THE GENERAL ASSEMBLY OF PENNSYLVANIA

HOUSE BILL

INTRODUCED BY FRANKEL, DeLUCA, MICOZZIE, DERMODY, MARKOSEK, BARBIN, BOYD, B. BOYLE, BRADFORD, BRIGGS, V. BROWN, BURNS, BUXTON, CHRISTIANA, CONKLIN, D. COSTA, P. COSTA, DALEY, DEASY, DePASQUALE, DeWEESE, ELLIS, J. EVANS, EVANKOVICH, FABRIZIO, FREEMAN, GEIST, GERGELY, GIBBONS, GOODMAN, HALUSKA, HANNA, HARHAI, HARKINS, HARRIS, HORNAMAN, JOSEPHS, W. KELLER, KORTZ, KOTIK, KRIEGER, KULA, LONGIETTI, MAHER, MAHONEY, MANN, MARSHALL, MATZIE, MUNDY, MUSTIO, NEUMAN, M. O'BRIEN, PASHINSKI, PAYTON, PRESTON, RAVENSTAHL, READSHAW, REESE, SABATINA, SACCONE, SAINATO, SANTARSIERO, SHAPIRO, M. SMITH, SONNEY, STABACK, STURLA, VULAKOVICH, WAGNER, WHEATLEY, WHITE, YOUNGBLOOD AND DONATUCCI, OCTOBER 4, 2011

REFERRED TO COMMITTEE ON INSURANCE, OCTOBER 4, 2011  

AN ACT

Amending Title 40 (Insurance) of the Pennsylvania Consolidated

Statutes, in general regulation, providing for contract

negotiation; and making an editorial change.

The General Assembly of the Commonwealth of Pennsylvania

hereby enacts as follows:

Section 1.  Part II of Title 40 of the Pennsylvania

Consolidated Statutes is amended to read:

REGULATION OF INSURERS AND RELATED

PERSONS GENERALLY

[(Reserved)]

CHAPTER 31

CONTRACT NEGOTIATION

Sec.

3101.  Declaration of policy.

3102.  Definitions.

3103.  Good faith negotiations and dispute resolution.

3104.  Arbitration.

3105.  Arbitration criteria.

3106.  Arbitration timing and rules.

3107.  Prohibited conduct.

3108.  Enforcement and remedies.

3109.  Existing consent decrees and final orders.

§ 3101.  Declaration of policy.

The General Assembly finds and declares as follows:

(1)  Property committed to charitable purposes should

have special protection under the law because it enjoys

tax‑exempt status and relieves the public burden by advancing

a specific charitable cause.

(2)  Under current law, charitable assets may not be

diverted from the purposes for which they were donated,

granted or devised without obtaining an order from the court

specifying the disposition of the assets.

(3)  Under current law, the Attorney General is empowered

to intervene and protect the public interest in regard to

property committed to a charitable purpose.

(4)  Over the course of the last ten years, the Attorney

General has intervened in the proposed transfer of property

committed to charitable purposes and has imposed a

requirement for good faith negotiations between certain

health plans and health care facilities, including specialty

hospitals and networks, followed by binding arbitration.

(5)  Tens of thousands of citizens of this Commonwealth

have made direct charitable contributions to tax-exempt, not-

for-profit specialty hospitals and networks which enable the

provision by the hospitals and networks of critical health

care services to citizens of this Commonwealth.

(6)  Every citizen of this Commonwealth makes an indirect

contribution to tax-exempt, not-for-profit specialty

hospitals and networks through government grants funded by

the payment of taxes.

(7)  A not-for-profit specialty hospital or network which

has been granted tax-exempt status by the Commonwealth enjoys

a financial benefit not available to specialty hospitals or

networks which have not been granted that status, and this

financial benefit results in an economic advantage over its

competitors.

(8)  In keeping with the intent of private donors of tax-

exempt, not-for-profit specialty hospitals and networks,

these hospitals and networks and their affiliated specialists

should be required to remain as accessible as possible to

every citizen of this Commonwealth, regardless of insurance

coverage.

(9)  It is in the public interest that tax-exempt, not-

for-profit specialty hospitals and networks and their

affiliated specialists continue to be accessible, in the same

manner and to the same extent that they historically have

been accessible, to individuals residing in the geographic

areas served by the tax-exempt, not-for-profit hospitals and

networks and their affiliated specialists for medically

necessary specialty health services.

