PRINTER'S NO.  256

  

THE GENERAL ASSEMBLY OF PENNSYLVANIA

  

HOUSE BILL

 

No.

246

Session of

2009

  

  

INTRODUCED BY MUNDY, BOYD, BRENNAN, CALTAGIRONE, CARROLL, COHEN, DeLUCA, FABRIZIO, FRANKEL, GIBBONS, GINGRICH, GOODMAN, GRUCELA, HENNESSEY, W. KELLER, KORTZ, KULA, MANDERINO, MANN, McILVAINE SMITH, MELIO, PALLONE, READSHAW, SANTONI, SIPTROTH, STABACK, STURLA, VULAKOVICH, WANSACZ AND THOMAS, FEBRUARY 4, 2009

  

  

REFERRED TO COMMITTEE ON INSURANCE, FEBRUARY 4, 2009  

  

  

  

AN ACT

  

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Amending the act of March 20, 2002 (P.L.154, No.13), entitled

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"An act reforming the law on medical professional liability;

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providing for patient safety and reporting; establishing the

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Patient Safety Authority and the Patient Safety Trust Fund;

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abrogating regulations; providing for medical professional

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liability informed consent, damages, expert qualifications,

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limitations of actions and medical records; establishing the

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Interbranch Commission on Venue; providing for medical

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professional liability insurance; establishing the Medical

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Care Availability and Reduction of Error Fund; providing for

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medical professional liability claims; establishing the Joint

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Underwriting Association; regulating medical professional

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liability insurance; providing for medical licensure

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regulation; providing for administration; imposing penalties;

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and making repeals," further providing for declaration of

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policy, for the Medical Care Availability and Reduction of

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Error Fund, for medical professional liability insurance by

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the joint underwriting association, for approval of medical

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professional liability insurers and for administrative

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definitions; and providing for functions of the Department of

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Health.

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The General Assembly of the Commonwealth of Pennsylvania

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hereby enacts as follows:

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Section 1.  Sections 102, 712(g), 733, 741 and 902 of the act

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of March 20, 2002 (P.L.154, No.13), known as the Medical Care

 


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Availability and Reduction of Error (Mcare) Act, are amended to

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read:

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Section 102.  Declaration of policy.

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The General Assembly finds and declares as follows:

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(1)  It is the purpose of this act to ensure that medical

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care is available in this Commonwealth through a

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comprehensive and high-quality health care system.

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(2)  Access to a full spectrum of hospital services and

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to highly trained physicians in all specialties must be

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available across this Commonwealth.

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(3)  To maintain this system, medical professional

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liability insurance has to be obtainable at an affordable and

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reasonable cost in every geographic region of this

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Commonwealth.

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(4)  A person who has sustained injury or death as a

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result of medical negligence by a health care provider must

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be afforded a prompt determination and fair compensation.

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(5)  Every effort must be made to reduce and eliminate

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medical errors by identifying problems and implementing

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solutions that promote patient safety.

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(6)  Recognition and furtherance of all of these elements

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is essential to the public health, safety and welfare of all

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the citizens of Pennsylvania.

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(7)  The costs of medical malpractice insurance premiums

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are directly impacted by medical errors.

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(8)  Research shows that a vast majority of medical

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errors are systemic rather than human errors.

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(9)  Total quality management systems implemented in

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industry and by the United States Department of Veterans

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Affairs hospital system have successfully reduced medical

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errors.

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(10)  It is the purpose of this act to improve patient

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safety, improve health care quality and lower health care

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costs by offering medical malpractice premium discounts to

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health care providers that institute total quality management

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health care systems.

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Section 712.  Medical Care Availability and Reduction of Error

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Fund.

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* * *

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(g)  Additional adjustments of the prevailing primary

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premium.--The department shall adjust the applicable prevailing

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primary premium of each participating health care provider in

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accordance with the following:

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(1)  The applicable prevailing primary premium of a

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participating health care provider which is not a hospital

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may be adjusted through an increase in the individual

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participating health care provider's prevailing primary

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premium not to exceed 20%. Any adjustment shall be based upon

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the frequency of claims paid by the fund on behalf of the

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individual participating health care provider during the past

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five most recent claims periods and shall be in accordance

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with the following:

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(i)  If three claims have been paid during the past

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five most recent claims periods by the fund, a 10%

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increase shall be charged.

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(ii)  If four or more claims have been paid during

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the past five most recent claims periods by the fund, a

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20% increase shall be charged.

