Bill Text: PA HB261 | 2011-2012 | Regular Session | Introduced

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Bill Title: Establishing the Community-Based Health Care Provider Assistance Program in the Department of Health; setting criteria for eligibility for and authorizing payments to community-based health care providers to assist in providing medically necessary care to Pennsylvanians; providing for powers and duties of the Department of Health; and establishing the Community-Based Health Care Provider Assistance Fund.

Spectrum: Slight Partisan Bill (Republican 23-15)

Status: (Introduced - Dead) 2011-03-21 - Referred to HEALTH [HB261 Detail]

Download: Pennsylvania-2011-HB261-Introduced.html

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PRINTER'S NO. 1225
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No. 261 Session of2011
INTRODUCED BY J. EVANS, AUMENT, CALTAGIRONE, CAUSER, COHEN, D. COSTA, CUTLER, DeLUCA, DENLINGER, EVERETT, FLECK, GEIST, GIBBONS, GRELL, HARHART, HARKINS, HICKERNELL, HORNAMAN, HUTCHINSON, JOSEPHS, KOTIK, MILLARD, MURPHY, MURT, MYERS, PICKETT, RAPP, READSHAW, ROAE, ROSS, SAYLOR, SONNEY, J. TAYLOR, VULAKOVICH AND WAGNER, MARCH 21, 2011
REFERRED TO COMMITTEE ON HEALTH, MARCH 21, 2011
AN ACT
Establishing the Community-Based Health Care Provider Assistance
Program in the Department of Health; setting criteria for
eligibility for and authorizing payments to community-based
health care providers to assist in providing medically
necessary care to Pennsylvanians; providing for powers and
duties of the Department of Health; and establishing the
Community-Based Health Care Provider Assistance Fund.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Short title.
This act shall be known and may be cited as the Community-
Based Health Care Provider Assistance Act.
Section 2. Findings.
The General Assembly finds that:
(1) There exists a great need for increased access to
community-based health care services throughout this
Commonwealth in order:
(i) to allow for individuals to establish medical
homes and obtain preventive care;
(ii) to reduce the inappropriate use of emergency
health care services by providing effective alternatives
to such services;
(iii) to reduce the burden of uncompensated care and
the needs of the uninsured; and
(iv) to improve maternal and child health.
(2) The availability of such community-based health care
services should be increased by the Commonwealth by assisting
in the expansion of community-based health care providers
through the provision of additional resources and generally
promoting their use as a cost-effective supplement to other
providers of health care services.
Section 3. 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:
"Community-based health care provider." Any of the following
nonprofit health care centers that provide primary health care
services:
(1) A federally qualified health center as defined in
section 1905(l)(2)(B) of the Social Security Act (49 Stat.
620, 42 U.S.C. § 1396d(l)(2)(B)).
(2) A rural health clinic as defined in section 1861(aa)
(2) of the Social Security Act (49 Stat. 620, 42 U.S.C. §
1395x(aa)(2)), certified by Medicare.
(3) A freestanding hospital clinic that serves a
federally designated:
(i) health care professional shortage area;
(ii) medically underserved area; or
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(iii) medically underserved population.
(4) A free or partial-pay health clinic that provides
services by volunteer medical providers.
(5) An entity meeting the requirements of the Federal
Government to be recognized as a federally qualified health
center look-alike.
(6) A nurse-managed health clinic that serves a
federally designated:
(i) health care professional shortage area;
(ii) medically underserved area; or
(iii) medically underserved population.
"Department." The Department of Health of the Commonwealth.
"Fund." The Community-Based Health Care Provider Assistance
Fund established under this act.
"Health care provider." A health care facility or health
care practitioner as defined in the act of July 19, 1979
(P.L.130, No.48), known as the Health Care Facilities Act, a
group practice or a community-based health care provider.
"Medical assistance." A State program of medical assistance
established under Article IV(f) of the act of June 13, 1967
(P.L.31, No.21), known as the Public Welfare Code.
"Nurse-managed health clinic." A nurse practice arrangement,
managed by advanced practice nurses, that provides primary care
and is associated with a school, college or department of
nursing, federally qualified health center or an independent
nonprofit health or social services agency.
"Program." The Community-Based Health Care Provider
Assistance Program established under this act.
Section 4. Community-Based Health Care Provider Assistance
Program.
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(a) Establishment.--The Community-Based Health Care Provider
Assistance Program is established within the department to
provide grants to community-based health care providers to:
(1) Improve the access to and quality of health care in
this Commonwealth.
(2) Assist in covering the reasonable costs of providing
health care services, outreach and care management
