PRIOR PRINTER'S NO. 4404 PRINTER'S NO. 4559
No. 2856 Session of 2004
INTRODUCED BY MICOZZIE, GODSHALL, BAKER, BARRAR, BROWNE,
CAPPELLI, CRAHALLA, CURRY, DeWEESE, FAIRCHILD, FLEAGLE,
HARHAI, LAUGHLIN, McILHINNEY, S. MILLER, SOLOBAY, TRUE,
WATSON, YUDICHAK, DeLUCA, GEORGE, LEH, MANN, PICKETT,
GILLESPIE, HARPER, KILLION, STEIL, GINGRICH, ROHRER, BOYD,
HICKERNELL, WRIGHT, WALKO, BARD, YOUNGBLOOD, SAYLOR,
E. Z. TAYLOR, STABACK, McCALL AND MACKERETH,
SEPTEMBER 28, 2004
AS AMENDED ON THIRD CONSIDERATION, HOUSE OF REPRESENTATIVES,
OCTOBER 19, 2004
AN ACT
1 Amending the act of June 13, 1967 (P.L.31, No.21), entitled "An
2 act to consolidate, editorially revise, and codify the public
3 welfare laws of the Commonwealth," FURTHER PROVIDING FOR <--
4 MEDICAL ASSISTANCE REIMBURSEMENT; including podiatrists to
5 the health care providers retention program; FURTHER <--
6 PROVIDING FOR THE EXPIRATION OF THE HEALTH CARE PROVIDER
7 RETENTION PROGRAM; and making a related repeal.
8 The General Assembly of the Commonwealth of Pennsylvania
9 hereby enacts as follows:
10 Section 1. Section 1301-A of the act of June 13, 1967 <--
11 (P.L.31, No.21), known as the Public Welfare Code, added
12 December 23, 2003 (P.L.237, No.44), is amended to read:
13 Section 1301-A. Definitions.
14 The following words and phrases when used in this article
15 shall have the meanings given to them in this section unless the
16 context clearly indicates otherwise:
17 "Account." The Health Care Provider Retention Account
1 established in section 443.7.
2 "Applicant." A health care provider who resides in or
3 practices in this Commonwealth and who applies for an abatement
4 under section 1304-A[.] or section 1305.1-A.
5 "Assessment." The assessment imposed under section 712(d) of
6 the act of March 20, 2002 (P.L.154, No.13), known as the Medical
7 Care Availability and Reduction of Error (Mcare) Act.
8 "Emergency physician." A physician who is certified by the
9 American Board of Emergency Medicine and who is either employed
10 full time by a trauma center or is working under an exclusive
11 contract with a trauma center.
12 "Health care provider." An individual who is all of the
13 following:
14 (1) A physician, licensed podiatrist or certified nurse
15 midwife.
16 (2) A participating health care provider as defined in
17 section 702 of the act of March 20, 2002 (P.L.154, No.13),
18 known as the Medical Care Availability and Reduction of Error
19 (Mcare) Act.
20 "Mcare Act." The act of March 20, 2002 (P.L.154, No.13),
21 known as the Medical Care Availability and Reduction of Error
22 (Mcare) Act.
23 "Program." The Health Care Provider Retention Program
24 established in section 1302-A.
25 "Trauma center." A hospital accredited by the Pennsylvania
26 Trauma Systems Foundation as a Level I or Level II Trauma
27 Center.
28 Section 2. The act is amended by adding a section to read:
29 Section 1305.1-A. Podiatrist Assessment Abatement.
30 (a) Application.--A health care provider who is a licensed
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1 podiatrist may apply to the Insurance Department for an
2 assessment abatement for calendar years 2003 and 2004. The
3 application must be submitted by February 15, 2005, and be on a
4 form required by the Insurance Department. In addition to a
5 completed application, an applicant shall submit all of the
6 supporting information required under section 1304-A.
7 (b) Review.--Upon receipt of a completed application, the
8 Insurance Department shall review the submitted information. If
9 the applicant self-certifies as eligible under section 1303-A,
10 the Insurance Department shall notify the department which shall
11 grant a partial assessment abatement of 50% of the amount of the
12 assessment imposed on the applicant in calendar years 2003 and
13 2004, minus the assessment discount provided to the applicant
14 under section 712(e)(2) of the Mcare Act for those years.
15 (c) Other provisions.--All other provisions of this article
16 shall apply to abatement provided to licensed podiatrists as set
17 forth under this section.
