PRINTER'S NO. 697
No. 623 Session of 2005
INTRODUCED BY KASUNIC, BOSCOLA, COSTA, LAVALLE, O'PAKE,
M. WHITE, MUSTO, RHOADES, LOGAN AND KITCHEN, APRIL 18, 2005
REFERRED TO BANKING AND INSURANCE, APRIL 18, 2005
AN ACT
1 Amending the act of April 9, 1929 (P.L.177, No.175), entitled
2 "An act providing for and reorganizing the conduct of the
3 executive and administrative work of the Commonwealth by the
4 Executive Department thereof and the administrative
5 departments, boards, commissions, and officers thereof,
6 including the boards of trustees of State Normal Schools, or
7 Teachers Colleges; abolishing, creating, reorganizing or
8 authorizing the reorganization of certain administrative
9 departments, boards, and commissions; defining the powers and
10 duties of the Governor and other executive and administrative
11 officers, and of the several administrative departments,
12 boards, commissions, and officers; fixing the salaries of the
13 Governor, Lieutenant Governor, and certain other executive
14 and administrative officers; providing for the appointment of
15 certain administrative officers, and of all deputies and
16 other assistants and employes in certain departments, boards,
17 and commissions; and prescribing the manner in which the
18 number and compensation of the deputies and all other
19 assistants and employes of certain departments, boards and
20 commissions shall be determined," establishing the Office of
21 Health Maintenance Organization Consumer Advocate as an
22 independent office within the Office of Attorney General and
23 prescribing its powers and duties.
24 The General Assembly of the Commonwealth of Pennsylvania
25 hereby enacts as follows:
26 Section 1. The act of April 9, 1929 (P.L.177, No.175), known
27 as The Administrative Code of 1929, is amended by adding an
28 article to read:
1 ARTICLE IX-C
2 OFFICE OF HEALTH MAINTENANCE ORGANIZATION CONSUMER
3 ADVOCATE
4 Section 901-C. Definitions.
5 The following words and phrases when used in this article
6 shall have the meanings given to them in this section unless the
7 context clearly indicates otherwise:
8 "Consumer." A person who meets either of the following
9 criteria:
10 (1) Makes direct use of or is the ultimate recipient of
11 a product or service supplied by a health maintenance
12 organization.
13 (2) May be a direct user or ultimate recipient of a
14 product or service supplied by a person or health maintenance
15 organization and may be affected in any way by any action by
16 a health maintenance organization.
17 "Department." The Insurance Department of the Commonwealth
18 and includes the Insurance Commissioner.
19 "Health maintenance organization" or "HMO." An organized
20 system which combines the delivery and financing of health care
21 and provides basic health services to voluntarily enrolled
22 subscribers for a fixed prepaid fee.
23 Section 902-C. Office of Health Maintenance Organization
24 Consumer Advocate.
25 (a) Establishment.--The Office of Health Maintenance
26 Organization Consumer Advocate is established as an independent
27 office within the Office of Attorney General to represent the
28 interest of consumers before the department.
29 (b) Administration.--The Office of HMO Consumer Advocate
30 shall be headed by the HMO Consumer Advocate who shall be
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1 appointed by the Attorney General and by reason of training,
2 experience and attainment shall be qualified to represent the
3 interest of consumers. The Executive Board shall set the
4 compensation of the HMO Consumer Advocate.
5 (c) Conflict of interest.--No individual who serves as HMO
6 Consumer Advocate shall, while serving in the position, engage
7 in any business, vocation or other employment, or have other
8 interests, inconsistent with the official responsibilities, nor
9 shall the individual seek or accept employment nor render
10 beneficial services for compensation with any health maintenance
11 organization subject to the authority of the office during the
12 tenure of the appointment and for a period of two years
13 immediately after the appointment is served or terminated.
14 (d) Restriction.--No individual who is appointed as HMO
15 Consumer Advocate shall seek election nor accept appointment to
16 any political office during the tenure as HMO Consumer Advocate
17 and for a period of two years after the appointment is served or
18 terminated.
19 Section 903-C. Assistant consumer advocates; employees.
20 The HMO Consumer Advocate shall appoint attorneys as
21 assistant HMO consumer advocates and additional clerical,
22 technical and professional staff as may be appropriate, and may
23 contract for additional services as shall be necessary for the
24 performance of the duties imposed by this article. The Executive
25 Board shall set the compensation of assistant HMO consumer
26 advocates and clerical, technical and professional staff. No
27 assistant HMO consumer advocate or other staff employee shall,
28 while serving in the position, engage in any business, vocation
29 or other employment or have other interests inconsistent with
30 official responsibilities.
