HB 51 — An Act amending the act of June 13, 1967 (P.L.31, No.21), known as the Human Services Code, in public assistance, providing for medical assistance deemed eligibility program for home care, home health and older adult daily living services.

PRIOR PRINTER'S NO.

62 PRINTER'STHE NO.GENERAL ASSEMBLY OF PENNSYLVANIA HOUSE BILL Session of No.

35751 THE2019 GENERALINTRODUCED ASSEMBLYBY OFBERNSTINE, PENNSYLVANIARYAN, HOUSEMcNEILL, BILLSCHLOSSBERG, SessionLONGIETTI, MENTZER, PICKETT, HILL-EVANS, WARREN, RAPP, MIZGORSKI, DeLISSIO, DeLUCA AND SOLOMON, JANUARY 28, 2019 REFERRED TO COMMITTEE ON HEALTH, JANUARY 28, 2019 AN ACT Amending the act of No.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 medical assistance deemed eligibility program center services.ome health and older adult daily living The General Assembly of the Commonwealth of Pennsylvania hereby enacts as follows:

51 2019 INTRODUCED BY BERNSTINE, RYAN, McNEILL, SCHLOSSBERG, LONGIETTI, DeLISSIO, DeLUCA, SOLOMON, KEEFER AND GAINEY,IZGORSKI, JANUARY 28, 2019 AS AS AMENDED, FEBRUARY 5, 2019EALTH, HOUSE OF REPRESENTATIVES, 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 medical assistance deemed eligibility program for home care, home health and older adult daily living center services.

<-- The General Assembly of the Commonwealth of Pennsylvania hereby enacts as follows:

Medical Assistance Deemed Eligibility Program for Home Care, Home Health and Older Adult Daily Living Center Services.--(a) The department shall establish a deemed <-- eligibility program for home care services, home health services and older adult daily living center services to prevent the <-- unnecessary and costly institutionalization of individuals who are eligible for medical assistance nursing facility services and want to receive home care and assistance with daily living in a less restrictive setting.

(1) be designed to provide home care services, home health services and older adult daily living center services only for <-- individuals who are sixty-five years of age or older and nursing facility clinically eligible;

(1) If a qualified entity determines that an individual is deemed eligible to receive medical assistance under subsection (b)(4), the individual may begin receiving home care services, home health services and older adult daily living center <-- services from a medical assistance provider as soon as a preliminary service plan is developed.

(2) If a qualified entity determines that an individual is deemed eligible under subsection (b)(4), and the individual is subsequently determined to be ineligible for home care services, home health services and older adult daily living center <-- 20190HB0051PN0357 - 2 - services by the department, the medical assistance provider 20190HB0051PN0062 - 2 - which provided home care services, home health services and older adult daily living center services under clause (1) shall <-- not be reimbursed by the Commonwealth for the cost of the home care services, home health services and older adult daily living center services provided during the period of deemed <-- eligibility.

If the individual provided fraudulent information under this section, the medical assistance provider may seek reimbursement from the individual for the cost of home care services, home health services and older adult daily living center services provided during the period of deemed <-- eligibility.

(3) Once the department makes a final determination of eligibility, the department shall authorize medical assistance payments for the first sixty days of home care services, home health services and older adult daily living center services <-- provided during the period of deemed eligibility following the date that the qualified entity established the preliminary service plan.

(e) The department shall issue a medical assistance bulletin which contains the Commonwealth policies and procedures 20190HB0051PN0357 - 3 - necessary to implement this section.

The publication of the 20190HB0051PN0062 - 3 - medical assistance bulletin under this subsection shall not delay the implementation of this section.

20190HB0051PN0357 - 4 - (i) The Legislative Budget and Finance Committee shall 20190HB0051PN0062 - 4 - conduct a study of the fiscal impact and effectiveness of the deemed eligibility program.

20190HB0051PN0357 - 5 - (v) 42 CFR 409.35 (relating to criteria for "practical 20190HB0051PN0062 - 5 - matter").

"Older adult daily living center services." Services <-- provided to assist an individual with activities of daily living and essential activities of daily living at an older adult daily living center as defined under 6 Pa.

SERVICES PROVIDED OR ARRANGED TO ASSIST IN MEETING <-- THE NEEDS, INCLUDING PERSONAL CARE, SOCIAL, NUTRITIONAL, HEALTH AND EDUCATIONAL NEEDS, OF CLIENTS THROUGH A PROGRAM OF SOCIAL, EDUCATIONAL, THERAPEUTIC, REHABILITATIVE, HABILITATIVE AND DEVELOPMENTAL ACTIVITIES.

THE TERM DOES NOT INCLUDE SERVICES PROVIDED FOR PERSONS WHOSE NEEDS CAN ONLY BE MET IN A LONG-TERM CARE FACILITY ON AN INPATIENT BASIS RECEIVING PROFESSIONALLY SUPERVISED NURSING CARE AND RELATED MEDICAL CARE AND OTHER HEALTH SERVICES.

"Qualified entity." A home care agency, home health agency, older adult daily living center or an organization authorized by the department which elects to determine the deemed eligibility of individuals to receive medical assistance under subsection 20190HB0051PN0357 - 6 - (b)(4).

(1) Except as set forth in paragraph (2), the addition of section 443.13 of the act shall take effect 30 days 20190HB0051PN0062 - 6 - following publication of the notice under section 2.

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