Bill Text: PA HB889 | 2009-2010 | Regular Session | Introduced

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Bill Title: Establishing the Community-Based Health Care Provider Access (CHCPA) Program in the Department of Health; providing for hospital health clinics and for a tax credit; and making an appropriation.

Spectrum: Slight Partisan Bill (Republican 22-8)

Status: (Introduced - Dead) 2009-03-12 - Referred to HEALTH AND HUMAN SERVICES [HB889 Detail]

Download: Pennsylvania-2009-HB889-Introduced.html

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PRINTER'S NO. 1008
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No. 889 Session of2009
INTRODUCED BY BAKER, REICHLEY, CLYMER, CUTLER, BRENNAN, CAUSER, FAIRCHILD, FLECK, FRANKEL, GOODMAN, HARHAI, HARHART, HENNESSEY, HESS, HUTCHINSON, M. KELLER, PICKETT, QUINN, SCAVELLO, SIPTROTH, J. TAYLOR, VULAKOVICH, CREIGHTON AND RAPP, MARCH 12, 2009
REFERRED TO COMMITTEE ON HEALTH AND HUMAN SERVICES, MARCH 12, 2009
AN ACT
Establishing the Community-Based Health Care Provider Access
(CHCPA) Program in the Department of Health; providing for
hospital health clinics and for a tax credit; and making an
appropriation.
The General Assembly finds and declares as follows:
The purpose of the Community-Based Health Care Provider
Access Program is to provide access to quality community-
based health care to improve the health of local residents.
Community health workers play an important role by
helping individuals who utilize community services understand
how to navigate the health care system. They provide
information to patients about staying healthy and managing
diseases, emphasizing prevention and primary care, resulting
in more appropriate use of the health care system, leading to
lower overall costs of care reducing the burden of
uncompensated care.
Specifically this act seeks to:
(1) Expand and improve health care access and
services, such as preventative care, chronic care and
disease management, prenatal, obstetric, postpartum and
newborn care, dental treatment, behavioral health, mental
health and substance abuse and primary services resulting
in improved health statuses of Commonwealth residents
regardless of insurance status or ability to pay.
(2) Reduce unnecessary utilization of hospital
emergency services by providing an effective alternative
health care delivery system.
(3) Encourage collaborative relationships among
community-based health care clinics, hospitals and other
health care providers.
Community health centers serve millions of patients
nationally. Federally qualified health centers (FQHC) alone
served 521,194 individuals as medical home and family
physician in the Commonwealth of Pennsylvania. Health centers
are located in areas where care is needed but scarce, their
costs rank among the lowest, and they reduce the need for
more expensive inpatient and specialty care. Only six states
served more individuals in FQHCs (California, Florida,
Illinois, New York, Texas and Washington). Pennsylvania has
no direct funding to health centers.
Ninety-one percent of patients served in community
centers are of low income with 71% being families with
incomes at or below poverty levels. Nearly two-thirds of
individuals accessing community care are racial and ethnic
minorities. About 39% of health center patients are uninsured
and another 35% depend on Medicaid. About half of health
center patients reside in rural areas, while the other half
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tend to live in economically depressed inner city
communities.
Expanding and strengthening community-based health
centers will continue to improve the health outcomes for this
Commonwealth's medically vulnerable as well as narrow health
disparities.
TABLE OF CONTENTS
Chapter 1. Health Care Assistance
Subchapter A. Preliminary Provisions
Section 101. Short title.
Section 102. Definitions.
Subchapter B. Community-Based Health Care Provider Access
(CHCPA)
Section 111. Community-Based Health Care Provider Access
(CHCPA) Program.
Section 112. Powers and duties of department.
Section 113. Hospital health clinics.
Section 114. Community-Based Health Care Provider Access
(CHCPA) Fund.
Section 115. Report and program adjustment.
Subchapter C. Tax Credit
Section 121. Scope of subchapter.
Section 122. Definitions.
Section 123. Establishment of program.
Section 124. Application.
