THE GENERAL ASSEMBLY OF PENNSYLVANIA

HOUSE BILL

INTRODUCED BY MANDERINO, McILVAINE SMITH, BELFANTI, BISHOP,

CALTAGIRONE, CLYMER, CRUZ, CURRY, DEASY, FAIRCHILD, FREEMAN,

GALLOWAY, GIBBONS, GOODMAN, GRUCELA, HARHAI, HARKINS, KORTZ,

KULA, MAHONEY, McGEEHAN, MUNDY, MYERS, OLIVER, PAYTON,

PRESTON, ROEBUCK, SANTONI, SIPTROTH, TALLMAN, J. TAYLOR,

THOMAS, WALKO, WHITE AND YOUNGBLOOD, JULY 14, 2009

REFERRED TO COMMITTEE ON HEALTH AND HUMAN SERVICES, JULY 14,

2009  

AN ACT

1

Providing for a Statewide comprehensive health care system;

2

establishing the Pennsylvania Health Care Plan and providing

3

for eligibility, services, coverages, subrogation,

4

participating providers, cost containment, reduction of

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errors, tort remedies, administrative remedies and

6

procedures, attorney fees, quality assurance,

7

nonparticipating providers, transitional support and

8

training; and establishing the Pennsylvania Health Care

9

Agency, the Employer Health Services Levy, the Individual

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Wellness Tax and the Pennsylvania Health Care Board and

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providing for their powers and duties.

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TABLE OF CONTENTS

13

Chapter 1.  Preliminary Provisions

14

Section 101.  Short title.

15

Section 102.  Definitions.

16

Chapter 3.  Administration and Oversight of the Pennsylvania

17

Health Care Plan

18

Subchapter A.  Pennsylvania Health Care Board

19

Section 301.  Organization.

20

Section 302.  Duties of board.

1

Subchapter B.  Pennsylvania Health Care Agency

2

Section 321.  Pennsylvania Health Care Agency.

3

4

Subchapter C.  (Reserved).

5

Subchapter D.  (Reserved).

6

Subchapter E.  (Reserved).

7

Subchapter F.  Immunity

8

Section 371.  Immunity.

9

Chapter 5.  Pennsylvania Health Care Plan

10

Section 501.  General provisions.

11

Section 502.  Universal health care access eligibility.

12

Section 503.  Covered services.

13

Section 504.  Excess and collective bargaining agreement health

14

insurance coverage.

15

Section 505.  Duplicate coverage.

16

Section 506.  Subrogation.

17

Section 507.  Eligible participating providers and availability

18

of services.

19

Section 508.  Rational cost containment.

20

Chapter 9.  Pennsylvania Health Care Trust Fund

21

Section 901.  Pennsylvania Health Care Trust Fund.

22

Section 902.  Limitation on administrative expense.

23

Section 903.  Funding sources.

24

Chapter 11.  Transitional Support and Training for Displaced

25

Workers

26

Section 1101.  Transitional support and training for displaced

27

workers.

28

Chapter 13.  Volunteer Emergency Responder Network

29

Section 1301.  Preservation of volunteer emergency responder

30

network.

1

Section 1302.  Eligibility certification.

2

Section 1303.  Eligibility criteria.

3

Section 1304.  Amount of tax credit.

4

Section 1305.  Reimbursement of Department of Revenue.

5

Chapter 45.  Miscellaneous Provisions

6

Section 4501.  Effective date.

7

The General Assembly of the Commonwealth of Pennsylvania

8

hereby enacts as follows:

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CHAPTER 1

10

PRELIMINARY PROVISIONS

11

Section 101.  Short title.

12

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

13

Business Healthcare Security Act.

14

Section 102.  Definitions.

15

The following words and phrases when used in this act shall

16

have the meanings given to them in this section unless the

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context clearly indicates otherwise:

18

"Agency."  The Pennsylvania Health Care Agency established

19

under this act.

20

"Board."  The Pennsylvania Health Care Board established

21

under this act.

22

"Certificate of need."  A notice of approval issued by

23

the Department of Health under the provisions of the act of July

24

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

25

Facilities Act, including those notices of approval issued as an

26

amendment to an existing certificate of need.

27

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

28

"Executive director."  The Executive Director of the

29

Pennsylvania Health Care Board.

30

"Fund."  The Pennsylvania Health Care Trust Fund established

1

under this act.

2

"Individual Fair Share Health and Wellness Tax."  The

3

Individual Fair Share Health and Wellness Tax established under

4

this act.

5

"Plan."  The Pennsylvania Health Care Plan established under

6

this act.

7

"Tax."  The Employer Fair Share Health and Wellness Tax

8

established under this act.

