THE GENERAL ASSEMBLY OF PENNSYLVANIA

SENATE BILL

INTRODUCED BY D. WHITE, PILEGGI, ALLOWAY, ERICKSON, ORIE, STACK AND PIPPY, FEBRUARY 24, 2009

SENATOR D. WHITE, BANKING AND INSURANCE, AS AMENDED, MARCH 10, 2009   

AN ACT

Establishing a system for payment or reduction in payment for

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preventable serious adverse events within this Commonwealth;

and providing for the powers and duties of the Department of

Health and the Department of State.

Establishing a system for payment or reduction in payment for

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preventable serious adverse events within this Commonwealth;

and providing for the powers and duties of the Department of

Health and the Department of State.

The General Assembly of the Commonwealth of Pennsylvania

hereby enacts as follows:

Section 1.  Short title.

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

Serious Adverse Events Act.

Section 2.  Definitions.

The following words and phrases when used in this act shall

have the meanings given to them in this section unless the

context clearly indicates otherwise:

"Health care facility."  A health care facility as defined

under section 802.1 of the act of July 19, 1979 (P.L.130, No.

48), known as the Health Care Facilities Act, or an entity

licensed as a hospital under the act of June 13, 1967 (P.L.31,

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

"Health care provider."  A health care facility or a person,

including a corporation, university or other educational

institution, licensed or approved by the Commonwealth to provide

health care or professional medical services as a physician, a

certified nurse midwife, a podiatrist, a certified registered

nurse practitioner, a physician assistant, a chiropractor, a

hospital, an ambulatory surgery center, a nursing home or a

birth center.

"Health payor."  An individual or entity paying for health

services on behalf of another.

"Medical assistance."  The Commonwealth's medical assistance

program established under the act of June 13, 1967 (P.L.31, No.

21), known as the Public Welfare Code.

"National Quality Forum."  A not-for-profit membership

organization created to develop and implement a national

strategy for health care quality measurement and reporting.

"Preventable serious adverse event."  An event that is within

the health care facility's control to avoid, but that occurs

because of an error or system failure, and results in a

patient's death, loss of body part, disfigurement, disability or

loss of bodily function lasting more than seven days or is still

present at the time of discharge from a health care facility.

Such events shall be within the list of reportable serious

events adopted by the National Quality Forum.

Section 3.  Payment policy for preventable serious adverse

events.

(a)  General rule.--Health care providers may not knowingly

seek payment from health payors, patients or the responsible

party of the patient for a preventable serious adverse event or

services required to correct or treat the problem created by an

event when the event occurred under their care or control.

(b)  Refunds.--A health care provider who discovers that

payment has been sought for a preventable serious adverse event

or services required to correct or treat the problem created by

such an event shall immediately notify the health payor, patient

or the responsible party of the patient and shall refund any

payment received within 30 days of discovery or receipt of

payment, whichever is later.

(c)  Liability.--A health care provider, in compliance with

this subsection, shall not constitute an acknowledgment or

admission of liability.

Section 4.  Duties of Department of Health.

In accordance with the act of July 19, 1979 (P.L.130, No.48),

known as the Health Care Facilities Act, the Department of

Health shall be responsible for investigating patient complaints

regarding a health care facility that is seeking payment from

the patient for a preventable serious adverse event.

Section 5.  Duties of Department of State.

The Department of State shall be responsible for

investigating patient complaints regarding a health care

provider that is not a health care facility that is seeking or

causing to be sought payment from the patient or responsible

party of the patient for a preventable serious adverse event.

Section 6.  Applicability.

(a)  Hospital medical assistance payment policy.--Nothing in

this act shall require the Department of Public Welfare to

alter, amend or reissue any payment policy for inpatient

hospitals relating to preventable serious adverse events that

was promulgated prior to the enactment of this act. Any

modifications of the Department of Public Welfare payment policy

issued after enactment of this act shall require a 60-day public

comment period.

(b)  Contracts.--Nothing in this act shall prohibit a health

care provider and payor from establishing by contract a payment

policy associated with serious preventable adverse events,

including policies related to payment reductions or medical

review of any events on the National Quality Forum serious

reportable event list.

(c)  Reporting.--Health care providers shall include all

applicable medical codes in making reports in compliance with

the act of July 8, 1986 (P.L.408, No.89), known as the Health

Care Cost Containment Act.

Section 7.  Effective date.

This act shall take effect in 180 days.

Section 1.  Short title.

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

Serious Adverse Events Act.

Section 2.  Definitions.

