MAINTENANCE AND OPERATION OF DISTRICT HEALTH CENTERS

Philadelphia Code tit. 6, ch. 6-700

in effect

Philadelphia Code § 6-701 The Council makes the following findings.

§ 6-701. The Council makes the following findings. (1) Since 1929 a variety of studies, starting with the Philadelphia Hospital and Health Survey, have called for the creation and maintenance of a network of neighborhood-based health centers to serve the citizens of Philadelphia. (2) Responding to and acknowledging the need for such District Health Centers, the Philadelphia Home Rule Charter, Section 5-300, establishes the clear and ongoing responsibility of the City to "establish, maintain and operate District Health Centers, stations and clinics, laboratories and other health facilities." (3) In the 1960's the City met this commitment by constructing District Health Centers in virtually every City Council District. (4) These District Health Centers provide traditional public health services and comprehensive primary health care to all Philadelphians who seek these services. The District Health Centers guarantee to residents of Philadelphia that health care is a right and not a privilege reserved to those who can afford to pay. They have brought quality health care to all our neighborhoods and are the backbone of public health protection in Philadelphia. (5) As of Fiscal Year 1990, one hundred thirteen thousand (113,000) individuals, seven percent (7%) of the population of Philadelphia, used services provided at the District Health Centers. These persons made over three hundred twenty-three thousand (323,000) patient visits to the District Health Centers. (6) The District Health Centers welcome medically underserved persons into early, continuous and preventive health care, and provide such care in reference solely to medical criteria without reference to financial criteria. Persons using the District Health Centers are a vulnerable population. In Fiscal Year 1990, eighty-eight thousand three hundred (88,300) of the people who used the district health centers either had incomes at or below the poverty level. In that same year more than seventy-two thousand six hundred (72,600) of District Health Center patients had no health care insurance and an additional twenty-six thousand three hundred (26,300) rely on Medicare and/or Medicaid. The persons using the District Health Centers are poorer than most Philadelphians and have far less access to health services. They are six (6) times more likely to be uninsured than the rest of the Philadelphia population. (7) The Family Medical Care Program in the District Health Centers not only saves lives, it saves Philadelphia considerable dollars. While the cost of providing primary pediatric and internal medicine services to sick and frail populations is high, the cost of not providing such services is much higher. Persons admitted into area hospitals through emergency rooms who have not received the type of services that are provided to patients in the Family Medical Care Program cost much more to the taxpayers and result in increasing uncompensated care costs to hospitals. Persons who do not have access to basic, comprehensive, primary medical care often require long hospital stays, followed by supervised convalescence. (8) People with Acquired Immune Deficiency Syndrome (AIDS) or who are known to be infected with the Human Immunodeficiency Virus frequently have difficulty in obtaining medical and dental treatment and, therefore often turn to the District Health Centers for treatment. (9) District Health Centers provide prenatal and family planning services throughout the City. These services are in short supply in many poor neighborhoods and are critical to Philadelphia's on going efforts to reduce its high infant mortality rate. Philadelphia would have an even higher rate of infant deaths without these services. (10) District Health Centers provide preventive, primary dental health services to many persons who would not otherwise have them available for economic and non-economic reasons: children, pregnant women, persons with AIDS or Human Immunodeficiency Virus, or other non-economic reasons and other adults. (11) District Health Centers have arrangements with other City services, programs and agencies to welcome persons with multiple health needs and other persons who historically have only limited access to doctors' offices and hospital outpatient programs: chronically mentally ill persons, persons with an intellectual disability, homeless persons, drug and alcohol using persons, persons with AIDS and persons with communicable diseases including sexually transmitted diseases and tuberculosis. 133 (12) The services provided by the District Health Centers are not only irreplaceable, they are life saving. The District Health Centers provide preventive and primary health care which reduces the number of costly and inappropriate visits to already overburdened hospital emergency rooms, again preventing an increase in the uncompensated care costs for hospitals. (13) In view of the fact that the care rendered in the District Health Centers saves lives, saves money and promotes prolonged productive lives, the Council reasserts the City's basic commitment to provide comprehensive District Health Center services to all of its citizens who wish to use the services. The Council stands behind that commitment, and, in order to assure its restoration to full strength, enacts the following provisions specifying the District Health Center services that are to be available, mandating a flow of information permitting adequate Council and citizen monitoring of those services, and providing citizen input and redress that will enable citizens themselves to assure full implementation of all such mandated services. (14) The Council possesses "complete powers of legislation ... in relation to (the City's) municipal functions...." Home Rule Charter, Section 1-100. Such legislative power necessarily includes the power to enact policies for the City that ensure the health, safety and welfare of its citizens, and that ensure that the mandates of the Home Rule Charter are carried out. In exercising its power, the Council is entitled "by ordinance ... (to) add new powers and new duties, not inconsistent with the scheme of this Charter to the powers and duties of the offices, departments, boards and commissions (of the City)...." (Home Rule Charter, Section 2-305.) In order to ensure that it has sufficient fiscal information with which to make its legislative decisions, the Charter further states that the "Mayor shall communicate to ... Council with such information on financial matters as the Council may from time to time request." (Home Rule Charter, subsection 4-101(a)). Notes 133 | Amended, Bill No. 130723 (approved January 20, 2014).

