PRINTER'S NO. 2231
No. 1750 Session of 2001
INTRODUCED BY FRANKEL, MANDERINO, L. I. COHEN, RUBLEY,
C. WILLIAMS, BARD, BASTIAN, BEBKO-JONES, BELARDI, BELFANTI,
BISHOP, BLAUM, BROWNE, BUXTON, CAPPELLI, M. COHEN, COSTA,
CRUZ, DALEY, DERMODY, DIVEN, D. EVANS, FREEMAN, GEORGE,
GRUCELA, HARHAI, HERMAN, JAMES, KAISER, KENNEY, LaGROTTA,
LEDERER, LEVDANSKY, MACKERETH, MARKOSEK, BUNT, CALTAGIRONE,
CIVERA, CORRIGAN, COY, CURRY, DeLUCA, DeWEESE, EACHUS, FEESE,
GABIG, GORDNER, HALUSKA, HENNESSEY, HORSEY, JOSEPHS, KELLER,
KIRKLAND, LAUGHLIN, LESCOVITZ, LUCYK, MANN, MAYERNIK, McCALL,
McILHATTAN, MICHLOVIC, MYERS, OLIVER, PETRARCA, PISTELLA,
READSHAW, ROEBUCK, SAINATO, SANTONI, SCRIMENTI, SOLOBAY,
STEELMAN, STETLER, SURRA, THOMAS, TRAVAGLIO, TRICH, VITALI,
WANSACZ, WOJNAROSKI, McGILL, MELIO, MUNDY, O'BRIEN, PALLONE,
PETRONE, PRESTON, ROBINSON, ROSS, RUFFING, SAMUELSON, SATHER,
SHANER, STABACK, STERN, STURLA, TANGRETTI, TIGUE, TRELLO,
VEON, WALKO, WATSON, YOUNGBLOOD, YUDICHAK, E. Z. TAYLOR,
ROBERTS AND COLAFELLA, JUNE 14, 2001
REFERRED TO COMMITTEE ON HEALTH AND HUMAN SERVICES,
JUNE 14, 2001
AN ACT
1 Providing medical assistance to certain eligible individuals for
2 breast and cervical cancer treatment and follow-up care; and
3 providing for the powers and duties of the Department of
4 Public Welfare.
5 The General Assembly of the Commonwealth of Pennsylvania
6 hereby enacts as follows:
7 CHAPTER 1
8 PRELIMINARY PROVISIONS
9 Section 101. Short title.
10 This act shall be known and may be cited as the Breast and
11 Cervical Cancer Treatment Guarantee Act.
1 Section 102. Legislative findings.
2 The General Assembly finds and declares as follows:
3 (1) Breast cancer is the most commonly diagnosed cancer
4 in Pennsylvania among both women and the entire population
5 and is the second-leading cause of female cancer deaths in
6 Pennsylvania.
7 (2) Approximately 12,000 women, or an average of 33
8 women each day, were diagnosed with new cases of breast
9 cancer in this Commonwealth in 2000. This number represented
10 33% of all female cancer diagnoses in Pennsylvania.
11 (3) In 2000, at least 2,180 women, or an average of six
12 women each day, died from breast cancer.
13 (4) Approximately one of every ten women can expect to
14 develop breast cancer in her lifetime.
15 (5) More than 600 new cases of cervical cancer were
16 diagnosed in Pennsylvania women during the year 2000.
17 (6) Cervical cancer caused the death of over 200 women
18 in Pennsylvania during the year 2000.
19 (7) Periodic screening mammography in conjunction with
20 good health care and monthly self-examination can reduce a
21 woman's risk of dying from breast cancer by 30%.
22 (8) Early detection of breast cancer is the most
23 effective means to reduce breast and cervical cancer
24 mortality. The five-year survival rate for localized breast
25 cancer is greater than 96%.
