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PRIOR PRINTER'S NO. 3606
PRINTER'S NO. 3662
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No.
2211
Session of
2015
INTRODUCED BY BAKER, FABRIZIO, SCHLOSSBERG, MILLARD, EVERETT,
WARD, KORTZ AND McNEILL, JUNE 22, 2016
AS AMENDED ON SECOND CONSIDERATION, HOUSE OF REPRESENTATIVES,
JUNE 28, 2016
AN ACT
Amending the act of June 13, 1967 (P.L.31, No.21), entitled "An
act to consolidate, editorially revise, and codify the public
welfare laws of the Commonwealth," in public assistance,
further providing for medical assistance payments for
institutional care; in children and youth, further providing
for provider submissions; in nursing facility assessments,
further providing for definitions and for time periods; in
intermediate care facilities for persons with an intellectual
disability assessments, further providing for definitions and
for time periods; in hospital assessments, further providing
for definitions and for time period; in departmental powers
and duties as to licensing, further providing for
regulations; establishing the Pennsylvania eHealth
Partnership Program; providing for the Pennsylvania eHealth
Partnership Fund; abrogating a related regulation; and making
a related repeal.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Section 443.1(7)(iv) of the act of June 13, 1967
(P.L.31, No.21), known as the Human Services Code, amended July
9, 2013 (P.L.369, No.55), is amended to read:
Section 443.1. Medical Assistance Payments for Institutional
Care.--The following medical assistance payments shall be made
on behalf of eligible persons whose institutional care is
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prescribed by physicians:
* * *
(7) After June 30, 2007, payments to county and nonpublic
nursing facilities enrolled in the medical assistance program as
providers of nursing facility services shall be determined in
accordance with the methodologies for establishing payment rates
for county and nonpublic nursing facilities specified in the
department's regulations and the Commonwealth's approved Title
XIX State Plan for nursing facility services in effect after
June 30, 2007. The following shall apply:
* * *
(iv) Subject to Federal approval of such amendments as may
be necessary to the Commonwealth's approved Title XIX State
Plan, for each fiscal year beginning on or after July 1, 2011,
the department shall apply a revenue adjustment neutrality
factor to county and nonpublic nursing facility payment rates so
that the estimated Statewide day-weighted average payment rate
in effect for that fiscal year is limited to the amount
permitted by the funds appropriated by the General Appropriation
Act for the fiscal year. The revenue adjustment neutrality
factor shall remain in effect until the sooner of June 30,
[2016] 2019, or the date on which a new rate-setting methodology
for medical assistance nursing facility services which replaces
the rate-setting methodology codified in 55 Pa. Code Chs. 1187
(relating to nursing facility services) and 1189 (relating to
county nursing facility services) takes effect.
* * *
Section 2. Section 704.3(a) of the act, amended December 28,
2015 (P.L.500, No.92), is amended to read:
Section 704.3. Provider Submissions.--(a) For fiscal years
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2013-2014[, 2014-2015 and 2015-2016] through 2016-2017, a
provider shall submit documentation of its costs of providing
services; and the department shall use such documentation, to
the extent necessary, to support the department's claim for
Federal funding and for State reimbursement for allowable direct
and indirect costs incurred in the provision of out-of-home
placement services.
* * *
Section 3. The definition of "medical assistance provider"
in section 801-A of the act, amended June 30, 2007 (P.L.49,
No.16), is amended to read:
Section 801-A. Definitions.--As used in this article--
* * *
"Medical assistance provider" means a person or entity
enrolled by the Department of [Public Welfare] Human Services as
a provider of services in the medical assistance program.
* * *
Section 4. Section 815-A of the act, amended June 30, 2012
(P.L.668, No.80), is amended to read:
Section 815-A. Time periods.--The assessment authorized in
this article shall not be imposed prior to July 1, 2003, or
after June 30, [2016] 2019.
Section 5. The definitions of "department," "medical
assistance program" or "program" and "secretary" in section 801-
C of the act, amended July 9, 2013 (P.L.369, No.55), are amended
to read:
Section 801-C. Definitions.
The following words and phrases when used in this article
shall have the meanings given to them in this section unless the
context clearly indicates otherwise:
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* * *
"Department." The Department of [Public Welfare] Human
Services of the Commonwealth.
* * *
"Medical assistance program" or "program." The medical
assistance program as administered by the Department of [Public
Welfare] Human Services.