(10)  A tax-exempt, not-for-profit specialty hospital or

network or its affiliated specialists that fail to negotiate

in good faith with a health plan or unreasonably refuse to

come to an agreement with a health plan regarding

reimbursement rates violate the will of its donors and, in

doing so, engage in the unauthorized diversion of charitable

assets from the purposes for which the specialty hospital or

network received its tax-exempt status.

§ 3102.  Definitions.

The following words and phrases when used in this chapter

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

context clearly indicates otherwise:

"Affiliated specialist."  A physician or other health care

professional or group of physicians or other health care

professionals that:

(1)  has been granted privileges by a specialty hospital

or network to provide medical care to patients receiving

treatment at the specialty hospital or network; and

(2)  has a practice owned directly or indirectly by:

(i)  the specialty hospital or network referred to in

paragraph (1); or

(ii)  a tax-exempt, not-for-profit corporation which

indirectly or directly owns or operates the specialty

hospital or network.

"Attorney General."  The Office of Attorney General of the

Commonwealth.

"Commissioner."  The Insurance Commissioner of the

Commonwealth.

"Health plan."  An organized health-service purchasing

program. The term includes a health insurance or managed-care

plan which is offered by government, a for-profit or nonprofit

third-party payer, a health care provider or another entity.

"MSA."  A metropolitan statistical area.

"Specialty hospital or network."  Any of the following:

(1)  A tax-exempt, not-for-profit hospital which:

(i)  is located in a county of the second class; and

(ii)  specializes in providing women's health care,

the treatment of mental illness or pediatric acute care.

(2)  Oncological consultation, referral, diagnostic,

treatment, rehabilitation or related services, coordinated or

provided directly through a clinical oncology care and

research network which is owned or operated directly or

indirectly by a tax-exempt, not-for-profit corporation

headquartered in a county of the second class.

(3)  Inpatient or outpatient behavioral and mental health

services coordinated or provided in this Commonwealth by a

hospital referred to in paragraph (1), regardless of whether

the services are provided at the hospital or at another

facility located in this Commonwealth.

(4)  The parent corporation of a hospital referred to in

paragraph (1) or a network referred to in paragraph (2), with

respect to all matters relating to the hospital or network

covered by this chapter.

(5)  A facility to which a hospital referred to in

paragraph (1) or a network referred to in paragraph (2)

transfers a substantial portion of its services.

"Tax exempt."  Possessing a valid exemption from the tax

imposed by Article II of the act of March 4, 1971 (P.L.6, No.2),

known as the Tax Reform Code of 1971.

§ 3103.  Good faith negotiations and dispute resolution.

(a)  Negotiation.--A specialty hospital or network, its

affiliated specialists and a health plan shall negotiate in good

faith concerning all of the following:

(1)  Contracts for services at the specialty hospital or

network.

(2)  Contracts with the affiliated specialists of the

specialty hospital or network.

(b)  Dispute resolution.--A specialty hospital or network or

its affiliated specialists shall participate in the dispute

resolution process initiated by a health plan under this

section. The following shall apply:

(1)  A health plan may initiate a dispute resolution

process by giving written notice to a specialty hospital or

network with which the health plan desires to contract or

continue to contract and its affiliated specialists. Notice

must be given as follows:

(i)  Except as set forth in subparagraph (ii), at

least 90 days prior to the expiration of an existing

contract.

(ii)  If the health plan does not have an existing

contract with the specialty hospital or network and its

affiliated specialists, at any time after the health plan

has notified the specialty hospital or network and its

affiliated specialists in writing of its interest in

negotiating a contract with the specialty hospital or

network and its affiliated specialists.

(2)  The health plan sending the notice under paragraph

(1) and the specialty hospital or network and affiliated

specialists receiving the notice shall negotiate in good

faith toward a contract or renewal of an existing contract

for the specialty hospital's or network's services and the

services of its affiliated specialists. If a contract or a

renewal of an existing contract is not agreed upon within 90

days following notice under paragraph (1), section 3104

(relating to arbitration) applies.

§ 3104.  Arbitration.

(a)  Request.---At the conclusion of the dispute resolution

process described in section 3103 (relating to good faith

negotiations and dispute resolution), the following apply:

(1)  The health plan may make a written request to the

commissioner for arbitration before an independent

arbitration panel. A copy of the request must be sent to the

specialty hospital or network and its affiliated specialists

with whom the health plan had been negotiating. The notice

must be accompanied by a written statement of the health plan

indicating the respective parties' last contract offers, a

description of issues that have been agreed to by all parties

and a description of issues still outstanding.

