PRIOR PRINTER'S NO. 2231 PRINTER'S NO. 3654
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, COLAFELLA, J. WILLIAMS AND HARPER, JUNE 14, 2001
AS REPORTED FROM COMMITTEE ON HEALTH AND HUMAN SERVICES, HOUSE
OF REPRESENTATIVES, AS AMENDED, APRIL 10, 2002
AN ACT
1 Providing medical assistance to certain eligible individuals <--
2 WOMEN for breast and cervical cancer treatment and follow-up <--
3 care; and providing for the powers and duties of the
4 Department of 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.) 2000 (PUBLIC LAW 106-354), the <--
16 Federal Government guarantees financial assistance to states,
17 through enhanced Medicaid matching funds, to provide
18 necessary treatment for uninsured 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 WOMEN are screened for <--
9 and often diagnosed with breast or cervical cancer by entities
10 not included in the program. Lack of guaranteed coverage for
11 breast or cervical cancer is a serious source of concern for
12 people 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 2000, for treatment for <--
17 uninsured and underinsured individuals WOMEN who have been <--
18 diagnosed with breast or cervical cancer, regardless of the
19 screening entity.
20 Section 104. Definitions.
21 The following words and phrases when used in this act shall
22 have the meanings given to them in this section unless the
23 context clearly indicates otherwise:
24 "Department." The Department of Public Welfare of the
25 Commonwealth.
26 "Health care facility." A health care facility that provides
27 clinically related health services. The term includes, but is
28 not limited to, a general or special hospital, psychiatric
29 hospital, rehabilitation hospital, ambulatory surgical facility,
30 long-term care nursing facility, screening mammography facility,
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1 cancer treatment center using radiation therapy on an ambulatory
2 basis and an inpatient drug and alcohol treatment facility, both
3 profit and nonprofit, a hospice and any similar facility
4 operated by an agency of State or local government. The term
5 shall not include an office used primarily for the private or
6 group practice by health care practitioners where no reviewable
7 clinically related health service is offered, a facility
8 providing treatment solely on the basis of prayer or spiritual
9 means in accordance with the tenets of any church or religious
10 denomination or a facility conducted by a religious organization
11 for the purpose of providing health care services exclusively to
12 clergy or other persons in a religious profession who are
13 members of the religious denominations conducting the facility.
14 "Health care provider." A licensed hospital or health care
15 facility, medical equipment supplier or person who is licensed,
16 certified or otherwise regulated to provide health care services
17 under the laws of this Commonwealth, including a physician,
18 podiatrist, optometrist, psychologist, physical therapist,
19 certified nurse practitioner, registered nurse, nurse midwife,
20 physician's assistant, chiropractor, dentist, pharmacist or an
21 individual accredited or certified to provide behavioral health
22 services.
23 "In need of treatment." An opinion of a physician who
24 conducts a screen or of a physician with whom a patient
25 consults, that deems the screen or subsequent diagnostic
26 evaluation as indicating that the patient is in need of further
27 treatment for breast or cervical cancer, including treatment for
28 a precancerous condition of the breast or cervix.
29 "Medical assistance." The State program of medical
30 assistance established under the act of June 13, 1967 (P.L.31,
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1 No.21), known as the Public Welfare Code.
2 "Patient." A natural person receiving health care in or from
3 a health care provider.
4 "Physician." A medical doctor or doctor of osteopathy
5 licensed under the laws of this Commonwealth to practice
6 medicine or surgery within the scope of the act of October 5,
7 1978 (P.L.1109, No.261), known as the Osteopathic Medical
8 Practice Act, or the act of December 20, 1985 (P.L.457, No.112),
9 known as the Medical Practice Act of 1985.
10 "Presumptive eligibility period." The period of eligibility
11 which:
12 (1) begins with the date on which a qualified entity
13 determines, on the basis of preliminary information, that the
14 family income of the individual WOMAN does not exceed the <--
15 maximum income level of eligibility under Chapter 3 or 5; and
16 (2) ends on the earlier of:
17 (i) the day on which the Department of Public
18 Welfare makes a determination with respect to the
19 eligibility of the individual WOMAN for medical <--
20 assistance under this act; or
21 (ii) the last day of the month following the month
22 during which the individual WOMAN was determined to be <--
23 presumptively eligible.
24 "Program." The National Breast and Cervical Cancer Early
25 Detection Program of the Center for Disease Control established
26 under Title XV of the Public Health Services Act (58 Stat. 682,
27 42 U.S.C. § 201 et seq.).
28 "Qualified entity." Any of the following:
29 (1) a physician;
30 (2) a hospital or other health care facility;
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1 (3) an entity that:
2 (i) is eligible to receive medical assistance
3 payments pursuant to this act; and
4 (ii) provides health care services covered under
5 this act; or
6 (4) an entity that is authorized by the Department of
7 Public Welfare to determine presumptive eligibility of an <--
8 individual A WOMAN seeking medical assistance pursuant to <--
9 this act;
10 that is duly licensed, certified or otherwise regulated to
11 diagnose, treat, mitigate, cure or provide health care services
12 to a patient with cancer, under the laws of this Commonwealth.
