Pennsylvania Act 2023-15 — HUMAN SERVICES CODE - OMNIBUS AMENDMENTS

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HUMAN SERVICES CODE - OMNIBUS AMENDMENTS
Act of Oct. 23, 2023, P.L. 63, No. 15Cl. 57

Session of 2023

No. 2023-15

HB 1351

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, further providing for medical assistance payments for institutional care and providing for emergency transportation services and for case-mix rates for nursing facilities; in Statewide quality care assessment, further providing for definitions, for implementation, for administration, for restricted account and for expiration; continuing the Pennsylvania Rural Health Redesign Center Authority and the Pennsylvania Rural Health Redesign Center Fund; and making a repeal.

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

Section 1. Section 443.1(1.1)(i) of the act of June 13, 1967 (P.L.31, No.21), known as the Human Services Code, is amended to read:

Section 443.1. Medical Assistance Payments for Institutional Care.--The following medical assistance payments shall be made on behalf of eligible persons whose institutional care is prescribed by physicians:

(1.1) Subject to section 813-G, for inpatient hospital services provided during a fiscal year in which an assessment is imposed under Article VIII-G, payments under the medical assistance fee-for-service program shall be determined in accordance with the department's regulations, except as follows:

(i) If the Commonwealth's approved Title XIX State Plan for inpatient hospital services in effect for the period of July 1, 2010, through June 30, [2023] 2028 , specifies a methodology for calculating payments that is different from the department's regulations or authorizes additional payments not specified in the department's regulations, such as inpatient disproportionate share payments and direct medical education payments, the department shall follow the methodology or make the additional payments as specified in the approved Title XIX State Plan.

Section 2. The act is amended by adding sections to read:

Section 443.13. Emergency Transportation Services.--S ubject to Federal approval as may be necessary and contingent on Federal financial participation, from money appropriated for the department under the act of August 3, 2023 (P.L.471, No.1A), known as the General Appropriation Act of 2023, sufficient funds shall be included to provide reimbursement for ground mileage for every loaded mile and to provide the greater of the highest Medicare rates published in the Ambulance Fee Schedule Public Use File for calendar year 2023 or the current Medicaid Ambulance Fees as updated by Medical Assistance Bulletin 26-22-07 effective date January 1, 2023, beginning January 1, 2024, for services provided under the Medical Assistance - Fee-for-Service, Medical Assistance - Capitation and Medical Assistance - Community HealthChoices appropriations in the General Appropriation Act of 2023.

Section 454.1. Case-Mix Rates for Nursing Facilities.--(a) From money appropriated for medical assistance long-term living under the act of August 3, 2023 (P.L.471, No.1A), known as the General Appropriation Act of 2023, for fiscal year 2023-2024, the department shall calculate each nursing facility's case-mix rate based on the cost database and peer group prices for each net operating cost center used in the calculation of each nursing facility's case-mix for fiscal year 2022-2023. Each nursing facility's case-mix rate shall be adjusted quarterly in accordance with 55 Pa. Code § 1187.96(a)(5) (relating to price- and rate-setting computations).

(b) From money appropriated for medical assistance Community HealthChoices under the General Appropriation Act of 2023, for fiscal year 2023-2024, the department shall calculate each nursing facility's case-mix rate based on the cost database and peer group prices for each net operating cost center used in the calculation of each nursing facility's case-mix for fiscal year 2022-2023. Each nursing facility's case-mix rate shall be adjusted quarterly in accordance with 55 Pa. Code § 1187.96(a)(5).

Section 3. The definitions of "net inpatient revenue" and "net outpatient revenue" in section 801-G of the act are amended to read:

Section 801-G. Definitions.

The following words and phrases when used in this article shall have the meanings given to them in this section unless the context clearly indicates otherwise:

"Net inpatient revenue." Gross revenues received or earned by a hospital for inpatient services, including medical assistance supplemental revenues received by the hospital for inpatient hospital services, less any deducted amounts for bad debt expense, charity care expense and contractual allowances as identified in the hospital's records and reported on forms specified by the department . [for:

(1) the State fiscal year commencing July 1, 2014, or such later State fiscal year, as may be specified by the department for use in determining an annual assessment amount owed on or after July 1, 2018; or

(2) the most recent State fiscal year, or part thereof, if amounts are not available under paragraph (1).]

