Amendment 5815 to Senate Bill 225 P.N. 1924, Regular Session 2021-2022

S0225B1924A05815 MSP:JSL 10/24/22 #90 A05815

AMENDMENTS TO SENATE BILL NO. 225

Sponsor: REPRESENTATIVE PICKETT

Printer's No. 1924

Amend Bill, page 50, lines 10 and 11, by striking out "BASED

ON MEDICAL NECESSITY " and inserting

subject to the external review process as set forth in

section 2164.1(a)

Amend Bill, page 51, line 3, by inserting after

"DETERMINATION"

by an insurer

Amend Bill, page 51, lines 4 and 5, by striking out "A

CONTRACT" and inserting

An agreement

Amend Bill, page 51, lines 5 and 6, by striking out "THE

DEPARTMENT OF HUMAN SERVICES OR PRIMARY CONTRACTOR OF"

Amend Bill, page 51, lines 8 and 9, by striking out "MEDICAL,

BEHAVIORAL HEALTH OR HOME AND COMMUNITY- BASED "

Amend Bill, page 51, line 9, by inserting after "SERVICES."

The term includes a county or multicounty agreement with the

Department of Human Services for behavioral health services.

[

Amend Bill, page 51, line 16, by inserting a bracket after

"SUPPLEMENT."

Amend Bill, page 51, line 24, by inserting after "STATES"

or this Commonwealth

Amend Bill, page 52, line 6, by striking out "UNAVAILABLE"

and inserting

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unable

Amend Bill, page 52, line 6, by inserting after "OR"

Amend Bill, page 53, line 15, by striking out "ELIGIBLE FOR

EXTERNAL REVIEW"

Amend Bill, page 53, line 20, by inserting after "DURING"

a covered person's or

Amend Bill, page 53, lines 26 and 27, by striking out "THE

TERM INCLUDES A COVERED" in line 26 and all of line 27

Amend Bill, page 54, lines 1 through 3, by striking out all

of said lines

Amend Bill, page 54, lines 6 through 9, by striking out all

of said lines and inserting

"Discharge planning." The formal process for determining,

prior to discharge from a facility, the coordination and

management of care that a covered person or enrollee will

receive following the discharge.

Amend Bill, page 54, line 24, by striking out the bracket

before "EMERGENCY"

Amend Bill, page 54, line 24, by inserting a bracket before

"AND"

Amend Bill, page 54, line 24, by inserting after "AND"

] or

Amend Bill, page 54, lines 26 and 27, by striking out "] THE

TERM INCLUDES EMERGENCY TRANSPORTATION AND RELATED" in line 26

and all of line 27

Amend Bill, page 55, by inserting between lines 14 and 15

(7) A facility licensed by the Department of Human Services

Office of Mental Health and Substance Abuse Services.

Amend Bill, page 55, line 15, by striking out "(7)" and

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inserting

(8)

Amend Bill, page 55, line 17, by striking out "(8)" and

inserting

(9)

Amend Bill, page 55, line 22, by striking out "2161.1" and

inserting

2164

Amend Bill, page 56, lines 20 through 22, by striking out

"FOR MA OR CHIP MANAGED CARE PLANS, THE TERM SHALL ALSO" in line

20 and all of lines 21 and 22 and inserting

The term includes an individual providing emergency services

under a licensed emergency medical services agency as defined in

35 Pa.C.S. § 8103 (relating to definitions).

Amend Bill, page 56, line 29, by striking out the comma after

"INJURY" and inserting

Amend Bill, page 56, lines 29 and 30, by striking out "OR

FUNCTIONAL LIMITATION "

Amend Bill, page 57, lines 1 through 4, by striking out "THE

TERM" in line 1 and all of lines 2 through 4

Amend Bill, page 57, line 28, by striking out "2161.10" and

inserting

2164.9

Amend Bill, page 58, lines 1 and 2, by striking out all of

said lines

Amend Bill, page 59, lines 12 and 13, by striking out "TO

ENROLLEES BY ARRANGEMENTS WITH HEALTH CARE PROVIDERS SELECTED TO

PARTICIPATE"

Amend Bill, page 60, line 29, by striking out "REQUIREMENTS"

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and inserting

policy

Amend Bill, page 61, lines 4 through 7, by striking out

"UNITED STATES FOOD AND DRUG" in line 4 and all of lines 5

through 7 and inserting

The use of United States Food and Drug Administration-

approved medications along with treatment other than medication,

as clinically indicated, to treat substance use disorders,

including opioid use disorders.