Section 125. Tax credit.
Section 126. Limitations.
Section 127. Report.
Chapter 51. Miscellaneous Provisions
Section 5101. Appropriations.
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Section 5102. Effective date.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
CHAPTER 1
HEALTH CARE ASSISTANCE
SUBCHAPTER A
PRELIMINARY PROVISIONS
Section 101. Short title.
This act shall be known and may be cited as the Community-
Based Health Care Provider Access (CHCPA) Act.
Section 102. Definitions.
The following words and phrases when used in this chapter
shall have the meanings given to them in this section unless the
context clearly indicates otherwise:
"Advanced practice nurse." A registered nurse with a
master's or doctorate degree licensed to practice as a
certificate-registered nurse practitioner, clinical nurse
specialist or certified nurse-midwife.
"Chronic care and disease management." A model of care that
includes the following:
(1) The provision of effective health management through
support and information that also promotes self-care for
patients with chronic conditions so they can effectively
manage their health.
(2) The use of evidence-based medicine to ensure
appropriate treatment decisions by health care providers.
(3) Tracking clinical information for individual and
general patient populations to guide treatment and
effectively anticipate community health care problems.
(4) Ensuring patients get the care they need by
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clarifying roles and tasks of health care providers and
encouraging a coordination of care for all who treat patients
and have centralized, up-to-date information about the
patient and that follow-up care is provided as a standard
procedure.
(5) Forming partnerships and alliances with State,
local, business, religious and other organizations to support
or expand care for those with chronic disease.
"Community-based health care clinic." A nonprofit health
care center located in this Commonwealth that provides
comprehensive health care services without regard for a
patient's ability to pay and that:
(1) meets either of the following criteria:
(i) serves a federally designated medically
underserved area, a medically underserved population or a
health professional shortage area; or
(ii) serves a patient population with a majority of
that population having an income less than 200% of the
Federal poverty income guidelines; and
(2) includes any of the following:
(i) 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)) or a federally
qualified health center look-alike.
(ii) 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.
(iii) A hospital health clinic.
(iv) A free or partial-pay health clinic that
provides services by volunteer and nonvolunteer health
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care providers.
(v) A nurse-managed health care clinic that is
managed by advanced practice nurses and is associated
with a nursing education program, a federally qualified
health center or an independent nonprofit health or
social services agency.
(vi) A not-for-profit dental clinic.
"Community health needs assessment." An assessment conducted
by a community-based health improvement partnership under
section 111.
"Department." Except as provided under section 122, the
Department of Health of the Commonwealth.
"Fund." The Community-Based Health Care Provider Access
(CHCPA) Fund.
"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. A
health care provider licensed to practice a component of the
healing arts by a licensing board within the Department of State
who provides health care services at a community-based health
care clinic.
"Hospital." An entity located in this Commonwealth that is
licensed as a hospital under the act of July 19, 1979 (P.L.130,
No.48), known as the Health Care Facilities Act.
"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 health care
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services to vulnerable populations and is associated with a
school, college or department of nursing, a federally qualified
health center or an independent nonprofit health or social
services agency.
"Patient." A natural person receiving health care in or from
a health care provider at a community-based health care clinic.
"Program." The Community-Based Health Care Provider Access
(CHCPA) Program.
SUBCHAPTER B
COMMUNITY-BASED HEALTH CARE PROVIDER ACCESS (CHCPA)
Section 111. Community-Based Health Care Provider Access
(CHCPA) Program.
(a) Establishment.--The Community-Based Health Care Provider
Access (CHCPA) Program is established within the department to:
(1) Improve availability, access to and provide quality
community-based health care, reduce unnecessary utilization
of emergency health care services by providing and supporting
the development and provision of appropriate alternatives
offered by or through community-based health care providers,
while reducing duplicative services.
(2) Expand and improve health care access and services
to medically necessary preventative care, chronic care and
disease management in an effort to optimize both individual
health outcomes and the use of health care resources,
obstetric services, including prenatal, postpartum and
newborn care, dental treatment, pharmacy services and
behavioral health care services provided in the Commonwealth
through community-based health care providers.
