Bill Text: PA HB254 | 2009-2010 | Regular Session | Amended

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Bill Title: In general powers of the Department of Public Welfare, further providing for determining whether applicants are veterans; in public assistance, further providing for medical assistance payments for institutional care; and providing for Statewide Quality Care Assessment.

Spectrum: Slight Partisan Bill (Republican 38-17)

Status: (Passed) 2010-07-09 - Act No. 49 [HB254 Detail]

Download: Pennsylvania-2009-HB254-Amended.html

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SENATE AMENDED
PRIOR PRINTER'S NOS. 264, 950, 1111, 2734 PRINTER'S NO. 4076
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No. 254 Session of2009
INTRODUCED BY FAIRCHILD, ADOLPH, BAKER, BARRAR, BEAR, BEYER, BOYD, BRENNAN, CIVERA, CLYMER, COHEN, CONKLIN, DENLINGER, EACHUS, EVERETT, FLECK, FRANKEL, GEIST, GEORGE, GINGRICH, GOODMAN, GRELL, GROVE, GRUCELA, HARKINS, HARRIS, HELM, HESS, KIRKLAND, KORTZ, McGEEHAN, McILVAINE SMITH, MICCARELLI, MILLER, MOUL, O'NEILL, PAYNE, PHILLIPS, PICKETT, RAPP, REICHLEY, SAYLOR, SCAVELLO, SIPTROTH, K. SMITH, SOLOBAY, STERN, VULAKOVICH, WANSACZ, YUDICHAK, ROCK, CAUSER, MICOZZIE, MURT AND BOBACK, FEBRUARY 4, 2009
SENATOR VANCE, PUBLIC HEALTH AND WELFARE, IN SENATE, RE-REPORTED AS AMENDED, JULY 1, 2010
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 general powers of the
Department of Public Welfare, further providing for <--
determining whether applicants are veterans; in public <--
assistance, further providing for establishment of county <--
boards and expenses and for lifetime limit; and, in hospital
assessment, further providing for definitions, for
authorization, for administration, for no hold harmless, for
tax exemption and for cessation medical assistance payments <--
for institutional care; and providing for Statewide Quality
Care Assessment.
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 Public Welfare Code, is amended by adding a section to
read:
Section 215. Veterans.--(a) The department shall make a
good faith effort to determine whether an applicant for cash,
medical or energy assistance is a veteran. While in the process
of making its determination, the department shall dispense
benefits to the applicant, if otherwise eligible.
(b) As a condition of eligibility to receive cash, medical
or energy assistance, unless there is good cause not to do so,
an applicant who is a veteran shall be required to contact a
veteran service officer accredited and recognized by the United
States Department of Veterans Affairs, the Department of
Military and Veterans Affairs or the county director of veterans
affairs in which the applicant resides in order to determine the
applicant's eligibility for veteran's benefits or to file a
veteran claims packet. The department shall develop a standard
form to be used by a veteran service officer to verify the
applicant's eligibility for veteran benefits.
(c) An applicant who is a veteran shall provide proof of
compliance with this section and the department shall, to the
greatest extent possible, require the applicant to provide
information on the final determination of eligibility for
veteran benefits and the type of benefits the veteran is
entitled to receive.
(d) As used in this section, the following words and phrases
shall have the following meanings:
"Assistance" means money, services and payment for medical
coverage or energy assistance for needy persons who are
residents of this Commonwealth, are in need of assistance and
meet all conditions of eligibility.
"Veteran claims packet" means an application requesting a
determination or entitlement or evidencing a belief in
entitlement to a benefit as provided for in 38 CFR (relating to
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pensions, bonuses, and veterans' relief) or 51 Pa.C.S. (relating
to military affairs).
Section 2. Section 415 of the act is amended to read:
Section 415. Establishment of County Boards; Expenses.--For
each county of the Commonwealth, there is hereby established a
county board of assistance, to be known as the County Board of
Assistance and referred to in this Article IV as the "county
board," which shall be composed of men and women, to be
appointed by the Governor [with the advice and consent of two-
thirds of all members of the Senate]. Each appointment by the
Governor shall bear the endorsement of the senator of the
district in which the nominee resides. In the case of a vacancy
in that senatorial district, the nominee shall be endorsed by
the senator of an adjacent district. The county boards shall be
composed as far as possible of persons engaged or interested in
business, social welfare, labor, industry, education or public
administration. The members of the county boards shall serve
without compensation, but shall be reimbursed for necessary
expenses. No member of a county board shall hold office in any
political party. Not all of the members of a county board shall
belong to the same political party.