Amend Bill, page 61, line 16, by inserting after "INSURER"

or MA or CHIP managed care plan

Amend Bill, page 62, lines 2 through 5, by striking out all

of said lines

Amend Bill, page 62, lines 17 through 19, by striking out

"AND INCLUDES THE SPECIFIC" in line 17, all of line 18 and

"TERMS OF THE APPLICABLE MEDICAL POLICY" in line 19

Amend Bill, page 63, line 8, by inserting a bracket before

"THE"

Amend Bill, page 63, line 8, by inserting after "THE"

] Participating

Amend Bill, page 64, lines 1 through 3, by striking out ",

NOT INCLUDING THE REVIEW OF A CLAIM THAT IS LIMITED TO" in line

1, all of line 2 and "DOCUMENTATION, ACCURACY OF CODING OR

ADJUSTMENT FOR PAYMENT" in line 3

Amend Bill, page 64, lines 29 and 30, by striking out all of

said lines

Amend Bill, page 66, line 4, by striking out "COVERAGE" and

inserting

the provider network

Amend Bill, page 66, line 8, by striking out the bracket

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before "THE"

Amend Bill, page 66, line 8, by striking out "] AN"

Amend Bill, page 66, line 9, by inserting after "DETERMINING"

authorization of

Amend Bill, page 68, line 15, by striking out the bracket

before "SHALL"

Amend Bill, page 68, line 15, by striking out "] MAY"

Amend Bill, page 69, line 10, by striking out the bracket

before "SHALL"

Amend Bill, page 69, line 10, by striking out "] MAY"

Amend Bill, page 71, line 9, by striking out "PERIOD OF

EMERGENCY" and inserting

presentation for emergency services

Amend Bill, page 71, line 23, by inserting after

"TRANSPORTED."

The requirements of subsection (a.1) do not apply to a

licensed emergency medical services agency under this paragraph.

Amend Bill, page 76, line 9, by inserting a bracket before

"MAINTAINS"

Amend Bill, page 76, line 9, by inserting after "MAINTAINS"

] receives

Amend Bill, page 76, line 9, by inserting after "RECORDS"

relating to a covered person or enrollee

Amend Bill, page 76, line 12, by inserting after "RECORDS"

where it occurs the first time

upon request of the covered person or enrollee

Amend Bill, page 82, lines 27 through 30, by striking out ",

INCLUDING WHETHER THE INSURER HAS COMPLIED WITH THE" in line 27,

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all of lines 28 and 29 and "2758)" in line 30

Amend Bill, page 83, line 4, by striking out "(A)" and

inserting

(c)(1)

Amend Bill, page 83, line 7, by inserting after "INCLUDING"

a request regarding

Amend Bill, page 83, line 9, by striking out "SURPRISE ACT"

and inserting

Surprises Act (Public Law 116-260, Div. BB, Title I, 134

Stat. 2758)

Amend Bill, page 83, line 12, by striking out "PERSON" and

inserting

benefit

Amend Bill, page 87, lines 2 and 3, by striking out "ADVERSE

BENEFIT DETERMINATION" and inserting

Denial

Amend Bill, page 87, lines 12 through 30; page 88, lines 1

through 7; by striking out all of said lines on said pages and

inserting

(a) For an appeal of a complaint:

(1) If the subject of the complaint is listed in section

2141.1(b)(6), an enrollee or the enrollee ' s authorized

representative shall have fifteen (15) days from receipt of the

notice of decision to appeal the decision to the department.

(2) If a second level review was completed, a covered person

or an enrollee, or the covered person ' s or enrollee ' s authorized

representative, shall have fifteen (15) days from receipt of the

notice of the decision from the second level review committee to

appeal the decision to the department.

(b) For an appeal of an administrative denial:

(1) A covered person or covered person ' s authorized

representative may appeal a decision about the coverage,

operations or management policies of an insurer, other than

decisions that are adverse benefit determinations.

