PRIOR PRINTER'S NOS. 578, 1578 PRINTER'S NO. 1973
No. 158 Session of 2003
INTRODUCED BY MICOZZIE, DeLUCA, HENNESSEY, MANDERINO, PIPPY,
SATHER, TANGRETTI, VANCE, WALKO, BISHOP, BROWNE, DAILEY,
J. EVANS, FREEMAN, LEVDANSKY, MUNDY, STABACK, STEIL, SURRA,
E. Z. TAYLOR, TIGUE, WASHINGTON AND YOUNGBLOOD,
FEBRUARY 26, 2003
AS AMENDED ON THIRD CONSIDERATION, HOUSE OF REPRESENTATIVES,
JUNE 9, 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 reporting; and <--
16 providing for DECLARATION OF POLICY, FOR POWERS AND DUTIES OF <--
17 THE AUTHORITY, FOR PATIENT SAFETY PLANS, FOR ADDITIONAL
18 ADJUSTMENTS OF THE PREVAILING PRIMARY PREMIUM, FOR MEDICAL
19 FACILITY REPORTS AND NOTIFICATION, FOR THE MEDICAL CARE
20 AVAILABILITY AND REDUCTION OF ERROR FUND, FOR MEDICAL
21 PROFESSIONAL LIABILITY INSURANCE BY THE JOINT UNDERWRITING
22 ASSOCIATION, FOR APPROVAL OF MEDICAL PROFESSIONAL LIABILITY
23 INSURERS, FOR ADMINISTRATIVE DEFINITIONS, FOR CLAIMS, FOR
24 MEDICAL PROFESSIONAL LIABILITY INSURANCE, FOR CANCELLATION OF
25 INSURANCE POLICY AND FOR REPORTING; PROVIDING FOR REPORTS BY
26 HOSPITALS AND HEALTH CARE FACILITIES AND FOR VOLUNTARY
27 CONTRACTUAL ARBITRATION; FURTHER PROVIDING FOR ANNUAL REPORT;
28 FURTHER DEFINING "NONPARTICIPATING HEALTH CARE PROVIDER" AND
29 "PARTICIPATING HEALTH CARE PROVIDER"; PROVIDING FOR public
30 disclosure of information concerning physicians; EXTENDING <--
1 PATIENT SAFETY STANDARDS TO CERTAIN ABORTION FACILITIES;
2 ESTABLISHING THE MCARE ASSESSMENT NEED PROGRAM; PROVIDING FOR
3 FAIR MEDICAL BILL PAYMENTS TO CERTAIN HIGH RISK HEALTH CARE
4 PROVIDERS AND ACUTE CARE INSTITUTIONS FOR CARE, TREATMENTS
5 AND SERVICES COVERED UNDER HEALTH INSURANCE POLICIES;
6 REQUIRING HEALTH INSURERS TO DISCLOSE FEE SCHEDULES AND ALL
7 RULES AND ALGORITHMS RELATING THERETO; REQUIRING HEALTH
8 INSURERS TO PROVIDE FULL PAYMENT TO PHYSICIANS WHEN MORE THAN
9 ONE SURGICAL PROCEDURE IS PERFORMED ON THE PATIENT BY THE
10 SAME PHYSICIAN DURING ONE CONTINUOUS OPERATING PROCEDURE; AND
11 PROVIDING FOR FUNCTIONS OF THE DEPARTMENT OF HEALTH, FOR
12 CAUSES OF ACTION AND FOR PENALTIES.
13 The General Assembly of the Commonwealth of Pennsylvania
14 hereby enacts as follows:
15 Section 1. Section 903 of the act of March 20, 2002 <--
16 (P.L.154, No.13), known as the Medical Care Availability and
17 Reduction of Error (Mcare) Act, is amended to read:
18 SECTION 1. SECTION 102 OF THE ACT OF MARCH 20, 2002 <--
19 (P.L.154, NO.13), KNOWN AS THE MEDICAL CARE AVAILABILITY AND
20 REDUCTION OF ERROR (MCARE) ACT, IS AMENDED TO READ:
21 SECTION 102. DECLARATION OF POLICY.
22 THE GENERAL ASSEMBLY FINDS AND DECLARES AS FOLLOWS:
23 (1) IT IS THE PURPOSE OF THIS ACT TO ENSURE THAT MEDICAL
24 CARE IS AVAILABLE IN THIS COMMONWEALTH THROUGH A
25 COMPREHENSIVE AND HIGH-QUALITY HEALTH CARE SYSTEM.
26 (2) ACCESS TO A FULL SPECTRUM OF HOSPITAL SERVICES AND
27 TO HIGHLY TRAINED PHYSICIANS IN ALL SPECIALTIES MUST BE
28 AVAILABLE ACROSS THIS COMMONWEALTH.
29 (3) TO MAINTAIN THIS SYSTEM, MEDICAL PROFESSIONAL
30 LIABILITY INSURANCE HAS TO BE OBTAINABLE AT AN AFFORDABLE AND
31 REASONABLE COST IN EVERY GEOGRAPHIC REGION OF THIS
32 COMMONWEALTH.
33 (4) A PERSON WHO HAS SUSTAINED INJURY OR DEATH AS A
34 RESULT OF MEDICAL NEGLIGENCE BY A HEALTH CARE PROVIDER MUST
35 BE AFFORDED A PROMPT DETERMINATION AND FAIR COMPENSATION.
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1 (5) EVERY EFFORT MUST BE MADE TO REDUCE AND ELIMINATE
2 MEDICAL ERRORS BY IDENTIFYING PROBLEMS AND IMPLEMENTING
3 SOLUTIONS THAT PROMOTE PATIENT SAFETY.
4 (6) RECOGNITION AND FURTHERANCE OF ALL OF THESE ELEMENTS
5 IS ESSENTIAL TO THE PUBLIC HEALTH, SAFETY AND WELFARE OF ALL
6 THE CITIZENS OF PENNSYLVANIA.
7 (7) THE COST OF MEDICAL MALPRACTICE INSURANCE PREMIUMS
8 ARE DIRECTLY IMPACTED BY MEDICAL ERRORS.
9 (8) HEALTH CARE PROVIDERS' COST OF POOR QUALITY IS
10 ESTIMATED TO BE AS HIGH AS 30% TO 50% OF THE TOTAL AMOUNT
11 PAID FOR HEALTH CARE.
12 (9) A 1999 STUDY BY THE INSTITUTE OF MEDICINE OF HARVARD
13 UNIVERSITY REVEALED THAT, EACH YEAR, AS MANY AS 98,000 PEOPLE
14 DIE AS A RESULT OF PREVENTABLE MEDICAL ERRORS WHICH COST THE
15 NATION AN ESTIMATED $29,000,000,000. THE STUDY CITES MEDICAL
16 ERRORS AS THE FIFTH LEADING CAUSE OF DEATH IN THE UNITED
17 STATES.
18 (10) RESEARCH SHOWS THAT A VAST MAJORITY OF MEDICAL
19 ERRORS ARE SYSTEMIC RATHER THAN HUMAN ERRORS.
20 (11) TOTAL QUALITY MANAGEMENT SYSTEMS IMPLEMENTED IN
21 INDUSTRY AND, RECENTLY, BY THE UNITED STATES DEPARTMENT OF
22 VETERANS AFFAIRS HOSPITAL SYSTEM HAVE SUCCESSFULLY REDUCED
23 MEDICAL ERRORS.
24 (12) IT IS THE PURPOSE OF THIS ACT TO IMPROVE PATIENT
25 SAFETY, IMPROVE HEALTH CARE QUALITY AND LOWER HEALTH CARE
26 COSTS BY OFFERING MEDICAL MALPRACTICE PREMIUM DISCOUNTS TO
27 HEALTH CARE PROVIDERS THAT INSTITUTE TOTAL QUALITY MANAGEMENT
28 HEALTH CARE SYSTEMS.
29 SECTION 2. THE DEFINITION OF "MEDICAL FACILITY" IN SECTION
30 302 OF THE ACT IS AMENDED AND THE SECTION IS AMENDED BY ADDING A
20030H0158B1973 - 3 -
1 DEFINITION TO READ:
2 SECTION 302. 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 "ABORTION FACILITY." A FACILITY OR MEDICAL FACILITY AS
7 DEFINED IN 18 PA.C.S. § 3203 (RELATING TO DEFINITIONS) WHICH IS
8 SUBJECT TO THIS CHAPTER PURSUANT TO SECTION 315(B) OR (C) AND
9 WHICH IS NOT SUBJECT TO LICENSURE UNDER THE HEALTH CARE
10 FACILITIES ACT.
11 * * *
12 "MEDICAL FACILITY." AN AMBULATORY SURGICAL FACILITY, BIRTH
13 CENTER [OR], HOSPITAL OR AN ABORTION FACILITY.
14 * * *
15 SECTION 3. SECTIONS 304(B), 305(C), 306(B), 307(D),
16 310(A)(2), 311(F)(1) AND 313 OF THE ACT ARE AMENDED TO READ:
17 SECTION 304. POWERS AND DUTIES.
18 * * *
19 (B) ANONYMOUS REPORTS TO THE AUTHORITY.--A HEALTH CARE
20 WORKER [WHO HAS COMPLIED WITH SECTION 308(A)] MAY FILE AN
21 ANONYMOUS REPORT REGARDING A SERIOUS EVENT WITH THE AUTHORITY.
22 UPON RECEIPT OF THE REPORT, THE AUTHORITY SHALL GIVE NOTICE TO
23 THE AFFECTED MEDICAL FACILITY THAT A REPORT HAS BEEN FILED. THE
24 AUTHORITY SHALL CONDUCT ITS OWN REVIEW OF THE REPORT UNLESS THE
25 MEDICAL FACILITY HAS ALREADY COMMENCED AN INVESTIGATION OF THE
26 SERIOUS EVENT. THE MEDICAL FACILITY SHALL PROVIDE THE AUTHORITY
27 WITH THE RESULTS OF ITS INVESTIGATION NO LATER THAN 30 DAYS
28 AFTER RECEIVING NOTICE PURSUANT TO THIS SUBSECTION. IF THE
29 AUTHORITY IS DISSATISFIED WITH THE ADEQUACY OF THE INVESTIGATION
30 CONDUCTED BY THE MEDICAL FACILITY, THE AUTHORITY SHALL PERFORM
20030H0158B1973 - 4 -
1 ITS OWN REVIEW OF THE SERIOUS EVENT AND MAY REFER A MEDICAL
2 FACILITY AND ANY INVOLVED LICENSEE TO THE DEPARTMENT FOR FAILURE
3 TO REPORT PURSUANT TO SECTION 313(E) AND (F).
4 * * *
5 SECTION 305. PATIENT SAFETY TRUST FUND.
6 * * *
7 (C) ASSESSMENT.--COMMENCING JULY 1, 2002, EACH MEDICAL
8 FACILITY SHALL PAY THE DEPARTMENT [A SURCHARGE ON ITS LICENSING
9 FEE] AN ASSESSMENT AS NECESSARY TO PROVIDE SUFFICIENT REVENUES
10 TO OPERATE THE AUTHORITY. THE TOTAL ASSESSMENT FOR ALL MEDICAL
11 FACILITIES SHALL NOT EXCEED $5,000,000. THE DEPARTMENT SHALL
12 TRANSFER THE TOTAL ASSESSMENT AMOUNT TO THE FUND WITHIN 30 DAYS
13 OF RECEIPT.
14 * * *
15 SECTION 306. DEPARTMENT RESPONSIBILITIES.
16 * * *
17 (B) DEPARTMENT CONSIDERATION.--THE RECOMMENDATIONS MADE TO
18 MEDICAL FACILITIES PURSUANT TO SUBSECTION (A)(4) MAY BE
19 CONSIDERED BY THE DEPARTMENT FOR LICENSURE PURPOSES UNDER THE
20 ACT OF JULY 19, 1979 (P.L.130, NO.48), KNOWN AS THE HEALTH CARE
21 FACILITIES ACT, AND, IN THE CASE OF ABORTION FACILITIES, AND FOR
22 APPROVAL OR REVOCATION PURPOSES PURSUANT TO 28 PA. CODE § 29.43
23 (RELATING TO FACILITY APPROVAL), BUT SHALL NOT BE CONSIDERED
24 MANDATORY UNLESS ADOPTED BY THE DEPARTMENT AS REGULATIONS
25 PURSUANT TO THE ACT OF JUNE 25, 1982 (P.L.633, NO.181), KNOWN AS
26 THE REGULATORY REVIEW ACT.
27 SECTION 307. PATIENT SAFETY PLANS.
28 * * *
29 (D) EMPLOYEE NOTIFICATION.--UPON APPROVAL OF THE PATIENT
30 SAFETY PLAN, A MEDICAL FACILITY SHALL NOTIFY ALL HEALTH CARE
20030H0158B1973 - 5 -
1 WORKERS OF THE MEDICAL FACILITY OF THE PATIENT SAFETY PLAN[.]
2 AND SPECIFICALLY DESIGNATE IN SUCH NOTIFICATION THE PROCESS
3 THROUGH WHICH HEALTH CARE WORKERS WILL REPORT ANY SERIOUS EVENTS
4 AND INCIDENTS AT THE MEDICAL FACILITY. THE DEPARTMENT SHALL
5 ESTABLISH FOR USE BY MEDICAL FACILITIES A UNIFORM PROCEDURE FOR
6 NOTIFYING HEALTH CARE WORKERS OF THE PATIENT SAFETY PLAN.
7 COMPLIANCE WITH THE PATIENT SAFETY PLAN SHALL BE REQUIRED AS A
8 CONDITION OF EMPLOYMENT OR CREDENTIALING AT THE MEDICAL
9 FACILITY.
10 SECTION 310. PATIENT SAFETY COMMITTEE.
11 (A) COMPOSITION.--
12 * * *
13 (2) AN AMBULATORY SURGICAL FACILITY'S, ABORTION
14 FACILITY'S OR BIRTH CENTER'S PATIENT SAFETY COMMITTEE SHALL
15 BE COMPOSED OF THE MEDICAL FACILITY'S PATIENT SAFETY OFFICER
16 AND AT LEAST ONE HEALTH CARE WORKER OF THE MEDICAL FACILITY
17 AND ONE RESIDENT OF THE COMMUNITY SERVED BY THE AMBULATORY
18 SURGICAL FACILITY, ABORTION FACILITY OR BIRTH CENTER WHO IS
19 NOT AN AGENT, EMPLOYEE OR CONTRACTOR OF THE AMBULATORY
20 SURGICAL FACILITY, ABORTION FACILITY OR BIRTH CENTER. NO MORE
21 THAN ONE MEMBER OF THE PATIENT SAFETY COMMITTEE SHALL BE A
22 MEMBER OF THE MEDICAL FACILITY'S BOARD OF GOVERNANCE. THE
23 COMMITTEE SHALL INCLUDE MEMBERS OF THE MEDICAL FACILITY'S
24 MEDICAL AND NURSING STAFF. THE COMMITTEE SHALL MEET AT LEAST
25 QUARTERLY.
26 * * *
27 SECTION 311. CONFIDENTIALITY AND COMPLIANCE.
28 * * *
29 (F) ACCESS.--
30 (1) THE DEPARTMENT SHALL HAVE ACCESS TO THE INFORMATION
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1 UNDER SECTION 313(A) OR (C) AND MAY USE SUCH INFORMATION FOR
2 THE SOLE PURPOSE OF ANY LICENSURE, APPROVAL OR CORRECTIVE
3 ACTION AGAINST A MEDICAL FACILITY. THIS EXEMPTION TO USE THE
4 INFORMATION RECEIVED PURSUANT TO SECTION 313(A) OR (C) SHALL
5 ONLY APPLY TO LICENSURE OR CORRECTIVE ACTIONS AND SHALL NOT
6 BE UTILIZED TO PERMIT THE DISCLOSURE OF ANY INFORMATION
7 OBTAINED UNDER SECTION 313(A) OR (C) FOR ANY OTHER PURPOSE.
8 * * *
9 SECTION 313. MEDICAL FACILITY REPORTS AND NOTIFICATIONS.
10 (A) SERIOUS EVENT REPORTS.--A MEDICAL FACILITY SHALL REPORT
11 THE OCCURRENCE OF A SERIOUS EVENT TO THE DEPARTMENT AND THE
12 AUTHORITY WITHIN 24 HOURS OF THE MEDICAL FACILITY'S CONFIRMATION
13 OF THE OCCURRENCE OF THE SERIOUS EVENT. THE REPORT TO THE
14 DEPARTMENT AND THE AUTHORITY SHALL BE IN THE FORM AND MANNER
15 PRESCRIBED BY THE AUTHORITY IN CONSULTATION WITH THE DEPARTMENT
16 AND SHALL NOT INCLUDE THE NAME OF ANY PATIENT OR ANY OTHER
17 IDENTIFIABLE INDIVIDUAL INFORMATION.
18 (B) INCIDENT REPORTS.--A MEDICAL FACILITY SHALL REPORT THE
19 OCCURRENCE OF AN INCIDENT TO THE AUTHORITY IN A FORM AND MANNER
20 PRESCRIBED BY THE AUTHORITY AND SHALL NOT INCLUDE THE NAME OF
21 ANY PATIENT OR ANY OTHER IDENTIFIABLE INDIVIDUAL INFORMATION.
22 (C) INFRASTRUCTURE FAILURE REPORTS.--A MEDICAL FACILITY
23 SHALL REPORT THE OCCURRENCE OF AN INFRASTRUCTURE FAILURE TO THE
24 DEPARTMENT WITHIN 24 HOURS OF THE MEDICAL FACILITY'S
25 CONFIRMATION OF THE OCCURRENCE OR DISCOVERY OF THE
26 INFRASTRUCTURE FAILURE. THE REPORT TO THE DEPARTMENT SHALL BE IN
27 THE FORM AND MANNER PRESCRIBED BY THE DEPARTMENT.
28 (D) EFFECT OF REPORT.--COMPLIANCE WITH THIS SECTION BY A
29 MEDICAL FACILITY SHALL SATISFY THE REPORTING REQUIREMENTS OF THE
30 ACT OF JULY 19, 1979 (P.L.130, NO.48), KNOWN AS THE HEALTH CARE
20030H0158B1973 - 7 -
1 FACILITIES ACT.
2 (E) NOTIFICATION TO LICENSURE BOARDS.--IF A MEDICAL FACILITY
3 DISCOVERS THAT A LICENSEE PROVIDING HEALTH CARE SERVICES IN THE
4 MEDICAL FACILITY DURING A SERIOUS EVENT FAILED TO REPORT THE
5 EVENT IN ACCORDANCE WITH SECTION 308(A), THE MEDICAL FACILITY
6 SHALL NOTIFY THE LICENSEE'S LICENSING BOARD OF THE FAILURE TO
7 REPORT.
8 (E.1) ADDITIONAL REPORTING.--IF A MEDICAL FACILITY IS NAMED
9 IN A MEDICAL LIABILITY ACTION WHICH RESULTS IN A JUDGMENT
10 AGAINST THE FACILITY OF $50,000 OR MORE, THE MEDICAL FACILITY
11 SHALL, WITHIN 30 DAYS OF FINAL ADJUDICATION, REPORT THE JUDGMENT
12 TO THE DEPARTMENT. THE REPORT SHALL CONTAIN A DESCRIPTION OF THE
13 OCCURRENCE, THE LOCATION THE OCCURRENCE TOOK PLACE AND THE
14 AMOUNT OF THE AWARD. THE DEPARTMENT SHALL MAKE SUCH REPORTS
15 AVAILABLE TO THE GENERAL PUBLIC ON ITS WORLD WIDE WEB SITE.
16 (F) FAILURE TO REPORT OR NOTIFY.--FAILURE TO [REPORT A
17 SERIOUS EVENT OR AN INFRASTRUCTURE FAILURE AS REQUIRED BY THIS
18 SECTION] COMPLY WITH THE REPORTING REQUIREMENTS OF SUBSECTION
19 (A), (B) OR (E.1) OR TO DEVELOP AND COMPLY WITH THE PATIENT
20 SAFETY PLAN IN ACCORDANCE WITH SECTION 307 OR TO NOTIFY THE
21 PATIENT IN ACCORDANCE WITH SECTION 308(B) SHALL BE A VIOLATION
22 OF THE HEALTH CARE FACILITIES ACT[.] AND, IN THE CASE OF AN
23 ABORTION FACILITY, MAY BE A BASIS FOR REVOCATION OF APPROVAL
24 PURSUANT TO 28 PA. CODE § 29.43 (RELATING TO FACILITY APPROVAL).
25 IN ADDITION TO ANY PENALTY WHICH MAY BE IMPOSED UNDER THE HEALTH
26 CARE FACILITIES ACT[,A] OR UNDER 18 PA.C.S. CH. 32 (RELATING TO
27 ABORTION):
28 (1) A MEDICAL FACILITY WHICH FAILS TO REPORT A SERIOUS
29 EVENT OR AN INFRASTRUCTURE FAILURE OR TO NOTIFY A LICENSURE
30 BOARD IN ACCORDANCE WITH THIS CHAPTER MAY BE SUBJECT TO AN
20030H0158B1973 - 8 -
1 ADMINISTRATIVE PENALTY OF $1,000 PER DAY IMPOSED BY THE
2 DEPARTMENT.
3 (2) A MEDICAL FACILITY WHICH FAILS TO NOTIFY A PATIENT
4 IN ACCORDANCE WITH SECTION 308(B) IS SUBJECT TO AN
5 ADMINISTRATIVE PENALTY OF $5,000 IMPOSED BY THE DEPARTMENT.
6 SECTION 4. THE ACT IS AMENDED BY ADDING A SECTION TO READ:
7 SECTION 315. ABORTION FACILITIES.
8 (A) GENERAL.--THIS SECTION SHALL APPLY TO ABORTION
9 FACILITIES.
10 (B) APPLICATION DURING CURRENT YEAR.--AN ABORTION FACILITY
11 THAT PERFORMS 100 OR MORE ABORTIONS AFTER THE EFFECTIVE DATE OF
12 THIS ACT DURING THE CALENDAR YEAR IN WHICH THIS SECTION TAKES
13 EFFECT SHALL BE SUBJECT TO PROVISIONS OF THIS CHAPTER AT THE
14 BEGINNING OF THE IMMEDIATELY FOLLOWING CALENDAR YEAR AND DURING
15 EACH SUBSEQUENT CALENDAR YEAR UNLESS THE FACILITY GIVES THE
16 DEPARTMENT WRITTEN NOTICE THAT IT WILL NOT BE PERFORMING 100 OR
17 MORE ABORTIONS DURING SUCH FOLLOWING CALENDAR YEAR AND DOES NOT
18 PERFORM 100 OR MORE ABORTIONS DURING THAT CALENDAR YEAR.
19 (C) APPLICATION IN SUBSEQUENT CALENDAR YEARS.--IN THE
20 CALENDAR YEARS FOLLOWING THE EFFECTIVE DATE OF THIS ACT, THIS
21 CHAPTER SHALL APPLY TO AN ABORTION FACILITY NOT SUBJECT TO
22 SUBSECTION (B) ON THE DAY FOLLOWING THE PERFORMANCE OF ITS 100TH
23 ABORTION AND FOR THE REMAINDER OF THAT CALENDAR YEAR AND DURING
24 EACH SUBSEQUENT CALENDAR YEAR UNLESS THE FACILITY GIVES THE
25 DEPARTMENT WRITTEN NOTICE THAT IT WILL NOT BE PERFORMING 100 OR
26 MORE ABORTIONS DURING SUCH FOLLOWING CALENDAR YEAR AND DOES NOT
27 PERFORM 100 OR MORE ABORTIONS DURING THAT CALENDAR YEAR.
28 (D) PATIENT SAFETY PLAN.--AN ABORTION FACILITY SHALL SUBMIT
29 ITS PATIENT SAFETY PLAN UNDER SECTION 307(C) WITHIN 60 DAYS
30 FOLLOWING THE APPLICATION OF THIS CHAPTER TO THE FACILITY.
20030H0158B1973 - 9 -
1 (E) REPORTING.--AN ABORTION FACILITY SHALL BEGIN REPORTING
2 SERIOUS EVENTS, INCIDENTS AND INFRASTRUCTURE FAILURES CONSISTENT
3 WITH THE REQUIREMENTS OF SECTION 313 UPON THE SUBMISSION OF ITS
4 PATIENT SAFETY PLAN TO THE DEPARTMENT.
5 (F) CONSTRUCTION.--NOTHING IN THIS CHAPTER SHALL BE
6 CONSTRUED TO LIMIT THE PROVISIONS OF 18 PA.C.S. CH. 32 (RELATING
7 TO ABORTION) OR ANY REGULATION ADOPTED UNDER 18 PA.C.S. CH. 32.
8 SECTION 5. THE DEFINITIONS OF "NONPARTICIPATING HEALTH CARE
9 PROVIDER" AND "PARTICIPATING HEALTH CARE PROVIDER" IN SECTION
10 702 OF THE ACT ARE AMENDED TO READ:
11 SECTION 702. DEFINITIONS.
12 THE FOLLOWING WORDS AND PHRASES WHEN USED IN THIS CHAPTER
13 SHALL HAVE THE MEANINGS GIVEN TO THEM IN THIS SECTION UNLESS THE
14 CONTEXT CLEARLY INDICATES OTHERWISE:
15 * * *
16 "NONPARTICIPATING HEALTH CARE PROVIDER." A HEALTH CARE
17 PROVIDER AS DEFINED IN SECTION 103 THAT CONDUCTS [20%] 50% OR
18 LESS OF ITS HEALTH CARE BUSINESS OR PRACTICE WITHIN THIS
19 COMMONWEALTH.
20 "PARTICIPATING HEALTH CARE PROVIDER." A HEALTH CARE PROVIDER
21 AS DEFINED IN SECTION 103 THAT CONDUCTS MORE THAN [20%] 50% OF
22 ITS HEALTH CARE BUSINESS OR PRACTICE WITHIN THIS COMMONWEALTH OR
23 A NONPARTICIPATING HEALTH CARE PROVIDER WHO CHOOSES TO
24 PARTICIPATE IN THE FUND.
25 * * *
26 SECTION 6. SECTIONS 712(G), 714(G), 732, 733, 741 AND 747 OF
27 THE ACT ARE AMENDED TO READ:
28 SECTION 712. MEDICAL CARE AVAILABILITY AND REDUCTION OF ERROR
29 FUND.
30 * * *
20030H0158B1973 - 10 -
1 (G) ADDITIONAL ADJUSTMENTS OF THE PREVAILING PRIMARY
2 PREMIUM.--THE DEPARTMENT SHALL ADJUST THE APPLICABLE PREVAILING
3 PRIMARY PREMIUM OF EACH PARTICIPATING HEALTH CARE PROVIDER IN
4 ACCORDANCE WITH THE FOLLOWING:
5 (1) THE APPLICABLE PREVAILING PRIMARY PREMIUM OF A
6 PARTICIPATING HEALTH CARE PROVIDER WHICH IS NOT A HOSPITAL
7 MAY BE ADJUSTED THROUGH AN INCREASE IN THE INDIVIDUAL
8 PARTICIPATING HEALTH CARE PROVIDER'S PREVAILING PRIMARY
9 PREMIUM NOT TO EXCEED 20%. ANY ADJUSTMENT SHALL BE BASED UPON
10 THE FREQUENCY OF CLAIMS PAID BY THE FUND ON BEHALF OF THE
11 INDIVIDUAL PARTICIPATING HEALTH CARE PROVIDER DURING THE PAST
12 FIVE MOST RECENT CLAIMS PERIODS AND SHALL BE IN ACCORDANCE
13 WITH THE FOLLOWING:
14 (I) IF THREE CLAIMS HAVE BEEN PAID DURING THE PAST
15 FIVE MOST RECENT CLAIMS PERIODS BY THE FUND, A 10%
16 INCREASE SHALL BE CHARGED.
17 (II) IF FOUR OR MORE CLAIMS HAVE BEEN PAID DURING
18 THE PAST FIVE MOST RECENT CLAIMS PERIODS BY THE FUND, A
19 20% INCREASE SHALL BE CHARGED.
20 (2) THE APPLICABLE PREVAILING PRIMARY PREMIUM OF A
21 PARTICIPATING HEALTH CARE PROVIDER WHICH IS NOT A HOSPITAL
22 AND WHICH HAS NOT HAD AN ADJUSTMENT UNDER PARAGRAPH (1) MAY
23 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 SEVERITY OF AT LEAST TWO CLAIMS PAID BY THE FUND ON
27 BEHALF OF THE INDIVIDUAL PARTICIPATING HEALTH CARE PROVIDER
28 DURING THE PAST FIVE MOST RECENT CLAIMS PERIODS.
29 (3) THE APPLICABLE PREVAILING PRIMARY PREMIUM OF A
30 PARTICIPATING HEALTH CARE PROVIDER NOT ENGAGED IN DIRECT
20030H0158B1973 - 11 -
1 CLINICAL PRACTICE ON A FULL-TIME BASIS MAY BE ADJUSTED
2 THROUGH A DECREASE IN THE INDIVIDUAL PARTICIPATING HEALTH
3 CARE PROVIDER'S PREVAILING PRIMARY PREMIUM [NOT TO EXCEED
4 10%]. ANY ADJUSTMENT SHALL BE BASED UPON THE LOWER RISK
5 ASSOCIATED WITH THE LESS-THAN-FULL-TIME DIRECT CLINICAL
6 PRACTICE.
7 (4) THE APPLICABLE PREVAILING PRIMARY PREMIUM OF A
8 HOSPITAL MAY BE ADJUSTED THROUGH AN INCREASE OR DECREASE IN
9 THE INDIVIDUAL HOSPITAL'S PREVAILING PRIMARY PREMIUM NOT TO
10 EXCEED 20%. ANY ADJUSTMENT SHALL BE BASED UPON THE FREQUENCY
11 AND SEVERITY OF CLAIMS PAID BY THE FUND ON BEHALF OF OTHER
12 HOSPITALS OF SIMILAR CLASS, SIZE, RISK AND KIND WITHIN THE
13 SAME DEFINED REGION DURING THE PAST FIVE MOST RECENT CLAIMS
14 PERIODS.
15 (5) A PARTICIPATING HEALTH CARE PROVIDER THAT
16 IMPLEMENTS, TO THE SATISFACTION OF THE DEPARTMENT OF HEALTH,
17 A TOTAL QUALITY MANAGEMENT HEALTH CARE SYSTEM APPROVED BY THE
18 DEPARTMENT OF HEALTH SHALL BE ENTITLED TO A 20% DISCOUNT IN
19 THE APPLICABLE PREVAILING PRIMARY PREMIUM FOR EACH FISCAL
20 YEAR IN WHICH THE SYSTEM IS IMPLEMENTED.
21 * * *
22 SECTION 714. MEDICAL PROFESSIONAL LIABILITY CLAIMS.
23 * * *
24 (G) [MEDIATION. - UPON THE REQUEST OF A PARTY TO A MEDICAL
25 PROFESSIONAL LIABILITY CLAIM WITHIN THE FUND COVERAGE LIMITS,
26 THE DEPARTMENT MAY PROVIDE FOR A MEDIATOR IN INSTANCES WHERE
27 MULTIPLE CARRIERS DISAGREE ON THE DISPOSITION OR SETTLEMENT OF A
28 CASE. UPON THE CONSENT OF ALL PARTIES, THE MEDIATION SHALL BE
29 BINDING. PROCEEDING CONDUCTED AND INFORMATION PROVIDED IN
30 ACCORDANCE WITH THIS SECTION SHALL BE CONFIDENTIAL AND SHALL NOT
20030H0158B1973 - 12 -
1 BE CONSIDERED PUBLIC INFORMATION SUBJECT TO DISCLOSURE UNDER THE
2 ACT OF JUNE 21, 1957 (P.L. 390, NO. 212), REFERRED TO AS THE
3 RIGHT-TO-KNOW LAW, OR 65 PA.C.S. CH. 7 (RELATING TO OPEN
4 MEETINGS).] MEDICAL MALPRACTICE SMALL CLAIMS DISPUTE
5 RESOLUTION.--
6 (1) IF A CLAIMANT BELIEVES THAT HE IS A VICTIM OF
7 MEDICAL MALPRACTICE, HE SHALL HAVE THE RIGHT TO REQUEST THAT
8 THE CLAIM BE HEARD BY MEDICAL MALPRACTICE SMALL CLAIMS
9 ARBITRATION, MEDICAL MALPRACTICE SMALL CLAIMS MEDIATION OR
10 SUMMARY JURY TRIAL AS ALTERNATIVES TO FORMAL LITIGATION IN
11 FEDERAL OR STATE COURT.
12 (2) (I) IN ORDER TO UTILIZE THE MEDICAL MALPRACTICE
13 SMALL CLAIMS ARBITRATION PROCEDURE, ALL PARTIES MUST
14 AGREE IN WRITING TO SUBMIT THE CLAIM TO MEDICAL
15 MALPRACTICE SMALL CLAIMS ARBITRATION AND BE SUBJECT TO
16 THE PROVISIONS OF THIS SUBSECTION. THE ARBITRATION
17 PROCEDURE SHALL BE COMMENCED BY THE CLAIMANT SERVING THE
18 DEFENDANT, VIA CERTIFIED OR REGISTERED MAIL, WITH A
19 STATEMENT OF CLAIM AND NOTICE OF INTENT. THE STATEMENT OF
20 CLAIM SHALL SET FORTH, WITH SUFFICIENT SPECIFICITY AS
21 REQUIRED IN A FORMAL CIVIL COMPLAINT PURSUANT TO THE
22 PENNSYLVANIA RULES OF CIVIL PROCEDURE, THE NATURE OF THE
23 ALLEGED MALPRACTICE, THE RESULTING INJURIES AND THE
24 DAMAGES SOUGHT. THE NOTICE OF INTENT SHALL STATE THAT THE
25 CLAIMANT DESIRES TO HAVE THE CLAIM HEARD BY MEDICAL
26 MALPRACTICE SMALL CLAIMS ARBITRATION AND INQUIRES WHETHER
27 THE DEFENDANT DESIRES THE SAME. IF THE DEFENDANT DOES NOT
28 RESPOND WITHIN 30 DAYS OF SERVICE OF THE STATEMENT OF
29 CLAIM AND NOTICE OF INTENT, IT SHALL BE DEEMED THAT THE
30 DEFENDANT DOES NOT AGREE TO HAVE THE CLAIM HEARD BY
20030H0158B1973 - 13 -
1 MEDICAL MALPRACTICE SMALL CLAIMS ARBITRATION AND THE
2 CLAIM SHALL NOT BE HEARD IN THAT MANNER. IF THE DEFENDANT
3 DOES AGREE TO HAVE THE CLAIM HEARD IN THAT MANNER, AN
4 AFFIRMATIVE RESPONSE SHALL BE SERVED UPON THE CLAIMANT
5 WITHIN 30 DAYS OF INITIAL SERVICE ALONG WITH AN ANSWER TO
6 THE STATEMENT OF CLAIM, AS WOULD BE FILED IN RESPONSE TO
7 A FORMAL CIVIL COMPLAINT PURSUANT TO THE PENNSYLVANIA
8 RULES OF CIVIL PROCEDURE. A DEFENDANT'S AGREEMENT,
9 DISAGREEMENT OR LACK OF RESPONSE TO A MEDICAL MALPRACTICE
10 SMALL CLAIMS ARBITRATION REQUEST SHALL IN NO WAY BE
11 DEEMED AN ADMISSION OF LIABILITY.
12 (II) (A) NONPARTY TESTIMONY, WHETHER EXPERT
13 TESTIMONY OR LAY TESTIMONY, CAN BE SUBMITTED WITHOUT
14 STANDARD FORMALITIES BY MEANS OF AFFIDAVIT, OPINION
15 LETTER, DEPOSITION TESTIMONY, CURRICULUM VITAE AND
16 EXHIBITS INCLUDING, BUT NOT LIMITED TO, PHOTOGRAPHS,
17 MEDICAL RECORDS, REPORTS AND BILLS, RADIOLOGY
18 STUDIES, EMPLOYMENT RECORDS, WAGE INFORMATION,
19 BUSINESS RECORDS, OFFICIAL RECORDS MAINTAINED BY THE
20 COMMONWEALTH AND STANDARD U.S. GOVERNMENT LIFE
21 EXPECTANCY TABLES, IF AT LEAST 30 DAYS' ADVANCE
22 WRITTEN NOTICE WAS GIVEN TO THE OPPOSING PARTY ALONG
23 WITH COPIES OF ALL MATERIALS THAT ARE TO BE
24 SUBMITTED.
25 (B) ANY MATERIALS SUBMITTED MAY BE USED ONLY FOR
26 PURPOSES WHICH WOULD BE PERMISSIBLE IF THE PERSON
27 WHOSE TESTIMONY IS WAIVED WERE PRESENT AND TESTIFYING
28 AT THE HEARING.
29 (C) THE PARTIES CAN TESTIFY LIVE, BY STANDARD
30 DEPOSITION OR BY VIDEOTAPE DEPOSITION.
20030H0158B1973 - 14 -
1 (D) EXCEPT AS PROVIDED FOR IN THIS SUBSECTION,
2 THE PENNSYLVANIA RULES OF EVIDENCE SHALL BE
3 APPLICABLE.
4 (E) ANY PARTY MAY HAVE A TRANSCRIPT AND
5 RECORDING OF THE ARBITRATION PROCEEDING MADE AT HIS
6 OR HER OWN EXPENSE.
7 (F) LEGAL MEMORANDA CAN BE SUBMITTED.