"Net outpatient revenue." Gross revenues received or earned by a hospital for outpatient services, including medical assistance supplemental revenues received by the hospital for outpatient hospital services, less any deducted amounts for bad debt expense, charity care expense and contractual allowances as identified in the hospital's records and reported on forms specified by the department . [for:

(1) the State fiscal year commencing July 1, 2014, or a later State fiscal year, as may be specified by the department for use in determining an annual assessment amount owed on or after July 1, 2018; or

(2) the most recent State fiscal year, or part thereof, if amounts are not available under paragraph (1).]

Section 4. Section 803-G(b)(4) and (5) and (c.2) of the act are amended, subsection (b) is amended by adding paragraphs and the section is amended by adding a subsection to read:

Section 803-G. Implementation.

(b) Assessment percentage.--Subject to subsection (c), each covered hospital shall be assessed as follows:

(4) for fiscal year 2018-2019, an amount equal to 2.98% of the net inpatient revenue of the covered hospital and 1.55% of the net outpatient revenue of the covered hospital; [and]

(5) for fiscal years 2019-2020, 2020-2021, 2021-2022 and 2022-2023, an amount equal to 3.32% of the net inpatient revenue of the covered hospital and 1.73% of the net outpatient revenue of the covered hospital[.] ;

(6) for fiscal year 2023-2024, an amount equal to 3.54% of the net inpatient revenue of the covered hospital and 1.78% of the net outpatient revenue of the covered hospital; and

(7) for fiscal years 2024-2025, 2025-2026, 2026-2027 and 2027-2028, an amount equal to 4.36% of the net inpatient revenue of the covered hospital and 2.20% of the net outpatient revenue of the covered hospital.

(c.2) Rebasing net inpatient revenue and net outpatient revenue amounts on amounts owed for fiscal years prior to 2023-2024 .--For purposes of calculating the annual assessment amount owed [on or after July 1, 2018,] for fiscal years 2018-2019, 2019-2020, 2020-2021, 2021-2022 and 2022-2023, the secretary may require the use of net inpatient revenue and net outpatient revenue amounts as identified in the records of covered hospitals for a State fiscal year commencing on or after July 1, 2015. If the secretary decides that the net inpatient and net outpatient revenue amounts should be based on a State fiscal year commencing on or after July 1, 2015, the secretary shall transmit a notice to the Legislative Reference Bureau for publication in the Pennsylvania Bulletin specifying the State fiscal year for which the net inpatient and net outpatient revenue amounts will be used at least 30 days prior to the date on which an assessment amount calculated with the rebased amounts is due to be paid to the department.

(c.3) Rebasing net inpatient revenue and net outpatient revenue amounts on amounts owed for fiscal year 2023-2024 and thereafter.--For purposes of calculating the annual assessment amount owed on or after July 1, 2023, the secretary may require the use of net inpatient revenue and net outpatient revenue amounts as identified in the records of covered hospitals for a State fiscal year commencing on or after July 1, 2018. If the secretary decides that the net inpatient and net outpatient revenue amounts should be based on a State fiscal year commencing on or after July 1, 2019, the secretary shall transmit a notice to the Legislative Reference Bureau for publication in the next available issue of the Pennsylvania Bulletin specifying the State fiscal year for which the net inpatient revenue and net outpatient revenue amounts will be used at least 30 days prior to the date on which an assessment amount calculated with the rebased amounts is due to be paid to the department.

Section 5. Section 804-G(a), (a.1) and (a.3) of the act are amended to read:

Section 804-G. Administration.

(a) Calculation and notice of assessment amount.--Using the assessment percentage established under section 803-G and covered hospitals' [net inpatient revenue for fiscal years commencing prior to July 1, 2018, or covered hospitals' net inpatient revenue and net outpatient revenue for fiscal years commencing on or after July 1, 2018] net inpatient revenue and net outpatient revenue , the department shall calculate and notify each covered hospital of the assessment amount owed for the fiscal year. Notification pursuant to this subsection may be made in writing or electronically at the discretion of the department.

(a.1) Calculation of assessment with changes of ownership.--

(1) If a single covered hospital changes ownership or control, the department will [continue to calculate the assessment amount using] calculate the assessment as follows :

(i) [the hospital's net inpatient revenue for State fiscal year 2010-2011 if the change of ownership occurs before July 1, 2018;] if the change of ownership occurs before July 1, 2018, the department shall calculate the assessment using the hospital's net inpatient revenue and net outpatient revenue amounts for State fiscal year 2018-2019, or a later fiscal year that has been specified by the secretary in accordance with section 803-G(c.3);