Philadelphia Code § 6-702 Definitions.

§ 6-702. Definitions. In this Chapter, the following definitions shall apply: (1) Advisory Committee. The Citizen Health Advisory Committee appointed pursuant to Section 6-709 of this Chapter. (2) Emergency Condition. A medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in placing the patient's health in serious jeopardy. (3) Urgent condition. A medical condition which, if untreated within two (2) to twenty-four (24) hours, could reasonably be expected to result in one (1) or more of the conditions listed in subsection 6-702(2). (4) District Health Centers. The District Health Centers currently directly operated by the Department of Public Health, and required to be directly operated and maintained in the future as set forth in this Chapter, which provide a range of health care programs, including but not limited to Family Medical Care; Women's Health Program including Prenatal, Obstetrics, Gynecological Care, and Family Planning; Dental Services; and diagnosis and treatment of Sexually Transmitted Diseases, Tuberculosis and other infectious diseases. (5) Health Committee. The Committee on Public Health, Human Services and Recreation of the Council, or such successor Committee of Council with duties pertaining to public health as may be designated by the President of Council. (6) Poverty Level. The level of income identified as the "Poverty Income Guideline" developed and updated annually by the United States Department of Health and Human Services. (7) Service Mandate. The level of services required to be provided to ensure availability and accessibility of health services by and/or through the District Health Centers under this Chapter. (8) Ambulatory Specialty Services. Ambulatory medical services provided to a patient by a medical specialist upon referral of such patient by District Health Center professional personnel. (9) Ambulatory Specialty Services Administration. The administrative component of the District Health Centers which is responsible for the operation of the District Health Centers. (10) Formulary. The list of medications, medical products and supplies approved by the Medical Director and the Administration of the District Health Centers. (11) Special Request Medications. Those medications which are non-formulary and requested by physicians on a case-by-case basis.

Philadelphia Code § 6-703 Operation and Function of District Health Centers.