8 (G) THE ARBITRATORS ARE TO ENSURE THAT A FULL,
9 FAIR AND IMPARTIAL HEARING AND REVIEW OF THE EVIDENCE
10 IS CONDUCTED.
11 (H) THE HEARING MAY PROCEED IN THE ABSENCE OF A
12 PARTY WHO, AFTER DUE NOTICE, FAILS TO APPEAR.
13 (I) UNLESS THE PARTIES AGREE OTHERWISE, THE
14 HEARING IS TO BE HELD IN THE COUNTY WHERE THE CAUSE
15 OF ACTION AROSE.
16 (III) THE FOLLOWING CRITERIA SHALL APPLY TO THE
17 ARBITRATION PANEL:
18 (A) THERE SHALL BE THREE ARBITRATORS IN AN
19 ARBITRATION PROCEEDING.
20 (B) EACH ARBITRATOR SHALL BE AN ATTORNEY
21 LICENSED IN THIS COMMONWEALTH.
22 (C) EACH PARTY SHALL SELECT AN ARBITRATOR. THE
23 SELECTED ARBITRATORS SHALL SELECT A CHAIR ARBITRATOR.
24 IF A PARTY DOES NOT SELECT AN ARBITRATOR WITHIN 20
25 DAYS OF BEING REQUESTED TO DO SO, IF THE ARBITRATORS
26 SELECTED CANNOT AGREE WITHIN 20 DAYS ON THE SELECTION
27 OF A CHAIR ARBITRATOR OR IF THERE ARE MORE THAN TWO
28 PARTIES INVOLVED AND THEY CANNOT AGREE WITHIN 20 DAYS
29 OF BEING REQUESTED TO JOINTLY SELECT AN ARBITRATOR,
30 EITHER PARTY MAY PETITION A COURT OF COMPETENT
20030H0158B1973 - 15 -
1 JURISDICTION TO MAKE THE NECESSARY SELECTIONS.
2 (D) THE ARBITRATORS SHALL BE INDEPENDENT OF ALL
3 PARTIES, WITNESSES AND LEGAL COUNSEL.
4 (E) EACH PARTY SHALL BE RESPONSIBLE FOR THE
5 COMPENSATION OF THE ARBITRATOR SELECTED BY OR FOR
6 THAT PARTY. THE COMPENSATION FOR THE CHAIR ARBITRATOR
7 SHALL BE SHARED BY THE PARTIES.
8 (F) AFTER THE ARBITRATORS ARE SELECTED AND
9 BEFORE AN AWARD IS MADE, THERE SHALL BE NO EX PARTE
10 COMMUNICATION WITH THE ARBITRATORS BY THE PARTIES OR
11 THEIR COUNSEL.
12 (G) THE ARBITRATORS SHALL CONSIDER ALL RELEVANT
13 EVIDENCE THAT HAS BEEN PROPERLY SUBMITTED ALONG WITH
14 ANY LEGAL MEMORANDA AND SHALL DECIDE THE ISSUES OF
15 LIABILITY, AMOUNT OF DAMAGES AND APPORTIONMENT OF
16 LIABILITY AMONG THE PARTIES.
17 (H) THE CHAIR ARBITRATOR, AT THE REQUEST OF A
18 PARTY AND UPON GOOD CAUSE SHOWN, MAY SUBPOENA A PARTY
19 OR INDIVIDUAL TO ATTEND THE HEARING OR A DEPOSITION
20 AND, UNLESS OTHERWISE PROVIDED FOR IN THIS
21 SUBSECTION, THE PARTY REQUESTING THE SUBPOENA SHALL
22 PAY THE REASONABLE FEES AND COSTS OF THE PERSON BEING
23 SUBPOENAED TO TESTIFY, INCLUDING A REASONABLE EXPERT
24 WITNESS FEE IF APPLICABLE.
25 (I) THE CHAIR ARBITRATOR SHALL DETERMINE THE
26 DATE, TIME AND PLACE OF THE HEARING AND SHALL PROVIDE
27 THE OTHER ARBITRATORS AND PARTIES WITH AT LEAST 30
28 DAYS' ADVANCE NOTICE.
29 (J) THE CHAIR ARBITRATOR SHALL DECIDE ANY
30 PREHEARING ISSUES THAT MAY ARISE.
20030H0158B1973 - 16 -
1 (K) ISSUES THAT ARISE DURING THE HEARING SHALL
2 BE HEARD BY THE ARBITRATORS AND SHALL BE DECIDED BY A
3 MAJORITY OF THE ARBITRATORS.
4 (L) THE CHAIR ARBITRATOR SHALL HAVE THE
5 AUTHORITY TO ADMINISTER OATHS OR AFFIRMATIONS TO
6 WITNESSES AND TO ADJOURN AN UNCOMPLETED HEARING FROM
7 DAY TO DAY.
8 (M) THE ARBITRATORS SHALL HAVE THE AUTHORITY TO
9 DECIDE ALL ISSUES OF LAW AND FACT, DETERMINE
10 LIABILITY AND AWARD DAMAGES.
11 (N) THE DECISION OF THE ARBITRATORS SHALL NOT BE
12 USED AS EVIDENCE IN ANY FUTURE PROCEEDING.
13 (O) THE ARBITRATORS MAY NOT BE CALLED AS
14 WITNESSES IN ANY FUTURE PROCEEDING.
15 (P) EXCEPT AS PROVIDED FOR IN THIS SUBSECTION,
16 THE ARBITRATORS SHALL FOLLOW THE LAWS OF THIS
17 COMMONWEALTH AND SHALL BE GUIDED BY THE PENNSYLVANIA
18 RULES OF CIVIL PROCEDURE AND THE PENNSYLVANIA RULES
19 OF EVIDENCE.
20 (IV) IF REQUESTED BY A DEFENDANT, THE CLAIMANT SHALL
21 UNDERGO ONE PHYSICAL EXAMINATION, ONE MENTAL EXAMINATION
22 AND ONE VOCATIONAL EXAMINATION. ALL EXPENSES ASSOCIATED
23 WITH THE EXAMINATION SHALL BE BORNE BY THE REQUESTING
24 PARTY. ALL EXAMINATIONS SHALL BE CONDUCTED IN THIS
25 COMMONWEALTH. IF THE EXAMINATION TO BE CONDUCTED IS
26 LOCATED MORE THAN 50 MILES FROM THE CLAIMANT'S RESIDENCE,
27 ANY TRAVELING AND ASSOCIATED EXPENSES OF THE CLAIMANT ARE
28 TO BE BORNE BY THE PARTY REQUESTING THE EXAMINATION. UPON
29 A CLEAR SHOWING OF GOOD CAUSE AND SUBSTANTIAL NEED, THE
30 CHAIR ARBITRATOR CAN ORDER ADDITIONAL EXAMINATIONS.
20030H0158B1973 - 17 -
1 (V) EACH PARTY SHALL PROVIDE UP TO FIVE DEPOSITIONS
2 WITHOUT ANY REQUEST TO BE COMPENSATED FOR LOST WAGES OR
3 TRAVEL EXPENSES. IT IS UP TO THE PARTIES TO AGREE WHERE
4 THE DEPOSITIONS ARE TO BE HELD WITH THE OBJECTIVE OF
5 MINIMIZING THE EXPENSE AND INCONVENIENCE OF THE PARTIES
6 AND WITNESSES. IF THE PARTIES CANNOT AGREE, THE CHAIR
7 ARBITRATOR SHALL HAVE THE AUTHORITY TO DECIDE WHEN AND
8 WHERE THE DEPOSITION WILL BE HELD. PARTIES SHALL BEAR
9 THEIR OWN EXPENSES AND THOSE OF THEIR COUNSEL. THE PARTY
10 REQUESTING THE DEPOSITION SHALL BEAR ANY COSTS OF THE
11 WITNESS AND ANY STENOGRAPHIC AND VIDEO COSTS OF THE
12 DEPOSITION.
13 (VI) OTHER THAN AS PROVIDED FOR IN THIS ACT, THE
14 PARTIES MAY EXERCISE ALL DISCOVERY RIGHTS, REMEDIES AND
15 PROCEDURES AVAILABLE AS IF THE CLAIM WERE PENDING IN A
16 COURT OF COMMON PLEAS EXCEPT THAT THE CHAIR ARBITRATOR
17 SHALL DECIDE ALL DISCOVERY ISSUES AND THERE SHALL BE NO
18 RIGHT TO APPEAL THE CHAIR ARBITRATOR'S DECISION REGARDING
19 DISCOVERY ISSUES.
20 (VII) THE TOTAL MONETARY AWARD, EXCLUDING ANY AWARD
21 OF DELAY DAMAGES, THAT CAN BE RENDERED FOR ANY AND ALL
22 DAMAGES PER CLAIM, WHETHER THE CLAIM INCLUDES ONE OR MORE
23 INDIVIDUAL CLAIMANTS, CANNOT EXCEED $250,000.
24 (VIII) IF THE PARTIES STIPULATE OR OTHERWISE AGREE
25 IN WRITING THAT THE ARBITRATION AWARD SHALL BE BINDING,
26 THE CLAIMANT SHALL BE ENTITLED TO REASONABLE ATTORNEY
27 FEES AND COSTS IF THE CLAIMANT IS THE PREVAILING PARTY AS
28 DEFINED IN 42 U.S.C. § 1988 (PUBLIC LAW 94-559).
29 (IX) ARBITRATORS SHALL HAVE THE AUTHORITY TO AWARD
30 DELAY DAMAGES.
20030H0158B1973 - 18 -
1 (X) ARBITRATORS SHALL RENDER AN AWARD WITHIN TEN
2 DAYS FROM THE CONCLUSION OF THE HEARING. THE AWARD SHALL
3 DISPOSE OF ALL CLAIMS AND BE SIGNED BY ALL ARBITRATORS OR
4 BY A MAJORITY OF THEM. THE AWARD NEED NOT CONTAIN FACTUAL
5 FINDINGS OR LEGAL CONCLUSIONS. ONCE SIGNED, THE AWARD
6 SHALL BE IMMEDIATELY SENT TO ALL PARTIES AND FILED WITH
7 THE PROTHONOTARY IN A COURT OF COMPETENT JURISDICTION
8 WHERE THE ACTION COULD HAVE BEEN ORIGINALLY FILED HAD THE
9 PARTIES NOT AGREED TO SMALL CLAIMS ARBITRATION.
10 (XI) UNLESS THE PARTIES STIPULATE OR OTHERWISE AGREE
11 IN WRITING, EITHER PARTY SHALL HAVE THE RIGHT TO APPEAL
12 THE AWARD FOR A TRIAL DE NOVO IN A COURT OF COMPETENT
13 JURISDICTION. NO REFERENCE TO THE AGREEMENT OF MEDICAL
14 MALPRACTICE SMALL CLAIMS ARBITRATION, THE HEARING, THE
15 FINDINGS OR THE AWARD SHALL BE MADE DURING A SUBSEQUENT
16 TRIAL, EXCEPT THAT TESTIMONY INTRODUCED AT THE
17 ARBITRATION HEARING MAY BE USED FOR PURPOSES OTHERWISE
18 PERMITTED UNDER THE LAWS OF THIS COMMONWEALTH. AN APPEAL
19 BY ANY PARTY SHALL BE DEEMED AN APPEAL BY ALL PARTIES AS
20 TO ALL ISSUES UNLESS OTHERWISE STIPULATED TO IN WRITING
21 BY ALL PARTIES. THE APPEAL SHALL BE FILED IN ACCORDANCE
22 WITH THE PENNSYLVANIA RULES OF CIVIL PROCEDURE.
23 (XII) UNLESS AN APPEAL IS PROPERLY FILED, A
24 DEFENDANT SHALL, IF THERE WAS NO FINDING OF JOINT AND
25 SEVERAL LIABILITY, IMMEDIATELY PAY ANY MONETARY
26 ARBITRATION AWARD OR ITS RESPECTIVE PORTION OF THE AWARD.
27 IF NO APPEAL HAS BEEN PROPERLY FILED AND THE ARBITRATION
28 HAS NOT BEEN PAID BY THE 30TH DAY FROM THE DATE OF THE
29 AWARD, INTEREST SHALL ACCRUE AT THE RATE OF 18% PER ANNUM
30 FROM THE DATE OF THE AWARD. THE AWARD MAY BE ENFORCED
20030H0158B1973 - 19 -
1 PURSUANT TO THE PENNSYLVANIA RULES OF CIVIL PROCEDURE.
2 (XIII) OTHER THAN AS PROVIDED FOR IN THIS SECTION,
3 THE PROCEDURES THAT CAN BE UNDERTAKEN ONCE AN AWARD HAS
4 BEEN RENDERED, INCLUDING, BUT NOT LIMITED TO,
5 TRANSFERRING, RECORDING AND ENFORCING A JUDGMENT, SHALL
6 BE GOVERNED BY THE PENNSYLVANIA RULES OF CIVIL PROCEDURE.
7 (XIV) THE SERVICE OF A STATEMENT OF CLAIM AND NOTICE
8 OF INTENT SHALL TOLL THE STATUTE OF LIMITATIONS. ALL
9 CLAIMS FOR RECOVERY PURSUANT TO THIS SECTION MUST BE
10 COMMENCED WITHIN THE APPLICABLE STATUTE OF LIMITATIONS.
11 (3) (I) IN ORDER TO UTILIZE THE MEDICAL MALPRACTICE
12 SMALL CLAIMS MEDIATION PROCEDURE SET FORTH IN THIS
13 SUBSECTION, ALL PARTIES MUST AGREE IN WRITING TO THE
14 PROCEDURE. THE MEDIATION PROCEDURE SHALL BE COMMENCED BY
15 THE CLAIMANT SERVING THE DEFENDANT, VIA CERTIFIED OR
16 REGISTERED MAIL, WITH A STATEMENT OF CLAIM AND NOTICE OF
17 INTENT. THE STATEMENT OF CLAIM SHALL SET FORTH, WITH
18 SUFFICIENT SPECIFICITY AS REQUIRED IN A FORMAL CIVIL
19 COMPLAINT PURSUANT TO THE PENNSYLVANIA RULES OF CIVIL
20 PROCEDURE, THE NATURE OF THE ALLEGED MALPRACTICE, THE
21 RESULTING INJURIES AND THE DAMAGES SOUGHT. THE NOTICE OF
22 INTENT SHALL STATE THAT THE CLAIMANT DESIRES TO HAVE THE
23 CLAIM HEARD BY MEDICAL MALPRACTICE SMALL CLAIMS MEDIATION
24 AND INQUIRES WHETHER THE DEFENDANT DESIRES THE SAME. IF
25 THE DEFENDANT DOES NOT RESPOND WITHIN 30 DAYS OF SERVICE
26 OF THE STATEMENT OF CLAIM AND NOTICE OF INTENT, IT SHALL
27 BE DEEMED THAT THE DEFENDANT DOES NOT AGREE TO HAVE THE
28 CLAIM HEARD BY MEDICAL MALPRACTICE SMALL CLAIMS MEDIATION
29 AND THE CLAIM SHALL NOT BE HEARD IN THAT MANNER. IF THE
30 DEFENDANT DOES AGREE TO HAVE THE CLAIM HEARD IN THAT
20030H0158B1973 - 20 -
1 MANNER, AN AFFIRMATIVE RESPONSE SHALL BE SERVED UPON THE
2 CLAIMANT WITHIN 30 DAYS OF INITIAL SERVICE ALONG WITH AN
3 ANSWER TO THE STATEMENT OF CLAIM AS WOULD BE FILED IN
4 RESPONSE TO A FORMAL CIVIL COMPLAINT PURSUANT TO THE
5 PENNSYLVANIA RULES OF CIVIL PROCEDURE. A DEFENDANT'S
6 AGREEMENT, DISAGREEMENT OR LACK OF RESPONSE TO A MEDICAL
7 MALPRACTICE SMALL CLAIMS MEDIATION REQUEST SHALL IN NO
8 WAY BE DEEMED AN ADMISSION OF LIABILITY.
9 (II) THE CONDUCT OF MEDIATION CONFERENCES SHALL BE
10 AS FOLLOWS:
11 (A) TESTIMONY SHALL BE SUBMITTED BY AFFIDAVIT,
12 OPINION LETTER, DEPOSITION TESTIMONY AND CURRICULUM
13 VITAE AND EXHIBITS, INCLUDING, BUT NOT LIMITED TO,
14 PHOTOGRAPHS, MEDICAL RECORDS, REPORTS AND BILLS,
15 RADIOLOGY STUDIES, EMPLOYMENT RECORDS, WAGE
16 INFORMATION, BUSINESS RECORDS, OFFICIAL RECORDS
17 MAINTAINED BY THE COMMONWEALTH AND STANDARD U.S.
18 GOVERNMENT LIFE EXPECTANCY TABLES CAN BE SUBMITTED IF
19 AT LEAST 30 DAYS' ADVANCE WRITTEN NOTICE WAS GIVEN TO
20 THE OPPOSING PARTY ALONG WITH COPIES OF ALL MATERIALS
21 THAT ARE TO BE SUBMITTED.
22 (B) ANY MATERIALS SUBMITTED MAY BE USED ONLY FOR
23 PURPOSES WHICH WOULD BE PERMISSIBLE IF THE PERSON
24 WHOSE TESTIMONY IS WAIVED WERE PRESENT AND TESTIFYING
25 AT THE HEARING.
26 (C) LEGAL MEMORANDA MAY BE SUBMITTED.