(ii) if the change of ownership occurs on or after July 1, 2018, the department shall calculate the assessment using the hospital's net inpatient revenue and net outpatient revenue amounts for State fiscal year [2014-2015] 2018-2019 , or a later fiscal year that has been specified by the secretary [for use in determining the assessment amounts due for the fiscal year in which the change occurs, if the change of ownership occurs on or after July 1, 2018] in accordance with section 803- G(c.3) ; or

(iii) [the hospital's net inpatient revenue and net outpatient revenue amounts for the most recent State fiscal year, or part thereof, if the net inpatient revenue and net outpatient revenue amounts specified in subparagraph (ii) is not available.] if the net inpatient revenue and net outpatient revenue amounts for the State fiscal year 2018-2019, or a later fiscal year that has been specified by the secretary in accordance with section 803-G(c.3), are unavailable due to a covered hospital's establishment as a new hospital under subsection (a.3), the department will calculate the assessment using the hospital's net inpatient revenue and net outpatient revenue amounts under subsection (a.3).

(1.1) The covered hospital is liable for any outstanding assessment amounts, including outstanding amounts related to periods prior to the change of ownership or control.

(2) If two or more hospitals merge or consolidate into a single covered hospital as a result of a change in ownership or control, the department will calculate the assessment amount owed by the single covered hospital resulting from the merger or consolidation [using] as follows :

(i) [the merged or consolidated hospitals' combined net inpatient revenue for State fiscal year 2010-2011 if the merger or consolidation occurs before July 1, 2018;] if the merger or consolidation occurs before July 1, 2018, the department shall calculate the assessment using the merged or consolidated hospitals' combined net inpatient revenue and net outpatient revenue amounts for State fiscal year 2018-2019 or a later fiscal year that has been specified by the secretary in accordance with section 803-G(c.3);

(ii) if the merger or consolidation occurs on or after July 1, 2018, the department shall calculate the assessment using the merged or consolidated hospitals' combined net inpatient revenue and net outpatient revenue amounts for State fiscal year [2014-2015] 2018-2019 or a later fiscal year that has been specified by the secretary [for use in determining the assessment amounts due for the fiscal year in which the merger or consolidation occurs, if the merger or consolidation occurs on or after July 1, 2018] in accordance with section 803-G(c.3) ; or

(iii) [the hospital's net inpatient revenue and net outpatient revenue amounts for the most recent State fiscal year, or part thereof, if the net inpatient revenue and net outpatient revenue amounts specified in subparagraph (ii) is not available, for any covered hospitals that were merged or consolidated into the single covered hospital.] if one or more hospitals' net inpatient revenue and net outpatient revenue amounts for the State fiscal year 2018-2019, or a later fiscal year that has been specified by the secretary in accordance with section 803-G(c.3), is unavailable due to the hospital's establishment as a new hospital under subsection (a.3), the following apply:

(A) The department shall calculate the assessment using the new hospital's net inpatient revenue and net outpatient revenue amounts under subsection (a.3).

(B) For a hospital that is not a new hospital, the department shall calculate the hospital's net inpatient revenue and net outpatient revenue amounts for State fiscal year 2018-2019 or a later fiscal year that has been specified by the secretary in accordance with section 803-G(c.3).

(C) The department shall combine the amount calculated under clause (A) with the amount calculated under clause (B) to determine the combined net inpatient revenue and net outpatient revenue amounts for the merged or consolidated hospitals.

(3) The single covered hospital is liable for any outstanding assessment amounts, including outstanding amounts related to periods prior to the change of ownership or control, of any covered hospital that was merged or consolidated.

(a.3) Calculation of assessment for new hospitals.--A hospital that begins operation as a covered hospital [during a fiscal year in which an assessment is in effect] after July 1, 2018, shall be assessed as follows:

(1) During the State fiscal year in which a covered hospital begins operation or in which a hospital becomes a covered hospital, the covered hospital is not subject to the assessment.

(2) For the State fiscal year following the State fiscal year under paragraph (1), the department shall calculate the hospital's assessment amount using[:

(i) the net inpatient revenue from the State fiscal year in which the covered hospital began operation or became a covered hospital if the covered hospital began operation or became a covered hospital prior to July 1, 2018; or

(ii) using the net inpatient revenue and net outpatient revenue from the State fiscal year in which the covered hospital began operation or became a covered hospital if the covered hospital began operation or became a covered hospital on or after July 1, 2018.] the net inpatient revenue and net outpatient revenue from the State fiscal year in which the covered hospital began operation or became a covered hospital through the end of the State fiscal year.