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(2)  The applicable prevailing primary premium of a

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participating health care provider which is not a hospital

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and which has not had an adjustment under paragraph (1) may

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be adjusted through an increase in the individual

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participating health care provider's prevailing primary

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premium not to exceed 20%. Any adjustment shall be based upon

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the severity of at least two claims paid by the fund on

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behalf of the individual participating health care provider

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during the past five most recent claims periods.

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(3)  The applicable prevailing primary premium of a

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participating health care provider not engaged in direct

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clinical practice on a full-time basis may be adjusted

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through a decrease in the individual participating health

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care provider's prevailing primary premium not to exceed 10%.

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Any adjustment shall be based upon the lower risk associated

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with the less-than-full-time direct clinical practice.

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(4)  The applicable prevailing primary premium of a

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hospital may be adjusted through an increase or decrease in

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the individual hospital's prevailing primary premium not to

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exceed 20%. Any adjustment shall be based upon the frequency

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and severity of claims paid by the fund on behalf of other

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hospitals of similar class, size, risk and kind within the

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same defined region during the past five most recent claims

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periods.

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(5)  A participating health care provider that

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implements, to the satisfaction of the Department of Health,

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a total quality management health care system approved by the

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Department of Health shall be entitled to a 20% discount in

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the applicable prevailing primary premium for each fiscal

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year in which the system is implemented.

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* * *

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Section 733.  Deficit.

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(a)  Filing.--In the event the joint underwriting association

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experiences a deficit in any calendar year, the board of

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directors shall file with the commissioner the deficit.

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(b)  Approval.--Within 30 days of receipt of the filing, the

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commissioner shall approve or deny the filing. If approved, the

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joint underwriting association is authorized to borrow funds

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sufficient to satisfy the deficit.

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(c)  Rate filing.--Within 30 days of receiving approval of

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its filing in accordance with subsection (b), the joint

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underwriting association shall file a rate filing with the

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department. The commissioner shall approve the filing if [the]:

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(1)  The premiums generate sufficient income for the

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joint underwriting association to avoid a deficit during the

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following 12 months and to repay principal and interest on

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the money borrowed in accordance with subsection (b).

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(2)  There is a 20% discount in each premium for a health

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care provider that implements, to the satisfaction of the

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Department of Health, a total quality management health care

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system approved by the Department of Health.

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Section 741.  Approval.

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In order for an insurer to issue a policy of medical

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professional liability insurance to a health care provider or to

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a professional corporation, professional association or

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partnership which is entirely owned by health care providers,

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the insurer must [be] comply with all of the following:

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(1)  Be authorized to write medical professional

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liability insurance in accordance with the act of May 17,

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

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1921.

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(2)  Offer a 20% discount in the premium for a health

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care provider that implements, to the satisfaction of the

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Department of Health, a total quality management health care

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system approved by the Department of Health.

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Section 902.  Definitions.

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The following words and phrases when used in this chapter

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

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context clearly indicates otherwise:

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"Department."  The Department of Health of the Commonwealth.

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"Licensure board."  Either or both of the following,

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depending on the licensure of the affected individual:

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(1)  The State Board of Medicine.

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(2)  The State Board of Osteopathic Medicine.

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"Physician."  An individual licensed under the laws of this

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Commonwealth to engage in the practice of:

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(1)  medicine and surgery in all its branches within the

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scope of the act of December 20, 1985 (P.L.457, No.112),

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known as the Medical Practice Act of 1985; or

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(2)  osteopathic medicine and surgery within the scope of

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the act of October 5, 1978 (P.L.1109, No.261), known as the

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Osteopathic Medical Practice Act.

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Section 2.  The act is amended by adding a section to read:

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Section 911.  Department of Health.

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(a)  Total quality management health care system approval.--

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(1)  A total quality management health care system may

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apply to the department for approval. The application must be

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on a form prescribed by the Department of Health and must be

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accompanied by a fee set by regulation.

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(2)  Within 30 days of receipt of an application under

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paragraph (1), the department shall do one of the following:

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(i)  If the department determines that the system

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will successfully reduce medical errors by a health care

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provider, approve the application.

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(ii)  If the department determines that the system

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will not successfully reduce medical errors by a health

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care provider, deny the application. This subparagraph is

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subject to 2 Pa.C.S. Ch. 7 Subch. A (relating to judicial

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review of Commonwealth agency action).

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(3)  Failure to act within the time specified in

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paragraph (2) shall be deemed approval of the application.

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(b)  Total quality management health care system

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implementation.--The department shall provide health care

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providers with certification of implementation of total quality

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management health care systems as required by sections 712(g)

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(5), 733(c)(2) and 741(2).

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(c)  Regulations.--The department may promulgate regulations

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to implement this section.

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Section 3.  This act shall take effect in 60 days.

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