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A02546
THE GENERAL ASSEMBLY OF PENNSYLVANIA
SENATE BILL
No.
695
Session of
2019
INTRODUCED BY BROOKS, MAY 31, 2019
REFERRED TO HEALTH AND HUMAN SERVICES, MAY 31, 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 medical assistance payments for
institutional care and for nonemergency medical
transportation services and providing for uniform Statewide
preferred drug list; in nursing facility assessments, further
providing for definitions, for calculation, for remedies, for
repayment and time periods; in intermediate care facilities
for persons with an intellectual disability assessments,
further providing for definitions and time periods; and, in
hospital assessments, further providing for time period.; and
making a related repeal.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Sections 443.1(7)(iv), 815-A, 811-C(b) and 808-
E(a) of the act of June 13, 1967 (P.L.31, No.21), known as the
Human Services Code, are amended to read:
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, 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,
[2019] 2022, 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 443.12 of the act is amended by adding
subsections to read:
Section 443.12. Nonemergency Medical Transportation
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Services.--* * *
(d) The department may not enter into a contract with a
broker under subsection (b) prior to the completion of the
analysis required under subsection (e).
(e) Prior to the implementation of the full-risk brokerage
model, the department, in coordination with the Department of
Transportation and the Department of Aging, shall commission an
analysis that provides at a minimum the following:
(1) An analysis of current Federal and State law,
regulations and policies controlling the nonemergency medical
transportation and other human services transportation programs
administered in the Commonwealth, including the authorized
methods of delivery and limitations or restrictions imposed on
the methods of delivery.
(2) An analysis of the effectiveness and efficiency of the
current nonemergency transportation service delivery as it
relates to all human service programs in this Commonwealth.
(3) A review of other states' models of delivering
nonemergency medical and other human services transportation,
including the number of other states that utilize a full-risk
brokerage model and the effect a brokerage model has had on
public transit in those states.
(4) An analysis of the positive and negative impact of
maintaining the current transportation delivery model versus
implementing a full-risk brokerage model as it relates to the
State and local government entities, including financial impact.
(5) An analysis of the impact on consumers, including an
increase or decrease in quality and service availability.
(f) The analysis under subsection (e) shall be completed no
later than ninety days from the effective date of this
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subsection, and shall be delivered to the following:
(1) The Secretary of Human Services.
(2) The Secretary of Aging.
(3) The Secretary of Transportation.
(4) The chairperson and minority chairperson of the
Appropriations Committee of the Senate.
(5) The chairperson and minority chairperson of the
Appropriations Committee of the House of Representatives.
(6) The chairperson and minority chairperson of the Health
and Human Services Committee of the Senate.
(7) The chairperson and minority chairperson of the Health
Committee of the House of Representatives.
Section 3. The act is amended by adding a section to read:
Section 459.1. Uniform Statewide preferred drug list.--(a)
The department may not implement a uniform Statewide preferred
drug list for the medical assistance managed care organizations
until an analysis has been conducted, as commissioned by the
department, to determine the projected cost to the medical
assistance managed care organization and the projected
supplemental rebates that could be obtained by the department
through the use of a uniform Statewide preferred drug list.
(b) The analysis under subsection (a) shall be completed
within sixty days of the effective date of this subsection. The
analysis shall be delivered to the following:
(1) The chairperson and minority chairperson of the
Appropriations Committee of the Senate.
(2) The chairperson and minority chairperson of the Health
and Human Services Committee of the Senate.
(3) The chairperson and minority chairperson of the
Appropriations Committee of the House of Representatives.
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(4) The chairperson and minority chairperson of the Health
Committee of the House of Representatives.
Section 4. The definitions of "county nursing facility,"
"medical assistance provider" and "nursing facility" in section
801-A of the act are amended and the section is amended by
adding a definition to read:
Section 801-A. Definitions.--As used in this article--
* * *
"County nursing facility" means a long-term care nursing
facility that is licensed by the Department of Health under the
act of July 19, 1979 (P.L.130, No.48), known as the "Health Care
Facilities Act," and controlled by the county institution
district or county government if no county institution district
exists. The term does not include intermediate care facilities
for [the mentally retarded] individuals with an intellectual
disability controlled by the county institution district or
county government.
"Medical assistance managed care organization" means a
Medicaid managed care organization as defined in section 1903(m)
(1)(A) of the Social Security Act (49 Stat. 620, 42 U.S.C. ยง
1396b(m)(1)(A)) that is a party to a Medicaid managed care
contract with the department. The term shall not include a
behavioral health managed care organization that is a party to a
Medicaid managed care contract with the department.
"Medical assistance provider" means a person or entity
enrolled by the [Department of Human Services] department as a
provider of services in the medical assistance program.