18 Section 3. Section 712(e)(2) of the act of March 20, 2002
19 (P.L.154, No.13), known as the Medical Care Availability and
20 Reduction of Error (Mcare) Act, is repealed insofar as it
21 relates to licensed podiatrists.
22 Section 4. This act shall take effect immediately.
23 SECTION 1. SECTION 443.6 OF THE ACT OF JUNE 13, 1967 <--
24 (P.L.31, NO.21), KNOWN AS THE PUBLIC WELFARE CODE, AMENDED JUNE
25 16, 1994 (P.L.319, NO.49), IS AMENDED TO READ:
26 SECTION 443.6. REIMBURSEMENT FOR CERTAIN MEDICAL ASSISTANCE
27 ITEMS AND SERVICES.--(A) IN ORDER TO RECEIVE REIMBURSEMENT FOR
28 ITEMS OR SERVICES ENUMERATED IN SUBSECTION (B), THE PROVIDER
29 MUST SECURE AUTHORIZATION PRIOR TO ACTUALLY PROVIDING THE ITEMS
30 OR SERVICES. THE REQUEST FOR PRIOR AUTHORIZATION MUST JUSTIFY TO
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1 THE REASONABLE SATISFACTION OF THE DEPARTMENT THE NEED FOR AN
2 ITEM OR SERVICE.
3 (B) PAYMENT FOR THE FOLLOWING MEDICAL ASSISTANCE ITEMS AND
4 SERVICES SHALL BE MADE ONLY AFTER PRIOR AUTHORIZATION HAS BEEN
5 SECURED:
6 (1) PROSTHESES AND ORTHOSES.