26 (9) Breast and cervical mortality rates are
27 significantly greater among racial and ethnic minority groups
28 as well as in lower income areas.
29 (10) The Commonwealth currently provides free breast and
30 cervical cancer screening for uninsured and underinsured
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1 women, through the National Breast and Cervical Cancer Early
2 Detection Program of the Center for Disease Control.
3 (11) Numerous family planning, community health and
4 other nonprofit groups provide screening programs to
5 thousands of women throughout this Commonwealth for breast
6 and cervical cancer.
7 (12) More than 10% of women examined for breast and
8 cervical cancer will need further treatment.
9 (13) Although most women have access to necessary
10 screening examinations for breast and cervical cancer, many
11 women do not have adequate health care coverage or financial
12 resources to seek necessary treatment.
13 (14) Due to the passage of the Breast and Cervical
14 Cancer Mortality Prevention Act of 1990 (Public Law 101-354,
15 42 U.S.C. § 330k et seq.), the Federal Government guarantees
16 financial assistance to states, through enhanced Medicaid
17 matching funds, to provide necessary treatment for uninsured
18 and underinsured women.
19 Section 103. Purpose.
20 Pursuant to the Breast and Cervical Cancer Mortality
21 Prevention Act of 1990 (Public Law 101-354, 42 U.S.C. § 330k et
22 seq.), the Commonwealth has established a screening program
23 aimed at early detection of breast and cervical cancer in
24 uninsured and underinsured persons, operated by the Department
25 of Health under the approval of the National Breast and Cervical
26 Cancer Early Detection Program of the Center for Disease
27 Control. The program has discovered cancer in Pennsylvania
28 residents at a rate that exceeds the national average and
29 presents a serious threat to the general health and welfare of
30 this Commonwealth and all of its inhabitants. Furthermore, under
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1 the Breast and Cervical Cancer Mortality Prevention Act of 1990,
2 persons screened under the program who are deemed to be in need
3 of treatment for breast or cervical cancer and who do not have
4 other means of public or private coverage for such treatment are
5 eligible to receive Federal Medicaid and State medical
6 assistance benefits, under an enhanced match formula, for the
7 treatment of breast or cervical cancer. However, thousands of
8 uninsured and underinsured individuals are screened for and
9 often diagnosed with breast or cervical cancer by entities not
10 included in the program. Lack of guaranteed coverage for breast
11 or cervical cancer is a serious source of concern for people
12 faced with inadequate financial resources for necessary
13 treatment. The purpose of this act is to provide State Medical
14 Assistance funds, as well as Federal Medicaid funds for eligible
15 recipients authorized by the Breast and Cervical Cancer
16 Mortality Prevention Act of 1990, for treatment for uninsured
17 and underinsured individuals who have been diagnosed with breast
18 or cervical cancer, regardless of the screening entity.
19 Section 104. Definitions.
20 The following words and phrases when used in this act shall
21 have the meanings given to them in this section unless the
22 context clearly indicates otherwise:
23 "Department." The Department of Public Welfare of the
24 Commonwealth.
25 "Health care facility." A health care facility that provides
26 clinically related health services. The term includes, but is
27 not limited to, a general or special hospital, psychiatric
28 hospital, rehabilitation hospital, ambulatory surgical facility,
29 long-term care nursing facility, screening mammography facility,
30 cancer treatment center using radiation therapy on an ambulatory
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1 basis and an inpatient drug and alcohol treatment facility, both
2 profit and nonprofit, a hospice and any similar facility
3 operated by an ageny of State or local government. The term
4 shall not include an office used primarily for the private or
5 group practice by health care practitioners where no reviewable
6 clinically related health service is offered, a facility
7 providing treatment solely on the basis of prayer or spiritual
8 means in accordance with the tenets of any church or religious
9 denomination or a facility conducted by a religious organization
10 for the purpose of providing health care services exclusively to
11 clergy or other persons in a religious profession who are
12 members of the religious denominations conducting the facility.