"Secretary." The Secretary of [Public Welfare] Human
Services of the Commonwealth.
* * *
Section 6. Section 811-C(b) of the act, amended July 9, 2013
(P.L.369, No.55), is amended to read:
Section 811-C. Time periods.
* * *
(b) Cessation.--The assessment authorized under this article
shall cease June 30, [2016] 2019, or earlier, if required by
law.
Section 7. The definitions of "general acute care hospital"
and "high volume Medicaid hospital" in section 801-E of the act,
reenacted October 22, 2010 (P.L.829, No.84), are amended to
read:
Section 801-E. Definitions.
The following words and phrases when used in this article
shall have the meanings given to them in this section unless the
context clearly indicates otherwise:
* * *
"General acute care hospital." A hospital other than a
hospital that the Secretary of [Public Welfare] Human Services
has determined meets one of the following:
(1) Is excluded under 42 CFR 412.23(a), (b), (d), (e) and
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(f) (relating to Excluded hospitals: Classifications) as of
March 20, 2008, from reimbursement of certain Federal funds
under the prospective payment system described by 42 CFR 412
(relating to prospective payment systems for inpatient hospital
services).
(2) Is a Federal veterans' affairs hospital.
(3) Is a high volume Medicaid hospital.
(4) Provides care, including inpatient hospital services, to
all patients free of charge.
(5) A free-standing acute care hospital organized primarily
for the treatment of and research on cancer and is an exempt
hospital under section 801-G.
"High volume Medicaid hospital." A hospital that the
Secretary of [Public Welfare] Human Services has determined
meets all of the following:
(1) is a nonprofit hospital subsidiary of a State-related
institution as that term is defined in 62 Pa.C.S. § 103
(relating to definitions); and
(2) provides more than 90,000 days of care to medical
assistance patients annually.
* * *
Section 8. Section 808-E(a) of the act, amended July 9, 2013
(P.L.369, No.55), is amended to read:
Section 808-E. Time period.
(a) Cessation.--The assessment authorized under this article
shall cease June 30, [2016] 2019.
* * *
Section 9. Section 1021(c) of the act, amended July 25, 2007
(P.L.402, No.56), is amended to read:
Section 1021. Regulations.--* * *
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[(c) The department shall have enforcement and licensure
staff dedicated solely to assisted living residences. All
inspections of residences dually licensed as assisted living
residences and personal care homes shall be conducted by a team
of surveyors comprised of both personal care home and assisted
living residence surveyors.]
* * *
Section 10. The act is amended by adding an article to read:
ARTICLE XIV-C
PENNSYLVANIA eHEALTH PARTNERSHIP PROGRAM
Section 1401-C. Definitions.
The following words and phrases when used in this article
shall have the meanings given to them in this section unless the
context clearly indicates otherwise:
"Board." The Pennsylvania eHealth Partnership Advisory
Board.
"Department." The Department of Human Services of the
Commonwealth.
"Electronic health record." An electronic record of health-
related information relating to an individual that is created,
gathered, managed and consulted by health care providers or
payers.
"Fund." The Pennsylvania eHealth Partnership Fund.
"Health care provider." A person licensed by the
Commonwealth to provide health care or professional clinical
services. The term includes:
(1) A "health care practitioner" as defined in section
103 of the act of July 19, 1979 (P.L.130, No.48), known as
the Health Care Facilities Act.
(2) A "health care provider" as defined in section 103
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of the Health Care Facilities Act.
(3) A public health authority.
(4) A pharmacy.
(5) A laboratory.
(6) A person that provides items or services described
in section 1861(s) of the Social Security Act (49 Stat. 620,
42 U.S.C. § 1395x(s)).
(7) A "provider of services" as defined in section
1861(u) of the Social Security Act (49 Stat. 620, 42 U.S.C. §
1395x(u)).
"Health information." Information, whether oral or recorded,
in any form or medium, that is created or received by a health
care provider relating to the following:
(1) The past, present or future physical or mental
health or medical condition of an individual.
(2) The past, present or future payment, treatment or
operations for the provision of health care to an individual.
"Health information exchange." A Statewide interoperable
system established under this article that electronically moves
and exchanges health information between approved participating
health care providers or health information organizations in a
manner that ensures the secure exchange of health information to
provide care to patients.
"Health information organization." An information technology
infrastructure with an interoperable system that is established
by a health care provider or payer or that connects
participating health care providers or payers to ensure the
secure digital exchange of health information among participants
engaged in the care of the patient.