opportunities to persons eligible to receive health care
services from or through community-based health care
providers.
(3) Improve access to medically necessary preventive,
curative and palliative physical, dental and behavioral
health care services offered by and through community-based
health care providers, while reducing unnecessary or
duplicative services.
(4) Reduce the unnecessary utilization of emergency
health care services by supporting the development and
provision of effective alternatives offered by or through
community-based health care providers.
(5) Improve the availability of quality health care
services offered by or through community-based health care
providers for women who are pregnant or who have recently
given birth and their children.
(6) Promote the use of chronic care and disease
management protocols offered by or through community-based
health care providers in an effort to optimize both
individual health outcomes and the use of health care
resources.
(b) Administration.--The program shall be administered by
the department and shall be funded by annual transfers as
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provided under this act to the fund to support community-based
health care providers' provision of health care.
(c) Department responsibilities.--After sufficient moneys
have been transferred or deposited into the fund, the department
shall:
(1) Administer the program.
(2) Within 90 days of such moneys being so transferred
or deposited, develop and provide an application form
consistent with this act.
(3) Determine the eligibility of community-based health
care providers for the assistance provided under this act,
based upon its consideration of community health needs across
this Commonwealth, revenue and cost data and other
information provided by community-based health care providers
and such other information as the department determines to be
appropriate to ascertain the financial condition and needs of
such programs and this Commonwealth.
(4) Establish a process to allocate funding as provided
under this act, to determine the optimal use of funds and to
reallocate funds if acceptable requests for funding within a
particular category are not received.
(5) Calculate and make grants to qualified community-
based health care providers from the funds deposited in the
fund for the purposes established under this act pursuant to
this section and section 5.
(6) Provide an annual report to the chairman and
minority chairman of the Public Health and Welfare Committee
of the Senate and the chairman and minority chairman of the
Health and Human Services Committee of the House of
Representatives describing the operation of the program and
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detailing grants made, the names and addresses of the
community-based health care providers receiving grants and
such other information as may be determined by the department
to be necessary or desirable.
(7) Audit grants awarded under this act to ensure that
funds have been used in accordance with this act and the
terms and standards adopted by the department.
(8) Provide ongoing assessment of the benefits and costs
of the assistance provided under this act.
(9) In consultation with the Department of Public
Welfare, seek Federal matching funds under medical
assistance, as well as grants and funding from other sources,
to supplement amounts made available under this act to the
extent permitted by law.
(d) Limitations on payments by department.--Payments to
community-based health care providers for assistance under this
act shall not exceed the amount of funds available in the fund
for the program and any payment under this act shall not
constitute an entitlement from the Commonwealth or a claim on
any other funds of the Commonwealth.
(e) Report.--A community-based health care provider that
receives a grant under this act shall report at least annually
to the department, which report shall include a description of:
(1) The community-based health care provider's efforts
to improve access to and the delivery and management of
health care services.
(2) The reduction of unnecessary and duplicative health
care services.
(3) Changes in overall health indicators and in
utilization of health care services among the communities and
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individuals served by the community-based health care
providers, with particular emphasis on indicators including,
but not limited to:
(i) The creation and maintenance of relationships
between health care providers and individuals directed at
establishing a medical home for such individuals and the
provision of preventive and chronic care management
services.
(ii) Prenatal and postpartum care.
(iii) The care of newborns and infants.
(iv) Such other matters as may be specified by the
department.
(4) An accounting of the expenditure of funds from the
grant and all funds received from other sources.
Section 5. Grants to community-based health care providers.
(a) Allocation of funds.--The department shall provide
grants to community-based health care providers on the basis of
the process established under this section.
(b) Grant award methodology.--