13 "Health care provider." A licensed hospital or health care
14 facility, medical equipment supplier or person who is licensed,
15 certified or otherwise regulated to provide health care services
16 under the laws of this Commonwealth, including a physician,
17 podiatrist, optometrist, psychologist, physical therapist,
18 certified nurse practitioner, registered nurse, nurse midwife,
19 physician's assistant, chiropractor, dentist, pharmacist or an
20 individual accredited or certified to provide behavioral health
21 services.
22 "In need of treatment." An opinion of a physician who
23 conducts a screen or of a physician with whom a patient
24 consults, that deems the screen or subsequent diagnostic
25 evaluation as indicating that the patient is in need of further
26 treatment for breast or cervical cancer, including treatment for
27 a precancerous condition of the breast or cervix.
28 "Medical assistance." The State program of medical
29 assistance established under the act of June 13, 1967 (P.L.31,
30 No.21), known as the Public Welfare Code.
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1 "Patient." A natural person receiving health care in or from
2 a health care provider.
3 "Physician." A medical doctor or doctor of osteopathy
4 licensed under the laws of this Commonwealth to practice
5 medicine or surgery within the scope of the act of October 5,
6 1978 (P.L.1109, No.261), known as the Osteopathic Medical
7 Practice Act, or the act of December 20, 1985 (P.L.457, No.112),
8 known as the Medical Practice Act of 1985.
9 "Presumptive eligibility period." The period of eligibility
10 which:
11 (1) begins with the date on which a qualified entity
12 determines, on the basis of preliminary information, that the
13 family income of the individual does not exceed the maximum
14 income level of eligibility under Chapter 3 or 5; and
15 (2) ends on the earlier of:
16 (i) the day on which the Department of Public
17 Welfare makes a determination with respect to the
18 eligibility of the individual for medical assistance
19 under this act; or
20 (ii) the last day of the month following the month
21 during which the individual was determined to be
22 presumptively eligible.
23 "Program." The National Breast and Cervical Cancer Early
24 Detection Program of the Center for Disease Control established
25 under Title XV of the Public Health Services Act (58 Stat. 682,
26 42 U.S.C. § 201 et seq).
27 "Qualified entity." Any of the following:
28 (1) a physician;
29 (2) a hospital or other health care facility;
30 (3) an entity that:
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1 (i) is eligible to receive medical assistance
2 payments pursuant to this act; and
3 (ii) provides health care services covered under
4 this act; or
5 (4) an entity that is authorized by the Department of
6 Public Welfare to determine presumptive eligibility of an
7 individual seeking medical assistance pursuant to this act;
8 that is duly licensed, certified or otherwise regulated to
9 diagnose, treat, mitigate, cure or provide health care services
10 to a patient with cancer, under the laws of this Commonwealth.
11 "Screening mammography facility." An individual,
12 organization, facility, institution or part thereof, staffed and
13 equipped to provide screening mammography services.
14 "Screening mammography services." A radiologic procedure
15 furnished to an asymptomatic woman for the purpose of early
16 detection of breast cancer. The term includes a physician's
17 interpretation of the results of the procedure.
18 "Secretary." The Secretary of Public Welfare of the
19 Commonwealth.
20 CHAPTER 3
21 INDIVIDUALS SCREENED UNDER PROGRAM
22 Section 301. Establishment.
23 Any person meeting the criteria established under this
24 chapter shall be eligible to receive medical assistance for
25 treatment and follow-up care for diagnosed incidences of breast
26 cancer or cervical cancer.
27 Section 302. Eligibility.
28 In order to receive medical assistance for treatment and
29 follow-up care for diagnosed incidences of breast cancer or
30 cervical cancer, an individual must:
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1 (1) Not be otherwise eligible for medical assistance
2 under Article IV of the act of June 13, 1967 (P.L.31, No.21),
3 known as the Public Welfare Code.
