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                                 SENATE AMENDED
        PRIOR PRINTER'S NOS. 4132, 4366               PRINTER'S NO. 4886

THE GENERAL ASSEMBLY OF PENNSYLVANIA


HOUSE BILL

No. 2699 Session of 2006


        INTRODUCED BY KENNEY, OLIVER, WATSON, ROSS, BEBKO-JONES, BISHOP,
           JAMES, KIRKLAND, MYERS, WATERS, ADOLPH, BARRAR, BLACKWELL,
           BOYD, BUXTON, CALTAGIRONE, CIVERA, COHEN, COSTA, CRAHALLA,
           CRUZ, DALLY, DERMODY, FABRIZIO, GANNON, GEORGE, GILLESPIE,
           GODSHALL, GOODMAN, HARHART, HENNESSEY, W. KELLER, KILLION,
           LEACH, LEDERER, LEVDANSKY, MACKERETH, MAHER, MAITLAND, MANN,
           McGEEHAN, MICOZZIE, O'BRIEN, PARKER, PETRONE, PHILLIPS,
           QUIGLEY, RAYMOND, ROEBUCK, RUBLEY, SABATINA, SHAPIRO,
           SIPTROTH, T. STEVENSON, E. Z. TAYLOR, J. TAYLOR, THOMAS,
           TIGUE, TRUE, WILLIAMS, YUDICHAK, O'NEILL, SATHER, CORNELL,
           BENNINGHOFF, PISTELLA, SONNEY, YOUNGBLOOD, BEYER, GINGRICH,
           McILHINNEY AND PETRI, JUNE 6, 2006

        AS AMENDED ON THIRD CONSIDERATION, IN SENATE, OCTOBER 23, 2006

                                     AN ACT

     1  Authorizing and directing the Department of Public Welfare to     <--
     2     establish and maintain a managed health care program for
     3     medical assistance recipients; requiring actuarially sound
     4     rates for certain managed care organizations; providing for
     5     the right of appeal and approval by the General Assembly of
     6     changes to the Commonwealth medical assistance plan and
     7     associated waivers; and repealing inconsistent portions of
     8     other acts.
     9  AMENDING THE ACT OF MAY 17, 1921 (P.L.682, NO.284), ENTITLED "AN  <--
    10     ACT RELATING TO INSURANCE; AMENDING, REVISING, AND
    11     CONSOLIDATING THE LAW PROVIDING FOR THE INCORPORATION OF
    12     INSURANCE COMPANIES, AND THE REGULATION, SUPERVISION, AND
    13     PROTECTION OF HOME AND FOREIGN INSURANCE COMPANIES, LLOYDS
    14     ASSOCIATIONS, RECIPROCAL AND INTER-INSURANCE EXCHANGES, AND
    15     FIRE INSURANCE RATING BUREAUS, AND THE REGULATION AND
    16     SUPERVISION OF INSURANCE CARRIED BY SUCH COMPANIES,
    17     ASSOCIATIONS, AND EXCHANGES, INCLUDING INSURANCE CARRIED BY
    18     THE STATE WORKMEN'S INSURANCE FUND; PROVIDING PENALTIES; AND
    19     REPEALING EXISTING LAWS," FURTHER PROVIDING, IN HEALTH CARE
    20     INSURANCE INDIVIDUAL ACCESSIBILITY, FOR EXPIRATION;
    21     PROVIDING, IN QUALITY HEALTH CARE ACCOUNTABILITY, FOR MANAGED
    22     CARE PLANS PARTICIPATING IN THE MEDICAL ASSISTANCE PROGRAM;
    23     FURTHER PROVIDING, IN CHILDREN'S HEALTH CARE, FOR LEGISLATIVE


     1     FINDINGS AND INTENT, FOR DEFINITIONS, FOR FREE AND SUBSIDIZED
     2     HEALTH CARE, FOR OUTREACH AND FOR PAYOR OF LAST RESORT AND
     3     INSURANCE COVERAGE; AND PROVIDING, IN CHILDREN'S HEALTH CARE,
     4     FOR FEDERAL WAIVERS AND FOR EXPIRATION.

     5     The General Assembly of the Commonwealth of Pennsylvania
     6  hereby enacts as follows:
     7  Section 1.  Short title.                                          <--
     8     This act shall be known and may be cited as the Health
     9  Choices Act.
    10  Section 2.  Legislative intent.
    11     It is the intent of the General Assembly to:
    12         (1)  Improve the accessibility, continuity and quality of
    13     health care services for participants in the Commonwealth's
    14     medical assistance program, while responsibly controlling
    15     program costs.
    16         (2)  Establish a process for the establishment and
    17     maintenance of a program to manage the care of participants
    18     in the medical assistance program.
    19         (3)  Ensure that managed care organizations serving
    20     medical assistance recipients receive compensation that is
    21     actuarially sound and otherwise compliant with Federal and
    22     Commonwealth statutes and regulations and that is determined
    23     through a transparent process.
    24         (4)  Provide for legislative approval of certain
    25     amendments to the Commonwealth State plan for the medical
    26     assistance program.
    27         (5)  Establish procedures by which managed care
    28     organizations may appeal decisions made by the Department of
    29     Public Welfare with respect to the calculation of capitation
    30     rates and payments and other contractual provisions.
    31  Section 3.  Definitions.

    20060H2699B4886                  - 2 -     

     1     The following words and phrases when used in this act shall
     2  have the meanings given to them in this section unless the
     3  context clearly indicates otherwise:
     4     "Actuarial standards board."  The body established by the
     5  American Academy of Actuaries to promulgate actuarial standards
     6  of practice.
     7     "Actuarially sound rates."  With respect to the health
     8  choices program, capitation rates which:
     9         (1)  Are adequate to cover the reasonably expected
    10     medical, administrative and assessment expenses, and a
    11     reasonable level of profit or contingency, associated with
    12     the fulfillment of a contractor's obligations in the
    13     applicable contract year.
    14         (2)  Make provision for assumed expense levels, for all
    15     expenses, that are reasonably attainable by all contractors
    16     in each geographic zone in the contract year, based primarily
    17     on the actual expense experience of such contractor during
    18     prior years and expenses actually expected to be incurred in
    19     the applicable contract year.
    20         (3)  Are based on assumptions that represent the most
    21     likely outcomes for costs and utilization expected within the
    22     range of assumptions developed for the populations and
    23     benefits covered in each geographic zone.
    24         (4)  Are compliant with all applicable standards,
    25     statutes, rules and regulations governing the development of
    26     such rates.
    27         (5)  Are based on methods, considerations and analyses
    28     that conform to applicable guidelines promulgated by the
    29     actuarial standards board.
    30     "Capitation."  A fee the Department of Public Welfare
    20060H2699B4886                  - 3 -     

     1  periodically pays to a contractor for each recipient enrolled
     2  under a contract for the provision of medical services, whether
     3  or not the recipient receives the services during the period
     4  covered by the fee.
     5     "CMS."  The Centers for Medicare and Medicaid Services of the
     6  United States Department of Health and Human Services and such
     7  successor entities which may from time to time discharge the
     8  duties of CMS with respect to the medical assistance program.
     9     "Contractor."  A managed care organization providing managed
    10  care services relating to medical care provided to recipients
    11  under one or more contracts with the Department of Public
    12  Welfare pursuant to the health choices program. This term shall
    13  also refer to a managed care organization seeking to enter into
    14  a contract with the Department of Public Welfare to provide
    15  services under health choices program.
    16     "Department."  The Department of Public Welfare of the
    17  Commonwealth.
    18     "HIPAA."  The Health Insurance Portability and Accountability
    19  Act of 1996 (Public Law 104-191, 110 Stat. 1936) and regulations
    20  promulgated thereunder.
    21     "In-plan services."  Services included in the medical
    22  assistance program pursuant to the State plan.
    23     "Managed care organization."  A public or private
    24  organization that is a federally qualified health maintenance
    25  organization or meets the State plan's definition of a health
    26  maintenance organization or otherwise qualifies as a managed
    27  care plan as defined in Article XXI of the act of May 17, 1921
    28  (P.L.682, No.284), known as The Insurance Company Law of 1921.
    29     "Medical assistance."  The Commonwealth program authorized by
    30  Subchapter XIX of the Social Security Act (49 Stat. 620, 42
    20060H2699B4886                  - 4 -     

     1  U.S.C. 1396 et seq.), known as Medicaid and authorized in this
     2  Commonwealth under the act of June 13, 1967 (P.L.31, No.21),
     3  known as the Public Welfare Code, and subject to regulations
     4  promulgated under such statutes. The term shall also refer to
     5  any successor program implemented by either the Federal
     6  Government or the Commonwealth, to the extent a contractor is
     7  providing services contemplated in this act with respect to such
     8  program.
     9     "Program."  The Commonwealth's health choices program, as
    10  provided for in this act, which provides mandatory managed
    11  health care to recipients in specified areas of this
    12  Commonwealth through contracts with managed care organizations.
    13     "Program change."  Amendments, revisions or additions to the
    14  Department of Public Welfare's medical assistance fee schedule,
    15  State plan or to Federal or Commonwealth regulations, laws,
    16  guidelines, waivers or policies, insofar as they affect the
    17  scope or nature of benefits available to eligible persons.
    18     "Recipient."  An individual eligible to receive health care
    19  or health-related services under the medical assistance program.
    20     "State plan."  The document prepared by the Commonwealth in
    21  the manner required by section 1396a(a) of the Social Security
    22  Act (49 Stat. 620, 42 U.S.C. § 1396a(a)), as approved by the
    23  Centers for Medicare and Medicaid Services, that describes the
    24  nature, scope and operation of the medical assistance program
    25  and gives assurances that the Commonwealth will administer the
    26  program in compliance with Federal requirements. The term shall
    27  also include waivers granted by the Centers for Medicare and
    28  Medicaid Services not otherwise included in the plan submitted
    29  by the Commonwealth for Centers for Medicare and Medicaid
    30  Services approval.
    20060H2699B4886                  - 5 -     

     1     "Waiver."  A determination made by the Centers for Medicare
     2  and Medicaid Services under Subchapter XIX of the Social
     3  Security Act (49 Stat. 620, 42 U.S.C. 1396 et seq.), known as
     4  Medicaid, and regulations promulgated thereunder, which allows
     5  the Commonwealth to make modifications in its operation of the
     6  medical assistance program.
     7     "Zone."  A geographic area, designated as provided in this
     8  act, within which contractors provide services to recipients.
     9  Section 4.  General provisions regarding program.
    10     (a)  Administration.--The Commonwealth, acting by and through
    11  the department, shall implement and administer the program in
    12  all areas of this Commonwealth as provided in this act.
    13     (b)  Replacing other law as the means for providing
    14  assistance.--The program shall require the provision of all
    15  medical assistance-covered medical benefits in the amount,
    16  duration and scope set forth in the act of June 13, 1967
    17  (P.L.31, No.21), known as the Public Welfare Code, for
    18  recipients in the following categories:
    19         (1)  Supplemental Security Income.
    20         (2)  Temporary assistance for needy families.
    21         (3)  Healthy beginnings.
    22         (4)  General assistance.
    23         (5)  Successors to the categories listed in paragraphs
    24     (1), (2), (3) and (4).
    25     (c)  Exclusion.--Recipients residing in long-term care
    26  facilities, residential facilities and Commonwealth facilities,
    27  other than State-operated intermediate care facilities for the
    28  mentally retarded, shall be excluded from participation in the
    29  program.
    30     (d)  Adding or removing optional benefits.--The department
    20060H2699B4886                  - 6 -     

     1  may amend the State plan to add or remove optional medical
     2  assistance benefits which are not required by this act, the
     3  Public Welfare Code, other acts of the General Assembly or by
     4  Subchapter XIX of the Social Security Act (49 Stat. 620, 42
     5  U.S.C. 1396 et seq.), known as Medicaid, and regulations
     6  promulgated thereunder to be provided by the Commonwealth to
     7  recipients, with the exception of pharmaceutical services, which
     8  shall remain a covered benefit under the program and provided by
     9  contracts with managed care contractors.
    10     (e)  Mandatory participation exclusion.--Notwithstanding the
    11  provisions of subsection (b), the department may exclude
    12  recipients from mandatory participation in the program as a
    13  result of:
    14         (1)  Determination by the department that the recipient
    15     is eligible for the Commonwealth's health insurance premium
    16     payment program.
    17         (2)  The recipient becoming ventilator-dependent in an
    18     acute or rehabilitation hospital for more than 30 consecutive
    19     days.
    20         (3)  The recipient's enrollment in the Department of
    21     Aging waiver.
    22         (4)  The recipient's enrollment in the Michael Dallas
    23     Model waiver.
    24     (f)  Alternative services.--Contracts executed by and between
    25  the department and contractors shall allow contractors to
    26  provide supplemental and cost-effective alternative services to
    27  recipients in lieu of or in addition to in-plan services and to
    28  take other measures which in the contractor's judgment promote
    29  quality of care or efficiency, and the process established in
    30  this act for determination of actuarially sound capitation rates
    20060H2699B4886                  - 7 -     