(2)  Within ten days after receiving a copy of the notice

and statement, the specialty hospital or network and its

affiliated specialists shall notify the commissioner and the

health plan in writing of:

(i)  their agreement with the health plan's

statement; or

(ii)  their reasons for disagreement with the health

plan's statement.

(b)  Determination.--

(1)  After review of the statement and responses

submitted under subsection (a), the commissioner shall do one

of the following:

(i)  Appoint an arbitration panel under subsection

(c).

(ii)  Reject a request for arbitration because the

number and scope of disputed contract issues and terms

exceed the number and scope of the agreed upon contract

issues and terms.

(2)  Upon a rejection under paragraph (1)(ii), all of the

following apply:

(i)  The commissioner shall notify all parties of the

rejection and order them to engage in another 30 days of

negotiation.

(ii)  Upon the expiration of the time period under

subparagraph (i) without resolution, all of the following

apply:

(A)  The health plan shall notify the

commissioner in writing.

(B)  The parties shall each submit the written

statement required under subsection (a), revised if

necessary, to reflect applicable changes resulting

from the additional period of negotiation.

(C)  The commissioner shall appoint the

arbitration panel under subsection (c).

(c)  Appointment of arbitration panel.--At the appropriate

time under subsection (b)(1)(i) or (2)(ii)(C), the commissioner

shall appoint five individuals to serve as an independent

arbitration panel:

(1)  One member must be a representative of the specialty

hospital or network or one of its affiliated specialists.

(2)  One member must be a representative of the health

plan.

(3)  One member must be a representative of a local

business advocacy group from the geographic service territory

of the specialty hospital or network or affiliated

specialist. The member under this paragraph must not:

(i)  be employed by, be on the board of or be

granted staff privileges by the specialty hospital or

network, any of its affiliated specialists or the health

plan; or

(ii)  act as a paid consultant or advisor to the

specialty hospital or network, any of its affiliated

specialists or the health plan.

(4)  One member must be a representative of a local

community advocacy group from the geographic service

territory of the specialty hospital or network and its

affiliated specialists. The member under this paragraph must

not:

(i)  be employed by, be on the board of or be

granted staff privileges by the specialty hospital or

network, any of its affiliated specialists or the health

plan; or

(ii)  act as a paid consultant or advisor to the

specialty hospital or network, any of its affiliated

specialists or the health plan.

(5)  One member must be a representative of a health care

consumer group from the geographic service territory of the

specialty hospital or network and its affiliated specialists.

The member under this paragraph must not:

(i)  be employed by, be on the board of or be

granted staff privileges by the specialty hospital or

network, any of its affiliated specialists or the health

plan; or

(ii)  act as a paid consultant or advisor to the

specialty hospital or network, any of its affiliated

specialists or the health plan.

(d)  Salary, experts and administrative support.--

(1)  Members of the arbitration panel shall not receive a

salary or any other compensation for their services.

(2)  An arbitration panel may retain experts or

consultants as necessary.

(i)  Eligibility to serve as an expert or consultant

is as follows:

(A)  The individual must not be an employee of,

be a member of a board of or be granted staff

privileges by the specialty hospital or network, any

of its affiliated specialists or the health plan.

(B)  Within five years immediately preceding

engagement, the individual must not have been an

employee of, have been a member of a board of or have

been granted staff privileges by the specialty

hospital or network, any of its affiliated

specialists or the health plan.

(ii)  The cost of experts and consultants shall be

divided equally between:

(A)  the health plan; and

(B)  the specialty hospital or network and its

affiliated specialists.

(3)  The department shall provide staff and

administrative support to the arbitration panel as necessary

for the panel to carry out its  responsibilities under this

chapter.

(4)  The arbitration panel shall not be subject to 65

Pa.C.S. Ch. 7 (relating to open meetings) or to the act of

February 14, 2008 (P.L.6, No.3), known as the Right-to-Know

Law. Notwithstanding this paragraph, the decision of the

arbitration panel shall be made available to the public upon

written request to the department and shall be posted on the

department's publicly accessible Internet website.

(e)  Contract terms.--The arbitration panel shall determine

the terms under which the specialty hospital or network and its

affiliated specialists shall contract with the health plan.

§ 3105.  Arbitration criteria.

