CORRECTIVE REPRINT

 

PRIOR PRINTER'S NO. 1871

PRINTER'S NO.  1872

  

THE GENERAL ASSEMBLY OF PENNSYLVANIA

  

HOUSE BILL

 

No.

1

Session of

2009

  

  

INTRODUCED BY EACHUS, DeLUCA, DeWEESE, BISHOP, BRIGGS, CALTAGIRONE, DALEY, DONATUCCI, FRANKEL, GIBBONS, GRUCELLA, HARHAI, HOUGHTON, MARKOSEK, McGEEHAN, McILVAINE SMITH, MELIO, READSHAW, SANTARSIERO, SEIP, SIPTROTH, SOLOBAY AND STABACK, MAY 21, 2009

  

  

REFERRED TO COMMITTEE ON INSURANCE, MAY 21, 2009   

  

  

  

AN ACT

  

1

Establishing the Expanded Adult Basic Coverage Insurance

2

Program; making appropriations; and making related repeals.

3

TABLE OF CONTENTS

4

Chapter 1.  Preliminary Provisions

5

Section 101.  Short title.

6

Section 102.  Definitions.

7

Chapter 3.  Pennsylvania Expanded Adult Basic Coverage Insurance

8

Program

9

Section 301.  Scope of chapter.

10

Section 302.  Definitions.

11

Section 303.  Pennsylvania Expanded Adult Basic Coverage

12

Insurance Program.

13

Section 304.  Duties of contractors.

14

Section 305.  Premiums and charges.

15

Section 306.  Data matching.

16

Section 307.  Information sharing.

 


1

Section 308.  Regulations.

2

Section 309.  Funding.

3

Section 310.  Federal waivers or State plan amendments.

4

Section 311.  Federal funds.

5

Section 312.  Federal programs.

6

Section 313.  Establishment.

7

Section 314.  Deposits into fund and appropriation.

8

Chapter 51.  Miscellaneous Provisions

9

Section 5101.  Repeals.

10

Section 5102.  Effective date.

11

The General Assembly of the Commonwealth of Pennsylvania

12

hereby enacts as follows:

13

CHAPTER 1

14

PRELIMINARY PROVISIONS

15

Section 101.  Short title.

16

This act shall be known and may be cited as the Expanded

17

Adult Basic Coverage Insurance Program Act.

18

Section 102.  Definitions.

19

The following words and phrases when used in this act shall

20

have the meanings given to them in this section unless the

21

context clearly indicates otherwise:

22

"Commissioner."  The Insurance Commissioner of the

23

Commonwealth.

24

"Department."  The Insurance Department of the Commonwealth.

25

CHAPTER 3

26

PENNSYLVANIA EXPANDED ADULT BASIC COVERAGE INSURANCE PROGRAM

27

Section 301.  Scope of chapter.

28

This chapter relates to offering health care coverage to

29

eligible adults. 

30

Section 302.  Definitions.

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1

The following words and phrases when used in this chapter

2

shall have the meanings given to them in this section unless the

3

context clearly indicates otherwise:

4

"Behavioral health services."  Mental health or substance

5

abuse services.

6

"Benefit package."  Insurance coverage which provides the

7

benefits set forth under section 303(h) for eligible adults.

8

"Children's Health Insurance Program."  The Children's Health

9

Care Program established under Article XXIII of the act of May

10

17, 1921 (P.L.682, No.284), known as The Insurance Company Law

11

of 1921. 

12

"Chronic care and disease management."  A model of health

13

care that manages chronic diseases in accordance with evidence-

14

based treatment guidelines and includes all of the following:

15

(1)  Planned, regular interactions with caregivers to

16

systematically assess the patient's condition and guide

17

patient self-care to prevent exacerbation and complications

18

of the chronic illness.

19

(2)  Support for the patient's role as self-manager

20

through education and continuing follow-up initiated by the

21

health care practice. 

22

(3)  Use of information systems to organize care and

23

monitor patient progress. 