(3) [For the State fiscal years following the first full State fiscal year under paragraph (2) but ending prior to July 1, 2018, the department shall calculate the hospital's assessment amount using the net inpatient revenue from the prior State fiscal year.] For the State fiscal [years] year following the first full State fiscal year under paragraph (2) [commencing on or after July 1, 2018], the department shall calculate the hospital's assessment amount using the net inpatient and net outpatient revenue from the prior State fiscal year. For subsequent State fiscal years, the department shall use the net inpatient revenue and net outpatient revenue calculated under this paragraph or a later fiscal year that has been specified by the secretary in accordance with section 803-G(c.3).

(4) If estimated net inpatient revenue and net outpatient revenue is used in calculating a covered hospital's assessment under this subsection, the department shall reconcile any amounts received based on reported actual net inpatient revenues and net outpatient revenues.

Section 6. Section 805-G(a)(2) and (b)(5) of the act are amended and subsection (b) is amended by adding paragraphs to read:

Section 805-G. Restricted account.

(a) Establishment.--There is established a restricted account, known as the Quality Care Assessment Account, in the General Fund for the receipt and deposit of revenues collected under this article. Funds in the account are appropriated to the department for the following:

(2) Making [adjusted capitation] payments to medical assistance managed care organizations for additional payments for inpatient hospital services in accordance with section 443.1(1.2), (1.3) and (1.4) and outpatient services.

(b) Limitations.--

(4.5) For State fiscal year 2023-2024, the amount used for the medical assistance payment for hospitals and medical assistance managed care organizations may not exceed the aggregate amount of the assessment funds collected for the year less $368,000,000.

(4.6) For State fiscal years 2024-2025, 2025-2026, 2026-2027 and 2027-2028, the amount used for the medical assistance payment for hospitals and medical assistance managed care organizations may not exceed the aggregate amount of the assessment funds collected for the year less $452,000,000.

(5) The amounts retained by the department pursuant to paragraphs (1), (2), (4), (4.1), (4.2), (4.3) [and] , (4.4) , (4.5) and (4.6) and any additional amounts remaining in the restricted accounts after the payments described in subsection (a)(1) and (2) are made shall be used for purposes approved by the secretary under subsection (a)(3), subject to paragraph (7).

Section 7. Section 815-G of the act is amended to read:

Section 815-G. Expiration.

The assessment under this article shall expire June 30, [2023] 2028 .

Section 8. The act is amended by adding an article to read:

ARTICLE XIV-D

PENNSYLVANIA RURAL HEALTH REDESIGN

CENTER AUTHORITY

SUBARTICLE A

PRELIMINARY PROVISIONS

Section 1401-D. Scope of article.

This article relates to the Pennsylvania Rural Health Redesign Center Authority.

Section 1402-D. Purpose.

It is the purpose of this article to protect and promote access by the residents of this Commonwealth to high-quality health care in rural communities by encouraging innovation in health care delivery.

Section 1403-D. Definitions.

The following words and phrases when used in this article shall have the meanings given to them in this section unless the context clearly indicates otherwise:

"Acute care hospital." A facility that provides inpatient and outpatient services, which may include an emergency department or intensive care unit.

"Authority." The Pennsylvania Rural Health Redesign Center Authority continued in section 1411-D.

"Board." The governing body of the authority.

"Conflict of interest." A situation in which a board member:

(1) Has an interest in one or more parties involved in an action under section 1412-D.

(2) May gain access to competitively sensitive or strategically relevant information about a participating payer or participant rural hospital.

"Critical access hospital." As defined in 42 U.S.C. § 1395x(mm)(1) (relating to definitions).

"Eligible hospital services." All inpatient and hospital-based outpatient items and services. The term shall exclude all other items and services, including the following:

(1) Postacute care.

(2) Professional services.

(3) Durable medical equipment.

(4) Dental services.

(5) Noninpatient or non-hospital-based outpatient behavioral health services.

(6) Long-term care services, except for swing bed services for critical access hospitals.

"Fund." The Pennsylvania Rural Health Redesign Center Fund continued in section 1441-D.

"Global budget." The prospectively set annual budget that is the basis for payment for each participant rural hospital for eligible hospital services by participating payers.

"Global budget model." An innovative payment and service delivery model that is intended to reduce health care costs while maintaining access to care, improving the quality of care in rural counties and meeting the health needs of participant rural hospitals' local communities, and under which participating payers pay participant rural hospitals using a global budget methodology established by the authority.

"Government program." A health benefit plan offered or administered by or on behalf of the United States or the Commonwealth or an agency or instrumentality of either, including:

(1) The medical assistance program.

(2) The children's health insurance program established under Article XXIII-A of the act of May 17, 1921 (P.L.682, No.284), known as The Insurance Company Law of 1921.