7 (2) PURCHASE OF APPLIANCES OR EQUIPMENT [IF THE APPLIANCE OR
8 EQUIPMENT COSTS MORE THAN ONE HUNDRED DOLLARS ($100)] AS THE
9 DEPARTMENT MAY AUTHORIZE BY PUBLICATION OF NOTICE IN THE
10 PENNSYLVANIA BULLETIN.
11 (3) RENTAL OF MEDICAL APPLIANCES OR EQUIPMENT [FOR A PERIOD
12 IN EXCESS OF THREE MONTHS] AS THE DEPARTMENT MAY AUTHORIZE BY
13 PUBLICATION OF NOTICE IN THE PENNSYLVANIA BULLETIN.
14 (4) OXYGEN AND RELATED EQUIPMENT IN THE HOME UNLESS A
15 PHYSICIAN STATES THAT THE PHYSICAL SURROUNDINGS IN THE HOME ARE
16 SUITABLE FOR THE USE OF OXYGEN AND THAT THE RECIPIENT IS
17 ADEQUATELY PREPARED AND ABLE TO USE THE EQUIPMENT.
18 (5) DENTAL SERVICES AS THE DEPARTMENT MAY [PROVIDE,
19 INCLUDING BUT NOT NECESSARILY LIMITED TO, DENTAL PROSTHESES AND
20 APPLIANCES, EXTRACTIONS RELATED TO DENTAL PROSTHESES AND
21 APPLIANCES, AND OTHER EXTRACTIONS AS MAY BE PROVIDED BY
22 DEPARTMENT REGULATIONS] AUTHORIZE BY PUBLICATION OF NOTICE IN
23 THE PENNSYLVANIA BULLETIN.
24 (6) ORTHOPEDIC SHOES OR OTHER SUPPORTIVE DEVICES FOR THE
25 FEET WHEN SUCH SHOES OR DEVICES ARE PRESCRIBED BY A PHYSICIAN
26 FOR THE PURPOSE OF CORRECTING OR OTHERWISE TREATING
27 ABNORMALITIES OF THE FEET OR LEGS WHICH CAUSE SERIOUS
28 DETRIMENTAL MEDICAL EFFECTS.
29 (7) OTHER ITEMS OR SERVICES AS THE DEPARTMENT MAY AUTHORIZE
30 BY PUBLICATION OF NOTICE IN THE PENNSYLVANIA BULLETIN.
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1 (C) THE PRIOR AUTHORIZATION REQUIREMENTS SET FORTH IN THIS
2 SECTION SHALL BE APPLICABLE ONLY TO THE EXTENT THAT THE ITEMS
3 AND SERVICES ENUMERATED IN SUBSECTION (B) ARE PROVIDED UNDER THE
4 PENNSYLVANIA MEDICAL ASSISTANCE PLAN. THIS SECTION SHALL NOT BE
5 CONSTRUED AS MANDATING THE PROVISION OF ANY ITEM OR SERVICE
6 ENUMERATED IN THIS SECTION.
7 (D) THE REQUIREMENTS OF THIS SECTION SHALL NOT APPLY IN AN
8 EMERGENCY SITUATION.
9 (E) THE DEPARTMENT SHALL PROMULGATE REGULATIONS TO IMPLEMENT
10 THIS SECTION AND SHALL ESTABLISH A PROCEDURE FOR PRIOR
11 AUTHORIZATION. SUCH REGULATIONS MAY ESTABLISH PROCEDURES FOR
12 ISSUING PRIOR AUTHORIZATION AT WHATEVER ADMINISTRATIVE LEVEL THE
13 DEPARTMENT THROUGH THE SECRETARY DEEMS APPROPRIATE.
14 APPROPRIATENESS SHALL BE DETERMINED BY THE SECRETARY AFTER
15 HEARINGS HAVE BEEN HELD AND PUBLIC INPUT IS RECEIVED.
16 PROCEDURES ADOPTED IN ACCORDANCE WITH THIS SECTION SHALL PROVIDE
17 AUTHORIZATION WHEN APPROPRIATE, WITHOUT UNDUE DELAY. WHEN NO
18 DECISION IS MADE ON A REQUEST TO THE DEPARTMENT FOR COVERED
19 SERVICES WITHIN TWENTY-ONE DAYS OF THE DATE THAT THE REQUEST IS
20 RECEIVED BY THE DEPARTMENT, THE AUTHORIZATION SHALL BE DEEMED
21 APPROVED. THE DEPARTMENT SHALL KEEP A RECORD OF THOSE CASES IN
22 WHICH NO DECISION IS MADE WITHIN TWENTY-ONE DAYS. THE
23 REQUIREMENTS OF THIS SECTION SHALL NOT APPLY IN A MEDICAL
24 EMERGENCY SITUATION AS DEFINED BY THE DEPARTMENT.
25 (F) UNDER NO CIRCUMSTANCES SHALL THE DEPARTMENT REIMBURSE A
26 PROVIDER FOR ANY MEDICAL SERVICES, PROCEDURES OR DRUGS RELATED
27 TO INFERTILITY THERAPY.
28 SECTION 2. SECTIONS 1301-A AND 1302-A OF THE ACT, ADDED
29 DECEMBER 23, 2003 (P.L.237, NO.44), ARE AMENDED TO READ:
30 SECTION 1301-A. DEFINITIONS.
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1 THE FOLLOWING WORDS AND PHRASES WHEN USED IN THIS ARTICLE
2 SHALL HAVE THE MEANINGS GIVEN TO THEM IN THIS SECTION UNLESS THE
3 CONTEXT CLEARLY INDICATES OTHERWISE:
4 "ACCOUNT." THE HEALTH CARE PROVIDER RETENTION ACCOUNT
5 ESTABLISHED IN SECTION 443.7.
6 "APPLICANT." A HEALTH CARE PROVIDER WHO RESIDES IN OR
7 PRACTICES IN THIS COMMONWEALTH AND WHO APPLIES FOR AN ABATEMENT
8 UNDER SECTION 1304-A[.] OR SECTION 1305.1-A.
9 "ASSESSMENT." THE ASSESSMENT IMPOSED UNDER SECTION 712(D) OF
10 THE ACT OF MARCH 20, 2002 (P.L.154, NO.13), KNOWN AS THE MEDICAL
11 CARE AVAILABILITY AND REDUCTION OF ERROR (MCARE) ACT.
12 "EMERGENCY PHYSICIAN." A PHYSICIAN WHO IS CERTIFIED BY THE
13 AMERICAN BOARD OF EMERGENCY MEDICINE AND WHO IS EITHER EMPLOYED
14 FULL TIME BY A TRAUMA CENTER OR IS WORKING UNDER AN EXCLUSIVE
15 CONTRACT WITH A TRAUMA CENTER.
16 "HEALTH CARE PROVIDER." AN INDIVIDUAL WHO IS ALL OF THE
17 FOLLOWING:
18 (1) A PHYSICIAN, LICENSED PODIATRIST OR CERTIFIED NURSE
19 MIDWIFE.
20 (2) A PARTICIPATING HEALTH CARE PROVIDER AS DEFINED IN
21 SECTION 702 OF THE ACT OF MARCH 20, 2002 (P.L.154, NO.13),
22 KNOWN AS THE MEDICAL CARE AVAILABILITY AND REDUCTION OF ERROR
23 (MCARE) ACT.