(a)  Adoption of proposed contract.--

(1)  If only one party has presented terms of a proposed

contract to the other parties, the arbitration panel shall

adopt the terms of the proposed contract.

(2)  If more than one party submits terms of a proposed

contract to the other parties, the following apply:

(i)  The arbitration panel shall undertake a review

of all proposed contracts and additional information as

the panel deems necessary in making a decision. The

arbitration panel may not consider the extent to which a

health plan is or is not purchasing other hospital or

physician services from the specialty hospital or network

or its affiliated specialists or from any other hospital

in common ownership or operation with the specialty

hospital or network or its affiliated specialists. The

arbitration panel shall inform the parties of the

additional information that should be submitted,

including:

(A)  Terms of the current contract between the

health plan and the specialty hospital or network or

its affiliated specialists.

(B)  Historic contract reimbursement rates for

the geographic area in this Commonwealth served by

the specialty hospital or network and its affiliated

specialists. This clause includes weighted average

rates of the hospitals in the area for all payers,

separately for each product line for which the health

plan is seeking a contract. 

(C)  Rate of inflation, as measured by the

Medical Care Portion of the Consumer Price Index,

since the current contract between the health plan

and the specialty hospital or network or its

affiliated specialists was entered into and the

extent to which a price increase incorporated into

the contract was less than the rate of inflation.

(D)  Inflation factors in the geographic area in

this Commonwealth served by the specialty hospital or

network and its affiliated specialists for health

care and medical services.

(E)  Average reimbursement rates for other

similar specialty hospitals or networks and their

affiliated specialists, as adjusted for the

difference in the cost of living between:

(I)  the closest MSA; and

(II)  the home MSA of each of the similar

specialty hospitals or networks or affiliated

specialists.

(F)  Costs incurred by the specialty hospital or

network and its affiliated specialists in providing

services to its patients.

(G)  Actuarial impact of a proposed contract or

reimbursement rates paid by the health plan and a

comparison of the health plan reimbursement rates in

this Commonwealth and health plan reimbursement rates

in other parts of the country.

(H)  Whether a reimbursement rate proposed by the

specialty hospital or network or its affiliated

specialists would subsidize a health plan owned or

operated by any tax-exempt, not-for-profit

corporation which owns or operates the specialty

hospital or network and the practice of the

affiliated specialists.

(I)  Reimbursement rates paid by the health plan

at similar specialty hospitals or networks or to

similar affiliated specialists.

(J)  Whether a proposed contract puts the

specialty hospital or network or its affiliated

specialists at risk of providing additional care

without additional compensation.

(K)  Expected patient volume which will likely

result from the contract.

(ii)  The arbitration panel may:

(A)  adopt one of the proposed contracts; or

(B)  impose other terms of a proposed contract.

§ 3106.  Arbitration timing and rules.

(a)  Commencement and length of process.--

(1)  The arbitration process provided for under this

chapter shall commence within 20 days after appointment of

the members of the panel by the commissioner and may not

exceed three days of presentation and testimony by all

parties.

(2)  The arbitration panel shall render a decision within

seven business days after the conclusion of the presentations

and testimony.

(3)  The parties, by agreement, or the arbitration panel,

due to the complexity of the issues involved, may extend any

of the time periods under this subsection, except that the

rendering of a decision by the arbitration panel may not

occur later than 90 days following the appointment of the

members of the panel by the commissioner.

(b)  Establishment of rules.--Once the arbitration process

has been invoked, the arbitration panel shall establish rules

for confidentiality, exchange and verification of information

and other procedures to ensure the fairness of the process for

all parties.

(c)  Effect of decision.--The parties shall be bound by the

decision of the arbitration panel.

(d)  Costs.--Each party shall bear the cost of its respective

presentations and testimony to the arbitration panel.

(e)  Reimbursement rates during arbitration process.--The

following shall apply during the period commencing with the

appointment of the members to the arbitration panel by the

commissioner and ending with the rendering of the panel's

decision:

(1)  An existing contract that is scheduled to expire by

its terms shall remain in full force and effect. If terms

that are different from those in the expiring contract are

imposed by the arbitration panel or are agreed to by the

parties, the new contract and terms shall be retroactive to

the day after the expiration date in the existing contract

and any change in reimbursement rates shall be adjusted

retroactively.

