S1137B1621A06050 VDL:JB 03/10/08 #90 A06050
AMENDMENTS TO SENATE BILL NO. 1137
Sponsor: REPRESENTATIVE WATSON
Printer's No. 1621
1 Amend Title, page 2, line 2, by striking out all of said line
2 and inserting
3 procedure, for certificate of retention, for the Health Care
4 Provider Retention Account and for expiration and providing for
5 the Health Care Provider Retention Reserve Account; providing
6 for small business health savings tax account tax credits, for
7 disease management tax credits, for healthy living and wellness
8 tax incentives, for community-based health provider assistance
9 and for health care comparison; and making a transfer.
10 Amend Bill, page 2, lines 9 through 30; pages 3 through 12,
11 lines 1 through 30; page 13, lines 1 through 27, by striking out
12 all of said lines on said pages and inserting
13 Section 1. Sections 711(d) and 712(c), (e) and (m) of the
14 act of March 20, 2002 (P.L.154, No.13), known as the Medical
15 Care Availability and Reduction of Error (Mcare) Act, are
16 amended to read:
17 Section 711. Medical professional liability insurance.
18 * * *
19 (d) Basic coverage limits.--A health care provider shall
20 insure or self-insure medical professional liability in
21 accordance with the following:
22 (1) For policies issued or renewed in the calendar year
23 2002, the basic insurance coverage shall be:
24 (i) $500,000 per occurrence or claim and $1,500,000
25 per annual aggregate for a health care provider who
26 conducts more than 50% of its health care business or
27 practice within this Commonwealth and that is not a
28 hospital.
29 (ii) $500,000 per occurrence or claim and $1,500,000
30 per annual aggregate for a health care provider who
31 conducts 50% or less of its health care business or
32 practice within this Commonwealth.
33 (iii) $500,000 per occurrence or claim and
34 $2,500,000 per annual aggregate for a hospital.
35 (2) For policies issued or renewed in the calendar years
36 2003, 2004 [and 2005], 2005, 2006 and 2007, the basic
37 insurance coverage shall be:
38 (i) $500,000 per occurrence or claim and $1,500,000
1 per annual aggregate for a participating health care
2 provider that is not a hospital.
3 (ii) $1,000,000 per occurrence or claim and
4 $3,000,000 per annual aggregate for a nonparticipating
5 health care provider.
6 (iii) $500,000 per occurrence or claim and
7 $2,500,000 per annual aggregate for a hospital.
8 (3) [Unless the commissioner finds pursuant to section
9 745(a) that additional basic insurance coverage capacity is
10 not available, for] For policies issued or renewed in
11 calendar year [2006 and each year thereafter subject to
12 paragraph (4)] 2008, the basic insurance coverage shall be:
13 (i) [$750,000] $550,000 per occurrence or claim and
14 $2,250,000 per annual aggregate for a participating
15 health care provider that is not a hospital.
16 (ii) $1,000,000 per occurrence or claim and
17 $3,000,000 per annual aggregate for a nonparticipating
18 health care provider.
19 (iii) [$750,000] $550,000 per occurrence or claim
20 and $3,750,000 per annual aggregate for a hospital.
21 [If the commissioner finds pursuant to section 745(a) that
22 additional basic insurance coverage capacity is not
23 available, the basic insurance coverage requirements shall
24 remain at the level required by paragraph (2); and the
25 commissioner shall conduct a study every two years until the
26 commissioner finds that additional basic insurance coverage
27 capacity is available, at which time the commissioner shall
28 increase the required basic insurance coverage in accordance
29 with this paragraph.]
30 (4) [Unless the commissioner finds pursuant to section
31 745(b) that additional basic insurance coverage capacity is
32 not available, for] For policies issued or renewed [three
33 years after the increase in coverage limits required by
34 paragraph (3)] in calendar year 2009 and for each year
35 thereafter, the basic insurance coverage shall be:
36 (i) [$1,000,000] $600,000 per occurrence or claim
37 and $3,000,000 per annual aggregate for a participating
38 health care provider that is not a hospital.
39 (ii) $1,000,000 per occurrence or claim and
40 $3,000,000 per annual aggregate for a nonparticipating
41 health care provider.
42 (iii) [$1,000,000] $600,000 per occurrence or claim
43 and $4,500,000 per annual aggregate for a hospital.
44 [If the commissioner finds pursuant to section 745(b) that
45 additional basic insurance coverage capacity is not
46 available, the basic insurance coverage requirements shall
47 remain at the level required by paragraph (3); and the
48 commissioner shall conduct a study every two years until the
49 commissioner finds that additional basic insurance coverage
50 capacity is available, at which time the commissioner shall
51 increase the required basic insurance coverage in accordance
52 with this paragraph.]
53 (5) For policies issued or renewed in calendar year 2010
54 and each year thereafter, the commissioner shall increase the
55 required per occurrence or claim basic insurance coverage by
56 $50,000 increments for a participating health care provider
57 that is not a hospital and for a hospital until such time as
58 the required per occurrence or claim basic insurance coverage
59 is $750,000.
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1 (6) For policies issued or renewed in the calendar year
2 immediately following the calendar year in which the required
3 per occurrence or claim basic insurance coverage is $750,000
4 and each year thereafter, the basic insurance coverage shall
5 be:
6 (i) $1,000,000 per occurrence or claim and
7 $3,000,000 per annual aggregate for a participating
8 health care provider that is not a hospital.
9 (ii) $1,000,000 per occurrence or claim and
10 $3,000,000 per annual aggregate for a nonparticipating
11 health care provider.
12 (iii) $1,000,000 per occurrence or claim and
13 $4,500,000 per annual aggregate for a hospital.
14 * * *
15 Section 712. Medical Care Availability and Reduction of Error
16 Fund.
17 * * *
18 (c) Fund liability limits.--
19 (1) For calendar year 2002, the limit of liability of
20 the fund created in section 701(d) of the former Health Care
21 Services Malpractice Act for each health care provider that
22 conducts more than 50% of its health care business or
23 practice within this Commonwealth and for each hospital shall
24 be $700,000 for each occurrence and $2,100,000 per annual
25 aggregate.
26 (2) The limit of liability of the fund for each
27 participating health care provider shall be as follows:
28 (i) For calendar year 2003 and each year thereafter,
29 the limit of liability of the fund shall be $500,000 for
30 each occurrence and $1,500,000 per annual aggregate.
31 (ii) If the basic insurance coverage requirement is
32 increased in accordance with section 711(d)(3), (4) or
33 (5) and, notwithstanding subparagraph (i), for each
34 calendar year following the increase in the basic
35 insurance coverage requirement, the limit of liability of
36 the fund shall be [$250,000 for each occurrence and
37 $750,000 per annual aggregate.] $1,000,000 per occurrence
38 or claim and $3,000,000 per annual aggregate for a health
39 care provider except a hospital or $1,000,000 per
40 occurrence or claim and $4,500,000 per annual aggregate
41 for a hospital, minus the amount required for basic
42 insurance coverage under section 711(d)(3) or (4) or the
43 amount the commissioner determines as the required basic
44 insurance coverage under section 711(d)(5), as
45 appropriate.
46 (iii) If the basic insurance coverage requirement is
47 increased in accordance with section [711(d)(4)]
48 711(d)(6) and, notwithstanding subparagraphs (i) and
49 (ii), for each calendar year following the increase in
50 the basic insurance coverage requirement, the limit of
51 liability of the fund shall be zero.
