PRIOR PRINTER'S NOS. 453, 948, 1809

PRINTER'S NO. 1837

THE GENERAL ASSEMBLY OF PENNSYLVANIA

SENATE BILL

No.

225

Session of

2021

INTRODUCED BY PHILLIPS-HILL, MARTIN, J. WARD, MENSCH, COLLETT,

MUTH, KANE, STEFANO, AUMENT, CAPPELLETTI, BAKER, BROOKS,

BOSCOLA, HUTCHINSON, SABATINA, TOMLINSON, LAUGHLIN,

consolidating the law providing for the incorporation of

insurance companies, and the regulation, supervision, and

protection of home and foreign insurance companies, Lloyds

associations, reciprocal and inter-insurance exchanges, and

fire insurance rating bureaus, and the regulation and

supervision of insurance carried by such companies,

associations, and exchanges, including insurance carried by

the State Workmen's Insurance Fund; providing penalties; and

repealing existing laws," in quality health care

accountability and protection, further providing for

criteria adopted by insurer, MCO or contractor, further

providing for internal complaint process, for appeal of

complaint, for complaint resolution, for certification, for

operational standards, providing for step therapy

considerations, for prior authorization review and for

provider portal, further providing for internal grievances

process, for records, for external grievance process, for

prompt payment of claims, for health care provider and

managed care plan, for departmental powers and duties, for

penalties and sanctions, for compliance with National

utilization review," "utilization review" and "utilization

review entity" in section 2102 of the act of May 17, 1921

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

are amended and the section is amended by adding definitions to

read:

Section 2102. Definitions.--As used in this article, the

following words and phrases shall have the meanings given to

them in this section:

* * *

"Administrative policy." A written document or collection of

written administrative standards for the administration of

benefits under a health insurance policy, MCO contract or CHIP

contract. The term does not include a denial based on medical

necessity.

"Adverse benefit determination." A determination by an

insurer, MCO, contractor or a utilization review entity

designated by the insurer, MCO or contractor that a health care

service has been reviewed and, based upon the information

provided, does not meet the insurer's, MCO's or contractor's

requirements for medical necessity, appropriateness, health care

"Applicable governmental guidelines." Clinical practice and

associated guidelines issued under the authority of the United

States Department of Health and Human Services, United States

Food and Drug Administration, Centers for Disease Control and

Prevention, Department of Health or other similarly situated

Federal or State agency, department or subunit thereof focused

on the provision or regulation of medical care, prescription

drugs or public health within the United States.

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

children's health care program under Article XXIII-A.

guidelines used by an insurer, MCO or contractor to determine

the necessity and appropriateness of health care services.

"Closely related service." One or more health care services

subject to prior authorization that are closely related in

purpose, diagnostic utility or designated health care billing

code and provided on the same date of service such that a

prudent health care provider, acting within the scope of the

health care provider's license and expertise, might reasonably

be expected to perform such service in conjunction with or in

lieu of the originally authorized service in response to minor

administration of a prescription drug or any part of a series or

course of treatments.

"Complaint." A dispute or objection regarding a

participating health care provider or the coverage, operations

or management policies of [a managed care plan] an insurer, MCO

or contractor, which has not been resolved by the [managed care

plan] insurer, MCO or contractor and has been filed with the

[plan] insurer, MCO or contractor or with the Department of

Health or the Insurance Department of the Commonwealth. The term

does not include a grievance.

requires medical records to be transmitted electronically, or a

health care provider is capable of transmitting medical records

electronically to support a complete prior authorization request

for a health care service, the health care provider shall ensure

the insurer , MCO OR CONTRACTOR has electronic access to,

including the ability to print, the medical records that have

been transmitted electronically, subject to any applicable law

and the health care provider's corporate policies. The inability

of a health care provider to provide such access shall not

constitute a reason to deny an authorization request.

this act, the act of December 29, 1972 (P.L.1701, No.364), known

as the Health Maintenance Organization Act or 40 Pa.C.S. Ch. 61

(relating to hospital plan corporation) or 63 (relating to

professional health services plan corporations).

* * *

"Drug formulary." A listing of [managed care plan] insurer,

MCO or contractor preferred therapeutic drugs.