     1  shall take the effect of such supplemental and cost-effective
     2  alternative services and other measures into account.
     3     (g)  Allocation of responsibility.--Contracts executed by and
     4  between the department and contractors may provide for the
     5  allocation of responsibility to provide health care services
     6  between physical and behavioral health care among contractors.
     7  Section 5.  Program administration.
     8     (a)  Zones.--The department shall administer the program for
     9  both physical health care and behavioral health care in the
    10  following areas of this Commonwealth, incorporating the
    11  provisions of this act:
    12         (1)  Southeast zone: Bucks, Chester, Delaware, Montgomery
    13     and Philadelphia Counties.
    14         (2)  Southwest zone:  Allegheny, Armstrong, Beaver,
    15     Butler, Fayette, Greene, Indiana, Lawrence, Washington and
    16     Westmoreland Counties.
    17         (3)  Lehigh and Capital zone: Adams, Berks, Cumberland,
    18     Dauphin, Lancaster, Lebanon, Lehigh, Northampton, Perry and
    19     York Counties.
    20         (4)  Other zones: Other counties, or groupings of
    21     counties, which are covered by program contracts in effect as
    22     of the effective date of this section by and between the
    23     department and contractors which provide for the provision of
    24     behavioral health care services to recipients residing in
    25     such counties.
    26     (b)  Designation.--Within 120 days of the effective date of
    27  this section, the department shall designate groupings of
    28  counties not included in the groupings described in subsection
    29  (a) as zones for expansion of the program to counties of this
    30  Commonwealth not covered by the program. Such determination
    20060H2699B4886                  - 8 -     

     1  shall be based upon factors, including, but not limited to:
     2         (1)  Population, in terms both of the total number of
     3     people who live in an area, and population density, as well
     4     as the number of current and anticipated recipients.
     5         (2)  Multicounty arrangements created under the act of
     6     October 20, 1966 (3rd Sp.Sess., P.L.96, No.6), known as the
     7     Mental Health and Mental Retardation Act of 1966, operating
     8     under other statutes relating to the provision of human
     9     services or cooperating in contracting with the Commonwealth
    10     or in the operation of human services programs.
    11         (3)  The department's regions.
    12         (4)  Constraints imposed by geography, transportation and
    13     health care provider systems.
    14         (5)  Relationships among consumers and providers.
    15         (6)  Managed care organization service areas.
    16     (c)  Residents of seventh or eighth class counties.--The
    17  department may exclude recipients residing in a county of the
    18  seventh or eighth class, as such classifications are established
    19  under the act of August 9, 1955 (P.L.323, No.130), known as The
    20  County Code, from participation in the program upon making a
    21  finding that population density, availability of providers or
    22  other factors make inclusion of such recipients in the program
    23  impracticable.
    24  Section 6.  Program expansion.
    25     (a)  Responsibilities of department.--Within 270 days of the
    26  effective date of this section, the department shall:
    27         (1)  Issue one or more requests for proposals for the
    28     expansion of the program to all counties of this Commonwealth
    29     not covered by one or more program contracts for physical
    30     health care at that time, based upon the zones created
    20060H2699B4886                  - 9 -     

     1     pursuant to section 5.
     2         (2)  Review and evaluate responses from managed care
     3     organizations to the requests for proposals issued pursuant
     4     to paragraph (1), in accordance with applicable Federal and
     5     Commonwealth laws and regulations.
     6         (3)  Select contractors for each zone into which the
     7     program is to be expanded in accordance with the provisions
     8     of section 7 and this section. The contractors having the
     9     responsibility to provide services for the benefit of all
    10     program recipients residing in these zones are subject only
    11     to the limitations imposed in section 4.
    12         (4)  Negotiate and execute contracts with selected
    13     contractors for each zone into which the program is to be
    14     expanded, incorporating terms and conditions in conformance
    15     with the provisions of this act, including, without
    16     limitation, actuarially sound capitation rates determined in
    17     accordance with section 7.
    18         (5)  Seek and make all efforts to obtain any necessary or
    19     desirable amendments to or approvals of waivers from CMS or
    20     any other agencies of the Federal Government to allow timely
    21     implementation of the expansion provided for in this section.
    22     (b)  Selection of contractors.--The department shall select
    23  no fewer than two contractors to provide managed care services
    24  for each zone into which the program is to be expanded, such
    25  contractors having the responsibility to provide services for
    26  the benefit of all program recipients residing in such zone,
    27  subject only to the limitations provided in section 4. If the
    28  department selects one or more counties to act as contractors to
    29  provide managed behavioral health care services to recipients
    30  residing in designated counties, the requirement to select more
    20060H2699B4886                 - 10 -     

     1  than one contractor shall not apply as to the provision of
     2  behavioral health care services in such counties only.
     3     (c)  Implementation of expansion.--The department may
     4  implement the expansion required by this section in phases, but
     5  program shall become operational in all zones to the full extent
     6  required under this act no later than 24 months after the
     7  effective date of this section.
     8  Section 7.  Capitation rates.
     9     (a)  Development and determination of rates.--The department
    10  shall adopt by regulation a methodology for development and
    11  determination of actuarially sound capitation rates to be paid
    12  to contractors which is in all respects compliant with this act.
    13  The methodology shall include a list of all relevant factors
    14  which the department shall take into account in the development
    15  of such rates.
    16     (b)  Annual capitation rates.--
    17         (1)  Capitation rates paid by the department to
    18     contractors shall be actuarially sound.
    19         (2)  Capitation rates shall be determined by the
    20     department in accordance with the methodology in the
    21     regulations adopted pursuant to subsection (a).
    22         (3)  The department shall use its best efforts to publish
    23     final capitation rates for each contractor for the next
    24     contract year not less than 120 days prior to the beginning
    25     of such contract year and shall advise contractors of any
    26     delays in the publication of such rates.
    27         (4)  The department shall disclose to contractors its
    28     application of all factors used in the development of the
    29     capitation rates for such contractor and all information
    30     submitted to CMS relating to such capitation rates, no later
    20060H2699B4886                 - 11 -     

     1     than the date the department discloses the rates it intends
     2     to offer with respect to a contract period. The department
     3     shall also provide the contractor with any other such
     4     information which it submits to CMS after the initial
     5     disclosure contemplated in this subsection within ten days of
     6     its submission to CMS.
     7     (c)  Intrayear adjustments to capitation rates.--
     8         (1)  The department shall adjust capitation rates within
     9     a contract year to achieve or maintain actuarially sound
    10     capitation rates for contractors to reflect program changes,
    11     such adjustments shall cover all applicable portions of the
    12     contract year to which such program changes apply and be
    13     developed pursuant to the methodology required be established
    14     under subsection (a).
    15         (2)  In considering the need for intrayear capitation
    16     rate adjustments, the department shall evaluate the impact of
    17     program changes which have been imposed during the course of
    18     the contract year in combination with prospective program
    19     changes.
    20         (3)  Other than program changes designated by the
    21     department as being emergency program changes or program
    22     changes required by changes in Federal law or regulation with
    23     an earlier effective date, no program change shall become
    24     effective with less than 60 days' notice to the contractor.
    25         (4)  The department shall disclose to contractors its
    26     application of all factors used in the development of the
    27     capitation rates with respect to an intrayear adjustment in
    28     capitation rates for such contractors and all information
    29     submitted to CMS relating to such capitation rates, no later
    30     than the date when the department disclosed the rates it
    20060H2699B4886                 - 12 -     

     1     intends to offer with respect to such intrayear adjustment.
     2     The department shall also provide the contractor with any
     3     other such information which it submits to CMS after the
     4     initial disclosure contemplated in this subsection within ten
     5     days of its submission to CMS.
     6  Section 8.  Appeals.
     7     (a)  Claims by contractor.--All claims against the department
     8  relating to any matter regarding any contract relating to the
     9  program may be filed by the contractor in the Board of Claims
    10  under 62 Pa.C.S. Ch. 17 Subch. C (relating to Board of Claims),
    11  including, without limitation, claims relating to the actuarial
    12  soundness of capitation rates.
    13     (b)  Effect of agreements between contractor and
    14  department.--No provision of any agreement by and between a
    15  contractor and the department, any request for proposal,
    16  regulation, bulletin or other statement issued by any agency or
    17  department of the commonwealth shall foreclose:
    18         (1)  The right of a contractor to file a claim before the
    19     Board of Claims, including its right to appeal any
    20     determination by the department as to the actuarial soundness
    21     of any capitation rate or to appeal a finding by the Board of
    22     Claims with respect to such claim.
    23         (2)  The right of a contractor to file any other claim or
    24     appeal in any forum having jurisdiction to consider such
    25     claim or appeal.
    26         (3)  The right of the contractor to perform at the
    27     capitation rate accepted by the department during the
    28     pendency of such claim or appeal. Any such provision shall be
    29     void and unenforceable against a contractor.
    30     (c)  Notification by contractor.--A contractor which desires
    20060H2699B4886                 - 13 -     

     1  to perform at the capitation rate accepted by the department
     2  during the pendency of proceedings in the Board of Claims or any
     3  appeal of a finding by the Board of Claims shall notify the
     4  department of its intention to file a claim in the Board of
     5  Claims no later than the date the contractor executes the
     6  contract incorporating such rate.
     7  Section 9.  Replacement of contractors.
     8     (a)  Requests for proposals.--The department may, from time
     9  to time, determine to issue requests for proposals:
    10         (1)  to expand the number of contractors serving one or
    11     more zones;
    12         (2)  to replace contractors;
    13         (3)  to assess the qualification or performance of
    14     current contractors; or
    15         (4)  at the discretion of the department.
    16     (b)  Compliance by department.--In the event the department
    17  exercises its right under this section, it shall comply with the
    18  provisions of section 7 with respect to the determination of
    19  capitation rates.
    20  Section 10.  Amendments to the State plan.
    21     (a)  Waiver or amendment submissions.--Prior to the
    22  department submitting a waiver, an amendment to the State plan
    23  or an amendment to a waiver to CMS for its approval where such
    24  waiver, State plan amendment or amended waiver would cause a
    25  change in expenditure of Commonwealth funds of more than $20
    26  million during any fiscal year, the department shall submit such
    27  proposed waiver, State plan amendment or waiver amendment for
    28  review under the provisions of the act of June 25, 1982
    29  (P.L.633, No.181), known as the Regulatory Review Act.
    30     (b)  Determination of expenditures.--In making the
    20060H2699B4886                 - 14 -     

     1  determination of Commonwealth expenditures required by
     2  subsection (a), the department shall take into account all
     3  waivers, State plan amendments and amended waivers then proposed
     4  or in effect, in combination with all waivers, State plan
     5  amendments and waiver amendments expected to be requested for
     6  the remainder of the then current fiscal year.
     7  Section 11.  General provisions.
     8     In discharging its responsibilities under this act, the
     9  department shall be subject to the provisions of the act of June
    10  21, 1957 (P.L.390, No.212), referred to as the Right-to-Know
    11  Law. The department shall not make available any information:
    12         (1)  in violation of the provisions of HIPAA; or
    13         (2)  disclosing capitation rates for individual managed
    14     care organizations, including, without limitation, financial
    15     and actuarial information provided by a managed care
    16     organization or a managed care organization contractor to the
    17     department for the purpose of negotiating or determining
    18     capitation rates to be paid for health care services on
    19     behalf of recipients.
    20  Section 12.  Report to General Assembly.
    21     (a)  Officials to receive report.--Within 12 months following
    22  the effective date of this section, and annually thereafter, the
    23  department shall deliver a report on the implementation and
    24  operation of the program to:
    25         (1)  The Speaker of the House of Representatives.
    26         (2)  The minority leader of the House of Representatives.
    27         (3)  The chairman of the Appropriations Committee of the
    28     House of Representatives.
    29         (4)  The minority chairman of the Appropriations
    30     Committee of the House of Representatives.
    20060H2699B4886                 - 15 -     