24

"Contractor."  An insurer or other entity or its subsidiaries

25

awarded a contract to provide health care services under this

26

chapter.

27

"Eligible adult."  A low-income adult who meets all of the

28

following:

29

(1)  Legally resides within the United States.

30

(2)  Is a resident of this Commonwealth at the time of

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1

application to the program.

2

(3)  Is not currently covered by a health insurance plan,

3

a self-insurance plan or a self-funded plan.

4

(4)  Has not been covered by a health insurance plan, a

5

self-insurance plan or a self-funded plan during the six

6

months immediately preceding the determination of

7

eligibility, except if one of the following apply: 

8

(i)  The low-income adult is eligible to receive

9

benefits under the act of December 5, 1936 (2nd Sp.Sess.,

10

1937 P.L.2897, No.1), known as the Unemployment

11

Compensation Law.

12

(ii)  The low-income adult was covered under a health

13

insurance plan, a self-insurance plan or a self-funded

14

plan, but, at the time of application for coverage, is no

15

longer employed and is ineligible to receive benefits

16

under the Unemployment Compensation Law. 

17

(iii)  The low-income adult lost coverage as a result

18

of divorce or separation from a covered individual or the

19

death of a covered individual.

20

(iv)  The low-income adult lost coverage as a result

21

of a change in employment status of a covered individual

22

resulting in either of the exceptions set forth under

23

subparagraph (i) or (ii) and both the eligible adult and

24

the spouse are low-income adults and applying for

25

coverage.

26

(v)  The low-income adult is transferring from

27

another government-subsidized health insurance program,

28

including a transfer that occurs as a result of failure

29

to meet income eligibility requirements.

30

(5)  The low-income adult is ineligible to receive

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1

continuous eligibility coverage under Title XIX or XXI of the

2

Social Security Act (49 Stat. 620, 42 U.S.C. § 301 et seq.),

3

except for benefits authorized under a waiver granted by the

4

United States Department of Health and Human Services to

5

implement the program.

6

(6)  The low-income adult is ineligible for Medicare.

7

"Enrollee."  An eligible adult who meets all the requirements

8

of this chapter and is enrolled in the Pennsylvania Expanded

9

Adult Basic Coverage Insurance Program.

10

"Health benefit plan."  An insurance coverage plan that

11

provides the benefits set forth under section 303(h). The term

12

shall not include any of the following:

13

(1)  An accident-only policy.

14

(2)  A credit-only policy.

15

(3)  A long-term care or disability income policy.

16

(4)  A specified-disease policy.

17

(5)  A Medicare supplement policy.

18

(6)  A Civilian Health and Medical Program of the

19

Uniformed Services (CHAMPUS) supplement policy.

20

(7)  A fixed-indemnity policy.

21

(8)  A dental-only policy.

22

(9)  A vision-only policy.

23

(10)  A workers' compensation policy.

24

(11)  An automobile medical payment policy under 75

25

Pa.C.S. (relating to vehicles). 

26

(12)  Other similar policies providing for limited

27

benefits.

28

"Health maintenance organization" or "HMO."  An entity

29

organized and regulated under the act of December 29, 1972

30

(P.L.1701, No.364), known as the Health Maintenance Organization

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1

Act.

2

"Hospital."  A hospital as defined and licensed under the act

3

of July 19, 1979 (P.L.130, No.48), known as the Health Care

4

Facilities Act.

5

"Hospital plan corporation."  A hospital plan corporation as

6

defined in 40 Pa.C.S. § 6101 (relating to definitions). 

7

"Insurer."  A company or health insurance entity licensed in

8

this Commonwealth to issue any individual or group health,

9

sickness or accident policy or subscriber contract or

10

certificate or plan that provides medical or health care

11

coverage by a health care facility or licensed health care

12

provider that is offered or governed under any of the following:

13

(1)  The act of May 17, 1921 (P.L.682, No.284), known as

14

The Insurance Company Law of 1921.

15

(2)  The act of December 29, 1972 (P.L.1701, No.364),

16

known as the Health Maintenance Organization Act.