27 (D) THE MEDIATOR SHALL ENSURE THAT A FULL, FAIR
28 AND IMPARTIAL MEDIATION AND REVIEW OF THE EVIDENCE IS
29 CONDUCTED.
30 (E) OTHER THAN THE MEDIATOR, ONLY COUNSEL OF THE
20030H0158B1973 - 21 -
1 PARTIES SHALL ATTEND THE MEDIATION CONFERENCE.
2 (F) UNLESS THE PARTIES AGREE OTHERWISE, THE
3 MEDIATION CONFERENCE SHALL BE HELD IN THE COUNTY
4 WHERE THE CAUSE OF ACTION AROSE.
5 (G) ANY DISCUSSIONS OR STATEMENTS MADE DURING
6 THE MEDIATION CONFERENCE SHALL REMAIN CONFIDENTIAL,
7 SHALL NOT BE DEEMED ADMISSIONS BY A PARTY AND SHALL
8 NOT BE UTILIZED IN ANY FUTURE PROCEEDING.
9 (III) THE FOLLOWING CRITERIA SHALL APPLY TO
10 MEDIATION CONFERENCES:
11 (A) THERE SHALL BE ONE MEDIATOR FOR EACH
12 MEDIATION CONFERENCE.
13 (B) EACH MEDIATOR SHALL BE AN ATTORNEY LICENSED
14 IN THE COMMONWEALTH, IN PRIVATE PRACTICE, WHO HAS AT
15 LEAST TEN YEARS OF MEDICAL MALPRACTICE LITIGATION
16 EXPERIENCE AND WHO HAS REPRESENTED BOTH CLAIMANTS AND
17 PHYSICIANS IN MEDICAL MALPRACTICE CASES.
18 (C) THE PARTIES CAN AGREE ON A MEDIATOR OR THE
19 COMMISSIONER SHALL SELECT A MEDIATOR IF THE PARTIES
20 ARE UNABLE TO AGREE AND AT LEAST 60 DAYS HAVE PASSED
21 SINCE THE PARTIES AGREED TO HAVE THE CLAIM DECIDED
22 UNDER THIS SUBSECTION.
23 (D) THE MEDIATOR SHALL BE INDEPENDENT OF ALL
24 PARTIES, WITNESSES AND LEGAL COUNSEL.
25 (E) THE COMPENSATION FOR THE MEDIATOR SHALL BE
26 SHARED BY THE PARTIES.
27 (F) AFTER THE MEDIATOR IS SELECTED THERE SHALL
28 BE NO EX PARTE COMMUNICATION WITH THE MEDIATOR BY THE
29 PARTIES OR THEIR COUNSEL.
30 (G) THE MEDIATOR SHALL CONSIDER ALL RELEVANT
20030H0158B1973 - 22 -
1 EVIDENCE THAT HAS BEEN PROPERLY SUBMITTED ALONG WITH
2 ANY LEGAL MEMORANDA TO HELP THE PARTIES REACH A
3 RESOLUTION OF THE CLAIM.
4 (H) THE MEDIATOR SHALL DETERMINE THE DATE, TIME
5 AND PLACE OF THE CONFERENCE AND SHALL PROVIDE THE
6 PARTIES WITH AT LEAST 30 DAYS' ADVANCE NOTICE.
7 (I) THE MEDIATOR SHALL NOT BE CALLED AS A
8 WITNESS IN ANY FUTURE PROCEEDING.
9 (IV) EACH PARTY SHALL PROVIDE UP TO FIVE DEPOSITIONS
10 WITHOUT ANY REQUEST TO BE COMPENSATED FOR LOST WAGES OR
11 TRAVEL EXPENSES. ALL DEPOSITIONS SHALL BE HELD IN THIS
12 COMMONWEALTH. THE PARTIES SHALL AGREE WHERE THE
13 DEPOSITIONS ARE TO BE HELD WITH THE OBJECTIVE OF
14 MINIMIZING THE EXPENSE AND INCONVENIENCE OF THE PARTIES
15 AND WITNESSES. IF THE PARTIES CANNOT AGREE, THE MEDIATOR
16 SHALL DECIDE WHEN AND WHERE THE DEPOSITION WILL BE HELD.
17 PARTIES SHALL BEAR THEIR OWN EXPENSES AND THOSE OF THEIR
18 COUNSEL. THE PARTY REQUESTING THE DEPOSITION SHALL BEAR
19 ANY COSTS OF THE WITNESS AND ANY STENOGRAPHIC AND VIDEO
20 COSTS OF THE DEPOSITION.
21 (V) EXCEPT AS PROVIDED FOR IN THIS ACT, THE PARTIES
22 MAY EXERCISE ALL DISCOVERY RIGHTS, REMEDIES AND
23 PROCEDURES AVAILABLE AS IF THE CLAIM WERE PENDING IN A
24 COURT OF COMMON PLEAS EXCEPT THAT THE CHAIR ARBITRATOR
25 SHALL DECIDE ALL DISCOVERY ISSUES AND THERE SHALL BE NO
26 RIGHT TO APPEAL THE CHAIR ARBITRATOR'S DECISION REGARDING
27 DISCOVERY ISSUES.
28 (VI) THE TOTAL DAMAGES, EXCLUDING ANY AWARD OF DELAY
29 DAMAGES, THE MEDIATOR CAN RECOMMEND FOR ANY AND ALL
30 DAMAGES PER CLAIM, WHETHER A CLAIM INCLUDES ONE OR MORE
20030H0158B1973 - 23 -
1 INDIVIDUAL CLAIMANTS, CANNOT EXCEED $250,000.
2 (VII) IF THE PARTIES STIPULATE OR OTHERWISE AGREE IN
3 WRITING THAT THE MEDIATOR'S RECOMMENDATION SHALL BE
4 BINDING, THE CLAIMANT SHALL BE ENTITLED TO REASONABLE
5 ATTORNEY FEES AND, IF APPLICABLE, COSTS AND DELAY DAMAGES
6 IF THE CLAIMANT IS THE PREVAILING PARTY.
7 (VIII) UNLESS THE PARTIES STIPULATE OR OTHERWISE
8 AGREE IN WRITING, THE RECOMMENDATIONS BY THE MEDIATOR
9 SHALL NOT BE BINDING.
10 (IX) IF THE PARTIES RESOLVE THE CLAIM, ANY MONETARY
11 SETTLEMENT SHALL BE PAID WITHIN 30 DAYS. IF THE
12 SETTLEMENT AMOUNT HAS NOT BEEN PAID IN FULL BY THE 30TH
13 DAY FROM THE DATE OF SETTLEMENT OF THE CLAIM, INTEREST
14 SHALL ACCRUE AT THE RATE OF 18% PER ANNUM FROM THE DATE
15 OF THE SETTLEMENT. IF A NONBREACHING PARTY HAS TO FILE AN
16 ACTION WITH A COURT FOR BREACH OF CONTRACT OR TO
17 OTHERWISE ENFORCE THE SETTLEMENT AGREEMENT, REASONABLE
18 ATTORNEY FEES, COSTS AND A PENALTY OF 50% OF THE
19 SETTLEMENT MAY BE IMPOSED ON THE BREACHING PARTY.
20 (X) THE SERVICE OF A STATEMENT OF CLAIM AND NOTICE
21 OF INTENT WILL TOLL THE STATUTE OF LIMITATIONS. ALL
22 CLAIMS FOR RECOVERY PURSUANT TO THIS SUBSECTION MUST BE
23 COMMENCED WITHIN THE APPLICABLE STATUTE OF LIMITATIONS.
24 (4) AFTER A WRIT OF SUMMONS OR COMPLAINT HAS BEEN
25 PROPERLY FILED, THE PARTIES MAY AGREE, IF PERMITTED BY THE
26 COURT IN WHICH THE SUMMONS OR COMPLAINT HAS BEEN FILED, TO
27 HAVE THE CLAIM HEARD BY WAY OF SUMMARY JURY TRIAL. UNLESS THE
28 COURT IN WHICH THE SUMMONS OR COMPLAINT WAS FILED PROVIDES
29 OTHERWISE, THE SUMMARY JURY TRIAL PROCEDURE SHALL BE AS
30 FOLLOWS:
20030H0158B1973 - 24 -
1 (I) UNLESS OTHERWISE AGREED TO BY THE PARTIES, THE
2 SUMMARY JURY TRIAL SHALL NOT BE BINDING.
3 (II) THE PARTIES, THEIR COUNSEL AND AN INDIVIDUAL
4 WHO HAS SETTLEMENT AUTHORITY SHALL ATTEND THE SUMMARY
5 JURY TRIAL.
6 (III) THE PARTIES SHALL AT ALL TIMES EXERCISE GOOD
7 FAITH EFFORT TO AMICABLY RESOLVE THE CLAIM.
8 (IV) UNLESS OTHERWISE AGREED TO BY THE PARTIES,
9 SUMMARY JURIES SHALL CONSIST OF 12 JURORS.
10 (V) EACH PARTY SHALL BE ENTITLED TO TWO PEREMPTORY
11 CHALLENGES.
12 (VI) THE CLAIMANT SHALL PROCEED FIRST AND MAY SAVE A
13 PORTION OF HIS ALLOTTED TIME FOR REBUTTAL.
14 (VII) COUNSEL FOR EACH PARTY SHALL BE ENTITLED TO A
15 ONE-HALF HOUR PRESENTATION OF THE CASE. THE PRESENTATION
16 MAY INVOLVE A COMBINATION OF ARGUMENT, A SUMMARY OF THE
17 EVIDENCE TO BE PRESENTED AND A STATEMENT OF THE
18 APPLICABLE LAW, IF NEEDED TO ANSWER ANY SPECIAL VERDICT
19 QUESTIONS. COUNSEL MAY QUOTE FROM DEPOSITIONS AND MAY USE
20 EXHIBITS. COUNSEL SHALL PROVIDE A LIST OF EXHIBITS HE
21 INTENDS TO USE TO OPPOSING COUNSEL AT LEAST 30 DAYS PRIOR
22 TO THE SUMMARY JURY TRIAL. COUNSEL SHALL PROVIDE PROPOSED
23 JURY INSTRUCTIONS TO OPPOSING COUNSEL AND THE COURT AT
24 LEAST 30 DAYS PRIOR TO THE SUMMARY JURY TRIAL. NOTHING
25 DONE BY COUNSEL WITH REGARD TO THE SUMMARY JURY TRIAL
26 WILL BE BINDING ON COUNSEL OR THE PARTIES OR SHALL
27 CONSTITUTE A WAIVER.
28 (VIII) NO LIVE TESTIMONY SHALL BE PERMITTED.
29 (IX) THE CLAIM SHALL BE SUBMITTED TO THE JURY BY
30 SPECIAL VERDICT QUESTIONS WHICH WILL BE PROVIDED BY THE
20030H0158B1973 - 25 -
1 PARTIES.
2 (X) A MAJORITY VERDICT REPRESENTING 5/6 OF THE JURY
3 SHALL BE REQUIRED WITH RESPECT TO EACH VERDICT QUESTION.
4 (XI) THE JURY SHALL DETERMINE LIABILITY AND DAMAGES.
5 (5) THE METHODS OF DISPUTE RESOLUTION IN THIS SUBSECTION
6 SHALL NOT BE CONSTRUED AS A LIMITATION ON THE PARTIES'
7 ABILITY TO AGREE ON ALTERNATIVE DISPUTE RESOLUTION METHODS OR
8 TO AGREE TO MODIFY THE METHODS PROVIDED IN THIS SUBSECTION.
9 * * *
10 SECTION 732. MEDICAL PROFESSIONAL LIABILITY INSURANCE.
11 (A) INSURANCE.--[THE] EXCEPT AS PROVIDED IN SUBSECTION (D),
12 THE JOINT UNDERWRITING ASSOCIATION SHALL OFFER MEDICAL
13 PROFESSIONAL LIABILITY INSURANCE TO HEALTH CARE PROVIDERS AND
14 PROFESSIONAL CORPORATIONS, PROFESSIONAL ASSOCIATIONS AND
15 PARTNERSHIPS WHICH ARE ENTIRELY OWNED BY HEALTH CARE PROVIDERS
16 WHO CANNOT CONVENIENTLY OBTAIN MEDICAL PROFESSIONAL LIABILITY
17 INSURANCE THROUGH ORDINARY METHODS AT RATES NOT IN EXCESS OF
18 THOSE APPLICABLE TO SIMILARLY SITUATED HEALTH CARE PROVIDERS,
19 PROFESSIONAL CORPORATIONS, PROFESSIONAL ASSOCIATIONS OR
20 PARTNERSHIPS.
21 (B) REQUIREMENTS.--THE JOINT UNDERWRITING ASSOCIATION SHALL
22 ENSURE THAT THE MEDICAL PROFESSIONAL LIABILITY INSURANCE IT
23 OFFERS DOES ALL OF THE FOLLOWING:
24 (1) [IS] EXCEPT AS PROVIDED IN SUBSECTION (D), IS
25 CONVENIENTLY AND EXPEDITIOUSLY AVAILABLE TO ALL HEALTH CARE
26 PROVIDERS REQUIRED TO BE INSURED UNDER SECTION 711.
27 (2) IS SUBJECT ONLY TO THE PAYMENT OR PROVISIONS FOR
28 PAYMENT OF THE PREMIUM.
29 (3) PROVIDES REASONABLE MEANS FOR THE HEALTH CARE
30 PROVIDERS IT INSURES TO TRANSFER TO THE ORDINARY INSURANCE
20030H0158B1973 - 26 -
1 MARKET.
2 (4) PROVIDES SUFFICIENT COVERAGE FOR [A HEALTH CARE
3 PROVIDER] THE HEALTH CARE PROVIDERS IT INSURES TO SATISFY ITS
4 INSURANCE REQUIREMENTS UNDER SECTION 711 ON REASONABLE AND
5 NOT UNFAIRLY DISCRIMINATORY TERMS.
6 (5) PERMITS [A HEALTH CARE PROVIDER] THE HEALTH CARE
7 PROVIDERS IT INSURES TO FINANCE ITS PREMIUM OR ALLOWS
8 INSTALLMENT PAYMENT OF PREMIUMS SUBJECT TO CUSTOMARY TERMS
9 AND CONDITIONS.
10 (C) CLAIMS-FREE CREDIT.--THE JOINT UNDERWRITING ASSOCIATION
11 SHALL PROVIDE A DISCOUNT OF AT LEAST 15% ON THE APPLICABLE
12 PREMIUM TO ANY NONINSTITUTIONAL FULL-TIME HEALTH CARE PROVIDER
13 MAKING APPLICATION FOR INSURANCE COVERING A PERIOD OF AT LEAST
14 SIX MONTHS, IF IT CAN BE DOCUMENTED THAT A HEALTH CARE PROVIDER
15 HAS A CLAIMS-FREE EXPERIENCE. THIS SUBSECTION SHALL EXPIRE TEN
16 YEARS AFTER THE EFFECTIVE DATE OF THIS SUBSECTION UNLESS
17 MAINTAINING THE DISCOUNT IS PROVEN TO BE ACTUARILY JUSTIFIED. NO
18 OTHER CREDIT FOR CLAIMS-FREE EXPERIENCE SHALL APPLY WHILE THIS
19 SUBSECTION REMAINS IN FORCE.
20 (D) CERTAIN POLICIES PROHIBITED.--EXCEPT AS PROVIDED IN
21 PARAGRAPH (5), THE JOINT UNDERWRITING ASSOCIATION SHALL NOT
22 OFFER MEDICAL PROFESSIONAL LIABILITY INSURANCE TO ANY HEALTH
23 CARE PROVIDER MAKING APPLICATION WHO DISCLOSES ANY OF THE
24 FOLLOWING:
25 (1) THE HEALTH CARE PROVIDER'S MEDICAL LICENSE HAS BEEN
26 REVOKED IN ANY STATE.
27 (2) THE HEALTH CARE PROVIDER'S LICENSE TO DISPENSE OR
28 PRESCRIBE DRUGS OR MEDICATION HAS BEEN REVOKED IN THIS
29 COMMONWEALTH OR ANY OTHER STATE.
30 (3) THE HEALTH CARE PROVIDER HAS HAD THREE OR MORE
20030H0158B1973 - 27 -
1 MEDICAL LIABILITY CLAIMS IN THE PAST FIVE MOST RECENT YEARS
2 IN WHICH THE JUDGMENT AGAINST THE PROVIDER OR SETTLEMENT
3 ENTERED WAS $500,000 OR MORE FOR EACH CLAIM.
4 (4) THE HEALTH CARE PROVIDER HAS BEEN CONVICTED, OR
5 ENTERED A PLEA OF GUILTY OR NO CONTEST FOR ANY OF THE
6 FOLLOWING OFFENSES:
7 (I) A FELONY VIOLATION OF THE ACT OF APRIL 14, 1972
8 (P.L.233, NO.64), KNOWN AS THE CONTROLLED SUBSTANCE,
9 DRUG, DEVICE AND COSMETIC ACT.
10 (II) 18 PA.C.S. CH. 25 (RELATING TO CRIMINAL
11 HOMICIDE).
12 (III) 18 PA.C.S. § 2702 (RELATING TO AGGRAVATED
13 ASSAULT).
14 (IV) 18 PA.C.S. § 2709.1 (RELATING TO STALKING).
15 (V) 18 PA.C.S. CH. 29 (RELATING TO KIDNAPPING).
16 (VI) 18 PA.C.S. CH. 31 (RELATING TO SEXUAL
17 OFFENSES).
18 (VII) 18 PA.C.S. § 3301 (RELATING TO ARSON AND
19 RELATED OFFENSES).
20 (VIII) 18 PA.C.S. § 3302 (RELATING TO CAUSING OR
21 RISKING CATASTROPHE).
22 (IX) 18 PA.C.S. CH. 35 (RELATING TO BURGLARY AND
23 OTHER CRIMINAL INTRUSION).
24 (X) 18 PA.C.S. CH. 37 (RELATING TO ROBBERY).
25 (XI) A FELONY VIOLATION UNDER 18 PA.C.S. CH. 39
26 (RELATING TO THEFT AND RELATED OFFENSES).
27 (XII) 18 PA.C.S. CH. 59 (RELATING TO PUBLIC
28 INDECENCY).
29 (5) A HEALTH CARE PROVIDER WHO IS INELIGIBLE TO OBTAIN
30 MEDICAL PROFESSIONAL LIABILITY INSURANCE UNDER PARAGRAPH (4)
20030H0158B1973 - 28 -
1 MAY BECOME ELIGIBLE TO APPLY FOR SUCH INSURANCE WITH THE
2 JOINT UNDERWRITING ASSOCIATION UPON A DETERMINATION BY THE
3 HEALTH CARE PROVIDER'S STATE LICENSING BOARD THAT THE HEALTH
4 CARE PROVIDER IS FIT TO PRACTICE MEDICINE. THE LICENSING
5 BOARD SHALL MAKE SUCH A DETERMINATION UPON THE HEALTH CARE
6 PROVIDER'S DEMONSTRATION TO THE LICENSING BOARD'S
7 SATISFACTION THAT THE HEALTH CARE PROVIDER HAS BEEN
8 REHABILITATED AND POSSESSES THE REQUISITE COMPETENCY, SKILL
9 AND MORAL CHARACTER TO RETURN TO PRACTICE. THE HEALTH CARE
10 PROVIDER SHALL NOT BE ELIGIBLE TO PETITION THE LICENSING
11 BOARD FOR A DETERMINATION THAT HE IS FIT TO PRACTICE UNTIL
12 AFTER THE RESOLUTION OF ANY DISCIPLINARY ACTION THAT MAY BE
13 PENDING AGAINST THE HEALTH CARE PROVIDER BEFORE THE LICENSING
14 BOARD.
15 (E) DEFINITIONS.--AS USED IN THIS SECTION, THE FOLLOWING
16 WORDS AND PHRASES SHALL HAVE THE MEANINGS GIVEN TO THEM IN THIS
17 SUBSECTION:
18 "CLAIMS-FREE EXPERIENCE." A DOCUMENTED PERIOD IN WHICH NO
19 CLAIMS HAVE BEEN MADE AGAINST A HEALTH CARE PROVIDER OVER THE
20 PAST FIVE MOST RECENT YEARS, AND THE HEALTH CARE PROVIDER HAS
21 HAD CONTINUOUS INSURANCE COVERAGE IN FORCE FOR THE FIVE YEARS
22 IMMEDIATELY PRECEDING THE PROPOSED EFFECTIVE DATE OF INSURANCE
23 COVERAGE AND NO JOINT UNDERWRITING ASSOCIATION SURCHARGE APPLIES
24 FOR THE FOLLOWING:
25 (1) LICENSING BOARD DISCIPLINARY PROCEDURES.
26 (2) HOSPITAL DISCIPLINARY PROCEEDINGS.
27 (3) MEDICARE AND MEDICAID ACTION.
28 (4) FEDERAL DRUG ENFORCEMENT ADMINISTRATION ACTION.