"Nursing facility" means a non-Federal, nonpublic long-term
care nursing facility licensed by the Department of Health
pursuant to the act of July 19, 1979 (P.L.130, No.48), known as
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the "Health Care Facilities Act." The term does not include
intermediate care facilities for [the mentally retarded]
individuals with an intellectual disability.
* * *
Section 5. Sections 807-A, 810-A(3) and 813-A of the act are
amended to read:
Section 807-A. [Calculation.--Using the assessment rates
implemented by the secretary pursuant to section 805-A(a), each
nursing facility shall calculate the assessment amount it owes
for a calendar quarter on a form specified by the department and
shall submit the form and the amount owed to the department no
later than the last day of that calendar quarter or thirty (30)
days from the date of the second notice published pursuant to
section 805-A(a), whichever is later. A nursing facility's
calculation of the assessment amount owed in any quarter is
subject to verification by the department pursuant to section
808-A.] Assessment Amount and Timing.--Each nursing facility
shall remit the assessment amounts due as determined by the
department pursuant to section 805-A(a) in periodic submissions,
not to exceed five times per year, as specified by the
department. A nursing facility shall report and remit the total
assessment amount owed electronically on forms and in accordance
with instructions and by the due dates prescribed by the
department. The prescribed due dates shall be at least thirty
(30) days after the date of publication of the second notice
under section 805-A(a).
Section 810-A. Remedies.--In addition to any other remedy
provided by law, the department may enforce this article by
imposing one or more of the following remedies:
* * *
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(3) When a nursing facility that is a medical assistance
provider or that is related through common ownership or control
as defined in 42 CFR 413.17(b) (relating to cost to related
organizations) to a medical assistance provider fails to pay all
or part of an assessment or penalty within sixty (60) days of
the date that payment is due, the department may deduct or
instruct a medical assistance managed care organization to
deduct the unpaid assessment or penalty and any interest owed
thereon from any medical assistance payments due to the nursing
facility or to any related medical assistance provider until the
full amount is recovered. Any such deduction shall be made only
after written notice to the medical assistance provider and may
be taken in amounts over a period of time taking into account
the financial condition of the medical assistance provider.
* * *
Section 813-A. Repayment.--No nursing facility shall be
directly guaranteed a repayment of its assessment in derogation
of 42 CFR 433.68(f) (relating to permissible health care-related
taxes after the transition period): Provided, however, That in
each fiscal year in which an assessment is implemented, the
department shall use the State revenue collected from the
assessment and any Federal funds received by the Commonwealth as
a direct result of the assessments to [maintain and increase
program payments] make program payments through fee-for-service
or managed care to medical assistance nursing facility providers
to the extent permissible under Federal and State law or
regulation and without creating an indirect guarantee to hold
harmless, as those terms are used in 42 CFR 433.68(f). If the
department implements an assessment on county nursing
facilities, the department shall allocate assessment revenues
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available to [maintain and increase program payments] make
program payments through fee-for-service or managed care to both
county and non county nursing facilities in a manner that is
consistent with Federal law and without creating a direct or an
indirect guarantee to hold any nursing facility harmless. The
secretary shall submit any [State Medicaid plan] Title XIX State
Plan amendments to the United States Department of Health and
Human Services that are necessary to make the [payment
increases] payments.
Section 6. Section 815-A of the act, amended June 30, 2012
(P.L.668, No.80), amendment declared unconstitutional, 188 A.3d
1135 (Pa. 2018), and amended July 8, 2016 (P.L.480, No.76), is
reenacted and 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, [2012] be imposed July 1, 2003, through June 30,
2022.
Section 7. The definitions of "department" and "secretary"
in section 801-C of the act 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:
* * *
["Department." The Department of Human Services of the
Commonwealth.]
* * *
["Secretary." The Secretary of Human Services of the
Commonwealth.]
* * *
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Section 8. Section 811-C(b) and 808-E(a) of the act are
amended to read:
Section 811-C. Time periods.
* * *
(b) Cessation.--The assessment authorized under this article
shall cease June 30, [2019] 2022 2024 , or earlier, if required
by law.
Section 808-E. Time period.
(a) Cessation.--The assessment authorized under this article
shall cease June 30, [2019] 2022.
* * *
Section 9. Repeals are as follows:
(1) The General Assembly declares that the repeal under
paragraph (2) is necessary to effectuate the reenactment or
amendment of sections 801-A, 807-A, 810-A(3), 813-A and 815-A
of the act.
(2) Section 1729-E(2)(ii) of the act of April 9, 1929
(P.L.343, No.176), known as The Fiscal Code, is repealed.
Section 2 10. This act shall take effect immediately.
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