Section 3. Section 441.4 of the act, added July 7, 2005
(P.L.177, No.42), is amended to read:
Section 441.4. [Lifetime Limit] Reasonable Limits on
Allowable Income Deductions for Medical Expenses When
Determining Payment Toward the Cost of Long-Term Care
Services.--(a) [Necessary medical or remedial care expenses
recognized under Federal or State law but not paid for by the
medical assistance program are allowable income deductions when
determining a recipient's payment toward the cost of long-term
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care services. An allowable income deduction for unpaid medical
expenses incurred prior to the authorization of medical
assistance eligibility and those medical expenses incurred for
long-term care services after medical assistance is authorized
shall be subject to a lifetime maximum of ten thousand dollars
($10,000) unless application of the limit would result in undue
hardship.] When determining a recipient's payment toward the
cost of long-term care services, long-term care medical expenses
incurred six months or more prior to application for medical
assistance shall be disallowed as a deduction, and medical and
remedial expenses that were incurred as a result of a transfer
of assets penalty shall be limited to zero unless application of
these limits would result in undue hardship.
(b) As used in this section, the term "undue hardship" shall
mean that either:
(1) denial of medical assistance would deprive the
individual of medical care and endanger the individual's health
or life; or
(2) the individual or a financially dependent family member
would be deprived of food, shelter or the necessities of life.
Section 4. The definitions of "exempt hospital" and "general
acute care hospital" in section 801-E of the act, added July 4,
2008 (P.L.557, No.44), are amended and the section is amended by
adding a definition 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:
* * *
["Exempt hospital." A hospital that the Secretary of Public
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Welfare has determined meets one of the following:
(1) Is excluded under 42 CFR 412.23(a), (b), (d) and (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 Pt. 412 (relating
to prospective payment systems for inpatient hospital services).
(2) Is a Federal veterans' affairs hospital.
(3) Is part of an institution with State-related status as
that term is defined in 22 Pa. Code § 31.2 (relating to
definitions) and provides over 100,000 days of care to medical
assistance patients annually.
(4) Provides care, including inpatient hospital services, to
all patients free of charge.]
"General acute care hospital." A hospital other than [an
exempt hospital.] a hospital that the Secretary of Public
Welfare has determined meets one of the following:
(1) Is excluded under 42 CFR 412.23(a), (b), (d), (e) and
(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.
"High volume Medicaid hospital." A hospital that the
Secretary of Public Welfare has determined meets all of the
following:
(1) Is a nonprofit hospital subsidiary of a State-related
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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 5. Sections 802-E, 804-E, 805-E, 807-E and 808-E of
the act, added July 4, 2008 (P.L.557, No.44), are amended to
read:
Section 802-E. Authorization.
(a) General rule.--In order to generate additional revenues
for the purpose of assuring that medical assistance recipients
have access to hospital services and that all citizens have
access to emergency department services, and subject to the
conditions and requirements specified under this article, a
municipality may, by ordinance, [impose] do the following:
(1) Impose a monetary assessment on the net operating
revenue reduced by all revenues received from Medicare of each
general acute care hospital located in the municipality [subject
to the conditions and requirements specified under this
article].
(2) Beginning on or after July 1, 2009, and subject to the
advance written approval by the secretary, impose a monetary
assessment on the net operating revenues reduced by all revenues
received from Medicare of each high volume Medicaid hospital
located in the municipality.
(b) Administrative provisions.--The [ordinance] ordinances
adopted pursuant to subsection (a) may include appropriate
administrative provisions including, without limitation,
provisions for the collection of interest and penalties.
(c) Maximum assessment.--In each year in which the
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assessment is implemented, the assessment shall be subject to
the maximum aggregate amount that may be assessed under 42 CFR
433.68(f)(3)(i) (relating to permissible health care-related
taxes) or any other maximum established under Federal law.
Section 804-E. Administration.
(a) Remittance.--Upon collection of the funds generated by
the assessment authorized under this article, the municipality
shall remit a portion of the funds to the Commonwealth for the
purposes set forth under section 802-E, except that the
municipality may retain funds in an amount necessary to
reimburse it for its reasonable costs in the administration and
collection of the assessment and to fund a portion of its costs
of operating public health clinics as set forth in an agreement
to be entered into between the municipality and the Commonwealth
acting through the secretary.
