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        PRIOR PRINTER'S NOS. 1488, 1491               PRINTER'S NO. 1510

THE GENERAL ASSEMBLY OF PENNSYLVANIA


SENATE BILL

No. 1137 Session of 2007


        INTRODUCED BY D. WHITE, RAFFERTY, PILEGGI, ORIE, SCARNATI,
           ROBBINS, ERICKSON, GORDNER, C. WILLIAMS, FONTANA, MADIGAN,
           ARMSTRONG, PIPPY, FERLO, WONDERLING, WAUGH AND BAKER,
           OCTOBER 23, 2007

        SENATOR ARMSTRONG, APPROPRIATIONS, RE-REPORTED AS AMENDED,
           OCTOBER 29, 2007

                                     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 and, for the Medical Care     <--
    17     Availability and Reduction of Error Fund AND FOR ACTUARIAL     <--
    18     DATA; providing for the Medical Care Availability and
    19     Reduction of Error (Mcare) Reserve Fund; and further
    20     providing for abatement program, for the Health Care Provider
    21     Retention Account and for expiration.

    22     The General Assembly of the Commonwealth of Pennsylvania
    23  hereby enacts as follows:
    24     Section 1.  Sections 711 and 712, 712 AND 745 of the act of    <--
    25  March 20, 2002 (P.L.154, No.13), known as the Medical Care
    26  Availability and Reduction of Error (Mcare) Act, are amended to

     1  read:
     2  Section 711.  Medical professional liability insurance.
     3     (a)  Requirement.--A health care provider providing health
     4  care services in this Commonwealth shall:
     5         (1)  purchase medical professional liability insurance
     6     from an insurer which is licensed or approved by the
     7     department; or
     8         (2)  provide self-insurance.
     9     (b)  Proof of insurance.--A health care provider required by
    10  subsection (a) to purchase medical professional liability
    11  insurance or provide self-insurance shall submit proof of
    12  insurance or self-insurance to the department within 60 days of
    13  the policy being issued.
    14     (c)  Failure to provide proof of insurance.--If a health care
    15  provider fails to submit the proof of insurance or self-
    16  insurance required by subsection (b), the department shall,
    17  after providing the health care provider with notice, notify the
    18  health care provider's licensing authority. A health care
    19  provider's license shall be suspended or revoked by its
    20  licensure board or agency if the health care provider fails to
    21  comply with any of the provisions of this chapter.
    22     (d)  Basic coverage limits.--A health care provider shall
    23  insure or self-insure medical professional liability in
    24  accordance with the following:
    25         (1)  For policies issued or renewed in the calendar year
    26     2002, the basic insurance coverage shall be:
    27             (i)  $500,000 per occurrence or claim and $1,500,000
    28         per annual aggregate for a health care provider who
    29         conducts more than 50% of its health care business or
    30         practice within this Commonwealth and that is not a
    20070S1137B1510                  - 2 -     

     1         hospital.
     2             (ii)  $500,000 per occurrence or claim and $1,500,000
     3         per annual aggregate for a health care provider who
     4         conducts 50% or less of its health care business or
     5         practice within this Commonwealth.
     6             (iii)  $500,000 per occurrence or claim and
     7         $2,500,000 per annual aggregate for a hospital.
     8         (2)  For policies issued or renewed in the calendar years
     9     2003, 2004 and 2005, the basic insurance coverage shall be:
    10             (i)  $500,000 per occurrence or claim and $1,500,000
    11         per annual aggregate for a participating health care
    12         provider that is not a hospital.
    13             (ii)  $1,000,000 per occurrence or claim and
    14         $3,000,000 per annual aggregate for a nonparticipating
    15         health care provider.
    16             (iii)  $500,000 per occurrence or claim and
    17         $2,500,000 per annual aggregate for a hospital.
    18         (3)  Unless the commissioner finds pursuant to section
    19     745(a) that additional basic insurance coverage capacity is
    20     not available, for policies issued or renewed in calendar
    21     year 2006 and each year thereafter subject to paragraph (4),
    22     the basic insurance coverage shall be:
    23             (i)  Up to $750,000 per occurrence or claim and
    24         $2,250,000 per annual aggregate for a participating
    25         health care provider that is not a hospital.
    26             (ii)  Up to $1,000,000 per occurrence or claim and
    27         $3,000,000 per annual aggregate for a nonparticipating
    28         health care provider.
    29             (iii)  Up to $750,000 per occurrence or claim and
    30         $3,750,000 per annual aggregate for a hospital.
    20070S1137B1510                  - 3 -     