13 "Screening mammography facility." An individual,
14 organization, facility, institution or part thereof, staffed and
15 equipped to provide screening mammography services.
16 "Screening mammography services." A radiologic procedure
17 furnished to an asymptomatic woman for the purpose of early
18 detection of breast cancer. The term includes a physician's
19 interpretation of the results of the procedure.
20 "Secretary." The Secretary of Public Welfare of the
21 Commonwealth.
22 CHAPTER 3
23 INDIVIDUALS WOMEN SCREENED UNDER PROGRAM <--
24 Section 301. Establishment.
25 Any person meeting the criteria established under this
26 chapter shall be eligible to receive medical assistance for
27 treatment and follow-up care for diagnosed incidences of breast
28 cancer or cervical cancer.
29 Section 302. Eligibility.
30 In order to receive medical assistance for treatment and
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1 follow-up care for diagnosed incidences of breast cancer or
2 cervical cancer, an individual A WOMAN must: <--
3 (1) Not be BE UNINSURED AND NOT otherwise eligible for <--
4 medical assistance under Article IV of the act of June 13,
5 1967 (P.L.31, No.21), known as the Public Welfare Code.
6 (2) Have been screened for AND FOUND TO HAVE breast or <--
7 cervical cancer under the program.
8 (3) Be in need of treatment for breast or cervical <--
9 cancer, including treatment for a precancerous condition of
10 the breast or cervix.
11 (4) Not otherwise have access to creditable coverage for
12 needed treatment, as defined in section 2701(c) of the Public
13 Health Services Act (58 Stat. 682, 42 U.S.C. § 201 et seq.).
14 (5) Not have attained 65 years of age.
15 (6) Have family income that does not exceed 300% of the
16 Federal poverty level, as established for that year by the
17 Department of Health and Human Services, for the same size
18 family.
19 (3) NOT HAVE ATTAINED 65 YEARS OF AGE. <--
20 Section 303. Limitation on eligibility.
21 Medical assistance made available to an individual under this <--
22 chapter shall be limited to the duration and scope of treatment
23 required for breast or cervical cancer. A patient may be
24 eligible to receive medical assistance under this act during
25 more than one noncontinuous period of time in each calendar
26 year, provided that the patient qualifies under the eligibility
27 criteria specified in section 302.
28 Section 304. Application for medical assistance.
29 An individual A WOMAN eligible to receive medical assistance <--
30 under this act must complete and submit an application, as <--
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1 established in section 902, to the department by the last day of
2 the month following the month during which a determination of
3 presumptive eligibility was made or treatment begun. The <--
4 department shall make a determination on the application within
5 30 days of filing. If the time period set forth in this section
6 is not met, the application shall be deemed approved.
7 CHAPTER 5
8 OTHER INDIVIDUALS WOMEN SCREENED FOR BREAST <--
9 AND CERVICAL CANCER
10 Section 501. Establishment.
11 A person meeting the criteria established under this chapter
12 shall be eligible to receive medical assistance for treatment
13 and follow-up care for diagnosed incidences of breast cancer or
14 cervical cancer.
15 Section 502. Eligibility.
16 In order to receive medical assistance for treatment and
17 follow-up care for diagnosed incidences of breast cancer or
18 cervical cancer, a patient must:
19 (1) Not be BE UNINSURED AND NOT otherwise eligible for <--
20 medical assistance under Article IV of the act of June 13,
21 1967 (P.L.31, No.21), known as the Public Welfare Code.
22 (2) Have been screened for AND FOUND TO HAVE breast or <--
23 cervical cancer by a health care provider who is duly
24 licensed, certified or otherwise regulated to diagnose,
25 treat, mitigate, cure or provide health care services to a
26 patient with cancer, under the laws of this Commonwealth.
27 (3) Be in need of treatment for breast or cervical <--
28 cancer, including treatment for a precancerous condition of
29 the breast or cervix.
30 (4) Not otherwise have access to creditable coverage for
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1 needed treatment, as defined in section 2701(c) of the Public
2 Health Services Act (58 Stat. 682, 42 U.S.C. § 201 et seq.).
3 (5) (3) Not have attained 65 years of age.
4 (6) (4) Have family income that does not exceed 300% <--
5 250% of the Federal poverty level, as established for that
6 year by the Department of Health and Human Services, for the
7 same size family.
8 Section 503. Limitation on eligibility.
9 Medical assistance made available to an individual A WOMAN <--
10 under this chapter shall be limited to the duration and scope of
11 treatment required for breast or cervical cancer. A patient may
12 be eligible to receive medical assistance under this act during
13 more than one noncontinuous period of time in each calendar
14 year, provided that the patient qualifies under the eligibility
15 criteria specified in section 502.