9

CHAPTER 3

10

ADMINISTRATION AND OVERSIGHT OF THE

11

PENNSYLVANIA HEALTH CARE PLAN

12

SUBCHAPTER A

13

PENNSYLVANIA HEALTH CARE BOARD

14

Section 301.  Organization.

15

(a)  Composition.--The Pennsylvania Health Care Board shall

16

be composed of 11 voting members. It shall be chaired by the

17

executive director who may vote only in the event of a tie vote.

18

(b)  Appointments.--

19

(1)  The executive director shall be appointed by the

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Governor. The members of the board shall be appointed by the

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Governor, the President pro tempore of the Senate, and the

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Speaker of the House of Representatives who collectively

23

shall make appointments of members from individuals

24

representative of each of the following constituencies:

25

(i)  Hospitals.

26

(ii)  Organized labor, private sector.

27

(iii)  Consumers.

28

(iv)  Business.

29

(v)  Agriculture.

30

(vi)  Physicians.

1

(vii)  Public sector employees.

2

(viii)  Nurses.

3

(ix)  Pharmacists.

4

(x)  Long-term care facilities.

5

(xi)  Social workers.

6

(2)  The Governor shall initially appoint the executive

7

director, who shall serve as chair of the board, appointments

8

of the members shall thereafter be made in a rotating fashion

9

beginning with the President pro tempore of the Senate, then

10

the Speaker of the House of Representatives and then the

11

Governor, with each in turn making an appointment from a

12

constituency category not previously filled.

13

(c)  Terms of members.--Each member appointed or reappointed

14

under this section shall hold office for three years, starting

15

on the first day of the first month following the member's

16

appointment. A serving member of the board shall continue to

17

serve following the expiration of the member's term until a

18

successor takes office or a period of 90 days has elapsed,

19

whichever occurs first.

20

(d)  Midterm vacancies.--Midterm vacancies shall be filled by

21

the same appointer and the individual appointed to fill a

22

vacancy occurring prior to the expiration of the term for which

23

a member is appointed shall hold office for the remainder of the

24

predecessor's term.

25

(e)  Compensation, benefits and expenses.--The executive

26

director and members of the board shall receive an annual

27

salary, benefits and expense reimbursement established by the

28

board, to be paid from the fund. The initial board shall

29

establish its own compensation. No increase or decrease in

30

salary or benefits adopted by the board for the executive

1

director or members shall become effective within the same

2

three-year term.

3

(f)  Meetings.--

4

(1)  The executive director shall set the time, place and

5

date for the initial and subsequent meetings of the board and

6

shall preside over its meetings. The initial meeting shall be

7

set not sooner than 50 nor later than 100 days after the

8

appointment of the executive director. Subsequent meetings

9

shall occur at least monthly thereafter.

10

(2)  All meetings of the board are open to the public

11

unless questions of patient confidentiality arise. The board

12

may go into closed executive session with regard to issues

13

related to confidential patient information.

14

(g)  Quorum.--Two-thirds of the appointed members of the

15

board shall constitute a quorum for the conducting of business

16

at meetings of the board. Decisions at ordinary meetings of the

17

board shall be reached by majority vote of those actually

18

present or, in the event of emergency meeting, those also

19

present by electronic or telephonic means. Where there is a tie

20

vote, the executive director shall be granted an additional vote

21

to break the tie.

22

(h)  Ethics.--The executive director, the members and their

23

immediate families are prohibited from having any pecuniary

24

interest in any business with a contract or in negotiation for a

25

contract with the agency. The board shall also adopt rules of

26

ethics and definitions of irreconcilable conflicts of interest

27

that will determine under what circumstances members must recuse

28

themselves from voting.

29

(i)  Prohibitions.--

30

(1)  No member of the board, except for the executive

1

director, may receive any additional salary or benefits by

2

virtue of serving on the board.

3

(2)  No member of the board may hold any other salaried

4

Commonwealth public position, either elected or appointed,

5

during the member's tenure on the board, including, but not

6

limited to, the position of State legislator or member of the

7

United States Congress.

8

(3)  The executive director may not be a State legislator

9

or member of the United States Congress.

10

Section 302.  Duties of board.

11

(a)  General duties.--The board is responsible for directing

12

the agency in the performance of all duties, the exercise of all

13

powers, and the assumption and discharge of all functions vested

14

in the agency. The board shall adopt and publish its rules and

15

procedures in the Pennsylvania Bulletin no later than 180 days

16

after the first meeting of the board.

17

(b)  Specific duties.--The duties and functions of the board

18

include, but are not limited to, the following:

19

(1)  Implementing statutory eligibility standards for

20

benefits.