17

(3)  The act of May 18, 1976 (P.L.123, No.54), known as

18

the Individual Accident and Sickness Insurance Minimum

19

Standards Act.

20

(4)  40 Pa.C.S. Ch. 61 (relating to hospital plan

21

corporations) or 63 (relating to professional health services

22

plan corporations).

23

"Low-income adult."  An individual who is at least 19 years

24

of age but less than 65 years of age and whose household income

25

is less than 200% of the Federal poverty level at the time of

26

eligibility determination.

27

"Medical assistance."  The State program of medical

28

assistance established under the Act of June 13, 1967 (P.L.31,

29

No.21), known as the Public Welfare Code.

30

"Medicare."  The Federal program established under Title

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1

XVIII of the Social Security Act (49 Stat. 620, 42 U.S.C. § 1395

2

et seq.).

3

"Offeror."  An insurer that submits a bid or proposal in

4

response to a solicitation issued under section 303(h).

5

"Pre-existing condition."  A disease or physical condition

6

for which medical advice, diagnosis, care or treatment was

7

recommended or received prior to the effective date of coverage.

8

"Premium assistance program."  A component of the

9

Pennsylvania Expanded Adult Basic Coverage Insurance Program,

10

approved under a State plan or approved waiver, under which the

11

Commonwealth pays part or all of the premium for an enrollee’s

12

group health insurance or coverage under a group health plan. 

13

"Prescription drug."  A controlled substance, other drug or

14

device for medication dispensed by order of an appropriately

15

licensed medical professional. 

16

"Professional health services plan corporation."  A not-for-

17

profit corporation operating under the provisions of 40 Pa.C.S.

18

Ch. 63 (relating to professional health services plan

19

corporations).

20

"Program."  The Pennsylvania Expanded Adult Basic Coverage

21

Insurance Program.

22

"Unemployment Compensation Law."  The act of December 5, 1936

23

(1937 2nd Sp.Sess., P.L.2897, No.1), known as the Unemployment

24

Compensation Law.

25

"Wait-list enrollee."  An eligible adult who meets all the

26

requirements of this chapter who is not enrolled in the program

27

due to insufficient appropriations, but who individually

28

purchases the benefit package.

29

Section 303.  Pennsylvania Expanded Adult Basic Coverage

30

Insurance Program.

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1

(a)  Program establishment.--There is established in the

2

department the Pennsylvania Expanded Adult Basic Coverage

3

Insurance Program. The program is contingent on, and shall not

4

be authorized without, sufficient Federal financial

5

participation to fund the program. Appropriations to the

6

department for the program shall be used for contracts to

7

provide basic health care insurance for eligible adults and

8

administration of outreach activities and for program operating

9

costs. The department shall, to the greatest extent practicable,

10

ensure that all eligible adults in this Commonwealth have access

11

to the program established in this section.

12

(b)  Eligible adult responsibilities.--An eligible adult

13

seeking to purchase coverage under the program shall:

14

(1)  Submit an application to the department or a

15

contractor.

16

(2)  Pay to the department, or the contractor with whom

17

the eligible adult is to be enrolled, the amount of the

18

premium specified under this subsection. Except to the extent

19

that changes may be necessary to meet Federal requirements

20

under section 310, subsidies for the 2009-2010 fiscal year

21

shall result in the following premium amount based on

22

household income for a health benefit plan:

23

(i)  For an enrollee whose household income is not

24

greater than 150% of the Federal poverty level, a monthly

25

premium of $0.

26

(ii)  For an enrollee whose household income is

27

greater than 150% but not greater than 175% of the

28

Federal poverty level, a monthly premium of $40.

29

(iii)  For an enrollee whose household income is

30

greater than 175% but not greater than 200% of the

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1

Federal poverty level, a monthly premium of $50.

2

(3)  Be responsible for any required copayments for

3

health care services rendered under the benefit package in

4

subsection (h).

5

(4)  Notify the department or the contractor with whom

6

the eligible adult is enrolled of any change in the eligible

7

adult's household income.

