See other bills
under the
same topic
PRINTER'S NO. 1530
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No.
1310
Session of
2019
INTRODUCED BY MURT, ROZZI, McNEILL, KIRKLAND AND McCLINTON,
APRIL 25, 2019
REFERRED TO COMMITTEE ON HEALTH, APRIL 25, 2019
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 other medical assistance payments and
providing for payments to providers for cognitive
rehabilitation therapy.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Section 443.3(a) of the act of June 13, 1967
(P.L.31, No.21), known as the Human Services Code, is amended to
read:
Section 443.3. Other Medical Assistance Payments.--(a)
Payments on behalf of eligible persons shall be made for other
services, as follows:
(1) Rates established by the department for outpatient
services as specified by regulations of the department adopted
under Title XIX of the Social Security Act (49 Stat. 620, 42
U.S.C. ยง 1396 et seq.) consisting of preventive, diagnostic,
therapeutic, rehabilitative or palliative services; furnished by
or under the direction of a physician, chiropractor or
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
podiatrist, by a hospital or outpatient clinic which qualifies
to participate under Title XIX of the Social Security Act, to a
patient to whom such hospital or outpatient clinic does not
furnish room, board and professional services on a continuous,
twenty-four hour a day basis.
(1.1) Rates established by the department for observation
services provided by or furnished under the direction of a
physician and furnished by a hospital. Payment for observation
services shall be made in an amount specified by the department
by notice in the Pennsylvania Bulletin and shall be effective
for dates of service on or after July 1, 2016. Payment for
observation services shall be subject to conditions specified in
the department's regulations, including regulations adopted by
the department to implement this paragraph. Pending adoption of
regulations implementing this paragraph, the conditions for
payment of observation services shall be specified in a medical
assistance bulletin.
(2) Rates established by the department for (i) other
laboratory and X-ray services prescribed by a physician,
chiropractor or podiatrist and furnished by a facility other
than a hospital which is qualified to participate under Title
XIX of the Social Security Act, (ii) physician's services
consisting of professional care by a physician, chiropractor or
podiatrist in his office, the patient's home, a hospital, a
nursing facility or elsewhere, (iii) the first three pints of
whole blood, (iv) remedial eye care, as provided in [Article
VIII] Subarticle (b) of Article XXII of the act of April 9, 1929
(P.L.177, No.175), known as "The Administrative Code of 1929,"
consisting of medical or surgical care and aids and services and
other vision care provided by a physician skilled in diseases of
20190HB1310PN1530 - 2 -
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
the eye or by an optometrist which are not otherwise available
under this [Article] article, (v) special medical services for
school children, as provided in the [Public School Code of
1949,] act of March 10, 1949 (P.L.30, No.14), known as the
"Public School Code of 1949," consisting of medical, dental,
vision care provided by a physician skilled in diseases of the
eye or by an optometrist or surgical care and aids and services
which are not otherwise available under this article.
(3) Notwithstanding any other provision of law, for
recipients aged twenty-one years or older receiving services
under the fee for service delivery system who are eligible for
medical assistance under Title XIX of the Social Security Act
and for recipients aged twenty-one years or older receiving
services under the fee-for-service delivery system who are
eligible for general assistance-related categories of medical
assistance, the following medically necessary services:
(i) Psychiatric outpatient clinic services not to exceed
five hours or ten one-half-hour sessions per thirty consecutive
day period.
(ii) Psychiatric partial hospitalization not to exceed five
hundred forty hours per fiscal year.
* * *
Section 2. The act is amended by adding a section to read:
Section 443.13. Payments to Providers for Cognitive
Rehabilitation Therapy.--(a) The department shall provide
payment to participating Medicaid providers for cognitive
rehabilitation therapy as a covered service when deemed to be
medically necessary by a licensed physician.
(b) Cognitive rehabilitation therapy will be considered
medically necessary as adjunctive treatment of cognitive
20190HB1310PN1530 - 3 -
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
deficits, including attention, language, memory, reasoning,
executive functions, problem solving and visual processing, when
all of the following are met:
(1) The cognitive deficits have been acquired as a result of
neurologic impairment due to traumatic brain injury, stroke or
encephalopathy.
(2) The individual has been seen and evaluated by a
neuropsychiatrist or neuropsychologist.
(3) Neuropsychological testing has been performed and
neuropsychological results will be used in treatment planning
and directing rehabilitation strategies.
(4) The individual is expected to make significant cognitive
improvement, as confirmed by a treating physician, which
includes not being in a persistent vegetative or custodial
state.
(c) In order to implement reimbursement payments for these
services, the department shall file a State plan amendment with
the Centers for Medicare and Medicaid Services of the United
States Department of Health and Human Services under Title XIX
of the Social Security Act (49 Stat. 620, 42 U.S.C. ยง 1396 et
seq.) by June 30, 2019. The program shall be structured and
administered by the department in accordance with Federal law
and applicable Federal guidelines for qualified State cognitive
rehabilitation therapy.
(d) The following words and phrases when used in this
section shall have the meanings given to them in this subsection
unless the context clearly indicates otherwise:
"Cognitive rehabilitation therapy" means services that are
designed to improve cognitive functioning after central nervous
system insult and that assist with the improvement of attention,
20190HB1310PN1530 - 4 -
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
auditory and visual processing, concentration, decision making,
judgment, language, learning, memory, perception, planning,
problem solving, reasoning, sequencing, thinking and executive
functions, including compensatory training and direct patient
contact performed by a licensed physician or licensed
psychologist or a licensed physical, occupational or speech
therapist with the desired outcomes of an enhanced capacity to
process and interpret information and an improved ability to
function in home and community life.
Section 3. This act shall take effect immediately.
20190HB1310PN1530 - 5 -
1
2
3
4
5
6
7
8
9
10