THE GENERAL ASSEMBLY OF PENNSYLVANIA

HOUSE BILL

INTRODUCED BY DeLUCA, BELFANTI, D. COSTA, GEORGE, HARKINS, HORNAMAN, JOHNSON, JOSEPHS, KOTIK, SOLOBAY, STABACK, J. TAYLOR, SIPTROTH, CALTAGIRONE, BRENNAN AND KULA, JUNE 12, 2009

REFERRED TO COMMITTEE ON HEALTH AND HUMAN SERVICES, JUNE 12, 2009  

AN ACT

Amending the act of December 2, 1992 (P.L.741, No.113), entitled

"An act providing a comprehensive plan for health care for

uninsured children; providing for medical education

assistance; making appropriations; and making repeals,"

making editorial changes.

The General Assembly of the Commonwealth of Pennsylvania

hereby enacts as follows:

Section 1.  Sections 103 and 1304 of the act of December 2,

1992 (P.L.741, No.113), known as the Children's Health Care Act,

are amended to read:

Section 103.  Definitions.

The following words and phrases when used in this act shall

have the meanings given to them in this section unless the

context clearly indicates otherwise:

"Child."  A person under 13 years of age[, except as provided

for in section 701(d)].

"Children's medical assistance."  Medical assistance services

to children as required under Title 14 of the Social Security

Act (Public Law 74-271, 42 U.S.C. § 301 et seq.), including

EPSDT services.

"Council."  The Children's Health Advisory Council

established [in section 701(i)] under section 2311(i) of the act

of May 17, 1921 (P.L.682, No.284), known as The Insurance

Company Law of 1921.

"Department."  The Department of Public Welfare of the

Commonwealth.

"EPSDT."  Early and periodic screening, diagnosis and

treatment.

"Fund."  The Children's Health Fund for health care for

indigent children established by section 1296 of the act of

March 4, 1971 (P.L.6, No.2), known as the Tax Reform Code of

1971.

"Genetic status."  The presence of a physical condition in an

individual which is a result of an inherited trait.

["Grantee."  An entity selected by the management team to

receive a grant under Chapter 7. The term includes an entity,

and its subsidiary, which is established under 40 Pa.C.S. Ch. 61 

(relating to hospital plan corporations) or 63 (relating to

professional health services plan corporations); the act of May

17, 1921 (P.L.682, No.284), known as The Insurance Company Law

of 1921; or the act of December 29, 1972 (P.L.1701, No.364),

known as the Health Maintenance Organization Act.]

"Group."  A group for which a health insurance policy is

written in this Commonwealth.

"Health maintenance organization" or "HMO."  An entity

organized and regulated under the act of December 29, 1972

(P.L.1701, No.364), known as the Health Maintenance Organization

Act.

"Health service corporation."  A professional health service

corporation as defined in 40 Pa.C.S. § 6302 (relating to

definitions).

"Hospital."  An institution having an organized medical staff

which is engaged primarily in providing to inpatients, by or

under the supervision of physicians, diagnostic and therapeutic

services for the care of injured, disabled, pregnant, diseased

or sick or mentally ill persons. The term includes facilities

for the diagnosis and treatment of disorders within the scope of

specific medical specialties. The term does not include

facilities caring exclusively for the mentally ill.

"Hospital plan corporation."  A hospital plan corporation as

defined in 40 Pa.C.S. § 6101 (relating to definitions).

"Insurer."  Any insurance company, association, reciprocal,

nonprofit hospital plan corporation, nonprofit professional

health service plan, health maintenance organization, fraternal

benefits society or a risk-bearing PPO or nonrisk-bearing PPO

not governed and regulated under the Employee Retirement Income

Security Act of 1974 (Public Law 93-406, 29 U.S.C. § 1001 et

seq.).

"MAAC."  The Medical Assistance Advisory Committee.

"Managed care organization."  A health maintenance

organization organized and regulated under the act of December

29, 1972 (P.L.1701, No.364), known as the Health Maintenance

Organization Act, or a risk-assuming preferred provider

organization or exclusive provider organization, organized and

regulated under the act of May 17, 1921 (P.L.682, No.284), known

as The Insurance Company Law of 1921.

"Management team."  The Children's Health Insurance

Management Team [established in section 701(f)].

"MCH."  Maternal and Child Health.

"Medical assistance."  The State program of medical

assistance established under the act of June 13, 1967 (P.L.31,

No.21), known as the Public Welfare Code.

"Medicaid."  The Federal medical assistance program

established under Title XIX of the Social Security Act (Public

Law 74-271, 42 U.S.C. § 1396 et seq.).

"Mid-level health professional."  A physician assistant,

certified registered nurse practitioner, nurse practitioner or a

certified nurse midwife.

"Parent."  A natural parent, stepparent, adoptive parent,

guardian or custodian of a child.

"PPO."  A preferred provider organization subject to the

provisions of section 630 of act of May 17, 1921 (P.L.682,

No.284), known as The Insurance Company Law of 1921.

"Preexisting condition."  A disease or physical condition for

which medical advice or treatment has been received prior to the

effective date of coverage.

"Secretary."  The Secretary of the Department of Health.

"Spenddown."  A qualifying procedure for medical assistance

set forth in 55 Pa. Code Ch. 181 (relating to income provisions

for categorically needy NMP-MA and MNO-MA).

"Subgroup."  An employer covered under a contract issued to a

multiple employer trust or to an association.

"Terminate."  Includes cancellation, nonrenewal and

rescission.

"Waiting period."  A period of time after the effective date

of enrollment during which a health insurance plan excludes

coverage for the diagnosis or treatment of one or more medical

conditions.

"WIC."  The Federal Supplemental Food Program for Women,

Infants and Children.

Section 1304.  Primary health care grants program.

(a)  Establishment.--The Department of Health shall, as part

of the Primary Health Care Practitioners Program provided for in

this chapter, establish a program for awarding demonstration

grants to promote the training, recruitment and retention of

primary health care practitioners in designated medically

underserved areas and to promote innovative methods for delivery

of primary medical services in rural designated medically

underserved areas. The purpose of these grants may include, but

need not be limited to, the following:

(1)  Promoting health care professions to high school

students.

(2)  Encouraging local communities in designated

medically underserved areas to support primary health care

practitioners.

(3)  Promoting specific programs for the education,

recruitment and retention of family practitioners,

particularly in designated medically underserved areas.

[Such programs] (b)  Grants.--Programs under subsection (a) may

include challenge grants to medical schools to promote medical

education opportunities for primary health care professionals

and assistance to communities to establish clinics, including

mobile health clinics. In establishing priorities, the

department shall give preference to programs which promote

coordination of existing resources, particularly in rural areas.

Section 2.  This act shall take effect in 60 days.