PRINTER'S NO. 306
No. 286 Session of 2003
INTRODUCED BY GREENLEAF, MOWERY, EARLL, O'PAKE, WOZNIAK,
ERICKSON AND ORIE, FEBRUARY 13, 2003
REFERRED TO BANKING AND INSURANCE, FEBRUARY 13, 2003
AN ACT
1 Amending the act of March 20, 2002 (P.L.154, No.13), entitled
2 "An act reforming the law on medical professional liability;
3 providing for patient safety and reporting; establishing the
4 Patient Safety Authority and the Patient Safety Trust Fund;
5 abrogating regulations; providing for medical professional
6 liability informed consent, damages, expert qualifications,
7 limitations of actions and medical records; establishing the
8 Interbranch Commission on Venue; providing for medical
9 professional liability insurance; establishing the Medical
10 Care Availability and Reduction of Error Fund; providing for
11 medical professional liability claims; establishing the Joint
12 Underwriting Association; regulating medical professional
13 liability insurance; providing for medical licensure
14 regulation; providing for administration; imposing penalties;
15 and making repeals," further providing for medical
16 professional liability insurance, for Medical Care
17 Availability and Reduction of Error Fund and for actuarial
18 data.
19 The General Assembly of the Commonwealth of Pennsylvania
20 hereby enacts as follows:
21 Section 1. Section 711(d) of the act of March 20, 2002
22 (P.L.154, No.13), known as the Medical Care Availability and
23 Reduction of Error (Mcare) Act, is amended and the section is
24 amended by adding subsections to read:
25 Section 711. Medical professional liability insurance.
1 * * *
2 (d) Basic coverage limits.--A health care provider shall
3 insure or self-insure medical professional liability in
4 accordance with the following:
5 (1) For policies issued or renewed in the calendar year
6 2002, the basic insurance coverage shall be:
7 (i) $500,000 per occurrence or claim and $1,500,000
8 per annual aggregate for a health care provider who
9 conducts more than 50% of its health care business or
10 practice within this Commonwealth and that is not a
11 hospital.
12 (ii) $500,000 per occurrence or claim and $1,500,000
13 per annual aggregate for a health care provider who
14 conducts 50% or less of its health care business or
15 practice within this Commonwealth.
16 (iii) $500,000 per occurrence or claim and
17 $2,500,000 per annual aggregate for a hospital.
18 (2) For policies issued or renewed in the calendar
19 [years 2003, 2004 and 2005,] year 2003, the basic insurance
20 coverage shall be:
21 (i) $500,000 per occurrence or claim and $1,500,000
22 per annual aggregate for a participating health care
23 provider that is not a hospital.
24 (ii) $1,000,000 per occurrence or claim and
25 $3,000,000 per annual aggregate for a nonparticipating
26 health care provider.
27 (iii) $500,000 per occurrence or claim and
28 $2,500,000 per annual aggregate for a hospital.
29 [(3) Unless the commissioner finds pursuant to section
30 745(a) that additional basic insurance coverage capacity is
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1 not available, for policies issued or renewed in calendar
2 year 2006 and each year thereafter subject to paragraph (4),
3 the basic insurance coverage shall be:
4 (i) $750,000 per occurrence or claim and $2,250,000
5 per annual aggregate for a participating health care
6 provider that is not a hospital.
7 (ii) $1,000,000 per occurrence or claim and
8 $3,000,000 per annual aggregate for a nonparticipating
9 health care provider.
10 (iii) $750,000 per occurrence or claim and
11 $3,750,000 per annual aggregate for a hospital.
12 If the commissioner finds pursuant to section 745(a) that
13 additional basic insurance coverage capacity is not
14 available, the basic insurance coverage requirements shall
15 remain at the level required by paragraph (2); and the
16 commissioner shall conduct a study every two years until the
17 commissioner finds that additional basic insurance coverage
18 capacity is available, at which time the commissioner shall
19 increase the required basic insurance coverage in accordance
20 with this paragraph.