     1         (5)  The chairman of the Health and Human Services
     2     Committee of the House of Representatives.
     3         (6)  The minority chairman of the Health and Human
     4     Services Committee of the House of Representatives.
     5         (7)  The President pro tempore of the Senate.
     6         (8)  The minority leader of the Senate.
     7         (9)  The chairman of the Appropriations Committee of
     8     Senate.
     9         (10)  The minority chairman of the Appropriations
    10     Committee of the Senate.
    11         (11)  The chairman of the Public Health and Welfare
    12     Committee of the Senate.
    13         (12)  The minority chairman of the Public Health and
    14     Welfare Committee of the Senate.
    15     (b)  Content of report.--This report shall include:
    16         (1)  The number of applicants per service per county,
    17     separated by those served and those denied.
    18         (2)  The total cost or savings to the Commonwealth by
    19     contractors, itemized by county per service provided.
    20         (3)  The number of doctors in each county, separated by
    21     those who accept medical assistance and those who do not
    22     accept medical assistance.
    23         (4)  The percentage change of each of the categories
    24     above since the implementation of the act.
    25         (5)  Policy recommendations.
    26  Section 13.  Repeals.
    27     All acts, including without limitation, the act of December
    28  3, 2002 (P.L.1147, No.142), are repealed to the extent they are
    29  inconsistent with this act.
    30  Section 14.  Effective date.
    20060H2699B4886                 - 16 -     

     1     This act shall take effect as follows:
     2         (1)  Section 7 shall take effect immediately.
     3         (2)  The remainder of this act shall take effect in 60
     4     days.
     5     SECTION 1.  SECTION 1012-A OF THE ACT OF MAY 17, 1921          <--
     6  (P.L.682, NO.284), KNOWN AS THE INSURANCE COMPANY LAW OF 1921,
     7  AMENDED DECEMBER 23, 2003 (P.L.358, NO.50), IS AMENDED TO READ:
     8     [SECTION 1012-A.  EXPIRATION.--THIS ARTICLE SHALL EXPIRE ON
     9  DECEMBER 31, 2006.]
    10     SECTION 2.  THE ACT IS AMENDED BY ADDING A SECTION TO READ:
    11     SECTION 2194.  MANAGED CARE PLANS PARTICIPATING IN THE
    12  MEDICAL ASSISTANCE PROGRAM.--(A)  THE GENERAL ASSEMBLY FINDS
    13  THAT:
    14     (1)  ACCESSIBILITY TO HEALTH CARE SERVICES RECEIVED BY
    15  PARTICIPANTS IN THE COMMONWEALTH'S MEDICAL ASSISTANCE PROGRAM
    16  MUST BE MAINTAINED THROUGHOUT THIS COMMONWEALTH.
    17     (2)  THE QUALITY AND CONTINUITY OF THESE SERVICES MUST BE
    18  ASSURED IN A MANNER THAT RESPONSIBLY AND EFFECTIVELY CONTROLS
    19  MEDICAL ASSISTANCE COSTS.
    20     (3)  MANAGED CARE PLANS CONTRACTING WITH THE DEPARTMENT OF
    21  PUBLIC WELFARE FOR PURPOSES OF PARTICIPATION IN THE MEDICAL
    22  ASSISTANCE PROGRAM HAVE DEVELOPED ACROSS THIS COMMONWEALTH AND
    23  PROVIDE VITAL HEALTH CARE SERVICES, INCLUDING PHARMACEUTICALS,
    24  TO THE MEDICAL ASSISTANCE POPULATION OF THIS COMMONWEALTH.
    25     (4)  A REVIEW OF THE DELIVERY OF SERVICES PROVIDED BY THESE
    26  MANAGED CARE PLANS IS NECESSARY TO ENABLE THE DEPARTMENT OF
    27  PUBLIC WELFARE, IN CONSULTATION WITH THE DEPARTMENT, TO
    28  FORMULATE A STRATEGY THAT PROPERLY UTILIZES COST CONTROL
    29  MECHANISMS THAT PRODUCE AVAILABLE SAVINGS TO THE COMMONWEALTH IF
    30  AN EFFECTIVE AND RESPONSIVE HEALTH CARE NETWORK IS TO BE
    20060H2699B4886                 - 17 -     

     1  MAINTAINED ACROSS THIS COMMONWEALTH, ESPECIALLY DUE TO
     2  CONTINUING CHANGES AT THE FEDERAL LEVEL.
     3     (B)  THE LEGISLATIVE BUDGET AND FINANCE COMMITTEE SHALL
     4  CONDUCT A REVIEW OF AND ISSUE A REPORT ON THE DELIVERY AND
     5  QUALITY OF HEALTH CARE SERVICES PROVIDED THROUGH THE CURRENT
     6  FEE-FOR-SERVICE PROGRAM, AS WELL AS BY MANAGED CARE PLANS
     7  PARTICIPATING IN THE COMMONWEALTH'S MEDICAL ASSISTANCE PROGRAM.
     8  THE REPORT SHALL INCLUDE THE FOLLOWING FOR EACH SERVICE DELIVERY
     9  SYSTEM:
    10     (1)  INFORMATION REGARDING THE NUMBER OF MEDICAL ASSISTANCE
    11  PARTICIPANTS PER SERVICE PER COUNTY, SEPARATED BY THOSE SERVED
    12  AND THOSE DENIED.
    13     (2)  THE TOTAL COST OR SAVINGS ACCRUED TO THE COMMONWEALTH
    14  ITEMIZED BY COUNTY PER SERVICE PROVIDED, INCLUDING
    15  PHARMACEUTICALS.
    16     (3)  RECOMMENDATIONS FOR REVISIONS IN PRACTICES USED BY THE
    17  DEPARTMENT OF PUBLIC WELFARE TO CONTRACT AND PROVIDE FOR ALL
    18  HEALTH CARE SERVICES AVAILABLE THROUGH THE MEDICAL ASSISTANCE
    19  PROGRAM.
    20     (4)  ANY OTHER RECOMMENDATIONS THAT WILL PROMOTE MEDICAL
    21  ASSISTANCE PROGRAM SAVINGS.
    22     (C)  THE DEPARTMENT OF PUBLIC WELFARE AND ALL OTHER AFFECTED
    23  STATE AGENCIES SHALL COOPERATE FULLY WITH THE LEGISLATIVE BUDGET
    24  AND FINANCE COMMITTEE IN PROVIDING ANY AND ALL INFORMATION
    25  NECESSARY TO CONDUCT ITS REVIEW AND PREPARE ITS REPORT.
    26     (D)  THE LEGISLATIVE BUDGET AND FINANCE COMMITTEE SHALL
    27  REPORT ITS FINDINGS AND RECOMMENDATIONS NO LATER THAN MARCH 1,
    28  2007, TO THE GOVERNOR, THE SECRETARY OF PUBLIC WELFARE, THE
    29  INSURANCE COMMISSIONER, THE CHAIRMAN AND MINORITY CHAIRMAN OF
    30  THE PUBLIC HEALTH AND WELFARE COMMITTEE OF THE SENATE, THE
    20060H2699B4886                 - 18 -     

     1  CHAIRMAN AND MINORITY CHAIRMAN OF THE HEALTH AND HUMAN SERVICES
     2  COMMITTEE OF THE HOUSE OF REPRESENTATIVES, THE CHAIRMAN AND
     3  MINORITY CHAIRMAN OF THE BANKING AND INSURANCE COMMITTEE OF THE
     4  SENATE AND THE CHAIRMAN AND MINORITY CHAIRMAN OF THE INSURANCE
     5  COMMITTEE OF THE HOUSE OF REPRESENTATIVES.
     6     (E)  FOR PURPOSES OF THIS SECTION, "MEDICAL ASSISTANCE" SHALL
     7  BE DEFINED AS THE STATE PROGRAM OF MEDICAL ASSISTANCE
     8  ESTABLISHED UNDER THE ACT OF JUNE 13, 1967 (P.L.31, NO.21),
     9  KNOWN AS THE "PUBLIC WELFARE CODE."
    10     SECTION 3.  SECTIONS 2302, 2303, 2311, 2312 AND 2313 OF THE
    11  ACT, ADDED JUNE 17, 1998 (P.L.464, NO.68), ARE AMENDED TO READ:
    12     SECTION 2302.  LEGISLATIVE FINDINGS AND INTENT.--THE GENERAL
    13  ASSEMBLY FINDS AND DECLARES AS FOLLOWS:
    14     (1)  [ALL CITIZENS] CITIZENS OF THIS COMMONWEALTH SHOULD HAVE
    15  ACCESS TO AFFORDABLE AND REASONABLY PRICED HEALTH CARE AND TO
    16  NONDISCRIMINATORY TREATMENT BY HEALTH INSURERS AND PROVIDERS.
    17     (2)  THE UNINSURED HEALTH CARE POPULATION OF THIS
    18  COMMONWEALTH IS ESTIMATED TO BE [OVER] APPROXIMATELY ONE MILLION
    19  PERSONS AND MANY THOUSANDS MORE LACK ADEQUATE INSURANCE
    20  COVERAGE. IT IS ALSO ESTIMATED THAT APPROXIMATELY TWO-THIRDS OF
    21  THE UNINSURED ARE EMPLOYED OR DEPENDENTS OF EMPLOYED PERSONS.
    22     (3)  [OVER ONE-THIRD] APPROXIMATELY FIFTEEN PER CENTUM (15%)
    23  OF THE UNINSURED HEALTH CARE POPULATION ARE CHILDREN. UNINSURED
    24  CHILDREN ARE OF PARTICULAR CONCERN BECAUSE OF THEIR NEED FOR
    25  ONGOING PREVENTIVE AND PRIMARY CARE. MEASURES NOT TAKEN TO CARE
    26  FOR SUCH CHILDREN NOW WILL RESULT IN HIGHER HUMAN AND FINANCIAL
    27  COSTS LATER.
    28     (4)  UNINSURED CHILDREN LACK ACCESS TO TIMELY AND APPROPRIATE
    29  PRIMARY AND PREVENTIVE CARE. AS A RESULT, HEALTH CARE IS OFTEN
    30  DELAYED OR FORGONE, RESULTING IN INCREASED RISK OF DEVELOPING
    20060H2699B4886                 - 19 -     

     1  MORE SEVERE CONDITIONS WHICH IN TURN ARE MORE EXPENSIVE TO
     2  TREAT. THIS TENDENCY TO DELAY CARE AND TO SEEK AMBULATORY CARE
     3  IN HOSPITAL-BASED SETTINGS ALSO CAUSES INEFFICIENCIES IN THE
     4  HEALTH CARE SYSTEM.
     5     (5)  HEALTH CARE MARKETS HAVE BEEN DISTORTED THROUGH COST
     6  SHIFTS FOR THE UNCOMPENSATED HEALTH CARE COSTS OF UNINSURED
     7  CITIZENS OF THIS COMMONWEALTH WHICH HAS CAUSED DECREASED
     8  COMPETITIVE CAPACITY ON THE PART OF THOSE HEALTH CARE PROVIDERS
     9  WHO SERVE THE POOR AND INCREASED COSTS OF OTHER HEALTH CARE
    10  PAYORS.
    11     (6)  NO ONE SECTOR CAN ABSORB THE COST OF PROVIDING HEALTH
    12  CARE TO CITIZENS OF THIS COMMONWEALTH WHO CANNOT AFFORD HEALTH
    13  CARE ON THEIR OWN. THE COST IS TOO LARGE FOR THE PUBLIC SECTOR
    14  ALONE TO BEAR AND INSTEAD REQUIRES THE ESTABLISHMENT OF A PUBLIC
    15  AND PRIVATE PARTNERSHIP TO SHARE THE COSTS IN A MANNER
    16  ECONOMICALLY FEASIBLE FOR ALL INTERESTS. THE MAGNITUDE OF THIS
    17  NEED ALSO REQUIRES THAT IT BE DONE ON A TIME-PHASED, COST-
    18  MANAGED AND PLANNED BASIS.
    19     (7)  ELIGIBLE UNINSURED CHILDREN IN THIS COMMONWEALTH SHOULD
    20  HAVE ACCESS TO COST-EFFECTIVE, COMPREHENSIVE PRIMARY HEALTH
    21  COVERAGE IF THEY ARE UNABLE TO AFFORD COVERAGE OR OBTAIN IT.
    22     (8)  CARE SHOULD BE PROVIDED IN APPROPRIATE SETTINGS BY
    23  EFFICIENT PROVIDERS, CONSISTENT WITH HIGH QUALITY CARE AND AT AN
    24  APPROPRIATE STAGE, SOON ENOUGH TO AVERT THE NEED FOR OVERLY
    25  EXPENSIVE TREATMENT.
    26     (9)  EQUITY SHOULD BE ASSURED AMONG HEALTH PROVIDERS AND
    27  PAYORS BY PROVIDING A MECHANISM FOR PROVIDERS, EMPLOYERS, THE
    28  PUBLIC SECTOR AND PATIENTS TO SHARE IN FINANCING INDIGENT
    29  CHILDREN'S HEALTH CARE.
    30     SECTION 2303.  DEFINITIONS.--AS USED IN THIS ARTICLE, THE
    20060H2699B4886                 - 20 -     