(2)  If the health plan does not have a contract with the

specialty hospital or network and its affiliated specialists,

the health plan shall pay, and the specialty hospital or

network or affiliated specialists shall accept as full

payment, for all services provided by the specialty hospital

or network and its affiliated specialists for which payment

has not already been made and accepted, an amount equal to

the average reimbursement rates for other similar specialty

hospitals or networks and their affiliated specialists as

adjusted for the difference in cost of living for the nearest

MSA as compared to the home MSA of each of the similar

specialty hospitals or networks and their affiliated

specialists. Upon entering into the contract imposed by the

arbitration panel, the amounts paid by the health plan shall

be adjusted retroactively to reflect the actual rates

contained in the contract.

(3)  The following shall apply:

(i)  If the arbitration panel imposes a reimbursement

rate that is different from the rate paid by the health

plan under this subsection, the resulting contract shall

provide for an appropriate credit or payment retroactive

to the date that the commissioner appoints the members of

the arbitration panel.

(ii)  If the reimbursement rate paid under this

subsection is less than the reimbursement rate required

under the resulting contract, the health plan shall pay

interest to the specialty hospital or network and its

affiliated specialists on the difference.

(iii)  If the reimbursement rate paid under this

subsection is greater than the reimbursement rate

required under the resulting contract, the specialty

hospital or network and its affiliated specialists shall

pay interest to the health plan on the difference.

(iv)  The interest rate payable under this paragraph

shall be equal to the average of the United States prime

lending rate offered by the three largest banks ranked by

total deposits in the nearest MSA as of the date of the

arbitration panel's decision.

§ 3107.  Prohibited conduct.

(a)  Staff privileges.--A specialty hospital or network may

not condition the granting of staff privileges at the specialty

hospital or network on any of the following:

(1)  Employment at a specialty hospital or network or

participation in a specific health plan owned or operated by

a tax-exempt, not-for-profit corporation that also owns or

operates the specialty hospital or network.

(2)  Prohibiting a physician from practicing at other

facilities.

(3)  The amount of business or patients a physician

brings or may bring to the specialty hospital or network,

unless the condition is directly related to quality‑of‑care

requirements.

(b)  Nonexclusivity.--

(1)  A specialty hospital or network or any of its

affiliated specialists may not enter into a contract with a

health plan containing terms which prohibit either of the

following:

(i)  the specialty hospital or network or any of its

affiliated specialists from contracting with any other

health plan for any services the specialty hospital or

network and its affiliated specialists provide; or

(ii)  the health plan from contracting with any other

health care provider for the types of services the

specialty hospital or network and its affiliated

specialists provide.

(2)  A specialty hospital or network may not prohibit

physicians who have privileges at the specialty hospital or

network and who are not employees of the specialty hospital

or network from providing services to any other hospital,

hospital network, health plan or integrated delivery system.

(c)  Nontying provisions.--

(1)  A health plan may not be required to contract with

another health care facility under common ownership with a

specialty hospital or network or its affiliated specialists

as a condition of contracting with the specialty hospital or

network or for the services of its affiliated specialists.

(2)  A specialty hospital or network or any of its

affiliated specialists may not require a hospital, health

system or other provider to have a contract with a health

plan owned or operated by the specialty hospital or network,

any of its affiliated specialists or any of its affiliates as

a condition of accepting patients referred by the hospital,

health system or other provider.

(3)  A specialty hospital or network or any of its

affiliated specialists may not require that a hospital,

health system or other provider agree not to contract with

certain health plans as a condition to accepting patients

referred by the hospital, health system or other provider.

(d)  Discrimination.--A specialty hospital or network or any

of its affiliated specialists may not discriminate against a

patient based upon the location of the patient's residence, the

patient's health plan or the patient's choice of physician. A

specialty hospital or network or any of its affiliated

specialists may not discriminate, in the provision of medically

necessary services or the release of medical records or

information about patients who receive treatment or services

from the specialty hospital or network or its affiliated

specialists, against health plans, physicians or other medical

providers based on ownership or employment of health plans,

physicians or other medical providers.

(e)  Use of most favored nation provisions.--A specialty

hospital or network or any of its affiliated specialists may not

enter into a contract with a health plan on terms that include a

most favored nations clause.

(f)  Participation in dispute resolution or arbitration.--A

specialty hospital or network or any of its affiliated

specialists may not refuse or fail to participate and cooperate

in the dispute resolution process under section 3103 (relating

to good faith negotiations and dispute resolution) or the

arbitration process under section 3104 (relating to arbitration)

once it has received a notice from a health plan under those

sections.