"Health information technology." Hardware, software,
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integrated technologies or related licenses, intellectual
property, upgrades or packaged solutions sold as services that
are designed for or support the use by health care entities or
patients for the electronic creation, maintenance, access or
exchange of health information.
"Interoperability." The ability of different operating and
software systems to employ federally-recognized standards to
exchange data securely, accurately, effectively and in a manner
that maintains and preserves the clinical purpose of the date.
"Participant." A person or entity which has been approved by
the department to send and receive health information using the
health information exchange.
"Payer." An entity that contracts or offers to contract to
provide, deliver, pay or reimburse any of the costs of health
care services, including an employer, a health care plan, the
Federal Government, the Commonwealth, a municipality, a labor
union or an entity licensed under any of the following:
(1) The act of May 17, 1921 (P.L.682, No.284), known as
The Insurance Company Law of 1921.
(2) The act of December 29, 1972 (P.L.1701, No.364),
known as the Health Maintenance Organization Act.
(3) 40 Pa.C.S. Ch. 61 (relating to hospital plan
corporations).
(4) 40 Pa.C.S. Ch. 63 (relating to professional health
services plan corporations).
"Secretary." The Secretary of Human Services of the
Commonwealth.
Section 1402-C. Pennsylvania eHealth Partnership Program.
There is hereby established the Pennsylvania eHealth
Partnership Program within the department.
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Section 1403-C. Powers and duties
The department's powers and duties include the following:
(1) Develop, establish and maintain a health information
exchange that complies with Federal and State law and that:
(i) Promotes efficient and effective communication
among multiple health care providers, payers and
participants.
(ii) Creates efficiencies and promotes accuracy in
the delivery of health care.
(iii) Supports the ability to improve community
health status.
(2) Determine criteria for organizations and individuals
to become and remain participants in the health information
exchange, including criteria for organizations and
individuals to be suspended and disengaged as participants in
the health information exchange.
(3) Develop and maintain a directory of health care
provider's contact information to enable participants to
share health information electronically.
(4) Develop and maintain standards to ensure
interoperability.
(5) Establish and collect fees. Fees may include
transaction fees, subscription fees or other fees or
donations, to cover costs of implementation and operation of
the health information exchange or for other services
provided under this article. Receipt of services provided by
or through the department may be conditioned on payment of
fees. Participation in the health information exchange by any
health care provider, payer, consumer or any other person is
voluntary.
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(6) Establish an advisory board under section 1404-C
with a diverse membership representing interested and
affected groups and individuals.
(7) Develop and conduct public information programs to
educate and inform consumers and patients about health
information.
(8) Submit an annual report to the Governor, the
President pro tempore of the Senate and the Speaker of the
House of Representatives for distribution to appropriate
legislative committees on the activities of the program for
the year, including a summary of the receipts and
expenditures, a list of contracts and a summary of any
reportable security breaches that occurred and corrective
actions that were taken.
(9) Develop and maintain:
(i) a registry of patients choosing to opt out of
the health information exchange; and
(ii) procedures to re-enroll into the health
information exchange.
(10) Promulgate regulations, as necessary, to implement
and administer this article.
(11) Perform all other activities in furtherance of the
purposes of this article.
Section 1404-C. Pennsylvania eHealth Partnership Advisory Board.
(a) Establishment.--The Pennsylvania eHealth Partnership
Advisory Board is established within the department as an
advisory board.
(b) Composition.--The board shall consist of 16 THE
FOLLOWING members, who must be residents of this Commonwealth,
with two additional, ex officio nonvoting members selected by
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members of the board, composed and SHALL BE appointed as
follows:
(1) The secretary or a designee, who shall be an
employee of the department in writing prior to service.
(2) The Secretary of Health or a designee, who shall be
an employee of the Department of Health designated in writing
prior to service.
(3) The Insurance Commissioner or a designee, who shall
be an employee of the Insurance Department designated in
writing prior to service.
(4) One representative of the health care community
focused on an unserved or underserved rural or urban patient
population, who shall be appointed by the secretary from a
list of individuals submitted for consideration by both the
Pennsylvania Area Health Education Center and the
Pennsylvania Association of Community Health Centers.
(5) One physician or nurse appointed by the secretary
from lists of individuals submitted by the Pennsylvania
Medical Society, the Pennsylvania Osteopathic Medical
Association, the Pennsylvania Academy of Family Physicians
and the Pennsylvania State Nurses Association. At least one
name on each list shall include an individual residing in an
unserved or underserved rural patient population area and an
individual in an unserved or underserved urban patient
population area.