The following words and phrases when used in this act shall

have the meanings given to them in this section unless the

context clearly indicates otherwise:

"Health care facility."  A health care facility as defined

under section 802.1 of the act of July 19, 1979 (P.L.130,

No.48), known as the Health Care Facilities Act, or an entity

licensed as a hospital under the act of June 13, 1967 (P.L.31,

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

"Health care provider."  A health care facility or a person,

including a corporation, university or other educational

institution, licensed or approved by the Commonwealth to provide

health care or professional medical services. The term shall

include, but not be limited to, a physician, a certified nurse

midwife, a podiatrist, a certified registered nurse

practitioner, a physician assistant, a chiropractor, a hospital,

an ambulatory surgery center, a nursing home or a birth center.

"Health payor."  An individual or entity paying for health

services for himself or itself or on behalf of another.

"Medical assistance."  The Commonwealth's medical assistance

program established under the act of June 13, 1967 (P.L.31,

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

"National Quality Forum."  A not-for-profit membership

organization created to develop and implement a national

strategy for health care quality measurement and reporting.

"Preventable serious adverse event."  An event that occurs in

a health care facility that is within the health care provider's

control to avoid, but that occurs because of an error or other

system failure and results in a patient's death, loss of body

part, disfigurement, disability or loss of bodily function

lasting more than seven days or still present at the time of

discharge from a health care facility. Such events shall be

within the list of reportable serious events adopted by the

National Quality Forum.

Section 3.  Payment policy for preventable serious adverse

events.

(a)  General rule.--Health care providers may not knowingly

seek payment from health payors, or patients for a preventable

serious adverse event or services required to correct or treat

the problem created by such an event when such an event occurred

under their control.

(b)  Refunds.--A health care provider who discovers that

payment has unknowingly been sought for a preventable serious

adverse event or services required to correct or treat the

problem created by such an event shall immediately notify the

health payor, or patient and shall refund any payment received

within 30 days of discovery or receipt of payment, whichever is

later.

(c)  Notification.--A health care payor who discovers that

payment has been sought for a preventable serious adverse event

or services required to correct or treat a problem created by

such an event shall notify the health care provider that payment

may not be sought for such an event or services and that payment

shall not be made for such events or services.

(d)  Liability.--Any information provided to any health care

payor or health care provider, in compliance with subsections

(b) and (c), shall not be discoverable or admissible in any

civil or administrative action related to the act of March 20,

2002 (P.L.154, No.13), known as the Medical Care Availability

and Reduction of Error (Mcare) Act.

Section 4.  Duties of Department of Health.

(a)  Publishing of updates.--The department shall publish in

the Pennsylvania Bulletin any updates to the list of reportable

serious adverse events adopted by the National Quality Forum

within 30 days of the update issued by the National Quality

Forum.

(b)  Health department responsibility.--In accordance with

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

Care Facilities Act, the Department of Health shall be

responsible for investigating patient complaints regarding a

health care facility that is seeking payment directly from the

patient or health care payor for a preventable serious adverse

event.

Section 5.  Duties of Department of State.

The Department of State shall be responsible for

investigating patient complaints regarding a health care

provider that is not a health care facility that is seeking or

causing to be sought payment directly from the patient or health

care payor for a preventable serious adverse event.

Section 6.  Applicability.

(a)  Hospital medical assistance payment policy.--Nothing in

this act shall require the Department of Public Welfare to

alter, amend or reissue any payment policy for inpatient

hospitals relating to preventable serious adverse events that

was promulgated prior to the enactment of this act. Any

modifications to the Department of Public Welfare payment policy

promulgated on or after the date of enactment of this act for a

health care provider for a preventable serious adverse event

shall require a 30-day public comment period.

(b)  Contracts.--Nothing in this act shall prohibit a health

care provider and payor from establishing by contract any

policies and procedures associated with serious preventable

adverse events necessary to implement the provisions of this

act.

(c)  Reporting.--

(1)  Health care providers shall include all applicable

medical codes in making reports in compliance with the act of

July 8, 1986 (P.L.408, No.89), known as the Health Care Cost

Containment Act.

(2)  A preventable serious adverse event shall be

reported pursuant to the requirements of the act of March 20,

2002 (P.L.154, No.13), known as the Medical Care Availability

and Reduction of Error (Mcare) Act.

(d)  Medicare payment.--Nothing in this act shall be

construed to supersede Medicare payment policies where the

services provided to the patient are paid for by Medicare. If

Medicare denies payment based on a determination that a

preventable serious adverse event has occurred, nothing in this

act shall be construed to require medical assistance or a health

payor to pay a claim for the event or services.

Section 7.  Effective date.

This act shall take effect in 180 days.