     1  FOLLOWING WORDS AND PHRASES SHALL HAVE THE MEANINGS GIVEN TO
     2  THEM IN THIS SECTION:
     3     "CHILD."  A PERSON UNDER NINETEEN (19) YEARS OF AGE.
     4     ["CHILDREN'S MEDICAL ASSISTANCE."  MEDICAL ASSISTANCE
     5  SERVICES TO CHILDREN AS REQUIRED UNDER TITLE XIV OF THE SOCIAL
     6  SECURITY ACT (49 STAT. 620, 42 U.S.C. § 301 ET SEQ.), INCLUDING
     7  EPSDT SERVICES.]
     8     "CONTRACTOR."  AN [ENTITY] INSURER AWARDED A CONTRACT UNDER
     9  SUBDIVISION (B) TO PROVIDE HEALTH CARE SERVICES UNDER THIS
    10  ARTICLE. THE TERM INCLUDES AN ENTITY AND ITS SUBSIDIARY WHICH IS
    11  ESTABLISHED UNDER 40 PA.C.S. CH. 61 (RELATING TO HOSPITAL PLAN
    12  CORPORATIONS) OR 63 (RELATING TO PROFESSIONAL HEALTH SERVICES
    13  PLAN CORPORATIONS); THIS ACT; OR THE ACT OF DECEMBER 29, 1972
    14  (P.L.1701, NO.364), KNOWN AS THE "HEALTH MAINTENANCE
    15  ORGANIZATION ACT."
    16     "COUNCIL."  THE CHILDREN'S HEALTH ADVISORY COUNCIL
    17  ESTABLISHED IN SECTION 2311(I).
    18     "DEPARTMENT."  THE INSURANCE DEPARTMENT OF THE COMMONWEALTH.
    19     "EPSDT."   EARLY AND PERIODIC SCREENING, DIAGNOSIS AND
    20  TREATMENT.
    21     "FUND."  THE CHILDREN'S HEALTH FUND FOR HEALTH CARE FOR
    22  INDIGENT CHILDREN ESTABLISHED BY SECTION 1296 OF THE ACT OF
    23  MARCH 4, 1971 (P.L.6, NO.2), KNOWN AS THE "TAX REFORM CODE OF
    24  1971."
    25     ["GENETIC STATUS."  THE PRESENCE OF A PHYSICAL CONDITION IN
    26  AN INDIVIDUAL WHICH IS A RESULT OF AN INHERITED TRAIT.]
    27     "GROUP."  A GROUP FOR WHICH A HEALTH INSURANCE POLICY IS
    28  WRITTEN IN THIS COMMONWEALTH.
    29     "HEALTH MAINTENANCE ORGANIZATION" OR "HMO."  AN ENTITY
    30  ORGANIZED AND REGULATED UNDER THE ACT OF DECEMBER 29, 1972
    20060H2699B4886                 - 21 -     

     1  (P.L.1701, NO.364), KNOWN AS THE "HEALTH MAINTENANCE
     2  ORGANIZATION ACT."
     3     "HEALTH SERVICE CORPORATION."  A PROFESSIONAL HEALTH SERVICE
     4  CORPORATION AS DEFINED IN 40 PA.C.S. § 6302 (RELATING TO
     5  DEFINITIONS).
     6     "HEALTHY BEGINNINGS PROGRAM."  MEDICAL ASSISTANCE COVERAGE
     7  FOR SERVICES TO CHILDREN AS REQUIRED UNDER TITLE XIX OF THE
     8  SOCIAL SECURITY ACT (49 STAT. 620, 42 U.S.C. § 301 ET SEQ.) FOR
     9  THE FOLLOWING:
    10     (1)  CHILDREN FROM BIRTH TO AGE ONE (1) WHOSE FAMILY INCOME
    11  IS NO GREATER THAN ONE HUNDRED EIGHTY-FIVE PER CENTUM (185%) OF
    12  THE FEDERAL POVERTY LEVEL;
    13     (2)  CHILDREN ONE (1) THROUGH FIVE (5) YEARS OF AGE WHOSE
    14  FAMILY INCOME IS NO GREATER THAN ONE HUNDRED THIRTY-THREE PER
    15  CENTUM (133%) OF THE FEDERAL POVERTY LEVEL; AND
    16     (3)  CHILDREN SIX (6) THROUGH EIGHTEEN (18) YEARS OF AGE
    17  WHOSE FAMILY INCOME IS NO GREATER THAN ONE HUNDRED PER CENTUM
    18  (100%) OF THE FEDERAL POVERTY LEVEL.
    19     "HOSPITAL."  AN INSTITUTION HAVING AN ORGANIZED MEDICAL STAFF
    20  WHICH IS ENGAGED PRIMARILY IN PROVIDING TO INPATIENTS, BY OR
    21  UNDER THE SUPERVISION OF PHYSICIANS, DIAGNOSTIC AND THERAPEUTIC
    22  SERVICES FOR THE CARE OF INJURED, DISABLED, PREGNANT, DISEASED
    23  OR SICK OR MENTALLY ILL PERSONS. THE TERM INCLUDES FACILITIES
    24  FOR THE DIAGNOSIS AND TREATMENT OF DISORDERS WITHIN THE SCOPE OF
    25  SPECIFIC MEDICAL SPECIALTIES. THE TERM DOES NOT INCLUDE
    26  FACILITIES CARING EXCLUSIVELY FOR THE MENTALLY ILL.
    27     "HOSPITAL PLAN CORPORATION."  A HOSPITAL PLAN CORPORATION AS
    28  DEFINED IN 40 PA.C.S. § 6101 (RELATING TO DEFINITIONS).
    29     ["INSURER."   ANY INSURANCE COMPANY, ASSOCIATION, RECIPROCAL,
    30  NONPROFIT HOSPITAL PLAN CORPORATION, NONPROFIT PROFESSIONAL
    20060H2699B4886                 - 22 -     

     1  HEALTH SERVICE PLAN, HEALTH MAINTENANCE ORGANIZATION, FRATERNAL
     2  BENEFITS SOCIETY OR A RISK-BEARING PPO OR NONRISK-BEARING PPO
     3  NOT GOVERNED AND REGULATED UNDER THE EMPLOYEE RETIREMENT INCOME
     4  SECURITY ACT OF 1974 (PUBLIC LAW 93-406, 29 U.S.C. § 1001 ET
     5  SEQ.).]
     6     "INSURER."  A HEALTH INSURANCE ENTITY LICENSED IN THIS
     7  COMMONWEALTH TO ISSUE ANY INDIVIDUAL OR GROUP HEALTH, SICKNESS
     8  OR ACCIDENT POLICY OR SUBSCRIBER CONTRACT OR CERTIFICATE THAT
     9  PROVIDES MEDICAL OR HEALTH CARE COVERAGE BY A HEALTH CARE
    10  FACILITY OR LICENSED HEALTH CARE PROVIDER THAT IS OFFERED OR
    11  GOVERNED UNDER THIS ACT OR ANY OF THE FOLLOWING:
    12         (1)  THE ACT OF DECEMBER 29, 1972 (P.L.1701, NO.364),
    13     KNOWN AS THE "HEALTH MAINTENANCE ORGANIZATION ACT."
    14         (2)  THE ACT OF MAY 18, 1976 (P.L.123, NO.54), KNOWN AS
    15     THE "INDIVIDUAL ACCIDENT AND SICKNESS INSURANCE MINIMUM
    16     STANDARDS ACT."
    17         (3)  40 PA.C.S. CH. 61 (RELATING TO HOSPITAL PLAN
    18     CORPORATIONS), 63 (RELATING TO PROFESSIONAL HEALTH SERVICES
    19     PLAN CORPORATIONS) OR 65 (RELATING TO FRATERNAL BENEFIT
    20     SOCIETIES).
    21     "MAAC."  THE MEDICAL ASSISTANCE ADVISORY COMMITTEE.
    22     "MANAGED CARE ORGANIZATION."  HEALTH MAINTENANCE ORGANIZATION
    23  ORGANIZED AND REGULATED UNDER THE ACT OF DECEMBER 29, 1972
    24  (P.L.1701, NO.364), KNOWN AS THE "HEALTH MAINTENANCE
    25  ORGANIZATION ACT," OR A RISK-ASSUMING PREFERRED PROVIDER
    26  ORGANIZATION OR EXCLUSIVE PROVIDER ORGANIZATION, ORGANIZED AND
    27  REGULATED UNDER THIS ACT.
    28     "MCH."  MATERNAL AND CHILD HEALTH.
    29     "MEDICAID."  THE FEDERAL MEDICAL ASSISTANCE PROGRAM
    30  ESTABLISHED UNDER TITLE XIX OF THE SOCIAL SECURITY ACT (49 STAT.
    20060H2699B4886                 - 23 -     

     1  620, 42 U.S.C. § 1396 ET SEQ.).
     2     "MEDICAL ASSISTANCE."  THE STATE PROGRAM OF MEDICAL
     3  ASSISTANCE ESTABLISHED UNDER THE ACT OF JUNE 13, 1967 (P.L.31,
     4  NO.21), KNOWN AS THE "PUBLIC WELFARE CODE."
     5     "MID-LEVEL HEALTH PROFESSIONAL."  A PHYSICIAN ASSISTANT,
     6  CERTIFIED REGISTERED NURSE PRACTITIONER, NURSE PRACTITIONER OR A
     7  CERTIFIED NURSE MIDWIFE.
     8     "PARENT."  A NATURAL PARENT, STEPPARENT, ADOPTIVE PARENT,
     9  GUARDIAN OR CUSTODIAN OF A CHILD.
    10     "PPO."  A PREFERRED PROVIDER ORGANIZATION SUBJECT TO THE
    11  PROVISIONS OF SECTION 630.
    12     "PREEXISTING CONDITION."  A DISEASE OR PHYSICAL CONDITION FOR
    13  WHICH MEDICAL ADVICE OR TREATMENT HAS BEEN RECEIVED PRIOR TO THE
    14  EFFECTIVE DATE OF COVERAGE.
    15     "PREMIUM ASSISTANCE PROGRAM."  A COMPONENT OF A SEPARATE
    16  CHILD HEALTH PROGRAM, APPROVED UNDER THE STATE PLAN, UNDER WHICH
    17  THE COMMONWEALTH PAYS PART OR ALL OF THE PREMIUM FOR AN ENROLLEE
    18  OR ENROLLEES' GROUP HEALTH INSURANCE COVERAGE OR COVERAGE UNDER
    19  A GROUP HEALTH PLAN.
    20     "PRESCRIPTION DRUG."  A CONTROLLED SUBSTANCE, OTHER DRUG OR
    21  DEVICE FOR MEDICATION DISPENSED BY ORDER OF AN APPROPRIATELY
    22  LICENSED MEDICAL PROFESSIONAL.
    23     "SUBGROUP."  AN EMPLOYER COVERED UNDER A CONTRACT ISSUED TO A
    24  MULTIPLE EMPLOYER TRUST OR TO AN ASSOCIATION.
    25     "TERMINATE."  INCLUDES CANCELLATION, NONRENEWAL AND
    26  RESCISSION.
    27     "UNINSURED PERIOD."  EXCEPT FOR CHILDREN TWO YEARS OF AGE OR
    28  LESS, A CONTINUOUS PERIOD OF TIME OF NOT LESS THAN SIX (6)
    29  CONSECUTIVE MONTHS IMMEDIATELY PRECEDING ENROLLMENT, DURING
    30  WHICH A CHILD HAS BEEN WITHOUT HEALTH CARE INSURANCE COVERAGE IN
    20060H2699B4886                 - 24 -     