* * *

"Enrollee." Any policyholder, subscriber, covered person or

other individual who is entitled to receive health care services

solely concerning the medical necessity [and], appropriateness,

health care setting, level of care or effectiveness of a health

care service. If the [managed care plan] insurer, MCO or

contractor is unable to resolve the matter, a grievance may be

filed regarding the decision that:

(1) disapproves full or partial payment for a requested

health care service;

(2) approves the provision of a requested health care

service for a lesser scope or duration than requested; or

(3) disapproves payment for the provision of a requested

"Health care service." Any covered treatment, admission,

procedure, medical supplies and equipment or other services,

including behavioral health, prescribed or otherwise provided or

proposed to be provided by a health care provider to an enrollee

[under a managed care plan contract.]

"Health insurance policy." A policy, subscriber contract,

certificate or plan issued by an insurer that provides medical

or health care coverage. The term does not include any of the

following:

(1) An accident only policy.

policy.

(7) A fixed indemnity policy.

(8) A hospital indemnity policy.

(9) A dental only policy.

(10) A vision only policy.

(11) A workers' compensation policy.

(12) An automobile medical payment policy.

(13) A homeowners' insurance policy.

(14) A short-term limited duration policy.

(15) Any other similar policy providing for limited

"Insurer." An entity licensed by the department to issue a

health insurance policy, subscriber contract, certificate or

plan that provides medical or health care coverage that is

offered or governed under any of the following:

(1) Article XXIV, section 630 or any other provision of this

act.

(2) A provision of 40 Pa.C.S. Ch. 61 or 63.

* * *

"MCO contract." The agreement between a medical assistance

managed care organization or MCO and the Department of Human

not include a behavioral health managed care organization that

is a party to a Medicaid managed care contract with the

Department of Human Services.

"Medical policy." A written document formally adopted,

maintained and applied by an insurer, MCO or contractor that

combines the clinical coverage criteria and any additional

administrative requirements, as applicable, necessary to

articulate the insurer's, MCO's or contractor's standards for

coverage of a given service or set of services under the terms

of a health insurance policy, MCO contract or CHIP contract.

nationally recognized requirements for scientific manuscripts

and which journal submits most of its published articles for

review by experts who are not part of the journal's editorial

staff.

(2) Peer-reviewed medical literature, including literature

relating to a therapy reviewed and approved by a qualified

institutional review board, biomedical compendia and other

medical literature that meet the criteria of the National

Institutes of Health's Library of Medicine for indexing in Index

Medicus (Medline) and Elsevier Science Limited for indexing in

Information.

(ii) Drug Facts and Comparison.

(iii) The American Dental Association Accepted Dental

Therapeutics.

(iv) The United States Pharmacopoeia-Drug Information.

(5) Findings, studies or research conducted by or under the

auspices of a Federal Government agency or nationally recognized

Federal research institute, including:

(i) The Federal Agency for Healthcare Research and Quality.

(ii) The National Institute of Health.

(vii) Any national board recognized by the National

Institutes of Health for the purpose of evaluating the medical

value of health care services.

(6) Other medical or scientific evidence that is comparable

to the sources specified in paragraphs (1), (2), (3), (4) and

(5).

"Medication assisted treatment." United States Food and Drug

Administration approved prescription drugs used in combination

with counseling and behavioral health therapies in the treatment

of opioid use disorders.

insurer, MCO or contractor to participate in one or more

designated networks of the insurer, MCO or contractor and to

provide health care services to enrollees under the terms of the

insurer's, MCO's or contractor's administrative policy.

* * *

"Prior authorization." A review by an insurer, MCO,

contractor or by a utilization review entity acting on behalf of

an insurer, MCO or contractor of all reasonably necessary

supporting information that occurs prior to the delivery or

provision of a health care service and results in a decision to

(1) Prohibit [a managed care plan] an insurer, MCO or

contractor from making a determination not to pay for a

particular medical treatment, supply or service, enforcing

reasonable peer review or utilization review protocols or making

a determination that a health care provider has or has not

complied with appropriate protocols.

(2) Be construed as requiring [a managed care plan] an

insurer, MCO or contractor to provide, reimburse for or cover

counseling, referral or other health care services if the [plan]

insurer, MCO or contractor:

and the section is amended by adding a subsection to read:

Section 2116. Emergency Services.--(a) If an enrollee seeks

emergency services and the [emergency] health care provider

determines that emergency services are necessary, the

[emergency] health care provider shall initiate necessary

intervention to evaluate and, if necessary, stabilize the

condition of the enrollee without seeking or receiving

authorization from the [managed care plan. The managed care

plan] insurer, MCO or contractor. No insurer, MCO or contractor

shall require a health care provider to submit a request for

deductibles[.], including testing and other diagnostic services

that are medically necessary to evaluate or treat an emergency

medical condition prior to the point at which the condition is

stabilized. When processing a reimbursement claim for emergency

services, [a managed care plan] an insurer, MCO or contractor

shall consider both the presenting symptoms and the services

provided. The [emergency] health care provider shall notify the

enrollee's [managed care plan] insurer, MCO or contractor of the

provision of emergency services and the condition of the

enrollee. If an enrollee's condition has stabilized and the

facility shall have a minimum of twenty-four (24) hours to

notify the enrollee's insurer, MCO or contractor of the

admission or placement with such timeframe to start at the later

of:

(1) the time of the inpatient admission or placement; or

(2) in the case of an enrollee that is unconscious, comatose

or otherwise unable to effectively communicate pertinent

information, the time at which the inpatient facility knew or

reasonably should have known, through diligent efforts, the

identity of the enrollee's insurer, MCO or contractor.

under an agreement with an emergency medical services agency

that has that ability, the [managed care plan] insurer, MCO or

contractor may not deny a claim for payment solely because the

enrollee did not require transport or refused to be transported.

* * *

(e) Nothing in this section shall require an insurer, MCO or

contractor to waive application of otherwise applicable clinical

review criteria.

Section 4. Section 2117 of the act is amended to read:

Section 2117. Continuity of Care.--(a) Except as provided

insurer, MCO or contractor of the termination or pending

termination. The [managed care plan] insurer, MCO or contractor,

in consultation with the enrollee and the health care provider,

may extend the transitional period if determined to be

clinically appropriate. In the case of an enrollee in the second

or third trimester of pregnancy at the time of notice of the

termination or pending termination, the transitional period

shall extend through postpartum care related to the delivery.

Any health care service provided under this section shall be

covered by the [managed care plan] insurer, MCO or contractor

including breach of contract, fraud, criminal activity or posing

a danger to an enrollee or the health, safety or welfare of the

public as determined by the [plan] insurer, MCO or contractor,

the [plan] insurer, MCO or contractor shall not be responsible

for health care services provided to the enrollee following the

date of termination.

(c) If the [plan] insurer, MCO or contractor terminates the

contract of a participating primary care provider, the [plan]

insurer, MCO or contractor shall notify every enrollee served by

that provider of the [plan's] insurer's, MCO's or contractor's

policy, MCO contract or CHIP contract. The [managed care plan]

insurer, MCO or contractor, in consultation with the enrollee

and the health care provider, may extend this transitional

period if determined to be clinically appropriate. In the case

of a new enrollee in the second or third trimester of pregnancy

on the effective date of enrollment, the transitional period

shall extend through postpartum care related to the delivery.

Any health care service provided under this section shall be

covered by the [managed care plan] insurer, MCO or contractor

under the same terms and conditions as applicable for

conditions as a participating health care provider.

(f) Nothing in this section shall require [a managed care

plan] an insurer, MCO or contractor to provide health care

services that are not otherwise covered under the terms and

conditions of the [plan] health insurance policy, MCO contract

or CHIP contract.

Section 5. The act is amended by adding a section to read:

Section 2118. Medication assisted treatment.--(a) An

insurer, MCO or contractor shall make available without initial

prior authorization coverage of at least one United States Food

requirements for documenting and posting any relevant medical

policy or prescription drug formulary information.

(c) With the exception of prior authorization for initial

coverage, nothing in this section shall prohibit an insurer, MCO

or contractor from requiring prior authorization on subsequent

requests for medication assisted treatment to ensure adherence

with clinical guidelines.

amended to read:

Section 2121. Procedures.--(a) [A managed care plan] An

initial enrollment, renewal, restrictions and termination of

credentials for health care providers.

(b) The department shall establish credentialing standards

for [managed care plans.] insurers, MCOs and contractors. The

department may adopt nationally recognized accrediting standards

to establish the credentialing standards for [managed care

plans] insurers, MCOs and contractors.

(c) [A managed care plan] An insurer, MCO or contractor

shall submit a report to the department regarding its

credentialing process at least every two (2) years or as may

contractor shall also disclose relevant credentialing criteria

and procedures pursuant to a court order or rule. Any individual

providing information during the credentialing process of [a

managed care plan] an insurer, MCO or contractor shall have the

protections set forth in the act of July 20, 1974 (P.L.564,

No.193), known as the "Peer Review Protection Act."

(e) No [managed care plan] insurer, MCO or contractor shall

exclude or terminate a health care provider from participation

in the [plan] health insurance policy, MCO contract or CHIP

contract due to any of the following:

conditions.