21

(2)  Annually adopting a benefits package for

22

participants of the plan.

23

(3)  Acting directly or through one or more contractors

24

as the single payer administrator for all claims for health

25

care services made under the plan.

26

(4)  At least annually, reviewing the appropriateness and

27

sufficiency of reimbursements and considering whether a

28

charge is fair and reasonable for its geographic region or

29

location.

30

(5)  Providing for timely payments to participating

1

providers through a structure that is well organized and that

2

eliminates unnecessary administrative costs.

3

(6)  Implementing standardized claims and reporting

4

methods for use by the plan.

5

(7)  Developing a system of centralized electronic claims

6

and payments accounting.

7

(8)  Establishing an enrollment system that will ensure

8

that those who travel frequently and cannot read or speak

9

English are aware of their right to health care and are

10

formally enrolled in the plan.

11

(9)  Reporting annually to the General Assembly and to

12

the Governor, on or before the first day of October, on the

13

performance of the plan, the fiscal condition of the plan,

14

recommendations for statutory changes, the receipt of

15

payments from the Federal Government, whether current year

16

goals and priorities were met, future goals and priorities,

17

and major new technology or prescription drugs that may

18

affect the cost of the health care services provided by the

19

plan.

20

(10)  Administering the revenues of the fund.

21

(11)  Obtaining appropriate liability and other forms of

22

insurance to provide coverage for the plan, the board, the

23

agency and their employees and agents.

24

(12)  Establishing, appointing and funding appropriate

25

staff, office space, equipment, training and administrative

26

support for the agency throughout this Commonwealth, all to

27

be paid from the fund.

28

(13)  Administering aspects of the agency by taking

29

actions that include, but are not limited to, the following:

30

(i)  Establishing standards and criteria for the

1

allocation of operating funds.

2

(ii)  Meeting regularly to review the performance of

3

the agency and to adopt and revise its policies.

4

(iii)  Establishing goals for the health care system

5

established pursuant to the plan in measurable terms.

6

(iv)  Establishing Statewide health care databases to

7

support health care services planning.

8

(v)  Implementing policies and developing mechanisms

9

and incentives to assure culturally and linguistically

10

sensitive care.

11

(vi)  Establishing rules and procedures for

12

implementation and staffing of a no-fault compensation

13

system for iatrogenic injuries or complications of care

14

whereby a patient's condition is made worse or an

15

opportunity for cure or improvement is lost due to the

16

health care or medications provided or appropriate care

17

not provided by participating providers under the plan.

18

(vii)  Establishing standards and criteria for the

19

determination of appropriate transitional support and

20

training for residents of this Commonwealth who are

21

displaced from work during the first two years of the

22

implementation of the plan.

23

(viii)  Evaluating the state of the art in proven

24

technical innovations, medications and procedures and

25

adopting policies to expedite the rapid introduction

26

thereof in this Commonwealth.

27

(ix)  Establishing methods for the recovery of costs

28

for health care services provided pursuant to the plan to

29

a beneficiary who is also covered under the terms of a

30

policy of insurance, a health benefit plan or other

1

collateral source available to the participant under

2

which the participant has a right of action for

3

compensation. Receipt of health care services pursuant to

4

the plan shall be deemed an assignment by the participant

5

of any right to payment for services from any such

6

policy, plan or other source. The other source of health

7

care benefits shall pay to the trust all amounts it is

8

obligated to pay to, or on behalf of, the participant for

9

covered health care services. The board may commence any

10

action necessary to recover the amounts due.

11

(14)  Recruiting the Health Advisory Panel of seven

12

members made up of a cross section of the medical and

13

provider community. The members of the advisory panel shall

14

be paid a per diem rate, established by the board, for

15

attendance at meetings and further be reimbursed for actual

16

and necessary expenses incurred in the performance of their

17

duties, which shall include:

18

(i)  Advising the board on the establishment of

19

policy on medical issues, population-based public health

20

issues, research priorities, scope of services, expansion

21

of access to health care services and evaluation of the

22

performance of the plan.

23

(ii)  Investigating proposals for innovative

24

approaches to the promotion of health, the prevention of

25

disease and injury, patient education, research and

26

health care delivery.

27

(iii)  Advising the board on the establishment of

28

standards and criteria to evaluate requests from health

29

care facilities for capital improvements.

30

(iv)  Evaluating and advising the board on requests

1

from providers, or their representatives, for adjustments

2

to reimbursements.

3

(15)  Establishing a secure and centralized electronic

4

health record system wherein a beneficiary's entire health

5

record can be readily and reliably accessed by authorized

6

persons with the objective of eliminating the errors and

7

expense associated with paper records and diagnostic films.