24 "MCARE ACT." THE ACT OF MARCH 20, 2002 (P.L.154, NO.13),
25 KNOWN AS THE MEDICAL CARE AVAILABILITY AND REDUCTION OF ERROR
26 (MCARE) ACT.
27 "PROGRAM." THE HEALTH CARE PROVIDER RETENTION PROGRAM
28 ESTABLISHED IN SECTION 1302-A.
29 "TRAUMA CENTER." A HOSPITAL ACCREDITED BY THE PENNSYLVANIA
30 TRAUMA SYSTEMS FOUNDATION AS A LEVEL I OR LEVEL II TRAUMA
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1 CENTER.
2 SECTION 1302-A. ABATEMENT PROGRAM.
3 THERE IS HEREBY ESTABLISHED WITHIN THE INSURANCE DEPARTMENT A
4 PROGRAM TO BE KNOWN AS THE HEALTH CARE PROVIDER RETENTION
5 PROGRAM. THE INSURANCE DEPARTMENT, IN CONJUNCTION WITH THE
6 DEPARTMENT, SHALL ADMINISTER THE PROGRAM. THE PROGRAM SHALL
7 PROVIDE ASSISTANCE IN THE FORM OF ASSESSMENT ABATEMENTS TO
8 HEALTH CARE PROVIDERS FOR CALENDAR YEARS 2003 [AND], 2004, 2005
9 AND 2006.
10 SECTION 3. THE ACT IS AMENDED BY ADDING A SECTION TO READ:
11 SECTION 1305.1-A. PODIATRIST ASSESSMENT ABATEMENT.
12 (A) APPLICATION.--A HEALTH CARE PROVIDER WHO IS A LICENSED
13 PODIATRIST MAY APPLY TO THE INSURANCE DEPARTMENT FOR AN
14 ASSESSMENT ABATEMENT FOR CALENDAR YEARS 2003 AND 2004. THE
15 APPLICATION MUST BE SUBMITTED BY FEBRUARY 15, 2005, AND BE ON A
16 FORM REQUIRED BY THE INSURANCE DEPARTMENT. IN ADDITION TO A
17 COMPLETED APPLICATION, AN APPLICANT SHALL SUBMIT ALL OF THE
18 SUPPORTING INFORMATION REQUIRED UNDER SECTION 1304-A.
19 (B) REVIEW.--UPON RECEIPT OF A COMPLETED APPLICATION, THE
20 INSURANCE DEPARTMENT SHALL REVIEW THE SUBMITTED INFORMATION. IF
21 THE APPLICANT SELF-CERTIFIES AS ELIGIBLE UNDER SECTION 1303-A,
22 THE INSURANCE DEPARTMENT SHALL NOTIFY THE DEPARTMENT WHICH SHALL
23 GRANT A PARTIAL ASSESSMENT ABATEMENT OF 50% OF THE AMOUNT OF THE
24 ASSESSMENT IMPOSED ON THE APPLICANT IN CALENDAR YEARS 2003 AND
25 2004, MINUS THE ASSESSMENT DISCOUNT PROVIDED TO THE APPLICANT
26 UNDER SECTION 712(E)(2) OF THE MCARE ACT FOR THOSE YEARS.
27 (C) OTHER PROVISIONS.--ALL OTHER PROVISIONS OF THIS ARTICLE
28 SHALL APPLY TO ABATEMENT PROVIDED TO LICENSED PODIATRISTS AS SET
29 FORTH UNDER THIS SECTION.
30 SECTION 4. SECTION 1310-A OF THE ACT, ADDED DECEMBER 23,
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1 2003, (P.L.237, NO.44), IS AMENDED TO READ:
2 SECTION 1310-A. EXPIRATION.
3 THE HEALTH CARE PROVIDER RETENTION PROGRAM ESTABLISHED UNDER
4 THIS ARTICLE SHALL EXPIRE DECEMBER 31, [2005] 2007.
5 SECTION 5. SECTION 712(E)(2) OF THE ACT OF MARCH 20, 2002
6 (P.L.154, NO.13), KNOWN AS THE MEDICAL CARE AVAILABILITY AND
7 REDUCTION OF ERROR (MCARE) ACT, IS REPEALED INSOFAR AS IT
8 RELATES TO LICENSED PODIATRISTS.
9 SECTION 6. THIS ACT SHALL TAKE EFFECT IMMEDIATELY.
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