8

(c)  Purchase of insurance.--An eligible adult's payment to

9

the department or the contractor with whom the eligible adult is

10

enrolled under subsection (b)(2) shall be used to purchase the

11

benefit package and shall be remitted so that it is received by

12

the department or the contractor before the first day of the

13

month for which coverage is provided. A grace period for

14

remittance shall be permitted as provided by Federal or State

15

law.

16

(d)  Premium assistance program.--The department shall

17

implement a premium assistance program permitted under Federal

18

regulations and as permitted through a Federal waiver or State

19

plan amendment made under this chapter. Notwithstanding any

20

other law to the contrary, in the event that it is more cost-

21

effective to purchase health care from an enrollee's employer-

22

based program and the employer-based program provides, at a

23

minimum, the benefits package described in subsection (h)(8),

24

employer-based coverage may be purchased in place of enrollment

25

in the program established under this chapter. An insurer shall

26

honor a request for enrollment and purchase of employee group

27

health insurance requested on behalf of an enrollee.

28

(e)  Waiting list.—-The department shall maintain a waiting

29

list of eligible adults who have applied for coverage under the

30

program but who are not enrolled due to insufficient

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1

appropriations. An eligible adult on the waiting list may

2

purchase the benefit package at the monthly per-member premium

3

cost negotiated by the department. The department shall create a

4

procedure to remove eligible adults from the waiting list and

5

enroll them in the program based upon available funding.

6

(f)  Entitlements and claims.--Nothing in this chapter shall

7

constitute an entitlement derived from the Commonwealth or a

8

claim on any funds of the Commonwealth. The Department of Public

9

Welfare, in conjunction with the department, shall seek approval

10

of State plan amendments and revisions to Federal waivers as are

11

necessary to ensure that expenditures in the program shall not

12

exceed available funding.

13

(g)  Department responsibilities.--The department shall work

14

in consultation and cooperation with other appropriate

15

Commonwealth agencies, including the Department of Public

16

Welfare, to carry out the functions of this chapter and shall:

17

(1)  Administer the program on a Statewide basis.

18

(2)  Enter into contracts for health care insurance for

19

the benefit package. Contracts may be awarded on a multiple-

20

award basis.

21

(3)  (i)  In order to effectuate the program promptly

22

upon receipt of all applicable waivers and approvals from

23

the Federal government, contracts as currently exist

24

under the Adult Basic Program or the Physical Health

25

Health Choices Program of the Department of Public

26

Welfare may be amended to provide benefits under the

27

program established in this section or may otherwise

28

procure services outside the competitive procurement

29

process.

30

(ii)  This paragraph shall expire at the same time as

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1

the contracts awarded under this section, but not later

2

than 18 months after the effective date of this section.

3

(4)  Subject to Federal requirements, impose reasonable

4

cost-sharing arrangements establishing and adjusting

5

copayments to be incorporated into the program by

6

contractors, thereby encouraging appropriate use by

7

contractors of cost-effective health care providers who will

8

provide quality health care. Changes to copayments shall be

9

forwarded to the Legislative Reference Bureau for publication

10

as notices in the Pennsylvania Bulletin.

11

(5)  Conduct monitoring, oversight and audits of executed

12

contracts for enforcement purposes.

13

(6)  Ensure that the eligibility of enrollees receiving

14

subsidization of the benefit package is redetermined on an

15

annual basis.

16

(7)  Monitor, review and evaluate each contractor’s

17

benefit package for the adequacy, accessibility and

18

availability of the services required under subsection (h).

19

(8)  Establish and coordinate development, implementation

20

and supervision of an outreach plan to ensure that all those

21

who may be eligible are aware of the program. The outreach

22

plan shall include provisions for:

23

(i)  Reaching special populations, including nonwhite

24

and non-English speaking individuals and individuals with

25

disabilities.

26

(ii)  Reaching different geographic areas, including

27

rural and inner-city areas.

28

(iii)  Assuring that special efforts are coordinated

29

within the overall outreach activities throughout this

30

Commonwealth.