(3) The health care provider objects to the provision of or

refuses to provide a health care service on moral or religious

grounds.

(f) If [a managed care plan] an insurer, MCO or contractor

denies enrollment or renewal of credentials to a health care

provider, the [managed care plan] insurer, MCO or contractor

shall provide the health care provider with written notice of

the decision. The notice shall include a clear rationale for the

decision.

regulations and professional ethical standards.

(b) To the extent [a managed care plan] an insurer, MCO or

contractor maintains medical records, the [plan] insurer, MCO or

contractor shall adopt and maintain procedures to ensure that

enrollees have timely access to their medical records unless

prohibited by Federal or State law or regulation.

(c) (1) Information regarding an enrollee's health or

treatment shall be available to the enrollee, the enrollee's

designee or as necessary to prevent death or serious injury.

(2) Nothing in this section shall:

Department of [Public Welfare] Human Services access to records

for purposes of quality assurance, investigation of complaints

or grievances, enforcement or other activities related to

compliance with this article and other laws of this

Commonwealth. Records shall be accessible only to department

employes or agents with direct responsibilities under the

provisions of this subparagraph.

(iii) Deny access to information necessary for a utilization

review entity to conduct a review under this article.

(iv) Deny access to the [managed care plan] insurer, MCO or

contractors, health care providers and their respective

designees for the purpose of providing patient care management,

outcomes improvement and research. For this purpose, enrollees

shall provide consent and shall remain anonymous to the greatest

extent possible.

Section 2136. Required Disclosure.--(a) [A managed care

plan] An insurer, MCO or contractor shall supply each enrollee

and, upon written request, each prospective enrollee or health

care provider with the following written information. Such

information shall be easily understandable by the layperson and

necessity used by the [plan] health insurance, MCO contract or

CHIP contract in determining whether these benefits will be

covered. The following statement shall be included in all

marketing materials in boldface type:

This [managed care plan] health insurance policy or contract

may not cover all your health care expenses. Read your

contract carefully to determine which health care services

are covered.

The notice shall be followed by a telephone number to contact

the [plan] insurer, MCO or contractor.

responsibility and caps on payments for health care services

provided under the [plan] health insurance policy, MCO contract

or CHIP contract.

(4) An explanation of an enrollee's financial responsibility

for payment when a health care service is provided by a

nonparticipating health care provider, when a health care

service is provided by any health care provider without required

authorization or when the care rendered is not covered by the

[plan] health insurance policy, MCO contract or CHIP contract.

(5) A description of how the [managed care plan] insurer,

authorization of a health care service or other information

regarding the [plan] health insurance policy, MCO contract or

CHIP contract.

(7) A summary of the [plan's] health insurance policy's, MCO

contract's or CHIP contract's utilization review policies and

procedures.

(8) A summary of all complaint and grievance procedures used

to resolve disputes between the [managed care plan] insurer, MCO

contractor and an enrollee or a health care provider, including:

(i) The procedure to file a complaint or grievance as set

participate in the complaint or grievance process as set forth

in this article.

(iv) A notice that all disputes involving denial of payment

for a health care service will be made by qualified personnel

with experience in the same or similar scope of practice and

that all notices of decisions will include information regarding

the basis for the determination.

(9) A description of the procedure for providing emergency

services twenty-four (24) hours a day. The description shall

include:

review entity.

Section 2152. Operational Standards.--(a) A utilization

review entity shall do all of the following:

* * *

(3) Ensure that a health care provider is able to verify

that an individual requesting information on behalf of the

[managed care plan] insurer, MCO or contractor is a legitimate

representative of the [plan] insurer, MCO or contractor.

(4) Conduct utilization reviews based on the medical

necessity [and], appropriateness, health care setting, level of

contained in section 2154(g).

* * *

(7) Notify the health care provider of additional facts or

documents required to complete the utilization review within

forty-eight (48) hours of receipt of the request for review[.]

or pursuant to section 2154(h) for missing clinical information

for all requests for prior authorization.

* * *

(c) Utilization review that results in a denial of payment

for a health care service, not including an administrative

Section 9. The act is amended by adding sections to read:

Section 2153. Step Therapy Considerations.--The following:

(1) If an insurer's, MCO's or contractor's medical policy

adopted under section 2137 incorporates step therapy criteria

for prescription drugs, an insurer, MCO or contractor shall

consider as part of the insurer's, MCO's or contractor's initial

prior authorization process or a request for an exception to the

insurer's, MCO's or contractors step therapy criteria, and based

on the enrollee's individualized clinical condition, the

following:

prescription drug prescribed by the enrollee's health care

provider.

