i) <-The addition of section 441.10 of the act.

22(ii) The amendment of section 443.1(1.1)(i), (1.4)
23and (7)(iv) and (v) of the act.

<-24(iii) <-(ii) The amendment or addition of sections
25704.1(g), (g.1) and (g.2) and 704.3 of the act.

<-26(iv) <-(iii) The amendment of the heading of Article
27VIII-C and sections 801-C, 802-C, 803-C, 804-C, 805-C,
28806-C, 807-C, 808-C, 809-C, 810-C and 811-C of the act.

<-29(v) <-(iv) The amendment of sections 802-E and 808-E
30of the act.

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

<-3(vii) <-(vi) The amendment of the heading of Article
4XIV-B, and sections 1402-B, 1403-B, 1404-B, 1405-B and
51406-B of the act.

<-6(viii) <-(vii) This section.

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