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1

(iv)  Allowing for the acceptance of applications at

2

county assistance offices operated by the Department of

3

Public Welfare.

4

(9)  Prepare and submit, by March 1, 2010, and annually

5

thereafter, a report to the chairman and minority chairman of

6

the Banking and Insurance Committee of the Senate and to the

7

chairman and minority chairman of the Insurance Committee of

8

the House of Representatives regarding the number of eligible

9

adults purchasing coverage under the program with a

10

geographic distribution, the identity of the contractors, the

11

scope of the services being provided, the level of outreach,

12

the cost of the insurance and the amount an eligible adult

13

contributes toward the insurance, including any copayments

14

and adjustments to the premiums. The annual report shall be

15

made available for public inspection and posted on the

16

department's publicly accessible Internet website.

17

(10)  Undertake efforts as are required to seek receipt

18

of and qualify for Federal financial participation.

19

(h)  Solicitation.--The department shall solicit bids or

20

proposals for the program. The solicitation shall require an

21

offeror to assure that if selected as a contractor it will do

22

all of the following:

23

(1)  Ensure that enrollees and wait-list enrollees have

24

access to qualified, cost-effective health care providers.

25

(2)  Contract with qualified, cost-effective health care

26

providers, which shall include primary health care

27

physicians, certified registered nurse practitioners,

28

physician assistants, clinical nurse specialists, nurse-

29

midwives, clinics and health maintenance organizations, to

30

provide health care for organizations, to provide health care

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1

for enrollees and wait-list enrollees in a manner that best

2

manages the costs of the services and utilizes other

3

appropriate medical cost-effective methods and in a manner

4

consistent with the provider's permitted scope of practice.

5

(3)  Ensure that the individual applying for coverage is

6

an eligible adult. If a review of the individual's

7

application for coverage indicates that the individual is not

8

eligible for adult basic coverage insurance, but may be

9

eligible for medical assistance, the application for benefits

10

and all accompanying documentation shall be promptly

11

transmitted to the appropriate county assistance office for a

12

determination of eligibility for medical assistance or other

13

Federal, State and local resources available to the

14

individual.

15

(4)  Not prohibit enrollment based upon a preexisting

16

condition nor exclude a diagnosis or treatment for the

17

condition based on the condition's preexistence.

18

(5)  Provide an insurance identification card to each

19

enrollee or wait-list enrollee covered under a contract

20

executed under this section. The card shall not identify the

21

enrollee or wait-list enrollee as low income.

22

(6)  Require each provider providing primary care

23

services under this section to make necessary arrangements

24

for admission to hospitals and for necessary specialty care.

25

(7)  Not pay any claim on behalf of an enrollee or wait-

26

list enrollee unless all other Federal, State and local

27

resources are first utilized and utilize subrogation and

28

coordination of benefits processes so that the program is the

29

payor of last resort.

30

(8)  Provide a benefit package to enrollees and wait-list

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1

enrollees consistent with the scope and duration requirements

2

determined by the department. The Commonwealth may elect to

3

provide any benefit independently and outside the scope of

4

any contract entered into with any contractor to provide the

5

benefit package under the program. The benefit package

6

determined by the department may include any of the following

7

services:

8

(i)  Preventive and wellness care.

9

(ii)  Outpatient primary care and specialist

10

services.

11

(iii)  Inpatient hospitalization.

12

(iv)  Outpatient services.

13

(v)  Emergency care.

14

(vi)  Laboratory and radiology.

15

(vii)  Clinic services.

16

(viii)  Prescription drugs.

17

(ix)  Diabetic medical supplies and equipment.

18

(x)  Emergency dental care.

19

(xi)  Maternity care.

20

(xii)  Skilled nursing.

21

(xiii)  Home health, palliative and hospice care.

22

(xiv)  Chronic care and disease management.

23

(xv)  Inpatient and outpatient behavioral health

24

services.