     1  ACCORDANCE WITH THE REQUIREMENTS OF THIS ARTICLE.
     2     "WAITING PERIOD."  A PERIOD OF TIME AFTER THE EFFECTIVE DATE
     3  OF ENROLLMENT DURING WHICH [A HEALTH INSURANCE PLAN] AN INSURER
     4  EXCLUDES COVERAGE FOR THE DIAGNOSIS OR TREATMENT OF ONE OR MORE
     5  MEDICAL CONDITIONS.
     6     "WIC."  THE FEDERAL SUPPLEMENTAL FOOD PROGRAM FOR WOMEN,
     7  INFANTS AND CHILDREN.
     8     SECTION 2311.  CHILDREN'S HEALTH CARE.--(A)  NOTWITHSTANDING
     9  ANY OTHER PROVISION OF LAW, THE DEPARTMENT SHALL TAKE SUCH
    10  ACTIONS AS MAY BE NECESSARY TO ENSURE THE RECEIPT OF FEDERAL
    11  FINANCIAL PARTICIPATION UNDER TITLE XXI OF THE SOCIAL SECURITY
    12  ACT (49 STAT. 620, 42 U.S.C. § 1397AA ET SEQ.) FOR SERVICES
    13  PROVIDED UNDER THIS ACT, AND TO QUALIFY THE BENEFIT EXPANSION
    14  PROVIDED BY SUBSECTION (C)(1.1) FOR AVAILABLE FEDERAL FINANCIAL
    15  PARTICIPATION.
    16     (B)  (1)  THE FUND SHALL BE DEDICATED EXCLUSIVELY FOR
    17  DISTRIBUTION BY THE [INSURANCE DEPARTMENT] DEPARTMENT THROUGH
    18  CONTRACTS IN ORDER TO PROVIDE FREE AND SUBSIDIZED HEALTH CARE
    19  SERVICES UNDER THIS SECTION, BASED ON AN ACTUARIALLY SOUND AND
    20  ADEQUATE REVIEW, AND TO DEVELOP AND IMPLEMENT OUTREACH
    21  ACTIVITIES REQUIRED UNDER SECTION 2312.
    22     [(B)  (1)] (2)  THE FUND, ALONG WITH FEDERAL, STATE AND OTHER
    23  MONEY AVAILABLE FOR THE PROGRAM, SHALL BE USED [TO FUND] FOR
    24  HEALTH CARE [SERVICES] COVERAGE FOR CHILDREN AS SPECIFIED IN
    25  THIS SECTION. THE [INSURANCE DEPARTMENT] DEPARTMENT SHALL ASSURE
    26  THAT THE PROGRAM IS IMPLEMENTED STATEWIDE. ALL CONTRACTS AWARDED
    27  UNDER THIS SECTION SHALL BE AWARDED THROUGH A COMPETITIVE
    28  PROCUREMENT PROCESS. THE [INSURANCE DEPARTMENT SHALL USE ITS]
    29  DEPARTMENT AND THE DEPARTMENT OF PUBLIC WELFARE SHALL USE THEIR
    30  BEST EFFORTS TO ENSURE THAT ELIGIBLE CHILDREN ACROSS THIS
    20060H2699B4886                 - 25 -     

     1  COMMONWEALTH HAVE ACCESS TO HEALTH CARE SERVICES TO BE PROVIDED
     2  UNDER THIS ARTICLE.
     3     [(2)] (3)  NO MORE THAN [SEVEN AND ONE-HALF PER CENTUM (7
     4  1/2%)] TEN PER CENTUM (10%) OF THE AMOUNT OF THE CONTRACT MAY BE
     5  USED FOR ADMINISTRATIVE EXPENSES OF THE CONTRACTOR. IF [AFTER
     6  THE FIRST THREE (3) FULL YEARS OF OPERATION] ANY CONTRACTOR
     7  PRESENTS DOCUMENTED EVIDENCE THAT ADMINISTRATIVE EXPENSES FOR
     8  PURPOSES OF EXPANDED OUTREACH AND SYSTEMS AND OPERATIONAL
     9  CHANGES ARE IN EXCESS OF [SEVEN AND ONE-HALF PER CENTUM (7
    10  1/2%)] TEN PER CENTUM (10%) OF THE AMOUNT OF THE CONTRACT, THE
    11  [INSURANCE DEPARTMENT MAY] DEPARTMENT SHALL MAKE AN ADDITIONAL
    12  ALLOTMENT OF FUNDS, NOT TO EXCEED [TWO AND ONE-HALF PER CENTUM
    13  (2 1/2%)] TWO PER CENTUM (2%) OF THE AMOUNT OF THE CONTRACT,
    14  [FOR FUTURE ADMINISTRATIVE EXPENSES] TO THE CONTRACTOR TO THE
    15  EXTENT THAT THE [INSURANCE DEPARTMENT] DEPARTMENT FINDS THE
    16  EXPENSES REASONABLE AND NECESSARY.
    17     [(3)] (4)  NO LESS THAN [SEVENTY PER CENTUM (70%)] EIGHTY-
    18  FOUR PER CENTUM (84%) OF THE [FUND] CONTRACT SHALL BE USED TO
    19  PROVIDE THE HEALTH CARE SERVICES PROVIDED UNDER THIS ARTICLE FOR
    20  CHILDREN ELIGIBLE FOR [FREE] CARE UNDER [SUBSECTION (D)] THIS
    21  ARTICLE. [WHEN THE INSURANCE DEPARTMENT DETERMINES THAT SEVENTY
    22  PER CENTUM (70%) OF THE FUND IS NOT NEEDED IN ORDER TO ACHIEVE
    23  MAXIMUM ENROLLMENT OF CHILDREN ELIGIBLE FOR FREE CARE AND
    24  PROMULGATES A FINAL FORM REGULATION WITH PROPOSED RULEMAKING
    25  OMITTED, THIS PARAGRAPH SHALL EXPIRE.]
    26     [(4)] (5)  TO ENSURE THAT INPATIENT HOSPITAL CARE IS PROVIDED
    27  TO ELIGIBLE CHILDREN, EACH PRIMARY CARE [PHYSICIAN PROVIDING]
    28  PROVIDER FURNISHING PRIMARY CARE SERVICES SHALL MAKE NECESSARY
    29  ARRANGEMENTS FOR ADMISSION TO THE HOSPITAL AND FOR NECESSARY
    30  SPECIALTY CARE.
    20060H2699B4886                 - 26 -     

     1     (C)  (1)  ANY [ORGANIZATION OR CORPORATION] INSURER RECEIVING
     2  FUNDS FROM THE [INSURANCE DEPARTMENT] DEPARTMENT TO PROVIDE
     3  COVERAGE OF HEALTH CARE SERVICES SHALL ENROLL, TO THE EXTENT
     4  THAT FUNDS ARE AVAILABLE, ANY CHILD WHO MEETS ALL OF THE
     5  FOLLOWING:
     6     (I)  [EXCEPT FOR NEWBORNS, HAS BEEN] IS A RESIDENT OF THIS
     7  COMMONWEALTH [FOR AT LEAST THIRTY (30) DAYS PRIOR TO
     8  ENROLLMENT].
     9     (II)  IS NOT COVERED BY A HEALTH INSURANCE PLAN, A SELF-
    10  INSURANCE PLAN OR A SELF-FUNDED PLAN OR IS NOT ELIGIBLE FOR OR
    11  COVERED BY MEDICAL ASSISTANCE, INCLUDING THE HEALTHY BEGINNINGS
    12  PROGRAM.
    13     (III)  IS QUALIFIED BASED ON INCOME UNDER SUBSECTION (D) OR
    14  (E).
    15     (IV)  MEETS THE CITIZENSHIP REQUIREMENTS OF [THE MEDICAID
    16  PROGRAM ADMINISTERED BY THE DEPARTMENT OF PUBLIC WELFARE.] TITLE
    17  XXI OF THE SOCIAL SECURITY ACT (49 STAT. 620, 42 U.S.C. § 1397AA
    18  ET SEQ.).
    19     (1.1)  BEGINNING JANUARY 1, 2007, AND SUBJECT TO THE
    20  PROVISIONS OF SECTION 2314, ANY INSURER RECEIVING FUNDS FROM THE
    21  DEPARTMENT TO PROVIDE COVERAGE OF HEALTH CARE SERVICES UNDER
    22  THIS SECTION SHALL ENROLL, TO THE EXTENT THAT FUNDS ARE
    23  AVAILABLE, ANY CHILD WHO MEETS ALL OF THE FOLLOWING:
    24     (I)  IS A RESIDENT OF THIS COMMONWEALTH.
    25     (II)  IS NOT COVERED BY A HEALTH INSURANCE PLAN, A SELF-
    26  INSURANCE PLAN OR A SELF-FUNDED PLAN, OR IS NOT PROVIDED ACCESS
    27  TO HEALTH CARE COVERAGE BY COURT ORDER, OR IS NOT ELIGIBLE FOR
    28  OR COVERED BY A MEDICAL ASSISTANCE PROGRAM ADMINISTERED BY THE
    29  DEPARTMENT OF PUBLIC WELFARE, INCLUDING THE HEALTHY BEGINNINGS
    30  PROGRAM.
    20060H2699B4886                 - 27 -     

     1     (III)  IS QUALIFIED BASED ON INCOME UNDER SUBSECTION (D),
     2  (E.1), (E.2), (E.3) OR (E.4) AND MEETS THE UNINSURED PERIOD
     3  REQUIREMENTS AS PROVIDED IN SUBSECTION (F.1).
     4     (IV)  MEETS THE CITIZENSHIP REQUIREMENTS OF TITLE XXI OF THE
     5  SOCIAL SECURITY ACT (42 U.S.C. § 1397AA ET SEQ.).
     6     (2)  ENROLLMENT MAY NOT BE DENIED ON THE BASIS OF A
     7  PREEXISTING CONDITION, NOR MAY DIAGNOSIS OR TREATMENT FOR THE
     8  CONDITION BE EXCLUDED BASED ON THE CONDITION'S PREEXISTENCE.
     9     (D)  THE PROVISION OF HEALTH CARE INSURANCE FOR ELIGIBLE
    10  CHILDREN SHALL BE FREE TO A CHILD [UNDER NINETEEN (19) YEARS OF
    11  AGE] WHOSE FAMILY INCOME IS NO GREATER THAN TWO HUNDRED PER
    12  CENTUM (200%) OF THE FEDERAL POVERTY LEVEL.
    13     [(E)  (1)  THE PROVISION OF HEALTH CARE INSURANCE FOR AN
    14  ELIGIBLE CHILD WHO IS UNDER NINETEEN (19) YEARS OF AGE AND WHOSE
    15  FAMILY INCOME IS GREATER THAN TWO HUNDRED PER CENTUM (200%) OF
    16  THE FEDERAL POVERTY LEVEL BUT NO GREATER THAN TWO HUNDRED
    17  THIRTY-FIVE PER CENTUM (235%) OF THE FEDERAL POVERTY LEVEL MAY
    18  BE SUBSIDIZED BY THE FUND AT A RATE NOT TO EXCEED FIFTY PER
    19  CENTUM (50%).
    20     (2)  THE DIFFERENCE BETWEEN THE PURE PREMIUM OF THE MINIMUM
    21  BENEFIT PACKAGE IN SUBSECTION (L)(6) AND THE SUBSIDY PROVIDED
    22  UNDER THIS SUBSECTION SHALL BE THE AMOUNT PAID BY THE FAMILY OF
    23  THE ELIGIBLE CHILD PURCHASING THE MINIMUM BENEFIT PACKAGE.
    24     (F)  THE FAMILY OF AN ELIGIBLE CHILD WHOSE FAMILY INCOME
    25  MAKES THE CHILD ELIGIBLE FOR FREE OR SUBSIDIZED CARE BUT WHO
    26  CANNOT RECEIVE CARE DUE TO LACK OF FUNDS IN THE FUND MAY
    27  PURCHASE COVERAGE FOR THE CHILD AT COST.]
    28     (E.1)  THE PROVISION OF HEALTH CARE INSURANCE FOR AN ELIGIBLE
    29  CHILD WHOSE FAMILY INCOME IS GREATER THAN TWO HUNDRED PER CENTUM
    30  (200%) OF THE FEDERAL POVERTY LEVEL BUT NO GREATER THAN TWO
    20060H2699B4886                 - 28 -     