     1     If the commissioner finds pursuant to section 745(a) that
     2     additional basic insurance coverage capacity is not
     3     available, the basic insurance coverage requirements shall
     4     remain at the level required by paragraph (2); and the
     5     commissioner shall conduct a study every [two years] year
     6     until the commissioner finds that additional basic insurance
     7     coverage capacity is available, at which time the
     8     commissioner shall increase the required basic insurance
     9     coverage in accordance with this paragraph.
    10         (4)  Unless the commissioner finds pursuant to section
    11     745(b) that additional basic insurance coverage capacity is
    12     not available, for policies issued or renewed [three] two
    13     years after the increase in coverage limits required by
    14     paragraph (3) and for each year thereafter, the basic
    15     insurance coverage shall be:
    16             (i)  Up to $1,000,000 per occurrence or claim and
    17         $3,000,000 per annual aggregate for a participating
    18         health care provider that is not a hospital.
    19             (ii)  Up to $1,000,000 per occurrence or claim and
    20         $3,000,000 per annual aggregate for a nonparticipating
    21         health care provider.
    22             (iii)  Up to $1,000,000 per occurrence or claim and
    23         $4,500,000 per annual aggregate for a hospital.
    24     If the commissioner finds pursuant to section 745(b) that
    25     additional basic insurance coverage capacity is not
    26     available, the basic insurance coverage requirements shall
    27     remain at the level required by paragraph (3); and the
    28     commissioner shall conduct a study every [two years] year
    29     until the commissioner finds that additional basic insurance
    30     coverage capacity is available, at which time the
    20070S1137B1510                  - 4 -     

     1     commissioner shall increase the required basic insurance
     2     coverage in accordance with this paragraph.
     3         (5)  The amount of basic insurance coverage per
     4     occurrence or claim under paragraphs (3) and (4) shall be no
     5     less than $500,000 and shall be set in $50,000 increments.
     6         (6)  IN NO EVENT SHALL THE TOTAL COVERAGE FOR BASIC        <--
     7     PRIMARY INSURANCE AND THE FUND, PER OCCURRENCE OR CLAIM, BE
     8     LESS THAN $1,000,000 OR LESS THAN $3,000,000 PER ANNUAL
     9     AGGREGATE FOR A PARTICIPATING OR NONPARTICIPATING HEALTH CARE
    10     PROVIDER, EXCEPT HOSPITALS WHICH HAVE TOTAL COVERAGE LIMITS
    11     OF NOT LESS THAN $1,000,000 PER OCCURRENCE OR LESS THAN
    12     $4,500,000 PER ANNUAL AGGREGATE.
    13     (e)  Fund participation.--A participating health care
    14  provider shall be required to participate in the fund.
    15     (f)  Self-insurance.--
    16         (1)  If a health care provider self-insures its medical
    17     professional liability, the health care provider shall submit
    18     its self-insurance plan, such additional information as the
    19     department may require and the examination fee to the
    20     department for approval.
    21         (2)  The department shall approve the plan if it
    22     determines that the plan constitutes protection equivalent to
    23     the insurance required of a health care provider under
    24     subsection (d).
    25     (g)  Basic insurance liability.--
    26         (1)  An insurer providing medical professional liability
    27     insurance shall not be liable for payment of a claim against
    28     a health care provider for any loss or damages awarded in a
    29     medical professional liability action in excess of the basic
    30     insurance coverage required by subsection (d) unless the
    20070S1137B1510                  - 5 -     