25

(i)  Bids or proposals.--Each professional health service

26

plan corporation, hospital plan corporation, health maintenance

27

organization owned or controlled by a professional health

28

service plan corporation or a hospital plan corporation and each

29

entity that provides services under the Department of Public

30

Welfare's Physical Health HealthChoices Program shall be

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1

required to submit a bid or proposal to the department to carry

2

out the purposes of this chapter. Each professional health

3

service plan corporation and hospital plan corporation, and

4

subsidiaries and affiliates doing business in this Commonwealth,

5

shall submit a bid or proposal to the department to carry out

6

the purposes of this section in the geographic area serviced by

7

that entity. Each health maintenance organization owned or

8

controlled by a health service plan corporation or hospital plan

9

corporation shall submit a bid or proposal with all eligible

10

licenses and certificates of authority under its control, in all

11

service zones in which it is licensed to do business in more

12

than 50% of the counties in that zone. The service zones shall

13

be determined by the department in consultation with the

14

Department of Health and the Department of Public Welfare. Each

15

entity that provides services under the Physical Health

16

HealthChoices Program of the Department of Public Welfare shall

17

submit a bid or proposal in all counties in which it provides

18

the services. All other insurers may submit a bid or proposal to

19

the department to carry out the purposes of this section.

20

(j)  Reviewing, scoring and selecting bids or proposals.--The

21

department, in consultation with the Department of Public

22

Welfare, shall review and score bids or proposals on the basis

23

of all of the requirements for the program. The department may

24

include other criteria in the solicitation and in the scoring

25

and selection of the bids or proposals that the department, in

26

the exercise of its administrative duties under this section and

27

in consultation with the Department of Public Welfare, deems

28

necessary. The department shall:

29

(1)  Select, to the greatest extent practicable, offerors

30

that contract with providers to provide health care services

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1

on a cost-effective basis and that use appropriate cost-

2

management methods that enable the program to provide

3

coverage to the maximum number of eligible adults and that,

4

whenever possible, pursue and utilize available public and

5

private funds.

6

(2)  Select, to the greatest extent practicable, only

7

offerors that comply with all procedures relating to

8

coordination of benefits as required by the department and

9

the Department of Public Welfare.

10

(3)  Select offerors that limit administrative expenses

11

to no more than 10% of the amount of the contract. If a

12

contractor presents documented evidence that administrative

13

expenses for operational changes from the previous AdultBasic

14

Program to the program implemented under this act are in

15

excess of 10% of the amount of the contract, the department

16

shall make an additional allotment of funds, not to exceed 1%

17

of the amount of the contract, to the contractor to the

18

extent that the department finds the expenses reasonable and

19

necessary.

20

(k)  Rates and negotiations.--Rates for the program shall be

21

approved annually by the department and may vary by region and

22

contractor. Rates shall be based on an actuarially sound and

23

adequate review. The department shall not negotiate a contract

24

for a period in excess of four years.

25

(l)  Limitation.--In no case shall the total aggregate amount

26

of annual contracts entered into pursuant to this section exceed

27

the amount of the aggregate annual appropriations to the

28

department for the program.

29

Section 304.  Duties of contractors.

30

A contractor that contracts with the department to provide a

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1

health benefit plan to eligible adults:

2

(1)  Shall process claims for the coverage.

3

(2)  Shall implement copayment adjustments as soon as

4

practicable following publication in the Pennsylvania

5

Bulletin, but in no event more than 120 days following

6

publication.

7

(3)  May not deny coverage to an eligible adult who has

8

been approved by the department to participate in the

9

program.

10

(4)  Shall provide to the department all data, including

11

individual claims data, as the department determines is

12

necessary for use in performance measurement and program

13

improvement.

14

(5)  Shall fulfill all requirements of any contract

15

issued to it pursuant to this section.

16

Section 305.  Premiums and charges.

17

(a)  Limitation on fees.--No eligible adult shall be assessed

18

a fee or other charge, other than those specified in this

19

chapter, as a requirement for participating in the program.