(b) Establishment.--There is established a restricted
account in the General Fund for the receipt and deposit of funds
under subsection (a). Funds in the account are hereby
appropriated to the department for purposes of making
supplemental or increased medical assistance payments for
emergency department services to general acute care hospitals
within the municipality and to maintain or increase other
medical assistance payments to hospitals within the
municipality, as specified in the Commonwealth's approved Title
XIX State Plan.
Section 805-E. No hold harmless.
No general acute care hospital or high volume Medicaid
hospital shall be directly guaranteed a repayment of its
assessment in derogation of 42 CFR 433.68(f) (relating to
permissible health care-related taxes), except that, in each
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fiscal year in which an assessment is implemented, the
department shall use a portion of the funds received under
section 804-E(a) for the purposes outlined under section 804-
E(b) 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 under 42 CFR 433.68(f)(i). The
secretary shall submit any State Medicaid plan amendments to the
United States Department of Health and Human Services that are
necessary to make the payments authorized under section 804-
E(b).
Section 807-E. Tax exemption.
Notwithstanding any exemptions granted by any other Federal,
State or local tax or other law, including section 204(a)(3) of
the act of May 22, 1933 (P.L.853, No.155), known as The General
County Assessment Law, no general acute care hospital or high
volume Medicaid hospital in the municipality shall be exempt
from the assessment.
Section 808-E. [Cessation] Time period.
(a) Cessation.--The assessment authorized under this article
shall cease June 30, 2013.
(b) Assessment.--A municipality shall have the power to
enact the assessment authorized in section 802-E(a)(2) either
prior to or during its fiscal year ending June 30, 2010.
Section 6. This act shall take effect immediately.
Section 1. Section 215 of the act of June 13, 1967 (P.L.31, <--
No.21), known as the Public Welfare Code, added December 17,
2009 (P.L.598, No.54), is amended to read:
Section 215. Determining Whether Applicants are Veterans.--
(a) The department shall make a good faith effort to determine
whether an applicant for cash, medical or energy assistance is a
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veteran. While in the process of making its determination, the
department shall dispense benefits to the applicant, if
otherwise eligible.
(b) As a condition of eligibility to receive cash, medical
or energy assistance, unless there is good cause not to do so,
an applicant who is a veteran shall be required to contact a
veteran service officer accredited and recognized by the United
States Department of Veterans Affairs, the Department of
Military and Veterans Affairs or the county director of veterans
affairs in which the applicant resides in order to determine the
applicant's eligibility for veteran's benefits or to file a
veteran claims packet. The department shall develop a standard
form to be used by a veteran service officer to verify the
applicant's eligibility for veteran's benefits and make this
form available on its official website.
(c) An applicant who is a veteran shall provide proof of
compliance with this section and the department shall, to the
greatest extent possible, require the applicant to provide
information on the final determination of eligibility for
veteran's benefits and the type of benefits the veteran is
entitled to receive.
(d) As used in this section, the following words and phrases
shall have the following meanings:
"Assistance" means money, services and payment for medical
coverage or energy assistance for needy persons who are
residents of this Commonwealth, are in need of assistance and
meet all conditions of eligibility.
"Veteran claims packet" means an application requesting a
determination or entitlement or evidencing a belief in
entitlement to a benefit as provided for in 38 CFR (relating to
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pensions, bonuses, and veterans' relief) or 51 Pa.C.S. (relating
to military affairs).
Section 2. Section 443.1 introductory paragraph and (1) of
the act, amended June 30, 2007 (P.L.49, No.16), are amended and
the section is amended by adding paragraphs to read:
Section 443.1. Medical Assistance Payments for Institutional
Care.--The following medical assistance payments shall be made
[in] on behalf of eligible persons whose institutional care is
prescribed by physicians:
(1) Payments as determined by the department for inpatient
hospital care consistent with Title XIX of the Social Security
Act (49 Stat. 620, 42 U.S.C. § 1396 et seq.). To be eligible for
such payments, a hospital must be qualified to participate under
Title XIX of the Social Security Act and have entered into a
written agreement with the department regarding matters
designated by the secretary as necessary to efficient
administration, such as hospital utilization, maintenance of
proper cost accounting records and access to patients' records.