8

The system shall ensure the privacy of all health records it

9

contains.

10

SUBCHAPTER B

11

PENNSYLVANIA HEALTH CARE AGENCY

12

Section 321.  Pennsylvania Health Care Agency.

13

(a)  Establishment of agency.--There is hereby established

14

the Pennsylvania Health Care Agency. The agency shall administer

15

the plan and is the sole agency authorized to accept applicable

16

grants-in-aid from the Federal Government and State government.

17

It shall use such funds in order to secure full compliance with

18

provisions of Federal and State law and to carry out the

19

purposes established under this act. All grants-in-aid accepted

20

by the agency shall be deposited into the Pennsylvania Health

21

Care Trust Fund established under this act, together with other

22

revenues raised within this Commonwealth to fund the plan.

23

(b)  Appointment of executive director.--The executive

24

director of the agency shall be appointed by the Governor for a

25

term of three years and is the chief administrator of the plan.

26

(c)  Personnel and employees.--The board shall employ and fix

27

the compensation of agency personnel as needed by the agency to

28

properly discharge the agency's duties. The employment of

29

personnel by the board is subject to the civil service laws of

30

this Commonwealth. The executive director shall oversee the

1

operation of the agency and the agency's performance of any

2

duties assigned by the board.

3

SUBCHAPTER C

4

(Reserved)

5

SUBCHAPTER D

6

(Reserved)

7

SUBCHAPTER E

8

(Reserved)

9

SUBCHAPTER F

10

IMMUNITY

11

Section 371.  Immunity.

12

In the absence of fraud or bad faith, the advisory panel, the

13

board and agency and their respective members and employees

14

shall incur no liability in relation to the performance of their

15

duties and responsibilities under this act. The Commonwealth

16

shall incur no liability in relation to the implementation and

17

operation of the plan.

18

CHAPTER 5

19

PENNSYLVANIA HEALTH CARE PLAN

20

Section 501.  General provisions.

21

(a)  Establishment of plan.--There is hereby established the

22

Pennsylvania Health Care Plan that shall be administered by the

23

independent Pennsylvania Health Care Agency under the direction

24

of the Pennsylvania Health Care Board.

25

(b)  Coverage.--The plan shall provide health care coverage

26

for all citizens of this Commonwealth and for certain eligible

27

visitors. The agency shall work simultaneously to control health

28

care costs, achieve measurable improvement in health care

29

outcomes, promote a culture of health awareness and develop an

30

integrated health care database to support health care planning

1

and quality assurance.

2

(c)  Reforms.--The board shall implement the reforms adopted

3

by the General Assembly hereby within one year of the effective

4

date of the plan.

5

Section 502.  Universal health care access eligibility.

6

(a)  Eligibility.--All Pennsylvania citizens, including an

7

alien or immigrant lawfully given admission to the United States

8

under the Immigration and Nationality Act (66 Stat. 163, 8

9

U.S.C. § 1101 et seq.), full-time out-of-State students

10

attending school in this Commonwealth, homeless persons and

11

migrant agricultural workers and their accompanying families are

12

eligible beneficiaries under the plan. The board shall establish

13

standards and a simple procedure to demonstrate proof of

14

eligibility.

15

(b)  Enrollment.--Enrollment in the plan shall be automatic

16

and beneficiaries shall be provided with access cards with

17

appropriate proof of identity technology and privacy protection.

18

(c)  Waivers.--If waivers are not obtained from the medical

19

assistance and/or Medicare programs operated under Title XVIII

20

or XIX of the Social Security Act (49 Stat. 620, 42 U.S.C. § 301 

21

et seq.), the medical assistance and Medicare nonwaived programs

22

shall act as the primary insurers for those eligible for such

23

coverage, and the plan shall serve as the secondary or

24

supplemental plan of health coverage. Until such time as waivers

25

are obtained, the plan will not pay for services for persons

26

otherwise eligible for the same benefits under Medicare or

27

Medicaid. The plan shall also be secondary to benefits provided

28

to military veterans except where reasonable and timely access,

29

as defined by the board, is denied or unavailable through the

30

United States Veterans' Administration, in which instance the

1

plan will be primary and will seek reasonable reimbursement from

2

the United States Veterans' Administration for the services

3

provided to veterans.

4

(d)  Priority of plans.--A plan of employee health coverage

5

provided by an out-of-State employer to a Pennsylvania resident

6

working outside of this Commonwealth shall serve as the

7

employee's primary plan of health coverage, and the plan shall

8

serve as the employee's secondary plan of health coverage.