(g)  Compliance with arbitration decision.--A specialty

hospital or network or any of its affiliated specialists or a

health plan may not refuse or fail to enter into or renew a

contract under the terms imposed by the arbitration panel under

section 3106 (relating to arbitration timing and rules) or to

comply with any other order or decision of the arbitration

panel.

§ 3108.  Enforcement and remedies.

(a)  Enforcement.--

(1)  The Attorney General shall have the power and duty

to enforce the provisions of this chapter, including the

authority to issue civil investigative demands under

subsection (b), institute proceedings under subsection (c)

and to take any other actions as may be necessary to

ascertain and investigate alleged violations or anticipated

violations of this chapter.

(2)  The Attorney General shall develop a complaint

procedure for any person wishing to report a suspected

violation or anticipated violation of this chapter and shall

post the procedure on its publicly accessible Internet

website.

(3)  Nothing contained in this section shall be construed

to limit the regulatory or investigative authority of the

Attorney General or any other department, agency or

instrumentality of the Commonwealth whose functions might

relate to persons or matters falling within the scope of this

chapter.

(b)  Civil investigative demand.--

(1)  If the Attorney General has reason to believe that

any person may be in possession, custody or control of

documentary material relevant to an investigation under this

chapter, the Attorney General may issue in writing and serve

upon the person a civil investigative demand requiring the

production of the material for examination.

(2)  Each demand shall:

(i)  state the nature of the conduct constituting the

alleged violation which is under investigation, the

applicable provision of law and the connection between

the documentary material demanded and the conduct under

investigation;

(ii)  describe the class of documentary material to

be produced with sufficient definiteness and certainty to

permit the material to be fairly identified;

(iii)  state the demand is returnable immediately

upon receipt or prescribe a return date which will

provide a reasonable time period within which the

material demanded may be assembled and made available for

inspection and copying or reproduction;

(iv)  identify an investigator to whom the material

shall be made available; and

(v)  contain the following statement printed

conspicuously at the top of the demand:

You have the right to seek the assistance of an

attorney and he may represent you in all phases of

the investigation of which this civil investigative

demand is a part.

(3)  A demand may not do any of the following:

(i)  Contain a requirement which would be held to be

unreasonable if contained in a subpoena duces tecum

issued by any court in connection with a grand jury

investigation of the alleged violation.

(ii)  Require the production of documentary evidence

which would be privileged from disclosure if demanded by

a subpoena duces tecum issued by a court in connection

with a grand jury investigation of the alleged violation.

(4)  Service of a demand or a petition filed under this

section shall be made in the manner prescribed by the

Pennsylvania Rules of Civil Procedure for service of writs

and complaints.

(5)  A verified return by the individual serving a demand

or petition setting forth the manner of the service shall be

prima facie proof of the service. In the case of service by

registered or certified mail, the return shall be accompanied

by the return post office receipt of delivery of the demand.

(6)  A person upon whom a demand issued under this

subsection has been duly served shall make the material

available for inspection and copying or reproduction to the

identified investigator at the principal place of business of

the person, or at any other place as the investigator and the

person may agree or as a court may direct, on the return date

specified in the demand. The person may, with the agreement

of the investigator, substitute copies of all or any part of

the material for the originals.

(7)  The following shall apply:

(i)  The investigator to whom documentary material is

delivered shall take physical possession of it and shall

be responsible for the use for which it is made and for

its return under paragraph (8) or (9).

(ii)  The investigator may cause the preparation of

copies of the material as required for official use.

(iii)  While in the possession of the investigator,

no material produced shall be available for examination

without the consent of the person who produced the

material by a person other than the investigator or a

representative of the Attorney General.

(iv)  Documentary material in the possession of the

investigator shall be available for examination by the

person who produced the material or a duly authorized

representative of the person, subject to reasonable terms

and conditions as prescribed by the Attorney General.

(8)  Upon completion of the investigation for which

documentary material was produced under this subsection and

any case or proceeding arising from the investigation, the

investigator shall return to the person who produced the

material all of the material other than copies made under

paragraph (6) which have not passed into the control of any

court or grand jury through introduction into the record of

the case or proceeding.