(2) A covered person or covered person ' s authorized

representative shall have fifteen (15) days from receipt of the

notice of a decision conducted under section 2164 on an

administrative denial, to appeal the decision to the department.

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(b.1) All records from the internal process for the

complaint or administrative denial shall be transmitted to the

department in the manner prescribed. The covered person or

enrollee, the covered person ' s or enrollee ' s authorized

representative, the health care provider or the insurer or MA or

CHIP managed care plan, may submit additional materials related

to the complaint or administrative denial.

Amend Bill, page 88, line 9, by inserting a bracket before

"APPROPRIATE"

Amend Bill, page 88, line 9, by inserting a bracket after

"APPROPRIATE"

Amend Bill, page 88, lines 13 and 14, by striking out

"ADVERSE BENEFIT DETERMINATION " and inserting

Denial

Amend Bill, page 88, line 19, by striking out "ADVERSE

BENEFIT DETERMINATION" and inserting

denial

Amend Bill, page 90, line 16, by inserting a bracket before

"PROSPECTIVE"

Amend Bill, page 90, line 16, by inserting after "REVIEW"

] prior authorization

Amend Bill, page 91, line 18, by striking out "2155(C)" and

inserting

2155(d)

Amend Bill, page 92, line 24, by inserting after "FOR"

any health care service that requires

Amend Bill, page 92, line 24, by striking out "SERVICE" and

inserting

that is

Amend Bill, page 94, line 12, by inserting after "OF"

Amend Bill, page 94, line 24, by striking out "CHANGE"

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Amend Bill, page 94, line 24, by inserting after

"NOTIFICATION"

of change

Amend Bill, page 94, line 29, by inserting after "PLAN"

shall,

Amend Bill, page 94, line 30, by striking out "SHALL"

Amend Bill, page 95, line 12, by striking out "SECTION" and

inserting

act

Amend Bill, page 95, line 20, by inserting after "TO"

a request for

Amend Bill, page 95, line 27, by inserting after "ALL"

relevant

Amend Bill, page 96, lines 6 and 7, by striking out "ADVERSE

BENEFIT DETERMINATIONS " and inserting

denials

Amend Bill, page 96, line 17, by inserting after "RECEIPT"

and review

Amend Bill, page 96, line 18, by striking out "MCO" and

inserting

Amend Bill, page 96, line 21, by striking out "MCO" and

inserting

Amend Bill, page 96, line 22, by striking out "MCO" and

inserting

Amend Bill, page 96, line 25, by inserting after "THE" where

it occurs the second time

missing

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Amend Bill, page 97, line 15, by striking out "A" and

inserting

Amend Bill, page 97, line 18, by striking out the period

after "QUESTION" and inserting

; or

Amend Bill, page 97, line 19, by striking out "A" and

inserting

Amend Bill, page 97, lines 24 and 25, by striking out ",

EXCEPT THAT ANY" and inserting

. Any

Amend Bill, page 97, line 30, by inserting after

"AUTHORIZATION"

request

Amend Bill, page 97, line 30; page 98, lines 1 through 3; by

striking out "ADVERSE BENEFIT" in line 30 on page 97, all of

lines 1 and 2 and "DOES NOT INVOLVE MEDICAL JUDGMENT" in line 3

on page 98 and inserting

denial

Amend Bill, page 98, line 5, by striking out "MEDICAL" and

inserting

health care

Amend Bill, page 98, line 8, by striking out "(C)" and

inserting

(d)

Amend Bill, page 98, line 11, by inserting after "REVIEW"

discussion

Amend Bill, page 98, line 16, by striking out "OR" and

inserting

and

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Amend Bill, page 99, line 17, by inserting after "PEER-TO-

PEER"

review

Amend Bill, page 99, line 21, by inserting after "PEER-TO-

PEER"

review

Amend Bill, page 99, line 22, by striking out "ADJUDICATING

A" and inserting

the insurer or MA or CHIP managed care plan making a

decision on the

Amend Bill, page 99, line 22, by inserting after "PEER-TO-

PEER"

review

Amend Bill, page 99, line 24, by inserting after "(H)"

or (i)