§ 6-703. Operation and Function of District Health Centers. (1) The Health Department shall continue at a minimum to maintain and directly operate a system of at least nine (9) District Health Centers at which each of the following services shall be offered, except one may provide only Sexually Transmitted Disease services, in a manner that makes available to all citizens of the City the following services: (a) a Family Medical Care Program providing the following pediatric and internal medicine ambulatory services to all enrollees: 134 (.1) completion of a medical history and provision of an initial complete physical examination; (.2) continuity of care for each individual by the assignment of a single physician to provide, or supervise the provision of, all medical services in the Family Medical Care Program; (.3) laboratory tests, EKG, and radiologic services, as needed; (.4) immunizations for children and adults with appropriate consent, on a walk-in basis as needed; (.5) medical services for the diagnosis and treatment of disease, and other preventive, counseling, and therapeutic or other services needed to maintain and promote good health, provided that: (.a) treatment at a District Health Center or referral to an appropriate cooperating hospital for emergency conditions shall be available on an immediate basis, and for urgent conditions shall be available no later than twenty-four (24) hours from the time of request; (.b) all other appointments shall be available on average no later than fourteen (14) days after the date of the request; (.6) referral for needed in-patient services to an appropriate hospital facility; (.7) same-day provision of required formulary medication on-site by a State-licensed pharmacist, through a pharmacy at each District Health Center participating in the Family Medical Care Program open for the receipt and dispensing of patient prescriptions during daytime hours of District Health Center operation with suitable arrangements for emergencies and other urgent cases occurring other times of District Health Center service, and provision of special order medication on-site by a State-licensed pharmacist as soon as possible, with approval by the Clinical Director and Pharmacy Director to be given in an event within seventy-two (72) hours of its being ordered; (.8) mental health, intellectual disability, drug and alcohol and social services on-site by referral; 135 (.9) nutritional counselling for patients determined to be suffering from or determined to be at high risk for illnesses for which nutrition has impact; (.10) referral to the Special Supplemental Food Program for Women, Infants and Children (WIC); (.11) ambulatory specialty services through arrangements with a hospital facility reasonably accessible to the referred enrollee; (.12) referral for visiting nursing care services for patients as needed; (.13) professional social work services on-site including referrals to other outside agency services; (.14) trained personnel and supplies for on-site administration of basic emergency medical stabilization. (b) Women's Health Program, including prenatal, obstetrics, gynecological and family planning and providing the following services in any District Health Center which is not limited to the diagnosis and treatment of Sexually Transmitted Disease. (.1) Completion of a medical history and provision of an initial comprehensive physical examination and, for those receiving prenatal obstetrical care, a risk assessment including identification of high risk factors (by obstetrical or medical history) that may require special management; (.2) Papanicolaou smears and follow-up; (.3) Laboratory tests as needed; (.4) Pregnancy testing; (.5) Reproductive health including family planning counseling; (.6) Contraceptive medicine and supplies; (.7) Routine gynecological care; (.8) Referral to needed in-patient services at an appropriate hospital facility on a timely basis; (.9) Same-day provision of required formulary medication on-site by a State licensed pharmacist, through a pharmacy at each District Health Center which is open during daytime hours with suitable arrangements for emergencies and other urgent cases occurring at other times of District Health Center activity; (.10) Complete prenatal medical care, including history and examination, laboratory tests, procedures and medication in as many visits as needed to provide comprehensive prenatal care; (.11) Appointments shall be available an average of no later than fourteen (14) days after the date of request; (.12) Professional social work services on-site including at least two (2) assessments during pregnancy (including one (1) during last trimester) and on-going assistance for patients requiring follow-up; (.13) For prenatal patients, assistance in applying for Medicaid and determination of presumptive eligibility for Medicaid; (.14) Professional nutrition services on-site including at least two (2) counseling sessions during pregnancy, and on-going assistance for patients requiring follow-up; (.15) Complete postpartum medical care for postpartum patients; (.16) Referral for supplemental food through the Women Infant and Children (WIC) program for pregnant women, new mothers and breastfeeding women. (c) a Dental Program providing preventive, primary dental services for all children under eighteen (18) years of age, pregnant women, and patients who, due to their infection with Human Immunodeficiency virus or for other non-economic reason, cannot purchase or obtain dental care from any other reasonably accessible source; and providing such services for all other adults on an as available basis. (d) a Sexually Transmitted Disease program providing comprehensive diagnosis, counseling and treatment services on a same day walk-in basis for all residents requesting such services. (2) The Health Department shall operate a comprehensive system for billing and collecting from third-party payers for the costs of any services provided at the District Health Centers for which such payers may be held responsible, as set forth more fully in subsection 6-706(1) below. (3) The Health Department shall directly operate each of the District Health Centers with sufficient and appropriate clinical and administrative staff so that all clinical and administrative services identified in this Section can be fully provided and the service mandate is complied with. (4) In each of the services described in the subsection 6-703(1), there shall be a quality assurance mechanism in accordance with contemporary professional standards. (5) The Pharmacy and Therapeutics Committee serving the District Health Centers shall review the pharmaceutical formulary at least annually. Notes 134 | Amended, Bill No. 130224 (approved May 8, 2013). 135 | Amended, Bill No. 130723 (approved January 20, 2014).

Philadelphia Code § 6-704 Availability of District Health Center Care.

§ 6-704. Availability of District Health Center Care. (1) The District Health Center shall continue to be located at such locations as to make them readily accessible by walking or public transportation to those citizens who, because of their economic or other circumstances, are most likely to utilize their services. (2) Each District Health Center shall be open to the public at least eight and one-half (8.5) hours every day from Monday through Friday. When the District Heath Centers are closed, services shall be provided, or otherwise arranged, by on-call physicians utilizing contracted hospital emergency services. (3) The Health Department shall maintain an adequate supply of essential products, including formulary products, and shall ensure availability of "special request" medications, so as to ensure daily access to needed medications at all District Health Centers. (4) The Health Department shall maintain the District Health Center facilities, including the making of necessary repairs to ensure the continual operation of the centers with regard to the physical safety and comfort of the patients and staff, and to maintain the efficiency and quality of the services provided.