     1     health care provider's medical professional liability
     2     insurance policy or self-insurance plan provides for a higher
     3     limit.
     4         (2)  If a claim exceeds the limits of a participating
     5     health care provider's basic insurance coverage or self-
     6     insurance plan, the fund shall be responsible for payment of
     7     the claim against the participating health care provider up
     8     to the fund liability limits.
     9     (h)  Excess insurance.--
    10         (1)  No insurer providing medical professional liability
    11     insurance with liability limits in excess of the fund's
    12     liability limits to a participating health care provider
    13     shall be liable for payment of a claim against the
    14     participating health care provider for a loss or damages in a
    15     medical professional liability action except the losses and
    16     damages in excess of the fund coverage limits.
    17         (2)  No insurer providing medical professional liability
    18     insurance with liability limits in excess of the fund's
    19     liability limits to a participating health care provider
    20     shall be liable for any loss resulting from the insolvency or
    21     dissolution of the fund.
    22     (i)  Governmental entities.--A governmental entity may
    23  satisfy its obligations under this chapter, as well as the
    24  obligations of its employees to the extent of their employment,
    25  by either purchasing medical professional liability insurance or
    26  assuming an obligation as a self-insurer, and paying the
    27  assessments under this chapter.
    28     (j)  Exemptions.--The following participating health care
    29  providers shall be exempt from this chapter:
    30         (1)  A physician who exclusively practices the specialty
    20070S1137B1510                  - 6 -     

     1     of forensic pathology.
     2         (2)  A participating health care provider who is a member
     3     of the Pennsylvania military forces while in the performance
     4     of the member's assigned duty in the Pennsylvania military
     5     forces under orders.
     6         (3)  A retired licensed participating health care
     7     provider who provides care only to the provider or the
     8     provider's immediate family members.
     9  Section 712.  Medical Care Availability and Reduction of Error
    10                 Fund.
    11     (a)  Establishment.--There is hereby established within the
    12  State Treasury a special fund to be known as the Medical Care
    13  Availability and Reduction of Error Fund. Money in the fund
    14  shall be used to pay claims against participating health care
    15  providers for losses or damages awarded in medical professional
    16  liability actions against them in excess of the basic insurance
    17  coverage required by section 711(d), liabilities transferred in
    18  accordance with subsection (b) and for the administration of the
    19  fund.
    20     (b)  Transfer of assets and liabilities.--
    21         (1)  (i)  The money in the Medical Professional Liability
    22         Catastrophe Loss Fund established under section 701(d) of
    23         the former act of October 15, 1975 (P.L.390, No.111),
    24         known as the Health Care Services Malpractice Act, is
    25         transferred to the fund.
    26             (ii)  The rights of the Medical Professional
    27         Liability Catastrophe Loss Fund established under section
    28         701(d) of the former Health Care Services Malpractice Act
    29         are transferred to and assumed by the fund.
    30         (2)  The liabilities and obligations of the Medical
    20070S1137B1510                  - 7 -     

     1     Professional Liability Catastrophe Loss Fund established
     2     under section 701(d) of the former Health Care Services
     3     Malpractice Act are transferred to and assumed by the fund.
     4     (c)  Fund liability limits.--
     5         (1)  For calendar year 2002, the limit of liability of
     6     the fund created in section 701(d) of the former Health Care
     7     Services Malpractice Act for each health care provider that
     8     conducts more than 50% of its health care business or
     9     practice within this Commonwealth and for each hospital shall
    10     be $700,000 for each occurrence and $2,100,000 per annual
    11     aggregate.
    12         (2)  The limit of liability of the fund for each
    13     participating health care provider shall be as follows:
    14             (i)  For calendar year 2003 and each year thereafter,
    15         the limit of liability of the fund shall be $500,000 for
    16         each occurrence and $1,500,000 per annual aggregate.
    17             (ii)  If the basic insurance coverage requirement is
    18         increased in accordance with section 711(d)(3) or (4)
    19         and, notwithstanding subparagraph (i), for each calendar
    20         year following the increase in the basic insurance
    21         coverage requirement, the limit of liability of the fund
    22         shall be [$250,000 for each occurrence and $750,000 per
    23         annual aggregate.
    24             (iii)  If the basic insurance coverage requirement is
    25         increased in accordance with section 711(d)(4) and,
    26         notwithstanding subparagraphs (i) and (ii), for each
    27         calendar year following the increase in the basic
    28         insurance coverage requirement, the limit of liability of
    29         the fund shall be zero] $1,000,000 per occurrence and
    30         $3,000,000 per annual aggregate, except hospitals which
    20070S1137B1510                  - 8 -     