52 * * *
53 [(e) Discount on surcharges and assessments.--
54 (1) For calendar year 2002, the department shall
55 discount the aggregate surcharge imposed under section
56 701(e)(1) of the Health Care Services Malpractice Act by 5%
57 of the aggregate surcharge imposed under that section for
58 calendar year 2001 in accordance with the following:
59 (i) Fifty percent of the aggregate discount shall be
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1 granted equally to hospitals and to participating health
2 care providers that were surcharged as members of one of
3 the four highest rate classes of the prevailing primary
4 premium.
5 (ii) Notwithstanding subparagraph (i), 50% of the
6 aggregate discount shall be granted equally to all
7 participating health care providers.
8 (iii) The department shall issue a credit to a
9 participating health care provider who, prior to the
10 effective date of this section, has paid the surcharge
11 imposed under section 701(e)(1) of the former Health Care
12 Services Malpractice Act for calendar year 2002 prior to
13 the effective date of this section.
14 (2) For calendar years 2003 and 2004, the department
15 shall discount the aggregate assessment imposed under
16 subsection (d) for each calendar year by 10% of the aggregate
17 surcharge imposed under section 701(e)(1) of the former
18 Health Care Services Malpractice Act for calendar year 2001
19 in accordance with the following:
20 (i) Fifty percent of the aggregate discount shall be
21 granted equally to hospitals and to participating health
22 care providers that were assessed as members of one of
23 the four highest rate classes of the prevailing primary
24 premium.
25 (ii) Notwithstanding subparagraph (i), 50% of the
26 aggregate discount shall be granted equally to all
27 participating health care providers.
28 (3) For calendar years 2005 and thereafter, if the basic
29 insurance coverage requirement is increased in accordance
30 with section 711(d)(3) or (4), the department may discount
31 the aggregate assessment imposed under subsection (d) by an
32 amount not to exceed the aggregate sum to be deposited in the
33 fund in accordance with subsection (m).]
34 * * *
35 (m) Supplemental funding.--Notwithstanding the provisions of
36 75 Pa.C.S. § 6506(b) (relating to surcharge) to the contrary,
37 beginning January 1, 2004, [and for a period of nine calendar
38 years thereafter,] all surcharges levied and collected under 75
39 Pa.C.S. § 6506(a) by any division of the unified judicial system
40 shall be remitted to the Commonwealth for deposit in the Medical
41 Care Availability and Restriction of Error Fund. These funds
42 shall be used to reduce surcharges and assessments [in
43 accordance with subsection (e). Beginning January 1, 2014, and
44 each year thereafter, the surcharges levied and collected under
45 75 Pa.C.S. § 6506(a) shall be deposited into the General Fund]
46 levied under this section.
47 * * *
48 Section 1.1. The act is amended by adding a section to read:
49 Section 762. Medical Safety Automation Fund established.
50 There is established within the State Treasury a special fund
51 to be known as the Medical Safety Automation Fund. No money in
52 the Medical Safety Automation Fund shall be used until
53 legislation is enacted for the purpose of providing medical
54 safety automation system grants to health care providers under
55 the act of July 19, 1979 (P.L.130, No.48), known as the Health
56 Care Facilities Act, a group practice or a community-based
57 health care provider.
58 Section 2. The definition of "account" in section 1101 of
59 the act, added December 22, 2005 (P.L.458, No.88), is amended to
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1 read:
2 Section 1101. Definitions.
3 The following words and phrases when used in this chapter
4 shall have the meanings given to them in this section unless the
5 context clearly indicates otherwise:
6 "Account." The Health Care Stabilization and Provider
7 Retention Account established in section 1112.
8 * * *
9 Section 3. Section 1102 of the act, amended October 27, 2006
10 (P.L.1198, No.128), is amended to read:
11 Section 1102. Abatement program.
12 (a) Establishment.--There is hereby established within the
13 Insurance Department a program to be known as the Health Care
14 Provider Retention Program. The Insurance Department, in
15 conjunction with the Department of Public Welfare, shall
16 administer the program. The program shall provide assistance in
17 the form of assessment abatements to health care providers for
18 calendar years 2003[, 2004, 2005, 2006 and 2007] and each year
19 thereafter until the liability of the fund under section
20 712(c)(2)(iii) is zero, except that licensed podiatrists shall
21 not be eligible for calendar years 2003 and 2004, and nursing
22 homes shall not be eligible for calendar years 2003, 2004 and
23 2005.
24 (b) Other abatement.--Emergency physicians not employed full
25 time by a trauma center or working under an exclusive contract
26 with a trauma center shall retain eligibility for an abatement
27 pursuant to section 1104(b)(2) for calendar years 2003, 2004,
28 2005 and 2006. Commencing in calendar year 2007, these emergency
29 physicians shall be eligible for an abatement pursuant to
30 section 1104(b)(1).
31 Section 4. Sections 1104, 1105 and 1112 of the act, added
32 December 22, 2005 (P.L.458, No.88), are amended to read:
33 Section 1104. Procedure.
34 (a) Application.--A health care provider may apply to the
35 Insurance Department for an abatement of the assessment imposed
36 for the previous calendar year specified on the application. The
37 application must be submitted by the second Monday of February
38 of the calendar year specified on the application and shall be
39 on the form required by the Insurance Department. The department
40 shall require that the application contain all of the following
41 supporting information:
42 (1) A statement of the applicant's field of practice,
43 including any specialty.
44 (2) Except for physicians enrolled in an approved
45 residency or fellowship program, a signed certificate of
46 retention.
47 (3) A signed certification that the health care provider
48 is an eligible applicant under section 1103 for the program.
49 (4) Such other information as the Insurance Department
50 may require.
51 (a.1) Electronically filed application.--A hospital may
52 submit an electronic application on behalf of all health care
53 providers when the hospital is responsible for payment of the
54 health care provider's assessment under this act and the
55 hospital has received prior written approval from the Insurance
56 Department.
57 (b) Review.--Upon receipt of a completed application, the
58 Insurance Department shall review the applicant's information
59 and grant the applicable abatement of the assessment for the
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1 previous calendar year specified on the application in
2 accordance with all of the following:
3 (1) The Insurance Department shall notify the Department
4 of Public Welfare that the applicant has self-certified as
5 eligible for a 100% abatement of the imposed assessment if
6 the health care provider was assessed under section 712(d)
7 as:
8 (i) a physician who is assessed as a member of one
9 of the four highest rate classes of the prevailing
10 primary premium;
11 (ii) an emergency physician;
12 (iii) a physician who routinely provides obstetrical
13 services in rural areas as designated by the Insurance
14 Department; or
15 (iv) a certified nurse midwife.
16 (2) The Insurance Department shall notify the Department
17 of Public Welfare that the applicant has self-certified as
18 eligible for a 50% abatement of the imposed assessment if the
19 health care provider was assessed under section 712(d) as:
20 (i) a physician but is a physician who does not
21 qualify for abatement under paragraph (1);
22 (ii) a licensed podiatrist; or
23 (iii) a nursing home.
24 (3) Notwithstanding paragraph (2), upon the required
25 basic insurance coverage being increased under section
26 711(d)(3), (4) or (5), the Insurance Department shall
27 annually increase the abatement each applicant is entitled to
28 claim under paragraph (2) by 10%.
29 (c) Refund.--If a health care provider paid the assessment
30 for the calendar year prior to applying for an abatement under
31 subsection (a), the health care provider may, in addition to the
32 completed application required by subsection (a), submit a
33 request for a refund. The request shall be submitted on the form
34 required by the Insurance Department. If the Insurance
35 Department grants the health care provider an abatement of the
36 assessment for the calendar year in accordance with subsection
37 (b), the Insurance Department shall either refund to the health
38 care provider the portion of the assessment which was abated or
39 issue a credit to the health care provider's professional
40 liability insurer.
