PRINTER'S NO. 2823
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No.
2402
Session of
2022
INTRODUCED BY GROVE, MARCH 16, 2022
REFERRED TO COMMITTEE ON HEALTH, MARCH 16, 2022
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 public assistance,
providing for hospital presumptive eligibility.
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 Human Services Code, is amended by adding a section to
read:
Section 443.13. Hospital Presumptive Eligibility.--(a) The
department shall request Federal approval from the Centers for
Medicare and Medicaid Services of the United States Department
of Health and Human Services for a demonstration waiver under
section 1115 of the Social Security Act (49 Stat. 620, 42 U.S.C.
§ 1315) to enable the department to eliminate mandatory hospital
presumptive eligibility and restrict presumptive eligibility
determinations to children and pregnant women eligibility
groups. If Federal approval for the waiver is denied, the
department shall resubmit a request for approval within twenty-
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four months of the original denial and each subsequent denial
thereafter.
(b) Unless required under Federal law, the department may
not designate itself as a qualified health entity for the
purpose of making presumptive eligibility determinations or for
any purpose not expressly authorized by State law.
(c) In making presumptive eligibility determinations, a
hospital shall:
(1) Notify the department of each presumptive eligibility
determination within five working days from the date that the
determination was made.
(2) Assist individuals determined to be presumptively
eligible with completing and submitting a full medical
assistance application form.
(3) Notify an applicant in writing and on all relevant forms
with plain language and large print that if the applicant does
not file a full medical assistance application with the
department before the last day of the following month,
presumptive eligibility coverage will end on that last day.
(4) Notify an applicant that if the applicant files a full
medical assistance application with the department before the
last day of the following month, presumptive eligibility
coverage will continue until an eligibility determination is
made on the application that was filed.
(d) The department shall use the following standards to
establish and ensure accurate presumptive eligibility
determinations made by each qualified hospital:
(1) Was the medical assistance presumptive eligibility card
received by the department within five working days from the
determination date?
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(2) Was a full medical assistance application received by
the department before the expiration of the presumptive
eligibility period?
(3) If a full medical assistance application was received,
was the individual found to be eligible for full medical
assistance coverage?
(e) The following apply to corrective action:
(1) The first time that a qualified hospital fails to meet
any of the standards established for any presumptive eligibility
determination that the hospital made, the department shall
notify the hospital in writing within five days from when the
standard was not met. The notice shall include:
(i) A description of the standard that was not met and an
explanation of why it was not met.
(ii) Confirmation that a second finding will require that
all applicable hospital staff participate in mandatory training
on hospital presumptive eligibility rules and regulations to be
conducted by the department.
(2) The second time that a qualified hospital fails to meet
any of the standards established for any presumptive eligibility
determination that the hospital made, within one year of the
first violation, the department shall notify the hospital in
writing within five days from when the standard was not met. The
notice shall include:
(i) A description of the standard that was not met and an
explanation of why it was not met.
(ii) Confirmation that all applicable hospital staff will be
required to participate in a mandatory training on hospital
presumptive eligibility rules and regulations to be conducted by
the department, including the date, time and location of the
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training as determined by the department.
(iii) A description of available appellate procedures by
which a qualified hospital may dispute the finding of failure
and remove the finding by providing clear and convincing
evidence that the standard was met.
(iv) Confirmation that if the hospital again fails to meet
the standards for presumptive eligibility for any determination,
the hospital will no longer be qualified to make presumptive
eligibility determinations.
(3) The third time that a qualified hospital fails to meet
any of the standards established for any presumptive eligibility
determination that the hospital made, within one year of the
second violation, the department shall notify the hospital in
writing within five days from when the standard was not met. The
notice shall include:
(i) A description of the standard that was not met and an
explanation of why it was not met.
(ii) A description of available appellate procedures by
which a qualified hospital may dispute the finding of failure
and remove the finding by providing clear and convincing
evidence that the standard was met.
(iii) Confirmation that, effective immediately, the hospital
is no longer qualified to make presumptive eligibility
determinations of any kind.
Section 2. This act shall take effect in 60 days.
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