Behind PA Assembly Lines: A Community Blog

Graduate student Teerah Goodrum provides updates on legislation in Pennsylvania's General Assembly

PA Community-Based Health Care and the Affordable Care Act

Written by Teerah Goodrum, Community Blogger | Aug 23, 2013 2:35 PM

PA General Assembly Senate Bill 5, known as the Community-Based Health Care (CHC) Act, was approved May 21, 2013 by Governor Corbett.  This bill establishes a Community-Based Health Care program through Pennsylvania’s Department of Health in conjunction with the Department of Public Welfare.  This law will establish a State run health care system in an attempt to meet the requirements and deadlines of the federal law known as the Patient Protection and Affordable Care Act.  The Affordable Care Act (ACA) mandates that States establish Exchanges by January 1, 2014 to offer health care services and insurance to uninsured citizens.  However, Part III Section 1321 of the ACA known as the State Flexibility Related to Exchanges section, allows States to opt out of creating Exchanges and establish alternative programs such as Community-Based Health Care programs.  Pennsylvania can still set up Exchanges if it chooses to.  However, building on services already in existence like CHC’s is an easy way to collect patient tracking information and transition into creating Exchanges in the future.  It may also be more cost effective.  Pennsylvania’s CHC program will aid in establishing new CHC’s and build upon already established CHC’s. The CHC Clinics must fulfill five requirements to qualify under the State run program.

CHC Clinic Requirements:

  1. Serve Federally designated medically underserved areas
  2. Serve patient populations with majority household incomes less than 200% of federal poverty income levels
  3. Must be a federally qualified Health Center
  4. Must participate with the Department of Public Welfare
  5. Must participate with Children’s Health Insurance Programs (CHIP)

These facilities will be free or partial-pay health clinics staffed with non-volunteer and volunteer health care providers.  The facilities will also be nurse managed health care clinics.  These clinics will coordinate care and us of accessible updated patient information and encourage follow-ups.  CHC’s will also track clinical information for individual and general patient populations.  The tracking of patients is an important ACA compliance piece.  CHC’s can serve Medicare, Medicaid and Chip recipients as well as the uninsured.  Because Medicare, Medicaid, and CHIP recipients may also qualify for the Exchange, tracking clinical information into a standard database will allow the Commonwealth to inform residents of their eligibility if Pennsylvania chooses to create Exchanges.  The Community-Based Health Care Clinics will be established for reasons I have listed below. 

Reasons to Establish CHC Program

  1. To provide grants to community-based health care clinics
  2. To expand and improve health care services and access, preventative care, chronic care and disease management, dental treatment, and behavioral health and pharmacy services
  3. To reduce unnecessary use of hospital Emergency Rooms
  4. To encourage collaborations between health care clinics, hospitals, and other health care providers

According to the reasons listed in the CHC legislation, Pennsylvania will comply with Section 1302(b) of the Affordable Care Act which lists the essential health benefits CHC’s must provide to be in compliance with federal law. 

Although the CHC bill did not list the kinds of coverage to be offered, they must offer coverage at the four levels outlined in the ACA to be in compliance with federal law.  The four levels are bronze, gold, silver, and platinum.  If you’re interested in eligibility requirements and/or a detailed description of what the coverage levels offer, you can visit the official government website to find the information you need. 

From my analysis, it seems that the CHC bill was a step in the direction towards creating Exchanges.  However, it should be noted that the Commonwealth may decide not to create Exchanges and keep the Community-Based Health Care Programs as a permanent alternative program instead.  Pennsylvania may also decide to provide both options, CHC's and Exchanges.  This bill has opened the doors to make any one of the possibilities I listed become a reality for Pennsylvania. 

P.S. The links allow you to go directly to PDF versions of both bills which I found on official State and Federal government websites.  I listed specific sections of the Affordable Care Act in case you wanted to read them.

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