41 Section 1105. Certificate of retention.
42 (a) Certificate.--The Insurance Department shall prepare a
43 certificate of retention form. The form shall require a health
44 care provider seeking an abatement under the program to attest
45 that the health care provider will continue to provide health
46 care services in this Commonwealth for at least one full
47 calendar year following the year for which an abatement was
48 received pursuant to this chapter.
49 (a.1) Hospital responsibility.--When a hospital has
50 submitted an application on behalf of a health care provider,
51 the hospital shall be responsible for ensuring compliance with
52 the certificate of retention and shall indemnify the health care
53 provider retention account for each health care provider who
54 fails to continue to provide medical services within this
55 Commonwealth for the year following receipt of the abatement.
56 (b) Repayment.--
57 (1) Except as provided in paragraph (2), if a health
58 care provider receives an abatement but, prior to the end of
59 the retention period, ceases providing health care services
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1 in this Commonwealth, the health care provider shall repay to
2 the Commonwealth 100% of the abatement received plus
3 administrative and legal costs, if applicable. A health care
4 provider subject to this paragraph shall provide written
5 notice to the Insurance Department within 60 days of the date
6 of cessation of health care services.
7 (2) Paragraph (1) shall not apply to a health care
8 provider who is any of the following:
9 (i) A health care provider who is enrolled in an
10 approved residency or fellowship program.
11 (ii) A health care provider who dies prior to the
12 end of the retention period.
13 (iii) A health care provider who is disabled and
14 unable to practice prior to the end of the retention
15 period.
16 (iv) A health care provider who is called to active
17 military duty prior to the end of the retention period.
18 (v) A health care provider who retires and who is at
19 least 70 years of age prior to the end of the retention
20 period.
21 (c) Tax.--An amount owed the Commonwealth under subsection
22 (b) shall be considered a tax under section 1401 of the act of
23 April 9, 1929 (P.L.343, No.176), known as The Fiscal Code. The
24 Department of Revenue shall provide assistance to the Insurance
25 Department in any collection effort. Any amount collected under
26 this chapter, including administrative and legal costs, shall be
27 deposited into the [Health Care Provider Retention Account]
28 account.
29 (d) Failure to pay.--The Insurance Department shall notify
30 the appropriate licensing board of any failure to pay an amount
31 required of a licensee under this section. Upon such
32 notification, the licensing board shall suspend or revoke the
33 license of the licensee.
34 Section 1112. Health Care Stabilization and Provider Retention
35 Account.
36 (a) Fund established.--There is established within the
37 General Fund a special account to be known as the Health Care
38 Stabilization and Provider Retention Account. Funds in the
39 account shall be subject to an annual appropriation by the
40 General Assembly [to the Department of Public Welfare. The
41 Department of Public Welfare shall administer funds appropriated
42 under this section].
43 (a.1) Abatement program appropriations.--Funds appropriated
44 to the Department of Public Welfare for the abatement program
45 shall be administered by the Department of Public Welfare
46 consistent with its duties under section 201(1) of the act of
47 June 13, 1967 (P.L.31, No.21), known as the Public Welfare Code.
48 (a.2) Health care stabilization appropriations.--Money in
49 the account shall be allocated annually by the Secretary of the
50 Budget as follows:
51 (1) Seventy-five million dollars shall be transferred to
52 be used for the small business health savings tax account tax
53 credit established under Chapter 13.
54 (2) Five million dollars shall be transferred to be used
55 for the disease management tax credit established under
56 Chapter 15.
57 (3) Five million dollars shall be transferred to be used
58 for the healthy living and wellness tax incentives
59 established under Chapter 17.
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1 (4) Five million dollars shall be transferred to the
2 Health Care Cost Containment Council to be used in accordance
3 with Chapter 21.
4 (5) Fifteen million dollars shall be transferred to the
5 Patient Safety Trust Fund for use by the Department of Public
6 Welfare for implementing section 407.
7 (6) Twenty-two million dollars shall be transferred to
8 the Low Income Health Care Access Fund to increase service in
9 accordance with Chapter 19.
10 (7) Ten million dollars shall be transferred to the
11 Medical Safety Automation Fund.
12 [(b) Transfers from Mcare Fund.--By December 31 of each
13 year, the Secretary of the Budget may transfer from the Medical
14 Care Availability and Reduction of Error (Mcare) Fund
15 established in section 712(a) to the account an amount equal to
16 the difference between the amount deposited under section 712(m)
17 and the amount granted as discounts under section 712(e)(2) for
18 that calendar year.]
19 (c) [Transfers] Abatement transfers from account.--The
20 Secretary of the Budget [may] shall annually transfer from the
21 account to the Medical Care Availability and Reduction of Error
22 (Mcare) Fund an amount [up] equal to the aggregate amount of
23 abatements granted by the Insurance Department under section
24 1104(b)[.], minus the sum of the amount deposited in the fund
25 under section 712(m) and any payments of the assessment levied
26 under section 712(d).
27 (d) Other deposits.--The Department of Public Welfare may
28 deposit any other funds received by the department which it
29 deems appropriate in the account.
30 [(e) Administration assistance.--The Insurance Department
31 shall provide assistance to the Department of Public Welfare in
32 administering the account.]
33 Section 5. Section 1115 of the act, amended October 27, 2006
34 (P.L.1198, No.128), is repealed:
35 [Section 1115. Expiration.
36 The Health Care Provider Retention Program established under
37 this chapter shall expire December 31, 2008.]
38 Section 6. The act is amended by adding a section to read:
39 Section 1116. Health Care Provider Retention Reserve Account.
40 (a) Establishment.--There is established within the General
41 Fund a special account to be known as the Health Care Provider
42 Retention Reserve Account. The funds in the account shall only
43 be used for the purpose of reducing unfunded liability under
44 Chapter 7.
45 (b) Transfer.--Notwithstanding any other provision of this
46 act, the Secretary of the Budget shall, as of December 31, 2007,
47 transfer all funds in the account into the Health Care Provider
48 Retention Reserve Account.
49 Section 6.1. The act is amended by adding chapters to read:
50 CHAPTER 13
51 SMALL BUSINESS HEALTH SAVINGS ACCOUNT TAX CREDIT
52 Section 1301. Scope.
53 This chapter relates to small business health savings account
54 tax credit.
55 Section 1302. Definitions.
56 The following words and phrases when used in this chapter
57 shall have the meanings given to them in this section unless the
58 context clearly indicates otherwise:
59 "Department." The Department of Revenue of the Commonwealth.
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1 "Employee" or "employees." An individual or group of
2 individuals employed by a small business. The term shall also
3 include a sole proprietor.
4 "Health insurance policy." An individual or group health,
5 sickness or accident policy or subscriber contract or
6 certificate issued by an entity subject to any one of the
7 following:
8 (1) The act of May 17, 1921 (P.L.682, No.284), known as
9 The Insurance Company Law of 1921.
10 (2) The act of December 29, 1972 (P.L.1701, No.364),
11 known as the Health Maintenance Organization Act.
12 (3) The act of May 18, 1976 (P.L.123, No.54), known as
13 the Individual Accident and Sickness Insurance Minimum
14 Standards Act.
15 (4) 40 Pa.C.S. Ch. 61 (relating to hospital plan
16 corporations) or 63 (relating to professional health services
17 plan corporations).
18 "Health Savings Account." As defined in section 223(d) of
19 the Internal Revenue Code of 1986 (Public Law 99-514, 26 U.S.C.
20 § 223(d)).