29 (5) THE CONTROLLED SUBSTANCE, DRUG, DEVICE AND COSMETIC
30 ACT.
20030H0158B1973 - 29 -
1 "FULL TIME." A HEALTH CARE PROVIDER WORKING MORE THAN 25
2 HOURS PER WEEK.
3 SECTION 733. DEFICIT.
4 (A) FILING.--IN THE EVENT THE JOINT UNDERWRITING ASSOCIATION
5 EXPERIENCES A DEFICIT IN ANY CALENDAR YEAR, THE BOARD OF
6 DIRECTORS SHALL FILE WITH THE COMMISSIONER THE DEFICIT.
7 (B) APPROVAL.--WITHIN 30 DAYS OF RECEIPT OF THE FILING, THE
8 COMMISSIONER SHALL APPROVE OR DENY THE FILING. IF APPROVED, THE
9 JOINT UNDERWRITING ASSOCIATION IS AUTHORIZED TO BORROW FUNDS
10 SUFFICIENT TO SATISFY THE DEFICIT.
11 (C) RATE FILING.--WITHIN 30 DAYS OF RECEIVING APPROVAL OF
12 ITS FILING IN ACCORDANCE WITH SUBSECTION (B), THE JOINT
13 UNDERWRITING ASSOCIATION SHALL FILE A RATE FILING WITH THE
14 DEPARTMENT. THE COMMISSIONER SHALL APPROVE THE FILING IF [THE]:
15 (1) THE PREMIUMS GENERATE SUFFICIENT INCOME FOR THE
16 JOINT UNDERWRITING ASSOCIATION TO AVOID A DEFICIT DURING THE
17 FOLLOWING 12 MONTHS AND TO REPAY PRINCIPAL AND INTEREST ON
18 THE MONEY BORROWED IN ACCORDANCE WITH SUBSECTION (B).
19 (2) THERE IS A 20% DISCOUNT IN EACH PREMIUM FOR A HEALTH
20 CARE PROVIDER THAT IMPLEMENTS, TO THE SATISFACTION OF THE
21 DEPARTMENT OF HEALTH, A TOTAL QUALITY MANAGEMENT HEALTH CARE
22 SYSTEM APPROVED BY THE DEPARTMENT OF HEALTH.
23 SECTION 741. APPROVAL.
24 IN ORDER FOR AN INSURER TO ISSUE A POLICY OF MEDICAL
25 PROFESSIONAL LIABILITY INSURANCE TO A HEALTH CARE PROVIDER OR TO
26 A PROFESSIONAL CORPORATION, PROFESSIONAL ASSOCIATION OR
27 PARTNERSHIP WHICH IS ENTIRELY OWNED BY HEALTH CARE PROVIDERS,
28 THE INSURER MUST [BE] COMPLY WITH ALL OF THE FOLLOWING:
29 (1) BE AUTHORIZED TO WRITE MEDICAL PROFESSIONAL
30 LIABILITY INSURANCE IN ACCORDANCE WITH THE ACT OF MAY 17,
20030H0158B1973 - 30 -
1 1921 (P.L.682, NO.284), KNOWN AS THE INSURANCE COMPANY LAW OF
2 1921.
3 (2) OFFER A 20% DISCOUNT IN THE PREMIUM FOR A HEALTH
4 CARE PROVIDER THAT IMPLEMENTS, TO THE SATISFACTION OF THE
5 DEPARTMENT OF HEALTH, A TOTAL QUALITY MANAGEMENT HEALTH CARE
6 SYSTEM APPROVED BY THE DEPARTMENT OF HEALTH.
7 SECTION 747. CANCELLATION OF INSURANCE POLICY.
8 (A) TERMINATION.--A TERMINATION OF A MEDICAL PROFESSIONAL
9 LIABILITY INSURANCE POLICY BY NONRENEWAL OR CANCELLATION, EXCEPT
10 FOR SUSPENSION OR REVOCATION OF THE INSURED'S LICENSE OR FOR
11 REASON OF NONPAYMENT OF PREMIUM, IS NOT EFFECTIVE AGAINST THE
12 INSURED UNLESS NOTICE OF NONRENEWAL OR CANCELLATION WAS [GIVEN
13 WITHIN 60 DAYS AFTER THE ISSUANCE OF THE POLICY TO THE INSURED,]
14 RECEIVED BY THE INSURED 120 DAYS PRIOR TO THE NONRENEWAL OR
15 CANCELLATION AND NO NONRENEWAL OR CANCELLATION SHALL TAKE EFFECT
16 UNLESS A WRITTEN NOTICE STATING THE REASONS FOR THE NONRENEWAL
17 OR CANCELLATION AND THE DATE AND TIME UPON WHICH THE TERMINATION
18 BECOMES EFFECTIVE HAS BEEN RECEIVED BY THE COMMISSIONER. MAILING
19 OF THE NOTICE TO THE COMMISSIONER AT THE COMMISSIONER'S
20 PRINCIPAL OFFICE ADDRESS SHALL CONSTITUTE NOTICE TO THE
21 COMMISSIONER.
22 (B) PREMIUM INCREASE.--A PREMIUM INCREASE FOR A MEDICAL
23 PROFESSIONAL LIABILITY INSURANCE POLICY SHALL NOT BE EFFECTIVE
24 AGAINST THE INSURED UNLESS NOTICE OF THE PREMIUM INCREASE WAS
25 RECEIVED BY THE INSURED 90 DAYS PRIOR TO THE PREMIUM INCREASE
26 AND NO PREMIUM INCREASE SHALL TAKE EFFECT UNLESS A WRITTEN
27 NOTICE STATING THE REASONS FOR THE PREMIUM INCREASE AND THE DATE
28 AND TIME UPON WHICH THE PREMIUM INCREASE BECOMES EFFECTIVE HAS
29 BEEN RECEIVED BY THE COMMISSIONER. MAILING OF THE NOTICE TO THE
30 COMMISSIONER AT THE COMMISSIONER'S PRINCIPAL OFFICE ADDRESS
20030H0158B1973 - 31 -
1 SHALL CONSTITUTE NOTICE TO THE COMMISSIONER.
2 SECTION 7. THE ACT IS AMENDED BY ADDING CHAPTERS TO READ:
3 CHAPTER 8
4 VOLUNTARY CONTRACTUAL ARBITRATION
5 SECTION 801. SCOPE.
6 THIS CHAPTER RELATES TO VOLUNTARY CONTRACTUAL ARBITRATION OF
7 CLAIMS OF PATIENTS ARISING FROM THE CARE AND TREATMENT OF HEALTH
8 CARE PROVIDERS.
9 SECTION 802. DEFINITIONS.
10 THE FOLLOWING WORDS AND PHRASES WHEN USED IN THIS CHAPTER
11 SHALL HAVE THE MEANINGS GIVEN TO THEM IN THIS SECTION UNLESS THE
12 CONTEXT CLEARLY INDICATES OTHERWISE:
13 "AGREEMENT." AN AGREEMENT TO SUBMIT ANY DISPUTE ARISING OUT
14 OF OR RELATING TO MEDICAL TREATMENT OR MEDICAL SERVICES TO
15 BINDING ARBITRATION, INCLUDING PROVISIONS RELATING TO FORUM,
16 VENUE, PROCEDURES AND LIMITATIONS, IF ANY, ON DAMAGES
17 RECOVERABLE AS LONG AS NO STATUTORY OR CONSTITUTIONAL PROVISION
18 IS VIOLATED.
19 "HEALTH CARE PROVIDER." A PRIMARY HEALTH CARE CENTER OR A
20 PERSON, INCLUDING A CORPORATION, UNIVERSITY OR OTHER EDUCATIONAL
21 INSTITUTION LICENSED OR APPROVED BY THE COMMONWEALTH TO PROVIDE
22 HEALTH CARE OR PROFESSIONAL MEDICAL SERVICES AS A PHYSICIAN, A
23 CERTIFIED NURSE MIDWIFE, A PODIATRIST, HOSPITAL, NURSING HOME,
24 BIRTH CENTER AND, EXCEPT AS TO SECTION 711(A) 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, AN OFFICER,
27 EMPLOYEE OR AGENT OF ANY OF THEM ACTING IN THE COURSE AND SCOPE
28 OF EMPLOYMENT PROVIDING MEDICAL CARE.
29 "HOSPITAL." AN ENTITY LICENSED AS A HOSPITAL UNDER THE ACT
30 OF JUNE 13, 1967 (P.L.31, NO.21), KNOWN AS THE PUBLIC WELFARE
20030H0158B1973 - 32 -
1 CODE, OR THE ACT OF JULY 19, 1979 (P.L.130, NO.48), KNOWN AS THE
2 HEALTH CARE FACILITIES ACT.
3 "PATIENT." A PERSON RECEIVING CARE OR TREATMENT BY A HEALTH
4 CARE PROVIDER, INCLUDING A PERSON'S NATURAL, LEGAL OR APPOINTED
5 GUARDIAN. IF THE PERSON RECEIVING CARE OR TREATMENT IS A MINOR,
6 THE TERM SHALL ALSO INCLUDE A PARENT, NATURAL, LEGAL OR
7 APPOINTED GUARDIAN. IN THE CASE OF A PREGNANT WOMAN, THE TERM
8 SHALL REFER TO THE MOTHER.
9 SECTION 803. VOLUNTARY ARBITRATION.
10 (A) AGREEMENT.--A PATIENT AND ANY HEALTH CARE PROVIDER MAY
11 EXECUTE AN AGREEMENT TO SUBMIT TO BINDING ARBITRATION ANY
12 DISPUTE, CONTROVERSY OR ISSUE ARISING OUT OF CARE OR TREATMENT
13 BY THE HEALTH CARE PROVIDER DURING THE PERIOD THAT THE AGREEMENT
14 IS IN FORCE OR THAT HAS ALREADY ARISEN BETWEEN THE PARTIES.
15 (B) FORM AND CONTENTS OF AGREEMENT.--EXECUTION OF AN
16 AGREEMENT UNDER THIS ACT BY A PATIENT MAY NOT BE MADE A
17 PREREQUISITE TO RECEIPT OF CARE OR TREATMENT BY THE HEALTH CARE
18 PROVIDER. AN AGREEMENT TO ARBITRATE, EXECUTED BEFORE CARE OR
19 TREATMENT IS PROVIDED, SHALL BE A SEPARATE DOCUMENT, WRITTEN IN
20 PLAIN LANGUAGE AND MUST:
21 (1) CLEARLY PROVIDE IN BOLD PRINT IN AT LEAST 12-POINT
22 BOLD TYPE ON THE FACE OF THE AGREEMENT THAT EXECUTION OF THE
23 AGREEMENT BY THE PATIENT IS NOT A PREREQUISITE TO RECEIVING
24 CARE OR TREATMENT.
25 (2) CLEARLY PROVIDE IN AT LEAST 12-POINT BOLD, UPPERCASE
26 TYPE:
27 (I) NOTICE WITH REGARD TO ANY TERMS OR CONDITIONS OF
28 THE AGREEMENT THAT CONSTITUTE WAIVERS AND RIGHTS AFFECTED
29 UPON EXECUTION; AND
30 (II) NOTICE WITH REGARD TO THE MANNER OF SELECTION
20030H0158B1973 - 33 -
1 OF THE ARBITRATORS.
2 (3) CONTAIN THE FOLLOWING NOTICE ABOVE THE SIGNATURE
3 LINE OF THE AGREEMENT IN AT LEAST 12-POINT BOLD, UPPERCASE
4 TYPE.
5 BY SIGNING THIS CONTRACT YOU ARE GIVING UP YOUR RIGHT TO
6 A JURY OR COURT TRIAL.
7 (4) ACKNOWLEDGE THE PATIENT'S RECEIPT OF THE AGREEMENT
8 AND SHALL BE DATED.
9 (C) VOIDABLE AGREEMENT.--IF A HEALTH CARE PROVIDER DOES NOT
10 COMPLY WITH THIS SECTION, THE AGREEMENT TO ARBITRATE IS VOIDABLE
11 AT THE OPTION OF THE PATIENT.
12 (D) REVOCATION OF AGREEMENT.--THE AGREEMENT MUST PROVIDE
13 THAT THE PATIENT MAY DO ANY OF THE FOLLOWING TO REVOKE THE
14 AGREEMENT:
15 (1) NOTIFY THE HEALTH CARE PROVIDER IN WRITING WITHIN
16 SEVEN DAYS AFTER TREATMENT HAS BEEN COMPLETED.
17 (2) NOTIFY THE HEALTH CARE PROVIDER IN WRITING WITHIN
18 SEVEN DAYS AFTER THE PATIENT HAS RECEIVED NOTICE OF A SERIOUS
19 EVENT PURSUANT TO SECTION 308.
20 (3) NOTIFY THE HEALTH CARE PROVIDER IN WRITING WITHIN 30
21 DAYS AFTER RETAINING COUNSEL IF THE PATIENT WAS NOT NOTIFIED
22 OF A SERIOUS EVENT PURSUANT TO SECTION 308.
23 (E) REEXECUTION OF AGREEMENT.--AN AGREEMENT TO ARBITRATE
24 BETWEEN A PATIENT AND A HOSPITAL MUST BE REEXECUTED EACH TIME A
25 PERSON IS ADMITTED TO A HOSPITAL. THE AGREEMENT MAY BE EXTENDED
26 BY WRITTEN AGREEMENT OF ALL PARTIES TO APPLY TO CARE AFTER
27 HOSPITALIZATION. A PERSON RECEIVING OUTPATIENT CARE FROM A
28 HOSPITAL OR CLINIC OR A MEMBER OF A HEALTH MAINTENANCE
29 ORGANIZATION MAY EXECUTE AN AGREEMENT FOR A CONTINUING PROGRAM
30 OF TREATMENT OR DURING CONTINUED MEMBERSHIP, BUT SHALL NOT BE
20030H0158B1973 - 34 -
1 EFFECTIVE UNLESS RENEWED IN THE SAME MANNER AS AN ORIGINAL
2 AGREEMENT AT LEAST ONCE EVERY 12 MONTHS.
3 (F) CONSTRUCTION OF AGREEMENT.--AN AGREEMENT TO ARBITRATE IS
4 NOT A CONTRACT OF ADHESION, NOR UNCONSCIONABLE, NOR OTHERWISE
5 IMPROPER, WHERE IT COMPLIES WITH THE PROVISIONS OF THIS ACT.
6 (G) ARBITRATION PROCEDURE.--THE PROCEDURE FOR ARBITRATION
7 SHALL BE AS FOLLOWS:
8 (1) ARBITRATORS SHALL BE SELECTED IN THE SAME MANNER AS
9 ARBITRATORS ARE SELECTED PURSUANT TO 42 PA.C.S. § 7361(A)
10 (RELATING TO COMPULSORY ARBITRATION).
11 (2) ARBITRATION SHALL BE CONDUCTED IN ACCORDANCE WITH
12 THE PROVISIONS OF 42 PA.C.S. CH. 73 SUBCH. A (RELATING TO
13 STATUTORY ARBITRATION), EXCEPT AS FURTHER PROVIDED IN THIS
14 SUBSECTION.
15 (3) AN ARBITRATOR SHALL BE SELECTED BY EACH PARTY AND
16 THE TWO ARBITRATORS SHALL SELECT A THIRD ARBITRATOR. IF THE
17 TWO ARBITRATORS SELECTED BY THE PARTIES CANNOT AGREE ON A
18 THIRD ARBITRATOR WITHIN 30 DAYS OF THEIR SELECTION, EITHER
19 ARBITRATOR MAY REQUEST THAT THE SELECTION BE MADE BY THE
20 COURT HAVING JURISDICTION.
21 (4) EACH PARTY SHALL:
22 (I) BEAR THE EXPENSES INCURRED BY THE ARBITRATOR
23 THEY SELECTED; AND
24 (II) EQUALLY BEAR THE EXPENSES INCURRED BY THE THIRD
25 ARBITRATOR.
26 (5) ARBITRATION SHALL TAKE PLACE IN THE COUNTY IN WHICH
27 THE PATIENT LIVES, UNLESS OTHERWISE AGREED TO BY BOTH
28 PARTIES. LOCAL RULES OF PROCEDURE AND EVIDENCE SHALL APPLY TO
29 THE PROCEEDINGS.
30 (6) A DECISION AGREED TO BY TWO OF THE ARBITRATORS SHALL
20030H0158B1973 - 35 -
1 BE BINDING ON THE PARTIES.
2 CHAPTER 8-A
3 MCARE ASSESSMENT NEED PROGRAM
4 SECTION 801-A. SCOPE.
5 THIS CHAPTER RELATES TO THE MCARE ASSESSMENT NEED PROGRAM.
6 SECTION 802-A. DEFINITIONS.
7 THE FOLLOWING WORDS AND PHRASES WHEN USED IN THIS CHAPTER
8 SHALL HAVE THE MEANINGS GIVEN TO THEM IN THIS SECTION UNLESS THE
9 CONTEXT CLEARLY INDICATES OTHERWISE:
10 "ASSESSMENT." THE ASSESSMENT LEVIED BY THE INSURANCE
11 DEPARTMENT ON HEALTH CARE PROVIDERS, ESTABLISHED UNDER THIS ACT.
12 "ELIGIBLE APPLICANT." A PHYSICIAN LICENSED IN GOOD STANDING
13 BY THE LICENSING BOARD, PRACTICING IN THIS COMMONWEALTH, WHO
14 MEETS THE CRITERIA ESTABLISHED BY THE PROGRAM ADMINISTRATOR
15 PURSUANT TO THIS CHAPTER AND WHO IS NOT DISQUALIFIED UNDER
16 SECTION 803-A(D).
17 "LICENSING BOARD." THE STATE BOARD OF MEDICINE, THE STATE
18 BOARD OF OSTEOPATHIC MEDICINE OR THE STATE BOARD OF PODIATRY.
19 "MEDICAL PROFESSIONAL LIABILITY INSURANCE." INSURANCE
20 AGAINST LIABILITY ON THE PART OF A HEALTH CARE PROVIDER ARISING
21 OUT OF ANY TORT OR BREACH OF CONTRACT CAUSING INJURY OR DEATH
22 RESULTING FROM THE FURNISHING OF MEDICAL SERVICES WHICH WERE OR
23 SHOULD HAVE BEEN PROVIDED.
24 "PHYSICIAN." AN INDIVIDUAL LICENSED OR CERTIFIED UNDER THE
25 LAWS OF THIS COMMONWEALTH BY THE STATE BOARD OF MEDICINE, THE
26 STATE BOARD OF OSTEOPATHIC MEDICINE OR THE STATE BOARD OF
27 PODIATRY. THE TERM SHALL INCLUDE A LICENSED NURSE MIDWIFE.
28 "PROGRAM." THE MCARE ASSESSMENT NEED PROGRAM ESTABLISHED
29 UNDER SECTION 803-A(A).
30 "PROGRAM ADMINISTRATOR." THE STATE AGENCY, BUREAU,
20030H0158B1973 - 36 -
1 DEPARTMENT OR OFFICE DESIGNATED BY THE GOVERNOR TO ADMINISTER
2 THE MCARE ASSESSMENT NEED PROGRAM.
3 SECTION 803-A. MCARE ASSESSMENT NEED PROGRAM.
4 (A) PROGRAM ESTABLISHED.--THE MCARE ASSESSMENT NEED PROGRAM
5 IS HEREBY ESTABLISHED TO PROVIDE ASSESSMENT REDUCTIONS TO
6 ELIGIBLE APPLICANTS. THE PROGRAM SHALL APPLY TO POLICIES DUE ON
7 OR AFTER JANUARY 1, 2003.
8 (B) RESTRICTED RECEIPTS ACCOUNT.--THERE IS HEREBY
9 ESTABLISHED IN THE TREASURY DEPARTMENT A NONLAPSING RESTRICTED
10 RECEIPTS ACCOUNT, TO BE KNOWN AS THE MCARE ASSESSMENT NEED
11 PROGRAM ACCOUNT, FOR THE PURPOSE OF FUNDING ASSESSMENT
12 REDUCTIONS FOR ELIGIBLE APPLICANTS.
13 (C) ELIGIBILITY.--TO BE ELIGIBLE FOR AN ASSESSMENT REDUCTION
14 UNDER THE PROGRAM, A PHYSICIAN MUST SUBMIT DOCUMENTATION
15 INCLUDING, BUT NOT LIMITED TO, THE FOLLOWING:
16 (1) STATEMENT OF EARNED AND UNEARNED INCOME;
17 (2) FEDERAL AND STATE TAX RETURNS AND SUPPORTING
18 DOCUMENTATION;
19 (3) DOCUMENTATION OF PAID MEDICAL PROFESSIONAL LIABILITY
20 INSURANCE PAYMENT, INCLUDING THE PRIMARY COVERAGE AND THE
21 ASSESSMENT;
22 (4) OTHER INFORMATION AS THE PROGRAM ADMINISTRATOR MAY
23 REQUIRE; AND
24 (5) FEDERAL AND STATE TAX RETURNS AND SUPPORTING
25 DOCUMENTATION OF THE THIRD PARTY, IF THE PHYSICIAN'S PREMIUMS
26 OR SURCHARGES ARE PAID BY A THIRD PARTY.
27 (D) PROHIBITIONS.--A PHYSICIAN SHALL NOT BE ELIGIBLE FOR
28 PARTICIPATION IN THE PROGRAM IF ANY OF THE FOLLOWING APPLY:
29 (1) THE PHYSICIAN'S MEDICAL LICENSE HAS BEEN REVOKED IN
30 ANY STATE.
20030H0158B1973 - 37 -
1 (2) THE PHYSICIAN'S LICENSE TO DISPENSE OR PRESCRIBE
2 DRUGS OR MEDICATION HAS BEEN REVOKED IN THIS COMMONWEALTH OR
3 ANY OTHER STATE.
4 (3) THE PHYSICIAN HAS HAD THREE OR MORE MEDICAL
5 LIABILITY CLAIMS IN THE PAST FIVE MOST RECENT YEARS IN WHICH
6 THE JUDGMENT AGAINST THE PROVIDER OR SETTLEMENT ENTERED WAS
7 $500,000 OR MORE FOR EACH CLAIM.