(3) Encourage collaborative relationships among
community-based health care clinics, hospitals and other
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health care providers as well as provide outreach into the
community to identify individuals who would qualify for the
program and integrate them into the program.
(4) Assist in covering the reasonable costs of providing
health care services, outreach and care management
opportunities to individuals eligible to receive services
from or through community-based health care providers.
(5) Provide for the establishment of a case manager
system for each eligible individual to assist the individual
in meeting his health care needs.
(6) Monitor the changes in health status of the low-
income residents in the community.
(b) Grant award methodology.--A methodology for the
allocation of grant awards shall be developed by the department
based on the following distribution:
(1) Fifty percent for the expansion of an existing or
the development of a new community-based health care clinic
using criteria that include:
(i) The actual and projected number of total
patients, new patients and patient visits for all
patients served or to be served, including the number of
low-income and uninsured patients, who fall below 200% of
the Federal poverty income guidelines.
(ii) The addition or expansion of ancillary health
care services, such as dental, behavioral health and
pharmacy.
(iii) The development or enhancement of preventive
and chronic care and disease management techniques.
(2) Twenty-five percent for improvements in prenatal,
obstetric, postpartum and newborn care.
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(3) Twenty percent for improved access and services,
including patient transportation, intended to reduce
unnecessary emergency room utilization.
(4) Five percent for the establishment of collaborative
relationships among community-based health care clinics,
hospitals and other health care providers.
(c) Limitation.--No more than 25% of the grants awarded
under subsection (b) shall go to federally qualified health
centers or Federally qualified health center look-alikes.
(d) Distribution.--Funds shall be distributed in a manner
that improves access and expands services in all geographic
areas of this Commonwealth.
(e) Reallocation.--The department shall reallocate funds
among the categories described in subsection (b) if sufficient
grant requests are not received to use all the funds available
in a specific category.
(f) Amount of grants.--A grant under this subsection shall
not exceed $500,000, and shall require a matching commitment of
25% of the grant, which can be in the form of cash or equivalent
in-kind services.
(g) Federal funds.--The department shall seek any available
Federal funds, as well as any available grants and funding from
other sources, to supplement amounts made available under this
subchapter to the extent permitted by law.
Section 112. Powers and duties of department.
The department shall have the following powers and duties:
(1) To administer the program.
(2) To develop an allocation methodology under section
111(b).
(3) Within 90 days of the effective date of this
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section, to develop and provide a grant application form
consistent with this act. The department shall provide
applications for grants under this section to all known
community-based health care clinics. A grant under this
section may be extended over two State fiscal years at the
request of the community-based health care clinic.
(4) To calculate and make grants to qualified community-
based health care clinics.
(5) To provide an annual report no later than November
30 to the chair and minority chair of the Public Health and
Welfare Committee of the Senate and the chair and minority
chair of the Health and Human Services Committee of the House
of Representatives. The report shall include accountability
measures for all of the following:
(i) The total dollar amount for each grant awarded,
listing the type of community-based health care clinic
and the name of the grantee.
(ii) A summary of the use of the grant by each
grantee.
(iii) A summary of how each grant expanded access
and services in accordance with the criteria set forth in
section 111(a) and (b), including a specific
documentation of low-income and uninsured patients
served, and the total amount of funds allocated in each
distribution category under section 111(b).
(iv) The impact of the grant on improving the
delivery and quality of health care in the community.
(v) An accountability assessment of the benefits of
the assistance provided under this subchapter and any
recommendations for changes to the program.
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The report shall be made available for public inspection and
posted on the department's publicly accessible Internet
website.
(6) To audit grants awarded under this subchapter to
ensure that funds have been used in accordance with this
subchapter and the terms and standards adopted by the
department.
(7) To establish and maintain an online database of
community-based health care clinics.
(8) To establish a toll-free telephone number for
individuals to obtain information about community-based
health care clinics.