21 "Pass-through entity." Any of the following:
22 (1) A partnership, limited partnership, limited
23 liability company, business trust or other unincorporated
24 entity that for Federal income tax purposes is taxable as a
25 partnership.
26 (2) A Pennsylvania S corporation.
27 "Qualified high deductible health plan." A health insurance
28 policy that would qualify as a high deductible health plan under
29 section 223(c)(2) of the Internal Revenue Code of 1986 (Public
30 Law 99-514, 26 U.S.C. § 223(c)(2)).
31 "Qualified tax liability." The liability for taxes imposed
32 under Article III, IV or VI of the act of March 4, 1971 (P.L.6,
33 No.2), known as the Tax Reform Code of 1971. The term shall
34 include the liability for taxes imposed under Article III of the
35 Tax Reform Code of 1971 on an owner of a pass-through entity.
36 "Secretary." The Secretary of Revenue of the Commonwealth.
37 "Small business." An employer who, on at least 50% of its
38 working days during the taxable year, employed fewer than 100
39 employees.
40 "Tax credit." The small business health savings account tax
41 credit.
42 "Taxpayer." A small business subject to tax under Article
43 III, IV or VI of the act of March 4, 1971 (P.L.6, No.2), known
44 as the Tax Reform Code of 1971. The term includes:
45 (1) the partner, shareholder, owner or member of a pass-
46 through entity; or
47 (2) a sole proprietor.
48 Section 1303. Credit for Health Savings Account contributions.
49 (a) Application.--A taxpayer who purchases and provides a
50 qualified high deductible health insurance policy to employees
51 and makes a contribution to a health savings account on behalf
52 of employees in a taxable year may apply for a tax credit as
53 provided in this chapter. By September 15, a taxpayer must
54 submit an application to the department for the aggregate
55 contribution made by the taxpayer to employee health savings
56 accounts in the taxable year that ended in the prior calendar
57 year.
58 (b) Computation.--A taxpayer who qualifies under subsection
59 (a) shall receive a tax credit for the taxable year in
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1 accordance with the following:
2 (1) Fifty percent of the aggregate contribution made by
3 the taxpayer to employee health savings accounts when the
4 contribution is provided for the benefit of employees,
5 spouses and dependents for the taxable year.
6 (2) Twenty-five percent of the aggregate contribution
7 made by the taxpayer to employee health savings accounts when
8 the contribution is provided solely for the benefit of an
9 employee.
10 (c) Notification.--By December 15 of the calendar year
11 following the close of the taxable year during which the
12 contribution to employee health savings accounts was made, the
13 department shall notify the taxpayer of the amount of the
14 taxpayer's tax credit approved by the department.
15 Section 1304. Limitation on credits.
16 (a) Limit.--The total amount of credits approved by the
17 department shall not exceed $30,000,000 in any fiscal year.
18 (b) Calculation.--If the total amount of small business
19 health savings account tax credits applied for by all taxpayers
20 exceeds the amount allocated for those credits, then the small
21 business health savings account tax credit to be received by
22 each applicant shall be the product of the allocated amount
23 multiplied by the quotient of the small business health savings
24 account tax credit applied for by the applicant divided by the
25 total of all small business health savings account credits
26 applied for by all applicants, the algebraic equivalent of which
27 is:
28 taxpayer's small business health savings account tax
29 credit = amount allocated for those credits X (small
30 business health savings account tax credit applied for by
31 the applicant/total of all small business health savings
32 account tax credits applied for by all applicants).
33 Section 1305. Carryover, carryback, refund and assignment of
34 credit.
35 (a) Carryover.--If the taxpayer cannot use the entire amount
36 of the tax credit for the taxable year in which the tax credit
37 is first approved, then the excess may be carried over to
38 succeeding taxable years and used as a credit against the
39 qualified tax liability of the taxpayer for those taxable years.
40 Each time that the tax credit is carried over to a succeeding
41 taxable year, it is to be reduced by the amount that was used as
42 a credit during the immediately preceding taxable year. The tax
43 credit may be carried over and applied to succeeding taxable
44 years for no more than 15 taxable years following the first
45 taxable year for which the taxpayer was entitled to claim the
46 credit.
47 (b) Application of credit.--A tax credit approved by the
48 department for monetary contributions made to employee health
49 savings accounts in a taxable year first shall be applied
50 against the taxpayer's qualified tax liability for the current
51 taxable year as of the date on which the credit was approved
52 before the tax credit is applied against any tax liability under
53 subsection (a).
54 (c) Prohibition.--A taxpayer is not entitled to assign,
55 carry back or obtain a refund of an unused tax credit.
56 Section 1306. Shareholder, owner or member pass-through.
57 (a) Shareholder's calculation.--If a Pennsylvania S
58 corporation does not have an eligible tax liability against
59 which the tax credit may be applied, a shareholder of the
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1 Pennsylvania S corporation is entitled to a tax credit equal to
2 the tax credit determined for the Pennsylvania S corporation for
3 the taxable year multiplied by the percentage of the
4 Pennsylvania S corporation's distributive income to which the
5 shareholder is entitled.
6 (b) Owner or member calculation.--If a pass-through entity
7 other than a Pennsylvania S corporation does not have an
8 eligible tax liability against which the tax credit may be
9 applied, an owner or member of the pass-through entity is
10 entitled to a tax credit equal to the tax credit determined for
11 the pass-through entity for the taxable year multiplied by the
12 percentage of the pass-through entity's distributive income to
13 which the owner or member is entitled.
14 (c) Application; restrictions.--The credit provided under
15 subsection (a) or (b) is in addition to any tax credit to which
16 a shareholder, owner or member of a pass-through entity is
17 otherwise entitled under this chapter. However, a pass-through
18 entity and a shareholder, owner or member of a pass-through
19 entity may not claim a credit under this chapter for the same
20 contributions made to employee health savings accounts.
21 Section 1307. Report to General Assembly.
22 The secretary shall submit an annual report to the General
23 Assembly indicating the effectiveness of the credit provided by
24 this chapter no later than March 15 following the year in which
25 the credits were approved. The report shall include the names of
26 all taxpayers utilizing the credit as of the date of the report
27 and the amount of credits approved and utilized by each
28 taxpayer. Notwithstanding any law providing for the
29 confidentiality of tax records, the information contained in the
30 report shall be public information. The report may also include
31 any recommendations for changes in the calculation or
32 administration of the credit.
33 Section 1308. Regulations.
34 The secretary shall promulgate regulations necessary for the
35 implementation and administration of this chapter.
36 CHAPTER 15
37 DISEASE MANAGEMENT TAX CREDIT
38 Section 1501. Scope.
39 This chapter relates to disease management insurance policy
40 tax credits.
41 Section 1502. Definitions.
42 The following words and phrases when used in this chapter
43 shall have the meanings given to them in this section unless the
44 context clearly indicates otherwise:
45 "Department." The Department of Revenue of the Commonwealth.
46 "Disease management insurance policy." A group or individual
47 health insurance policy that includes a disease management
48 program.
49 "Disease management program." A set of interventions
50 designed to improve the health of individuals, especially those
51 with certain ailments or diseases. A disease management program
52 may include:
53 (1) Identifying patients and matching the intervention
54 with need.
55 (2) Support for adherence to evidence-based medical
56 practice guidelines, including providing medical treatment
57 guidelines to physicians and other providers, and providing
58 support services to assist the physician in monitoring the
59 patient.
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1 (3) Services designed to enhance patient management and
2 adherence to an individualized treatment plan, including
3 patient education, monitoring and reminders, and behavior
4 modification programs aimed at encouraging lifestyle changes.