(3) A health benefit plan offered or administered by or on behalf of the Commonwealth or an agency or instrumentality of the Commonwealth.

(4) Health care benefits administered under 10 U.S.C. (relating to armed forces) or 38 U.S.C. (relating to veterans' benefits).

(5) The Medicare program established under 42 U.S.C. Ch. 7 Subch. XVIII (relating to health insurance for aged and disabled).

"Insurer." A person, corporation or other entity licensed by the Commonwealth with authority to offer, issue or renew an insurance policy, subscriber contract or certificate providing health care coverage, including:

(1) An insurance company, association or exchange governed by The Insurance Company Law of 1921, including section 630 and Article XXIV of The Insurance Company Law of 1921.

(2) A health maintenance organization governed by the act of December 29, 1972 (P.L.1701, No.364), known as the Health Maintenance Organization Act.

(3) A hospital plan corporation as defined in 40 Pa.C.S. Ch. 61 (relating to hospital plan corporations).

(4) A professional health service corporation as defined in 40 Pa.C.S. Ch. 63 (relating to professional health services plan corporations).

"Medicaid managed care organization." An entity as defined in 42 U.S.C. § 1396b(m)(1)(A) (relating to payment to states) that is a party to an agreement with the department, including a county Medicaid managed care organization and a permitted assignee of an agreement. The term does not include an assignor of an agreement.

"Participant rural hospital." A rural hospital that has been selected and signs an agreement to participate in the global budget model.

"Participating payer." A payer that operates in rural counties and, with respect to one or more specified products, programs or payment arrangements, signs an agreement with the authority to participate in the global budget model.

"Payer." An insurer, government program or Medicaid managed care organization that pays or administers payment for health care services under an insurance policy, subscriber contract, certificate, administrative services arrangement or other payment arrangement.

"Rural county." A county within this Commonwealth where the population density is less than 284 persons per square mile as defined by the Center for Rural Pennsylvania, established under section 301 of the act of June 30, 1987 (P.L.163, No.16), known as the Rural Pennsylvania Revitalization Act.

"Rural hospital." An acute care hospital or critical access hospital located in a rural county.

"Rural hospital transformation plan." A description of the health care delivery system transformation that a participant rural hospital will undergo under the global budget model, as approved by the board and the Federal Government.

"Swing bed." A hospital bed that has been approved by the Medicare program established under under 42 U.S.C. Ch. 7 Subch. XVIII to provide posthospital skilled nursing facility care when the rural hospital participates in the Medicare program.

SUBARTICLE B

PENNSYLVANIA RURAL HEALTH REDESIGN

CENTER AUTHORITY

Section 1411-D. Pennsylvania Rural Health Redesign Center Authority.

(a) Continuation.--The Pennsylvania Rural Health Redesign Center Authority is continued as a body corporate and politic constituting a public corporation and government instrumentality. The powers and duties of the authority shall be vested in and exercised by the board, which shall have the sole power to employ staff, including an executive director, legal counsel, consultants or any other staff deemed necessary by the board to effectuate the purposes of this article. Individuals employed by the board shall not be employees of the Commonwealth for any purpose, including for purposes of compensation, pension benefits or retirement.

(b) Composition.--The board shall consist of the following members:

(1) The Secretary of Health or a designee, who shall be an employee of the Department of Health designated in writing prior to service.

(2) The secretary or a designee, who shall be an employee of the department designated in writing prior to service.

(3) The Insurance Commissioner or a designee, who shall be an employee of the Insurance Department designated in writing prior to service.

(4) One member selected by each participating payer that is an insurer on behalf of the participating payer and the participating payer's parents, affiliates, subsidiaries, other associated entities and successors. The selection under this paragraph shall exclude any affiliated, subsidiary or otherwise associated Medicaid managed care organization.

(5) One member selected by each participating payer that is a Medicaid managed care organization.

(6) One member selected by the organization representing hospitals and health systems in this Commonwealth. This member shall be considered a participant rural hospital member on the board.

(7) Participant rural hospital members, the number of which shall not exceed the number of participating payer members. The participant rural hospital members shall represent the participant rural hospitals and shall be selected from different, geographically diverse participant rural hospitals and appointed as follows:

(i) The President pro tempore of the Senate, the Minority Leader of the Senate, the Speaker of the House of Representatives and the Minority Leader of the House of Representatives shall each appoint one member.

(ii) The Governor shall appoint the remaining members.

(8) Two members appointed by the Governor who are nationally recognized experts in rural health care delivery or in developing and administering global budgets.

