PRINTER'S NO.  2119

  

THE GENERAL ASSEMBLY OF PENNSYLVANIA

  

HOUSE BILL

 

No.

1678

Session of

2009

  

  

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

  

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

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"An act providing a comprehensive plan for health care for

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uninsured children; providing for medical education

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assistance; making appropriations; and making repeals,"

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making editorial changes.

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The General Assembly of the Commonwealth of Pennsylvania

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hereby enacts as follows:

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

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

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are amended to read:

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Section 103.  Definitions.

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The following words and phrases when used in this act shall

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have the meanings given to them in this section unless the

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context clearly indicates otherwise:

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

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for in section 701(d)].

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"Children's medical assistance."  Medical assistance services

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to children as required under Title 14 of the Social Security

 


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

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EPSDT services.

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"Council."  The Children's Health Advisory Council

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

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

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Company Law of 1921.

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"Department."  The Department of Public Welfare of the

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Commonwealth.

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"EPSDT."  Early and periodic screening, diagnosis and

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treatment.

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

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indigent children established by section 1296 of the act of

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

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1971.

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

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individual which is a result of an inherited trait.

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

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

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

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

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professional health services plan corporations); the act of May

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

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

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known as the Health Maintenance Organization Act.]

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

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written in this Commonwealth.

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

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organized and regulated under the act of December 29, 1972

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

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Act.

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"Health service corporation."  A professional health service

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

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definitions).

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"Hospital."  An institution having an organized medical staff

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which is engaged primarily in providing to inpatients, by or

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under the supervision of physicians, diagnostic and therapeutic

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

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or sick or mentally ill persons. The term includes facilities

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for the diagnosis and treatment of disorders within the scope of

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specific medical specialties. The term does not include

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facilities caring exclusively for the mentally ill.

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"Hospital plan corporation."  A hospital plan corporation as

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

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

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nonprofit hospital plan corporation, nonprofit professional

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health service plan, health maintenance organization, fraternal

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

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not governed and regulated under the Employee Retirement Income

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

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seq.).

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"MAAC."  The Medical Assistance Advisory Committee.

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"Managed care organization."  A health maintenance

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organization organized and regulated under the act of December

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

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Organization Act, or a risk-assuming preferred provider

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organization or exclusive provider organization, organized and

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

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as The Insurance Company Law of 1921.

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"Management team."  The Children's Health Insurance

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

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"MCH."  Maternal and Child Health.

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"Medical assistance."  The State program of medical

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

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

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"Medicaid."  The Federal medical assistance program

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established under Title XIX of the Social Security Act (Public

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

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

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certified registered nurse practitioner, nurse practitioner or a

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certified nurse midwife.

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

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guardian or custodian of a child.

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"PPO."  A preferred provider organization subject to the

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

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

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"Preexisting condition."  A disease or physical condition for

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which medical advice or treatment has been received prior to the

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effective date of coverage.

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

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"Spenddown."  A qualifying procedure for medical assistance

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

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

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

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multiple employer trust or to an association.

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"Terminate."  Includes cancellation, nonrenewal and

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rescission.

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

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of enrollment during which a health insurance plan excludes

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coverage for the diagnosis or treatment of one or more medical

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conditions.

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

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Infants and Children.

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Section 1304.  Primary health care grants program.

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

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of the Primary Health Care Practitioners Program provided for in

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this chapter, establish a program for awarding demonstration

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grants to promote the training, recruitment and retention of

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primary health care practitioners in designated medically

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underserved areas and to promote innovative methods for delivery

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of primary medical services in rural designated medically

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

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need not be limited to, the following:

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(1)  Promoting health care professions to high school

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students.

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(2)  Encouraging local communities in designated

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medically underserved areas to support primary health care

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practitioners.

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(3)  Promoting specific programs for the education,

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recruitment and retention of family practitioners,

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particularly in designated medically underserved areas.

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

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include challenge grants to medical schools to promote medical

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education opportunities for primary health care professionals

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and assistance to communities to establish clinics, including

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mobile health clinics. In establishing priorities, the

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department shall give preference to programs which promote

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coordination of existing resources, particularly in rural areas.

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

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