     1  HUNDRED FIFTY PER CENTUM (250%) OF THE FEDERAL POVERTY LEVEL MAY
     2  BE SUBSIDIZED BY THE FUND AT A RATE NOT TO EXCEED SEVENTY-FIVE
     3  PER CENTUM (75%) OF THE PER MEMBER PER MONTH PREMIUM COST.
     4     (E.2)  THE PROVISION OF HEALTH CARE INSURANCE FOR AN ELIGIBLE
     5  CHILD WHOSE FAMILY INCOME IS GREATER THAN TWO HUNDRED FIFTY PER
     6  CENTUM (250%) OF THE FEDERAL POVERTY LEVEL BUT NO GREATER THAN
     7  TWO HUNDRED SEVENTY-FIVE PER CENTUM (275%) OF THE FEDERAL
     8  POVERTY LEVEL MAY BE SUBSIDIZED BY THE FUND AT A RATE NOT TO
     9  EXCEED SIXTY-FIVE PER CENTUM (65%) OF THE PER MEMBER PER MONTH
    10  PREMIUM COST.
    11     (E.3)  THE PROVISION OF HEALTH CARE INSURANCE FOR AN ELIGIBLE
    12  CHILD WHOSE FAMILY INCOME IS GREATER THAN TWO HUNDRED SEVENTY-
    13  FIVE PER CENTUM (275%) OF THE FEDERAL POVERTY LEVEL, BUT NO
    14  GREATER THAN THREE HUNDRED PER CENTUM (300%) OF THE FEDERAL
    15  POVERTY LEVEL MAY BE SUBSIDIZED BY THE FUND AT A RATE NOT TO
    16  EXCEED SIXTY PER CENTUM (60%) OF THE PER MEMBER PER MONTH
    17  PREMIUM COST.
    18     (E.4)  THE FOLLOWING APPLY:
    19     (1)  FOR AN ELIGIBLE CHILD WHOSE FAMILY INCOME IS GREATER
    20  THAN THE MAXIMUM LEVEL ESTABLISHED UNDER SUBSECTION (O), THE
    21  FAMILY MAY PURCHASE THE MINIMUM BENEFIT PACKAGE SET FORTH IN
    22  SUBSECTION (L)(6) FOR THAT CHILD AT THE PER MONTH PER MEMBER
    23  PREMIUM COST, WHICH (COST) SHALL BE DERIVED SEPARATELY FROM THE
    24  OTHER ELIGIBILITY CATEGORIES IN THE PROGRAM, AS LONG AS THE
    25  FAMILY DEMONSTRATES ON AN ANNUAL BASIS AND IN A MANNER
    26  DETERMINED BY THE DEPARTMENT EITHER ONE OF THE FOLLOWING:
    27     (I)  THE FAMILY IS UNABLE TO AFFORD INDIVIDUAL OR GROUP
    28  COVERAGE BECAUSE THAT COVERAGE WOULD EXCEED TEN PER CENTUM (10%)
    29  OF THE FAMILY INCOME OR BECAUSE THE TOTAL COST OF COVERAGE FOR
    30  THE CHILD IS ONE HUNDRED FIFTY PER CENTUM (150%) OF THE GREATER
    20060H2699B4886                 - 29 -     

     1  OF:
     2     (A)  THE PREMIUM COST ESTABLISHED UNDER THIS SUBSECTION FOR
     3  THAT SERVICE AREA; OR
     4     (B)  THE PREMIUM COST ESTABLISHED UNDER THE PROGRAM FOR THAT
     5  SERVICE AREA.
     6     (II)  THE FAMILY HAS BEEN REFUSED COVERAGE BY AN INSURER DUE
     7  TO THE CHILD OR A MEMBER OF THAT CHILD'S IMMEDIATE FAMILY HAVING
     8  A PRE-EXISTING CONDITION AND COVERAGE IS NOT AVAILABLE TO THE
     9  CHILD.
    10     (2)  FOR PURPOSES OF THIS SUBSECTION, "COVERAGE" SHALL NOT
    11  INCLUDE COVERAGE OFFERED THROUGH ACCIDENT ONLY, FIXED INDEMNITY,
    12  LIMITED BENEFIT, CREDIT, DENTAL, VISION, SPECIFIED DISEASE,
    13  MEDICARE SUPPLEMENT, CIVILIAN HEALTH AND MEDICAL PROGRAM OF THE
    14  UNIFORMED SERVICES (CHAMPUS) SUPPLEMENT, LONG-TERM CARE OR
    15  DISABILITY INCOME, WORKERS' COMPENSATION OR AUTOMOBILE MEDICAL
    16  PAYMENT INSURANCE.
    17     (F.1)  TO BE ELIGIBLE FOR COVERAGE UNDER SUBSECTIONS (E.1),
    18  (E.2), (E.3) AND (E.4), A CHILD OVER TWO (2) YEARS OF AGE MUST
    19  HAVE BEEN UNINSURED FOR THE UNINSURED PERIOD UNLESS:
    20     (1)  THE CHILD'S PARENT IS ELIGIBLE TO RECEIVE BENEFITS
    21  PURSUANT TO THE ACT OF DECEMBER 5, 1936 (2ND SP.SESS., 1937
    22  P.L.2897, NO.1), KNOWN AS THE "UNEMPLOYMENT COMPENSATION LAW";
    23     (2)  THE CHILD'S PARENT WAS COVERED BY A HEALTH INSURANCE
    24  PLAN, A SELF-INSURANCE PLAN OR A SELF-FUNDED PLAN BUT, AT THE
    25  TIME OF APPLICATION FOR COVERAGE, IS NO LONGER EMPLOYED AND IS
    26  INELIGIBLE TO RECEIVE BENEFITS UNDER THE "UNEMPLOYMENT
    27  COMPENSATION LAW"; OR
    28     (3)  A CHILD IS TRANSFERRING FROM ONE GOVERNMENT-SUBSIDIZED
    29  HEALTH CARE PROGRAM TO ANOTHER.
    30     (F.2)  FOR ENROLLEES UNDER SUBSECTIONS (E.1), (E.2), (E.3)
    20060H2699B4886                 - 30 -     

     1  AND (E.4), THE FOLLOWING APPLY:
     2     (1)  THE DEPARTMENT SHALL HAVE THE AUTHORITY TO IMPOSE
     3  COPAYMENTS FOR THE FOLLOWING SERVICES, EXCEPT AS OTHERWISE
     4  PROHIBITED BY LAW:
     5     (I)  OUTPATIENT VISITS.
     6     (II)  EMERGENCY ROOM VISITS.
     7     (III)  PRESCRIPTION MEDICATIONS.
     8     (IV)  ANY OTHER SERVICE DEFINED BY THE DEPARTMENT.
     9     (2)  THE DEPARTMENT SHALL HAVE THE AUTHORITY TO ESTABLISH AND
    10  ADJUST THE LEVELS OF THESE COPAYMENTS IN ORDER TO IMPOSE
    11  REASONABLE COST SHARING AND TO ENCOURAGE APPROPRIATE UTILIZATION
    12  OF THESE SERVICES. IN NO EVENT SHALL THE PREMIUMS AND COPAYMENTS
    13  FOR ENROLLEES UNDER SUBSECTIONS (E.1), (E.2) AND (E.3) AMOUNT TO
    14  MORE THAN THE PER CENTUM OF TOTAL HOUSEHOLD INCOME WHICH IS IN
    15  ACCORD WITH THE REQUIREMENTS OF THE CENTERS FOR MEDICARE AND
    16  MEDICAID SERVICES.
    17     (G)  THE [INSURANCE DEPARTMENT] DEPARTMENT SHALL:
    18     (1)  ADMINISTER THE CHILDREN'S HEALTH CARE PROGRAM PURSUANT
    19  TO THIS ARTICLE.
    20     (2)  REVIEW ALL BIDS AND APPROVE AND EXECUTE ALL CONTRACTS
    21  FOR THE PURPOSE OF EXPANDING ACCESS TO HEALTH CARE SERVICES FOR
    22  ELIGIBLE CHILDREN AS PROVIDED FOR IN THIS SUBDIVISION.
    23     (3)  CONDUCT MONITORING AND OVERSIGHT OF CONTRACTS ENTERED
    24  INTO.
    25     (4)  ISSUE AN ANNUAL REPORT TO THE GOVERNOR, THE GENERAL
    26  ASSEMBLY AND THE PUBLIC FOR EACH [FISCAL] CALENDAR YEAR NO LATER
    27  THAN MARCH 1 OUTLINING PRIMARY HEALTH SERVICES FUNDED FOR THE
    28  YEAR, DETAILING THE OUTREACH AND ENROLLMENT EFFORTS AND
    29  REPORTING BY NUMBER OF CHILDREN BY COUNTY AND BY PER CENTUM OF
    30  THE FEDERAL POVERTY LEVEL, THE NUMBER OF CHILDREN RECEIVING
    20060H2699B4886                 - 31 -     

     1  HEALTH CARE SERVICES [FROM THE FUND,] BY COUNTY AND BY PER
     2  CENTUM OF THE FEDERAL POVERTY LEVEL, THE PROJECTED NUMBER OF
     3  ELIGIBLE CHILDREN AND THE NUMBER OF ELIGIBLE CHILDREN ON WAITING
     4  LISTS FOR [HEALTH CARE SERVICES] ENROLLMENT IN THE HEALTH
     5  INSURANCE PROGRAM ESTABLISHED UNDER THIS ACT BY COUNTY AND BY
     6  PER CENTUM OF THE FEDERAL POVERTY LEVEL.
     7     (5)  IN CONSULTATION WITH APPROPRIATE COMMONWEALTH AGENCIES,
     8  COORDINATE THE DEVELOPMENT AND SUPERVISION OF THE OUTREACH PLAN
     9  REQUIRED UNDER SECTION 2312.
    10     (6)  IN CONSULTATION WITH APPROPRIATE COMMONWEALTH AGENCIES,
    11  MONITOR, REVIEW AND EVALUATE THE ADEQUACY, ACCESSIBILITY AND
    12  AVAILABILITY OF SERVICES DELIVERED TO CHILDREN WHO ARE ENROLLED
    13  IN THE HEALTH INSURANCE PROGRAM ESTABLISHED UNDER THIS
    14  SUBDIVISION.
    15     (H)  THE [INSURANCE DEPARTMENT] DEPARTMENT MAY PROMULGATE
    16  REGULATIONS NECESSARY FOR THE IMPLEMENTATION AND ADMINISTRATION
    17  OF THIS SUBDIVISION.
    18     (I)  THE CHILDREN'S HEALTH ADVISORY COUNCIL IS ESTABLISHED
    19  WITHIN THE [INSURANCE DEPARTMENT] DEPARTMENT AS AN ADVISORY
    20  COUNCIL. THE FOLLOWING SHALL APPLY:
    21     (1)  THE COUNCIL SHALL CONSIST OF FOURTEEN VOTING MEMBERS.
    22  MEMBERS PROVIDED FOR IN SUBPARAGRAPHS (IV), (V), (VI), (VII),
    23  (VIII), (X) AND (XI) SHALL BE APPOINTED BY THE INSURANCE
    24  COMMISSIONER. THE COUNCIL SHALL BE GEOGRAPHICALLY BALANCED ON A
    25  STATEWIDE BASIS AND SHALL INCLUDE:
    26     (I)  THE SECRETARY OF HEALTH EX OFFICIO OR A DESIGNEE.
    27     (II)  THE INSURANCE COMMISSIONER EX OFFICIO OR A DESIGNEE.
    28     (III)  THE SECRETARY OF PUBLIC WELFARE EX OFFICIO OR A
    29  DESIGNEE.
    30     (IV)  A REPRESENTATIVE WITH EXPERIENCE IN CHILDREN'S HEALTH
    20060H2699B4886                 - 32 -     

     1  FROM A SCHOOL OF PUBLIC HEALTH LOCATED IN THIS COMMONWEALTH.
     2     (V)  A PHYSICIAN WITH EXPERIENCE IN CHILDREN'S HEALTH
     3  APPOINTED FROM A LIST OF THREE QUALIFIED PERSONS RECOMMENDED BY
     4  THE PENNSYLVANIA MEDICAL SOCIETY.
     5     (VI)  A REPRESENTATIVE OF A CHILDREN'S HOSPITAL OR A HOSPITAL
     6  WITH A PEDIATRIC OUTPATIENT CLINIC APPOINTED FROM A LIST OF
     7  THREE PERSONS SUBMITTED BY THE HOSPITAL ASSOCIATION OF
     8  PENNSYLVANIA.
     9     (VII)  A PARENT OF A CHILD WHO RECEIVES PRIMARY HEALTH CARE
    10  COVERAGE FROM THE FUND.
    11     (VIII)  A MID-LEVEL PROFESSIONAL APPOINTED FROM LISTS OF
    12  NAMES RECOMMENDED BY STATEWIDE ASSOCIATIONS REPRESENTING MID-
    13  LEVEL HEALTH PROFESSIONALS.
    14     (IX)  A SENATOR APPOINTED BY THE PRESIDENT PRO TEMPORE OF THE
    15  SENATE, A SENATOR APPOINTED BY THE MINORITY LEADER OF THE
    16  SENATE, A REPRESENTATIVE APPOINTED BY THE SPEAKER OF THE HOUSE
    17  OF REPRESENTATIVES AND A REPRESENTATIVE APPOINTED BY THE
    18  MINORITY LEADER OF THE HOUSE OF REPRESENTATIVES.
    19     (X)  A REPRESENTATIVE FROM A PRIVATE NONPROFIT FOUNDATION.
    20     (XI)  A REPRESENTATIVE OF BUSINESS WHO IS NOT A CONTRACTOR OR
    21  PROVIDER OF PRIMARY HEALTH CARE INSURANCE UNDER THIS
    22  SUBDIVISION.
    23     (2)  IF ANY SPECIFIED ORGANIZATION SHOULD CEASE TO EXIST OR
    24  FAIL TO MAKE A RECOMMENDATION WITHIN NINETY (90) DAYS OF A
    25  REQUEST TO DO SO, THE COUNCIL SHALL SPECIFY A NEW EQUIVALENT
    26  ORGANIZATION TO FULFILL THE RESPONSIBILITIES OF THIS SECTION.
    27     (3)  THE INSURANCE COMMISSIONER SHALL CHAIR THE COUNCIL. THE
    28  MEMBERS OF THE COUNCIL SHALL ANNUALLY ELECT, BY A MAJORITY VOTE
    29  OF THE MEMBERS, A VICE CHAIRPERSON FROM AMONG THE MEMBERS OF THE
    30  COUNCIL.
    20060H2699B4886                 - 33 -     