8 (4) THE PHYSICIAN HAS BEEN CONVICTED OR ENTERED A PLEA
9 OF GUILTY OR NO CONTEST FOR ANY OF THE FOLLOWING OFFENSES:
10 (I) A FELONY VIOLATION OF THE ACT OF APRIL 14, 1972
11 (P.L.233, NO.64), KNOWN AS THE CONTROLLED SUBSTANCE,
12 DRUG, DEVICE AND COSMETIC ACT.
13 (II) 18 PA.C.S. CH. 25 (RELATING TO CRIMINAL
14 HOMICIDE).
15 (III) 18 PA.C.S. § 2702 (RELATING TO AGGRAVATED
16 ASSAULT).
17 (IV) 18 PA.C.S. § 2709.1 (RELATING TO STALKING).
18 (V) 18 PA.C.S. CH. 29 (RELATING TO KIDNAPPING).
19 (VI) 18 PA.C.S. CH. 31 (RELATING TO SEXUAL
20 OFFENSES).
21 (VII) 18 PA.C.S. § 3301 (RELATING TO ARSON AND
22 RELATED OFFENSES).
23 (VIII) 18 PA.C.S. § 3302 (RELATING TO CAUSING OR
24 RISKING CATASTROPHE).
25 (IX) 18 PA.C.S. CH. 35 (RELATING TO BURGLARY AND
26 OTHER CRIMINAL INTRUSION).
27 (X) 18 PA.C.S. CH. 37 (RELATING TO ROBBERY).
28 (XI) A FELONY VIOLATION UNDER 18 PA.C.S. CH. 39
29 (RELATING TO THEFT AND RELATED OFFENSES).
30 (XII) 18 PA.C.S. CH. 59 (RELATING TO PUBLIC
20030H0158B1973 - 38 -
1 INDECENCY).
2 (E) PROGRAM ADMINISTRATOR DUTIES.--THE PROGRAM ADMINISTRATOR
3 SHALL:
4 (1) ADMINISTER THE PROGRAM AND ESTABLISH PROCEDURES AND
5 FORMS AS MAY BE NECESSARY TO IMPLEMENT THE PROGRAM.
6 (2) ESTABLISH CRITERIA TO IDENTIFY ASSESSMENT REDUCTION
7 RECIPIENTS FROM AMONG ALL PHYSICIANS WHO QUALIFY AND APPLY
8 FOR A REDUCTION AND THE AMOUNT OF EACH REDUCTION. THE
9 CRITERIA SHALL INCLUDE THE AMOUNT OF FUNDS ALLOCATED TO THE
10 PROGRAM, THE APPLICANT'S ACTUAL FINANCIAL NEED, THE
11 COMMUNITY-BASED NEED FOR THE APPLICANT'S SERVICES AND THE
12 APPLICANT'S SPECIALTY CLASSIFICATION. THE PROGRAM
13 ADMINISTRATOR MAY ESTABLISH ANY OTHER CRITERIA NECESSARY TO
14 ENSURE ACCESS TO QUALITY HEALTH CARE IN ALL REGIONS OF THIS
15 COMMONWEALTH.
16 (3) AWARD REDUCTIONS IN ASSESSMENTS TO ELIGIBLE
17 APPLICANTS BY NO LATER THAN 90 DAYS AFTER THE PRECEDING
18 CALENDAR YEAR FOR WHICH THE NECESSARY DOCUMENTATION IS
19 REQUIRED.
20 (4) REQUIRE ASSESSMENT REDUCTION RECIPIENTS TO MAINTAIN
21 ALL NECESSARY INFORMATION IN A FORMAT SPECIFIED BY THE
22 PROGRAM ADMINISTRATOR.
23 (5) PROMULGATE REGULATIONS TO IMPLEMENT THIS CHAPTER.
24 (6) REPORT TO THE GOVERNOR AND THE CHAIRMAN AND MINORITY
25 CHAIRMAN OF THE BANKING AND INSURANCE COMMITTEE OF THE SENATE
26 AND THE CHAIRMAN AND MINORITY CHAIRMAN OF THE INSURANCE
27 COMMITTEE OF THE HOUSE OF REPRESENTATIVES ON THE REDUCTIONS
28 AWARDED, THE IMPACT ON THE RECIPIENTS AND THE AMOUNT
29 DISBURSED BY THE PROGRAM. IN ADDITION TO THE CONTENT
30 SPECIFIED IN THIS PARAGRAPH, THE REPORT SHALL INCLUDE ANY
20030H0158B1973 - 39 -
1 OTHER INFORMATION NECESSARY TO ACCURATELY INFORM THE PUBLIC
2 ABOUT THE PROGRAM, DEMOGRAPHICS OF ELIGIBLE APPLICANTS AND
3 ASSESSMENT REDUCTION RECIPIENTS, THE FINANCIAL CONDITION OF
4 HEALTH CARE PROVIDERS IN THIS COMMONWEALTH AND PATIENTS'
5 ACCESS TO HEALTH CARE IN THIS COMMONWEALTH. THE REPORT SHALL
6 BE DUE NOVEMBER 30 OF EACH YEAR AND SHALL BE MADE AVAILABLE
7 FOR PUBLIC INSPECTION AND POSTED ON THE PROGRAM
8 ADMINISTRATOR'S PUBLICLY ACCESSIBLE WORLD WIDE WEB SITE.
9 (F) CONFIDENTIAL INFORMATION.--THE DOCUMENTATION SPECIFIED
10 IN SUBSECTION (C) SHALL BE CONFIDENTIAL AND SHALL NOT BE
11 RELEASED TO ANYONE.
12 (G) EXPIRATION.--THIS SECTION SHALL EXPIRE JANUARY 1, 2014.
13 SECTION 804-A. PROGRAM FUNDING.
14 (A) DEPOSIT.--
15 (1) NOTWITHSTANDING THE PROVISIONS OF 75 PA.C.S. §
16 6506(B) (RELATING TO SURCHARGE) AND SECTION 712(M) TO THE
17 CONTRARY, ALL SURCHARGES LEVIED AND COLLECTED UNDER 75
18 PA.C.S. § 6506(A) BY ANY DIVISION OF THE UNIFIED JUDICIAL
19 SYSTEM SHALL BE REMITTED TO THE COMMONWEALTH FOR DEPOSIT IN
20 THE MCARE ASSESSMENT NEED PROGRAM ACCOUNT.
21 (2) BEGINNING JANUARY 1, 2014, AND EACH YEAR THEREAFTER,
22 THE SURCHARGES LEVIED AND COLLECTED UNDER 75 PA.C.S § 6506(A)
23 SHALL BE DEPOSITED INTO THE GENERAL FUND.
24 (B) TRANSFER OF FUNDS.--AMOUNTS DEPOSITED IN THE MEDICAL
25 CARE AVAILABILITY AND RESTRICTION OF ERROR FUND IN ACCORDANCE
26 WITH SECTION 712(M) AFTER DECEMBER 31, 2002, AND BEFORE THE
27 EFFECTIVE DATE OF THIS SECTION SHALL BE TRANSFERRED BY THE STATE
28 TREASURER TO THE MCARE ASSESSMENT NEED PROGRAM ACCOUNT.
29 (C) USE OF FUNDS.--AMOUNTS DEPOSITED OR TRANSFERRED INTO THE
30 MCARE ASSESSMENT NEED PROGRAM ACCOUNT SHALL BE USED BY THE
20030H0158B1973 - 40 -
1 PROGRAM ADMINISTRATOR TO PROVIDE ASSESSMENT REDUCTIONS TO
2 ELIGIBLE APPLICANTS AS DETERMINED UNDER SECTION 3.
3 (D) EXPIRATION.--EXCEPT FOR SUBSECTION (A)(2), THIS SECTION
4 SHALL EXPIRE JANUARY 1, 2014.
5 SECTION 805-A. INTERIM REGULATIONS.
6 THE PROGRAM ADMINISTRATOR SHALL PROMULGATE INTERIM
7 REGULATIONS TO IMPLEMENT THE PROGRAM WITHIN 90 DAYS OF THE
8 EFFECTIVE DATE OF THIS SECTION. THE INTERIM REGULATIONS SHALL
9 EXPIRE AFTER TWO YEARS OR UPON THE ADOPTION OF FINAL
10 REGULATIONS, WHICHEVER IS EARLIER. THE INTERIM REGULATIONS SHALL
11 NOT BE SUBJECT TO SECTION 201 OR 205 OF THE ACT OF JULY 31, 1968
12 (P.L.769, NO.240), REFERRED TO AS THE COMMONWEALTH DOCUMENTS
13 LAW.
14 CHAPTER 8-B
15 HEALTH CARE PROVIDER REIMBURSEMENTS
16 SECTION 801-B. SCOPE.
17 THIS CHAPTER RELATES TO HEALTH INSURANCE REIMBURSEMENTS FOR
18 HIGH RISK HEALTH CARE PROVIDERS AND INSTITUTIONS.
19 SECTION 802-B. FINDINGS.
20 THE GENERAL ASSEMBLY OF THE COMMONWEALTH OF PENNSYLVANIA
21 FINDS THAT:
22 (1) MANY HIGH RISK HEALTH CARE PROVIDERS AND
23 INSTITUTIONS IN THIS COMMONWEALTH ARE RECEIVING
24 REIMBURSEMENTS EVEN LESS THAN MEDICARE RATES FOR SERVICES
25 THEY PROVIDE FOR COVERED CARE.
26 (2) HIGH RISK HEALTH CARE PROVIDERS AND INSTITUTIONS ARE
27 CURRENTLY BEING UNDERCOMPENSATED FOR TREATMENTS AND SERVICES
28 PROPERLY COVERED UNDER HEALTH INSURANCE POLICIES.
29 (3) THE CONTINUING LOW REIMBURSEMENT RATES TO THESE
30 PROVIDERS THREATEN THE HEALTH, SAFETY AND WELFARE OF THE
20030H0158B1973 - 41 -
1 CITIZENS OF THIS COMMONWEALTH BECAUSE HIGH RISK HEALTH CARE
2 PROVIDERS AND INSTITUTIONS MAY LEAVE THIS COMMONWEALTH OR
3 CLOSE DOWN IF THE LOW REIMBURSEMENTS CONTINUE SIMILAR TO WHAT
4 HAS HAPPENED IN THE STATE OF CALIFORNIA.
5 (4) FAIR REIMBURSEMENTS MUST BE ESTABLISHED FOR HIGH
6 RISK HEALTH CARE PROVIDERS AND INSTITUTIONS FOR SERVICES
7 PROVIDED TO INDIVIDUALS FOR CARE, TREATMENTS AND SERVICES
8 COVERED UNDER HEALTH INSURANCE POLICIES.
9 SECTION 803-B. DEFINITIONS.
10 THE FOLLOWING WORDS AND PHRASES WHEN USED IN THIS CHAPTER
11 SHALL HAVE THE MEANINGS GIVEN TO THEM IN THIS SECTION UNLESS THE
12 CONTEXT CLEARLY INDICATES OTHERWISE:
13 "HEALTH INSURANCE POLICY." AN INDIVIDUAL OR GROUP HEALTH
14 INSURANCE POLICY, CONTRACT OR PLAN WHICH PROVIDES MEDICAL,
15 MENTAL, DENTAL, OPTICAL, PSYCHOLOGICAL OR HEALTH CARE COVERAGE
16 BY ANY HEALTH CARE FACILITY OR LICENSED HEALTH CARE PROVIDER ON
17 AN EXPENSE INCURRED, SERVICE OR PREPAID BASIS WHICH IS OFFERED
18 BY OR IS GOVERNED UNDER ANY OF THE FOLLOWING:
19 (1) THE ACT OF MAY 17, 1921 (P.L.682, NO.284), KNOWN AS
20 THE INSURANCE COMPANY LAW OF 1921.
21 (2) THE ACT OF JUNE 13, 1967 (P.L.31, NO.21), KNOWN AS
22 THE PUBLIC WELFARE CODE.
23 (3) THE ACT OF DECEMBER 29, 1972 (P.L.1701, NO.364),
24 KNOWN AS THE HEALTH MAINTENANCE ORGANIZATION ACT.
25 (4) THE ACT OF MAY 18, 1976 (P.L.123, NO.54), KNOWN AS
26 THE INDIVIDUAL ACCIDENT AND SICKNESS INSURANCE MINIMUM
27 STANDARDS ACT.
28 (5) A NONPROFIT CORPORATION SUBJECT TO 40 PA.C.S. CHS.