Philadelphia Code § 6-705 Non-Discrimination.

§ 6-705. Non-Discrimination. All District Health Center services shall be provided without discrimination on the basis of race, religion, color, nationality, national origin, sex, sexual orientation, gender identity, age, handicap, type of illness, or financial status. Notes 136 | Amended, Bill No. 130224 (approved May 8, 2013).

Philadelphia Code § 6-706 Charges for Services.

§ 6-706. Charges for Services. (1) The City shall bill all third party payers for all services to the maximum extent possible, and shall collect fees directly from patients pursuant to a sliding scale for those services not required to be provided without charge (listed below), provided, however, that no person shall be denied service for failure to pay a bill, and provided further that no collection activity shall be initiated against any patient in connection with any such bill other than the mailing of non-threatening reminder notices which are literacy appropriate, unless such patient, known to have or be eligible for third party health insurance, fails to cooperate with the billing process. (2) No patient charges shall be assessed for: (a) diagnosis and treatment of sexually transmitted disease and tuberculosis; (b) immunizations, including the visits associated with such services; (c) prenatal and post-partum care; and (d) family planning for persons under eighteen (18) years of age.

Philadelphia Code § 6-707 Administrative Discretion of Department.

§ 6-707. Administrative Discretion of Department. (1) Nothing contained in this Chapter shall be construed to require the Health Department to: (a) employ any particular number of personnel, either in the aggregate or within any particular personnel classification; or (b) purchase, lease or otherwise obtain any particular amount of supplies, equipment, goods or wares; or (c) exercise its administrative discretion regarding the best means of achieving the service mandate in any manner other than such as the Department shall determine to be reasonable and appropriate. (2) Notwithstanding the provisions of subsection 6-707(1), the discretion reserved to the Department must be exercised in a manner consistent with the full implementation of the service mandate.

Philadelphia Code § 6-708 Submission of Data to Council.

§ 6-708. Submission of Data to Council. (1) In order to ensure that the Council is fully aware of the annual operating and capital appropriation levels needed to fulfill the service mandate, and pursuant to his duties under subsection 4-101(a) of the Home Rule Charter, the Health Commissioner shall, during the budgetary process in which the Mayor delivers his proposed annual operating budget to the Council, deliver a statement to the Council showing the following: (a) the numbers and types of positions required to staff the District Health Centers to the level needed to satisfy the service mandate, and the budgetary cost thereof; (b) the quantities and types of supplies, medicines and equipment needed to satisfy the service mandate and the budgetary cost thereof; (c) the nature and cost of necessary repairs and other facility maintenance; (d) the number of individual patients served by, and patient visits made to, each District Health Center during the prior fiscal year and a projection of such numbers for the subsequent fiscal year, showing both individual patient and patient visits totals broken down according to: (.1) race; (.2) relevant age groupings; (.3) gender; (.4) relevant income groupings; (.5) District Health Center of service; (.6) any other or more specifically detailed category that the President of Council, Chairperson of the Health Committee or Council by resolution shall request; (e) an itemized estimate of all appropriations that would be required from the General Fund to the Health Department and each of its budgetary classes in the next Fiscal Year in order to fulfill the service mandate. Such estimate shall be reasonable, verifiable, and based upon a documented review of prior budgets and service delivery levels, as well as a forecast of future demands for service and of anticipated revenues identified in subsection 6-708(1)(f). Such documented review and forecast shall be submitted to the Council at the same time as the itemized estimate; (f) an itemized estimate of all anticipated revenues from third-party and self-payers for services to be rendered by the District Health Centers in the following Fiscal Year. (2) In the event the itemized estimate and documented review required by subsection 6-708(1)(e) is not timely submitted to the Council, it shall be presumed that full funding of the Mayor's Operating Budget request for the Health Department represents full funding of the service mandate. (3) In order to assist the Council in monitoring fulfillment of the service mandate, the Health Department shall report to the Health Committee, semi-annually or at such other times as the Chair of the Committee shall request, the following data: (a) the nature and number of all District Health Center staff positions funded in the Health Department budget as it may have been amended from time to time; (b) the number of such positions authorized by the Administration to be filled as of the date of the report for each District Health Center; (c) the number of such positions actually filled as of the date of the report at each District Health Center; (d) the number of persons served at each District Health Center compared to the number served at each such District Health Center during the same period in each of the prior three (3) fiscal years; (e) the number and identity of formulary drugs "out of stock" or otherwise unavailable to patients at any time, and the estimated number of days each drug was so unavailable, during the previous half-year, by District Health Center; (f) the nature and cost of necessary repairs and other facility maintenance; (g) such other information related to fulfillment of the service mandate as the Chair of the Health Committee may request.