(6) One hospital representative appointed by the
secretary from a list of individuals submitted by the
Hospital and Healthsystem Association of Pennsylvania. At
least one name on this list shall include an individual
residing in an unserved or underserved rural or urban patient
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population area.
(7) One insurance representative appointed by the
secretary from lists of individuals submitted by the Blue
Cross and Blue Shield plans and the Insurance Federation of
Pennsylvania.
(8) One representative of an assisted living residence,
personal care home, long-term care nursing facility,
continuing care facility or behavioral or mental health
facility who shall be appointed by the secretary.
(9) Two consumer representatives appointed by the
secretary who are not primarily involved in providing health
care or health care insurance. At least one of these
individuals shall have expertise in health care or health
care information technology or the laboratory industry.
(10) Three representatives from established health
information organizations appointed by the President pro
tempore of the Senate, in consultation with the Majority
Leader and the Minority Leader of the Senate, each of whom
shall recommend one person. At least one of these
representatives shall be from the private information
technology sector with knowledge about security issues.
(11) Three representatives from established health
information organizations appointed by the Speaker of the
House of Representatives, in consultation with the Majority
Leader and the Minority Leader of the House of
Representatives, each of whom shall recommend one person. At
least one of these representatives shall be from the private
information technology sector with knowledge about security
issues.
(12) ONE HOME CARE OR HOSPICE REPRESENTATIVE APPOINTED
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BY THE SECRETARY FROM A LIST OF INDIVIDUALS SUBMITTED BY A
STATEWIDE HOME CARE ASSOCIATION.
(13) TWO EX OFFICIO NONVOTING MEMBERS APPOINTED BY THE
OTHER MEMBERS OF THE BOARD.
(c) Ex officio members.--The Secretary of Health, the
Insurance Commissioner, or their designees, shall serve on the
board as nonvoting ex officio members of the board.
(d) Terms.--Except a member as specified in subsection (b)
(1), (2) or (3), a member of the board shall serve for a term of
three years after completion of the initial terms designated in
subsection (h) and may not be eligible to serve more than two
full consecutive three-year terms. A member shall remain on the
board until the member's replacement is appointed.
(e) Quorum.--A majority of the appointed members of the
board shall constitute a quorum for the transaction of any
business. An act by a majority of the members present at a
meeting at which there is a quorum shall be deemed to be that of
the board.
(f) Meetings.--The board shall hold meetings at least
quarterly and may provide for special meetings as the board
deems necessary. The meetings shall be subject to the
requirements of 65 Pa.C.S. Ch. 7 (relating to open meetings).
Meetings of the board may be held anywhere within this
Commonwealth.
(g) Chairperson.--The secretary shall appoint a chairperson
of the board. The members of the board shall annually elect, by
a majority vote of the members, a vice chairperson from among
the members of the board.
(h) Initial appointment and vacancy.--
(1) A member appointed under subsection (b)(4), (5) or
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(6) shall be appointed to an initial term of two years with
the option for reappointment to two additional three-year
terms.
(2) A member appointed under subsection (b)(7) or (8)
shall be appointed to an initial term of one year with the
option for reappointment to two additional three-year terms.
(3) A member appointed under subsection (b)(9) shall be
appointed to an initial term of three years with the option
for reappointment to one additional three-year term.
(4) A member appointed under subsection (b)(10) or (11)
shall be appointed to an initial term that coincides with the
appointing members' terms with the option for reappointment
to two additional three-year terms.
(i) Formation.--The board shall be formed within 90 days of
the effective date of this article.
(j) Reimbursement.--The members of the board may not receive
a salary or per diem allowance for serving as members of the
board but shall be reimbursed for actual and necessary expenses
incurred in the performance of the members' duties.
Section 1405-C. Establishment of fund.
The Pennsylvania eHealth Partnership Fund, established under
section 501 of the act of July 5, 2012 (P.L.1042, No.121), known
as the Pennsylvania eHealth Information Technology Act, is
continued.
Section 1406-C. Funds.
All money deposited into the fund shall be held for the
purposes under this article and may not be considered a part of
the General Fund but shall be used only to effectuate the
purposes of this article as determined by the department. All
interest earned from the investment or deposit of money
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accumulated in the fund shall be deposited in the fund for the
same use.