Amend Bill, page 99, line 28, by inserting after "DENY"

Amend Bill, page 99, line 28, by inserting after

"AUTHORIZATION"

request

Amend Bill, page 101, line 2, by inserting after "LINES"

for requests submitted to insurers

Amend Bill, page 101, lines 20 through 30; page 102, lines 1

through 12; by striking out all of said lines on said pages and

inserting

(3) For prior authorization requests other than as

specified in subparagraph (i), within 15 days. The following

apply:

(i) The 15-day deadline may be extended by the

insurer if all of the following apply:

(A) upon receipt of the prior authorization

request, the insurer provided notification of missing

information pursuant to subsection (c)(1); and

(B) the notification of missing information was

communicated as soon as possible following the

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submission of the prior authorization request to

allow an opportunity to respond prior to the

expiration of the 15-day deadline with the identified

missing information.

(ii) If the insurer grants an extension, the insurer

may extend the deadline for at least 45 days to allow the

provider to respond. Upon receipt of the missing

information, the insurer shall render a decision without

delay.

(iii) No insurer shall unreasonably delay or

withhold the specific notice of additional information

needed to complete a review of a prior authorization

request.

(iv) Nothing in this paragraph shall require an

insurer to extend the initial 15-day deadline.

Amend Bill, page 103, by inserting between lines 7 and 8

(k) Notice and statement.--An insurer, when sending a notice

to a covered person of a denial of a request for prior

authorization made under this section, shall include with such

notice the following statement:

THE STATEMENT BELOW IS REQUIRED BY

PENNSYLVANIA STATE LAW.

Actions You Can Take and How to Get Help.

You, or someone on your behalf, recently requested

approval from your health insurance plan for a health care

service or item. Your health insurance plan denied the

request.

You have the right to ask your health insurance plan to

change this decision. This is called an internal appeal. If

the request is not approved after an internal appeal, your

request may be eligible for a review by an independent third

party. This is called an external review. The independent

third party may change your health insurance plan's decision.

Please read carefully the information your health

insurance plan has provided with this insert. This

information explains the reason(s) for the health insurance

plan's decision, as well as how to ask for an internal appeal

or external review, including any deadlines and timing.

You should also feel free to contact your health

insurance plan or the Pennsylvania Insurance Department to

help you understand your rights and answer any questions.

Contact information for both your health insurance plan and

the Department is included in the information your health

insurance plan has provided.

Amend Bill, page 103, line 28, by inserting after

"ENROLLEE'S"

health care

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Amend Bill, page 104, lines 11 through 28, by striking out

all of said lines and inserting

(a) Minimum requirement.--An insurer or MA or CHIP managed

care plan shall make available coverage of at least one

prescription drug approved by the United States Food and Drug

Administration for use in medication-assisted treatment for

opioid use disorders, including coverage of at least one of each

of the following without prior authorization:

(1) Buprenorphine/naloxone prescription drug combination

product.

(2) Injectable and oral naltrexone.

(3) Methadone.

(b) Coverage and cost tier.--If a medication-assisted

treatment prescription drug set forth in subsection (a) is

covered as a pharmacy benefit, then the insurer or MA or CHIP

managed care plan shall cover the prescription drug on the

lowest nonpreventive cost tier of the health insurance policy or

MA or CHIP managed care plan.

Amend Bill, page 105, line 3, by inserting a bracket before

"TWO"

Amend Bill, page 105, line 3, by inserting after "LEVELS"

] one level

Amend Bill, page 105, line 6, by inserting after "ENROLLEE"

or the enrollee's authorized representative

Amend Bill, page 105, line 11, by inserting a bracket before

"AN"

Amend Bill, page 105, line 12, by inserting after "INITIAL"

] a

Amend Bill, page 105, lines 28 and 29, by striking out "FOR

APPEALING THE DECISION " and inserting

to file a request for an external review

Amend Bill, page 106, line 15, by inserting after "DECISION."

] A review conducted under this section shall include a

licensed physician or, where appropriate, a licensed

psychologist or licensed dentist, in the same or similar

specialty that typically manages or consults on the health care

service.