5 (4) Routine reporting and feedback loops, including
6 communication with patient, physician, health plan and
7 ancillary providers, and practice profiling.
8 (5) Collection and analysis of process and outcome
9 measures.
10 "Pass-through entity." Any of the following:
11 (1) A partnership, limited partnership, limited
12 liability company, business trust or other unincorporated
13 entity that for Federal income tax purposes is taxable as a
14 partnership.
15 (2) A Pennsylvania S corporation.
16 "Primary contractor." A person licensed to conduct business
17 in this Commonwealth that develops, implements or monitors
18 disease management programs.
19 "Qualified tax liability." The liability for taxes imposed
20 under Article III (relating to personal income tax), IV
21 (relating to corporate net income tax) or VI (relating to
22 capital stock franchise tax) of the act of March 4, 1971 (P.L.6,
23 No.2), known as the Tax Reform Code of 1971. The term includes
24 the liability for taxes imposed under Article III of the Tax
25 Reform Code of 1971 on a sole proprietor, partner, shareholder,
26 owner or member of a pass-through entity.
27 "Secretary." The Secretary of Revenue of the Commonwealth.
28 "Service provider." A person licensed to conduct business in
29 this Commonwealth that is selected by the primary contractor to
30 provide disease management programs.
31 "Small business." A taxpayer with fewer than 50 employees.
32 "Tax credit." The disease management insurance policy tax
33 credit authorized under this chapter.
34 "Taxpayer." An entity subject to tax under Article III
35 (relating to personal income tax), IV (relating to corporate net
36 income tax) or VI (relating to capital stock franchise tax) of
37 the act of March 4, 1971 (P.L.6, No.2), known as the Tax Reform
38 Code of 1971. The term includes:
39 (1) the partner, shareholder, owner or member of a pass-
40 through entity that receives a tax credit; or
41 (2) a sole proprietor.
42 Section 1503. Credit for disease management insurance policies.
43 (a) Application.--
44 (1) A taxpayer who purchases and provides a disease
45 management insurance policy to employees in a taxable year
46 may apply for a tax credit as provided in this chapter. By
47 September 15, a taxpayer must submit an application to the
48 department for premiums paid in the taxable year that ended
49 in the prior calendar year.
50 (2) A taxpayer with 50 or more employees who purchases
51 and provides a disease management insurance policy to
52 employees in a taxable year may apply for a tax credit as
53 provided in this chapter. By September 15, a taxpayer must
54 submit an application to the department for premiums paid in
55 the taxable year that ended in the prior calendar year.
56 (b) Tax credit.--A taxpayer qualified under subsection
57 (a)(1) shall receive a tax credit for the taxable year in the
58 amount of $500 for each employee of the taxpayer covered by a
59 disease management insurance policy. A taxpayer qualified under
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1 subsection (a)(2) shall receive a tax credit for the taxable
2 year in an amount equal to 50% of the cost to the taxpayer for
3 providing health care coverage for employees, contingent on
4 proof the purchased coverage utilizes disease management
5 protocols.
6 (c) Notification of credit.--By December 15 of the calendar
7 year following the close of the taxable year, the department
8 shall notify the taxpayer of the amount of the taxpayer's tax
9 credit approved by the department.
10 Section 1504. Certification requirement.
11 (a) Application.--In order to qualify for the tax credit, a
12 taxpayer, in conjunction with the Department of Labor and
13 Industry and the Insurance Department, shall make application
14 for the certification of the disease management program
15 purchased as part of the disease management insurance policy.
16 The Insurance Department shall develop the certification
17 criteria.
18 (b) Reapplying.--In the subsequent tax year, a taxpayer
19 reapplying for the tax credit must provide verification to the
20 Department of Labor and Industry and the Insurance Department
21 that the disease management program meets the certification
22 requirements and continues to be purchased by the taxpayer.
23 Section 1505. Carryover, carryback, refund and assignment of
24 credit.
25 (a) General rule.--If the taxpayer cannot use the entire
26 amount of the tax credit for the taxable year in which the tax
27 credit is first approved because the amount of the tax credit
28 exceeds the tax liability of the taxpayer for the year in which
29 the tax credit under section 1503 (relating to credit for
30 disease management insurance policies) is to be applied, the
31 excess may be carried over to succeeding taxable years and used
32 as a credit against the qualified tax liability of the taxpayer
33 for those taxable years. Each time the tax credit is carried
34 over to a succeeding taxable year, it shall be reduced by the
35 amount that was used as a credit during the immediately
36 preceding taxable year. The tax credit may be carried over and
37 applied to succeeding taxable years for no more than 15 taxable
38 years following the first taxable year for which the taxpayer
39 was entitled to claim the credit.
40 (b) Application of tax credit.--A tax credit approved by the
41 department for premiums incurred in a taxable year shall first
42 be applied against the taxpayer's qualified tax liability for
43 the current taxable year as of the date on which the credit was
44 approved before the tax credit may be applied against any tax
45 liability under subsection (a).
46 (c) Unused tax credit.--A taxpayer is not entitled to
47 assign, carry back or obtain a refund of an unused tax credit.
48 Section 1506. Time limitations.
49 A taxpayer is not entitled to a tax credit for health
50 insurance premiums providing for disease management programs
51 incurred in taxable years ending after December 31, 2010.
52 Section 1507. Limitation on credits.
53 (a) Allocation for small businesses.--Forty percent of
54 available funds shall be allocated exclusively for small
55 businesses. However, if the total amounts allocated to either
56 the group of applicants exclusive of small businesses or the
57 group of small business applicants is not approved in any fiscal
58 year, the unused portion will become available for use by other
59 qualifying taxpayers.
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1 (b) Proration of tax credits.--
2 (1) If the total amount of tax credits applied for by
3 all taxpayers, exclusive of small businesses, exceeds the
4 amount allocated for those credits, the tax credit to be
5 received by each applicant shall be prorated by the
6 department among all applicants, exclusive of small
7 businesses, who have qualified for the credit.
8 (2) If the total amount of tax credits applied for by
9 all small businesses exceeds the amount allocated for those
10 credits, the tax credit to be received by each small business
11 applicant shall be prorated by the department among all small
12 business applicants who have qualified for the credit.
13 Section 1508. Shareholder, owner or member pass-through.
14 (a) Pennsylvania S corporations.--If a Pennsylvania S
15 corporation does not have an eligible tax liability against
16 which the tax credit may be applied, a shareholder of the
17 Pennsylvania S corporation is entitled to a tax credit equal to
18 the tax credit determined for the Pennsylvania S corporation for
19 the taxable year multiplied by the percentage of the
20 Pennsylvania S corporation's distributive income to which the
21 shareholder is entitled.
22 (b) Pass-through entities.--If a pass-through entity other
23 than a Pennsylvania S corporation does not have an eligible tax
24 liability against which the tax credit may be applied, an owner
25 or member of the pass-through entity is entitled to a tax credit
26 equal to the tax credit determined for the pass-through entity
27 for the taxable year multiplied by the percentage of the pass-
28 through entity's distributive income to which the owner or
29 member is entitled.
30 (c) Entitlement.--The credit provided under subsection (a)
31 or (b) is in addition to any tax credit to which a shareholder,
32 owner or member of a pass-through entity is otherwise entitled
33 under this chapter. However, a pass-through entity and a
34 shareholder, owner or member of a pass-through entity may not
35 claim a credit under this chapter for the same premium or
36 employee.