Section 113. Hospital health clinics.
(a) Program.--The Department of Public Welfare shall be
responsible for administering the program as it relates to
hospital health clinics in accordance with the requirements of
this act and shall have the following additional duties:
(1) To develop an application and collect such data and
information as may be necessary to determine the eligibility
of hospital health clinics for payments under this section
using the criteria set forth in section 111(a) and (b).
(2) To review an application and make a final
determination regarding a hospital health clinic's
eligibility for funding within 90 days of receipt.
(3) To make payments to hospital health clinics in
accordance with the payment calculation set forth in
subsection (e).
(b) Submission of application.--In order to qualify for
funding pursuant to this section, a hospital health clinic shall
submit the required application to the Department of Public
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Welfare no later than 90 days after the effective date of this
act.
(c) Funding.--
(1) For fiscal year 2009-2010 and each year thereafter,
upon Federal approval of an amendment to the Medicaid State
plan, the Department of Public Welfare shall annually
distribute any available funds obtained under this act for
hospital health clinics through disproportionate share
payments to hospitals to provide financial assistance that
will assure readily available and coordinated comprehensive
health care to the citizens of this Commonwealth.
(2) The Secretary of Public Welfare shall determine the
funds available and make appropriate adjustments based on the
number of qualifying hospitals with hospital health clinics.
(d) Maximization.--The Department of Public Welfare shall
seek to maximize any Federal funds, including funds obtained
under Title XIX of the Social Security Act (49 Stat. 620, 42
U.S.C. § 1396 et seq.).
(e) Payment calculation.--
(1) Thirty percent of the total amount available shall
be allocated to eligible hospital health clinics of hospitals
located in counties of the first and second class. The total
amount available for each hospital health clinic at a
hospital in these counties shall be allocated on the basis of
each hospital's percentage of medical assistance and low-
income hospital health clinic visits compared to the total
number of medical assistance and low-income hospital health
clinic visits for all hospitals in these counties.
(2) Fifty percent of the total amount available shall be
allocated to eligible hospital health clinics of hospitals
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located in counties of the third, fourth and fifth class. The
total amount available for each hospital health clinic at a
hospital in these counties shall be allocated on the basis of
each hospital's percentage of medical assistance and low-
income hospital health clinic visits compared to the total
number of medical assistance and low-income hospital health
clinic visits for all hospitals in these counties.
(3) Twenty percent of the total amount available shall
be allocated to eligible hospital health clinics of hospitals
located in counties of the sixth, seventh and eighth class.
The total amount available for each hospital health clinic at
a hospital in these counties shall be allocated on the basis
of each hospital's percentage of medical assistance and low-
income hospital health clinic visits compared to the total
number of medical assistance and low-income hospital health
clinic visits for all hospitals in these counties.
(4) Any hospital that has reached its disproportionate
share limit under Title XIX of the Social Security Act shall
receive its share of the State funds available under this
act.
(f) Definition.--As used in this section, the term "low-
income" means under 200% of the Federal poverty income
guidelines.
Section 114. Community-Based Health Care Provider Access
(CHCPA) Fund.
(a) Establishment.--The Community-Based Health Care Provider
Access (CHCPA) Fund is established in the State Treasury.
(b) Funding sources.--Funding sources for the fund shall
include all of the following:
(1) Transfers or appropriations to the fund.
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(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) Use.--The department shall utilize the fund to carry out
the program.
Section 115. Report and program adjustment.
(a) The department shall provide a report to the chair and
minority chair of the Public Health and Welfare Committee of the
Senate and the chair and minority chair of the Health and Human
Services Committee of the House of Representatives no later than
July 1, 2012, 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 section 111(b) that the
department intends to make beginning in the fourth year of the
program.
(b) The department shall develop the program changes
anticipated by this subsection and included in the report under
subsection (a) 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.
(c) The department, after determining program changes, shall
make necessary revisions in the 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) A community-based health care provider that receives a
grant under this act shall report at least annually to the
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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
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 preventative and chronic care management
services.