[

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Amend Bill, page 106, lines 20 through 24, by striking out "A

REVIEW CONDUCTED UNDER THIS SECTION" in line 20 and all of lines

21 through 24

Amend Bill, page 106, line 27, by striking out ", INCLUDING

AN EXPEDITED EXTERNAL GRIEVANCE PROCESS,"

Amend Bill, page 106, line 29, by inserting after "ENROLLEE"

, enrollee's authorized representative

Amend Bill, page 107, line 4, by inserting after "EXPEDITED"

external

Amend Bill, page 107, line 10, by inserting a bracket before

"INDEPENDENT"

Amend Bill, page 107, line 10, by inserting after "ENTITY"

] review organization

Amend Bill, page 107, line 22, by inserting a bracket before

"THE"

Amend Bill, page 107, line 22, by striking out "MA OR CHIP"

Amend Bill, page 107, line 23, by striking out ", THE

ENROLLEE'S AUTHORIZED REPRESENTATIVE"

Amend Bill, page 107, line 25, by striking out the bracket

before "UTILIZATION"

Amend Bill, page 107, line 25, by striking out "] IRO"

Amend Bill, page 107, line 26, by inserting after "DAYS."

] Within the same two (2) business day time frame set forth

in paragraph (1), the department shall notify the enrollee or

the enrollee's authorized representative of the name, address,

e-mail address, fax number and telephone number of the IRO

assigned under this subsection. The notice shall inform the

enrollee and the enrollee's authorized representative of the

right to submit additional written information to the IRO within

twenty (20) days of the date the IRO assignment notice was

mailed and shall include instructions for submitting additional

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information to the IRO by mail, facsimile and electronically.

Amend Bill, page 108, line 7, by inserting a bracket before

the comma after "PROVIDER"

Amend Bill, page 108, line 7, by striking out the bracket

before "UTILIZATION"

Amend Bill, page 108, line 7, by striking out "] IRO"

Amend Bill, page 108, line 8, by inserting a bracket after

"GRIEVANCE"

Amend Bill, page 108, line 10, by striking out "IRO" and

inserting

MA or CHIP managed care plan

Amend Bill, page 108, line 15, by inserting a bracket before

"UTILIZATION"

Amend Bill, page 108, line 15, by inserting after "ENTITY"

] IRO

Amend Bill, page 108, line 21, by inserting after "THE" where

it occurs the second time

notice of the

Amend Bill, page 108, line 22, by striking out "OR" and

inserting a comma

Amend Bill, page 108, line 23, by inserting after

"REPRESENTATIVE"

or health care provider

Amend Bill, page 109, line 1, by striking out "],"

Amend Bill, page 109, line 1, by inserting after "APPROVED"

Amend Bill, page 109, line 2, by striking out "APPROVED"

Amend Bill, page 109, line 20, by striking out "MA OR CHIP

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MANAGED CARE"

Amend Bill, page 109, line 21, by inserting a bracket before

"PLAN."

Amend Bill, page 109, line 21, by inserting after "PLAN"

] agreement with the Department of Human Services

Amend Bill, page 110, line 4, by inserting after "PROVIDER"

and the health care provider was not the enrollee's

authorized representative

Amend Bill, page 110, line 5, by striking out "] IRO"

Amend Bill, page 110, line 5, by inserting a bracket after

"OR" where it occurs the first time

Amend Bill, page 110, line 7, by inserting after "ESTIMATED"

fees and

Amend Bill, page 112, line 8, by striking out "(RESERVED)."

and inserting

Disputes regarding an insurer's compliance with the

surprise billing and cost-sharing protections under sections

2799a-1 and 2799a-2 of the Public Health Service Act (58

Stat. 682, 42 U.S.C. § 300gg-19) and regulations promulgated

thereunder.