29 61 (RELATING TO HOSPITAL PLAN CORPORATIONS) AND 63 (RELATING
30 TO PROFESSIONAL HEALTH SERVICES PLAN CORPORATIONS).
20030H0158B1973 - 42 -
1 "HIGH RISK INSTITUTION." ANY LEVEL I OR LEVEL II TRAUMA
2 CENTER ACCREDITED BY THE PENNSYLVANIA TRAUMA SYSTEMS FOUNDATION
3 UNDER THE ACT OF JULY 3, 1985 (P.L.164, NO.45), KNOWN AS THE
4 EMERGENCY MEDICAL SERVICES ACT.
5 "HIGH RISK PROVIDER." A MEDICAL PROVIDER WHO PAYS MEDICAL
6 MALPRACTICE PREMIUMS IN THIS COMMONWEALTH IN ONE OF THE FOUR
7 HIGHEST CLASSES.
8 "INSURER." AN ENTITY THAT INSURES AN INDIVIDUAL OR GROUP
9 HEALTH INSURANCE POLICY, CONTRACT OR PLAN DESCRIBED UNDER A
10 HEALTH INSURANCE POLICY.
11 SECTION 804-B. FAIR REIMBURSEMENTS FOR HIGH RISK HEALTH CARE
12 PROVIDERS AND INSTITUTIONS.
13 (A) GENERAL RULE.--SUBJECT TO SUBSECTION (B), EVERY HEALTH
14 INSURANCE POLICY THAT PROVIDES COVERAGE TO AN INDIVIDUAL AND IS
15 EFFECTIVE, DELIVERED, ISSUED, EXECUTED OR RENEWED IN THIS
16 COMMONWEALTH ON OR AFTER THE EFFECTIVE DATE OF THIS CHAPTER
17 SHALL PROVIDE PAYMENT TO ANY HIGH RISK HEALTH CARE PROVIDER OR
18 HIGH RISK INSTITUTION PROVIDING ANY CARE COVERED UNDER A HEALTH
19 INSURANCE POLICY FOR ALL CARE INCLUDING TREATMENT,
20 ACCOMMODATION, PRODUCTS, OR SERVICES TO A COVERED INDIVIDUAL FOR
21 TREATMENTS AT A MINIMUM OF 110% OF THE APPLICABLE FEE SCHEDULE,
22 THE RECOMMENDED FEE OR THE INFLATION INDEX CHARTS; OR 110% OF
23 THE DIAGNOSTIC-RELATED GROUPS (DRG) PAYMENT; WHICHEVER PERTAINS
24 TO THE SPECIALTY SERVICE INVOLVED, DETERMINED TO BE APPLICABLE
25 IN THIS COMMONWEALTH UNDER THE MEDICARE PROGRAM AND ITS
26 REGULATIONS FOR COMPARABLE SERVICES AT THE TIME THE SERVICES
27 WERE RENDERED OR AT THE PROVIDER'S USUAL AND CUSTOMARY CHARGE,
28 WHICHEVER IS LESS.
29 (B) MEDICARE ALLOWANCE MODIFICATIONS.--
30 (1) THE GENERAL ASSEMBLY FINDS THAT THE REIMBURSEMENT
20030H0158B1973 - 43 -
1 ALLOWANCE APPLICABLE IN THIS COMMONWEALTH UNDER THE MEDICARE
2 PROGRAM IS AN APPROPRIATE BASIS TO CALCULATE PAYMENTS FOR
3 CARE INCLUDING TREATMENTS, ACCOMMODATIONS, PRODUCTS OR
4 SERVICES FOR CARE AND TREATMENT.
5 (2) FUTURE CHANGES OR ADDITIONS TO THE MEDICARE
6 ALLOWANCES SHALL APPLY TO THIS SECTION. IF THE INSURANCE
7 COMMISSIONER DETERMINES THAT AN ALLOWANCE UNDER MEDICARE IS
8 NOT REASONABLE, THE INSURANCE COMMISSIONER MAY ADOPT A
9 DIFFERENT ALLOWANCE BY REGULATION, WHICH ALLOWANCE SHALL BE
10 APPLIED AGAINST A PERCENTAGE LIMITATION IN THIS SECTION.
11 (3) IF A PREVAILING CHARGE, FEE SCHEDULE, RECOMMENDED
12 FEE, INFLATION INDEX CHARGE OR DRG PAYMENT IS NOT BEING
13 CALCULATED UNDER THE MEDICARE PROGRAM FOR A PARTICULAR
14 TREATMENT, ACCOMMODATION, PRODUCT OR SERVICE, THE
15 REIMBURSEMENT MAY NOT BE LESS THAN 80% OF THE PROVIDER'S
16 USUAL AND CUSTOMARY CHARGE.
17 (4) IF ACUTE CARE IS PROVIDED IN AN ACUTE CARE FACILITY
18 TO A PATIENT WITH IMMEDIATE LIFE-THREATENING OR URGENT INJURY
19 BY A LEVEL I OR LEVEL II TRAUMA CENTER, ACCREDITED BY THE
20 PENNSYLVANIA TRAUMA SYSTEMS FOUNDATION UNDER THE ACT OF JULY
21 3, 1985 (P.L.164, NO.45), KNOWN AS THE EMERGENCY MEDICAL
22 SERVICES ACT, OR TO A MAJOR BURN INJURY PATIENT BY A BURN
23 FACILITY WHICH MEETS ALL OF THE SERVICE STANDARDS OF THE
24 AMERICAN BURN ASSOCIATION, THE REIMBURSEMENT MAY NOT BE LESS
25 THAN THE USUAL OR CUSTOMARY CHARGE WHILE THE PATIENT IS STILL
26 AT AN IMMEDIATE LIFE-THREATENING OR URGENT INJURY LEVEL.
27 SECTION 805-B. DIRECT BILLING TO INSUREDS PROHIBITED.
28 NO HIGH RISK PROVIDER OR HIGH RISK INSTITUTION SUBJECT TO
29 THIS ACT MAY:
30 (1) BILL AN INSURED DIRECTLY, BUT MUST BILL THE INSURER
20030H0158B1973 - 44 -
1 FOR DETERMINATION OF THE AMOUNT PAYABLE.
2 (2) IF RECEIVING FAIR PAYMENTS UNDER THIS CHAPTER, BILL
3 OR OTHERWISE ATTEMPT TO COLLECT FROM AN INSURED THE
4 DIFFERENCE BETWEEN THE PROVIDER'S OR INSTITUTION'S FULL
5 CHARGE AND THE FAIR AMOUNT PAID BY THE INSURER, UNLESS
6 REQUIRED BY A COPAYMENT UNDER THE HEALTH INSURANCE POLICY.
7 SECTION 806-B. REPEALS.
8 ALL ACTS AND PARTS OF ACTS ARE REPEALED INSOFAR AS THEY ARE
9 INCONSISTENT WITH THIS CHAPTER.
10 CHAPTER 8-C
11 HEALTH INSURANCE PAYERS
12 SECTION 801-C. SCOPE.
13 THIS CHAPTER RELATES TO HEALTH INSURANCE FEE SCHEDULES AND
14 PROVIDER REIMBURSEMENTS.
15 SECTION 802-C. LEGISLATIVE FINDINGS.
16 THE GENERAL ASSEMBLY FINDS THAT:
17 (1) A MAJORITY OF PHYSICIANS IN THIS COMMONWEALTH ARE
18 REIMBURSED FOR THEIR SERVICES TO PATIENTS BY THIRD-PARTY
19 PAYORS. IN SOME CASES, THIS CONTRACTUAL RELATIONSHIP BETWEEN
20 PHYSICIAN AND INSURER HAS EXISTED FOR YEARS WITHOUT THE
21 PHYSICIAN RECEIVING FROM THE INSURER A FORMAL CONTRACT OR AN
22 ACCURATE OR COMPLETE FEE SCHEDULE DETAILING FEES OR THE RULES
23 OR ALGORITHMS THAT ACTUALLY DEFINE THE RATES AT WHICH
24 PHYSICIANS ARE COMPENSATED FOR THE SERVICES THEY RENDER TO
25 THE PAYORS' INSUREDS. MOST HEALTH CARE INSURERS IN THIS
26 COMMONWEALTH REFUSE TO FULLY AND ACCURATELY DISCLOSE THEIR
27 FEE SCHEDULES TO PARTICIPATING PHYSICIANS; THEREFORE, DOCTORS
28 DO NOT KNOW AND CANNOT FIND OUT WHAT THEY WILL RECEIVE IN
29 COMPENSATION PRIOR TO PERFORMING A SERVICE. THIS INSURER
30 POLICY IS MANIFESTLY UNFAIR TO PHYSICIANS; IT IS A BREACH OF
20030H0158B1973 - 45 -
1 THE PHYSICIANS' CONTRACTS; AND IT FACILITATES FURTHER
2 BREACHES OF SUCH CONTRACTS BY MAKING IT IMPOSSIBLE FOR
3 PHYSICIANS TO ENFORCE THEIR RIGHT TO FULL PAYMENT FOR
4 SERVICES RENDERED.
5 (2) DURING THE COURSE OF A SINGLE OPERATIVE SESSION, A
6 SURGEON MAY PERFORM MULTIPLE SURGICAL PROCEDURES ON THE
7 PATIENT. THESE MULTIPLE SURGICAL PROCEDURES ARE SEPARATE AND
8 DISTINCT OPERATIONS IN LAYMAN'S TERMS AND AS DEFINED BY THE
9 CURRENT PROCEDURE TERMINOLOGY CODING SYSTEM CREATED BY THE
10 AMERICAN MEDICAL ASSOCIATION AND OTHER PROFESSIONAL MEDICAL
11 SOCIETIES. THE GENERAL ASSEMBLY FURTHER FINDS THAT THE
12 CURRENT PROCEDURAL TERMINOLOGY (CPT) CODING SYSTEM IS
13 UTILIZED BY ALL PHYSICIANS TO IDENTIFY TO PAYORS THE SERVICES
14 RENDERED BY PHYSICIANS AND THAT PAYORS PURPORT TO ADOPT THE
15 SAME CPT CODING SYSTEM IN DEFINING THE SERVICES FOR WHICH
16 THEY COMPENSATE SUCH PHYSICIANS. THE GENERAL ASSEMBLY ALSO
17 FINDS, HOWEVER, THAT, CONTRARY TO THE DICTATES OF THE CPT
18 CODING SYSTEM AND WITHOUT DISCLOSING ANY SUCH DEVIATION TO
19 THE PHYSICIANS WITH WHOM THEY CONTRACT, A NUMBER OF HEALTH
20 CARE INSURERS IN THIS COMMONWEALTH COMPENSATE PHYSICIANS AS
21 IF THE PROCEDURES PERFORMED IN ADDITION TO THE PRIMARY
22 PROCEDURE WERE MERELY INCIDENTAL TO THE PRIMARY PROCEDURE AND
23 THEREFORE SUCH PAYORS WILL COMPENSATE THE SURGEON FOR ONLY
24 ONE PROCEDURE. THIS INSURER POLICY IS INCONSISTENT WITH THE
25 MEDICAL JUDGMENTS UPON WHICH THE CPT CODING SYSTEM IS BASED,
26 IT IS NOT ACCURATELY DISCLOSED TO PHYSICIANS, IT IS
27 MANIFESTLY UNFAIR TO SURGEONS, IT LEADS TO A LACK OF ACCESS
28 TO QUALITY HEALTH CARE SERVICES FOR PATIENTS, AND IT ADDS TO
29 THE EXCESS PROFITS INSURERS TAKE FROM THE HEALTH CARE
30 DELIVERY SYSTEM.
20030H0158B1973 - 46 -
1 SECTION 803-C. DECLARATION OF INTENT.
2 THE GENERAL ASSEMBLY HEREBY DECLARES THAT IT IS THE POLICY OF
3 THIS COMMONWEALTH THAT PHYSICIANS SHOULD RECEIVE FROM HEALTH
4 CARE INSURERS A COMPLETE AND ACCURATE SCHEDULE OF THE
5 REIMBURSEMENT FEES, INCLUDING ANY RULES OR ALGORITHMS UTILIZED
6 BY THE PAYOR TO DETERMINE THE AMOUNT A PHYSICIAN WILL BE
7 COMPENSATED IF MORE THAN ONE PROCEDURE IS PERFORMED DURING A
8 SINGLE TREATMENT SESSION. THE GENERAL ASSEMBLY FURTHER DECLARES
9 THAT IT IS THE POLICY OF THIS COMMONWEALTH THAT INSURERS MUST
10 COMPLY WITH THEIR CONTRACTUAL OBLIGATIONS AND THAT SURGEONS
11 SHOULD BE FAIRLY AND JUSTLY COMPENSATED FOR ALL SURGICAL
12 PROCEDURES THEY PERFORM IN A SINGLE OPERATIVE SESSION.
13 SECTION 804-C. DEFINITIONS.
14 THE FOLLOWING WORDS AND PHRASES WHEN USED IN THIS CHAPTER
15 SHALL HAVE THE MEANINGS GIVEN TO THEM IN THIS SECTION UNLESS THE
16 CONTEXT CLEARLY INDICATES OTHERWISE:
17 "FEE SCHEDULE." THE GENERALLY APPLICABLE MONETARY ALLOWANCE
18 PAYABLE TO A PARTICIPATING PHYSICIAN FOR SERVICES RENDERED AS
19 PROVIDED FOR BY AGREEMENT BETWEEN THE PARTICIPATING PHYSICIAN
20 AND THE INSURER, INCLUDING, BUT NOT LIMITED TO, A LIST OF
21 HEALTHCARE COMMON PROCEDURE CODING SYSTEM (HCPCS) LEVEL I
22 CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES, HCPCS LEVEL II
23 NATIONAL CODES AND HCPCS LEVEL III LOCAL CODES AND THE FEES
24 ASSOCIATED THEREIN; AND A DELINEATION OF THE PRECISE METHODOLOGY
25 USED FOR DETERMINING THE GENERALLY APPLICABLE MONETARY
26 ALLOWANCES, INCLUDING, BUT NOT LIMITED TO, FOOTNOTES DESCRIBING
27 FORMULAS, ALGORITHMS, RULES AND CALCULATIONS ASSOCIATED WITH
28 DETERMINATION OF THE INDIVIDUAL ALLOWANCES.
29 "HCPCS." HCFA (HEALTH CARE FINANCING ADMINISTRATION) COMMON
30 PROCEDURAL CODING SYSTEM, A UNIFORM METHOD FOR HEALTH CARE
20030H0158B1973 - 47 -
1 PROVIDERS AND MEDICAL SUPPLIERS TO REPORT PROFESSIONAL SERVICES,
2 PROCEDURES, PHARMACEUTICALS AND SUPPLIES.
3 "HCPCS LEVEL I CPT CODES." THE DESCRIPTIVE TERMS AND
4 IDENTIFYING CODES USED IN REPORTING SUPPLIES AND PHARMACEUTICALS
5 USED BY AND SERVICES AND PROCEDURES PERFORMED BY PARTICIPATING
6 PHYSICIANS AS LISTED IN THE AMERICAN MEDICAL ASSOCIATION'S
7 PHYSICIAN'S CURRENT PROCEDURAL TERMINOLOGY (CPT).
8 "HCPCS LEVEL II NATIONAL CODES." DESCRIPTIVE TERMS AND
9 IDENTIFYING CODES USED IN REPORTING SUPPLIES AND PHARMACEUTICALS
10 USED BY AND SERVICES AND PROCEDURES PERFORMED BY PARTICIPATING
11 PHYSICIANS.
12 "HCPCS LEVEL III LOCAL CODES." DESCRIPTIVE TERMS AND
13 IDENTIFYING CODES USED IN REPORTING SUPPLIES AND PHARMACEUTICALS
14 USED BY AND SERVICES AND PROCEDURES PERFORMED BY PARTICIPATING
15 PHYSICIANS WHICH ARE ASSIGNED AND MAINTAINED BY PENNSYLVANIA'S
16 CENTERS FOR MEDICARE AND MEDICAID SERVICES CARRIER.
17 "INSURER." ANY INSURANCE COMPANY, ASSOCIATION OR EXCHANGE
18 AUTHORIZED TO TRANSACT THE BUSINESS OF INSURANCE IN THIS
19 COMMONWEALTH. THIS SHALL ALSO INCLUDE ANY ENTITY OPERATING UNDER
20 ANY OF THE FOLLOWING:
21 (1) SECTION 630 OF THE ACT OF MAY 17, 1921 (P.L.682,
22 NO.284), KNOWN AS THE INSURANCE COMPANY LAW OF 1921.
23 (2) ARTICLE XXIV OF THE ACT OF MAY 17, 1921 (P.L.682,
24 NO.284), KNOWN AS THE INSURANCE COMPANY LAW OF 1921.
25 (3) THE ACT OF DECEMBER 29, 1972 (P.L.1701, NO.364),
26 KNOWN AS THE HEALTH MAINTENANCE ORGANIZATION ACT.
27 (4) 40 PA.C.S. CH. 61 (RELATING TO HOSPITAL PLAN
28 CORPORATIONS).
29 (5) 40 PA.C.S. CH. 63 (RELATING TO PROFESSIONAL HEALTH
30 SERVICES PLAN CORPORATIONS).
20030H0158B1973 - 48 -
1 (6) 40 PA.C.S. CH. 67 (RELATING TO BENEFICIAL
2 SOCIETIES).
3 "PARTICIPATING PHYSICIAN." AN INDIVIDUAL LICENSED UNDER THE
4 LAWS OF THIS COMMONWEALTH TO ENGAGE IN THE PRACTICE OF MEDICINE
5 AND SURGERY IN ALL ITS BRANCHES WITHIN THE SCOPE OF THE ACT OF
6 DECEMBER 20, 1985 (P.L.457, NO.112), KNOWN AS THE MEDICAL
7 PRACTICE ACT OF 1985, OR IN THE PRACTICE OF OSTEOPATHIC MEDICINE
8 WITHIN THE SCOPE OF THE ACT OF OCTOBER 5, 1978 (P.L.1109,
9 NO.261), KNOWN AS THE OSTEOPATHIC MEDICAL PRACTICE ACT, WHO BY
10 AGREEMENT PROVIDES SERVICES TO AN INSURER'S SUBSCRIBERS.
11 SECTION 805-C. DISCLOSURE OF FEE SCHEDULES.
12 WITHIN 30 DAYS OF THE EFFECTIVE DATE OF THIS CHAPTER,
13 INSURERS SHALL PROVIDE THEIR PARTICIPATING PHYSICIANS WITH A
14 COPY OF THEIR FEE SCHEDULE, INCLUDING ALL APPLICABLE RULES AND
15 ALGORITHMS UTILIZED BY THE INSURER TO DETERMINE THE AMOUNT ANY
16 SUCH PHYSICIAN WILL BE COMPENSATED FOR PERFORMING ANY SINGLE
17 PROCEDURE AND ANY GROUP OF PROCEDURES DURING A SINGLE TREATMENT
18 SESSION, WHICH ARE APPLICABLE ON JULY 1, 2002, AND ANNUALLY
19 THEREAFTER. INSURERS SHALL ALSO PROVIDE PARTICIPATING PHYSICIANS
20 WITH UPDATES TO THE FEE SCHEDULE AS MODIFICATIONS OCCUR.
21 SECTION 806-C. PROCEDURE FOR PAYMENT OF MULTIPLE SURGICAL
22 PROCEDURES.
23 WHEN A PARTICIPATING PHYSICIAN PERFORMS MORE THAN ONE
24 SURGICAL PROCEDURE ON THE SAME PATIENT AND AT THE SAME OPERATIVE
25 SESSION, INSURERS SHALL PAY THE PARTICIPATING PHYSICIAN THE
26 GREATER OF THE AMOUNT CALCULATED ON THE BASIS OF THE APPLICABLE
27 INSURER FEE SCHEDULE AND:
28 (1) ANY RULES, ALGORITHMS, CODES OR MODIFIERS INCLUDED
29 THEREIN, GOVERNING REIMBURSEMENT FOR MULTIPLE SURGICAL
30 PROCEDURES; OR
20030H0158B1973 - 49 -
1 (2) THE PRINCIPLES GOVERNING REIMBURSEMENT FOR MULTIPLE
2 SURGICAL PROCEDURES SET FORTH AND ESTABLISHED BY THE CENTERS
3 FOR MEDICARE AND MEDICAID SERVICES WITHIN THE UNITED STATES
4 DEPARTMENT OF HEALTH AND HUMAN SERVICES, INCLUDING THE RULE
5 MANDATING PAYMENT TO THE PHYSICIAN OF:
6 (I) ONE HUNDRED PERCENT OF THE GENERALLY APPLICABLE
7 MAXIMUM MONETARY ALLOWANCE FOR THE PROCEDURE WHICH HAS
8 THE HIGHEST MONETARY ALLOWANCE.
9 (II) FIFTY PERCENT OF THE GENERALLY APPLICABLE
10 MAXIMUM MONETARY ALLOWANCE FOR THE SECOND THROUGH FIFTH
11 PROCEDURES WITH THE NEXT HIGHEST VALUES.
12 (III) PROCEDURES IN EXCESS OF FIVE REQUIRE
13 SUBMISSION OF DOCUMENTATION AND INDIVIDUAL REVIEW TO
14 DETERMINE PAYMENT AMOUNT.
15 SECTION 807-C. CONTRACT PROVISIONS.
16 ANY PROVISION IN ANY CONTRACT, INSURER POLICY OR FEE SCHEDULE
17 THAT IS INCONSISTENT WITH ANY PROVISION OF THIS CHAPTER IS
18 HEREBY DECLARED TO BE CONTRARY TO THE PUBLIC POLICY OF THE
19 COMMONWEALTH AND IS VOID AND UNENFORCEABLE.
20 SECTION 808-C. VIOLATIONS.
21 AN INSURER VIOLATES:
22 (1) SECTION 805-C IF THE INSURER FAILS TO PROVIDE A
23 PARTICIPATING PHYSICIAN WITH A COPY OF THE FEE SCHEDULE AND
24 UPDATES TO THE FEE SCHEDULE IN THE TIME FRAME PROVIDED IN
25 SECTION 805-C.
26 (2) SECTION 806-C IF THE INSURER FAILS TO ADHERE TO THE
27 POLICY FOR PAYMENT OF MULTIPLE SURGERIES AS SET FORTH AND
28 ESTABLISHED BY THE CENTERS FOR MEDICARE AND MEDICAID SERVICES
29 WITHIN THE DEPARTMENT OF HEALTH AND HUMAN SERVICES.
30 SECTION 809-C. CAUSE OF ACTION.
20030H0158B1973 - 50 -
1 IN ADDITION TO ALL STATUTORY, COMMON LAW AND EQUITABLE CAUSES
2 OF ACTION WHICH ALREADY EXIST, A PARTICIPATING PHYSICIAN SHALL
3 HAVE A PRIVATE CAUSE OF ACTION FOR ANY VIOLATION OF ANY
4 PROVISION OF THIS CHAPTER TO ENFORCE THE PROVISIONS OF THIS
5 CHAPTER. A PARTICIPATING PHYSICIAN SHALL BE ENTITLED TO RECOVER
6 FROM AN INSURER ANY LEGAL FEES AND COSTS ASSOCIATED WITH ANY
7 SUIT BROUGHT UNDER THIS SECTION.
8 SECTION 810-C. TERMINATION OF AGREEMENT.
9 IN ADDITION TO OTHER REMEDIES PROVIDED IN THIS CHAPTER, A
10 PARTICIPATING PHYSICIAN MAY TERMINATE HIS AGREEMENT IF AN
11 INSURER VIOLATES THE PROVISIONS OF THIS CHAPTER. THE PHYSICIAN
12 MAY CONTINUE TO PROVIDE SERVICES TO THE INSURER'S INSUREDS AND
13 SHALL RECEIVE COMPENSATION AS AN OUT-OF-NETWORK PROVIDER.
14 SECTION 811-C. PENALTIES.
15 VIOLATIONS OF THIS CHAPTER SHALL BE CONSIDERED VIOLATIONS OF
16 THE ACT OF MAY 17, 1921 (P.L.682, NO.284), KNOWN AS THE
17 INSURANCE COMPANY LAW OF 1921, AND ARE SUBJECT TO THE PENALTIES
18 AND SANCTIONS OF SECTION 2182 OF THE INSURANCE COMPANY LAW OF
19 1921.