37 Section 1509. Accountability.
38 (a) Review procedures.--Any taxpayer that receives a tax
39 credit under this chapter shall be subject to a performance
40 review by the Department of Labor and Industry, in conjunction
41 with the Insurance Department. As appropriate, the performance
42 review shall be based upon information submitted to the
43 department that includes the following:
44 (1) The contractor's or service provider's strategic
45 goals and objectives for disease management programs.
46 (2) The contractor's or service provider's annual
47 performance plan setting forth how these strategic goals and
48 objectives are to be achieved and the specific methodology
49 for evaluating results, along with any proposed methods for
50 improvement.
51 (3) The contractor's or service provider's annual
52 performance report setting forth the specific results in
53 achieving its strategic goals and objectives for disease
54 management, including any changes in the health of
55 participants in the disease management program.
56 (4) The progress made in achieving expected program
57 priorities and goals.
58 (5) Any other information deemed necessary by the
59 department.
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1 (b) Penalty.--If a performance review indicates that a
2 primary contractor or a service provider failed to comply with
3 contract requirements or meet performance goals, taxpayers may
4 be subject to a reduction in or ineligibility for future tax
5 credit funding under this chapter.
6 Section 1510. Report to General Assembly.
7 (a) Submission of report.--The secretary shall submit an
8 annual report indicating the effectiveness of the credit
9 provided by this chapter no later than March 15 following the
10 year in which the credits were approved to the Governor, the
11 chairmen and the minority chairmen of the Public Health and
12 Welfare Committee and the Appropriations Committee of the Senate
13 and the chairmen and minority chairmen of the Health and Human
14 Services Committee and the Appropriations Committee of the House
15 of Representatives.
16 (b) Contents.--The report shall include the names of all
17 taxpayers utilizing the credit as of the date of the report and
18 the amount of credits approved and utilized by each taxpayer.
19 (c) Public information.--Notwithstanding any law providing
20 for the confidentiality of tax records, the information
21 contained in the report shall be public information.
22 (d) Recommendations.--The report may also include any
23 recommendations for changes in the calculation or administration
24 of the credit.
25 Section 1511. Termination.
26 The department shall not approve a tax credit under this
27 chapter for taxable years ending after December 31, 2010.
28 Section 1512. Regulations.
29 The secretary shall promulgate regulations necessary for the
30 implementation and administration of this chapter.
31 CHAPTER 17
32 HEALTHY LIVING AND WELLNESS TAX INCENTIVES
33 Section 1701. Scope.
34 This chapter relates to tax incentives for wellness services
35 and healthy living equipment and products.
36 Section 1702. Definitions.
37 The following words and phrases when used in this chapter
38 shall have the meanings given to them in this section unless the
39 context clearly indicates otherwise:
40 "Annual limitation." $2,500.
41 "Annual personal income tax return." The return required to
42 be filed under section 330 of the act of March 4, 1971 (P.L.6,
43 No.2), known as the Tax Reform Code of 1971.
44 "Code." The act of March 4, 1971 (P.L.6, No.2), known as the
45 Tax Reform Code of 1971.
46 "Department." The Department of Revenue of the Commonwealth.
47 "Healthy living product." Exercise equipment used in a
48 residential property, nutritional supplements purchased by a
49 taxpayer, a membership to a gym, exercise facility or a similar
50 facility, the cost of a class or a course providing for the
51 instruction of a physical activity, including martial arts,
52 sports, dance or similar activities.
53 "Qualified expense." The cost incurred for the purchase at
54 the sale at retail or use of a healthy living product or a
55 wellness service.
56 "Tax credit." The healthy living and wellness tax credit.
57 "Taxable income." The term shall have the same meaning as
58 given to it in section 301 of the act of March 4, 1971 (P.L.6,
59 No.2), known as the Tax Reform Code of 1971.
SB1137A06050 - 15 -
1 "Taxpayer." The term shall have the same meaning as given to
2 it in section 301 of the act of March 4, 1971 (P.L.6, No.2),
3 known as the Tax Reform Code of 1971.
4 "Wellness service." Pregnancy care, fitness centers, weight
5 management, nicotine cessation, stress management and other
6 similar services.
7 Section 1703. Healthy living and wellness tax credit.
8 (a) Application.--A taxpayer may apply on the annual
9 personal income tax return for a tax credit for qualified
10 expenses as provided under this chapter.
11 (b) Department duties.--The following apply:
12 (1) The department shall provide a form by which a
13 taxpayer may apply for the tax credit.
14 (2) The department shall make the form available with
15 the annual personal income tax return.
16 (3) The department shall not grant a tax credit for a
17 qualified expense that was not incurred by the taxpayer.
18 (4) The department shall prescribe a method by which a
19 taxpayer may apply for the tax credit, including making
20 available a method by which a taxpayer may claim and provide
21 proof of qualified expenses when applying for the tax credit.
22 (5) The department shall grant a tax credit to a
23 taxpayer who satisfies the requirements of this section.
24 (c) Computation.--A taxpayer who applies under subsection
25 (a) shall be eligible to receive a tax credit for the taxable
26 year equal to the amount of qualified expenses incurred by the
27 taxpayer.
28 (d) Limitations.--The following apply:
29 (1) The amount of a tax credit awarded to a taxpayer
30 under this section shall not exceed the annual limitation.
31 (2) A taxpayer shall be ineligible for a tax credit if
32 the taxpayer is not up to date with all tax payments for tax
33 liabilities prior to the tax year for which a taxpayer is
34 applying for a tax credit.
35 (3) The amount of a tax credit awarded to a taxpayer
36 under this section shall not result in taxable income being
37 less than zero.
38 Section 1704. Sales and use tax exclusion.
39 In addition to the exclusions from tax provided for under
40 section 204 of the code, the sale at retail or use of healthy
41 living products and wellness services shall not be subject to
42 the tax imposed under Article II of the code.
43 Section 1705. Construction.
44 To the extent necessary, a term used in this chapter that is
45 not defined in section 1702 shall carry the same meaning given
46 to it under Article II or III of the code unless the context
47 clearly indicates otherwise.
48 Section 1706. Regulations.
49 The department shall promulgate rules and regulations as
50 necessary for effectuating the provisions of this chapter.
51 Section 1707. Applicability.
52 This chapter shall apply to taxable years beginning after
53 June 30, 2008.
54 CHAPTER 19
55 COMMUNITY-BASED HEALTH PROVIDER ASSISTANCE
56 Section 1901. Scope of chapter.
57 This chapter relates to community-based health provider
58 assistance.
59 Section 1902. Definitions.
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1 The following words and phrases when used in this chapter
2 shall have the meanings given to them in this section unless the
3 context clearly indicates otherwise:
4 "Community-based health care provider." Any of the following
5 nonprofit health care centers which provide primary health care
6 services:
7 (1) A federally qualified health center as defined under
8 section 1905(1)(2)(B) of the Social Security Act (49 Stat.
9 620, 42 U.S.C. § 1396d(1)(2)(B)).
10 (2) A rural health clinic as defined under section
11 1861(aa)(2)) of the Social Security Act (49 Stat. 620, 42
12 U.S.C. § 1395x(aa)(2)), certified by Medicare.
13 (3) A freestanding hospital clinic serving a federally
14 designated health care professional shortage area.
15 (4) A free or partial-pay health clinic which provides
16 services by volunteer medical providers.
17 "Department." The Department of Health of the Commonwealth.
18 "Health care provider." A health care facility or health
19 care practitioner as defined in the act of July 19, 1979
20 (P.L.130, No.48), known as the Health Care Facilities Act, a
21 group practice or a community-based health care provider.
22 "Medical assistance." A State program of medical assistance
23 established under Article IV(f) of the act of June 13, 1967
24 (P.L.31, No.21), known as the Public Welfare Code.