Amend Bill, page 112, line 15, by striking out "ADVERSE

BENEFIT DETERMINATIONS" and inserting

denials

Amend Bill, page 116, line 15, by striking out "2164.7" and

inserting

2164.6

Amend Bill, page 116, line 18, by striking out "2136.1" and

inserting

2136(c)

Amend Bill, page 117, line 16, by inserting after

"RETROSPECTIVE"

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utilization

Amend Bill, page 120, line 17, by inserting after

"RETROSPECTIVE"

utilization

Amend Bill, page 120, line 22, by striking out "SERVICE" and

inserting

benefit

Amend Bill, page 122, line 29, by striking out "FIVE" and

inserting

Amend Bill, page 125, line 4, by striking out the comma after

"PERSON" and inserting

Amend Bill, page 125, line 5, by striking out "OR THE COVERED

PERSON'S TREATING PROVIDER"

Amend Bill, page 125, line 17, by striking out "OPTION"

Amend Bill, page 129, line 25, by striking out the comma

after "PERSON" and inserting

Amend Bill, page 129, line 26, by striking out "OR THE

COVERED PERSON'S TREATING PROVIDER"

Amend Bill, page 131, line 13, by striking out "REASON" where

it occurs the second time and inserting

reasons

Amend Bill, page 131, line 28, by inserting after "ADVERSE"

where it occurs the first time

benefit determinations

Amend Bill, page 132, line 22, by striking out "CERTIFICATES"

and inserting

certifies

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Amend Bill, page 133, line 3, by striking out "SUBSECTION

(B)" and inserting

section 2164.5(b)

Amend Bill, page 133, line 19, by striking out "(3)" and

inserting

(4)

Amend Bill, page 133, line 21, by striking out "PARAGRAPH

(2)" and inserting

section 2164.5(b)

Amend Bill, page 133, line 30, by striking out "(4)" and

inserting

(5)

Amend Bill, page 133, line 30, by striking out "UNDER

PARAGRAPH (2)" and inserting

that the expedited external review request meets the

reviewability requirements of subsection (b)(2)

Amend Bill, page 136, line 30, by inserting a comma after

"REPRESENTATIVE"

Amend Bill, page 137, line 6, by inserting a comma after

"REPRESENTATIVE"

Amend Bill, page 137, line 12, by inserting a comma after

"REPRESENTATIVE"

Amend Bill, page 138, line 3, by striking out "(C)" and

inserting

(a)(4) or (c)(4)

Amend Bill, page 139, line 1, by striking out "2611.1" and

inserting

2164.10

Amend Bill, page 139, line 6, by inserting a comma after

"INSURER"

2022/90MSP/SB0225A05815 - 17 -

Amend Bill, page 139, line 10, by striking out "(E)" and

inserting

(h)

Amend Bill, page 140, line 13, by inserting after

"REPRESENTATIVE"

in response to the notice provided

Amend Bill, page 143, line 24, by striking out "WITHIN" and

inserting

Except as required under section 2164.6(e) for an

expedited external review, within

Amend Bill, page 144, line 23, by striking out "OPINION" and

inserting

opinions

Amend Bill, page 146, line 9, by striking out "SUBARTICLE"

and inserting

subdivision

Amend Bill, page 146, line 13, by inserting after "UNDER"

section 2162 or

Amend Bill, page 146, line 17, by inserting after "UNDER"

section 2162 or

Amend Bill, page 146, line 23, by striking out "2611.1" and

inserting

2164.10

Amend Bill, page 147, line 3, by inserting after "UNDER"

section 2162 or

Amend Bill, page 147, line 30, by striking out "PERIODICALLY"

and inserting

annually

Amend Bill, page 147, line 30, by inserting after "IROS"

and their fees

Amend Bill, page 148, lines 14 and 15, by striking out

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"SECTIONS 2162, 2162.6 AND 2162.7 " and inserting

section 2162 and this subdivision

Amend Bill, page 148, line 30, by striking out "SUBDIVISION"

and inserting

article

Amend Bill, page 150, line 9, by inserting after "OR" where

it occurs the third time

a national, state or local trade association of

Amend Bill, page 150, line 13, by striking out "SECTIONS

2162, 2162.6 OR 2162.7" and inserting

section 2164.9

Amend Bill, page 152, line 12, by inserting after "UNDER"

section 2162 or

Amend Bill, page 152, line 17, by inserting after "UNDER"

section 2162 or

Amend Bill, page 153, line 4, by inserting after "THE"

grievance decision,

Amend Bill, page 153, line 6, by inserting after "THE"

grievance decision,

Amend Bill, page 153, line 29, by striking out "SUBARTICLE"

and inserting

subdivision

Amend Bill, page 155, line 14, by striking out ", 2181 AND

2182" and inserting

and 2181

Amend Bill, page 155, line 16, by inserting a bracket before

"(A)"