Such efficient administration shall require the department to
permit participating hospitals to utilize the same fiscal
intermediary for this Title XIX program as such hospitals use
for the Title XVIII program[;].
(1.1) Subject to section 813-G, for inpatient acute care
hospital services provided during a fiscal year in which an
assessment is imposed under Article VIII-G, payments under the
medical assistance fee-for-service program shall be determined
in accordance with the department's regulations, except as
follows:
(i) If the Commonwealth's approved Title XIX State Plan for
inpatient hospital services in effect for the period of July 1,
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2010, through June 30, 2013, specifies a methodology for
calculating payments that is different from the department's
regulations or authorizes additional payments not specified in
the department's regulations, such as inpatient disproportionate
share payments and direct medical education payments, the
department shall follow the methodology or make the additional
payments as specified in the approved Title XIX State Plan.
(ii) Subject to Federal approval of an amendment to the
Commonwealth's approved Title XIX State Plan, in making medical
assistance fee-for-service payments to acute care hospitals for
inpatient services provided on or after July 1, 2010, the
department shall use payment methods and standards that provide
for all of the following:
(A) Use of the All Patient Refined-Diagnosis Related Group
(APR/DRG) system for the classification of inpatient stays into
DRGs.
(B) Calculation of base DRG rates based upon a Statewide
average cost which are adjusted to account for a hospital's
regional labor costs, teaching status, capital and medical
assistance patient levels and such other factors as the
department determines may significantly impact the costs that a
hospital incurs in delivering inpatient services and which may
be adjusted based on the assessment revenue collected under
Article VIII-G.
(C) Adjustments to payments for outlier cases where the
costs of the inpatient stays exceed cost thresholds established
by the department.
(iii) Notwithstanding subparagraph (i), the department may
make additional changes to its payment methods and standards for
inpatient hospital services consistent with Title XIX of the
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Social Security Act, including changes to supplemental payments
currently authorized in the State Plan based on the availability
of Federal and State funds.
(1.2) Subject to section 813-G, for inpatient acute care
hospital services provided under the physical health medical
assistance managed care program during a fiscal year in which an
assessment is imposed under Article XIII-G, the following shall
apply:
(i) For inpatient hospital services provided under a
participation agreement between an inpatient acute care hospital
and a medical assistance managed care organization in effect as
of June 30, 2010, the medical assistance managed care
organization shall pay, and the hospital shall accept as payment
in full, amounts determined in accordance with the payment terms
and rate methodology specified in the agreement and in effect as
of June 30, 2010, during the term of that participation
agreement. If a participation agreement in effect as of June 30,
2010, uses the department fee for service DRG rate methodology
in determining payment amounts, the medical assistance managed
care organization shall pay, and the hospital shall accept as
payment in full, amounts determined in accordance with the fee
for service payment methodology in effect as of June 30, 2010,
including, without limitation, continuation of the same grouper,
outlier methodology, base rates and relative weights, during the
term of that participation agreement.
(ii) Nothing in subparagraph (i) shall prohibit payment
rates for inpatient acute care hospital services provided under
a participation agreement to change from the rates in effect as
of June 30, 2010, if the change in payment rates is authorized
by the terms of the participation agreement between the
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inpatient acute care hospital and the medical assistance managed
care organization. For purposes of this act, any contract
provision that provides that payment rates and changes to
payment rates shall be calculated based upon the department's
fee for service DRG payment methodology shall be interpreted to
mean the department's fee for service medical assistance DRG
methodology in place on June 30, 2010.
(iii) If a participation agreement between a hospital and a
medical assistance managed care organization terminates during a
fiscal year in which an assessment is imposed under Article
VIII-G prior to the expiration of the term of the participation
agreement, payment for services, other than emergency services,
covered by the medical assistance managed care organization and
rendered by the hospital shall be made at the rate in effect as
of the termination date, as adjusted in accordance with
subparagraphs (i) and (ii), during the period in which the
participation agreement would have been in effect had the
agreement not terminated. The hospital shall receive the
supplemental payment in accordance with subparagraph (v).
(iv) If a hospital and a medical assistance managed care
organization do not have a participation agreement in effect as
June 30, 2010, the medical assistance managed care organization
shall pay, and the hospital shall accept as payment in full for
services, other than emergency services, covered by the medical
assistance managed care organization and rendered during a
fiscal year in which an assessment is imposed under Article
XIII-G an amount equal to the rates payable for the services by
the medical assistance fee for service program as of June 30,
2010. The hospital shall receive the supplemental payment in
accordance with subparagraph (v).