(c) Terms.--The following shall apply to terms of the members of the board:

(1) The terms of the members specified under subsection (b)(1), (2) and (3) shall be concurrent with their holding of public office.

(2) The board members specified in subsection (b)(4), (5) and (6) shall serve for a term of three years and shall not be eligible to serve more than two full consecutive three-year terms.

(3) A board member specified in subsection (b)(7) shall serve for a term of two years and shall not be eligible to serve more than two full consecutive two-year terms.

(4) A board member specified in subsection (b)(8) shall serve for a term of four years and shall not be eligible to serve more than two full consecutive four-year terms.

(5) If a member of the board leaves prior to completing a term due to change in professional status, including, but not limited to, retirement, changing jobs, failure to qualify or other reason, a new member shall be appointed or selected within 60 days of the seat becoming vacant.

(d) Quorum.--A majority of the members of the board shall constitute a quorum. Action may be taken by the board at a meeting upon a vote of a majority of its members present in person or through electronic means. If a tie vote occurs at any meeting, it shall be the duty of the chairperson to cast the deciding vote.

(e) Meetings.--The board shall meet at the call of the chairperson or as may be provided in the bylaws of the board. The board shall hold meetings at least quarterly, which shall be subject to the requirements of 65 Pa.C.S. Ch. 7 (relating to open meetings).

(f) Chairperson.--The Governor shall appoint a chairperson from among the board members.

(g) Formation.--The board shall be formed within 90 days of the effective date of this section.

(h) Conflict of interest.--Board members shall recuse themselves from discussions and actions where a conflict of interest may exist. Board members may not receive confidential information, data or material related to an entity where a conflict of interest may exist.

(i) Compensation and expenses.--Members of the board shall not receive a salary or per diem allowance for serving as members of the board but shall be reimbursed for actual and necessary expenses incurred in the performance of their duties. Reasonable expenses may include reimbursement of travel and living expenses while engaged in board business. The expenses shall be paid for by the fund.

Section 1412-D. Powers and duties.

(a) General rule.--The board shall exercise all powers necessary and appropriate to carry out its duties under this article, including the following:

(1) Adopt bylaws necessary to carry out the provisions of this article. The bylaws shall include a provision addressing conflicts of interest as well as a provision that restricts board discussions and decisions to the administration of the global budget model as provided under subsection (b).

(2) Make, execute and deliver contracts, grants and other instruments necessary or convenient to exercise the powers and duties of the board.

(3) Apply for, solicit, receive, establish priorities for, allocate, disburse, contract or grant for, administer and expend money in the fund and other money made available to the authority from any other source consistent with the purposes of this article. The authority shall be exempt from the provisions of 62 Pa.C.S. Pts. I (relating to Commonwealth Procurement Code) and II (relating to general procurement provisions).

(4) Apply for, accept and administer grants and loans to carry out the purposes of the authority.

(5) Accept money from both public and private sources, consistent with Federal and State law.

(6) Take, hold, administer, assign, lend, encumber, mortgage, invest or otherwise dispose of, at public or private sale, on behalf of the authority and for any of the authority's purposes, real property, personal property and money or any interest therein, including any mortgage or loan interest owned by the authority or under its control or in its possession and the income therefrom either absolutely or in trust. The following apply:

(i) The board may acquire property or money for this purpose by purchase or lease and by the acceptance of gifts, grants, bequests, devises or loans, but no obligation of the authority shall be a debt of the Commonwealth, and the authority shall have no power to pledge the credit or taxing power of the Commonwealth nor to make its debts payable out of any money except those of the corporation. This subparagraph is not intended to mean that the board may acquire rural hospitals or participant rural hospitals.

(ii) All accrued and future earnings from money invested by the board and other accrued and future nonappropriated funds, including, but not limited to, funds obtained from the Federal Government and contributions, shall be available to the authority and shall be deposited in the State Treasury and may be utilized at the discretion of the board for carrying out any of the corporate purposes of the authority. Any placement of the funds by the State Treasurer in depositories or investments shall be consistent with guidelines approved by the board. For the purpose of administration, the authority shall be subject to sections 610, 613 and 614 of the act of April 9, 1929 (P.L.177, No.175), known as The Administrative Code of 1929.

(7) Seek waivers from State agency requirements as necessary to carry out the purposes of this article.

(8) Coordinate with the appropriate State agency to seek waivers from Federal requirements as necessary to carry out the purposes of this article.

(9) Establish advisory groups with a diverse membership representing interested and affected groups and individuals as the board finds necessary to carry out the purposes of this article.