4 (2) Have been screened for breast or cervical cancer
5 under the program.
6 (3) Be in need of treatment for breast or cervical
7 cancer, including treatment for a precancerous condition of
8 the breast or cervix.
9 (4) Not otherwise have access to creditable coverage for
10 needed treatment, as defined in section 2701(c) of the Public
11 Health Services Act (58 Stat. 682, 42 U.S.C. § 201 et seq).
12 (5) Not have attained 65 years of age.
13 (6) Have family income that does not exceed 300% of the
14 Federal poverty level, as established for that year by the
15 Department of Health and Human Services, for the same size
16 family.
17 Section 303. Limitation on eligibility.
18 Medical assistance made available to an individual under this
19 chapter shall be limited to the duration and scope of treatment
20 required for breast or cervical cancer. A patient may be
21 eligible to receive medical assistance under this act during
22 more than one noncontinuous period of time in each calendar
23 year, provided that the patient qualifies under the eligibility
24 criteria specified in section 302.
25 Section 304. Application for medical assistance.
26 An individual eligible to receive medical assistance under
27 this act must complete and submit an application, as established
28 in section 902, to the department by the last day of the month
29 following the month during which a determination of presumptive
30 eligibility was made or treatment begun. The department shall
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1 make a determination on the application within 30 days of
2 filing. If the time period set forth in this section is not met,
3 the application shall be deemed approved.
4 CHAPTER 5
5 OTHER INDIVIDUALS SCREENED FOR BREAST AND CERVICAL CANCER
6 Section 501. Establishment.
7 A person meeting the criteria established under this chapter
8 shall be eligible to receive medical assistance for treatment
9 and follow-up care for diagnosed incidences of breast cancer or
10 cervical cancer.
11 Section 502. Eligibility.
12 In order to receive medical assistance for treatment and
13 follow-up care for diagnosed incidences of breast cancer or
14 cervical cancer, a patient must:
15 (1) Not be otherwise eligible for medical assistance
16 under Article IV of the act of June 13, 1967 (P.L.31, No.21),
17 known as the Public Welfare Code.
18 (2) Have been screened for breast or cervical cancer by
19 a health care provider who is duly licensed, certified or
20 otherwise regulated to diagnose, treat, mitigate, cure or
21 provide health care services to a patient with cancer, under
22 the laws of this Commonwealth.
23 (3) Be in need of treatment for breast or cervical
24 cancer, including treatment for a precancerous condition of
25 the breast or cervix.
26 (4) Not otherwise have access to creditable coverage for
27 needed treatment, as defined in section 2701(c) of the Public
28 Health Services Act (58 Stat. 682, 42 U.S.C. § 201 et seq).
29 (5) Not have attained 65 years of age.
30 (6) Have family income that does not exceed 300% of the
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1 Federal poverty level, as established for that year by the
2 Department of Health and Human Services, for the same size
3 family.
4 Section 503. Limitation on eligibility.
5 Medical assistance made available to an individual under this
6 chapter shall be limited to the duration and scope of treatment
7 required for breast or cervical cancer. A patient may be
8 eligible to receive medical assistance under this act during
9 more than one noncontinuous period of time in each calendar
10 year, provided that the patient qualifies under the eligibility
11 criteria specified in section 502.
12 Section 504. Application for medical assistance.
13 An individual eligible to receive medical assistance under
14 this act must complete and submit an application, as established
15 in section 902, to the department no later than the last day of
16 the month following the month during which a determination of
17 presumptive eligibility was made, or treatment begun. The
18 department shall make a determination on the application within
19 30 days of filing. If the time period set forth in this section
20 is not met, the application shall be deemed approved.
21 CHAPTER 7
22 PRESUMPTIVE ELIGIBILITY
23 Section 701. Authorization to determine presumptive
24 eligibility.