     1     (4)  THE PRESENCE OF EIGHT MEMBERS SHALL CONSTITUTE A QUORUM
     2  FOR THE TRANSACTING OF ANY BUSINESS. ANY ACT BY A MAJORITY OF
     3  THE MEMBERS PRESENT AT ANY MEETING AT WHICH THERE IS A QUORUM
     4  SHALL BE DEEMED TO BE THAT OF THE COUNCIL.
     5     (5)  ALL MEETINGS OF THE COUNCIL SHALL BE CONDUCTED PURSUANT
     6  TO [THE ACT OF JULY 3, 1986 (P.L.388, NO.84), KNOWN AS THE
     7  "SUNSHINE ACT,"] 65 PA.C.S. CH. 7 (RELATING TO OPEN MEETINGS)
     8  UNLESS OTHERWISE PROVIDED IN THIS SECTION. THE COUNCIL SHALL
     9  MEET AT LEAST ANNUALLY AND MAY PROVIDE FOR SPECIAL MEETINGS AS
    10  IT DEEMS NECESSARY. MEETING DATES SHALL BE SET BY A MAJORITY
    11  VOTE OF MEMBERS OF THE COUNCIL OR BY CALL OF THE CHAIRPERSON
    12  UPON SEVEN (7) DAYS' NOTICE TO ALL MEMBERS. THE COUNCIL SHALL
    13  PUBLISH NOTICE OF ITS MEETINGS IN THE PENNSYLVANIA BULLETIN.
    14  NOTICE SHALL SPECIFY THE DATE, TIME AND PLACE OF THE MEETING AND
    15  SHALL STATE THAT THE COUNCIL'S MEETINGS ARE OPEN TO THE GENERAL
    16  PUBLIC. ALL ACTION TAKEN BY THE COUNCIL SHALL BE TAKEN IN OPEN
    17  PUBLIC SESSION AND SHALL NOT BE TAKEN EXCEPT UPON A MAJORITY
    18  VOTE OF THE MEMBERS PRESENT AT A MEETING AT WHICH A QUORUM IS
    19  PRESENT.
    20     (6)  THE MEMBERS OF THE COUNCIL SHALL NOT RECEIVE A SALARY OR
    21  PER DIEM ALLOWANCE FOR SERVING AS MEMBERS OF THE COUNCIL BUT
    22  SHALL BE REIMBURSED FOR ACTUAL AND NECESSARY EXPENSES INCURRED
    23  IN THE PERFORMANCE OF THEIR DUTIES.
    24     (7)  TERMS OF COUNCIL MEMBERS SHALL BE AS FOLLOWS:
    25     (I)  THE APPOINTED MEMBERS SHALL SERVE FOR A TERM OF THREE
    26  (3) YEARS AND SHALL CONTINUE TO SERVE THEREAFTER UNTIL THEIR
    27  SUCCESSORS ARE APPOINTED.
    28     (II)  AN APPOINTED MEMBER SHALL NOT BE ELIGIBLE TO SERVE MORE
    29  THAN TWO FULL CONSECUTIVE TERMS OF THREE (3) YEARS. VACANCIES
    30  SHALL BE FILLED IN THE SAME MANNER IN WHICH THEY WERE DESIGNATED
    20060H2699B4886                 - 34 -     

     1  WITHIN SIXTY (60) DAYS OF THE VACANCY.
     2     (III)  AN APPOINTED MEMBER MAY BE REMOVED BY THE APPOINTING
     3  AUTHORITY FOR JUST CAUSE AND BY A VOTE OF AT LEAST SEVEN MEMBERS
     4  OF THE COUNCIL.
     5     (8)  THE COUNCIL SHALL REVIEW OUTREACH ACTIVITIES AND MAY
     6  MAKE RECOMMENDATIONS TO THE [INSURANCE DEPARTMENT] DEPARTMENT.
     7     (9)  THE COUNCIL SHALL REVIEW AND EVALUATE THE ACCESSIBILITY
     8  AND AVAILABILITY OF SERVICES DELIVERED TO CHILDREN ENROLLED IN
     9  THE PROGRAM.
    10     (J)  THE [INSURANCE DEPARTMENT] DEPARTMENT SHALL SOLICIT BIDS
    11  AND AWARD CONTRACTS THROUGH A COMPETITIVE PROCUREMENT PROCESS
    12  PURSUANT TO THE FOLLOWING:
    13     (1)  TO THE FULLEST EXTENT PRACTICABLE, CONTRACTS SHALL BE
    14  AWARDED TO [ENTITIES] INSURERS THAT CONTRACT WITH PROVIDERS TO
    15  PROVIDE PRIMARY CARE SERVICES FOR ENROLLEES ON A COST-EFFECTIVE
    16  BASIS. THE [INSURANCE DEPARTMENT] DEPARTMENT SHALL REQUIRE
    17  CONTRACTORS TO USE APPROPRIATE COST-MANAGEMENT METHODS SO THAT
    18  [THE FUND CAN BE USED TO PROVIDE THE] BASIC PRIMARY BENEFIT
    19  SERVICES CAN BE PROVIDED TO THE MAXIMUM NUMBER OF ELIGIBLE
    20  CHILDREN AND, WHENEVER POSSIBLE, TO PURSUE AND UTILIZE AVAILABLE
    21  PUBLIC AND PRIVATE FUNDS.
    22     (2)  TO THE FULLEST EXTENT PRACTICABLE, THE [INSURANCE
    23  DEPARTMENT] DEPARTMENT SHALL REQUIRE THAT ANY CONTRACTOR COMPLY
    24  WITH ALL PROCEDURES RELATING TO COORDINATION OF BENEFITS AS
    25  REQUIRED BY THE [INSURANCE DEPARTMENT] DEPARTMENT OR THE
    26  DEPARTMENT OF PUBLIC WELFARE.
    27     (3)  CONTRACTS MAY BE FOR A TERM OF UP TO THREE (3) YEARS[.],
    28  WITH THE OPTION TO EXTEND FOR TWO ONE-YEAR PERIODS.
    29     (K)  UPON RECEIPT OF A [REQUEST FOR PROPOSAL] SOLICITATION
    30  FROM THE [INSURANCE DEPARTMENT] DEPARTMENT, EACH [HEALTH PLAN
    20060H2699B4886                 - 35 -     

     1  CORPORATION OR ITS] HEALTH SERVICE CORPORATION AND HOSPITAL PLAN
     2  CORPORATION OR THEIR ENTITIES DOING BUSINESS IN THIS
     3  COMMONWEALTH SHALL SUBMIT A BID OR PROPOSAL TO THE [INSURANCE
     4  DEPARTMENT] DEPARTMENT TO CARRY OUT THE PURPOSES OF THIS SECTION
     5  IN THE AREA SERVICED BY THE CORPORATION. ALL OTHER INSURERS MAY
     6  SUBMIT A BID OR PROPOSAL TO THE DEPARTMENT TO CARRY OUT THE
     7  PURPOSES OF THIS SECTION.
     8     (L)  A CONTRACTOR WITH WHOM THE [INSURANCE DEPARTMENT]
     9  DEPARTMENT ENTERS INTO A CONTRACT SHALL DO THE FOLLOWING:
    10     (1)  ENSURE TO THE MAXIMUM EXTENT POSSIBLE THAT ELIGIBLE
    11  CHILDREN HAVE ACCESS TO PRIMARY HEALTH CARE PHYSICIANS AND NURSE
    12  PRACTITIONERS [ON AN EQUITABLE STATEWIDE BASIS] WITHIN THE
    13  CONTRACTOR'S SERVICE AREA.
    14     (2)  CONTRACT WITH QUALIFIED, COST-EFFECTIVE PROVIDERS, WHICH
    15  MAY INCLUDE PRIMARY HEALTH CARE PHYSICIANS, NURSE PRACTITIONERS,
    16  CLINICS AND HEALTH MAINTENANCE ORGANIZATIONS, TO PROVIDE PRIMARY
    17  AND PREVENTIVE HEALTH CARE FOR ENROLLEES ON A BASIS BEST
    18  CALCULATED TO MANAGE THE COSTS OF THE SERVICES, INCLUDING, BUT
    19  NOT LIMITED TO, USING MANAGED HEALTH CARE TECHNIQUES AND OTHER
    20  APPROPRIATE MEDICAL COST-MANAGEMENT METHODS.
    21     (3)  ENSURE THAT THE FAMILY OF A CHILD WHO MAY BE ELIGIBLE
    22  FOR MEDICAL ASSISTANCE RECEIVES ASSISTANCE IN APPLYING FOR
    23  MEDICAL ASSISTANCE.[, INCLUDING, AT A MINIMUM, WRITTEN NOTICE OF
    24  THE TELEPHONE NUMBER AND ADDRESS OF THE COUNTY ASSISTANCE OFFICE
    25  WHERE THE FAMILY CAN APPLY FOR MEDICAL ASSISTANCE.]
    26     (4)  MAINTAIN WAITING LISTS OF CHILDREN FINANCIALLY ELIGIBLE
    27  FOR BENEFITS WHO HAVE APPLIED FOR BENEFITS BUT WHO WERE NOT
    28  ENROLLED DUE TO LACK OF FUNDS.
    29     (4.1)  NOTIFY FAMILIES OF CHILDREN WHO ARE PAYING A PREMIUM
    30  OF ANY CHANGES IN SUCH PREMIUM OR COPAYMENT REQUIREMENTS.
    20060H2699B4886                 - 36 -     

     1     (4.2)  COLLECT SUCH PREMIUMS OR COPAYMENTS FROM THE FAMILY OF
     2  ANY CHILD RECEIVING BENEFITS AS MAY BE REQUIRED.
     3     (4.3)  CANCEL POLICIES FOR NONPAYMENT OF PREMIUM, IN
     4  ACCORDANCE WITH ALL OTHER APPLICABLE INSURANCE LAWS.
     5     (5)  STRONGLY ENCOURAGE ALL PROVIDERS WHO PROVIDE PRIMARY
     6  CARE TO ELIGIBLE CHILDREN TO PARTICIPATE IN MEDICAL ASSISTANCE
     7  AS QUALIFIED EPSDT PROVIDERS AND TO CONTINUE TO PROVIDE CARE TO
     8  CHILDREN WHO BECOME INELIGIBLE FOR [PAYMENT] COVERAGE UNDER THE
     9  [FUND] PROVISIONS OF THIS ARTICLE, BUT WHO QUALIFY FOR MEDICAL
    10  ASSISTANCE.
    11     (6)  [PROVIDE] SUBJECT TO ANY NECESSARY FEDERAL APPROVAL,
    12  PROVIDE THE FOLLOWING MINIMUM BENEFIT PACKAGE FOR ELIGIBLE
    13  CHILDREN:
    14     (I)  PREVENTIVE CARE. THIS SUBPARAGRAPH INCLUDES WELL-CHILD
    15  CARE VISITS IN ACCORDANCE WITH THE SCHEDULE ESTABLISHED BY THE
    16  AMERICAN ACADEMY OF PEDIATRICS AND THE SERVICES RELATED TO THOSE
    17  VISITS, INCLUDING, BUT NOT LIMITED TO, IMMUNIZATIONS, HEALTH
    18  EDUCATION, TUBERCULOSIS TESTING AND DEVELOPMENTAL SCREENING IN
    19  ACCORDANCE WITH ROUTINE SCHEDULE OF WELL-CHILD VISITS. CARE
    20  SHALL ALSO INCLUDE A COMPREHENSIVE PHYSICAL EXAMINATION,
    21  INCLUDING X-RAYS IF NECESSARY, FOR ANY CHILD EXHIBITING SYMPTOMS
    22  OF POSSIBLE CHILD ABUSE.
    23     (II)  DIAGNOSIS AND TREATMENT OF ILLNESS OR INJURY, INCLUDING
    24  ALL MEDICALLY NECESSARY SERVICES RELATED TO THE DIAGNOSIS AND
    25  TREATMENT OF SICKNESS AND INJURY AND OTHER CONDITIONS PROVIDED
    26  ON AN AMBULATORY BASIS, SUCH AS LABORATORY TESTS, WOUND DRESSING
    27  AND CASTING TO IMMOBILIZE FRACTURES.
    28     (III)  INJECTIONS AND MEDICATIONS PROVIDED AT THE TIME OF THE
    29  OFFICE VISIT OR THERAPY AND OUTPATIENT SURGERY PERFORMED IN THE
    30  OFFICE, A HOSPITAL OR FREESTANDING AMBULATORY SERVICE CENTER,
    20060H2699B4886                 - 37 -     