9

(e)  Reimbursement.--The plan shall reimburse providers

10

practicing outside of this Commonwealth at plan rates, or the

11

reasonable prevailing rate of the locale where the service is

12

provided, for health care services rendered to a beneficiary

13

while the beneficiary is out of this Commonwealth. Services

14

provided to a beneficiary out of this Commonwealth by other than

15

a participating provider shall be reimbursed to the beneficiary

16

or to the provider at a fair and reasonable rate for that

17

location.

18

(f)  Presumption of eligibility.--Any individual who arrives

19

at a health care facility unconscious or otherwise unable due to

20

their mental or physical condition to document eligibility for

21

coverage shall be presumed to be eligible, and emergency care

22

shall be provided without delay occasioned over issues of

23

ability to pay.

24

(g)  Rules.--The board shall adopt rules assuring that any

25

participating provider who renders humanitarian emergency or

26

urgent care within this Commonwealth to a not actually eligible

27

recipient shall nevertheless be reimbursed for such care from

28

the plan subject to such rules as will reasonably limit the

29

frequency of such events to protect the fiscal integrity of the

30

plan. It shall be the agency's responsibility to secure

1

reimbursement for the costs paid for such care from any

2

appropriate third party funding source, or from the individual

3

to whom the services were rendered.

4

Section 503.  Covered services.

5

(a)  Benefits package.--The board shall establish a single

6

health benefits package within the plan that shall include, but

7

not be limited to, all of the following:

8

(1)  All medically necessary inpatient and outpatient

9

care and treatment, both primary and secondary.

10

(2)  Emergency services.

11

(3)  Emergency and other medically necessary transport to

12

covered health services.

13

(4)  Rehabilitation services, including speech,

14

occupational, physical and massage therapy.

15

(5)  Inpatient and outpatient mental health services and

16

substance abuse treatment.

17

(6)  Hospice care.

18

(7)  Prescription drugs and prescribed medical nutrition.

19

(8)  Vision care, aids and equipment.

20

(9)  Hearing care, hearing aids and equipment.

21

(10)  Diagnostic medical tests, including laboratory

22

tests and imaging procedures.

23

(11)  Medical supplies and prescribed medical equipment.

24

(12)  Immunizations, preventive care, health maintenance

25

care and screening.

26

(13)  Dental care.

27

(14)  Home health care services.

28

(15)  Chiropractic and massage therapy.

29

(16)  Complementary and alternative modalities that have

30

been shown by the National Institute of Health's Division of

1

Complementary and Alternative Medicine to be safe and

2

effective for possible inclusion as covered benefits.

3

(17)  Long-term care for those unable to care for

4

themselves independently and including assisted and skilled

5

care.

6

(b)  Exclusions for preexisting conditions.--The plan shall

7

not exclude or limit coverage due to preexisting conditions.

8

(c)  Copayments, deductibles, etc.--Beneficiaries of the plan

9

are not subject to copayments, deductibles, point-of-service

10

charges or any other fee or charge for a service within the

11

package and shall not be directly billed nor balance billed by

12

participating providers for covered benefits provided to the

13

beneficiary. Where a beneficiary has directly paid for

14

nonemergency services of a nonparticipating provider, the

15

beneficiary may submit a claim for reimbursement from the plan

16

for the amount the plan would have paid a participating provider

17

for the same service. Where emergency services are rendered by a

18

nonparticipating provider, the beneficiary shall receive

19

reimbursement of the full amount paid to such nonparticipating

20

provider not to exceed 125% of the amount the plan would have

21

paid a participating provider for the same service.

22

(d)  Exclusions of coverage.--

23

(1)  The board shall remove or exclude procedures and

24

treatments, equipment and prescription drugs from the plan

25

benefit package that the board finds unsafe or that add no

26

therapeutic value.

27

(2)  The board shall exclude coverage for any surgical,

28

orthodontic or other procedure or drug that the board

29

determines was or will be provided primarily for cosmetic

30

purposes unless required to correct a congenital defect, to

1

restore or correct disfigurements resulting from injury or

2

disease or that is certified to be medically necessary by a

3

qualified, licensed provider.

4

(e)  Choice by beneficiary.--Beneficiaries shall normally be

5

granted free choice of the participating providers, including

6

specialists, without preapprovals or referrals. However, the

7

board shall adopt procedures to restrict such free choice for

8

those individuals who engage in patterns of wasteful or abusive

9

self-referrals to specialists. Specialists who provide primary

10

care to a self-referred beneficiary will be reimbursed at the

11

board-approved primary care rate established for the service in

12

that community.