20 SECTION 8. SECTIONS 902 AND 903 OF THE ACT ARE AMENDED TO
21 READ:
22 SECTION 902. DEFINITIONS.
23 THE FOLLOWING WORDS AND PHRASES WHEN USED IN THIS CHAPTER
24 SHALL HAVE THE MEANINGS GIVEN TO THEM IN THIS SECTION UNLESS THE
25 CONTEXT CLEARLY INDICATES OTHERWISE:
26 "DEPARTMENT." THE DEPARTMENT OF HEALTH OF THE COMMONWEALTH.
27 "LICENSURE BOARD." EITHER OR BOTH OF THE FOLLOWING,
28 DEPENDING ON THE LICENSURE OF THE AFFECTED INDIVIDUAL:
29 (1) THE STATE BOARD OF MEDICINE.
30 (2) THE STATE BOARD OF OSTEOPATHIC MEDICINE.
20030H0158B1973 - 51 -
1 "PHYSICIAN." AN INDIVIDUAL LICENSED UNDER THE LAWS OF THIS
2 COMMONWEALTH TO ENGAGE IN THE PRACTICE OF:
3 (1) MEDICINE AND SURGERY IN ALL ITS BRANCHES WITHIN THE
4 SCOPE OF THE ACT OF DECEMBER 20, 1985 (P.L.457, NO.112),
5 KNOWN AS THE MEDICAL PRACTICE ACT OF 1985; OR
6 (2) OSTEOPATHIC MEDICINE AND SURGERY WITHIN THE SCOPE OF
7 THE ACT OF OCTOBER 5, 1978 (P.L.1109, NO.261), KNOWN AS THE
8 OSTEOPATHIC MEDICAL PRACTICE ACT.
9 Section 903. Reporting.
10 (a) Duty of physician to report.--A physician shall report
11 to the State Board of Medicine or the State Board of Osteopathic
12 Medicine, as appropriate, within [60] 30 days of the occurrence
13 of any of the following:
14 (1) Notice of a complaint in a medical professional
15 liability action that is filed against the physician. The
16 physician shall provide the docket number of the case, where
17 the case is filed and a description of the allegations in the
18 complaint.
19 (2) Information regarding disciplinary action taken
20 against the physician by a health care licensing authority of
21 another state.
22 (3) Information regarding sentencing of the physician
23 for an offense as provided in section 15 of the act of
24 October 5, 1978 (P.L.1109, No.261), known as the Osteopathic
25 Medical Practice Act, or section 41 of the act of December
26 20, 1985 (P.L.457, No.112), known as the Medical Practice Act
27 of 1985.
28 (4) Information regarding an arrest of the physician for
29 any of the following offenses in this Commonwealth or another
30 state:
20030H0158B1973 - 52 -
1 (i) 18 Pa.C.S. Ch. 25 (relating to criminal
2 homicide)[;]. <--
3 (ii) 18 Pa.C.S. § 2702 (relating to aggravated
4 assault)[; or]. <--
5 (iii) 18 Pa.C.S. Ch. 31 (relating to sexual
6 offenses).
7 (iv) A violation of the act of April 14, 1972
8 (P.L.233, No.64), known as The Controlled Substance,
9 Drug, Device and Cosmetic Act.
10 (b) Duty of prothonotary.--The prothonotary in any county in <--
11 which a complaint in a medical professional liability action is
12 filed against a physician shall report the filing to the State
13 Board of Medicine or the State Board of Osteopathic Medicine
14 within 30 days of the filing. The report shall include the
15 (B) FILING OF COMPLAINTS.--WITHIN 60 DAYS OF FILING A <--
16 COMPLAINT IN A MEDICAL PROFESSIONAL LIABILITY ACTION AGAINST A
17 PHYSICIAN, THE PLAINTIFF MUST DO ALL OF THE FOLLOWING:
18 (1) REPORT THE FILING TO THE STATE BOARD OF MEDICINE,
19 THE STATE BOARD OF OSTEOPATHIC MEDICINE OR THE DEPARTMENT OF
20 HEALTH, AS APPROPRIATE. THE REPORT UNDER THIS PARAGRAPH MUST
21 INCLUDE THE docket number of the case, where the case is
22 filed and a description of the allegations in the complaint.
23 (2) CERTIFY TO THE PROTHONOTARY THAT THE REPORT UNDER <--
24 PARAGRAPH (1) HAS BEEN MADE.
25 (c) Penalties.--In addition to any other penalty provided in
26 this act, a physician who fails to comply with the requirements
27 of this section shall be subject to a fine by the licensing
28 board in the following amount: $500 for a first offense, $1,000
29 for any second offense; and $2,500 for any third or subsequent
30 offense.
20030H0158B1973 - 53 -
1 Section 2. 9. The act is amended by adding a section to <--
2 read:
3 SECTION 904.1. REPORTS BY HOSPITALS AND HEALTH CARE FACILITIES. <--
4 (A) ACTION REPORT.--ANY HOSPITAL OR HEALTH CARE FACILITY
5 LICENSED UNDER THE ACT OF JULY 19, 1979 (P.L.130, NO.48), KNOWN
6 AS THE HEALTH CARE FACILITIES ACT, SHALL REPORT TO THE
7 APPROPRIATE LICENSURE BOARD IF THE HOSPITAL OR FACILITY DENIES,
8 RESTRICTS, REVOKES OR FAILS TO RENEW STAFF PRIVILEGES OR ACCEPTS
9 THE RESIGNATION OF A PHYSICIAN FOR ANY REASON RELATED TO THE
10 PHYSICIAN'S COMPETENCE TO PRACTICE MEDICINE OR FOR ANY VIOLATION
11 OF LAW, REGULATION, RULE OR BYLAW OF THE HOSPITAL OR FACILITY.
12 THE REPORT SHALL BE FILED WITHIN 30 DAYS OF THE OCCURRENCE OF
13 THE REPORTABLE ACTION AND INCLUDE DETAILS REGARDING THE NATURE
14 AND CIRCUMSTANCES OF THE ACTION, ITS DATE AND THE REASONS FOR
15 IT.
16 (B) LIABILITY.--NO HOSPITAL, HEALTH CARE FACILITY OR PERSON
17 THAT REPORTS INFORMATION TO A LICENSURE BOARD UNDER THIS SECTION
18 SHALL BE LIABLE TO THE PHYSICIAN REFERENCED IN THE REPORT FOR
19 MAKING THE REPORT, PROVIDED THAT THE REPORT IS MADE IN GOOD
20 FAITH AND WITHOUT MALICE.
21 SECTION 10. SECTION 909 OF THE ACT IS AMENDED TO READ:
22 SECTION 909. LICENSURE BOARD REPORT.
23 (A) ANNUAL REPORT.--EACH LICENSURE BOARD SHALL SUBMIT A
24 REPORT NOT LATER THAN MARCH 1 OF EACH YEAR TO THE CHAIR AND THE
25 MINORITY CHAIR OF THE CONSUMER PROTECTION AND PROFESSIONAL
26 LICENSURE COMMITTEE OF THE SENATE AND TO THE CHAIR AND MINORITY
27 CHAIR OF THE PROFESSIONAL LICENSURE COMMITTEE OF THE HOUSE OF
28 REPRESENTATIVES. THE REPORT SHALL INCLUDE:
29 (1) THE NUMBER OF COMPLAINT FILES AGAINST BOARD
30 LICENSEES THAT WERE OPENED IN THE PRECEDING FIVE CALENDAR
20030H0158B1973 - 54 -
1 YEARS.
2 (2) THE NUMBER OF COMPLAINT FILES AGAINST BOARD
3 LICENSEES THAT WERE CLOSED IN THE PRECEDING FIVE CALENDAR
4 YEARS.
5 (3) THE NUMBER OF DISCIPLINARY SANCTIONS IMPOSED UPON
6 BOARD LICENSEES IN THE PRECEDING FIVE CALENDAR YEARS AND THE
7 SPECIFIC REASONS FOR THE SANCTIONS.
8 (4) THE NUMBER OF AND SPECIFIC REASONS FOR REVOCATIONS,
9 AUTOMATIC SUSPENSIONS, IMMEDIATE TEMPORARY SUSPENSIONS AND
10 STAYED AND ACTIVE SUSPENSIONS IMPOSED, VOLUNTARY SURRENDERS
11 ACCEPTED, LICENSE APPLICATIONS DENIED AND LICENSE
12 REINSTATEMENTS DENIED IN THE PRECEDING FIVE CALENDAR YEARS.
13 (5) THE RANGE OF LENGTHS OF SUSPENSIONS, OTHER THAN
14 AUTOMATIC SUSPENSIONS AND IMMEDIATE TEMPORARY SUSPENSIONS,
15 IMPOSED DURING THE PRECEDING FIVE CALENDAR YEARS.
16 (B) POSTING.--THE REPORT SHALL BE POSTED ON EACH LICENSURE
17 BOARD'S PUBLICLY ACCESSIBLE WORLD WIDE WEB SITE.
18 SECTION 11. THE ACT IS AMENDED BY ADDING SECTIONS TO READ:
19 Section 911. Public disclosure.
20 (a) Data repository established.--There shall be jointly
21 established between the State Board of Medicine and the State
22 Osteopathic Board of Medicine a data repository which shall
23 annually collect information to create individual profiles on
24 each physician licensed in the Commonwealth. The information
25 shall be collected on a form prescribed by the licensing board
26 and shall be made available to the general public on the
27 Department of State's publicly accessible World Wide Web site.
28 (b) Required information.--By July 1, 2003, and every year
29 thereafter, each physician shall submit to the licensing board
30 on the prescribed form the following:
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1 (1) Information regarding the sentencing of a physician
2 for an offense as provided in section 15 of the act of
3 October 5, 1978 (P.L.1109, No.261), known as the Osteopathic
4 Medical Practice Act, or section 41 of the act of December
5 20, 1985 (P.L.457, No.112), known as the Medical Practice Act
6 of 1985.
7 (2) Information regarding the conviction of a physician
8 or a plea of guilty or no contest by a physician WITHIN THE <--
9 TEN MOST RECENT YEARS for any of the following offenses in
10 this Commonwealth or another state:
11 (i) 18 Pa.C.S. Ch. 25 (relating to criminal
12 homicide).
13 (ii) 18 Pa.C.S. § 2702 (relating to aggravated
14 assault).
15 (iii) A FELONY VIOLATION UNDER 18 Pa.C.S. § 2709.1 <--
16 (relating to stalking).
17 (iv) A FELONY VIOLATION UNDER 18 Pa.C.S. Ch. 29 <--
18 (relating to kidnapping).
19 (v) 18 Pa.C.S. Ch. 31 (relating to sexual offenses).
20 (vi) A FELONY VIOLATION UNDER 18 Pa.C.S. § 3301 <--
21 (relating to arson and related offenses).
22 (vii) 18 Pa.C.S. § 3302 (relating to causing or
23 risking catastrophe).
24 (viii) A FELONY VIOLATION UNDER 18 Pa.C.S. Ch. 35 <--
25 (relating to burglary and other criminal intrusion).
26 (ix) 18 Pa.C.S. Ch. 37 (relating to robbery).
27 (x) A felony violation under 18 Pa.C.S. Ch. 39
28 (relating to theft and related offenses).
29 (xi) A FELONY VIOLATION UNDER 18 Pa.C.S. Ch. 59 <--
30 (relating to public indecency).
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1 (XII) 75 PA.C.S. § 3731 (RELATING TO DRIVING UNDER <--
2 INFLUENCE OF ALCOHOL OR CONTROLLED SUBSTANCE).
3 (xii) (xiii) A violation of the act of April 14, <--
4 1972 (P.L.233, No.64), known as The Controlled Substance,
5 Drug, Device and Cosmetic Act.
6 (3) A description of any final disciplinary actions
7 taken against a physician by the licensing board in the
8 Commonwealth or a health care licensing authority in another
9 state within the ten most recent years.
10 (4) A description of any FINAL revocation or involuntary <--
11 restriction of hospital privileges for reasons related to
12 competency or character taken by a hospital's governing body
13 or any other official of a hospital after procedural due
14 process has been afforded, or the resignation from or
15 nonrenewal of medical staff membership or the resignation of
16 privileges at a hospital in lieu of or in settlement of a
17 pending disciplinary case related to competence or character
18 of the physician in that hospital in the ten most recent
19 years.
20 (5) All medical malpractice judgments or settlements in <--
21 which a payment of $50,000 or more is awarded to a
22 complaining party within the ten most recent years.
23 Disposition of paid claims shall be reported in a minimum of
24 three graduated categories indicating the level of
25 significance of the judgment or settlement. Information <--
26 involving paid malpractice claims shall be put in context by
27 the repository by showing a comparison between a physician's
28 judgment awards and settlements to the experience of other <--
29 physicians within the same specialty classification and <--
30 within the same rating territory as established by the Joint
20030H0158B1973 - 57 -
1 Underwriting Association. Information concerning all
2 settlements shall be accompanied by the following statement:
3 Settlement of a malpractice claim may occur for a variety
4 of reasons which do not necessarily reflect negatively on
5 the professional competence or conduct of a physician. A
6 payment in settlement of a malpractice claim should not
7 be construed as creating a presumption that medical
8 malpractice has occurred.
9 Nothing in this paragraph shall be construed to limit or
10 prevent the licensing board from providing further
11 information about the significance of categories in which
12 settlements are reported. AND WITHIN THE SAME COUNTY. NO <--
13 INFORMATION REGARDING ANY PENDING MEDICAL LIABILITY ACTION
14 AGAINST A PHYSICIAN SHALL BE DISCLOSED BY THE LICENSING BOARD
15 TO THE GENERAL PUBLIC.
16 (6) Names of medical schools attended, graduate medical
17 education obtained and dates of graduation.
18 (7) Specialty board certification.
19 (8) Number of years in practice.
20 (9) Names of hospitals at which privileges are attained.
21 (10) Appointments to medical school faculties.
22 (11) Information on published articles in peer review
23 literature.
24 (12) The location and telephone number of the
25 physician's primary practice setting.
26 (13) An indication as to whether the physician
27 participates in the Medicare or State medical assistance
28 program.
29 (c) Explanation.--Physicians may provide an explanation of
30 any information disclosed pursuant to subsection (b) which shall
20030H0158B1973 - 58 -
1 be included by the licensing board in the profile.
2 (d) Initial profile.--The licensing board shall provide
3 physicians with a copy of their initial profile prior to its
4 release to the general public. Physicians shall have no more
5 than 30 days from the date of receipt of this profile to correct
6 any factual inaccuracies that appear in the profile and return
7 it to the licensing board at which time the initial profile
8 shall be published.
9 (e) Revision or correction.--The licensing board shall
10 establish a process through which each physician may revise or
11 correct any information contained in the profile, provided
12 however, that revisions to information disclosed under
13 subsection (b)(1), (2), (3), (4), (5) and (6) shall be made
14 within 30 days of any conviction, plea of guilty or no contest,
15 sentencing or other final action taken against a physician.
16 (f) Penalties.--In addition to any other penalty provided
17 for in this act, the licensing board shall impose a civil
18 penalty for any violations of the provisions of this section in
19 the following manner: $1,000 for a first offense, $2,500 for any
20 second offense; and $5,000 for any third or subsequent offenses.
21 (G) TELEPHONE HOTLINE.--THE STATE BOARD OF MEDICINE AND THE <--
22 STATE BOARD OF OSTEOPATHIC MEDICINE SHALL ESTABLISH A TELEPHONE
23 NUMBER WHICH SHALL BE OPERATIONAL ON EVERY BUSINESS DAY BETWEEN
24 THE HOURS OF 9 A.M. AND 6 P.M. LOCAL TIME FOR THE PURPOSE OF
25 DISSEMINATING INFORMATION PURSUANT TO THIS SECTION TO ANY
26 INQUIRY.
27 SECTION 912. DEPARTMENT OF HEALTH.
28 (A) TOTAL QUALITY MANAGEMENT HEALTH CARE SYSTEM APPROVAL.--
29 (1) A TOTAL QUALITY MANAGEMENT HEALTH CARE SYSTEM MAY
30 APPLY TO THE DEPARTMENT FOR APPROVAL. THE APPLICATION MUST BE
20030H0158B1973 - 59 -
1 ON A FORM PRESCRIBED BY THE DEPARTMENT OF HEALTH AND MUST BE
2 ACCOMPANIED BY A FEE SET BY REGULATION.
3 (2) WITHIN 30 DAYS OF RECEIPT OF AN APPLICATION UNDER
4 PARAGRAPH (1), THE DEPARTMENT SHALL DO ONE OF THE FOLLOWING:
5 (I) IF THE DEPARTMENT DETERMINES THAT THE SYSTEM
6 WILL SUCCESSFULLY REDUCE MEDICAL ERRORS BY A HEALTH CARE
7 PROVIDER, APPROVE THE APPLICATION.
8 (II) IF THE DEPARTMENT DETERMINES THAT THE SYSTEM
9 WILL NOT SUCCESSFULLY REDUCE MEDICAL ERRORS BY A HEALTH
10 CARE PROVIDER, DENY THE APPLICATION. THIS SUBPARAGRAPH IS
11 SUBJECT TO 2 PA.C.S. CH. 7 SUBCH. A (RELATING TO JUDICIAL
12 REVIEW OF COMMONWEALTH AGENCY ACTION).
13 (3) FAILURE TO ACT WITHIN THE TIME SPECIFIED IN
14 PARAGRAPH (2) SHALL BE DEEMED APPROVAL OF THE APPLICATION.
15 (B) TOTAL QUALITY MANAGEMENT HEALTH CARE SYSTEM
16 IMPLEMENTATION.--THE DEPARTMENT SHALL PROVIDE HEALTH CARE
17 PROVIDERS WITH CERTIFICATION OF IMPLEMENTATION OF TOTAL QUALITY
18 MANAGEMENT HEALTH CARE SYSTEMS AS REQUIRED BY SECTIONS
19 712(G)(5), 733(C)(2) AND 741(2).
20 (C) REGULATIONS.--THE DEPARTMENT MAY PROMULGATE REGULATIONS
21 TO IMPLEMENT THIS SECTION.
22 SECTION 12. ALL ACTS AND PARTS OF ACTS PROVIDING FOR
23 NONRENEWAL, CANCELLATION OR PREMIUM INCREASE NOTICE ARE REPEALED
24 INSOFAR AS THEY ARE INCONSISTENT WITH SECTION 747 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.
27 SECTION 3. THIS ACT SHALL TAKE EFFECT IMMEDIATELY. <--
28 SECTION 13. THIS ACT SHALL TAKE EFFECT AS FOLLOWS:
29 (1) THE ADDITION OF CHAPTER 8-A OF THE ACT SHALL TAKE
30 EFFECT JANUARY 1, 2004.
20030H0158B1973 - 60 -
1 (2) THE AMENDMENT OR ADDITION OF SECTIONS 102, 302,
2 305(C), 306(B), 310(A)(2), 311(F)(1), 315, 712(G), 732, 733,
3 741, 902 AND 912 OF THE ACT SHALL TAKE EFFECT IN 60 DAYS.
4 (3) THE REMAINDER OF THIS ACT SHALL TAKE EFFECT
5 IMMEDIATELY.
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