     1  INCLUDING ANESTHESIA PROVIDED IN CONJUNCTION WITH SUCH SERVICE
     2  OR DURING EMERGENCY MEDICAL SERVICE.
     3     (IV)  EMERGENCY ACCIDENT AND EMERGENCY MEDICAL CARE.
     4     (V)  PRESCRIPTION DRUGS.
     5     (VI)  EMERGENCY, PREVENTIVE AND ROUTINE DENTAL CARE. THIS
     6  SUBPARAGRAPH DOES NOT INCLUDE ORTHODONTIA OR COSMETIC SURGERY.
     7     (VII)  EMERGENCY, PREVENTIVE AND ROUTINE VISION CARE,
     8  INCLUDING THE COST OF CORRECTIVE LENSES AND FRAMES, NOT TO
     9  EXCEED TWO PRESCRIPTIONS PER YEAR.
    10     (VIII)  EMERGENCY, PREVENTIVE AND ROUTINE HEARING CARE.
    11     (IX)  INPATIENT HOSPITALIZATION UP TO NINETY (90) DAYS PER
    12  YEAR FOR ELIGIBLE CHILDREN.
    13     (6.1)  THE DEPARTMENT SHALL IMPLEMENT A PREMIUM ASSISTANCE
    14  PROGRAM PERMITTED UNDER FEDERAL REGULATIONS AND AS PERMITTED
    15  THROUGH FEDERAL WAIVER OR STATE PLAN AMENDMENT MADE PURSUANT TO
    16  THIS ARTICLE. NOTWITHSTANDING ANY OTHER LAW TO THE CONTRARY, IN
    17  THE EVENT IT IS MORE COST EFFECTIVE TO PURCHASE HEALTH CARE FROM
    18  A PARENT'S EMPLOYER-BASED PROGRAM AND THE EMPLOYER-BASED PROGRAM
    19  MEETS THE MINIMUM COVERAGE REQUIREMENTS, EMPLOYER-BASED COVERAGE
    20  MAY BE PURCHASED IN PLACE OF ENROLLMENT IN THE HEALTH INSURANCE
    21  PROGRAM ESTABLISHED UNDER THIS SUBDIVISION. AN INSURER SHALL
    22  HONOR A REQUEST FOR ENROLLMENT AND PURCHASE OF EMPLOYE GROUP
    23  HEALTH INSURANCE REQUESTED ON BEHALF OF AN INDIVIDUAL APPLYING
    24  FOR COVERAGE UNDER THIS ARTICLE IF THAT INDIVIDUAL:
    25     (I)  IS A RESIDENT OF THIS COMMONWEALTH;
    26     (II)  IS QUALIFIED BASED ON INCOME UNDER SECTION 2311(D),
    27  (E.1), (E.2) OR (E.3);
    28     (III)  MEETS THE UNINSURED PERIOD, EXCEPT THAT ANY DELAY DUE
    29  TO AN ENROLLMENT RESTRICTION, WHICH MAY NOT EXCEED NINETY (90)
    30  DAYS, OR DUE TO THE LENGTH OF THE DEPARTMENT'S COST
    20060H2699B4886                 - 38 -     

     1  EFFECTIVENESS DETERMINATION SHALL BE COUNTED TOWARDS CALCULATING
     2  THE UNINSURED PERIOD; AND
     3     (IV)  MEETS THE CITIZENSHIP REQUIREMENTS OF SECTION
     4  2311(C)(1.1)(IV).
     5     (6.2)  THE DEPARTMENT SHALL HAVE THE AUTHORITY TO REVIEW,
     6  AUDIT AND APPROVE ANNUAL ADMINISTRATIVE EXPENSES INCURRED BY
     7  CONTRACTORS PURSUANT TO THIS SECTION.
     8     (7)  [EACH] EXCEPT FOR CHILDREN COVERED UNDER PARAGRAPH
     9  (6.1), EACH CONTRACTOR SHALL PROVIDE AN INSURANCE IDENTIFICATION
    10  CARD TO EACH ELIGIBLE CHILD COVERED UNDER CONTRACTS EXECUTED
    11  UNDER THIS ARTICLE. THE CARD MUST NOT SPECIFICALLY IDENTIFY THE
    12  HOLDER AS LOW INCOME.
    13     (M)  THE [INSURANCE DEPARTMENT] DEPARTMENT MAY GRANT A WAIVER
    14  OF THE MINIMUM BENEFIT PACKAGE OF SUBSECTION (L)(6) UPON
    15  DEMONSTRATION BY THE APPLICANT THAT IT IS PROVIDING HEALTH CARE
    16  SERVICES FOR ELIGIBLE CHILDREN THAT MEET THE PURPOSES AND INTENT
    17  OF THIS SECTION.
    18     (N)  AFTER THE FIRST YEAR OF OPERATION AND PERIODICALLY
    19  THEREAFTER, THE [INSURANCE DEPARTMENT] DEPARTMENT IN
    20  CONSULTATION WITH APPROPRIATE COMMONWEALTH AGENCIES SHALL REVIEW
    21  ENROLLMENT PATTERNS FOR BOTH THE FREE INSURANCE PROGRAM AND THE
    22  SUBSIDIZED INSURANCE PROGRAM. THE [INSURANCE DEPARTMENT]
    23  DEPARTMENT SHALL CONSIDER THE RELATIONSHIP, IF ANY, AMONG
    24  ENROLLMENT, ENROLLMENT FEES, INCOME LEVELS AND FAMILY
    25  COMPOSITION. BASED ON THE RESULTS OF THIS STUDY AND THE
    26  AVAILABILITY OF FUNDS, THE [INSURANCE DEPARTMENT] DEPARTMENT IS
    27  AUTHORIZED TO ADJUST THE MAXIMUM INCOME CEILING FOR FREE
    28  INSURANCE AND THE MAXIMUM INCOME CEILING FOR SUBSIDIZED
    29  INSURANCE BY REGULATION. IN NO EVENT, HOWEVER, SHALL THE MAXIMUM
    30  INCOME CEILING FOR FREE INSURANCE BE RAISED ABOVE TWO HUNDRED
    20060H2699B4886                 - 39 -     

     1  PER CENTUM (200%) OF THE FEDERAL POVERTY LEVEL.[, NOR SHALL THE
     2  MAXIMUM INCOME CEILING FOR SUBSIDIZED INSURANCE BE RAISED ABOVE
     3  TWO HUNDRED THIRTY-FIVE PER CENTUM (235%) OF THE FEDERAL POVERTY
     4  LEVEL. CHANGES IN THE MAXIMUM INCOME CEILING SHALL BE
     5  PROMULGATED AS A FINAL-FORM REGULATION WITH PROPOSED RULEMAKING
     6  OMITTED IN ACCORDANCE WITH THE ACT OF JUNE 25, 1982 (P.L.633,
     7  NO.181), KNOWN AS THE "REGULATORY REVIEW ACT."]
     8     (O)  NOTWITHSTANDING SUBSECTION (N), BEGINNING JANUARY 1,
     9  2007, AND THEREAFTER, AND SUBJECT TO THE PROVISIONS OF SECTION
    10  2314, THE MAXIMUM INCOME CEILING FOR SUBSIDIZED INSURANCE SHALL
    11  NOT BE RAISED ABOVE THREE HUNDRED PER CENTUM (300%) OF THE
    12  FEDERAL POVERTY LEVEL.
    13     SECTION 2312.  OUTREACH.--(A)  THE [INSURANCE DEPARTMENT]
    14  DEPARTMENT, IN CONSULTATION WITH APPROPRIATE COMMONWEALTH
    15  AGENCIES, SHALL COORDINATE THE DEVELOPMENT OF AN OUTREACH PLAN
    16  TO INFORM POTENTIAL CONTRACTORS, PROVIDERS AND ENROLLEES
    17  REGARDING ELIGIBILITY AND AVAILABLE BENEFITS. THE PLAN SHALL
    18  INCLUDE PROVISIONS FOR REACHING SPECIAL POPULATIONS, INCLUDING
    19  NONWHITE AND NON-ENGLISH-SPEAKING CHILDREN AND CHILDREN WITH
    20  DISABILITIES; FOR REACHING DIFFERENT GEOGRAPHIC AREAS, INCLUDING
    21  RURAL AND INNER-CITY AREAS; AND FOR ASSURING THAT SPECIAL
    22  EFFORTS ARE COORDINATED WITHIN THE OVERALL OUTREACH ACTIVITIES
    23  THROUGHOUT THIS COMMONWEALTH.
    24     (B)  THE COUNCIL SHALL REVIEW THE OUTREACH ACTIVITIES AND
    25  RECOMMEND CHANGES AS IT DEEMS IN THE BEST INTERESTS OF THE
    26  CHILDREN TO BE SERVED.
    27     SECTION 2313.  PAYOR OF LAST RESORT; INSURANCE COVERAGE.--THE
    28  CONTRACTOR SHALL NOT PAY ANY CLAIM ON BEHALF OF AN ENROLLED
    29  CHILD UNLESS ALL OTHER FEDERAL, STATE, LOCAL OR PRIVATE
    30  RESOURCES AVAILABLE TO THE CHILD OR THE CHILD'S FAMILY ARE
    20060H2699B4886                 - 40 -     

     1  UTILIZED FIRST. THE [INSURANCE DEPARTMENT] DEPARTMENT, IN
     2  COOPERATION WITH THE DEPARTMENT OF PUBLIC WELFARE, SHALL
     3  DETERMINE [THAT NO] IF ANY OTHER INSURANCE COVERAGE IS AVAILABLE
     4  TO THE CHILD THROUGH A CUSTODIAL OR NONCUSTODIAL PARENT ON AN
     5  EMPLOYMENT-RELATED OR OTHER GROUP BASIS. IF SUCH INSURANCE
     6  COVERAGE IS AVAILABLE, THE [INSURANCE DEPARTMENT SHALL
     7  REEVALUATE THE] CHILD'S ELIGIBILITY UNDER SECTION 2311[.] SHALL
     8  BE REEVALUATED, AS SHALL THE MOST COST-EFFECTIVE MEANS OF
     9  PROVIDING COVERAGE FOR THAT CHILD.
    10     SECTION 4.  THE ACT IS AMENDED BY ADDING SECTIONS TO READ:
    11     SECTION 2314.  STATE PLAN.--THE DEPARTMENT, IN COOPERATION
    12  WITH THE DEPARTMENT OF PUBLIC WELFARE, SHALL AMEND THE STATE
    13  PLAN AS DEEMED NECESSARY TO CARRY OUT THE PROVISIONS OF THIS
    14  ARTICLE. THE REPEAL OF SECTION 2311(E) AND (F) AND THE EXPANSION
    15  OF FINANCIAL ELIGIBILITY UNDER SECTION 2311(E.1), (E.2) AND
    16  (E.3) SHALL BE CONTINGENT UPON FEDERAL APPROVAL.
    17     SECTION 2362.  EXPIRATION.--THIS ARTICLE SHALL EXPIRE
    18  DECEMBER 31, 2010.
    19     SECTION 5.  WHEN THE DEPARTMENT RECEIVES FEDERAL APPROVAL OF
    20  THE STATE PLAN AMENDMENTS REQUESTED UNDER SECTION 2314 OF THE
    21  ACT, IT SHALL TRANSMIT NOTICE OF THAT FACT TO THE LEGISLATIVE
    22  REFERENCE BUREAU FOR PUBLICATION AS A NOTICE IN THE PENNSYLVANIA
    23  BULLETIN.
    24     SECTION 6.  THIS ACT SHALL TAKE EFFECT AS FOLLOWS:
    25         (1)  THE FOLLOWING PROVISIONS SHALL TAKE EFFECT
    26     IMMEDIATELY:
    27             (I)  THE AMENDMENT OF SECTION 1012-A OF THE ACT.
    28             (II)  THE ADDITION OF SECTION 2194 OF THE ACT.
    29             (III)  THE ADDITION OF SECTION 2314 OF THE ACT.
    30             (IV)  THE ADDITION OF SECTION 2362 OF THE ACT.
    20060H2699B4886                 - 41 -     

     1             (V)  SECTION 5 OF THIS ACT.
     2             (VI)  THIS SECTION.
     3         (2)  THE REMAINDER OF THIS ACT SHALL TAKE EFFECT ON THE
     4     LATER OF:
     5             (I)  30 DAYS AFTER THE DATE OF PUBLICATION OF THE
     6         NOTICE UNDER SECTION 5 OF THIS ACT; OR
     7             (II)  JANUARY 1, 2007.
















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