13

(f)  Service.--No participating provider shall be compelled

14

to offer any particular service so long as the refusal is

15

consistent with the provider's practice and is in no way

16

discriminatory.

17

(g)  Discrimination.--The plan and participating providers

18

shall not discriminate on the basis of race, ethnicity, national

19

origin, gender, age, religion, sexual orientation, health

20

status, mental or physical disability, employment status,

21

veteran status or occupation.

22

Section 504.  Excess and collective bargaining agreement health

23

insurance coverage.

24

Subject to the regulations of the Insurance Commissioner and

25

all applicable laws, private health insurers shall be authorized

26

to offer coverage supplemental to the package approved and

27

provided automatically under this act.

28

Section 505.  Duplicate coverage.

29

The agency is subrogated to and shall be deemed an assignee

30

of all rights of a beneficiary who has received duplicate health

1

care benefits, or who has a right to such benefits, under any

2

other policy or contract of health care or under any government

3

program.

4

Section 506.  Subrogation.

5

The agency shall have no right of subrogation against a

6

beneficiary's third-party claims for harm or losses not covered

7

under this act. Nor shall any beneficiary under this act have a

8

claim against a third-party tortfeasor for the services provided

9

or available to the beneficiary under this act. In all personal

10

injury actions accruing and prosecuted by a beneficiary on or

11

after January 1, 2008, the presiding judge shall advise any jury

12

that all health care expenses have been or will be paid under

13

the plan, and, therefore, no claim for past or future health

14

care benefits is pending before the court.

15

Section 507.  Eligible participating providers and availability

16

of services.

17

(a)  General rule.--All licensed health care providers and

18

facilities are eligible to become a participating provider in

19

the plan in which instance they shall enjoy the rights and have

20

the duties as set forth in the plan as stated in this section or

21

as adopted by the board from time to time. Nonparticipating

22

providers shall not enjoy the rights nor bear the duties of

23

participating providers.

24

(b)  Required notice.--In advance of initially providing

25

services to a beneficiary, nonparticipating providers shall

26

advise the beneficiary at the time the appointment is made that

27

the person or entity is a nonparticipating provider and that the

28

recipient of the service will be initially personally

29

responsible for the entire cost of the service and ultimately

30

responsible for the cost in excess of the reimbursement approved

1

by the board for participating providers. Failure to make such

2

financial disclosure will be deemed a fraud on the beneficiary

3

and entitle the beneficiary to a refund from the provider equal

4

to 200% of the amount paid to the nonparticipating provider in

5

excess of the board-approved reimbursement for the services

6

rendered, plus all reasonable fees for collection. The burden of

7

proof that such disclosure was made shall be on the

8

nonparticipating provider.

9

(c)  Plan by board.--The board shall assess the number of

10

primary and specialty providers needed to supply adequate health

11

care services in this Commonwealth generally and in all

12

geographic areas and shall develop a plan to meet that need. The

13

board shall develop financial incentives for participating

14

providers in order to maintain and increase access to health

15

care services in underserved areas of this Commonwealth.

16

(d)  Reimbursements.--Reimbursements shall be determined by

17

the board in such a fashion as to assure that a participating

18

provider receives compensation for services that fairly and

19

fully reflect the skill, training, operating overhead included

20

in the costs of providing the service, capital costs of

21

facilities and equipment, cost of consumables and the expense of

22

safely discarding medical waste, plus a reasonable profit

23

sufficient to encourage talented individuals to enter the field

24

and for investors to make capital available for the construction

25

of state-of-the-art health care facilities in this Commonwealth.

26

(e)  Adjustments to reimbursements.--Participating providers

27

shall have the right alone or collectively to petition the board

28

for adjustments to reimbursements believed to be too low. Such

29

petitions shall be initially evaluated by the administrator of

30

provider services, with input from the Health Advisory Panel,

1

who shall submit a report to the executive director within 30

2

days. The executive director will then submit a recommendation

3

to the board for action at the next scheduled board meeting.

4

Participating providers who remain dissatisfied after the board

5

has ruled may appeal the board's determination to Commonwealth

6

Court, which shall review the action of the board on an abuse of

7

discretion standard.

8

(f)  Evaluation of access to care.--The board annually shall

9

evaluate access to trauma care, diagnostic imaging technology,

10

emergency transport and other vital urgent care requirements and

11

shall establish measures to assure beneficiaries have equitable

12

and ready access to such resources regardless of where in this

13

Commonwealth they may be.

14

(g)  Performance reports.--The board, with the assistance of

15

the Health Advisory Panel, shall define performance criteria and

16

goals for the plan and shall make a written report to the

17

General Assembly at least annually on the plan's performance.