(v) For new enrollees, whether the enrollee has already

satisfied a step therapy protocol with their previous health

insurer that required trials of drugs from each of the classes

that are required by the current insurer's, MCO's or

contractor's step therapy protocol.

(2) The provisions of section 2154 shall apply to step

therapy reviews conducted under this section.

Section 2154. Prior Authorization Review.-- (a) (1)

provider.

(2) At the time of review, an insurer, MCO or contractor

shall also verify the enrollee's eligibility for coverage under

the terms of the applicable health insurance policy, MCO

contract or CHIP contract.

(3) Appeals of administrative denials shall be subject to

the complaint process under subarticle (g).

(b) An insurer, MCO or contractor shall make available a

list, posted in a publicly accessible format and location on the

insurer's, MCO's or contractor's publicly accessible Internet

knowledge or experience in the same or similar specialty that

typically manages or consults on the health care service in

question. Alternatively, an insurer, MCO or contractor may

satisfy this requirement through the completion of the review by

a licensed medical professional in consultation with an

appropriately qualified third-party medical professional,

licensed in the same or similar medical specialty as the

requesting health care provider or type of health care provider

that typically manages the enrollee's associated condition,

provided that any compensation paid to the consulting

(d) In the case of a denied prior authorization, the

insurer, MCO or contractor shall make available to the

requesting health care provider a licensed medical professional

for a peer-to-peer review discussion. The peer-to-peer reviewer

provided by the insurer, MCO or contractor shall meet the

standards under subsection (c) and have authority to modify or

overturn the prior authorization decision. The procedure for

requesting a peer-to-peer review shall be available on the

insurer's, MCO's or contractor's publicly accessible Internet

website and provider portal. An insurer's, MCO's or contractor's

uses a third-party vendor or utilization review entity to

conduct peer-to-peer reviews for denials administered by the

vendor or entity, the procedure under subsection (i) shall

include contact information and information on the hours of

availability of the vendor or entity necessary for a requesting

health care provider to schedule a peer-to-peer discussion.

(e) A health care provider may designate, and an insurer,

MCO or contractor shall accept, another licensed member of the

health care provider's affiliated or employed clinical staff

with knowledge of the enrollee's condition and requested

performing or prescribing the requested health care service.

Such authority may be established through a supervising

physician consistent with applicable State law for non-physician

practitioners. The insurer, MCO or contractor must accept and

review the information submitted by other members of a health

care provider's affiliated or employed staff in support of a

prior authorization request. The insurer, MCO or contractor may

not limit interactions with an insurer's, MCO's or contractor's

clinical staff solely to the requesting health care provider.

(f) A peer-to-peer discussion shall be available to a

or deny prior authorization shall be rendered within the

following timeframes and following the submission of a COMPLETE

prior authorization request:

(1) An insurer, MCO or contractor shall issue a prior

authorization determination for a medical health care service in

accordance with the following timeframes:

(i) Review of request for urgent health care services as

expeditiously as the enrollee's health condition requires but no

more than seventy-two (72) hours.

(ii) Review of request for non-urgent medical services not

accordance with the following timeframes:

(i) Review or urgent request not more than twenty-four (24)

hours.

(ii) Review of standard request not more than two (2)

business days and not to exceed seventy-two (72) hours.

(3) If at any time after requesting prior authorization the

health care provider determines the enrollee's medical condition

requires emergency services, such services may be provided under

section 2116.

(4) UPON RECEIPT OF A SUBMISSION OF A PRIOR AUTHORIZATION

complete a review, the insurer, MCO or contractor shall notify

the health care provider of any missing clinical information

necessary to complete the review within twenty-four (24) hours

of receipt of the prior authorization request for urgent health

care services or within two (2) business days of receipt of all

other types of prior authorization requests and allow the

requesting health care provider or any member of the requesting

health care provider's clinical or administrative staff to

submit such information within the established review time

lines. A request for information under this subsection shall be

gathering the requested documentation shall be added to the time

frame provided under subsection (g).