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(v) The department shall make enhanced capitation payments
to medical assistance managed care organizations exclusively for
the purpose of making supplemental payments to hospitals in
order to promote continued access to quality care for medical
assistance recipients. Medical assistance managed care
organizations shall use the enhanced capitation payments
received pursuant to this section solely for the purpose of
making supplemental payments to hospitals and shall provide
documentation to the department certifying that all funds
received in this manner are used in accordance with this
section. The supplemental payments to hospitals made pursuant to
this subsection are in lieu of increased or additional payments
for inpatient acute care services from medical assistance
managed care organizations resulting from the department's
implementation of payments under paragraph (1.1)(ii). Medical
assistance managed care organizations shall in no event be
obligated under this section to make supplemental or other
additional payments to hospitals that exceed the enhanced
capitation payments made to the medical assistance managed care
organization under this section. Medical assistance managed care
organizations shall not be required to advance the supplemental
payments to hospitals authorized by this subsection and shall
only make the supplemental payments to hospitals once medical
assistance managed care organizations have received the enhanced
capitation payments from the department.
(vi) Nothing in this subsection shall prohibit an inpatient
acute care hospital and a medical assistance managed care
organization from executing a new participation agreement or
amending an existing participation agreement on or after July 1,
2010, in which they agree to payment terms that would result in
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payments that are different than the payments determined in
accordance with subparagraphs (i), (ii), (iii) and (iv).
(vii) As used in this paragraph, the term "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. § 1396b(m)(1)(a))
that is a party to a Medicaid managed care contract with the
department, other than a behavioral health managed care
organization that is a party to a medical assistance managed
care contract with the department.
* * *
Section 3. The act is amended by adding an article to read:
ARTICLE VIII-G
STATEWIDE QUALITY CARE ASSESSMENT
Section 801-G. 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:
"Assessment." The fee, known as the Quality Care Assessment,
authorized to be implemented under this article on every covered
hospital.
"Bad debt expense." The cost of care for which a hospital
expected payment from the patient or a third-party payer, but
which the hospital subsequently determines to be uncollectible,
as further described in the Medicare Provider Reimbursement
Manual published by the United States Department of Health and
Human Services.
"Charity care expense." The cost of care for which a
hospital ordinarily charges a fee but which is provided free or
at a reduced rate to patients who cannot afford to pay but who
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are not eligible for public programs, and from whom the hospital
did not expect payment in accordance with the hospital's charity
care policy, as further described in the Medicare Provider
Reimbursement Manual published by the United States Department
of Health and Human Services.
"Contractual allowance." The difference between what a
hospital charges for services and the amounts that certain
payers have agreed to pay for the services as further described
in the Medicare Provider Reimbursement Manual published by the
United States Department of Health and Human Services.
"Covered hospital." A hospital other than an exempt hospital.
"Critical access hospital." Any hospital that has qualified
under section 1861(mm)(1) of the Social Security Act (49 Stat.
620, 42 U.S.C. § 1395x(mm)(1)) as a critical access hospital
under Medicare.
"Exempt hospital." Any of the following:
(1) A Federal veterans' affairs hospital.
(2) A hospital that provides care, including inpatient
hospital services, to all patients free of charge.
(3) A private psychiatric hospital.
(4) A State-owned psychiatric hospital.
(5) A critical access hospital.
(6) A long-term acute care hospital.
"Hospital." A facility licensed as a hospital under 28
Pa.Code Pt. IV Subpt. B (relating to general and special
hospitals).
"Long-term acute care hospital." A hospital or unit of a
hospital whose patients have a length of stay of greater than 25
days, and that provide specialized acute care of medically
complex patients who are critically ill.
20090HB0254PN4076 - 16 -
"Medical assistance managed care organization." 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. § 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.
"Net inpatient revenue." Gross charges for facilities for
inpatient services less any deducted amounts for bad debt
expense, charity care expense and contractual allowances as
reported on the Medicare Cost Report for Federal Fiscal Year
2008 or to the Pennsylvania Health Care Cost Containment Council
for Federal fiscal year 2008, if the Medicare Cost Report is not
available, and validated by the department.
"Program." The Commonwealth's medical assistance program as
authorized under Article IV.
Section 802-G. Authorization.