18

All such reports, including the survey results obtained, shall

19

be made publicly available with the goal of total transparency

20

and open self-analysis as a defining quality of the agency. The

21

board shall establish a system to monitor the quality of health

22

care and patient and provider satisfaction and to adopt a system

23

to devise improvements and efficiencies to the provision of

24

health care services.

25

(h)  Data reporting.--All participating providers shall, in a

26

prompt and timely manner, provide existing and ongoing data to

27

the agency upon its request.

28

(i)  Coordination of services.--The board shall coordinate

29

the provision of health care services with any other

30

Commonwealth and local agencies that provide health care

1

services directly to their charges or residents.

2

Section 508.  Rational cost containment.

3

(a)  Approval of expenditures.--As part of its cost

4

containment mission and based on the certificate of need, the

5

board shall screen and approve or disapprove private or public

6

expenditures for new health care facilities and other capital

7

investments that may lead to redundant and inefficient health

8

care provider capacity. Procedures shall be adopted for this

9

purpose with an emphasis upon efficiency, quality of delivery

10

and a fair and open consideration of all applications.

11

(b)  Capital investments.--Based on the certificate of need

12

all capital investments valued at $1,000,000 or greater,

13

including the costs of studies, surveys, design plans and

14

working drawing specifications, and other activities essential

15

to planning and execution of capital investment and all capital

16

investments that change the bed capacity of a health care

17

facility by more than 10% over a 24-month period or that add a

18

new service or license category shall require the approval of

19

the board. When a facility, an individual acting on behalf of a

20

facility or any other purchaser obtains by lease or comparable

21

arrangement any facility or part of a facility, or any equipment

22

for a facility, the market value of which would have been a

23

capital expenditure, the lease or arrangement shall be

24

considered a capital expenditure for purposes of this section.

25

(c)  Study.--Those intending to make capital investments or

26

acquisitions shall prepare a business case for making each

27

investment and acquisition. It shall include the full-life-cycle

28

costs of the investment or acquisition, an environment impact

29

report that meets existing State standards and a demonstration

30

of how the investment or acquisition meets the health care needs

1

of the population it is intended to serve. Acquisitions may

2

include, but not be limited to, acquisitions of land,

3

operational property or administrative office space.

4

(d)  Deemed approval.--Capital investment programs submitted

5

for approval shall be deemed approved by the board within 60

6

days from the date the submissions are received by the executive

7

director. A 60-day extension may apply if the board requires

8

additional information.

9

(e)  Recommendations.--Recommendations of the Pennsylvania

10

Heath Cost Containment Council and such other public and private

11

authoritative bodies as shall be identified from time to time by

12

the board shall be received by the executive director and

13

submitted to the board with the executive director's

14

recommendation regarding implementation of the recommended

15

reforms. The board shall receive input from all interested

16

parties and then shall vote upon all such recommendations within

17

60 days. Where procedural or protocol reforms are adopted,

18

participating providers will be required to implement such

19

designated best practices within the next 60 days.

20

(f)  Appeal.--A decision of the board may be appealed through

21

a uniform dispute resolution process that has been established

22

by unanimous approval of the board.

23

(g)  Required investments.--The board is authorized to adopt

24

programs to assist participating providers in making capital

25

investments responsive to best practice recommendations.

26

(h)  Decertification.--Participating providers refusing to

27

adopt recommended reforms shall, after a reasonable opportunity

28

to be heard, be subject to such sanctions as the board shall

29

deem appropriate and necessary up to and including the

30

suspension or permanent decertification of the participating

1

provider.

2

CHAPTER 9

3

PENNSYLVANIA HEALTH CARE TRUST FUND

4

Section 901.  Pennsylvania Health Care Trust Fund.

5

(a)  Establishment.--The Pennsylvania Health Care Trust Fund

6

is hereby established within the State Treasury. All moneys

7

collected and received by the plan shall be transmitted to the

8

State Treasurer for deposit into the fund, to be used

9

exclusively to finance the plan.

10

(b)  State Treasurer.--The State Treasurer may invest the

11

principal and interest earned by the fund in any manner

12

authorized under law for the investment of Commonwealth moneys.

13

Any revenue or interest earned from the investments shall be

14

credited to the fund.

15

Section 902.  Limitation on administrative expense.

16

The system budget referred to in this chapter shall comprise

17

the cost of the agency, services and benefits provided,

18

administration, data gathering, planning and other activities

19

and revenues deposited with the system account of the fund. The

20

board shall limit ongoing administrative costs, excluding start-

21

up costs, to 5% of the agency budget and shall annually evaluate

22

methods to reduce administrative costs and publicly report the

23

results of that evaluation.