25 "Program." The Community-Based Health Provider Assistance
26 Program.
27 "Uncompensated care." The cost of reasonable and medically
28 necessary care provided to individuals unable or unwilling to
29 pay for services provided by a community-based health provider.
30 Section 1903. Program.
31 (a) Program established.--The Community-Based Health
32 Provider Assistance Program is established to provide grants to
33 community-based health providers to:
34 (1) Improve the access to and quality of health care in
35 this Commonwealth.
36 (2) Assist in covering the reasonable costs of providing
37 health care services, outreach and care management
38 opportunities to persons eligible to receive health care
39 services from or through community-based health providers.
40 (3) Improve access to medically necessary preventive,
41 curative and palliative physical, dental and behavioral
42 health care services offered by and through community-based
43 health providers, while reducing unnecessary or duplicative
44 services.
45 (4) Reduce the unnecessary utilization of emergency
46 health care services by supporting the development and
47 provision of effective alternatives offered by or through
48 community-based health providers.
49 (5) Improve the availability of quality health care
50 services offered by or through community-based health
51 providers for expectant mothers, women who have recently
52 given birth and their children.
53 (6) Promote the use of chronic care and disease
54 management protocols offered by or through community-based
55 health providers in an effort to optimize both individual
56 health outcomes and the use of health care resources.
57 (b) Administration.--The program shall be administered by
58 the department and shall be funded by annual transfers to the
59 Low Income Health Care Access Fund to support community-based
SB1137A06050 - 17 -
1 health providers' provision of health care.
2 (c) Department responsibilities.--The department shall have
3 the following powers and duties:
4 (1) Administer the program.
5 (2) Within 90 days of the effective date of this
6 section, develop and provide an application form consistent
7 with this chapter.
8 (3) Determine the eligibility of community-based health
9 providers for the assistance provided under this chapter,
10 based upon its consideration of revenue and cost data and
11 other information provided by community health providers, as
12 well as such other information as the department determines
13 to be appropriate to reflect the financial condition and
14 needs of such centers and the Commonwealth.
15 (4) Establish a process to allocate funding as provided
16 under this chapter, to determine the optimal use of funds and
17 to reallocate funds if acceptable requests for funding within
18 a particular category are not received.
19 (5) Calculate and make payments to qualified community
20 health providers from the funds deposited in the Low Income
21 Health Care Access Fund.
22 (6) Provide an annual report to the chairman and
23 minority chairman of the Public Health and Welfare Committee
24 of the Senate and the chairman and minority chairman of the
25 Health and Human Services Committee of the House of
26 Representatives describing the operation of the program and
27 detailing grants made, the names and addresses of the
28 community-based health providers receiving grants and such
29 other information as may be determined by the department to
30 be necessary or desirable.
31 (7) Audit grants awarded under this chapter to ensure
32 that funds have been used in accordance with the terms and
33 standards adopted by the department.
34 (8) Provide ongoing assessment of the benefits and costs
35 of the assistance provided under this chapter.
36 (d) Other funding sources.--The Commonwealth is authorized
37 and directed to seek Federal matching funds under medical
38 assistance, as well as grants and funding from other sources, to
39 supplement amounts made available under this chapter to the
40 extent permitted by law.
41 (e) Limitations on payments by department.--Payments made
42 under this chapter in a fiscal year shall not exceed the amount
43 of funds available in the Low Income Health Care Access Fund for
44 the program and any payment under this chapter shall not
45 constitute an entitlement from the Commonwealth or a claim on
46 any other funds of the Commonwealth.
47 (f) Report.--Each community-based health provider receiving
48 a grant under this chapter shall report at least annually to the
49 department, as specified by the department, and shall include
50 all of the following:
51 (1) The efforts undertaken to improve access to and the
52 delivery and management of health care services.
53 (2) The reduction of unnecessary and duplicative health
54 care services.
55 (3) The improvements in overall health indicators and in
56 utilization of health care services, with particular emphasis
57 on indicators including an assessment of:
58 (i) The establishment of relationships between
59 providers and individuals directed toward funding medical
SB1137A06050 - 18 -
1 homes for such persons, as well as the provision of
2 preventive and chronic care management services.
3 (ii) The care of expectant mothers.
4 (iii) Postpartum care of mothers.
5 (iv) The care of newborn children and infants.
6 (4) An accounting of the expenditure of funds from the
7 grant and all funds received from other sources.
8 Section 1904. Grants to community-based health providers.
9 (a) Allocation of funds.--The department shall provide grant
10 assistance to community health providers on the basis of the
11 process established in this section, subject to reallocation as
12 provided under subsection (f).
13 (b) Method of awarding grants.--The department shall develop
14 a methodology to determine grant amounts to be awarded under
15 this chapter, based upon community need for the services to be
16 supported by funding provided to community-based health
17 providers. It is the intent of the General Assembly that during
18 the first three years of the program the department shall use
19 its best efforts to make grants as follows, subject to
20 reallocation as provided under subsection (f):
21 (1) Twelve million dollars for expansion of current
22 community-based health providers or development of new
23 community-based health providers.
24 (2) Five million dollars for improvements in prenatal,
25 obstetrics, postpartum and newborn care provided by or
26 through community-based health providers.
27 (3) Five million dollars for services intended to reduce
28 unnecessary emergency room utilization and to expand capacity
29 and services offered by or through existing community-based
30 health providers.
31 (c) Additional information.--In addition to the application,
32 the applicant shall provide:
33 (1) A feasibility study of the proposed uses of funds to
34 be provided under the grant.
35 (2) A business or financial plan that describes the
36 long-term sustainability, financial cost to the applicant and
37 the proposed benefits of the work to be accomplished pursuant
38 to the grant.
39 (3) A strategic plan and schedule for the development
40 and implementation of the work to be accomplished under the
41 grant.
42 (d) Limitation.--The amount of a grant to any specific
43 community-based health care provider under this program shall
44 not exceed $2,000,000 and shall be for a term of not more than
45 five years.
46 (e) Reallocation.--The department shall reallocate funds
47 among the categories provided under subsection (b) if sufficient
48 requests are not received by the department that comply with
49 this chapter or the requirements of the department.
50 Section 1905. Low Income Health Care Access Fund.
51 (a) Restricted account established.--There is established a
52 restricted account in the Mcare Fund, to be known as the Low
53 Income Health Care Access Fund.
54 (b) Funding.--The Low Income Health Care Access Fund shall
55 be funded by:
56 (1) Appropriations to the Low Income Health Care Access
57 Fund.
58 (2) Money received from the Federal Government or other
59 sources.
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1 (3) Money required to be deposited in the Low Income
2 Health Care Access Fund pursuant to other provisions of this
3 chapter or any other law.
4 (4) Return on money in the Low Income Health Care Access
5 Fund, net of investment costs.
6 (c) Nonlapse.--The money in the Low Income Health Care
7 Access Fund is continuously appropriated to the Low Income
8 Health Care Access Fund and shall not lapse at the end of any
9 fiscal year.
10 CHAPTER 21
11 HEALTH CARE COMPARISON
12 Section 2101. Definitions.
13 The following words and phrases when used in this chapter
14 shall have the meanings given to them in this section unless the
15 context clearly indicates otherwise:
16 "Adult basic." The health investment insurance program
17 established under Chapter 13 of the act of June 26, 2001
18 (P.L.755, No.77), known as the Tobacco Settlement Act.