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1 Section 904-C. Powers and duties of the HMO Consumer Advocate.
2 (a) General rule.--In addition to any other authority
3 conferred by this article, the HMO Consumer Advocate shall, in
4 carrying out the responsibilities under this article, represent
5 the interest of consumers as a party, or otherwise participate
6 for the purpose of representing an interest of consumers before
7 the department in any matter properly before the department, and
8 before any court or agency, initiating proceedings if, in the
9 judgment of the HMO Consumer Advocate, the representation may be
10 necessary, in connection with any matter involving regulation by
11 the department or the corresponding regulatory agency of the
12 Federal Government, whether on appeal or otherwise initiated.
13 (b) Monitoring.--The HMO Consumer Advocate may monitor all
14 cases before departments of the United States, including, but
15 not limited to, the Department of Health and Human Services,
16 which impact the interests of consumers in this Commonwealth and
17 may formally participate in those proceedings which in his
18 judgment warrant participation.
19 (c) Exercise of discretion.--The HMO Consumer Advocate may
20 exercise discretion in determining the interests of consumers
21 which will be advocated in any particular proceeding and in
22 determining whether or not to participate in or initiate any
23 particular proceeding and, in so determining, shall consider the
24 public interest, the resources available and the substantiality
25 of the effect of the proceeding on the interest of consumers.
26 The HMO Consumer Advocate may refrain from intervening when, in
27 the judgment of the HMO Consumer Advocate, intervention is not
28 necessary to represent adequately the interest of consumers.
29 (d) Other duties.--In addition to any other authority
30 conferred by this article, the HMO Consumer Advocate shall
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1 represent an interest of consumers which is presented for
2 consideration, upon petition in writing, by a substantial number
3 of persons who are consumers. The HMO Consumer Advocate shall
4 notify the principal sponsors of the petition within a
5 reasonable time after receipt of the petition of the action
6 taken or intended to be taken with respect to the interest of
7 consumers presented in that petition. If the HMO Consumer
8 Advocate declines or is unable to represent the interest,
9 written notification and the reasons for the action shall be
10 given to the sponsors.
11 (e) Action.--Any action brought by the HMO Consumer Advocate
12 before a court or an agency of this Commonwealth shall be
13 brought in the name of the HMO Consumer Advocate. The HMO
14 Consumer Advocate may name a consumer or group of consumers in
15 whose name the action may be brought or may join with a consumer
16 or group of consumers in bringing the action.
17 (f) Public statement.--At a time as the HMO Consumer
18 Advocate determines, in accordance with applicable time
19 limitations to initiate, intervene or otherwise participate in
20 any department, agency or court proceeding, the HMO Consumer
21 Advocate shall issue publicly a written statement, a copy of
22 which shall be filed in the proceeding in addition to any
23 required entry of appearance, stating concisely the specific
24 interest of consumers to be protected.
25 Section 905-C. Duties of department.
26 In dealing with any proposed action which may substantially
27 affect the interest of consumers, the department shall:
28 (1) Notify the HMO Consumer Advocate when notice of the
29 proposed action is given to the public or at a time fixed by
30 agreement between the HMO Consumer Advocate and the
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1 department in a manner to assure the HMO Consumer Advocate
2 reasonable notice and adequate time to determine whether to
3 intervene in the matter.
4 (2) Consistent with its other statutory
5 responsibilities, take action with due consideration to the
6 interest of consumers.
7 Section 906-C. Reports.
8 The HMO Consumer Advocate shall transmit to the Governor, the
9 Attorney General and the General Assembly, and shall make
10 available to the public, an annual report on the conduct of the
11 Office of HMO Consumer Advocate. The HMO Consumer Advocate shall
12 make recommendations as may, from time to time, be necessary or
13 desirable to protect the interest of consumers.
14 Section 907-C. Savings provision; construction.
15 Nothing contained in this article shall in any way be
16 construed:
17 (1) to limit the right of a consumer to bring a
18 proceeding before either the department or a court; or
19 (2) to impair the statutory authority or responsibility
20 of the department to regulate health maintenance
21 organizations in the public interest.
22 Section 2. This act shall take effect in 60 days.
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