24

Section 903.  Funding sources.

25

Funding of the plan shall be obtained from the following

26

dedicated sources:

27

(1)  Funds obtained from existing or future Federal

28

health care programs.

29

(2)  Funds from dedicated sources specified by the

30

General Assembly.

1

(3)  Receipts from the tax of 10% of gross payroll,

2

including self-employment profits. One percent of the tax

3

shall become effective the date that shall be the first day

4

of a calendar month no less than 32 days after the effective

5

date of this act, and the tax shall become fully effective 60

6

days before the plan takes effect. Employers who are part of

7

a collective bargaining agreement whereby the health care

8

benefits are no less generous than those provided under the

9

plan shall be excused from paying 90% of the tax.

10

(4)  Receipts from the Individual Fair Share Health and

11

Wellness Tax of 3% on income as defined in sections 301 and

12

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

13

Tax Reform Code of 1971. One-half of one percent of the

14

Individual Fair Share Health and Wellness Tax shall become

15

effective the date that shall be the first day of a calendar

16

month no less than 32 days after the effective date of this

17

act, and the Individual Fair Share Health and Wellness tax

18

shall become fully effective 60 days before the plan takes

19

effect.

20

(5)  In the event the General Assembly has not responded

21

to a request by the board for an increase in funding in

22

anticipation of projected expenses, the board is hereby

23

authorized to order a temporary increase, for no more than 90

24

days, in the tax and/or the Individual Fair Share Health and

25

Wellness Tax of not more than 250 basis points each to

26

respond to a threatened insolvency of the plan.

27

CHAPTER 11

28

TRANSITIONAL SUPPORT AND TRAINING FOR DISPLACED WORKERS

29

Section 1101.  Transitional support and training for displaced

30

workers.

1

(a)  Determination of eligibility.--The plan shall determine

2

which citizens of this Commonwealth employed by a health care

3

insurer, health insuring corporation or other health care-

4

related business have lost their employment as a result of the

5

implementation and operation of the plan, including the amount

6

of monthly wages that the individual has lost due to the plan's

7

implementation. The plan shall attempt to position these

8

displaced workers in comparable positions of employment or

9

assist in the retraining and placement of such displaced

10

employees elsewhere.

11

(b)  Compensation.--The plan shall forward the information on

12

the amount of monthly wages lost by Commonwealth residents due

13

to the implementation of the plan to the board. Compensation

14

shall be up to $5,000 each month but may not exceed the monthly

15

wages of the individual when he was displaced. Compensation will

16

cease upon reemployment or after two years, whichever comes

17

first. A displaced worker shall be eligible to receive

18

compensation, training assistance, or both, from the fund.

19

Training assistance may not exceed $20,000.

20

(c)  Coordination of services.--The plan shall fully

21

coordinate activity with public and private services also

22

available or actually participating in the assistance to the

23

affected individuals.

24

(d)  Appeals.--Persons dissatisfied with the level of

25

assistance they are receiving may appeal to the office of the

26

executive director whose determination shall be final and not

27

subject to appeal.

28

CHAPTER 13

29

VOLUNTEER EMERGENCY RESPONDER NETWORK

30

Section 1301.  Preservation of volunteer emergency responder

1

network.

2

Because this Commonwealth is dependent upon the volunteered

3

services of firefighters, emergency medical technicians and

4

search and rescue workers, the board is further charged with

5

administering a Commonwealth income tax credit program for such

6

volunteers.

7

Section 1302.  Eligibility certification.

8

Annually, in January, administrators of volunteer

9

firefighting and rescue departments, emergency medical

10

technicians and paramedics stations and similar volunteer

11

emergency entities shall certify the identity of Commonwealth

12

residents providing active services during the prior calendar

13

year.

14

Section 1303.  Eligibility criteria.

15

Active status shall require a minimum of 200 hours of service

16

during the preceding year and response to no less than 50% of

17

the emergency calls during at least three of the four calendar

18

quarters.

19

Section 1304.  Amount of tax credit.

20

Each volunteer certified as active shall be granted a credit

21

equal to $1,000 toward their State income tax obligation under

22

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

23

the Tax Reform Code of 1971. Any eligible volunteer who does not

24

incur $1,000 in annual State income tax liability shall

25

nevertheless be eligible for a refund equal to the amount the

26

credit exceeds that volunteer's tax obligation.

27

Section 1305.  Reimbursement.

28

The State Treasury shall be reimbursed the value of such

29

volunteer credits from the fund.

30

CHAPTER 45

1

MISCELLANEOUS PROVISIONS

2

Section 4501.  Effective date.

3

This act shall take effect immediately.