In order to generate additional revenues for the purpose of
assuring that medical assistance recipients have access to
hospital services, the department shall implement a monetary
assessment, known as the Quality Care Assessment, on each
covered hospital subject to the conditions and requirements
specified in this article, including section 813-G.
Section 803-G. Implementation.
(a) Health care-related fee.--The assessment authorized
under this article, once imposed, shall be implemented as a
health care-related fee as defined under section 1903(w)(3)(B)
of the Social Security Act (49 Stat. 620, 42 U.S.C. § 1396b(w)
(3)(B)) or any amendments thereto and may be collected only to
the extent and for the periods that the secretary determines
20090HB0254PN4076 - 17 -
that revenues generated by the assessment will qualify as the
State share of program expenditures eligible for Federal
financial participation.
(b) Assessment percentage.--Subject to subsection (c), each
covered hospital shall be assessed as follows:
(1) for fiscal year 2010-2011, each covered hospital
shall be assessed an amount equal to 2.69% of the net
inpatient revenue of the covered hospital; and
(2) for fiscal years 2011–2012 and 2012-2013, an amount
equal to 2.84% of the net inpatient revenue of the covered
hospital.
(c) Adjustments to assessment percentage.--The secretary may
adjust the assessment percentage specified in subsection (b)
(2), subject to the following:
(1) Before adjusting, the secretary shall publish a
notice in the Pennsylvania Bulletin that specifies the
proposed assessment percentage and identifies the aggregate
impact on covered hospitals subject to the assessment.
Interested parties shall have 30 days in which to submit
comments to the secretary. Upon expiration of the 30-day
comment period, the secretary, after consideration of the
comments, shall publish a second notice in the Pennsylvania
Bulletin announcing the assessment percentage.
(2) The secretary may not adjust the assessment
percentages to exceed 2.95% of the net inpatient revenue of
covered hospitals.
(3) An adjustment in the assessment percentage shall be
approved by the Governor.
(d) Maximum amount.--In each year in which the assessment is
implemented, the assessment shall be subject to the maximum
20090HB0254PN4076 - 18 -
aggregate amount that may be assessed under 42 CFR 433.68(f)(3)
(i) (relating to permissible health care-related taxes) or any
other maximum established under Federal law.
(e) Limited review.--Except as permitted under section 810-
G, the secretary's determination of the assessment percentage
pursuant to subsection (b) shall not be subject to
administrative or judicial review under 2 Pa.C.S. Chs. 5 Subch.
A (relating to practice and procedure of Commonwealth agencies)
and 7 Subch. A (relating to judicial review of Commonwealth
agency action), or any other provision of law; nor shall any
assessments implemented under this article or forms or reports
required to be completed by covered hospitals pursuant to this
article be subject to the act of July 31, 1968 (P.L.769,
No.240), referred to as the Commonwealth Documents Law; the act
of October 15, 1980 (P.L.950, No.164), known as the Commonwealth
Attorneys Act; and the act of June 25, 1982 (P.L.633, No.181),
known as the Regulatory Review Act.
Section 804-G. Administration.
(a) Calculation and notice of assessment amount.--Using the
assessment percentage established under section 803-G(b) and
covered hospitals' net inpatient revenue, the department shall
calculate and notify each covered hospital of the assessment
amount owed for the fiscal year. Notification pursuant to this
subsection may be made in writing or electronically at the
discretion of the department.
(b) Payment.--A covered hospital shall pay the assessment
amount due for a fiscal year in four quarterly installments.
Payment of a quarterly installment shall be made on or before
the first day of the second month of the quarter or 30 days from
the date of the notice of the quarterly assessment amount,
20090HB0254PN4076 - 19 -
whichever day is later.
(c) Records.--Upon request by the department, a covered
hospital shall furnish to the department such records as the
department may specify in order to determine the assessment for
a fiscal year or the amount of the assessment due from the
covered hospital or to verify that the covered hospital has paid
the correct amount due.
(d) Underpayments and overpayments.--In the event that the
department determines that a covered hospital has failed to pay
an assessment or that it has underpaid an assessment, the
department shall notify the covered hospital in writing of the
amount due, including interest, and the date on which the amount
due must be paid, which shall not be less than 30 days from the
date of the notice. In the event that the department determines
that a covered hospital has overpaid an assessment, the
department shall notify the covered hospital in writing of the
overpayment and, within 30 days of the date of the notice of the
overpayment, shall either refund the amount of the overpayment
or offset the amount of the overpayment against any amount that
may be owed to the department from the covered hospital.