(10) Collaborate with all applicable State agencies for purposes of implementing this article.

(11) Perform all other activities necessary to further the purposes of this article.

(b) Global budget model.--The board is responsible for administering the global budget model and shall:

(1) Evaluate and select rural hospitals for participation in the global budget model as a participant rural health hospital on the basis of diversity, vision and commitment to health care delivery transformation.

(2) Provide technical assistance, training and education to rural hospitals and participant rural hospitals.

(3) Collect and maintain data from rural hospitals and participant rural hospitals, participating payers and others as necessary to carry out the responsibilities of this article.

(4) Perform data analysis and quality assurance.

(5) Calculate, approve and administer global budgets. The global budgets may include payments for eligible hospital services provided under a participant rural hospital's employee health plan.

(6) Consistent with Federal and State law, review and approve rural hospital transformation plans, advise and approve changes to operational and payment mechanisms and approve exceptions to agreed-upon payment rules through an approved procedure provided in the board's bylaws.

(7) Assist rural hospitals and participant rural hospitals in working with community-based organizations to determine the targeted population health improvement goals.

(8) Evaluate the progress of the implementation of each participant rural hospital's global budget toward population health improvement goals and the cost of achieving health care goals.

(9) Monitor global budgets and quality metrics for participant rural hospitals.

(10) Provide an annual assessment of each participant rural hospital's compliance with its rural hospital transformation plan and global budget targets.

(11) Require a participant rural hospital to submit a corrective action plan for failure to submit a rural hospital transformation plan, comply with its rural hospital transformation plan or meet its global budget targets.

(12) Terminate a participant rural hospital from the global budget model in accordance with the participant rural hospital's participation agreement.

(13) Contract with an independent evaluation group to provide the board and executive director with an evaluation of the global budget model's progress in the areas of population health, quality of care and cost targets.

(14) Review and update the definition of "eligible hospital services" by transmitting a notice to the Legislative Reference Bureau for publication in the Pennsylvania Bulletin, subject to obtaining all necessary Federal approvals. The board shall use data collected under paragraph (3) in its review.

(c) Audit.--

(1) The accounts and books of the authority shall be examined and audited annually by an independent certified public accounting firm. The audit shall be public information.

(2) The authority shall, by December 31 of each year, file a copy of the audit of the preceding Commonwealth fiscal year required under paragraph (1) with the Secretary of the Senate and the Chief Clerk of the House of Representatives and provide a copy to the Department of Health.

(d) Reports.--The authority shall:

(1) Electronically submit an annual report on the performance and compliance of each participant rural hospital to the Department of Health and to other appropriate parties, including associations, foundations, academic institutions and community-based organizations, as determined by the board.

(2) Electronically submit an annual report to the Governor, the President pro tempore of the Senate and the Speaker of the House of Representatives for distribution to the Health and Human Services Committee of the Senate and the Health Committee of the House of Representatives on the activities of the authority for the year.

(3) Comply with applicable Federal reporting requirements.

(e) Publication.--The authority shall annually transmit a financial statement and the authority's audit as a notice to the Legislative Reference Bureau for publication in the next available issue of the Pennsylvania Bulletin.

SUBARTICLE C

PARTICIPATION IN GLOBAL BUDGET MODEL

Section 1421-D. Roles of participating payers.

(a) Letter of interest.--A payer may submit a letter of interest to the authority to participate in the global budget model.

(b) Agreement to participate.--As a condition of participation, a participating payer shall sign an agreement with the authority. The agreement shall detail the terms and conditions of participation in the global budget model.

(c) Termination.--A participating payer may terminate its participation with a participant rural hospital according to the terms and conditions of the agreement under subsection (b).

Section 1422-D. Roles of participant rural hospitals.

(a) Letter of interest.--A rural hospital may submit a letter of interest to the authority to participate in the global budget model.

(b) Condition of participation.--As a condition of participation, the following shall occur:

(1) A rural hospital shall submit an initial rural hospital transformation plan in the manner and form prescribed by the authority for review and approval.

(2) A participant rural hospital shall sign an agreement with the authority. The agreement shall detail the terms and conditions of participation in the global budget model.

(3) A participant rural hospital shall submit annual updates to its rural hospital transformation plan in the manner and form prescribed by the authority for review and approval.

SUBARTICLE D

DATA COLLECTION AND CONFIDENTIALITY

Section 1431-D. Data collection and retention.