(9)  If documentary material has been produced by a

person under this subsection for use in an investigation and

no case or proceeding arising from the investigation has been

instituted within a reasonable time after completion of the

examination and analysis of all evidence assembled in the

course of the investigation, the person shall be entitled,

upon written demand made upon the Attorney General, to the

return of all documentary material, other than copies made

under paragraph (6), produced by the person.

(10)  The following shall apply:

(i)  Within 20 days after the service of the demand

upon a person, or at any time before the return date

specified in the demand, whichever period is shorter, the

person may file in Commonwealth Court and serve upon the

Attorney General a petition for an order of the court

modifying or setting aside the demand.

(ii)  The time allowed for compliance with the demand

in whole or in part as deemed proper and ordered by the

court shall not run during the pendency of the petition

in the court. The petition shall specify each ground upon

which the petitioner relies in seeking the relief and may

be based upon a failure of the demand to comply with this

subsection or upon a constitutional or other legal right

or privilege of the person.

(11)  Subject to paragraph (10), if a person fails to

comply with a civil investigative demand duly served upon the

person under this subsection or if satisfactory copying or

reproduction of the material cannot be done and the person

refuses to surrender the material, the Attorney General may

file in Commonwealth Court and serve upon the person a

petition for an order of the court for the enforcement of the

demand.

(12)  If the Attorney General is in custody or control of

documentary material delivered by a party in compliance with

a demand, the person may file in Commonwealth Court and serve

upon the Attorney General a petition for an order of the

court requiring the performance of a duty imposed under this

subsection.

(13)  If a petition is filed under paragraph (10), (11)

or (12), the court shall have jurisdiction to hear and

determine the matter presented and, after a hearing at which

all parties are represented, to enter an order to carry out

this subsection.

(14)  If an individual refuses, on the basis of the

person's Fifth Amendment privilege against self-

incrimination, to comply with a civil investigative demand

issued under this subsection, the Attorney General may invoke

42 Pa.C.S. § 5947 (relating to immunity of witnesses).

(c)  Civil remedies.--

(1)  Commonwealth Court shall have jurisdiction to

prevent, restrain and remedy violations of this chapter by

issuing appropriate orders, including:

(i)  Ordering a person who has been found to be in

violation of section 3107(a), (b), (c), (d) or (e)

(relating to prohibited conduct) to immediately cease and

desist from engaging in any such conduct.

(ii)  Ordering a person who has been found to be in

violation of section 3107(f) to immediately commence full

participation in the dispute resolution or arbitration

process and to continue to participate until completion

of the process.

(iii)  Ordering the immediate implementation of the

contract terms contained in the arbitration panel's

decision or order, regardless of whether the contract is

executed by the person who has been found to be in

violation of section 3107(g).

(iv)  Enjoining the conduct of a person found to have

demonstrated intent to violate section 3107.

(v)  Any other order as the court deems necessary or

appropriate under the circumstances.

(2)  In addition to any other remedy provided for under

this section or ordered by the court, the court shall order

the following:

(i)  The revocation of the tax-exempt status of a

specialty hospital or network and its tax-exempt, not-

for-profit corporate parent if the court finds that the

specialty hospital or network or any of its affiliated

specialists have violated section 3107. If the court

revokes the tax-exempt status of an entity under this

subparagraph, neither the specialty hospital or network

nor its tax-exempt, not-for-profit corporate parent

shall, after the revocation, be deemed to be an

institution of purely public charity under the act of

November 26, 1997 (P.L.508, No.55), known as the

Institutions of Purely Public Charity Act.

(ii)  Costs and expenses, including a reasonable sum

for attorney fees, to the Attorney General for any

proceeding instituted by the Attorney General under this

section in which the Attorney General prevails, payable

by the person found to be in violation or anticipated

violation of section 3107 (relating to prohibited

conduct).

§ 3109.  Existing consent decrees and final orders.

Nothing in this chapter shall be interpreted to invalidate

any part of a consent decree or final order that establishes an

arbitration process between a specialty hospital or network and

its affiliated specialists or any other health care facility and

a health plan agreed to or issued prior to June 30, 2011, as

long as the terms of the consent decree or final order are in

full force and effect. If a conflict exists between a provision

of this chapter and a provision of the consent decree or final

order, the provision of the consent decree or final order shall

prevail as long as the terms of the consent decree or final

order are in full force and effect.

Section 2.  The addition of 40 Pa.C.S. Ch. 31 shall apply to

contracts negotiated, expiring or proposed to be terminated on

and after the effective date of this section.

Section 3.  This act shall take effect immediately.