Section 805-G. Restricted account.
(a) Establishment.--There is established a restricted
account, known as the Quality Care Assessment Account, in the
General Fund for the receipt and deposit of revenues collected
under this article. Funds in the account are appropriated to the
department for the following:
(1) Making medical assistance payments to hospitals in
accordance with section 443.1(1.1) and as otherwise specified
in the Commonwealth's approved Title XIX State Plan.
(2) Making enhanced capitation payments to medical
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assistance managed care organizations for supplemental
payments for inpatient hospital services in accordance with
section 443.1(1.2).
(3) Any other purpose approved by the secretary.
(b) Limitations.--
(1) For the first year of the assessment, the amount
used for the medical assistance payments for hospitals and
Medicaid managed care organizations may not exceed the
aggregate amount of assessment funds collected for the year
less $121,000,000.
(2) For the second year of the assessment, the amount
used for the medical assistance payments for hospitals and
medical assistance managed care organizations may not exceed
the aggregate amount of assessment funds collected for the
year less $59,000,000.
(3) For the first two years of the assessments, the
aggregate amount used for the medical assistance payments for
hospitals and Medicaid managed care organizations may not
exceed the aggregate amount of assessment funds collected for
the two years less $180,000,000.
(4) For the third year of the assessment, the amount
used for the medical assistance payment for hospitals and
medical assistance managed care organizations may not exceed
the aggregate amount of the assessment funds collected for
the year less $51,500,000.
(5) The amounts retained by the department shall be used
for purposes approved by the secretary under subsection (a)
(3).
(c) Lapse.--Funds in the Quality Care Assessment Account
shall not lapse to the General Fund at the end of a fiscal year.
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If this article expires, the department shall use any remaining
funds for the purposes stated in this section until the funds in
the Quality Care Assessment Account are exhausted.
Section 806-G. No hold harmless.
No covered hospital shall be directly guaranteed a repayment
of its assessment in derogation of 42 CFR 433.68(f) (relating to
permissible health care-related taxes), except that, in each
fiscal year in which an assessment is implemented, the
department shall use the funds received under this article for
the purposes outlined under section 805-G 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 under 42 CFR 433.68(f)(i). The secretary
shall submit to the United States Department of Health and Human
Services any State Medicaid plan amendments that are necessary
to make the payments authorized under section 805-G.
Section 807-G. Federal waiver.
To the extent necessary in order to implement this article,
the department shall seek a waiver under 42 CFR 433.68(e)
(relating to permissible health care-related taxes) from the
Centers for Medicare and Medicaid Services of the United States
Department of Health and Human Services. The department shall
not implement the assessment until approval of the waiver is
obtained. Upon approval of the waiver, the assessment shall be
implemented retroactive to the first day of the fiscal year to
which the waiver applies.
Section 808-G. Tax exemption.
(a) General rule.--Notwithstanding any exemptions granted by
any other Federal, State or local tax or other law, no covered
hospital other than an exempt hospital shall be exempt from the
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assessment.
(b) Interpretation.--The assessment imposed under this
article shall be recognized by the Commonwealth as uncompensated
goods and services under the act of November 26, 1997 (P.L.508,
No.55), known as the Institutions of Purely Public Charity Act,
and shall be considered a community benefit for purposes of any
required or voluntary community benefit report filed or prepared
by a covered hospital.
Section 809-G. 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:
(1) When a covered hospital fails to pay an assessment
or penalty in the amount or on the date required by this
article, the department shall add interest at the rate
provided in section 806 of the act of April 9, 1929 (P.L.343,
No.176), known as The Fiscal Code, to the unpaid amount of
the assessment or penalty from the date prescribed for its
payment until the date it is paid.
(2) When a covered hospital fails to file a report or to
furnish records to the department as required by this
article, the department shall impose a penalty against the
covered hospital in the amount of $1,000, plus an additional
amount of $200 per day for each additional day that the
failure to file the report or furnish the records continues.
(3) When a covered hospital 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
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60 days of the date that payment is due, the department may
deduct the unpaid assessment or penalty and any interest owed
thereon from any medical assistance payments due to the
covered hospital 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
covered hospital and medical assistance provider and may be
taken in installments over a period of time, taking into
account the financial condition of the medical assistance
provider.