21 (4) Unless the commissioner finds pursuant to section
22 745(b) that additional basic insurance coverage capacity is
23 not available, for policies issued or renewed three years
24 after the increase in coverage limits required by paragraph
25 (3) and for each year thereafter, the basic insurance
26 coverage shall be:
27 (i) $1,000,000 per occurrence or claim and
28 $3,000,000 per annual aggregate for a participating
29 health care provider that is not a hospital.
30 (ii) $1,000,000 per occurrence or claim and
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1 $3,000,000 per annual aggregate for a nonparticipating
2 health care provider.
3 (iii) $1,000,000 per occurrence or claim and
4 $4,500,000 per annual aggregate for a hospital.
5 If the commissioner finds pursuant to section 745(b) that
6 additional basic insurance coverage capacity is not
7 available, the basic insurance coverage requirements shall
8 remain at the level required by paragraph (3); and the
9 commissioner shall conduct a study every two years until the
10 commissioner finds that additional basic insurance coverage
11 capacity is available, at which time the commissioner shall
12 increase the required basic insurance coverage in accordance
13 with this paragraph.]
14 (d.1) Experience rating.--
15 (1) For the calendar year 2004, and each year
16 thereafter, a health care provider, other than a hospital,
17 shall insure or self-insure its professional liability in the
18 amount mandated by the department's experience rating system,
19 which shall not be more than $1,000,000 and less than
20 $250,000.
21 (2) The department shall establish an experience rating
22 system which shall be utilized by insurers in determining the
23 amount of medical professional liability insurance a health
24 care provider must obtain in order to provide health care in
25 this Commonwealth. The system shall include, but not be
26 limited to, the following criteria: number of years free from
27 serious and valid claims, frequency and severity of claims,
28 payout level of any settlements or jury verdicts, any
29 suspensions or disciplinary actions by a State licensing
30 board or hospital and degree of fault.
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1 (3) If the commissioner finds pursuant to section 745(a)
2 that additional basic insurance coverage capacity is
3 available, the commissioner shall, to the extent possible,
4 increase the percentage of basic insurance coverage and
5 decrease the percentage of fund coverage that comprises a
6 health care provider's total mandated medical professional
7 liability coverage level based on the health care provider's
8 experience rating. The commissioner shall conduct a study
9 every two years similar to the initial study required under
10 section 745(a).
11 (d.2) Disclosure of coverage.--A health care provider shall,
12 upon implementation of the department's experience rating system
13 under subsection (d.1), provide notice to the health care
14 provider's patients of the level of medical professional
15 liability coverage the health care provider is required to
16 maintain. The notice shall be printed on any consent form that
17 the patients must sign for a medical procedure.
18 * * *
19 Section 2. Section 712(c) of the act is amended to read:
20 Section 712. Medical Care Availability and Reduction of Error
21 Fund.
22 * * *
23 (c) Fund liability limits.--
24 (1) For calendar year 2002, the limit of liability of
25 the fund created in section 701(d) of the former Health Care
26 Services Malpractice Act for each health care provider that
27 conducts more than 50% of its health care business or
28 practice within this Commonwealth and for each hospital shall
29 be $700,000 for each occurrence and $2,100,000 per annual
30 aggregate.
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1 (2) The limit of liability of the fund for each
2 participating health care provider [shall be as follows:
3 (i) For] for calendar year 2003 [and each year
4 thereafter, the limit of liability of the fund] shall be
5 $500,000 for each occurrence and $1,500,000 per annual
6 aggregate.
7 [(ii) If the basic insurance coverage requirement is
8 increased in accordance with section 711(d)(3) and,
9 notwithstanding subparagraph (i), for each calendar year
10 following the increase in the basic insurance coverage
11 requirement, the limit of liability of the fund shall be
12 $250,000 for each occurrence and $750,000 per annual
13 aggregate.
14 (iii) If the basic insurance coverage requirement is
15 increased in accordance with section 711(d)(4) and,
16 notwithstanding subparagraphs (i) and (ii), for each
17 calendar year following the increase in the basic
18 insurance coverage requirement, the limit of liability of
19 the fund shall be zero.]
20 * * *
21 Section 3. Section 745(b) of the act is repealed.
22 Section 4. This act shall take effect in 60 days.
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