(i) An insurer, MCO or contractor may supplement submitted

information based on current clinical records or other current

medical information for an enrollee as available, provided that

the supplemental information is also made available to the

enrollee or health care provider as part of the enrollee's

authorization case file upon request. In response to any request

for missing information, an insurer, MCO or contractor shall

also accept supplemental information from any member of the

contractor of the performance of the closely related service no

later than seventy two (72) hours following completion of the

service but prior to the submission of the claim for

payment. The submission of the notification shall include the

submission of all relevant clinical information necessary for

the insurer, MCO or contractor to evaluate the medical necessity

and appropriateness of the service.

(2) Nothing in this subsection shall be construed to limit

an insurer's, MCO's or contractor's consideration of medical

necessity and appropriateness of the closely service, nor limit

MCO or contractor shall establish a provider portal that

includes, at minimum, the following features:

(1) Electronic submission of prior authorization requests.

(2) Access to an insurer's, MCO's or contractor's applicable

medical policies.

(3) Information necessary to request a peer-to-peer review.

(4) Contact information for an insurer's, MCO's or

contractor's relevant clinical or administrative staff.

(5) For any prior authorization service not subject to

electronic submission via the provider portal, copies of any

contractor shall make available to health care providers and

their affiliated or employed staff access to training on the use

of the insurer's, MCO's or contractor's provider portal.

(c) Within eighteen (18) months following the establishment

of provider portals under subsection (a), a health care provider

seeking prior authorization shall submit such request via an

insurer's, MCO's or contractor's provider portal, provided that:

(1) Submission via provider portal shall only be required to

the extent an insurer's, MCO's or contractor's provider portal

is available and operational at the time of attempted

operational provider portal.

(3) Insurers, MCOs and contractors may elect to maintain

allowances for submission of prior authorization requests

outside of the provider portal.

Section 10. Sections 2161, 2162, 2163, 2166, subarticle (k)

heading of Article XXI and sections 2171, 2181, 2182 and 2191 of

the act are amended to read:

Section 2161. Internal Grievance Process.--(a) [A managed

care plan] An insurer, MCO or contractor shall establish and

maintain an internal grievance process [with two levels of

health care provider under this section may not file a separate

grievance.

(b) The internal grievance process shall consist of [an

initial] a review that includes all of the following:

(1) A review by [one] three or more persons selected by the

[managed care plan] insurer, MCO or contractor who did not

previously participate in the decision to deny payment for the

health care service.

(2) The completion of the review within thirty (30) days of

receipt of the grievance.

(4) A written notification to the enrollee and health care

provider regarding the decision within five (5) business days of

the decision. The notice shall include the basis and clinical

rationale for the decision and the procedure to file a request

[for a second level review of] appealing the decision as an

external grievance.

[(c) The grievance process shall include a second level

review that includes all of the following:

(1) A review of the decision issued pursuant to subsection

(b) by a second level review committee consisting of three or

five (45) days of receipt of a request for such review.

(4) A written notification to the enrollee and health care

provider regarding the decision of the second level review

committee within five (5) business days of the decision. The

notice shall include the basis and clinical rationale for the

decision and the procedure for appealing the decision.]

(d) Any [initial review or second level] review conducted

under this section shall include a licensed physician, or, where

appropriate, an approved licensed psychologist, in the same or

similar specialty that typically manages or consults on the

investigate potential violations of the article based upon

information received from enrollees, health care providers and

other sources in order to ensure compliance with this article.

(e) The department and the Insurance Department shall

promulgate such regulations as may be necessary to carry out the

provisions of this article.

(f) The department in cooperation with the Insurance

Department shall submit an annual report to the General Assembly

regarding the implementation, operation and enforcement of this

article.

known as the "Unfair Insurance Practices Act."

(c) The department or the Insurance Department may maintain

an action in the name of the Commonwealth for an injunction to

prohibit any activity which violates the provisions of this

article.

(d) The department may issue an order temporarily

prohibiting [a managed care plan] an insurer, MCO or contractor

which violates this article from enrolling new members.

(e) The department may require [a managed care plan] an

insurer, MCO or contractor to develop and adhere to a plan of

(f) In no event shall the department and the Insurance

Department impose a penalty for the same violation.

Section 2191. Compliance with National Accrediting

Standards.--Notwithstanding any other provision of this article

to the contrary, the department shall give consideration to [a

managed care plan's] an insurer's, MCO's or contractor's

demonstrated compliance with the standards and requirements set

forth in the "Standards for the Accreditation of Managed Care

Organizations" published by the National Committee for Quality

Assurance or other department-approved quality review

organizations.

Section 11. This act shall apply to health insurance

policies offered, issued or renewed on or after January 1, 2024.

Section 12. This act shall take effect in 30 days.