(ii) Prenatal, postpartum, new born and infant care.
(iii) Such other matters as may be specified by the
department.
SUBCHAPTER C
TAX CREDIT
Section 121. Scope of subchapter.
This subchapter deals with the community-based health care
clinic tax credit.
Section 122. Definitions.
The following words and phrases when used in this subchapter
shall have the meanings given to them in this section unless the
context clearly indicates otherwise:
"Business firm." An entity authorized to do business in this
Commonwealth and subject to taxes imposed under Article IV, VI,
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VII, VIII, IX or XV of the act of March 4, 1971 (P.L.6, No.2),
known as the Tax Reform Code of 1971.
"Contribution." A donation of cash or personal property by
the business firm to the Commonwealth.
"Department." Notwithstanding section 102, the Department of
Community and Economic Development of the Commonwealth.
Section 123. Establishment of program.
A community-based health care clinic tax credit program is
hereby established in order to fund the Community-Based Health
Care Provider Access (CHCPA) Program.
Section 124. Application.
(a) Application.--A business firm shall apply to the
department in a form and manner determined by the department for
a tax credit under section 125.
(b) Availability of tax credits.--Tax credits under this
subchapter shall be made available by the department on a first-
come, first-served basis within the limitations established
under section 126.
(c) Contributions.--A contribution shall be made no later
than 60 days following the approval of an application under
subsection (a).
Section 125. Tax credit.
(a) Grant.--The Department of Revenue shall grant a tax
credit against any tax due under Article IV, VI, VII, VIII, IX
or XV of the act of March 4, 1971 (P.L.6, No.2), known as the
Tax Reform Code of 1971, to a business firm that has applied
for, been approved for and made a contribution. In the taxable
year in which the contribution is made, the credit shall not
exceed 75% of the total amount contributed by the business firm.
The credit shall not exceed $100,000 annually per business firm.
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(b) Expense.--All money received from business firms in
accordance with this subchapter shall be expended solely for
community-based health care clinics pursuant to Subchapter A.
Section 126. Limitations.
(a) Amount.--The total aggregate amount of all tax credits
approved under this subchapter shall not exceed $5,000,000 in a
fiscal year.
(b) Activities.--No tax credit shall be approved for
activities that are a part of a business firm's normal course of
business.
(c) Tax liability.--A tax credit granted for any one taxable
year may not exceed the tax liability of a business firm.
(d) Use.--A tax credit not used in the taxable year the
contribution was made may not be carried forward or carried back
and is not refundable or transferable.
Section 127. Report.
(a) Delivery.--The department shall provide a report to the
chair and minority chair of the Appropriations Committee of the
Senate, 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 House of Representatives and
the chair and minority chair of the Health and Human Services
Committee of the House of Representatives.
(b) Substance.--The report shall include:
(1) The total amount of the tax credits awarded.
(2) The total amount of the contributions from all
business firms.
(3) The total number of additional persons served
through the program due to contributions from business firms,
by county.
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CHAPTER 51
MISCELLANEOUS PROVISIONS
Section 5101. Appropriations.
(a) Department of Health.--The sum of $35,000,000 from the
Community-Based Health Care Provider Access (CHCPA) Fund is
hereby appropriated to the Department of Health for the fiscal
year July 1, 2009, to June 30, 2010, to carry out the provisions
of Ch. 1 Subch. B, with the exception of funding under section
113.
(b) Department of Public Welfare.--The sum of $10,000,000
from the Community-Based Health Care Provider Access (CHCPA)
Fund is hereby appropriated to the Department of Public Welfare
for the fiscal year July 1, 2009, to June 30, 2010, to carry out
the provisions of Ch. 1 Subch. B and the funding of hospital
health clinics under section 113.
(c) Limitations on payments.--Payments to community-based
health care clinics for assistance under this act shall not
exceed the amount of funds available 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.
Section 5102. Effective date.
This act shall take effect in 90 days.
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