     1         shall be $1,000,000 per occurrence and $4,500,000 per
     2         annual aggregate, minus the amount the commissioner
     3         determines for basic insurance coverage under section
     4         711(d)(3) and (4).
     5     (d)  Assessments.--
     6         (1)  For calendar year 2003 and for each year thereafter,
     7     the fund shall be funded by an assessment on each
     8     participating health care provider. Assessments shall be
     9     levied by the department on or after January 1 of each year.
    10     The assessment shall be based on the prevailing primary
    11     premium for each participating health care provider and
    12     shall, in the aggregate, produce an amount sufficient to do
    13     all of the following:
    14             (i)  Reimburse the fund for the payment of reported
    15         claims which became final during the preceding claims
    16         period.
    17             (ii)  Pay expenses of the fund incurred during the
    18         preceding claims period.
    19             (iii)  Pay principal and interest on moneys
    20         transferred into the fund in accordance with section
    21         713(c).
    22             (iv)  Provide a reserve that shall be 10% of the sum
    23         of subparagraphs (i), (ii) and (iii).
    24         (2)  The department shall notify all basic insurance
    25     coverage insurers and self-insured participating health care
    26     providers of the assessment by November 1 for the succeeding
    27     calendar year. The BEGINNING JANUARY 1, 2008, THE department   <--
    28     shall bill and collect the assessment from all participating
    29     health care providers.
    30         (3)  Any appeal of the assessment shall be filed with the
    20070S1137B1510                  - 9 -     

     1     department.
     2     (e)  Discount on surcharges and assessments.--
     3         (1)  For calendar year 2002, the department shall
     4     discount the aggregate surcharge imposed under section
     5     701(e)(1) of the Health Care Services Malpractice Act by 5%
     6     of the aggregate surcharge imposed under that section for
     7     calendar year 2001 in accordance with the following:
     8             (i)  Fifty percent of the aggregate discount shall be
     9         granted equally to hospitals and to participating health
    10         care providers that were surcharged as members of one of
    11         the four highest rate classes of the prevailing primary
    12         premium.
    13             (ii)  Notwithstanding subparagraph (i), 50% of the
    14         aggregate discount shall be granted equally to all
    15         participating health care providers.
    16             (iii)  The department shall issue a credit to a
    17         participating health care provider who, prior to the
    18         effective date of this section, has paid the surcharge
    19         imposed under section 701(e)(1) of the former Health Care
    20         Services Malpractice Act for calendar year 2002 prior to
    21         the effective date of this section.
    22         (2)  For calendar years 2003 and 2004, the department
    23     shall discount the aggregate assessment imposed under
    24     subsection (d) for each calendar year by 10% of the aggregate
    25     surcharge imposed under section 701(e)(1) of the former
    26     Health Care Services Malpractice Act for calendar year 2001
    27     in accordance with the following:
    28             (i)  Fifty percent of the aggregate discount shall be
    29         granted equally to hospitals and to participating health
    30         care providers that were assessed as members of one of
    20070S1137B1510                 - 10 -     

