PRIOR PRINTER'S NOS. 2834, 3655 PRINTER'S NO. 3986
No. 2122 Session of 2001
INTRODUCED BY BROWNE, ARGALL, BELARDI, BENNINGHOFF, CAPPELLI,
CLARK, L. I. COHEN, CURRY, DAILEY, DALLY, DeLUCA, FORCIER,
FRANKEL, FREEMAN, GEIST, GEORGE, GRUCELA, HARHART, HENNESSEY,
HERMAN, HORSEY, HUTCHINSON, JAMES, MANDERINO, MANN, McCALL,
McILHATTAN, MELIO, S. MILLER, NAILOR, PIPPY, ROSS, SAMUELSON,
SATHER, SCHRODER, SHANER, SOLOBAY, STABACK, STEELMAN,
E. Z. TAYLOR, THOMAS, TIGUE, TRICH, WALKO, WASHINGTON,
WATERS, WATSON, C. WILLIAMS, WILT, WOJNAROSKI, YOUNGBLOOD,
YUDICHAK, ZUG AND HABAY, NOVEMBER 13, 2001
AS AMENDED ON THIRD CONSIDERATION, HOUSE OF REPRESENTATIVES,
JUNE 10, 2002
AN ACT
1 Amending the act of July 8, 1986 (P.L.408, No.89), entitled, as
2 reenacted and amended, "An act providing for the creation of
3 the Health Care Cost Containment Council, for its powers and
4 duties, for health care cost containment through the
5 collection and dissemination of data, for public
6 accountability of health care costs and for health care for
7 the indigent; and making an appropriation," further providing
8 for definitions, for data submission and collection and for
9 data dissemination and publication.
10 The General Assembly of the Commonwealth of Pennsylvania
11 hereby enacts as follows:
12 Section 1. Section 3 of the act of July 8, 1986 (P.L.408,
13 No.89), known as the Health Care Cost Containment Act, reenacted
14 and amended June 28, 1993 (P.L.146, No.34), is amended by adding
15 a definition to read:
16 Section 3. Definitions.
17 The following words and phrases when used in this act shall
1 have the meanings given to them in this section unless the
2 context clearly indicates otherwise:
3 * * *
4 "Enrollee." A policyholder, subscriber, covered person or
5 other individual who is entitled to receive health care services
6 under an HMO plan.
7 * * *
8 Section 2. Section 6(d) of the act is amended to read:
9 Section 6. Data submission and collection.
10 * * *
11 (d) [Provider quality] Quality and [provider] service
12 effectiveness data elements.--
13 (1) In carrying out its duty to collect data on provider
14 quality and provider service effectiveness under section
15 5(d)(4) and subsection (c)(21), the council shall define a
16 methodology to measure provider service effectiveness which
17 may include additional data elements to be specified by the
18 council sufficient to carry out its responsibilities under
19 section 5(d)(4). The council may adopt a nationally
20 recognized methodology of quantifying and collecting data on
21 provider quality and provider service effectiveness until
22 such time as the council has the capability of developing its
23 own methodology and standard data elements. The council shall
24 include in the Pennsylvania Uniform Claims and Billing Form a
25 field consisting of the data elements required pursuant to
26 subsection (c)(21) to provide information on each provision
27 of covered services sufficient to permit analysis of provider
28 quality and provider service effectiveness within 180 days of
29 commencement of its operations pursuant to section 4.
30 (2) In order to comparably measure performance of health
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1 maintenance organizations, the council has the following
2 powers and duties:
3 (i) To adopt and implement a system to comparatively
4 evaluate the quality of care outcomes and performance
5 measurements of health maintenance organizations on an
6 objective basis. This subparagraph includes, but is not
7 limited to, surveying enrollee satisfaction and assessing
8 health maintenance organizations' clinical and service
9 performance for:
10 (A) information and communication;
11 (B) treatment;
12 (C) preventive care;
13 (D) services for individuals with special needs;
14 (E) referrals; and
15 (F) options available to patients.
16 (ii) In carrying out its responsibilities, the
17 council shall not require health maintenance
18 organizations to report on additional data elements that
19 are not reported to nationally recognized accrediting
20 organizations or to the Department of Health or the
21 Insurance Department in quarterly or annual reports.
22 Furthermore, the council shall not require reporting by
23 HMOs in different formats than are required for reporting
24 to nationally recognized accrediting organizations or on
25 quarterly or annual reports submitted to the Department
26 of Health or the Insurance Department as required by
27 regulations of either department. The council may adopt
28 the quality findings as reported to nationally recognized
29 accrediting organizations.
30 * * *
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1 Section 3. Section 7(a) of the act is amended by adding a
2 paragraph to read:
3 Section 7. Data dissemination and publication.
4 (a) Public reports.--Subject to the restrictions on access
5 to council data set forth in section 10 and utilizing the data
6 collected under section 6 as well as other data, records and
7 matters of record available to it, the council shall prepare and
8 issue reports to the General Assembly and to the general public,
9 according to the following provisions:
10 * * *
11 (5) (i) The council shall, for every health maintenance
12 organization in this Commonwealth, prepare and issue an
13 annual report to assist consumers, purchasers and
14 providers with a comparison of health plan performance.
15 The council shall coordinate its work with existing
16 health plan performance measurement efforts developed by
17 other State agencies or nationally recognized accrediting
18 organizations. The annual report shall include, but is
19 not limited to, information in the following areas:
20 (A) Availability and appropriateness of services
21 and treatment provided to enrollees.
22 (B) Availability and appropriateness of
23 preventive care provided to enrollees.
24 (C) Availability and appropriateness of services
25 provided to enrollees with ongoing and/or severe
26 medical needs as well as those with special needs.
27 (D) Enrollee satisfaction, including access to
28 specialty care and services, satisfaction with
29 network adequacy and health plan materials.
30 (E) Licensure and accreditation status.
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1 (F) WAYS THAT CONSUMERS, PURCHASERS AND <--
2 PROVIDERS CAN FIND ADDITIONAL INFORMATION ON HEALTH
3 MAINTENANCE ORGANIZATIONS FROM OTHER COMMONWEALTH
4 AGENCIES, INCLUDING THE INSURANCE DEPARTMENT AND THE
5 DEPARTMENT OF HEALTH AND WHICH COMMONWEALTH AGENCIES
6 THEY MAY CONTACT IF THEY HAVE A PROBLEM WITH THEIR
7 HEALTH MAINTENANCE ORGANIZATION.
8 (ii) The council shall ensure that HMOs have an
9 opportunity to review the annual report at least 45 days
10 prior to public release.
11 (III) THE COUNCIL SHALL PUBLISH THE ANNUAL REPORT ON <--
12 THE COUNCIL'S INTERNET HOME PAGE AND PROVIDE EASILY
13 ACCESSIBLE ELECTRONIC MEANS TO VIEW THE INFORMATION
14 DESCRIBED IN SUBPARAGRAPH (I)(F), INCLUDING ANY RELEVANT
15 ELECTRONIC COMPLAINT FORMS ALREADY AVAILABLE ONLINE FROM
16 THE COMMONWEALTH.
17 * * *
18 Section 4. This act shall take effect in 180 days.
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