20

(b)  Premium adjustment.--For each fiscal year beginning

21

after June 30, 2010, the department may adjust the premium

22

amounts under section 303(b)(2) to reflect changes in the cost

23

of medical services and shall forward notice of the new premium

24

amounts to the Legislative Reference Bureau for publication as a

25

notice in the Pennsylvania Bulletin.

26

(c)  Copayment adjustment.--For each fiscal year beginning

27

after June 30, 2010, the department may adjust the copayment

28

amounts under section 303(b)(3) to reflect changes in the cost

29

of medical services and shall forward notice of the new premium

30

amounts to the Legislative Reference Bureau for publication as a

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1

notice in the Pennsylvania Bulletin.

2

Section 306.  Data matching.

3

(a)  Covered adults.--All entities providing health insurance

4

or health care coverage within this Commonwealth shall, at least

5

once every month, provide the names, identifying information and

6

any additional information on coverage and benefits as the

7

department may specify for persons for whom the entities provide

8

insurance or coverage.

9

(b)  Use of information.--The department shall use the

10

information obtained under subsection (a) to determine whether

11

another entity has primary liability for health care claims paid

12

by the program. If a determination is made that the enrollee or

13

wait-list enrollee has other health care coverage, the

14

eligibility of the enrollee or wait-list enrollee shall be

15

reevaluated, as shall the most cost-effective means of providing

16

coverage for that enrollee or wait-list enrollee.

17

Section 307.  Information sharing.

18

Notwithstanding any provision of law to the contrary, the

19

program and other departments or programs of the Commonwealth

20

with information relating to the eligibility of individuals for

21

a Commonwealth program, shall share the information with each

22

other for purposes of determining and coordinating eligibility

23

for any State program. Those departments and programs include,

24

but are not limited to, the Department of Revenue, the

25

Department of Labor and Industry, the Department of Public

26

Welfare, the Children's Health Insurance Program and the

27

program. The information shall be confidential, shall be exempt

28

from disclosure under the act of February 14, 2008 (P.L.6,

29

No.3), known as the Right-to-Know Law, and may not be subject to

30

subpoena and may not be made public by any department or

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1

program, except that it may be disclosed to another Commonwealth

2

agency or law enforcement official of the Federal or State

3

government at any time so long as the agency or office receiving

4

the information agrees in writing to hold it confidential and in

5

a manner consistent with this act. No individual who receives

6

information while acting under the authority of this act shall

7

be permitted or required to testify in a private civil or other

8

action concerning the information subject to this section. 

9

Section 308.  Regulations.

10

The department may promulgate regulations for the

11

implementation and administration of the program. Until final

12

regulations are adopted, the department shall operate the

13

program under interim guidelines consistent with this chapter.

14

Section 309.  Funding.

15

(a)  Funding contingency for subsidization.--Subsidization of

16

premiums and copayments paid under subsection (b) is contingent

17

upon the amount of the funding available to the program and the

18

Federal poverty levels approved by the Federal waiver or State

19

plan amendments granted under section 310, and is limited to

20

eligible adults who are in compliance with the requirements

21

under this chapter.

22

(b)  Use of funding.--Funding shall be used by the department

23

to pay the difference between the total monthly cost of the

24

health benefit plan and the premium payments and copayments by

25

the eligible adult and for administration and outreach

26

activities required under subsection 303(f).

27

Section 310.  Federal waivers or State plan amendments.

28

(a)  Application for waivers or amendments.--The Department

29

of Public Welfare, in cooperation with the department, shall

30

apply for all applicable waivers from the Federal Government and

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1

shall seek approval to amend the State plan under Title XIX of

2

the Social Security Act (49 Stat. 620, 42 U.S.C. § 1396 et seq.)

3

as necessary to carry out the provisions of this chapter. 

4

(b)  Notice of approval.--If the Department of Public Welfare

5

receives approval of a waiver or approval of a State plan

6

amendment, it shall notify the department and shall transmit

7

notice of the waiver or State plan amendment approvals to the

8

Legislative Reference Bureau for publication as a notice in the

9

Pennsylvania Bulletin. 