25 A qualified entity may determine an individual to be eligible
26 for medical assistance under this act for a presumptive
27 eligibility period prior to a final determination of
28 eligibility, under section 302 or 502, from the department.
29 Section 702. Procedure.
30 A qualified entity that determines an individual to be
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1 presumptively eligible for medical assistance shall:
2 (1) Notify the department of the determination within
3 five working days after the date on which the determination
4 of presumptive eligibility is made.
5 (2) Inform the individual at the time a determination of
6 presumptive eligibility is made that such a determination is
7 only temporary and services may be discontinued unless the
8 individual completes and submits an application for medical
9 assistance, as established in section 902, no later than the
10 last day of the month following the month during which the
11 determination of presumptive eligibility was made.
12 Section 703. Limitations.
13 An individual shall be eligible for one presumptive
14 eligibility period during each 12-month period. If an individual
15 is determined to be presumptively eligible for medical
16 assistance under this act and subsequently determined not to be
17 eligible for medical assistance by the department, the
18 individual that was determined to be presumptively eligible for
19 medical assistance shall reimburse the department for all funds
20 expended by the department in paying for treatment during the
21 period of presumptive eligibility.
22 CHAPTER 9
23 RESPONSIBILITIES OF DEPARTMENT
24 Section 901. Federal Medicaid matching funds.
25 The department shall:
26 (1) Submit a State medical assistance plan amendment, as
27 well as any additional required documentation, to the Health
28 Care Financing Administration within 60 days of the effective
29 date of this act.
30 (2) Seek to maximize the receipt of Federal Medicaid
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1 matching funds authorized by the participation of eligible
2 individuals under this act.
3 Section 902. Application for medical assistance.
4 (a) Requirements.--A person applying for medical assistance
5 under this act shall be required to sign a statement setting
6 forth that person's family income and such other facts as may be
7 required by the department, in order to determine whether that
8 person is entitled to medical assistance. Every such applicant
9 shall make affidavit that the facts set forth in such statement
10 are true and correct. Every person employed in the
11 administration of medical assistance shall have power to
12 administer oaths for the purpose of carrying into effect the
13 provisions of this section. As a condition of eligibility for
14 medical assistance, all applicants and recipients shall
15 cooperate with the department in providing and verifying
16 information necessary for the department to determine initial or
17 continued eligibility in accordance with the provisions of this
18 act.
19 (b) Specific information.--An individual applying for
20 medical assistance pursuant to this act shall complete an
21 application, established by the secretary, containing such
22 information required to establish eligibility. The application
23 shall include, but not be limited to, the following information:
24 (1) Names of the individuals to receive aid.
25 (2) Birth date of the individual to receive aid.
26 (3) Social Security number of the individual to receive
27 aid or proof of application for such Social Security number.
28 (4) Place of residence for the individual to receive
29 aid.
30 (5) The family income of the individual to receive aid.
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1 Section 903. Report to General Assembly.
2 The department shall make an annual report to the General
3 Assembly on the implementation of this act.
4 Section 904. Rules and regulations.
5 The department shall be responsible for the administration of
6 this act and shall promulgate further rules and regulations
7 necessary to implement and enforce its provisions.
8 CHAPTER 11
9 MISCELLANEOUS PROVISIONS
10 Section 1101. Funding.
11 (a) Annual appropriation.--The General Assembly shall
12 include in the appropriation to the department in the General
13 Appropriation Act an annual appropriation from the General Fund
14 in an amount sufficient to provide medical assistance for the
15 purpose of providing coverage for the treatment of breast or
16 cervical cancer to uninsured and underinsured women pursuant to
17 this act.
18 (b) Federal Medicaid funding.--The department shall utilize
19 all Federal Medicaid funding received for the purpose of
20 carrying out the provisions of this act.
21 Section 1102. Repeals.
22 All acts and parts of acts are repealed insofar as they are
23 inconsistent with this act.
24 Section 1103. Effective date.
25 This act shall take effect in 60 days.
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