H1907B2609A07689     SFL:BTW  12/13/11     #90        A07689

AMENDMENTS TO HOUSE BILL NO. 1907

Sponsor: REPRESENTATIVE PASHINSKI

Printer's No. 2609

Amend Bill, page 1, line 15, by inserting after "providing"

 for declaration of policy,

Amend Bill, page 1, line 15, by inserting after "damages"

, for Medical Care Availability and Reduction of Error Fund, for

medical professional liability insurance by the joint

underwriting association, for approval of medical professional

liability insurers and for administrative definitions; and

providing for functions of the Department of Health

Amend Bill, page 1, lines 18 through 20, by striking out all

of said lines and inserting

Section 1.  Sections 102, 505(d), 712(g), 733, 741 and 902 of

the act of March 20, 2002 (P.L.154, No.13), known as the Medical

Care Availability and Reduction of Error (Mcare) Act, are

amended to read:

Section 102.  Declaration of policy.

The General Assembly finds and declares as follows:

(1)  It is the purpose of this act to ensure that medical

care is available in this Commonwealth through a

comprehensive and high-quality health care system.

(2)  Access to a full spectrum of hospital services and

to highly trained physicians in all specialties must be

available across this Commonwealth.

(3)  To maintain this system, medical professional

liability insurance has to be obtainable at an affordable and

reasonable cost in every geographic region of this

Commonwealth.

(4)  A person who has sustained injury or death as a

result of medical negligence by a health care provider must

be afforded a prompt determination and fair compensation.

(5)  Every effort must be made to reduce and eliminate

medical errors by identifying problems and implementing

solutions that promote patient safety.

(6)  Recognition and furtherance of all of these elements

is essential to the public health, safety and welfare of all

the citizens of Pennsylvania.

(7)  The costs of medical malpractice insurance premiums

are directly impacted by medical errors.

(8)  Research shows that a vast majority of medical

errors are systemic rather than human errors.

(9)  Total quality management systems implemented in

industry and by the United States Department of Veterans

Affairs hospital system have successfully reduced medical

errors.

(10)  It is the purpose of this act to improve patient

safety, improve health care quality and lower health care

costs by offering medical malpractice premium discounts to

health care providers that institute total quality management

health care systems.

Amend Bill, page 2, by inserting between lines 26 and 27

Section 712.  Medical Care Availability and Reduction of Error

Fund.

* * *

(g)  Additional adjustments of the prevailing primary

premium.--The department shall adjust the applicable prevailing

primary premium of each participating health care provider in

accordance with the following:

(1)  The applicable prevailing primary premium of a

participating health care provider which is not a hospital

may be adjusted through an increase in the individual

participating health care provider's prevailing primary

premium not to exceed 20%. Any adjustment shall be based upon

the frequency of claims paid by the fund on behalf of the

individual participating health care provider during the past

five most recent claims periods and shall be in accordance

with the following:

(i)  If three claims have been paid during the past

five most recent claims periods by the fund, a 10%

increase shall be charged.

(ii)  If four or more claims have been paid during

the past five most recent claims periods by the fund, a

20% increase shall be charged.

(2)  The applicable prevailing primary premium of a

participating health care provider which is not a hospital

and which has not had an adjustment under paragraph (1) may

be adjusted through an increase in the individual

participating health care provider's prevailing primary

premium not to exceed 20%. Any adjustment shall be based upon

the severity of at least two claims paid by the fund on

behalf of the individual participating health care provider

during the past five most recent claims periods.

(3)  The applicable prevailing primary premium of a

participating health care provider not engaged in direct

clinical practice on a full-time basis may be adjusted

through a decrease in the individual participating health

care provider's prevailing primary premium not to exceed 10%.

Any adjustment shall be based upon the lower risk associated

with the less-than-full-time direct clinical practice.

(4)  The applicable prevailing primary premium of a

hospital may be adjusted through an increase or decrease in

the individual hospital's prevailing primary premium not to

exceed 20%. Any adjustment shall be based upon the frequency

and severity of claims paid by the fund on behalf of other

hospitals of similar class, size, risk and kind within the

same defined region during the past five most recent claims

periods.

(5)  A participating health care provider that

implements, to the satisfaction of the Department of Health,

a total quality management health care system approved by the

Department of Health shall be entitled to a 20% discount in

the applicable prevailing primary premium for each fiscal

year in which the system is implemented.

* * *

Section 733.  Deficit.

(a)  Filing.--In the event the joint underwriting association

experiences a deficit in any calendar year, the board of

directors shall file with the commissioner the deficit.

(b)  Approval.--Within 30 days of receipt of the filing, the

commissioner shall approve or deny the filing. If approved, the

joint underwriting association is authorized to borrow funds

sufficient to satisfy the deficit.

(c)  Rate filing.--Within 30 days of receiving approval of

its filing in accordance with subsection (b), the joint

underwriting association shall file a rate filing with the

department. The commissioner shall approve the filing if [the]:

(1)  The premiums generate sufficient income for the

joint underwriting association to avoid a deficit during the

following 12 months and to repay principal and interest on

the money borrowed in accordance with subsection (b).

(2)  There is a 20% discount in each premium for a health

care provider that implements, to the satisfaction of the

Department of Health, a total quality management health care

system approved by the Department of Health.

Section 741.  Approval.

In order for an insurer to issue a policy of medical

professional liability insurance to a health care provider or to

a professional corporation, professional association or

partnership which is entirely owned by health care providers,

the insurer must [be] comply with all of the following:

(1)  Be authorized to write medical professional

liability insurance in accordance with the act of May 17,

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

1921.

(2)  Offer a 20% discount in the premium for a health

care provider that implements, to the satisfaction of the

Department of Health, a total quality management health care

system approved by the Department of Health.

Section 902.  Definitions.

The following words and phrases when used in this chapter

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

context clearly indicates otherwise:

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

"Licensure board."  Either or both of the following,

depending on the licensure of the affected individual:

(1)  The State Board of Medicine.

(2)  The State Board of Osteopathic Medicine.

"Physician."  An individual licensed under the laws of this

Commonwealth to engage in the practice of:

(1)  medicine and surgery in all its branches within the

scope of the act of December 20, 1985 (P.L.457, No.112),

known as the Medical Practice Act of 1985; or

(2)  osteopathic medicine and surgery within the scope of

the act of October 5, 1978 (P.L.1109, No.261), known as the

Osteopathic Medical Practice Act.

Section 2.  The act is amended by adding a section to read:

Section 911.  Department of Health.

(a)  Total quality management health care system approval.--

(1)  A total quality management health care system may

apply to the department for approval. The application must be

on a form prescribed by the Department of Health and must be

accompanied by a fee set by regulation.

(2)  Within 30 days of receipt of an application under

paragraph (1), the department shall do one of the following:

(i)  If the department determines that the system

will successfully reduce medical errors by a health care

provider, approve the application.

(ii)  If the department determines that the system

will not successfully reduce medical errors by a health

care provider, deny the application. This subparagraph is

subject to 2 Pa.C.S. Ch. 7 Subch. A (relating to judicial

review of Commonwealth agency action).

(3)  Failure to act within the time specified in

paragraph (2) shall be deemed approval of the application.

(b)  Total quality management health care system

implementation.--The department shall provide health care

providers with certification of implementation of total quality

management health care systems as required by sections 712(g)

(5), 733(c)(2) and 741(2).

(c)  Regulations.--The department may promulgate regulations

to implement this section.

Amend Bill, page 2, line 27, by striking out "2" and

inserting

 3