     1         the four highest rate classes of the prevailing primary
     2         premium.
     3             (ii)  Notwithstanding subparagraph (i), 50% of the
     4         aggregate discount shall be granted equally to all
     5         participating health care providers.
     6         (3)  For calendar years 2005 and thereafter, if the basic
     7     insurance coverage requirement is increased in accordance
     8     with section 711(d)(3) or (4), the department may discount
     9     the aggregate assessment imposed under subsection (d) by an
    10     amount not to exceed the aggregate sum to be deposited in the
    11     fund in accordance with subsection (m).
    12     (f)  Updated rates.--The joint underwriting association shall
    13  file updated rates for all health care providers with the
    14  commissioner by May 1 of each year. The department shall review
    15  and may adjust the prevailing primary premium in line with any
    16  applicable changes which have been approved by the commissioner.
    17     (g)  Additional adjustments of the prevailing primary
    18  premium.--The department shall adjust the applicable prevailing
    19  primary premium of each participating health care provider in
    20  accordance with the following:
    21         (1)  The applicable prevailing primary premium of a
    22     participating health care provider which is not a hospital
    23     may be adjusted through an increase in the individual
    24     participating health care provider's prevailing primary
    25     premium not to exceed 20%. Any adjustment shall be based upon
    26     the frequency of claims paid by the fund on behalf of the
    27     individual participating health care provider during the past
    28     five most recent claims periods and shall be in accordance
    29     with the following:
    30             (i)  If three claims have been paid during the past
    20070S1137B1510                 - 11 -     

     1         five most recent claims periods by the fund, a 10%
     2         increase shall be charged.
     3             (ii)  If four or more claims have been paid during
     4         the past five most recent claims periods by the fund, a
     5         20% increase shall be charged.
     6         (2)  The applicable prevailing primary premium of a
     7     participating health care provider which is not a hospital
     8     and which has not had an adjustment under paragraph (1) may
     9     be adjusted through an increase in the individual
    10     participating health care provider's prevailing primary
    11     premium not to exceed 20%. Any adjustment shall be based upon
    12     the severity of at least two claims paid by the fund on
    13     behalf of the individual participating health care provider
    14     during the past five most recent claims periods.
    15         (3)  The applicable prevailing primary premium of a
    16     participating health care provider not engaged in direct
    17     clinical practice on a full-time basis may be adjusted
    18     through a decrease in the individual participating health
    19     care provider's prevailing primary premium not to exceed 10%.
    20     Any adjustment shall be based upon the lower risk associated
    21     with the less-than-full-time direct clinical practice.
    22         (4)  The applicable prevailing primary premium of a
    23     hospital may be adjusted through an increase or decrease in
    24     the individual hospital's prevailing primary premium not to
    25     exceed 20%. Any adjustment shall be based upon the frequency
    26     and severity of claims paid by the fund on behalf of other
    27     hospitals of similar class, size, risk and kind within the
    28     same defined region during the past five most recent claims
    29     periods.
    30     (h)  Self-insured health care providers.--A participating
    20070S1137B1510                 - 12 -     

     1  health care provider that has an approved self-insurance plan
     2  shall be assessed an amount equal to the assessment imposed on a
     3  participating health care provider of like class, size, risk and
     4  kind as determined by the department.
     5     (i)  Change in basic insurance coverage.--If a participating
     6  health care provider changes the term of its medical
     7  professional liability insurance coverage, the assessment shall
     8  be calculated on an annual basis and shall reflect the
     9  assessment percentages in effect for the period over which the
    10  policies are in effect.
    11     (j)  Payment of claims.--Claims which became final during the
    12  preceding claims period shall be paid on or before December 31
    13  following the August 31 on which they became final.
    14     (k)  Termination.--Upon satisfaction of all liabilities of
    15  the fund, the fund shall terminate. Any balance remaining in the
    16  fund upon such termination shall be returned by the department
    17  to the participating health care providers who participated in
    18  the fund in proportion to their assessments in the preceding
    19  calendar year.
    20     (l)  Sole and exclusive source of funding.--Except as
    21  provided in subsection (m), the surcharges imposed under section
    22  701(e)(1) of the Health Care Services Malpractice Act and
    23  assessments on participating health care providers and any
    24  income realized by investment or reinvestment shall constitute
    25  the sole and exclusive sources of funding for the fund. Nothing
    26  in this subsection shall prohibit the fund from accepting
    27  contributions from nongovernmental sources. A claim against or a
    28  liability of the fund shall not be deemed to constitute a debt
    29  or liability of the Commonwealth or a charge against the General
    30  Fund.
    20070S1137B1510                 - 13 -     