10

(c)  Program changes.--The department is authorized to change

11

the benefits under section 303(h), the premium amounts payable

12

under section 303(b) and any eligibility requirements under this

13

chapter in order for the program to meet Federal requirements.

14

Section 311.  Federal funds.

15

Notwithstanding any other provision of law, the Department of

16

Public Welfare, in cooperation with the department, shall do all

17

of the following:

18

(1)  Seek the receipt of Federal financial participation

19

under Title XIX of the Social Security Act (49 Stat. 620, 42

20

U.S.C. § 1396 et seq.) for coverage and services provided

21

under this article.

22

(2)  Qualify for available Federal financial

23

participation under Title XIX of the Social Security Act.

24

Section 312.  Federal programs.

25

If the Federal Government enacts programs similar to the

26

program, the program shall be construed to only supplement the

27

Federal programs; and adults qualified for coverage under the

28

Federal program shall utilize that Federal program before

29

utilizing the program.

30

Section 313.  Establishment.

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1

There is established within the State Treasury a special fund

2

to be known as the Pennsylvania Expanded Adult Basic Coverage

3

Insurance Program Fund. 

4

Section 314.  Deposits into fund and appropriation.

5

(a)  Health Care Provider Retention Account.--On the

6

effective date of this section, the sum of $362,000,000 shall be

7

transferred from the Health Care Provider Retention Account to

8

the Pennsylvania Expanded Adult Basic Coverage Insurance Program

9

Fund.

10

(b)  Tobacco Settlement Act.--Notwithstanding section

11

5101(b), funds appropriated under section 306(b)(1)(vi) of the

12

act of June 26, 2001 (P.L.755, No.77), known as the Tobacco

13

Settlement Act, for the program established in former Chapter 13

14

of that act, shall be deposited into the Pennsylvania Expanded

15

Adult Basic Coverage Insurance Program Fund.

16

(c)  Premium tax.--Commencing with calendar years beginning

17

after December 31, 2010, every hospital plan corporation and

18

professional health service plan corporation operating in this

19

Commonwealth shall pay the tax on gross premiums payable under

20

Article IX of the act of March 4, 1971 (P.L.6, No.2), known as

21

the Tax Reform Code of 1971. The tax payable in calendar year

22

2011 shall be for gross premiums received in calendar year 2010.

23

Notwithstanding the provisions of any law to the contrary, the

24

sums received by the Commonwealth as a result of this tax shall

25

be deposited into the Pennsylvania Expanded Adult Basic Coverage

26

Insurance Program Fund. This subsection shall not be effective

27

if the Agreement on Community Health Reinvestment entered into

28

February 2, 2005, by the department and Capital BlueCross,

29

Highmark, Inc., Hospital Service Association of Northeastern

30

Pennsylvania and Independence Blue Cross and published in the

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1

Pennsylvania Bulletin at 35 Pa.B. 4155 (July 23, 2005) is

2

extended or otherwise renegotiated to continue, at least, at the

3

level of Annual Community Health Reinvestment contributed under

4

that agreement. In that event, the sums received by the

5

Commonwealth shall be deposited into the Pennsylvania Expanded

6

Adult Basic Coverage Insurance Program Fund.

7

(d)  Appropriation.--Money in the Pennsylvania Expanded Adult

8

Basic Coverage Insurance Program Fund is appropriated, upon

9

approval of the Governor, for health care coverage and services

10

under this chapter.

11

CHAPTER 51

12

MISCELLANEOUS PROVISIONS

13

Section 5101.  Repeals.

14

(a)  Declaration of policy.--The General Assembly declares

15

that the repeal under subsection (b) is necessary to effectuate

16

this act.

17

(b)  Specific.--Chapter 13 of the act of June 26, 2001

18

(P.L.755, No.77), known as the Tobacco Settlement Act, is

19

repealed.

20

(c)  Inconsistent.--All acts and parts of acts are repealed

21

insofar as they are inconsistent with this act.

22

Section 5102.  Effective date.

23

This act shall take effect in 90 days.

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