19 "Ambulatory service facility." A facility licensed in this
20 Commonwealth, not part of a hospital, which provides medical,
21 diagnostic or surgical treatment to patients not requiring
22 hospitalization, including ambulatory surgical facilities,
23 ambulatory imaging or diagnostic centers, birthing centers,
24 freestanding emergency rooms and any other facilities providing
25 ambulatory care which charge a separate facility charge.
26 Physician's offices and offices of other licensed health care
27 providers, whether in group or individual practices, shall be
28 considered ambulatory service facilities for the purposes of
29 this act.
30 "Children's Health Insurance Program" or "CHIP." The program
31 established under Article XXIII of the act of May 17, 1921
32 (P.L.682, No.284), known as The Insurance Company Law of 1921.
33 "Council." The Health Care Cost Containment Council.
34 "Covered services." Any health care services or procedures
35 connected with episodes of illness that require either inpatient
36 hospital care or major ambulatory service such as surgical,
37 medical or major radiological procedures, including any initial
38 and follow-up outpatient services associated with the episode of
39 illness before, during or after inpatient hospital care or major
40 ambulatory service. The term includes routine outpatient
41 services connected with episodes of illness that do not require
42 hospitalization or major ambulatory service, including all
43 office visits to physicians, chiropractors and other data
44 sources including other licensed health care providers.
45 "Data source." A hospital; ambulatory service facility;
46 physician; audiologist; birthing center; chiropractor; dentist;
47 doctor of medicine; mental health professional including
48 psychologists; nurse practitioner; optometrist; osteopath;
49 physical therapist; podiatrist; speech pathologist or other
50 licensed health care provider; health maintenance organization
51 as defined in the act of December 29, 1972 (P.L.1701, No.364),
52 known as the Health Maintenance Organization Act; hospital,
53 medical or health service plan with a certificate of authority
54 issued by the Insurance Department, including, but not limited
55 to, hospital plan corporations as defined in 40 Pa.C.S. Ch. 61
56 (relating to hospital plan corporations) and professional health
57 services plan corporations as defined in 40 Pa.C.S. Ch. 63
58 (relating to professional health services plan corporations);
59 commercial insurer with a certificate of authority issued by the
SB1137A06050 - 20 -
1 Insurance Department providing health or accident insurance;
2 self-insured employer providing health or accident coverage or
3 benefits for employees employed in the Commonwealth;
4 administrator of a self-insured or partially self-insured health
5 or accident plan providing covered services in the Commonwealth;
6 any health and welfare fund that provides health or accident
7 benefits or insurance pertaining to covered service in the
8 Commonwealth; the Department of Public Welfare for those covered
9 services it purchases or provides through the medical assistance
10 program under the act of June 13, 1967 (P.L.31, No.21), known as
11 the Public Welfare Code, and any other payor for covered
12 services in the Commonwealth other than an individual. This term
13 shall also include physicians.
14 "Health care facility." A general or special hospital,
15 including tuberculosis and psychiatric hospitals, kidney disease
16 treatment centers, including freestanding hemodialysis units,
17 birthing centers, offices of physicians, chiropractors and other
18 data sources including other licensed health care providers, and
19 ambulatory service facilities as defined in this section, and
20 hospices, both profit and nonprofit, and including those
21 operated by an agency of State or local government.
22 "Licensee." An individual who is a data source and is
23 licensed or certified by the Commonwealth of Pennsylvania to
24 provide a covered service in a hospital, an office or other
25 health care facility in this Commonwealth.
26 "Medical assistance." Medical treatment which is subsidized
27 or completely paid for by the Commonwealth under Article IV of
28 the act of June 13, 1967 (P.L.31, No.21), known as the Public
29 Welfare Code.
30 "Medicare." The program established under Title XVIII of the
31 Social Security Act (Public Law 74-271, 42 U.S.C. § 1395 et
32 seq.).
33 "Other licensed health care provider." Any of the following:
34 (1) a licensee;
35 (2) a health care facility; or
36 (3) an officer, employee or entity of a licensee or
37 health care facility acting in the course and scope of
38 employment.
39 "Physician." An individual licensed under the laws of this
40 Commonwealth to practice medicine or surgery within the scope of
41 the act of October 5, 1978 (P.L.1109, No.261), known as the
42 Osteopathic Medical Practice Act, or the act of December 20,
43 1985 (P.L.457, No.112), known as the Medical Practice Act of
44 1985. The term includes other licensed health care providers.
45 "Provider." A hospital, an ambulatory service facility or a
46 physician or a data source, a birthing center or other licensed
47 health care provider.
48 "Work group." The data abstraction and technology work group
49 established by the council under section 6(a.1) of the act of
50 July 8, 1986 (P.L.408, No.89), known as the Health Care Cost
51 Containment Act.
52 Section 2102. Powers and duties of council.
53 The council is hereby authorized to and shall compile and
54 establish an Internet database for the general public showing
55 physician charge comparisons for common services and treatments.
56 Section 2103. Data submission and collection.
57 (a) Abstraction and technology work group.--
58 (1) The work group shall develop a system of data
59 collection and analysis on physician charges for common
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1 services and treatments working with council staff and
2 outside third-party venders as needed and authorized by the
3 council. The analysis shall provide a methodology for
4 developing a charge comparison Internet search capability
5 showing most commonly utilized medical services and
6 treatments.
7 (2) The work group will, as part of its analysis,
8 examine physician charge comparison systems used in other
9 states as an addendum to its report identifying which
10 components of those other state systems are applicable or
11 appropriate to Pennsylvania. This analysis of other states
12 shall include descriptions as to how the physician charge
13 data is collected and shall include a recommendation to the
14 council, as to the most efficient, cost-effective and least
15 intrusive way to determine the physician charge comparisons
16 for common utilized services and treatments. The work group
17 recommendation to the council shall contain comparison by
18 common physician service or treatment and geographic location
19 of the physician searchable by county.
20 (3) This physician charge comparison shall also contain
21 data on reimbursement rates for adult basic, CHIP, Medicaid,
22 medical assistance, Medicare and insurer reimbursement rates
23 by insurer.
24 (4) The work group shall report its recommendations to
25 the council no later than 180 days after the effective date
26 of this section. The physician charge comparison described in
27 this paragraph shall be available to consumers beginning
28 January 1, 2009, or sooner.
29 (b) Data elements.--For each covered service performed in
30 Pennsylvania, the council shall be required to collect charges
31 from physicians for commonly utilized treatments as approved by
32 the council in accordance with subsection(a)(4).
33 Section 7. Section 1211 of the act of March 4, 1971 (P.L.6,
34 No.2), known as the Tax Reform Code of 1971, is repealed insofar
35 as it is inconsistent with the provisions of this act.
36 Section 8. All surcharges levied under 75 Pa.C.S. § 6506(a)
37 shall be transferred to the Hazardous Sites Cleanup Fund on and
38 after the effective date of this section.
39 Section 9. This act shall take effect as follows:
40 (1) Section 8 of this act shall take effect December 31,
41 2007, or immediately, whichever is later.
42 (2) The following provisions shall take effect July 1,
43 2008, or immediately, whichever is later:
44 (i) The repeal of section 712(e) of the act.
45 (ii) The amendment of the definition of "account" in
46 section 1101 of the act.
47 (iii) The amendment of section 1102(a) of the act.
48 (iv) The amendment of section 1105 of the act.
49 (v) The amendment of section 1112 of the act.
50 (vi) The addition of section 1116 of the act.
51 (vii) The addition of Chapter 13 of the act.
52 (viii) The addition of Chapter 15 of the act.
53 (ix) The addition of Chapter 17 of the act.
54 (x) The addition of Chapter 19 of the act.
55 (3) The remainder of this act shall take effect
56 immediately.
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