     1     (m)  Supplemental funding.--Notwithstanding the provisions of
     2  75 Pa.C.S. § 6506(b) (relating to surcharge) to the contrary,
     3  beginning January 1, 2004, and for a period of nine calendar
     4  years thereafter, all surcharges levied and collected under 75
     5  Pa.C.S. § 6506(a) by any division of the unified judicial system
     6  shall be remitted to the Commonwealth for deposit in the Medical
     7  Care Availability and Restriction of Error Fund. These funds
     8  shall be used to reduce surcharges and assessments in accordance
     9  with subsection (e). Beginning January 1, 2014, and each year
    10  thereafter, the surcharges levied and collected under 75 Pa.C.S.
    11  § 6506(a) shall be deposited into the General Fund.
    12     (n)  Waiver of right to consent to settlement.--A
    13  participating health care provider may maintain the right to
    14  consent to a settlement in a basic insurance coverage policy for
    15  medical professional liability insurance upon the payment of an
    16  additional premium amount.
    17  SECTION 745.  ACTUARIAL DATA.                                     <--
    18     (A)  INITIAL STUDY.--THE FOLLOWING SHALL APPLY:
    19         (1)  NO LATER THAN APRIL 1, 2005, EACH INSURER PROVIDING
    20     MEDICAL PROFESSIONAL LIABILITY INSURANCE IN THIS COMMONWEALTH
    21     SHALL FILE LOSS DATA AS REQUIRED BY THE COMMISSIONER. FOR
    22     FAILURE TO COMPLY, THE COMMISSIONER SHALL IMPOSE AN
    23     ADMINISTRATIVE PENALTY OF $1,000 FOR EVERY DAY THAT THIS DATA
    24     IS NOT PROVIDED IN ACCORDANCE WITH THIS PARAGRAPH.
    25         (2)  BY JULY 1, 2005, THE COMMISSIONER SHALL CONDUCT A
    26     STUDY REGARDING THE AVAILABILITY OF ADDITIONAL BASIC
    27     INSURANCE COVERAGE CAPACITY. THE STUDY SHALL INCLUDE AN
    28     ESTIMATE OF THE TOTAL CHANGE IN MEDICAL PROFESSIONAL
    29     LIABILITY INSURANCE LOSS-COST RESULTING FROM IMPLEMENTATION
    30     OF THIS ACT PREPARED BY AN INDEPENDENT ACTUARY. THE FEE FOR
    20070S1137B1510                 - 14 -     

     1     THE INDEPENDENT ACTUARY SHALL BE BORNE BY THE FUND. IN
     2     DEVELOPING THE ESTIMATE, THE INDEPENDENT ACTUARY SHALL
     3     CONSIDER ALL OF THE FOLLOWING:
     4             (I)  THE MOST RECENT ACCIDENT YEAR AND RATEMAKING
     5         DATA AVAILABLE.
     6             (II)  ANY OTHER RELEVANT FACTORS WITHIN OR OUTSIDE
     7         THIS COMMONWEALTH IN ACCORDANCE WITH SOUND ACTUARIAL
     8         PRINCIPLES.
     9     (B)  ADDITIONAL STUDY.--THE FOLLOWING SHALL APPLY:
    10         (1)  THREE YEARS FOLLOWING THE INCREASE OF THE BASIC
    11     INSURANCE COVERAGE REQUIREMENT IN ACCORDANCE WITH SECTION
    12     711(D)(3), EACH INSURER PROVIDING MEDICAL PROFESSIONAL
    13     LIABILITY INSURANCE IN THIS COMMONWEALTH SHALL FILE LOSS DATA
    14     WITH THE COMMISSIONER UPON REQUEST. FOR FAILURE TO COMPLY,
    15     THE COMMISSIONER SHALL IMPOSE AN ADMINISTRATIVE PENALTY OF
    16     $1,000 FOR EVERY DAY THAT THIS DATA IS NOT PROVIDED IN
    17     ACCORDANCE WITH THIS PARAGRAPH.
    18         (2)  THREE MONTHS FOLLOWING THE REQUEST MADE UNDER
    19     PARAGRAPH (1), THE COMMISSIONER SHALL CONDUCT A STUDY
    20     REGARDING THE AVAILABILITY OF ADDITIONAL BASIC INSURANCE
    21     COVERAGE CAPACITY. THE STUDY SHALL INCLUDE AN ESTIMATE OF THE
    22     TOTAL CHANGE IN MEDICAL PROFESSIONAL LIABILITY INSURANCE
    23     LOSS-COST RESULTING FROM IMPLEMENTATION OF THIS ACT PREPARED
    24     BY AN INDEPENDENT ACTUARY. THE FEE FOR THE INDEPENDENT
    25     ACTUARY SHALL BE BORNE BY THE FUND. IN DEVELOPING THE
    26     ESTIMATE, THE INDEPENDENT ACTUARY SHALL CONSIDER ALL OF THE
    27     FOLLOWING:
    28             (I)  THE MOST RECENT ACCIDENT YEAR AND RATEMAKING
    29         DATA AVAILABLE.
    30             (II)  ANY OTHER RELEVANT FACTORS INCLUDING ECONOMIC
    20070S1137B1510                 - 15 -     

