PRINTER'S NO. 62

THE GENERAL ASSEMBLY OF PENNSYLVANIA

HOUSE BILL

No.

51

Session of

2019

INTRODUCED BY BERNSTINE, RYAN, McNEILL, SCHLOSSBERG, LONGIETTI,

MENTZER, PICKETT, HILL-EVANS, WARREN, RAPP, MIZGORSKI,

DeLISSIO, DeLUCA AND SOLOMON, JANUARY 28, 2019

for home care, home health and older adult daily living

center services.

The General Assembly of the Commonwealth of Pennsylvania

hereby enacts as follows:

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

as the Human Services Code, is amended by adding a section to

read:

Section 443.13 . Medical Assistance Deemed Eligibility

Program for Home Care , Home Health and Older Adult Daily Living

Center Services .--(a) The department shall establish a deemed

(b) The program shall:

(1) be designed to provide home care services , home health

services and older adult daily living center services only for

individuals who are sixty-five years of age or older and nursing

facility clinically eligible;

(2) permit a qualified entity to submit an application for

medical assistance on behalf of individuals to the department;

(3) permit an individual who is applying for medical

assistance to declare income and assets on an application form

and attest to the accuracy of the income and assets provided on

(b)(4), the individual may begin receiving home care services ,

home health services and older adult daily living center

services from a medical assistance provider as soon as a

preliminary service plan is developed . As authorized under

Federal law, the department shall apply a final determination of

medical assistance eligibility beginning on the date that a

qualified entity determines that an individual is deemed

eligible for medical assistance under subsection (b)(4).

(2) If a qualified entity determines that an individual is

deemed eligible under subsection (b)(4), and the individual is

not be reimbursed by the Commonwealth for the cost of the home

care services , home health services and older adult daily living

center services provided during the period of deemed

eligibility. If the individual provided fraudulent information

under this section, the medical assistance provider may seek

reimbursement from the individual for the cost of home care

services , home health services and older adult daily living

center services provided during the period of deemed

eligibility.

(3) Once the department makes a final determination of

(4) The department shall verify the information on the

application and make a final determination of medical assistance

eligibility. The department may request additional information

from an applicant for the purpose of completing the verification

process under this clause .

(d) Upon request, the department shall provide information

to a qualified entity about Commonwealth policies and procedures

on how to determine whether an individual may be deemed eligible

for medical assistance under subsection (b)(4).

(e) The department shall issue a medical assistance bulletin

(f) Within seventy-five days of the effective date of this

subsection, the department shall apply for any necessary Federal

waiver or State plan amendment. Fifteen days prior to applying

for any necessary Federal waiver or State plan amendment, the

department shall submit the proposed application to the Health

and Human Services Committee of the Senate, the Health Committee

of the House of Representatives and the Human Services Committee

of the House of Representatives. The department shall maximize

the use of Federal money for the program.

(g) Within seventy-five days of the effective date of this

House of Representatives and the Human Services Committee of the

House of Representatives.

(h) On or before January 1 of each year, the department

shall issue a report to the General Assembly with the following

information about the program:

(1) The number of individuals who participated in the

program.

(2) The average cost for each individual in the program.

(3) The number of qualified entities in the program.

(4) The administrative costs.

report with its findings and recommendations to the Secretary of

the Senate and the Chief Clerk of the House of Representatives

by October 31, 2024.

(j) This section shall expire October 31, 2025.

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

shall have the following meanings:

"Home care services." As defined in 28 Pa. Code § 611.5

(relating to definitions).

"Home health services." Part-time, intermittent skilled

nursing services and therapy services provided under 28 Pa. Code

or medical condition by a physician which requires the

individual to receive health services in accordance with the

following:

(i) Skilled nursing and skilled rehabilitation services as

defined in 42 CFR 409.31 (relating to level of care

requirement).

(ii) 42 CFR 409.32 (relating to criteria for skilled

services and the need for skilled services).

(iii) 42 CFR 409.33 (relating to examples of skilled nursing

and rehabilitation services).

of a planned program of health care and management which was

only previously available through an institutional facility.

"Nursing facility services." As defined in 42 CFR 440.40

(relating to nursing facility services for individuals age 21 or

older (other than services in an institution for mental

disease), EPSDT, and family planning services and supplies) or

42 CFR 440.155 (relating to nursing facility services, other

than in institutions for mental diseases).

"Older adult daily living center services." Services

provided to assist an individual with activities of daily living

older adult daily living center or an organization authorized by

the department which elects to determine the deemed eligibility

of individuals to receive medical assistance under subsection

(b)(4).

Section 2. The Secretary of Human Services shall transmit to

Section 3. This act shall take effect as follows:

of section 443.13 of the act shall take effect 30 days

take effect immediately.

immediately.