16 Section 504. Application for medical assistance.
17 An individual A WOMAN eligible to receive medical assistance <--
18 under this act must complete and submit an application, as <--
19 established in section 902, to the department no later than the
20 last day of the month following the month during which a
21 determination of presumptive eligibility was made, or treatment <--
22 begun. The department shall make a determination on the
23 application within 30 days of filing. If the time period set
24 forth in this section is not met, the application shall be
25 deemed approved.
26 CHAPTER 7
27 PRESUMPTIVE ELIGIBILITY
28 Section 701. Authorization to determine presumptive
29 eligibility.
30 A qualified entity may determine an individual A WOMAN to be <--
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1 eligible for medical assistance under this act for a presumptive
2 eligibility period prior to a final determination of
3 eligibility, under section 302 or 502, from the department.
4 Section 702. Procedure.
5 A qualified entity that determines an individual A WOMAN to <--
6 be presumptively eligible for medical assistance shall:
7 (1) Notify the department of the determination within
8 five working days after the date on which the determination
9 of presumptive eligibility is made.
10 (2) Inform the individual WOMAN at the time a <--
11 determination of presumptive eligibility is made that such a
12 determination is only temporary and services may be
13 discontinued unless the individual WOMAN completes and <--
14 submits an application for medical assistance, as established <--
15 in section 902, no later than the last day of the month
16 following the month during which the determination of
17 presumptive eligibility was made.
18 Section 703. Limitations. <--
19 An individual shall be eligible for one presumptive
20 eligibility period during each 12-month period. If an individual
21 is determined to be presumptively eligible for medical
22 assistance under this act and subsequently determined not to be
23 eligible for medical assistance by the department, the
24 individual that was determined to be presumptively eligible for
25 medical assistance shall reimburse the department for all funds
26 expended by the department in paying for treatment during the
27 period of presumptive eligibility.
28 CHAPTER 9
29 RESPONSIBILITIES OF DEPARTMENT
30 Section 901. Federal Medicaid matching funds.
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1 The department shall:
2 (1) Submit a State medical assistance plan amendment, as
3 well as any additional required documentation, to the Health
4 Care Financing Administration within 60 days of the effective
5 date of this act.
6 (2) Seek to maximize the receipt of Federal Medicaid
7 matching funds authorized by the participation of eligible
8 individuals WOMEN under this act. <--
9 Section 902. Application for medical assistance. <--
10 (a) Requirements.--A person applying for medical assistance
11 under this act shall be required to sign a statement setting
12 forth that person's family income and such other facts as may be
13 required by the department, in order to determine whether that
14 person is entitled to medical assistance. Every such applicant
15 shall make affidavit that the facts set forth in such statement
16 are true and correct. Every person employed in the
17 administration of medical assistance shall have power to
18 administer oaths for the purpose of carrying into effect the
19 provisions of this section. As a condition of eligibility for
20 medical assistance, all applicants and recipients shall
21 cooperate with the department in providing and verifying
22 information necessary for the department to determine initial or
23 continued eligibility in accordance with the provisions of this
24 act.
25 (b) Specific information.--An individual applying for
26 medical assistance pursuant to this act shall complete an
27 application, established by the secretary, containing such
28 information required to establish eligibility. The application
29 shall include, but not be limited to, the following information:
30 (1) Names of the individuals to receive aid.
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1 (2) Birth date of the individual to receive aid.
2 (3) Social Security number of the individual to receive
3 aid or proof of application for such Social Security number.
4 (4) Place of residence for the individual to receive
5 aid.
6 (5) The family income of the individual to receive aid.
7 Section 903 902. Report to General Assembly. <--
8 The department shall make an annual report to the General
9 Assembly on the implementation of this act.
10 Section 904 903. Rules and regulations. <--
11 The department shall be responsible for the administration of
12 this act and shall promulgate further rules and regulations
13 necessary to implement and enforce its provisions.
14 CHAPTER 11
15 MISCELLANEOUS PROVISIONS
16 Section 1101. Funding.
17 (a) Annual appropriation.--The General Assembly shall
18 include in the appropriation to the department in the General
19 Appropriation Act an annual appropriation from the General Fund
20 in an amount sufficient to provide medical assistance for the
21 purpose of providing coverage for the treatment of breast or
22 cervical cancer to uninsured and underinsured women pursuant to
23 this act.
24 (b) Federal Medicaid funding.--The department shall utilize
25 all Federal Medicaid funding received for the purpose of
26 carrying out the provisions of this act.
27 Section 1102. Repeals.
28 All acts and parts of acts are repealed insofar as they are
29 inconsistent with this act.
30 Section 1103. Effective date.
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1 This act shall take effect in 60 days.
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