     1         CONSIDERATIONS WITHIN OR OUTSIDE THIS COMMONWEALTH IN
     2         ACCORDANCE WITH SOUND ACTUARIAL PRINCIPLES.
     3     Section 2.  Chapter 7 of the act is amended by adding
     4  subchapters to read:
     5                            SUBCHAPTER E
     6          MEDICAL CARE AVAILABILITY AND REDUCTION OF ERROR
     7                        (MCARE) RESERVE FUND
     8  Section 751.  Establishment.
     9     There is established within the State Treasury a special fund
    10  to be known as the Medical Care Availability and Reduction of
    11  Error (Mcare) Reserve Fund.
    12  Section 752.  Allocation.
    13     Money in the Medical Care Availability and Reduction of Error
    14  (Mcare) Reserve Fund shall be allocated annually as follows:
    15         (1)  Fifty percent of the total amount in the Medical
    16     Care Availability and Reduction of Error (Mcare) Reserve Fund
    17     shall remain in the Medical Care Availability and Reduction
    18     of Error (Mcare) Reserve Fund for the sole purpose of
    19     reducing the unfunded liability of the fund.
    20         (2)  Twenty-five percent of the total amount in the
    21     Medical Care Availability and Reduction of Error (Mcare)
    22     Reserve Fund shall be transferred to the Patient Safety Trust
    23     Fund for use by the Department of Public Welfare for
    24     implementing section 407.
    25         (3)  Twenty-five percent of the total amount in the
    26     Medical Care Availability and Reduction of Error (Mcare)
    27     Reserve Fund shall be transferred to the Medical Safety
    28     Automation Fund.
    29                            SUBCHAPTER F
    30                   MEDICAL SAFETY AUTOMATION FUND
    20070S1137B1510                 - 16 -     

     1  Section 762.  Medical Safety Automation Fund established.
     2     There is established within the State Treasury a special fund
     3  to be known as the Medical Safety Automation Fund. No money in
     4  the Medical Safety Automation Fund shall be used until
     5  legislation is enacted for the purpose of providing medical
     6  safety automation system grants to health care providers under
     7  the act of July 19, 1979 (P.L.130, No.48), known as the Health
     8  Care Facilities Act, a group practice or a community-based
     9  health care provider.
    10     Section 3.  Section 1102 of the act, amended October 27, 2006
    11  (P.L.1198, No.128), is amended to read:
    12  Section 1102.  Abatement program.
    13     (a)  Establishment.--There is hereby established within the
    14  Insurance Department a program to be known as the Health Care
    15  Provider Retention Program. The Insurance Department, in
    16  conjunction with the Department of Public Welfare, shall
    17  administer the program. The program shall provide assistance in
    18  the form of assessment abatements to health care providers for
    19  calendar years 2003, 2004, 2005, 2006 [and], 2007 and 2008,
    20  except that licensed podiatrists shall not be eligible for
    21  calendar years 2003 and 2004, and nursing homes shall not be
    22  eligible for calendar years 2003, 2004 and 2005.
    23     (b)  Other abatement.--Emergency physicians not employed full  <--
    24  time by a trauma center or working under an exclusive contract
    25     (B)  OTHER [ABATEMENT.--] ABATEMENTS.--                        <--
    26         (1)  EMERGENCY PHYSICIANS NOT EMPLOYED FULL TIME BY A
    27     TRAUMA CENTER OR WORKING UNDER AN EXCLUSIVE CONTRACT with a
    28     trauma center shall retain eligibility for an abatement
    29     pursuant to section 1104(b)(2) for calendar years 2003, 2004,
    30     2005 and 2006. Commencing in calendar year 2007, these
    20070S1137B1510                 - 17 -     

