35 Pa. Stat. § 5701.1105

Current through Pa Acts 2024-53, 2024-56 through 2024-95
Section 5701.1105 - Reimbursement for extraordinary expense
(a) Program establishment.-- There is established in the department a Hospital Extraordinary Expense Program. Appropriations to the department for the Hospital Extraordinary Expense Program pursuant to section 1106(b) shall be used to reimburse hospitals for extraordinary expenses in treating the uninsured on an inpatient hospital basis.
(b) Department responsibilities.--The department has the following powers and duties:
(1) Administer the Hospital Extraordinary Expense Program.
(2) Collect the data necessary to administer this section, including data from the council.
(3) Contact the appropriate data source if there is missing data and obtain the necessary information.
(4) Determine the eligibility of hospitals from information collected under paragraph (2).
(5) Pay eligible hospitals by October 1 of each fiscal year an amount consistent with subsection (d).
(6) Seek Federal matching funds under the medical assistance program to supplement payments under this chapter.
(7) 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 also be made available for public inspection and be posted on the department's publicly accessible World Wide Web site. The report shall list all of the following:
(i) The name, address and payment amount for each eligible hospital.
(ii) The health system affiliation of each eligible hospital.
(iii) The methodology and data utilized to determine the eligibility of each hospital.
(c) Eligibility.--
(1) Except as provided in paragraph (3), a hospital may receive payment under this section if the hospital does not qualify for payment under section 1104 and the hospital provided uncompensated care to a patient with extraordinary expenses in the most recent fiscal year for which data is available.
(2) A hospital receiving payment under this section shall meet all the requirements of section 1104(b).
(3) A hospital may elect to receive payment under this section in lieu of payment under section 1104.
(d) Payment methodology.--Payment to a hospital under this section shall equal the lesser of the cost of:
(1) the extraordinary expense claim; or
(2) the prorated amount of each hospital's percentage of extraordinary expense costs as compared to all eligible hospitals' extraordinary expense costs, as applied to the total funds available in the Hospital Extraordinary Expense Program for the fiscal year.
(e) Limitations.--Except as provided in section 1106:
(1) In no case shall payments to a hospital under this section exceed the aggregate cost of services furnished to patients with extraordinary expenses.
(2) In no case shall the aggregate amount of extraordinary expense payments in any fiscal year exceed the amount of the appropriation to the department for the Hospital Extraordinary Expense Program. The provision of extraordinary expense payments under this section shall not constitute an entitlement derived from the Commonwealth or a claim on any other funds of the Commonwealth.

35 P.S. § 5701.1105

2001, June 26, P.L. 755, No. 77, § 1105, effective 7/1/2001.