Amend Bill, page 155, line 16, by striking out the bracket

before "A"

Amend Bill, page 155, lines 16 and 17, by striking out "] AN"

2022/90MSP/SB0225A05815 - 19 -

Amend Bill, page 155, line 17, by striking out the bracket

before "A"

Amend Bill, page 155, line 17, by striking out "] MA OR CHIP"

Amend Bill, page 155, line 18, by striking out "OR COVERED

PERSON"

Amend Bill, page 155, line 20, by striking out the bracket

before "A" where it occurs the first time

Amend Bill, page 155, line 20, by striking out "] AN"

Amend Bill, page 155, line 20, by striking out the bracket

before "A" where it occurs the second time

Amend Bill, page 155, line 20, by striking out "] MA OR CHIP"

Amend Bill, page 155, line 25, by striking out the bracket

before "LICENSED"

Amend Bill, page 155, line 25, by striking out the bracket

after "LICENSED"

Amend Bill, page 155, line 26, by striking out "MA OR CHIP"

Amend Bill, page 155, line 27, by inserting after "DOLLARS."

] (a) A n insurer plan shall pay a clean claim submitted by a

health care provider or covered person within forty-five (45)

days of receipt of the clean claim.

(a.1) An MA or CHIP managed care plan shall pay a clean

claim submitted by a health care provider within forty-five (45)

days of receipt of the clean claim.

(b) If an insurer fails to remit the payment as provided

under subsection (a), interest at ten per centum (10%) per annum

shall be added to the amount owed on the clean claim. Interest

shall be calculated beginning the day after the required payment

date and ending on the date the claim is paid. The insurer shall

not be required to pay any interest calculated to be less than

two ($2) dollars.

Amend Bill, page 156, line 7, by inserting after "PERSONS"

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Amend Bill, page 156, line 8, by inserting after "PERSONS"

or enrollees

Amend Bill, page 156, line 24, by inserting after "REQUEST,"

notwithstanding section 2181.1, may be used

Amend Bill, page 156, line 26, by inserting after "COMPILE"

aggregate

Amend Bill, page 157, line 21, by inserting a bracket before

"THE"

Amend Bill, page 157, line 22, by inserting after "ASSEMBLY"

] the chairperson and minority chairperson of the Banking and

Insurance Committee of the Senate and the chairperson and

minority chairperson of the Insurance Committee of the House of

Representatives

Amend Bill, page 157, line 23, by inserting a bracket before

the period after "ARTICLE"

Amend Bill, page 157, line 23, by inserting after "ARTICLE."

], including the aggregate data the department has compiled

under subsection (b).

Section 8.1. The act is amended by adding a section to read:

Section 2181.1. Confidentiality.--(a) All records,

documents, data, materials and copies of records, documents,

data and materials in the possession or control of the

department that are produced by, obtained by or disclosed to the

department under section 2181 shall be privileged and:

(1) shall not be subject to discovery or admissible in

evidence in a private civil action;

(2) shall not be subject to subpoena;

(3) shall be exempt from access under the act of February

14, 2008 (P.L.6, No.3), known as the "Right-to-Know Law"; and

(4) shall not be made public by the department or any other

person, except to the regulatory or law enforcement officials of

other jurisdictions, without the prior written consent of the

insurer or the MA or CHIP managed care plan to which the

records, documents, data or materials pertain.

(b) The department or any other person that receives

records, documents, data, materials and copies of records,

documents, data and materials while acting under the authority

of the department or with whom the records, documents, data,

materials and copies of records, documents, data and materials

are shared under section 2181 may not be permitted or required

to testify in a private civil action concerning the records,

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documents, data, materials and copies of records, documents,

data and materials.

through the records, documents, data, materials and copies of

records, documents, data and materials described in subsections

(a) and (b) and release the aggregated data for the purpose of

complying with section 2181(b). The aggregated data shall not

include any information that could reveal the identity of

covered persons, enrollees, health care providers, insurers or

MA or CHIP managed care plans.

Section 8.2. Section 2182 of the act is amended to read:

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