(1) The department shall develop a methodology to
determine grant amounts to be awarded under this act based
upon an assessment by the department of community need for
the services to be supported by funding available to
community-based health care providers and the needs of
community-based health care providers applying for such
assistance.
(2) During each of the first three years of the program,
the department shall use its best efforts to make grants as
follows, subject to reallocation as provided under subsection
(f):
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(i) (A) Fifty percent for expansion of current
community-based health care providers and development
of new community-based health care providers.
(B) Amounts provided under this subparagraph, in
addition to funds provided for the costs of expansion
and development, may be used by the department to
make planning grants to community-based health care
providers not to exceed more than $25,000 for any
single community-based health care provider.
(C) In making grants under this subparagraph,
the department shall give first priority to
applications that seek to use grant proceeds for
machinery, equipment and reasonably necessary
renovation of existing facilities rather than new
construction. All reasonable actions should be taken
to optimize the use of the funding provided under
this act and avoid unnecessary construction costs.
(ii) Twenty-five percent for improvements in
prenatal, obstetric, postpartum and newborn care provided
by or through community-based health care providers,
which amount during the initial three-year period shall
include grants for at least one new mobile clinic serving
primarily rural areas and one new mobile clinic serving
primarily urban areas.
(iii) Twenty-five percent for services intended to
reduce unnecessary emergency room utilization and to
expand capacity and services offered by or through
existing community-based health care providers.
(c) Program adjustment.--
(1) The department shall provide a report to the
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chairman and minority chairman of the Public Health and
Welfare Committee of the Senate and the chairman and minority
chairman of the Health Committee and the Human Services
Committee of the House of Representatives no later than July
1, 2014, that includes an assessment of the effectiveness of
the initial phase of the program and describes any changes in
the allocation of funds described in subsection (b) that the
department intends to make beginning in the fourth year of
the program.
(2) The Department shall develop the program changes
anticipated by this subsection and included in the report
required under paragraph (1) after consultation with and
receiving input from community-based health care providers,
consumers and others with an interest in the provision of
community-based health care.
(3) The department, after determining program changes,
shall make necessary revisions in program requirements and
procedures and provide notice to prospective applicants, such
that grants can be awarded on a timely basis beginning in the
fourth year of the program.
(d) Additional information.--In addition to the application,
an applicant must provide:
(1) A feasibility study of the proposed uses of funds to
be provided under the grant.
(2) A business or financial plan that describes the
long-term sustainability, financial cost to the applicant and
the proposed benefits of the work to be accomplished pursuant
to the grant.
(3) A strategic plan and schedule for the development
and implementation of the work to be accomplished pursuant to
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the grant.
(e) Limitation.--The total amount of grants under the
program to any single community-based health care provider shall
not exceed $2,000,000 and no grant shall be for a term in excess
of five years.
(f) Reallocation of funds.--The department shall reallocate
funds among the categories described in subsection (b) if
sufficient requests are not received by the department that
comply with this act or the requirements of the department.
Section 6. Community-Based Health Care Provider Assistance
Fund.
(a) Establishment.--The Community-Based Health Care Provider
Assistance Fund is established in the State Treasury.
(b) Funding sources.--The fund shall consist of:
(1) Transfers or appropriations to the fund.
(2) Money received from the Federal Government or other
sources.
(3) Money required to be deposited in the fund pursuant
to other provisions under this act or any other law.
(4) Investment earnings from the fund, net of investment
costs.
(c) Nonlapse.--The money in the fund is appropriated on a
continuing basis to the department for the purposes of this act
and shall not lapse at the end of any fiscal year.
Section 7. Funding contingency.
The powers and duties of the department under this act shall
be contingent on funds being appropriated or otherwise made
available to the department for the purposes of this act.
Section 8. Effective date.
This act shall take effect July 1, 2012, or immediately,
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whichever is later.
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