(a) Authority.--The authority may collect and analyze data from participating payers, rural hospitals, participant rural hospitals and the department necessary to carry out the authority's responsibilities under this article. Data collected by the authority shall only be used for administering the global budget model. The authority shall obtain the written approval of a participating payer, rural hospital, participant rural hospital or the department before the authority can use the entity's data for any other purpose. The authority shall retain the data for no more than seven years.

(b) Participant rural hospital.--A participant rural hospital may authorize its insurer or administrator to provide data to the authority regarding payments for eligible hospital services provided under the hospital's employee health plan.

(c) Release of data.--Unless specifically provided for in this article, the authority may not release and no data source, person, member of the public or other user of any data of the authority may gain access to:

(1) Raw data which could reasonably be expected to reveal the identity of an individual patient.

(2) Raw data disclosing discounts or allowances between participating payers and participant rural hospitals which is prejudicial to an individual participating payer or participant rural hospital.

(3) Data which the department provides to the authority, unless the secretary or the designee of the secretary specifically authorizes the release or access.

(4) Any data where a conflict of interest occurs.

Section 1432-D. Confidentiality of data, contracts and agreements.

(a) Right-to-Know Law inapplicable.--Any contract or agreement between participating payers and participant rural hospitals or any data, including patient data, provided by a participating payer, a participant rural hospital, including a participant rural hospital's insurer or administrator, a rural hospital or the department to the authority and maintained by the authority for the purposes of carrying out the requirements of this article shall be confidential and shall not be subject to the act of February 14, 2008 (P.L.6, No.3), known as the Right-to-Know Law, or discoverable or admissible as evidence in any civil, criminal or administrative action or proceeding.

(b) Authority access to data.--Nothing in this section shall prohibit the authority from accessing the data to carry out its responsibilities in accordance with law.

(c) Release of data.--Data provided to the Centers for Medicare and Medicaid Services, or any other entity, by the authority shall be provided consistent with applicable laws and regulations, including the Health Insurance Portability and Accountability Act of 1996 (Public Law 104-191, 110 Stat. 1936), the Health Information Technology for Economic and Clinical Health Act (Public Law 111-5, 123 Stat. 226-279 and 467-496) and implementing regulations, to the extent allowed by law and written agreements between the authority and each participating payer and participant rural hospital.

SUBARTICLE E

PENNSYLVANIA RURAL HEALTH REDESIGN

CENTER FUND

Section 1441-D. Continuation of fund.

The Pennsylvania Rural Health Redesign Center Fund is continued as a separate fund in the State Treasury.

Section 1442-D. Money in fund.

The General Assembly may appropriate money to carry out the provisions of this article. All money deposited into the fund shall be held for the purposes of the authority and may not be considered a part of the General Fund but shall be used only to effectuate the purposes of this article as determined by the authority. All interest earned from the investment or deposit of money accumulated in the fund shall be deposited in the fund for the same use. Any money returned to the authority by any party shall be deposited into the fund.

Section 9. Repeals are as follows:

(1) The General Assembly declares that the repeal under paragraph (2) is necessary to effectuate the addition of Article XIV-D of the act.

(2) The act of November 27, 2019 (P.L.742, No.108), known as the Pennsylvania Rural Health Redesign Center Authority Act, is repealed.

Section 10. The addition of Article XIV-D of the act is a continuation of the act of November 27, 2019 (P.L.742, No.108), known as the Pennsylvania Rural Health Redesign Center Authority Act. The following apply:

(1) Except as otherwise provided in the addition of Article XIV-D of the act, all activities initiated under the Pennsylvania Rural Health Redesign Center Authority Act shall continue and remain in full force and effect and may be completed under the addition of Article XIV-D of the act. Orders, regulations, rules and decisions which were made under the Pennsylvania Rural Health Redesign Center Authority Act and which are in effect on the effective date of section 9 of this act shall remain in full force and effect until revoked, vacated or modified under the addition of Article XIV-D of the act. Contracts, obligations and collective bargaining agreements entered into under the Pennsylvania Rural Health Redesign Center Authority Act are not affected nor impaired by the repeal of the Pennsylvania Rural Health Redesign Center Authority Act.

(2) Except as set forth in paragraph (3), any difference in language between the addition of Article XIV-D of the act and the Pennsylvania Rural Health Redesign Center Authority Act is not intended to change or affect the legislative intent, judicial construction or administration and implementation of the Pennsylvania Rural Health Redesign Center Authority.

(3) Paragraph (2) does not apply to the addition of the following provisions:

(i) Section 1411-D(c) of the act.

(ii) Section 1442-D of the act.

Section 11. This act shall take effect immediately.

APPROVED--The 23rd day of October, A.D. 2023.

JOSH SHAPIRO

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