     1     emergency physicians shall be eligible for an abatement
     2     pursuant to section 1104(b)(1).
     3         (2)  BIRTH CENTERS SHALL RETAIN ELIGIBILITY FOR ABATEMENT  <--
     4     PURSUANT TO SECTION 1104(B)(2) FOR CALENDAR YEARS 2003, 2004,
     5     2005, 2006 AND 2007. COMMENCING IN CALENDAR YEAR 2008, BIRTH
     6     CENTERS SHALL BE ELIGIBLE FOR AN ABATEMENT PURSUANT TO
     7     SECTION 1104(B)(1).
     8     Section 4.  Section 1112 of the act, added December 22, 2005
     9  (P.L.458, No.88), is amended to read:
    10  Section 1112.  Health Care Provider Retention Account.
    11     (a)  Fund established.--There is established within the
    12  General Fund a special account to be known as the Health Care
    13  Provider Retention Account. Funds in the account shall be
    14  subject to an annual appropriation by the General Assembly to
    15  the Department of Public Welfare. The Department of Public
    16  Welfare shall administer funds appropriated under this section
    17  consistent with its duties under section 201(1) of the act of
    18  June 13, 1967 (P.L.31, No.21), known as the Public Welfare Code.
    19     (b)  Transfers from Mcare Fund.--By December 31 of each year,
    20  the Secretary of the Budget may transfer from the Medical Care
    21  Availability and Reduction of Error (Mcare) Fund established in
    22  section 712(a) to the account an amount equal to the difference
    23  between the amount deposited under section 712(m) and the amount
    24  granted as discounts under section 712(e)(2) for that calendar
    25  year.
    26     (c)  Transfers from account.--The Secretary of the Budget may
    27  annually transfer from the account to the Medical Care
    28  Availability and Reduction of Error (MCARE) Fund an amount up to
    29  the aggregate amount of abatements granted by the Insurance
    30  Department under section 1104(b).
    20070S1137B1510                 - 18 -     

     1     (c.1)  Transfers to the Medical Care Availability and
     2  Reduction of Error (Mcare) Reserve Fund.--If the Secretary of
     3  the Budget makes a transfer from the account under subsection
     4  (c), the remaining funds in the account shall be transferred to
     5  the Medical Care Availability and Reduction of Error (Mcare)
     6  Reserve Fund. If the Secretary of the Budget does not make a
     7  transfer from the account under subsection (c), all of the funds
     8  in the account shall be transferred to the Medical Care
     9  Availability and Reduction of Error (Mcare) Reserve Fund.
    10     (d)  Other deposits.--The Department of Public Welfare may
    11  deposit any other funds received by the department which it
    12  deems appropriate in the account.
    13     (e)  Administration assistance.--The Insurance Department
    14  shall provide assistance to the Department of Public Welfare in
    15  administering the account.
    16     Section 5.  Section 1115 of the act, amended October 27, 2006
    17  (P.L.1198, No.128), is amended to read:
    18  Section 1115.  Expiration.
    19     The Health Care Provider Retention Program established under
    20  this chapter shall expire December 31, [2008] 2009.
    21     Section 6.  Section 5106 of the act is amended to read:
    22  Section 5106.  Expiration.
    23     Section 312 shall expire on December 31, [2007] 2008.
    24     Section 7.  This act shall take effect in 60 days              <--
    25  IMMEDIATELY.                                                      <--




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