(4) Within 60 days after the end of each calendar
quarter, the department shall notify the Department of Health
of any covered hospital that has assessment, penalty or
interest amounts that have remained unpaid for 90 days or
more. The Department of Health shall not renew the license of
any such covered hospital until the department notifies the
Department of Health that the covered hospital has paid the
outstanding amount in its entirety or that the department has
agreed to permit the covered hospital to repay the
outstanding amount in installments and that, to date, the
covered hospital has paid the installments in the amount and
by the date required by the department.
(5) The secretary may waive all or part of the interest
or penalties assessed against a covered hospital pursuant to
this article for good cause as shown by the covered hospital.
Section 810-G. Request for review.
A covered hospital that is aggrieved by a determination of
the department as to the amount of the assessment due from the
covered hospital or a remedy imposed pursuant to section 809-G
may file a request for review of the decision of the department
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by the Bureau of Hearings and Appeals, which shall have
exclusive jurisdiction in such matters. The procedures and
requirements of 67 Pa.C.S. Ch. 11 (relating to medical
assistance hearings and appeals) shall apply to requests for
review filed pursuant to this section, except that in any such
request for review, a covered hospital may not challenge an
assessment percentage determined by the secretary pursuant to
section 803-G(b) but only whether the department correctly
determined the assessment amount due from the covered hospital
using the assessment percentage in effect for the fiscal year. A
notice of review filed pursuant to this section shall not
operate as a stay of the covered hospital's obligation to pay
the assessment amount due for a fiscal year as specified in
section 804-G(b).
Section 811-G. Liens.
Any assessments implemented and interest and penalties
assessed against a covered hospital under this article shall be
a lien on the real and personal property of the covered hospital
in the manner provided by section 1401 of the act of April 9,
1929 (P.L.343, No.176), known as The Fiscal Code, may be entered
by the department in the manner provided by section 1404 of The
Fiscal Code and shall continue and retain priority in the manner
provided in section 1404.1 of The Fiscal Code.
Section 812-G. Regulations.
The department may issue such regulations and orders as may
be necessary to implement the Quality Care Assessment program in
accordance with the requirements of this article.
Section 813-G. Conditions for payments.
The department and the medical assistance managed care
organizations shall not be required to make payments as
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specified in section 443.1(1.1) and (1.2) and a covered hospital
shall not be required to pay the Quality Care Assessment as
specified in section 804-G(b) unless all of the following have
occurred:
(1) The department receives Federal approval of a waiver
under 42 CFR 433.68(e) (relating to permissible health care-
related taxes), authorizing the department to implement the
Quality Care Assessment as specified in this article.
(2) The department receives Federal approval of a State
plan amendment authorizing the changes to its payment methods
and standards specified in § 443.1(1.1)(ii).
(3) The department receives Federal approval of a waiver
under section 1915(b) of the Social Security Act (49 Stat.
620, 42 U.S.C. § 1396n(b)) for the HealthChoices Program and
amendments to its medical assistance managed care
organization contracts authorizing supplemental payments for
inpatient hospital services funded in accordance with section
805-G.
Section 814-G. Report.
Not later than 180 days prior to the expiration date
specified in section 815-G, the department shall prepare and
submit a report to the chair and minority chair of the Public
Health and Welfare Committee of the Senate, the chair and
minority chair of the Appropriations Committee of the Senate,
the chair and minority chair of the Health and Human Services
Committee of the House of Representatives and the chair and
minority chair of the Appropriations Committee of the House of
Representatives. The report shall include the following:
(1) The name, address and amount of assessment for each
covered hospital subject to the Quality Care Assessment.
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(2) The total amount of assessment revenue collected for
each year.
(3) The amount of assessment paid by each covered
hospital, including any interest and penalties paid.
(4) The name and address of each hospital receiving
supplemental payments instituted as a result of the Quality
Care Assessment.
(5) The payment amount and type of supplemental payment
received by each hospital.
(6) The total amount of fee-for-service inpatient acute
care payment made to each hospital.
(7) The number of medical assistance patient days and
discharges by hospital.
(8) Any proposed changes to the payment methodologies
and standards.
Section 815-G. Expiration.
This article shall expire June 30, 2013.
Section 816-G. Retroactive applicability.
This article shall apply retroactively to July 1, 2010.
Section 4. This act shall take effect immediately.
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