Section 1407-C. Consent and confidentiality of health
information.
(a) Construction.--
(1) Nothing in this article shall be construed to
prohibit a health care provider or payer from obtaining and
storing a patient's health records in electronic form or
exchanging health information with another health care
provider or payer in accordance with Federal law or State law
other than this article.
(2) Nothing in this article shall supersede or limit any
other law which requires additional consent to the release of
health information or otherwise establishes greater
restrictions or limitations on the release of health
information.
(b) Consent.--The department shall publish a consent form
including notice of a patient's ability to decline to allow
exchange of the patient's electronic health information in the
health information exchange. The notice shall include, at a
minimum and in plain language, the following information:
(1) Definition of a health information exchange.
(2) Explanation of the benefits of participation in the
health information exchange.
(3) Explanation of the limits of the patient's ability
to decline the release or exchange of the patient's health
information with the health information exchange.
(4) Explanation of the manner in which the health
information exchange will address privacy issues.
(5) Explanation of the manner in which an individual may
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decline to participate in the health information exchange.
(c) Opt-out registry.--
(1) In order to decline participation in the health
information exchange, a patient must sign and date a form
declining participation. If appropriate, the signature must
be witnessed by the patient's representative. Copies of the
completed form shall be sent by the provider within five
business days to the department to be included in an opt-out
registry.
(2) After receipt of the form, the department shall
within five business days notify health information
organizations that the patient has not authorized the release
of the health information through the health information
exchange.
(3) Once the patient is included in the opt-out
registry, the department shall notify the patient. The
notification shall include a copy of the completed form
signed by the patient or electronic notification to the
patient.
(4) The patient alone shall decide to opt out of the
health information exchange.
(d) Disclosure.--
(1) The department may not disclose, without prior
written consent of the patient, any health information that
the department or its employees, agents or contractors retain
under this article, or to which the department or its agents
or contractors have access or any other health records
maintained or accessible by the department under this
article, to any person who is not an authorized employee,
agent or contractor of the department, except as required or
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permitted by law.
(2) Sharing health information among participants in the
health information exchange shall not be considered a
disclosure under paragraph (1).
(3) Violations of this subsection:
(i) Shall subject employees, agents and contractors
to administrative discipline, including discharge and
suspension.
(ii) Shall subject contractors to monetary penalties
or contract revocation or suspension.
(e) Construction.--Nothing in this article may be construed
to alter a proprietary interest held by any participant in any
record, data or information released, accepted or included in
the health information exchange, except insofar as the paperwork
approved by the department may require participants to license
those interests by contract in order to allow for the free flow
of information.
Section 1408-C. Nonapplicability.
(a) This article is subject to 1 Pa.C.S. § 2310 (relating to
sovereign immunity reaffirmed; specific waiver).
(b) Health information or personally identifying information
shall not be considered a public record for purposes of the act
of February 14, 2008 (P.L.6, No.3), known as the Right-to-Know
Law.
(c) Nothing in this article is intended to affect common law
or statutory rights or obligations with respect to patient
accessibility to their electronic or nonelectronic medical
records.
(d) Nothing in this article shall be construed to alter,
limit or supersede any other provision of law regarding the
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Department's duties, powers, responsibilities and authority that
exist separate from this article.
Section 11. Repeals are as follows:
(1) The General Assembly declares that the repeal under
paragraph (2) is necessary to effectuate the addition of
Article XIV-C of the act.
(2) The act of July 5, 2012 (P.L.1042, No.121), known as
the Pennsylvania eHealth Information Technology Act, is
repealed.
Section 12. Except as otherwise provided in Article XIV-C of
the act, all activities initiated under the act of July 5, 2012
(P.L.1042, No.121), known as the Pennsylvania eHealth
Information Technology Act, shall continue and remain in full
force and effect and may be completed under Article XIV-C of the
act. Orders, regulations, rules and decisions which were made
under the Pennsylvania eHealth Information Technology Act and
which are in effect on the effective date of this section shall
remain in full force and effect until revoked, vacated or
modified under Article XIV-C of the act. Contracts and
obligations entered into under the Pennsylvania eHealth
Information Technology Act are not affected nor impaired by the
repeal of the Pennsylvania eHealth Information Technology Act.
All contracts, grants, procurement documents and partnership
agreements under the Pennsylvania eHealth Information Technology
Act in effect on the effective date of this section are assigned
to the Department of Human Services.
Section 13. This act shall take effect immediately.
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