Section 5701.1103 - Hospital uncompensated care payments(a) Program establishment.--There is established in the department the Hospital Uncompensated Care Program. Appropriations from the fund to the department for the Hospital Uncompensated Care Program pursuant to section 1106(b) shall be used to annually compensate hospitals in accordance with section 1104 for a portion of the uncompensated care provided to patients.(b) Department responsibilities.--The department has the following powers and duties: (1) Administer the Hospital Uncompensated Care Program.(2) Determine the eligibility of hospitals on an annual basis in accordance with section 1104(b). Notice of eligibility shall be published in the Pennsylvania Bulletin by April 1 for the forthcoming fiscal year.(3) Calculate uncompensated care scores for eligible hospitals under section 1104(c).(4) Calculate and make payments to qualified hospitals under section 1104(d) on an annual basis.(5) Seek Federal matching funds under medical assistance to supplement payments made under section 1104.(6) Prepare and submit a report no later than November 30, 2002, and annually thereafter to the chair and minority chair of the Public Health and Welfare Committee and the chair and minority chair of the Appropriations Committee of the Senate and the chair and minority chair of the Health and Human Services Committee and the chair and minority chair of the Appropriations Committee of the House of Representatives. The annual report shall be made available for public inspection and posted on the department's publicly accessible World Wide Web site. The report shall list all of the following:(i) The name and address of each eligible hospital.(ii) The name, address and payment amount for each qualified hospital.(iii) The health system affiliation of each qualified hospital.(iv) The uncompensated care score for each qualified hospital.(v) The methodology utilized to compute the uncompensated care score for each eligible hospital.(7) No later than June 30, 2003, the department shall contract with an independent entity to evaluate the payment methodology to determine the extent to which payments under this section are made to hospitals with the greatest uncompensated care burden. The report shall contain recommendations to the Governor, the department and the General Assembly concerning the payment methodology.(c) Information collection.--The department shall:(1) Collect data and information as necessary to determine hospital eligibility for payment under this chapter, including the department's medical assistance data for medical assistance inpatient days percentage, the uncompensated care percentage and net patient revenue data from the council and data from the Centers for Medicare and Medicaid Services or their designee regarding Medicare SSI days percentage.(2) Contact the appropriate data source if there is missing data and obtain the necessary information.(d) Reporting requirements.--(1) Within 60 days of the effective date of this chapter, the department in consultation with the council shall establish an advisory committee comprised of nine individuals with expertise in hospital administration, hospital finance and reimbursement and hospital patient accounts management, including a representative of the department and representative of the council. The purpose of the advisory committee shall be to assist the department and the council in improving the accuracy, consistency and timeliness of the information collected and used to determine payments to hospitals under the Hospital Uncompensated Care Program. The advisory committee shall make recommendations to the department concerning the information that is required to more accurately measure the amount of bad debt expense incurred and charity care expense provided by hospitals to uninsured patients in this Commonwealth.(2) Within 180 days of the effective date of this chapter, the department shall develop and provide public notice to hospitals of the uniform reporting requirements for uncompensated care which shall address both charity care expense and bad debt expense components. The uniform reporting requirements for charity care expense shall incorporate the recommendations of the advisory committee and address the following: (i) Patient eligibility for other public or private coverage.(ii) Income eligibility threshold based on family size.(iii) Consideration of other resources available to a patient or responsible party.(iv) Patient or responsible party employment status and earning capacity.(v) Other financial obligations of the patient or responsible party.(vi) Other sources of funds available to the hospital such as endowments or donations specified for charity care. The uniform reporting requirements for bad debt expense shall incorporate the recommendations of the advisory committee and shall address hospital collection procedures for unpaid patient responsibility, including deductibles, coinsurance, copayments and noncovered services. Patients are presumed to be able to pay for medically necessary services until and unless information is obtained to indicate an inability or refusal to pay.
(3) For fiscal years beginning on or after January 1, 2002, hospitals shall report uncompensated care information to the council in accordance with the reporting requirements set forth in this section in order to receive payments under the Hospital Uncompensated Care Program.2001, June 26, P.L. 755, No. 77, § 1103, effective 7/1/2001.