Philadelphia Code § 6-709 Citizen Health Advisory Committee.

§ 6-709. Citizen Health Advisory Committee. (1) Within sixty (60) days of the enactment of this Chapter, the Mayor shall appoint a Citizen Health Advisory Committee to the Health Department. The Citizen Health Advisory Committee shall be comprised of thirteen (13) persons, all of whom shall be residents of Philadelphia, none of whom, with the exception of the person described in subsection (b)(.4) shall be employees of the City of Philadelphia. In selecting these persons, consideration shall be given to geographical, age, gender and racial diversity, and, to the extent reasonably possible, they shall be selected in accordance with the following provisions: (a) there shall be among them nine District Health Center patients; (b) of the remaining four (4), there shall be among them at least one (1) person in each of the following categories: (.1) person who is a health services provider; (.2) person experienced in health services management; (.3) person who is a health advocate; (.4) person experienced in representing unionized health care workers; (c) where there is a District Health Center Community Advisory Committee, as provided in subsection 6-709(5), it may provide recommendations for appointment to the Departmental Citizen Health Advisory Committee; (d) Members of the Citizen Health Advisory Committee shall be selected for their expertise in community affairs, local government, finance and banking, legal affairs, trade unions, and other commercial and industrial concerns, or social services agencies within the community. (2) Persons appointed to the Citizen Health Advisory Committee shall serve for terms of two (2) years, and may serve additional terms upon reappointment by the Health Commissioner, except that, to achieve a staggering of membership, six (6) of the initial appointments, four (4) of whom shall be District Health Center patients, shall be for three (3) year terms. (3) It shall be the duty of the Citizen Health Advisory Committee to: (a) advise the Commissioner on the programs and performance of Ambulatory Health Services; (b) assist in the establishment, implementation and/or review of personnel policies and procedures related to Ambulatory Health Services; (c) assist in establishment, implementation and/or review of policy for financial management practices, budgetary and programmatic issues, District Health Center priorities, criteria for payment schedules and long-range financial planning; (d) evaluate District Health Center activities including service utilization patterns, efficiency, patient satisfaction, achievement of project objectives and development of a process for hearing and resolving patient grievances; (e) held assure that the District Health Centers operate in compliance with applicable Federal, State and local laws and regulations; and (f) assist in the establishment, implementation and/or review of health care policies including scope and availability of services, location and hours of services and quality-of-care audit procedures. (4) Health Department personnel shall cooperate fully with all requests for information from the Citizen Health Advisory Committee. No City employee may be disciplined in any manner for cooperating with the activities of the Citizen Health Advisory Committee, or for providing it through the appropriate administrative channels with any information within the scope of its responsibilities, provided, however, that the Citizen Health Advisory Committee shall not request, nor shall any employee provide any confidential health care records. (5) Each District Health Center shall encourage, provide meeting space for, and otherwise facilitate its own Citizen Health Advisory Committee, consisting of individuals such as: current District Health Center patients, community-based health professionals familiar with the special health needs of their neighborhoods, and members of community-based organizations, including churches and schools, and labor unions experienced with neighborhood needs.

Philadelphia Code § 6-710 Availability of Feminine Hygiene Products.

§ 6-710. Availability of Feminine Hygiene Products. (1) Definition. For purposes of this Section, the term "feminine hygiene products" shall mean the tampons and sanitary napkins for use in connection with the menstrual cycle. (2) Availability of feminine hygiene products. District Health Centers shall provide feminine hygiene products to be used at the facility, either by use of a dispenser or to individuals upon their request. Notes 137 | Added, Bill No. 210364 (approved June 23, 2021).

Source: City of Philadelphia, The Philadelphia Code and Home Rule Charter (American Legal Publishing, codelibrary.amlegal.com)URL: https://codelibrary.amlegal.com/codes/philadelphia/latest/philadelphia_pa/0-0-0-273543Fetched: 10/27/2026